These are the inventories of goods delivered to Vavuniya and Padaviya. These are inventoried and checked by the receiving doctors at each hospital. You can see the same in the Padaviya video above.

Padaviya

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.

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:

1. 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.
2. 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.

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.