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FOYA BORMA HOSPITAL
- a general introduction
Created by Stine Toft and Kim Foss
7/1/2012
The purpose of this document is to give a general idea about the infrastructure of Foya Borma Hospital as
well as the daily routines at the hospital. This document should be updated with every change.
Foya Borma Hospital – a general introduction
July 2012
Table of Contents
Introduction ....................................................................................................................................................... 3
The Outpatient Department (OPD) ................................................................................................................... 4
Infrastructure and interior ............................................................................................................................ 4
The daily routines .......................................................................................................................................... 4
The Inpatient Department (IPD) ........................................................................................................................ 5
Infrastructure and interior ............................................................................................................................ 5
The daily routines .......................................................................................................................................... 5
The Pediatric Ward (PEDS) ................................................................................................................................ 6
Infrastructure and interior ............................................................................................................................ 6
The daily routines .......................................................................................................................................... 6
The Emergency Room (ER) ................................................................................................................................ 6
Infrastructure and interior ............................................................................................................................ 6
The daily routines .......................................................................................................................................... 6
The Obstetric Ward (OB) ................................................................................................................................... 7
Infrastructure and interior ............................................................................................................................ 7
The daily routines .......................................................................................................................................... 7
The Pharmacy .................................................................................................................................................... 7
Infrastructure and interior ............................................................................................................................ 8
The daily routines .......................................................................................................................................... 8
The Dispensaries................................................................................................................................................ 8
Infrastructure and interior ............................................................................................................................ 8
The daily routines .......................................................................................................................................... 8
The Laboratory .................................................................................................................................................. 8
Infrastructure and interior ............................................................................................................................ 8
The daily routines .......................................................................................................................................... 8
The Operation Room (OR) ................................................................................................................................. 9
Medical Training ................................................................................................................................................ 9
Appendixes .......................................................................................................... Error! Bookmark not defined.
Appendix I – a view from above .................................................................................................................. 10
Appendix II – currently available medicine at FBH .......................................... Error! Bookmark not defined.
Created by Kim Foss and Stine Toft
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Foya Borma Hospital – a general introduction
July 2012
Introduction
In June 2010 Foya Borma Health Center was upgraded to a hospital, Foya Borma Hospital (FBH). Located in
Foya, Lofa County in the Northern part of Liberia, the hospital has a catchment population of 75.000
persons from Liberia and the bordering countries Sierra Leone and Guinea. FBH has approximately 100 staff
members and 103 beds for admitted patients.
The hospital is divided into the outpatient department (OPD), the in-patient department (IPD), the
operation room (OR) and the emergency room (ER). The IPD is further subdivided into the male and female
ward, the obstetric ward (OB) and the pediatric ward (PEDS). In addition to this, FBH contains a laboratory,
a pharmacy and the two dispensaries and a dressing room. 9 smaller clinics in the area are referring to FBH.
All available treatment at FBH is free of charge. The European Development Fond (EDF) is the main financial
support in the rebuilding of the health care system of Liberia. EDF has selected the International Rescue
Committee (IRC) to carry out this task. Thus the IRC pays the “incitements” (a kind of salary) to the staff and
supplies the hospital with most medical and non-medical items, including most medicine.
The administrative chart of FBH is found below. The church at the top is the Pentecostal Church, that
founded the hospital:
FBH is a hospital in one level located on the top of a hill. Appendix I shows a blueprint of the hospital along
with a list of the different buildings and their usage. See appendix I for an infrastructural overview of the
different wards.
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Foya Borma Hospital – a general introduction
July 2012
The Outpatient Department (OPD)
The OPD is the first line of health service at FBH, and is comparable to a general practitioner. The main
function of the OPD is the screening of patients that come to the hospital. Furthermore the OPD serves as
the community health center with the national vaccination program (EPI) and screening of malnourished
children (community health department).
Infrastructure and interior
The OPD is located in the first building encountered when entering the hospital compound. In the main
area, the OPD houses the waiting patients, the registration room, the vital signs table, the child-screening
area, the vaccination area and the screening rooms. In addition to this, a laboratory, a dispensary, a
dressing room, a counseling room and a room for “continues care” are found in the OPD.
Left: Numbers handed out to the patients at the gate. Middle: The OPD showing the waiting area, the
malnourishment screening area and the EPI. Right: The archive with all the OPD charts.
