Jaffna Teaching Hospital IMPROVING THE CARDIOLOGY UNIT OF JAFFNA TEACHING HOSPITAL AND ENHANCING THE SERVICES PROVIDED Dr.P.Lakshman Jaffna Teaching Hospital

Situation in General and Situation at Jaffna Teaching Hospital

Health care facilities available at the developing countries are usually below the standard of developed countries.

Situation in regions riddled with armed conflict is even worse Our home land – North and Eastern region of Srilanka has both features Part of a developing country Affected by a protracted conflict for nearly 25 years.

Impact clearly visible in all spheres of life Jaffna peninsula is one of the worst affected areas during this conflict Impact clearly visible in all spheres of life

Population of Jaffna Several thousand people 1981 – One million 2007 – Half a million Several thousand people left the region and took refuge in other countries continue their life in camps for internally displaced people or moved to other safer areas.

Cardiology service is available only at Jaffna Teaching Hospital. Most of the people who have left the country are from the upper strata of society which consisted the most affluent and educated families. Paved way to a severe dearth of professionals and health sector is the most affected Almost all the hospitals have lack of facilities Considerably increased the work load of Jaffna teaching hospital. Cardiology service is available only at Jaffna Teaching Hospital. Thus it has become a service to the entire peninsula-in other words to the northern province.

PRESENT STATE OF THE CARDIOLOGY UNIT.

Continue…. Cardiology unit was established at Jaffna Teaching Hospital in 2005 with the generous contribution of Dr.G.R.Handy memorial trust in memory of Dr.G.R.Handy who was the pioneer cardiologist in Sri Lanka.

PRESENT CADIOLOGY UNIT A Coronary Care Unit with 7 beds Cardiac Investigation unit Echo, Exercise Treadmill, Holter monitor Out Patient Clinic – twice a week Cardiac Rehabilitation clinic Newly established cardiac ward with 18 beds future high dependency unit…?

PRESENT CADIOLOGY UNIT Continue……. Echocardiography section Exercise treadmill section

Out patient clinic Rehabilitation clinic

Newly established cardiac ward with 18 beds - future high dependency unit…?

January to December 2007 578 patients admitted to CCU further 4959 patients with heart related conditions treated at EU another 3483 patients at the medical wards Directly admitted to Jaffna Teaching Hospital or being transferred from other hospitals.

In addition 190 patients with serious cardiac ailments were transferred by air for further investigation and management with the help of ICRC

190 patients transferred to Govt. hospitals Only mode of transport available for transfer of patients to Colombo from Jaffna Twice a week Each trip about 5-8 patients transferred Patients face tremendous hardships during this process. 190 patients transferred to Govt. hospitals Several hundred patients had gone to private hospitals on their own Apart from this a huge number who couldn’t afford a trip to Colombo managed medically in Jaffna

We have lost few patients while awaiting transfer or during transfer A 19 year old boy with atrial myxoma died in CCU while awaiting transfer A 30 year old gentleman with severe aortic stenosis who was awaiting for AVR died during transfer. If proper facilities are available in Jaffna Teaching Hospital all these patients would have been benefited.

SUGGESTIONS TO IMPROVE THE CARDIAC SERVICES

ESTABLISHMENT OF A HIGH DEPENDENCY UNIT High dependency unit is important to manage patients who no longer needed to be in the CCU but not yet ready to be transferred to ordinary wards Thus it was planned to establish a high dependency unit and it is not yet materialized Establishment of a high dependency unit will enhance the efficient usage of CCU beds HDU beds could be utilized to observe patients after procedures.

CARDIOLOGY HIGH DEPENDENCY UNIT ESTIMATED COST Cardiac Bed 10 x 80 000 800 000 Mattress 10 x 5 000 50 000 Defibrillator 1 x 650 000 650 000 Cardiac monitor 2 x 600 000 1200 000 ECG recorder 1 x 150 000 150 000 Pulse oxymeter 2 x 140 000 280 000 Syringe pumps 10x 140 000 1400 000 sphygmomanometer 4 x 7500 30 000 sucker 2 x 40 000 80 000 Total cost SLR= 4.64million (US$ = 46 400)

2. ESTABLISHMENT OF A CARDIAC CATHETERIZATION LABORATORY WITH FACILITIES FOR INVESTIGATION AND INTERVENTION Coronary angiogram Percutaneous coronary intervention Pacemaker implantation Balloon valvuloplasty especially PTMC Device closure of congenital defects

ESTIMATED COST TO ESTABLISH A CARDIAC CATHETERIZATION LABORATORY Philips Integris Allura X per FD10C Digital Cathlab US $ 800 000 Euro Colombus Digital Cathlab US $ 520 000

Necessary human resources available at JTH Two cardiologists with necessary training Nursing and paramedical staff who could be trained in Colombo – NHSL If facility is available at JTH Many lives could have been saved Transfers to Colombo would have been greatly reduced

Running cost and the consumables could be obtained from the Ministry of Health once a unit is established.

3. EXPANSION OF CORONARY CARE UNIT Increasing the bed strength to ten Further training for the Doctors / Nursing staff

4. ESTABLISHMENT Of CARDIAC WARD Patients who are being treated at cardiology unit are transferred to medical wards later for further management It would be beneficial for the patients if ward facilities are available Thus it is planned to establish a ward with 40 beds

UPGRADING CARDIAC REHABILITATION CLINIC Rehabilitation clinic functions with bare minimum facilities

Present staff who man this clinic need further training

Apart from this equipments are also needed to enhance the present activities Audio visual aids Health education materials booklets and leaflets

“SERVICE IS THE RENT WE PAY FOR THE ROOM WE OCCUPY ON EARTH” THANK YOU “SERVICE IS THE RENT WE PAY FOR THE ROOM WE OCCUPY ON EARTH”