URC-SWAZILAND MONTHLY NEWSLETTER May 2014 Issue Volume 1, Issue 5 10 June 2014 Inside this issue: Headquarters Visits Swaziland Infection Prevention & Control Training: Emergency Medical Services Unit Equipped on Transmission Prevention Measures Pigg s Peak Hospital Laboratory Mentorship: Applying Quality Improvement Approaches to Achieving Accreditation International Nurse s Day: Providing Free Health Services to the Public GeneXpert Training: Building the Capacity of Lab Managers on New Technologies Injection Safety & Waste Management Training: Improving Injection Handling TB Management in the Mining Community: Dialogues with Community Leaders from Mamisa Chiefdom Swaziland health Laboratory Services Biosafety Training: Strengthening Health and Safety to Reach Accreditation Assessing Quality & Quantity of Sputum Climbing the Corporate Ladder 2 3 4 5 6 7 8 10 11 12 Other Activities in April 14 FOREWORD BY THE COUNTRY DIRECTOR The month of May brought special events which are worth noting, especially because they involved tracking the progress of most projects by both the USAID ASSIST and CDC Lab projects and motivating the staff. The two key events were the URC Swaziland Update meeting on the 21 st of May and the Internal Auditing of laboratories in the country. The URC-Swaziland, Country Director, Dr Samson Haumba had the following to share about the months activities: The updates by the staff on the progress of each project were quite informative allowing us to see gaps that we need to fill. Our new slogan Applying Ourselves has allowed us to become a cutting edge team when looking at the work we do. We are indeed doing great work, but we can still do more. In the month of June we will be expecting new additions to the staff. Hopefully these new additions will ease the pressure of our work, smoothening and improving work effectiveness and efficiency. It was also such a privileged to be visited by our colleagues from HQ, Dr. Neeraj KaK, URC Senior Vice President PST and Ms. Alisha Arthur Smith, Deputy Director of PST. Our Dr Samson Haumba, URC Swaziland Country Director colleagues provided technical support for on-going activities, especially M-Health, listened to our success stories and challenges in the field, which motivated staff. We appreciate the visit to our office which is a symbol of commitment and dedication of URC towards improving the health systems in Swaziland. In the subsequent month CDC-URC lab project will support the Swaziland Health Laboratory Services (SHLS) to conduct laboratory audits by African Society Laboratory Medicine (ASLM). This activity will require the CDC-URC lab project to tireless work to prepare the selected labs for accreditation. I would like to thank the staff for the work that has already gone in preparation, I am opportunistic that the supported laboratories will attain some stars.
Page 2 HEADQUARTERS VISITS SWAZILAND Like nature has assigned every parent the responsibility to always check on their young, the University Research CO., LLC (URC) headquarters has not let up on this role. URC-Swaziland was privileged to have its parents from the United States provide an opportunity for a visit to see how the nest is holding, on the 21 st of May 2014. The visit was by Dr Neeraj Kak, URC Senior Vice President, PST and Alisha Smith, Deputy Director of PST. Excited about the visit the URC-Swaziland team put up presentations to share on how each project in the country is doing. A total of 12 projects were shared each highlighting some of the key innovations and results in USAID ASSIST project, CDC-URC Lab project, Injection Safety and Waste management project, In-service training project, TB in the mines University Research South Africa (URSA) project, Wellness Centre TB screening project, Monitoring and Evaluation support, Knowledge Management and Advocacy Communication and Social Mobilization (ACSM) progress and finally Research. This no doubt came in handy as it allowed for resourceful inputs by the guests. The overall impression that was picked up by the end of all presentations was excitement and pride, especially from the Country Director, Dr Samson Haumba who seemed to be quite anxious at the beginning of the update meeting. Dr Kak congratulated the team for the impressive work and success achieved by the team. He added that he was confident that the team works hard because of the manner in which it responds to assign- ments. You are public health people and have a strong drive inside each one of you that moves you to work hard, he highlighted. Words by Dr Kak brought smiles to the all the staff present at the meeting and no doubt left all of them motivated. Phrases by Dr Kak, If you are good you are asked to do more and Success pushes you to do more managed to echo for weeks in the passages of the URC-Swaziland office. These words encouraged the team ensuring them that the added work load meant that the team works hard and delivers commendable results. URC Swaziland staff posing after the debriefing session with HQ colleagues, Dr Neeraj Kak, Senior Vice President, PST and Alisha Smith, Deputy Director of PST.
