I cannot believe that I only arrived on Monday. My first week at work has quickly transitioned me to feel at home at the hospital with both the staff and the patients. The hospital is set up so that all of the buildings are interconnected by outdoors sidewalks with roofing and railing. Words cannot describe the happiness I feel when I am walking outside and the children yell at me from across the hospital to say hello (all wearing their new sunglasses, of course). I feel so welcomed at FOCOS and in Ghana, and already envision future experiences here.
I began my Friday rounding with Prof. It was so exciting when we arrived at the ICU only to find out that both Esther and Bai were stable and had been moved to the wards. Esther, though in pain, is working hard on her breathing exercises with her incentive spirometer. This is a device that measures the amount of air the patient expels to keep their lungs clear, active, and regaining strength after surgery (Cleveland Clinic). We then checked up on Bai, and I was so taken aback when he greeted us with total calmness and a sweet smile. After all that Bai has undergone mentally and physically, he is so content to be alive and one step closer to standing tall. Prof estimates that Bai has grown five inches from his procedures. During our rounds we also saw Franklin, the three-year-old I introduced yesterday who underwent an arthrogryposis repair. Franklin was in visible pain, due to the nature of his surgery and more so his age. He was fortunate to have his family at his bedside, and his recovery was going smoothly. Eunice, who had a below-the-knee amputation, was also recovering nicely. All of the patients we saw were so thankful for Prof and the FOCOS team. I am so inspired by not only the work that FOCOS does, but also how thankful the patients (especially the children) are. It is very difficult for pediatric patients, especially those far away from home and without family, to understand why they are surrounded by unfamiliar faces and experiencing such severe pain. I am moved by how the kids are able to put age-expected feelings aside to express gratitude for their second chance at life.
I spent the rest of the day with Gifty in the procurement department, which is responsible for the acquisition of all items needed by the hospital. In one year alone, the FOCOS Hospital spends well over $1 million on consumables. Consumables are all purchases except for fixed costs such as electricity or water treatment. There are many stages of approval for each purchase, first traveling up the procurement chain before they are brought to the head of finance. A purchase approval is just the beginning, as multiple quotes then need to be compared to find the best price and potential discounts. All procurement matters are logged into the hospital’s digital system, HIS, and recorded in writing as well. Most purchases are made based on timing; Gifty knows how often they use each item and how much of it has to be ordered when they hit low stock. However, there are also emergency purchases, which usually occur when a unique patient needs a new medication. Though many purchases come from Ghana, a bulk of the medications and medical supplies are only sold internationally. Gifty makes usual purchases from South Africa, Israel, France, Germany, and the United States. The US purchases are compiled and sent by sea in a massive container two times a year. In the interim, a warehouse in New York receives the items purchased. Fortunately there are some donors, like the Hospital for Special Surgery and medical supplies companies (either those that produce one product and thus can donate some, or those that donate their surplus).
The most frequently used items are gloves, lap sponges, and syringes. The most expensive purchases are lab reagents. Other common pricey purchases include OR equipment, nutrition requests, and bracing material at $142 a sheet. A huge source of expense is one-time-use products, which are abundant in medicine. Though some OR items can be sterilized using the autoclave, plenty have to be discarded after used in a surgery. Selection of OR items largely depends on the doctors’ preferences, and the price must be paid to make sure that the surgeons are doing their complex procedures with tools they feel comfortable with.
Gifty toured me around the warehouse and I was in awe of its magnitude. The large warehouse is packed with various items, and it has distinct employees responsible for logging, storing, and delivering the items there. A new warehouse was just created to store items requiring colder temperatures, and those products will be moved over by next week. It is so interesting to learn about all that goes into operating a foundation-based hospital, and I have gained newfound appreciation for all the moving parts that make this organization run.