All in all the doctors, nurses and minor staff together with the paramedical staff are doing a heroic dedicated service. They work almost 20 hours per day with the arrival of every new batch of patients which is once every 2 to 3 days! It is almost a miracle that the health of this staff has been able to withstand the trauma both physical and mental. The stories that the patients come out with are unbelievably tragic and will no doubt affect the health of the patients and staff treating them in the long term. They need to be protected.
The DMO of the Hospital Dr.Mahinda Uyangoda, is a remarkable person in whom one sees a combination of compassion, selfless service, good personal relationships with staff, forces and the public and a quick mind looking for solutions to complex problems. He was a very tired man when I met him having slept less than 4 hours the previous night. But he took time to go round the entire hospital and garment factory showing us the entire facility and explaining to us the problems and how he has overcome many of them.
He was ably supported by Dr.Muditha Amerasinghe MO, who too is doing a marvelous job working very hard to hold the facility together.
STAFF:
General Surgeon – adequate
Orthopaedic team of 1 SR, 3 nurses from Kandy and Karapitiya go in rotation. Need to encourage other Teaching Hospitals to send teams.
Junior doctors- At least another 10 Medical officers are urgently required.
Apart from persuading doctors to go there, there is in addition the problem of accommodation for all grades of staff sent to Padaviya. Doctors apparently demand single rooms with attached toilets. Currently rooms are shared. A solution to this problem is hard to find. There are no more suitable houses available for renting. The nearest town is Kebbetigollawa where suitable houses are not available. Mihintale appears to too far.
The only solutions appear to be:
- Rent houses in Mihintale and work out a scheme where doctors spend 3 days in Padaviya staying in “on call” rooms and getting one full day off.
- Rapid construction of prefabricated semi permanent quarters.
Nurses are also highly overworked. There are 15 permanent and 25 Pupil nurses from Ratnapura who were due to leave the next day. There is fear amongst the parents of nurses regarding security. A good public relations exercise is needed to allay their fears. Nurses live in overcrowded rooms. At least 30 more staff nurses are needed. A facility to house extra nurses too should be planned as for doctors.
Attendents/Labourers/orderlies (Minor staff) Casual labourers are forced to work under threat of dismissal. Hence their commitments are minimal. Persuade ICRC to hire labourers/volunteers as in Vavuniya
MAJOR ADMINISTRATIVE PROBLEMS
When patients are sent to TH Kandy especially with head injuries, the attendant and nurse accompanying the patients have to attend to the admission, accompany them tothe Ward, be present near the CT room, and get the report. If negative, the patients back are brought back to Padaviya i.e travel usually lasting a full day or more. The reasons for this during normal situations are understandable. A meeting with the Director and Consultants explaining the current situation of shortage of staff and the hours of work of the staff at Padaviya may be useful to get a temporary “amnesty” from their rigid rules. Traffic is not allowed on these roads after 6pm.
No accompanying persons are allowed to stay with the patient. If a child is injured and has 2 other young brother and sister, and father is dead the mother has to take the children along when the injured child is transferred e.g. to TH Kandy. If the policy of TH Kandy is not to allow “bystanders” a solution has to be worked again meeting the Director and Consultants to accommodate them temporarily.
EQUIPMENT & CONSUMABLES
- ICU needs at least 2 portable ventilators to transfer acutely ill patients safely.
- Wards need 4 to 5 Pulse oxymeters to monitor acutely ill patients not needing ICU care.
- 2 Defibrillators needed, one in OT and the other for Wards
- O.T needs the following
- Amputation Saw, Vascular clamps and Fogarty catheters, 6/0 and5/0 Proline sutures, External fixators
- Wards also need Nylon cord for Traction. 100 soft cervical collars, 200 bed head rests.
- 20 patient trolleys, 100 pillows with plastic washable covers
- Blood Bank needs a microscope
- Consultant Physician needs the following: 4 adult and 1 paediatric nebulizers
- Calcium resornium sachets for management of over 100 patients in chronic renal failure. Initially 1000 sachets.
- Azithromycin 250 mg tablets 200
- Tramadol tablets 50 mg 1000
- Antibiotics and analgesics are consumed rapidly since over 90% wounds are infected
- Consultant Ob/Gyn needs: Portable gynaecological Ultra sound scanner,
- Cartograph machine and Baby resuscitator/warmer
- Children’s Ward requirements: Children’s clothes, basic washable toys, educational material.
- Nebulizer
- X-Ray room is unprotected for radiation
General: Packets containing the following will help: Plastic Mug/cup, Plastic plate, soap, sarong/sari/children’s clothes, male/female. Numbers are difficult to predict. An INGO supplies such packets on arrival. There are over 200 patients in the Wards with another 300 to 400 accompanying persons/family/children in the Hospital. The abandoned garment factory has almost 150 patients and 279 accompanying persons looked after by 3 nurses.
