1. society
2. welfare
3. healthcare
4. hospital

St Francis' Hospital
Annual Report 2000 and 2001
TABLE OF CONTENTS
1.
INTRODUCTION ........................................................................................................................................... 3
2.
GENERAL REVIEW OF 2000....................................................................................................................... 4
3.
GENERAL REVIEW OF 2001....................................................................................................................... 4
4.
MANAGEMENT OF THE HOSPITAL........................................................................................................ 6
4.1
4.2
THE JOINT ANGLICAN/CATHOLIC MANAGEMENT BOARD .................................................................................. 6
HOSPITAL MANAGEMENT COMMITTEE AT 31ST DECEMBER 2001 ....................................................................... 6
5.
HOSPITAL FINANCES ................................................................................................................................. 7
6.
STAFFING ....................................................................................................................................................... 9
6.1
6.2
6.3
6.4
6.4.1
6.4.2
6.4.3
6.4.4
STAFF LIST: MEDICAL, NURSING AND PARAMEDICAL AT 31ST DECEMBER 2001 ................................................ 9
STAFF LIST ADMINISTRATIVE AND TECHNICAL ................................................................................................ 10
HOSPITAL STAFFING AT 31ST DECEMBER 2001 ................................................................................................. 11
STAFF CHANGES ............................................................................................................................................... 12
Staff Arrivals .................................................................................................................................................... 12
Staff Departures ............................................................................................................................................... 13
Short Term Volunteer Staff............................................................................................................................... 13
Staff who have passed Away............................................................................................................................. 14
7.
HOSPITAL SERVICES ................................................................................................................................ 14
7.1
7.2
7.2.1
7.3
7.3.1
7.3.2
7.4
7.4.1
7.4.2
7.4.3
7.4.4
7.4.5
REFERRAL SYSTEM ........................................................................................................................................... 14
OUT-PATIENT DEPARTMENT ............................................................................................................................. 15
Specialist Clinics.............................................................................................................................................. 16
INPATIENT SERVICES ........................................................................................................................................ 19
Theatres............................................................................................................................................................ 23
Maternity Department...................................................................................................................................... 23
PARAMEDICAL DEPARTMENTS ......................................................................................................................... 25
Radiography Department................................................................................................................................. 25
Physiotherapy Department............................................................................................................................... 25
Dental Department........................................................................................................................................... 26
Laboratory Department ................................................................................................................................... 27
Outreach .......................................................................................................................................................... 27
8.
ANCILLARY DEPARTMENTS.................................................................................................................. 27
8.1
8.2
8.3
8.4
8.5
8.6
8.7
8.8
8.9
SECURITY DEPARTMENT................................................................................................................................... 28
HOSPITAL KITCHEN .......................................................................................................................................... 28
LAUNDRY ......................................................................................................................................................... 28
RECORDS DEPARTMENT ................................................................................................................................... 28
ACCOUNTS........................................................................................................................................................ 29
WORKSHOP ....................................................................................................................................................... 29
BUILDING DEPARTMENT ................................................................................................................................... 30
TRANSPORT ...................................................................................................................................................... 30
HOUSING .......................................................................................................................................................... 30
9.
AIDS DEPARTMENT................................................................................................................................... 31
9.1
9.2
9.2.1
9.3
9.4
9.4.1
9.4.2
SUMMARY FOR 2000......................................................................................................................................... 31
SUMMARY FOR 2001......................................................................................................................................... 31
Achievements.................................................................................................................................................... 32
COMPOSITION OF AIDS PROGRAMME TEAM (AT 31ST DECEMBER 2001).......................................................... 32
STATISTICS – 2001, FIGURES FOR 2000 IN BRACKETS ....................................................................................... 32
HIV Counselling and Testing ........................................................................................................................... 32
Home Based Care ............................................................................................................................................ 33
1
St Francis' Hospital
Annual Report 2000 and 2001
9.4.3
9.4.4
9.4.5
9.4.6
STD Clinic Attendance......................................................................................................................................33
AIDS Education by Community Based Volunteers ...........................................................................................33
Orphans Support...............................................................................................................................................34
Acknowledgements............................................................................................................................................34
10.
TRAINING......................................................................................................................................................34
10.1
10.2
10.3
10.4
10.5
10.6
GENERAL NURSE TRAINING SCHOOL (NTS) .....................................................................................................34
MIDWIFERY SCHOOL .........................................................................................................................................35
MMED SURGERY TRAINING ..............................................................................................................................35
MEDICAL LICENTIATE TRAINING PROGRAMME .................................................................................................35
MEDICAL STUDENTS .........................................................................................................................................36
STAFF DEVELOPMENT .......................................................................................................................................36
11.
RESEARCH ....................................................................................................................................................37
12.
JERSEY SCHOOL.........................................................................................................................................37
13.
PROJECTS .....................................................................................................................................................38
2
St Francis' Hospital
1.
Annual Report 2000 and 2001
Introduction
St Francis’ Hospital was founded in 1948 as an Anglican hospital. It is situated in Katete
District in Eastern Province, on the Great East Road, 500km east of the capital Lusaka
and 125km from the Malawi border.
Although founded by the Anglican Church, St Francis’ Hospital has been jointly managed
by the Anglican and Catholic Churches, the position of Chair of the Board alternates
between the Anglican Bishop of the Eastern Diocese and the leader of the Catholic
Church in Eastern Province.
St Francis’ is a mission hospital but following the memorandum of understanding in 1996
and the health reforms is considered an integral part of the Health Service in Zambia.
Mission institutions still provide 30% of the health services in Zambia, and in the rural
areas they are responsible for 50%. Mission hospital and health centres are represented
by the Churches Medical Association of Zambia (CMAZ).
St Francis’ is a second level hospital according to the classification of the Central Board
of Health (CBoH). This means that it acts as a referral hospital for much of the Eastern
Province (population 1 million), particularly for surgical, orthopaedic, gynaecological,
obstetric and eye patients. It is also the 1st level hospital for Katete District. The hospital
not only provides curative services but also preventative services and gives support to the
15 Rural Health Centres in the District as well as being a Rural Health Centre for the local
community.
Katete District has a population of 185,000 inhabitants. The majority of the local
population are subsistence farmers, growing maize, cotton, groundnuts and sunflower.
The local economy is on a small scale with the only large employer being a cotton ginnery
built in 1999. Even here, many of the jobs are seasonal.
Training has always been an important aspect of the work of St Francis’ Hospital. In 1953
the School of General Nursing (the second official nursing school in the country) was
opened, and in 1956 the first School of Midwifery in Zambia was opened. In 1983 the
hospital was recognised by the University of Zambia and the Royal College of Surgeons
of England as a suitable place to give training in surgery. Doctors studying for the Master
of Medicine (surgery) of Zambia spend six months of their four year course at St Francis’
Hospital gaining experience in a wide range of surgery. For many years Medical Students
from all over the world, including Zambia have come to St Francis’ to do their electives.
Many have gained greatly from the experience and for some it is the start of a long
interest in medicine in the developing world, either at St Francis’ or elsewhere in the
world. More recently the hospital has been selected as a place where Medical Licentiates
trained in Tanzania receive their final training before gaining a license from the Medical
Council of Zambia to practise. The hospital also receives students in many fields such as
Clinical Officers, Radiographers, Physiotherapists, Pharmacy and Laboratory Technician
who come to the hospital to gain valuable practical experience as a part of their studies.
More than ever before, St Francis’ has a role to play in the training of health
professionals.
The hospital receives a monthly grant from the government for providing 2nd level
services and running the nursing schools. It also receives a grant via Churches Medical
3
St Francis' Hospital
Annual Report 2000 and 2001
Association of Zambia, which is specifically for paying the Classified Daily Employees.
During the period covered by this report the hospital has made arrangements with Katete
District and the other surrounding districts to pay for the first level services that it provides
for them. This is because following the reforms, the hospital is not funded for first level
services, but this money is given to Health Districts. The medical fees from the patients
make only a small contribution to the running costs (less than 5%). The hospital receives
many donations from abroad and within Zambia and these are absolutely vital for the
running of the hospital. A large proportion of these donations is used to buy drugs and
medical supplies. The remaining donations are mainly for capital projects, which are
entirely funded from donations.
The main aim of the hospital was, at the outset, to be a practical expression of our Lord’s
compassion for the sick and disadvantaged and to train health workers. Despite all the
new challenges we find today, this aim remains the same and is still relevant.
2.
General Review of 2000
Not for the first time, a review for a year will start with the phrase ‘this was a difficult year’.
There were changes in the senior management, continued financial problems and staff
unrest. Added to this was the expectation of retrenchment for many of the workers.
Another major problem for the hospital is the devastating effect of HIV/AIDS. This shows
itself in the increase in disease, particularly among the young and also in sickness and
death among the workforce.
Dr Ziche Makukula resigned as Executive Director at the end of 1999. Happily for the
hospital he has continued to work as a Consultant Gynaecologist and Obstetrician. Dr
Parkinson who had been the deputy Executive Director took over for a short while but had
already arranged to return to the UK in February 2000 for further clinical training.
Thankfully Dr Yotham Phiri, Consultant Surgeon agreed to take over as Acting Executive
Director. He was reluctant to take on this extra responsibility as he wanted to concentrate
on his surgery, but put the needs of the hospital first. As ever there were many challenges
to face. Early in the year there was some unrest among the CDE’s caused by the
uncertainty over the retrenchment programme. Happily this was resolved and is
mentioned in more detail later. The hospital continued to encounter difficulty in attracting
and retaining certain groups of staff. The problem is worst with the more qualified staff of
whom there is a shortage in Zambia and so St Francis' Hospital is not alone in this. In
particular we continue to have problems keeping a good number of Nursing Tutors at the
hospital, to the point that the Midwifery School was almost forced to close. Towards the
end of 2000 the Manager Administration, Mr Edward Banda was suspended and
subsequently had his contract terminated because of unprofessional conduct.
3.
General Review of 2001
In February Dr Shelagh Parkinson returned to St Francis' Hospital with her family to take
on the role of Executive Director and Paediatrician. Following the departure of Edward
Banda, the Board appointed Mr Ian Parkinson as Manager Administration in April 2001. In
June there was a national Civil Servants strike, staff were claiming a large pay increase.