The daily routines
The OPD is open Monday to Friday 8am to 4pm and Saturday 8am to 12am. Tuesday and Thursday are for
pregnant women and children only while the other days are for everyone.
The screening: At their arrival the patients receive a number from the security guard at the gate. The
numbers are supposedly given out in chronological order after who arrives first. Critical cases are sent
directly to the ER.
The day starts at 8am with the Devotion - prayer, bible reading and sermon. After the Devotion the patients
are sent to the Registration room to fetch their chart registered by their hospital number. A new chart and
hospital number are made for new patients.
Following the registration, the patients go to the vital signs table to have their vital signs taken (blood
pressure, temperature and weight). The vital signs are written in the chart, which are then placed in a stack
ready for screening. Children <5 years have their vital signs, height, weight and middle upper arm
circumference (MUAC)-score taken at the children’s monitoring table.
The screeners call the patients to the screening room one by one according to their number. If any of the
patients have abnormal vital signs, they will be prioritized. In the screening room the screener takes the
history of the patient and does the physical examination. If needed, the patient will be sent to the
laboratory with a sheet of the requested laboratory test. When the test is done, the laboratory writes the
test results on the sheet and the patient carries it back to the screener. The screener diagnoses the patient
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Foya Borma Hospital – a general introduction
July 2012
and, if necessary, admits the patient or prescribes appropriate medicine to take at home. Prescribed
medicine is picked up at the dispensary. All surgical cases are referred to the doctor.
Malnourishment monitoring: All children in the OPD, both those who come for treatment and those who
come for vaccination have their vital signs, weight, height and MUAC-score taken at the children’s
monitoring table. The weight and height are plotted into a curve, which tells the screeners whether the
child is underweight and/or malnourished. The underweight and malnourished children can be enrolled in a
treatment program.
Vaccinations of children and pregnant women also take place in the OPD. The children follow the Liberian
Vaccination Program and receive a certificate whenever all the vaccinations are completed. The Liberian
Government provides all vaccines.
Dressing room: Patients in the OPD (and sometimes from the other wards) with wounds or ulcers are sent
to the dressing room to have their wounds/ulcers cleaned and dressed. Injections, such as tetanus booster
and penicillin, drainage of abscesses and removal of sutures also take place in the dressing room.
Continous care: This room is meant for follow up on patients with chronic diseases.
Counseling Room: Samaritans Purse occupies a room in the OPD. Intentionally their focus should be
counseling on HIV, but to avoid stigmatization they do counseling on various topics. This room is
independently run from the rest of the OPD.
The Inpatient Department (IPD)
The IPD also includes the OB and the PEDS, but since these are run independently, they will be described
separately. Thus the following description of the IPD only covers the male and female ward.
Infrastructure and interior
The IPD consists of the male-, female-, post operative
ward and the annexes. The organizational center of the
IPD is the nurse station.
The male ward is used for all the adult male patients and
the female ward is used for all the adult female patients.
The post operational ward is used for post operative
patients. As the patients improve, they will be moved
into the male or female ward. These wards contain 33
beds in total.
The two annexes are two separate buildings with two rooms each. One room is used for the assistant
medical director’s office, and the rest are used for isolated patients or other patients when there is
shortness of bed. The annexes contain 7 beds in total.
The daily routines
There are two shifts in the IPD, the day shift (8-18) and the night shift (18-8). The staff at the IPD consists of
nurses and nurse aids.
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Foya Borma Hospital – a general introduction
July 2012
A shift is supposed to be passed on with a verbal as well as a written report concerning the status of the
wards. Twice every shift the nurse or nurse aid does the nurse rounds and takes the vital signs of all the
patients on the wards. Most days, the rounds are done by the doctor, a physician assistant (PA) or a nurse.
After the rounds it is the nurse’s responsibility to make sure that the orders from the rounds are carried
out. This could be discharging patients, change medication, order laboratory requests etc. The nurse or
nurse aid is also responsible for serving medication at 6am, 10am, 14pm and 22pm. The medication is
picked up at the IPD dispensary.
When a patient is sent to the laboratory, they carry a laboratory request along. When the laboratory tests
are done, the laboratory staff brings the results back to the nursing station. The nurse or nurse aid attaches
the results to the patient’s chart.
The Pediatric Ward (PEDS)
Infrastructure and interior
The PEDS is located in two neighboring buildings. One of the buildings is shared
with the ER. The ER and the PEDS share both the nursing station and the staff.
