KLIMANJARO CHRISTIAN MEDICAL CENTRE
An Institution of The Good Samaritan Foundation
Annual Report 2014
KILIMANJARO CHRISTIAN
MEDICAL CENTRE
An Institution of the Good Samaritan Foundation
ANNUAL REPORT
2014
i
TABLE OF CONTENTS
Introduction........................................................................................................iv
General administration.......................................................................................iv
1.0 Clinical departments....................................................................................1
1.1 Department of Anaesthesia.......................................................................2
1.2 Casualty/Outpatient Department..............................................................6
1.3 Care and Treatment Clinic (CTC) & Child Centred Family Care Clinic
(CCFCC)..............................................................................................9
1.4 Clinical Laboratory Department...........................................................18
1.5 Community Health Department............................................................20
1.6 Dental Department..............................................................................24
1.7 Dermato-venereology Department........................................................26
1.8 Diabetes Clinic..................................................................................30
1.9 Department of Diagnostic Radiology and Medical Imaging...............31
1.10 Department of Internal Medicine.....................................................34
1.11 Main Theatre and Central sterile Supplies Department............................38
1.12 Departmet of Obstetric and Gynaecology..........................................41
1.13 Occupational Therapy Department.....................................................46
1.14 Ophthalmology Department................................................................49
1.15 Department of Orthopaedics..............................................................52
1.16 Department of Orthopaedics Workshop.............................................56
1.17 Otorhinolaryngology Department........................................................58
1.18 Department of Pathology....................................................................61
1.19 Department of Urology......................................................................63
2.0 Paramedical departments...........................................................................68
2.1 Department of Physiotherapy...............................................................69
2.2 Medical Records department...............................................................73
2.3 Kilimanjaro Clinical Research Institute (KCRI)...................................74
ii
3.0 Hospital Supporting Deparments...................................................................80
3.1 Chaplaincy Department..........................................................................81
3.2 Catering Unit.........................................................................................82
3.3 Department of Engineering.....................................................................84
3.4 Housekeeping Unit ...............................................................................87
3.5 Information Communication Technology (ICT) Department.....................88
3.6 Laundry Unit.........................................................................................90
3.7 Legal Department..................................................................................91
3.8 Procurement Management unit.............................................................92
3.9 Department of Social Welfare.................................................................93
3.10 Security Unity .....................................................................................97
3.11 Telephone Unit ....................................................................................97
4.0 Schools...........................................................................................................98
4.1 Assistant Medical Officers General school............................................99
4.2 School of Anaesthesia...........................................................................101
4.3 School of Nursing.................................................................................104
4.4 School of Occupational Therapy...........................................................107
4.5 School of Optometry.............................................................................110
4.6 School of Advanced Diploma Paediatric Nursing...................................111
4.7 School of Physiotherapy.......................................................................113
4.8 Training Centre for Health Records Technology..................................114
4.9 Tanzania Training Centre for Orthopaedic Technologists.......................116
5.0 Hospital Statistics............................................................................120
6.0 Formulas/Definition of terms...........................................................127
7.0 List of Abbreviations.........................................................................128
iii
INTRODUCTION
Kilimanjaro Christian Medical Centre (KCMC) was established in 1971 as a Zonal Referral
Consultant hospital owned by the Evangelical Lutheran Church of Tanzania (ELCT) under the
Good Samaritan Foundation (GSF). The aim was to create an independent legal body which
nevertheless is to be permanently linked to the ELCT and Christian Council of Tanganyika.
The immediate purpose of the foundation was to a body capable of establishing the Kilimanjaro
Christian Medical Centre. The referral hospital was established in order to serve the northern,
eastern and central zone of Tanzania. It is one among the four Consultant hospitals in Tanzania.Its
record in Medical Services, Research, and Education has significant influence in Tanzania, East
Africa and beyond.
In 2014, KCMCcontinued to carry out its services to people according to the mission statement,
“To render God’s healing services to set mankind free from the bondage of sickness, suffering and
sin”, “To reflect Christ’s character of love, mercy, compassion and faithfulness in the course of
fulfilling the call to care and heal the sick” and “To share God’s grace and love through the power
of the Holy Spirit in the course of treating and caring for the sick”.
GENERAL ADMINISTRATION
During the year 2014,KCMC under its Management Team continued to carry out its role of
management of patients, teaching and research with collaborators, other stakeholders and foreign
institutions.In the year, the Management Team in place was:
Management Team:
SN.
1
2
3
4
5
6
NAME
Prof.Raimos M. Olomi
Dr. Mark G. Mvungi
Mr. Essy S. Mmbaga
Prof. Egbert Kessi
Mrs. Hilda Mungure
Prof. Gibson Kibiki
POSITION
Ag. Executive Director (KCMC) & Executive Secretary (GSF)
Ag. Director of Hospital Services
Director of Human Resources Management & Administration
Provost of KCMU College
Director of Finance
Director of Research
iv
In2014, the Management Team worked under the guidance of the Board of Trustees, Board of
Governors and GSF Council. Membership of the boards and council were as follows:Board of Trustees:
• Rt. Rev. Dr. Alex G.Malasusa
-
Chairperson
• Rt. Rev. Dr. Martin F. Shao
-
Member
• Dr.Geofrey G.Sigalla
-
Member
• Dr. Adeline Kimambo
-
Member
• Rev. Dr. Leonard Mtaita
-
Member
• Mr. Brighton Killewa
-
Member
• Mr. Reginald Mawalla
-
Legal advisor
• Prof.Raimos M.Olomi
-
Ag. Executive Secretary - GSF.
• Rt. Rev. Dr. Alex G. Malasusa
-
Chairperson
• Rt. Rev. Dr. Martin F. Shao
-
Member
• Mr. John Haule
-
Member
• Mrs. Hilda Gondwe
-
Member
• Dr. Adeline Kimambo
-
Member
• Mr. Brighton Killewa
-
Member
• Prof.RaimosM. Olomi
-
Ag. Executive Director –KCMC.
• Rt. Rev. Dr. Alex G. Malasusa.
-
Chairperson
• Rt. Rev. Dr. Martin F. Shao
-
Member
• Rt. Rev. Simon Makundi
-
Member
• Mr. Brighton Killewa
-
Member
• Prof. Ester Mwaikambo
-
Member
• Mr. Reginald Mawalla
-
Legal advisor
• Prof.RaimosM. Olomi
-
Executive Secretary–GSF.
Board of Governors:
GSF Council:
v
CLI N I C A L
D EPA RTM E N TS
1
DEPARTMENT OF ANAESTHESIA
Head of department: Dr. Andrew Hellar
Introduction
The Department of Anaesthesiology is always active and keen in providing safe anaesthetic services
to the patients undergoing minor or major operations like Thoracotomy, Laminectomy, Endoscopic
operations, Phoeachromocytoma and Open Heart Surgery. AMREF outreach anaesthetic services
are as well provided by the department.
Staffing
In the year 2014 has been fruitful to the department to celebrate to mark the graduation of the
MMed graduate who had been mentored by our Anaesthesiologist. One Medical Officer (Registrar)
and three clinical officers were posted to the department.
Staff situation
SN
1
2
3
4
5
6
7
8
Cadre
Anaesthesiologists
Residents
Registrar
AMO Anaesthetists
Nurse Anaesthetist BSc. Nursing
Nurse Anaesthetists
Clinical Officers (on training)
Nurse Assistants
Total
Number of Staff
2
1
1
3
3
12
3
6
31
Activities
Casualty - Staff Rotation in Anaesthesia department
Three clinical officers fromcasualty were scheduled to rotate for three months in department of
anaesthesia in order to acquire basic knowledge and skills on how to manage critically sick patient.
Anaesthesia department appreciates for the steps taken by the administration.
Teaching - Students (Rotation in the Department)
Lecture discussion sessions were conducted in the class and hand on patient procedures were
demonstrated to students.
Workshop to Medical students
Surgical and Anaesthetic skills Workshop was conducted to Medical students
(These are MD III and MD IV and AMO general students)
2
The practical and teaching activities are listed below:
Department
G/Surgery
Orthopedic
Gynaecology
Obstetrics
Urology
ENT
EYES
Dental
Total
Total
Emergencies
Total Under 5
General Anaesthesia
EL
EM
1293
355
359
69
360
27
28
31
168
6
1314
28
543
27
35
4,100
543
KEY: EL = Elective = 5949;
Regional Anaesthesia
EL
EM
196
65
529
151
103
2
291
1298
730
8
1,849
1,524
Technique
Spinal nerve block
Epidural nerve block
Saddle nerve block
Axillary nerve block
Supraclavicular nerve block
Biers block
TOTAL
GA=4643
1,364
RA=3373
EM = Emergency = 2,067
Number of Patient
3,347
3
8
0
13
2
3,373
Drug utilization
General Anaesthetics
No.
1
2
3
4
Drug
Halothane
Isoflurane
Ketamine Bolus
Ketamine Drip
Total
Number of Patients
3,244
959
94
346
4,643
Other Anaesthetic Drugs
No.
1
2
3
Drug
Atropine
Lignocaine 2%
Diazepam
Number of patients
4,802
3,244
3,185
3
1909
1108
492
1648
912
1342
570
35
8,016
2067
Common Regional Techniques
No.
1
2
3
4
5
6
Total
4
5
6
7
8
9
10
11
12
13
14
15
Thiopentone
Suxamethonium
Pancuroneum
Atracurium
Neostigmine
Lignocaine 5%
Marcaine
Ephedrin
Pethedine
Diprivan (Propofol )
Pitocin
Ergometrine
2,894
4,643
2,136
11
2,146
2,523
832
30
80
20
1646
2
Labour ward coverage
Caesarean Section
Nature of procedure
Elective C/S
Emergency C/S
Total
Number of patients
319
1329
1648
Caesarean Section: General anaesthesia (GA) and Regional anaesthesia (RA)
Nature of procedure
General Anaesthesia C/S
Regional Anaesthesia C/S
Total
Number of patients
59
1589
1648
Comments
Majority of the operations are obstetric emergencies. Ninety two percent of all Caesarean sections
are mainly obstetric emergencies. The common anaesthetic technique is spinal (Regional)
anaesthesia. From the above obstetric situation, the Department has set a shift system; morning,
evening and night shifts. to ensure that there is prompt response to the Obstetric Emergencies.
Anaesthetic complications
Cardiovascular System
Hypotension
Tachycardia
Bradycardia
Reversed Cardiac arrest
Total
Number of patients
158
38
11
10
217
4
Respiratory System
Laryngeal Spasms
Difficult Intubation
Total
Number of patients
13
19
32
Regional Anaesthetic Complications
Regional Anaesthetic Complications
Post Spinal Head ache
High Spinal
Total
Number of patients
3
1
4
Achievements
Equipment
The Department has nine operating theatres equipped with modern anaesthetic machines.
Mechanical Ventilators are available in the Intensive Care Unit. Monitors (ECG, Pulse Oxiometer)
are available.
Constraints
Equipment
The Department is requesting for more endotracheal tubes as the number of operations is
increasing, a set of Fiber Optic Laryngoscope for difficult Intubations, pediatric ventilator
(preferably Evitadura ventilator which can be used in the neonates) because the number of underfive operation is relatively high.
Requests
Drugs: We had aconstant supply of Isoflurane this year denoted from Bugando Hospital. We
request for our own supply because BMC has no more supply. We request for Ephedrine, protocol,
Dopamine and Fentanyl
Equipment:
1. The Department is requesting for more endotracheal tubes and Oropharyngeal Airways
2. A set of Fiber Optic Laryngoscope for difficult Intubations
3. 2 ventilators for both Paediatric, infants and Adults
4. Two Cardiac monitors for labor ward and one cardiac monitor for Urology Theatre.
Way forward
The department is planning to discuss with the administration to train more nurse anesthetists and
AMO anesthetists to join the department. This will alleviate anaesthetist workload in operating
theatre, Intensive Care Unit, Casualty and cannulation in the wards. Year 2014 the department has
5
trained three clinical officers from Casualty department. The department has planned to discuss
with the heads of the departments, on critical care management since will soon get an emergency
department which is now being built.
CASUALTY/OUTPATIENT DEPARTMENT
Head of department: Dr.Isaria Maruchu
Introduction
Casualty/Outpatient department is the entry point to KCMC. In other words, it is the face of
this famous institution, and perhaps the busiest department. All patients, emergencies and nonemergencies, referrals and self-referrals must pass through this department which operates for
24 hours. The department receives emergencies, either brought in directly or referred from
other health units within and outside the catchments area of KCMC, and from the neighbouring
countries. Referrals for specialized services pass through casualty/OPD.
The goal has always been to attend all patients regardless of their colour, faith, race, economic
status, etc. at all times. The spirit of team work, sharing knowledge and ideas has made the unit
stand.The vision is to make the department a centre of excellence in emergency medical care. The
department receives an average of 80 to 100 patients a day. In spite of the very small space, it has
been possible to attend all these patients.
Activities:
*
*
Attending to all emergencies brought in
Consultations to either referred or self-referred patients and to those coming for follow
up.
*
Interdepartmental consultations
*
Counseling and testing services done by trained counselors within the department
*
Teaching to medical students,nurse studentsand visiting foreign students
*
Collection of samples from patients and sending them to the laboratory.
Clinics in the Department
1.
Medical Clinic -
Monday and Friday
2.
Surgical clinic
-
Tuesday and Thursday
3.
Orthopaedic clinic
-
Tuesday and Thursday
4.
Obstetrics and Gynaecology Clinic -
Mondays, Wednesday and Fridays
5.
Paediatrics
-
Tuesday and Thursday
6.
Diabetic Clinic -
Wednesday and Friday
7.
Dental Clinic -
Daily except Mondays
6
8.
IDC/CTC -
Mondays, Wednesday and Fridays
9.
CCFCC
-
Mondays, Wednesday and Fridays
10. Occupational Therapy -
Monday to Friday
11. Reproductive Health
-
Tuesday, Wednesday and Thursday
12. NONETO
-
Wednesday
13. Cardiac Clinic
-
Wednesday monthly
14. Adolescence Clinic
-
Monday and Wednesday
Staffing:
*
1 Principle Medical Officer – Head of Department
*
4 Register Medical officers
*
1 AMO
*
3 Clinical Officers
*
2 Nursing Officers
*
17 Assistance Nursing Officers
*
2 Enrolled Nurses
*
12 Medical attendants
Staff Movements:
*
1 Doctor joined Emergency medicine
*
3 clinical Officer went for short course on anaesthesia
*
1 Nursing Officer Resigned
*
1 ANO on BSc. training Course
*
1 ANO went for Anaesthesia courses
*
1 Enrolled nurses retired on March 2014
Staff Requirements:
1.
Doctors
-
At least 14(One to be responsible for the staff clinic)
2.
Nurses
-
At least 32
3.
Medical Attendants - At least 20
4.
Porters
At least 4
-
With the proposed Emergency Medicine department, the following will be required:
Radiographer, ultrasonographer, anaesthetist and nurseswith experience in emergency medical
care and doctors interested and hopefully trained in Emergency Medicine.
7
Equipment:
»
In the present emergency room there are2working monitors and 2 working suction
machines which are not enough. The following equipment are needed:
»
Monitors at least 3 more
»
Suction machine at least two
»
Portable suction machine
»
Oxygen delivery heads
»
Blood Pressure machine digital at least 10
»
Thermometers, wheel chairs at least 10
»
Stretchers. The presently used stretchers are too old
»
Extra chairs for patients, the available chairs are not enough for the number of patients
attending the unit.
»
Screens or partitioning the emergency room with curtains.
»
Scales for weighing patients ( paediatric and adult scale )
Challenges:
»
Consultations rooms are not enough compared with the number of the patient and
Doctors(No Privacy)
»
Lack of instruments i.e. enough suture sets and cut down sets
»
Stretcher by needs to be worked out. During the rainy season the place in slippery.
»
The department doesn’t have a tea room
»
A room for a medical records attendant and cashier is really needed in the department
»
In times of emergency it takes too long to get patients file and to the patients it takes time
for them to pay their bills especially in the afternoons.
»
The Department has no internet connection
»
No renovation especially in Toilet
Achievements:
»
One nurse graduated in Enrolled Nurse
»
2 Medical Officers employed at Department
»
1 Medical Attendant employed
»
3 clinical Officers went for short course in Anesthesia
»
1 Assistance Nurse Officer joined anesthesia
»
Customer care services started at Department
»
We received enough chairs for Doctors and patient
8
Way forwards:
*
To train more human resource on emergency medicine (Doctors and Nurses and
anaesthetist, Ultrasonographists).
*
To prepare enough equipment for emergency department.
CARE AND TREATMENT CLINIC (CTC) & CHILD CENTRED FAMILY CARE
CLINIC (CCFCC)
Reported by: Sr. Zawadi Hillu
Introduction
Kilimanjaro Christian Medical Centre (KCMC) is among the first four sites in Tanzania to offer free
Anti-retroviral Therapy (ART) since September 2004. The existing Care &Treatment at KCMC is
focusing on increasing the number of people on ART and linking PLHIV to the community. From
the beginning provision of services for adults and children was harmonized so that parents could
receive services at the same time as their children and the number of children on ART was around
20% of all patients’ right from the start. The centre has been receiving funds from Elizabeth Glaser
Pediatric Foundation (EGPAF) to implement Care & Treatment services for adults and children.
Goal
To provide comprehensive care and treatment services to adults, adolescents and children living
with HIV, within the catchment’s area and beyond. The centre established Child Centered Family
Care clinic [CCFCC] in October 2006 and official inauguration was done on 6th December 2007.
The aim is to link the care and treatment of children and their families including primary and
specialty medical care, social services, prevention of mother to child transmission (PMTCT) and
home based care. Further it supports improvement of care and treatment in Continuous Pediatrics
Education Program [CPEP] sites in Kilimanjaro and Arusha Regions.
Based on the special needs for adolescents the centre has established adolescents/youth clinic
since November 2007 .The clinic is done once per month on the last Saturday of the month. To
date there are 59 adolescents and 61 youths attending clinic. (Total 120)
Vision & mission of CCFCC
Vision
•
To become a model of pediatric health care in Tanzania through the integration of Care
&Treatment, Training and Research.
Mission
•
To provide health care services for all children and their families in Northern Tanzania
with a focus on Care &Treatment, Training and research.
9
Objectives
•
Strengthen quality of Care and treatment services to children and their families living with HIV
•
Update knowledge and skills to service providers including PLWHIV.
•
Scale up Continuing Pediatric Education Program (CPEP) in Kilimanjaro and Arusha
regions.
•
Strengthen linkage between CCFCC/CTC and other HIV /AIDS program.
•
Strengthen internal and external community linkages within Kilimanjaro region and
beyond through CHBC.
•
Strengthen clinical laboratory services for PLHIV to care and treatment sites in the
Northern zone and beyond
•
Strengthen Monitoring and Evaluation system on care and treatment services.
Staffing
The CTC/CCFCC operated with one overall coordinator, one administrator, one training
coordinator, one community linkage Nurse and two clinics Nurse in charges. Other members are
as follows:
CCFCC Clinic:
*
1 Pharmacist
*
1 Social worker
*
2 Assistant Nursing officers
*
2 Medical recorders
*
1 Data clerk
*
2 Medical attendants
*
1One office attendant
CTC:
*
One Assistant Nursing officer, contract ended in Feb 2014
*
Received one Assistant Principle Nursing officer from ENT clinic
*
One Medical attendant was transferred to Medical two
*
Received two medical attendants from medical one and Pediatric two
*
Two Medical recorders were employed on one year contract basis from 2014.
Staff movements
Two Assistant Nursing officers, one contract ended in October 2013 and the second one retired.
10
One Assistant Nursing officer, contract ends in Feb. 2014
Two medical recorders resigned in October 2013
Staff requirements:
One pharmacist and one Social worker
* Currently the pharmacist and Social worker are on contract employment by KCMC and
EGPAF
Activities
CTC:
» Adult’s clinic on every Mondays, Wednesdays and Fridays.
» ART adherence counseling to all new enrollees to Care and treatment
» Ongoing group/individual counseling on every clinic days
» Proper documentations of monitoring and evaluation tools
» Internal & eternal linkages
» Youths clinic on one Saturday every month
» Provider initiated counseling and testing (PITC)
CCFCC:
Eligibility to the family clinic is 2 members and above, the entry point is a child
» Pediatric CTC on Mondays
» Family clinics on Mondays, Wednesdays and Thursdays.
» HIV Exposed babies and their mothers are seen on Wednesdays.
» Adolescent clinic on one Saturday every month
» Proper documentations of monitoring and evaluation tools
» Internal & eternal linkages
» Continuous pediatric education program (CPEP) to support quality of C&T in other sites
(Arusha and Kilimanjaro regions )
» Clinical attachments.
» Provider initiated counseling and testing (PITC)
» Outreach services to two orphanage centre’s on monthly basis
Services provided to all family members includes:
»
Counseling and testing
»
PMTCT
11
»
Care and treatment
»
Antiretroviral treatments (ART)
»
Physical examinations
»
Family planning
»
Home-based care and external linkages
»
Cervical cancer and TB screening.
»
Psychosocial support.
Key CTC performance/achievements
•
Capacity building through seminars/ Mentoring and coaching:
1.
CPEP seminar was conducted in March 2014 for two days with the theme “What is new
in paediatric 2014” Several topics were discussed such as, PMTCT, HIV in children, Diabetes/DKA, Hypoglycaemia in Children, Malaria, Care for premature baby, Neonatal sepsis, Pneumonia, TB in children and Meningitis management.The seminar was
attended by 18 service providers from CPEP sites.
2.
service providers (10 from outside and 6 from KCMC). The expected outcome is to improve podiatric care within the Centre and beyond.
3.
Two service providers (Nurses) attended TB/HIV care experience sharing meeting organized by the Moshi municipal Council for 3 days.
4.
Four participants (social worker & 3 adolescents) attended psychosocial support in
The second CPEP seminar was conductedin October 2014 with the theme, “Quality in Neonatal Care”, with the following topics, Neonatal examination, How to handle neonatal emergencies and Common Drug Dosage in paediatrics, Neonatal feeding, Prematurity, Birth injury, Kangaroo Mother Care, Neonatal meningitis, Neonatal Jaundice, Birth asphyxia, Care for HIV exposed Child. The seminar was attended by 16
ARIEL camp activity in Arusha for six days. The activity was organized by EGPAF centrally.
•
Continuous Paediatric Education program (CPEP):The Continuous Paediatric Education Program (CPEP) visits were conducted to 9 hospitals in Kilimanjaro region &
4 hospitals in Arusha region, whereby members of the Paediatric department from
KCMC provided formal lectures (mainly HIV related), case review and bedside teaching.
•
Adolescent’s clinic:
The clinic for adolescents is conducted once per month on the last Saturday of each
month. To date there are 60 adolescents and 92 youths attending Care and treatment services at KCMC (Total 152). Among them 4 were transferred to Adults CTC.
12
•
Outreach to Orphanage centres ( Kalali & Light in Africa)
The program is supporting 2 orphanages centre: Outreach was conducted as planed to Light in Africa and 32 HIV infected children were attended (27 children on ART and 5
on care). Kalalicentre, 40 children were attended with different health problems .Among them one is HIV infected and on ART.
•
Clinical attachments: -
During the period of Jan - December We managed to receive fifteen groups ( 30 service providers ) for clinical attachment from Arusha (St. Elizabeth), Kilimanjaro (Kilema), Tabora (Goweko and Kigwa B dispensaries) and NachingweaLindi (Liwale District Hospital), Tabora region (Town clinic dispensary), Tabora (Kaliuwa and Uliyankulu
Health Centre) and Lindi (Kilwa District hospital) regions, MwangaDistct - Usangi District hospital, Arusha region - Dream CTC Holy Ghost Father USA RC Health Centre and Usariver Health Centre (Government), Same, Arusha (Kaloleni Health Centre), .
Tabora (Igunga District), Lindi (KinyongaDistct Hospital –Kilwa), Kilimanjaro
(Karanga Prisons CTC & CCP HC) From January to December 2014, a total of 59 visits were conducted, 48 visits were conducted in Kilimanjaro and 11 in Arusha.
The attachment program was of benefit to them as they were mentored to gain
knowledge and skills on pediatric HIV/AIDS management, Pediatric conditions, Adults CTC, PMTCT option B+, and DBS sample collection and packing procedures. The total number of 667 service providers and 122 students were mentored.
•
Conduct outreach services at St. Joseph hospital in Moshi Urban district:
Comprehensive care and treatment at St Joseph hospital is going on well. During the
period 35 clients were seen at Care and treatment. The team of service providers from KCMC provided formal lectures (mainly HIV related), clinical mentorship/coaching and bedside teaching.
•
All clients attended CTC for both adults and children (2,494) were screened for TB on each visit. Throughout the year a total of 47 clients (adults 42 and 5 child) were found to have Tb. All confirmed were provided TB treatment and further management.
•
Provide TB/HIV integration services at CTC/CCFCC:
Improve Internal and external linked activities:
Tracing of clients (235) through phone conversation with the outcomes of 189 clients being re-enrolled to CTC and self-transfer out were 15 clients. Expert patients (PLHIV) were involved in Group and individual counselling adherence at CTC and participated in tracing of LTFU (235 clients).
13
•
Provide family planning services integration at CTC.
The services are integrated at CTC/CCFCC .Counselling on Family planning was
provided to 2694 clients attending CTC (Male 851 and female 1843).
•
Conducting meetings to improve quality of services provided.