This lasted for a few weeks and initially staff at St Francis’ carried on working. Sadly they
4
St Francis' Hospital
Annual Report 2000 and 2001
were pressurised into joining the strike by union officials. Fortunately the strike only lasted
for one week and senior staff assisted by the student nurses maintained services. Later in
the year three senior staff received unpleasant anonymous letters and temporarily
stopped working but were given the full support of the board and returned to work.
On a happier note the hospital yet again received containers from the United Kingdom
and Netherlands. Thanks are due to the States of Jersey Overseas Aid Committee who
again provided £35,000 for drugs. Also, the Medical Support Group in the Netherlands
and supporters of the hospital in the UK, many of them ex-staff who continue to be
interested in and support the hospital. We have to acknowledge that without this great
assistance from overseas the hospital would not be able to serve the community here as
well as it does.
Further good news came as a result of action by many of Zambia’s bishops and church
leaders who refused to take the answer no from politicians and secured K2,000,000,000
that was owed to church institutions by the government. The K93,000,000 share that St
Francis’ Hospital received made a huge difference to the finances for the year. As ever
dealing with financial problems took a great deal of management time. Government
funding in terms of Running Cost Grant and CDE’s Salaries Grant were often late and
sometimes never received at all. Overall probably only 40% of the expected funding
arrived. The hospital managed to pay the workers each month, although often very late,
we are thankful that they continue to work and wait for their pay patiently.
One constant problem throughout the period of this report is recruiting and retaining
trained staff. This is not a problem that is particular to St Francis' Hospital but a national
problem. The number of staff being lost each year is increasing; there are two major
factors. Firstly, health workers are among the hardest hit groups by the AIDS epidemic.
So many staff have died or been unable to work because of sickness. Secondly, many
staff are moving abroad (mainly within Southern Africa) because conditions of service in
surrounding countries are better. This is a testimony to the good training that Zambian
staff receive, but is having a serious effect on the staffing levels in hospitals and health
centres. In addition to these factors, the hospital has not received any staff through the
posting system, it has to attract staff to come and work at the hospital and this is
becoming more difficult as Districts have started to receive much improved funding.
5
St Francis' Hospital
4.
Annual Report 2000 and 2001
Management of the Hospital
The hospital has a management board, which meets twice a year. An executive board meets
between the Full Board Meetings to deal with any issues that need urgent attention. The board
consists of representatives from the two mother churches, representatives from the Provincial
Health Office and the District Health Board and the community. Senior members of the Hospital
Management and staff representatives are in attendance but do not vote. The Hospital Board
determines policy, considers major expenditure and deals with matters referred by the
Management Committee. The Management Committee is responsible for the day to day running
of the hospital in conjunction with the senior officers, i.e. Executive Director, Manager
Administration, Nurse Advisor and Accountant.
4.1
The Joint Anglican/Catholic Management Board
Chairman, alternating each year
Monsignor George Lungu, Apostolic Administrator General, Chipata Catholic Diocese
The Rt. Reverend John Osmers, Anglican Bishop of the Diocese of Eastern Zambia
Church Representatives
Fr William Muchombo
Fr Faston Tembo
Fr Dennis. Punthambuyo
Fr G. Msipu Phiri
Sr. Viola. Muninshi
Prof John Jellis
Mr H. Chikwanda
Mrs Z. Ngulube
Hospital Staff Representative
Mr Alison Mumba
4.2
Representatives of the Ministry of Health
Dr E. Bwalya, Provincial Health Director
Mrs Nyirenda, Katete District Health Board
Mr K. Nyirenda, Community Development
Hospital Management Members
Dr Shelagh Parkinson, Ex Director - Secretary
Dr Yotham Phiri, Deputy Executive Director
Mr Ian Parkinson, Manager Administration
Mrs Mwaka Seya, Nurse Advisor
Hospital Management Committee at 31st December 2001
Dr Shelagh Parkinson
Dr Yotham Phiri
Mr Ian Parkinson
Mrs M. Seya
Ms Xoliswa Siwale
Mr Danwell Simbeya
Mrs Margaret Chambule
Mr Robert Banda
Sr Euphrasia Banda
Mr Harrison Tembo
Mr Paul Splint
Mr Cyprian Menyani
Mr Alison Mumba
Executive Director - Chairman
Consultant Surgeon - Dep. Exec. Director
Manager Administration
Nurse Advisor
Acting Principal Tutor
AIDS Co-ordinator
Senior Nursing Officer
Personnel Officer
Public Relations Officer
Acting Principal Clinical Officer
Technical Advisor
Eye Clinic - In-charge
Staff Representative
6
St Francis' Hospital
5.
Annual Report 2000 and 2001
Hospital Finances
2001
2000
K000's
Income
Running Cost Grant (GRZ)
Salary Grant
Donations – Local
Donations – Overseas
Donations – In Kind
User Fees
Income from Referral System
Drugs from New Medical Stores
NTS Fees and Lodging
Bank Interest
Other Operating Capital
Amortisation of Capital Grant
K000's
544,660
271,893
14,000
88,188
515,582
71,010
274,540
127,585
K000's
400,004
170,370
13,864
97,259
15,250
8,583
12,936
340,153
3,103
43,533
275,082
2,229,176
Expenditure
Personnel Costs
Drugs and Medical Supplies
Transport Charges
Food, Linen & Cleaning
General Expenses
Maintenance
Electricity, Telephone & Postage
Other Expenses
Depreciation
708,353
661,506
168,547
255,879
84,464
143,617
87,015
13,189
336,528
(Deficit) of Income over Expenditure
K000's
1,058,419
653,624
40,303
102,982
115,083
98,654
15,719
440,201
2,459,098
1,466,566
(229,922)
(408,147)
K000's
319,341
895,341
(340,434)
14,938
889,186
K000's
218,046
397,188
(340,153)
44,260
319,341
Summary of Project Finances
Balance Brought Forward
Income
Expenditure
Exchange Adjustment
Balance Carried Forward
7
St Francis' Hospital
Annual Report 2000 and 2001
It goes without saying that the financial situation during 2000 and 2001 continued to be
very difficult, particularly in 2000.
The GRZ running cost grant for 2000 averaged K33.3 million per month compared to an
expected K60 million. There was a considerable improvement in 2001 with the monthly
grant averaging K45.4 million. Although this was still below the expected level and often
late, grants were received for each month, which was an improvement on previous years
and we are grateful to the Government for this.
The salary grant for CE’s showed a large increase from 2000 to 2001. There were several
reasons for this, the salary for CE’s was increased by the Government towards the end of
2001 with a corresponding increase in the grant. There was a change in the method
paying the money by the Government, which resulted the grant becoming much more
regular. In addition the hospital received K93 million, being its share of the K2 billion
owed to Mission institutions for salaries finally paid by the Government. This would not
have been given without the efforts of Churches Medical Association of Zambia (CMAZ)
and particularly the Church Leaders. Another K1billion remains outstanding, but the
money received helped St Francis’ and many other missions greatly.
Another major difference in the figures for 2000 and 2001 is the income from donations.
There are no ‘Donations – Overseas’ and ‘Donations – In Kind’ included in the figures for
2000 but large sums shown for 2001. There is also a corresponding increase in the
expenditure on Drugs and Medical Supplies between 2000 and 2001. This reflects a
change in policy by the hospital to show the value of donations (in terms of money for
drugs and medical supplies and actual donations) in the financial reports to CBoH. This
change was made as management felt it was very important to show clearly the value of
donations. For several years the hospital has received a container from the UK and more
recently from the Netherlands. These are packed with drugs, medical supplies and
equipment either directly donated or purchased with donated funds from Jersey Overseas
Aid, Friends of St Francis’ in the UK, and Medical Support Group in the Netherlands. On
the expenditure side, the figures for 2001 give a much fairer representation of the cost of
running a busy 2nd Level hospital, particularly in terms of drugs and medical supplies.
They also demonstrate clearly the financial contribution made by donors.
Another major change between 2000 and 2001 is the Income from Referral system. This
reflects the fact that the Government Grant received by the hospital is for the provision of
2nd Level services. During 2000 and 2001, the hospital management negotiated with
Katete District and surrounding Districts and set in place a system for receiving funding
for providing 1st Level funding. This is because the government provides District Health
Boards with the funding for 1st Level services. By the end of 2001 the system was not
ideal and further work was necessary, but the funds realised had made a substantial
impact.
8
St Francis' Hospital
6.
6.1
Annual Report 2000 and 2001
Staffing
Staff List: Medical, Nursing and paramedical at 31st December 2001
Executive Director & Paediatrician
Consultant Surgeon & Dep. Exec Dir
Consultant Obs & Gynaecologist
General Medical Officer
Pharmacist
Nurse Advisor
Senior Nursing Officer
Nursing Officer
Acting Principal Tutor
Tutor
Sr Midwifery Tutor
Midwifery Tutor
Clinical Instructors
Registered Nurses
Acting Principal Clinical Officer
Senior Clinical Officers
Clinical Officers
Physiotherapists
Radiographers
Pharmacy Technician
Senior Laboratory
Technologist
Senior Laboratory Assistant
Laboratory Technicians
Dental Attendant
Enrolled Nurse/Midwives
Ms Jane Banda
Ms Mary Kasawara Banda
Ms Esnart Mudenda Banda
Ms Mary Kaonga Chanda
Mr Nhamo Daka
Ms Tikku Sakala Daka
Mr Lufeyo Kamanga
Ms Patricia Mumba Mahlangu
Mr Alison Mumba
Mr Japhet Mulipa
Dr Shelagh Parkinson MBBS, MRCP, MRCPCH, DTM&H
Dr Yotham Phiri MB BCh, MMed Surg
Dr Ziche Makukula MB BCh MRCOG
Dr Francis Phiri MB BCh
Dr Simon Chisi MB BCh
Vacant
Mrs Mwaka Seya RN RM BSc(NEd)
Mr Margaret Chambule RN RM
Mrs Grace Ngwenya RN RM
Ms Xoliswa Siwale RN BSc(Ned)
Mrs Gertrude Zulu RN BSc(Ned)
Vacant
Vacant
Mrs Agness Zimba, Mr Felix Chisha, Mr Joseph Mseteka RN
Mrs Charity Banda RN RM, Mrs Esther Y. Phiri RN RM
Ms Iredy Zulu RN, Ms Esnart T. Banda RN
Mr Harrison Tembo Psy
Mr Rodwell Banda, Gen/Anaes
Mr Danwell Simbeya Gen/STD/AIDS
Mr Enocks Nyambe Gen, Mr Mathews Mbale Anaes
Mr Peter Banda Psy, Mr Lucas Mtonga Anaes
Mr Emmanuel Munyansho Dental
Mr Chongo Mwansa & Mr Anderson Phiri, Dip Physio
Mr Sheckson Musonda Dip Rad, Mr Reuben Banda Dip Rad
Mr Phyela Phiri Dip Rad
Mr Jeremiah Nyirenda & Mr Malunga Sakala, Dip Pharm
Ms Marcelline Kimakinda Dip Lab Tech
Mr Raphael Banda
Mr Adrian Chambule, Mr Crispin Chatipwa
Ms Hilda Magawa
Ms Fredah Phiri
Ms Petronella Zimba Mutale
Ms Theresa Zulu Mwanza, OTN
Ms Agrassia Phiri
Sr Hilda G.K. Phiri
Ms Tomaida F. Phiri
Ms Setrida Sakala, OTN
Ms Grace M Tembo
Ms Rosemary Tembo
Ms Helen Zulu
9
St Francis' Hospital
Annual Report 2000 and 2001
Staff List: Medical, Nursing and paramedical at 31st December 2001 (cont.)
