Improving the Paediatric services at Jaffna Teaching Hospital
Dr M G Sathiadas Consultant Paediatrician Teaching Hospital Jaffna
Next 30 Minutes.... 1. Situation in General 2. Impact on our Children 3. Paediatric services at Jaffna Teaching Hospital – Past & Current 4. Step Forward.....
1. Situation in General
Demography • Population 21 million • Under 5 mortality rate:14 per 1000live births • Neonatal mortality rate 21 • Maternal mortality rate 92 per 100,000 live birth
Resettlement process going on at a slower pace
Situation in General
Teaching Hospital Jaffna
Shifted twice to other areas during the conflict time
Situation in General
Teaching Hospital Jaffna
Rebuilding efforts and reconstruction work at a slow rate - Teaching Hospital – JAICA project - No provision to improve paediatric services
Situation in General
Teaching Hospital Jaffna • Only tertiary centre for entire northern region - OPD patients 880-1000/d - Admissions 400-450/d - Children 80-100/day - Admissions 35-40/day - August 2011 22,436 patients seen
Situation in General
Paediatrics in general • Population covered: 1 million and 40% of them are children • Districts: Jaffna, Kilinochchi, Mullaitivu, Mannar and outskirts of Vavuniya • Paediatric medical wards 3 with paediatricians • Each ward 40 beds • Very sick from the region are transferred– Nearly 15% of admissions from the region
• No HDU/PICU/NICU • No rehabilitation unit • No separate surgical wards
6 year old girl was transferred from a peripheral unit in dengue shock syndrome, died after 12 hours in the adult ICU
Situation in General
• Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level
2. Impact on our Children
Impact on our Children
Disease spectrum 1% 10%
10%
2%
6%
Infection Nutrition Renal Snakebite Colombo Tx others 70%
Impact on our Children
Why this disease spectrum? • Infectious diseases – Poor living conditions – Poor hygienic measures – Lack of safe water – Disposal of waste
Impact on our Children
• Nutritional deficiency – Poverty – Lack of a secure job
Impact on our Children
• War victims – Single parent family – No Parents – Psychological trauma – Disabling war injuries • Societal problems affecting children – Lack of job – child labour – Drug trafficking – Alcohol abuse – domestic violence – Increased incidence of child abuse
8year old boy from Wanni psychological trauma as father is in Prison, mother unemployed, no house to live in Jaffna
Impact on our Children
• Child abuse Orphaned
• Single parent families
3. Paediatric Services at Jaffna Teaching Hospital – Past & Current
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Past…. • Well
established Paediatric unit in the country during 1980 to 1987. • Most of the speciality services were available. • Two paediatric units with a diarrhoeal unit • Community clinics • Research activity
Paediatric Services at Jaffna Teaching Hospital – Past & Current
1987 Hospital Massacre…. • The Indian Peace Keeping For shot and killed our Consultant Paediatrician Dr. Sivapathasundaram and 22 other medical staff within the hospital premises.
This well known Hospital Massacre crippled the Paediatric services at Teaching Hospital Jaffna.
*** Brain drain ***
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of ‌. Paediatric services including the out patient clinics
Neonatal services
Record Keeping
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of …. Neonatal services Current “SCBU” ‘Survival Of The Fittest’
2010 - Deliveries – 6972 - SCBU admissions – 1309 - At risk babies who need specialised care - 623 babies were preterm - Deaths 130 nearly 10% - 5% of these babies were admitted to adult ICU for ventilation and half of them died - Death was mainly prematurity, surfactant deficiency and sepsis
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of ‌. Neonatal services
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of ‌. Neonatal services
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of …. Neonatal services Current “SCBU” ‘Unacceptable space’
• Lack of space: - Current space makeshift room - 105m² - can accommodate 10-12 - We accommodate 20-25 babies - Cross infection is a risk factor - No area for septic babies • Babies transferred from other units - No separate area to isolate these babies
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of …. Neonatal services Space…far below international standard
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of ‌. Neonatal services
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of ‌. Neonatal services No dedicated area for breast feeding
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of …. Neonatal services Lack of equipment
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of …. Record Keeping
• Maintained 100 % manually • Manual filing record books occupy a 20’ x 20’ room • Depending on few experienced staff. • Unwanted delays due to manual lab operation • Lack of properly defined strategy to integrate a single system • All departments are very keen on single electronic record keeping system.
