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