The following meetings were conducted during the period of Jan – December 2014.
Quality improvement (QI) team meetings were conducted on monthly basis. Clinical issues
discussed in the meetings wereon QI performance indicators e.g. cervical cancer screening
to all women of reproductive age who are HIV +ve attending CTC and this is done on every
Monday;quality of data and use of client’s appointment tools andintegration of family planning
to CTC and proper filing of family planning information in CTC 2 cards. The clinical issues were
discussed and plan for action were made.
Meetings with Health Care Workers living with HIV (Huduma group A -a group of KCMC 18
health care workers)
The purpose: Experience sharing on use of ART, adherence to treatment, stigma reduction, strategies
and disclosure process. The outcome was strategies on adhering to appointment, treatment and
disclosure.
Meeting with youths (PLHIV)
Adolescents /youths (120) attended; they share success stories on use of ARV’s; reminded on CD4
Cohort checkup, income generating activities; Self-care, religious and beliefs. Few members
complained they got difficult time to take drugs when they travel and meet with people who
are unaware of their sero-status. The challenge was discussed among the members and possible
solutions made.
CTC/CCFCC staff meetings
Proper documentation of CTC2 cards reminded, service providers were provided on job training
on use of appointment register, discussion done on CD4, internal linkage, follow up, tracing of
clients lost to follow up. Difficult issues were discussed and actions were made. The expected
outcome is to improve quality of care & treatment services for both adults and children.
Meetings with people living with HIV (PLHIV)
The meeting was conducted to 50 PLHIV attending clinic at KCMC.
The purpose: Experience sharing on use of ART, testimonies and adherence to treatment. The
outcome was stigma reduction strategies and disclosure of sero-status.
CTC and PMTCT service provider’s (49) Multi-disciplinary team meeting
The purpose: experience sharing on challenges, review of TB infection prevention policy, new
14
updates and review of checklist. Expected outcome is to improve quality of care to PLHIV
Supportive supervision and monitoring of the program activities
Supportive supervision/mentorship on documentation to all service providers working at the CTC/
CCFCC was conducted on every clinic days, identified weakness such as PITC in paediatric
wards, cohort CD 4 check-up, Clients lost to follow up, disclosure of sero status to Adolescents
living with HIV & improper documentation in CTC2, were discussed and actions were made.
Reports /data was presented during QI team meetings for sharing, planning and ordering etc.
Statistics:
*Source of data: KCMC Quarterly Facility-based reporting to the MoHSW
15
16
Major challenges and the way forwards:
S/N Challenges
1 Inadequate knowledge on filing
IPT form for TB.
2 Self-referrals to nearby CTC
3 Clients resist to use IPT for TB
4
High demand in treatment
adherence counseling
Way forward
Conduct on job training and clinical mentorship to
service providers working at all key sections
Conduct meetings/ ongoing education /counseling
Ongoing treatment counseling and H/education
on importance of IPT and conduct meetings with
clients to discuss the advantages of IPT for TB.
Conduct ongoing group adherence counseling/
Involve expert clients in treatment adherence counseling
Planned activities for the year 2015:
»
Provide ongoing comprehensive HIV Care and treatment services at KCMC and beyond.
»
Continue to Provide CPEP activities in Kilimanjaro and Arusha regions
»
Conduct ongoing Supportive supervision and monitoring of the program activities
»
Hold and attend different meetings.
»
Conduct quality improvement team meetings
Acknowledgement
All these achievements have been made possible through support from the management of KCMC
in collaboration with EGPAF. The CCFCC/CTC team of service providers appreciates for the
support given to the unit and other health facilities.
17
CLINICAL LABORATORY DEPARTMENT
Head of Department: Dr. Baltazar Nyombi
Introduction
The Department of Clinical Laboratory is one of the clinical service departments within the
KCMC hospital.
Activities
KCMC Clinical Laboratory has the following activities:
Clinical Diagnostics
KCMC Clinical Laboratory support the patient’s care by conducting investigations on patient’s
specimens in different sections including Haematology, Clinical Biochemistry, Microbiology,
Serology, Blood Transfusion, Parasitology and Molecular diagnostics (DNA PCR for HIV Early
Infant Diagnosis-HEID and viral load). During the year 2014 a total of 83,243 specimens were
received and on which, 144,676 laboratory investigations were conducted as compared to 129,537
investigations conducted in 2013. The main reasons for the increase in the number of investigations
(15,139 – 11.7%) were due to improved maintenance and operation of the laboratory equipment,
improved stock management and reduced incidence of stockouts of reagents as well as hiring of
more technical staff.
Teaching
Scientists and technical staff in the department were involved in teaching various programmes
at KCMU College. Students from different programmes conducted their Clinical rotations in the
department. These included Medical Doctors, Bachelor of Science in Health Laboratory Sciences
and Diploma Health Laboratory Sciences. Furthermore, students from other Health Laboratory
Schools in the country spend some time in the laboratory during their field practical attachments.
Laboratory Management and Staffing
The leadership of KCMC Clinical Laboratory is comprised of the Head of Department assisted by
the Laboratory Manager, Quality OfficerandSafety Officer as well as their Deputies.Support staff
include laboratory attendants, data clerks and a secretary. The department continues to experience
shortage of trained technical staff and in addressing this problem, KCMC and in collaboration
with EGPAF, six laboratory technical staff were employed in 2014. One laboratory Scientist was
transferred from KCRI Biotechnology Laboratory as well as two staff, one Laboratory Scientist
and Laboratory Technologist,completed their studies and joined the Clinical laboratory. Three
staff left for further studies, two for MSc and one for BSc. Efforts are being made to recruit more
technical staff to support and sustain the laboratory services. In comparison of the number of staff
required for a zonal laboratory, by the end of 2014 the staff in the department comprised of:
18
Category
Laboratory Scientists
Specialist Technologists
General Technologists
Laboratory Technicians
Laboratory Attendants
secretary
Data Clerks
Total
KCMC Clinical
Laboratory
6
1
10
1
5
1
4
28
Zonal Laboratory
Requirements
15
10
15
5
6
1
5
57
Progress/Achievements:
The following achievements were noted during the year 2014:
*
Improved performance of most laboratory investigations as per request, and remarkable reduction in turnaround time of investigational reports to clinicians.
*
Continuous reviewing of quality manual, safely manual and sample collection manual as
well as implementation of the quality management system in the department in
compliancy to ISO15189:2012.
*
The laboratory continued to perform well on proficiency testing (External Quality
Assessment) on all enrolled tests that were performed in Clinical Biochemistry, HIV
DNA PCR and Serology.
*
Regular departmental meetings to discuss technical, infection prevention and control as well as quality improvement issues were conducted
*
In October, 2014, the department continued to receive Medical Laboratory Scientist
Interns who graduated their BSc degree course. The interns were expected to be
supervised for one year
*
Most of the equipment were under service contract and Planned Preventative
Maintenance (PPM) was conducted
*
In October 2014 we were joined by new six technical staff
Problems faced:
»
Inadequate number of trained technical staff
»
Not all tests done in the clinical laboratory could be enrolled in EQA
»
Long equipment down time (Elecsys 2010), sporadic stockouts of some of the reagents and supplies as well as long lead times
»
Insufficient supply of blood transfusion units from NBTS to meet the demand
19
Efforts made to solve problems
»
Strengthening stock management by forecasting, timely ordering of reagents and
supplies from competent suppliers.
»
Service contracts were made between EGPAF and equipment suppliers to support implementation of PPM of equipment
»
Continuous education and sensitizing staff to adhere to Good Clinical Laboratory
Practice (GCLP).
»
Review of Laboratory documentationand implementation of ISO 15189:2012
»
Implementation of 5S and IPC principles
Future plans to ensure efficiency in service delivery:
»
Enhancement of Laboratory Accreditation process ready for initial assessment
»
Identification and hiring more technical staff and creation of conducive environment for their retention
»
Replacement of current haematology analyzers and installation of new clinical
biochemistry laboratory equipment (Blood gas, Protein and Haemoglobin electrophoresis)
»
Enroll all laboratory investigations conducted in the laboratory into EQA programme by credible bodies.
COMMUNITY HEALTH DEPARTMENT
Head of Department: Dr. Rachel Manongi
Introduction
The Community Health Department (CHD) is located in the third floor of the KCMC main
building. The department activities are based on the three pillars of KCMC which are Services,
Teaching and Research. The CHD has the vision “to see a working whole system that actively
facilitates learning, research, as well as provision of community services that fulfill the KCMC
vision” and the mission “to send for mighty hope, and work together to heal the world.”
CHD Department has the following objectives:
•
To promote the concept of sustainable health promotion.
•
To conduct family health mobile clinics.
•
To compile available health information and development indicators.
•
To carry out medico-social action research.
•
To facilitate University campus-community partnerships.
•
To provide creative and competent life-long learning health workforce.
•
To enhance and build nutritive collaborative links.
20
•
To carry out consultancy work.
Staffing
Department of CHD is understaffed as shown below:
Staffs at the Community Health Department
The below number of staff available includes two Public Health Nurses who are also serving as
Zonal RCH coordinators in the Northern zone and four staff who are on training (three undertaking
PhD and one Masters).
Designation
Doctors
Senior Public Health Promotion
specialist
Senior Epidemiologist
Medical Doctors
AMO
Basic science
Senior statistician
Statistician
Senior Nutritionist
Nutritionist
Community Development
Environment Health Specialist
Public Health Nurses
Public Health Nurses
Secretariat
Secretary
Supportive staff
Office Assistants
Messenger
Total
Employee
Staff needed Staff available
Deficit
MOHSW
2
1
1
MOHSW
MOHSW
2
3
1
1
0
1
1
3
0
KCMU-College
GSF&
KCMU College
KCMU College
KCMU College
-
3
3
1
2
2
1
1
2
2
1
0
1
1
0
1
1
1
1
GSF
9
6
3
KCMU College
1
1
0
GSF
-
1
1
32
1
0
16
0
1
16
Activities
A) Services
In the Hospital
CHD is known for its efficiency in conducting health education within the hospital for both in and
out patients. The Health education given varies according to current issues globally; nationally
and locally. This year we had opportunity to use Radio FM in Moshi and SautiyaIinjili to educate
surrounding communities about Ebola disease.
21
Within the hospital, we have managed to give health education at various departments in regular
basis as follows:
OG Department: Health education to pregnant women who are admitted in OG1 and OG2
before and after delivery. Topic covered ranged from importance of early clinic attendance with
their partners, danger signs, anemia in pregnancy ,and importance of breast feeding and how to
handle the baby during breast feeding, how to express milk and safe storage of the milk for the
babies for working mothers. Also postnatal mothers were educated on the importance of giving
immunization and different types of vaccine to their babies. At the Antenatal clinics additional
topic of family planning was given.
Paediatric Department: Health education to postnatal mothers was provided. This includedpost natal care, counseling on nutrition, young infant feeding and importance of mother’s milk,
how to position the baby during breastfeeding, good attachment, immunization for mother and the
baby and also family planning.
OPD: Outbreak Diseases [Dengue, Ebola, etc.], Hypertension, Obesity and diabetic lifestyle
predisposing factors were taught. This including facilitating the diabetic clinic.
In total, a total of 6000 patients and clients received health education during the period of
reporting.
Infectious Control at KCMC Kitchen and nearby restaurants: At KCMC Kitchen, 41 staff
handling food for in-patients, students, and staffs were assessed for their health status. Routine
medical examination was done as per KCMC infectious control guidelines (three times per year).
Urine and stool was checked. This exercise is considered important in order to avoid transmission
of the infection (a detailed report is available in the department and the Matrons’ office).
For the nearby hotels, we have conducted environmental and sanitation checkups. Problems were
identified (poor cleanness and medical check-up for staff not done) and discussed with hotel
owners.
Community services:
In collaboration with the collage we managed to conduct outreach activities training the”
tomorrows” doctor on how to work with the communities ; We took them to the dispensaries
to learn the role of dispensaries’ committees in relation to communities they are serving. The
students were also taken to CCBRT, sewage system and we visited people with disability. The aim
for all this community outreach it to make the students aware of the community needs so that they
can from their early career development plan to work in rural areas.
Supervision of MNCH in the Northern zone: In total 26 health facilities were visited (Kilimanjaro
region 12; Arusha region 14). Challenges found were mainly lack of skilled staff; readiness of the
health facilities to tackle MNCH issues and monitoring indicators for MNCH are not documented
(a separate detailed report is available in the department).
22
Zonal RCH Meeting
Zonal RCH Meeting was conducted from 3rd to 5th December. Regional participants from Arusha,
Kilimanjaro and Tanga attended plus Zonal level and stakeholders from EGPAF AND Engender
health attended the meeting. The major aim was to discuss on how to improve quality of MNCH
services in the zone. Zonal and Regional RCH Reports were presented showing the achievements
and challenges. Other educative topics were presented i.e. sharpened one plan and score card
to show regional and district performance were presented, RCH live serving commodities, ILS
Gate way and report format for RCH Services. (Summary report of the meeting is available in the
department)
Youth Friendly Reproductive Health Clinic: We conduct Youth Friendly Reproductive Health
Clinic daily but specific on Tuesday and Thursday. Youth from various Colleges in Moshi
city, Secondary school students From Moshi Municipal and Moshi Rural District, and other
adolescents from various communities attended this clinic. Health education and counseling of
HIV testing, STI plus provision of condoms are part of the services provided. The total number of
youth attended since January to December 2014 were 249.
B) Training and students’ supervision
Training is one of the major activity the CHD department is involved. We train Research
Methodology, Epidemiology, Biostatistics and Health Promotion to all undergraduates and Post
graduates within the KCMU College as per planned timetable. Teaching methodologies includes
class lectures, Team Based learning-TBL, Problem Based Learning-PBL, and rotational blocks
mainly at different hospital departments like OPDs, Occupational Health, and Physiotherapy which
enabled students to acquire the theoretical and practical skills of the subject course contents.
C) Research
The department conducted the following research funded by MEPI - Medical Education Partnership
Initiative an independent organization that works in partnership with the KCMU College:
“Module Village for Medical Students at KCMC College” – We have received all the equipment
needed and data collection phase ended on 15thDecember 2014. Six hundred households were
visited and different variables collected plus GIS mapping of the model village done.
Assessment of school policies and environment in promoting physical activity and nutrition toward
prevention of non-communicable diseases among school age children in Moshi Municipality,
Tanzania
Research on knowledge and practice on physical activity and nutrition on non-communicable
diseases among health care workers in Kilimanjaro region
NIH R21 Grants funded research on development of mental health treatment for Obstetric fistula
patients in Tanzania
23
Challenges
»
Lack of equipment to conducting health education i.e.TV, Loudspeaker, digital cassette, video camera to facilitate training activities.
»
Lack of laptop and projectors for presentations and training.
»
Congestion of patient in OPDs due to limited space.
»
Limited staff to facilitate training and provision of health education at the OPD and wards.
»
Inadequate knowledge on infection prevention among some of the staff.
»
Parents not responsible in educating their youth.
»
Youths coming at a late stage, on the issue of treatment of STI diseases.
»
Some of the mothers do not want to breastfeed their babies.
»
Owner to renovate KCMC restaurants which are under his custodian
»
Funds to conduct research for evidence based practice within the hospital
DENTAL DEPARTMENT
Head of Department: Dr. Deogratias S. Rwakatema
Introduction
Dental department is among the outpatient departments located on the ground floor near to GSF
pharmacy. The department is comprised of two dental units and one dental laboratory located in
room 8, 7, and 6 respectively. Notwithstanding the department smallness in terms of infrastructures
and staffing, it is valuable on catering for most of the oral health care needs at KCMC.
Staffing
The department is staffed by one dental specialist, two dental registrars, one nursing officer,
one nurse attendant and a dental laboratory technician. One of our Dental registrar and a dental
laboratory technician were on study leave for the whole of this year.
Activities
KCMC, from outpatient clinics at KCMC and inpatients from various wards. Concomitantly
with this, academic activities were as well sufficiently run. Most of dental patients admitted in
the wards had orofacial trauma and few with orofacial dental abscess. These were admitted to
surgical, paediatric and orthopaedic wards.
Statistics
Table 1, 2 and 3 below summarizes the annual return of Dental Outpatient Department statistics.
24
Table 1: Distribution of the number of patients attended at KCMC Dental Outpatient Clinic by
months in 2014
Month
Total
251
214
217
200
210
222
207
158
144
211
128
2162
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
TOTAL
Males
130
108
97
111
120
115
123
68
71
92
54
1089
Specific demographics
Females
Children
121
46
106
55
120
43
89
37
90
20
107
34
84
28
90
26
73
23
119
24
74
38
1073
374
Adults
205
159
174
188
190
209
179
132
121
187
90
1834
Table 2: Distribution of the number of the diagnosed conditions in patients attending at KCMC Dental
Month
Caries
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
TOTAL
182
178
136
166
162
178
180
196
130
125
180
1813
Diagnosis
Periodontitis
Orofacial
trauma
12
21
22
17
18
24
20
21
22
18
25
24
19
22
21
15
29
21
26
26
30
28
217
237
Neoplasms
21
20
25
15
19
10
26
15
6
11
22
190
Table 3: Distribution of the number of treatments provided to patients attending at KCMC Dental
Month
JAN
FEB
Extractions Fillings
62
44
96
66
Treatments provided
Prothodon- Orofacial surg.
tics
Procedures
31
39
24
23
25
Others
Scaling
9
7
62
44
MAR
APR
MAY
JUN
JUL
AUG
SEPT
OCT
NOV
TOTAL
46
50
66
56
40
44
36
44
38
526
57
63
42
84
78
69
63
82
79
779
26
15
16
26
22
14
19
16
30
236
17
22
44
43
53
25
18
25
56
365
5
6
9
10
10
9
4
9
9
87
46
50
66
56
40
44
36
44
38
526
Achievements
Most of the patients who came to us were successfully treated throughout the year. ‘Malocclusion
in our set up’ topic was presented to the clinical conference audience by one of our colleague.
Proper recording, uninterrupted procurement of dental materials and upsurge of patients footing
bills using National Insurance have made us to restore a good number of teeth in this year.
Through donation we have managed to receive a second hand operative dental unit. Already
installed and in use.
Limitations
Lack of replacement for a dental laboratory technician (they are hard to come) so far has created
a deficiency in that aspect of oral health services at our institution.
Future plans
The department is engaged into modernization of dental units’ rooms and possibly establishment
of Oral and maxillofacial Surgery Centre.
We are also planning to start fixed orthodontic appliance services but initial capital investment is
a stumbling block.
DERMATO-VENEREOLOGY DEPARTMENT
Head of Department: Prof. Elisante J. Masenga
Introduction
RDTC has since 1992 to date trained a total of 242 Dermato-Venereology Officers from 17
African countries (65 come from Tanzania the host country). The MMed programme started in
the year 2000. It has so far trained 19 MMed Residents from Kenya (3), Ethiopia (2), Ghana (1),
Rwanda (3), Botswana (1), Malawi (2) and Tanzania (7). We are currently having a total of 12
M.Med Residents. The Centre is highly appreciative to IFD for sponsoring majority of our ADDV
students. We also appreciate the support from the MoHSW to the Tanzanian MMed candidates.
26
RDTCStaffing situation and the projections(Dermatology Wards) include
SN Designation
1.
2.
3.
4.
5.
6.
7.
Salary Scale
Doctor
Senior consultant
TGHS-K
Specialist Dermatology
TGS-J
Dermato-pathologist
TGS-J
Registrar in Dermatology
TGS-H
Public Health Derm.
TGHS E-I
Nurse Staff (OPD & Ward)
PNO
TGS.H.10
ANO 1 & II
TGHS
Medical Attendants
TGHOS
Pharmacy Section (OPD & Sunscreen)
Pharmacist
Pharm Tech
TGSH B
Pharmaceutical Assistant
TGOS/B12
Public Health worker
Occupational Therapist
TGS D3
Community Reh. worker
TGS D2
Laboratory Section
Technician/Technologists
TGHS E/I
Laboratory Assistant
TGS D 3
Accountant Section
Accountant II
TGS D.2
Cashier/Accountant Assist
TGS C.1
Library Section
Senior Library Assistant
Librarian Assistant
8. Transport Section
Drivers
9. Administration
Administrator
10. Secretariat
Secretaries
11. Others supportive staff
Office Assistants
Warden (RDTC Hostel)
Messenger
Cleaners/Gardeners
Security Guards
Total
Employee
Actual Required Variation
2014
2015
Remarks
MoHSW
MoHSW
MoHSW
GSF/RDTC
MoHSW
0
2
1
0
1
2
4
1
2
1
-2
-2
0
-2
0
2 Vacancies
2 Vacancies
GSF
GSF
GSF
2
7
9
2
13
14
0
-6
-5
6 Vacancies
5 Vacancies
GSF
0
0
1
1
3
2
-1
-3
-1
1 Vacancy
3 Vacancies
1 Vacancies
GSF
0
1
1
1
-1
0
1 Vacancy
-
GSF/MoHSW
GSF/MoHSW
2
1
2
2
0
-1
1 Vacancy
GSF
-
1
0
1
1
0
-1
1 Vacancy
-
0
0
2
2
-2
-2
2 Vacancies
2 Vacancies
GSF
1
2
-1
1 Vacancy
?
0
1
-1
1 Vacancy
TGS C.8
GSF/MoHSW
2
3
-1
1 Vacancy
TGOS A.2
MoHSW
RDTC
1
1
0
0
0
33
2
2
1
4
3
75
-1
-1
-1
-4
-3
42
1 Vacancy
1 Vacancy
1 Vacancy
4 Vacancies
3 Vacancies
42 Vacancies
2 Vacancies
Doctors
This is one of the critical areas RDTC is facing:
•
The current 2 Senior Consultants working at RDTC are retired. Prof Grossmann has 27
kindly volunteered his services at RDTC but not throughout the year and Prof
Masenga’s two years contract ends July this year.
•
Entirely dependent on volunteers especially for the MMed programme
•
We have only 2 Specialists (Drs.Mavura and Mshana) – heavy load for the increasing RDTC activities
•
Thanks for the MoHSW for allocating us the General Pathologist
•
Dr ConsolataSwai who was our Registrar 2 years ago is now on MMed programme. We are still hopeful she will join us upon completion of the Course
•
The Centre is highly appreciative to the sixVolunteers in the year 2014: Michael
Diggelen (Netherlands), Mafalda Valdes (Pharmacist Spain), Catherine Balestra (USA), Lonneke Franken (The Netherlands), RoudHorlings (The Netherlands), and Jennifer Gwazadauskas (USA – data for PWA)
•
Our previous Board Chairman had advised RDTC to develop a strategic plan
(“road map”) for future developments. A sub-committee was formed to deal with this
issue which I believe will shade light to the acute shortage of Human Resource at RDTC. I welcome Dr.DaudiMavura to present their work.
Laboratory
•
We have one GSF sponsored technologist, one Molecular Biologist on part-time basis
and a Laboratory Assistant
•
Mr. Moses who was once with us has again been offered (by the Government –
Utumishi) another one year effective 1st June 2014 a leave without pay. We request the MoHSW to give us replacement since he has not effectively rendered any services at RDTC.
Nurses
•
If we combine the OPD and In-patient activities, we have a shortage of 6 Nurses and 5 Medical attendants. We request the MoHSW/GSF to help us in this area
Pharmacy Section
•
RDTC needs a Pharmacist for the sunscreen Unit. We are still negotiating with the MoHSW
•
RDTC needs 3 Pharmaceutical Technicians; 2 for the compounding and 1 for the
Sunscreen Units
•
A back up of 2 Pharmaceutical Assistants needed for both Units
28
Library section
•
The current Senior Librarian Assistant is retired and shows no interest to continue. Extra help from MoHSW/GSF is requested in this area
RDTC has no Librarian only one retired Librarian Assistant (Ms.Silayo) who is under contract. She may not sign another contract next year. We request the MoHSW/GSF to help in this problem.
Secretary and Account Sections
•
With these expanding activities, RDTC needs a strong back up of a qualified Secretary to man her duties properly. The current two ones are too junior to cope.
•
Equally needed is a Cashier to help in the account Section
Drivers:
•
Thanks to GSF for seconding one driver (Mr. Fred Komba) to RDTC. The Second one
(Mr.Shayo) is still paid by RDTC despite increasing financial constraints. We request
GSF/MoHSW to employ Drivers to RDTC.
Other Supportive Staff
Other shortages as reflected under table 4.2 need close attention as RDTC work load increases
with the decreasing Human Resource.
Building Progress
•
The Herbert Stiefel Dermatology Wards and Burn Unit are all complete
•
The Theatre and the connecting walk way are now complete
•
KCMC Library modifications now complete
•
We started moving our patients to one Dermatology Wing since 3rd October 2014
•
We are highly thankful to Charles Stiefel who initiated the support and specifically appreciative to Barbara Stiefel for her generous support for completing the Dermatology wards, initiating and completing the Burn Unit and the modification of the Library.
These big Projects have involved huge money amounting to around 3 billion Tanzanian shillings. Thanks so much Barbara and may God richly bless you
•
The new Care Unit for People with Albinism (CUPWA) is running smoothly. Sincere thanks go to Canadian NGO - Under the Same sun, “Africa directo” of Spain, BASF in Germany, and IFD
29
DIABETES CLINIC
Head of Clinic: Dr. Isack Lyaruu
Introduction
The diabetes clinic started operating since 1996. It has been a very busy clinic. Since the Wednesday
clinic was overcrowded, we decided to open Friday clinics for more education and services to our
diabetic patients and Monday clinic for children. This started over the past 2 years.
