Archive for November, 2009

9-13 August, 2009

BALI INTERNATIONAL CONVENTION CENTRE (BICC)
NUSA DUA, BALI,
INDONESIA.

THEME: ‘Empowering People, Strengthening Networks’.

The trip was a worthwhile and educational exposure for the whole team that went and participated in the plenary, oral, poster presentations, satellite meetings, and skills building workshop, symposia, Asia Pacific village and the Congress field trips.

The team consisted of Dr Apa, Dr Frank, Dr Wari, Dr Mondurafa and Mr Wai. We were accommodated at the beautiful Grand Hyatt hotel and our travel allowance was used to cover for our meals, transportation and emergency use as was in the case of the three of us that lost our baggage (Drs Frank and Wari and Mr Wai).

THE BALI 09 TEAM

(From  L to R) –Mr Wai , Dr Apa , Dr Mondurafa , Tour guide and Dr Wari. Dr Frank was taking the photo.

The meeting began with an opening at Lotus Pond; Garuda Wisnu Kencana Cultural park proceeded by a dinner. The President of Indonesia officially opened the congress.

The five days were divided into a combined Plenary session from 0845 to 1030 hours than community forums from 1045 to 1915 hours at night. The days were generally very busy for us running in between the different sessions that were of interest.

We attended sessions that covered areas in Political commitment for HIV programmes, PPTCT programmes , HIV/AIDS planning sessions , Clinical updates of HIV, HIV/AIDS programmes in resource poor settings, and responses of both governments and NGO’s in combating HIV/AIDS in the region.

It was very difficult to attend all the sessions as they were all important and very educational.

We were not able to take the field trips as they coincided with our presentations.

The group presented a poster presentation on the Self help projects being undertaken by the Clinton Foundation and the Compassionate care in PPTCT leads to retention in Paediatrics. Our Clinton Colleagues from Port Moresby spoke on the PMGH PPTCT experience and the Early infant diagnosis in PNG as well as the ART data management system in PNG.

Key lessons learnt at the Congress were:

1. Good PPTCT programme can lead to reduced HIV in the population
2. Data management is very vital in assessing how programmes are going and for patient management and care.
3. People of all groups such as gays , lesbians, homosexuals, drug users, PLWHA, commercial sex workers, clinicians ,scientists, politicians, administrative groups , pathologists, radiologists must work together to combat the illness.
4. There is a new vaccine being trialed in Thailand.
5. Goroka’s protocols are that of those which have been proven to work
6. We need to understand the epidemic and strengthen prevention efforts.
7. Strengthening partnership for treatment, care and support.
8. HIV/AIDS in Context: Understanding and addressing Socio-Cultural, Economic and political determinants
9. Leadership and broadening the response.

RECOMMENDATION:

1. Strengthen our PPTCT programme in Goroka.
2. Keep very good data and manage it accordingly.
3. Learn to work with all stakeholders in the community.
4. Empowering our staff to do research and present in country and internationally.
5. Keep abreast with the latest clinical management through our association with Clinton Foundation.
6. Keeping management aware of benefits of such gatherings.
   Implementing what we as a group have picked up in areas of clinical and management.

We would like to thank the Clinton Foundation for sponsoring the trip.

For the Bali Team.

Dr Paul WARI
Paediatric Registrar.

GOROKA GENERAL HOSPITAL

RURAL OUTREACH CLINICAL PROGRAM

OFFICE OF THE a/COORDINATOR

Part of the campsite; in the forefront are the pit latrines.

Report of Special Clinical Campout – Korofegu, Bena

From 5^th – 11^th November 2009

BACKGROUND

The Seventh-Day Adventist Church hosted its national women’s convention from the 5th-11th November 2009 at Korofegu, Benabena, Eastern Highlands Province. People started flocking into the camping venue as early as 2nd November 2009 from throughout Papua New Guinea. The program was supposed to have been conducted in early October 2009 but deferred to the said date due to an instruction from Provincial Taskforce on Disease Control and Epidemic due to the recent outbreak of Cholera, Dysentery and Influenza. More than 17,000 delegates attended and participated in this convention/gathering. The hospital responded to the organizers request for medical assistance in terms of manpower and logistics, with blessings from the Provincial Taskforce on Disease Control and Epidemic in its deliberation on Thursday 29th October 2009. The Rural Clinical Outreach Office was thus delegated this task to coordinate this health operation within this period.