Enrolled Nurses
Mr Bernard Banda
Ms Bertha Banda
Ms Evelyn Banda
Ms Helen Banda
Mr Leonard Banda
Mr Raphael Banda
Ms Regina Banda
Mr Charles Bwalya
Mr Peter Chanda, OTN
Ms Loveness Chulu Chisumpa
Mr Charles Chupa
Mr Josephat Chulu
Mr Phillimon Daka
Ms Luwa Phiri Jumbe
Ms Angela Chongo Kalaba
Ms Patricia Kamanga
Ms Veronica Daka Kasauka
Mr Isaac Khunga
Mr James Manda
Ms Peretine Matimba
Ms Judith Mazala
Mr Cyprian Menyani, Cert Ophth
Mr Clement Miti
Ms Jesse Lungu Moyo
Mr Martin Moyo
Mr Kennedy Mufuzi
Ms Theresa Mukuka
Mr Christopher Mulenga
Ms Ruth Mungwa
Ms Merina Nkhuwa Musonda
Mr Greyson Mvula
Ms Anna Botha Mwale
Ms Gladys Mwale
Mr Joseph Mwale
Ms Martha Mwale
Ms Veronica Mwale
Mr Eliphas Mwanza
Ms Betty Mwanza
Ms Veronica Mwazima
Ms Linda Nyambe Mweene
Ms Olipa Phiri Nkhoma
Ms Belina Nyirenda
Ms Aliness Phiri
Mr Christopher Phiri
Mr Dennis Phiri
Mr Dickson Phiri
Ms Emely Phiri
Pharmacy Dispensers
Pharmacy Assistants
Ms Mavis Mwanza, Ms Norah Banda
Mr Alfred Banda, Mr Mark Phiri
6.2
Staff List Administrative and Technical
Manager Administration
Mr Ian Parkinson
Accountant
Vacant
Assistant Accountant
Mr Joseph Duma
Hospital Engineer
Vacant*
Personnel Officer
Mr Robert Banda
Public Relations Officer
Sr Euphrasia Banda
Workshop Foreman
Mr Saule Phiri
Building Foreman
Mr Zumani Juma
Nurses Home Warden
Mrs Esther Banda
* Mr Paul Splint advised on technical matters
10
Mr Emmanuel Phiri
Mr Epiphano Phiri
Ms Maureen Phiri
Ms Monica Kazoka Phiri
Ms Ruth Mbirintengelenji Phiri
Ms Vainess Phiri
Mr Ganizani Sakala
Ms Linda Mbewe Sakala
Mr Stanely Sakala
Ms Florence Shikabeta
Mr Emmanuel Sikateyo
Mr Bima Soko
Ms Esnart Bwalya Tembo
Ms Nduba Tembo
Ms Victoria Manda Tembo
Mr Khuzuet Tuwele
Ms Emely Mpelule Zimba
Mr Jackson Zimba, OTN
Ms Veronica Zimba
Ms Chandiona Mumba Zulu
Mr James Zulu
Mr Joseph Zulu
Ms Onester Mseteka Zulu
St Francis' Hospital
6.3
Annual Report 2000 and 2001
Hospital Staffing at 31st December 2001
Total Govt
Medical , Nursing & Paramedical
Medical Officers
Specialists 3
2
General
Registrar 0
2
1
1
3
5
Nurse Advisor/Principal Tutor
Senior Nursing Officer
Nurse Tutors
Assistant Tutor/Clinical Instructors
Registered Nurses
Clinical Officers
Acting Principal Clinical Officer
Senior Gen/Psy/Anaes/STD/AIDS/TB
Clinical Officers Gen/Psy/Dental/Anaes
Physiotherapists
Radiographers
Pharmacy Technician
Senior Laboratory Technician
Senior Laboratory Assistant
Laboratory Technicians
Dental Attendant
Enrolled Nurse/Midwives
Enrolled Nurse
Pharmacy Dispensers/Assistants
Subtotal
Senior Administrative and Technical
Manager Administration
Accountant/Assistant
Public Relations Officer
Personnel Officer
Hospital Engineer
Foreman Workshop
Foreman Building
Nurses Home Warden
Subtotal
Other Administrative, Technical & Manual
Maintenance and Workshop
Drivers
Clerical/Accounts/Records
Storekeepers
Kitchen and Laundry
Wards and Hospital Departments
Domestic Ward Workers
Watchmen
General
Nursing Schools and Hostels
Subtotal
TOTAL
11
1
2
5
2
3
2
1
1
3
1
19
70
4
131
1
2
1
1
0
1
1
1
8
16
4
15
2
7
40
15
10
22
12
143
282
CDE
Grant Church
2
2
1
2
1
1
3
5
1
2
5
2
3
2
1
1
3
1
19
70
126
4
4
0
1
1
2
1
1
1
1
1
1
3
0
127
9
4
11
1
6
20
8
9
8
10
86
93
3
1
7
4
1
1
20
7
1
14
2
57
60
0
2
St Francis' Hospital
Govt
-
CDE
-
Annual Report 2000 and 2001
these are Civil Servants and are paid directly by the government and are
seconded to ST Francis’ Hospital
these are Classified Daily Employees. They are paid for by the government, but by
a grant sent to CMAZ and then sent to each mission institution.
staff employed by the hospital and paid out of the monthly running cost grant.
Staff supported by missionary organisations
Grant Church-
6.4
Staff Changes
6.4.1
Staff Arrivals
Name
Lucas Mtonga
Benjamin Banda
Saul Banda
Dr David Elphick
Dr Heather Elphick
Miss Iredy Zulu
Mathews Mbale
Dr Rahman
Betty T. Mwanza
Setrida Sakala
Sr Euphrasia Banda
Ian Parkinson
Phyela Phiri
Japhet Mulipa
Anderson Phiri
Esther Manda
Isaac Tembo
Mambo Mwinga
Kelvin Mwanja
Shadreck Syazyombo
Malunga Sakala
Robert Banda
Mavis Mwanza
Norah Banda
Tasila Banda
Grace Tembo
Post
CO Anaesthetics
Medical Licentiate
Medical Licentiate
Registrar Physician (USPG)
Registrar Physician (USPG)
Registered Nurse
CO Anaesthetics
Surgical Registrar (MMed Programme)
ZEM/OTN
ZEM/OTN
Public Relations Officer
Manager Administration
Radiographer
ZEM
Physiotherapist
RN/RM
Medical Licentiate
Medical Licentiate
Medical Licentiate
Medical Licentiate
Pharmacy Technologist
Personnel Officer
Pharmacy Dispenser
Pharmacy Dispenser
RN
ZEM
Date
January 2000
February 2000
February 2000
August 2000
August 2000
October 2000
October 2000
January 2001
January 2001
January 2001
April 2001
May 2001
July 2001
September 2001
October 2001
October 2001
October 2001
November 2001
November 2001
November 2001
November 2001
December 2001
December 2001
December 2001
December 2001
December 2001
The following Zambia Enrolled Nurses (ZEN’s) took up posts at the hospital in October 2000 after
graduating from St Francis’ Nurse training school in June 2000:
Dennis Phiri
Martha Mwale.
Clement Miti
Ruth Mungwa
The following Zambia Enrolled Nurses (ZEN’s) took up posts at the hospital in November 2001
after graduating from St Francis’ Nurse training school in June 2001:
Dickson Phiri
Eliphas Mwanza
Emmanuel Phiri
Phillimon Daka
Aliness Phiri
Leonard Banda
Khuzuet Tuwele
Patricia Kamanga
Patricia had actually graduated in 2000 but had a year off to have her first child.
12
St Francis' Hospital
6.4.2
Staff Departures
Name
Dr Jonathan Tembo
Susan Andrew
Mrs Anne Chipungu,
Jonathan Mutonga
Chimuka Hambulo
Edward Banda
James Mwale
Eunice Muwowo
Nellie Mvula Longwe
Elke Radcliffe
Benjamin Banda
Saul Banda
Elizabeth Phiri
Dr Jolanda de Jong
Grace Nyawana
Ignatius Miti
George Gondwe
Grace Gondwe Banda
Dr Rahman
Nazarius Mvula
Selenia Tembo
Febby Phiri
Dr David Elphick
Dr Heather Elphick
Green Singoyi
Dickson Tsamwa
Violet Zulu
Mubita Mubita
6.4.3
Annual Report 2000 and 2001
Post
Surgical Registrar
Night Superintendent
Principal Tutor
Medical Licentiate
ZEN
Manager Administration
Laboratory Technician
ZEN/ZEM
ZEN
Clinical Instructor
Medical Licentiate
Medical Licentiate
Night Superintendent
GMO (Memisa)
ZEN
ZEN
Laboratory Technician
ZEN/ZEM
Surgical Registrar
Accountant
ZEN
ZEN
Registrar Physician (USPG)
Registrar Physician (USPG)
Personnel Officer
Principal Clinical Officer
ZEN
RN
Date
January 2000
April 2000 (Retired)
May 2000
September 2000
October 2000
January 2001
January 2001
January 2001
January 2001
January 2001
February 2001
February 2001
February 2001
March 2001
April 2001
June 2001
July 2001
July 2001
July 2001
August 2001
September 2001
October 2001
August 2000
August 2000
October 2001
October 2001 (Retired)
October 2001 (Retired)
December 2001
Short Term Volunteer Staff
Name
Dr Patrick Nearney
Sarah Nearney
Dr Cathy Simon
Sarah Nearney
Dr Mark Wood
Dr Julie Wood
Post
Paediatrics
Physiotherapist
Medicine
Physiotherapist
Paediatrics
Medicine
Dates
February – September 2001
February – September 2001
June – November 2001
February – September 2001
October – November 2001
October – November 2001
13
St Francis' Hospital
6.4.4
Staff who have passed Away
Name
Lyford Mwale
Harrison Muwowo
Yobe Moyo
Victoria Banda
Jiyo Mwale
Enala Chirwa
Andreya Mbewe
Sarah Manda
Joyce Banda Soko
Dorothy Chondo
Prekeria Phiri
Nefati Banda
Eddina Mwanza
7.
