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P.I.C.U. Charity Group

Saving Children’s lives! Initiative to develop a paediatric intensive care unit in Sri Lanka

Dear PICU Friends,

A lot has happened since you have got my previous Newsletter. We are working hard to achieve autonomy of the Paediatric Intensive Care Unit P.I.C.U. This would not have been possible without you. For that - our warmest thanks! Please stay with us! Your support will be further on needed – PICU eventually should become autonomous as soon as possible.

In the name of the PICU-Team

Wolf D. Gogoll

Hannover, March 2016

March 2016 Newsletter for readers in a

hurry…

New visions in the country’s policy

The policy in Sri Lanka and its condition setting is predominantly determined by the President’s vision: New constitution under way towards a representative democracy, pacification after the long civil war and beaconing of the economic recovery. That PICU might quickly benefit from an enhanced health budget of the country, from 1,8 % to 3% of the BIP, has not yet come true for the time being. After the horrible war damages most investment run into the development of the health system of the North and the East of Sri Lanka. PICU as a very successful project obviously does lose places in urgency rankings.

PICU rescued critically burned child

Again PICU announced two spectacular medical-intensive intervention. One child critically burned, 70% of its skin destroyed, could be rescued; and another one whose esophagus was pierced by a swallowed hair clip.

Doctors and nurses need to acquire new respectively advanced knowledge and skills around the imaging processes now available. - PICU is going to become the number one learning centre for the Sri Lankan paediatric intensive care community as paediatrists and others.

More PICU staff missing

There are still no news regarding further staff – unfortunately, unfortunately as we would like to have it. Missing nurses are the reason for delays in capacity increase of the High Dependency Unit, the Intermediate Care, on first floor. As we were informed further nurses might come in 2017 when the next nurses’ generation will have left school. Examined nurses are THE bottleneck in the development of the Sri Lankan Health system.

NEWS

4 clusters of strategic measures to reach PICU’s autonomy

1. Hardware: Building – Medical Technology – Consumptives

Ultra Sound System with first application. Further knowledge and skills enhancement necessary
Procurement of annual demand for hygiene material, floor-, area-, and reusable-desinfection products by PICU Charity Group
Cupboards and rags procured and installed; financed by PICU Charity Group

2. Development of Competences

Training sequences to be run by an expert nurse from Hannover Medical School regarding advanced hygiene and handling of critical infections.
Training sequence to be run by senior technician from Hannover Medical School supported by German Senior Experts Organization regarding advanced knowledge and skills around hygiene.

3. Support by Sri Lankan Deciders

GD Medical Services and Ministry of Health, Dr. Mahipala. Personally handed over to PICU the so-called „A-plus Unit Award“ for sustainable hygiene management
Hospital administration increase the PICU budget

4. Financial Resources and Coordination of Process Development

Disproportion between PICU’s self-perception and benchmark need intervention
Higher number of District NH 111 Lions Clubs took over fostership for PICU
All sponsors made it possible to finance hygiene training, disinfection aids, and cleaning-mops procurement.

The upcoming investment is for …

Education and training of doctors and nurses in Sri Lanka:

Professional handling around the new imaging systems and reliability in the use of advanced medical technology. And – the Never-Ending-Story „Hygiene-Management“. It is all about travel expenses.

Education and training of doctors and nurses in Hannover:

Travel expenses for 2 doctors and 2 nurses, each for 4 weeks, once per year

Consumptive goods for effective hygiene management

Disinfection wipes for cleaning of sensor heads of the ultra sound system. transmission-gel for sonography, sterillium for hand-hygiene, disinfection liquids for cleaning of ventilation hoses, and for all other desinfection

Support will be needed still for a while until everything will be part of the firm hospital PICU budget.

The upcoming investment is for …

Education and training of doctors and nurses in Hannover:

Travel expenses for 2 doctors and 2 nurses, each for 4 weeks, once per year

Consumptive goods for effective hygiene management

Support will be needed still for a while until everything will be part of the firm hospital PICU budget.

Please continue to support PICU generously!

Förderverein PICU
IBAN: DE65 2505 0180 0910 0380 90
BIC-/SWIFT-Code: SPKHDE2HXXX
Bank Name: Sparkasse Hannover
Re. „Sri Lanka“

Please win your friends for PICU….

Transfer the PICU Newsletter March 2016 to them or…
transfer the link to our homepage www.picu-sri-lanka.com
All news are coming as well via facebook https://www.facebook.com/PICU-837732389627991

…and now in more detail...

The political environment has a lot of sustainable impact on PICU

As promised Maithripala Sirisena commenced his tenure as representative president. Decisive rights will be with the Government. Controlling of its work will with the Parliament. A new Constitution is in the make. Not surprisingly the political system has got its problems with the new political visions as we are learning from our Sri Lankan partners: There are violent controversy in parliamentary debates and people in the country feel that they talk only and do not act at all.