REPORT OF IMPRESSIONS GATHERED DURING MINISTRY OF HEALTH SPONSORED VISIT TO DH PADIVIYA AND GH VAVUNIYA
BY PROFESSOR A.H. SHERIFFDEEN, ACCOMPANIED BY DR. JAYALAL
All in all the doctors, nurses and minor staff together with the paramedical staff are doing a heroic dedicated service. They work almost 20 hours per day with the arrival of every new batch of patients which is once every 2 to 3 days! It is almost a miracle that the health of this staff has been able to withstand the trauma both physical and mental. The stories that the patients come out with are unbelievably tragic and will no doubt affect the health of the patients and staff treating them in the long term. They need to be protected.
Doctors interviewed: Dr. Bhavani Pasupathiraja, Medical Superintendent who appears confident and in total control of the difficult situation and appeared to command the respect of all grades of staff; Dr.Purupananda, MO Anaesthesia who was familiar with almost every patient in the ICU and wards, working well above the call of duty; Dr. Akhilan Registrar, Surgery who was confident and looked capable.
Conclusions: Sending extra staff is a priority. Whilst the logistics of this are being worked out, it is important that at least the equipment and consumables requested are sent as soon as possible so that the doctors working under trying conditions are made aware that the Ministry is listening to them and trying to help.
STAFF
Surgeons with SHOs work round the clock dealing with emergencies and infected wounds, resulting from delayed access to treatment. The delay is caused by the difficulty faced by patient in getting to a medical facility from the site of injury. Infected compound fractures are the rule rather than the exception.Extra MOs for Wards urgently needed especially since WHO and Pradesha Sabha funded temporary Wards are coming up.
Anaesthetist SRs support the surgical team admirably. They could do with extra medical officers in OT and more in the Wards.
Permanent orthopaedic Surgeon urgently required. External fixators required for the compound fractures.
EQUIPMENT & CONSUMABLES
- OT: Sutures 3/0 and 5/ Proline needed. Also needed are bone wax, Gelfoam and artery forceps of all sizes. Elastoplast and Micropore plasters needed in OT and Wards.
- ICU: Requires a Paediatric ventilator and 2 Monitors. Total Parenteral Nutrition (TPN) solutions are not available.
- Extra supplies of inotropes: adrenaline,dopamine, dobutamine needed.
- 3 way urinary catheters required especially for patients with haematuria.
- Path Lab: no facilities for Histopathology and Microbiology. The latter is urgently needed in view of the large number of infected wounds.
- Consumables: consumption of antiobiotics and analgesics very high needing urgent replenishment of stocks.
- Cefuroxime (intravenous) is not available and urgently needed.
- Other frequently use antiobiotics are Co amoxyclav, Ciprofloxacin, Metronidazole, Cloxacillin and oral Norfloxacin
- Children’s Ward requirements: Children’s clothes, basic washable toys, educational material.
- Nebulizer
- Consultant Physician needs the following: 4 adult and 1 paediatric nebulizers
- Calcium resornium sachets for management of over 100 patients in chronic renal failure. Initially 1000 sachets.
- Azithromycin 250 mg tabletsx 200
- Tramadol tablets 50 mg x1000
- Antibiotics and analgesics are consumed rapidly since over 90% wounds are infected
General: Packets containing the following will help: Plastic Mug/cup, Plastic plate, soap, sarong/sari/children’s clothes, male/female. Numbers are difficult to predict. An INGO supplies such packets on arrival. There are over 2000 patients in the Wards with another 500 to 600 accompanying persons/family/children in the Hospital.
The next delivery is scheduled for early May and will cover Vavuniya and Padaviya Hospitals. A date will be fixed as soon as our imported items arrive.
Medical Imports
All credit to ACT Member Govinda Tidball whose close relationship with an international aid organisation has led to their anonymous donation (their 2nd to ACT) of over $60,000 in medical supplies.
Based on the shortfalls noticed and lists provided by doctors at the scene, ACT will raise the following aid:
Vavuniya & Padaviya Hospital Delivery List
For kids:
- Pedia Sure
- Nan 1 & 2/LACTOGEN
- Nutrigen
- Anchor 1+
- Nebulisers
- Pediatric Nebulising Masks
- Domperidome Syrup/Suppositories
- Volteron suppositories, for kids
- Blood Pressure Monitors, for kids
- Anti-biotics
- Painkillers
- Kids clothes
For Adults
- Roll up mattresses
- Bed pans
- Adult Diapers
- Macintoshes
- Sterilised Gauze/Dressings
- Housecoats/Sarongs
- Local Applications (Fucidin, Soframycin etc)
- Drugs (Anti-bios, Painkillers)
- Rehydration Salts (Jeevani)
- IV Stands
- High-energy Supplements
How To Help
We need to buy goods and put them on trucks up North. You can contribute either money or goods.
Donations
If you’re in Sri Lanka please contact Krishni at accounts@actlanka.org. Internationally please make a wire transfer to our NDB account, but do make a personal contact first.
Goods
You can drop-off goods at the location below. You can also contact Michelle (medicines@actlanka.org) or Tamara (supplies@actlanka.org) for wholesale purchasing and better pricing.
