Resigning/retiring from our respective professions in the UK and moving to Ethiopia took Chris and me away from the increasingly burdensome bureaucracy in the education and medical systems. Chris doesn’t miss “Ofsted”, and I don’t miss the CQC (the Care Quality Commission). We both think these august bodies do a great deal of good but under rather oppressive political pressure and sometimes go perhaps a little further in their relentless pursuit of ever tightening “standards” than is absolutely necessary.

My previous partnership at the Lodge and Highfield Surgeries in St Albans was recently inspected by the CQC and did fine of course. One of the things that felt a little unnecessary was the requirement to have documented details of when examination couch curtains were laundered – every 6 months, at 60 Celsius, in an industrial washing machine. Or, use disposable couch curtains changed every 6 months. Apparently couch curtains are an infection risk.  (I’ve solved the problem here – just don’t have couch curtains. The curtains in the room I had my ECG in at the Addis Cardiac Hospital last year were obviously a wretched nuisance as they were tied up in a big knot and hooked up out of the way. I doubt they were disposable.)

Well, my clinic has been inspected by the Ethiopian Federal Ministry of Health. I can safely say I will never complain about the CQC ever again. They’ve been three times now. I missed the first two by being at my Wednesday Bingham clinic or on holiday, but I was there for the third visit. Six stern-faced inspectors came with one agenda item only this time – we are registered as a “medium” clinic and as such we have to have blood test facilities on site. The government says so. Well we don’t. Like any good GP surgery in the UK we use a professional laboratory service. We take our own blood specimens and they go to “International Clinical Laboratories” (ICL) accredited by the American college of pathologists and linked to a company in Germany. They do a comprehensive range of tests for us, return the results promptly, are reliable and co-operative, and we have good relationships with their lab and their medical director. (Ironically Ermias, the link guy to ICL, came to see me while the inspection was going on). The clinic has used ICL for years. Under no circumstances could we do tests to the same standard with the same quality control on site. Impossible. “You don’t meet the standard” said Stern-Faced Inspector#1. Smiling blithely I reply: “I think you can see we exceed the standard. Our patients get comprehensive timely blood tests done at a laboratory with international recognition. we exceed the standard.” “You don’t do blood tests here,” interjected Stern-Faced Inspector#2, “so you don’t meet the standard. You must do them here. You need a lab technician and machines.” Blithe smile fixed in place I turn to him. “I’m sure you will want us to continue providing our patients with a service that exceeds the standards. They have their blood taken here and we get extremely good results and the patients are very happy” I reply, teeth getting closer together; jaw muscles tightening. “You have to meet the standard” adds Stern-Faced Inspector#3, “so you have to do the tests here. The government says so.” I mustn’t talk through clenched teeth. I mustn’t hit him. Diplomatic skills fully functioning I say: “As we exceed the standard I’m sure you must be happy with that. Please help us to continue to provide such an excellent service for our patients. We get a much better service than we could ever do by having a few machines here. Can you help us continue doing that?” I think I spotted Stern-Faced Inspector#2, a youngish chap in jeans and a tee shirt, soften slightly. Perhaps he could see I was talking common sense. “You don’t meet the standard” repeated Stern-faced Inspector#1. “We will do a report. You have to meet the standard.” Shaking their hands warmly as they made to leave and smiling broadly and totally insincerely I say: “Thank you. I hope you will be able to report that we exceed the standard and that you will be able to help us continue our service to our patients.”

So that’s it. We don’t meet the standard. To meet the standard we will have to get some machines and do our own tests. To continue as a “medium” clinic we will have to start doing worse medicine. We will have to reduce quality. If we don’t get worse, we may have to close. And they didn’t even mention couch curtains.

There are a few things we are trying to do to mitigate the possibility of closure. I am relying on people here who understand and know how to handle bureaucracy that has no basis in logic or common sense.  We will have to approach people further up the food chain. Other institutions have had to cope with similar things and have succeeded. Recently I was told Bingham was inspected once and the inspectors wanted 60 years of financial details, expressing surprise that such records were not all on computer. The medical director at the CURE Hospital has successfully parried similar demands. I hope we will survive.

Pleas pray about this. And remember – in Ethiopia, “why?” is always a rhetorical question.

Oh by the way, another standard requirement for a “medium” clinic that we have to comply with is that we have to have a gardener. We haven’t; mainly because we occupy the first floor of an office building, and don’t have a garden.