We are running diabetes clinic 3 times in a weeki.e. Monday, Wednesday and Friday. Wednesday
clinic is a large clinic with a big team of specialty doctors, residents and medical students.
Staffing
The clinic has a total of 3 members of staff.
Statistics
For the year 2014the following patients were attended monthly:
S/N
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
MONTHS
January
February
March
April
May
June
July
August
September
October
November
December
Total
Wednesday clinic
163
180
185
213
129
143
152
156
179
253
148
186
2087
Friday clinic
51
38
27
26
25
20
33
38
31
32
45
29
370
Children
49
63
60
42
53
39
25
64
53
44
26
51
569
Challenges
»
We have only one room which is shared between doctors, nurses and patients.
»
Lack of confidentiality due to small consultation room.
»
There is shortage of trained staff we need 3 trained nurses 2 doctors stationed at the clinic
30
DEPARTMENT OF DIAGNOSTIC RADIOLOGY AND MEDICAL IMAGING
Head of department: Dr. Clemence F. Kalambo
Department overview/Composition
Diagnostic Radiology and Medical Imaging is the use of X-rays, high frequency sound waves,
magnetic resonance and other techniques of imaging to diagnose disorders not visible from outside
of the human body.
The Department of Diagnostic Radiology and Medical Imaging came up immediately with the
inauguration of KCMC in 1971. It is located on the ground floor of a three – floored hospital
building close to the Casualty Department and the outpatient’s clinics. In 2006 services were
extended to the OPD/Casualty building whereby X-ray, mammography and ultrasound services
are being provided mainly to outpatients.
The mission of the Diagnostic Radiology and Medical Imaging Department is to carry out
the functions of health care, teaching, research and consultancy in Christian principles in a
dignified, sustainable and affordable manner and facilitate efficient medical imaging development
collaboration with all stakeholders.
Plant and Equipment: The list of the equipment, which is in good condition and working, is as
follows:
1 Phillips Fluoroscopic Unit (Duo Diagnostic);
2 Phillips MRS radiographic units;
1 General electric radiographic unit;
1 portable radiographic units;
1 Mobile radiographic unit;
2 mammograhy units;
1 Automatic film processor;
6 Ultrasound units including a portable one, all with Doppler capabilities.
Specific year objectives
1. To recruit and increase the number of qualified and competent human resources by 10% by 31st December 2014.
2. To spear-head the acquisition of a multidetector CT by 31st December 2014.
3. To train more students in Ultrasonography by increasing the intake capacity by 20% by October
31
Staffing
*
There are 2 consultant radiologists, 1 registrar, 6 radiographers, 2 nurses, 3 medical attendants, 1 office attendant and 1 secretary.
*
8 MMed Residents and 16 AMO radiologists’ trainees make the complete human
resources inventory in the department.
*
Currently the registrar is pursuing Masters Degree in Diagnostic Radiology in Kenya.
*
Staff attrition is the major challenge to us due to the competitive labour market.
Activities
1.
Clinical activities
I.
X-Ray examinations
Type of examination
Chest
Extremities
Spine/pelvis
Abdomen
Skull
Urological
OG/special/others
Gastrointestinal
Mammograms
Total
2013
Number
12,461
6,182
2,688
2,497
2,562
1,123
1,372
746
95
29,726
%
41.91%
20.79%
9.04%
8.40%
8.61%
3.77%
4.61%
2.50%
0.31%
100%
2014
Number
12,503
7,123
2,917
2,875
1,942
1,653
231
761
52
30,057
%
42%
24%
10%
10%
6%
5%
0.8%
2%
0.2%
100%
There is a general increase of 39.49% in X-ray examinations compared to last year. This is mainly
due to skull films in the absence of CT in cases of head injuries, extremities films mainly following
MTA and fluoroscopic investigations after the repair of the fluoroscopy machine.
II. Ultrasound examinations
Type of examination
Abdomen
Echocardiogram
Obstetric
Others
Vascular
Brain
Eyes
Musculoskeletal
Breast
Total
2013
Number
11,110
3,116
2,952
1,988
926
541
92
92
91
29,726
2014
%
53.13%
14.90%
14.11%
9.50%
4.42%
2.58%
0.44%
0.44%
0.43%
100%
32
Number
11,201
4,236
2,987
2,024
946
573
102
%
50%
19%
13%
9%
4%
3%
1%
72
30,057
1%
100%
Ultrasound is by and large being used as a cross sectional imaging modality in the absence of CT,
MRI etc.
There is a general increase of 5.890% in ultrasound examinations compared with last year.
2. Training
We continued with training activities parting knowledge in Anatomy and Diagnostic Radiology to
short and long courses students and residents, in various certificates, diplomas, advanced diploma,
degrees and post graduate degree courses.
39 Sonographers, 7 AMO Radiologists and 2 MMed Radiologists graduated from our department
this year.
3. Research
Research activities in the department included Point of Care Sonography in pneumonia in
children, The Role of Ultrasound in Intestinal Obstruction and Radiation Doses in Pediatrics
X-ray examinations.
Collaboration
Various local, medical and non-medical students spent time in the department as part of their
fieldwork or on project assignments.
Progress/Achievements
1. One registrar was employed and one attendant transferred in.
2. A multidetector CT has been purchased and will be installed early 2015
3. Thirty one Ultrasonography students graduated in 2013 an increase of 14.5% over last year.
Problems
1. Shortage of human resources.
2. Erratic supply of suitable consumables from MSD.
3. Inadequate existing infrastructure: Lack of an office for radiological personnel, lack of MMed
residents’ room, lack of a tea room, changing room, bigger viewing room and examination
rooms.
4. Ageing facilities and equipment with frequent breakdowns.
5. Unstable and frequent power failure.
6. Lack of biomedical technology engineers.
Recommendations
1. To be competitive in the labour market so as to be able to employ and recruit more staff
33
and have capacity building plans for existing staff. GSF should have its own salary scheme.
2. To employ or contract suitable biomedical engineers to service and repair breaking down
equipment and also have service contract agreements for newly bought equipment.
3. To have reliable availability of consumables.
4. Improvement of existing facilities in terms of replacing old and worn out equipment plus the
infrastructure. Planned preventive maintenance exercise should be reinforced.
5. To have the stand-by generator supply power to all examination rooms.
6. Improvement and progress in providing new services such as Screening Mammography
and Interventional Radiology singly or on collaboration with other stakeholders local or
international.
7. Furtherance of training in Medicine in Diagnostic Radiology
8. Introduction of the Digital Imaging and PACS.
9. To have Magnetic Resonance Imaging services available.
10. To purchase a multidetector CT scanner utilizing the 16 years savings from the CT account.
Conclusion
Based on the existing laid down strategies, the department in collaboration with other stakeholders
has been implementing its mandated responsibilities of improving health services and social
welfare.
DEPARTMENT OF INTERNAL MEDICINE
Head of department: Dr. Venance P. Maro
Introduction
The Department of internal medicine is one the clinical departments at Kilimanjaro Christian
Medical centre located in the main building at the first floor. The main activities of the department
is to provide quality Patients care, Teaching and Research. For administrative purposes, the
department is divided into 4 main sections which are Medical Intensive care (MICU), Endoscopy,
Medical I(MI),Medical II(general and private).
Staff profile
#
1
2
3
4
5
6
Category
Professors
Consultant Physicians
Specialist Physicians
Residents
Registrars
Nurse Officers
Total number
1
3
6
9
1
10
34
7
8
9
Enrolled Nurses
Assistant Nursing Officers
Health attendants
8
28
22
Bed capacity
The Total Bed capacity of the department has remained the same (107) like the last annual report
as shown below:
#
1
2
3
Section
Medical I
Medical II
Medical ICU
TOTAL
Bed Capacity
38
63
6
107
Patients care
One of the important activity of the department is to provide a Quality patients care at a specialist
level both in and outpatients.
Inpatients activities
The patients are usually admitted in our wards through outpatients department and they receive the
clerkship as soon as possible by the team on call which consists an intern, Registrar/Resident and
a specialist. The same will plan for the management of the patient which will include additional
laboratory tests and Medication. All serious patients who are admitted must be discussed by the
panel of specialists during morning reports. Every day the ward rounds are been conducted from
9.00 am to 1.00pm.However, Tuesdays and Thursdays are for the major ward rounds on which
teachings and large decisions are made by Specialists. Endoscopies and ECGs are done every day
and bookings continue as usual while emergencies been attended on spot.
Outpatient’s clinics
#
1
2
3
4
5
6
7
Clinic
MEDICAL OPD
DIABETIC CLINIC
CARDIAC CLINIC
Care and Treatment Centre(HIV/AIDS)
Neurology Clinics
Child Centered Family Clinic Care
Care and Treatment Centre (Adolescents)
Day
Monday/Friday
Wednesdays
Every last Wednesday of the month
Mondays,Wednesdays,Fridays
Mondays
Mondays and Wednesdays
Every last Saturday of the month
Other activities of the department
Outreach Programs continues as usual which consists of Flying doctors services coordinated by
AMREF, St. Joseph CTC, and Community outreach program (KNCU health plan) coordinated by
Pharm Access in collaboration with the Department of Internal Medicine.
35
Out patients’ statistics
#
1
2
3
4
5
6
7
8
9
10
11
12
MONTH
JANUARY
FEBRUARY
MARCH
APRIL
MAY
JUNE
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
TOTAL
Number of patients
328
237
274
350
501
586
203
231
286
286
160
150
3582
Inpatients’ statistics
Ward
Medical I
Medical II
MICU
TOTAL
Admission
2257
2302
31
4590
Discharge
1670
1972
37
3679
Death
356
356
117
829
Transfer in
131
287
396
814
Transfer out
347
253
270
870
Endoscopic procedures
Type of Procedure
Oesophagodeudenoscopies (OGD)
Colonoscopies
Sigmoidoscopies
Bronchoscopies
Sclerotherapies
Polypectomies
Number 2013
627
7
3
3
9
2
Number 2014
230
60
6
1
1
3
The “Ten Top” conditions seen in the department has almost remained the same as in 2013.These
includes the following:
#
1
2
3
4
5
6
Condition
Upper Gastrointestinal Bleeding
HIV/AIDS
Diabetes Mellitus
Stroke
Hypertension
Pneumonias
36
7
8
9
10
Diabetes Ketoacidosis
Anaemia
Kidney Diseases (Acute and Chronic)
Congestive Cardiac Failure
Teaching activities
The Department continues to be involved heavily in teaching and couching/mentoring activities
.The following cadre of students rotate in our department to receive bed side teachings (BEST)
and tutorials. The Teaching is usually conducted by the assigned academic staff. However in every
major ward rounds students have to attend to receive extra practical teachings.
The following cadre rotates in our department:
#
1
2
3
4
5
6
7
8
9
10
Cadre
Diploma in Nursing
Diploma in Physiotherapy
Advanced Diploma (Clinical Officer)
Diploma HIV/AIDS
Degree in Nursing (BSc)
Degree in Physiotherapy
Degree in Doctors of Medicine
Masters of Medicine in Internal Medicine
Elective Students outside the country
Intern Doctors (Inside and Outside the country)
Research activities
Research activities are ongoing to find out areas of improvement and to compliment the trainings
of the Undergraduates, Post Graduates and PHDs as they collect data for their thesis. We still
continue collecting data on Bacterial Zoonosis, Renal diseases, Tuberculosis/HIV, and resistant
partner on antiretroviral drugs. We have by this year written a proposal on the Burden of Morbidity
and Mortality on febrile illness at KCMC which will hopefully been sponsored by Medical
Education Partnership Initiative (MEPI).This will have a heavy involvement of faculty members
and Undergraduate students ,to strengthen their capacity in research .
Achievements
1.
Two Residents graduated for their Master’s degree in Internal Medicine and they were awarded their degree in November 2014.One is our member of department and will strengthen our specialist care
2.
Two Nurses Graduated in Bachelor of Nursing and they were awarded their degree in
BSc in November 2014.These will strengthen nursing care in our department
3.
Dr.KajiruKilonzo who went for specialization of Nephrology is now back and graduated in the field. He is expected to start nephrology services at this centre as soon as it is feasible. The department wishes to thanks the sponsors who made it possible.
4.
We continue getting specialist advises/Teachings from experts from outside the 37
country(USA/Netherlands,Australia,UK et).This has been very useful to the academic staff students and KCMC at large
5.
Three young doctors who are still in master’s program graduated in Diploma in Tropical Medicine been offered by London’s School of Hygiene.The department wishes to congratulate them very much
6.
Patients with skin conditions (Dermatology) who were been nursed in Medical two ward have been transferred to their new wards. This will give us more space. We congratulate Professor Grossman, Professor Masenga, Dr. Mavura and the entire management of
KCMC for making this possible.
Challenges
•
Shortage of staff-We continue facing a challenge of staff shortage particularly in nursing cadre. It is believed that nurses are not so many in the market, but in the other way the newly employed staff is also faced with motivation challenge. The management continue to look at this challenge critically.
•
Inadequate diagnostic facilities-For a physician to practice a quality medicine diagnostics
are very crucial. We are often faced with shortage of reagents and machine errors.
Computerised Tomography machine has not been working for Three years.
The Endoscopy unit has not been working because the machine/scopes need replacement. The hospital is working on it very aggressively despite of the scarcity of funds.
•
Shortage/unavailability of medicines. We still experience severe shortage and
unavailability of some essential medicines. Many times patients have to buy these medications on their own outside KCMC which heavily affects patients care. We
continue looking for the solution which includes carefully collecting more money from our National Health Insurance and cost sharing, and allocating more funds for medicine
(at least 60% )
•
Working equipments-Shortage of working medical equipmentslike Monitors, Pulsoxymeters, Oxygen cylinder heads etc. continues to strike patients care.
MAIN OPERATING THEATRE / CENTRAL STERILE SUPPLY
Theatre superintendent - Sr. Margareth Msoma
Introduction
The Department is located at the second floor in the main hospital building. It has two units
mainly, the Main Operating Theatre (MOT) and Central Sterile Supply, Department (CSSD).
MOT: - Is an important department of the hospital where major surgical operations are performed.
It receives its clients from all departments including General Surgery Orthopedic, Dental,
38
Gynecology, Pediatrics and sometimes direct form Casualty. It consists of 5 operating suites - 4
for clean cases and 1 for septic cases.
CSSD: - Is where processing of used (dirty) professional instrument is performed;
(Decontamination, cleaning, packing, sterilization) and supply of sterile packs / trays.
Philosophy
We believe that all patients have the right to be attended with dignity according to their specific
needs regardless of economic status, political affiliation color, race, religion.
Objectives
1.
To provide safe and high standard theatre services
2. To teach students in various programs on safe, feasible
techniques
and sustainable theater
Staffing
The department is still managed by inadequate number of trained nursed. This includes; one floor
coordinator and 2 unit in charge
Staff movement in MOT
Category
Nurse
Officer
Assistant
Nurse
Officer
Enrolled
Nurse
Medical
Attendants
Newly
Employed
In
school
Back
from
school
Transfer
in
Transfers
Total at
Out
Left Retired
work
2
1
1
-
-
2
-
2
1
6
-
-
-
-
-
-
-
2
-
-
-
3
3
-
-
9
In
school
Back
from
school
Transfer
in
-
-
-
-
-
-
-
1
-
-
Staff movement CSSD
Category
Nurse
Officer
Assistant
Nurse
Officer
Newly
Employed
39
Transfers
Total at
Out
Left Retired
work
1
3
Enrolled
Nurse
Medical
Attendants
-
-
-
-
-
-
-
-
1
-
-
3
3
-
-
11
Statistics for mot
Operations done from January to December 2014
Department
General surgery
Gynecology
Orthopaedics
Total
Elective operations
Emergency Operations
Major
Minor
Major
Minor
1377
680
414
166
800
398
2591
1244
Grand Total Operation 3835
Total
2057
580
1198
3835
List of sterilized items
S/N
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
ITEMS
Dressing Pack drums
Special trays
OT bundles
OT. Sets
Labour ward bundles
Labour ward trays
Orthobands trays
Vaseline Gauze trays
Burn gauze drums
OT Gauze Drums
Swab drums
Abdiminal Mops
Total
NUMBER OF ITEMS
98,500
69,000
62,000
45,000
51,000
28,000
37,000
26,000
20,000
21,000
32,000
13,000
502,500
Achievement
The department still collaborates closely with partners from various institutions in the world:
*
Northumbria NHS in UK ( Laparascopic Surgeries)
*
AMREF reconstructive surgeons
*
Northumbria Burn Team
We successfully task force to perform 35 operations and we have been observing good outcome.
Constraints
»
Shortage of nursing staff
40
»
Frequent breakdown of autoclaving machine
»
Leakage from the roof
Future plan:
To request for renovation of the Main Operating Theatre /CSSD
DEPARTMET OF OBSTETRIC AND GYNAECOLOGY
Head of department: Dr. Gileard Masenga
Introduction
Gynaecological and obstetric department is located at the third floor in KCMC main building.
This Department is divided into three units, which includes Delivery unit (Labor Ward), Obstetric,
and Gynaecology unit. The department also runs two outpatients clinics, i.e. the GOPD and
Reproductive Health Clinic (RHC)
Obstetric unit
The unit has 59 beds, and admits mothers waiting for delivery or with pregnancy complications
and post delivery.
Gynaecological unit
It has bed capacity of 52 beds, receives all patients referred with gynaecological problems.
Labour unit
It has 4 delivery cubicles and two theatre rooms.
Philosophy
The department believes that every human being is an individual with unique needs, and problems
which must be addressed individually irrespective of race, age, educational status, religion, political
or social status. Therefore our responsibility is to give quality care to every woman and maintain
good harmony and team spirit among the staff. Thus will make us work more comfortably and
maintain cheerfulness among clients, our relatives and us. It’s also the goal of the department to
assist medical students, assistant medical officer students and nursing students in their clinical
rotations teaching.
Objectives of the department
»
Maintain good interpersonal relationship, team spirit and good harmony among the
41
staffs, students, clients and relatives in order to promote conductive working atmosphere.
»
To provide quality services to all patients admitted to the department and identify
patients at high risk and act promptly.
» Prevent and manage obstetric complications so as to reduce maternal/neonatal morbidity and mortality rate.
» To provide practical oriented clinical teaching to students and staff as continuing education.
» To conduct evidence based clinical research.
Staff situation
1.
Head of department
-
Dr.GileardMasenga
2.
Coordinator
-
Sr. Beatrice Saritha
3.
Obstetrician and Gynecologist
-
3
4.
Resident 4th year
-
3
-
6
-
3
i.
ii. Resident
2nd year
iii. Resident
1st year
-
6
-
1
1.
Graduate Nurse Officer
-
5
2.
Assistant Nurses Officer
-
15
3.
Enrolled Nurse
-
10
4.
Medical Attendants
-
25
5.
Temporarily Employed Nurses -
3
6.
Office Attendant
-
1
7.
Personal Secretary
-
1
5.
Resident
Registrar
3rd year
Other staff
Seminar /workshop
»
We have conducted 8 Advanced life support in Obstetrics(ALSO) courses in various districts in Tanzania, as follows:-
*
Iringa regional hosp- 2 courses
*
Dodoma- Mpwapwa/Bahi - 2 courses
*
Tanga – 1 course
*
Dareda – 1 course
*
KCMC (nurse and residents) - 2 courses
42
»
We had 20 outreach programmes in various hospitals in Tanzania in Collaboration with AMREF flying doctors.
»
One workshop was conducted in Lindi district on basic surgical skills in obstetric fistula repair.
»
We provided training on Structured Obstetrics Operative Procedures (SOO) to all
AMO – Students in 2014.
»
We also conducted 2 training cervical cancer screening, where by 6 postgraduate
students and two nurses were trained on screening for cervical cancer.
Achievements
1.
In the year 2014, about 1227 women were screened for cervical cancer in our RHC clinic, of which 56 were diagnosed to have cervical carcinoma, while 92 were diagnosed to have precancerous lesions. A total of 78 women of those with precancerous lesions, needed treatment, of which 36 had Cryotherapy and 42 had LEEP been done.
2.
The department also continues with Laparoscopic procedures and in the year 2014, a
total of 27 diagnostic Laparoscopic procedures were done.
3.
We have managed to establish collaboration with the University of Southern Denmark, Odense university hospital. This will enable the members of our department to obtain more exposure in different areas of subspecialty such as Gynecological Oncology, endocrinology and Infertility, plus urogynecology through the established exchange program.
4.
We have strengthen the collaboration with the Duke University, where by two senior consultant members of faculty from Duke have been visiting us and provide teaching
to the residents and medical students. In addition our partners from Duke are assisting the department in advancing medical care in area of laparoscopy, gynecology oncology and fetal medicine.
5.
DiafamPharmacetical in Tubingen Germany; Through this collaboration which started in 2011, we have been receiving regularly a donation of cytotoxic drugs for all patients
with Gestational trophoblastic neoplasia. In addition Diafam supply us with Misoprostol for treatment of Postpartum Haemorrhage
Constraints
»
Inadequate number of nursing staff.
»
Lack of delivery beds that can accommodate mother and her new born baby.
»
A working CTG machine in the Labor Ward, and a Doppler machine for the Antenatal Clinic (GOPD)
»
The constant stock-out of essential drugs like parenteral Hydralazine has been a great set back in management of patients with severe pre eclampsia.
»
The newly established ICU in the department is lacking the necessary equipment for intensive care: pulse oxy-meter, ventilator, ECG monitor Suction machine (electrical)
43
»
The labor ward theater rooms are lacking a working suctioning machine, and anesthetic Machine ( only one available for the 2 rooms)
»
The Labor Ward theater rooms are also lacking A/C, making the atmosphere very hot.
»
The patient’s toilets in OGI and OGII are very old and they need major renovation.
»
Private rooms toilets are not functioning properly and they need major repair
Future plans
To develop subspecialty among the consultants working in the department in areas of gynecological
oncology, maternal – fetal medicine, endocrinology and infertility and urogynaecology.
Conditions admitted in the department
1.
Normal pregnancy and complicated pregnancy with medical conditions such as Pre-
eclampsia, Eclampsia, Antepartum and post-partum haemorrhage, anaemia in pregnancy, malaria in pregnancy, diabetic mellitus in pregnancy and UTI in pregnancy, BOH and those in need of cesarean section.
2.
Gynaecological conditions like – benign conditions (uterine fibroids, abortions,
infertility, dysfunction uterine bleeding and puerperal sepsis. malignant conditions:
cancer of cervix, ovarian and endometrium tumours, surgical cases; ectopic pregnancies, vesico- vagina fistulas.
Statistics for obstetric
Total number of admissions
Total number of deliveries
Spontaneous vaginal deliver
Caesarean section
Vacuum extraction
Laparatomy due ruptured uterus
Maternal Death
4429
3778
2252
1369
64
3
6
Gynaecological statistics
Admissions
Discharges
Absconders
Total operations
Deaths
1708
1176
10
456
35
Gynaecological operation
In the gynaecology unit we had a total number of 456 surgeries, performed of which 455 were
44
major and 1 was minor surgery.
Cervical and breast cancer screening program
In this unit we have been able to screen 1227 women coming from areas surrounding KCMC and
other referred from various hospitals from North Eastern zone of our country.
“Top ten” obstetric conditions
1.
Pre eclampsia
2.
Twins pregnancy
3.
Anaemia in pregnancy
4.
Antepartum haemorrhage
5.
Bad obstetric history (BOH)
6.
Malaria in pregnancy
7.
UTI in pregnancy
8.
Diabetic mellitus in pregnancy
9.
Eclampsia
10. HIV in pregnancy
“Top ten” gynaecological conditions
1.
Cervical Cancer
2.
Uterine Fibroids
3.
Threatened Abortion
4.
Incomplete abortion
5.
Ovarian Cyst
6.
Ectopic Pregnancy
7.
VVF/RVF
8.
PID
9.
Malaria in Pregnancy
10. Ovarian Tumor
Research activities in the department
1.
Five researches were successfully done in our department or in collaboration with
faculty’s members and published in peer’s reviewed journals , the titles are as follows:-
-
Prevalence of Multiple Pregnancies and Fetal Maternal Outcomes at KCMC
Prevalence and Risk Factors of Abruption Placenta at KCMC between 2000 to 2010
45
2.
Ongoing research activities at the department
-
Prevention and control of Surgical Site of Infection. A hospital base study, MEPI mentored research Grant
A pilot study on Development of an Intervention on Mental health among
-
obstetric fistula patients admitted at KCMC
-
3.
Burden on cervical cancer Disease in Kilimanjaro region
Upcoming research
-
Cervical cancer screening using smart phone
-
WHO HPV test/ Vaccine trial
OCCUPATIONAL THERAPY DEPARTMENT
Head of department: Mr. Peter Mashaka
Introduction
The department is within the Orthopaedic Rehabilitation Unit since October 2014.The department
has been given two rooms for therapy. We moved from the OPD building to give space for the
construction of the “Remodelling of the emergency medicine Department”. The department gives
services for in and out- patients both adults and children with various conditions /disabilities. The
aim of the Occupational therapy is to assist patients/clients to achieve optimal participation in
their valued activities of daily living (World Federation of Occupational Therapists, 2004)
The OT works with the patient to improve or maintain their ability to perform activities of daily
living that are meaningful to that individual at home, at work and in the community. The OT
assists patients and their families in efforts to adapt to disruptions in lifestyle.
Vision
To be a reputable department in maintaining an effective, efficient, holistic, client centred and
sustainable quality of rehabilitation programmes.
