Download Masanga Hospital Annual Report 2012

2012
Rehabilitation Project
Year Report Masanga Hospital
Version May 2013
Year Report 2012
2
Contents
Foreword ................................................................................................................................................. 4
Executive Summary ................................................................................................................................. 6
Masanga Hospital Rehabilitation Project (MHRP)................................................................................... 7
History and Background ...................................................................................................................... 7
Health .................................................................................................................................................. 8
Education............................................................................................................................................. 8
Business ............................................................................................................................................... 8
Health – Masanga Hospital ..................................................................................................................... 9
Out Patient Department.................................................................................................................... 10
HIV counselor ................................................................................................................................ 10
Eye Clinic........................................................................................................................................ 10
The Wards ......................................................................................................................................... 11
Analysis of admissions ................................................................................................................... 12
Ward .............................................................................................................................................. 15
Mortality ........................................................................................................................................ 17
Maternity Ward and Labour Room ............................................................................................... 20
Emergency Grace Unit ................................................................................................................... 21
Supportive Departments ................................................................................................................... 22
Operating Theatre ......................................................................................................................... 22
X-ray............................................................................................................................................... 22
Laboratory and Blood Bank ........................................................................................................... 23
Security .......................................................................................................................................... 23
Administration, Finances and Logistics ............................................................................................. 24
Big Store, big success..................................................................................................................... 24
No more power problems ............................................................................................................. 24
Cut down on transportation costs................................................................................................. 25
Staff and Volunteers .......................................................................................................................... 26
Volunteers, Internships and Research .......................................................................................... 27
Rehabilitation of the Buildings .......................................................................................................... 28
Paula’s house used before finished............................................................................................... 28
Year Report 2012
3
New wound dressing room ........................................................................................................... 28
Renovation Houses on the “Noral Compound” ............................................................................ 29
Construction toilets and showers.................................................................................................. 29
Education............................................................................................................................................... 30
Surgical Training Program ............................................................................................................. 30
Nursing Aide Training .................................................................................................................... 30
Other Educational Programs ......................................................................................................... 31
In Memoriam 2012 ................................................................................................................................ 32
Warah Kamara ............................................................................................................................... 32
Santigi Koroma .............................................................................................................................. 32
Appendix 1 – List of Acronyms .............................................................................................................. 33
Appendix 2 – Our Partners .................................................................................................................... 34
Appendix 3 – Overview of doctors in 2012 ........................................................................................... 35
Appendix 4 – Operations Masanga Hospital 2012 ................................................................................ 36
Year Report 2012
4
Foreword
We are pleased to serve the people of Sierra Leone. In 2012 we treated 21,700 patients, bringing the
total number of patients treated since start of the project in 2006 to over 100,000. In line with
national health strategies, maternity and under-fives continue to receive priority attention at
Masanga.
Health, education and business enterprise remain the three pillars of our sustainability strategy.
People are our most important asset to create a sustainable health institution. Thanks to our
committed staff, our partners, stakeholders and supporters Masanga hospital is gaining reputation
for providing quality health care. We are open to the most needy and do not screen out on ability to
pay. Our success to delivery good patient care to the needy depends on our employees. The
Masanga International Board is committed to make continuous improvement on the working
environment for our staff and attract quality dedicated workers.
The work we do at Masanga is attracting attention nationally and internationally for innovation and
capacity building. The first two of our students in our surgical training programme, Emmanuel and
Amara have successfully gone through our WHO developed surgical skills task shifting course. This is
a good example of Masanga developing heath skills for capacity building in Sierra Leone.
Congratulations to them as they move on to use their acquired skills in other hospitals. Thanks to our
project partners Capacare for a job extremely well done.
2012 saw significant mile stone achievements. We launched the Tonkolili College of Health Sciences
and Technology, obtained accreditation from the Sierra Leone Nursing Board and took in our first
batch of 62 students in September for training as State Enrolled Community Health Nurses. Our long
term aim is to become the leading teaching hospital of choice for training middle level healthcare
professionals in Sierra Leone. We expect that there will be challenges on the way but together we
can succeed.
Thanks to our Masanga UK friends the Grace Emergency Admission Unit was completed. It is the only
such unit in a health district of some 400, 000 people.
This year has been tremendously challenging. A 30% increase in the total number of patients
admitted (maternity admission went up by 170%) placed pressure on the entire team of staff. Our
greatest challenge has been acquiring the necessary funds in the current economic climate to deliver
our services. We can do more with better resources. Thanks to all our supporters for their
generousity and look forward to their continued support. And to the staff for working together as
one in one project to over challenges we faced. I am filled with gratitude and admiration for our
staff. We must continue to review our work to face challenges of the future.
Year Report 2012
5
The only constant in life is change. To meet the challenges of an expanding and increasingly complex
project we restructured the entire organisation. It is my great honour to take over Chairmanship of
the International Board of Masanga Rehabilitation Project from Dr Peter Bo Jorgensen who has lead
with exceptional qualities and vision to take the organisation to where it is today. I am grateful for
the confidence the International Board, partners and stakeholders have placed on me.
We are putting into place strong local leadership. We have appointed as Program Director Mr
Ibrahim Sesay, the former Deputy Minister of Health who was pivotal in the processes that lead to
the signing of the tripartite agreement between SLAA, AFOM and GOSL for rehabilitation and
management of Masanga Hospital.
We are in service for a better community and better future.
Dr Edward Cole
Masanga Hospital rehabilitation International Board Chairman
Photo 1: Children in Masanga
Year Report 2012
6
Executive Summary
Since 2006 Masanga Hospital continues to develop faster than was expected as we continue to give
free treatment to all categories of patients throughout the country. In April 2011, the honorable
Minister of Health at that time came to visit the hospital and announced that Magburka hospital
should be closed for renovation. Initially the plan was for only 3 months but for the rest of 2011 and
2012 the District Hospital was closed. This had great impact on the number of activities in Masanga
and increased dramatically the pressure on the resources.
