Our second trip from 25-Jan through 1-Feb to Minga Mission Hospital as a Sustainability Planning Team had a different set of goals than the first.  Our first trip was focused on observing/listening/assessing – essentially building our understanding of the hospital’s current operation and getting to know the In-Charge leadership team and them us.  The second trip was focused on sharing our learnings and recommendations, synthesized through multiple team workshops since trip one, and also walking them through what we propose as a two-year roadmap to:

1. Building clinical, biomedical and process capacity, and competence to be ready to fully utilize and manage the new infrastructure the Helmsley Trust grant is funding and EMI is project managing; and
2. Help them close the large and unsustainable financial gap operating as a level one district hospital.

The two-year roadmap timeframe coincides with EMI’s project cycle of finalizing the new infrastructure designs, tendering and awarding bids, constructing the infrastructure and finally commissioning it to hand over to the hospital’s management.  By April 2027, the project will have delivered:

•  a new and fully-equipped three Operating Room (OR) surgical suite building with intensive care and recovery sub units;
•  new solar-based electrical plant to operate the hospital complex fully off-grid;
•  new fresh water and waste water management systems;
•  new oxygen manufacturing plant; and
•  renovated, upgraded and expanded Men’s, Women’s and Children’s wards; laundry and kitchen facilities.

The EMI Team

The team was a similar mix as our first onsite visit with the exceptions of having Jason Chandler and Ellery Walker from the EMI global offices in the US join us (Jason oversees the Helmsley Trust donor relationship and Ellery is an urban health planning specialist) as well as Daniel Steenkamp (from Stellenbosch, SA) who was the Sustainability Planning team member and was unable to join the first onsite trip back in September.  You can see below the nine-member team as we gathered for dinner in Lusaka before heading out to Minga the following morning:

Left to right around the table: Jason Chandler, Gerhard van der Merwe, Andy, Dr. Jason Fader, Daniel Steenkamp, Kerstin Fourie, Ellery Walker, James Forest, and Andre Olwagen.

View from the other end of the table

The Drive to Minga

As we departed Lusaka, we split up into three groups – one to do some exploratory drop-ins to other hospitals in the Eastern Province (Gerhard, Jason, Ellery, and Andre) while enroute to Minga, one to head directly to Minga to get started on the Sustainability workshops and finalization of construction drawings/plans (Kerstin, Dr. Jason, Daniel, myself) and James who stayed behind in Lusaka to interview various general contractors in order to qualify them in order to produce tendering shortlist.

While my group was enroute to Minga on the 5.5-hour drive along the “Great East highway” (T4) we couldn’t help but notice how remarkably green and lush the countryside was compared to our first trip, when all one could see was dry desolation everywhere.  After three years of failed rains and severe drought, the annual rainy season that historically happens between November through March finally came with strength this season and it was wonderful to see their positive impact with maize fields planted and already producing tall stocks, dense bush everywhere and rivers flowing wide and strong.

Below are a couple photos of a stop we made along the highway for a stretch, some lunch and a comfort break (behind some trees 😊).

From left to right: Andy, Daniel, Dr. Jason

Minga Hospital Campus

Once arrived at Minga, we unpacked and settled in again into our quarters at the Nunnery and enjoyed greeting Sister Asperanza and her team and getting caught up.  As this was Daniel’s first time visiting the site, we had Sr. Asperanza give the Sustainability team a tour of the hospital complex to bring him up to speed and it was a good refresher for Dr. Jason and myself.

New hospital signboard in main parking area is a welcomed sight (vs. the old, very weathered one)

OPD patients awaiting to be called forward for consultation

A collage of Men’s, Ladies and Pediatrics wards buildings and grounds

S
Sister Asperanza with Daniel, Dr. Jason and Andy walking away from the Maternity Ward up on the hill of the campus.

At the end of a full travel day, it was time for our first dinner together in the dining room of the Nunnery and in addition to the usual spread of local, delicious foods, the Sisters blessed us with a special welcome song….

And at the end of the meal, for dessert, sister Cecilia who runs the kitchen, presented a special welcome cake that we had to cut up as they all sang a special song in Swahili for the occasion!

