FUN WITH A PURPOSE

Team Building Day

 

 

 

 

 

Great imagination from Nick lead to an excellent day for the health care workers at the Diocese. It was team building, even a fun day and it looks like ----- fun!

 

 



Another Great Team Member.

Some time ago Nick was really pleased to report the progress of a new team member. Emma had fitted in so well with the role given. I thought I had misinterpreted Nick's antipodean accent when he said he (not she) is making a huge difference. In the UK, Emma is normally female but our Emmanuel is a bloke!

 

He is proving to be a perfect fit taking over some of he roles of Natasha, nurse educator, teaching remand home inmates and health unit staff for half of his hours and the rest of the time he works at St Philips.

A great nurse and radiant Christian, he is having a very positive effect.

Oberabic

The Next Steps

Oberabic Health Centre

We are so excited at the progress in Oberabic where patient care and facilities are advancing together.

Oberabic is very remote and poor. It is a privilege to help such a destitute community where there is no electricity, poor water availability, very limited health care facilities and where many children show signs of malnutrition.

At the health unit, we recently financed the building of a two roomed maternity unit. This has been a success as a report from Nick posted above shows. To take progress further we have four advances scheduled.

1. Maternity Unit Equipment.

Two beds and a haemoglobinometer are needed. Money is set aside for these when Nick and Fiona make the request.

     2. Repair to Borehole



The health unit shares their borehole with the local  village. The water is now polluted with mud. This will take time to organise but we have money set aside for when it is.

Children collecting water

  3. Improvement of Staff Accommodation.

Staff have to live on the campus and the accommodation is terrible comprising of a small single room each with  an incomplete partition wall and no ceiling meaning it is cramped, affords no privacy and has no insulation -  Uganda can get vey hot. When we have proper accommodation we will be able to upgrade the health unit further by being more attractive to staff. This will be a big step forward.

This will take around £25,000. We have asked Nick and Fiona for a full estimate

Staff accommodation

   4. Apaa

As the post below shows the opening of this new venture was delayed on account of communal vilence. The unit opened last week with funds from Gulu Connection. It is in a very, very remote area more than an hour along the track from Oberabic. Our prayers and thoughts are with the nurse who is going to staff this facility. Being so remote she will face some very serious health issues. 

Apaa Unit in Operation

Pastor who came to open unit, with patients.

 

New Apaa Health Unit on hold

 

Community engulfed in violence

 

Bloody tribal conflict has reemerged in the Apaa area claiming the lives of four, seriously injuring 20 and displacing 700. When the situation settles down Nick will re-evaluate the possibilities for opening a new unit in this very needy community. We are still raising money in the expectation that he will succeed!

 



The Boring Work of Saving Lives

 

Not exciting, colourful or trendy, copied here is an Excel.

 

 

 

This shows some of the support that Gulu Connection is able to give to The healthcare work in Uganda.

 

We are particularly proud of the second item namely the gratuity for staff who have completed 1 year. This is a Gulu Connection  initiative aimed at encouraging qualified staff to stay on. As so many payments were made, we are hopeful that this is having some success. In addition money has been sent to pay for or subsidise staff at Saint Peter’s, staff at Oberabic and also drugs. We are very pleased to be co-working with Nick and Fiona in this way.

 

Up To Date,  Old News

 

It was a routine inspection of Keyo Health Centre ...

 

 

Mercifully quiet so there was time to check the books and chat to staff.

 

Then came a very distressed child about nine years old. She was in extreme pain and it was soon apparent that she had a grossly infected knee joint. See the very blurred picture. This shows the poor child screaming.

 

The boring work of saving lives

 

It happened sometime ago when Peter was in Uganda but the story is an every day one. The child was an orphan who had AIDS. The lady looking after her was pressured with the care of her own children - she had a young baby -  and, like everybody in that area, very short of money. Our team Referred her to the local hospital.

 

The Step mother went back to the village to gather her things and this poor child who obviously felt very ill just lay down on the floor.

 

 

 

 A boda was summonsed and all 4 went to Lacor hospital.

 

 

 

The knee was  drained,  antibiotics given and the child was soon home. Without the Health Centre there could  well have been no care whatsoever. The child would have been in terrible pain and with AIDS, could well have died of septicaemia as her immunity was so compromised by AIDS.

 

These are desperate and tragic situations that our health centres deal with every day.

 

EFFECTIVE TRANSFORMATION

Saving Lives - One Step at a Time.

Reporting the Report.

It might seem a dull process but the results are exciting  - lives are being saved.

 

Nick and the team visit each health unit quarterly and measure them according to set criteria. Good  practice is praised and weaknesses discussed. This painstaking approach is yielding results. Oberabic Health Centre II was visited in March. Here is the report. As well as the nuts and bolts, this report gives a glimpse onto life at Oberabic, how to get phone reception, a clinical case  and -- a very special person -- a baby born in the new unit!

Oberabic Supervision Report 23/3/2017

 

Dr. Nicolas Laing (DHC), Assistant Akwero Fiona, and intern Florence Oyet visited the facility. It’s worth noting that for the previous month they were operating without the in-charge Christopher, who was away on annual leave. Chis is due to return 4/4/2017

 

Gloria takes an important phone call under the Papaya tree – the only place with good reception!