Statistics; This increase in activity is clearly shown in the number of admissions that increased from
2884 patients in 2011 to 3731 patients in 2012. Also the total number of deliveries increased from
261 in 2011 to 526 in 2013. See more key statistics in box 1.
The project will only be able to continue providing accessible and affordable high quality health care
services when the government plays a bigger role in the funding and staffing of the organization.
Together with the financial support of the business section and the increase in level of staff by the
education sector the program is sustainable for the future.
Box 1 – Key
statistics
Total Admissions: 3731
Total Out patients: 17800
Total Deliveries: 526
Total Operations: 1191
Year Report 2012
7
Masanga Hospital Rehabilitation Project (MHRP)
History and Background
Masanga Hospital was established by the Sierra Leonean Government as Masanga Leprosy Hospital
in 1964 and run as a leprosy hospital by the Seven Day Adventist Church until 1997. The Hospital shut
down during the civil war and was reopened through the Danish organization Association Friends of
Masanga (AFOM) and the English based Sierra Leonean Adventists Abroad (SLAA).
The two organizations signed an Memorandum of Understanding with the Sierra Leonean
government July 13th 2006 to rehabilitate and manage Masanga Leprosy Hospital, Tonkolili District.
In the original agreement it states that the Hospital shall be managed with the objective:
(a) To provide to the medical needs of patients of all faiths and creeds who seek attention at or
admission into the Hospital, subject to the limitation of its facilities.
(b) To expand the medical treatment capacity of the Hospital to deliver a general range of medical
and surgical interventions consistent with the expertise and rehabilitation facilities at the hospital at
that time.
(c) To train Medical Staff in the diagnosis and treatment of general medical conditions.
(d) To conduct outpatient treatment of medical conditions in cooperation with other agencies,
institutions and programs in Sierra Leone consistent with the expertise and facilities at the hospital at
that time.
(e) To re-establish specialist treatment of leprosy patients.
(f) To establish a program for treatment of HIV/AIDS and TB
Photo 2: Dr Josien working in Operating Theatre
Photo 3: the Hut in front of the wards
Year Report 2012
8
The Masanga Hospital Rehabilitation Project has developed into three legs to accomplish the above
stated objectives:
Health
To have full functioning general hospital providing health care service to the people. The vision is to
have a self sustainable hospital and the mission is to promote free access to health care. This is in line
with the national strategic heath plan and the Agenda for Change. The self sustainable element will
be developed through the two other legs, education and business.
Masanga Hospital now offers a pediatric ward, a male and female surgical ward, a maternity ward, a
stabilization Centre for acutely malnourished children, an out patient department, an eye care clinic,
a wound clinic, an x-ray department, a laboratory, a pharmacy, a blood bank and the newely opened
emergency grace unit. All of these units are functioning with the help of our trained staff. The
Hospital beds capacity is now 100, the hospital has 2 specialist tropical doctors covering the basic
need for medical and surgical assistance in the Hospital.
Education
The education of health care professionals, but also post graduate education in broader terms to
enhance growth through knowledge in the area and on a national level. Education is the key to
development and through the upcoming College we ensure the transfer of knowledge and are
including educational programs in business development, project managing and entrepreneurships
as well as vocational training and adult teaching programs for the community members.
Business
Economical growth and development through the establishment of businesses in the local area.
These businesses support the hospital financially and at the same time create jobs, development and
vocal training opportunities.
Year Report 2012
9
Health – Masanga Hospital
Since 2006 Masanga Hospital continues to develop faster than was expected as we continue to give
free treatment to all categories of patients throughout the country. In April 2011, the honorable
Minister of Health at that time came to visit the hospital and announced that Magburka hospital
should be closed for renovation. Initially the plan was for only 3 months but for the rest of 2011 and
2012 the District Hospital was closed. This had great impact on the number of activities in Masanga
and increased dramatically the pressure on the resources.
Statistics; This increase in activity is clearly shown in the number of admissions that increased from
2884 patients in 2011 to 3731 patients in 2012. Also the total number of deliveries increased from
261 in 2011 to 526 in 2013.
Year Report 2012
10
Out Patient Department
In the year 2013 a total of 17800 patients attended the out patient department. In the beginning of
the year more patients attended the clinic per month that later in the year. This might be a result of
the increase of the registration fees.
Table 1: OPD attendance 2011 per month
Under-5
Pregnancy
TB
Leprosy
Other
Total
Jan
173
123
10
57
1401
1764
Feb
163
90
10
54
1085
1402
Mar
195
84
10
100
1396
1785
Apr
232
111
16
80
1212
1651
May
278
142
17
76
1377
1890
Jun
151
125
10
117
1106
1509
Jul
188
135
17
96
1128
1564
Aug
165
113
11
45
1080
1414
Sept
301
82
5
55
1039
1482
Oct
167
49
12
80
1028
1336
Nov
96
81
7
92
800
1076
Dec
167
131
4
67
558
927
Total
2276
1266
129
919
13210
17800
HIV counselor
The HIV/AIDS program is a governmental program assisted by Global Fund that is integrated in the
hospital. During the year the number of patients on antiretroviral drugs increased from 13 in 2011 to
38 in 2012. HIV Councilor Alphina I Sesay delivered a baby girl and received an assistant from Akim
Conteh.
Table 2: Number of patients on ARV treatment per year
2008
2009
1010
Male
1
5
3
Female
1
7
6
Total
2
12
9
2011
4
9
13
2012
10
28
38
Eye Clinic
In the beginning of the year dr John Buchan came to Masanga to perform cataract and some other
eye operations. During his stay he operated in total 46 patients. In the summer the group in
Denmark decided to stop to support the running of the eye clinic and the motorbike was handed
over to the hospital. Also dr Buchan left the country and we are waiting for a replacement to set up
new outreaches to collect cataract patients.
Year Report 2012
11
The Wards
As described before the hospital has extended its activities in various ways. Compared to last year
the total number of admissions increased from 2884 patients in 2011 to 3731 patients in 2012. Two
factors contributing to this increase were the fact that Magburka Hospital was under renovation for
the whole year and the opening of the new emergency unit. Table 3 and Graph 1 give an overview of
the number of admissions during the year.
