NICU Proposal Jaffna Teaching Hospital

Improving the Paediatric services at Jaffna Teaching Hospital

Dr M G SathiadasConsultant Paediatrician

Teaching Hospital Jaffna

1.Situation in General

2. Impact on our Children

3.Paediatric services at Jaffna Teaching Hospital – Past & Current

4.Step Forward.....

Next 30 Minutes....

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

Teaching Hospital Jaffna

Shifted twice to other areas during the conflict time

Situation in General

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

Situation in General

Teaching Hospital Jaffna

- OPD patients 880-1000/d- Admissions 400-450/d- Children 80-100/day- Admissions 35-40/day- August 2011 22,436 patients seen

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

Situation in General

2. Impact on our Children

Disease spectrum

70%

6%

10%2%

1%10%

InfectionNutritionRenal SnakebiteColombo Txothers

Impact on our Children

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

Why this disease spectrum?

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

Impact on our Children

3. 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 at Jaffna Teaching Hospital – Past & Current

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......

Urgent Next Steps:-

1. Repair and construction of NICU

Required Next Steps:-

1. Electronic Record Keeping2. Separate Paediatric Hospital and

Modernising the Paediatric Out Patient Clinic

Step Forward...

Urgent Next Steps:- Expansion of PBU

Step Forward

Outcome would be:-

- Doubles the current Space so avoids cross infection

- Dedicated space for breast feeding/rooming in- Separate area for septic babies

Urgent Next Steps:- Expansion of PBU

Step Forward

For Expansion and Reconstruction:-

- Land space already identified and allocated

Current PBU Allocated Land

Urgent Next Steps:- Expansion of PBU

Step Forward

For Expansion and Reconstruction:-

- But NONE of the authorities and local NGOs are willing or keen on improving this.

Stages of reconstruction

• Stage 1 building US$70,000.00.00

• Stage 2 essential equipment US$ 70,000.00

• Stage 3 other equipment US$ 40,000.00

(final stage)

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 Rs7,000,000.00US$70,000.00

Step Forward

Urgent Next Steps:- Modernising the Paediatric Out Patient Clinic

Step Forward

• Renovation - Partitioning, Floor tiling, Roof work, Painting & Wiring and furnitureRs. 2.3million (US$ 23,000)

• Equipments:- Clinic (available)- Computers and Peripheries- NetworkingRs. 1.2 Million (US$ 12,000)

Total cost to improve the clinic:- Rs. 3.5 Million (US$ 35,000)

Paediatric block

• Land available• Cost Rs450million (US$ 4.5 million)

Step Forward

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)

Step Forward...... In a Nut Shell.

Sandford point

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

Thank You