Collection Point (Mon-Fri, 9-5)
Radhika Philip/ACT
c/o Investor Access Asia
60, Fifth Lane
Colombo 3
Please contact Neesha (inventory@actlanka.org) prior to delivery.
Act representatives visited Vavuniya Hospital on 4th April 2009, accompanying the 1st donation of aid by our Trust. The hospital had a capacity to treat 300 patients, which it has currently expanded to 430 patients. However, warded patients are now at 1,200. In addition, there are accompanying family members plus those with minor/healing injuries, who are prohibited from leaving (and have nowhere to go). As such, the number of Survivors presently residing in Vavuniya Hospital, are approximately 3000 in number.
It is a well run hospital, under the care of Dr. Bavani Pasupathyrajah (Medical Director, Vavuniya Hospital). The sheer number of patients is the major problem they are facing. Of these, a very large number were children under the age of 5. There were a lot of babies and breast feeding mothers, newborns and toddlers with injuries.
Based on the data collected and upon request from the doctors in Vavuniya, Phase 1 Part 2 will include another delivery of relief items to Vavuniya.
Padaviya Hospital
Emergency treatment is provided as civilians come off the boats in Pulmodai. Patients with a good chance of survival are dispatched to Padaviya Hospital.
Our Trust Chairman Professor A.H Sheriffdeen travelled to Padaviya Hospital on 19th April 2009, to assess the medical situation. He confirms that treatment facilities are overcrowded and Padaviya Hospital is over capacity (despite an expansion into a donated garment factory). Human resources are limited (doctors, junior doctors, nurses, orderlies) and as such, need to be expanded.
As expected, there were a large numbers of babies and children under 5. Total number of patients is around 1,500.
Pulmodai Field Hospital
Very little data is presently available to ACT. Reports range from the existence of a fully equipped hospital, to quick “on-the spot” emergency treatment facilities after which, patients are transferred to Vavuniya or Padaviya. We will be researching how to help Pulmodai Field Hospital shortly.
This post has been updated
Action & Care Trust is ready to make its second delivery. This time, we will be delivering supplies to both Vavuniya and Padaviya Hospitals.
The ACT Trustees have decided that we remain in Phase 1, which will be an on-going commitment of emergency relief support to the hospitals that are receiving the injured. Therefore, the second delivery will be considered Phase 1: Part 2.
We have plans for Phase 2 (Rehabilitation) and Phase 3 (Sustainability). However, we expect to remain in Phase 1 until we are no longer needed.
We have a large consignment of medicine coming in (thanks once again to ACT Member Govinda Tidball). Therefore we will not be concentrating as heavily on purchasing anti-biotics and painkillers. We have decided instead, based on the high number of infants and children under 5, that our focus this time will be PEDIATRICS and associated supplies. We have learned (and seen) that malnutrition and respiratory infections are the primary concern in the pediatric wards. Therefore milk and high energy supplements is a priority. We will also purchase nebulisers for children.
The other patients also need our care. Our Chairman Professor Sheriffdeen travelled to Vavuniya and Padaviya on Saturday, at the request of the Ministry of Health. He confirms our own sentiments, that over-crowding is a major problem. Vavuniya Hospital (as of today) has capacity for 430, but has 1,200 warded patients and including families, over 3000 people reside at the Hospital. Padaviya Hospital currently has 1,500 patients, once again with a high number of babies.
A complete list of Items to be purchased is attached. A detailed proposal on Phase 1: Part 2 is also available on request. We have wholesale pricing on all goods so please contact us if purchasing directly, we will give you our pricing.
We hope to make the next delivery within 2 weeks, pending the arrival of our imported medicine.
We, the Trustees of ACT, would like to thank all of you who worked to make our first delivery possible. The same Teams will now manage the second delivery. We hope we can count on your continued support. Please contact us asap if you have any queries.
Hiranjan, Krishni & Radhika
Please read the updated post for a full supplies list and contacts
Just returned from delivering relief to Vavuniya Hospital. A great thanks to the kind donors as well as the Ministry and military officials and staff who made this possible. A special thanks to our military escorts for this and their continued service to Sri Lanka and all Sri Lankans.
The Action and Trust team is clean, fed and safe with their families, which many people we’ve met will not be, for years. The government staff and volunteers are doing a remarkable job of running the Vavuniya Hospital under immense presssure. They and many other hospitals can use continued support.
Will write a fuller report after some rest. It is something, even when it feels like not nearly enough. Thank you for your support and please extend your thoughts, metta and prayers to those that continue to suffer tonight.
[youtube=http://www.youtube.com/watch?v=QoVvKmmqXbk]
We are now en route to Vavuniya to deliver the medical items we’ve collected. This is a video of some volunteers loading medical supplies onto one of the two lorries heading up. The lorries contain medicine, crutches, mattresses and some basics like milk powder. Now passing Kurunegala. Will try to update from Anuradhapura then Vavuniya
Please note that ACT Lanka is in no way shape or form associated with ACT-NOW in UK. This is a purely Sri Lankan citizens based initiative working directly with the government and Army.
[youtube=http://www.youtube.com/watch?v=AaP9eNEGgHU]