Table 3: Number of admissions for the different wards in 2012 per month
Ward
Surgical
Male
Female
Jan
150
96
54
Feb
118
85
33
Mar
98
73
25
Apr
122
74
48
May
155
99
56
Jun
133
92
41
Jul
136
82
54
Aug
152
86
66
Sept
108
58
50
Oct
107
67
40
Nov
56
26
30
Dec
55
27
28
Total
1390
865
525
Pediatrics
Male
Female
115
66
49
76
48
28
90
50
40
72
39
33
139
89
50
143
83
60
137
78
59
138
76
62
94
58
36
97
53
44
69
41
28
46
32
14
1216
713
503
73
27
46
73
27
46
Emergency
Male
Female
SC
Male
Female
15
7
8
17
6
11
22
11
11
26
10
16
23
11
12
23
10
13
22
6
16
17
10
7
20
11
9
17
9
8
16
3
13
13
8
5
231
102
129
Maternity
Total
52
332
60
271
71
281
84
304
72
389
91
390
79
374
61
368
59
281
71
292
64
205
57
244
821
3731
Graph 1: Number of admissions 2012 for the different wards per
month
Year Report 2012
12
Analysis of admissions
Age and sex
A total of 3826 patients were admitted in 2012, 54% female and 46% male (Table 4). Female patients
made up the majority between the ages of 15 and 39, reflecting the number of admissions for
reasons connected with pregnancy and childbirth, while there were more male patients among
children and older adults (Figure 2).
More than a third of admissions were children, with young children aged 1-4 years being the largest
age group with 22.2% of all admissions (Figure 3).
Table 4: Patients admitted by age group and sex
Age group
(years)
<1
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
Total
Female
Number Percent
of age
group
182
44.9
374
44.0
54
38.0
32
41.6
240
83.3
259
77.1
259
67.8
190
67.9
173
62.5
69
40.6
48
35.0
35
36.8
29
37.7
33
41.3
25
34.2
26
33.8
25
31.3
2053
53.7
Male
Number
Percent
of age
group
223
55.1
476
56.0
88
62.0
45
58.4
48
16.7
77
22.9
123
32.2
90
32.1
104
37.5
101
59.4
89
65.0
60
63.2
48
62.3
47
58.8
48
65.8
51
66.2
55
68.8
1773
46.3
All persons
Number
Percent
of all
ages
405
10.6
850
22.2
142
3.7
77
2.0
288
7.5
336
8.8
382
10.0
280
7.3
277
7.2
170
4.4
137
3.6
95
2.5
77
2.0
80
2.1
73
1.9
77
2.0
80
2.1
3826
100.0
Year Report 2012
13
Figure 2: Sex distribution by age group
90.0
80.0
70.0
Percent of age group
60.0
50.0
Female
Male
40.0
30.0
20.0
10.0
0.0
<1
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
Age group
Figure 3: Number admitted by age group
900
800
700
Number of admissions
600
500
Female
Male
All persons
400
300
200
100
0
<1
1-4
5-9
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74
Age group
75+
75+
Year Report 2012
14
Seasonality
There were most admissions in May (10.4% of the total), almost twice as many as in November, which had the
least admissions (5.5%) (Table 5).
Table 5: Patients admitted by month
Month
Number
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
340
279
283
319
402
399
382
375
289
296
212
250
Percent
of total
8.9
7.3
7.4
8.3
10.5
10.4
10.0
9.8
7.6
7.7
5.5
6.5
Total
3826
100.0
Year Report 2012
15
Ward
The largest number of patients, 38%, was admitted to the surgical ward. This was followed by the
paediatric ward at 32%, consistent with the age profile of patients. The seasonal pattern of
admissions was fairly consistent across all wards, but most notable in paediatric and surgical
admissions (Table 7). The Emergency Unit did not open until the end of the year.
Table 6: Patients admitted by ward
Ward
Number
Emergency
Maternity
Paediatrics
Stabilization
Surgical
75
840
1219
231
1461
Percent
of total
2.0
22.0
31.9
6.0
38.2
Total
3826
100.0
Table 7: Number of admissions by ward by month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Total
Emergency
75
Maternity
52
63
72
90
75
93
79
63
59
72
65
57
Paediatrics
115
76
90
72
140
144
137
138
94
97
70
46
Stabilization
15
17
22
26
23
23
22
17
20
17
16
13
Surgical
158
123
99
131
164
139
144
157
116
110
61
59
75
840
1219
231
1461
Year Report 2012
16
Diagnosis
By far the most common diagnoses were malaria (29.7% of all admissions) and problems in
pregnancy or childbirth (21.6%) (Table 5). No other single condition made up more than 10% of the
total.
Malaria was most common in children, making up 68% of admissions under 5 years of age and 52% at
5-14 years (Table 6). Admissions for nutritional deficiency were also common under 5 years. At ages
15-44 years almost half of all admissions, 47%, were for problems relating to pregnancy and
childbirth. In older adults aged 45 years and over, musculoskeletal and gastrointestinal problems
were the most common, along with unspecified ‘other’ conditions.
