Tuesday, November 9, 2010

Difficulties using ICT for Coordination of Care in La Romana, DR

La Romana, a city along the south eastern coast of the Dominican Republic keeps a unique but somewhat disturbing balance- wealthy American and Europeans expats enjoy the luxuries of low living expenses, pristine beaches and the tropical sun at the city center, while thousands of Haitian refugees work back-breaking days, at less than minimal-wage at the numerous sugarcane plantations that surround the city. These refugee families live in over 200 settlements, locally known as 'bataeys', where the conditions are less than optimal- 9 to 10 family members squeezed into single-room homes, severe water and sanitation issues , poorly developed education systems and very little access to health care.

The El Buen Samaritano hospital in La Romana has been working for over 2 decades to establish programs that can provide quality and free health care to bataey-dwellers. Their mission is well supported with over 60 volunteer groups visiting them from North America every year, to provide medical care, assist with construction, conduct bible study camps, and provide resources, as needed. However, as can be expected with a situation like this, little to no coordination exists between these groups. Each team brings down experts they believe are needed, and while no team leaves without helping as much as they can, work is duplicated, medical supplies are brought at random, patients seen at the bataeys have no medical history recorded, and the system remains less efficient than there is potential for it to be.

Last week, I accompanied a team of young and enthusiastic clinical and public health specialists, on a 10 day mission to do our part. But this year, we were going to try something different- we wanted to put in place a coordination of care model that would use ICT to provide channels of communication between various mission groups and hospital staff, in order to improve the efficiency with which resources in time, energy, skills and money were distributed, and care was delivered in this setting. We soon realized that while this was definitely a noble cause, it was indeed a difficult one. Here are some of the issues we faced:
  • We started a simple, easy-to-understand Electronic Medical Records system that assigned a code to every patient we treated, and attached it to a digital picture, and a brief record of the conditions that were seen and treated- all in a basic excel file. We spent hours trying to figure out the easiest way to get this system started, but realized that without a structured way to get buy-in from all of the stakeholders involved (the volunteer mission groups, as well as the hospital staff), there was no way the system would get off the ground.
  • We wanted to develop a website that all visiting mission groups could access before they arrived in La Romana. This way everyone could get a common understanding of the long-term strategic plan at the hospital to ensure that their work was contributing constructively towards it. They could all keep track of the schedule for groups visiting the bataeys and of medical supplies that would be needed to be brought, as they ran out. It was not as easy as we thought it would be. It turned out that there were already atleast 3 main existing platforms, and atleast a few more less known ones that were attempting to do the same thing, but that had so far not had too much success:
  1. El Buen Samaritano website
  2. A website developed by an American nurse who has been working at El Buen Samaritano
  3. A website developed by an American doctor who has spent many years working at El Buen Samaritano
With such a backdrop, would our website make things better, or simply add to the confusion?
  • We started a record keeping system to record inventory of medical supplies- we used simple tags like 'none needed', 'need more', and need urgently' to describe the current situation for specific medical supplies, with the hope that we could hand this over to the next team coming, and convince them to do the same before they left. Again, as simple as this seemed at first thought, it has been incredibly hard to get follow through- no concrete schedule exists for visiting groups and without one website everyone goes to, there isn't a common space for an open source update by each group as they come and go.

These are just the beginnings of the many problems we foresee as we take our mission forward to use ICT to implement a coordination of care model that will improve efficiency in both theory and practice.

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