Staffing
The department has a total number of 8 employees. 6 Occupational therapists employed by GSF
and 2 Medical attendants. Currently, the department has 1 full – time occupational therapist. 3
OT’s are on study leave. We are grateful that one Of the Occupational therapist who was on study
leave for 3 years, successfully completed his studies and joined colleagues in the department.
Conditions seen
Adults with physical disabilities:
*
Common Conditions: Spinal cord injuries, Stroke (CVA), Brain injuries, Hand
injuries + brachial plexus injuries, arthritis, fractures and Neuropathies.
46
*Rare Conditions: Epilepsy, Cerebellar ataxia, Guillain – Bare Syndrome (GBS),
Leprosy, amputations, Transverse myelitis, Rheumatoid arthritis and Dystonia.
Children with disabilities
* Common Conditions: Cerebral Palsy (CP), Delayed milestone, Microcephaly,
Developmental and learning disabilities, Intellectual impairment, Autism, Hydrocephalus, Spinal
Bifida and Others.
Activities
-
In –patient skills training in and outside the wards
-
Out -patient performance skills training in the OT Clinical department
-
Workshop activities, fabricating assistive and protective devices
-
Home visits and environmental adaptations
-
Teaching and clinical supervision of local and international students.
Statistics
Number of in and out patients attended in Occupational Therapy Department in the year 2014 is
as follows -:
In-patients
Ward
Medical I and II
Orthopaedic
General Surgery SI & SICU B
Sub Total A
Outpatients
Paediatrics OPD
Adult OPD
Neuro Paediatric Outpatient Clinic (NPOC)
Sub Total B
Grand Total ( A + B)
No. of patients
20
50
20
90
115
170
983
1268
1358
Home Visits:
In order to prepare some of our people with disabilities for everyday life at home, school or at
work, our intervention necessitates visits to home/school/ work-places/community. Most clients
seen in our department would require one such visit. Last year we were able to carry 20 visits to
the homes, schools, institutions, community and work–places.
Visitors
The department has had 98 (local and International) visitors who visited the department as from
47
January 2014 to December 2014 for the purpose of learning and sharing different skills in the
clinical aspect.
S/N
1.
2.
3.
4.
5.
6.
7.
8.
9
10
11.
University College/ Country
Bergen University (Senior Officials)
KCMUco ( Students)
Purpose
Number
To review the fieldwork Manual
3
Learning about Occupational therapy
24
profession.
Bergen University (Students)
Clinical Placement
3
KCMUco ( BScN Students)
Learning about Occupational therapy
36
Profession
University of Toronto
Clinical Placement
2
Duquesne University
Learning &sharing skills in O.T
14
Jhpiego - DSM
Exploring possibilities for research
4
collaboration.
University of Minnesota - USA
Familiarization visit
2
Umea University (Teaching staff)
Teaching exchange programme.
3
Neema Crafts Therapy – Iringa town. Learning & sharing skills in O.T
2
Umea University (students)
Familiarization visit
8
Events
The department moved from the Extension of OPD and given 2 therapy rooms at the Orthopaedic
Rehabilitation Unit. This building is behind the paediatric wards. The management has promised
to identify a new premise for the Occupational Therapy department before June 2015.
Collaboration, training and research
The department Continues supervising International and local students from different programmes
at KCMC, including occupational therapy, Medicine and Nursing. The department enjoys
networking with other stakeholders who are working with different groups of people with
disabilities in the Northern Zone. The department has strengthened the ongoing collaboration
with the University of Bergen (Norway), University of Toronto (Canada) and Oslo University
(Norway). The department has collaborated in a project with the University of Toronto on
“Inclusive Playground for Children at KCMC” and we look forward into implementation of
this project before June 2015. The department did present a scientific paper in the OTWORLD
14 Congress which was held in Leipzig 13th – 16th May in Germany 2014. The title of the paper
reads “The importance of Home – visits, home Modifications and the use of assistive devices to
people with compromised mobility in a less resourced setting”
Achievements
Despite the critical shortage of staff, the department has managed to achieve the following -:
■
Creating awareness to the KCMC Community on issues pertaining to services to the
people with disabilities and thus enabling them to lead productive life.
■
Continuing our role in advancing our profession by regularly giving clinical supervision to students at KCMC.
48
■
students, visitors and volunteers.
■
Continuing creating an environment for mutual learning by hosting international
Facilitating teaching and procurement of a multi-functional work –bench for woodwork
as well as other handy-crafty
■
Securing donation of reference books, digital Camera, thermoplastic materials, a Multi – Media Projector, additional toys and Equipment to be used in the Paediatrics unit.
Challenges
■
Critical shortage of staff.
■
There’s still a circle of mind of confusing the difference between occupational therapy
and physiotherapy among other health professionals
■
Lack of Annual departmental Budget
■
Lack of printing facilities
■
Limited transport/fund for conducting home visits.
■
Failure to perform scheduled home -visits
Future plans
■
To have improved home – visit schedule
■
To improve the working environment by the use of 5’s
■
To recruit more Occupational therapists
■
To initiate interdepartmental meetings with the Multidisciplinary Team members whom we work with in the Rehabilitation field
■
To establish an Inclusive playground for children at KCMC.
OPHTHALMOLOGY DEPARTMENT
Head of department: Dr. William Makupa
Introduction
The Eye Department KCMC is a 68 bed tertiary eye healthcare facility located within the
Kilimanjaro Christian Medical Centre. The department is composed of three units, namely
the Eye Clinic, Eye Ward and Eye Operating Theatre. It is staffed by six ophthalmologists, 12
ophthalmology residents, two assistant medical officers ophthalmology, 15 AMOO trainees, 25
nurses, five optometrists and 15 medical attendants.
49
Goals Achieved
1. The department had established an Eye Department Development Plan (EDDP) in June 2011, and currently we are entering the fourth year of implementation of this 10 year plan.
2. We have managed to recruit one ophthalmologist, Dr ElisanteMuna who has been posted to
the AMOO School by the Ministry of Health.
3. We managed to acquire two Inami L-0189 Slit Lamp Biomicroscopes with financial support
from ChristoffelBlindenmission.
4. An Ophthalmic Operating Table was acquired from Deepak India, increasing our operational
capacity.
5. The laundry facilities were finished, we now have a fully operational laundry service, this has
reduced the loss of eye specific theatre garments.
6. Our Oculoplastic Surgeon, Dr Honest Maro had hands on training in the Netherlands,
improving
KCMC’s capacity to deal with orbital diseases.
7. The Pediatric Ophthalmology Fellowship Programme has recommenced, with two fellows
having being trained this year, Dr AboubakrSidik Domingo and Dr EmebetGirmaTigeneh
8. A team of three (W. Makupa, H. Philippin and E. Mgaya) from the Eye Department attended
the Scientific Conference of COECSA in Livingstone Zambia.
Impact
1. Improvement in the quality of eye healthcare provided at KCMC by the development and
consolidation of Oculoplastic Services.
2. Raising the profile of KCMC as a training centre by recommencement of Paediatric
Fellowship Programme that had been suspended in 2011.
3. Removal of barriers to accessing eye healthcare by children, women, the poor, handicapped
and the elderly through Eye Outreach Programme.
Constrains
1. Lack of sub-specialist for Cornea and Uveitis.
2. Insufficient number of nursing staff.
3. Limited availability of certain types of ocular pharmaceutical products.
Didactical Activities and Research
In the year 2014, some five MMed Ophthalmology residents graduated as well as six Assistant
Medical Officers Ophthalmology. Moreover some 149 Medical Students did their clinical
ophthalmology through the eye department.
50
Statistics
General Information
Total Consultations
Return Visits
Children (< 16 years)
Top Ten Diseases
1 Conjunctiva Disorders
2 Cataract
3 Pseudophakia
4 Other Disorders of Eye
5 Refractive Errors
Top Ten Diseases Children
1 Conjunctiva Disorders
2 Other Disorders of Eye
3 Refractive Errors
4 Pseudophakia
5 Normal Eyes
Eye Outreach
Outreach Visits DEDSO1
Numbers Screened DEDSO
Numbers Operated DEDSO
Total
26087
18422
4798
New Consultations
Male / Female
Boys / Girls
Total
7665
13147/12940
2617/2181
4787
3896
3742
3544
3530
6 Glaucoma
7 Retina Diseases
8 Normal Eyes
9 Keratitis
10 Cornea Opacity
3017
2682
1022
689
660
1345
931
462
335
310
6 Cataract
7 Cornea Opacity
8 Trauma
9 Glaucoma
10 Strabismus
201
154
151
140
117
12
1748
92
Surgical Outreach Visits
Numbers Screened WESO2
Numbers Operated WESO
12
2041
264
Outreach
1. Day Eye Diseases Screening Outreach.
2. Week-long Eye Surgical Outreach.
Collaborations
1. ChristoffelBlindenmission.
2. Light for the World – Austria.
3. University Hospital Birmingham.
4. Eye Care Foundation – Netherlands.
5. College of Ophthalmology for East Central and Southern Africa.
6. Dr Hans Joachim Miertsch
51
DEPARTMENT OF ORTHOPAEDICS
Head of department: Dr. Elifuraha G. Maya
Introduction
The Orthopaedic department is also known as surgical two. This name originates from historical
background. It used to be a unit of general surgery until 1986 when it became an independent
department. It is located in second floor of the main hospital building.
Sections in the department
The department has three sections thus:-
1.
General wards i.e. Room 6, 7, 8, 9, 10 and 11
2.
Private wards i.e. Room 12, 13, 14 and 15 which are shared with surgical department (SI)
3.
Orthopaedic Rehabilitation unity
Staffing
The department organogram consist of:
■
Head of Department
■
Nurse of coordinator
■
Nurse in charge of department
■
Nurse in charge of ORU
Other staffing:
■
Graduate nurse officers -
4
■
Assistant nurse officers
- ■
Enrolled nurse -
■
Medical attendants - ■
Orthopaedic surgeon
-
4
■
Orthopaedicthietre nurses
-
6
■
Orthopaedic plaster technician -
13
3
18
1
Staff development
•
EriminaKimbion BSc Nursing Course - KCMC
•
Dr. Honest Massawe on orthopaedic surgery – KCMU CO
•
Dr. Pallangyo on orthopaedic surgery – KMCU CO
52
Workshop and seminars
•
Tuesday and Wednesday conference attended by all nurses
•
One nurse attended 5 days seminars on palliative care
•
One nurse attended I day seminar on PMTCT
•
One nurse attended 5 days workshop on KAIZEN
Achievements
■
The department was able to provide high quality care despite of shortage of staff and overcrowding of patients.
■
The department succeeded to transfer some of spinal cord injury of patients to
rehabilitation unit.
■
The department achieves to get, heater for hot water which is available in the kitchen room
■
All old mattresses were exchanged
■
Some old blankets were exchanged.
Constraints
■
Shortage of staff
■
Hospital beds are old, new one are needed
■
Shortage of non-human resource i.e. suction machine private patient utensils, curtains,
and patients uniforms
■
Working C – ARM in theater IV
Future plan and recommendations
■
Recruit more nurses and medical attendants.
■
Reduce the number of patients on fraction to reduce hospital staying, the cost of
treatment and Borden to the nursing staff.
■
Expand orthopedic department to allow for more beds, more theater rooms and large
rooms for lectures and morning repots.
■
If possible allow nurses to specialize on orthopedic and trauma management
Top ten diseases
1.
Fracture of femur -
271
2.
Fracture of tibia/ Fibular -
190
3.
Cervical + Spinal cord injuries -
55
4.
Fracture of radius / ulna
-
48
5.
Osteomyelitis -
47
53
6.
Intertrochanteric fracture
-
41
7.
Supracondylar fracture -
40
8.
Fracture of humerus
-
34
9.
Dislocation -
30
10. Fracture of ankle
-
25
Killer Disease
1.
Cervical injuries
2.
Open fracture tibia / fibula, femur
3.
Intertrochanteric fracture in old age
4.
Spinal cord injuries with bed sore
Statistics
General statistics
Month
January
February
March
April
May
June
July
August
September
October
November
December
Total
Admission
Discharge
M
F Total M
F Total
101 39 149 91
42
133
95
36 131 91
35
126
95
30 125 82
39
121
80
30 110
87
32
119
78
34 112
77
31
108
90
36 126 80
38
118
72
31 103 78
36
114
67
28
95
60
26
86
86
34 120 75
36
111
83
40 123 86
39
125
76
35 111
79
31
110
84
35 119
66
45
111
1007 408 1415 952 430 1382
M
1
4
4
1
2
2
1
1
1
1
1
Death
F Total
1
1
1
4
4
1
2
1
1
1
1
3
4
Absconded
M
F
Total
5
5
1
1
2
1
3
2
1
3
2
2
6
6
8
1
9
3
1
4
4
1
5
5
5
4
1
5
2
2
44
6
50
Operations/ procedures performed in 2014.
S/N
1.
2.
3.
4.
5.
6.
NAME OF PROCEDURES
S-nailing
K-nailing
Closed reduction
ORIF
Girdlestone
Arthroscopy
TOTAL
35
72
44
136
31
10
54
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
Angular plating
Austin Moore prosthesis
External fixation
Laminectomy
Surgical debridement
Surgical toilet
Implant removal
UFN Universal Femoral Nail
Amputation
Plating
Sequestrectomy /saurcerisation
DHS Dynamic Hip Screw
Osteotomy
Biopsy
Tendon Repair
Arthrodesis
Arthrotomy
Skin grafting
Others
TOTAL
24
1
40
15
57
265
44
3
36
35
31
1
28
27
15
11
11
11
122
1102
NB:
All other procedures that are not so commonly done. To mention few these are
1.
Nerve exploration
2.
Contracture release
3.
Bone grafting
4.
Revisions
5.
Secondary suturing
6.
Talectomy
7.
Clubfoot surgeries
8.
Pediatric surgeries
9.
Foreign body exploration
10. Darackoparation
11. Excisions
Collaboration
1.
Health volunteer overseas of America
2.
Stokemanda-ville hospital of United kingdom
3.
Nijmegen university of Netherland
55
DEPARTMENT OF ORTHOPAEDICS WORKSHOP
Head of department: Mr. Prosper Kaaya
Introduction
Orthopedic Workshop located adjacent to TATCOT. The department received patients who came
from all corners of Tanzania and the nearby Countries. All people living with physical disabilities
were attended accordingly.
Staffing
Still we have shortage of staff due to the increase of the number of Clients who are in need of our
services.
Up to December 2014 the department was maintained by the following staff:
ProsthetistOrthotist
-
5
Orthopaedic Technologist -
3
Orthopaedic Technician
-
2
Office attendant
-
2
Orthopaedic attendant
-
1
Orthopaedic Shoe maker -
2
Wheel chair Technician
-
1
Secretary
-
1
Storekeeper
-
1
Total
18
Activities
Department managed to offer services to all clients who came for orthopedic devices. The
department used to receive students from TATCOT and KCMU College for field work and
research. Some of the staffs are involved in teaching of student at TATCOT and KCMU College.
Statistics
The following devices were delivered to the people living with physical disabilities.
No.
1
2
3
4
5
Item
Trans tibial prostheses
Trans femoral prostheses
Knee ankle foot orthoses
Ankle foot orthoses
Foot Orthoses
Total
70
41
25
307
49
56
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
Spinal Orthoses
Orthopaedic Sandals
Posterior Shell
Arm Brace
Axillar Crutches
Elbow crutches
Knee disarticulation prosthesis
Ankle stabilizer
Knee orthoses
Cervicles Neck Collar
Inner Shoe
Cork up splints
Orthopaedic boots
Thomas Orthoses
Wheel Chairs
Figure 8 clavicle harness
Different repairs
Flexible lumbar corset
Trans Radius Prostheses
Trans wrist prostheses
Trans Humerus prostheses
Ortho prostheses
Total
10
59
49
89
93 (Pairs)
51 (Pairs
15
6
9
50
32
25
19
36
49
25
88
45
6
4
4
22
1278
Number of patients attended the department
No.
1
2
3
4
5
6
7
8
9
10
11
Month
January
February
March
April
May
June
July
August
September
October
November
Total
Total
82
89
79
88
70
89
69
90
69
81
79
1,044
Constraints
»
Shortage of Orthopaedic Materials and components
»
Shortage of office attendant. Currently we have two office Attendants.
57
»
Insufficient number of Orthopaedic Technologist which are not match with increase
number of patients.
»
Shortage of some of the machines and machines tools.
Impacts
»
We managed to provide services to all people living with physical disability by providing appropriate Orthopedic devices.
»
The department work hard to clear outstanding bills for materials and components and other debts.
Future plans
»
To look for short and long courses for staffs in order for them to gain more knowledge
and skills.
»
To look for more donors, in order for them to support department so that we can produce orthopedic devices which can be affordable to the poor patients.
»
Renovation of ground floor
»
To establish Departmental development plan.
Collaboration
»
Department has collaboration with CCBRT
»
Department has collaboration with CBM.
»
Department has collaboration with TATCOT/KCMU College.
»
MERSOL
»
Faraja primary school- SanyaJuu
OTORHINOLARYNGOLOGY DEPARTMENT
Head of department: Dr. Aloyce Msaki
Introduction
The department continual to render services under the leadership of Dr.A. Msaki despite of
shortage of Human resources especially Doctors.
The department has three units namely:»
Ward
»
Clinic
»
Theater
In 2014, the total capacity was is 24 because one Room of 4 beds was converted to tea Room
58
»
General ward 20 beds
»
Private room 3 beds
We usually admit daily and operate daily, Monday to Friday. Furthermore there is daily ward
round, bedside teaching and interdepartmental consultation.
Clinic
Clinics are conducted on Tuesday and Thursday. Wednesday is special for KCMC Staffs and
student. There is Audiology Unit which is located within the outpatient premises and it operates
daily.
Theatre
We have two operating room we schedule operation from Monday to Friday Emergencies are
operated as they arrive.
Philosophy of the department
To provide quality care for the patients as professional responsibility
Staff situation and movement
There is one principal medical officerand four residents/registrars in the department.
DR’S: Principal medical officer
Registrar
Residents
-
1
- 1
- 3
Nurses
UNIT
Ward
Clinic
Theatre
TOTAL
NO
1
1
2
APNO ASNO ANO
6
1
0
1
6
EN
1
1
1
3
SMA MA ATENDANT
4
1
1
2
1
7
1
1
Constraints
»
Increased number of patients in relation to the number of staffs.
»
Replacement of old surgical instruments which are no longer functional.
»
Bed capacity
»
Renovation of the department
»
Changing room
59
TOTAL
14
3
4
21
Top Ten Diseases
1.
Adenoid hypertrophy
2.
Adenotonsilitis
3.
Tonsillitis
4.
Hypertrophic Allergic rhinitis
5.
Aerodigestive foreign bodies
6.
Tumors
7.
Nasal polyps
8.
Epitasis
9.
Chronic Otitis Media
10. Juvenile Laryngeal Papilomas
Statistics
Inpatients statistics
Month
January
February
March
April
May
June
Julay
August
September
October
November
December
Total
Admissions
F
M
53
66
50
58
48
65
51
61
52
67
65
57
44
53
39
59
58
81
59
72
64
92
64
71
647
804
Discharge
F
55
48
47
51
53
57
52
41
49
61
65
62
641
M
70
56
65
64
56
63
49
66
71
72
91
72
795
Death
F
M
1
1
1
1
1
2
7
7
1
1
2
2
Outpatient statistics
Out patients
New client
Revisit
Male
571
1411
Female
471
1747
60
Total
1042
3158
Number of death
Causes
Oropharyngeal tumour
Nasalpharyngealtumor
Severe anemia sec to lymphoma
Laryngeal tumour
Foreign body in the airway
Anaphylactic reaction
Juvenile laryngeapapiloma
TOTAL
Total
5
2
1
1
1
1
1
10
Achievements
During departmental visits by different ENT surgeon we managed to perform complicated
surgeries that were not performed in our Department, MMED and other students rotated within
our department acquired knowledge and skills.
Despite shortage of staff we managed to increase number of operation days from two to five days
per week
Future plans
»
To train more residents.
»
We need two registrar to alleviate the shortage of doctors
»
We need speech therapist.
»
Renovation of the department.
»
To train nurses on different ENT specialties
DEPARTMENT OF PATHOLOGY
Head of department: Mr. Yona Kasebele
Introduction
The Department of anatomical Pathology is does offer clinical services to this hospital and
several other outreach hospitals. The Anatomical Pathology department is yet to get a resident
pathologist, however the department functioned satisfactorily this is due to combined effort of
GSF and Nijmegen University. We have been getting support of pathologists from Nijmegen
University of The Netherlands. A total of five pathologists worked in the department at different
times this year, these included Prof.Slotweg, Prof.Arrends, Dr. Van Tweel, Dr.ValeskaTepstra, and
Dr. Van Beeek.We advise the administration should find a final should find a final solution to the
Pathologist issue.
61
Staffing
One technical staff member finished her internship in October this year and joined the department
in November, and yet another technical staff member enrolled for PhD at KCMU College this
academic year. The current staffing situation is as shown in the table below;5 Morgue staff:
S/N
1
2
3
4
5
6
7
Staff category
Doctor
Laboratory scientists (MSc.)
Laboratory scientist (BSc.)
Cancer registrar
Health attendants
Secretary
Morgue attendants
Number
1( currently studying at Makerere university)
2
1
1
2
1
5
Activities
Pathologists who visited/worked in the department also participated to teach Basic Pathology to
MD 3 students at K.C.M University College. Laboratory Technical staff continued to take part in
teaching Diploma and BSc. Students for Health Laboratory Science.
The Department also supervised all students for their rotation on hands on skills.
Achievements
Dr. Patrick Amsi is the 2nd year at Makerere University as a resident in Pathology, and Mr.
George Semango has this academic year joined K.C.M. University college for a PhD degree with
a research titled “Unravelling the Role of Interleukin 32 in HIV related Kaposi Sarcoma”.
Workshops/Seminars
r. Y.Kasebele and G Semango attended a course on routine histotechnology methods and special
stains from 18th to 20th August 2014. The course was conducted by East Africa Division of
International Academy of Pathology and sponsored by British Division of IAP.
Statistics
The following tables represent the various specimens processed and examined in the department
for the year 2014
Histology
Source
K.C.M.C
Other hospitals
Total
Number of specimen
2355
147
2502
62
Cytology
Source
Pap smears
FNAC
Other
Seminalysis
Total
Number of specimen
5
383
4
59
451
*More than 82% of surgical biopsies are from K.C.M.C Hospital and the rest from other
hospitals
Death statistics – Morgue.
From K.C.M.C
Adults
Male
Female
Total
583
498
1081
Children
Male
Female
220
180
400
From outside K.C.M.C
Adults
Male
Female
Total
500
580
1080
Children
Male
Female
4
5
9
Postmortem examinations
Type of PM
Clinical
Police
Total
Number.
3
271
274
DEPARTMENT OF UROLOGY
Head of department: Dr. Frank Bright
Introduction
Urology department is situated on top of the pathology department at KCMC. It has two operating
theatres, one major and one minor, a clinic and wards of 38 patients.
63
Philosophy
■
We believe that every person is an individual with needs and problems regardless of
race, sex, age, religion, politics or social status.
■
We believe that every individual has the right to get optimal nursing care.
■
We believe that surgery is one technology of rendering the best well-being of an
individual from diseases so best pre and post-operative care is essential.
■
We believe that we are God’s instruments for caring the sick.
Objectives:
■
To maintained good interpersonal relationship between staff, students, patients and relatives.
■
To promote quality nursing care to patients.
■
Working as a team with doctors, physiotherapists, and anaesthetists so as to meet our
goals concerning patients.
■
To ensure proper documentations to all activities done.
■
Monitoring ward cleanliness every day to prevent infection.
■
Utilization of nursing care process.
■
Have 5s implemented in urology department.
■
To ensure availability of supplies material and equipments.
■
To keep updated inventory of all equipments.
■
To emphasise on continuing education.
Statistics
Table 1: Main theatre procedures
Procedure
TURP
DVU
URETHROPLASTY
TURBT &TURBx
BNI
Circumcision
Hypospadias repair
Hernioraphy
Stoma revision
Valve ablation
Hydrocelectomy
Pyelolithotomy
Pyeloplasty
Total
288
89
59
67
29
28
52
33
9
16
48
24
6
64
Scrotal exploration
Nephrectomy
RPP
Stent removal
Varicocelectomy
Urinary diversion
Orchidopexy
Laparotomy
Vesicostomy
Ureterostomy
Debridement
Elective SPC
Colostomy closure
Cystolitomy
TOTAL
28
15
8
8
4
6
31
13
11
2
6
8
1
6
895
Table 2: Minor theatre procedures
Procedure
TCB
BSO
Stent removal
Hydrocelectomy
SPC
Stoma Calibration
I&D
Circumcisions
WLE
TOTAL
Total
51
26
3
9
5
10
3
5
2
114
Activities
Teaching as our role and also one of the mission of KCMC: Last year our department received
students from Malawi , Kenya and Uganda. The department provides training for the student to
graduate as Urologist. The students are taught according to KCMUco. postgraduate guideline,
supervised for the research work, and we lastly we provide examinations under KCMUCo.
Guideline. Thereafter, the student successfully graduated as Urologist. We also have more students
joining the department as resident doctors from various part of continent including Tanzania,
Kenya and Rwanda, who are still progressing with their studies at the department and the clinical
work.