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of …. Paediatric Services
• Affected from 1987 onwards • Wards are situated in an abandoned building • Recent increase in number of wards • No area for rehabilitation - No proper services of OT/PT/SLT • No surgical ward - Accommodated in adult surgical wards • ICU care- 6 bedded adult ICU with JAICA 10 bedded but no specialised PICU - In 2010 – 95/495 almost 20%
Paediatric Services at Jaffna Teaching Hospital – Past & Current
Current status of …. Paediatric Clinics
• Paediatric clinics - Registered patients 12999/8833 2010 - New patients 1774/1226 July 2011 • Monday to Saturday • Accommodates 80-100 per day but seating arrangement not enough • Lack of facilities- Record room, breast feeding area, blood letting and injection • No sub speciality clinics
Step Forward......
Step Forward... Urgent Next Steps:1. Repair and construction of NICU
Required Next Steps:-
1. Electronic Record Keeping 2. Separate Paediatric Hospital and Modernising the Paediatric Out Patient Clinic
Step Forward
Urgent Next Steps:-
Expansion of PBU
Outcome would be:- Doubles the current Space so avoids cross infection - Dedicated space for breast feeding/rooming in - Separate area for septic babies
Step Forward
Urgent Next Steps:-
Expansion of PBU
For Expansion and Reconstruction:-
Land space already identified and allocated
Current PBU
Allocated Land
Step Forward
Urgent Next Steps:-
Expansion of PBU
For Expansion and Reconstruction:-
But NONE of the authorities and local NGOs are willing or keen on improving this.
Step Forward
Stages of reconstruction • Stage 1 building US$70,000.00.00 • Stage 2 essential equipment US$ 70,000.00 • Stage 3 other equipment (final stage)
US$ 40,000.00
Step Forward
Cost of equipment needed urgently Equipment
Unit price
Number
Total
Incubator
1,270,000.00
5
6,350,000.00
Neonatal cots
18,400.00
10
184,000.00
CPAP
500,000.00
2
1,000,000.00
Ventilator
1,872,902.00
2
3,743,804.00
Pulse oximeter
130,000.00
5
650,000.00
Phototherapy unit
175,000.00
3
525,000.00
Total
12,498,603.00
Lions club
5,000,000.00
Needed fund
Rs7,000,000.00 US$70,000.00
Step Forward
Urgent Next Steps:-
Modernising the Paediatric Out Patient Clinic
• Renovation - Partitioning, Floor tiling, Roof work, Painting & Wiring and furniture Rs. 2.3million (US$ 23,000) • Equipments: - Clinic (available) - Computers and Peripheries - Networking Rs. 1.2 Million (US$ 12,000) Total cost to improve the clinic:- Rs. 3.5 Million (US$ 35,000)
Step Forward
Paediatric block • Land available • Cost Rs450million (US$ 4.5 million)
Step Forward...... In a Nut Shell. Modernising Paediatric OPD
Expansion of PBU
(Urgent Next Step)
(Urgent Next Step)
Renovation - 2.3 million (US$ 23,000)
Building & Reconstruction - 7 million (US$ 70,000)
Equipment - 1.2 million (US$ 12,000)
Equipment - 12 million (US$ 120,000)
Electronic Record Keeping
Paediatric Hospital
Automating Labs
Well equipped state of the art Paediatric Hospital
Automating Paediatric Unit and other identified Units.
Available Funds (Lions Club) - 5 million (US$ 50,000) Required Fund
3.5 million (US$ 35,000)
14 million (US$ 140,000)
2 million (US$ 20,000)
450 million (US$ 4.5 million)
Sandford point • English is an official language • Politically stable and democratic • The need is there for a secondary level care
Thank You