Good Shepherd Hospital blog

Hey Iam looking for a former friend that works at the Good Sheppard Hospital in (Administration) off of Rt.22 in Illinois,Barrington? Her madien name was Julie MacIntosh and she grew up in Wauconda, Il. Any info to find her would be great, please respond to my e-mail at wheresmycircle@yahoo.com Thanks, ConnieKnutsen

Sphere: Related Content

Scaling up HIV Testing and Counselling in Lubombo - Claypotts Fund

Second Quarter Report May- July 2008

Clockwise form top left

- OPD at Good Shepherd Hospital

- TB HIV patient in Male medical ward Dec 07

- ART roll out day at Mpolonjeni (rural clinic)

1. Summary. 2

3. Report on HTC Clinics. 4

4. Progress against Targets. 6

5. TB HIV - Cough screening. 6

6. Finances. 7

7. Third Quarter Projections. 8

1. Summary

The HIV testing and counseling program is going extremely well. The hiccoughs of the first quarter have been rectified. Both teams are busy counseling, testing and taking bloods both in the hospital and all over Lubombo.

The Swaziland Demographic Health Survey (graph 1) demonstrated that less men than women were aware of their status and had had a recent HIV test.  This was also the case for people in rural areas compared to people in urban areas. As the team has scaled up the testing we have also started to look at targeting both men and rural areas.  The way the programme is set up already does help those living in rural areas by taking the team out to the rural clinics.

Patient “TD” “my husband and I had always wanted to know our HIV status, but HTC is not done here at our clinic. Then I heard from my neighbour that you were coming here and we decided we could not miss this one for the world. Now we have tested and we know our stand as far as HIV is concerned. Thank you so much”

Figure 1 Percentage of population aged 15-45 receiving results of HIV test in the past 12 months (DHS 2007)

2. Report on HTC in the Hospital

Team: Sifiso Magagula -                     Counsellor, tester

Tenele Ngamphala -                 phlebotomist

2.2 Wards

Throughout March and April nurses at Good Shepherd were trained in HIV testing and counselling.  There are now 85% trained - up from 47% in January 2008.

Male Ward Pilot

Before the HTC programme was rolled out across the hospital, a pilot was done on the male medical ward so we could assess the impact of the intervention.

The outcome of this pilot was that after the intervention many more men were tested for HIV, approximately 3 times as many and this was a significant difference.

Details

The assessment of the baseline data  (all patients admitted to male ward January 2007) indicated that 16.34 % of patients had a recorded HIV test in the 3 months prior to admission or during admission. 6% of these were during admission. The assessment of the pilot on Male showed there had been a 6 fold increase in testing with 48% percentage knowing their status by discharge. This included people with a range of diagnosis including broken legs, burns and malaria in line with current HTC guidelines to offer to all patients an HIV test not only those with diagnosis consistent with HIV.

	Baseline	Pilot	Test of difference	CI
Number of patients	104	62
Age ( mean, range)	37.2	39.4
No. known HIV status	17 (16.34%)	30 (48.39%)	OR 3.05 Chi squared 11.08
Number with test during admission	6 (3.85%)	13 (20.97%)		(1.48-6.31) P=0.00087

(95% CI, power 80%, to detect a change from 17-40% testing a baseline number of 98 patients were needed and 49 in the pilot - stat calc, from 17 to 37% would need 124 to 62).

Following these results the programme was rolled out to other wards including peadiatric ward and female medical.

The nurses were interviewed regularly to assess the impact on their workload which they all feared.  This did not materialize as the numbers tested were equivalent to less than one patient per nurse per week.  What seemed important was the increased awareness of the staff and their confidence to do the counseling.

Next Steps:

The staff members were under the impression that ‘everyone’ was now being tested however, this is not the case from our data collection.  There are still another four or five patients a week that should at least be counseled (only a couple of patients were reported as being counselled but not tested). Although this would be equivalent to each member of staff testing up to one more patient a week again this should not impact too greatly on the work load.

Some of these patients had complications as far as counseling and testing were concerned - they were only 13 years old, were bed bound etc but each of these should be discussed with one of the professional HTC team ( nurse or counsellor) who support the nurses on the wards to ensure all patients are offered testing.