The PEDS has 28 beds in total.
The PEDS ward is for children, ages ranging from 6 weeks to 14 years. Each
child is admitted with a caretaker.
In addition, a “private ward” for hospital staff or delicate cases is found in the
PEDS. This is a room with 2 beds. Furthermore the IPD dispensary and the
hospital “library” are located in the nursing station.
The daily routines
The routines are similar to the routines in the IPD, except the fact that the staff also attends to the ER
which often makes this ward very busy. The staff at the PEDS and ER consists of nurses and nurse aids.
The Emergency Room (ER)
Infrastructure and interior
The ER is a single room located in one of the ends of the PEDS’ main
building. The ER contains 3 structures (plank beds). In proximity to
the ER there is an additional entrance gate to ease the access for
the ambulance.
The equipment available in the ER covers the basic needs for
procedures such as establishing an IV line, suturing, dressing
wounds, giving oxygen therapy and taking vital signs.
The daily routines
Patients can either rush to the ER themselves or come referred from the OPD or other health clinics. The
reason of contact involves everything from traffic accidents to severe anemia and malaria.
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Foya Borma Hospital – a general introduction
July 2012
When a patient arrives in the ER, the patient or their caretaker is asked to go to the registration room to
fetch the patient’s chart and new admission papers. Afterwards the nurse takes the vital signs and history,
does the physical examination and makes a plan. The patient is either sent home with medicine or
admitted at one of the wards. In critical cases the assessment is supposed to be initiated immediately.
The Obstetric Ward (OB)
Infrastructure and interior
The OB consists of the prenatal ward, the postpartum ward, the
labor room, the delivery rooms, the nursing station with stock
and the OB office. Beside this, the OB contains the antenatal
care, the family planning and counseling for HIV in pregnancy.
The prenatal ward is for women with complicated pregnancies
and women who live far away. They are offered to spend the
last weeks prior to labor at the hospital. This ward contains 15
beds.
The postpartum ward is for women who recently gave birth. Beside this, ill babies up to the age of 6 weeks
are admitted here. This ward contains 15 beds.
The labor room and the two delivery rooms are located next to each other. These rooms contain 3 labor
beds and 3 delivery beds.
The daily routines
The routines regarding the prenatal and postpartum wards are similar to the routines in the IPD. The staff
at the OB consists of certified midwifes and nurse aids.
Counseling: The OB counsels on HIV in pregnancy and the prevention of mother to child transmission
(WHO’s PMTCT program) and on family planning, which includes prevention methods.
Ante-natal care (ANC): The pregnant women can come for monitoring on a regular basis during their
pregnancy or anytime they feel ill. The ANC takes place every day, but Tuesday and Thursday are by far the
busiest. These mornings the OB staff conducts health education concerning pregnancy while the women
are waiting to have their vital signs taken.
The Pharmacy
The pharmacy is the medical stock of FBH. It provides the two dispensaries in the IPD and the OPD with
medical supplies. IRC has employed staff in the pharmacy to make sure that everything is done according to
IRC guidelines. Sometimes the pharmacy runs out of important drugs, such as malaria medicine or
antibiotics, which therefore can be unavailable for days or weeks. In that case, the patients are referred to
the local drug stores to purchase the needed medication.
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Foya Borma Hospital – a general introduction
July 2012
Infrastructure and interior
The Pharmacy is located in the administrative building next to the non-medical stock. It consists of two
rooms for medicine and medical equipment.
The daily routines
The pharmacy is responsible for keeping track of all medical supplies. They distribute requested medicine
to the two dispensaries once a week or if urgently needed. However, the ARV medicine (for HIV) is
distributed directly to the continuous care room or counseling room. The pharmacy’s opening hours are
8am to 4pm. When the pharmacy is closed, the staff can be called in case of urgent needs.
The Dispensaries
Infrastructure and interior
OPD: The OPD dispensary consists of a single room and is unsurprisingly located in the OPD. Only medicine
that can be administered by the patient is dispensed here (PO, PR, topical etc.).
IPD: The IPD dispensary is located in the nursing station of the PEDS ward. It consists of a single room. In
addition to the medicine found in the OPD dispensary, medicine for hospital administration is also found in
the IPD dispensary (IV, IM etc.). Beside the drugs, this dispensary also has other medical supplies and
single-use equipment used on the wards (needles, syringes, gloves etc.).
