Two Years in The Gambia

The weather here is still perfect, cool 25oC nights and lovely 32oC clear blue sky days. The mangos are ripe and delicious. Everyone is eating them, including the big fruit bats. This year’s grapefruit are sweet and juicy and hanging abundantly on the trees. The only downside is that our two years as volunteers in The Gambia are almost over. We will be returning to the UK in mid May and will probably live in the Aylesbury area. So this will be our last e-mail from Africa.

We thought we would reflect on what we have done here. Almost two years ago Margaret entered the GOVI compound and saw a bright crimson bird perched on a stalk of corn, amidst a sea of post rain weeds. She was welcomed with many smiles and requests and was installed in a dark dusty office complete with resident frogs, mice and cockroaches. There was an air of “We need help” about the place. Now as she leaves GOVI, clutching her prized certificate of honorary membership awarded by the long awaited general conference, she looks back at a neater compound. There are banana plants growing, brightly painted play equipment for the children and a new office nestling in the corner. Has she done all this? No but she has helped. She caught the frogs and set the mice free in the compound. The old office now houses an adult literacy class and the Braille technician has moved out of the restructured library into his own space. The new office boasts an improved filing system and a confident accounts clerk.

The executive director is working at the computer responding to e-mails from partners and friends and, hopefully, dumping all the junk ones offering services best left to the imagination. In the hall, with its new stage and fresh blue curtains, one of many events is taking place bringing in much needed income. The new treasurer sits with the outgoing one, gathering information and advice, while the teacher in charge prepares to head out on his motor bike to visit children in integrated schools. Margaret leaves behind the fundraising officer working together with the new board, liaising with fundraising advisers from the Institutional Development Programme. The immediate financial needs of the organisation have been identified and budgets prepared. There are the beginnings of strategic plans for the future and work is in hand to find ways of funding these.

The youth wing members are making music, the women are busy with their soap making project and there is a new confidence in the organisation. It is good to see the positive progress made in the two years and all Margaret can do now is hope that it will continue. How much of this is down to Margaret? Given that she spent two years trying not to do anything, just to give advice she’s not sure. She taught the accounts clerk to improve his spreadsheet skills and advised him about the way he should work with his director and treasurer. She has advised on the importance of transparent and accountable reporting. Together the director, secretary and she devised a new filing system. Teachers have been trained in the use of computers, partly by Margaret and partly by her identifying a free course for them. She has supported the director in communicating with partners, in improving his administrative skills and taught him to use e-mail and internet. He can now type his own letters if necessary. At her suggestion a hall committee was set up to administer hall bookings and she has worked with the youth and women’s wings to develop their work plans. The fundraising officer and Margaret ran a workshop to enable the organisation to develop future plans to enable fundraising bids to be written. Along the way she has demonstrated the benefits of regular communications both between departments and with external partners.

Report writing has been improved. Generous donations from friends and family have helped with improvements to the garden, new musical instruments and equipment for the school. She advised the committee who were developing an updated constitution which was adopted at the first AGM for many years. She also helped with the planning and fundraising for the General Conference which elected the new board, which has a much better gender balance. The new energetic board has breathed new life into the organisation and will move GOVI forward over the next few years.

The hospital was where Allan worked was pretty big, with 1200 staff and 550 beds. It was built by the British in 1953 and progressively refurbished since then. There were three fundamental problems. Firstly the hospital needed about 100 million dalasis (£2 million) to function anywhere like properly and the government provided only D30 million (£600,000). Secondly there were no written procedures. Arrangements were made by word of mouth, people made up the rules as they went along and there was terrific wastage of time, effort and materials. It other words little or no recognisable organisation. Thirdly there was and is endemic theft and fraud. The people here are extremely poor with 56% of the children being malnourished. So goods, equipment and medicines flowed freely out of the hospital. This characteristic was not unique to the hospital the other businesses and hotels in The Gambia also struggled to retain their resources. The management in the hospital were very capable and enthusiastic medical people and some career civil servants who had little or no management training. So they tended to fire fight, jumping from crisis to crisis, achieving small successes each day. When Allan joined this team he asked them what they wanted him to do. They wanted more money, a strategy to allow long term forward planning and a way to make the hospital run more efficiently. So he started by asking all of the staff where they thought the hospital should be going and how they thought they could get there. This was done by a short questionnaire and discussion groups in local languages. There were of course more complex discussions within the Hospital Board, the Senior Management Team and with the chief executives of other, smaller hospitals in The Gambia. The upshot was a ten year Strategy Plan, focussed on the next two years. This covered all of the hospital’s departments and services, including the structure and organisation of the hospital management. The Strategy Plan called for negotiation with the Government for better funding and the introduction of commercial medicine. This would allow the hospital to set up a commercial clinic where well off Gambians, ex-pats, and visitors could be treated. The income would then flow back into the hospital and the public health service to supplement the Government grant. No profits would go to individuals or shareholders.

Next Allan suggested that the Senior Management Team needed to be re-organised and expanded, with the addition of an Estates Manager to oversee hospital maintenance. The existing Management Team had no middle management to delegate duties to. That is why they were always solving immediate problems rather that planning and taking action to avert them. So the hospital promoted and trained promising young people and recruited some in. For instance senior nurses were promoted to be departmental matrons, each running a couple of wards. It was not really rocket science.

To further improve the management of the hospital Allan suggested that they establish a Quality Management System. This included a description of the management structure and who was responsible for what. It was interesting that there were some sections of the hospital which did not appear to be under any senior management control. Next the staff started writing down all the informal procedures and work practices. Allan trained 24 Quality Representatives to talk to their colleagues and capture in writing what people believed the procedures were for doing their job. These were then discussed with heads of departments and then formalised as Standard Hospital Procedures. The hospital now has organisational charts for every department, job descriptions for the first time and over 250 Standard Hospital Procedures. During the course of this work some alarming facts were discovered.

The Chief Medical Director was a dental surgeon and one of her dreams was to reach out to the community offering dental education, treatment and care. Allan found a dental van which had been donated some years previously. So he negotiated with some of the local tourist hotels and found one which liked the idea of sponsoring a mobile dental clinic. The Kombo Beach Hotel agreed to pay for a dentist, two nurses and a driver and all the drugs, stores, fuel and maintenance for the vehicle. Since October 2005 the clinic has toured the country and treated over 2500 patients.

The hospital also had a steady stream of tourists wanting to see the hospital. These people usually brought some small donations but it took up a lot of time of the hospital Public Relations Officer to look after them. Allan suggested setting up a Hospital Tours Group to look after visitors in a more organised way. He trained 12 hospital staff to be part time tour guides. He also established a visitor’s centre. Now there are regular tours which bring in useful additional income to the hospital. He also set up the Friends of the Hospital scheme so that interested British people can donate a small amount regularly in the UK. We have really enjoyed living and working in The Gambia. We appreciate all the wonderful support we have received from our friends and relatives that made our time here so worthwhile. In the past two years we have learned an enormous amount about Africa, her geography, people culture and politics. It has been a breathtaking experience.

More pictures.