Meanwhile the President is trying to reconcile between Tamils and Singhalese after more than 30 years of civil war. As few examples, he pardoned Sivaraja Jenivan, a member of the so-called Tamil-Tigers of Tamil Eelam (LTTE)“, who tried to assassinate him 10 years ago by shaking hands with him publically or by trying everything to enhance the investment budgets primarily for the destroyed North and East of the country. Alert! Included of course investment for the medical development of those parts of the country to the disadvantage of the West and the South where our PICU is located. And we felt it already: Only in March 2017 there will come a new group of nurses for the IMC on first floor – urgently needed. And further examples: Coming soon, as once in South Africa, a reconciliation commission will start working. At Sri Lanka’s national holiday, February 4, the national anthem was sung for the first time in both languages, Tamil and Singhalese; and so will it be kept continuously for the years to come.
He is asking emigrants back home, who once flew from the war, that they might come and help reconstructing the country. He is visiting many countries, from Thailand to Vatican to promote for Sri Lanka and the new style. By this he also visited Germany from February 16 to 18 where he was welcomed by Chancellor Merkel with military honours, and getting the promise that Germany would help by investments into the upcoming economy of his country.

It has to be reported that the economy is now continuously growing – even booming! The number of tourists are higher than ever and Prime Minister Wickremesinghe just recently presented a development plan for Colombo, the capital, that within the next 10 years around 10 B$ will be invested into the growth of the city to make Colombo a „Megacity “with 20 Mio. people Now… we will see…

Intensive-medical interventions are progressing

When on October the ultrasound system arrived the PICU team wrote. "The Eagle has landed" Almost a 200 kg packed safely for airfreight. Unpacking, becoming familiar with the operation, training of its handling.

And very soon the machine could be used – for a wide range. Dr. Pradeep, one of the two consultant intensivists (left) and his colleague Dr. Jayalath have sent a picture, which is showing that they used the USS in order to detect an appropriate veins of a very small child for a central entrance - sometimes not even easy to find.

And also the THK cardiologists were occasionally called in for support for instance in cases of echo cardiography for little patients.

Hair clip swallowed!
PICU rescued 4 years old girl

Not only that the PICU staff has become more and more successful in treating diseases with relatively high numbers of fatal outcomes like septic shock, causing as well here in Germany quite many deaths. Just recently they were able to help a four years old girl who was brought in because she had swallowed a hair clip. It had destroyed parts of the esophagus. The inflammation spread into the surrounding tissues (mediastinum). Disabled breathing and acute danger of life. The child was put in an artificial coma and ventilated. By an elaborate and highly complex emergency surgery the esophagus could be sutured, and the hair clip could be retrieved. Deep concern that the surrounding tissue might inflame in spite of careful treatment and potentially high risk. Critically in particular the first few days. By a weeklong antibiotic therapy the inflammation could be managed and the child was rescued. For the parents it sounded like a miracle. What a success story for the PICU team. And another example for the growing cooperation between paediatric surgery of THK and available high level paediatric intensive treatment at PICU.

Kid´s Day - The PICU Team invited former patients and their parents

Right before Christmas, Christmas is also celebrated in the Buddhistic Sri Lanka, the PICU team invited all 2015 hospitalized little patients together with their parents for a so-called KID'S Day; a festive, but at the same time cheerful event driven by gratitude of those concerned. This gratitude may in particular be understood as an important positive feedback for supporters and friends of the PICU development initiative.

Upgrade of staff – unfortunately not as we like

On occasion of our latest Newsletter we said that this is our most important construction zone. The full operation of first floor High Dependency Unit, financed by you, does not get forward as scheduled due to the situation as everywhere in the country: Missing educated certified nurses. As long as this will be the case patients have to stay much too long in the excellently equipped intensive care part of the unit blocking capacity for new and emergency admissions. Or with other words the capacity available is not effectively used.

Unfortunately we cannot report real improvement.

On the contrary: The German Embassy in Colombo informed us by the above shown Daily Mirror article “Shortage of Surgeons” of February 26, 2016. This will for sure have consequences for PICU as well. On the other hand our PICU let us know that development plans will be kept and that delegation of new nurses for PICU can be expected in March 2017.

Let’s hope that this might happen. There is not really another option as waiting. And let’s also hope that our doctors will not be effected by the facts reported in Daily Mirror and being eventually transferred into other wards..

Working on improvement of hygiene

Since the two consultants intensivists started working in PICU there was improvement with respect to hygiene management. As an example – the team got a THK award for best in class hand hygiene (of course also due to the application of sterillium sponsored from Germany more effective than the local ones used). And Director General for Hospital Services of the country, Dr. Mahipala, handed PICU over the so-called „A-plus Unit Award“ for sustainable hygiene-management.

Nurse Nilanthi, well known to everybody since she was in Germany for training received another PIC-internal award for team work around hygiene management of the unit.

Nevertheless the MHH team is not yet completely satisfied with respect to hygiene management and what actually is done. Standards for paediatric intensive care units in Western countries are definitely higher. This might have a lot to do with the non-availability of sufficient state-of-the-art disinfection material in THK for intensive care. But not only…

Benchmarking PICU’s performance with Sri Lankan standards is unfortunately not sufficient. And there is still room for improvement as far as realisation of leading-edge-hygiene standards are concerned.

