|
Post-tsunami medical mission to Sri Lanka
provides
much-needed training and education
|
|
 |
|
Shown with some of the supplies they donated to hospitals in Sri Lanka are, from left: Dr. Steven Abrams, Dr. Coburn Allen, registered nurse Sheri Hemphill, registered nurse Carmen Roberts, Dr. David Hilmers, registered nurse Donna Thomas, respiratory therapist Lee Evey and registered nurse Tina Reyes. Not pictured are pharmacist Karen Gurwitch,
physical/occupational therapist Gail Spraul and Cancer
Center staff member and native Sri Lankan Maheshika Ratnayake.
|
|
View more
photos from medical mission |
By Steven Abrams, M.D. A
multidisciplinary team from Texas Children’s Hospital recently
traveled to Sri Lanka to provide training and education in perinatal and pediatric care at hospitals in some of the areas
hardest hit by the tsunami of 2004. We took with us
$40,000-$50,000 in equipment and supplies donated by Texas
Children’s.
The team consisted of three physicians; me, Dr. David Hilmers
and Dr. Coburn Allen; four registered nurses, including three
neonatal nurses and one pediatric intensive care nurse; one
physical therapist/occupational therapist; the director of
pharmacy services, Karen Gurwitch; and the director of
respiratory care services, Lee Evey.
During our two weeks in Sri Lanka, we spent time at each of the
four neonatal intensive care facilities in the country: one in
Galle, one in the capital of Colombo, and the last two in Kandy,
the second largest city in central Sri Lanka.
| |
|
Baylor spearheads groundbreaking
HIV/AIDS project for African children
Bristol-Myers Squibb Co. and Baylor College of Medicine are
forming a pediatric AIDS corps and building four new
clinical centers of excellence as part of a groundbreaking
program to provide medical care for African children with
HIV/AIDS.
The $40 million joint project expands Baylor’s International
Pediatric AIDS Initiative, which has built and operates
several of the world’s largest pediatric HIV/AIDS treatment
centers in developing countries in Africa and Eastern
Europe. Still, fewer than 1 percent of the estimated 2.2
million children living globally with AIDS are being
treated.
“This initiative makes it possible to treat huge numbers of
HIV-infected children across Africa, changing forever the
way pediatric HIV/AIDS is perceived and managed,” said Dr.
Mark W. Kline, professor of Pediatrics at Baylor, chief of
Retrovirology at Texas Children’s Hospital and director of
the Baylor International Pediatric AIDS Initiative.
Fifty physicians will be recruited for the corps in the
first year of the program and as many as 250 physicians over
the next five years. |
|
| |
|
Recovery is slow in Galle
The tsunami of Dec. 26, 2004, directly struck the city of Galle,
Sri Lanka with 20-foot waves that destroyed virtually all of the
buildings near the shore, including near-complete destruction of
the maternity hospital. This forced the transition of all
perinatal care to the larger General Hospital in Galle, where
virtually all of it is provided at this time. Galle is a city of
about 100,000 people, but a referral center for a much larger
region.
A total of 31,000 people are known dead and 4,000 more missing
and presumed dead from the tsunami. The single largest death
toll came from the destruction of the Galle-Colombo train that
was carrying some 1,500 people when the tsunami hit. Another
550,000 people lost their homes – mostly poor people who lived
by the coast and whose livelihood was related to the fishing
industry. About 50,000 currently live in tents and similar
refugee housing, the rest live with relatives or others.
In Galle, we devoted two days at the general hospital providing
training sessions to approximately 120 staff members from
throughout the southern region representing eight hospitals. The
audience consisted of physicians and nurses and included nearly
all of the pediatric trained doctors and residents in the
southwestern provinces of Sri Lanka.
The training included six lectures and six to eight hours of
bedside teaching. Our team was divided into “stations” covering
aseptic technique and hand washing, ventilator management,
nutrition support, including tube feeding, family-centered care,
airway clearance, medication storage, administration and use,
and clinical consults in the Neonatal Intensive Care Unit and
pediatric wards.
A large number of equipment was donated to the hospital from
around the world immediately after the tsunami struck. However,
some equipment, such as a new transport ventilator, was not
being utilized because hospital personnel were untrained in how
to use it. Lee Evey worked with them on this and similar issues
related to equipment.
Other limitations included the lack of training of the staff,
especially nursing, in many fundamental aspects of neonatal
care. In addition, many medications needed for the care of
critically ill infants were completely absent from this
hospital and from virtually all hospitals in Sri Lanka.
Training physicians and nurses in Colombo and Kandy
In Colombo, we conducted a training session, similar to the
program in Galle, at the Lady Ridgeway Hospital for Children –
the only pediatric hospital in the country and a huge facility
of about 500 beds. The program in Colombo was modified to
include training in neonatal resuscitation, as requested
specifically by the physicians and nurses. We had extensive
discussions in small groups about all aspects of neonatal
resuscitation.
We were asked to provide the same program in Kandy to about 40
physicians and 20 nurses in this region. Kandy has two primary
hospitals and is currently completing construction of the second
children’s hospital in Sri Lanka, which is expected to open
later in 2005. Dr. Hilmers, Dr. Allen, Karen Gurwitch and Gayle
Spraul (PT/OT) visited the Kandy Hospital observing care,
conducting rounds and providing feedback to the members of the
medical and nursing teams there.
Opportunities exist for ongoing collaboration
In all three locations, we identified specific items needed to
enhance perinatal care. In Colombo, the maternity hospital we
visited had a severe shortage of equipment and supplies not
observed in other hospitals. We left many of our supplies, such
as pulse oximeters, at this hospital. In both cities, Texas
Children’s guidebooks on nutrition, pharmacy and physical
therapy were in tremendous demand.
Total parenteral nutrition (TPN) virtually did not exist in the
country, not only because of a lack of specific IV components,
but also because of the lack of a clean room to prepare it.
We were asked by the medical faculty and nursing staff at all of
the facilities we visited to continue collaboration for
education and training through future visits sponsored by Texas
Children’s. They are particularly interested in combination
nursing-physician training programs. As with many developing
countries, training of nurses is very limited and there is a
tremendous shortage of nurses.
A rewarding experience
It was a privilege to represent Texas Children’s Hospital and
Baylor College of Medicine in assisting post-tsunami capacity
building in Sri Lanka. We were warmly welcomed in Sri Lanka and
there was widespread enthusiasm for our efforts, as well as
appreciation of the value of international programs of medical
education and training. Sri Lanka is trying to make use of the
extensive donations they received during the recovery period
from the tsunami to enhance and develop perinatal care. I am
confident this trip enhanced the role of Texas Children’s
Hospital internationally and contributed to the recovery efforts
in Sri Lanka.
Steven Abrams, M.D., is a neonatologist at Texas Children’s
Hospital and a professor of Pediatrics at Baylor College of
Medicine.
Back to top
|
