Arulnithy Presentation IMHO 2011

Dr K Arulnithy Teaching Hospital, Batticaloa.

Health care needs across Eastern Sri Lanka

Districts of the Eastern province

Trincomalee

Batticaloa

Ampara

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Current Status of Eastern province

• Includes Batticaloa, Trincomalee and Ampara districts.

• Geographically low flat land.(1.5m above sea level) • All districts share common health care issues.

• Quite far from capital Colombo( Eg. Batticaloa --340km) • Mostly farmers and fishermen.

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Common Issues in the Eastern Province • People of this region have evidenced many disasters and destruction silently over decades. • There are significant disparity between societies, due to internal displacement or relocation over last few decades. • People at villages are in very low socio, economic and educational standards due to lack of guidance and long term isolation (Majority).

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Recent Floods

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Life in village‌

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Life in village‌

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Issues Related to Health Care

• Higher rates of malnourished children.

• Low level of health care awareness and health education.

• Very limited health facilities at rural hospitals.

• Major hospitals are not in optimal standards.

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Teaching Hospital Batticaloa

• • • • • •

Major hospital of Eastern province Bed strength is 800 No of Consultants 20 In door admission 67,982 on 2009 OPD patients 155,515 on 2009 Clinic attendants 186,397 on 2009

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Teaching Hospital Batticaloa

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Special units with consultants • • • • • • • • • • •

Medical units Surgical units Paediatric units Gyn and Obs units Eye and ENT units Haematology and Pathology units Cardiology unit Oncology and Oncosurgical units Psychiatry unit Radiology unit Forensic unit (JMO) 11

Identified draw backs

• No specialized Neurology or Neurosugical care available in Eastern province.

• No cardiothoracic care available in eastern province.

• No specialized Nephrology or Urology care available.

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Cardiology Unit

• • • • •

Started only in 2008 Sharing with OPD unit, no separate building.

Seven medical officers including CCU. Five ECG technicians and 2 minor staff.

No separate clinic rooms or sharing paediatric clinic rooms.

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Issues related to Cardiology care • • • •

Different among population groups.

Some problems have roots at the social level.

IHD – The most common Common Risk factors Diabetes, Hypertension, Smoking, lifestyle • Congenital Heart disease • Valvular – Rheumatic • Heart blocks and other arrhythmias 14

Cardiology Unit at present.

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What we have and What we do

• Coronary Care Unit – Bed strength is five – Basic cardiac monitors with no central monitoring system.

– Admission per month 35 to 40, – Most of them acute MI, – NSTEMI and unstable angina patients are treated at wards.

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Our Coronary Care Unit

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Services available at present cont….

• 2 D echocardiography – We have a basic echocardiographic machine.

– We do get patients from whole eastern province.

– 700 per month average and considerable amount of paediatric patients.

– 2D echo for critical patients in CCU and PBU using portable machine provided by IMHO.

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Services available at present cont….

• Treadmill Exercise Test – Only form of stress test we have.

– Ten years old and inspite of frequent breakdowns, still in running condition.

– Around 100 patients per month with 2month waiting list.

• Holter monitoring and Ambulatory BP monitoring.

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Our ETT and 2D echocardiographic machines

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Immediate needs

• As we are providing only diagnostic service we need a dedicated Echocardiographic machine.

• C arm fluoroscopy is essential for TPM insertion.

• Central monitoring system for our CCU. 21

Cardiology Ward

• • • • •

Beds and mattresses Cardiac monitors Defibrillators ECG recorders Staff

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Our future plan and requirements • Cardiology Unit building – As our current unit space is grossly inadequate we are planning to build a new cardiology unit.

• Echocardiographic Lab – Need to establish diagnostic 2D echocardiographic lab with adult, paediatric, transoesophageal and stress echo facilities.

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Future Plan cont…

• Minimizing the muscle loss in patients with MI. – We successfully initiated two peripheral thrombolytic centers at Valaichenai (Batticaloa North) and in Kaluwanchikudy (Batticaloa south).

– Cardiac monitors and ECG machines are provided

by IMHO and SLHA – North America.

– Ideally we need to switch to better thrombolytics from streptokinase as we do not have primary PCI facility within 300 km. But it is very costly.

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Valaichenai Base Hospital

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Future plan cont…

• Safe transport (Cardiac ambulance with proper equipments) – We are transferring lot of critical patients to Colombo for further management including urgent intervention – For Retrieval from peripheral thrombolytic centers.

• Improving CCU standard – Central monitoring system – Need extension – Better equipments to manage critical patients.

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Future plan cont…

• Cardiac rehabilitation clinic – Running with very minimum facilities – Needs instruments and space

• Chest pain clinic – Plan to start a chest pain clinic – To quick sort out patients coming with chest pain.

– Need treadmill exercise ECG machine and ECG machine.

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Future plan cont…

• Data collection and primary prevention – To track patients who lost from follow up.

– Limitations are staff and computer.

• Cardiac cath lab and cardiothoracic facility – Definite and important need for the people of eastern province – Our patients for valvular plasty, coronary angiogram, intervention for congenital heart disease and for CABG are in very long waiting list at Colombo or at Kandy.

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Final note

• We are doing our maximum to provide better care for our patients, paying attention to their family and social background, through formal and informal channels. • But we know that we are not providing an optimal care. We are hoping to achieve at least in the future. • It is very much possible with the moral and material support of IMHO and other charitable organization.

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We may travel to the edge of universe, but the travel has no meaning if we don’t share that at home.

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