Situation Report 18th March 2010
Kilinochchi & Palai Hospital

ACT Team
Radhika Philip, Michele Mirchandani, Suresh Dominic

MOH Team Kilinochchi
RDHS Kilinochchi, GH Kilinochchi Dr. Sivananthan, Acting VOG Kilinochchi Dr.Saravanabhanu

Introduction

The Government of Sri Lanka announced free movement out of the IDP on the 1st of December 2009.Migration numbers increased prior to the General Elections on the 19th of January 2010. 2010 has seen the return of residents to their homes in the former war zones Kilinochchi & Mulativu.

Action & Care Trust have identified these areas to help assess and determine the emergancy medical relief needs. ACT is currently working directly with the MOH Disaster Management Unit and the Regional MOH Teams on improvement of medical services to the Kilinochchi area.

ACT visited Kilinochchi on 18th of March – please find below details from this visit.
Palai Divisional Hospital

Observations

There is no power supply to this hospital. The hospital comprises of a few rooms of a house, windows that have been blocked out with sheeting, which let in little ventilation and no light. Windows have been damaged and replaced by wooden boards, rather than glass and curtaining. This hospital cannot stock any refrigerated IV drugs, suppositories, and refrigerated medications. This poses a major concern with the high number of snakebite victims in the areas who then need to be transported by ambulance to either Kilinochchi or Jaffna. Any kind of medical investigations have to be referred to Jaffna as Kilinochchi Hospital too has limited or no laboratory facilities. Dengue is another deadly disease in the area, as blood counts cannot be monitored regularly. Torch-lights are used after dark and admissions are referred to either Jaffna or Kilinochchi.

ACT Recommendations:
• Supply electricity or a small generator or inverter urgent.
• Replace windows, allowing light and ventilation into the Clinic.
• Check emergency telephone connections to get message to Killinochchi or Jaffna in the case of emergency patients, establish quick-response protocol.
• Supply beds and sheeting.
• Repair damage to building.

Kilinochchi Base Hospital

Medical stores & main building Damaged water supply & lab facility
Observations

The Kilinochchi Base Hospital has been damaged due to the war. Upgrade of health services by Ministry of Health continues, however there appears to be no initiative to deal with infrastructural and administrative matters that delay medical care and productivity. These problems include:
• The main water supply to the hospital has been damaged, as has the shell of the building.
• There is no power supply to this hospital. One generator supplies sections of the hospital..
• The hospital stores need a shelving system to make storage, inventory and stocks easier to maintain. This hospital has refrigeration and stocks refrigerated IV drugs, suppositories, and medicines in addition to a basic pharmacy of drugs
• The Laboratory and theater facilities are not operational.
• The centrifuge in the Lab is not compatible with the test tubes supplied to local hospitals.
• The donated gluco-meter is not compatible with the standard strips available in the market.
• Any kind of medical investigations have to be referred to Jaffna.
• Dengue is a potentially fatal disease here, as blood counts cannot be monitored regularly.
• All theater procedures are referred 2.5hrs by road to The Jaffna Hospital.
• One ward has been created to treat maternity, pediatric and females admitted. This ward has no fans; limited beds are given to patients having drips or children. If beds are full remaining patients sleep on the floor with out pillows or sheets. (Only 8 beds for women and children’s wards in total)
• The Kilinochchi Hospital is amidst construction and repair with no completion date given.

Recommendations:
ACT seeks to assist in the improvement and upgrade of medical facilities to better provide on-site treatments with fewer patient transfers to Jaffna Hospital.

Assessment of needs in priority:

1. Supply of power to the area hospitals
2. Lab equipment and facility for standard blood, hb, urine testing
3. Additional nursing staff required
4. Operating theater functions – currently 30 expectant mothers all in 3rd trimester

Assessment of equipment needs:

1. 10nos Cardiac beds
2. 10nos Multipara monitors
3. 10nos Pulse oxymeter
4. 06nos Oxygen Concentrator
5. 02nos Autoclave large & mini
6. 05nos Sucker
7. 05nos Microscopes (binocular)
8. 04nos Phototherapy unit
9. 05nos Ambu bag set – adult/ pediatric / infant
10. 01no Cardiac defibrillator
11. 15nos Glucometer
12. 20nos Wheels chairs
13. 30nos IV infusion stands
14. 02nos Theater tables
15. 03nos Theater lamps
16. 10nos Oxygen regulators, keys, stand
17. 10nos Oxygen cylinder
18. 01no X ray machine (Kilinochchi has a trained Radiologist on site)
19. 10nos ESR tube
20. 10nos Sterilizers
21. 01no Centrifuge machine
22. 01no Hemo Cue meter LOT 9042472
23. 10nos Digital thermometer
24. 10nos Weighing scales
25. 05nos Injection trolley
26. 05nos Medicine trolley
27. 05nos Dressing trolley
28. 15nos Sphygmomanometer
29. 15nos Stethoscope
30. 25nos Glass cabinet for medicines
31. 10nos Knee hammer
32. 10nos Nebulizer
33. Theater instruments
34. 20nos Folding screen
35. 25nos Oxygen masks – adults, pediatric
36. 1000nos Face masks & caps disposable
37. 1000nos Surgical gloves disposable
38. 20nos Colostomy bags
39. 20nos Volumatic spacer unit

Maternity needs:

Kilinochchi currently has 40 expectant mothers with 30 in the 3rd trimester. Kilinochchi hospital is currently unable to intervene with C-section during delivery and any complications have to be transported 3hours by road (road in bad condition) to Jaffna. This is not practical in the case of a delivery. The chances of these pregnancies needing assistance during delivery is high due to the fact that all 40 of the expectant mothers are being treated for severe anemia during pregnancy. This urgent situation needs to be addressed early.

1. 10nos Labor beds
2. 05nos Gynecological examination beds
3. 04nos Infusion pumps
4. 05nos CTG machines
5. 03nos Vacuum extractors
6. 04nos Obstetric forceps sets
7. 02nos Ultrasound scanner
8. 05nos Doppler Feto Heart Meters
9. Delivery theater
10. Misoprostol tablets – currently not available with Osu Sala.
11. 01nos Infant warmer
12. 25nos Baby cots
13. 05nos Episiotomy set

Drugs in short supply or high demand:

1. Tablet Mefanamic acid 500mg
2. Tablet BCo
3. Tablet Prednisolone 5mg
4. Tablet Augmentin 375mg
5. Tablet Ciprofloxacin 250mg
6. Syrup Piriton
7. Syrup Paracetamol
8. Inj Phenytoin
9. In Calcium gluconate
10. Tablet Buscopan
11. Capsule Omeprazole
12. Eye drops Ciprofloxacin
13. Eye drops Hydrocortisone
14. 5% Permite cream
15. Rectal diazepam solution
16. Tablet Atorvastatin 10mg
17. Northistrerone 5mg
18. Tamoxifen 10mg
19. Fludrocortisone 0.1mg
20. Tablet Thyroxin 50mcg
21. Tablet Misoprostol
22. Inj Heparin
23. Inj Magnisium Sulphate
24. Inj Anti Rabies serum (1000iu)
25. Inj Tetanus toxide