ANNUAL REPORT 2015 Kiunga Hospital
2 ANNUAL REPORT 2015 Contents Acronyms and Abbreviations 3 Foreword 4 Executive Summary 5 Kiunga Hospital 7 The Community 8 2015 Overview of Progress 10 Administration 11 Human Resources 12 Training and Development 14 Health Information 15 Operational Review 16 Primary Health Care Services 16 General Outpatient Department and A&E 16 Tuberculosis Clinic 17 Maternal and Child Health Clinic 17 Sexually Transmitted Infections Clinic 19 Clinical Services 21 General Ward 21 Obstetrics and Gynaecology Ward 21 Operating Theatre and Surgical Ward 22 Tuberculosis Ward and Isolation Ward 22 Paramedical Services 23 Laboratory and Biomedical Engineering 23 Medical Imagery 23 Dispensary 23 Rehabilitation 24 Support Services 25 Housekeeping Services 25 Maintenance 25 Mortuary Services 25 2016 and Beyond 26 Contact Us 27
KIUNGA HOSPITAL 3 Acronyms & Abbreviations A&E ANC BSP CBRO CHW CMCA CMSFHP DHIO GOPD HEO JICA MCH NDoH NF NFHSDP NHIS NO OIC OTDF OTML PNG PPP STI TB WFA Accident and Emergency Antenatal Care Bank South Pacific Community Based Rehabilitation Officer Community Health Worker Community Mine Continuation Agreement CMCA Middle South Fly Health Program District Health Information Officer General Outpatient Department Health Extension Officer Japan International Cooperation Agency Maternal and Child Health National Department of Health North Fly North Fly Health Services Development Program National Health Information System Nursing Officer Officer in Charge Ok Tedi Development Foundation Ok Tedi Mining Limited Papua New Guinea Public Private Partnership Sexually Transmitted Infection Tuberculosis Weight For Age
4 ANNUAL REPORT 2015 Foreword Kiunga Hospital is a district hospital that continues to improve the health services available to the communities of Kiunga and surrounding villages. Support has been provided by our colleagues and counterparts in health services, corporate services and the community. This support has assisted the hospital in making significant improvements to infrastructure and the equipment used in the hospital, and subsequently the quality of services provided. As the communities we serve continue to grow, so does demand for services from the hospital. The General Outpatient Department experienced a 20% increase in presentations in 2015, compared to 2014. The dry weather event experienced in 2015 also influenced demand for services: outpatient presentations increased from 90 to 200 during October, and presentations of diarrhoea increased substantially between September and November, which suggested an association with the effects of the dry weather event. I was pleased to observe several infrastructure improvements at the hospital over the year, including renovations in the General Ward and TB Ward, and several donations of equipment. Hospital staff were able to attend professional development trainings, and the hospital welcomed a number of student and volunteer placements from national and international institutions. As mentioned above, achievements such as those listed and many others would not have been possible without our major supporters and partners. Ok Tedi Mining Limited, through the North Fly Health Services Development Program, contributes funding and in-kind support to supplement government services. This funding has enabled continued recruitment of three medical officers and an anaesthetist, and ongoing engagement with the Hospital Administrator. Without all of this support, as well as that from other local health and business organisations, we would not have been able to achieve as many improvements as detailed in this report. I am proud to see the continued improvements being made at Kiunga Hospital for the good of the patients who use it and I would like to congratulate all staff at the hospital for the services they provide and encourage them to continue to improve those services. I encourage everyone to read the 2015 Kiunga Hospital Report. Dume Wo o Acting North Fly District Chief Executive Officer
KIUNGA HOSPITAL 5 Executive Summary I am pleased to present the 2015 Kiunga Hospital Report on behalf of North Fly District Management and staff of Kiunga Hospital. This report provides an update of activities at Kiunga Hospital during 2015, including administrative functions, operations, health service delivery and health outcomes. The report highlights achievements, service enhancements, areas for improvement and opportunities for additional support. This is my fourth year as Hospital Administrator, employed by Abt Associates (formally known as Abt JTA) under a public private partnership agreement between Ok Tedi Mining Limited (OTML) and the Fly River Provincial Government to assist with the management and development of the provision of hospital health services. 2015 was a busy year and saw great improvements to hospital infrastructure and service delivery. A significant donation by Bank South Pacific (BSP) led to refurbishments in the General Ward; a 10-seater ambulance was donated by the Governor of Western Province; and Ok Tedi Development Foundation (OTDF) donated a water tank. Smaller but equally appreciated donations included bed nets, food rations, and medical supplies from various individuals and organisations throughout the year. A visiting urologist from Mount Hagen Regional Hospital provided specialist consultations and conducted surgeries on patients with urinary problems. The hospital was also supported by two volunteers from the Japan International Cooperation Agency (JICA) and fourth-year medical students from Griffith University, who conducted their elective at the hospital for six weeks. The combination of the hospital s clinical staff, locum medical specialists and medical and nursing students provides a continual learning environment at the hospital. Western Province was heavily affected by a dry weather event in 2015, which lasted from July through to December. Kiunga experienced population growth during this time as many people moved from Tabubil following temporary mine closure. The General Outpatient Department, Obstetrics and Gynaecology Ward, and Dispensary were all impacted by the dry weather event and experienced an increased demand for services. Medical supplies were difficult to obtain due to restricted access along the Fly River. Hospital staff saw an increase in patients with fevers, diarrhoeal incidence in children, and cases of women with hypoglycaemia (low blood sugar). Whilst these events cannot be solely attributed to the dry weather event, there is reasonable evidence of an association. Despite these pressures, hospital staff collectively pushed hard to maintain the delivery of services. The Western Province Interagency Disaster Committee was formed and contributed to contingency planning for the dry weather event.
