Today there is less atmosphere photos, more of a problem and work report.
About our positive impressions we have already written enough. The following is an extract from the quarterly report to the Leipzig Mission.
an unusual task and challenge we had expected, but on the everyday worries and difficulties in the hospital could not be prepared in Germany.
In Lugala we feel almost at home and would feel completely at home when the children do not always shout "Mzungu Mzungu," and remind us of our origin would be.
Medical care in the hospital, as measured by the possibilities, really good. Of course there are needs and challenging ideas. But it is also available in every hospital in Germany and moja kwa moja here is probably a lot can still be improved. The real difficulty is that there was only a rudimentary administration and an absolutely chaotic financial status. The variety of tasks and associated problems in the administration is described later, this report is only the most important- reporting on money.
The hospital is financed by own revenues and grants from various donors. The state subsidies for the wages, with much less money will be provided as it according to the Einzugs-/Versorgungsgebiet and the number of beds would be the case. A change is not in sight and a visit to this matter in the Ministry of Health can be really depressing. There is also money from Tunajali (an American fund) for anything that can be associated with HIV / AIDS. With this support, the objectives are defined rather stringently. Furthermore, there are means of Basket Fund, SOLID ARMED, AMREF and Others without this here to describe in detail. All these funds were combined until a few weeks to a large sum, and despite ever used for different purposes as needed. Thus, no one could say exactly how much of each fund just exhausted and thus the financial status of the hospital was. gave even a simple accounting with daily Einnahme-/Ausgabebelegen it is not practical.
from the overall budget was also a loan program for funding of the hospital staff (very social, with no interest up to 500,000 TSh). The repayments were received but also in the "big pot." General and financial management load on only one person (Mr. Njaala) and this was - even with good will and in spite of numerous unpaid overtime - hopelessly overloaded. To this lack of financial transparency and unsolved problems in the administration are still two other major difficulties. First, the employees last year had a salary increase (retroactive for the entire year 2009) fought. The sponsors paid the grants but still only the same amount as before and the patient revenues could not be increased. Secondly, despite higher salaries any additional fees have been maintained for the employees. These allowances or charges are for extra dutys some absurdly high. Said one employee gets for a 3-day seminar in Morogoro, Arusha or any other major city TSh 250 000, representing about one month's salary. There are extra fees for inappropriate on-call, overtime or even to participate training programs. Here was a system - that was sure to motivate even thought well - ad absurdum. While in recent years, the hospital always just so, on balance, a zero in the black, was created by the above-described development of a structural deficit. This means a monthly consumption of 3.8 and 2.7 million TSh of the capital depending on whether conservative or creative rate.
what's this? The hospital is far and wide the largest employer and an entire region is not only dependent on medical care by the hospital. The hospital also secures directly and indirectly sustained, albeit for some only modest incomes for employees and their families - with an African family can be described as a clan and to compare with a family in Germany.
The straight wage increase can and should be reduced again under any circumstances. That leaves only three options: you can save staff, cut the remaining costs and / or labor organization . Improve Personal - especially when it must be fit and proper can not be saved. The agencies in the individual stations are just busy in other areas, eg in the laboratory, there are too many personnel to stay and all the other costs and working hours. First, could the allowance - mischief to be changed. The hospital has in recent weeks and months, the posting of employees not directly affect the daily work-related seminars, which are themselves pay the per diems had to very restrictive. Furthermore, it is as common in Germany to pay the hospitals for on-call waiting time for only a small amount for tatsächliche Einsatzzeiten erheblich mehr. Hier in Lugala hält sich jeweils ein Labor- oder OP- Mitarbeiter jede Nacht im Hospital auf, obwohl er ohnehin in unmittelbarer Nachbarschaft wohnt und höchstens zweimal pro Nacht in Anspruch genommen wird, meistens nie. Er bekommt die „verwartete“ Zeit aber ausgesprochen großzügig vergütet. Weiterhin machen die Mitarbeiter im OP abwechselnd nach ihrer Dienstzeit Überstunden mit Sterilisationsarbeiten. Diese können erst nach 19 Uhr erledigt werden, da es erst dann ausreichend Strom durch den Generatorbetrieb gibt. Es ist naheliegend, dass sich diese Überstunden mit Arbeitszeitverschiebungen vermeiden lassen. Flexible Arbeitszeiten sind hier bisher unbekannt. Auch damit könnte man viel Geld sparen.
Natürlich sind all das willkommene Hinzuverdienste und es wird bei der Einführung neuer Regelungen erhebliche Widerstände geben. Aber aus diesen Darstellungen wird auch klar: Wir müssen im Laufe der nächsten Monate eine vernünftige Finanzstruktur finden, müssen den Angestellten die notwendigen Schritte immer wieder erklären und müssen auf ihre Mitarbeit setzen. Andernfalls wird das Hopital mittelfristig vor dem Bankrott stehen (die benachbarte Tumaini Secondary School erlebt das gerade).
Ich muss ein bisschen um Verständnis bitten. Der vorliegende Bericht ist – abweichend von bisher üblichen Rundbriefen – ziemlich administrativ und finanzlastig become. But that is why we are here in Lugala and I very much hope that in addition to what we can make a person, also a Mongoose anisaidie 'is. used
Or as my grandmother say: Help yourself, then God will help you.
Dr. Peter Gundermann
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