SFH in 2007

Introduction

It seems incredible that we are approaching the end of another year in the life of St Francis’ Hospital. As ever it has been a year full of highs and lows, many challenges and successes. Next year will be the 60^th Anniversary of the founding of the hospital and it will be a good opportunity to reflect on what has been achieved over the years. We should also give thanks to God for the Vision of those who founded the hospital and for those who have continued the work and for all who have received healing and the many staff who have been trained at St Francis’. It will also be a chance to think of the future and renew our vision and the strategies needed to accomplish it.

For many years the two main challenges in providing the services that we would like have been staff shortages and insufficient funds. Staffing remains a challenge, but funding has improved. Government grants have been regular and significantly increased from previous years and AIDSRelief have provided funds for the ever-expanding Antiretroviral (ART) programme. 

The Year in Brief

February saw very heavy rains in Eastern Province. Large areas suffered flooding resulting in harm to the maize crop and damage to the infrastructure with roads and bridges being washed away resulting in increased difficulty in travelling particularly the more remote areas. Even the Great East Road was impassable at one stage. We had a surprise and unannounced visit from the Vice President of Zambia who had been visiting areas of Eastern Province most affected by the flooding. He came to the hospital to follow the progress of a young man who had been attacked by a crocodile and had been referred from a smaller hospital. Sadly the young man had to have his leg amputated, but the visit from the Vice President ensured that funds were donated so that he could have an artificial leg fitted. What can I say? Just like London buses, no visits from a Vice President for years and then two in two weeks! The 2nd was in response to our request that he officially re-open our newly renovated Medical Wards. It was a wonderful occasion and the Vice President gave a very personal speech recalling when he was a schoolboy at Katete Boarding School and that he visited St Francis’ when he was sick and he still considered it has ‘his hospital’. We were so thankful that the torrential downpour occurred after the end of the outdoor ceremony. Very many of the hospital staff worked hard to make the occasion a success. We remain hugely grateful to Wilde Ganzen, De Tweede Jas and Medical support Group from the Netherlands and the Beit Trust for providing the funding for the building work that has transformed the Medical Wards.

March was a very busy month at the hospital. We had a large influx of patients, most likely due to shortages of drugs in surrounding health institutions. Staff particularly in the outpatients, laboratory and pharmacy, had to work very hard to ensure that all patients were seen, working until 7pm on a number of occasions. We also welcomed two staff from VSO, Susan Webster, Accountant and Lucy Mackie, Project Engineer.

In April we again hosted student nurses, midwives and teachers along with their tutors from Katho College in Belgium. It is a partnership that was established a number of years ago and we look forward to the link continuing.

June and July are hectic months for the Nurse Training Schools. The student nurses and midwives take their finals in June and it is a very nerve wracking time for the students and all those involved in teaching them. In July we received the new intake of students nurses. In response to the government plans to increase the number of nurses we increased our number of students to 50 per year instead of 35. Accommodation remains a problem for the training school and so we took on day students. 18 midwifery students also started their studies and we are grateful to the Herke’s Bursary that enabled the hospital to sponsor two of our own enrolled nurses for midwifery training.

July is a busy month for the procurement department. It is when we purchase enough maize to last for the next 12 months. It is used to feed the patients and the nursing students, and our annual requirement is about 70 tonnes, which has to be treated and stored. We then use our mill to grind it ready for consumption each week. It is probably fair to say that everyone in Zambia is a farmer at heart and the hospital allocates land to staff to grow their own maize. When purchasing maize we give first chance to our staff to sell their surplus. Although the harvest was affected by the heavy rains in February we were able buy enough maize from our staff.

August saw another celebration - the 50^th anniversary of the Midwifery School. When it started in 1956 it was the first Midwifery School in Zambia and has trained hundreds of midwives in the intervening years. You may have noticed that we were a year late with our celebration; it’s not that we can’t do our maths, but we were unable to hold the event the previous year. It was a good day and a chance to reflect on how many of the church administered institutions have been pioneers and innovators in health care in Zambia.

August also saw the arrival of two containers, the first container was sent by Direct Relief International in the United States and contained drugs and medical supplies. We also received a container from Medical Support Group (Netherlands) full of drugs, medical supplies (esp. theatre), beds, workshop equipment, new washing machines and other donations.

In September we had a visit from Tim Johnson and Mauve Fort from the Beit Trust. They had come specifically to follow up the programme they have to support Medical Students who come to St Francis’ for their elective placement. The Beit Trust provides support to both Zambian medical students and those from overseas. In 2007, we have welcomed over 40 students from 11 different countries. They can be very helpful to the medical staff assisting with ward rounds and clinics and most learn a lot and appreciate the opportunity to apply their skills in a very different environment. There are other benefits, several medical students have returned to the hospital to work after qualification, others retain an interest and support the hospital various ways. A special mention must also be made to the students from Galway who have brought tens of thousands of pounds to the hospital over recent years. It should also be noted that the Beit Trust have provided funds for the hospital since it was founded and a large proportion of the infrastructure has been built with their support – most recently they funded the building of the Midwifery School, upgrading of 6 staff houses and contributed to the cost of the rehabilitation of the Medical Wards.

