Doors past and present!

  As I was sat on the platform at Cardiff earlier I was pondering some stuff that I’ve been involved with in Zambia both past and present and then I looked up and saw the cleverly designed Dr. Who portal doors covering the lift in the station. And it triggered a few memories of my quest for a door (for the paediatric equipment storeroom). And I thought, if Dr Who can go back in time, why can’t I? So this blog is a bit of a cheat I’m afraid. I have taken a previously written blog about a storeroom and added some bits of the future to it. To those familiar with the story and have read it before – please feel free to skip to the later stages….

There are many different ways to combat child mortality and there are many fantastic programs going on all over Zambia and the world to this very end. This is a particularly important topic, so why did I decide to blog about it 4 months into my 6 months stint as a ZADP last time?

(previous entry): Well…..   Last week highlighted some of the most exciting times for me as a ZADP trainee. Despite plenty of interesting clinical work and really fulfilling teaching sessions over the course of that week I got incredibly excited about a door.  It does seem like quite a crazy thing to get excited about – I mean it’s something we use on a daily basis – it opens and it shuts and it serves it purpose but it’s hardly the highlight of anybody’s week usually.

So what type of a door was it?

The door in question is a plain, brown wooden door, which I confess does not fire up the imagination. So why have I become so excited by this particular door?

If you think about it carefully a door is actually something that appears quite a lot in children’s stories and they are significant not by their appearances, but by what they contain behind them:

There is the wardrobe door to enter Narnia in ‘The Lion, the witch and the wardrobe”, the changing room door where Mr. Ben disappears into his various different worlds wearing his fancy dress outfits and, of course, who could forget the Alice in Wonderland door down the rabbit hole!

Behind my featured door is the new anaesthetic storeroom for the paediatric (children’s) theatre block.  It is where we will be able to safely store and register all the required equipment for the safe delivery of anaesthetics to children in UTH.  It means that we will no longer have to scramble around searching to find items that may or may not be present or kept elsewhere. We will be able to keep a detailed inventory of all the equipment which will allow timely ordering of things before they run out and also allow the theatres to have less equipment strewn around them and become a more ordered place to work.  This is a project that was started over a year ago. The main focus initially was to secure a storage area in the main theatre complex as there was nowhere for anaesthesia equipment to be kept apart from a small toilet block that regularly leaked and caused damage to vital equipment.

After much work and tireless negotiation by my previous colleagues, this was finally secured last June and since then has become well stocked and ordered with 2 of the anaesthetic MMeds in charge of it. Since this time we have secured a similar area in the emergency theatres and so when I arrived in August my remit was to focus on getting a safe area of storage for the paediatric theatre block. We quickly identified a store area but required a door to serve as a secure area for us to develop. Since this time (3 and a half months) it has taken painstaking negotiations with more people than I could ever have imagined being linked with the hanging of a door! Many a letter and meeting and cajoling visit to the workshops and purchasing departments all added to the momentum that could also be called just plain nagging! The help of the theatre matron was critical and with her additional nagging I think we managed to get the ‘project’ up and running. Initially the victory was getting a doorframe placed, as there wasn’t one.

 

The frame getting placed and held up by batons as the concrete dries.

Once the frame was placed there was then the inevitable three-week wait to get the plastering dry and the doorframe procured  – no such DIY shop down the road here! So Friday was the celebration of conquering the beaurocracy and of all those frustrating weeks of doubt by the visualization of an actual door sitting in its frame!

The door! I am hopeful there may be a paint touch up at some stage, hopefully after the lock appears. 

There are still things to do – the little problems of a lack of a lock, clearing the space out as it has accumulated lots of ‘junk’ over the years, sort out some shelves, stock up and make an inventory are all in front of us… but this is most certainly a step forwards and a great achievement for the improvement of patient safety in UTH. 

Mmed Naomi in recovery with decorated walls

To celebrate, we managed to decorate the walls of the recovery room and holding bay with some wall stickers that some friends had brought out for me – ok, this is not strictly a UN MDG 4 goal but it is important to provide stimulation and create a child-friendly atmosphere in the theatre block whilst the children wait for their surgeries. It was great to get all of the staff – from theatre porters, nurses, trainees, consultants and surgeons to give their opinions and to help in placing the decorations and become enthused over such a simple but important aspect of emotional care for the children.  As you can see from the snaps the place looks a lot brighter now! I think both children and staff will enjoy being in the department a lot more now!

Theatre reception jazzed up a bit 

 So on my return it was joyful to see that the door was there with a lock and a sign on it! Rachel my successor with ZADP had worked really hard to clear the space and get some shelves and stock it appropriately.

Ushma in the cramped main store

But meanwhile, the main storeroom had become a bit of a tight squeeze, what with new equipment arriving, more stock being brought in and placed indiscriminately thus creating difficulties in getting the right stuff easily. In fact you could say it was almost bursting at the seams. Even my mind, which is at best described as cluttered, was beginning to ache at looking at the higgeldipiggeldi mess! So something had to be done. So, on one morning last week when I went in and my operating list got cancelled and the next list I tried to join also got cancelled, and the next…. You’re getting the picture (lack of blood, no lifts and the nurses were all keen to leave to attend a colleague’s funeral in the afternoon). So I thought I’d use the time constructively and headed to the main storeroom. Fortunately for me two ‘victims’ (ahem I mean willing volunteers!) were in there. And actually credit where credit’s due to two of the 4^th year Mmeds – Ushma and Christine, they were also tackling the quagmire.

Boxes crammed into main store

  So, many hands make light work and we made the executive decision to decant most of the paediatric equipment to the Paediatric Storeroom and only keep a few bits in the Main theatre area (as we still do children in there for a few operations).

Moving equipment up the corridor

And so…. We shifted, we sorted, we boxed, we laboured, we heaved, we pushed and we pulled and soon we’d loaded up a full trolley of stuff to move to the paediatric storeroom. So off we went, pushing this conglomeration of stuff up the concrete ramp (having changed from our theatre clogs into shoes, as there is strictly no wearing of any theatre items outside the RED lines of theatres. 

In fact we were frowned upon walking in our blues and a hat (apparently that’s when you don your white/blue coat… Memo to self!) These red lines seem to like the dividing line of a gold digging pitch – they are sacrosanct. And its not just people they’re strict with but trolleys too. To cross the red line (which I‘m doing a disservice to really as it’s a raised red wooden block) with a trolley, one must first wash the wheels (granted from a bucket of dirty water with a dirty rag) before lifting it up and over the line! However the sentiment is there, the strict adherence to infection control is admirable but also confusing in other aspects as nobody seems to flutter an eyelash with the cockroaches scuttling around on the floor inside the theatre! Anyway I digress!

Theatre porter Gift cleaning the wheels

We were greeted like pirates returning with our spoils of war in the paeds area and we soon had the wheels washed and the trolley heaved over the line! So now we have two well stocked, ordered storerooms that are functioning well as well as the obstetrics equipment cupboard (commissioned by Rachel and refined inside by Emily – departing ZADP reg). So all in all there is order on the equipment side, which bodes well for the future and is heartening to see some things that you’ve instituted that are continued in your absence. 

Ordered and fully stocked Paediatric Store

Christine in the 'emptier and a bit tidier' main storeroom

And so I feel I can now close the door on that chapter of service development and concentrate on something else!