6 ANNUAL REPORT 2015 On behalf of the management team and staff at Kiunga Hospital, I would like to thank the following people and organisations for their support in 2015: The Provincial Administrator, the District Administrator and their teams; I would also like to thank the hospital staff for their support and hard work throughout the year and as a team we look forward to continuing to improve the services we provide to the people of Kiunga and surrounding communities in North Fly District. North Fly Health Services Development Program and CMCA Middle South Fly Health Program; OTML, OTDF, BSP, Griffith University, Kiunga Fuel Distributors, Rotary Club of Castlemaine, Heritage Oil, Callan Services, JICA, Repsol, Niugini Pride, Catholic Health Services, and Daru Hospital for their kind donations of a range of hospital equipment and assistance; and Graeme Hill Hospital Administrator The volunteers who kind-heartedly give their time to assist our staff in many departments throughout the hospital.
KIUNGA HOSPITAL 7 Kiunga Hospital Kiunga Hospital is a government-funded hospital in the North Fly (NF) District and has been operational since 1985. The hospital is a Level Four health facility as classified under the National Health Services Standards for Papua New Guinea (2011-2020). The hospital has a 70 bed capacity and delivers medical, nursing and related services seven days a week. The Tabubil-Kiunga Health Agreement, which was signed by the Fly River Provincial Government and Ok Tedi Mining Limited (OTML) in 2011 is a public private partnership (PPP) providing innovative means for a resource-constrained government to improve health infrastructure and the provision and delivery of clinical services. Three medical officers and an anaesthetist continue to be funded under this Agreement. Abt Associates is contracted under the OTML-funded North Fly Health Services Development Program (NFHSDP) to support operational activities and quality improvements at Kiunga Hospital primarily through the placement of a Hospital Administrator. A range of services is provided at Kiunga Hospital and is delivered at outpatient clinics and inpatient wards. These central services are supported by a range of essential and ancillary services. This report provides an update of activities at Kiunga Hospital during 2015, including administrative functions, operations, health service delivery and health outcomes. Reported achievements, areas for improvement and opportunities for additional support are informed by analysis of existing reports; hospital health records; and 19 informal interviews with hospital staff. Staff were asked to report on the barriers and facilitators to carrying out their duties during 2015 and to provide suggestions for hospital improvements. Outpatient services are provided in: General outpatient department (GOPD); Accident and emergency (A&E); Specialist maternal and child health (MCH) clinics (i.e. Family Planning and Antenatal Care); Tuberculosis (TB) clinic; A sexually transmitted infections (STI) clinic that offers voluntary confidential counselling and testing (VCCT) and anti-retroviral treatment (ART) for the human immunodeficiency virus (HIV). Inpatient services are provided in: General ward TB ward Obstetrics and gynaecology ward; Operating theatre
8 ANNUAL REPORT 2015 POLITICAL MAP OF WESTERN PROVINCE The Community North Fly District encompasses the plains of the Ok Tedi, Strickland and Fly Rivers, and is landlocked. The District therefore relies on the river system for shipping and transporting goods, people and services. Domestic airlines, Air Niugini and PNG Air, provide some airline transportation. OTML is the largest contributor to the NF economy, generating local employment opportunities and subsequent population growth. Kiunga is the main administrative centre of the District and in recent years there has been an increase in commercial business, such as trade stores and lodges, which has contributed to economic growth. A large rubber factory also operates in Kiunga. There are 49,257 people living in the Kiunga Hospital catchment area. Kiunga Urban Clinic, and Drimdemasuk, Moian and Gre Aid Posts are within a 15 kilometre radius of the hospital. The community in Kiunga is becoming more diverse than previous years, with an increase of people from neighbouring provinces. With increased population comes increased demand for services, which is evidenced throughout this report and in the tables.