7.1
Annual Report 2000 and 2001
Post
General Worker
Asst. Manager Administration
Carpenter
ZEN
Watchman
Student Nurse
General Worker
ZEN/Student Midwife
ZEN
ZEN
ZEN
Theatre Porter
Domestic Ward Worker
Hospital Services
Referral System
Health Centres - serve populations of between 30,000 and 50,000 in urban areas and around
10,000 in rural areas. Their role is to carry out primary health care and they are the first point of
call for patients. District Health Boards receive funding to provide these services.
District/First Level Hospitals - are found in most, but not all of the 72 districts in Zambia. They are
intended to serve a population of 80,000 – 200,000 with medical, surgical, obstetric and
diagnostic services and with all clinical services to support health centre referrals. District Health
Boards receive funding to provide these services.
General/Second Level Hospitals - are at provincial level and are intended to cater for a catchment
population of between 200,000 - 800,000 people, with services in internal medicine, general
surgery, paediatrics, obstetrics and gynaecology, dental, psychiatry and intensive care services.
These hospitals are intended to act as a referral facility for the first level institutions, including
technical backup and training functions. 2nd Level Hospitals receive funding directly from Central
Board of Health for 2nd level patients and nurse training. Where they provide 1st Level Services for
a district, the District Health Board should pay for these services. There are two 2nd Level
hospitals in Eastern Province, St Francis' and Chipata General.
Central/Third Level Hospitals - are at national level and have sub-specialities. University Teaching
Hospital is a 3rd Level Hospital and receives referrals from 2nd Level Hospitals. They are funded
directly by Central Board of Health.
14
St Francis' Hospital
7.2
Annual Report 2000 and 2001
Out-patient Department
The outpatient department is busy and performs a number of different roles. For the
immediate population it acts as a Rural Health Centre, with patients coming directly to the
hospital. The department also receives referrals from the 15 Rural Health Centres in
Katete District as well as from many Rural Health Centres further afield. These are
categorised as 1st Level referrals. Being the only hospital in the district St Francis’
Hospital does receive most of the first level patients, although a few living at the Western
end of the district attend either Nyanje Hospital or Petauke District Hospital because they
are much nearer. Chadiza district has no hospital so we receive most of their patients
who are deemed to need hospital services. In addition St Francis’ also acts as a referral
unit for other hospitals to refer patients that they cannot manage. Theoretically these
should be 2nd level referrals but there are also many 1st level patients referred from other
hospitals.
There are several reasons for St Francis' Hospital receiving 1st Level referrals:
• Inability to manage various conditions because of either a lack of staff (mainly
medical), or the staff are very junior and lack experience
• lack of equipment
• lack of drugs or medical supplies
• poor organisation
All these patients coming from a variety of sources put a great strain on the staff in the
OPD and the area is often very congested. It is however testimony to the reputation of St
Francis’, built up over many years, that patients choose to make difficult and expensive
journeys, and other institutions look to us for assistance.
With the reforms and the improved funding of primary health care services through the
District Health Management Boards attempts have been made to rationalise the access
to health services. Districts are responsible for the provision of primary and 1st level
services. Patients are meant to attend their local health centre first and only attend a
hospital if referred. To try to encourage patients to follow this referral route a ‘By-Pass’
Fee of K15,000 was introduced in late 2000. This is viewed as expensive compared to
the charge of K6,800 for a card and a consultation, or K1,800 a consultation when a card
has previously been purchased (adult prices). The immediate effect was a reduction in
outpatient attendance and a dramatic increase in referred cases from Health Centres.
Patients from the immediate vicinity of St Francis' Hospital are not expected to go to a
Health Centre first and are therefore not charged a ‘By-Pass’ Fee. It is not known what
effect the introduction of a the By-Pass Fee has had on patient care in terms of patients
gaining access to appropriate care within a reasonable time or at all. Tables below give
information on outpatient’s attendances, and source of referrals.
15
St Francis' Hospital
7.2.1
Annual Report 2000 and 2001
Specialist Clinics
Type
Comments
Gynaecology
Medical Clinic
Surgical Clinic
TB Clinic
Eye
HIV & STD
Dental
Children’s Clinic
ANC
Postnatal
Family Planning
Waiters
Weekly – Gynaecologist led
Includes Paediatric cases – weekly – Physician led
All surgical problems including orthopaedics – twice weekly – Surgeon led
TB follow up as per national guidelines – weekly – Physician led
Daily Monday - Saturday - Enrolled Nurse led
Daily Monday - Saturday - Clinical Officer led
Daily Monday - Saturday - Clinical Officer led
Daily Monday - Saturday - Nurse led
Weekly – Midwife led
Weekly – Midwife led
Weekly – Midwife led
Seen daily by midwives who can refer to doctor
Figure 7.1
Out Patient Clinics including specialised clinics - Attendance’s
Clinic
General Outpatients
Children's Clinic
Ante-Natal
Dental
Eye Clinic (Hospital Only)
Surgical (including Orthopaedics)
Gynaecological
Medical
Psychiatric (including outreach)
STD
Family Planning
Post Natal
2001
20334
8588
1021
2046
1437
2027
2179
1658
1680
705
540
62
2000
34320
15188
1161
2534
2709
2101
2070
3056
85
2079
728
139
1998
24113
27780
19310
8483
2087
2712
2152
2742
1578
2068
1206
136
1997
50088
26765
17039
2810
1927
3275
1614
1697
2499
1739
1780
156
General outpatient attendance’s reduced dramatically in 1998 and again in 2001. These
reductions are probably attributed to the increase in user fees in 1997 and introduction of
the by-pass fee in 2000 and the increasing difficulty many of the local population find in
paying for transport. Transport costs have increased more rapidly than most costs
because of the steep rise in the cost of fuel. Also the dramatically improved funding
received by districts has lead to an improvement in the services provided at rural health
centres and they may now be meeting the needs of some patients who previously
attended St Francis' Hospital. In addition the patients seen on outreach are no longer
included in the above figures.
16
St Francis' Hospital
Figure 7.2
Annual Report 2000 and 2001
First Attendance in Out Patient Department – By Diagnosis
Over 5’s
Under 5’s
Disease
2001 2000
Disease
2001 2000
Malaria
2088 4656
Malaria
2025 3344
Respiratory infection
122
153
Dental Diseases
1855 2270
Dental Diseases
115
113
Respiratory infection
703
781
Protein energy Malnutrition
101
74
STD
695
1038
Pneumonia
66
65
Trauma
364
414
Trauma
66
73
Digestive system (not infectious)
268
466
Anaemia
64
265
Anaemia
264
330
Diarrhoea non-bloody
56
477
Pneumonia
251
268
Skin Infections
44
53
Diarrhoea non-bloody
222
357
TOTAL
3118 6331
TOTAL
9940 13253
As can be seen from the above table, the major cause of attendance in the outpatient
department remains malaria. In children it accounts for more than two thirds of the cases.
Even in adults it is a major factor.
17
St Francis' Hospital
Figure 7.3
Annual Report 2000 and 2001
Source of Referrals
2000
1st Level
No.
%
2225 58
2225 58
2nd Level
No.
%
19
21
19
21
2001
1st Level
No.
%
6326 70
6326 70
2nd Level
No.
%
87
40
87
40
Petauke District Health Centres
Petauke Hospital
Nyanje Hospital
Minga Hospital
District Total
172
117
55
10
354
4
3
1
0
9
5
17
10
2
34
5
18
11
2
37
193
274
77
11
533
2
3
1
0
6
7
20
14
2
43
3
9
6
1
20
Chipata District
407
31
1
439
11
1
0
11
7
5
9
21
8
5
10
23
913
57
9
979
10
1
0
11
11
35
9
55
5
16
4
25
Chadiza District Health Centres
District Total
602
602
16
16
6
6
7
7
813
813
9
9
3
3
1
1
Mambwe District Health Centres
Kamoto Hospital
District Total
174
1
175
5
0
5
5
1
6
5
1
7
202
2
204
2
0
2
4
4
8
2
2
4
Nyimba District
Nyimba Hospital
District Total
36
36
1
1
6
6
7
7
76
76
1
1
14
14
6
6
Lundazi District
Lundazi Hospital 0
Lumezi Hospital 0
District Total
0
0
0
0
0
0
0
0
0
0
9
2
11
0
0
0
2
0
2
1
0
1
Others
0
0
0
0
52
1
5
2
Total
3831
100
92
100
8994
100
277
100
Source of Referral
Katete
Health Centres
District Total
Health Centres
Chipata General
Mwami Hospital
District Total
The large increase in Referrals in 2001 (8994 referrals) compared to 2000 (3831
referrals) was due to the introduction of a ‘By-pass’ fee for those attending hospital from
outside the catchment area without a referral letter. This policy did indeed result in more
patients visiting their local rural health centres before coming to hospital. As can be seen
from these figures, patients come from all over the Eastern Province (and some from
beyond) for treatment.