Table 8: Patients admitted by diagnosis
Diagnosis
Number
Malaria
Pregnancy & childbirth
Musculoskeletal
Gastrointestinal
Nutritional
Dermatitis
Trauma & burns
Respiratory infection
Cardiovascular
Parasitic infection
Urinary infection
Cancer
Other infectious diseases
All other
1138
825
346
285
252
111
107
90
60
39
32
19
98
424
Percent
of total
29.7
21.6
9.0
7.4
6.6
2.9
2.8
2.4
1.6
1.0
0.8
0.5
2.6
11.1
Total
3826
100.0
Table 9: Distribution of diagnosis by broad age group
Diagnosis
Malaria
Pregnancy & childbirth
Musculoskeletal
Gastrointestinal
Nutritional
Dermatitis
Trauma & burns
Respiratory infection
Cardiovascular
Parasitic infection
Urinary infection
Cancer
Other infectious diseases
All other
<5 years
68.3
0.0
0.4
2.5
18.8
1.8
1.0
3.4
0.0
0.6
0.2
0.2
0.3
2.5
Percent of all admissions in age group
5-14 years
15-44 years
52.1
7.4
0.9
47.3
5.9
9.3
9.1
8.5
6.4
0.1
5.5
2.5
6.4
3.5
2.3
1.3
0.0
1.1
1.8
1.2
0.0
1.0
0.5
0.3
2.7
3.8
6.4
12.6
45+ years
6.3
0.6
27.0
13.7
0.0
5.3
3.2
3.1
6.6
1.3
1.9
1.6
3.6
25.7
Year Report 2012
17
Total
100.0
100.0
100.0
100.0
Mortality
Just below 5% of patients died (180 total, 4.7%). Male patients were slightly more likely to die than
female, 5.4% as opposed to 4.1%. Children were more likely to die than adults, with the highest
mortality rate being 7.8% at ages 1-4 years and the lowest 1.2% at 40-44 years (Table 10). The age
group 1-4 years had both the highest mortality rate and the largest absolute number of deaths,
compared to all other ages (Figure 4).
Mortality rates varied by month, the highest rate at 6.0% of admissions being in May, the busiest
month of the year for admissions, and the lowest rate at 3.2% being in December (Table 11).
Nearly half of all deaths (48%) were of patients admitted with malaria, while 12% were due to
conditions of pregnancy and childbirth (Table 12). The highest risk of death by diagnosis (also known
as the fatality rate) was to patients admitted for acute respiratory infections, at 12% of patients
admitted with that diagnosis (Figure 5). The next highest risk of death was from trauma and burns at
8%.
Table 10: Mortality rate by age group
Age group
(years)
<1
1-4
5-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75+
Mortality rate
(percent of
admissions)
6.7
7.8
7.0
3.9
2.1
2.4
3.1
2.9
5.1
1.2
2.2
6.3
5.2
5.0
1.4
3.9
3.8
Total
4.7
Year Report 2012
18
Figure 4: Numbers of deaths and mortality rate (percent) by age group
70
9.0
8.0
60
7.0
50
6.0
40
5.0
Number of deaths
Mortality rate (percent)
4.0
30
3.0
20
2.0
10
1.0
0
0.0
<1
1-4
5-9
10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74
Age group
Table 11: Mortality rate (percent) by month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Mortality rate
(percent of
admissions)
5.3
4.7
5.0
3.4
6.0
4.8
5.0
4.5
4.2
4.7
5.2
Dec
3.2
75+
Year Report 2012
19
Table 12: Number of deaths and fatality rate (percent) by diagnosis
Diagnosis
Number of deaths
Malaria
Pregnancy & childbirth
Musculoskeletal
Gastrointestinal
Nutritional
Dermatitis
Trauma & burns
Respiratory infection
Cardiovascular
Parasitic infection
Urinary infection
Cancer
Other infectious
diseases
All other
86
21
4
6
11
7
9
11
4
2
0
0
8
Fatality rate
(percent of
admissions)
7.6
2.6
1.2
2.1
4.4
6.3
8.4
12.2
6.7
5.1
0.0
0.0
8.2
Percent of all
deaths
11
2.6
6.1
Total
180
4.7
100.0
47.8
11.7
2.2
3.3
6.1
3.9
5.0
6.1
2.2
1.1
0.0
0.0
4.4
Figure 5: Number of deaths and fatality rate (percent) by diagnosis
100
14
90
12
80
10
70
60
8
Number of deaths
Fatality rate (percent)
50
6
40
30
4
20
2
10
se
he
r
ot
es
as
ce
di
us
ct
io
in
fe
rin
U
O
th
er
Diagnosis
Al
l
r
n
an
C
tio
ar
y
in
f
iti
c
ra
s
Pa
in
fe
c
ec
tio
n
ar
n
as
cu
l
ar
di
ov
or
y
ira
t
Re
sp
C
&
in
fe
c
bu
tio
rn
s
at
iti
s
m
a
Tr
au
io
n
rm
De
al
tin
te
s
N
ut
rit
et
al
in
ke
l
lo
s
as
tro
ild
cu
&
ch
M
us
G
ria
al
a
M
y
an
c
Pr
eg
n
al
0
bi
rth
0
Year Report 2012
20
Maternity Ward and Labour Room
The largest new inflow of patients during the closure of Magburaka Hospital happened on the
Maternity Ward and the Labour Room. This is clearly seen in table 13 and 14.
In 2012 we have increased the level of care in the Maternity Ward and Labour Room. Many protocols
were made. Our staff, mch-aids in training and STP students have received many (on the job)
teaching on emergency obstetric care. Danish Medical students (formerly attached to the IMCC
group in Denmark) helped us by launching monthly Facility-Based Maternal Death Reviews. These
audits are highly needed in Sierra Leone where the maternal mortality unfortunately is still among
the highest in the world. This audit gives an insight how to increase or improve the care we can give
in the hospital to improve the outcome for mothers during childbirth.
We want to thank all Capacare specialists, Danish medical students and Danish midwives who all
helped us to improve the care in the maternity ward and labour room this year.
In 2012 four of our maternity nursing aid staff were enrolled by the Government in to the MCH-aid
training. After this enrollment three new nursing aid were employed in the Maternity Ward.
