I have been planning this practicum formally since December 2014, and informally since I found out that my degree program required a practicum. Midwives For Haiti was the obvious choice, because I already have in-depth knowledge of the ins-and-outs of the programs, I am already well-known by the Haitian and American staff, and I am fluent in all three languages I could possibly need to complete the job.
I began conversations with Leona, the past In-Country Director, in January or so about a specific project. All MFH staff seemed to be in agreement that data collection needed some major TLC, and that my skills would be best used if focused towards data collection. Mobile clinic was the priority, but connecting mobile prenatal clinic patient data to hospital birth data (i.e. following a patient who had received prenatal care and then delivered at the hospital to determine their outcome and that of their infant) was also needed. I created a plan for my work down here: begin the foundations for a formal monitoring and evaluation plan for mobile clinic; revamp the data collection process; troubleshoot.
Despite working on limited battery power, I got a really solid start last week when I was able to develop first drafts of a logic model and a monitoring plan. The logic model lists the inputs (e.g. staff, financial resources, equipment), outputs (i.e. activities, such as prenatal care and STI testing; and participation, such as the women we reach and SBA students who train there), and outcomes (long- and medium-term goals, which ultimately lead to our final goals: reductions in maternal and infant mortality. Mapping things out in this way allow us to reflect on the changes we hope to lead to those reductions in mortality. The model also can be incredibly useful in determining how we, as an organization, will evaluate if we have achieved those intermediate and final outcomes.
The monitoring plan is primarily to ensure that what we intend to happen is actually happening. For example, we want every new mobile clinic patient to be tested for gonorrhea and chlamydia. But, these tests must be done in a private area since they require a speculum exam. If the table breaks, or the facility is not private, or the test kits do not arrive on time, we are not able to perform the tests. Or, we want to make sure we are arriving at every clinic each month. This cannot possibly happen because sometimes the vehicle breaks down, the river is too high, or it is a holiday. In-country staff knows when things like this happen, but keeping track of them using a monitoring plan can help ensure that problems are recognized and can provide evidence for follow-up. From the monitoring plan sprung a simple checklist that can be filled out by a MFH volunteer or staff member (with the help of a translator) at a clinic. Emily, Stephanie and I worked together to determine when and how often monitoring would take place. Here is part of the first draft of the checklist:
I imagine that developing the logic model and monitoring plan will be an iterative process, but my next steps with mobile clinic are to work on the physical data collection sheets and the indicators we are looking for. Currently, there are a couple of different methods being used for diagnostics and for data collection. As much as possible, we need to merge the two! Steve and I did some brainstorming and I'm excited to begin working on a draft in the next few weeks.
I'm also going to be looking at data collection at the hospital. Hospital Ste Thérèse is an interesting place, and our role there is always a bit unclear to me. It is an MSPP (Ministère de la Santé Publique et de la Population; AKA the Ministry of Health) hospital, so all paperwork is done the MSPP way. We have access to their data, but the only readily available data is the few indicators we select from the birth log each month. The birth log, la registre de maternité, is literally a massive paper-back book whose cover is held on by bandaids. Every patient gets one long row that spans two pages, where their demographic information and basic information about their delivery gets recorded. Individual patients have patient records which are archived swiftly after the mother leaves the hospital. Apparently the archives room is a ridiculous labyrinth and I hope to never have to venture inside to find patient information. THAT is why electronic medical records are so necessary. Long story short, Midwives For Haiti cannot access patient information unless we locate and go through every individual patient chart ourselves. The organization simply does not have the manpower for that. So, the postnatal midwives, who see almost 100% of the patients who deliver at Ste Thérèse, have been enlisted to fill out simple, MFH-designed data sheets so that we can find out who received prenatal care from our mobile clinic, who was referred to the hospital by the mobile clinic, who had complications, and who was properly treated for those complications, etc. There is a system in place to compensate the midwives for completing the sheets, collect the sheets, enter the data, and I hope to help create a plan for data analysis. Phew!
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Lastly, I'll be working with Stephanie on MFH's strategic plan for 2015, as well as a way to log our progress and a system for checking in to be sure all staff have the goals and objectives in mind. Phew!
I should mention that a wrench has been thrown into the mix. In the last week, we learned of three individuals who have stayed at the MFH house in the last month and tested positive for Dengue fever. A few staff members have had fevers and body aches, but we are not sure if there is a mini-outbreak. Emily is fully convinced that Chikungunya morphed into a milder version of itself after everyone in Haiti became immune after infection last year. Frankly, any outbreak of Dengue would have to be very widespread for the infectious disease community to take notice, so I'm really just hanging out, using bug spray, and hoping for the best. I'll keep you updated here!
