It was all very dull and uninteresting. In fact the most interesting thing was this big blue sign that faced me as I struggled up the stairs to the seventh floor of the offices of the “Food, Medicine and Health Care Administration and Control Authority of Ethiopia”. Fikre had picked me up from HQ that morning, we had parked in all the chaos outside, and we were in here again to try to renew my clinic licence for another year. It really doesn’t feel like a year ago that we last did this. As on previous occasions, I was anticipating much bloggable fun.
However, it was not to be. Entering the same office as last year there were no queues of people – just us. The desk we needed to go to was occupied. After a look at the paperwork and a quick stamp and signature, we were directed to another desk at which a very similar procedure took place. Then out into the corridor to the director’s office, another stamp, deposit the paperwork in the archive office, and its done. Licensed for another year.
A clue as to the reason why this went so smoothly was sitting in the Director’s office. Sister Abi is well-known to us now. She likes our clinic, attends a theological college for evening classes that SIM set up, and knows Sr Aster very well. She stood to greet us warmly as we entered. But, most importantly, for the second consecutive year Sr Abi had been part of the clinic inspection team. It’s often true here that it’s not so much what you know, as who you know.
Sr Abi and her team of two other inspectors had turned up at our clinic out of the blue one morning a month or two ago. My adrenaline reaction, dampened slightly by my beta-blocker blood pressure medication, rapidly developed. Dry mouth, racing heart, slight tremor – these people have the power to close us down. However I suppress the temptation to indulge my “fight or flight” reaction by doing the “fight” bit, and begin greeting them, praising God and asking after their health and that of their families. A good start. Now, divide and rule. Sr Aster goes off with one of the men to do the administration assessment, Sr Abi goes with Mahelet1 to inspect the “laboratory”2. I’m left with the remaining guy, who I recognise from last year and who’s a bit of a stickler for detail, so we’ll do the clinical bit. He produces a blank copy of the same 15 page “Medium Clinic Assessment Checklist” form as we completed only 10 months ago, so I suggest I find the previously completed copy and we start from there. His incredulous look stymies that possibility: so, OK, we’re going to do the whole thing again from scratch. And we do. “Where are your policies?” I pull the folder off the shelf, which has been on the shelf for 10 months. “Here you are!” I smile brightly, whilst thinking, “the ones you made me write last year? What did you think I’d done with them? Burnt them?” (It was tempting…) Boxes are ticked. I studiously make sure every criterion has a box ticked next to it, as they all add up to a score and I’m not going to let him miss any. We arrive at the list of equipment. “You have tendon hammer?” he demands. “Of course!” I sparkle, “I have two!” “Show me!” he insists, whilst I’m thinking “what did you think I’d done with it since you last saw it 10 months ago? Sold it on eBay?”. I politely lead him into my consulting room, open the drawer and extract the hammer. He studies it, then ticks the box. “Would you like me to show you how I know what to do with it?” I think; “Lay down…”. Not interested in having his tendon reflexes checked, and having satisfied himself that I also own a tuning fork, we go on to complete the check-list in a little over 90 minutes.
I score some significant points for having brought some single-use minor surgery packs from the UK. After the check-lists are completed we sit the inspectors down and ply them with coffee and pancakes from the guesthouse kitchen, and show off our equipment. Even Sr Abi, who’s very sensible, is nonplussed - she’s not seen anything like this before. She shakes the pack. “Is it plastic?” she wonders. “No” I inform her, “they’re all single-use metal instruments. They incinerate to a black powder.” I’ve deliberately reinforced the fact that we have an incinerator on site – a big sticking point last year as it was the other side of the courtyard in a different building as opposed to being physically in our clinic. Somehow it’s not a problem this year.
They are slightly irritated by my insistence on keeping a copy of all the morning’s paperwork, but when we receive something from them through email in a few weeks I want to be able to confirm that what arrives is the same as what was agreed during this long and stressful morning. Shortly before lunch we bid our inspectors farewell, then it’s high-fives all round as this seems to have gone well, and we anticipate a high score.
As expected the electronic copy of the assessment arrived a few weeks later. It was full of errors and the boxes ticked were very different from the copy I had kept. However on the last page was a score of 91% - enough to give us a green licence for another year, so I was very happy to let sleeping dogs lie. Good job I had that tuning fork.