October saw another big day in the hospital calendar as we hosted the Graduation Ceremony for not just St Francis’ School of nursing, but also the schools from Chipata General and Mwami Adventist hospitals. There were over 100 graduates and it is a very special occasion as qualifying as a nurse is a real achievement for so many of the students. The pass rates are also an achievement to be proud of for the schools, with the nursing school notching up a 97% pass rate and the Midwifery school getting 100% again. It was a day full of celebration, music and dancing.

We see so many staff come and go and in October we said goodbye to volunteer doctors Mike and Anna Maze from New Zealand. They made a great contribution and we wish them well for the future. Maybe they will come back sometime.

This time of year is a busy time for the maternity department (yes there are seasonal fluctuations in the number of deliveries!) and it was necessary to open up half of the disused TB ward to accommodate the overflow of ‘waiters’. ‘Waiters’ are expectant women who are considered to be at risk of experiencing complications during delivery. As they may live far from the hospital and if any problem occurred they would not be able to get appropriate care in time they are advised to stay at the hospital. They are not strictly inpatients but we do accommodate them and feed them and midwives check their condition each day. Often there are 40-50 waiters but when it reached 80-90 and they were sleeping under as well as on the beds management had to do something.

Building Projects

It has been a busy year for the building department as there is an ongoing programme of rehabilitation, improvements, and expansion.

Outpatients Department

A few years ago we created an outpatients in the building that had previously been used as an isolation ward (St Luke’s). At the time it seemed ideally suited to the new use. Due to the rapid increase in patient numbers in the ART Clinic, more about that later, it was no longer big enough. We therefore built an extension consisting of three extra consulting rooms and a toilet. That was Phase I of our plans and was completed in June 2007 and is now in use. Phase II is an exciting plan to put a roof over the open-air quadrangle in the middle. As this report is written the steel structure is in place and the remaining work is put on the roofing sheets. It is a race against time to finish the work before the rains come in full force, and hampered by the fact that we are only able to work at weekends as the clinics cannot be moved and it would be too dangerous to work with patients and staff underneath. Once completed it will create a good reception and waiting area, sheltered from the elements.

Hospital Kitchen

The hospital kitchen cooks three meals per day for around 300 patients. It was in poor condition with only 2 cooking pots in working condition and no oven. This year we received 4 new cooking pots, a stove and water heaters. The kitchen was also fully rehabilitated replacing all existing electrical and plumbing installations. A canopy and chimney have been built to expel the hot air produced during cooking and the area was redecorated throughout. The kitchen was back in operation in May. Efforts are being made to improve the quality and variety of meals prepared with groundnuts being added to the porridge and beef or chicken being served once a week and eggs also now on the menu. 

Mbusa - Children’s Ward

A large crack in the walls and floor of the rooms on the eastern side of the ward caused by subsidence needed to be repaired. Various options were considered, but we decided that the best approach was to demolish the outside wall (while supporting the roof!) and replace the foundations and then rebuild the wall. The building work was completed in November and the rooms will be decorated shortly.

Eye Theatre

Due to the volume of eye surgery being carried out at the hospital (more than 500 cataract operations in 2006) it was felt necessary to have a dedicated eye theatre. One of the rooms behind the CSSD (old theatre) has been fully upgraded including air conditioning. It is now ready to be used.

Water System Rehabilitation

The project has been in progress for some years. Initially the work involved sinking a new borehole and cleaning out two existing boreholes. The main water tank and adjacent top tanks were rehabilitated, main circulation pumps replaced and relocated. The three ring mains around the hospital have been re-laid using larger PVC pipes instead of the iron pipes. All departments are now connected to the new system.

Burns Unit

Prevention of infection is absolutely critical when caring for patients who have been seriously burned. The hospital receives many badly burned patients often they are patients who suffer from epilepsy and an attack is caused by the flames of an open fire which the patient then falls in and is not removed because people believe they may catch the epilepsy. To reduce the chance of infection the burns rooms on Kizito and Mukasa wards are being upgraded and new equipment purchased. Work is underway and should be completed early in 2008.

