HUMAN RESOURCES
EXPATRIATE HUMAN RESOURCES
- Co-ordinator of the CTC (medical or paramedical)
- Logistician - sanitarian
- Water Hygiene and Sanitation supervisor (or local)
- Logistic supervisor (or local)
LOCAL HUMAN RESOURCES
- Water Hygiene and Sanitation supervisor (or expatriate)
- Logistic supervisor (or expatriate)
- Health worker
- Nurse
- Hygiene worker
- Water supply responsible
- Chlorine solution responsible
- Stretcher bearer
- Laundry worker
- Cook
- Cook helper
- store keeper
- watchman
- sprayer
- registrator
HOW TO ESTIMATE THE NEEDS?
1- PER TENT OF 20 PATIENTS
100 patients
permanently
- 1 staff able to put an IV line
- 1 or 2 helpers
- 2 cleaners
 x 3 for 24 hours
15 nurses
15 to 30 helpers
30 cleaners ???
2- FOR 10 TENTS OF 20 PATIENTS
permanently
- 2 medical supervisors
at night
- 1 medical supervisor
OK
OK
+ logistic and wat/San staff, quantity depending on the size of the CTC.
HOW TO MOTIVATE THE STAFF?
The motivation is easier to keep when the staff is entirely under the responsibility of MSF,
which is more often the case in closed than in open situation.
1- MAIN PROBLEMS
- No regular salary
- More work, work at night and no compensation
- Epidemic last longer in open setting
- Corruption
2- SOLUTIONS
- Substitution
- Increase organisation of work
- Give a precise job profile to every worker, and a clear organigramme
- Increase equipment for structures and staff
- Increase knowledge of staff
- Give feed-back of information
- Give allowance or special gifts to the staff (food for work,…)
ORGANIGRAMME
CTC Activities
External Activities
CHOLERA CO-ORDINATOR
CTC CO-ORDINATOR
WAT / SAN CO-ORDINATOR
Medical Dr
Pharmacist/
Store Keeper
Logistician
medical staff
paramedical staff
assistant
cook
cook helper
hygiene workers
water supply responsible
chlorine responsible
stretcher bearers
laundry responsible
watchman
sprayers
workers
hygiene workers
CW
health educators
CHW (+medical supervision)
JOB DESCRIPTIONS EXAMPLES
NURSE WORKING IN THE TRIAGE AREA
A.GENERAL
- Admits all patient with diarrhoea and / or vomiting with only one relative.
- Fills in observation sheet.
- Indicates : - Date, Hour of beginning of symptoms
- Number and aspect of diarrhoea, vomiting
- Others: pain, fever, cough,...
B. ASSESSMENT, DIAGNOSIS
- Looks at dehydration signs (chart assessment)
- Takes for the first time pulse, temperature.
C. TREATMENT
1. If a patient presents severe or moderate dehydration and vomiting;
- puts in an IV line (or ask helper to do it).
- notes treatment in regards to age, weight, on patients sheet and on IV.
- reassesses the patient every hour, during four hours.
2. If a patient presents moderate dehydration and can drink;
- notes quantity of ORS in regards to weight / age on sheet.
- asks helper to explain to the patient / relative the importance of ORS.
3. If a patient is in general good condition and not vomiting;
- begins re-hydration with ORS, ask the helper to do it.
- write quantity on observation sheet.
 Assess, write down status of the patient each hour for 4 hours,
- pulse
- temperature
- urine
- diarrhoea
- vomiting
 Refers patient to appropriate area IV or ORS after 4 hours according to the protocol.
THE NURSE WORKING IN THE IV AREA
- ADMISSION OF A NEW PATIENT.
- Looks at general condition, pulse, temperature, dehydration status.
- If treatment already indicated, apply the treatment.
- SURVEILLANCE OF A PATIENT.
- Assess the patient every 2 hours,
- pulse
- consciousness
- skin pinch
- diarrhoea
- vomiting
- urine
- temperature 2x / day
- Surveillance of the perfusion, gives the quantity required at time, change the bottle
on time.
- Keeps the empty bottles above the patient, to know the quantity received.
- Adapts perfusion in regards of pulse and dehydration.
- Asks helper to give as soon as possible, ORS.
- Asks assistance from nurse supervisor in case of a problem.
- ASSESSMENT OF THE PATIENT.
- When patient is re-hydrated and no vomiting for 6 hours, send patient to ORS.
HELPER WORKING IN ORS AREA
ADMISSION OF A NEW PATIENT.
- Installs the patient, gives a place for the patient.
- Explains importance of continuation of the treatment if they are coming from IV area.
