At the newly donated modern Chinese hospital in rural Liberia, Dr. Francis Nah Kateh has a class that is poised to transform the way health administration and medical services are practiced in a country still lacking behind in the contemporary world’s advanced professional field of medicine.
Called in to handle the enormous tasks at the timely but challenging Jackson Fiah Doe (JFD) Hospital, Dr. Kateh becomes the first professional Liberian doctor to be entrusted with pioneering the operations of such huge regional medical facilities looking to meet the huge health needs in rural Liberia and the sub-region.
The US$10 million facility is a 100-bedroom ultra-modern hospital built and donated by the Chinese government as one of three Independence gifts given their Liberian counterpart during last year’s National Independence Day (the other two being the modern Fendell University Campus and the Center for Agricultural Research Institute in Montserrado and Bong Counties respectively).
With the responsibilities of providing leadership and direct program development and implementation that will establish program standards for the JFD as its medical director and chief executive officer (CEO), Dr. Kateh brings to the fore wide range of diverse professional medical expertise and medical credentials. Teethed with two masters that include a Master of Professional Studies in Homeland Security Leadership (University of Connecticut, Storrs, CT) and Master of Health Administration (Governors State University, University Park, IL), it is his former Master’s that seems to put the former Director of Health for the Anson County Health Department in North Carolina (the USA) far ahead that would help him achieve the ‘unexpected’.
In this FPA exclusive interview, the man who headed the United Methodist run Ganta hospital for three years before adding the record of being the lone Liberian to head a major US county health team talks about his relative short period of success, challenges and dreams of transforming the hospital that boasts of the country’s first CT scan that has already begun receiving foreign patients from neighboring Guinea and Sierra Leone.
How the medical guru can ensure that quality health services are not compromised and his ‘different health standards’ among the staffs of 134 personnel and how to translate his homeland security degree to prevent future disaster in the post-conflict nation are also highlighted in this lengthy interview.
FrontPageAfrica: Back at the Jackson F. Doe Memorial Hospital, what have changed since its formal dedication in February? What are strides you and your staff have made as well as challenges being encountered at this new hospital?
Dr. Kateh: One of the things that I’m proud of is the good team that we have here. And when I talk about team, I mean from the cleaner up to the doctors. We formulated this team and work together as a team because we see the importance of every person on this team. That is how I look at it. We have been having a very good working relationship with the staff which is one.
The next thing we have done is that we are introducing a different mindset about how healthcare system is run. We have informed our people [staff] regarding number one-- confidentiality. We mean patients come to the hospital and right after their diagnosis, the next thing you know is that their information is out there in the public, around the community. They’ve been warned, they’ve been talked to about it and the importance of why it is vital to maintain confidentiality. The consequence we’ve told them is that whenever we get the information that a person leaks a patient’s information, that person will be fired. I mean this is something that I take very seriously. For now, my staffs are very, very happy because they have come to understand the importance of this.
Another thing that we’re happy about is our approach to patients. Jackson F. Doe [Hospital] is setting a different standard in terms of patients’ care. We place our patients’ care at the very top of our priorities. So, the staff is aware that they have a job because of the patients and that when there are no patients there will be no jobs. So when a patient comes over to the hospital, that patient has to be treated well. It is almost like a business where you have to exercise good customers’ care. And the patients are like our customers. So we have to provide the necessary care to them. They [staffs] are aware of that. That is something we have achieved.
Another thing that we have achieved is building of capacities. First, the opening of the John F. Kennedy Memorial (JFK) Hospital in Monrovia USAID brought the entire management team from the United States when it was just built. They recruited them from all over the US that ran that institution for five years before they had Liberians trained as their counterparts. So, this is the first time-in the history of Liberia as far as I can recall and anybody can correct me on that-that a Liberian is being asked to take this task from scratch, especially looking at the sophistication and complexity of this institution to have it functional. I think we have done some good things. We are not too happy because there are some challenges and so forth. But we are happy about how far we’ve come. At this point, we can say that we are running the hospital at some 60 to 65 % of its capacity. So just imagine when we get up to some 80 to 90 % of its capacity, this hospital could set a record within the region. We are happy about that.
Another thing we are happy about is the relationship we’ve built with the Ministry of Health-Dr. [Walter] Gwenigale, Dr. Dahn. And that relationship is yielding some of the positive results that we have. We also have a board that we’re also commendable to. I’m very grateful to have a board that is very flexible in working along with me. One of the things that we have done which is the biggest achievement which is not from our side but from the Chinese Government is their willingness to continue to help us in whatever direction they see fit. For example, 25 of our staffs including myself went to China and went through a six-week intensive basic care training and understanding some of the equipment and how the institution runs and so forth. This has helped us a lot in building up the kind of fabric that we have up here today.
