Budgets. A life or death matter

Posted: 2 October 2017 in Business Systems, Haiti
Tags: , ,
haiti grave.JPG

Haitian graveyard

I was so pleased with the hospital budget planning, and outcome.  A sudden patient death was a shock. Cause of death – our budget?

This more complicated than you might think. The patient had all their care to date at Hospital Convention Baptiste d’Haiti (HCBH) in Cap-Haïtien in north Haiti. That day the patient suddenly arrived with a haemorrhage.  The doctor prepared for surgery.  Unfortunately when they were to announce start, there was an emergency elsewhere. Another patient was now in surgery and was being anesthetized.  The hospital had one anaesthetist.  So it called upon a sessional anaesthetist as backup.  But they were not available.  HCBH called the government hospital in town, but they could not help.  Then called the Roman Catholic hospital that was not too distant.  They could help.  The patient was rushed off in the ambulance, but it was too late.  They died.

Why no second anaesthetist?  I had helped the Hospital to set a balanced budget.  I, colleagues at Hope Health Action, and HCBH senior managers had agreed to squeeze planned costs.  The budget had scope for an additional sessional anaesthetist and no more.  We were very pleased with the quality of the preparatory work and the (hard) discussions that followed to get what we thought were good results.

Personally I was shocked to hear of this death, so soon after the budget was agreed.  The medical team were angry.  They had cared for the patient in the run up to the surgery, and then – tragedy.  I did not have to face their remonstrations, but my Haitian colleagues certainly did.

So- we got the Hospital budget wrong and this resulted in a death?  I don’t think so.  Budgets are an inexact business.  They are a punt on the future, not a crystal ball.  Furthermore – a financially tight budget for a hospital in a poor country will always mean not everyone can be helped in time.  That will lead to aggravated illnesses or death.  Just that most cases are not so immediate, and not so visible as this one was.

I salute my colleagues at the Hospital.  They did not just blow the budget and appoint extra staff.  They knew from my departmental analyses that a smaller but significant services offered made a loss.  So they decided to close that service, and moved the budget allocated for that services to increase the anaesthesiology budget.  Good outcome to a sad tale.  The key leaders were already well informed to respond to an unhappy situation.

Budgets – just playing with numbers?  Don’t you believe it – someone’s life may depend on where you put that decimal point.



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