KIUNGA HOSPITAL 9 2015 Progress Overview Enhancements to the hospital during 2015 made possible through hospital funding and external support included: Major improvements to the General Ward following generous donation by Bank South Pacific (BSP) 12 boxes of medical supplies from Horizon Oil Building alterations made in order to move the TB Clinic to the TB Ward Food packages for patients donated by the Chinese business community, Seventh Day Adventist church and Four Square church Bed nets donated through the Japan International Cooperation Agency (JICA) Water tanks supplied by Tommy Transport and water provided by Repsol 68 mattresses and fuel for hospital mowers provided by Repsol Local hospital staff member George Wire donated PGK 5000 to purchase spare parts Mr and Mrs W. Dutton donated a new lawn mower Anaesthetic equipment in the Operating Theatre received from Daru Hospital 30,000 litre tank donated by Ok Tedi Development Foundation (OTDF) 10-seater ambulance donated by the Governor, Hon. Ati Wobiro Biochemistry machine installed in the laboratory and functionality tests on all machines conducted by Meddent Rice purchased by Niugini Pride supermarket for hospital staff An electrocardiogram donated by Griffith University Improvements made to the doctors houses Maintenance of hospital ride-on mower by Kiunga Fuel Distributor
10 ANNUAL REPORT 2015 Administration Kiunga Hospital is a public hospital that relies on government funding. During the year the hospital conducted its operations within the allocated financial resources from the national government, which is channeled through the Provincial and District Administrations to the hospital on a quarterly basis. The hospital received additional funding under the Tabubil-Kiunga Health Agreement signed by the Fly River Provincial Government and OTML to provide support to the Kiunga and Tabubil Hospitals. Kiunga Hospital regularly seeks and welcomes external donations, grants and sponsorships from a variety of stakeholders. In 2015, JICA and BSP provided significant support. Human Resources Kiunga Hospital is a government service that is overseen by the North Fly District Administrator and the District Health Manager, John Lari. The District Administrator is supported by a Hospital Executive committee made up of the Director of Nursing, Thomas Pok; Hospital Secretary, Geawi Giriha; and Senior Medical Officer, Dr Julius Plinduo. The committee is responsible for managing and overseeing operations and is also supported by the Hospital Administrator, Graeme Hill, who is funded through NFHSDP. The Hospital Administrator provides daily operational support and is also based within the Administration department of the hospital. The nursing teams at the hospital were commended by the Director of Nursing for their continued motivation during challenging periods of staff shortages and delays in salary payments. The availability and quality of nursing accommodation is still a concern - the need for improvements was raised in the 2014 Annual Report but due to funding constraints refurbishments have not yet been possible. Medical services are provided by: Three medical officers One anaesthetist Four health extension officers Nursing care is provided by: 12 registered nurses 41 community health workers Medical services are supported by: Laboratory manager, biomedical technician and three laboratory assistants Imaging technician and an assistant Community-based rehabilitation officer Pharmacy dispenser
KIUNGA HOSPITAL 11 INTERVIEW WITH THE JAPAN INTERNATIONAL COOPERATION AGENCY The Japan International Cooperation Agency (JICA) provides technical cooperation services in the area of health, vocation, education, climate and tourism to countries around the world. JICA s services in Papua New Guinea are focused on strengthening the economic growth base; improving social services; and addressing environmental issues such as climate change. The organisation currently has 52 volunteers working in the country. JICA volunteers, Takayoshi Sakurai (pictured below) and Syota Kobie, currently support infection control and rehabilitation services respectively at the hospital. Takayoshi has supported awareness and procedures around infection control including the use of proper handwashing techniques, hygiene, and emergency response. Syota is a physiotherapist, and has supported rehabilitation services at the hospital since January. Both volunteers have given presentations as part of grand rounds and have visited communities to discuss the importance of disease prevention and good hygiene practices. JICA also donated 80 bed nets to the hospital, some of which are placed above the patient beds in the Obstetrics and Gynaecology Ward. A JICA Volunteer Coordinator, Murone Yoshiro, reviewed JICA s experience of providing volunteer support to Kiunga Hospital during a recent visit. Whilst there was some concern expressed by volunteers during the dry weather event, support provided by the Hospital Administrator and colleagues was highly praised. INTERVIEW WITH BANK SOUTH PACIFIC What community projects are funded by Bank South Pacific? Bank South Pacific (BSP) is Papua New Guinea s (PNG) largest bank, with 42 branches across the country. BSP values their customers, and one of their core values is to give back to the communities. Thomas Tembil (pictured above), Manager of the local BSP branch, explained that since 2010, each branch in PNG has funded community projects worth around PGK 25,000 each year. Representatives from BSP branches visit communities and identify what is needed, with a focus on funding projects that benefit the broader population. In Kiunga, Thomas and a team from BSP have funded improvement in services at the Kiunga Secondary School and Catholic Primary School; developed recreational areas and the community basketball court; and provided some support to the hospital in 2013. What donations did BSP make to Kiunga Hospital in 2015? In 2015, Thomas consulted with nurses in the General Ward at Kiunga Hospital and identified a need for a new suction machine and an improved Isolation Ward. Curtains were installed and refurbishments made, including a nurse station, which cost approximately PGK 25,600. Representatives from BSP wrote a letter to Provincial Administration and were successful in obtaining PGK 15,000 for the suction machine to be purchased. What impact did BSP s donations have? The new and improved General Ward opened in October. Following their support to Kiunga Hospital, Thomas and other BSP representatives remarked on the visual improvements to the appearance of the ward, and that patients appeared relaxed in their comfortable and private surroundings. Thomas also remarked that nurses were more motivated to work in the wards following the improvements.