 

Spot check Organisational score

3/2017             40/47  4^th out of 10 health Centres reviewed. Still good
12/2016          40/47  2^nd out of 10 Health Centres reviewed, well done
10/2016          39/47 = 83%    2^nd of 10 health centres reviewed – well done
7/2016             40/48 = 83%    1^st of 10 health centres reviewed – great job!
4/2016             33/44 = 75%
9/2015             26/44 = 59%

 Positives
- Still well organized, scoring highly amongst all our health centres
- New nursing assistant Alex settling in very well. I’m confident he can work out well.
- Continuing to pay one nursing assistant via cost share which is encouraging 6 months down the line
- Numbers averaging around 400 monthly, not increasing any more but still good. We don’t expect  any increases from here as the district spraying program has been completed in the area and this should have a drastic effect on malaria in the area (if it hasn’t already), with patient numbers potentially even dropping a little. I still believe 400 monthly is realistic when malaria drops
- Toilets clean
- Staffing now improved with new nursing assistant on board
- New Hepatitis B testing and vaccination initiative going well, now charging 2000 per test or vaccine which has reduced numbers a lot to a manageable level (previously could be 100 on vaccination days, now 5-20)
- Drug accountability excellent, no errors found on reviewing 3 common drugs
- Family planning still maintaining good numbers
- Antenatal numbers very high
- Broke delivery record with 11 deliveries in month of March.
- New family planning project generated 800,000 UgSh first month, likely to increase to 1.2 million plus for the next few months.

Services delivered Monthly (Ranges given from December to Feb)

Outpatients                            400-500
Antenatal consultations       50-70
Deliveries                                6-11
Family planning methods      20-45
Outreaches                              4x monthly
Child vaccination                   30-50
Hepatitis B test and vax        5-20 weekly

  

One of the first babies born in the new maternity unit.

 

Issues
- Still not adequate hand washing? have added one but still need 2 more
- Not using stock book still which is disappointing.
- No duty roster still
- Patients latrine was very dirty. Discussed with staff that cleaner is neglecting some jobs, need to follow up on this and make sure is done well
- HIV test kits expired, few remaining

Medical Quality

Spot Check Score

3/16    20/29 =  69%               5^th of 10 health centres reviewed
12/16 14/29 = 48%               8^th of 10 health centres reviewed
10/16  23/29 = 79%              1^st of 10 health centres reviewed
7/16    12/23 = 52%              7^th of 10 health centres reviewed
4.16     11/23 = 48%
8.15 4/15         = 23%

Positives
- Antibiotic percentage between 40-50% for both adults and Children. Improvement from last time
- Nurse at midwife now seeing most of the patients, very few seen by nursing assistant.
- Remains the top performing diocese health centre under Marie Stopes.
- Drugs per patient improved to 2.5, still not back to old levels
- No longer giving antibiotics for URTI
- Guideline following improved to 70% but still not good enough.

Shortfalls
- Folic acid just ran out due to high number of antennal. Essential stock outs like this must not happen
- Not following guidelines properly for some conditions
- Still not performing as well as they previously were – hoping for greater improvement next time.

 



Abalo face and ankles were swollen. The urine dipstick showed huge protein and small blood, and she was treated with steroids and a diuretic. It’s amazing what you can do in the bush!

Recommendations achieved (from last assessment)

-          Do between 5 and 10 deliveries a month on average over the next 2 months. Well done all!

-          (Diocese discussed with DHO) Start charging 2000 equipment fee for hep vaccines Done, no problems

-          Reduce Hepatitis B vaccines and testing to under 30 per day on Tuesdays and Thursdays to make more realistic for staff Done, now 5-20 only

-          Start Maternity Project Well done, initial assessment by voucher plus good, and 800,000 made first month

-          - Sort out housing situation for Jennifer, by her sleeping in a different house (New nursing assistant living in hut no problems.

-           Complete maternity and toilet block construction (February 2016)

-          - Christopher and Gloria to plan for Annual Leave (Chris already taken, Gloria planned well done)

Recommendations  not achieved (from last assessment)

-          Get written document by man who gifted land to health center, allowing some of his children free treatment for a few years from now. Still not done

-          Buy 2 new hand washing buckets and set them up (Only one bought)

-          Improve prescribing quality back to over 75% on our assessment. This is the most important performance indicator for staff and we expect great improvement in this area. Not achieved, only 70% achieved

New Recommendations

-          Average over 1 million shillings monthly on Voucher plus project (May 2017)

-          Improve guidelines following – over 75% on (May 2017)

-          Have in place the 3 extra handwashing basins (May 2017)

-          Over 50 antenatal visits monthly (May 2017)

-          Average over 8 deliveries monthly for March, April, May (May 2017)

-          Increase costshare by 500 shillings for all age groups (May 2017)

-          Be completing stock books monthly (May 2017)

-          No stock outs of essential medications (May 2017)

  

The assessment continues to be good, with a small slide in quality probably because of the lack of the in-charge there. The diversity of services continues to impress; with OPD, antenatal, deliveries, family planning, vaccination and outreaches all thriving. The quality of prescribing still needs some improvement but is better than last time.  

God Bless, Dr. Nicolas Laing
Health Co-ordinator, Diocese of Northern Uganda