Page 3 INFECTION PREVENTION AND CONTROL TRAINING: Emergency Medical Services Unit Equipped on Transmission Prevention Measures Nomathamsanqa Ndlovu Mavuso, URC Infection Prevention & Control Technical Advisor, facilitating during the training. Participants demonstrating how to ensure hand hygiene by using hand wash and alcohol hand rub The Ministry of Health (MOH) has a program known as the Emergency Preparedness and Response Program (EPR) which is responsible for responding to all kinds of medical emergencies. The unit under the program is referred to as the Emergency Medical Services (EMS) Unit, and its key responsibilities are to resuscitate and stabilize critically injured and ill patients as well as transporting patients in an ambulance. Working in such demanding and critical conditions each EMS staff is still expected to take appropriate infection prevention and control (IPC) measures. This is to prevent any form of infectious transmission to and from themselves, exposing themselves or the patients to any communicable diseases. To strengthen these safe practices the USAID ASSIST project held a two- day training for two groups running from the 13 th to the 15 th of May 2014 at Esibayeni Hotel in Manzini. A total of 43 paramedics benefitted from the training done in the form of lectures, discussion groups, case studies, illustrations, visual demonstrations and question and answer sessions. Sharing a few words, the EPR Programme Manager, Masitsela Mhlanga extended his appreciation for the needed support from the University Research CO., LLC (URC-Swaziland). As a way to show their appreciation for the training, Mhlanga further pledged the EPR Programme to a zero tolerance infection transmission policy. Participant demonstrating proper use of Personal Protective Equipment, like the N95 respiratory mask The workshop focused on the following: Standard Precautions ( Health Care waste Management, Hand Wash, Disinfection, Linen management, Injection Safety, Proper use of PPE, Cleaning of environment) Transmission based Precautions ( contact, airborne and droplet precautions) Post Exposure Prophylaxis ( PEP) Handling and Transportation of an infectious patient / Preparedness and Response in disease outbreaks Cholera Disease Team building sessions with the EMS team.
Page 4 PIGG S PEAK HOSPITAL LABORATORY MENTORSHIP: Applying Quality Improvement Approaches to Achieving Accreditation The month of March to May served as a productive period for intense preparation of the Pigg s Peak (PPK) laboratory for accreditation. The CDC URC- Lab project Quality Assurance Laboratory Services Advisor, Cinisile Ndlangamandla, has been the key person providing mentorship to the PPK laboratory to improve quality management systems. With the staff committed to seeing their laboratory achieve the stars, implementing these systems has been effective presenting a noticeable and remarkable change in the PPK laboratory. The first action towards a quality assured laboratory included correcting and improving documentation systems and developing a quality manual. The filing system has since been improved with 40 files opened as it was targeted in the beginning. By the month of April 31 files were updated filled with data and records, leaving 9 which still needed to be filled. The second action towards laboratory accreditation focused on organizing the personnel. This process involved identifying and forming a quality team; developing reporting structure and job descriptions guided by an SOP; updating personnel files; developing duty rosters and the workstations; identifying management calendars to improve personnel communication and finally ensuring that staff meetings are held frequently also guided by an SOP. Quality Assurance Laboratory Services Advisor, Cinisile Ndlangamandla Pigg s Peak key mentor. Updated data and records, filed and arranged accordingly in shelves. Archiving room in the process of being arranged. Shelves were cleared and labelled clearly. The next step worked on improving the use and management of the laboratory equipment. Files for all machinery in the laboratory were opened including small equipment such as centrifuges and timers. To further improve the management of equipment an inventory list was developed. A system of uniquely identifying equipment was developed and added in the Quality manual. Enforcing all pillars of quality management, the quality team focused on purchasing and inventory management as the next step. This process involved identifying inventory focal person; rearranging the storeroom and labeling of shelves; stock count was done in preparation of ordering; SOPs for stock management were customized and finally stock counts were identified making use of quality indicator. Finally the quality team conducted a customer survey to measure how services provided by PPK lab meet or surpass customer expectations and needs. Labelling of all equipment in the PPK laboratory, Including the work areas. The PPK laboratory storeroom after it was arranged and labelled.
