Rural Outreach

26
Nov

Korofegu Bena Camp-Out November 2009

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GOROKA GENERAL HOSPITAL

RURAL OUTREACH CLINICAL PROGRAM

OFFICE OF THE a/COORDINATOR

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

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.

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]