Table 13 Type of deliveries in 2012 per month
Normal
Assisted
Caesarian Section
Total
Jan
24
3
10
37
Feb
23
3
19
45
Mar
22
8
11
41
Apr
23
13
20
56
May
27
10
10
47
Jun
38
9
15
62
Jul
34
2
7
43
Aug
38
2
12
52
Sept
18
2
10
30
Oct
25
2
15
42
Nov
15
5
16
36
Dec
22
4
9
35
Total
309
63
154
526
Table 14 Outcome of deliveries in 2012 per month
Live birth
Still birth
Macerated
Total
Jan
33
1
4
38
Feb
35
8
4
47
Mar
35
2
7
44
Apr
43
11
4
58
May
38
11
1
50
Jun
53
11
5
69
Jul
34
6
3
43
Aug
44
9
2
55
Sept
24
6
1
31
Oct
42
5
0
47
Nov
37
12
0
49
Dec
29
5
3
37
Total
447
87
34
568
Year Report 2012
21
Photo 4 Building Emergency Unit
before the rehabilitation
Photo 5 The new east side of the
Emergency unit (ambulance entrance)
Emergency Grace Unit
With the rehabilitation of the Emergency Unit Masanga Hospital has made an important step in
increasing the level of quality care in the Hospital. Critically ill patients are now intensively monitored
at the high dependency unit. All new emergency cases can be stabilized in the resuscitation room.
Critical Post-operative patients can be monitored to their needs. The unit has 24 hours of light. The
unit is able to provide 24 hours of monitoring and oxygen therapy.
The rehabilitation of the Emergency Unit is the result of a successful cooperation between Masanga
UK, Dawnus (construction company) and Masanga Hospital. Masanga UK raised the necessary funds
and supplied the knowhow by sending Dr. Doug Watts and Dr. Louise Wade. Dawnus supplied
building materials free of charge and send the highly skilled Mark .. who supervised the work on site.
Our manager Logistics Bart-jan Metz supervised the construction workers and coordinated the whole
process. Special thanks goes to Chris Foster, Austin Hunt and Geoff Eaton (Masanga UK) and Richard
Davies and Roy Duffy (Dawnus) for making it happen.
The rehabilitation started in the beginning of 2012 and
was completed just before the end of the year. In
November the building was first used during the Plastic
Surgery Camp of Doctors of the World for the lodging of
patients. In December 2012 the unit started with the
startup phase with a new staff and the first patients.
Photo 6; December 2012; Resuscitation Room fully operational
On the 14th of January 2013 the Grace Emergency Unit was
officially opened by the honorable Member of Parliament for
Tonkolili District together with local officials, representatives
from the ministry of health and sanitation, representatives from
Dawnus and African Minerals and a Norwegian delegation. The
opening is an important milestone because it marks the
completion of the rehabilitation of the hospital complex.
Photo 7 The new name after the opening ceremony; The Grace Emergency
Unit
Year Report 2012
22
Supportive Departments
Operating Theatre
In 2012 almost 1200 operations were performed. The most performed procedure was the hernia.
Figure 6 show the operations per month per category. The complete table with all the operations you
find in appendix 4.
Figure 6 : Operations done in 2012 per month
X-ray
Because of technical problems, the second half of 2012 no X-rays were performed. In December we
were able to start working with a newly donated machine. Table 15 shows the overview of all the
performed X-rays per month and per category.
Table 15: Number of different X-rays per month in 2012
Jan
Feb
Mrt
Apr
Mei
Jun
Jul
Aug
Sep
Okt
Nov
Dec
Skull
0
0
0
2
0
0
2
0
0
0
0
0
Spine
0
2
1
3
7
3
1
4
0
0
0
0
Upper arm
0
0
1
2
0
0
0
2
0
0
0
0
Lower arm
5
5
8
12
8
10
8
3
0
0
0
0
Upper leg
4
6
3
3
3
2
2
1
0
0
0
2
Lower Leg
8
18
7
20
13
10
7
17
0
0
0
9
Chest
14
5
2
8
13
3
9
8
0
0
0
11
Other
8
3
5
11
9
7
10
8
0
0
0
2
Total
39
39
27
61
53
35
39
43
0
0
0
24
Year Report 2012
23
Laboratory and Blood Bank
It also has been a busy year for the laboratory and the blood bank. With thanks to foreign donors
there was improvement in equipment and in a general sufficient supply of test and reagents. The
government, through the National Blood and Safety Services, was able to help us with the majority of
supplies needed for blood bank. Table 16 and 17 shows the pediatric and adult blood transfusions.
Table 18 shows the different laboratory tests in 2012.
Table 16: Pediatric and Adult blood transfusions in 2012
Jan
40
19
59
Pediatric
Adult
Total
Feb
25
20
45
Mar
30
10
40
Apr
28
26
54
May
49
18
67
Jun
71
35
106
Jul
70
38
108
Aug
79
27
106
Sept
57
28
85
Oct
37
39
76
Nov
37
27
64
Dec
31
33
64
Table 17: Pediatric and Adult blood transfusions since opening of the blood bank
Pediatric
Adult
Total
2009
14
24
38
2010
84
38
122
2011
436
127
563
2012
554
320
874
Total
1088
509
1597
Table 18: Laboratory tests in 2012
Jan
Feb
Mrt
Apr
Mei
Jun
Jul
Aug
Sep
Okt
Nov
Dec
Malaria
861
890
1034
1050
895
1042
998
931
985
1094
1060
1062
VDRL
119
129
122
148
70
278
228
180
215
105
150
142
Oncho
9
15
17
27
14
54
24
21
25
3
13
5
Leprosy
7
7
6
5
3
9
4
5
2
1
3
4
TB
38
39
58
52
40
31
51
40
30
39
28
32
HIV
61
54
42
67
75
112
115
118
92
85
74
66
Hep B
63
54
42
66
75
110
118
118
104
107
90
76
Hep C
61
54
42
67
75
110
118
118
93
85
74
66
Total
1219
1242
1363
1482
1247
1746
1656
1531
1546
1519
1492
1453
Security
Unfortunately this year the hospital had to face an increased number of stealing. Boxes with
medication (from the IDA order), solar panels, money for the construction of the secondary school,
money from the Doctors of the World were amongst the stolen items. For the first time we
experienced forced entry to compound houses. As a response we have increased the number of
security guards from 4 to 7. We are working together with the town elders to increase security in
Masanga and on hospital grounds. We are supporting the construction of a police post in Masanga.