In theory throughout the next quarter all the three wards not yet carrying HTC - female, peadiatric and Ophthalmology should have started to do it.

2.3 HIV testing in the hospital, OPD patients

Every morning all OPD patients now receive group counseling on HIV.  Three days a week this is done by Sifiso and the other days it is done by one of the OPD nurses which retains ownership of HTC by the OPD nurses without overburdening.  This is going well.  In addition they have started to specifically mention the need for men to be tested. Following this counseling they are invited to come to Sifiso for testing. Sifiso has now tested 264 people (102 males and 122 females). 139 tested positive for HIV (73 females, 66 males). and 85 were negative.

Month	Number of tests	Number Men tested	Number Women Tested	Total number positive	Total number negative	Number positive men	Number positive Women	Average age
May	64	30	34	43	21	19	24	34.5
June	58	30	28	38	20	18	20	37.1
July	102	42	60	58	44	29	29	37.6

Next Steps:

We are in the process of collecting how many of these patients are being tested by the VCT team to check that the introduction of Sifiso has meant a true increase in testing not just testing the patients which were otherwise being tested by the VCT team. We are also looking at the number of people coming through OPD to assess how many have had an HIV test before they arrive at OPD and what percentage have an HIV test during their time at OPD. This should be available by the next quarterly report.

Figure 2 - Results of  people tested 2nd quarter by age group

3. Report on HTC Clinics

Team: Steven Lukhele - driver , phlebotomist, assistant counsellor

Tivelele Sigwane-  HIV counsellor, Pre ART counsellor, phlebotomist

The HTC clinic programme was started on May 1^st 2008.  In the first weeks all those clinics that already had a strong link with Good Shepherd Hospital were visited. From the initial 14 clinics visited some felt they already had an adequate service and transport system.  From these 7 were identified to receive fortnightly visits.

In June the rest of the clinics in Lubombo could be visited and offered the service all the other  8 visited were keen to take up the service and these visits were started toward the end of June 2008 and continue into July.

All rural clinics in Lubombo have now been offered the services of this HTC programme - including counseling, phlebotomy and more frequent transportation of samples - bloods, sputum and dried blood spot.

Figure 3- Number of clinics being served by the HTC programme

Of course, merely visiting a clinic does not mean that patients are being tested and that the goal of testing more people in Lubombo is being achieved.

From the graphs below we can see

1. That the HTC have increased the number of tests they are doing in May and June
2. That the overall number of people being tested at the clinics being served has increased by 26% from the baseline.(29% May and 24% June).

Figure 4 - Number of people tested by the clinic HTC team

Figure 5 - Overall number of people being tested for HIV by the HTC team including both those tested by the clinics and by the HTC team

The slight decrease from 293 people (May) to 282 people (June) despite an increase of 37 tested by the HTC team is due to the clinics doing slightly less tests (196 as oppose to 227) this could just be a chance or one off finding. This will need to be monitored as our service is meant to be an additional service and cannot replace the routine testing done by the nurses.

Patient “A”

“I tested HIV positive  2 years ago. I never got the chance to do my CD4 count, because I do not have money to travel to GSH for the test. Thanks to the HTC roll out programme now I can have my CD4 count test done here at the local clinic”

4. Progress against Targets

Targets

1. To train 80% of nurses in GSH in HTC by July 2008  Achieved
2. To recruit phlebotomy support for both the hospital and clinics to aid increased taking of blood in the first quarter of 2008 Achieved
3. To increase the number of people tested for HIV at GSH from 10% in 2007

to

1. • >25% of  by the end of 2008 Achieved on ward. Need to recheck VCT data in OPD

• > 50% by end of 2009
• >70% by the end of 2010
• aiming for 90% of those arriving at OPD to have test or know status by 2011

4.      To increase the number of people tested at community clinics (more details on this when data has been collected and analysed) Has been increased - need to monitor that this continues

5. TB HIV - TB screening

Each year people living with HIV and AIDS ( PLWHA) have a 1 in 10 chance of developing TB. Half of the people infected with HIV will die of TB.  TB is treatable but it is often picked up too late.  For this reason all people being testing positive for TB are being asked about symtoms of TB.  This ‘symptomatic screening’ has been shown to be highly effective in Botswana where it has been used throughout the country.  It has also been shown to be effective in other parts of Africa on a smaller scale in picking up cases earlier aswell as educating patients about the risk of this common disease.  Swaziland has the highest rate of TB in the world. All the counselors have been trained on TB and TB screening and Tivelele and Stephen now routinely record the TB screen on all people who test positive.  They then collect sputums from the patients who ‘screen positive’.  To recognize the extra work that this involves and as other staff ( who receive government wages) receive ‘lunch allowance’ when they are away from the hospital they have been awarded E15 daily ( about £1) from the COMDIS fund which is supporting the TB HIV initiatives in the clinics. This will be evaluated later in the year.

