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.

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.