12 ANNUAL REPORT 2015 STAFF PROFILE - RHONDA KAPTIGAU Anaesthetist Rhonda (pictured right) is a trained anaesthetist with three years working experience at Kiunga Hospital. Rhonda s anaesthetic services include pre-operative assessment of patients, administering anaesthetic drugs, and supporting post-operative recovery and surgeons in emergencies e.g. resuscitation. Surgeries are undertaken on Tuesdays and Thursdays and the clinicians might see up to seven patients in a day. Rhonda reports on a monthly basis to the administrative department and has recently undertaken performance appraisals with theatre staff. Rhonda also completed an inventory of all medical instruments and improved the booking system for surgical patients. Prior to 2015, the anaesthetic machine ceased to operate effectively and Rhonda was unable to provide paediatric care. Fortunately the faulty anaesthetic machine was replaced with a donated machine from Daru Hospital in 2015. A consultant from EBOS medical supplies company visited and provided training to Rhonda so that she would be able to administer anaesthetics to children. Despite resource constraints, Rhonda has received considerable support from her assistant, administrative staff, and volunteers who have been on placement at the hospital. Rhonda has maintained a pro-active and determined attitude in order to contribute to improvements at the hospital. PUBLIC PRIVATE PARTNERSHIPS The Kiunga Hospital Health Secretary, Geaewi Giriha, praised the partnership with OTML and Abt JTA - particularly the support that Health Administrator, Graeme Hill, has provided in terms of encouraging knowledge sharing and communication amongst hospital staff. The Hospital Executive Committee expressed their pride in showcasing the effectiveness of a public private partnership (PPP). District Health Manager, John Lari, also commended the PPP, stating that Ok Tedi Mining Limited has been a really good support in providing doctors and has helped to improve radios, cold chain, drugs and area medical stores, logistics support and funds and acknowledged good engagement between partners as a facilitator of these services. RADIOLOGY TRAINING COURSE MANUAL DEVELOPED FOR X-RAY ASSISTANT TECHNICIANS Medical Imaging Technologist, Negege Kekela, independently designed the Radiology Training Course Manual for X-Ray Assistant Technicians, which is now accepted as a national training document and will be rolled out for use in 2016. Five trainees completed the X-ray technicians course in 2015 at Kiunga Hospital. When asked about future goals, the Medical Imaging Technologist said, don t wait for it to happen, work towards it he wants to encourage his colleagues to be proactive and show interest in their career and development.
KIUNGA HOSPITAL 13 Training and Development Considerable training has been conducted at Kiunga Hospital, much of which has been facilitated by NFHSDP and the CMCA Middle South Fly Health Program (CMSFHP). The Hospital Executive committee praised the support provided by NFHSDP and CMSFHP in facilitating training and education, and obtaining external funding. In March, CMSFHP conducted Village Health Volunteer training with six women at Moian village and the training involved hands-on experience in the hospital Labour Ward and Antenatal Clinic. The training lasted one week. Surgeon, Dr Kalala attended the 51st PNG Annual Symposium in Goroka in late August. Medical Imaging Technologist, Negege Kekela also joined the symposium and presented the Radiology Training Course Manual he had independently developed. For two weeks in September, two staff from the MCH Clinic at the hospital participated in the Family Planning and Contraceptive Implant training, facilitated by Marie Stopes PNG, with support from the National Department of Health (NDoH) and Reproductive Health Training Unit. The Eighth Global Scientific Conference was held between 7th and 11th September in Mexico City; an oral and poster presentation was given by Clinical HEO, Georgina Tendiki. The Hospital Administrator met with North Fly Open Member, Boka Kondra, and participated in a press conference, which was televised on EMTV. In November, four Health Extension Officers (HEOs) and two resident HEOs worked at the hospital. One of the HEOs was due to complete their residency by the end of 2015. In addition to training and professional development opportunities, Kiunga Hospital runs regular in-house training and presentations. Grand rounds are short presentations given on a variety of topics relating to clinical services; these are conducted weekly and facilitated by the Medical Imaging Technologist. Hospital staff benefit from information presented during grand rounds, but requests for more detailed training and seminars were raised. Priority topics in the areas of Accident and Emergency care, deliveries and paediatric management are required. The community is also kept informed of the latest progress and activities at Kiunga Hospital through distribution of bi-monthly newsletters that are shared amongst the hospital, patients, suppliers/ donors, OTML, OTDF and the broader community. The newsletters are prepared by the Medical Imaging Technologist and Hospital Administrator and provide an overview of activities undertaken at the hospital and other health-related topics. Health Information National Health Information System (NHIS) monthly summary forms required by NDoH are completed by staff at the hospital and passed on to the District Health Information Officer (DHIO), Elwin Sobi. The DHIO also collates all reports from the NF District and forwards them to Provincial Health Information Officer. These forms are then forwarded to NDoH where the data is entered and analysed in order to provide District level health information for the Sector Performance Annual Review. In 2015, 58% of reports were submitted to NDoH from Kiunga Hospital; and 93% for NF District. The DHIO experienced some constraints in reporting during 2015, due to personal circumstances and staff delays in completing the reports on time. The DHIO suggested refresher training for hospital staff in recording accurate data and completing monthly forms to improve quality reporting and timeliness.
14 ANNUAL REPORT 2015 MEDICAL STUDENTS REFLECTIONS Medical students (pictured above) visited Kiunga Hospital for a fourth-year elective from Griffith University to support service delivery and experience a rural placement. Oscar Close, one of the students who visited between January and February, gave the following overview of his time at Kiunga Hospital: The experience was entirely rewarding and provided an insight into rural medicine in the region and in Papua New Guinea. We attended the hospital in a time of transition where two new doctors were returning to work full time and as such bolstering the services and quality of care that could be provided. The doctors were incredibly welcoming and treated us as members of their team and placed trust in our ability to work within our scope. There is a limit to what you can achieve when your medical plan hinges on the support of nurses to assist you and the patient whether it be an insufficient number of nurses or simply an attention to detail or not understanding the utility/benefit/risk of tasks such as bandages, intravenous fluids, and vital signs. How warm and grateful the patients were was like nothing I had ever experienced before. I learnt what it feels like to be part of a community that you will rarely experience in an Australian town.
