Improving the Paediatric services at Jaffna Teaching Hospital

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Improving the Paediatric services at Jaffna
Teaching Hospital

• Dr M G Sathiadas
• Consultant Paediatrician
• Teaching Hospital
• Jaffna

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Next 30 Minutes....

1. Situation in General
2. Impact on our Children
3. Paediatric services at Jaffna Teaching Hospital
   Past Current
4. Step Forward.....

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1. Situation in General
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Demography

• Population 21 million
• Under 5 mortality rate14 per 1000live births
• Neonatal mortality rate 21
• Maternal mortality rate 92 per 100,000 live birth

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Resettlement process going on at a slower pace
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Teaching Hospital Jaffna
Situation in General
Shifted twice to other areas during the conflict
time
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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
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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
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Paediatrics in general
Situation 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
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Situation in General
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2. Impact on our Children
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Disease spectrum
Impact on our Children
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Impact on our Children
Why this disease spectrum?

• Infectious diseases
• Poor living conditions
• Poor hygienic measures
• Lack of safe water
• Disposal of waste

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Impact on our Children

• Nutritional deficiency
• Poverty
• Lack of a secure job

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Impact on our Children
8year old boy from Wanni psychological trauma as
father is in Prison, mother unemployed, no house
to live in Jaffna

• 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

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Impact on our Children

• Child abuse Orphaned
• Single parent families

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3. Paediatric Services at Jaffna Teaching
Hospital Past Current
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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

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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

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Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of .
Paediatric services including the out patient
clinics
Neonatal services
Record Keeping
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Current SCBU
Survival Of The Fittest
Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of . Neonatal services

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
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Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of . Neonatal services

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Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of . Neonatal services

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Current SCBU
Unacceptable space
Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of . Neonatal services

• 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

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Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of . Neonatal services

Spacefar below international standard
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Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of . Neonatal services

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Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of . Neonatal services

No dedicated area for breast feeding
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Paediatric Services at Jaffna Teaching Hospital
Past Current
Current status of . Neonatal services

Lack of equipment
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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.

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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

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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

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Step Forward......
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Step Forward...
Urgent Next Steps-

1. Repair and construction of NICU

Required Next Steps-

• Electronic Record Keeping
• Separate Paediatric Hospital and
• Modernising the Paediatric Out Patient Clinic

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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

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Step Forward
Urgent Next Steps- Expansion of PBU

• For Expansion and Reconstruction-
• Land space already identified and allocated

Current PBU Allocated Land
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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.

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Stages of reconstruction
Step Forward

• Stage 1 building US70,000.00.00
• Stage 2 essential equipment US 70,000.00
• Stage 3 other equipment US 40,000.00
• (final stage)

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Cost of equipment needed urgently
Step Forward
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 US70,000.00
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Step Forward
Urgent Next Steps- Modernising the Paediatric
Out Patient Clinic

• Renovation - Partitioning, Floor tiling, Roof
  work, Painting Wiring and furnitureRs.
  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)

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Paediatric block
Step Forward

• Land available
• Cost Rs450million (US 4.5 million)

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Step Forward...... In a Nut Shell.
Modernising Paediatric OPD(Urgent Next Step) Expansion of PBU(Urgent Next Step) Electronic Record Keeping Paediatric Hospital
Renovation - 2.3 million (US 23,000) Equipment- 1.2 million(US 12,000) Building Reconstruction- 7 million(US 70,000)Equipment- 12 million(US 120,000) Available Funds(Lions Club)- 5 million(US 50,000) Automating Labs Automating Paediatric Unit and other identified Units. Well equipped state of the art Paediatric Hospital
Required Fund 3.5 million (US 35,000) 14 million(US 140,000) 2 million(US 20,000) 450 million(US 4.5 million)
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Sandford point

• English is an official language
• Politically stable and democratic
• The need is there for a secondary level care

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Thank You