The conditions at the above hospital seemed to have improved when visited on, 18th June. The number of patients had reduced to 1000. The number of patients keep fluctuating, as a result of patients needing isolation; being brought in from the IDP Camps, on a regular basis. Similarly they are discharged once the disease has run its course. The hospital seemed more organised due to the number of patients being almost halved, at the time. Our delivery of medicine was much appreciated. Act could help by replenishing medicines on request by the Doctor in charge.
Dr. Vijayakumar, who was handling all these patients single-handedly, has been having a visiting doctor from Vavuniya, to help him, Still the numbers are too high for two doctors to manage. Getting more relief doctors would be a great help!
There were only two nurses at the time, but they seemed to be managing with some help from Sri Lankan red cross workers. The improvement of the bathing facilities and the building of more toilets, have been undertaken by a citizens group who are presently supplying the hospital with the necessary nutritional foods. They are also in the process of getting the drinking water tested in the hope of getting it purified. For the moment, they have supplied the hospital with large boilers to manage the drinking water.
Next visit is planned for the 6th of July. Dr. Vijayakumar, will forward ACT a list of required medicines closer to the date.
Fifty sets of External Fixators were delivered to the above hospital. These are used on amputees so they can accept artificial limbs at a later date.
At the time of delivery we met up with Dr. Bhavani Pasupothyrajah to get an update on the present situation.
The number of patients were down to a 1000 on that day. However she mentioned that the disease pattern had changed completely. She reported types of encephalitis, respiratory infections and a few cases of meningitis. This calls for different types of medicines and she has supplied ACT with a new list of required medicines. We at ACT, are currently purchasing these medicines under advisement of Professor Sheriffdeen. Some should be delivered this Sunday.
On arrival at Vavuniya Hospital, it was found that there were 2000 patients. According to the doctor they are equipped to handle 400 patients. The number of doctors has increased to eighty at present. The hospital was expecting 1000 additional patients the same night. To create space for the new arrivals, they needed to discharge around 850 patients. When patients are discharged, they are reluctant to leave the hospital premises. In this confusion the doctors are not sure who the discharged patients are.
The hospital is so overcrowded, that wherever possible; the wards are being expanded. There is a new section that is being built at present but will take some time to complete. There are people in every bit of space they can find along the sides of the corridors leading to the wards, even on the retention walls of the drains.
The wards that were visited seemed orderly despite the mayhem. An additional pediatric ward has been created, for malnourished kids. Malnourishment is rife amongst adults and children alike. Most of the patients are suffering from pneumonia according to the doctor.
The two contagious diseases that are being dealt with are Chickenpox and Hepatitis A. These patients are together in a separate section due to lack of space. The patients with Chickenpox are contracting Hepatitis A, and vice-versa.
Their stores seemed to have only about, quarter of the space occupied by medicines on arrival. However, after the ACT delivery the rest of the space was utilised. This included the mattresses, linen, pillows, milk food, cereals etc.
The doctor was very happy with the ‘ACT members’, personal contribution of chocolates and coffee, to be shared by all the doctors. Unfortunately they don’t seem to have a common room at their disposal, for their breaks (if they do have time for it!). The present ‘common room’, seems to be a demarcated lobby area, where there is a couch for them to get some rest! Therefore, it was a great ‘thank you’, for the remarkable job being done, under stressful conditions.
Above is the video documentation of the trip and below is a photo gallery. This is of Padaviya, Vavuniya documentation will be added shortly.
ACT members present
Govindha Tidball
Indi Samarajiva
Simon Wijegooneratne
Thamara Spitzner
Accompanied by 2 lorry loads, 2 drivers including 1 Supervisor provided by the Medical Supplies Division, Ministry of Health, Sri Lanka.
Contact person Padaviya District Hospital
Dr. Mahinda Uyangoda
District Medical Officer
General
The two ACT teams traveling to Vavuniya and Padaviya Hospitals separated at Medawachchiya check point. The lorries were thoroughly checked for approximately two and a half hours following which the teams went their separate ways.
Upon arrival the general atmosphere of the hospital was very quite; there were no persons/families settled outside nor were there any new patients being brought in. Very evident was the large stock of government provided medicine boxes piled up in the corridors as well as ongoing construction work at the site.
