Author: Alanna Shaikh

Physician training has very little impact

By Alanna Shaikh | | 0 Comments |

Jishnu Das writes about research on physician training in low-resource countries. His disheartening conclusion is that the training has very little impact on improving quality of care.

The research was as follows:

Our approach has been to try and decompose the quality of medical advice into two components—what doctors know and what doctors do. What doctors know—measured by testing doctors—represents the maximum care that a doctor could provide. What doctors do—measured by watching doctors—represents the care they actually provide to real patients. We call the first “competence” and the second “practice quality”.

And the depressing conclusion:

In Tanzania we find that two additional years of school and three additional years of medical school buys an increase of only 1 point in the percentage of essential tasks completed. Results are similar for other countries.

Training doctors has been a standard way to improve the quality of health care for years. It’s a major shock to discover this minimal impact. I wonder if the quality of training make a difference? Perhaps competency based training would make a difference.

While this is depressing research, it’s not necessarily telling us things we didn’t already know. If you want to change a physician’s behavior, you don’t just give her training. You change the system she is part of. Good projects health projects recognize that, and so do American HMOs.

Lesson: Don’t try to change individuals, try to change the system they are part of.

Looking for a few good questions

By Alanna Shaikh | | 0 Comments |
Based on a couple of emails I’ve received recently, I want to start a Q & A feature on this blog. I’ll answer readers’ questions about international development, both theory and practice. If you’ve ever wondered exactly what IMCI stands for, or why it’s a good strategy, now is your chance to ask. What’s the difference between a PSC and a PCV? What is “do no harm”? I’m at your disposal. If I can’t answer your question, I’ll find someone who can and make them write a guest post.
Just post in the comments on this entry or drop me an email at alanna.shaikhNOSPAM@gmail.com. (For the uninitiated – take that NOSPAM out of the address.)

You Weren’t Meant to Have a Boss

By Alanna Shaikh | | 0 Comments |

Paul Graham on large companies. This is one of the best descriptions I’ve ever seen on why big organizations are so hellishly unwieldy. I wonder, though, if there are economies of scale that make up for the loss of individual freedom and productivity.

I also adore the ultra-minimal site design.

Lesson: A bigger project is not necessarily a better one.

Doing good and doing harm

By Alanna Shaikh | | 1 Comments |

Bad development projects are worse than no help at all. A bad project can break a local economy, create a culture of dependency, and damage a community until community members cannot even imagine attempting to solve their own problems. This is what the do no harm approach is all about. This the lesson you should learn from James Shikwati. He lumps all aid together, true, the good and the bad, but he’s right about how dangerous bad aid can be.

Those of us involved in international aid should take our role seriously. When your project takes criticism, you shut up and listen. You act like any other professional, and you examine the criticism to see if it is accurate.

Here’s what you don’t do. You don’t say, ever “Why would you be so mean when we are just trying to help?” If you find yourself about to say that, it means you have failed. Pack up your souvenirs and go home.

Lesson: There is no free pass for good intentions.

A timely and relevant post.

Two aid workers kidnapped in Somalia

By Alanna Shaikh | | 0 Comments |

Two UN contract workers kidnapped in Somalia. Murray Watson and Patrick Amukhuma were kidnapped in Somalia yesterday. Patrick is Kenyan, and Murray is British. Murray Watson is an ecologist with a long history of work in Africa. I am praying for a quick release, like last time an expat was kidnapped in Somalia.

One thing I find interesting about the media coverage on this is how few outlets have gotten their jobs right. They were contractors for an Indian company which held a subcontract with FAO to do aerial survey work. Not all that unusual if you’re used to how the system works, but hard for an unfamiliar reporter to grasp.

Target audiences

By Alanna Shaikh | | 0 Comments |

My mother received the email posted below this morning. She’s good with computers – she shops online, keeps in touch with her friends via email, and uses Google to look for medical information. She’s comfortable, in short, with the internet.

When she got this email, she was outraged. She thought it was an attempt to prey on the poor and uneducated, and that citing medical authorities must be some kind of unethical.

I thought it was hysterical, and asked her to forward it to me so I could read it and snicker.

To be fair to my mom, neither of us remembered it was April first. She might have had more of a sense of humor if she’d remembered. I’m not sure, though. I think this email was a misjudgment of their audience. Allegro medical sells home medical supplies like walkers, heating pads, and adaptive technology. Most of their target market is either old or sick. How many of them have the kind of lives that remember and enjoy April Fool’s day?

Lesson: Know your audience very, very well before you send your message.

——————-

From: Craig Hood
Date: 01 Apr 2008 00:17:25 -0700
Subject: Breakthrough Study Reveals Important Link
To: xxxx.shaikh@gmail.com

Hello Marylin,

The New England Medical Center in conjunction with the Harvard Journal of Medicine published a document today noting that people who shop at AllegroMedical.com tend to be smarter and better looking than most. The control group of non-Allegro shoppers were also found to exhibit poor hygiene skills in addition to lower cognitive abilities. “More studies are required as we can’t yet pinpoint whether smart, good looking people simply choose to shop at Allegro Medical or people who shop at Allegro Medical somehow become smarter and better looking,” says researchers conducting the study.

Upon learning of this groundbreaking study, the team at Allegro Medical is here to celebrate your “smarterness” by offering all smart Allegro Shoppers $10 off their next purchase of over $100. It’s no joke, Just use the code “Smart10” today through Tuesday, April 8, 2008.

Good hygiene, like smart shopping is a learned skill. So if you know anyone suffering from poor shopping practices, help’m out by forwarding this limited time deal on to friends or family in need.

Sincerely,

Craig Hood
President/Founder
Allegro Medical
800-861-3211 ext 121

Hopefully this is the most interesting email you have ever received. However, if you would rather not receive future e-mails or advertisements from me or the crew, please visit the opt-out link here: click here. Allegro Medical, 1833 W Main St, #131, Mesa, AZ, 85201
Please note that this message was sent to the following email address: xxxxx.shaikh@gmail.com