KIUNGA HOSPITAL 15 Operation Review The following section provides an overview of the services provided in 2015 in clinical services, primary health care services, paramedical services and support services. Dental services were provided by Dr Solok and funded by Heritage Oil until April 2015, when company constraints meant services could no longer be provided. Primary Health Care Services The following section provides an outline of the range and nature of services provided by the hospital during 2015, comparing against hospital-level data for previous years where available. Primary health care services generally refer to the first point of contact that a person has with the health system and first elements of a continuing health care process. Kiunga Hospital has a GOPD, TB Clinic, MCH Clinic and STI Clinic, which all provide primary health care services to the public. General Outpatient Department and A&E The officer in charge (OIC), Sister Bainon, manages a team of one nursing officer (NO), nine community health workers (CHWs) and one HEO in the GOPD. The GOPD opens from 7.45am to 4.00pm, Monday to Sunday, and continues to be one of the busiest departments at Kiunga Hospital. 42,440 patients presented at GOPD during 2015, contributing to the NF District adjusted total of 258,190 (Figure 1). The total number of outpatients at the hospital in 2015 was 20% higher than 2014. The ward is very busy, and as a consequence, sometimes there is only enough time to address the presenting concern rather than conduct a full check- up and record a child s nutritional or immunisation status. In 2015, leading presentations at the GOPD in descending order were malaria (diagnosed through rapid diagnostic tests), simple coughs, diarrhoea, fever of unknown cause, pneumonia, other respiratory diseases and malaria (diagnosed clinically). A&E runs alongside the GOPD and patients needing emergency care are brought to the GOPD and prioritised. A&E operates 24 hours a day, seven days a week. There were 268 emergency presentations in 2015. An ambulance service is available to bring urgent emergency cases to the hospital and four drivers are employed to provide this service. EMERGENCY A large vehicle accident occurred on 5th December on the Tabubil-Kiunga highway when a motor vehicle ran off the road. The accident resulted in 24 people requiring care: 12 people were treated at Rumginae Rural Health Centre and 12 people were treated at Kiunga Hospital. Two people died as a result of the accident. The hospital s Senior Medical Officer, Dr Plinduo, coordinated the treatment of patients with the assistance of staff on duty. Off-duty hospital staff and staff from CMSFHP and NFHSDP also assisted. Figure 1: Attendances to the General Outpatient Department in 2015, by month
16 ANNUAL REPORT 2015 Tuberculosis Clinic The TB Clinic is open every day from 9.00am to 4.00 pm. Hawks Wode, the District Disease Control Officer works at the busy clinic diagnosing and treating TB and leprosy cases. Referrals from the GOPD are screened at the TB clinic. In 2015, there were 381 total attendances, which is an 11% increase from 2014 (Figure 2). Of the 381 attendances for suspected TB or leprosy, approximately 8% were diagnosed as positive TB cases following a sputum smear test. The District Disease Control Officer is also responsible for referring patients and increasing awareness in the community, however funding and transport constraints have prevented him from being able to do supervisory visits. Maternal and Child Health Clinic Midwife Lamia Rikai is the OIC of the MCH Clinic. The MCH clinic provides immunisations against vaccine preventable diseases; antenatal care (ANC) inclusive of HIV and syphilis testing; provision of long-lasting insecticide treated nets to children and pregnant mothers; and family planning advice and methods. ANC clinics are now held Monday - Friday in response to the growing demand from the community. The OIC reported a good continuation of pregnant mothers receiving 1st and 4th ANC support. However, in 2015, 717 pregnant women attended their 1st ANC visit, but only 435 attended their 4th visit (Table 1). The total number of attendances was 23% higher in 2015 than in 2014. Whilst deliveries still occur in the village, mothers often bring their newborns to the clinic for immunisation. A marked decrease in total ANC visits was reported in December and most likely reflects the shortage of available staff due to annual leave (Figure 3). The number of new acceptors of family planning methods increased in 2015 to 441, compared to 302 in 2014 (Table 2). Child growth is an important indicator of nutritional status and health. The number of children under five years of age who were assessed for nutritional status has increased by approximately 16% each year since 2013 (Table 3). The proportion of children who had less than 60% of the average weight for their age (malnourished) increased by 4.5% in 2015 compared to the previous year (Figure 4). The proportion with 60-80% of the average weight for their age (moderately nourished) was 11% in 2015, which is also an increase from 5.5% in 2014. The proportion with more than 80% of the average weight for age (well nourished) decreased by 10% in 2015 compared to 2014. Vitamin A deficiency is the leading cause of preventable blindness in children and can increase susceptibility to infection, and decrease growth rates and bone development in children. Vitamin A supplements were provided to 1,030 children in 2015, which is a 32% increase from 2014 (Table 4). Immunisations were provided to 9,149 children and the most common vaccines administered were measles for babies over one year of age, pneumococcal conjugate vaccine first-dose and the diphtheria, pertussis and tetanus first-dose. Figure 2: Total attendance and No. of positive TB cases at TB Clinic, 2013-2014
KIUNGA HOSPITAL 17 2013 2014 2015 Total ANC attendances 3423 3236 3966 ANC 1st Visit 632 582 717 ANC 4th Visit 394 305 435 Figure 3: Antenatal Clinic attendances by month, 2015 Table 1: Antenatal Clinic attendances, 2013-2015 2013 2014 2015 Total Family Planning Attendances 3958 4719 4421 New FP acceptors 252 302 441 Table 2: Family Planning provision at Family Planning Clinics, 2013-2015 Figure 4: Nutritional status of children assessed at Kiunga Hospital in 2015 (top pie chart) compared to North Fly District-level (bottom pie chart) Total number of children assessed for nutritional status Malnourished <60% Weight For Age (WFA) Moderately nourished 60-80% WFA Well-nourished >80% WFA 2013 2014 2015 3153 3627 4230 2% 0.5% 5% 13% 5.5% 11% 85% 94% 84% Table 3: Nutritional status of children assessed at Kiunga Hospital, 2013-2015.