18
St Francis' Hospital
7.3
Annual Report 2000 and 2001
Inpatient Services
Figure 7.4
Hospital Admissions – By Ward
2001
2000
1998
Admissions
Admissions
Admissions
35
2747
3052
2528
Mbusa was Bwino (Children<5yr) 80
4119
5138
3981
St Monica (Female Medical)
40
1314
1498
1616
St Augustine (Male Medical)
40
1225
1208
1556
Kizito (Male Surgical)
40
958
840
1422
Mukasa (Female Surgical)
30
1471
1506
765
York (TB)
63
362
453
415
Special Care Baby Unit
12
269
294
352
441
472
14430
13107
Actual
No.
Ward
Bethlehem (Maternity)
Bed
St Luke's (Isolation)
Total
Figure 7.5
340
12465
Average Length of Stay and Occupancy by Ward
Ward
Bethlehem (Maternity)
Mbusa was Bwino (Children<5yr)
St Monica (Female Medical)
St Augustine (Male Medical)
Kizito (Male Surgical)
Mukasa (Female Surgical)
York (TB)
Special Care Baby Unit
St Luke's (Isolation)
Total
2001
2000
1998
Av. Stay Occupancy
Av. Stay Occupancy
Av. Stay
Occupancy
7.9
6.1
5.8
6.4
12.3
8
32.9
12.4
60
69
21
22
32
32
33
9
7.4
278
8.5
5.4
5.3
6.1
9.6
8.0
28.1
12.3
6.2
6.8
10.3
5.5
5.9
6.6
7
9.4
15
10
8
7.3
71
60
26
28
27
20
17
10
10
270
71
76
22
20
33
22
35
10
7
295
N.B. The overall average stay figures do not include York the TB ward.
As can be seen from Figure 7.4 the number of admissions increased in 2000 and then
returned to a level just below that of 1998 in 2001. The major exceptions were Mukasa,
which had many more admissions in 2001 than 1998, and St Luke’s, the isolation ward,
which was closed due to staff shortages in July 2000.
Although the number of admissions reduced from 2000 to 2001, this decrease was not as
sharp as the number of patients seen in OPD, which suggests that on the whole those
sick enough to require admission were still coming to the hospital. If this is the case, then
19
St Francis' Hospital
Annual Report 2000 and 2001
the introduction of the by-pass fee was successful in encouraging patients to visit their
health centre first. It will be important to monitor the system in the future.
Bethlehem, the maternity ward, admits antenatal patients with a gestation age of more
than 24 weeks, and postnatal patients. The Special Care Baby Unit (SCBU) admits
newborn babies with weights below 2000g, or gestational age less than 36 weeks or a full
term baby in need of special care for other reasons.
Children below the age of 5 years are admitted to the Children’s Ward. Mbusa wa Bwino.
Children above that age are admitted to the adult wards.
Paediatric surgical patients are all admitted to Mukasa, the female surgical ward.
Mukasa receives female surgical patients, including gynaecological cases and Kizito
receives male surgical patients. Medical patients are admitted to St Augustine and St
Monica along with those with abscesses and septic wounds to prevent cross infection on
the surgical wards.
St Luke’s was the isolation ward until closure due to shortage of staff. Infectious cases
are now nursed in side rooms on the main wards and burns cases are kept together on
the surgical wards.
All confirmed cases of TB are treated on the TB ward, York. Prior to diagnosis they are
usually admitted to the medical wards and nursed on the verandahs. The length of stay
increased in both 2000 and 2001 due to a change in the treatment protocol.
20
St Francis' Hospital
Figure 7.6
Annual Report 2000 and 2001
Admission to Hospital – Principal Diagnoses – Under 5’s
2001
2000
Disease
Admissions
Deaths
Malaria
3085
256
Case
Fatality
Rate %
8.3
Anaemia
887
40
Respiratory infection
554
Protein energy Malnutrition
Admissions
Deaths
3840
214
Case
Fatality
Rate %
5.6
4.5
780
24
3.1
32
5.8
300
16
5.3
317
85
26.8
328
89
27.1
Pneumonia
260
52
20.0
302
40
13.2
Diarrhoea non-bloody
178
27
15.2
338
52
15.4
Any perinatal conditions
170
34
20.0
137
20
14.6
Skin Infections
108
5
4.6
143
2
1.4
Trauma
87
2
2.3
130
5
3.8
AIDS
49
8
16.3
34
8
23.5
Meningitis
48
23
47.9
38
7
18.4
Muscular skeletal & connective
tissue (not trauma)
37
0
0.0
26
1
3.8
TB
24
5
20.8
26
9
34.6
Pulmonary diseases (not
infectious)
24
0
0.0
17
0
0.0
Cardio-vascular diseases
22
1
4.5
28
3
10.7
TOTAL
6081
591
9.7
6812
528
7.8
Figure 7.7
Admission to Hospital – Principal Diagnoses – Over 5’s
2001
2000
Disease
Admissions
Deaths
Trauma
844
24
Case
Fatality
Rate %
2.8
Malaria
558
30
TB
400
Neoplasm
Admission
s
Deaths
802
10
Case
Fatality
Rate %
1.2
5.4
645
38
5.9
87
21.8
326
37
11.3
393
49
12.5
326
28
8.6
AIDS
302
72
23.8
172
63
36.6
Genital-Urinary diseases
292
4
1.4
319
3
0.9
Skin Infections
262
1
0.4
269
2
0.7
Complications of pregnancy
232
3
1.3
278
1
0.4
Pneumonia
194
29
14.9
204
39
19.1
Respiratory infection
176
19
10.8
154
12
7.8
Cardio-vascular diseases
157
32
20.4
217
47
21.7
Digestive system (not inf.)
139
12
8.6
143
6
4.2
Diarrhoea non-bloody
134
12
9.0
184
32
17.4
Anaemia
122
5
4.1
136
3
2.2
Complications of delivery
98
8
8.2
94
1
1.1
TOTAL
5594
486
8.7
5440
394
7.2
21
St Francis' Hospital
Figure 7.8
Annual Report 2000 and 2001
Theatre: List of Major Operations
2001
General
Appendectomy
Cholecysto-jejunostomy
Colostomy
Colostomy – closure
Feeding jejunostomy
Duhamel Operation
Exomphalos, repair
Gastro-enterostomy
Groin dissection
Hernia
Hydrocelectomy
Imperforate anus reconstruction
Intestinal resection/anast
Laparotomy - exploratory
Laparotomy - intest obstr.
Laparotomy - peritinitis
Major debridement/suturing
Open chest drainage -thoractomy
Simple mastectomy
Splenectomy
Thyroidectomy
Tracheostomy
Wide excision soft tissue tumour
Mini-laparotomy
Other
Total
Genito-urinary
Cysto(s)tomy
Amputation Penis
Orchidectomy
Orchidopexy
Prostatectomy
Ureteric transplant
Others
Total
Ophthalmic
Cataract extraction
Enucleation
Evisceration
Iridectomy/suturing cornea
Needling/lavage
Tarsorrhaphy
Trabeculectomy
Removal FB ant chamber
Other
Total
Reconstructive
SSG>5%
Cleft lip/face repair
Cleft palate repair
Release contructure/Z-plasty
Syndactyly
Other
Total
1
3
5
7
2
57
27
2
8
50
27
7
5
2
2
3
1
1
4
8
222
2000
4
3
1
67
8
6
42
10
12
2
4
3
2
8
13
3
188
4
4
1
1
19
4
2
29
64
1
27
11
5
22
3
7
3
82
1
15
2
1
3
8
1
105
113
18
2
4
2
2
3
23
8
1998
2001
Orthopaedic
Arthrodesis
Arthrotomy
Bilateral obturator neurectomy
Bone graft
Chiselling
Correction talipes equinovarus
Costo-transversectomy
Drilling for osteitis
Dyllon Evans
Excision bone tumour
Excision patella
External fixation
Giddle stone arthroplasty
Interdental wiring
K-nail
Major amputation/disarticulation
Moore's prosthesis
O.R.I.F.
Open reduction
Osteotomy
Sequestrectomy
Tendon transfer/release/repair
Other
Total
5
1
5
2
2
2
2
62
13
1
15
31
5
15
2
1
2
6
3
2
8
18
203
2
2
4
10
33
1
13
65
73
4
22
3
9
1
12
1
4
129
9
4
3
2
5
1
24
22
Obstetrics and Gynaecology
Abdominal Pregnancy
BTL (as single procedure)
Ectopic pregnancy
Extended hysterectomy
Hysterectomy for rupt uterus
Hysterorrhaphy for rupt uterus
Laparotomy for PID
LSCS
Myomectomy
Ovarian cyst/tumour
Repair RVF
Repair vaginal prolapse
Repair VVF
Salpingolysis/salpingectomy
Total hysterectomy (elective)
Vaginal hysterectomy
Abdominal VVF repair
Other
Total
Neurosurgical
Ventriculo-peritoneal shunt
Revision VPS
Elevation depressed skull fract.
Repair periheral nerves
Burr holes
Other
Total
2000
37
3
14
2
6
3
1
1
1998
5
18
1
1
9
11
4
3
4
2
3
3
3
4
32
2
2
5
2
19
4
102
152
13
29
2
10
5
249
2
9
1
5
22
9
42
2
5
2
559
32
2
1
3
2
3
31
3
25
3
5
23
9
1
1
106
8
2
7
125
1
135
16
1
82
18
3
8
4
7
213
12
12
2
278
18
1
23
1
44
1
1
545
29
23
2
1
19
29
2
4
416
4
4
37
33
26
17
2
2
3
5
55
Total No. of Major Operations
1077
1015
1017
Total No. of Minor Operations
1924
1758
1960
1
St Francis' Hospital
7.3.1
Annual Report 2000 and 2001
Theatres
The theatres are very busy; there are three theatre days, Mondays, Wednesdays and
Fridays. Emergencies can be done at any other time. Mr Peter Chanda is the nurse in
charge of the theatres and Rodwell Banda the senior anaesthetist. The staff are split into
teams and there are always nurses, an anaesthetist and of course a surgeon on call.
There are two clean operating rooms and one for septic cases.
As can be seen from the above table the number of operations is fairly constant, although
showing a slight increase in 2001. Many of the patients are from out of Katete District as
St Francis' Hospital is a referral hospital for surgery. Figure 7.8 does demonstrate the
range of operations performed by our surgeons and shows how versatile they need to be.
The theatres are generally in good condition, having been upgraded in 1999. The range
of instruments is good, as a result of the priority the hospital places on surgery, but some
supplies still run short due to the problems with funding and actually locating the supplies.
