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Fathuhulla Naseem G. Atoll Hospital 1/1/2010

Introduction Gn. Atoll Hospital plays a key role in creating and enhancing public awareness, providing medical facilities for the people of the island and is responsible for managing all aspects of preventive and curative health care of the Atoll. The Atoll hospital was established in the year 2001 comprising of 21 beds along with 45 dedicated staff members. The hospital is open 24 hours a day, seven days a week. Specialty consultation services ranging from Obstetrics and Gynecology, General Surgery, Orthopedics and Pediatrics are run in the hospital with a view to cater the public with the maximum of possible health care. Furthermore 24 hours laboratory and Radiology services are made available in the interest of the patients, alongside inpatient and outpatient services running back to back. Much effort is put in controlling communicable and non communicable diseases within the island. Developing and optimizing the existing health care services is a major challenge the Atoll hospital is facing at present. Lack of certain equipments / instruments and trained personnel’s in and around the field is the major loophole the hospital is facing at the moment. Identifying these problematic areas, to adequately improvise the provision of services, mainly provision of equipments / instruments, training and getting the best of services from the concerned personnel’s are to be focused. Human resource capacity building is of priority to meet the demands of the population. Gn. Atoll Hospital is in dire need for in receipt of medical equipment and instrument for provision of effective health care services to cater to its emergent population. Aim This paper is put together as a result of the meeting held at Gn. Atoll office on 6th August 2009 to identify the important areas to be developed by improving the health care services in Gn. Atoll Hospital under the Grant Assistance Program initiated by the Atoll Development Committee, and is aimed at; -

Informing the Atoll Development Committee about the priority needs of the Health care services in the Hospital. Proposing a rational justification for improving the services in the identified areas.

1. Identified Areas for Developing The following areas are highlighted to bring to notice the most important seven areas, where the hospital needs improvement, further developing and optimizing.

Service Areas Area to be developed


ICU (intensive To provide essential medical care for Care Unit)

critically ill patients by enhancing its facilities

Labour Room

To decline maternal and fetal mortality and morbidity by improving the prenatal and perinatal care.

Priority level

Requirement Description Qty Periphera 1. Patient Monitor 02 l 2. Pulse oxymeter 02 Level

3. 4. 5. 6. 7.

Suction Machine Defibrillator ECG Machine Ventilator Portable Ventilator

Periphera 1. NST Machine l 2. Fetal Doppler 3. Episiotomy scissor 4. Allis Forceps


Price •

02 01 01 01 01

01 02 02


In the near future the existing services of this hospital will be transferred to the new hospital building which has a 2 bedded ICU department without necessary equipment. A single set of critical care equipment is available at present, which is been used in both the theatre and wards. So it is difficult treat 2 patients simultaneously.

33% of the patients are posted for caesarian sections, in view of maternal complications and/or fetal distress. To evaluate and manage such cases and to get a good perinatal outcome in high risk pregnancies.

NICU (Neonatal Intensive Care Unit)

To provide essential care for newly born babies in critical conditions and those babies who are brought to hospital in critical conditions.


To provide essential care for patients with traumatic injury and chronic Orthopedic pathological disorders and develop a basic rehabilitation centre.

General Surgery

To provide possible instant care, and management of surgical conditions which require immediate attention, and to maintain a good post

1. Baby warmer + 01 Neonatal resuscitator 2. Infant 01 Incubator

1.Short Wave Diathermy Machine 2.Interferential Therapy Machine 3.Wax Bath Tub 4. Lumbar Traction Set with pulley & weights. 5. Cervical traction set. 6.Electric Cast cutting machine

*Please see Appendix 1 (List of Surgical Instrument)

01 01 01 02

01 01

Presently there is only one set of machines but, it is utilised to treat two babies at the same time and so difficulties have been encountered to provide equal care for two babies at the same time.

• Presently a large population of the Atoll population suffering from chronic Orthopedic conditions like Rheumatoid Arthritis /Osteoarthritis/Lumbar and Cervical Spondylosis for which physiotherapy remains the mainstay of management, further number of people coming post surgery either from abroad or Male’ for their post-op management and rehabilitation in this hospital. • Previous Electric cast cutting machine is not in working condition. • Due to lack of certain surgical /diagnostic facilities and instruments quite a number of people has to be reffered further on to Addu/ Male’ to get the required surgery and

operative care.

Diagnostic Service

Diagnostic services will enable the best treatment for common illnesses seen in this Atoll effectively with specialized investigations.

1.Ultrasonography 2.Mammography 3.Bone densitometry 4. Specialized dental X-rays 5.Dental mirrors 6.Diagnostic set with Ophthalmoscope + Otoscope 7.PAP smear 8. Cervical biopsy

investigations done. And only empirical treatment can be started in such cases in this hospital setup. • With the emergent new hospital, facilities that enhance further diagnosis of certain commonly seen conditions would be a blessing. At present people have to travel to Addu /Male’ for these investigations. The unavailability of pathology services in the laboratory is a big hindrance for certain screening tests to be conducted.

2. Rationale Certain limitations have been encountered while working towards the goal of developing the hospital setup, the main downhill’s are due to untrained personnel’s running administrative and managerial functions, and developing skills relying on their experience over the years, and the abundance of expatriates in the health field. About 70-90 percent of expatriates provide their services in this health sector, however due to a communication gap at times; the best of their services is not sought. One of the important aspects of quality care which is effective communication and coordination among consumers of health care and health care providers are compromised due to language barrier. Another major concern at present is standardized care for which the competence of the health care professional comes into account. Due to the wide variation in workforce’s educational background and skills, uniformity cannot be ensured. 3. Conclusion At present the number of trained personnel’s in the health hospital does not meet the requirement for providing health care services in this Atoll, thus limiting the provision of effective, efficient and quality services. Therefore, it is important to look into opportunities to pave a pathway to train and develop human resources and upgrade facilities for the betterment of the health care services in this Atoll. …………………………………………………

Appendix 1

List of Surgical Instrument 1- Sponge holders 6” 2- Sponge holders 8” 3- Curved artery forceps 4- Straight artery forceps 5- Babcocks 6- 6.Allis forceps 7- Mayo scissors 8- Small bowls 9- Small kidney tray 10- Towel clips 11- Bone cutter 6” 12- Mosquito arteries curved 13- Mosquito arteries straight 14- Scalpel handle no..4 15- Scalpel handle no.3 16- Dissecting forceps toothed 6” 17- Dissecting forceps plain 6” 18- Fistular probe with director 19- Proctoscope (adult size) 20- Proctoscope (pediatric size) 21- Sygmoidoscope 22- Needle holder 6” 23- Needle holder 8” 24- Skin grafting Humby’s Knife 25- Softratullae/Gelonet 26- Sinus forceps 27- Prolene mesh 28- Surgicell 29- Abdominal retractors 6” 30- Abdominal retractors 8” 31- Intestinal clamp 32- Straight scissors 6” 33- Curved scissors 8” 34- Hernia ring 35- Hernia director

Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos. Pack Nos. Dozens Nos. Nos. Nos. Nos. Nos. Nos. Nos. Nos.

08 08 06 04 04 12 02 06 02 12 04 12 08 04 04 04 04 02 04 02 02 02 02 01 10 02 01 04 04 02 02 01 02 02 01

Proposal for the development of hospital