 

Confirming New Infrastructure Construction Plans

As mentioned earlier, some EMI team members (Kerstin and Andre) joined this second site visit in order to hold walk-through’s of the engineering design drawings and plans with the In-Charge team in order to get them finalized and signed off.

After a couple sessions, the plans were finalized, enabling EMI to put the full $3.5 million US infrastructure construction project out for bid.  Once we hear of which general contractor has been awarded the contract, I will update this blog – should be sometime late April, after which construction will begin in earnest.

Workshops with the In-Charge Leadership Team

As already mentioned, the two-fold focus of the Sustainability Planning team (Dr. Jason, Daniel and myself) was focused on conveying our rationale (the why’s behind) and recommendations for “how to” transition from their current unsustainable operation to being fully ready to operate as an effective and efficient district hospital delivering high-quality and caring medical services as well as helping them kick start implementation plans to get key initiatives underway that will generate new sources of revenue, contain costs, ramp up clinical, process and biomedical capacity, so that they are ready to manage and operate the new infrastructure effectively come April, 2027.

Andy presenting to the In-Charge leadership team during one of the workshops

Daniel and I tag teamed leading and co-facilitating various workshops with the In-Charge leadership team (Medical Officer, Administrator, HR Officer, Nursing Officer, Finance head) and other small group leadership meetings across the 5 days we had on the ground.

Daniel presenting to the In-Charge leadership team during one of the workshops.

The Administration building where we held most of our workshop meetings in their main conference room.

Here is one key slide that was referenced multiple times that depicts pictorially the roadmap for the next two years of building readiness and closing the operating gaps:

Several informal chats with In-Charge leadership also took place like this one with Sr. Asperanza:

We took one morning to hold a workshop with the prior members of the hospital’s Board of Trustees, which desperately needs revitalization (they hadn’t met together as a board since 2021!).  During the workshop Daniel and I were able to bring them up to speed on the proposed two-year roadmap toward sustainable operations, set out principles for how mission hospital boards can function in a healthy and engaged manner, and proposed a new governing structure that brings the board back to a place of accountability between the Ministry of Health and the Catholic Diocese stakeholders and the hospital’s executive leadership team.   The members present were in alignment that a “reset button needed to be pressed” and seemed to embrace the way forward approach that we tabled.  The newly appointed board chair who was also present, Father Damingo Ngoma (Eastern Province Diocese Bishop) committed to convene the trustees within the next 30 days and begin to enact the suggested next steps to effect these changes.

In the end we were able to gain excellent acceptance from the In-Charge leadership of our recommendations for revenue enhancement and cost containment and alignment on the two-year roadmap (slide shown above).

Overall the meetings were highly successful in building trust and helping the In-Charge team get momentum going with a project plan template that guides follow-up actions for the next 90 days.

Existing Surgery Revamp

On the clinical side of building longer-term sustainability and the medical capacity to provide surgical procedures for Minga patients, Dr. Jason has been adamant since our first onsite trip that the dilapidated existing operating room (OR) can be brought back into service with a small investment in equipment and some simple renovations. For the last while, all C-section delivering mothers were referred to the neighboring district hospital at Petauke and all other surgical services were curtailed, given the very poor condition of the OR and lack of functioning sterilizer and oxygen concentrator equipment.  While Daniel and I have been working on operational / financial sustainability, Dr. Jason has been putting together a plan to get the existing OR back into service and to start ramping up elective surgery procedures.  The three Medical Officers on staff have general surgical training.

Existing OR “St Paul Theatre” with dilapidated ceiling.  Dr. Jason evaluating best approach to renovations and equipment replacements

The adjacent OR room that already benefitted from Jason’s efforts while onsite.  All it needs is a functioning sterilizer and Oxygen concentrator which have been ordered.

What has been difficult to access at Minga is the consistent services of an OR Anesthetist.  Through the commitments of the Minister of Health and Provincial Health Director (see next section below), assignment of a full-time Anesthetist to Minga hospital was made, effective this coming April.  Dr. Jason spent some time assessing the state of the OR facility and equipment and helped the staff put together a plan for renovations and a procurement list for equipment.  The In-Charge team’s goal is to have the first “surgery day” in latter April when a number of elective surgeries will be performed in the newly renovated OR and then keep ramping these services up month by month so that by time the new three-OR surgical suite is delivered by April 2027, the surgical volumes with expanded complexities, process and biomedical capacity and competence to take on this new facility will be in-hand with the Minga clinical staff.  That’s the plan!