18 ANNUAL REPORT 2015 Immunisations 2013 2014 2015 Total Admissions 6650 4908 9901 Total immunisations 5688 4126 8871* Vitamin A 962 782 1030 * 278 immunisations were also administered in the Obstetrics Ward in addition to the 8,871 Table 4: Immunisations and Vitamin A supplements provided at the MCH Clinic, 2013-2015 CONTRACEPTIVE IMPLANTS Contraceptive implants are provided to women at the Maternal and Child Health (MCH) Clinic, in addition to other Family Planning services. The implant is inserted in the arm during a short procedure and provides contraceptive protection for up to five years. Health promotion delivered by Marie Stopes PNG and the focus of improved Family Planning as part of the National Health Plan, has led to an increased demand for contraceptive implants. Midwife, Sister Rikai and a Community Health Worker were trained in 2015 and have administered approximately 104 implants since to women of child bearing and rearing age. Sister Rikai commended the Family Planning training provided by the North Fly Health Services Development Program Sexually Transmitted Infections Clinic The STI Clinic is managed by OIC, Alice Rosario and her team. The STI Clinic provides medical testing and treatment for STIs, and also offers voluntary confidential counselling and testing services and antiretroviral treatment for people living with HIV. Mobile clinics are conducted in Kiunga urban areas every month, and in rural areas every two months, and the team has been conducting these since 2007. STI clinic staff also provide provider-initiated counselling and testing to inpatients as needed in selected wards at the hospital. 2015 was a quiet year for the STI Clinic, there was reduced demand during the dry period and no new attendances were recorded. Towards the end of the dry weather event, patients increased again. Only one mobile clinic was conducted at the Defence Force Camp to raise awareness about the importance of STI prevention; dry weather event-induced funding constraints prevented the clinic from conducting more outreach during 2015. No. STI positive cases No. HIV tests conducted No. HIV positive cases 2013 2014 2015 131 NA 33 1039 NA 640 12 NA 17 Table 5: Presentations to STI Clinic, 2013 and 2015
KIUNGA HOSPITAL 19 IMPACT OF DRY WEATHER EVENT From July onwards, a severe dry weather event affected the Western Province. Lack of water led to the scale-down of Ok Tedi Mining Limited operations in Tabubil and as a consequence many people moved to Kiunga and surrounding villages. The scale-down of health facilities in the mine area also led to an increased number of referrals to Kiunga Hospital. The Laboratory and General Ward stayed fully functional during the dry weather event despite issues with water depletion. From September to December the medical supplies available at the hospital were depleted. The hospital was able to source emergency drugs from neighbouring health centres and hospitals that had spare stocks. Medical kits were brought in from other facilities. Demand in some wards of the hospital increased during the dry weather event. Outpatient presentations increased from 90 to 200 during October. The number of presentations to outpatients with diarrhoea increased dramatically between September and November, suggesting that the dry weather event influenced risk factors such as access to clean water and sanitation (Figure 5). The annual incidence of diarrhoea per 1000 children less than five years old was 212 at Kiunga Hospital, compared to 602 in NF District-level, and 436 at National level 1. There were five cases of dengue fever during the dry weather event. This was likely to correlate with concentrated breeding habitats of denguetransmitting mosquitoes in shallow puddles of water near homes. The Obstetrics and Gynaecology Ward was impacted by the dry weather event; staff tended to many women who were suffering from hypoglycaemia. It was thought that women did not have access to sufficient food and water. 1 Source: NHIS 2015 health data, extracted 2 June, 2016, replacing Kiunga hospital data with the more complete hospital records Despite the dry weather event, the hospital staffcollectively worked hard to maintain the delivery of services. The Western Province Interagency Disaster Committee was formed and contributed to contingency planning for the dry spell; a team of administrative and medical staff from the hospital attended the meetings. Kiunga Hospital employees were kept informed of the impact of the dry weather event a formal presentation was given in October following the development of a status report Kiunga Hospital during the El Nino, and the report was presented to the North Fly District Health Management team. Kiunga Hospital also responded to the consequences of the dry weather event by increasing health promotion activities in the community and keeping the public informed of the impacts of activities. Figure 5: Diarrhoea presentations to the General Outpatient Department, 2015 by month
20 ANNUAL REPORT 2015 Clinical Services General Ward Sister Mary-Anne Nuau manages a team of two NOs and 5 CHWs in the General Ward. The General Ward is a 20-bed open plan ward. Upgrades to the General Ward in 2015 included a new staff toilet and shower, dispensary, 12 new mattresses and electrical wiring replacements. 