The main problem is with the operating tables, none of which function correctly.
7.3.2
Maternity Department
Figure 7.9
Deliveries in Hospital
Total Deliveries
Breech deliveries (incl. Multiple births)
Lower Segment Caesarean Section
%LSCS of Total
Vacuum extraction
Forceps Delivery
Symphysiotomy
Destructive Deliveries
Ruptured Uterus
- hysterectomy
- hysterorrhaphy
Maternal Deaths
2001
1707
71
245
14.4
37
0
0
4
16
8
8
13
23
2000
1873
84
265
14.1
61
0
0
6
15
6
9
6
1998
1962
116
224
11.4
56
0
3
11
16
8
8
8
St Francis' Hospital
Annual Report 2000 and 2001
Figure 7.10 Babies Born in Hospital
2001
2000
1998
1778
1918
2023
% premature birth/total births
21
21
21
Multiple births - twins
52
64
80
2
0
3
Full term - live births
1318
1436
1541
Full term - still births
78
85
54
Full term - neonatal deaths
11
13
12
Full term - perinatal deaths/1000
64
64
41
Premature Births - live births
309
335
386
Premature Births - still births
73
62
42
Premature Births - admitted after birth
94
125
168
Premature Births - neonatal deaths
62
78
115
284
268
263
Total Born in Hospital
Multiple births - triplets/quads
Premature Births - perinatal deaths/1000
Dr Ziche Makukula, Consultant Obstetrician and Mrs Grace Ngwenya the senior nurse
lead the maternity department.
The department consists of:
• the main ward and is made up of the main ward, catering for prenatal and antenatal
mothers
• the labour ward
• special care baby unit (SCBU)
• the ‘Waiters’
The department is staffed by midwives and a few enrolled nurses.
The SCBU admits babies with low birth weigh, prematurity or other conditions that
necessitate special care. There are 10 simple incubators made of wood and glass with
heat provided by a light bulb. Sometimes there are two babies in each incubator, being
monitored, kept warm, naso-gastrically tube fed and nursed by their mothers under the
supervision of the nursing staff.
The ‘waiters’ are expectant mothers who are expecting their first child or have a history of
miscarriages or other obstetric problems or are considered ‘at risk’. They do not stay on
the maternity ward itself, but in other accommodation within the hospital and are
monitored daily by midwives and referred to the doctor if necessary. This service
definitely gives the mothers a better chance of delivering a healthy baby but has in part
led to the increase in caesarean sections.
The rates for caesarean sections (14.4%) and premature births (21%) are relatively high.
24
St Francis' Hospital
Annual Report 2000 and 2001
This is due to the fact that although the overall number of deliveries in hospital has
decreased, the proportion of complicated cases has increased. This is in keeping with the
role of St Francis' Hospital as a second level referral hospital.
7.4
Paramedical Departments
7.4.1
Radiography Department
Sheckson Musonda heads the department and following the arrival of Phyela Phiri in July
2001 there are now 3 radiographers. The equipment consists of a new Philips x-ray
machine (donated by Simavi from the Netherlands in 1999), an elderly but still useful
back up x-ray machine, a portable x-ray and an ultrasound machine. There was an
increase in the investigations carried out, possibly due to more junior staff and improved
availability of film.
X-Rays
2001
2000
1998
Chest
1447
1491
1311
Lower limb
654
577
577
Upper limb
664
561
599
Spine
155
120
130
Skull
78
106
62
Abdomen
110
137
51
Pelvis
126
89
84
Barium Studies
52
35
50
Dental
18
31
11
Urograms/cystograms
16
7
7
Hysterosalpingogram
12
21
13
Total
3332
3175
2895
Ultrasound Examinations
2139
1662
2072
7.4.2
Physiotherapy Department
Mr Chongo Mwansa took over as in charge of the department from Julius Banda who left
in 2000. He worked alone in the department until the arrival of Sarah Nearney a
physiotherapist from the UK who worked in the department from February to September
2001. Anderson Phiri arrived in October 2001. Heather Godfrey also visited the
department and there were several students from Evelyn Hone College gaining practical
experience.
The physiotherapy department provides a valuable service to patients suffering from
burns, spinal injuries, fractures (particularly those who have been in traction), strokes and
cerebral palsy. Patients are seen on the wards or if mobile they can visit the department.
25
St Francis' Hospital
Annual Report 2000 and 2001
Patients are also seen as outpatients and on outreach. A physiotherapist assists at
surgical outpatient clinics.
Physiotherapy Statistics
Attendances
2001
2000
1998
750
626
677
3110
2982
3419
224
301
297
82
91
87
Calipers
0
0
1
Orthoshoes
4
0
55
Leprosy shoes (pairs)
2
2
2
3
3
0
First attendances
Total attendances
Crutches
Orthosticks
Appliances made
Prostheses modified
7.4.3
Dental Department
Dental services are provided to inpatients and outpatients at the Dental Clinic. The Dental
Clinic is run by Clinical Officer, Mr Emmanuel Munyansho assisted by Mrs Fredah Phiri,
Dental Assistant. The department is very busy.
Attendances
2001
2000
1998
1934
2406
2734
111
128
112
Total
2045
2534
2846
Permanent teeth
1267
1646
1982
Deciduous teeth
53
48
69
Permanent teeth
180
145
41
9
4
110
24
19
9
34
30
28
460
512
512
Adults
Children - under 15
Extractions
Fillings
Temporary teecth
Anterior
Scalings, operculectomy
Dental Checks
26
St Francis' Hospital
7.4.4
Annual Report 2000 and 2001
Laboratory Department
This comprises the blood bank, haematology, clinical chemistry and microbiology. Mrs
Marceline Kimakinda, Senior Laboratory Technologist was in charge of this department,
assisted by Raphael Banda, Adrian Chambule and Chrispin Chatipwa.
Department
No. Tests In 2000
No. Tests In 2001
Haematology
Parasitology
Malaria Parasitology
Microbiology
Biochemistry
Blood Bank
Others (Cytology)
5061
3789
18680
3364
2474
3490
23
8076
3410
13359
5951
1593
3613
23
The equipment being used in the laboratory is old and needs modernisation.
7.4.5
Outreach
Following the health reforms the District Health Management Board is responsible for
primary health care and the services in the rural health centres. St Francis’ Hospital
continues to help out and provides support to the Health Centres by sending out a team
of clinical officers and paramedical staff five times per month. The team comprises
officers specialising in Dental, Eyes, Physiotherapy and Psychiatry. On occasions, when
the medical staffing in the hospital allowed, a medical officer joined the team. The
intention is that the staff from St Francis’ work with the clinic staff so that they can learn
new skills. Sadly the clinic staff are not always present, a joint technical committee should
deal with this and other problems, but this has not functioned for some considerable time.
8.
Ancillary Departments
These provide an essential, not so glamorous and often forgotten service to the hospital.
2000 was a difficult year as many long serving and experienced staff were retrenched.
The government had started this process but they never provided the money to pay for
Long Service Bonus and other money owed to the workers. Originally the intention was to
retrench all the general workers but lack of money prevented this. The uncertainty as
regards funding made life very difficult for the workers and management and was part of
the reason for the unrest mentioned earlier in this report. Thankfully for the hospital,
money was raised, largely due to the efforts of Bishop John and the generosity of ‘The
Diocese of Bath and Wells’ and the United Society for the Propagation of the Gospel’ and
30 workers were retrenched. The money was also used to pay the families of a number of
other workers who had passed away and were owed terminal benefits. Sadly the issue of
money for the remaining CDE’s has still not been resolved although Churches Medical
Association of Zambia continues to campaign on behalf of all the Church institutions in
Zambia. As a result of the retrenchments a number of departments lost experienced staff
and had to cope with fewer workers.
27
St Francis' Hospital
8.1
Annual Report 2000 and 2001
Security Department
Number of staff - 10
During 2000 the staff in the department received new uniforms and were trained. Both of
these measures led to increased moral and performance from the department. During
2001, on one memorable night, two of the staff apprehended two burglars inside a
rondavel. They were arrested and later appeared in court. Due to the work of Vincent
Zulu the In-charge, Kwezikani Zulu his deputy and the rest of the staff the number of
thefts reduced. There is no place for complacency, as the hospital and staff houses
remain attractive to local thieves.
8.2
Hospital Kitchen
Number of Staff - 3
This kitchen provides in the region of 306,600 meals a year. The food is basic, maize
porridge for breakfast and then nshima (maize meal) with beans or vegetables for lunch
and supper. Meat is served once a year at Christmas! We would like to serve a more
varied diet but financial constraints make this impossible. It is definitely hard work with the
staff reporting for work at 4am to prepare breakfast. It is difficult to imagine cooking
nshima for 400 people but it is stirred with something that resembles (or actually may be)
a canoe paddle. Many of the large electric cooking pots are on their last legs and
regularly require repair. We were therefore indebted to Bishop John and Jersey Overseas
Aid who provided the hospital with two new pots.
8.3
Laundry
Number of staff - 4
The department washes all the bedding and theatre linen for the hospital. Much of the
equipment is old and no longer working effectively. Although the two washing machines
work, they only rotate in one direction and do not heat the water, so as a result the linen
is not as clean as we would like. The squeezers do not work most of the time, and the
tumble drier and pressing machine have not worked in the period covered by this report.
The ironing is currently done with domestic irons. Despite these difficulties the staff
continue to do their best. Jason Banda is in charge.
8.4
Records Department
Number of Staff - 2
This department is responsible for keeping the hospital patients record and producing the
many statistics that a report such as this, the Central Board of Health and the hospital
management require. All this is currently done manually. The hospital has to provide
information to meet the guidelines the Central Board of Health has laid out in the Health
Management Information System (HMIS). This is challenging and something that the
hospital will have to work hard at as more and more emphasis is being placed on
28
St Francis' Hospital
Annual Report 2000 and 2001
provision of information. The staff work hard and the problems often lie with the health
care professionals who do not always see the importance of filling in forms accurately, or
at all on occasions! Bornface Phiri is the Records Officer.
8.5
Accounts
Number of Staff - 8
The above number of staff includes revenue collectors on the wards and in the outpatient
department. The actual number of staff based in the accounts department itself is five.