Furthermore, we are planning to start the preparation for biannual JL Eshleman workshop which
is supposed to be held on Nov 2015. We have managed to send first announcement on Dec.
65
It is our hope we will hold several meeting so that we can make the workshop success.
In addition, as the department we also have a role in the KCMUCo. As Lectures and Senior
Lecturers to provide teaching to the undergraduates and resident doctors on the Urological
conditions including: Pheochromocytoma, WilmsTumor,
Bladder outlet obstruction, prostate cancer and etc. The department has a role to teach MD One
and MD Four students in the First Semester of their curriculum. This was successfully done and
the students were examined and all pass.
Moreover, the department proceeds to provide care and treatment, support to people/ patients
who cannot reach our hospital- KCMC through provision of flying doctor services. This year we
manage to attend 10 trips from various hospital including: Nkinga, Berega, Itigi,NdalaMakiungu,
Nzega,Kiomboi , Sikonge, Kilimatinde,Iambi and Dareda Hospital. The service provided was
sufficient and the cooperation between these hospitals continued to be appreciated from both
sides.
Last but not least, the department is running two days clinic in a week which is on Tuesday and
Friday. The clinics are constantly busy with the average of 60 patients with different conditions
attending per clinic per day, with the average of 2 consultants, 1 urologist, 1 clinic nurse, 1 nurse
attendant and 3 students. The number of the experts is not enough as a result it always brought
about long waiting for our patients; complains from the patients and short time spent with patients
due to volume of patients. This estimate of patients number attended makes a total of 4678 patients
who attended our clinic in 2014.
Lastly, the department is not working in isolation. We still proceed with our collaboration between
Urolink and British Association Urology Society (BAUS). The aim of this collaboration is to have
an exchange programme for our Junior and senior Doctors within the network to learn professional
experience from various countries within collaboration. Currently, we have Dr.AlexzandiriaZazho
from Greece a 4th year Medical doctor from the University of Alexndria Greece who is in the
department for six months. She is learning different procedures and practice under supervision
from the local supervisors. She completed her study period in March 2014. This became possible
due to the collaboration with BAUS and Urolink.
Challenges faced by the department
•
Electricity instability which is long term problem in our hospital as well as our country.
This has led to constant break down of our endoscopic equipments as well as diathermy machines.
•
Shortage of professional and non- professional staff such as specialist, consultants and
ward attendants. The shortage have result into patients spend more time in the our clinic
as specialist are few. The other problem which have come is the specialists tend to spend little time with patients so they can finish to see all patients. This has led to some patients not satisfy with our services.
•
Lack of quality consumables example catheters, face masks and surgical gloves. The problem has led into risking the workers safety and led to consume more materials as for 66
example some of the gloves have holes so instead of using two pairs you end up using three or more.
Future Plans
•
To train more residents in order to alleviate current shortage.
•
To start percutaneous endourology services
67
PARAMEDICAL
DEPARTMENTS
68
PHYSIOTHERAPY DEPARTMENT
Head of Department: Mathew J. Shayo
Introduction
Physiotherapy department is one of the clinical departments that provide services to individuals
and populations to develop, maintain and restore maximum movement and functional ability
throughout the lifespan. This includes providing services in circumstances where movement and
function are threatened by ageing, injury, pain, diseases, disorders, conditions or environmental
factors. The aim of physiotherapy services is to maximise “functional movement” which is central
to what it means to be healthy.
Physical therapy is concerned with assessment and maximising quality of life and movement
potential within the domains of promotion, prevention, treatment/intervention, habilitation and
rehabilitation. This embraces physical, psychological, emotional, and social wellbeing as well
as enhancing active life among normal subjects in prevention of none communicable diseases.
Physical therapy involves the interaction between the physical therapist, patients/clients, other
health professionals, families, care givers and communities in a process where movement potential
is assessed and goals are agreed upon, using knowledge and skills unique to physical therapists.
Our Clients
Our clients are Inpatients and Outpatients, adults and children, old and young with pain,
movement and activity limitation, participation restriction resulting from physical, pathological or
psychological disorders. We therefore stretched our services to 8 main areas in the hospital i.e.
•
General surgery ward
•
Orthopedic ward
•
Medical wards
•
Obstetrics and Gynecology
•
Pediatric
•
Orthopedic rehabilitation unit
•
Outpatients (adult and Pediatric)
•
Dermatology ward
With the expected expansion of the hospital our services are expected to expand to “Burn Unit”
and “Open Heart surgery unit” which are on the process to be established.
Objectives
The department is focusing on the delivery of high quality physiotherapy services in Tanzania by
adhering to the international clinical guidelines for physiotherapy; Evidence based practice and
Infection Prevention and Control protocol.
To provide proper education to the clients and community for prevention of diseases that threatens
the individuals’ lives and/or freedom of movement for physical wellbeing of our clients.
69
Staffing
This year Physiotherapy services were provided by 11 physiotherapists and one supporting staff.
The shortage of human resources has been the main challenge; with the expected expansion of
services to “Burn Unit” and “Open Heart Surgery”, the manpower will be stretched too thin for us
to provide quality services. Therefore recruiting new physiotherapy staff is of priority.
The table below show the areas of work, current number of staff and the proposed required number
of new staff.
Human resource requirement for the Physiotherapy Department
Type of staff
Area of work
Physiotherapist
Physiotherapist
Outpatient
Medical I, II and MICU
Physiotherapist
Paediatrics
Physiotherapist
Physiotherapist
Orthopaedic ward
ORU
Physiotherapist
Physiotherapist
Physiotherapist
General Surgery ward
SICU A and B
Obs & Gynae/ Urology
& ENT
Physiotherapist Burn Unit
Physiotherapist Open Heart surgery unit
Physiotherapist Planning and co-ordinating PT services
Supporting staff Overall
Total No of Staff
Current
number
1
2(1Out for BSc
studies and 1
expecting to retire
in 2015)
2 (1 Out for BSc
studies)
1
1(On PhD
studies)
1
1
Proposed
required number
of new staff
2
Total
3
1
3
0
2
1
2
1
2
1
1
2
2
1*
0
1
0
0
1
1
1
1
1
0
1
1
12 (11 PT and 1
Supporting staff)
1
9 (8 PTs and 1
Supporting staff)
2
19
*Physiotherapist in OG is not permanently placed in that ward. S/He works on consultation basis.
Achievements
Despite the shortage of human resource we are facing, the department have worked hard to
attend clients and to run the following activities.
In-patients in Surgical, Orthopaedics, Medical, Paediatrics, Obstetrics and Gynaecology,
dermatology and ORU wards.
Outpatients
Outpatient services: run 5days Adult Outpatient clinic and Paediatric outpatient clinic.
70
Special Clinics:
Cardiac Outpatient Clinic (once in a month) where we provide the necessary information and
training prior or post-open heart surgery. We are also involved in follow up of post open heart
surgery patients in resuming the highest level of functional ability.
Neuro-paediatric clinic NPOC (once a week) where we work as part of interdisciplinary team,
Club foot clinic (twice a week).
The department is always ready to respond to on call services provided to patients who have life
threatening conditions who needs physiotherapy two or three times a day.
Outreach services
The department also provides service to the community during routine home visits for the
disabled patients before they are discharged and if necessary after discharge, also as part of
training activities. We also reach the community through AMREF flying doctors services
Training
The department continued to offer support to different levels of education in theoretical and
practical bedside sessions to students of different levels to local and international students; at the
level of diploma, Bachelor of Science and masters. However, the department is lacking a room
with IT facilities to facilitate learning.
Elective Students: The department also receives and train students from different countries for
clinical skills and research. The table below shows the number of elective students in 2014
Elective students 2014
Name of University
Umea
Maine
Country
Sweden
USA
Number
4
1
Level of Education
BSc
BSc
Continuous Education
Three physiotherapists are on training. Of these, two are full time students for BSc Physiotherapy
KCMU College and one is on PhD studies Umeå University. One member of staff has graduated
for MSc Physiotherapy from Bergen University College-Norway. This has raised the current
number of physiotherapist specialists in the department from 2 to 3 (1 PT specialist in Orthopaedic
and Manual Therapy, 1 PT specialist in Clinical PT in Orthopaedics and Rheumatology and 1
PT Specialist in Clinical PT in Lung and Cardiovascular conditions). There is a need for more
specialities especially in paediatrics and Neurology.
Through collaboration with Bergen University College the department managed to conduct
a disability workshop in December 2015, which was very successful and stimulated interdisciplinarity in management for children with disability.
71
Statistics
Ward
Orthopaedic
General Surgery SI
SICU A & B
Medical I , II & MICU
Paediatric I,II & III
ORU
Dermatology ward
Sub Total A
Adult OPD
Paediatric OPD
Sub Total B
Grand Total (A+B)
In-patients
Number of patients
1040
578
375
863
420
6
5
3,287
Out-patients
5080
1186
6,266
9,553
No of Treatments
7256
3315
738
3206
998
240
25
15,778
5080
7116
12,196
27,974
Collaboration
The department continued to collaborates with different institutions worldwide. There is
collaboration between Umea University-Sweden, Bergen University College Norway with School
of Physiotherapy/ Physiotherapy Department KCMC. Through collaborations some members of
staff have managed to pursue for further studies and one workshop was successfully conducted.
We are on the way to establish collaboration with Maine in USA.
Constraints
The following issues surfaced to be the major problems of the department:
»
Inadequate number of Physiotherapists to overcome the workload and supporting staff.
»
The department has old equipment and has not been renovated for long time.
»
No study room with ICT facilities (Clinical teaching room) for students
Future plans
In order to improve client services; the department is focusing on improving continuous
education to its staff through collaborations with other departments within the hospital, school of
physiotherapy and KCMU-college.
72
MEDICAL RECORDS DEPARTMENT
Head of Department: Mr. Syprian S. Mvungi
Introduction
Medical records are essential components in the effective management of the patients’ health care.
The medical records department contains information needed to plan, provide and evaluate the
care given to the patient. It serves as a tool for communicating information to all health personnel
who deal with the patients and contributes to the continuity of patients care.
Units
The department has 7 units namely:»
Census,
»
In-patients Coding,
»
Out- patients Coding,
»
Filling,
»
Master Index,
»
Reception, and
»
Admission.
Purposes of medical records department
*
Serves as a source of data/information for management and planning.
*
Serves as a basis for planning patient’s care
*
Serves as a basis for analysis study and evaluation of the quality of the care render the patient.
*
Provide data for the clinical or for the epidemiological research and for research.
Overall/major functionsof the department
*
To manage and organize health records
*
To code and classify diseases
*
To store and retrieve health records
*
To collect, tabulate, analyze and interpret data for research, training and administrative use.
*
To capture data by using Care2x
*
To trainhealth records students in real practice (THRT)
Staffing
The total number of staffs served the Department in 2014 were 23 of which 10 were trained
73
personnel (Health Records Officers), and the remaining 12 were not trained personnel(Medical
Records Attendants) who are either attended the short course/training in Health Records or on job
training with good experience of work in the department and 1 staff was office attendant
The summary of staffing in the department is tabulated below:
STAFF
Trained
Untrained
Office attendant
IT
Statistician
TOTAL
Available
10
12
1
23
Required
17
18
1
2
1
39
Total required
27
30
2
2
1
62
Constraints:
* Shortage of skilled Staff
* Electricity fluctuations which affects data entry in Care 2x System
* Lack of enough archives for files storage
* Lack of enough space for filling system
* Instability of database software (Care 2x system), there was a collapse of network since
December 2013 up to date.
* Isolation from Health Scheme of Services
Achievements:
■
One members of staff graduated a 3 years training at Training Centre for Health Records Technician (KCMC) and reported back at the department in 2014.
KILIMANJARO CLINICAL RESEARCH INSITUTE (KCRI)
Director of Institute: Prof. Gibson Kibiki
Introduction
Kilimanjaro Clinical Research Institute (KCRI) is an academic centre for evidence based health
interventions. The institute initiates and conducts medical research to develop evidences for
interventions and provide research training and necessary research logistics to collaborators and
partners. It collaborates according to the four C’s which are conduct, contract, coordinate and
consult.
Vision
The vision of KCRI is to be an internationally recognized centre of excellence in health research,
74
well embedded in the academic medical setting of KCMC, the Tanzanian health care system and
international research networks.
Mission
The mission is to create a critical mass of researchers embedded in an academic setting that is
rooted in a region with specific health problems, which is a powerful tool to develop evidence for
medical interventions and health policies. It is a prerequisite for developing a research agenda,
which is suitable for the recipient population in the endeavor of improving health.
Strategy
The board recommends future strategies of the Institute; it helps to foster links with other
institutions, and national and international collaborations.
Meetings
KCRI has a management team. They meet weekly to discuss the general operations of the institute;
the meeting is chaired by the KCRI Director. Weekly reports covering research, training, finance
and administrative issues are discussed. The Team consists of the KCRI Director, Heads of the
six KCRI departments, Chief Accountant, ICT person, Administrative secretary and Human
Resource Officer. The Director meets on a regular basis with project PIs, heads of departments, and
programme coordinators to discuss issues pertaining to research and capacity building activities.
The head of the department of research administration meets with research administrators weekly
to follow up progress of research and implementation of weekly action plan.
Staffing
In 2014 KCRI was having 58 staff; Including 7 research scientists, 16 laboratory technologist &
1 laboratory technician,5 laboratory assistances, 2 research nurse ,4 research administrators, 1
Human resource officer, 2 accountants, 1 system administrator, 1 data manager and 4 data entry
personnel, 1 secretary, 3 drivers, 2 laboratory attendants, 6 office assistance and 3 gardeners.
Therefore KCRI had 34 employees in permanent positions and 22 are on contract through various
projects (in temporary positions). Of which 33 are women and 25 Men.
Challenges
•
Salary:-The total of 22 employees who are on contract have not been included in the government pay roll therefore the institution fail to retain staff in terms of salary thus leading to a loss of man power to the institution.
•
Retention: Because of the project based funds which are budgeted for a certain period of time employees are contracted for a certain period of time based on a particular
project thus leading to the loss of skilled and experienced man power as well as reliable employees
75
Biotechnology Research Laboratory
The KCRI Biotechnology laboratory formerly called KCMC biotechnology laboratory was built
with a grant from Bill and Melinda Gates’ Foundation (BMGF) under the umbrella of Joint
Malaria Programme (JMP). The construction work started in 2002 and completed in 2008, and was
officially opened in 2009. In March 2009, all research infrastructures at KCMC were put together
to establish the Kilimanjaro Clinical Research Institute (KCRI), which became the third pillar of
the Good Samaritan Foundation, the owner of KCMC and KCMUCo. Currently the KCRI-BL
provides services to projects in HIV, Malaria, Tuberculosis, Diarrheal infections, Trachoma and
Non-infectious diseases.
1.0. Laboratory infrastructure
1.1 New Laboratory wing
Research Laboratory has undergone administrative structure changes; this includes introduction
of unit/section and heads of respective units. Currently there are seven functional units, Unit one:
Molecular biology and Immunology, Unit two: Protein expression unit, Unit three: Biochemistry,
Hematology and Blood Parasitology , Unit Four : BSL3 and BSL2 , Unit Five: Genomics, Unit
Six :Bio-analytical ,Unit seven: Biorepository.
The new lab wing accommodated the following units:
(i)Unit 3
-
Biochemistry, Hematology and blood Parasitology
(ii) Unit 4
-
Biosafety level-3 laboratory (MTB lab)
-
Biosafety level-2 laboratory (microbiology other than MTB)
(iii) Unit 5
-
Genomics
(iv) Unit
-
Bio-Analytical (pharmacokinetics and Pharmadynamic studies )
NB: Unit 1, 2 and 5 are situated in the old laboratory building and these are Molecular/Immunology
unit and Expression studies unit respectively
1.2 Biorepository
The biorepository measures 1290 sq feet (120M2) and has capacity to accommodate up to 30 big
-80 freezers. Currently the biorepository contains the following freezers
•
Fifteen -80 freezers
•
Two -40 freezers,
•
One -30 freezer
•
Fourteen -20 freezers
•
Two LN2 freezers
•
8 LN2 storage tanks
76
1.3 Warehouse
Due to the need for a storage place for Laboratory supplies, the KCRI biotechnology Laboratory
has managed to refurbish the old freezer room into a warehouse where all research projects can
securely store their supplies. Each project is provided with a key for lockable cabinets for storage
of very sensitive reagents/kits.
1.4 Laboratory security
Biometric system /finger print and card reader lock have been improved to all main laboratory
accession door and surveillance (CCTV) cameras in all laboratory corridors and in the biorepository.
3.0 Laboratory accreditation
The KCRI-BL under support of the East African Consortium for Clinical Research (EACCR)
has entered into stars-based accreditation process i.e. Stepwise Laboratory Improvement towards
Accreditation (SLIPTA) based process.
A first diagnostic auditing has been completed to define the current status and non-conformities of
the lab after which a second audit for accreditation will be initiated. EACCR is funded by EDCTP.
There has been no progress since after the first audit this is because the sponsor i.e. EDCT is
transitioning to phase two hence most of the proposed activities could not be done.
Achievements
Purchase of a new generator
With the expansion of the lab the power requirement has exceeded the current generator (100KvA)
capacity so the new generator 300KVA capacity has been purchased and installed
Purchase a more powerful Power central stabilizer
Due to the sensitivity of most of lab equipments to power fluctuation a central oil cooled power
stabilizer with capacity of 300kva has been purchased and installed. The cost up to installation
was 45,000USD.
KCMC/KCRI projects 2014
Years
2014
Number of projects
13
Challenges
1.
TANESCO power
Power supply from the national power supply company, TANESCO has continued to be
a major problem at the Biotech lab.
2.
Imposition of tax on quality control/assurance materials – an impediment to quality laboratory services
3.
Service contracts
77
We have continued depending of companies from outside Tanzania for service and maintenance of equipment. This is not an effective way of operating such a facility as it
is expensive and not timely
Future prospects
1.
Upgrading of software for lab management
2.
Purchase of Laboratory Information Management System
Due to restructuring at the laboratory, there is a great need to purchase Laboratory information management system (LIMS) software. This is expected to cost 37,000usd one time investment; these funds are not available at the moment. Acquisition of LIMS
at KCRI-BL is a milestone towards better management of Laboratory activities and
hence an added value towards accreditation.
3.
Setting up KCRI-BL as reference laboratory
KCRI –BL management has agreed to improve in house quality management system, setting up research policy and custom satisfaction survey as initial plan towards setting
us a reference laboratory. The plan is to make the KCRI-BL a reference laboratory in Tanzania for HIV, TB and Malaria diagnostic.
4.
ISO15189 Training
Since the laboratory is planning to achieve accreditation through SLIPTA scale, training and coaching in ISO 15189 is mandatory. The quotation we obtained from RAMS for
this purposes was 24000USD, again funds are not available and we are still struggling to get them from our stake holders.
5.
Sample archive and biobank
The biotechnology laboratory management has started process of improving data base
for all stored samples. Funds for this have been obtained through EDCTP under EACCR consortium. This work is ongoing and we expect to expand it and create a Biobank for
all archived samples.
6.
Electronic temperature Monitoring system
There is great need to install a temperature monitoring system at the bio-repository. This will help to keep the temperature records of freezers and hence reduce human error in tracing temperature drop out.
7.
Building of file storage room
There is a great need for the institution to have enough space for keeping its file safely. This will help to keep the research file as per agreed standard operating procedure (SOPs)
Current research programmes at KCRI/KCMC; some have been established under KCRI while others started before the establishment of the Research Institute:
•
East African Consortium for Clinical Research (EACCR) – a collaboration between research and academic institutions of East Africa (Tanzania, Uganda, Kenya, Sudan and Ethiopia) and European countries (UK, The Netherlands, German, Sweden, Norway). 78
Supported by EDCTP initiative for establishment of Network of Excellence (NoE).
KCRI serves as a sub-HQ and the training node. KCRI Director serves as the Deputy Director of the consortium.
•
Pan African Consortium for Evaluation of Antituberculous Agents (PanACEA) – collaboration between institutions in Africa (Tanzania, South Africa, Uganda) and
European countries (UK, The Netherlands and Germany) supported by EDCTP to
evaluated antiTb agents for improvement of the Tb regime and treatment duration.
•
Malaria Capacity Development Consortium (MCDC) – collaboration between African Universities from Tanzania (KCMC), Uganda (Makerere), Senegal (Dakar), Malawi
(CoM) and Ghana (Kumasi), and European Universities from the UK (LSHTM, LSTM) and Denmark (CMP, DBL) supported by Welcome Trust.
•
Optimization of Diagnosis – collaboration between KCMC and University of Virginia (USA) supported by NIH (USA)
•
Training Health Researchers into Vocational Excellence in East Africa (THRiVE) – collaboration between Institutions from East Africa: KCMC, NIMR (Tanzania),
Makerere, Gulu, UVRI (Uganda), National University (Rwanda) and ICIPE (Kenya),
and The UK universities (LSHTM, Cambridge) supported by Welcome Trust
•
KCMC – Duke University collaboration funded mainly by NIH (USA)
•
Kilimanjaro Reproductive Health Program funded mainly by NIH (USA) through
Harvard School of Public Health.
•
KCMC Reproductive Health Centre support from WHO, Norway and USA
79
HOSPITAL SUPPORTING
DEPARMENTS
80
CHAPLAINCY DEPARTMENT
Head of department: Rev. Archboldy Lyimo
Introduction
God has given us an opportunity to serve Him here at KCMC through the provision of Pastoral
Care and Counselling to patients, staff and students.
In addition to Pastoral Care and Counselling, the chaplaincy department conducts the following
services:
»
Bible study and fellowship every week.
»
Morning devotion to staff and students from Monday to Friday every week.
»
Worship services every Sunday.
»
HCF prayer meetings every Tuesday and every first Saturday in a month.
»
Christian education to students and confirmation classes to children of our staff.
»
Holy Communion to the patients and KCMC community.
»
Holy Baptism (emergency) to adults and children admitted in the wards (when requested).
»
Reconciliation and counselling ministry as need arises to KCMC community.
»
A four months CPE training programme twice a year.
»
Daily visitation for admitted patients.
»
Services and last respects for the deceased in the mortuary/chapel.
»
Sunday services, morning devotions, preaching, prayers and choir music to the patients through the public address system.
»
Outreaches to Maasai Community with a special focus on HIV/AIDS awareness
seminars, children’s education and conservation and promotion of the environment. It also focuses on support treatments to those suffering from eye and ear diseases and deals with identifying and supporting primary education to vulnerable children and orphans.
Staffing
Chaplaincy department was served by the following members of staff during the year 2014:
»
Rev. A.E. Lyimo
»
Rev. P Urassa
»
Fr. F. Darkshen
»
Rev. P. E. Hiiti
»
Rev. A. Mongi
»
Rev. D. Msanya
81
»
Rev. W. Bartels
»
Ms. J. Lyatuu
»
Ms. F. Kisanga
Statistics
S/N Consultations
1. Holy Communion to patients,
relatives staff and students
2. Sunday services, adult and
children
3. Religious instruction and
Holy Communion
4. Confirmation classes
5. Baptisms:- Infants
Adults
Protestants
Roman Catholic
Total
2484
6296
8780
3212
35442
38654
1125
13400
14525
316
3
14
453
5
14
137
2
TOTAL
6974
62431
“May God’s love and grace through the power of the Holy Spirit abound on the KCMC community;
in the course of treating and caring for patients and each other.”
CATERING UNIT
Head of Unit: Mrs. Regina Mtui
Introduction
Catering Unit operates with a total number of 40 staff comprising of one caterer, one nutritionist, 11
cooks and 27 kitchen mess attendants. The catering unit, daily prepares and provides nutritionally
healthy, cost effective and quality food and food services to an average of between 400 and 450
inpatients, 381 to 400 students, 1,200 staff and about 47 intern doctors.
The unit prepares meals for different groups:
Category
Patients
Students
Staff
1ntern doctors
Total
400 - 450
381 - 400
1200
47
Objectives
*
To prepare and provide nutritionally healthy meals to patients, students, intern doctors
and hospital staff.
82
*
To comply effectively to standards of infection prevention control and 5s in the course to deliver clean and quality food to clients from clean cooking environment.
*
To maintain cost effective and healthy high quality meals to various categories of its
food consumers with minimal complaints.
*
To prepare and provide meals to general and specific patients as a prescribed requirement from the sickness.
*
The ensure quality supply of tendered food raw materials to reduce cooked and raw food wastes.
Average food cost per year
Category
General Patients
Special Case
Patients
Private Patients
Staff (tea &
bites)
Staff (on night
shift)
Staff in Meetings
Intern Doctors
Students
TOTAL
365
40
Average food
cost per person
day
2,064
3,057
35
1,200
8,000
368
366
366
102,480,000
161,625,600
120
1,305
366
57,315,600
18
43
381
2,202
1,500
7,000
3,461
264
366
292
7,128,000
110,166,000
385,043,172
1,144,242,612
Average no. Of
people
Average no. Of
days in a year
Food cost per
year
366
366
275,729,760
44,754,480
Achievements
*
of its food consumers with minimal complaints.
*
The unit continued providing professionally high standard hospitality meal service to
their meal consumers with satisfaction throughout 2014.
*
We successfully timely provided the meals in appropriate proportions and to the right consumer with minimal delay.
*
The unit ensured quality supply of tendered raw materials with success and greatly
The unit maintained cost-effective and nutritionally healthy meals to various categories
reduced cooked and raw food wastes from receiving, preparation and serving.
