Providing Medical Support to Disaster, War and Impoverished Areas

Tangalle District Hospital, Tangalle, Sri Lanka

Tangalle Hospital Rehabilitation Project

Slideshows

May 2007

Awarding us a grant for our relief work in Sri Lanka and entering into a tsunami-relief partnership with RMF, Direct Relief International procured a Matachana High Pressure Steam Sterilizer, Model 1006 E-1 (valued at $70,000.00), from Premium International (Pvt) Ltd, Sri Lanka. This equipment was procured directly and delivered to the Operating Theater at the Tangalle Hospital.

Since April 2007, this sterilizer has been used in the Operating Theater at the Tangalle District Hospital to ensure that quality health services are available for the long-term. We are immensely grateful to Direct Relief International for making this possible. The autoclave, the essential equipment and heart of the hospital, allows the whole hospital to function on an unprecedented level, seeing record numbers of patients, and saving innumerable lives. The impact this donation has now already and will have for the future is immeasurable.

Background:
Tangalle is a medium-sized town in the district of Hambantota, in the south of Sri Lanka, one of the areas worst affected by the December 2004 tsunami. Over one-third of the 533,000-strong population lives below the poverty line. The district records one of the country's highest suicide rates, mainly due to endemic poverty. The average monthly income is less than $30 for more than 75% of the families.

Tangalle Hospital - due to lack of funds - was a facility in extremely poor condition and severely under-equipped, even before the tsunami. The dilapidated buildings and structures suffered a further blow with the arrival of the tsunami, which destroyed what was remaining. As this hospital, starting in January 2005 and due to a private initiative, was completely renovated and upgraded, a fully equipped Operating Theater and a 3-bed-ICU were donated by NGOs. But the heart of the whole hospital, a high-pressure sterilizer, was not available at that time. Without it, performance of any surgeries was impossible, and patients needing such surgeries had to be transferred to hospitals about 50km away. Patients needing emergency care had to be transferred as well, and many of them succumbed to their injuries during this transfer.

With the autoclave completing the upgrade of the brand-new operating theater in April 2007, the medical staff is now able to attend to all emergencies as well as perform surgeries, routine and emergency, under sterile conditions - thereby saving the patients and preventing infections of the surgical wounds as well as cross infections. This also helps to reduce the unnecessary usage of antibiotics and thus to avoid drug resistance. The patients don't get their surgical wounds infected, and thus their hospital stay is minimized. All wound dressings and the instruments used are now autoclaved.

Dr. K.H.R. Karunaratne, FRCS, the former Head Surgeon of the Base Hospital at Diyatalawa, was assigned as the Head Surgeon of the Tangalle Base Hospital in June 2006. Under his guidance, the new Operating Theater was completed and opened in October 2006. The autoclave was fully installed by the beginning of April 2007. A demonstration of its functions for the surgical and nursing staff took place at Tangalle Hospital on April 18th by Premium personnel. 17 test runs were completed, every run was recorded. The demonstration was supervised by Dr. Karunaratne and his second in staff, Dr. Chamal Sanjeewa, who is also the Medical Consultant of RMF's clinic in Yayawatta, Seenimodara.

For the month of April 2007, OPD attendance was 8,626. Admissions to the wards were 1,733. 20 major surgeries were performed, 98 minor surgeries; 44 major OB/Gyn surgeries (including all LSCS); 43 OB/Gyn minor surgeries; 178 deliveries. 400 to 600 patients are treated daily by various medical consultants, i.e. Internal Medicine, Surgery, Pediatrics, Neonatal, Gynecology, Dental; the numbers increase daily. The number of in-patients varies from 100 to 150 per day on different wards.

Tangalle Base Hospital not only serves the city of Tangalle, but also drains patients from the adjoining villages such as Walasmulla, Beliatta, Runna, and Weeracatiya. There are six MOH divisions around Tangalle.

Map MOH Divisions, Hambantota District

The population of those divisions is as follows: Tangalle (78,714), Ambalantota & Runna (68,088), Angunakola Palassa (45,179), Beliatta (61,556), Weerakatiya & Walasmulla (84,212), and Katuwana (66,269). Patients from the rural hospitals in Walasmulla, Beliatta and Ambalantota are now referred to the Base Hospital Tangalle for better and advanced care. Referrals to other base hospitals in Matara and Hambantota have significantly decreased.