The daily routines
OPD: The OPD dispensary has the same opening hours as the OPD. When a patient is prescribed medicine
in the OPD, the pharmacist in the dispensary will dispense the medicine and inform the patient about how
and when to take the medicine. Any injections prescribed in the OPD will be given in the dressing room.
IPD: The medicine for all the admitted patients in the hospital is dispensed in the IPD dispensary. The
dispensed medicine is picked up by the nurses or nurse aids prior to the serving of medicine. When the
wards run out of medical equipment, it can be provided by the IPD dispensary.
The Laboratory
Infrastructure and interior
The laboratory is currently located in the OPD, but will soon be
moved to the old OR. Therefore the infrastructure and interior
will not be described further.
The picture shows the current laboratory.
The daily routines
The laboratory is used by the entire hospital. It is open for OPD patients in the OPD opening hours and for
IPD patients both day and night.
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Foya Borma Hospital – a general introduction
July 2012
Usually the patients go to the laboratory, but if a patient is not able to do so, a laboratory technician goes
to the patient to collect the specimen.
Currently the laboratory can do malaria test (malaria smear and Paracheck), hemoglobin, white blood cell
count, blood grouping, hepatitis B, RPR (syphilis quick test), HIV quick test, sickle cell test (microscopy),
stool analysis (microscopy), urine analysis (microscopy and stix), pregnancy test, vaginal/urethral smear
(microscopy) and skin snip. Additional tests can be done upon request if material is available. Some of the
electrical apparatuses require electricity and therefore only function when the current is on. The
microscope can be used in sunny weather as well. The tests in the laboratory vary a lot and some tests can
be unavailable for longer periods.
The laboratory also collects and tests the blood for blood transfusions.
The Operation Room (OR)
The OR will soon be moved into the new OR building. These
infrastructural changes will lead to changes in the daily routines
too, why no further descriptions follows.
The picture shows the new OR building.
Medical Training
Every Monday morning after devotion there is a general assembly in the palaver hut for the Monday
presentation. The presentations are on various topics, prepared and presented by different staff members.
In addition to the Monday presentations, workshops can be arranged if further elaboration is required on
specific topics.
Left: A PUMUI expat using a whiteboard in the Monday presentation. Middle: Participating staff. Right: The
palaver hut, were the participants are taking notes after the presentation.
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Foya Borma Hospital – a general introduction
July 2012
Appendix I – a view from above
A01
A02
A1
A2
A3
A4
A5
A6
A7
A8
A9
A10
A11
A12
A13
A14
A15
B1
B2
B3
Community Health Department + EPI
Registration and patient line
Screening room 1 and 2
Entrance to screening room 3 and
toilet
Counselling room/Screening room 3
Blood bank
Laboratory
Samaritans Purse Counseling Room
Continuous Care
OPD Dispensary
Dressing room
Medical Director’s Office
Operation Room 1
Operation Room 2
Medical equipment stock
Recovery room
Wardrobe and stock
Male ward
Male ward
Female ward
B4
B5
B6
B7
B8
C1
C2
C3
C4
C5
C6
C7
C8
C9
D1
D2
D3
D4
D5
D6
D7
Female ward
Post-operative ward
Post-operative ward
Nurse station
NSG Director’s Office
Antenatal screening room
OB Counseling room
Delivery room
Labour room
Delivery room
Nurse station + stock
Post-partum ward
OB office
Pre-natal ward
Pharmacy stock
Non-medical stock
Administrative director’s office
Waiting- and copy room
Drug storage room
Non-medical stock
Finance office
E1
E2
E3
E4
E5
E6
E7
E8
F1
F2
F3
F4
F5
F6
F7
G1
G2
H1
H2
I
Emergency room
Nurse station + library
Pediatric ward
Pediatric ward
IPD Dispensary
Pediatric ward
Pediatric ward
Pediatric ward
Facility Managers Office
Private ward
Pediatric room
Office
Pediatric ward
Pediatric ward
Pediatric ward
Assistant Medical Director’s Office
IPD isolation
IPD isolation
IPD isolation
Kitchen for the patients
In blueprint above is an old version from the time of Foya Health Center. Thus, additional buildings that do not appear at the
blueprint exist at the compound. These include the new OR in extension of the B building, a garage and a newly build, unused
canteen.
Created by Kim Foss and Stine Toft
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