So, we are always grateful to the Chinese Government-the previous ambassador and the current one. The present ambassador has visited us and is kind of excited in helping us to move this institution forward. Another thing is that when former ambassador was here, there was a tripartite agreement signed between the Chinese, Egyptian and Liberian Governments. That is about to yield some positive results. We will be having at least two doctors that will be coming from Egypt to provide one or two services. So, in term of capacity building we are trying to build the necessary capacities in terms of having the trained specialized doctors. The hospital was built with the intent of specialized services. So, we are trying to recruit the specialized doctors in the various areas in order to have this hospital effective. We are getting there!
FPA: So, as we speak what are the specialized areas that you have and where are areas you are still lacking specialized doctors?
Dr. Kateh: For now, we are basically running the OB Gynic area, the general surgical area; we are also running internal medicine, the pediatrics which is the major areas that we are now running. We have not begun the process of ear-nose-and-throat [ENT], gastroenterology, cardiology, ophthalmology, pathology, radiology and anesthesiology. We don’t have a dental area yet but there is a room that has been identified though there is no [dental] equipment. All of the other areas that I have identified we have equipment for them. We have not begun our pathology and radiology departments. We have the CT scanner there but we really need a radiologist and we also need a pathologist that is going to help us with some of the problems that we are going to uncover.
FPA: What about those guys I saw yesterday operating the CT scanner?
Dr. Kateh: Those are just technicians.
FPA: You mentioned that hospital’s operational scale between 60 to 65 %. One could wonder what the average number of patients here is, either daily or monthly.
Dr. Kateh: From our available gathered statistics, the influx of patients averages a little over 500 patients weekly which goes up to 3,000 monthly at times.
FPA: What is the numerical strength of your staff?
Dr. Kateh: We have 134 staffers.
FPA: Let’s now look at some of your challenges as a new hospital with immeasurable tasks to perform in this part of the country.
Dr. Kateh: One of the challenges here is that most of our patients have had different medications and diagnosis. Now, we need high class antibiotics which are not easily seen on the markets that have high potency too. We’ve engaged the National Drugs Service (NDS) and provided them with some listings of the drugs we need.
FPA: As a new institution, this year’s new budget should be your first enlistment in the National Budget. How much is needed to run this hospital effectively and how much have you proposed to national government for that in the pending National Budget?
Dr. Kateh: Budgetary constraint is another challenge here too. For the National Budget, we’ve presented a minimum of US$2.5 million is needed to effectively run this hospital. But we are hearing that this is being cut down to US$1.6 million to be approved. Another concern is having the right staff and retaining them. It is not only money that makes staffs happy. Housing is also important and other little purse that will make a successful self-retainin. But we are happy that we have not lost any of our staffs to another institution due to greener pasture or whatsoever. We are also looking at performance base.
FPA: Taking a tour of the hospital for the past two days and observing some of the interactions between your staffers and some of the patients, It was noticed in several cases that some of the patients were either not able to afford the total amount of money needed to treat them or no money at all but they were still treated. Now, running a huge hospital in this rural part of the country where getting anything here is costly and considering the cost of even daily operations including running your generators, I was just wondering how you’re coping and will cope now with news that your anticipated budget may be reduced?
Dr. Kateh: We have realized that most of our people cannot afford, which makes us to do some services for some of them on gratis. Talking about power generation, it is true that we are still finding it difficult in that area. We have three generators of 625 KVA each. That is an estimated value of US$225,000 to US$245,000 to run them annually including lubricants. That is why we need that which we have presented in the National Budget.
FPA: During the formal dedication and subsequent official opening of the hospital, you were keen on paving the road that runs in front of the facilities in order to protect the expansive equipment here. I’m back in few months and the road is already paved. How did you manage?
Dr. Kateh: I remember the former Chinese Ambassador who always said he admired a persistent leader. They had intended to build the hospital near Monrovia but the President was persistent that she had promised the people of Nimba a hospital. Now with the hospital built here, there were concerns about the equipment which are very costly. The CT Scanner in itself is US$1.2 million in addition to other equipment here that are also expensive. So we asked the President during the dedication ceremony for the road passing in front of the hospital to be paved. We requested for three kilometers of it to be paved. And I must hasten here to say a big thank you to [Public Works] Minister Kofi Woods and Deputy Minister Johnson Gwaikolo. Now we have two kilometers paved which will protect our equipment for the risk of dust. And guess what? The Chinese engineers who did the road said it can last for up to 30 years. The only problem here is the drainage system, which I understand was supposed to be done by a Liberian contractor. Part of the road there, just a few feet from the hospital as you drive is cut and that is danger. The Chinese did their part by paving the road but the Liberian contractor doing the drainage is not even doing it. In fact, they should have done that before the Chinese could do the road.