We expect to see a further substantial increase in patients, admissions and surgical procedures. Plans to train new nurses, especially ICU and ER nurses are underway. A residents' program is also being discussed.

April 2007

Rubina Mumtaz and I visited the Tangalle Hospital in March. The progress that has been made is fantastic. If I hadn't witnessed this hospital immediately after the tsunami, I would not believe it is the same hospital. It turned from a dilapidated and depressing facility into a 'Type A' Base Hospital. A massive increase of admissions, new doctors, and nurses has taken, and is taking place. Patients have new confidence and are using the hospital in unprecedented numbers. Doctors are now excited and eager to work at Tangalle Hospital. The overall value of this project exceeds US$1,000,000.00. And this once run-down hospital is now buzzing with life! www.tangallehospital.org

Tangalle Hospital now includes: A brand-new Operating Theater with two operating suites. The existing suite was reconstructed, enlarged & fitted with piped gas, air & oxygen, as well as a 'Fresh-Air A/C system' for each theater.
And: renowned Surgeon Dr. K.H.R. Karunaratne.
An Intensive Care Unit including brand-new apparatus & infrastructure.
A new 140KVA 'Back-up Generator' - purchased & installed for the Operating Theaters and ICU. A brand-new Matachana High Pressure Steam Sterilizer, Model 1006 E-1, procured by Direct Relief International.
A Blood Bank - renovated & fully equipped to receive, test & store blood for surgeries and emergencies. An X-ray Department - completely renovated and upgraded, as well as an Ultra Sound Scanner.
Six patient wards including bathrooms - completely renovated, furnished & equipped.
Two Incubators for premature babies.
Patient Monitors & Defibrillators. A Tuberculosis testing room. A new Outpatient Building with fully equipped Dental Unit.
An enlarged Laboratory & Internal Pharmacy. Two Nurses’ Rooms – completely renovated & furnished. A completely upgraded Infrastructure – corridors, floor & wall tiles, electrical & plumbing improvements, septic tanks, drain channels, guttering, plasterwork, roof repairs, new toilets & sinks throughout the hospital, new electricity transformer room, and much more. A brand-new Kitchen – extended, reconstructed, fully tiled & fitted with modern, high quality, stainless steel fabrications. A new Laundry – complete with full-size industrial washing, drying & pressing machines. A new Clinical Waste Incinerator, meeting European emission standards. A Morgue - renovated, extended & equipped with a refrigeration unit.
Additional Initiatives: Basic Training of supporting Staff to promote hygiene & improve patient care. Participation in projects to improve General Standards. Cleaning & Maintenance Program: Throughout the entire project, a team was employed to minimize inconvenience to patients, staff and management. Free Staff Training in cooperation the German Klinikum Weiden medical team. For continuity, Nick Buckingham has recently joined the Hospital Development Committee and will participate in the future evolution and development of the Base Hospital Tangalle.

October 2006

With immense gratitude and pleasure, we at the Real Medicine Foundation would like to thank Direct Relief International for awarding us the following grant for our relief work in Sri Lanka:

Direct Relief International will procure a Matachana High Pressure Steam Sterilizer, Model 1006 E-1, from Premium International (Pvt) Ltd, Sri Lanka (valued at $70,000). This equipment will be used in the Operating Theater Suite at the Tangalle District Hospital to ensure that quality health services are available for the long-term. It will be delivered to the Operating Theater at the Tangalle District Hospital by January 2007.

We are grateful and proud to enter into this tsunami-relief partnership and would like to express our immense gratitude to Direct Relief International for making this possible. Because of your generosity, thousands of people will receive much needed surgeries. Countless lives will be saved. It is impossible to measure the impact your donation will have.

Progress followed by Dr. Martina Fuchs - REAL MEDICINE FOUNDATION

Nick Buckingham of BTR Tangalle District Hospital (BTRTDH) Trust writes:

In the first few days after the Tsunami it took some intense deliberation to prioritise. What could I and others do towards the relief effort? At that time, everyone wanted to help - professionals and volunteers alike. With chaos, destruction and fear all around, for the inexperienced and first time 'do-gooder'knowing where to start wasn't so straightforward.