The accounts department provides a range of services to the hospital. They deal with all
the routine hospital income and expenditure, they run the payroll of in the region of 150
staff and maintain the accounts for all the projects. The work is complex. Unfortunately
the Hospital Accountant during the period 2000 and 2001 was under-qualified and had a
great deal of time off work due to sickness. He passed away in September 2001. As a
result of this and other problems management has found it difficult to get timely reports
and returns to CBoH have been submitted late. It has also been very difficult to give the
many donors who support the hospital as much information as they and we would like.
Towards the end of 2001 the hospital management approached Voluntary Services
Overseas (VSO) and they agreed to search for a suitably qualified accountant. It is hoped
that this will improve the service provided by the department.
8.6
Workshop
Number of Staff - 12
This department was probably the hardest hit by the retrenchments. By the end of 2000
the only skilled staff remaining were: the Workshop Foreman (also electrician), one
plumber and 3 drivers. The remaining staff were either semi-skilled or completely
unskilled. This situation in addition to the fact that the hospital had not had a qualified
engineer since the end of 1997 and chronic lack of funding had resulted in the
infrastructure reaching a very low level. In 2000 a Dutch engineer was sent by an
organisation called NMCP at the request of the Netherlands Medical Support Group for a
period of 3 months. He provided a report that made clear the serious position that faced
the hospital and made some recommendations for the future. It has to be said that his
visit caused some frustration as some workers expected him to fix things whereas his
remit from NMCP was advisory and to make a report. During 2001 some new staff were
recruited as the staffing levels had made even basic maintenance almost impossible. In
September 2001 Mr Paul Splint, another volunteer from NMCP arrived at the hospital.
The intention is that he will stay for one year and have a more ‘hands on’ role. There are
several areas that need urgent attention. The hospital suffers regular water shortages,
only five of the eight bore hole pumps are working, the two circulating pumps are getting
near the end of their life and there are leaks in the storage tanks and pipe work. The
generator, which provides power to the hospital during the regular power cuts that we
have, has had some major problems during 2001 despite being serviced. The ablution
blocks on many of the wards are in a very bad state. The roofing timber on the TB Ward
has been attacked by termites and will soon be in a dangerous state. These are some of
the critical areas but there are many more.
29
St Francis' Hospital
8.7
Annual Report 2000 and 2001
Building Department
Number of Staff - 8
The building department has for many years undertaken most of the building at St
Francis’. They are also responsible for building repairs and maintaining the hospital site.
Mr Zumani Juma is the Foreman and the longest serving member of staff, having started
at St Francis' Hospital in 1954.
8.8
Transport
Below is a list of the vehicles owned by St Francis' Hospital. As can be seen, the newest
vehicles on the list were supplied in 1997. There is currently no mechanic employed by
the hospital so as the vehicles become older it will be expensive and difficult to keep them
on the road. The purchase of at least one new vehicle should be considered soon.
Inventory of Current Transport
No.
Make
Vehicle
Number
Year
Condition
Comments
1
Massey Ferguson 375 Tractor
AAK 849
1990
Non-runner
Should be disposed of.
2
Toyota Hilux
AAK 3470
1991
Runner
Fair, small repairs needed
3
Toyota Hi-ace Minibus
AAL 1890
1992
Non-runner
Needs engine overhaul
4
Landrover Defender 110
AAM 6156
1994
Runner
Fair condition
5
Honda 110 Trail Bike
AAM 6988
1994
Non-runner
6
Toyota Truck 3300
AAM 7076
1994
Runner
7
Honda 125
AAN 1581
1995
Non-runner
8
Fiat Tractor 70-56
AAL 4273
1996
Runner
Fair condition (PAM)
9
Honda 110 Trail
AAP 119
1996
Runner
Needs battery
10
Toyota Hilux 4WD
AAP 7455
1997
Runner
Fair
11
Toyota Landcruiser
AAP 7456
1997
Runner
Fair– needs new shocks
12
Toyota Landcruiser
AAP 9181
1997
Runner
Good condition – AIDS Dept
8.9
Good condition
Housing
St Francis is a large hospital, and has a large housing stock. Despite this there are
several problems. Much of the housing is old and in need of renovation. Another factor is
that expectations have increased and many new staff demand better housing. Quite a
number of the houses were built when the number of expatriate staff was much great and
their needs (most of them being single) are very different from the needs of the local staff.
The staff at the hospital not only have to look after their own family but in most cases a
number of dependants. As mentioned earlier, it is difficult to attract staff and as a result,
provision of good quality housing has become more important than ever before if we are
to entice good quality staff to come and work at St Francis’.
The main issues with housing are therefore:
• Not enough housing
• Many of the existing houses in poor condition
• Existing houses too small
30
St Francis' Hospital
9.
Annual Report 2000 and 2001
AIDS Department
St Francis' Hospital has had an AIDS Department for since 1989, being one of the first
hospitals to see the need to devote special attention to dealing with the problem of
HIV/AIDS. Despite being funded separately from the rest of the hospital, the funding
being provided by donors, the department is still an integral part of the hospital. The
overall aim was, and still is, to increase AIDS awareness in the community through
education, counselling, caring and support for the infected and affected people. The staff
in the department are seconded from the hospital on a full time or part time basis. The
Co-ordinator is Mr Danwell Simbeya, a Senior Clinical Officer specialised in STD’s
including HIV and AIDS. Mr Grayson Mvula, the Deputy Co-ordinator who is a Zambia
Enrolled Nurse, assists him. The Technical Advisor to the department is Dr Yotham Phiri.
The main activities of the project are:
• Pre and post Counselling of In and Out-Patients
• Home Based Care
• Clinical and Supportive Services (VCT and STD clinics)
• Laboratory Services (HIV Screening)
• AIDS Education
• Community and Schools Education
• Anti-AIDS Drama
• Training of Community Volunteers
• Orphan Support
9.1
Summary for 2000
2000 was the final year of a three-year programme and to plan for the future of the
project, it was agreed with CORDAID, one of the main donors that they send Dr Piet
Reijer to carry out an evaluation of the project in September and October. This would not
only assess the current project but be used to develop a Workplan and Budget for the
future.
Overall, the project continued to make progress in various areas. Another 300 Community
Based AIDS Volunteers were trained bringing the total number to 504. These volunteers
take part in care of patients at home, community education and counselling. The aim of
training community volunteers is to encourage community participation and increase the
coverage of the programme. Other achievements were improved co-operation with
community leaders (Chiefs, Village Headmen) and collaboration with other organisations
involved in the field of HIV/AIDS. There were also problems encountered during the year,
largely related to difficulties in communicating with donors and late receipt of funding.
9.2
Summary for 2001
The year 2001 for the HIV/AIDS Programme was one in which programmes were partially
suspended. The previous programme evaluation was received towards the end of 2000
and the subsequent programme workplan and budget was finalised and received in May
2001. It was developed with the assistance of Dr Piet Reijer who was contracted by
Cordaid to help in both programme evaluation and workplan and budget development.
31
St Francis' Hospital
Annual Report 2000 and 2001
The implementation of the new workplan, which was supposed to start January 2001,
was therefore delayed and full funding for it was not received until the end of the year.
The new programme should now start from January 2002 and will last for 36 months,
hence the rather disjointed programme for 2001 which was really a continuation of the
previous programme with some monetary restrictions.
9.2.1
•
•
•
•
Achievements
Increased community participation in HIV/AIDS prevention, care and support activities.
(714 community based AIDS volunteers working in 514 villages)
Networking with Governmental and non-governmental organisations involved in AIDS
work
Over 60% of school age orphans who had lost a chance of schooling have continued
going to school.
AIDS programme evaluation has facilitated the implementation of the new AIDS
programme, which started January 2002.
9.3
Composition of AIDS Programme Team (at 31st December 2001)
Name
Mr Danwell W. Simbeya
Position/Status
AIDS Project Co-ordinator Senior Clinical Officer STD/AIDS,
Psychosocial Counsellor – full time seconded
Mr Grayson Mvula
Deputy AIDS Project Co-ordinator, Zambia Enrolled Nurse,
Psychosocial Counsellor – full time seconded
Mrs Fredah Phiri
Dental Assistant – part time seconded
Mr Harrison Tembo
Senior Clinical Officer Psychiatry - part time seconded
Mr Raphael C. Banda
Laboratory Technician - part time seconded
Mrs Charity Nkosi
Secretary/Typist – Full time project Employee
Dr Yotham Phiri
Surgeon – AIDS Project Technical Advisor
Dr Shelagh Parkinson
Paediatrician, Hospital Executive Director, Communications/fund
raising
9.4
Statistics – 2001, figures for 2000 in brackets
9.4.1
HIV Counselling and Testing
January – December 2001 (2000)
Males
Females
Total
Total number of clients pre-counselled
283
(297)
248
(352)
531
(649)
Total number of clients who accepted the HIV test
195
(281)
187
(331)
382
(612)
Total number of clients who declined the HIV test
88
(11)
61
(13)
149
(24)
Total number tested positive
165
(157)
164
(188)
329
(345)
Total number post-counselled (neg. and pos.)
195
(281)
187
(331)
382
(612)
Total number who accepted home-based care
6
(59)
20
(77)
26
(136)
Total number opting for HIV support clinic
21
(8)
16
(12)
37
(20)
32
St Francis' Hospital
9.4.2
Annual Report 2000 and 2001
Home Based Care
January – December 2001
Males
Number of clients carried forward from 2000 (1999)
Females
Total
82
(69)
85
(73)
167
(142)
6
(59)
20
(77)
26
(136)
Total on the register during 2001(2000)
88
(128)
105
(150)
193
(278)
Number who died during 2001 (2000)
18
(21)
24
(27)
42
(48)
Number who declined further HBC
22
(2)
5
(5)
27
(7)
Number who moved out of the District
24
(15)
12
(21)
36
(36)
8
(8)
6
(12)
14
(20)
56
(42)
1325
(1362)
Number of new clients accepting HBC in 2001 (2000)
Number failed to trace
Total visits made by AIDS programme team
Total contacts made by AIDS programme team
602
(644)
723
(718)
Total visits made by community volunteers
324
Total contacts made by community volunteers
1120
Total number of clients at the end of 2001 (2000)
9.4.3
(82)
58
2461
(85)
74
(167)
STD Clinic Attendance
January – December 2001 (2000)
Genital ulcer disease (new)
Genital discharge (new)
Total new cases
Total reviews
9.4.4
16
1341
Males
152
101
253
242
(267)
(94)
(361)
(318)
Females
178
(188)
121
(113)
299
(301)
287
(258)
Total
330
222
552
529
(455)
(207)
(662)
(576)
AIDS Education by Community Based Volunteers
Place visited
Methods used
No. visits
Total Audience
Schools:
Primary
Songs, discussions, role plays
Basic
Lectures, discussions, debates, role plays
70
(64)
15,600
(14,470)
8
(10)
3,128
(4,075)
312
(299)
22014
(23,607)
Communities:
Villages
Songs, discussions, role plays
Churches
Songs, debates, discussions, role plays
22
(34)
6522
(7,226)
Health centres
Songs, discussions, role plays
65
(16)
4658
(2,855)
Women’s’ clubs Songs, discussions, role plays
34
(42)
1384
(1,660)
Football clubs
52
(20)
2113
(1,400)
563
(485)
55419
(55,293)
Discussions, songs, posters
Total
In addition, Omelo-Mumba school has developed an Anti- AIDS club sponsored by our
AIDS programme, which is doing child to child peer education and visited 7 other schools.