*
Successfully ensured proper preservation of all raw foods and maintained standard operation procedure for issuing portions for preparations with minimal loss.
*
Visited, prepared and provided individually requested meals to all private patients for the hospital per year and ensured their queries are professionally and ethically handled.
*
Ensured repair and maintenance of health kitchen and its facilities according to the
83
general guidelines and adoption of 5s.
Challenges
*
The need to upgrade the working tools such as cooking pots, food trolleys, potato peeler machine only to mention a few.
*
Kitchen floor is just too old to maintain cleanliness at the expected standards apart from taking longer time for cleaning and scrubbing by our staff.
*
Needs to have more trained and well-motivated cooks for professional practice, ethics
and standards on top of increased quality of service and output.
*
Control of preferage need to be addressed technologically by installation of CCTIV cameras.
Future plans On understanding that proper nutrition is part of the patients’ treatment plans, the Catering Unit has
planned to improve Patient’s menu into more palatable and nutritious dishes, apart from improving
its quality of service to patients, staff, students and intern doctors at the maintained costs. This
is especially important for HIV patients in various categories, obese, stroke and malnourished
patients. To accomplish this plan, few items summarized in the table below might be needed or
modified.
Table 2. List and justification of the required items for the future improvements.
Item required
Heavy Duty Oven
Heavy duty potato
peeler
Available
Nil
Nil
Needed
1
1
Man power
40
5
Justification
For all kinds of barking
Highly required as manual potato peeling
costs lots of staff time causing unnecessary
constraints.
To balance the workload to activities
DEPARTMENT OF ENGINEERING
Head of Department: Mrs. Mary A. Mushi
Introduction
The Department is located at the bottom floor of the main building. It operates under eight sections
namely:
*
Bio Medical Equipment
*
Electrical
*
Carpentry
*
Building-Manson
*
Fitter Mechanics
84
*
Motor vehicle mechanics
*
Plumbing
*
Cooling System & Refrigeration
Staffing
»
The department Operated with 30 staffs with different qualifications.
»
Bio Medical Engineer/ Technicians- 2
»
Mechanical Enginee-1
»
Electrical Technicians-5
»
Electronic Technician-1
»
Instruments Technicians-4
»
Artist/Decorator-1
»
Plumbers-5
»
Refrigeration/AC-1
»
Carpenters-3
»
Fitter Mechanics-2
»
Mason-1
»
Motor Vehicle Mechanics-2
»
Boiler operators-3
»
Incinerator operators-2
»
Toilering-1
»
Office attendant-1
Activities
We normally work on repair and maintenance of all medical equipment, Plants, Generators and
Motor Vehicles. Department managed to service all medical equipment, Autoclaving Machine,
Laundry machines, kitchen equipment, lighting system, plumbing system, Carpentry and other
break down happened in our centre which were within our ability.
Water supply
For the all period of year 2014 we had no problem with our water pumps, but we faced a problem
on the main water pipe line which was leaking and we manage to rectify the problem. But the
water consumption is too high due to new buildings expansion. We have already consulted a
surveyor from Pangani water basin-Moshi and we are finding a Quotation for new water bore
hole. We advise the management to set aside money for a new bore hole to conquer these new
buildings.
Electricity
The Tanzania Electricity Company (TANESCO) continues to provide power supply to our centre
85
for the whole year.
The Electricity is not yet stable. We are still facing a serious problem of power cut and power
fluctuations, Correspondences have been made with TANESCO but no any improvement though
we have a new power station for KCMC. We have a transformer of 800KVA which supplies
electricity in our main building and few new buildings (i.e. KCRI, ORU, NEW EYE OT and
KCCO). We advise the management to set aside money for a new Transformer to all new buildings.
But there is ongoing project of installing a solar system to reduce the electricity bill.
Generators
We have three generators of which one is 800kva and two small one of 42kva and 32kva.
When there is Black out (power cut) our hospital generators supply electricity only areas which
have been identified as essential ones. We had a breakdown of our big generator. A stator motor
burnt on November 2014. We advise the management for the near future to buy a bigger generator
to cover the new buildings.
Steam production.
We continue to produce the steam for central sterile supply and Main Pharmacy with our
Boilers.
This boilers are under-utilized it is only used in Pharmacy and Central Sterile Supply Department.
The hospital is making an effort to have self-steam generated Autoclaves so as to have a backup.
Laundry machines
The year 2014 hospital run with three Washing machine, one Drier and Roller (Ironer). All these
have been maintained by Hospital Engineering Department.
Kitchen
The only three pressure cooking pots are working but the spare parts like heating elements they
should be stored in the main store. The kitchen needs major repair which will involve replacement
of kitchen equipment and terrazzo floor.
Radiology
The Ministry of Health and social Welfaresign a contract withTanzania Philips Medical Systems
to Maintain and repair our Radiology/ X- ray equipment. The hospital has made an effort to buy
a new CT scan.
Lighting system
We managed to replace bulbs and tube lights as required in the deferent Departments, Units and
compound Houses.
Main theatre lighting system
The theatre rooms needs completely replacement of ceiling fluorescent fittings with diffuser, two
86
pin round earthed sockets and other renovations like plumbing system, carpentry and Manson
works.
Pharmacy
We manage to repair pharmacy autoclave. This pharmacy Autoclave which is used for Infusion
is too old. It was installed since 1971 and lots of spare parts are not available therefore we are
working for new Infusion Autoclaving machine which will be self-steam generated.
Collaboration outside
Since the year 2007 during the summer period we receive students from overseas under Engineering
World Health which are Bio-Medical Engineers for practical training.
“We thank Almighty God for that achievement and may he continue blessing us so that we can
serve better the needy ones.”
HOUSE-KEEPING UNIT
Head of unit: Mr. Jerome N. Mgeni
Introduction
Housekeeping Unit deals with cleaning the hospital inside and outside the hospital premises. It
further deals with activities such as planting grass, shading trees and flowers etc.
Staffs
During the year 2014. Housekeeping unit served by 33 members of staff. Their distribution
according to areas of duties is as follows:
A. Inside main building -
13
B. Outside main building - 6
C. Hostels and schools
-
14
Challenges
*
We have shortage of staff to cover the huge hospital area.
*
The grass cutting machine is old which needs replacement
Future plan
*
To plant more trees around hospital premises.
*
To increase number of gardens within the hospital by planting flowers.
87
Acknowledgement
We would like to thank the hospital management for the continued daily support.
INFORMATION COMMUNICATION TECHNOLOGY (ICT) DEPARTMENT
Head of department: Mr. Hans T. Yambazi
Introduction
The department of ICT is located at KCMC main building ground floor. The overall responsibility
of the department is to plan, procurement, coordinate and implementing all ICT function and to
work as implementers of ICT activities assigned by KCMC management.
The department is made of the following units with their objectives
1. ICT user training Coordination:
Responsible for organization of day to day training activities, e.g. class teaching of KCMC staffs
as well as other students from all over KCMC and outsiders In the year 2014 about 180 student
have been trained.
2. Website Designing/Updating:
Responsible for website development and maintenance, in the year 2014 the department manage
to issue that the website is available in the web 24/7 and update most of materials in the web
3. Managing emails:
The department is responsible for registration and maintenance of mail server at KCMC and in the
year 2014 department issue that all users are getting smooth communication in and out of KCMC
higher level of security the mail server is now having about 250 users.
4. Coordinating the Implementation of Computerization of ICT function at KCMC
In the year 2014 the department manage to review process of computerization at Medical records
using tailored made software (imedics) in collaboration with local company in Arusha so the
implementation have now in progress at Medical record department as phase one. Then, phase 2
will be the implementation at Lab, Radiology and Pediatric ward.
5. Maintenance of computers and its accessories:
The responsible of ICT department is to keep all computers in a good working condition by
providing preventive maintenance quarterly and in daily bases if need arise.
6. User support for ICT clients:
As part of daily routine the department is dedicated to provide user support online and in physical
88
so in the year 2014 we gave service to more than 2000 users around KCMC. Our clients are
Medical Doctors, Technicians, Accounts clerks, administrators as well as students at KCMC and
allied health science schools
7. Internet Services:
The department is responsible for the internet services at the hospital it has to issue that the internet
is working and all security options are maintained to avoid unauthorized users and hackers, the
department is also responsible to issue that all website are filtered to those usefully sites to restrict
usage of strange sites
Staffing
During the year, the department has a total of 7 members of staff as follows:
•
Head of department: 1
•
Network Administrator:
1
•
Computer Technician
2
•
Database administrator
1
•
Computer trainer 1
•
Data clerks 1
Challenges
The department is facing the following challenges:
•
Lack of funds to finance ICT project
•
Rapid change of Technology which affect both hardware and software
•
The cost of ICT and its technology
•
Lack of adequate ICT infrastructure e.g. LAN, power backup etc.
•
Lack of Human capacity to fill the post of fully functional ICT department
•
Practical unforeseen events which occurs during implementation of computer software in the hospital environment.
•
Silence sabotage from the users. During installation we observe most of users fears to
lose their job when computerization process successes so it slow down all process
•
Change of working attitude is a challenge for the whole organization from top to bottom.
Goals and Objectives of the department for 2015
1.
To issue that the implementation of imedics is completed in the following departments:
a.
Medical records
b.
Laboratory
c.
Radiology
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d.
Accounts (Cash collection area)
e.
Pediatric ward
f.
OG ward
2.
To issue that the department is sustainable and maintain all its functions in relation to overall objective of rendering good service to the patient
3.
To use ICT and its technology to improve patient care.
LAUNDRY UNIT
Head of Unit: Ms. Asinath Minja
Introduction
During the year 2014, the unit was using only two washing machines and two flat presses which
are always overworked as we don’t have spare units to allow minor maintenance.
Staffing
The unit is operated by 11 staff.
Constraints/Limitations
In this year we experienced a regular shortage of Electricity supply in this unit causing delay in
our work.
Requirements
We have very essential needs of the following to meet our target:
•
Two washing and spinning machines
•
Two Flat pressing machines
•
One drying machine
•
Three Staff
•
Enough laundry machines spares in stock to avoid delay in ordering process.
•
We request 3 heavy duty trolleys with Custer wheels in the drying yard outside.
90
LEGAL DEPARTMENT
Head of Department: Adv. Rachel Mboya
Introduction
Legal department continued to provide its services in ensuring that proper procedure are followed
before performing or making any decision. Hence to make sure that any decision is reached with
fair and sufficient reasons.
Staffing
The department is operated with 2 legal officers in collaboration with the outsourced Legal
Advisor.
Aim
To adhere with proper laws and regulations that gives guidance to our day to day activities. In
fulfilling that our responsibility is to enlighten staff whenever they are in need of clarification of
any procedure.
Apart from that we give assistance to the managements in interpretation of any laws that the
hospital is bound to fulfil.
Challenges
1.
A quite number of staff are not fully aware of the working performance procedure.
2.
Some of decisions are made without seeking for legal opinion.
3.
In often occasions decisions are implemented otherwise to affect the expected results.
4.
Delaying of issuance of accessories and equipments.
Workshop/Seminar
A vote of thanks to the management for giving our department opportunity to attend various
workshop/Seminars that’s equipping us with the current knowledge of laws.
Achievements
Despite the aforementioned challenges, department managed to reach some of its goals and
peacefully provided services to the hospital according to the raised need.
Future plans
To assist management in fulfilling the need of reaching goals of performing basic employments
standards and reduce disputes in working place.
91
PROCUREMENT MANAGEMENT UNIT
Head of Unit: James S. Mosha
Introduction
The procurement division is staffed with procurement professionals together with the necessary
supporting and administrative staff. Currently there are18procurement staff with good qualifications
and experience in Stores and Supply chain management.
Activities
To provide expertise and services in procurement, storage and supply of goods and services for the
Commission. The activities of the Unit are:-
■
Advise the Management on matters pertaining to the procurement of goods and services and logistics management in the Commission;
■
Manage all procurement and disposal by tender activities of the procuring entity except adjudication and the award of contract;
■
Support the functioning of the Tender Board;
■
Implement the decisions of the Tender Board;
■
Act as a secretariat to the Tender Board;
■
Plan the procurement and disposal by tender all activities of the procuring entity;
■
Recommend procurement and disposal by tender procedures;
■
Check and prepare statements of requirements;
■
Prepare tendering documents;
■
Prepare advertisements of tender opportunities;
■
Prepare contract documents;
■
Issue approved contract documents;
■
Maintain and archive procurement documents;
■
Maintain a list or register of all contracts awarded;
■
Prepare monthly reports for the Tender Board;
■
Co-ordinate the procurement and disposal activities of all the departments of the
procuring entity; and
■
Prepare other reports as may be required from time to time.
■
Procure, maintain and manage supplies, materials and services to support the logistical requirements of the Office;
■
Maintain and monitor distribution of office supplies and materials.
■
Maintain and update inventory of goods, supplies and materials;
92
Objectives
The main objectives of PMU department is to ensure availability of goods and services at the right
quantity, right time, right quality and at the reasonable price
Challenges
1.
Most of the medical supplies are not available in the medical Store Department (MSD) especially laboratory reagents, suture and dental supplier. This leads us to procure them from other source at higher cost.
2.
Use of manual method in data processing and record keeping instead of automated (computerized) system. The software would help us accomplish our task accurately and timely as well as assurance of security of information to authorized people.
3.
Delaying payment of supplier which result partial delivery of items, and Suppliers
delaying delivery of goods and services.
Future plans
■
We encourage PMU staff to attend number of short courses tailored to upgrade
professional knowledge and skills in various aspects and disciplines. These courses are conducted by (PSPTB) Procurement and Supplies and Technicians Board at different places in this Country. We therefore request for permission and financial support to
attend these workshops/seminars
■
Also we request permit ion and financial support to attend these workshops/seminars
Acknowledgement
We would like to express our sincere appreciation to Executive Director, Tender Board Member,
Directorate of Finance Inspection committee and User department for their support in purchasing
of Medicine, medical supplies and equipment at different suppliers.
DEPARTMENT OF SOCIAL WELFARE
Reported by: Ms. Christina Haule
Introduction
Social welfare is a speciality by which individual will mitigate his problems under social
organization .The unit is actively involved in patients care programmes and maintaining welfare
for all including the poor and the vulnerable. Identify various social problems affecting the medical
team, patients, relatives and the public and give the appropriate advice.
Philosophy of social welfare
All patients have the right to get medical services and care regardless of their race, colour, and
93
political affiliation religious or economic status. Polite language to patients, staff and other
colleagues is the first healing tool.
Vision
The unit is the centreof excellence in providing guidance and counselling and problem solving
approach, thus establishingpleasant therapeutic environment to clients depending to their needs.
Staffing
As from January 2014 to November 2014, the unit had 3 full –time employees, one office attendant
and 2 social welfare officers. Currently, the unit has 2 full – time staff, 1 office attendant and 1
social Welfare Officer. In November 2014, 1 social welfare officer retired and her vacancy has not
as yet being filled.
Activities
The primary function is to provide and maintain good standards to patients, students, foreign
visitors and community at large.
To interview patients with social problems and identify factors which might lead to patients
illness.
•
To screen vulnerable patients who are in capable to access Medicare.
•
To conduct counselling to patients according to their needs.
•
To conduct home visiting to spinal cord injury and other disabled patients, the Unit managed to visit six (6) homes for spinal cord injury patients before discharge in collaboration with Physiotherapist and Occupational therapist.
•
To trace homes/families of abandoned patients especially children and elderly, thereafter if failed plan to take them to respective places like orphanage centre or destitute homes.
•
To coordinate issues of unclaimed dead bodies who have stayed more than 14days in the mortuary by liaising with the police and Municipal Council.
•
To undertake the responsibility of Staff welfare by processing condolence contribution to staff whenever death occurs.
•
To Collaborate with Police on issues concerned to unknown and abandoned patients.
Burial at Moshi cemetery
To prepare and arrange burials for unclaimed dead bodies left at KCMC morgue. A total number
11 of unclaimed dead bodies buried.
18 Abandoned patients
Assist abandoned patients, trace their homes or relatives and if not found, arrange for accommodation
at destitute camp or orphanage centre.
14Abandoned babies
We managed to take14 babies to the orphanage centres like Kalali and upendo children’s home.
94
Summary of exempted patients from January - December 2014
Month
January
February
March
April
May
June
July
August
September
October
November
December
Total
No of patients
Total bill
17
3,711,500.00
13
2,127,700.00
19
3,682,170.00
31
10,355,300.00
31
9,684,510.00
38
14,746,320.00
37
17,834,835.00
34
15,754,360.00
26
14,702,850.00
29
11,773,150.00
22
9,205,850.00
24
17,304,855.00
321
130,883,400.00
Amount paid
403,000.00
900,000.00
3,448,000.00
2,423,000.00
2,764,800.00
6,205,650.00
3,220,000.00
4,687,600.00
2,417,000.00
794,000.00
7,491,000.00
34,754,050.00
Amount exempted
3,711,500.00
1,724,700.00
2,782,170.00
6,907,300.00
7,261,510.00
11,981,520.00
11,629,185.00
12,534,360.00
10,015,250.00
9,356,150.00
8,411,850.00
9,813,855.00
96,129,350.00
Summary of patient granted bond from January to December 2014
Month
January
February
March
April
May
June
July
August
September
October
November
December
Total
No of patients
21
7
16
11
4
8
9
10
12
11
12
20
144
Total bill
6,739,150.00
1,376,700.00
3,979,830.00
2,749,900.00
1,465,520.00
2,518,780.00
4,728,840.00
4,361,400.00
15,083,970.00
8,773,800.00
7,479,100.00
10,868,400.00
70,125,390.00
Amount paid
2,871,000.00
661,000.00
1,927,150.00
1,404,900.00
825,000.00
1,490,000.00
3,305,900.00
2,520,000.00
5,590.000.00
4,519,000.00
3,718,000.00
5,521,000.00
28,762,950.00
Deficit
3,868,150.00
751,700.00
2,052,680.00
1,345,000.00
640,520.00
1,028,780.00
1,422,940.00
1,841,400.00
9,493,970.00
4,254,800.00
3,761,100
5,347,400.00
41,362,440.00
Summary of abscondee from January to December 2014
Month
January
February
March
April
May
June
July
No of patients
8
2
7
10
13
19
Total bill
1,476,670.00
415,900.00
815,150.00
1,612,800.00
2,853,180.00
5,142,830.00
Amount paid
50,000.00
60,000.00
21,500.00
71,000.00
115,000.00
95
Deficit
1,426,670.00
355,900.00
793,650.00
1,612,800.00
2,782,180.00
5,027,830.00
August
September
October
November
December
Total
30
25
30
26
29
199
7,639,670.00
9,244,920.00
10,698,750.00
5,678,520.00
8,498,930.00
54,077,320.00
100,000.00
50,000.00
467,500.00
7,639,670.00
9,144,920.00
10,698,750.00
5,628,520.00
8,498,930.00
53,609,820.00
Achievements
Despite the critical shortage of staff and poor working environment, the unit has manage to achieve
the following
»
Continuing tracing home/families of abandoned patient.
»
Continuing tracing abscondee patients.
»
Conduct counselling to patients according to their needs.
»
Decrease the number of out- patients who come to seek for assistance.
»
Educating patients on the importance of paying their hospital bills.
Challenges
»
Inadequate number of staff.
»
Limited transport/Fund for conducting home visit.
»
Lack of an appropriate room for conducting counselling.
»
Lack of Annual unit Budget.
»
Lack of means of communication i.e. mobile phone
»
Lack of privacy, due to the fact that the office is also used by photographer.
»
Lack of adequate information about hospital issues/decisions made in the various
Machinery system of the hospital.
Future plans
»
To have a home visit schedule which will fit with the departments of OT&PT.
»
To recruit more social welfare officers.
»
To establish poor and underprivileged patient’s Fund.
»
To have a representation in the Hospital Management Team Meeting.
»
To have our own car for conducting Home – visit by liaising with other departments who we collaborate with
96
SECURITY UNITY
Head of Unit: Mr. Benson I. Ulomi
Introduction
During the year 2014, the unit had a total of 64 security guards working in 33 different stations.
The staff have been operating day and night to maintain high security level around/within hospital
and its surrounded compounds.
Achievement
The unit has been able to maintain security and safety within the hospital, hostels and GSF
residences.
Constraints
•
Lack of equipments such as uniform, military boots, gumboot and rain coats.
•
No security camera for high level safety maintenance.
•
Lack of radio-calls for proper communications between guards.
•
Shortage of security guards
TELEPHONE UNIT
Head of Unit: Ms. Dorothy Malisa
Introduction
During the year 2014, Telephone Unit operated with six (6) members of staff. One member of
staff is allocated at IDC Clinic and the rest at the main switchboard.
Activities
Currently, telephone extensionsat Compound residence, Reproductive health unit, Lengai hostel
and International Collaboration offices are not working. We need to install telephone services
in the newly launched buildings (orthopaedic Rehabilitation Unit) and Dermatology ward for
smooth communications around the hospital. Lastly, the unit needs a computer for official uses.
97
SCHOOLS
98
ASSISTANT MEDICAL OFFICERS -GENERAL SCHOOL
Principal: Dr. Levina J. Msuya
Introduction
Assistant Medical Officers are frequently used interchangeably with graduate medical officers.
Because of longtraining and inadequate output of general Medical Officers, there is a need to have
anintermediate, better trained cadre between Clinical Officer (CO) and graduate MedicalOfficers
that is the AMOswho will be able to independently fulfill crucial functions in the delivery of
health care in the urban, suburban and particularly on the rural areas.
Justification for training Assistant Medical Officers
This is based on the following facts:
1.
bridge the gap
2.
There is Urbanization of graduate doctors despite the fact that 80 - 90% of the population live in the rural areas. This calls for training of AMO to provide Health services to the
rural population.
3.
The Doctor population ratio is still high (1: 25,000) hence the need to train AMO to
Increasing need of Primary Health Care Service and Health Sector Reforms
requires highly trained Allied health personnel.
The Assistant Medical Officers School KCMC started in 1977with 40 students who were
undergoing a one year course. After the first group the course was changed to two academic years
on main subjects: Obstetrics and Gynecology, Internal Medicine, General surgery, Community
Health and Pediatrics and Child Health.
The school is 37 years old and 985 students have graduated and most of the graduants are rendering
services within Tanzania and outside the country.
Students completed first year of their studies 28 of which 12 Female and 16 Males completed
successful. There was transfer of 1 student Florian Fidelis from AMO School Mbeya. 5 students
were expelled from school due to forgery of certificates.
Currently the school have 29 students, 12 females and 17 males.
Teaching and learning activities
There are two academic years.
First academic year:
First year students start with introduction to clinical medicine for 8 weeks. The following 8
weeks students starts junior rotation at the major clinical areas namely: Pediatrics’ and Child
99
Health, Internal Medicine, General surgery and Obstetrics and Gynecology. The students achieve
competence skills learning through clerkship, bedside teaching, performing procedure and
assisting/performing operations.
Second academic year:
Students rotates in other specialized departments that is Urology, ENT, Pathology, Ophthalmology,
Radiology, Anesthesia for orientation of common conditions encountered in sub Saharan Africa.
Community medicine:
The aim of community medicine course is to enable the Assistant Medical Officer to manageboth
effectively and efficiently the Primary Health Care programs. This is achieved by lectures, field
work and research project from each student.
Before final qualifying examination the students do senior clinical rotations in major departments
8 weeks each.
The course is conducted on adult learning/teaching methods. The following are themain teaching/
learning methods:
Group discussions, lectures, seminars, demonstrations, bedside teaching, tutorials, case
presentations, field visits and work, individual assignments, night duty and ward calls to practice
skills supervised by tutors.
Staffing:
The school had 6 teaching staff:
Principal – Dr Levina J. Msuya
Assistant Principal – Dr Rogers Temu
Academic Master – Dr JumaAdinani
Office Attendant – Debora Lyatuu
Permanent tutors:
Dr GisselaNyakunga, Dr RemigiusRugakingira, Dr NyobasiGesase are currently persuing master
degree training at KCMUCo of TumainiMakumira.
Part time tutors are from Pediatrics and Child Health, Obstetrics and gynecology, General Surgery,
Orthopaedics, ENT, radiology, anesthesiology, Dermatology, Ophthalmology, Pathology and
Internal Medicine.
Achievements:
Dr AdinaniJuma completed his MSc. Epidemiology and Biostatistics at KCMUCo and graduated
at November 2014.
100
Constraints
•
The school has no lecture room.
•
80% of academic staff are on part-time basis.
•
There are no supporting staffs like warden, secretary and hostel attendant.
•
There is no school transport, currently using shared Allied Health Schools car and hired buses from other institutions.
•
Heavy workload due to lack of permanent staffs.
The way forward:
•
To liaise with MOHSW regarding purchase of a vehicle for the school.
•
An improved infrastructure for the school is needed and this has to be discussed with
GSF and MOHSW
•
Permanent academic and non-academic staffs to be employed at the school.
Collaborations
•
The school has collaboration with Canadian Network for International surgery who sponsored students for
*
Essential Surgical Skills.
*
ALAM – Emergency Obstetrics conditions
*
SOO – Structure Operative Obstetrics
SCHOOL OF ANAESTHESIA
Principal: Dr. Simon Kavavila
Introduction
The School and The Department of Anaesthesilogy have integrated activities which have common
goal towards teaching and provision of safe Anaesthetic Services to the patients.
Historical background
The School of Anaesthesia has a characteristic pattern showing chronological stages of professional
developments.