AIMS / OBJECTIVES OF THIS HEALTH OPERATION:

1. To provide Curative Health care on site, to reduce morbidity and prevent mortality, and ultimately to prevent as much as possible morbidity and logistics/capacity burden on Goroka General Hospital and Eastern Highlands Province:

Activities
- sick patients to be reviewed immediately and treated on site.
- very sick or critically ill patients to be evacuated to Goroka General Hospital (Port Moresby and/or overseas medical evacuation to be borne by the church, however, hospital officers will escort if required).

2. To encourage Promotive Health:

Activities
- tent settings, mess/kitchen facilities, pit latrines, waste disposal pits, water supply within the camping grounds etc as well as local food stalls and markets to be inspected on a daily basis and advise concerned stakeholders to maintain infection control measures especially in regard to recent cholera, flu and dysentery outbreaks as well as other water and/or food borne diseases.
- active surveillance to be implemented and if there is an outbreak concerned stakeholders will be notified immediately.

3. To disseminate information on Preventive Health:

Activities
- Pamphlets, posters, information booklets etc to be provided as giveaways on all public health diseases, conditions and issues.
- Presentations, Talks, Discussions etc to be carried out if opportunity is given in this gathering.

CATEGORY OF HEALTH WORKERS THAT PARTICIPATED

* Doctors : 2
* Physiotherapists : 6
* Dental Officers : 2
* Nursing Officers/CHWs : 22
* Eye Nurses : 2
* Clinton/MAC officers : 12
* Anaesthetic Officers : 2
* Laboratory Technicians : 1
* Pharmacists : 2
* Drivers : 2

Total Staffs: 53

And of course we had several dedicated volunteers from the church who participated especially in the evenings and nights.

Rosters for the respective divisions were formulated and the staffs were scheduled for duties accordingly. We had almost 15 staffs during the day, and about 5 during the evenings and night shifts.

A one hour staff briefing was done on Tuesday 3rd November 2009; rural outreach protocols on work standard ethics and especially infection control measures was emphasized, as most of the partaking staffs were not rural outreach team members.

LOGISTICS / PHARMACEUTICALS

Vehicles

: 2 hospital ten-seaters utilised for drop off and pick up of hospital staffs
: 1 private open-back landcruiser stationed 24 hours with private driver for medical evacuations only

Pharmaceuticals

: oxygen cylinders x 2 (one portable and one large with its accessories)
: Dental Officers, MAC & Clinton officers, Physiotherapists, Ophthalmology Nurses, Anaesthetists, and Laboratory Technician came in with their own gear for patient diagnosis and management.
: K2600.00 cheque given to Goroka General Hospital by organising committee of this program; basic pharmaceuticals worth K2900.00 supplied (see attachment from Hospital Pharmacist, Mr Malcolm Sabak)

Clinic Setting

: well-set traditional building with kunai-thatched roof; rooms for staffs, dispensary, outpatients, and inpatients. Separate extension/confinement for staffs outside for breaks. The Clinic was connected with treated water supply and genset electricity which was occasionally going off. Toilet/Shower facilities is 5 minutes walking distance (sick patients should take longer than that)
: Infection Control – sharps were discarded in standard sharps container for incineration at Goroka General Hospital

OVERVIEW OF THE CAMPSITE

Venue partitioned into 10 divisions according to the SDA Church’s 10 national divisions. Well over 17,000 people attended this church gathering from throughout Papua New Guinea.

