Resistance to Change

Those of you who know me know that I can be very resistant to change. When my parents wanted to get rid of our 18-year-old worn, stained, crayon-graffitied coffee table I was so upset I insisted they store it for me; it now sits in all of its glory in my living room.  I am still reeling from the change of management in the Health Science Library coffee shop and have resorted to returning home for my afternoon coffee rather than buying the new coffee from the new baristas.

This is all to say that I am sympathetic to individuals and institutions who do not wish to undergo dramatic transformations or systematic restructuring.  Yet one of the most frustrating aspects of working at KCH is the staunch refusal to change inefficient and often broken systems. This has been a common frustration amongst the other medical students working here. Two years ago Mariah implemented a program to help better support the guardians at KCH. When she met with the hospital director this summer he had never heard of this program despite guardians being a constant problem for the hospital.

Similarly, Timica is working in the hospital lab, and planned to spend the summer doing an analysis of whether the lab tests offered at KCH were those that were clinically relevant and assess clinicians’ knowledge of what lab tests are available.  Yet when she arrived it was made clear that the administration was not interested in this study, and moreover was not interested in implementing any changes based on its results.

The study that I am working has thus far been well-received, but I realized on Friday night that my study is a response to resistance to change. One of the UNC undergrads was asking me about my work here, and when I told her that we were investigating alternatives to the DNA-PCR test currently used to diagnose neonates she didn’t understand why an alternative was needed. I explained that the DNA-PCRs take at least a month to get results from the lab, and that a benefit of the p24 antigen test is that it can be done at point-of-care. The student responded by telling me that DNA-PCRs should be able to be done within a week, and she didn’t understand why changes couldn’t be made in the lab to deliver DNA-PCR results more efficiently.

Though I have previously written about this issue in my grant applications and read about it in the IRB proposal this was the first time I really understood the ridiculousness of the situation that precipitated our study. The probability of the hospital lab initiating changes that enable efficient delivery of DNA-PCR results is so low that it is worth immense amounts of time, money and effort to do a new study on a test that will essentially circumvent the lab all together.

Yet even in these frustrating situations I find it a fine line to walk to be honest and critical of the hospital and it’s administration without being ethnocentric and close-minded. How do foreign students and professionals in Malawi work to identify weaknesses and improve on them without undermining the authority of the KCH administration? How do physicians balance the immediate need of patients with the need to respect their Malawian colleagues and create a sustainable system based on Malawian expertise and commitment?

 I think the answer to these questions lies in humility and cooperation on both sides. Just because we have one system in the U.S. does not mean implementing the same system here is the best course of action. Conversely, simply because the KCH lab has followed certain protocols for years and years does not mean these protocols are not without fault.  Yet these lessons are easier said than learned, I will try to remember when sipping my home-brewed coffee at my stained coffee table while the rest of my class enjoys Magical Mochas at the clean linoleum tables of the Friends Café.