The Local Unit Commander (LUC) has promised to send police officers as soon as the police post is
finished. We have informed our volunteers to be more careful with their belongings.
Year Report 2012
24
Administration, Finances and Logistics
In 2012 we experienced many shifts on senior management positions. In February Bart-jan Metz
started as interim Logistics Manager to fill the vacant position. In June the board decided to transfer
Finance Manager Michael Jones’s to the Nurse School, that was in full preparations for their first
college year. Bart-jan Metz was asked to take over the main responsibilities of the Finance Manager.
In September General Manager Thomas Fortune left the project. Just before the end of the year
former Logistics Manager Jinnah Musa returned to his old job. Due to a planned organization
structure change, the leaving managers were not replaced.
Financially the hospital has had a very difficult year. Every month there was a lot of financial pressure
and uncertainty. At the end of the year we are proud to report with have faced the challenges and
achieved great results with the limited funds. We have managed to keep the hospital running the
whole year. A few times we were only weeks away from closing the hospital. But every month we
succeeded to have medication for our patients, fuel for our generator to power the operations and
money for salaries.
Big Store, big success
The Big Store has been fully reorganized. Our carpenters with volunteer Rene made new shelves for
storage. Volunteer Ellen made a new structure for storing items. All volunteers helped to move the
items to their appropriate place. Manager Bart introduced new store keeping records. All Big Store
entries are recorded and signed. All important items have stock cards on which entries and supplies
are registered. After putting on new locks on all doors, the Big Store is clean, organized and safe.
No more power problems
In the beginning of the year we had three old generators that broke down regularly. The hospital was
frequently without power. On our switchboard all fuses we hotwired. It was a dangerous situation.
Sallini (operating the Bumbuna dam) saved us by lending out their generator and installing a new,
safe switchboard. We used their generator for more than half a year, until two new 115KvA
generators donated by the Lion’s arrived. Sallini helped us again with installing the generators and
the new change over. Thanks to the Lions and Sallini we now have a safe and steady power supply.
Year Report 2012
25
Photo 8: arrival of the new generators; Photo 9 the new generators installed
Cut down on transportation costs
From August there was no money to send our hospital cars (Toyota Landcruiser, Ford Ranger, and 2
Landrover Defenders) for repairs to MotorCare. With the help of volunteer Kasper, mechanic Abdul
managed to keep the Ford Ranger and the Landrover Defender running with very limited resources.
We were lucky to have dr. Alex’s car to help us meet our transportation needs. We were forced to
use one of the Defenders for spare parts and sell the Toyota Landcruiser. At the end of the year the
hospital had two operational cars.
Year Report 2012
26
Staff and Volunteers
In the beginning of 2012 the hospital had 86 employees. By the end of the year this number had
increased to 104, and difference of 17,31%. The increase of 18 employees were only in the medical
and support area. The two most important changes in the human resources was that the general
manager Thomas Fortune had to leave the project and Jinnah Musa came back as logistic manager.
Table 19 gives the full overview of the staff situation in January and December 2012.
Table 19: Overview of staff in January and December 2012
Jan 2012
53
2
2
2
44
3
Dec 2012
64
2
3
3
53
3
Difference
17,19%
0,00%
33,33%
33,33%
16,98%
0,00%
Admistration
Manager
Cashier / bookkeeper / storekeeper
Registration
8
3
3
2
8
3
3
2
0,00%
0,00%
0,00%
0,00%
Support
Groundsman
Carpenter
Electricen / painter
Driver / mechanic
Cleaner / laundry / incinerator
Security
Total
25
3
5
1
3
8
5
86
32
4
6
2
3
11
6
104
21,88%
25,00%
16,67%
50,00%
0,00%
27,27%
16,67%
17,31%
Medical
Doctor
CHO
Nurse
Nursing Aide
Vaccinator / OT assistant / Pharmacy assistant
Year Report 2012
27
Volunteers, Internships and Research
Over the last months a lot of visitors and volunteers assisted in the hospital and by doing internships
and research projects. The students and volunteers working in the medical field came from different
backgrounds and geographic areas. Here is a list that gives a brief overview.
•
•
•
•
•
•
Three CHO in training from the paramedical school in Bo did their final internship in Masanga
Hospital.
MCHAide students from Magburka came to gain experience in the PHU in Masanga. Only 2
came to work for two weeks.
medical students from the UK, did a research project on Buruli ulcers in Sierra Leone. They
found some smear positive cases and they are waiting for confirmation of their lab results
from Ghana.
They assisted with deliveries and did on the job training of nursing aides.
Sofie and Søren, two Pharmacy students from Denmark, improved the systems and
procedures for drug distribution in the hospital.
The IMCC students from Denmark worked on an outreach project to the surrounding PHU.
Besides that they participated in the daily work in the hospital, assisted in training the health
staff and were responsible for the management of the eye clinic.
Year Report 2012
28
Rehabilitation of the Buildings
Besides the rehabilitation of the Emergency ward
Paula’s house used before finished
Four architects without borders worked on the new and beautiful Paula’s house that now
accommodates our Community Health Officers. Our CHO’s were so eager to live there that they
moved in before everything was finished. That makes Paula’s house is a big success. Special thanks go
to Swedish architects Pi and Cecilia for listening carefully to local needs and their brave last minute
design change.
Photo 10: Paula’s House
Photo 11: Handing over of the keys
New wound dressing room
The wound dressing room has been upgraded. Volunteers Ellen & Rikke helped to make a room in
the OT building into a clean and proper equipped wound dressing room. The walls were tiled, the
ceiling fixed and painted. Before this room all wounds were dressed on the wards by different Nurse
Aids. Now all wounds are dressed by Nurse Aid Frank, T-roy and colleagues in the wound dressing
room. This means that wounds are better dressed, patients recover faster and costs go down.
Year Report 2012
29
Renovation Houses on the “Noral Compound”
The “Noral Compound” is the group houses between the Managers house and Masanga 2. The
houses are build before the war and are in relatively good shape. Three out of the seven houses were
renovated in 2012: the Double House, the Teachers House and Jaspers House.
