NICU Proposal Jaffna Teaching Hospital

Improving the Paediatric services at Jaffna Teaching Hospital

Dr M G Sathiadas Consultant Paediatrician Teaching Hospital Jaffna

Next 30 Minutes....

1. Situation in General 2. Impact on our Children 3. Paediatric services at Jaffna Teaching Hospital – Past & Current 4. Step Forward.....

1. Situation in General

Demography • Population 21 million • Under 5 mortality rate:14 per 1000live births • Neonatal mortality rate 21 • Maternal mortality rate 92 per 100,000 live birth

Resettlement process going on at a slower pace

Situation in General

Teaching Hospital Jaffna

Shifted twice to other areas during the conflict time

Situation in General

Teaching Hospital Jaffna

Rebuilding efforts and reconstruction work at a slow rate - Teaching Hospital – JAICA project - No provision to improve paediatric services

Situation in General

Teaching Hospital Jaffna • Only tertiary centre for entire northern region - OPD patients 880-1000/d - Admissions 400-450/d - Children 80-100/day - Admissions 35-40/day - August 2011 22,436 patients seen

Situation in General

Paediatrics in general • Population covered: 1 million and 40% of them are children • Districts: Jaffna, Kilinochchi, Mullaitivu, Mannar and outskirts of Vavuniya • Paediatric medical wards 3 with paediatricians • Each ward 40 beds • Very sick from the region are transferred– Nearly 15% of admissions from the region

• No HDU/PICU/NICU • No rehabilitation unit • No separate surgical wards

6 year old girl was transferred from a peripheral unit in dengue shock syndrome, died after 12 hours in the adult ICU

Situation in General

• Click to edit Master text styles – Second level – Third level • Fourth level – Fifth level

2. Impact on our Children

Impact on our Children

Disease spectrum 1% 10%

10%

2%

6%

Infection Nutrition Renal Snakebite Colombo Tx others 70%

Impact on our Children

Why this disease spectrum?

• Infectious diseases – Poor living conditions – Poor hygienic measures – Lack of safe water – Disposal of waste

Impact on our Children

• Nutritional deficiency – Poverty – Lack of a secure job

Impact on our Children

• War victims – Single parent family – No Parents – Psychological trauma – Disabling war injuries • Societal problems affecting children – Lack of job – child labour – Drug trafficking – Alcohol abuse – domestic violence – Increased incidence of child abuse

8year old boy from Wanni psychological trauma as father is in Prison, mother unemployed, no house to live in Jaffna

Impact on our Children

• Child abuse Orphaned

• Single parent families

3. Paediatric Services at Jaffna Teaching Hospital – Past & Current

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Past….

• Well

established Paediatric unit in the country during 1980 to 1987.

• Most of the speciality services were available.

• Two paediatric units with a diarrhoeal unit • Community clinics • Research activity

Paediatric Services at Jaffna Teaching Hospital – Past & Current

1987 Hospital Massacre….

• The Indian Peace Keeping For shot and killed our Consultant Paediatrician Dr. Sivapathasundaram and 22 other medical staff within the hospital premises.

This well known Hospital Massacre crippled the Paediatric services at Teaching Hospital Jaffna.

*** Brain drain ***

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of ‌.

Paediatric services including the out patient clinics

Neonatal services

Record Keeping

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of …. Neonatal services Current “SCBU” ‘Survival Of The Fittest’

2010 - Deliveries – 6972 - SCBU admissions – 1309 - At risk babies who need specialised care - 623 babies were preterm - Deaths 130 nearly 10% - 5% of these babies were admitted to adult ICU for ventilation and half of them died - Death was mainly prematurity, surfactant deficiency and sepsis

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of ‌. Neonatal services

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of ‌. Neonatal services

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of …. Neonatal services Current “SCBU” ‘Unacceptable space’

• Lack of space: - Current space makeshift room - 105m² - can accommodate 10-12 - We accommodate 20-25 babies - Cross infection is a risk factor - No area for septic babies • Babies transferred from other units - No separate area to isolate these babies

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of …. Neonatal services Space…far below international standard

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of ‌. Neonatal services

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of ‌. Neonatal services No dedicated area for breast feeding

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of …. Neonatal services Lack of equipment

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of …. Record Keeping

• Maintained 100 % manually • Manual filing record books occupy a 20’ x 20’ room • Depending on few experienced staff.

