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Hospital in Sri Lanka made a better place
PUM expert Anne van Montfoort travelled to Sri Lanka to assist the Hymavathie Hospital to improve the quality of its nursing. She provided lessons in hygiene and first aid and advised the hospital management. Below are a number of extracts from her diary.
Following my arrival in Sri Lanka, I was faced with a further seven hours’ travel by car to Trincomalee, a large town in the Tamil area. I was asked by the Hymavathie Hospital to assist in improving its market position, by working on motivation and nursing quality. In the hospital, to my surprise I was welcomed by Dr Usha, the wife of my contact person who turned out to be in Tanzania. Dr Usha is a physician and assisted me among others as interpreter.
During my first talks with the senior nurse, it became clear to me that the low level of training of the nursing staff was a real problem. Here they follow just one year of theoretical training and six months internship in a private clinic, where they are not actually allowed to do anything themselves. They are not allowed to administer medicines; that is exclusively the task of experienced nurses, following an initial check by a doctor. For my lessons on hygiene and (preventing) infection, I came across an excellent example, in the hospital corridor. Here, the medicines were laid out on the dirty floor. When I asked one of the nurses to prepare everything for stitching a wound, she ran from room to room collecting the necessary items.
I gave the nurses the task of assessing all the treatment rooms for hygiene and efficiency. They drew up improvement plans and contributed actively to the discussion on what the terms reputation and hospitality mean for patients. ‘No patients – no hospital – no jobs.’ They all had good ideas for improving their own skills and creating order from chaos. The sterile surgical instruments are now placed in order prior to the operation and they have drawn up lists of instruments and sundries needed. I have provided a whole series of training sessions over the past few days.
At the start of my lesson on first aid, I allowed myself to slip from my chair ‘unconscious’. Six people started grabbing at me, to hoist me onto a bed. Once laughing had sufficiently overcome the initial shock, I taught them how to place someone gently on the ground, in a single smooth movement. The skills lab teaching took the form of role playing; in the afternoon, the morning group taught the afternoon group. The lessons of the ECG (heart film) were also highly valuable. The nurses have a better understanding on how to assess the readout. In between classes, I continued to work hard on my report for Dr Usha. In my hotel, the large cockroach was joined today by a second large cockroach. They are so big I dare not beat them to death. Bathroom visits will require extra care from now on?.
Dr Usha and her husband are delighted with my report. They can now take real steps forward, and expand the clinic. My discussions with Dr Usha about HRM were also extensive. Focusing structural attention on the nurses in the form of annual evaluations is completely new to her. She can use the assessment form I provided her to give some structure to the process. I am delighted that she has taken up this task, to eradicate the possibility of inequality between men and women playing a role. After a few visits to other hospitals, with acquisition for PUM, the time had arrived for a farewell party. The senior nurse held an emotional speech, in her best English. They have learned a great deal from me, and are grateful. The nurses then sang a number of Tamil songs. After some urging, I even managed to get the outpatients doctor, the only man in the group, to join in. A fantastic end to a valuable mission.