Minister of Health Visit

One of the unique highlights of our time onsite was an unplanned drop in by the Health Minister of Zambia and his entourage.  Like memories I can recall from our time serving in Malawi, when a senior government official decides to come by, everything else must stop and make way!  This sudden descending on Minga hospital was no different, where Daniel and I had to suddenly stop our Wednesday afternoon workshop and wait for the Minister of Health to formally address the hospital executive team.  What we learned while we were waiting for his speech is that he was travelling around the district drumming up support for his party’s candidate in a byelection for Petauke.  The entourage came bounding into the parking lot driving several large black SUV’s from which the dignitaries, their security detail and various aids emerged.

Left to right: Simon Banda (New Congress Party candidate); Hon. Dr. Elijah J. Muchima, Phd, MP; Bert Mushala, Permanent Secretary for Ministry of Health.

Hon. Dr. Elijah Muchima (standing) making his address

Gerhard and team had tried to connect with the Health Minister earlier in the week in Lusaka but were cancelled at the last minute.  This impromptu visit was a godsend and helped us put forward our plans for Minga (new infrastructure coming a roadmap to self-sustainability) and petition the Minister to address several clinical operating gaps including lack of personnel (Anesthesiologist and General Surgeon), shortages of drugs and laboratory reagents supplied from central medical stores, and permission to begin for Minga as a Mission Hospital to charge for differentiated (fast track) medical services and elective surgeries which form part of our revenue enhancement strategies leading to sustainable operations.

As with all political speeches, time will tell whether the promises that Minister Elijah Muchima made during his address actually come to pass.  He certainly knew how to speak and as you can see from the photo below, made a good connection with all the staff and EMI team present.

As we were assembling for the usual photo op on the steps of the administration building, the Minister of Health passed out several of his personal cards to those of us standing by – he handed one to me – I guess I can call him up sometime and chat!

The Minister of Health [black vest] and his entourage, including several members of the EMI and hospital In-Charge teams

(as an aside, earlier when we were gathered inside and introductions were made, all the EMI team were asked to stand and give a brief introduction of themselves.  When it came to my turn, I mentioned my role on the team, a brief summary of my quals and that I was a Canadian living in South Africa.  When hearing this the Minister piped up and said, “Canada – I love Canada, I have sent all my three children to be educated in Canada.  You have a wonderful country – thank you for coming to help us in Zambia”.  So perhaps as he was handing out his card he recalled that moment when our gaze connected)

Business card of the Minister of Health – passed to Andy while assembling for the Photo Op above

And so, before we knew it, the five days onsite were complete, and we were up at 5:00 AM starting out on our drive back to Lusaka.  As we finished nibbling some light breakfast and sipping a coffee the Sisters once again sent us on our way with singing – this time a farewell prayer which was very special…

 

Drive back to Lusaka

Given that while we were at Minga there were mostly non-stop rains, enroute to Lusaka we came up to a road blockade by the police due to a partial washout of the tarmac on the highway.  They required all passengers to get out of the truck and we all had to pass over the precarious area on foot while Kerstin drove the truck over by herself.  How the weight of us four passengers made a difference vs. the weight of the truck I do not know, but we complied!

Looking from the roadblock, team members setting out on foot, while our vehicle awaits being called forward to pass through near the washed out tarmac (photo below)

And a bit further down the highway we came upon this smashed heavy truck that was left in the middle of the road from a crash likely the day or two before.

We hope and pray no one was seriously injured.  It reminded me of how important and effective your prayers for our safety are when we travel along these African roads.  All in a day travelling in a developing country in Africa!  Thankfully, we all arrived safely into Lusaka and had one more team dinner together recalling a successful and engaging week with the Minga leadership before departing for Cape Town the next morning.

Until my next update….. blessings, Andy.