The Double House, Teachers House and Jaspers House
What’s in a name? The double house is in fact a double house. It has two houses with three
bedrooms and one common room under one roof. The renovation of the house started in spring
2012. The house was finished at the end of the year. The project was on hold for two months
because we have limited, skilled workers and the management team prioritized the finishing of other
building projects. With the renovation of the double house the hospital now has extra staff
accommodation which is highly needed. In Sierra Leone educated health staff will expect to be
accommodated by their employer. We are now able to house some of our new
nurses.
Photo 12 the double house before renovation; photo 13 the double house after renovation
Jaspers House
Thanks to an interesting arrangement with Motorcare, Masanga Hospital has an extra renovated
houses on the Noral commpound. Former volunteer Jasper (now working for MotorCare Makeni)
hired a contractor to renovate one of the single houses fast and to high standards. The plan
succeeded. Jasper’s house is considered to be one of the nicest houses on the compound.
Construction toilets and showers
On the compound, close to the hospital there are some simple houses (rooms) that accommodate
staff. They still carry their old name: Welfare. Most of the staff living there is either senior hospital
staff or staff that is on call and needs to be able to come to the hospital quickly and regularly during
the nights. The houses are simple but much appreciated by the staff because of their location. The
houses however had NO or very poor toilet and shower facilities. Last year we constructed a new 4
toilet / 4 shower unit.
The construction started in spring 2012, first 4 deep holes had to be dug for the pit-latrines. It is
impressive how this work was done, with only a pick axe, shovel, bucket and rope. After the holes
had been dug, the construction of the building started. Finishing a project in Masanga is sometimes
pretty time consuming however with the help of Fokko (Alex his father) who was in Masanga during
Year Report 2012
30
the summer the painting and finishing touch was done. He was able to hand over the keys of the new
facility to Samuel Matthew one of the senior staff living there. SM said: “Thank you very much! First
our children had to go into the bush now they stay clean and safe close to home.”
Education
Surgical Training Program
After years of preparation the Surgical Training Program started in January 2011 under the
supervision of dr Håkon from Norway. With the cooperation of the government we started the
program with two students. The focus of the training is on life saving surgical and obstetric skills.
Masanga has the privilege to function as the teaching hospital and the coordinating center. All
students start their first six month in Masanga. During 2012 the program clearly expanded. In
December 2012 the total number of students has grown to 13. All these students work and live in
different hospitals all over Sierra Leone. In the end of 2012 the first two STP students: Emmanuel
tommy and Amara Conteh finished their two years training. They are awaiting their final
examinations in January 2013. In 2012 two interviews were held in Freetown. There were far more
applicants than vacant places. For the next year we expect a further expansion of the program in
Sierra Leone.
Nursing Aide Training
Under supervision of Patrice Komeh,
Annemarie Keus and Josien Wesendorp the
third batch of nursing aides finished their in
training Masanga Hospital nursing aid
course in October 2012. The group
composed of 25 students from Masanga
area and 15 students from Yoni Bana
supported by the Better Life Foundation.
The training consisted of the entrance
exam, the introduction phase, three time
practicals and theoretical training. It was a
very succesfull training.
Photo 14; Graduation Ceremony Nursing Aides
On the 17th of October the graduation ceremony was held with attendance of All the 40 students
completed their course and most of the ones who are from the Masanga area started to work in the
Hospital.
Year Report 2012
31
Other Educational Programs
In the upcoming college we want to implement more educational programs such as, vocational
training, project management, business administration, general education for the staff and adult in
the community, more medical training session, postgraduate courses, emergency courses,
resuscitation and postgraduate course in ultrasound scanning.
Masanga Hospital is a training institution. This is clearly visible through the nursing aide program, the
SECHN course and the surgical training program. Most of the volunteers who come to Masanga
participate in the training of the staff theoretical and practical. Where we can, we promote further
educational development of our employees in collaboration with the Masanga Education Sponsor
Project.
Year Report 2012
32
In Memoriam 2012
Warah Kamara
Our governmental SECHN Warah Kamara was placed in Masanga Hospital during the closure of
Magburaka Hospital. She was highly respected and loved in Masanga. On the 11th of November she
passed away after given birth to a son.
Santigi Koroma
Our cleaner of the laboratory department has worked for Masanga Hospital for many years. As a
cause of a sudden illness he passed away.
Warah Kamara and Santigi Koroma will continue to live in our hearts, we will surely not forget them.
May their soul rest in peace.