6. Finances

A Review in July of the work being carried out by the team and comparison of wages of similar qualified practitioners in other parts of the country suggested that rather than employ two more people we would slightly increase the basic wage.  This is also because one of the original employed people, who never took on the role, was going to be doing all the administration.  This has meant that Tivelele, Steven and Sifiso have had to do administrative work, including data entry, and have each contributed to the analysis and writing of this report.  This is beyond their original job description but they are each working hard and have been keen to do this. Therefore there has been an increase of E100 for Steven (the hospital drivers earn E2800, so despite having the extended skills and role of phlebotomist and counsellor he is still earning less than them) and E500 for Sifiso to bring him more into line with the other counselors.  He acts well in all his roles and is well liked by the patients.

This still keeps us well within the agreed budget whist still achieving the targets and will give room for leeway as the programme develops and needs are reassessed.

6. 1.Wages - ongoing with adjustments

Job title	Name	wage	TOTAL
Phlebotomist 1	Tenele Ngamphala	E2400	E2400×3 E7200
Driver phlebotomist	Steven Lukhele	E2400 (E2300 May, june)	E2400 + 4600 =E7000
HTC counselor, phlebotomist key  link with clinics	Tivelele Sigwane	E2500	E2500 +5000 E7770
Group Counsellor OPD/TB etc	Sfiso Magagula	E2200 (E1700 May, June)	E2200 +3400 =E5600
			E27570

6.2.Travel/lunch allowance for July

(This is to be paid for by the COMDIS ( not Claypotts) fund to reflect the work that they are doing  screening for TB)

For Tivelele Sigwane   18 days out @ E15 a day          E 270

Steven Lukhele             19 days out @ E15 a day         E 285

Sfiso Magagula             1 day out @   E15                    E 15

6.3.Training

From Mr Dlamini for phlebotomy - for Tivelele and Steven

E350  x2 x 2 = E 1400

Total for second  quarter 2008 (1^st April- 31^st July 2008) from Claypotts is:

E27570 +1400 = E28,970

7. Third Quarter Projections

Training - It is proposed that Steven will be sent on the official HTC counslling course that Tivelele and Sifiso has been on. In addition Sifiso and Steven have attended Pre ART training ( Tivelele was already a Pre ART counselor).

Unfortunately approximately 20% of the general hospital staff have left the hospital and so the high level of training of HTC that had been achieved ( 85%) will have to be reassessed when the new staff are in place. Many of these will hopefully have been trained already, but if may be necessary to hold some specific sessions.

Wages - it is not proposed to change the wages or take on further staff in the third quarter, this will be reassed in the further quarter

OPD - the results of s study done by a British MSc student should be available by October allowing further analysis of the situation in OPD and making practical suggestions of what may be done to increase the testing there if a further increase si needed

Wards - continued encouragement to the wards to ensure that HTC takes place on all wards.

Gender Issues - to continue to monitor the distribution of males and females being tested and to continue to develpp methods of engaging more men in testing.

CD4s - to monitor the number of CD4s being collected and do a retrospective comparison of the CD4s that were not collected previously. A mobile phone has been allocated to the team, to work with the hospital adherence officers (who also do home visits) in order to contact people who do not return to collect results.  In the past there has been a large number but anecdotally this number has dropped by the current system of bringing results back to the clinics.

