Bamako-Banjul Medico-Surgical Initiative: A Prototype South-South Collaboration
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1 Bamako-Banjul Medico-Surgical Initiative: A Prototype South-South Collaboration 3-11 December 2009 MusaTouray MD-PhD FMH Internal Medicine Bijilo Medical Center/Hospital The Gambia West Africa info@gambiahealth.org
2 Preview 1. Healthcare Systems in The Gambia 2. Challenges in Providing Quality Healthcare 3. Bijilo Medical Centre (BMC) 4. Method of Medical Practice at BMC 5. Projects for Development 6. Human Resources Needs 7. Acknowledgements
3 Objectives of The Initiative To facilitate professional exhange between our hospital and various institutions in Mali Build up the capacity of BMC by covering specialised human resources needs (Surgeons, Gynecologists, Laboratory Technicians)
4 The Gambia: Basic Facts Smallest African country 400 km x 85 km English colony until Million inhabitants 85 % Muslims, 10% Christian, 5% Others Mandinka, Wollof, Fulah, Sarahuleh, Jolla, Serere, Manjagoh
5 The Gambia: Healthcare Facilities Medical School established in 2001 Nursing School established in Public Hospitals 25 health Centers 58 Health Posts 3 NGO Health Facilities 3 Private Health facilities 1 Physician Inhabitants
6 The Gambia: Naturally Nice
7 The Gambia: Nice People
8 The Gambia: Peace and Security
9 The Gambia: Cost of Living Housing Transport Food Clothing Medicine Leisure
10 Challenges in Providing Quality Healthcare Family Issues Demotivating Salaries Impaired Professionalism Inadequately Trained Staff Lack of Critical Mass and Reduced Scientific Credibility Poor Access to Information Minimal Resource Setting Socio-Cultural Consideration High Dependency Ratio Poverty and its Consequences Regressive Fatalism Notion of Time
11 Establishment of BMC: `I Have a Dream`
12 Multiple Bureacratic Hurdles
13 BMC: Basic Infrastructure
14 BMC: Facilities 30-Bed-Ward (Female, Male and Paediatric wards) Outpatient-Policlinic Unit X-Ray Unit Clinical Diagnostic Laboratory A Surgical Theatre Prenatal, Maternity, Delivery & Child Healthcare Unit Immunisation-Vaccination Services 24-Hour Mobilisable Ambulance Service
15 BMC: Permanent Staff List 2 Physicians Local Consultants in Surgery and Gynaecology 4 State Registered Nurses 3 Nurse Aids 1 Laboratory Technician 1 Pharmacy Assistant 3 Receptionists 1 Administrator (50%) 3 House Keepers 2 Grounds Men 2 Security Workers
16 Number of Consultations from July 2007 to January 2008 consultations July August September October November December January
17 BMC: Surgical Theater
18 BMC: Female Ward
19 BMC: Method of Medical Practice Evidence Based Clinical Approach Anamnesis Physical Examination List of Problems Paramedical Examinations Diagnosis Treatment
20 Gambia: Common Pathologies Infectious Diseases Malaria Respiratory Infections Gastroenteritis Dermatosis Pelvic Inflam Disease STD (HIV, Siphilis, Gonorhoe, Chlamydia, HBV Neoformations Prostate GI and Liver Metabolic Diseases Hypertension Diabetes Endocrinopathies
21 BMC: Diagnostic Laboratory
22 Diagnostic Tests Presently Available Biochemistry 1. Creatinine, Urea, Uric acid 2. Blood Glucose 3. Elctrolytes (Na, K) 4. Cholesterol 5. LFTs: ALT, AST, Bilirubin, Alkaline Phosphatase 6. Amylase 7. Creatinine kinase 8. Pregnancy test Hematology 1. Hemoglobin 2. White blood Cell Count 3. Blood Film (Malaria) 4. Sickle Cell Test Microbiology 1. Urine stix Serology 1. HIV 1 and 2 2. VDRL
23 Tests Yet to be established Hematology 1. Full Blood Count, 2. INR / Prothrombin Time (PT) 3. ESR 4. Blood Grouping/ Cross matching Microbiology 1. Stool microscopy, 2. Gram staining, 3. blood culture. Biochemistry 1. Calcium, 2. Quantitative PSA, 3. AFP, 4. Ferritin, Endocrine 1. TSH, T3,T4, 2. PRL, LH, Progesterone, Serology 1. HBsAg, Anti HBC
24 16 Months Old Girl: Bronchopneumonia
25 35 Year Old Woman: Metabolic Syndrome
26 51 Year Old Woman: Hepatocarcinoma
27 Congenital Cardiopathy X
28 Polydactyly
29 Ulcers
30 Cutaneous Leishmaniosis?
31 Blind Gambian Woman
32 BMC German Volunteers Staff
33 BMC: Projects For Development Our Objective: Develop BMC into a Centre of Excellence for: Primary Health Care Continuing Training Clinical Research
34 Concrete Steps to Attain Our Objective 1. Ameliorate Diagnostic Facilities 2. Build Up Capacity by Providing Appropriate Training Radio diagnostic: X-Ray and Ultrasonography Minor surgery, Gynaecology and Obstetrics In House training for 5 Nurses Provide funds of ex-house Training of Nurses 3. Develop Research Programmes Relevant to National Healthcare Provision Metabolic syndrome: Prevalence, Mortality, Morbidity, Demography Preventive Community Orientated Activities 4. Promote Effective Communication & Collaboration Between: Healthcare Professionals in The Gambia South-South Collaboration North-South Partnerships
35 BMC: Establishing The X-Ray Unit
36 BMC: Establishing The X-Ray Unit
37 BMC: Establishing The X-Ray Unit
38 BMC: Human Resources Needs Gynecologist General Surgeon Lab Technician Midwife X-ray Tecnician
39 BMC: Routine Gynecology Objective: Promote women`s and children`s health Procedures Gynaecological history taking Gynaecological physical examination (Speculum and ultrasound) Recognition and treatment of frequent gynaecological infections Treatment of dysmenorrhoea Preliminary investigations in case of infertility Antenatal clinic Delivery room organisation and management D and C in minimal resource condition (surgical theater present) Oversee Child vaccination scheme
40 Surgical Proceedures to be Set Up Gynecology Caesarian Episiotomies Myomectomy Hysterectomy Dilatation and Curettage Diagnostic and therapeutic laparatomy General Surgery Inguinal Hernia repair Umbilical Hernia repair Lipomectomy Appendectomy
41 Conclusion South-South Collaboration Together we stand, divided we Fall.
42 Acknowledgments 1. Medical School, University of Lausanne, Switzerland 2. Dr. Noumou Sidibe, Cardiology Consultant, Gabriel Toure Public Hospital, Bamako, Mali 3. Family Toure, Lafiabougou, Bamako 4. Dr Fanta Kaba, House Officer, Gabriel Toure Public Hospital 5. BMC Dream Team
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