INTERNATIONAL NURSE S DAY: Providing Free Health Services to the Public Page 5 A view of the TB screening stall at the Freedom Square Park, Mbabane. Healthcare workers that were present on the day providing health information on eye care. Healthcare workers providing health information, TB screening and sharing some of the BCC materials. International Nurses Day (IND) is celebrated every year globally on the 12 th of May 2014. This day was founded to commemorate the birth anniversary of the Florence Nightingale and to mark the nurses contributions towards people s health. The Swaziland Nurses Association together with the Hhohho RHMT did not want to be left out in the celebrations, therefore requested for support from the USAID ASSIST project. Together the team decided that they would commemorate the day by giving back to the community through providing free health services to the public in the Mbabane City centre. In Swaziland the actually commemoration took place on the 13 th of May at the Freedom Square Park where a number of stalls were set up each providing a different health service. The services ranged from HIV testing, basic medical check-ups and TB screening a practise of expertise within the organisation. The commemoration of the day included two activities, the first being a breakfast meeting held at Emafini. This activity provided the opportunity for nurses to discuss and interrogate some issues that have overcome the medical field in the country and still go unnoticed. The key issue which was discussed was to try and identify the root cause of the increasing maternal deaths despite the fact that baby deliveries are being conducted by skilled personnel. The second activity was an outdoor-do which provided the University Research CO., LLC (URC-Swaziland) team the opportunity to screen 67 people out of the 98 that visited the URC stall. The screening process did not end there as the 30 that screened positive were referred to the Mbabane Government Hospital for further management. By the end of the day 294 Behavioural Change Communication (BCC) materials on basic facts of TB, the TB smart card and MDR-TB were shared.
Page 6 GENEXPERT TRAINING: Building the Capacity of Lab Managers on New Technologies GeneXpert Mentor, Tandzile Zikalala facilitating during practical sessions in a laboratory. GeneXpert training in the past few years has focused on solely laboratory staff members who operate the machine and perform the assay. In Swaziland this would include trainings set for microscopists. However, to increase efficiencies in laboratory and build competency among staff, there is need to cross train laboratory managers. This would be effective as it will allow management to be capacitated on the new technology, used by their staff on a daily basis in the laboratories that they manage. On the 13 th to the 15 th of May 2014, a training was held at the Tums George, in Manzini. A total of 10 participants were trained on the GeneXpert MTB/RIF assay, performance, principles and maintenance. The training enabled management to have the necessary technical and practical skills and knowledge to successfully utilize and oversee the rollout of GeneXpert MTB/RIF diagnostics at facility level. Well-trained laboratory personnel with the competency to perform Xpert MTB/RIF tests and troubleshoot potential problems are expected to contribute in increasing capacity for full utilization of the instrument and hence improve quality services. Objectives for the training were to ensure that participants understand the following: Understand and differentiate the TB diagnostic platforms Understand basic PCR technology Understand GeneXpert technology and Xpert MTB/Rif procedures Correctly record, report and interpret Xpert MTB/Rif results and perform data management tasks Troubleshoot potential problems Perform Quality Assurance procedures At the end of the training, a training evaluation form indicated that 63% of the participants felt that the GeneXpert training was very good and effective. Beyond the evaluation of the overall training, the test scores attested to the success of the training. The lowest recorded average score from the pre-test was 40% which then improved during the post-test to an average of 85%. Pictures of practical session s in the lab with Laboratory Managers
Page 7 INJECTION SAFETY & WASTE MANAGEMENT TRAINING: Improving Injection Handling & Disposal Amongst High Usage Groups URC Injection Safety & Waste Management Advisor, Mandzisi Mkhontfo one of the key facilitators during the training. On the 19 th to 23 rd of May, a training on Injection Safety and Waste Management (ISWM) was held targeting Infection Prevention and Control (IPC) focal persons, who in turn would become ISWM focal persons. A total of 19 participants who have direct experience and involvement with handling injections and managing healthcare waste were the main targets during this workshop because of their involvement and high volumes of injection usage in the country. The key objective of this training was to impart knowledge on injection safety and waste management persons on the skills needed to execute the project within their facilities, through support from The University Research CO., LLC (URC) to improve on quality. The training methods were designed to have illustrative presentations which were all followed by question, brainstorming sessions, field visits and small group discussions. The field visits were to the two main hospitals in the country, Raleigh Fitkin Hospital (RFM) and the Mbabane Government Hospital. Two teams were assigned to each hospital where they would spend four hours. This activity was aimed at helping the focal persons to understand how to collect data for improvement indicators and learn how to facilitate a QI team meeting. These methods were quite effective because by the end of the training it allowed the participants to: Be able to describe the broad concepts of injection safety and health care waste management Be motivated to improve standards of safe injection and waste management practices Be able to define in simple terms basic quality improvement concepts Be supported to draft action plans for their facilities for the next 3-6 months Group work sessions, which helped participants understand the importance of team meetings, site visits and guided discussion when working as a team. Participants developing a work plan for facilities, making use of the Plan Do Study & Act (PDSA) cycle.