Nurse Anaesthetist Training Program
In 1973 KCMC started Un Official short Course of Anaesthesia to the nurses (3-6 Months) later
on, in 1985 the course was extended to One Year (hence One Year Course for Students Nurse
Anaesthetist)
101
Anaesthetic Officer Training Program (A.O.)
Training Anaesthetic Officer started in1984 following the Lusaka meeting of Health Ministers of
East and Central African Countries, 1983.
AMO Anaesthetist Training Program
In 1997 the Ministry of Health directed that Assistant Medical Officer should be registered for
Anaesthetic Officer Course instead of Medical Assistant for the title of AMO Anaesthetist which
was implemented in 1998. (The first batch started)
M-Med Anaesthesiology Program
This programme has started in 2001 under the TumainiUniversity.
Professional cadres
The school trains the following cadres:
1.
Masters of Medicine Anaesthesiology affiliated to Tumaini University.
2.
Assistant Medical Officer Anaesthetists for Advanced Diploma in Clinical sciences.
3.
Nurse Anaesthetist for a certificate level.
Staffing
There are 2 permanent teachers one attached from KCMC and one secretary.
Part-time teaching staff
SN
1
2
3
4
5
6
Cadre
Anaesthesiologists
Resident
Registrar
AMO Anaesthetists
Nurse Anaesthetist BSc. Nursing
Nurse Anaesthetist Diploma
Total
No. of Staff
2
1
1
3
3
12
22
Statistics AMO Anaesthetistand M.Med Anaesthetist
Cadre
AMO Anesthetist
MmedAnesthetist
Grand Total
1st Year
M
3
1
4
2nd Year
F
-
M
5
5
102
F
-
Grand Total
M
F
8
1
9
Nurse anesthetist – One year course
Year
May 2013 To April 2014
August 2013 To April
2014
Intake May 2013
M
F
Total
9
5
14
Intake August 2013
M
F
Total
16
15
31
Qualified in 2014
14 candidates sat for exam, all passed the
exam.
Qualified in 2014
31 andidates sat for exam, all passed the
examination
Clinical training activities
Students and Tutors participate actively in all clinical activities of the Department as indicated in
the table.
Monday to Friday
Time
Activities
1.
7.00 am - 8.00 am
2.
8.30 am – 2.00 pm
3.
3.00 pm – 4.00 pm
Receiving Night Report and Capsule
Presentation
Clinical Teaching in Operating Rooms and
Intensive Care Units
Didactic Teaching in Anaesthesia class or
Anaesthesia Hostel
4.
4. 30 pm – 6 .30 am
5.
6.30 pm On wards
Weekend / Holidays
Pre Operative Patient review in the wards
Students on call will report in the Operating
Theatre ready for any possible Emergency
Operations.
Two students are allocated One for day time
and the Other for night duty ready for
emergency operations
Presenter
Staff
Student
Facilitator
Student
Students
Hand on patients
Staff
Mentoring
Staff
Mentoring
Staff
Mentoring
Student
Facilitator
Students
Hand on patients
Staff
Mentoring
Scientific Discussion and Journal Club presented by students on Thursdays and Fridays evening
respectively. Presentation is facilitated by the staff.
MD 3 and MD 4 and AMO general who rotated in the Department attended for theoretical sessions
in the class and hand on patient skills in operating theatres
Didactic teaching
The School experienced critical staff shortage the teaching was mainly supported by the staff from
the Department of Anaesthesia and visiting volunteers from USA under the American Overseas
Training Programme (AOTP) and United Kingdom (UK).
Visitors
S/N
1
2
NAME
Prof Charles Gomerall
Dr Van Richard
COUNTRY
UK
UK
103
Constraints
»
Shortage of teaching and supporting staff for the school.
»
The Principal of the school and Academic Officer have retired and are working on
contract granted by Good Samaritan Foundation.
»
Few AMO generalto join for the AMO Anaesthesia Course
»
No Continuing Medical Education (CME)
Way forward
»
Suggestions to advise the Ministry of Health and Social Welfare to employ full time
tutors and plan for the CME to exchange medical experience with other colleagues
»
The school has strategic plan to visit Assistant Medical Officer Training School with the aim of sensitizing the AMO general to join the school
»
To encourage Doctors (MDs) to apply for M-Med in Anaesthesiology.
»
Suggestions to advise the Ministry of Health and Social Welfare to have full sponsorship for the students who are willing to join AMO Anaesthesia school.
SCHOOL OF NURING
Principle: Mr. John Y. Sumaye
Introduction
KCMC School of Nursing was established in March 1971to train Pre-service nursing students.
The school is located within the premises Kilimanjaro Christian Medical Centre. The school is
registered by the National Accreditation Council for Technical Education (NACTE). It received
full accreditation status in 2006.
The school layout includes; offices for staff, two furnished ICT rooms one for tutors and the other
one for students, common room for staff, furnished library with computers, skills laboratory, three
stores, two classrooms and one hostel for all students.
During the year 2014, teaching and learning activities were conducted by twelve full time tutors.
One of them is newly employed by the Ministry of Health and Social Welfare. The acting Principal
of the School retired in December 2014. One of the teaching staff went for further studies at
UDOM, Dodoma. The school also has two full time support staff.
104
Staffing and Students Situation
Table 1: Number of staff in the year 2014
Category
Nurse Tutors (Full time)
Supporting staff
Total
Number
12
2
14
Table 2: Number of students (ordinary diploma) in 2014
Level of Training
NTA LEVEL 4
NTA LEVEL 5
NTA LEVEL 6
Total
Number
Male
15
14
29
Female
23
25
46
94
Total
38
39
46
123
Table 3: Number of students (certificate) in 2014
Level of Training
NTA LEVEL 4
Total
Number
Male
5
5
Female
11
11
Total
16
16
Table 4: Number of students (eLearning up-grading) in 2014
Level of Training
First year
Second year
Total
Number
Male
11
11
Female
4
9
13
Total
4
20
24
Goals
1.
To organize school learning activities in all settings
2.
To increase the number of new students for eLearning program which was designed by
the MoHSW in collaboration with AMREF to upgrade Enrolled Nurses to Registered Nurses
3.
To enroll students for certificate program
Teaching and Learning Activities
Teaching and learning both in class and practicum sites were implemented in two semesters as
105
follows:
•
NTA level 4 had 24 weeks each for semester one and two
•
NTA level 5 and 6 had twenty two weeks each for semester one and two
•
Competence skills learning implemented were supervised by clinical mentors in each department.
•
Clinical practice areas were KCMC Consultant Hospital, Mawenzi Referral Hospital and Majengo Health Centre.
•
Community health nursing field practice was conducted at Kibosho Village by NTA
Level 5 students in semester from February to March.
•
Students for eLearning upgrading program were supervised by tutors and preceptors as planned.
Achievements
•
A total of 60 NTA Level 6 students sat for final Nursing and Midwifery examinations
in August 2014. Out of them, 57 passed the examinations and 3 will sit for
supplementary examination in March 2015.
Three (4) tutors successfully completed their professional studies in the followingareas; Bachelor of Science in Midwifery at MUHAS, Bachelor of Science in Nursing at
KCMUCo, Bachelor of Science in Nursing Education at CUHAS and Master of Science in Nursing Education at KeMU in Kenya.
•
One (1) tutor joined UDOM for Masters of Science in Mental Health Nursing in October 2014
•
Enrollment of 20 students for eLearning upgrading program for Enrolled Nurses to Registered Nurse
•
Enrollment of 16 students for certificate program
•
Successful collaboration with different stakeholders from within and outside the country
Constraints
•
The school has no vehicle to meet the needs of transport for students and staff
•
Warden is retired, therefore, someone is needed to cover that position
•
Lack of hostel attendant, librarian and skills laboratory attendant
•
Inadequate number of classrooms
•
Students hostel is in debilitating state, it need refurbishment
Collaboration
Apart from the practicum sites, the school also collaborated well with;
•
Nursing Schools in northern zone
•
Tanzania Nursing Scholarship Program from USA who sponsor some of our female 106
students from poor families by paying their school fees and pocket money
•
Sannarpsgymnasiet in Sweden
•
Bergen University in Norway
Visitors
The School received many visitors both from within and outside the country in the year 2014.
The following are few among many visitors;
1.
Dr.Otilia F. Gowelle, Director of Human Resource from MoHSW (other officials from MoHSW also visited the School in different periods)
2.
DavidaNgilangwa together with other fourteen members from AMREF Health Africa,
Dar es Salam
3.
Oliver Karabwa from Lugalo NTC and Clement Subeti from Mvumi NTC - assessors
for final Nursing and Midwifery Examinations
4.
Sr. Maria Asenga from Morogoro for eLearning entrance examination
5.
Anthony van Werkhooven from USA for TNSP
6.
Ronny Mellgren together with other 10 members from Sannapsgymnasiet, Halmstad in Sweden for the exchange program
7.
Dink C. Christensen together with other 19 members from the University of
Copenhagen, Denmark
Acknowledgement
We earnestly recognize the following stakeholders for their outstanding contributions:
•
Ministry of Health & Social Welfare for continued support to the school
•
The Executive Director for continued technical support and encouragement
•
The Tanzania Nursing Scholarship Program from USA for providing financial support to some female students
•
KCMC Consultant Hospital, Mawenzi Referral Hospital and Majengo Health Centre for supporting practical learning experience of students
•
School of Advanced Paediatrics & Ophthalmic Nursing for working with us as one team
SCHOOL OF OCCUPATIONAL THERAPY
Program coordinator: Ms. Sarah Mkenda
Introduction
The Diploma course in Occupational Therapy which is the only one in Tanzania has been there for
15 years now. This programme runs under the umbrella of KCM College of Tumaini University
Makumira and the Ministry of Health and Social Welfare.
107
Overall aim
It aims at qualifying Occupational Therapists who will appreciate the social, psychological
and physiological effects of disability by providing the intervention based on sound theoretical
principles and models of the profession. Graduates will be competent communicators and
motivators for continual profession development in Tanzania.
Vision
The overall vision is for the school of Occupational Therapy at KCMC, Tumaini University is, to
train Occupational Therapists for Tanzania and the surrounding countries in Africa e.g. Malawi,
Zambia and Europe (e.g. Germany).
Mission
»
To train competent occupational therapist for Tanzania and other African countries, as is required.
»
To provide a training course that is appropriate to the needs of the local population.
»
To empower locally trained staff to run and administer the OT school from the year 2009.
»
To ensure that adequate facilities are in place to execute the training of occupational Therapy students.
Staffing
The school has the following teaching staff:
1.
Mr. Dominique Mshanga – Academic Officer (away for further studies in South)
2.
Ms. Sarah Mkenda - Course coordinator, employed by MoHSW full time.
3.
Mr. Anthony Ephraim – employed by KCMU College full time.
4.
Mr. Simon Mallya - employed by GSF but currently on study leave, works in the school as part time.
5.
Glory Cuthbert – fully time tutor, employed by the MoHSW as well works part time in
the clinical department.
6.
Eraneus Josiah - fully time tutor, employed by the MoHSW as well works part time in
the clinical department.
Supporting staff
The school has no secretary neither office attendant at the moment. According to a strategic plan
was put in place in 2005 the school needs 7 full time and 5 part time occupational therapists
qualified in teaching for it to operate smoothly. There is a shortage of 3 full time tutors and 3 part
time tutors, secretary/ administrator and office attendant.
108
Statistics
The school has a capacity of taking 20 students each year although we have never reached that
number because of lack facilities and resources.Thestudentsenrolledin2014/2015 areonly4males.
Theintakefortheacademicyears2012/2013,2013/2014and2014/2015 is asfollows:1.
Year
2012/2013
2013/2014
2014/2015
Male
6
5
4
Female
6
0
0
Total
12
5
4
Achievements
*
The schools have managed to graduate a total number of 16 local students in the
academic year 2013/2014.
*
1 part time tutor is still on study leave doing Masters in OT in South Africa.
*
The MoHSW employed 2 full time tutors who have join the OT teaching team already.
*
The school has managed to maintain its collaboration with international school of
Munich – German who normally donates money to support the struggling students in paying their school fees through their yearly visit, Umea University in Sweden which is
2 way teaching exchange programme, Toronto University etc.
Constraints
*
Following the acknowledgement of the MoHSW as owner of the OT programme in September 2010, there has not been any financial support as promised.
*
Staff development is progressing very slowly and no support neither from the MoHSW, GSF nor KCMUCollege, people are taking their own initiatives and upon qualifying
there is no recognition.
*
Low enrollment of students due to high school fees rates, high entry criteria and poor awareness of this profession in the country
Wayforward
Ourlongtermplansforthisprogrammeare:
1. Developthepresentstafftoacquirequalificationstomeetthestatusofuniversityrequirements
astheyallhavebasicdiplomasexcept 2.
2. Recruitatleastfive(5)more full time tutors whoarealreadyinvolvedinteachingandsuper
visingourstudentsaspart-timetutors.
3. Expose the present and future academic staff in teaching methodology
4. Plans are in place to develop a BSc curriculum in Occupational Therapy.
5. The school is planning to have its own building by end 2015/2016 and fund raising strat
egies are place already. The land for building has been granted by Good Samaritan Foun
dation.
109
SCHOOL OF OPTOMETRY
Principal: Mr. Julius C. B. Kamugisha
Introduction
The school of optometry at KCMC started in 1979 by the Ministry of Health and Social Welfare
(MoHSW) with the assistance of the Swedish Organization for the Visual Handicapped (SHIA)
and run a three year training programme in optometry. The aim of the course was to train an
optometrist who will be able to manage refractive errors and refer pathological cases for further
management.
Staffing
The school is managed by 6 full-time tutors, 6 part-time tutors and two supporting staff.
Statistics
So far about 365 Tanzanian Optometrists and 20 Foreign Optometrists have graduated from the
school. About one third are working in Public Hospitals/Institutions and the rest are in NGO’s,
Private Institutions and outside the country.
Student Body
The school had a total of forty two students (40):- eleven (16) first year, fifteen (13) second year
and sixteen (11) third year students.
Field Work attachment
Clinical practice for third year students was conducted at different centres – Muhimbili National
Hospital (MNH) in Dar es Salaam, CCBRT in Dar-es-Salaam, Kibosho Hospital in Kilimanjaro,
Mombo Hospital in Tanga and Sekou Toure Hospital in Mwanza.
Academic/Consultancy activities
Despite taught course in class and clinical settings; the school in collaboration with the eye
department continued with various outreach programme for students to acquire various community
experience. All staff of the school were involved in MoHSW´s consultancy activities outside
KCMC.
Institutional/International Collaboration
The school continued to enjoy the collaboration from various Institutions. These included Synsam
of Sweden, Brien Holden Vision Institute, World Council of Optometry, International Association
of Contact Lens Educators (IACLE) and Tanzania Optometric Association (TOA).
110
Achievement
*
15 optometry candidates successfully completed their course of study and all have been employed in various health settings in the country.
*
The school is fully accredited by NACTE and is using a competency based curriculum.
*
The school completed the B.Sc. Curriculum preparation and submitted it to the college
for further action.
*
Two optometry staff Mr. Gaspar Mmari and Mr. Kanuti Siara joined the B.Sc
Programme at Mzuzu University Malawi.
Future Plans
*
The school together with KCMC-College are looking forward for the establishing a B.Sc Programme in Optometry.
*
Efforts are underway to get 2 more full time tutors/lectures to assist in teaching some of the modules in the CBET Curriculum.
*
To have more tutors with higher qualifications (M.Sc) or develop the current staff.
Challenges
*
Financial constraints
*
Limited training professional opportunities in the country for the graduates.
SCHOOL OF ADVANCED DIPLOMA PAEDIATRIC NURSING
Principal- Ms. Margareth S. Kimweri
Introduction
KCMC School of Advanced Paediatrics Nursing is the only government school which produces
Paediatrics nurses in Tanzania. The school was established in 1978 under the license of KCMC
School of nursing. In year 1994 the school got its own registration under which it operates up to
date. This is an in-service school where by the students are already employed by the government
and non-government organizations.
Currently the school has no students because the Government has issued directive for phasing
out Advanced Diploma Awards. Therefore In 2010, the MOHSW has started developing new
curriculum under requirement of NACTE (National Council for Technical Education). The
program will have two levels: NTA (National Technical Awards) Level 7 which is Higher diploma
and level 8 (Bachelor degree). The program will be Competence Based Education (CBET) and
before was Knowledge Based Education (KBET). The curriculum is read but the program not yet
started waiting MOHSW to finish administrative matters and to announce the course.
111
The school has two academic staff. We have also one office attendant shared by three schools:
school of nursing; ophthalmic nursing and Paediatrics nursing school.
Goals and activities
•
Because the school does not have students, we are working together with School of diploma in Nursing to make sure that the products produced is competent in knowledge, skills and attitude.
Constraints
•
Inadequate classrooms to hold large number of students.
•
Inadequate teaching staff with paediatric specialty.
Statistics:
KCMC School of Advanced Paediatric Nursing has produced a number of qualified paediatric
nurses since 1994 as shown in the table below:
Table 1: Students output
Year
1994-96
1996-98
1998-2000
2000-02
2002-04
2004-06
2006-08
2008-2010
2010-2012
TOTAL
Male
3
2
1
2
4
3
2
1
18
Female
9
10
13
11
13
12
13
19
15
115
Total
12
12
14
11
15
16
16
21
16
133
Collaboration
The school collaborates with the School of Nursing and Ophthalmic Nursing. We are sharing
classes, skills lab. At the moment we are teaching fully time at School of Nursing. We are also
sharing supporting staff.
At the moment we do not have any collaboration from outside the country.
112
SCHOOL OF PHYSIOTHERAPY
Principal: PT. Egfrid M. Mkoba
Introduction
During the year 2014 the school activities were conducted by seven (7) full-time and seven (7)
part-time profession tutors who were involved in carrying out academic activities. The school
also continued to benefit from other external tutors from other departments including Medical,
Surgical, Orthopaedics, Paediatrics, Nursing and Radiology.
Student Body:
The school had a total of forty seven (47) students – thirteen (13) first year; thirteen (13) second
year and twenty one (21) third year students.
Outreach activities.
Clinical education for third year students was conducted in four different centres –Muhimbili
National Hospital (MNH) in Dar Es Salaam; Mbeya Referral Hospital in Mbeya, Saint Francis
Hospital Ifakara and Teule in Muheza. During this period of time students had opportunity to gain
experience in various working environments.
Staff Development
One academic staff from the school completedMaster of Medical Science in Physiotherapy
(M.Med.Sci – Physiotherapy) of the University of Umeå in Sweden. Two staffs joined this sandwich
program in October 2014. Two (one full-time and another one part-time staffs) have successfully
completed the first year of their PhD studies on sandwich scheme in the same university. One
staff who joined Master program in Mzumbe University (MU) Morogoro for Master in Health
Systems Management is expecting to accomplish his course of education in June 2015 and return
to school.
Staff Movement
The school operated without a secretary following her retirement. Sole Office Attendant was
transferred to another department leaving the school without any, therefore, depending on interim
allocation from house-keeping department.One tutor was hired by the Ministry of health and
Social Welfare to join a monitoring and evaluation program for basic health services project. This
person will return to school towards the end of 2015.
Academic/consultancy activities
Despite taught courses in class and wards/clinical settings the school continued with various
outreach programme for students to acquire various community experience. The school continues
to remain an integral part in the development of the BSc. Physiotherapy programme of the KCMCollege. Four staffs of the school were involved in MoHSW’s consultancy activities outside
KCMC and two staffs are currently provide consultancy for the development of activities to realise
country’s “Persons with Disabilities Act.”
113
Institutional/International collaboration
The school continued to enjoy the collaboration from various parts of the world. Owing to the
fact that there has been frequent mingling of these activities between it and the department of
physiotherapy at KCMC it may be difficult to mention sole collaborations with the school. The school
continued to enjoy collaborations with the Swedish Church Mission and Umeå UniversitySweden.
Through these collaborations further education for all physiotherapists at KCMC continues to be
envisaged.
Achievements
A total of twenty two (22) physiotherapy candidates successfully completed their course of study
and all have been employed in various health settings in the country. Seven candidates were referred
to a six months supplementary period before they qualify. Through collaborations, the school in
collaboration with the department of physiotherapy successfully developed their all diploma staffs
to degree.
Further plans
The school in collaboration with KCMC and KCMU-College looks forward to re-establishing
collaboration with University of Bergen.
TRAINING CENTRE FOR HEALTH RECORDS TECHNOLOGY
Principal: Mr. Joseph A. Msami
Introduction
The Training Centre for Health Records Technology (TCHRT), which is the only one in the
country. It started in 1976 with the support from the Ministry of Health, KCMC administration and
the Church of Sweden. It continues to collaborate and receive support from the Church of Sweden
Mission (CSM) in terms of upgrading its academic staff
Aims
The overall aim of the Training Centre for Health Records Technology is to prepare health personnel
who are capable of managing and maintaining health records and information systems.
Staffing
There are 2 permanent teachers one attached from KCMC. Among the permanent teachers one
went for further training at Kenyata University Kenya.
Module of Training
Twenty four (24) students sat for final qualifying examination in August, 2014 for First Diploma
in Health Records Technology all students passed and awarded a Diploma in Health Records
114
Technology. The nineteen (19) students who sat for NTA level 5 examination fifteen (15)
students successful pass and continue to NTA level 6 Ordinary Diploma in Health Records and
Information Technology which four (4) of them failed Health Care Data Classification and they
are waiting to sit for the supplementary examination in February, 2015.
Theory
Modules are performed in Class as per curriculum; Lecture/ discussions, group discussions,
illustration, self-study, assignments, tutorial,project or research work.
Practical
Modules are performed in Medical Record Department KCMC, in the field attachment at Manyara,
Dares Salaam, Mwanza, Musoma, Tanga and Arusha regions within Tanzania mainland.
Activities
Supporting services
There are supporting services including Secretary and two Office Attendants attached from
KCMC.
Training
The school continued conducting short courses in collaboration withKCMCMedical Records
Department.
Students were exposed to the nearest Hospitals and Health Centre to practise their training
During the year the school conducted the training of ICD-10 staff working at Tabora, Dar es
Salaam, Tanga and Iringa hospitals
Consultation
The school received consultation from various Health Care deliveries in Tanzania and Health
training institutions.
Future plans
The school continue to implement the newly developed curriculum from Ministry and Social
Welfare.
Achievements
First bench of Diploma in Health Records and Information Technology graduated in August,
2014.
Clinical coding Refresher Training was done to our teaching staff from United Kingdom Expert.
115
Constraints/limitations/challenges
*
The school is facing shortage of academic teaching staff.
*
Computers and other teaching equipments are worn out requires replacement
*
The building in the school and hostel needs renovation especially at the roof because it
has never done since 1997.
*
The cadre has not yet recognized as a Health Care Provider, it is combined together with non-Medical cadre.
*
School depending much in part time teachers which used a lot of funds for payment.
Visitors
Various visitors were received from NACTE, MOH, NHIF, Treasure Moshi and from Government
non-Government organizations.
TANZANIA TRAINING CENTRE FOR ORTHOPAEDIC TECHNOLOGISTS
Principal: Mr. Harold G. Shangali
Introduction
During the year the school continued conducting the three years Diploma Course in Orthopaedic
Technology, Certificate course in Lower limb Orthotics/Prosthetics, Wheelchair Technology and
short courses in Basic and Intermediate Level in Wheelchair Technology respectively.
Diploma in Orthopaedic Technology (DOT)
First Year DOT:
A total number of nine (9) students were enrolled in the first year of study in October 2013.
Distribution in terms of gender were (3) females and (6) males.
Second year DOT
Total number of (10) candidates were enrolled into the second year of training with gender
distribution (1) female and (9) males.
Third Year DOT:
Total number of ten (10) Candidates were enrolled into the final year of study. Genderdistribution
(3) females and (6) males. All candidates successfully passed all subjects andrecommended for
award of Diploma in Orthopaedic Technology
Administration
The school main activities in respect to resource management, teaching, as well as staff training/
116
development were fairly accomplished. The 27th Advisory Committee Meeting was held on 13th
January 2014 in which different reports and recommendations were presented and discussed for
implementation
Staff Training and Development
Long-Term Courses
1.
at -University of Cape Town, South Africa in June 2014
2.
Mr. Aston Ndosireported to have completed his M. Phil Degree in DisabilityStudies
Mr. Joachim Moshyhas completed successfully Diploma course in Orthopaedic
Technology and has resumed back to support the academic teaching staff
3.
Mr. Aron Dilluhas postponed B.Sc Degree Course in Prosthetics and Orthotics atTumaini University due to illness.
4.
Mr.ExaudKasegezyacompleted third year B.sc Degree Course in Prostheticsand
Orthotics at Tumaini University. He is now in the final year of study.
5.
Mr. Baraka Moshi completed second year B.sc Degree Course in Prosthetics and
Orthotics at Tumaini University. He is now attending third year of study.
6.
Ms.ElianasoMalisawas accepted to joint first year Bsc. Degree course atTumaini
University in Prosthetics and Orthotics in October 2014.
7.
Mr.L.Mtalopostponed his Master’s programme to 2016
Short Courses and Seminars
The following staff members attended different courses/seminars during the year 2014 as indicated
below;
The school conducted short courses as follows: Basic and Intermediate Wheelchair Course in
Wheelchair Technology as from 4th August 2014 up to 15th August 2014 and 17th August 5th
September 2014 respectively.
Ms. Salome Sariaattended the following courses and meetings.
1.