This is exactly the reason why PICU Charity Group is sponsoring the annual demand of hygiene products for 2016 – for floor cleaning, area cleaning, disinfection of equipment as e.g. ventilation pipes etc. And in order to achieve real enhancement the experienced hygiene technician Karl-Heinz Ross, more than 30 years working on the same subject in MHH, had been sent for four weeks to Galle, supported by the German Expert Services Organisation.

As not otherwise expected – it was necessary to work on the basics: The “floor-cloth-water-bucket-soft-soap-concept” was replaced by a wish-mop-system connected with quite some training sequences as to be seen on the pictures. Working with different cleaning and disinfection material for different purposes – unknown. Therefore buckets with different colours were introduced. Even the subject of hand hygiene although awarded by local prizes already needed retraining „hand hygiene in intensive care units“ is still another level compared to general hand hygiene. The quality of excellent hand hygiene can be easily shown by means of a black light box. Not sufficiently removed germs can be made visible as fluorescents. Kalle, as they called Mr. Ross, constructed a usable alternative out of an old parcel.

„Kalle“is showing how to use local material for the construction of a black light checking device for germs not sufficiently removed.,

See parts of the training programme run by MHH in January

	Morning session	Afternoon session
31.12.	All about critically ill children and resuscitation
01.01.	Airway and ventilation day
02.01.	Care of a patient with cardiac condition or disease
03.01.	Care of the patient in renal failure	Hygiene: where do we stand and how to go on
04.01.	Care of the patient with acute neurological dysfunction	Introduction and repetition of WHO hygiene project
05.01.	Care of the patient with gastrointestinal or endocrine dysfunction	All about cleaning, disinfection and sterilisation
06.01.	Trauma and thermal injury care	„black box“ training WHO clean hands project
07.01.	Nutrition and fluid management	Introduction of new bucket and wipe system for surfaces and the floor
08.01.	Pain and sedation in intensive care	Training equipment and surface hygiene
09.01.	Managing skin integrity, wound healing and care	Training equipment and surface hygiene
10.01.	Transportation	Continuing days of Hygiene* and Repairs (if necessary)
11.01.	Day of not yet answered questions
12.01.	How to introduce new colleagues to children’s intensive care	Survey feedback: Show and discussion of results. How to ensure ongoing success
13.-28.01.	Training for equipment, floor, and surface hygiene	Compliance checks of hand hygiene by WHO tools

1. Hardware: Buildings – Medical Technology – Consumptives

The previous months were determined by trying to decide the adequate PICU benchmark for hygiene standards and to define products to reach these goals. Predominantly the work was about making clear the WHY – for example that different material must be applied for different purposes – floor, areas, thermolabile and thermostable instruments, e.g. ventilation hoses, and that there must be a standardized application pattern: How much, for which purpose, how often…?

Not just a trivial story in particular since the team had already the local award in hands….Why this? Aren’t we good enough? We are much better than everybody around!

Procurement of annual demand for hygiene material, floor-, area-, and reusable-disinfection products as well as of cupboards and rags financed by PICU Charity Group. But perhaps a generous sponsor will be able to jump in!

2. Development of competences

Plan was to run a training sequence of 4 weeks in January 2016 with in-depth education and learning sessions run by Roswitha and Karl-Heinz Ross. Targeted also on simple issues as for instance giving up of the “floor-cloth-water-bucket-soft-soap-concept” awarded by local prices. This was eventually only successful after shown by WHO evaluation processes that there were different and better outcomes by using the modern systems. Consequently it became necessary to install a formal wish-mop-training. And Roswitha and Kalle were struck how much of a training was needed.

Hand-hygiene was also a training subject. Well known that when switching between patients hand disinfection is “forgotten”. By the way – this is not so much different here in Germany! Again the WHO evaluation procedures proved to be very helpful for convincing the attendants.

3. Support by Sri Lankan Deciders

This was and will be a never ending story. Requiring numerous small steps. The decisive stakeholders to whom relationship continuously must be maintained – apart from the PICU team, in particular the Lions friends of Hikkaduwa LC, the Director of the Teaching Hospital Karapitiya, the Director General for all Sri Lankan Hospital Services, the Minister of Health, and the Sri Lankan Embassy in Berlin.

Great thanks goes to the German Ambassador Dr. Morhard and his team in Colombo – without their ongoing support nothing would have been possible.

4. Financial Resources and Coordination of Process Development

Yearlong friends and sponsors of the PICU project made hygiene training and development possible. A growing number of Lions Clubs of the Lions District NH111 committed in fostership agreements for THEIR international project – a significant step forward to basic financial strength.

Regarding strategic development the disproportion between self-perception of the PICU team and the scientifically proven standards for paediatric intensive care has to be tackled.
Regarding the development management of PICU towards an independent and autonomously working unit we will report extensively in our next Newsletter.

Impressum: PICU Förderverein,
Geschäftsführung:
Prof. Wolf Dieter Gogoll I Tel. +49.5131.53538
Hartmuth Schulz I Tel. +49.511.5179571
E-Mail: w.d.g@t-online.de and hartmuth.schulz@t-online.de

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