2.
HOSPITAL ACTIVITIES
2.1
CURATIVE SERVICES
2.1.1
Outpatient
Department (OPD)
In 2002 there were 39911 attendances
making an increase of 10% compared to the year 2001. The average OPD attendances per day was 109. The increase in OPD attendances in the year
2002 is due to the increased cases of malaria in all age groups. Poverty also contributed significantly to
the increased attendance because people could not afford to seek medical
services from the private health facilities.
The top ten causes of OPD attendances were Malaria, Dental caries, Acute respiratory infections, Urinary tract infections, Pneumonia, diarrhoeal diseases, Conjunctivitis, Diabetes, Intestinal worms, and Hypertension. The Outpatient Department was open from Monday to Sunday to cater for ordinary cases and emergencies as well. There was always a doctor to cater for emergencies after working hours and weekends.
At OPD patients were either seen by clinical officers or doctors depending on the condition and patient’s grade. The problem of self-referrals was still there.
(See appendices VI, VIIA, VIIB for OPD attendances)
2.1.2
Inpatient
Department
The Hospital has 200 registered
beds. In 2002 the bed occupancy was
100%. A total of 9873 patients were
admitted with an average hospital stay of 8 days. Like OPD attendances there was an increase of the number of
patients admitted. The hospital death
rate was 5.6% being a decrease of 0.4% compared to the year 2001. Malaria was the leading cause of deaths
accounting for 23% of all deaths.
Ward rounds were done three days a
week (Monday, Wednesday, and Friday).
One doctor was always available to handle emergency cases after working
hours.
The nursing care was done by nurses
of different cadres. We allowed
relatives of very ill patients to stay in the wards to help our nurses to look
after them.
Like the year 2001, we received many patients with
meningitis (122), 55% died.
(See
appendices VII, VIII & IX for inpatients statistics)
2.1.3
Obstetrical
Services
The maternity ward has a total of 36 beds and 6 delivery beds. It is equipped with facilities for doing vacuum extraction, incubators for premature babies, ultrasound machine, suction machines, oxygen concentrators etc.
In 2002 we had a total of 2037 deliveries being a increase of 73.5% compared to the year 2001. Like previous years many deliveries were conducted at home by the traditional birth attendants. At the hospital deliveries were conducted by qualified nurse midwives/officers and doctors.
The caesarean section rate was 21% being an increase of 2% compared to the year 2001. Late referrals of mothers who are in labour continued to be observed in the year 2002. This contributed markedly to the lower Apgar scores and subsequent brain damage. There were 24 maternal deaths caused by factors shown in appendix XII
Continued Medical Education was done to nurses working in the
maternity ward.More emphasis was put on the use of partogragh.
2.1.4
Surgical Operations
In 2002 we performed a total of 398
major and 1068 minor operations.
Caesarean section accounted for 51.5 % of all major operation
performed. Generally there was
adecrease of 19% for major operations done compared to the year 2001. Cold cases were done on Tuesdays and Thursdays. Other days were for ward rounds and
emergency operations.
We still use the OMV and EMO. Ether and Halothane are the main general anaesthetic drugs used. Oxygen concentrator machines are used for the provision of oxygen.
We have experienced anaesthetic nurses who were able to administer anaesthesia to patients with different conditions.
All post-operative patients were admitted to the surgical ward except for obstetrical cases who were admitted in the maternity ward.
(See appendix XIII for operations done)
2.1.5
Dental Unit
In 2002 the Unit
attended 3278 patients being an increase of 7% compared to the year 2001. Dental caries accounted for 79% of all
diagnoses made. The Unit has 2 doctors;
Dental Surgeon and Assistant Dental Officer.
The campaigns against the practice of extracting the so called ‘plastic teeth’ bore some fruits. The number of people practising it has come down after taking some legal action against the culprits. The hospital is doing everything possible to equip the dental unit to the basic standard.
(See appendix XIV ‑ Dental Unit statistics).
