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

2. Situation in General and Situation at Jaffna Teaching Hospital

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

4. 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.

5. 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

6. Population of Jaffna Several thousand people
– One million
– 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.

7. 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.

8. PRESENT STATE OF THE CARDIOLOGY UNIT.

9. 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.

10. 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…?

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

12. Out patient clinic
Rehabilitation clinic

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

14. 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.

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

16. 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

17. 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.

18. SUGGESTIONS TO IMPROVE THE CARDIAC SERVICES

19. 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.

20. CARDIOLOGY HIGH DEPENDENCY UNIT ESTIMATED COST
Cardiac Bed
10 x
Mattress
10 x
50 000
Defibrillator
1 x
Cardiac monitor
2 x
ECG recorder
1 x
Pulse oxymeter
2 x
Syringe pumps
10x
sphygmomanometer
4 x
30 000
sucker
2 x
80 000
Total cost SLR= 4.64million (US$ = )

21. 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

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

23. 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

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

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

26. 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

27. UPGRADING CARDIAC REHABILITATION CLINIC
Rehabilitation clinic functions with bare minimum facilities

28. Present staff who man this clinic
need further training

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

30. “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”