• Unwanted delays due to manual lab operation • Lack of properly defined strategy to integrate a single system • All departments are very keen on single electronic record keeping system.

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of …. Paediatric Services

• Affected from 1987 onwards • Wards are situated in an abandoned building • Recent increase in number of wards • No area for rehabilitation - No proper services of OT/PT/SLT • No surgical ward - Accommodated in adult surgical wards • ICU care- 6 bedded adult ICU with JAICA 10 bedded but no specialised PICU - In 2010 – 95/495 almost 20%

Paediatric Services at Jaffna Teaching Hospital – Past & Current

Current status of …. Paediatric Clinics

• Paediatric clinics - Registered patients 12999/8833 2010 - New patients 1774/1226 July 2011 • Monday to Saturday • Accommodates 80-100 per day but seating arrangement not enough • Lack of facilities- Record room, breast feeding area, blood letting and injection • No sub speciality clinics

Step Forward......

Step Forward...

Urgent Next Steps:1. Repair and construction of NICU

Required Next Steps:-

1. Electronic Record Keeping 2. Separate Paediatric Hospital and Modernising the Paediatric Out Patient Clinic

Step Forward

Urgent Next Steps:-

Expansion of PBU

Outcome would be:- Doubles the current Space so avoids cross infection - Dedicated space for breast feeding/rooming in - Separate area for septic babies

Step Forward

Urgent Next Steps:-

Expansion of PBU

For Expansion and Reconstruction:-

Land space already identified and allocated

Current PBU

Allocated Land

Step Forward

Urgent Next Steps:-

Expansion of PBU

For Expansion and Reconstruction:-

But NONE of the authorities and local NGOs are willing or keen on improving this.

Step Forward

Stages of reconstruction • Stage 1 building US$70,000.00.00 • Stage 2 essential equipment US$ 70,000.00 • Stage 3 other equipment (final stage)

US$ 40,000.00

Step Forward

Cost of equipment needed urgently Equipment

Unit price

Number

Total

Incubator

1,270,000.00

5

6,350,000.00

Neonatal cots

18,400.00

10

184,000.00

CPAP

500,000.00

2

1,000,000.00

Ventilator

1,872,902.00

2

3,743,804.00

Pulse oximeter

130,000.00

5

650,000.00

Phototherapy unit

175,000.00

3

525,000.00

Total

12,498,603.00

Lions club

5,000,000.00

Needed fund

Rs7,000,000.00 US$70,000.00

Step Forward

Urgent Next Steps:-

Modernising the Paediatric Out Patient Clinic

• Renovation - Partitioning, Floor tiling, Roof work, Painting & Wiring and furniture Rs. 2.3million (US$ 23,000) • Equipments: - Clinic (available) - Computers and Peripheries - Networking Rs. 1.2 Million (US$ 12,000) Total cost to improve the clinic:- Rs. 3.5 Million (US$ 35,000)

Step Forward

Paediatric block • Land available • Cost Rs450million (US$ 4.5 million)

Step Forward...... In a Nut Shell.

Modernising Paediatric OPD

Expansion of PBU

(Urgent Next Step)

(Urgent Next Step)

Renovation - 2.3 million (US$ 23,000)

Building & Reconstruction - 7 million (US$ 70,000)

Equipment - 1.2 million (US$ 12,000)

Equipment - 12 million (US$ 120,000)

Electronic Record Keeping

Paediatric Hospital

Automating Labs

Well equipped state of the art Paediatric Hospital

Automating Paediatric Unit and other identified Units.

Available Funds (Lions Club) - 5 million (US$ 50,000) Required Fund

3.5 million (US$ 35,000)

14 million (US$ 140,000)

2 million (US$ 20,000)

450 million (US$ 4.5 million)

Sandford point • English is an official language • Politically stable and democratic • The need is there for a secondary level care

Thank You