Dr. Uyangoda was available in his office and immediately requested staff to ready the wards and army personnel to grant us permission to visit the factory where patients with minor injuries and their families had been settled. District Hospital staffs were requested to ready themselves to assist us with unloading the lorries.
Dr. Uyangoda welcomed us in to his office and gave us a general overview of the current situation at the hospital. He stated that things had drastically changed within the last two days; the government had provided large quantities of very basic medicines required and was upgrading the hospital through major renovations.
At present the hospital had 300 patients with the capacity to host another 100. In total 3 surgeons, 15 doctors, 60 nurses and 70 minor staff were based at the location.
Dr. Uyangoda was very pleased with the donation of medicines provided by Heart to Heart. He stated that Padaviya Hospital was currently overstocked with basic medicines in order to manage well but did not have anything extra to treat for example fungal skin conditions, the latest outbreak very apparent in children being Scabies.
Examining the inventories Dr. Uyangoda decided on sending excess toys and clothes to the factory where the need was more apparent. He was very particular about ensuring that each item inventoried was delivered especially with regard to expensive medical equipment. He was overjoyed to receive the ultrasound scanner (which they did not have), foldable as well as water mattresses which he said would be extremely useful for his patients. Concerning the large stock of milk he said there is a huge need for high energy food and drink at the factory where he would advise army personnel to distribute according to how they normally do.
2 lorry loads
The MOH drivers, Padaviya hospital nurses and ACT members unloaded the lorry. Dr. Uyangoda requested that the person in charge of medicines and inventories assists us. As a time consuming matter he suggested that the Heart to Heart medicines are checked at a later stage, he promised to sign and seal the list and fax ACT as well as MOH a copy of it. The majority of toys, all foldable mattresses and most of the milk powder were separated for the factory by which time permission was granted for us to visit.
Dr. Uyangoda suggested that we move on to visiting the wards while distributing toys.
Wards
Everything was in order and several beds had been made vacant at the time of visit as Padaviya hospital serves as a transfer hospital, once patients stabilize they are bussed out to make room for the next ones coming in. Roughly 20% of the patients that come in are in critical condition, the rest have minor wounds. At any given time Padaviya hosts 200 patients in addition another 100 local patients were on site. When IDP buses come in the total number will swell to around 500 patients. As soon as the patients stabilize they are sent across to one of five hospitals depending on the availability of space (GH Polonnaruwa, Dambulla Base Hospital, Kurunegala Teaching Hospital, Vavuniya Hospital or Mannar).
The toys were a huge hit with the children, the number one request among the toys that we had were for cars, even among the girls (many wanted to exchange an initial toy for a car if at all possible). In discussion with the ACT team it was recommended to send in toys again. The people really lit up when the box was opened. More importantly next time if possible toys that spark more social involvement and interaction among the children should be included i.e. cricket bats, soccer balls etc. space in the factory field for this type of activity was available and ongoing.
Factory
The factory though not so well maintained as the hospital had an almost full ward of females including a few new born babies. The general impression is that the level of hygiene is poor due to so many flies on the infants and very dirty toilets. Scabies was very apparent in many, Dr. Uyangoda pointed out many children with this skin condition. The men’s ward was rather empty upon our arrival they were all smiles. It was nice to see two of them enjoying a nice game of chess. Our visit at the factory was short as we had to get to Medawachchiya before 6.00p.m in time for road closure. We observed if could be said a lot of happiness amongst the children in the factory field engaged in a serious game of cricket. Therefore it is suggested that equipment for group activity is sent in the next delivery.
Dr. Uyangoda stated that he would be in touch with us about specific medicines, equipment and any other items required by the hospital. He sincerely together with the nurses thanked us for the gift items and our visit.
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
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
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.
ACT under the scope of rehabilitation will support the efforts in the North and East to set up psychosocial centers for the well being of children. ...
ACT worked closely with the Disaster Management Unit to assess the needs and supply urgent and essential medical supplies to the Kilinochchi & Pullmodia area hospitals. ...
http://www.heartsforharmony.ca/
Visit this site for details of the fundraiser organised by Hearts For Harmony of Canada for medical relief items for the Internally Displaced Persons. ...
We are proud to announce that Action & Care Trust received an award of recognition by the Directorate for IDP Healthcare through the Ministry of Healthcare & Nutrition on the 22nd of December 2009. ...