Housing

: tents accommodating 2-3 persons (some more than that depending on capacity)
: 12 round kunai houses (10 for respective church regions, and 2 for guests)

Water Supply

: piped into 7 Tuffa tanks from about a kilometre away; chlorinated and distributed into respective sections via another 7 Tuffa tanks. This treated water supply was used for both drinking and bathing; the bathing area was further down the nearby stream (5 minutes walking distance), whilst drinking taps were scattered throughout the site

Toilet

: about 100 human-dug toilet pits covered with concrete slab cover, a latch and ventilation vent via a bamboo pipe. Some of the toilets were quickly filled and had to be dug again by a back-hoe excavator during the week

Kitchen

: 4 well – set kitchen but open-air for serving which was prone to dust and flies; cooking done with gas cookers, and boiling water was self-served via electric heaters; there was a separate building for storage of food

Food Stalls

: From observation, no cooked foods were sold in the stalls/markets; the locals had adhered to the advice given

It was practically difficult to monitor sanitation and hygiene practices and to do daily inspections of water, toilet, kitchen and food stalls; request was made verbally to Mr Opa Kairu – Coordinator of Provincial Health Disease Outbreak Team for manpower (health inspectors) in this area of duty, but the response was negative. Therefore day to day monitoring was not effectively carried out as we were busy in clinical duties.

PATIENTS SEEN AND TREATED AT THE CLINIC

A total of 1048 patients were seen and treated by 53 participating staffs, as depicted in Table 1 and Table 2. There were 870 females as expected (83 %), and 63 sick children (6 %).

There were more medical cases (34 %) followed by eye (26 %), dental (~12 %), and so forth. The ‘Others’ patient category consists of Voluntary Counseling and Testing patients (52), as well as ENT and skin cases (14); All VCTs were nonreactive or negative.

Medical and Paediatric cases were mainly Upper Respiratory Tract Infections, Uncomplicated Malarias, Arthragias, Myalgias and non-specific headaches; only few had chest infections; there were only 3 diarrhoea cases which were treated as climate/weather and stress-related, and do not fulfill the case definition of Cholera.

The Surgical morbidity were mostly strain or sprain, followed by minor cuts and abscesses; the operations performed were suturing of a mother who had deep scalp laceration who was hit by a falling iron tent pole, whilst the other 2 patients were removal of foreign bodies from legs.

For Dental cases, mostly extractions were done, followed by dressings, fillings and dentures; dentures were done at the Hospital.

For the Ophthalmology cases, most were due to refractive errors that required glasses; affordable reading glasses were given to the patients on the site after their problems were identified; a few cataracts and pterygium were referred for surgical operations but unfortunately the operations had to be cancelled as the Ophthalmologist was on his way to Australia.

Gynaecology patients were mostly PIDs, with few menstrual disorders; we had 5 patients coming in for their depo injections as part of family planning.

Physiotherapy cases were mainly athralgias and myalgias.

Of the 17 patients referred, 5 were emergencies (acute appendicitis, pyomyositis, threatened abortion, trigeminal neuralgia and infected plantar wart), and 12 were dental cases requiring dentures, filling, and specialized extractions.

Apart from the execution of clinical duties, health education was also presented every day on health issues concerning Cholera, HIV/AIDS etc.

CONCLUSION/ACKNOWLEDGEMENT

The clinical health program undertaken by Goroka General Hospital was crucial and timely, as there were no constraints of resources on the hospital during this peak period, and also for disease control especially in regard to the recent cholera, dysentery and influenza outbreaks.

The Chief Executive Officer of Goroka General Hospital, Dr Joseph Apa, and The Director of Eastern Highlands Provincial Health & Taskforce Chairman of Disease Control and Epidemic, Mr Ben Haili, are hereby acknowledged for their approval for this exercise, which is ultimately for the wellbeing of our people.

All staffs who took part in this program are thanked for making Eastern Highlands Province a healthy place to thrive.

And finally the SDA Church is thanked for setting the standard in outdoor camp meetings.