While searching for missing friends (thankfully found) I dropped off the contents of my medicine cabinet at the inadequate hospital in the town, knowing it would have precious few supplies. In doing so, a project to rehabilitate the 150 bed Tangalle District Hospital stood out as a vital and urgent need. Post-Tsunami disease outbreaks were envisaged, as was the possibility of more tsunamis to follow. We would certainly need a functioning hospital in the town.

Talking to hospitalised survivors and their families, hearing horror stories of inadequate care for serious injuries, unnecessary death, lack of equipment and treatment in corridors next to the dead; it was becoming clear that this appalling excuse for a hospital needed a 'band-aid'. When witnessing the many years of neglect and virtually zero equipment, I got very angry and very frustrated! Walking through such dilapidated buildings, seeing and smelling the degrading place first hand - most westerners would have felt just the same as I did. I couldn't just turn my back and walk away like we all tend to do most of the time. Nor could I help wondering - what kind of world do we live in that allows this?

But, as an ordinary 45 year old UK businessman living and working in Sri Lanka, what did I know about hospitals? Early on, this frequently asked question was usually answered by "Nothing! But we're here and I don't think we'll make it any worse!!"

I set up the BTRTDH Trust 14 months ago and we're still going strong. No disease outbreaks or tsunamis thankfully and, a mature project which has already achieved more than could have been imagined. It's great to see patients in humane surroundings and soon our medical purchases will be saving and improving people's lives.

With every US$1 going to the heart of the project it's staggering how far the money goes here in Sri Lanka. Initially proposed as a $90,000 - 3 month clean-up/second-hand equipment exercise, BTR Tangalle District Hospital Trust has grown into the most talked about post-tsunami initiative in town. The Trust survives thanks to its donors, volunteers and hard working 'day labour' workforce. The only salaried staff are: Construction Manager Shantha, Nimal the Supervisor and, our multi-skilled Office Manager Kalpa - all Sri Lankans. Administration costs are kept minimal - at around just 1% of overall estimated project value, and there are NO expense accounts!

So far, five patient wards have been completely renovated and are back in use. A virtual reconstruction of the Operating Theatre Suite comprising; two theatres, preparation and recovery area, and, a post-operative intensive care unit - is near to completion. Infrastructure cornerstones such as the brand new laundry and our newly opened Kitchen are just part of the story. The new generator arrived today and medical equipment is in transit. c$930,000 is the current estimate of the overall project value - more than ten times what we set out to achieve. Around 65% of that sum is medical equipment, beds and furniture.

Since our arrival at the hospital, others have 'come to the party'. Malaysian Buddhists through 'The Aloka Trust' have erected a large new outpatient building - eventually to provide Accident & Emergency plus other facilities. Importantly, combined efforts have elevated the hospital status to that of Base Hospital 'Type A', which means better trained/higher qualified staff, a bigger budget for maintenance and cleaning, and, hopefully a transition from medieval patient care to something approaching up-to -date!

So long as we can find a little more money - around $112,000, we can complete our task of rehabilitating the existing old buildings. It would be sad not to finish now that we are so close to our goal but it's getting tough. Tsunami is old news; Katrina, Pakistan and other disasters have dominated the news, and money's too tight to mention!

Despite our cash shortage we persevere! We believe that someone, somewhere, will come to our rescue. Maybe you?

Finally, you'd be forgiven for thinking that Tangalle is leaving it all up to us to fix up the hospital. Recently, in a heart warming bid to say thanks, public support for our project turned to action when, hearing of our fund shortfall, local business and community leaders staged the largest musical show ever held in the town. 8000 boisterous fans packed into the small cricket ground to cheer on top name artists who that night performed free. The event 'A Drop of Sweat for Our Hospital' was a huge success - raising more than $4000 for our efforts and, motivating us to continue. Sri Lankans helping us to help them gives me hope for a brighter future for this hospital and humanity.

For more information: www.tangallehospital.org