Covered Walkways

The hospital consists of separate buildings linked by walkways. For those of you who know Zambia, you will know that spending just a few seconds in the very heavy rain that we can experience in the ‘rains’ will result in a severe drenching. Imagine being a patient on a trolley on the way to theatre. We therefore have a programme of covering the walkways. This year we had the funds to cover the critical sections between the surgical wards, maternity and the theatres. At least the theatre porters won’t need their umbrellas anymore. There are still more sections to cover and we hope to receive more funds to complete the project.

High Density Housing - Toilets

The houses in the high-density area were initially built without toilets. In the 1970’s they had an extension built consisting of a kitchen, shower and toilet. The toilets were pit latrines with the pit below the toilet. There have been a lot of problems with the toilets in recent years and they are very unpopular with the staff that live in them. We have been able to fully upgrade some of the houses including giving them flushing toilets. Funds are not sufficient to fully upgrade the remaining houses but we have decided to install flushing toilets connected to septic tanks. As this report goes to press about half the houses now have flushing toilets and we hope to complete the scheme early in 2008.

ZNA Tuck shop

The Zambia Nurses Association (ZNA) has a programme to support nurses with HIV. The ZNA started to run a trolley to raise funds for the project. This became popular and a small building behind the physiotherapy department has been turned into a permanent tuck shop.

Power protection, regulation and backup

Although not strictly a building project, this has been a very important task. Over recent years the hospital has been fortunate to receive significant amounts of new equipment. This is good news as it helps us improve our services. It has also brought new problems due to the very irregular power supply. Nominally 230volts, power can go as low as 150volts and this damages all sorts of equipment from Haematology analysers in the Laboratory, to air conditioners, borehole pumps, autoclaves, computers and even fluorescent tubes, which don’t work when the voltage is very low. We have therefore installed voltage stabilisers and protection equipment to try to ensure that equipment can still be used when power is poor. We have also installed battery backup systems in the wards and theatre so that during power cuts the battery backup automatically cuts in. We have also installed two solar powered borehole pumps to try to improve the water supply and are switching to energy saving bulbs, which work much better with low voltage and of course reduce energy consumption.

Hospital Workload

* 2007 Projected figures based on first half of 2007.

Almost all the indicators show an increase in workload. First attendances at the HAHC and Outpatients department are showing a significant increase. Contributory factors could be removal of Medical Fees in rural areas and patients coming for ART. There is only a slight increase in overall admissions, although children’s admissions have reduced in the period largely due to less admission for malaria. Deliveries increased from 2004 to 2005 but have remained fairly constant since then, and numbers of caesarean sections has followed the same trend. Major operations have increased year on year, the largest increases being in Obs & Gynae and Ophthalmology operations. The occupancy has reduced a little due to slightly reduced length of stay rather than less admissions.

ART Programme

The Antiretroviral Therapy (ART) programme is having a major impact on the overall work of the hospital and providing hope to the large number in our community with HIV/AIDS. The programme is funded by AIDSRelief through Catholic Relief Services (CRS). St Francis' Hospital started working with AIDSRelief in 2004. The hospital was already running an HIV clinic but could only offer Antiretroviral drugs (ARV’s) to patients who could afford to buy their own drugs, as the cost of the drugs is very high. The AIDSRelief programme provides all the ARV’s free of charge and provides funding for all the other drugs needed to treat ‘opportunistic infections’ caused by the AIDS virus. Laboratory equipment and reagents are provided to enable the clinicians to monitor the patients closely, which is such an important aspect of ART. Record keeping is important and AIDSRelief has supplied computers and database software. AIDSRelief also covers all staff costs associated with the programme. The benefits have not been just for the ART programme, but for the hospital as a whole – the pharmacy and now has air conditioned stores for all drugs, not just ARV’s and similarly in the laboratory where new equipment in air conditioned rooms is used not just for patients on ARV’s but for all patients who need those tests.

Once the treatment became free our numbers increased rapidly. St Francis’ now has one of the largest clinics in the country and the biggest amongst AIDSRelief and CHAZ members with over 7500 patients having been enrolled on the programme and almost 4000 patients on ARV’s. When the programme started the clinic was held one afternoon per week and staffed by a doctor and a nurse. The clinic is now held all day, five days a week and staffed by doctors, clinical Officers and nurses. There are also 10 visits to satellite clinics per month by a team of doctors/clinical officers, nurses, pharmacy and laboratory staff, and two visits per month by a clinical officer/nurse to more remote clinics by motorbike. We have trained a large number of staff, mainly nurses, in ART provision so the service is run mainly by Nurses and Clinical Officers with doctors overseeing and dealing with the more complicated cases. The growth of the clinic brings many challenges including staffing, procuring all the supplies and having enough rooms to see all the patients and store all the records. We have already increased the size of the Outpatient’s but if growth continues we will have to provide bigger premises next year. It has also had an impact on Inpatient services with the Medical Wards receiving many admissions related to HIV and in many cases the management is complex and demanding. The other major challenge is to ensure that the growth of the ART Programme does not have a detrimental effect on other hospital services.