FPA: On a more personal note, Doc, let’s look at what you have brought to Liberia’s troubling and challenging health sector. You have what I will term as a fabulous CV, noticeably among which is what find to be strange for a medical practitioner. Flipping through it, I find ‘Homeland Security’ weird for a medical personnel. Why did you have to do this and what is its importance to the medical professional vis-à-vis Liberia’s contemporary health crisis if you may?
Dr. Kateh: Basically, when I served as the Health Director for Anson County [in North Carolina, the United States] which I took over from May 2000 until my resignation August 6, 2011 I was attracted to taking this course in ‘Homeland Security’ with emphasis in ‘Disaster Preparedness’. After the Hurricane Katrina in New Orleans [in the US], as a public health director who ran the entire healthcare system in that county and I saw the devastation that went on, the first thing that came to my mind was, ‘What would I do if I was in New Orleans and going through this devastation? How would I prepare the public and how would I decrease the causality level and so forth?’ So, it was based on these that I decided to look around and see if there was a school that could prepare me for such a challenge whenever it comes. I then began to search the internet and realized that the University of Connecticut had just opened this program.
After the ‘9-11’ incidence, homeland security became a major issue in the United States. The navy already had a problem in California and the University got into collaboration with the naval school in California. Based on that, they established this program in ‘homeland security’. In leadership….there are many tracks in ‘homeland security’ and you can choose one of those tracks. One track could be security and you can get your Master’s in ‘homeland security’ and your specialty in only in security. You can get one and your specialty is in transport. One can get one that relates you to my own area which is ‘Public Health Disaster Preparedness’. Since I was in charge of public health in my county, I went into that area. Up to the time that I left North Carolina, I was the only health director in the state of North Carolina that had a medical doctor degree plus a Master’s in Health Administration and then a Master’s in Homeland Security with emphasis in Public Health Disaster Preparedness. Though most of my colleagues have a medical doctor degree background, I was the only with those three areas at once. Now in order to become a medical health director in the state of North Carolina, there are criteria set. You can be a medical doctor plus few years of experience working at a clinic or whatever. Or you can be a medical doctor with a background in Public Health then you need a minimum of two-year experience to become a health director. Or you can have your Master’s in Public Health with about five-year experience before you can be health director. Now you can also become a medical director and a Master’s in Health Administration and you need just a year’s experience to. I already had those backgrounds plus a Master’s in Homeland Security when emphasis in Public Health Disaster Preparedness when I took over the job.
FPA: So, bringing this home, how will this help our health sector now that you are heading a major health institution? Like for instance, we had the situation of the caterpillar worms’ invasion about two years ago. Can this help in such incidences?
Dr. Kateh: Definitely, that could help. The first thing I would do in that instance is to go and access the affected area. Then I’ll figure out where would be the next direction they [the caterpillars] are headed. And then advise accordingly. For instance, if a landslide or any disaster like fire outbreak occurs in this hospital I’m about now drafting plans on how we can do an evacuation of all the patients while at the same time continuing care.
FPA: During my last interview with you during the dedication ceremony six months ago, you mentioned something about a helipad. Do you still maintain such an ambitious plan, Doc of having an ambulance-helicopter that will administer first aid to patients…..?
Dr. Kateh: Yes and that is attainable! The fact that we have the only CT scanner in the country means we could have patients with stroke or other sicknesses that require urgent care while en route here from where-so-ever we may be taking them from. In medicine, time is very important because the faster, the better the prognosis. Additionally, we are also considering other plans. Like later tomorrow, we will be going to the Gbi people to discuss with them what their problems are there. We will discuss with them how to get land to build a little first aid health center there and to also plant rubber for the sustainability of this hospital where the sales could help fill in some financial gaps here at the hospital.
FPA: As we conclude, Doc, can you speak to anything else of importance not touched in this interview?
Dr. Kateh: Finally, this is a regional referral hospital and there is a need for all Liberians to be proud of it. We now have the country’s first CT Scanner here as well as other medical equipment that have not been used in this country before. For this, we have been having patients coming from Grand Gedeh, Sinoe, Lofa and other counties and even as far as Guinea and Sierra Leone.
FPA: Thanks for the time Doc and wish you success in your endeavor to transform Liberia’s poor health sector.
Dr. Kateh: Thanks too, Nat and hope you will have a better result from your CT scan (smiles)
Interview by Nat Bayjay,