33
St Francis' Hospital
Annual Report 2000 and 2001
18 other schools in the District have now formed Anti-AIDS clubs and it is hoped that the
remaining 76 schools will follow suit in 2002.
9.4.5
Orphans Support
January – December 2001 (2000)
Boys
Girls
Total
1043
(1045)
957
(955)
2000
(2000)
1
(2)
4
(3)
5
(5)
Number moved away from the catchment area
17
(11)
25
(10)
42
(21)
Number dropped from the register (>18 years)
47
(17)
16
(6)
63
(23)
6
(1)
44
(12)
50
(13)
71
(31)
89
(31)
160
(62)
102
(29)
58
(33)
160
(62)
1076
(1043)
924
(957)
2000
(2000)
Number on the register at the end of 2000 (1999)
Number who died during 2001(2000)
Number dropped from the register (married)
Total number deleted from the register
New enrolments in 2001
Total on the register at end of 2001
9.4.6 Acknowledgements
We are grateful to the following donors without whom our AIDS programme activities
could not have continued:
Christian Aid
Cordaid
Cafod
Missio Austria
Zambia Society, UK
Fedburgh East Presbyterian Council
St Basil and All Saints Church
Sandy Logie Fund
10. Training
10.1
General Nurse Training School (NTS)
The NTS provides training for Zambia Enrolled Nurses, the course lasts for 2 years. In
recent years the school has had just one intake per year due to shortage of staff. New
students arrive in July and take their examinations in June.
The July 1999 intake (set 94) has 24 students.
The July 2000 intake (set 95) has 14 students.
The July 2001 intake (set 96) has 37 students.
In June 2000, 18 students sat their final exams with 14 (78%) passing.
In June 2001 17 candidates sat their final examination and all passed including the only
distinction in the country, Emmanuel Phiri.
34
St Francis' Hospital
Annual Report 2000 and 2001
The results are excellent considering the staffing levels in the school. Following the
departure of Mrs Chipungu, Ms Xoliswa Siwale has been Acting Principal Tutor, assisted
by Mrs Gertrude Zulu, Tutor and Mrs Agness Zimba and Mr Felix Chisha, Clinical
Instructors.
10.2
MidwiferySchool
The in-service training of Zambia Enrolled Midwives takes one year. Students commence
their studies in July and take their examinations the following June.
During 2000 the school faced a crisis with the departure of Mrs A. Chipungu and
Ms Lyamba for further training. The General Nursing Council recommended that the
school should be closed down but this situation was averted when Mrs M Seya agreed to
take on the added responsibility of Midwifery Tutor.
The July 1999 intake was 14. Of the 14 who sat their examinations in June 2000, 13
passed (93%), including 3 with honours (the only honours in the country) and one student
failed.
The July 2000 intake was 8 students. Yet again the examinations in July 2001 saw 100%
pass rate as all students passed, one with honours.
The July 2001 intake was 9. Sadly one of our own students, Sarah Manda passed away
on 31st December 2001.
The Graduation Ceremony for both schools was held on the 4th October 2001 and the
guest of honour was the Honourable Minister for Health, Mr Levison Mumba. He made a
donation of K1,000,000 (£200) to the schools and pledged a minibus. Sadly this promise
has yet to be fulfilled.
10.3
MMed Surgery Training
Sadly this programme has suffered from a shortage of students as many junior doctors
left the country after the strike in early 2000. This has resulted in a drastically reduced
number of students coming to St Francis’ as a part of their training. Previously we have
had two students at a time, but during the period covered by this report, only Dr Jonathan
Tembo who left in January 2000 and Dr Ahmed Rahman who was here for six months
from February to July 2001 have come to St Francis’ for training. This has obviously had
an impact on the workload for the senior surgeon, but more seriously will lead to
problems for Zambia as a whole as there will be a dramatic reduction in the number of
trained specialist surgeons.
10.4
Medical Licentiate Training Programme
Since 1999 St Francis’ has been receiving Medical Licentiates for periods of up to one
year following their completion of a two-year training course in Tanzania. These are
former clinical officers who have upgraded their qualifications and provide a useful
additional source of medical manpower. They come to St Francis’ Hospital to gain
35
St Francis' Hospital
Annual Report 2000 and 2001
practical experience and to reinforce the training they have received. At the end of the
year medical staff at St Francis’ recommend their registration with the Medical Council of
Zambia provided they have performed satisfactorily. Senior Medical staff put considerable
efforts in to training the Licentiates but St Francis’ does benefit from the extra pairs of
medical hands they provide.
During 2001 plans were made to start a similar training programme in Zambia based at
Chainama Hospital. St Francis’ has been selected as one of the four hospitals for
practical experience for the students during their two-year course.
10.5
Medical Students
For many years St Francis’ has received medical students from Zambia and all over the
world. They are generally in the final year of their training and spend at least 6 weeks at
the hospital. Many of them contribute greatly to the hospital and most leave the hospital
enriched by the experience and more ready to take on the responsibility of being a doctor.
It is also worth noting that almost without exception, doctors deciding to serve in Africa
have spent their elective there.
10.6
Staff Development
During 2000, three Zambia Enrolled Nurses (ZEN’s) were supported by the hospital as
they went to upgrade their training to that of Registered Nurses. This is a two-year course
and our staff went to train in Lusaka and Kitwe. In July 2001 two more staff went for
Registered Nurse training. This puts an extra strain on the staffing levels in the hospital,
but the benefits are an increase in the number of Registered Nurses at the hospital and
also to provide staff with extra motivation.
In addition two ZEN’s were also sponsored to undertake midwifery training at our own
midwifery training school. They commenced their one-year course in July 2001.
List of Staff Undergoing Further Training – 2000/01
Name
Position
Training
Duration
Josephat Chulu
ZEN
Registered Nursing
June 2000 - June 2002
Raphael Banda
ZEN
Registered Nursing
June 2000 - June 2002
Stanely Sakala
ZEN
Registered Nursing
June 2000 - June 2002
Joseph Zulu
ZEN
Registered Nursing
June 2001 - June 2003
Victoria Manda
ZEN
Registered Nursing
June 2001 - June 2003
Veronica Mwazima
ZEN
Enrolled Midwifery
June 2001 - June 2002
Simon Chisi
GMO
Eye Surgery
2000 – 2004
Joseph Mseteka
RN
Midwifery
Jan 2000 - Dec 2000
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St Francis' Hospital
Annual Report 2000 and 2001
11. Research
In 2001 a group of Dutch Researchers from Rotterdam looked at pulmonary TB sputum
culture to see if atypical mycobacterium were present and also resistance patterns to
conventional treatment. They used patients from St Francis’ and also Sesheke Hospital in
Southern Province.
12. Jersey School
There has been a pre-school at the hospital for some years. In 1999 the need for a good
primary school was identified as another important factor when recruiting and retaining
qualified staff. One of the major deterrents for staff considering working at St Francis’,
particularly those coming from the major urban areas was the poor quality of education in
Katete, particularly primary. The Jersey Primary School was therefore founded and
shared accommodation with the pre-school. The beginnings were very basic, with parents
teaching and materials being gathered from wherever possible. Even at this stage, the
need for founding the school on a more official basis was recognised and efforts were
made to obtain recognition from the District Education Office. The school officially opened
in June 2000 with a total of sixty-two pupils in Grades 1 to 6. The District Education
Officer sent three teachers including Mr E. Banda, the Head Teacher. Since opening, the
school has gradually grown and by July 2001 there were 108 pupils. During 2001, two
volunteers from the Anglican charity, The Right Hand Trust, helped out at the school for 6
months.
37
St Francis' Hospital
Annual Report 2000 and 2001
13. Projects
Most projects are funded from overseas donation and it is fair to say that without these St
Francis' Hospital would not be able to provide the services it does today.
It is appropriate to mention a few organisations whose support for the hospital is both
valuable and enduring. The Friends of St Francis’, in the UK, co-ordinated by James and
Faith Cairns continues to raise a great deal of money, much of it from former members of
staff, and is put towards the cost of sending a container packed with drugs and medical
supplies for the hospital. The impact of the Medical Support Group, based in the
Netherlands has grown over the past few years. Once again formed by ex members of
staff they now make a major contribution to the hospital. In particular the annual summer
concert, and the bed sponsorship scheme organised by Eric Masseus. The money from
the concerts is usually put towards specific projects and the sponsorship money is spent
on drugs and medical supplies. The support of Friends of St Francis Hospital and the
Medical Support Group is not just financial, the members of both organisations do a great
deal to promote the work of the hospital and put us in touch with individuals and
organisations that can assist the hospital. Other significant supporters of the hospital over
a number of years have been:
• The Beit Trust - provided funding for many of the buildings
• Memisa/Cordaid - provided staff, vehicle and supported the AIDS Project
• The United Society for the Propagation of the Gospel - provided staff and funding for
many years
• Jersey Overseas Aid - sent work groups and funded building projects, make a major
contribution to the cost of purchasing drugs and medical supplies
• Guernsey Overseas Aid - funding for staff houses
We are deeply grateful for the assistance we receive from so many individuals and
organisations – thank you.
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