Nearly Halfway - a Checklist update

The checklist team has traversed thousands of miles since they were launched from the ship on September 13th!  These miles have not been easy.  There have been 2:30 wakeup calls to catch flights on tiny rattling planes; 12 hour days on pothole-filled washer board gravel roads in public transport not built for comfort or the lengths of Linden and Emily, two very tall members of our Checklist team; they have experienced chilly evenings and sweltering days and sleeping in a new, not-so-comfortable bed every couple of nights.

But through all the difficulties, transformation is happening.  From Linden Baxter, Checklist team member:

At the end of every road, we have found a reward that makes every mile worthwhile; like seeing the team [we have trained] use their new pulse-oximeters for the first time to monitor the oxygen levels and heart rate of a very sick patient following a bad road traffic accident. Due to the injuries involved, the anesthetic was tricky and the operation was complex, but the team was able to use the teaching they received during that week to improve their teamwork and communication, incorporating new safety checks and using new monitoring equipment to keep their patient safe.

These hospitals are referral centers for very large populations, up to 2 million people!  The opportunity to work together to build up surgical services through delivering team training and essential equipment makes every bump in the road and every early morning worth it.

The hospitals have been very welcoming and the feedback so far has been really encouraging! Everywhere they go, OR staff mentions the benefit they see that using the Checklist has on their team spirit, level of communication, and awareness of patient safety. One hospital told us that although there are many great public health interventions in their area, (for example vaccination programs and malaria prevention), this was the first time anyone had ever come to do training like ours specifically for their operating department.  That is a big motivator and encouragement for all of us, as many people don’t realize that a lack of access to surgical services is one of the most important, yet frequently overlooked issues in global public health

Another course participant wrote on their feedback form, “This course has brought our team closer together; the training has newly reinforced the cohesion in our team.”

The team has done an incredible job of adapting the training to each hospital they visit.  Two hospitals now have had eye specialists for whom they have been able to create an eye-surgery specific Checklist and the surgeon and team have been extremely grateful, engaged, and encouraged that pursuing surgical safety isn’t just for big surgeries!  The result is not only improved surgical safety and adaptation of both checklists; but in one hospital the eye surgeon was willing to lend his OR for practical scenarios, the only one with air conditioning - which was a welcome, generous gift in a city boiling in the tropical heat of the southwest region!

The team takes every opportunity possible to not just teach the participants, but encourage and empower them to teach each other. After one teaching session about the Lifebox (pulse oximeter), one of the anesthetic nurses gave a dynamic and detailed 10 minute summary to the rest of the theatre staff.  He remarked during his teaching, “There is always something more to learn, you never know 100% of everything! So we should always be learning.”  

The team has been flexible as well in not only practicing the Checklist in scenarios and simulations, but stepping into the OR when an emergency case comes in during the training session! In one city this was three emergency cases they got to practice in the OR and were encouraged by the cohesion and teamwork as a result!  By crossing that invisible barrier between practice and reality continued implementation and use after the team’s departure is hopefully much more realistic.

The Checklist team not only trains surgeons, anesthetists, and nurses, but anyone else who works in the OR is welcome and encouraged to attend.  In one city that was quite a few non-medical technical and support staff who were enthusiastic, engaged, and demonstrated excellent understanding of the purpose and goals of using the Checklist.  One surgeon in that city commented, “When you leave, they (the support staff) won’t let us forget about doing the checklist.  They already don’t stop talking about how important this training is, they are really serious!”

They have called a few of the hospitals that they visited in the early weeks; just to check in and see how they are progressing, and to troubleshoot with them any problems that have come up.  All of the hospitals they have called report they are using the Checklist and the Lifeboxes, with some difficulties in overnight and emergency cases, but seem to want to persevere!  One hospital surgeon reported a case that he believes the Lifebox saved the man’s life by enabling them to monitor him throughout the emergency case.

Today the team finishes up training in Maevatanana, heading directly on to Antsohihy over the weekend.  Please keep them in your thoughts and prayers as they near the half-way point in their journey offering hope, healing, and transformation to healthcare professionals and their patients across Madagascar.
For more information and background on the Checklist project, please visit: 
Checklist Part 1 and Checklist Part 2

--Krissy Close and the Checklist team
--Photos by Linden Baxter
Posted by Krissy Close on Nov 13, 2015 2:06 AM CST

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