Sunday, June 14, 2015

Moving on up---MUST READ PREVIOUS BLOG for this to be complete

So how does Bere move past the huge amounts of money that has been stolen by hospital employees? (See previous blog.)

Fed up with all the stealing, we had started randomly asking patients where they had paid for their labs when we couldn’t find a receipt. One gentleman told me that he had paid outside of the lab (they are supposed to pay at the cashier’s office). The patient was all set to show me who he gave the money to, but the employee wasn’t at work that day. I was sure who it was, but two days later when I asked him to identify the accused, he could no longer be sure who it was. I’m sure someone else had gotten to him first, and told him to be quiet. And probably paid him to do so. Others we discovered and fired.

But we’re tired of all the interrogations and corruption. I didn’t come to Africa to practice criminal investigation. I came to practice medicine. But it seemed that so much of my day was taken up asking where the patient got this medicine, or where did he pay, or why weren’t the number of medicines correct with the receipt. It was getting old. Time after time this kept happening. We were firing people left and right for stealing.

So we decided to be proactive.

One way to do this is with our A-team!

Introducing Dr. Dirk Wunderlich and Zachri Jensen!

If you’ve ever visited Bere Adventist Hospital, you have seen our patient charting. You have seen our notes and orders scribbled down in the little patient medical book called a carnet (car-NAY).

But lo and behold, things have changed!

We now have an Electronic Medical Record system!!!

Dirk, a German neurosurgeon, came to Bere via providence. Looking for something to do with his vacation, he emailed a supporting mission of the Adventist church and said, well, if they respond, maybe I’ll go on a mission trip. If not, maybe I’ll take a week and go skiing!

Well, the organization forwarded the email to a friend, who forwarded it to Olen, and Olen replied to Dirk, all in the matter of a few minutes. Olen explained to him that there wouldn’t be any neurosurgery to do, but he’d be welcome to come anyway. Dirk, figuring he’d never hear back and would be free to go skiing, was surprised and figured he shouldn’t ignore providence. So he came!

When Dirk got here, he was… Well, he had the same reaction everybody has when they see our hospital for the first time. A reaction that can’t really be put into words. Overwhelming needs. He was also crazy enough to think he could implement an EMR in the bush of Africa. Olen told him he could do it if he was willing to foot the bill and do all the work. (Olen is generous like that.)

Dirk had already created a note-tracking EMR for hospitals in Germany and Australia. So he set to work writing code so the program could do everything else we needed it to.

Again by providence, Olen got a random email from a Walla Walla University student, Zachri Jensen, asking if there was still validity to an ancient request we had made for somebody to start a computer school. We told him no, but there’s this project to implement an EMR. He agreed to help.

Now here’s where providence turns into divine intervention…

In November, when Zachri arrived, most of my staff had never touched a computer. Including 100% of my pharmacists and cashiers. Literally! As in, they didn’t know what one felt like on their fingertips. Let alone find the on button. Including my 58-year-old charge nurse and lead consultant in the emergency room, our main intake for the entire hospital.

So when we say, ‘Our first lesson was “Here’s the on button,”’ that’s a lie. Our first lesson was, ‘This is how you open a laptop. Now here’s the on button. And now here are the keys you need to peck at to log in.’ Our first hour was spent logging in.

In December, we started twice-weekly hour-long lectures. In mid-January, Dirk arrived to work out some kinks. January 24 at 9pm, we went live. Think about that for a second. In less than two months, we went from a majority of employees never having caressed a computer… To having a functional EMR. This may seem daunting for an American nursing staff to all learn a new EMR at once. But my nursing staff was different…

On top of this, there was ZERO network installed when Zachri arrived. He had to set up a server, a router, a switch, six unidirectional antennas and five access points. In addition, he built into the network no less than six backups of our patient data, five updated continuously and the other updated hourly and saving the backups for a month. Oh, and he also translated the EMR from German/English into French.

On top of this, we went live during our highest patient volume period (well over 2000 new patients per month for the first three months in a 70-bed hospital with 23 nurses).

And 100% of my employees have bought in.

We use this EMR for registering patients and their demographic data, prescribing ultrasounds and lab testing, ordering surgeries and tracking the surgical schedule, ordering medications, tracking ALL income, receipt printing, tracking ALL stock, automatically generating medication and consumable purchase orders for the hospital to prevent our stock from running out, surgical reports, ultrasound reports, admission notes, progress notes, discharge summaries, staff list, track floor usage of consumables, track inpatient list by service, track individual prescriptions of our precious free medications, track individual intake by each cashier/pharmacist and many other things. In addition, the software is capable of doing payroll and data mining and a glut of other modules we haven’t implemented.

This also opens up huge avenues for research too with capabilities to search the medical records.

Our humble little bush hospital, in a region of a million people with no electrical grid or public running water, 42 kilometers from the nearest pavement, computer-illiterate… We have an electronic medical record, despite all my bets against it. Credit goes where it is due. A really hard-working staff, three genius programmers (Dirk, Zachri and Adrian) and a pretty amazing God.

We are convinced that stealing, like in the rest of the world, is like a cancer. We can’t completely stop it. But we can better control it. We are so thankful to Dr. Dirk and Zachri for setting up and continuing to work out the details of this system!

Bere will never be the same! We have moved on up!!!

(We should state that this system has actually helped us continue to catch thieves, although we won’t reveal our secrets and state how.)


  1. WOW!!! This is an amazing change! I want to come back and visit and see it for myself! Prayers were answered in the space of me reading the two blog entries :)

  2. PRAISE the Lord!!!!!!!!!!!!!!!!! Praying for you all the time! And, using words once in a while! SUCH a huge blessing - who knows how God is going to use this valuable tool, and His willing servants - from many and diverse parts of the world!!! PRAISE the Lord!!!!!!