385 patients were admitted to the General Ward during the year (compared to 387 in 2014, and 332 in 2013) and common cases included malaria, pneumonia, gastroenteritis and malnutrition. Towards the end of the year the ward was split to include TB inpatients as the TB ward closed, and this led to some issues with the ability of nurses to split their time between the two wards. TB patients tend to stay for two to three days following treatment and are then discharged. Obstetrics and Gynaecology Ward Sister Waite is the OIC of the Obstetrics and Gynaecology Ward. The Ward has a 17-bed capacity, of which six beds are in the prenatal observation ward, two beds in the delivery room and nine in the post-natal recovery ward. Maintenance was undertaken on the toilets and bathrooms in 2015, and air conditioning was installed in the delivery section of the ward. There are two incubators in the ward for neonates, and an electronic birthing bed. The ward has experienced an increase in mothers requiring obstetrics and gynaecological services (Table 6). On average, 85 mothers pass through the ward on a monthly basis, which is higher than previous years (77 and 78 in 2014 and 2013 respectively). Common reasons for gynaecological admissions included miscarriages, prolonged vaginal bleeding and malaria during pregnancy. There were 850 supervised deliveries in 2015, of which 22 were caesarean sections (Table 7). 2013 2014 2015 Total admissions 939 928 1016 No. Obstetric admissions No. Gynaecological admissions Avg. Admissions per month 856 829 884 83 99 132 78 77 85 Table 6: Admissions to the Obstetrics and Gynaecological Ward, 2013-2015 No. Supervised Deliveries 2013 2014 2015 826 873 850 Table 7: Number of supervised deliveries at Kiunga Hospital, 2013-2015
KIUNGA HOSPITAL 21 Operating Theatre and Surgical Ward Kiunga Hospital has one Operating Theatre. Surgical operations are supported by a trained anaesthetist and assistant. Patients are often referred from a number of locations, including Balimo, Lake Murray and Rumginae. The 10-bed surgical ward opened in May 2015 and the total number of admissions from May to December was 152. A total of 98 major and 168 minor surgical procedures were undertaken in the Operating Theatre in 2015 (Table 8). The total number of procedures for 2015 was 266, which was 46 less than the previous year. Common surgical procedures included laparotomies, open prostatectomy, appendectomies; and caesarians. In 2013 and 2014, eye operations were conducted at the hospital, however due to funding constraints, there were no eye operations in 2015. Since the Surgery Ward opened, the team has managed to significantly cut down surgical referrals to other centres because many surgical emergencies are now handled independently at Kiunga Hospital. A specialist visit was made by a Urologist who performed a number of surgeries. From June 2015 funding constraints meant that additional specialist visits were not obtainable. Should funding become available, specialist visits in ears,nose and throat surgery; ophthalmology and gynaecology are a priority. Tuberculosis Ward and Isolation Ward A TB Ward was built in 2013 and originally had a capacity of 10 beds; an additional 10 beds were installed in 2014. The TB Ward closed in December 2015 due to a shortage of available staff to run the ward. TB patients are currently housed in a separate section of the General Ward. Total No. Surgical Procedures 2013 2014 2015 483 312 266 No. Major 338 87 98 No. Minor 145 225 168 Table 8: Operating Theatre activity, 2013-2015 VISITING SPECIALIST: UROLOGIST Urologist, Dr Timmy Tingee (pictured above, right) from Mount Hagen Regional Hospital visited in May for two weeks and saw 19 patients for consultations and conducted 12 operations on patients with urinary problems. Dr Tingee also gave two grand round presentations on benign prostate hyperplasia and urinary tract infections during his locum visit.
22 ANNUAL REPORT 2015 Paramedical Services Laboratory and Biomedical Engineering 2013 2014 2015 The Laboratory at Kiunga Hospital provides pathological services and a blood bank service. Services include haematology, biochemistry, serology, and microbiology. A total of 29,288 tests were conducted in 2015 (Table 9). Thomas Mebo, Medical Laboratory Assistant, has worked at Kiunga Hospital for six years and works in a team of eight (including some volunteers) under Laboratory Supervisor, Awoke Some. The service is supported by Rumginae and Tabubil Hospital laboratory staff who support each other with cross-checking samples. The blood bank service is a labour intensive yet fundamental component of the hospital s functionality. Relatives are often asked to donate when a patient is in need, but about five community members voluntarily return to the blood bank to donate. In 2015, there were 366 new voluntary donors, which is a 175% increase from 2014 (Table 10). However, there were only 256 units collected, as not every donor who is screened gives blood at that time. Medical Imagery Total No. tests 17172 20224 29288 No. Haematology 11089 13810 20328 No. Biochemistry 1387 3541 5802 No. Serology 1338 204 544 No. Microbiology 786 909 657 No. Other 2572 1760 1747 Table 9: Laboratory tests processed at Kiunga Hospital, 2013-2015 Total No. voluntary donors 2014 2015 216 489 No. units collected 233 256 The Medical Imagery department, managed by Negege Kekela, offers x-ray and ultrasound services and like other paramedical services, provides support to emergency cases and inpatients and outpatient departments. In 2015, 2,988 people received services in the department, which is an increase of 654 people since 2014 (Table 11). The waiting room was renovated during 2015 and can now seat six people. The Medical Imagery Technician, who has worked at Kiunga Hospital for 20 years, developed a training manual that was accepted under National Standards for radiography assistants. Dispensary No. new voluntary donors Table 10: Blood Bank Service 133 366 The Dispensary is managed by Ogat Ambetu, who maintains the medical stocks and dispenses medications as prescribed by the on-site medical team. In 2015, a total of 7,238 prescriptions were administered (Table 12). Of these prescriptions, 90% were administered free-of-charge. Vaccines, medications, dangerous drugs, oxygen, surgical instruments and equipment are ordered through the Figure 6: Laboratory tests processed at Kiunga Hospital by nature of test, 2015