Attended Alumni conference-Hospital Management for Health Professionals in Nairobi Kenya as from 24th March up to 28th March 2014
2.
Consultation in 5S-KAIZEN- TQM at Huruma, Machame and Hai hospitals as from
23rd April 2014 up to 25th April 2014.
3.
Consultation visit on 5S-KAIZEN-TQM at Muhimbili National Hospital as from 22nd September 2014 up to 26th September 2014.
4.
Facilitate 15th Progress Report on 5S-KAIZEN TQM in Dar es Salaam as from 21st October 2014 up to 26th September 2014.
5.
Mr. David Shirimaattended two weeks course on Ischial Containing Socket for Trans-
femoral prosthesis at CCBRT – Dar es Salaam as from 15th September to
117
26th September 2014
6.
Mr. Servas Shiyo attended ISPO Congress in Cape Town-South Arica where he
presented a paper on recycling of Plaster of Paris as from 25th September to
27th September 2014
7.
Mr. Harold Shangali attended ISPO Congress in Cape Town-South Africa as from 23rd September up to 29th September 2014.
8.
Ms. Jackline Mtei attended training on Quality Improvement (KAIZEN) in Dar esSalaam
as from 30th September up to 3rd October 2014
9.
Ms. Salome Saria, Mr. Rashid Simba and Mr. Davis Shirima conducted a Survey on Rehabilitation service care delivery in Health facilities in Tanzania in the following regions; Manyara, Arusha, Kilimanjaro, Tanga,Ruvuma, Dodoma, Mbeya, Unguja,
Dar es Salaam, Mwanza and Kigoma, as from 26th September to 9th October 2014.
Collaborators:
*
Orthopedics Rehabilitation Centers: The School continued utilizingProsthetist/
Orthotist in MuhimbiliOrthopedics Institute, Monduli Rehabilitation Centre, Regional Orthopedics
*
Workshop in Dodoma, Usa River Rehabilitation Centre, Comprehensive Community Based Rehabilitation Tanzania (CCBRT-DSM), Youth with Disability Community Programme (YDCP)-Tanga to supervise students during field work attachment rotations.
*
Sophie’s Minde-Norway: The exchange programme between North South and
SouthNorth has continued to prosper over the four years. The project will come to an end in October 2015.
*Mr.NanyaroEliupendo from Usa River Rehabilitation field work centre is onExchange Programme in Norway for one year i.e. from October 2014 up to October 2015. (North-
South Exchange Programme)
*
Ms. Lauren Jackline from Australia is on Exchange Programme at TATCOT for
periodof one year up to October 2015. (North-South Exchange Programme)
*
Cambodia School of Prosthetics and Orthotics (CSPO)
*
South -South exchange programme between TATCOT and CSPO has continued well as we come close to the end of the project by October 2015
*Mr. Prosper Kaaya from Orthopaedic W/C KCMC clinical services department is onthe fifth round of Exchange Programme in Cambodia for one year, i.e. from October 2014
up to October 2015 (South-South Exchange Programme)
118
*Ms.SrengSreyRath from Cambodia is on the fifth round of Exchange
Programmeat TATCOT as from October 2014 up to September 2015. (South-South ExchangeProgramme)
Visitors
During the year 2014 we were privileged to have among others a number of visitors, the purpose
of their visit was;
*
Attending meetings e.g. Advisory Board Meeting, Partnership meeting
*
Collaboration
*
Consultation of patients
*
Evaluation of programs which are run in the school
*
Invigilation and supervision of exams
*
Attending short courses conducted by the school e.g. Spinal Orthotics e-learning, Basic/
Intermediate Wheel Chair Training and Orthopaedic shoe wear course.
119
HOSPITAL STATISTICS
Admission and OPD attendance in 2014
Month
Admission
M
1058
F
January
1211
February
908
1060
March
1037 1253
April
912
1048
May
963
1055
June
911
1127
July
829
1030
August
858
1013
September 971
1115
October
916
1105
November 862
966
December 872
956
Total
10497 13839
GRAND
TOTAL
24336
Death
M
F
78
59
73
51
122 85
89
49
90
54
88
59
73
56
103 59
81
50
83
53
69
60
88
47
1037 682
1719
New
registration
M
F
1465
1329
1475
1283
1345
1338
1226
1343
1258
1436
1241
1280
16019
1627
1411
1530
1381
1444
1431
1289
1378
1449
1509
1243
1246
16938
32957
Return
attendance
M
F
4523
4107
4277
4106
4636
4495
4107
4277
4358
4473
3990
3888
51237
5774
5600
6021
5414
6031
5774
5234
5926
5820
6044
5569
4915
68122
119359
OPD Attendance
M
F
Total
5988
5436
5752
5389
5981
5833
5333
5620
5616
5909
5231
5168
67256
7401
7011
7551
6795
7475
7205
6523
7304
7269
7553
6812
6161
85060
13389
12447
13303
12184
13456
13038
11856
12924
12885
13462
12043
11329
152316
152316
Birth at the hospital in 2014 by months
Birth
Jan.
Febr.
March
Aprily
May
June
JULY
AUGUST
SEPTEMBER
OCTOBER
NOVEMBER
DECEMBER
TOTAL
Male
132
128
129
156
146
116
146
109
135
129
136
144
1606
Female
136
128
154
132
156
140
140
115
155
128
117
98
1599
120
Total
268
256
283
288
302
256
286
224
290
257
253
242
3205
Hospital Statistics - January - December 2014
Statistics
Total bed capacity
Total admissions
Total discharges live
Total deaths
Total number of patient days
1.Average daily in patient days
2.Average daily admissions
3.Average length of stay
4. Percentage of occupancy
5. Birth
Male
Female
11152
9343
1096
83012
227.4
30.6
8.0
49.8%
1607
12788
12043
736
81473
223.2
35.0
6.4
48.8%
1660
Total
543
23940
21386
1832
164485
450.6
65.6
7.1
98.6%
3267
Statistics
New regstrations
Return attendances
Total attendances
Average per day
Male
16019
51237
67256
184.3
Female
16938
68122
85060
233.0
Total
32957
119359
152316
417.3
Hospital statistics (January to December 2014) according to units - year 2014
BEDS
ADMISSIONS
DISCHARGES
DEATHS
NO.OF
PATIENTS
DAYS
AV.DAILY
IN-PTS
CENSUS
AV.DAILY
ADMISSION
AV.LEGHTH
OF STAY
%BED
OCCUPANCE
PAED -1
34
1336
1118
118
8804
24
4
7
71%
PAED -.2
34
565
642
33
7728
21
2
11
62
PAED -3
25
2018
1712
307
14641
40
6
7
160
MEDICAL -.1
38
2257
997
356
14485
40
6
11
104
MEDICAL -2
62
2302
2015
356
21185
58
6
9
94
MEDICAL-ICU
6
31
38
118
1853
5
0.1
1
85
SURG.- 1
37
3089
2711
151
20772
57
8
7
154
SURG.- 2
59
1415
1432
22
14361
39
4
10
67
SURG.- ICU-A
7
74
55
120
2088
6
0.2
12
82
UNITS
SURG.- ICU-B
7
53
80
76
1979
5
0.2
13
77
UROLOGY
42
1032
1024
16
8369
23
3
8
55
OB/GYN.- 1
59
4170
4149
6
18762
51
11
5
87
OB/GYN.- 2
50
1608
1571
29
11907
33
4
7
65
EYE
59
2583
2579
-
10520
29
7
4
49
ENT
24
1451
1442
9
5514
15
4
4
63
ORU *
18
-
4
-
386
4
-
96
23
DERMATOLOGY
24
52
41
2
1075
12
0.5
25
49
GRAND.TOTAL
24036
22310
1719
176103
482
66
7
87
Birth
1606
1459
121
New outpatient registration according to districts
NEW OUT PATIENT RESTRATION-KILIMANJARO ACCODING TO DISTRICT-JAN.-DEC. 2014
MONT
H.
MOSHI
URBAN
MOSHI RURAL
ROMBO
SAME
HAI
SIHA
MWANGA
GRAND TOTAL
M
F
M
F
M
F
M
F
M
F
M
F
M
F
M
F
JAN.
330
426
304
373
91
116
78
88
115
119
80
95
82
90
1080
1307
FEB
274
354
265
302
85
83
75
77
110
127
90
96
84
95
983
TOT.
1134
2387
2117
MAR
299
352
303
304
92
85
76
86
138
147
96
120
89
96
1093
1190
2283
APR.
269
324
254
282
82
84
78
73
104
136
72
99
72
90
931
1088
2019
MAY
294
322
245
316
87
94
79
88
119
137
74
101
66
96
964
1161
2125
JUN
280
321
246
314
89
82
72
77
124
123
83
114
96
93
990
1124
2114
JULY
272
283
222
248
84
84
72
76
110
128
71
91
81
79
912
989
1901
AUG
268
327
259
274
75
90
89
79
133
123
83
103
93
92
1000
1088
2088
SEPT
229
334
250
322
78
88
81
86
110
120
77
101
78
91
903
1142
2045
OCT.
279
351
306
313
88
97
86
90
133
145
94
113
78
92
1064
1201
2265
NOV
283
330
249
277
63
70
78
61
101
99
80
71
57
65
911
973
1884
DEC.
289
16
222
256
73
67
66
67
115
116
79
89
65
80
909
991
1900
Total
3366
4040
3125
3581
987
1040
930
948
1412
1520
979
1200
941
1059
11740
13388
25128
GR.
TOT
7406
6706
2027
1878
2932
2179
2000
25128
Admissions and new registration/return attendance according to regions 2014
CATCHMENT AREA
ADMISION
REGIONS
NEW REGSTRATION
RE - ATTENDANCES
M
F
T
M
F
T
M
F
T
KILIMANJARO
8529
10899
19428
11740
13388
25128
42472
60218
112690
ARUSHA
1067
895
1962
1760
1497
3257
3861
3739
7600
TANGA
359
229
588
531
369
900
1358
923
2281
MANYARA
384
347
731
668
577
1245
1130
1141
2271
SINGIDA
154
110
264
222
181
403
466
437
903
10493
12480
22973
14921
16012
30933
49287
66458
115745
SUB TOTAL
OUTSIDE CATCHMENT AREA
ADMISION
NEW REGSTRATION
RE - ATTENDANCES
DODOMA
98
54
152
148
111
259
410
222
632
DARESSALAAM
61
93
154
133
163
296
186
268
454
IRINGA
21
14
35
31
30
61
83
63
146
MBEYA
26
11
37
49
33
82
77
52
129
KIGOMA
15
11
26
26
28
54
51
68
119
LINDI
2
-
2
3
-
3
6
1
7
MARA
29
26
55
66
53
119
127
156
283
MOROGORO
54
42
96
95
77
172
184
174
358
MTWARA
5
2
7
7
5
12
8
16
24
MWANZA
30
31
61
73
71
144
113
107
220
PWANI
7
4
11
6
7
13
4
12
16
RUKWA
7
7
14
21
9
30
48
17
65
SHINYANGA
41
24
65
69
67
136
146
158
304
RUVUMA
-
6
6
7
11
18
25
21
46
TABORA
60
28
88
93
65
158
178
139
317
KAGERA
9
3
12
27
15
42
33
37
70
NJOMBE
1
4
5
5
5
10
6
13
19
GEITA
8
5
13
13
8
21
12
14
26
122
KATAVI
3
1
4
4
3
7
5
3
8
SIMIYU
1
-
1
2
2
4
5
3
8
ZANZIBAR
31
2
34
47
5
52
85
16
101
BURUNDI
1
-
1
1
-
1
2
-
2
KENYA
90
88
178
146
137
283
154
94
248
UGANDA
-
-
-
-
1
1
-
2
2
ZAMBIA
-
-
-
-
1
1
-
3
3
CONGO
-
-
-
-
-
1
1
2
-
-
1
1
-
-
1
RWANDA
2
NAMIBIA
-
-
-
-
-
-
-
1
TOURIST
3
3
6
25
18
43
1
3
4
604
459
1063
1098
926
2024
1950
1664
3614
12480
22973
14921
16012
30933
49287
66458
115745
TOT(OCA )
TOTAL(IN-CA)
10493
GRAND TOTAL
24036
32957
119359
Referral status according to regions 2014
CATCHMENT AREA
REFERRAL
REGIONS
SELF
TOTAL ATTENDANCES
M
F
T
M
F
T
M
F
T
KILIMANJARO
5617
5892
11509
6123
7496
13619
11740
13388
25128
ARUSHA
959
709
1668
801
788
1590
1760
1497
3257
TANGA
337
209
546
194
160
354
531
369
900
MANYARA
399
302
701
269
275
544
668
577
1245
SINGIDA
137
104
241
85
77
161
222
181
403
SUB TOTAL
7449
7216
14665
7472
8796
16268
14921
16012
30933
OUTSIDE CATCHMENT AREA
REFERRAL
SELF
TOTAL ATTENDANCES
DODOMA
67
44
111
81
67
148
148
111
259
DARESSALAAM
29
36
65
104
127
231
133
163
296
IRINGA
16
8
24
15
22
37
31
30
61
MBEYA
16
12
28
33
21
54
49
33
82
KIGOMA
14
15
29
12
13
25
26
28
54
LINDI
1
-
1
2
-
2
3
-
3
MARA
22
22
44
44
31
75
66
53
119
MOROGORO
42
19
61
53
58
111
95
77
172
MTWARA
-
-
-
7
5
12
7
5
12
MWANZA
26
18
44
47
53
100
73
71
144
PWANI
2
1
3
4
6
10
6
7
13
RUKWA
7
-
7
14
9
23
21
9
30
SHINYANGA
37
31
68
32
36
68
69
67
136
RUVUMA
3
1
4
4
10
14
7
11
18
TABORA
51
28
79
42
37
79
93
65
158
KAGERA
8
6
14
19
9
28
27
15
42
NJOMBE
2
4
6
3
1
4
5
5
10
GEITA
4
5
9
9
3
12
13
8
21
KATAVI
3
2
5
1
1
2
4
3
7
SIMIYU
2
-
2
-
2
2
2
2
4
ZANZIBAR
12
-
12
35
5
40
47
5
52
ZAMBIA
-
-
-
-
1
1
-
1
1
KENYA
76
67
143
70
70
140
146
137
283
-
1
1
-
-
-
-
1
1
UGANDA
123
RUANDA
-
-
-
1
1
2
1
1
2
S/AFRICA
-
-
-
1
-
1
1
-
1
TOURIST
1
2
3
24
16
40
25
18
43
TOT(OCA )
441
322
763
657
604
1261
1098
926
2024
TOTAL(IN-CA)
7449
14665
7472
8796
16268
14921
16012
30933
GRAND TOTAL
7216
15428
17529
32957
OUT PATIENT STATISTICS FROM CLININS (JAN. – DECEMBER 2014)
MONTH
JAN.
FEB.
MARC
APR.
MAY
JUNE
JULY
AUG.
SEPT.
OCT.
NOV.
DEC.
GRAND
TOTAL
CAS
1323
1051
1029
2011
2082
2105
2510
2132
2017
2127
2004
2677
23068
ENT
284
341
404
325
350
336
266
539
291
281
481
283
4181
ORTH
252
185
138
637
539
501
195
213
270
288
150
245
3620
EYE
2112
2110
2114
2168
2168
2167
2259
2260
2259
2109
2109
2109
25944
SSHS
271
150
98
104
208
225
131
132
167
141
150
105
1882
SOPD
440
325
388
291
555
428
315
350
297
249
170
218
4026
CLINIC
POPD
110
98
49
97
79
94
75
74
66
80
96
52
970
SKIN
660
458
301
670
676
653
420
714
849
749
426
560
7136
GOPD
1103
954
638
701
922
841
839
915
575
251
321
380
8440
OT
50
46
45
138
142
149
60
75
100
83
80
50
1018
MOPD
328
237
274
350
501
586
203
231
286
286
160
150
3592
UROL
180
150
142
130
128
211
150
135
128
142
129
102
1727
PHYS
130
119
105
278
287
324
314
179
172
160
114
217
2399
DOPD
207
183
231
171
189
188
177
155
151
219
129
179
2179
NPOC
65
100
59
72
86
89
70
88
97
90
95
72
983
CCFCC
612
480
558
527
624
588
432
514
535
475
550
471
6366
IDC
792
618
791
604
452
564
543
623
532
498
550
635
7208
DIAB.
270
146
150
236
218
220
138
157
205
197
180
150
2267
POPNF
60
67
59
76
92
52
80
90
70
48
40
45
779
CARDIAC
37
45
35
35
22
22
32
33
33
29
40
24
387
9292
7863
7608
9621
10320
10350
9209
9609
9100
8502
7974
8724
108,172
GRANDTOT.
OPD ATTENDANCE ACCORDING TO AGE (JANUARY - DECEMBER 2014)
CLINICS
NPOC
0-5YRS
6-59YRS
60YRS+
TOTAL
410
551
22
982
POPD
557
413
0
970
ENT
947
2757
477
4181
CCFCC
1125
5061
180
6366
GOPD
1
8373
66
8440
SKIN
929
5335
872
7136
IDC
4
6298
906
7208
DENTAL
77
1764
338
2179
POPNF
779
0
0
779
UROL
87
726
914
1727
SOPD
567
2460
999
4026
MOPD
156
2276
1160
3592
ORTHO
365
2429
826
3620
124
OT
326
599
93
1018
SSHS
63
1654
165
1882
EYE
0
25944
0
25944
DIAB
30
1169
1068
2267
PHYSIO
249
1744
406
2399
CAS
2409
17420
3239
23068
CARDIAC*
GRAND TOTAL
-
327
60
387
9,081
87,300
11,791
108,172
OPD ‘TOP TEN’ diseases general
S/N
1
2
3
4
5
6
7
8
9
10
DISEASES
TOTAL
Diseases of oral cavity, salivary glands and jaws
543
Dermatitis and eczema
524
Other diseases of upper respiratory tract
300
Person’s encountering health services in circumstances related to reproduction
290
Hypertensive diseases
266
Protozoa diseases
192
Other anaemia’s
112
Other forms of heart diseases
89
Diabetes mellitus
88
mycoses
65
OPD ‘TOP TEN’ diseases in Eye department
S/N
1
2
3
4
5
6
7
8
9
10
DISEASES
Allergic conjunctivas
Pseudophakia
Other eye disorders
Glaucoma
Mature cataract
Diadetic retinopathy
Early cataract
Myopia/hyperopia
Presbyopia
Normal eye
TOTAL
3781
3727
3529
2997
2117
1921
1759
1701
1484
1014
Inpatients – general ’TOP TEN’ diseases
S/N DISEASES
1
2
3
4
5
Single spontaneous delivery
Single delivery by caesarean section
Transport accident
Essential (primary)hypertension
Diabetics mellitus
DISCHARGES
M
F
1954
1325
757
163
346
472
395
362
125
DEATH
M
F
64
61
64
20
54
42
GRAND TOTAL
M
F
Total
1954
1954
1325
1325
821
183
1004
407
526
933
459
404
863
6
7
8
9
10
Chronic disease of tonsils and adenoids
Human immunodeficiency virus (HIV)
All other external
Bacterial sepsis of new born
Pneumonia organism unspecified
505
389
437
268
301
316
207
193
239
219
1
65
51
53
59
22
15
506
454
488
321
301
316
266
215
254
219
822
720
703
575
520
‘TOP TEN’ diseases for Inpatients Under five (5) years
S/N DISEASES
1
2
3
4
5
6
7
8
9
10
Chronic disease of tonsils and adenoids
Bacterial sepsis of new born
Disorders relatedto short gest.and lowbirthweight not elsewhere classified.
Pneumonia,organism unspecified
Birth asphyxia
Respiratory distress of new-born
Other septicaemia
Transitory disorder of carbohydrates metabolism specific foetus and new-born
Meningitis due to other and unspecified
causes
Unspecified malaria
DISCHARGES
M
F
400
237
268
239
DEATH
M
F
4
2
53
15
GRAND TOTAL
M
F
Total
404
239
643
321
254
575
209
166
29
19
238
185
423
164
63
68
59
119
37
36
15
12
42
33
10
4
28
25
15
176
105
101
69
123
65
61
30
299
170
162
99
48
35
1
2
49
37
86
37
11
21
11
58
22
80
30
36
4
2
34
38
72
“TOP TEN” diseases for inpatients aged 6-59 years
S/N DISEASES
DISCHARGES
M
F
1
Single sponteneous delivery
2
3
4
5
6
7
8
9
Singledelivery by caesariansection
Trasport accident
Human immunodeficient virus (HIV)
Other anaemias
All other external
Diabetes mellitus
Intra cranial injury
Maternal care for known or suspected abnormality of pelvic organs
Essential (primary)hypertension
10
DEATH
M
F
GRAND TOTAL
M
F
Total
1954
-
-
-
1954
1954
669
124
101
330
160
305
1325
136
266
291
123
215
41
38
75
43
6
22
19
5
64
40
2
17
1
707
199
144
336
182
324
1325
141
330
331
125
232
42
1325
848
529
475
461
414
366
-
354
-
5
-
359
359
82
181
24
16
106
197
303
“TOP TEN” diseases for inpatients aged 60 years and above
S/N DISEASES
DISCHARGES
M
F
DEATH
M
F
GRAND TOTAL
M
F
Total
1
Diabetes mellitus
204
160
50
25
254
185
439
2
Disorders of bladder
355
2
9
3
364
5
369
126
3
4
5
6
7
8
9
10
Essential (primary) hypertension
Hyperplasia of prostate
Heart failure
Stroke
All other external
Urethral stricture
Hypertensive heart disease
Other anaemia
163
318
89
45
68
110
50
37
135
74
49
30
35
25
21
8
21
31
13
12
22
26
19
3
5
12
18
184
326
110
30
81
110
62
59
161
93
79
35
47
43
“TOP TEN” disease in EYE ward - 2014
SN
1
2
3
4
5
6
7
8
9
10
DISCRIPTIONS
Cataract
Others
Injuries
Glaucoma
Retina detarchment
Conjactival mass
Corneal ulcer
DCR
Retina blastoma
Keratitis
CASES
1243
338
305
143
130
87
63
27
22
14
FORMULAS/DEFINITION OF TERMS
Average daily inpatient census = Total number of patient day in the period (month, year)
Days in the period (30,365)
Average daily admission = Total admission in the period
Days in the period
Average length of stay (days) = Total number of patient days in the period
Discharges (live + death) in the period
127
345
326
203
109
116
110
109
102
LIST OF ABBREVIATIONS
AIDS
-
Acquired Immune Deficiency Syndrome
AMO -
Assistant Medical Officer
BPH
-
Benign Prostate Hyperplasia
CAS
-
Casualty
CCF
-
Congestive Cardiac Failure
CCFCC
-
Child Centered Family Care Clinic
CHD
-
Community Health Department
CPD
-
Cephalo-Pelvic-Disproportional
DUB
-
Dysfunctional Uterine Bleeding
ELCT
-
Evangelical Lutheran Church in Tanzania
ENT
-
Ear Nose and Throat
EUA
-
Examination under Anaesthesia
GCLP
-
Good Clinical & Laboratory Practice
GIT
-
Gastro-Intestinal Tract
GOPD
-
Gynaecology Outpatient Department
GSF
-
Good Samaritan Foundation
HIV
-
Human Immunodeficiency Virus
IDC
-
Infectious Disease Control
ISPO
-
International Society of Prosthetic and Orthotic
IUFD
-
Intra-Uterine-Fetal Death
KCMC
-
Kilimanjaro Christian Medical Centre
KCM-College-
Kilimanjaro Christian Medical College
LLPT
-
Lower Limb Prosthetic Technology
LLOT -
Lower Limb Orthotic Technology
LSCS
-
Low Segment Caesarean Section
MA -
Medical Attendant
MoHSW -
Ministry of Health and Social Welfare
MOI
-
Muhimbili Orthopaedics Institute
MOPD
-
Medical Outpatient Department
MOT
-
Main Operating Theatre
MUHAS
-
Muhimbili University of Health and Allied Sciences
MSD
-
Medical Supplies Department
MTA
-
Motor Traffic Accident
ND -
Northern Diocese
128
NHIF
-
National Health Insurance Fund
NM -
Nurse Midwife
NO -
Nursing officer
OPAC
-
Online Public Access Catalogue
OSEA
-
Ophthalmological Society of East Africa
PID -
Pelvic Inflammatory Disease
PIH
-
Pregnancy Induced Hypertension
POPD
-
Paediatric Outpatient Department
PROM
-
Premature Rupture of Membrane
PTB
-
Pulmonary Tuberculosis
RDTC -
Regional Dermatology Training Centre
RVF
-
Rectal Vaginal Fistula
SOPD
-
Surgical Outpatient Department
SICU
-
Surgical Intensive Care Unit
SVD
-
Spontaneous Vaginal Delivery
TATCOT
-
Tanzania Training Centre for Orthopaedic Technology
TCHRT -
Tanzania Centre for Health Records Technology
USAID
-
United States Agency for International Development
UTI
-
Urinary Tract Infection
VVF
-
Vesicle Vaginal Fistula
WHO
-
World Health Organization
This report has been prepared by the management of Kilimanjaro Christian Medical Centre.
This work has been compiled and edited by Mr. Damian Jeremia (Hospital statistician)
Contact Address:
Kilimanjaro Christian Medical Centre
P. O. Box. 3010, Moshi, Tanzania.
Tel. +255 027 27543777/80
Fax: +255 027 2754381
E-mail: kcmcadmn@kcmc.ac.tz
Website: www.kcmc.ac.tz
129
130