Today, I started the planning process with a 20 strong Working Group for the Hospital Self Assessment, which will be conducted by a team from IHQ (London). First exercise what small group discussion on what we do well and what we need to improve. Here's a flavour....

WHAT WE DO WELL.....

• Work well under difficult conditions
• Spread little money and use staff wisely
• Support each other
• Maternal and Child Health Services
• Resource mobilisation - not entirely dependent on govt.
• Community response and capacity building
• Community ownership of hospital
• Financially disciplined
• Move with the issues e.g. Leprosy, HIV/AIDS
• Try to listen
• Transport - Reach far / remote place
• Really care for people in the Hospital
• Recognise the whole person
• Host people
• Staff motivation
• Committed in what we do
• Manage outbreaks e.g. cholera and dyssentry
• Innovative - we try
• Provision of Anti Retroviral Treatment (HIV/AIDS)
• Good medical care

WHAT WE NEED TO IMPROVE ON....

• Personal relationships
• Inter denominational boundaries
• integrating our community programmes
• life saving equipment
• mental health services
• strengthening community based structures - Care and Prevention Teams
• Power and Water supply
• Inter-departmental communication
• Finances
• Home based care
• Maintenance (need the Joint Board)
• Diet for patients
• communication facilities
• OPD Toilet facilities
• more nurses
• staff accomodation
• ambulance service
• handling emergencies - code blue
• Integrated Mission
• Buildings and Equipment
• Drug supplies

It was a very interesting process and three hours we looked at the "brutal facts" (Jim Collins speak). We also looked at our mission statement and whether it reflected what we do, what we believe and what we stand for. It was the start of a long process but I am encouraged. It was a good start.

This week we have started the process of giving out 10,000 mosqito nets in our catchment area as part of our Child Survival Project, funded by The Salvation Army World Service Office in Washington. The case fatality rate for under 5's in Chikankata is truly appalling. Along with other diseases it is estimated that 1 in 5 children in this area does not make it to their 5th birthday. Most die of preventable diseases. The mosquito nets mark a year long programme educating and teaching people about malaria. The nets are being given out to under 5's and pregnant mothers - those who are most vulnerable to malaria. Now we have moved on to tackling malnutrition.

Today is the Healthcare Sunday in the Salvation Army. Highlight of the day at Chikankata was some of the Songsters from the Corps (church) singing to the patients in the wards. It was the first time this had happened since we were here and was appreciated by the patients and enjoyed by the singers. It was agreed by all that it should be repeated on a regular basis. It was lovely to watch and listen. I have often wondered why the Salvation Army involved itself in health care, I guess there are thesis (what is the plural of thesis- thesis's or thesi) anyway I have had to figure it out as I try to really catch what our mission here is all about. Anyway, today was special for us and special to the patients. The sight of every single mothers kneeling down at the beds of their children in the pediatric ward when the time came to pray was very moving and a picture I will not forget in a while. The picture is of the Songster in our ICU, recently decorated by our good friends from Aberdeen Citadel.

On a altogther more mumpy note, I am getting really narked off with the water situation. No running water for about 6 weeks in our house. I have had to have what Heidie refers to as "flippin' buckets baths", ie getting a bucket load of cold water and chucking it over yerself (You'll be pleased to know there's no picture attached to this paragraph). Man, it cannot be good for you!

Finally, the ambulance appeal is coming on well. So far, I reckon we are almost half way there - which is a significant achievement. Thanks to all who have contributed so far, one way or another. We really need it here and appreciate the hard work and kindness we know is being afforded us.

I should have been there before now, but as they say better late than never; today I have visited Chaanga. What a place! Chaanga Clinic, School and Church was founded by the Salvation Army in the 1940's. The Clinic is now run by Chikankata Hospital so I went there today to meet with the Headmen, visit the Clinic and open a refurbished part of the building. The School is now run by the Government of Zambia. Unfortunately all the buildings have not been kept well so we are making some effort just to do our part by renovating one part and now we will paint the main clinic.

Chaanga is one of the most remote rural Health Centres in Zambia. It's basically in the middle of nowhere. From Chikankata it is about 32 km. It took us two and a half hours to get there and three hours to get back. The road is bad and on some occassion you just drive on rocks! We past the spot where one of the ambulances was blown up by a landmine, a spillover from the Zimbabwean coflicts in the 1980's. Regular reader of this blog, Alan Slator was one of the passengers on that vehicle. Mr Hachintu from Hampande was the driver. Both are still around to tell the tale!

Two things struck me. One is that the Salvation Army has a really rich heritage and in Zambia is going where other people won't go to serve the people. I thought this would be a good motto for the Salvation Army - maybe a bit too in yer face. But the people in Chaanga really trust the Salvation Army and are very loyal to Chikankata. The second thing that struck me is the resolve and effort of the people. Chaanga is a very poor place. Many of the malnourished cases at the Hospital are from such areas. But they really have hope and are really trying to help themselves and build each other up - we from the developed world could really learn alot from Chaanga.

The one that did not get away!

There are so many different adventures and issues at the hospital and Zambia in general that I am finding hard to be selective in what I write. So forget about being caught in a full scale riot in Lusaka on Sunday, forget about Chikankata being reclassified and upgraded to a Level 2 Hospital once again due to the progress, forget about all the financial hassles, forget the building work that is going well, forget the elections in Zambia, forget that the rain storms have come early and everyone is in a state of panic because they haven't planted their maize, forget that we have had to live and work without electricity and water from Saturday afternoon until Tuesday afernoon - look at the snake that we killed in our garden yesterday.

Now I know the Bradbury's can be prone to a little exaggeration from time to time - but this was a truly huge snake! It must have been 4 foot long. We've have recently switched houses (long story!) and we have been clearing out the debris round the bannana tress in our new garden. It seems that this snake enjoyed the warmth of the setting of being hidden in the mound of leaves and other things. Whilst I would love to write I slaughtered this spitting adder myself, I have to confess that Bright, the man who looks after our garden was the hero.

ps. This is a very very rare occurance - this is only the 2nd snake I've seen in Zambia - for anyone who is planning to visit

pps I haven't told Heidie about this little incident yet - she'd totally freak out. This is strictly between me and you!