Distracted by putting theory into practice

LSHTM logoI’ve a really good excuse for not writing for over a month. Really good.  I’ve been too busy putting into practice the theory I haven’t even had time to learn yet. I told you all last time that I’d chosen Health Services Management as my specialty stream for my MSc in Public Health.

Well, admittedly to the detriment of my study, I’ve felt for the last month or so that I got thrown into a very long and realistic classroom scenario exercise in health services management, save for the fact that it’s not just exercise but real life.  As I mentioned last time, I got involved with St. Joseph’s Hospice in Rawalpindi, Pakistan a few months back on the premise that I was apparently young enough to help ‘rev up’ the Facebook page.  That benign suggestion was the beginning of one very long rabbit hole, that I admittedly let myself get pulled into.

St Joseph's Hospice foundation stoneMy natural inclination is to dig towards problems and sort them out, so to find out that the Hospice was months away from potentially shutting its doors just after its 50th anniversary, I thought it would be short of lunacy to only help with the Facebook page. Curiosity got the better of me and my mother’s voice rang out: “There’s a solution to every problem…”  So now I find myself sitting on the board.

Through the Hospice, I’m finding myself confronting on a small scale the breadth of issues that we cover in our studies, with all the predictable unpredictability of human behavior thrown in the mix.  Sounds a whole lot easier in the textbook.

It’s an incredible institution in many senses, managing on a shoe string, and maintaining a morale and spirit that could well do with being captured through qualitative research (five geek points for reference to coursework in blog post?) with a bunch of in-depth interviews and participant observation over time.  I’ll have my case study primed and ready when I get to the Organisational Management module… muahaha.

Indeed, I’m watching (or being part of) a major time of change and transition – what kind of ‘change management’ is going on? How are the staff, the whole environment, dealing with change?  How on earth do we go about managing some of the very difficult changes?  How much can we minimize the difficulty?  Even just the whiff of it in the air can create anxiety amongst the staff.  This is the first time in my life that I’m sitting on a board where we’re potentially seen as the ‘big, scary, heartless board members’…while we’re also very concerned and feel very responsible for keeping this place afloat.

The nursery ward entertains at St Joseph's Hospice 50 year anniversary

The nursery ward entertains at St Joseph’s Hospice 50 year anniversary (Photo courtesy of the Hospice’s Facebook page)

I’ve not yet got to the point of drawing graphs with marginal costs curves meeting marginal revenue curves, but some of those basic principles are playing a critical role in figuring out – is our X-ray department breaking even?  What kind of fee structure would most simply, equitably and effectively help us do so?  Per patient or per X-ray? How elastic is the demand if we raise the fee?  Oh, and not to forget that the service is meant for those for whom a jump from $1.20 to $2.00 per X-ray is enough to make many forfeit the service entirely and consider it unaffordable? How far can we push before it’s too far – both in terms of economics and equity?  How could we improve our physiotherapy services to both improve the quality of services and bring in more income for the Hospice?

St Joseph's Hospice front entry

St Joseph’s Hospice front entry

Or then there’s the Hospice’s environment that has suddenly widened thanks to the local media coverage that we were completely unprepared for after Voice of America lead a TV special on the situation, that creates a wider social interest especially given the unusual dynamic of a Christian charity in a Muslim context like Pakistan.   The story that makes the news – “Hospice may have to close after 50 years” – is but a sound bite of the real story that more accurately consists of growing effort and determination to build a sustainable structure to make sure private donations go as far as possible…without compromising on the mandate and ethos that has made the Hospice so beloved. Limited by time and resources, we have to just to the best we can to keep up with the media coverage, knowing it has a life span of it’s own, and simultaneously show our gratitude for highlighting the Hospice’s plight, and set the record straight as best as possible where errors are reported. All this could have both positive and negative impacts upon the Hospice’s future – the environment within which the Hospice has to exist.

Or what about at a more basic level, the role of a Hospice like this – a classic, old school model of charity run first of all on love and compassion – amidst a world of development and sustainability, infinitely more process and policy oriented.  Finding the balance to both keep the best of what has made the Hospice a special place, and reach out to new horizons for the sake of the longevity and health of the Hospice and it’s residents, is a multi-faceted (and sometimes slightly chaotic) exercise in human psychology, financial number crunching, tough decisions and a good dose of entrepreneurial spirit.

Choosing to study distance via UoL is allowing me to get ‘distracted’ by inspiring and relevant things that come along, like the Hospice, allowing me to flip back and forth between theory and practice in a way I’d never be able to if I were dedicated in the classroom.   That, quite frankly, is ‘sweet as’ as we say in New Zealand!

Lucy is studying the MSc Public Health by distance learning in Pakistan.

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