- Calculates good quantity of ORS to be given.
SURVEILLANCE OF THE PATIENT.
- Write quantity ORS given to the patient.
- Supervises the patient and write on sheet, pulse, number and aspect of stool and
vomiting regularly.
- Be able to see if some relapse and sends back to IV.
DISCHARGE OF A PATIENT.
- Advises supervisor for discharging the patients.
HELPER IN IV AREA
- Gives ORS for the patients when they can drink, to ensures that the cups are always full.
- Inform patient and family, the importance of giving water, ORS to cure the patient.
- Stimulates the relative to give ORS.
- Inform patient and family about what is cholera, how to prevent themselves.
- Supervises hygienic measures of patient and relative.
- Informs patient that they have 1 bucket for vomiting, one for stool, latrines, the importance
of washing hands, education, rules of the camp,...
- Notes on the hospitalisation sheet: - urine
- vomiting
- diarrhoea
- temperature 2x / day
- ORS given
- Assesses evolution of the patient.
- Keep nurse informed on evolution of patient.
-Warns cleaner and sprayer if needed (vomiting on floor, buckets full, or cleaning place for a
new patient).
HELPER IN OBSERVATION AREA
1. ADMISSION OF A PATIENT.
- Sets up the patient when arriving.
- Observes the patient hour / hour after treatment has started,
-pulse
-temperature
-vomiting
-diarrhoea
-number of cups of ORS each hour
- Provides full cups of ORS, regarding the protocol or prescription of the nurse.
- Assess the evolution of the patient and informs the nurse if patient gets worse.
- Puts IV line if needed according with the nurse.
- Looks if ORS, water to drink, solution 0,2 % are available. If not, asks responsible
ORS to fill it.
- When a patient has diarrhoea, or vomiting or is living to an other area, asks the cleaner to
clean buckets, plastics before a new patient arrives.
- Guides a patient in IV or ORS area with only one relative after instruction of nurse.
2. EDUCATION.
- Informs patient and relative about cholera, rules to preserve against cholera.
- Gives explanations about what is ORS and the importance of it.
REGISTRATOR IN OBSERVATION AREA
GENERAL : Takes care of registration of patients in appropriate register.
1. Book for outpatients
An outpatient is a patient staying in observation area during four hours and going
home after wards.
(= suspected case of cholera who will NOT be admitted in IV or ORS.)
Notes :
-Name
-Sex
-treatment given
-Age
-Location
2. Book for inpatients
An inpatient is a patient who will be admitted in IV or ORS area to receive
treatment.
Notes :
-Number:
-Name
-Age
-Location
-Treatment
-Date of exit
for new cases new number
for re-admission uses the old number of registration.
-Sex
-Symptoms
-Date of entrance
-Kind of exit (Recovered, dead, escaped, transferred)
3. Folder
Keeps folder in order, patients sheets discharged, deaths sheets, complete with dates.
SPECIFIC
- Makes a day / day report and at the end of each week.
- Asks extra forms before stock is finished.
- Provides soap to every patient admitted in IV or ORS.
NURSE SUPERVISOR
GENERAL
- Is the contact person for medical issues for the MSF expatriates.
- Has the overall responsibility for the adequate treatment of cholera patients.
- Is fully aware of the organisation of the cholera camp, the rules and the protocols.
- Is responsible for the medical staff in the different areas, the adherence to the work
schedule.
- Fulfilment of tasks of the staff
- use of treatment protocols.
- Supervises the medical staff and trains nurses and helpers where needed.
SPECIFIC
- Reads the night reports and assesses critical part immediately, instructs nurses when
necessary on adequate actions.
- Makes morning round to know overall medical situation in the camp. Checks if the
patient sheets are filled.
- Assists the nurses in the IV, Observation areas when workload requires so.
- Prescribes and hands out appropriate antibiotic treatment for cholera patient according
to protocol and write s this on sheet.
- Prescribes others treatment if indicated and write this on sheet.
- Replaces nurses during lunch time in their respective areas.
- Inform nurses on their day off and ensures replacement.
- Ensures application of re-hydration protocols in all areas.
- Assists nurses with IV placement, naso-gastric tubes when necessary.
- Stimulates health education of patient and relatives by health education nurse.
- Is responsible for registration of IV, drugs, supplies consumption per day and per
week.
- Makes timely orders for drugs and perfusion fluids and supplies.
- Sits down once a day with the MSF expatiate to evaluate general situation in the camp.
- Prepares the day report for the night shift and indicates critical patients.
- Supervises hygienic situation in the camp and gives instructions to appropriate people if
necessary.