Sphere: Related Content

The year was full of challenges. At the end of 2006 Dr. Aby Philip left Good Shepherd Hospital to return to India. The Administrator, Mrs. Dumisile Simelane, took him to his Majesty King Mswati to bid farewell. The King thanked Dr Philip for his service to Swaziland and the Swazi people. Dr Philip had been awarded the King’s Medal of honour some years back for his service to the Kingdom. He had been with us since 1982 and knew people from all walks of life and has given most of his life to the service of Good Shepherd. His wisdom and commitment will be missed by all. He had an extraordinary way of keeping in touch with everything that went on in the hospital and was loved and respected by all. Dr. Petros Hailliemarie, a Specialist surgeon from Eritrea, took over the position as Chief Medical Officer. Although Dr. Petros has already been with us for over two years he was hard pressed keeping up with his duty as surgeon as well as the duties of the running of the Hospital. We relieved him of some of the pressure by recruiting Dr, Tefere, also from Eritrea, who took over some of the Surgery taking the load off Dr. Petros His is now in a much better position to handle the administrative work. The Good Shepherd Hospital, as the Regional Hospital for Lubombo region has not lost its reputation as one of the best hospitals in Swaziland. Patients come to us from all the other regions in the Kingdom. They flock to us because of the competence of our doctors and our ability to supply the patients with drugs, even if it be at the expense of extending our finances to purchase the drugs.

We have been joined by Dr. Gladje, an Ear Nose and Throat Specialist, from India, who has brought much of his Equipment with him. His wife, Dr Asha, has also joined the staff, and being a lady doctor, has already earned the respect of women from many parts of Swaziland who especially come to see her. We also have on our team, Dr Kalungero, a Specialist Physician, from the Republic of Congo. He has his wife, Valerie with him who has joined the Home Based Care Nursing Staff. It is a good thing in a small community like ours to have one’s partner with one, as Siteki is a little isolated. Dr Joyce Maserewa, left us to serve in the Paediatrics Section of an Mbabane Hospital, we are grateful for all the she did for the Children at Good Shepherd. Her position has been taken over by Dr. Hailu who is now in charge of Paediatrics. We are very proud of our Children’s Ward that provides such a nice area for the children as compared to the cramped conditions that we were operating under in years gone by. I wish to thank our Eye Department, headed by Dr. Jonathan Pons and his very capable team. He is the only Ophthalmologist in Swaziland, and is sponsored by the Christian Blind Mission (CBM) in conjunction with the Good Shepherd Hospital. They provide an excellent service and have patients from as far as South Africa and Mozambique.

Our Home Based Care Team goes out to the communities and visits different homesteads on a daily basis. They carry Drugs and Food parcels which are distributed to the needy.

Without the help of so many donors and interested caring people the hospital would not function as it does. Thanks to Jon and Amy Berman and the Remote Area Medical also to Kathleen Hartman, they provide sponsorship and payment of food parcels distributed by the Home Based Care Team. The Catholic Medical Mission also sponsor Staff and ARV Drugs used in the Mother to Child HIV prevention program.

Thanks to Ron Rousse now replaced by Julie and our own staff who go out daily.

Many people work in the background and go unnoticed but without their help we would not be able to serve the community as we do.

Dr. David & Catherine Wakely kept our Web Site active for many years. This is now taken over by my son, Malcolm and can be viewed at www.goodshepherdhosp.org

We have a steady flow of Medical Students who learn of us through the internet. Our interaction with our fellow human beings from different countries has a very positive influence on our lives. Many friends who are made at the hospital remain friends for years.

We are very grateful for container of medical equipment from donated to us by the Carnival Group UK from one of their passenger ships. S/N Jane Bates personally accompanied to crates that were delivered to the hospital. We also received an X-ray machine from the P & O Lines through Dr. Schramm coordinated by Dr. Jonathan Pons. We appreciate the interest shown by Leeds University and the research and help that they provide to the hospital. They provide backing for projects and work together with our staff in helping in the community. I am encouraged by the ongoing activity at the hospital. Unfortunately I am bound to miss out thanking a lot of people. If I have done so please forgive me.

I also need to say that we are grateful to His Majesties’ Government who through the Ministry of Health, who provide us with the largest portion of our operating budget, without their subvention we could not operate. We have recently received an Ambulance, sponsored by Nerche. We had been without an Ambulance for many years and have been transporting patients in an ordinary van. This was most unsatisfactory.

.