Report compiled by:

Dr Beron T Kongona
a/Coordinator Rural Outreach Clinical Program
(17th November 2009)

A slideshow of the photos taken out at Korefegu can be viewed below

[Show as slideshow]

Lucy was my mentor and companion during my visit and I thank her for her friendship and for sharing so much of the ‘ways of doing things in Goroka’. The group photo is of the Monash Goroka Alumni and in the meeting we had there was so much energy and enthusiasm with each person talking about what they have been doing in their nursing career since studying at Monash and their hopes for the future. We spent time talking about research and nursing leadership and how it is up to us as individuals, within the organisation, to make a difference in the care we provide and to help others to reach out and to do the best possible. There are many examples of good practice, in health care delivery, within the hospital. The request for further undergraduate programs was taken to the Head of School and the Dean of the Faculty of Medicine, Nursing and Health Science and we are forming a committee to look at how and when we could implement such a program again.

Working with all the staff was for me enjoyable…I aimed to have them tell me of their good work and achievements and how they do so despite a poverty in essential resources. They were able to recognise that even though there are limitations in equipment and qualified staff, it is still possible to create culturally appropriate and sensitive care for unwell people and their families and to be person centred.

Diane and Simone also achieved their aims, to provide antenatal care and to be with birthing women, to work with the local midwives and to maintain high standards of care. Care that would meet the Australian Nursing and Midwifery Council standards of practice. What was important in this for me, was to see how these students translated their skills in a new and challenging culture,  in practice, in environment and among people who understand and speak a different language and experience a different lifestyle.

We received a wonderful welcome by all we met, those in the hospital and people in the streets and markets. Sonia  always kept us safe and ensured that we were able to experience wonderful opportunities such as a local wedding and a lunch with friends, sometimes we spent many hours at night talking, talking, talking about everything! As only friends can do. In what we were experiencing, sharing our thoughts, telling stories, and writing our journals, Sonia was always supportive. Thankyou ever so much. Thankyou also to Dr Jo and your many colleagues who made us welcome too and for the provision of vehicles and drivers to ensure we were able to get out to the health centres, to shop for provisions to give to the birthing women, to the markets to buy fresh produce.

Many people shared their plans and hopes for a bright new hospital, and we wish you well on this quest. But in the meantime we send you our best wishes and our thoughts, and thank everyone for what can only be described as a remarkable experience with remarkable people.

Kind regards

Dr Kay McCauley-Elsom
Senior Lecturer
Bachelor of Midwifery Coordinator
School of Nursing and Midwifery
Monash University

November, 2008

The Goroka General Hospital staffs were privileged to undergo the public service induction training. For some they had been working for more than ten years, while for others they had been working for only a year. The trainees included doctors, nurses, administrative staff, allied health staff and the hospital maintenance staff. All in all there was 120 staff from the hospital that attended the 2 weeks induction. The first batch of 60 in the first week and the second batch of 60 the following week.

The facilitators were from the National Department of Health as well as from the Institute of Public Administration in Port Moresby.

Topics covered in the course were:

1. Orientation to the Public Service
2. Orientation to the agency (Central and line Departments)
3. Orientation to the Agency ( Provincial)
4. Orientation to the job.

The public service in PNG is often termed as ineffective or disorientated and I believe as a participant that this is because many public servants have not been inducted or due to the fact that there has not been any refresher courses for older public servants on the code of ethics, the Public Service ‘General Orders’ and lack of general quality supervision from supervisors at all levels.

With many more of these Inductions planned for other provinces and the PSWDI sponsored development of ten Basic Modules to help public servants to develop their core competencies in their jobs, the Public Service culture can be revolutionized.

A big thank you to the Management of Goroka General Hospital for releasing its staff and funding and also the NDOH/PNGIPA for facilitating and co funding the Induction.

We all hope that there can be a cultural change in Productivity and efficiency in our hospital now that we have been educated and inducted.

Finally, ‘an EDUCATED Public Service is an EFFECTIVE Public Service’.

Dr Paul WARI
Participant.