Page 8 TB MANAGEMENT IN THE MINING COMMUNITY: Dialogues with Community Leaders from Mamisa Chiefdom Mamisa is a small chiefdom of the Mamba clan under Sithobela Inkhundla in the Lowveld of Swaziland. A majority of the community members from this location earn their living through working in the mines in Maloma and also in South Africa. Cabrini Ministries Mission Clinic is the local facility for this chiefdom and over the years has experienced a number of health challenges with miners and ex-miners from the chiefdom. Ex- miners (especially the ones working in South Africa) who return home, due to illness, normally TB, usually out of fear of stigmatisation do not seek health care and if they do they usually report to the facility at advanced stages of the TB disease. Take for instance, in the previous year two patients from the chiefdom who were miners returned home after falling ill, later on they were both diagnosed with TB and initiated on TB treatment. Due to poor adherence one of these patients ended up developing drug resistant TB after which he died. The National TB Control Program (NTCP) together with the University Research CO., LLC (URC) as a supporting partner, and Cabrini Ministries Mission clinic felt it was necessary to concentrate on these miners from the chiefdom through conducting a dialogue with the traditional leaders in the chiefdom. Traditional leaders open doors to community interventions leading them to legitimacy and credibility. They have a key role in social mobilisation of the community to increase their efforts towards community interventions. Traditional leaders are also influential and play a fundamental role in changing the community norms such that they become conducive and supportive for the community intervention. The team therefore felt that it was necessary to conduct a dialogue with the traditional leaders from the chiefdom to undertake advocacy and to ensure that the local traditional leaders take a leadership role in improving the management of TB among miners in the chiefdom. Once the 17 community members as well as the 3 facilitators settled in a semi-circle the discussions were started off by addressing the challenges faced by the clinic concerning TB management amongst miners. This discussion sparked an interest amongst each community leader present in the forum, which suggested that the leaders were oblivious to the implications paused by the problem experienced in Mamisa Chiefdom. Amongst the forum were members of the Inner Council (formerly known in siswati as Libandla Lelincane ) sharing their experience, testified that the challenges faced by the clinic were due to stigmatisation attached to the disease and that they were aware of some ex-miners who died without accessing needed care because of the very reasons.
Page 9 Babe Jabulani Mamba, a member of the inner-council and also an ex-miner openly sharing his story during the community dialogue. The open forum availed the platform for the participants to freely share their personal experiences. One of the members, Babe Jabulani Mamba, willingly shared his story as an ex-miner who suffered from TB disease. Narrating his story he stated that after returning home due to ill health he was faced with a lot of challenges one of which was losing his source of income. Babe Mamba related that shortly afterwards he was diagnosed with TB, This was very challenging for me because apart from dealing with my sickness I had to deal with stigmatization and discrimination by my neighbours and other community members. I felt like an outcast in my own community, people I considered my friends changed and soon became strangers, they would even go as far as openly talk and laugh about my illness. The gossiping about Babe Mamba did not stop there the community soon made allegations that the fact that he was sick with TB was a clear indication that he had AIDS and that he was going to die soon. Babe Mamba showing signs of how he was affected by the stigmatization and discrimination went on to say, What hurt me the most was when they started victimizing my children, saying that they were also a hazard to their children. It soon became too much, I could not take it I was ready to give up. Two months after I had started my TB treatment I lost all hope and stooped taking my medications for a week. I will forever be grateful to my family for encouraging me to continue taking my medication, had they not spurred me on I might not even be here. Babe Mamba expressed how excited and relieved he was about the visit of the team and then he committed himself to driving for positive change in the community with issues pertaining to TB. Mamba pledged to continue advocating for behavioural change which will move the community to seek for health assistance and empower the communities.
Page 10 SWAZILAND HEALTH LABORATORY SERVICES BIOSAFETY TRAINING: Strengthening Health and Safety to Reach Accreditation With the Swaziland Health Laboratory Services (SHLS) mission of getting accredited, strengthening health and safety programs was has not been left out of the checklist. First on the agenda for strengthening safety programs, Safety Officers have been appointed by laboratory mangers. These officers are responsible for implementing biosafety requirements based on World Health Organization Biosafety Manual, ISO 15189 and ISO 15190 in each laboratory. However, these Safety Officers required skills that can equip them to carry out their duties professionally and effectively. It is on this regard then that on the 5 th to 9 th of May 2014, the University Research CO., LLC (URC-Swaziland) supporting the Ministry of Health held a Biosafety Training at the George Hotel in Manzini targeting a total of 21 participants from different facilities around the country. The main objective for this training was to improve health and safety in the laboratories and to equip Safety Officers on Infection Prevention and Control (IPC), first aid as well as fire safety and biosafety. At the end of the training the expected outcomes were to have well trained and confident Safety Officers whom can carry out their duties accordingly. The One of the training s facilitators, URC Health and Safety Officer, Sanele Matsebula. training would also help improve health and safety in laboratories through complying to introduced safety standards. The training included presentations which were followed by question and answer sessions. Beneficial for the trainees were the team building sessions which included practical activities related to the trainings. Some of these activities included, creating a 6 inch tall man who can stand without being supported from paper; first aid basics level 1; and extinguishing fire. Concluding remarks were shared by a representative standing in for the Chief Technologist whom highlighted the importance of safety practices to improve the quality of laboratories and the safety of workers. Presentations on fire safety and waste management. Outdoor activities which helped participants apply what they learnt on distinguishing fire with the two types of extinguishers. Practical sessions on First Aid treatment during the training.
