To begin with, my fatherʼs garden is not in a dire state and is actually very beautiful. He takes great pride in making sure that the hedges are trimmed, the flowers are constantly watered and that the grass is green all year round. So much so that he makes his own manure and if you leave your food untouched on your plate for too long, it might end up in his beloved compost box.

He has a water irrigation system which makes use of recycled water from inside our house, so you should also fray from thinking this article can act as an expose to get the municipality to start looking into our water consumption, although I am sure there is still a case to be made for that. Rather the point I want to make is that even with his self made manure and recycled water, there are still ways that resources that may not be used in the most optimal manner, just like in our hospitals, can improve our work and every now and then we need to stop and take stock of what we are doing so that we do not fall into common traps of our broken health system.

My father is a very busy obstetrician and gynaecologist, he very seldom gets more than 4 hours of sleep during the week, but come the weekend he turns into arguably an even busier gardener. To get him out of his garden on the weekend, is harder than trying to clear out a busy casualty on month end – itʼs not going to happen. The only thing that will put an end to his saturday gardening is completion of the tasks he has set out for himself, neither darkness, hunger nor fatigue can stop him. That being said, once he eventually sits down – the sandman pays an unwelcome visit and getting him up again is another battle.

A few weekends ago, I came home for a visit. Not even a second after putting my bags down, I was thrust into the garden like the manual labourer my father envisions meto be. Sleeves rolled up, the smell of ‘special manureʼ became my adapted fragrance for the afternoon.

Have you ever seen those huge jojo water tanks? The ones typically seen on farms and rural areas but now also in urban areas because many areas in South Africa have water issues? The recycling system used at my family home makes use of rain and recycled water placed into these jojo tanks. When it comes to watering the garden my father has a system in place where he places watering cans under the openly flowing taps of the jojo tanks, one after the other as the tap continuously flows. My job is then to constantly deliver the full water cans to him wherever he may be in the garden so that he can water the plants. I need to simultaneously ensure that as I remove one watering can, that I place another can under the tap. Almost like a conveyor belt, the aim of what we are trying to do is to ‘efficiently’ get the plants watered, avoid wasting water but still ensure that the job gets done as quickly as possible. Under ideal conditions, as I come back from delivering the full cans of water from my father, I return with empty cans. The cans that I left under the taps should be nearing completion so that I can almost immediately switch those cans with the returning empty cans. Not to mention I also need to be moving at a pace fast enough so that I can take the full cans back to my father as he is about to finish using the cans that I have just delivered to him.

As you can imagine, we never get this process completely right. Inevitably, my father has to wait a few seconds for me to get to him; the watering cans under the taps almost always overflow and some water is always bound to fall out as I run back and forth down this conveyor belt. Alternatively, if I run the tap at a slower rate, the delay to my father is even longer and that can mean up to an extra  hour of gardening in the dark.

My father probably isn’t trying to turn watering his garden into an exact science, whereas on my annual solitary garden shift I can’t help but wonder why we cannot.

Should we try dialing the tap back a bit so that it runs only a fraction slower?

Should I run faster and spend more time in the gym so that I am able to flex my arms just enough so that water is not spilt as easily?

Should I encourage my father to invest in bigger watering cans so that more time is needed for them to get filled and to be poured out?

Should I get someone smart enough to draw up a mathematical model detailing the maximum distance I potentially need to cover to reach my father, using that information I can work out the velocity that the water from the tap should run at to fill the volume of a can that is roughly in between that of the smallest and largest watering cans?

These are all options to solving the problem that I have, but they do not completely solve the issue either. My father and I may need to spend more time waiting around (we already finish gardening at 6.30pm). I will most probably continue to spill lots of water, I don’t really have that much time to go to the gym more often, especially for this ‘very important’ cause. I will not be able to effectively carry much bigger watering cans (maybe I do need to go to the gym more often). Lastly, I certainly do not know how to draw up mathematical models, especially ones that work. I would need to outsource someone for that – for which I would not know where to look and would cost me money.

I know I have been rambling on for some time without actually mentioning how this all relates to public health or global surgery, but we are getting there. Thank you for being so patient.

If you take a look again at the problems and potential solutions I have pointed out, they tend to paint a familiar picture. Wastage of available resources, resource constraints, time inefficiencies and a ‘know-it-all’ coming out of nowhere claiming to have all the answers after spending 2 minutes in the situation. This is what our public health systems across the world face. So many problems with not enough solutions, so many problems without asking enough questions.

The most important thing I think that needs to be done whenever problems come up in our daily practice is for us to stop and take stock of what exactly is happening. If we continue as we currently are, we will never get anywhere. We first need to determine if there is actually a problem, if so we need to then quantify it. In this example I have given, I cannot come and start pointing out all the problems because I do not have enough context on the day to day ongoings of my father’s garden. He knows how much water his plants need, he knows that there is no one watering the garden during the week, he knows in which season he thinks it is best to put his manure. He is the only one that can actually say if there is a problem or not (he will probably not be too happy with me saying his garden is a public health crisis). I can only come and summize best on what I am seeing then and there at my visits that take place every 2 months at best, I cannot be the chief stakeholder over this when there is someone who oversees this ‘project’ everyday. These are important principles that we must realize when undertaking endeavours in public health and the rapidly growing field of global surgery. As much as you want to contribute, you need to ask those closest to the problem what they think is going on because you may end up realizing that actually the biggest problem is that, “you grew up in the city and the reason why the the gardening is taking so long is because you keep spilling the water and you keep asking to take a break every 5 minutes!” Besides, this water that is spilt along the way may not actually be that much to cause the city to go into a drought

Written by Dr Farai Chigumadzi