2.1.6
Tuberculosis and
Leprosy
The National Tuberculosis and Leprosy treatment
protocols were adhered to. The Regional
and District TB and Leprosy co-ordinators conducted regular supervisions. The DTLC office is located within the
hospital premises. In 2002 we had 179
new TB cases and 3 relapses. The number
of new cases was equal to the year 2001.
No patients with Leprosy were seen.
(See appendix XV)
2.1.7
Ophthalmology
Eye services were carried out on static and outreach basis. The number of patients attended increased significantly. However many people in the villages are not aware of the existence of this service at Nyakahanga Hospital. The Department is planning to conduct awareness campaigns in the near future.
(See appendix XXIII for services offered in the year 2002)
2.1.8
Psychiatry
DIAGNOSIS
|
OPD
|
INPATIENTS
|
||
|
< 5 YEARS |
+ 5 YEARS |
< 5 YEARS |
+ 5 YEARS |
|
|
PSYCHOSES |
0 |
18 |
0 |
0 |
|
NEUROSES |
0 |
74 |
1 |
1 |
|
EPILEPSY |
3 |
51 |
2 |
0 |
Patients care was done by general duty doctors and nursing officers
trained in psychiatric nursing.
2.2
PRIMARY HEALTH CARE
A five year Primary Health Care
Programme funded by DANIDA through DMCDD started in September 2001. The
programme objective is to strengthen PHC services within Nyakahnga Hospital
Catchment area . It entails deliberate
effort towards extension of the hospital services beyond the hospital compound
to address the root cause in collaboration with the stake holders with ultimate
goal of community empowerment and sustainability of the health services.
The PHC activities were carried out
in three Wards namely; Nyakahanga, Bugene and Ihanda. A total of ten villages were served namely: Nyakahanga, Bugene,
Ihanda, Rukole, Chonyonyo, Kishao, Bujuruga, Omurusimbi, Bisheshe and Kashanda.
Activities, preventive and promotive services carried out were;
· HIV/AIDS Control
· Immunization
· Antenatal service
· Family planning
· School health education
· Weight monitoring for children up to the age of 5 years
· Village health committees seminars
· Eye care outreach services
· Dental care outreach services
· Traditional birth attendants training
· Water and sanitation
· Essential drugs programme
PHC activities were carried out on both static and outreach basis. Villages served at Nyakahanga MCH clinic were – Nyakahanga, Bugene, Kishao, Omurushaka and Ihanda. Villages served on outreach basis were; Kashanda, Chonyonyo, Bisheshe, Bujuruga, Cherunga, Omurusimbi and Rukole.
(There is a detailed separate report on PHC activities)
2.2.1
HIV/AIDS Control
HIV/AIDS Control activities were carried out by the
ELCT AIDS CONTROL PROJECT. Activities
done were; Counseling, Health education, HIV Screening, support to HIV/AIDS
victims, counseling services were also extended to people coming for blood
donation.
Basing on blood donors at Nyakahanga Hospital the HIV seropositivity is increasing. HIV seropositivity among blood donors for the past 5 years is as follows
YEAR
|
TOTAL DONORS |
HIV POSITIVE |
HIV NEGATIVE |
PERCENTAGE +VE |
|
1998 |
3034 |
521 |
2503 |
17.2% |
|
1999 |
948 |
174 |
774 |
18.4% |
|
2000 |
939 |
194 |
745 |
20.6% |
|
2001 |
1216 |
208 |
1007 |
17.1% |
|
2002 |
871 |
184 |
687 |
21.1% |
2.2.2
Immunization
MCH Clinic carried out the Immunization programme
according to the national policy. Vaccines given were BCG, Polio, DPT, Measles and Tetanus
Toxoid. The unit participated very well
in the National Immunization campaigns.
(See appendix XVIII for vaccinations statistics).