My thanks to our Lord Bishop, Louis Ncamisa Ndlovu, of the Catholic Diocese of Manzini, who is the Head of the hospital, and my fellow board members for all their help and support and also to our Hospital Administrator, Mrs. Dumisile Simelane, and Thulie Dlamini, Board Member and Consultant who I have worked so closely with in steering the hospital through the problems that we have encountered in the past year.

I am pleased to be part of a team that does so much to providing Health Care to the people of this region.

Graham Duke

Chairman of the Board

Sphere: Related Content

We are very grateful for container of medical equipment from donated to us by the Carnival Group UK from one of their passenger ships. S/N Jane Bates personally accompanied to crates that were delivered to the hospital. We also received an X-ray machine from the P & O Lines through Dr. Schramm coordinated by Dr. Jonathan Pons.

Sphere: Related Content

Hi all

The site is fixed again and the link that was down is up again.

Malcolm

Hi All

I have just noticed that some how your of the pages from the site have been dropped. Every thing will be up and running in the next 24 hours

Thanks

Webmaster

Sphere: Related Content

Dear Friends

This has been a year of consolidation of the clinical service: Numbers of cataract surgeries are unchanged, but we offer a broader service than before. 459 people had free/subsidised surgery thanks partly to a LCIF grant! CBMI continues to offer excellent financial, professional and logistical support. The Good Shepherd Hospital is a stable foundation on which the service is based. This makes it possible to offer a comprehensive eye service.

Happenings……. We opened a new clinic and eye theatre in Manzini: A partnership with a private clinic where our poor patients can have surgery…………. 2 weeks of Vitreo-Retinal Surgery experience at Moorfields hospital in London (with Dr Gregor) was truly inspiring and I learned so much that it took weeks to digest. My diagnosis and management of retinal conditions has improved! We need a Vitrectomy machine for Swaziland to continue this service…… Dr Lavy, Paed Ophthalmologist, and Dr Shlugman, Anaesthetist, from the UK did several children’s surgeries with me in November. This is now an annual event and many children have been helped with vision………A week at Moshi, Tanzania, discussing training of eye surgeons was a pleasure: My role in Southern Africa as a cataract surgery trainer may increase due to RSA training sites being closed to African doctors………. I enjoy teaching and have taken in Medical Students from UK, Hong Kong, Ireland, RSA and USA this year………. I still run SLUDG: Swaziland Lowveld Doctors Group, the only journal club in Swaziland……Sadly, Dr David Tyers, the UK doctor who helped me with the management of the project had to return to the UK. Picking up from where he left off has been a challenge. However, with much hard work and the help of Mr Duke, the administration is in a better state than it has ever been.

“Feed My People”: Since 2005, when we began a feeding scheme based in the eye service, we have provided food parcels for people just commenced on Anti RetroViral drugs (HIV meds): The Home Based Care team distributes these, enough food for a family for a week. This is made possible by the Berman family and Remote Area Medical fund in the US. The fund also paid for a nutritional assistant to malnourished children.

Research is well underway: Looking into the possible connection between restoring vision through cataract surgery, and the benefits to orphan care. Preliminary data shows that 80% of elderly in Swaziland have an orphan living in their home!

Difficulties:

• I am still the only Eye Surgeon in the country, making for difficult times when I leave the country for more than a week at a time. There are very long queues and clinics. The Government has not yet appointed an Ophthalmologist: Apparently due to lack of accommodation for him/her.
• Cataract numbers are not increasing much due to the slow pace of Case finding. Swazi’s live in dispersed homesteads in rough terrain, where buses, bicycles or other cheap transport cannot reach. With only 2 case finders and the rise in fuel price, we are prevented from doing more.

Please convey the thanks from our patients and staff for your part in all these successes! May God truly bless you as you have sowed living resources into the lives of so many struggling people in Swaziland!

Kind regards

Dr Jonathan Pons and Eye team

 

Outpatients seen:10 672, Cataract Surgeries:772, Other Surgeries:405, Spectacles Distributed:729

 

 

 

 

 

 

Sphere: Related Content

Hi all i have just updated the site and the blog all seems to be running well

Malcolm

Hi there and welcome to Good shepherd Hospital blog

please feel free to blog about anything to do with experences to do with Swaziland, travel or anything to do with Medical infomation or related subjects!

Sphere: Related Content