KIUNGA HOSPITAL 23 dispensary. Medicine stock takes are undertaken every two months by OICs of each ward and the information is given to the dispenser who places orders with the Area Medical Store in Port Moresby. The Dispenser commended the support provided by NFHSDP in picking up orders from Port Moresby. Rehabilitation Rehabilitation services are provided by a Community Based Rehabilitation Officer (CBRO), Jerome Kandok, and his JICA assistant, Syota Kobie. Rehabilitation services are provided Monday Friday and after hours in emergencies. The CBRO responds to doctors requests for patient rehabilitation, and provides physiotherapy consultations and follow-up support. The CBRO sees approximately 15 patients in a month, compared to 11 in 2014 and 15 in 2013. Common conditions in 2015 included therapeutic services for fractures (25 patients in 2015), post-operative care (56 patients in 2015), and soft tissue injuries (11 patients in 2015) (Figure 7). The CBRO has maintained a good relationship with Callan Services, which provides disability services within the District, and has been able to receive assistance when required. The Rehabilitation Unit is not easily identifiable at the hospital and would benefit from clear signage or a separate building. During the dry weather event and subsequent delays in equipment and supplies reaching the hospital, the CBRO innovatively made crutches from available materials to support patients desperately in need. Crutches have since been received. Total patients receiving services 2013 2014 2015 2331 2334 2988 No. X rays 2773 2472 2335 No. Ultrasounds - 666 774 Table 11: Services provided in the Medical Imagery Department, 2013-2015 2012 2013 2014 2015 No. prescriptions 3578 6056 6995 7238 No. dispensed free 4708 5850 6488 No. charged 2 Kina 1348 1145 750 Table 12: Prescriptions provided at the Hospital Dispensary, 2013-2015 Figure 7: Categories of conditions that received rehabilitation services in 2015
24 ANNUAL REPORT 2015 Support Services Housekeeping Services A laundry officer, three cooks and three cleaners provide housekeeping services. Services include provision of breakfast, lunch and dinner for patients; and cleaning and maintaining wards. There are four security officers who attend to mortuary duties and monitor people movement throughout the hospital. Maintenance Maintenance Officer, Jack Mika, provides electrical, logistical and carpentry services to the hospital, and regularly repairs biomedical equipment. Whilst the Maintenance Officer has had no formal education, he praised the training opportunities received during his nine years at Kiunga Hospital, including that from an Australian volunteer who provided carpentry and electrical support. In 2015, the Maintenance Officer provided major independent maintenance work, including repairs to broken air conditioning units, water tanks and a suction machine, which was a noteworthy achievement. The Maintenance Officer is able to call a technician for support with particular issues as part of a maintenance contract the hospital has with Cairns-based company, Getinge. Availability of servicing equipment has greatly improved over the years but there are still delays, which are often a result of funding delays. Mortuary Services CLEANLINESS OF THE HOSPITAL A key recommendation arising from the 2014 Annual Report was to improve cleanliness around the hospital and provide a comfortable and safe environment for patients. A public toilet for patients waiting to be seen in clinics was funded by Kiunga Urban Local-Level Government and is under construction. A number of Clean-up Days supported by staff and community members were held in 2015. General upkeep around the hospital includes regular lawn mowing and ensuring that dogs are removed from the premises. The mortuary includes a 12-bed capacity fridge and maintains a bio-hazard free environment for the deceased until burial. There were 41 registered deaths at Kiunga Hospital in 2015.
KIUNGA HOSPITAL 25 2016 and Beyond Kiunga Hospital has continued to provide health services despite challenges such as population growth, funding constraints and the dry weather event experienced from July to the end of the year. Looking beyond 2015, Kiunga Hospital will continue to seek funding from external organisations and agencies in order to continue to improve services. Recommendations for continued improvement include: Improving staff accommodation and increasing security: the current situation has impacted on staff recruitment and retention and is a particular concern for female nurses after-hours Computer literacy and administrative skills: many staff commented on the need to improve basic skills in computer literacy and database management. This could be provided in-house by experienced staff and could consist of a short series of training sessions. Maintenance works: improve drainage and the electrical system in the hospital; and provide a maintenance workshop/storage space Strengthening monthly reporting: reporting hospital activities accurately and efficiently on a monthly basis is paramount for both health planning at the hospital, district and national level Disaster planning: concern for the transmission of drug resistant TB from Daru in to North Fly District highlights the need for improved disease outbreak planning and TB services Preventive health and good hygiene practices are lacking in the community, which often leads to avoidable illness and a burden on the health system. Community members are also perceived to leave illness until at an acute stage before seeking health care. Health promotion is needed in the communities.
26 ANNUAL REPORT 2015 Contact Us Kiunga Hospital Vaks Street (PO BOX 254) Kiunga Town, North Fly District, Western Province, Papua New Guinea Telephone: + 675 6491245 Facsimile: +675 6491167 Mr. Graeme Hill Hospital Administrator Telephone: +675 6491177 Mobile: +675 71901929 Email: graeme.hill@oktedi.com Mr. Geawi Giriha Hospital Secretary Telephone: +675 6491166 Dr Julius Plinduo Accident and Emergency Physician Telephone: +675 6491105 Email: jplinduo@gmail.com Mr. Thomas Pok Nursing Services Coordinator Telephone: +675 6491106