Page 11 URC-SWAZILAND MONTHLY NEWSLETTER May 2014 KNOWLEDGE NUGGETS ASSESSING QUALITY & QUANTITY OF SPUTUM With the tips we shared last issue on best practices for collecting sputum, it is only appropriate not to leave that discussion hanging, but share more knowledge nuggets about the quality and quantity of sputum. A lot can go wrong when collecting sputum resulting to the specimen being rejected. To avoid rejection pay close attention to the things you need to focus for ensured smooth sailing under the microscope The Sputum Specimen Make Sures... Sputum specimen does not have any food particles Sputum is not washed down by saliva Sputum is not old (especially samples for culture/dst) Sputum container is completely sealed and there are no leaks Sputum is in sufficient volumes, should not be less than 1 ml The Request Form s Make Sures Carefully complete the request forms writing in a legible writing Include all patient details (e.g. patient name, date of birth, age) Include specimen origin (e.g. clinic name, ward) Form must be signed by nurse or doctor Avoid mismatching specimen and request form VISUALS... Characteristics of a good sputum specimen Minimum amounts of saliva Good (Mucoid) Good (Purulent) Minimum amounts of saliva Mucoid/mucopurulent appearance Optimal volume: 5ml-10ml Minimum volume: 0.5ml Good (Bloody) Poor (Thin & watery)
Page 12 SOCIAL CORNER CLIMBING THE CORPORATE LADDER WONDER MTHETHWA 25 April 2014 Community MDR-TB Linkages Assistance ALEX KINTU June 2014 Operations Manager 7th March 2012 Driver February 2012 Finance Manager 17 January 2011 PROJECT ACCOUNTANT
Page 13 SOCIAL CORNER For Laughs LINDIWE MKHATSHWA October 2013 Director of Health Strengthening Systems Technical 2011 Health Strengthening Systems Tech. Advisor 2009 HIV Testing &Counselling Technical Advisor August 2006 HIV Testing & Counselling Country Coordinator
URC SWAZILAND OTHER ACTIVITIES IN APRIL: Who Are We University Research CO., LLC (URC) is dedicated to improving the quality of healthcare, social services and health education worldwide. Internal Lab Audits TB NSP Finalization GeneXpert training Clinicians Mission URC s mission is to provide innovative, evidence based solutions to health and social challenges worldwide. Expertise In Swaziland, URC expands access to and improves the quality of services addressing infectious diseases including HIV/AIDS, TB, and improving laboratory quality management system Approaches URC focuses on finding ways to deliver proven approaches to health care problems, applying quality improvement (QI) methods and conducting research and evaluation to tailor those approaches to various settings. Recognizing implementation barriers unique to each setting, we train local managers and service providers to apply QI methods to strengthen health systems, integrate system elements, and bring improvements to scale. URC also specializes in designing health messages and materials to educate target audiences about improving health behaviors. UPCOMING ACTIVITIES IN JUNE: External audits Kick TB Campaign Men s health month RHMT training PSI Cough Officer training on TB management Community mobilization: Shukuma Gogo Phlebotomist Biosafety Training TB/HIV Management training Wellness Centre Healthcare Screening Report Sharing With Focal Persons MDR-TB training IST Quality Improvement Model Clinics Collaborative Learning & Sharing Sessions Intensive Case finding PHU Training SWAMIWA Volunteers training Pre-service Training for Graduating SANU Nurses RSSC Feedback Session & On-site QA/QI Training EDITORIAL TEAM Jilly B. Motsa Janet Ongole Dr Marianne Calnan Dr Samson Haumba University Research CO., LLC (URC) 3rd Floor, North Wing, Building 1 Mbabane Office Park Sozisa Road P. O. Box 1404 Mbabane H100, Swaziland Tel: (+268) 2404 7154/56/69 Fax: (+268) 2404 7199 Website: www.urc-chs.com