After kicking off her assignment by winning the women’s swim race on New Ireland Day in July 2012, ADI’s Dr Romany Topsfield is hard at work servicing the Namatanai community. She’s providing clinical care to hospital patients and training staff including through interactive quizzes –
“The exciting thing is that I repeated the malaria diagnosis and treatment quiz one week after the initial quiz and subsequent teaching. Every single participant’s score improved. One person’s score went from 2.5/38 up to 27.5/38.”
Romany is also developing a dispensary inventory system to help ensure essential life-saving drugs are always on hand.
The clinical staff members at Namatanai Hospital are some of the most dedicated and caring health professionals I have ever worked with and I feel privileged to be a part of their team. I also feel privileged to be living in this beautiful town and amongst the wonderful Namatanai community. I have felt welcomed and very much supported in my role. However, the hospital is struggling with huge problems related to failing infrastructure, lack of funding and inadequate staffing numbers. This includes no running water and unreliable electricity. In order to highlight the difficulties faced, here’s a snapshot of what happened yesterday: a typical day…
On the paediatric ward there were three children with severe malnutrition, which can lead to death, long term illness and impaired brain development. However, it wasn’t possible to give any supplementary feeding because there was no available formula and no potable water. In fact, the hospital tanks were completely dry and the nurse had not had time to walk down to the river to collect water and then to boil it to make it safe for consumption. For much of the day there was no power with which to boil the water either!
There were three children with vomiting and diarrhoea. Gastroenteritis is the second highest cause of death in children aged less than 5 years old. According to the World Health Organisation guidelines, the most effective and safest treatment for the children is with ORS (oral rehydration solution). Yet by day’s end the infants with gastroenteritis had not received any ORS due to the lack of potable water and inadequate staff capacity to collect water from the river.
There were two infants with severe pneumonia. Pneumonia is the highest cause of mortality in the under 5 age group. For these children, I prescribed antibiotics and requested that supplementary oxygen be available during breastfeeding. This allows the infants to feed more effectively and to recover faster. However, the hospital was currently out of stock of the appropriate antibiotics and there was no power to allow the oxygen concentrator (donated by ADI) to function.
In the women’s ward, male ward and TB ward there were patients with similar levels of need for medical care.
During a single shift, a single clinical staff member has to attend the ward round (this alone takes 3-4 hours) and perform regular observations on all patients, administer all prescribed drugs, perform wound care, admit and discharge patients from the ward, educate patients and family members regarding their medical condition and self-care, fetch water, boil water, make solutions up, order drugs, clean the wards, document all their activities and much, much more. It is impossible for any one human being to perform all these duties.
During the course of a day, the single clinical HEO had to attend the ward round, co-ordinate management of the morgue refrigerator which had broken down, co-ordinate documentation and removal of bodies killed in an industrial accident, assess and manage patients in the outpatient department, review patients on the ward, order medications and much, much more.
In addition to my clinical work, I have been conducting case-based training with staff as well as in-service group training on topics including childhood illnesses, malaria, diabetes, and administration of IV fluids. Up to 17 staff at a time attend my sessions, even when they are off duty.
As part of this training, I developed a quiz on malaria diagnosis and treatment. The exciting thing is that I repeated the quiz one week after the initial quiz and subsequent teaching. Every single participant’s score improved. One person’s score went from 2.5/38 up to 27.5/38! Several other people more than doubled their score, and only one went up by less than double digits. I was so thrilled!
I’ve also designed a system of medical stores record keeping in liaison with the Namatanai District Health Manager. Since the departure of the dispensary officer many months ago, the hospital has struggled to keep proper records of drugs and medical equipment. Supplies of crucial drugs frequently run dry and then the hospital must wait several weeks or months for drug orders to be filled. This is costing lives.
Our project will involve clearing and organising the dispensary, identifying all donated drugs and equipment, recording all stores, developing a system for recording all ingoing and outgoing medications, fluids and equipment, developing a functional drugs of dependency recording system, developing an ordering system that takes into account lead time, average monthly consumption and minimum and maximum stock balance, providing intensive in-service training for (ideally) 2 clinical officers to manage the system in the long term and providing basic in-service training for all staff to ensure all are aware of the project, understand the system and are engaged in maintaining it.