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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