2.2.3
Antenatal Service
Antenatal services were carried out as planned. Many pregnant mothers started to attend after the 20th week of pregnancy. (See appendix XIX)
2.2.4
Family planning
A wide range of contraception methods were
offered. The number of women who came
for surgical contraception (BTL) was 323 being an increase of 90% compared to
the year 2001. However many clients
opted for injectables.
(See appendix XVII)
2.2.5
School Health
Programme
School health programme was conducted in 20 primary
schools within the Nyakahanga PHC catchment area.
(Detailed report under PHC programme)
2.3
SUPPORTIVE SERVICES
2.3.1
Laboratory
In 2002 a total of 83824 tests were done being an increase of 2% compared to the year 2001. Blood slides accounted for 25% of total tests done. We were able to perform most of the basic laboratory tests. We experienced occasional shortages of some reagents e.g. for testing SGOT, SGPT, Na+, K+ and Cl-.
The laboratory staff consisted of one laboratory Technologist, two laboratory assistants and 6 laboratory attendants. We were also privileged to be visited by Laboratory Specialists from AMREF Nairobi Kenya. Their inputs helped very much to improve the quality of service.
(See appendix XX for laboratory tests done).
2.3.2
X-ray Department
The department was ran by one Radiographer and 2
radiographic assistants. The old X-ray
machine we have (> 30 years) had some minor breakdowns.
X-rays examinations done were 1796 being an increase of 47% compared to the year 2001. Chest x-rays taken accounted for 47% of total x-rays examinations done.
Ultrasound examinations done were 1411.
(See appendix XXI- for rays taken)
2.3.3
Pharmacy
The hospital
pharmacy staff consisted of one Pharmaceutical Technician, two Pharmaceutical
Assistant and four other medical attendants.
The main source of drugs and medical supplies was The Zonal Medical
Stores (MSD). Other sources were
private pharmacies and some donations.
The main problem we faced was on and off out of stocks at MSD. The capitalization of hospital pharmacies improved the availability of drugs and other medical supplies.
The drug revolving fund project continued very well.
The infusion making plant continued to operate normally. We produced different types of intravenous fluids; Normal Saline, 5% Dextrose, Dextrose/ Saline, Blood Bottles, Ringer lactate and Water for injection. We acquired a new autoclave for the infusion unit. (See appendix XXII)
2.3.4
Technical
Department
The department
dealt with all technical matters including medical equipment, plumbing,
carpentry, electricity, motor vehicle mechanics and plant mechanics.
The department still lacks a trained hospital technician. Occasionally we had to hire technicians from outside the hospital to repair our equipment.
2.3.5
Domestic Department
2.3.5.1
Catering Services
The hospital provided food to all inpatients. The World Food Programme (WFP) continued to support the hospital. Patients got 3 meals per day.
We used firewood and charcoal for preparing food. We haven’t started using electric cookers.
2.3.5.2
Laundry Services
Laundry attendants carried out the service. They used electric operated machine. Water supply was adequate, so was electricity.
2.3.5.3
Estate Services
Staff tried their best to keep the hospital compound clean and attractive. Flowers and trees were planted in the hospital compound.
2.3.5.4
Water supply
Water supply to the hospital compound and staff houses was steady. We had no machine/pump breakdowns to impair water supply. The hospital has big water tanks for harvesting rain water amounting to 870,000 litres.
2.3.6
Medical Records
Department
Patients’ records are kept at OPD. We still use a manual way of keeping
patients’ records. However we have
started to computerize some of the patients statistics. The department was strengthened by the
newly trained Health Records Technician who graduated from KCMC.
3.
SPIRITUAL SERVICES
The department is headed by the
Hospital Evangelist who is responsible for providing spiritual care to the
patients and staff. He also works in
collaboration with the Parish Pastors.
Daily morning devotions for hospital staff were conducted as usual. Almost all hospital staff participated fully.
Counseling services were also offered to the patients, their relatives and hospital staff. The hospital has 3 employees trained in clinical-pastoral education at Bugando Medical Centre.