Year Report 2012
33
Appendix 1 – List of Acronyms
AFOM
DMO
IMCC
MHSE
MHRP
OT
OPD
SC
SLAA
SLSA
STP
TB
UMC
Associated Friends of Masanga
District Medical Officer
International Medical Cooperation Committee
Masanga Hospital Sustainability Enterprise
Masanga Hospital Rehabilitation Project
Operating Theatre
Out Patient Department
Stabilization Center
Sierra Leonean Adventist Abroad
Sierra Leone Shipping Agency
Surgical Training Program
Tuberculosis
United Methodist Church
Year Report 2012
Appendix 2 – Our Partners
34
Year Report 2012
35
Appendix 3 – Overview of doctors in 2012
Name
Claar Bijleveld
Dorine Drejer
Herman Lonee
Frank van Raaij
Marco Versluis
Lasse Raasberg
Maria Milland
Niels Jørgen Secher
John Buchan
Wim Klein Poelhuis
Henk Jansen
Xander Bakker
Yvonne Smulders
Klaus Melf
Marie Luise Vrang
Louise Wade
Doug Watts
Brynjulf Ystgaard
Håkon A. Bolkan
Knut Skreden
Peter Bo Jørgensen
Alex van Duinen
Erdi Huizenga
Jet Gerdanus
Josien Westendrop
Mark Londema
Period
2 weeks
2 weeks
2 weeks
1 month
1 month
2 weeks
1 month
3 weeks
2 weeks
1 week
1 week
2 weeks
2 weeks
2 months
1 month
3 months
3 months
3 weeks
1 month
1 month
2 months
12 months
1 month
3 months
12 months
3 months
Specialty
Anesthesiology
Anesthesiology
Anesthesiology
Obstetrics/gynaecology
Obstetrics/gynaecology
Obstetrics/gynaecology
Obstetrics/gynaecology
Obstetrics/gynaecology
Opthalmology
Opthalmology
Opthalmology
plastic surgery
plastic surgery
public health
Radiology
rural medicine
rural medicine
Surgery
Surgery
Surgery
Surgery
tropical medicine (incl surg and obs)
tropical medicine (incl surg and obs)
tropical medicine (incl surg and obs)
tropical medicine (incl surg and obs)
tropical medicine (incl surg and obs)
Nationality
Dutch
Dutch
Dutch
Dutch
Dutch
Danish
Danish
Danish
British
Dutch
Dutch
Dutch
Dutch
German
Norwegian
British
British
Norwegian
Norwegian
Norwegian
Danish
Dutch
Dutch
Dutch
Dutch
Dutch
Year Report 2012
36
Appendix 4 – Operations Masanga Hospital 2012
Operation
Hernia / hydrocele
Umbelical hernia
Inguinal hernia
Stangulated hernia
Femoral hernia
Incisional hernia
Hydrocele unilat
Hydrocele bilat
Orthopectomy
Jan
43
3
33
3
2
0
0
2
0
Feb
44
1
34
2
2
0
3
2
0
March
37
0
29
3
1
0
1
3
0
April
25
1
18
4
0
0
1
1
0
May
67
3
51
4
3
0
3
2
1
June
36
1
28
4
1
1
1
0
0
July
46
3
27
4
4
0
4
1
3
Aug
27
2
14
4
3
0
2
1
1
Sept
31
3
21
3
2
0
2
0
0
Oct
37
0
30
5
0
0
1
1
0
Nov
22
0
19
0
0
0
3
0
0
Dec
17
2
12
1
2
0
0
0
0
Total
432
19
316
37
20
1
21
13
5
Amputation
Finger
Hand
Arm
Toe
Above Knee Amputation
Below Knee Amputation
1
0
0
0
0
0
1
1
0
0
0
0
0
1
5
0
0
0
0
1
4
5
1
0
1
0
1
2
3
1
0
0
0
1
1
4
0
0
0
1
2
1
3
0
0
0
0
0
3
1
0
0
0
1
0
0
2
0
0
0
0
1
1
4
0
1
0
0
1
2
0
0
0
0
0
0
0
3
1
0
0
0
1
1
32
3
1
1
2
8
17
Trauma and Orthopedics
Sequesterectomy
Traction hip
Reposition Elbow/Ankle
Reposition Other
Orthopedics Other
4
2
0
0
0
2
2
2
0
0
0
0
1
1
0
0
0
0
3
1
0
1
0
1
1
1
0
0
0
0
2
1
0
0
1
0
0
0
0
0
0
0
1
1
0
0
0
0
0
0
0
0
0
0
4
4
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
18
13
0
1
1
3
Abdominal
Laparotomy
16
16
9
9
6
6
8
8
14
14
9
9
9
9
7
7
11
11
8
8
1
1
7
7
105
105
Eye
Cataract
Eyeball Removal
27
27
0
0
0
0
19
17
2
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
46
44
2
Year Report 2012
37
Operation
Obstetrics and Gynaecology
Ceasarian Section
Dilatation & Curretage
Hysterectomy
Manual placenta removal
Breach Extraction
Obstetrics other
Vaginal prolaps operation
Jan
19
10
6
3
0
0
0
0
Feb
24
17
3
1
3
0
0
0
March
16
9
2
1
1
3
0
0
April
27
20
1
1
2
0
3
0
May
14
10
0
2
1
0
1
0
June
20
16
1
1
2
0
0
0
July
18
7
1
3
2
0
2
3
Aug
19
14
0
3
2
0
0
0
Sept
10
10
0
0
0
0
0
0
Oct
20
16
0
2
2
0
0
0
Nov
20
16
0
0
0
3
1
0
Dec
14
8
0
4
1
1
0
0
Total
221
153
14
21
16
7
7
3
Minor Procedures
Necrotectomy
Incision & Drainage
Excision Lipoma
Excision other
Cleaning & Dressing
Secundary Closure
Evacuation Hematoma
Wound suturing
Removing Corpus Alienum
Suprapubic Catheter
Thorax Drain
28
7
11
0
0
6
2
0
1
1
0
0
10
1
5
2
0
1
1
0
0
0
0
0
16
0
7
1
1
3
0
0
1
0
3
0
18
1
5
2
2
5
2
0
1
0
0
0
46
9
14
4
5
8
3
0
0
2
0
1
11
1
4
2
1
0
2
1
0
0
0
0
20
2
9
0
2
3
2
0
1
0
1
0
17
1
10
1
1
3
1
0
0
0
0
0
17
1
6
3
3
2
2
0
0
0
0
0
9
0
1
3
1
2
2
0
0
0
0
0
11
7
1
0
1
2
0
0
0
0
0
0
14
0
4
2
3
4
1
0
0
0
0
0
217
30
77
20
20
39
18
1
4
3
4
1
Plastic Surgery
Skingraft
Plastic surgery other
2
2
0
2
2
0
1
1
0
1
1
0
4
4
0
0
0
0
4
4
0
4
4
0
1
1
0
16
13
3
36
26
10
2
2
0
73
60
13
Other Procedures
Mastectomy
Circumcision
Other
0
0
0
0
1
0
0
1
0
0
0
0
2
1
0
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
3
0
0
0
0
7
1
1
5
Dental
Extraction
11
11
2
2
1
1
6
6
10
10
3
3
5
5
1
1
1
1
0
0
0
0
0
0
40
40
Total
151
95
102
95
159
85
105
77
73
98
94
57
1191