Despite all the challenges it is a very rewarding programme. We know many of the patients very well and the change we have seen in their lives is amazing. Many of the patients on ART would have died if the drugs had not been available. But the treatment doesn’t just keep people alive, in a lot of cases patients are able to return to work and live a normal life. This not only improves their ability to support their families but also has a very positive effect on their self-esteem, as they are able to contribute to their family and the community where previously they were just a burden.

Overseas Support

The support we receive from overseas is incredible and the hospital just wouldn’t be what is without it. There is a great deal of support for individual projects and programmes, but 3 organisations have made a huge impact on the hospital as a whole.

United Society for the Propagation of the Gospel (USPG)

USPG has supported the hospital since the beginning. They have provided many staff and funds over the years. Today they are responsible for supporting the Executive Director and Hospital Administrator. They also provide funds that are used to purchase drugs and medical supplies and fund staff training, which is a vital part of our human resource plan.

Medical Support Group (MSG)

Based in the Netherlands they have been working with the hospital for a number of years and many of the members have previously worked at the hospital. They raise funds in conjunction with the Bed Sponsor Scheme, the Annual Summer Concert and through organisations and individual donors. But they do much more than fund raising, they advocate on our behalf and develop links between the hospital and a number of large donors and source many donated goods that prove useful to the hospital. They also provide technical assistance (particularly in building and maintenance) and assist with recruitment of doctors.

Friends of St Francis’

This again is made up of former hospital staff, most of who worked at the hospital many years ago but still have a keen interest in the work of St Francis’. The Friends also receive money for the hospital from individuals, churches, other organisations and special events. Through small and large gifts the Friends raise a considerable amount of money and this is used in three main ways. A large proportion of the money is used to purchase drugs and medical supplies, many of which are not available in Zambia or are much more expensive to purchase in Zambia. We buy in bulk and transport by container. Another portion of the money is used to pay retention packages to our most senior Zambian staff. This is in recognition that our senior staff (particularly the doctors) have sacrificed the chance of much higher earnings by working in a rural area compared to being in one of the urban areas. An important part of payment is to assist them with the education of their children. The third main use of the funds is to support training. We have training pharmacy, laboratory and accounting staff as well as enrolled nurses going for further training as midwives and registered nurses. Friends of St Francis also assist greatly with the recruitment of doctors.

We are so thankful for all the support that we receive in so many different ways, not least the knowledge that people all around the world continue to pray for the hospital and staff.

The Parkinson’s

We have now been at St Francis’ since 1998, supported by the United Society for the Propagation of the Gospel. Shelagh is the Executive Director of the hospital and also Paediatrician while Ian is the Hospital Administrator. Both jobs are challenging, often frustrating and demanding but ultimately very rewarding. We also have a fairly hectic family life with our six children. The oldest three board at Chengelo School, Mkushi about 500 miles away. Amy, Jack and Kate are all doing very well and have really grown in many ways since starting at the school; we just wish it was closer. Jim, Chiko and Joshua are still at home and enjoy the freedom that growing up in Zambia gives them. They miss their older brother and sisters and really enjoy the holidays when we have a full house. We had a visit from some of our family earlier on in the year, which gave us a good excuse to go and get drenched at Victoria Falls. Who can fail to be inspired by such a sight? Later in the year we had a bit of an adventure, picking the children up from school and entering the South Luangwa National Park from the north. The guidebooks recommend that this trip should only undertaken by two fully equipped 4-wheel drive vehicles. We only had one 4-wheel drive full of children, but we managed. The guidebook also described how you ‘drop over’ the escarpment and then cross a couple of rivers. We travelled about 6km in two hours as we descended down a very steep and rocky track, but enjoyed absolutely incredible views and didn’t get our feet wet crossing the rivers. Ian was diagnosed with testicular cancer in 2006 and had surgery at St Francis’ and then chemotherapy in the UK. It was a difficult time for the family as being apart for 4 months compounded the worries about Ian’s health. Again this year Ian (who feels fine) has had to travel to the UK for routine check ups and this has put a great strain on Shelagh as she combines her work as Executive Director, Paediatrician and mother. We really appreciate the prayers of so many and are thankful for God’s grace in enabling us to continue to do his work at St Francis’. We look forward to the challenges ahead, and our hopes and prayers for the hospital for the next year are that there will be sufficient staff to provide the best possible services for our patients, that the 60^th anniversary celebrations are a success with many former staff being able to join us and that we gain a real sense of direction for the hospital and how we should develop over the next few years. On a more personal level we hope that we can get enough time to relax as a family away from the pressures of work and that our eldest daughter, Amy is successful in her GCSE’s.