February 8, 2017

Paramedic Services

Infection Prevention Unit

The Infection Prevention Unit was not officially established until 2008, but as with so many sections of Mae Tao Clinic, the activities of the Infection Prevention programme started long before there was an official title for them.

 

History

All health care related trainings conducted by MTC over the years have contained a universal precautions module, with staff learning basic infection prevention techniques such as hand washing and using protective barriers such as gloves, but there was not always a monitoring and evaluation system within the departments to ensure these actions were being performed. In 2000, the blood transfusion, HIV prevention programs, and medical waste disposal programs were upgraded and Mae Sot Hospital staff came to the clinic to demonstrate appropriate techniques for labelling and separation of medical waste.

The Reproductive Health Monitoring and Evaluation Project initiated in 2002 was a two year project, implemented to improve quality of Reproductive Health services. The post-abortion care training within this project included an “infection control” section within the monitoring and evaluation training component. The staff began using a monitoring and evaluation checklist that included such things as: hand washing, using gloves correctly, and using barriers such as masks or gloves. This was an opportunity to ensure that infection prevention procedures were being followed. Training included sterilisation techniques, via either boiling or the use of reagents. Room safety and sterilisation was also addressed. As this training program finished in the RH department, it was clear that all the departments of the Clinic would benefit from incorporating a similar infection control aspect into their monitoring and evaluation program. In order to make this possible, more training was needed. An upgrade training was provided for all current medics to ensure that they received the new information, and all health care training curriculums were permanently changed, and to implement this, a 3 to 4 day infection prevention component was added to the monitoring and evaluation module.

Challenges and Services

Working independently of each other, with some departments finding greater success than others; in 2006 it was decided to move towards more standardised protocol. An infection prevention working group was brought together with its first task being to evaluate the current procedures of each department. From this initial evaluation it became apparent that external factors were playing a major role in medics not properly adhering to the procedures. Therefore, the second task of the working group was to focus on improving supplies and logistics; how could a person be expected to wash their hands if sinks weren’t always working properly or there wasn’t any soap? Facilities were improved, and changes were made to the management of supplies, including ordering and storage, resulting in improved availability of soap and other sterilisation products. These improvements to supply management and logistics certainly led to enhancements in medics’ infection prevention behaviours, but they were not the only influencing factors to consider.

Another external factor influencing adherence to infection prevention procedures was a lack of knowledge; even though all medics were receiving training on the topic during their initial health care training, it was decided that this was not enough:  upgrade trainings were needed. In 2008 the Infection Prevention Unit (IPU) was established, with ongoing upgrade trainings incorporated as one of the responsibilities of the staff in this Unit. An added responsibility of the IPU is the sterilisation of medical equipment and the preparation of bandaging materials, such as gauze, for the clinic departments.

New challenges are presented in relation to the broadening range of services provided by the Clinic, and by the wider range of illnesses treated. This combination increases threats and necessitates continually improving techniques. Each department appoints a person who looks after infection prevention; however, further steps need to be taken to ensure new staff members are trained, and that supplies are always available.

The expansion of the Clinic and the broadening range of services provided represents a challenge for the training and supply activities of the unit. There is a focal point for IPU in each department, but further steps need to be taken to ensure that new staff are trained and that supplies are available.

The IPU is also in need of a new autoclave, due to the large amounts of procedures done in the Clinic. The desire of the IPU team is to reduce the risk of infection, for both staff and patients.

Laboratory and Blood Bank

 

Having our own Laboratory and Blood Bank enables us to more efficiently and cost effectively test for all kinds of conditions, and we are able to provide essential blood transfusions quickly, and as needed.

 

History and services
Since its inception in 1989, malaria has been the most common illness presented at MTC; thus it made sense for the clinic to have laboratory facilities with the ability to perform malaria screening, rather than relying on an external laboratory.  Laboratory work first began at MTC in 1992, with a staff of approximately four tucked away in a small corner with 2 microscopes, and a freezer.  The staff performed malaria screening, haemoglobin testing for anaemia, and blood typing.

Since 2004, malaria and haemoglobin screening has been provided to all pregnant women and children under 12 years old suffering from malnutrition. HIV screening started in 2001 as part of the antenatal health services provided at MTC, in collaboration with MSH, to support the prevention of mother to child transmission program (PMTCT). Two years later, the voluntary counselling and testing unit (VCT) was introduced. By 2008, the clinic had created a PMTCT program for quicker results and further counselling of patients.

Our laboratory testing and screening services include:  HIV antibody, Hepatitis B surface antigen, Hepatitis C antibody, urine stick, syphilis (VDRL), and STI testing. Mae Sot Hospital performs other tests not available, such as complete blood counts, metabolic tests, and renal function tests. The labratory staff coordinates the transfer of lab specimens to Mae Sot Hospital and the Shoklo Malaria Research Unit for testing and quality control.

The laboratory has a staff of 29, and malaria microscope slides constitute the bulk of the laboratory’s work. On average, around 160 samples per day re processed each day. Approximately 120 of these will be testing for malaria, with the remainder being primarily the screening of pregnant women and blood donors.

Blood donation Program

In 1995, the clinic began blood donor screening on a case-by-case basis, but there was no storage facility for donations.  In 1996, there were 36 transfusions, still using case-by-case screening, using mainly clinic staff as the donors.  If there were no donors available, blood was purchased from MSH.  In 1997 MTC began collecting blood from factory workers in order to keep sufficient inventory and stored it in Mae Sot Hospital.

This wasn’t a sustainable or cost-effective approach, so in 2000, MTC with the support of Mae Sot Hospital, set up a blood donation centre and blood bank for the blood transfusions performed at the clinic.  Since then, MTC has performed blood transfusions, as they have been necessary for the large numbers of patients arriving at the clinic with anaemia due to malaria, tuberculosis, nutritional deficiency, chronic disease or blood loss due to complications of childbirth or surgery.

The Blood Donation Centre service at MTC now encompasses the collection, screening, storage and administration of over 1,000 units of blood each year.  All donors are unpaid volunteers, with the safety of the blood supply ensured through the universal screening (by Mae Sot Hospital) of donated blood for hepatitis B and C, HIV, syphilis and malaria.  Most often donors are factory workers that come as a group to donate. This poses a challenge, as factory workers have very limited free time, with the entire process of risk assessment and donation of up to 100 people having to be completed in a few hours.  This is also seen simultaneously as a valuable opportunity to provide donors with health education about transmissible diseases, in particular, HIV and hepatitis.

The blood donation program activities include: ensuring a safe supply, collection, screening, storage, counselling, and training in safe collection and transfusion. To ensure a safe and adequate blood supply, all blood donors are screened for HIV, hepatitis B, hepatitis C, syphilis, and malaria. Donors are given a health risk assessment and health education on HIV, hepatitis B and C, and syphilis. Those donors wishing to know their HIV status are referred to the VCT program.

Pharmacy

 

Our Pharmacy provides limited but essential medecines to our patients daily. As there are so many language barriers due to the variety of different ethnicities and literacy levels presented at the Clinic, all medications are dispensed with pictorial as well as written instructions.

 

History and services

When MTC first started, it had no budget to provide medicine for patients. For its first two years, medication was donated to the Clinic by a Catholic organisation, with staff having to collect the necessary medicine from a supplier each week.  As well as this donation, visitors to the Clinic would sometimes donate medication. From 1992 – 1997, Médecins Sans Frontières donated medicine on a monthly basis. While struggling to secure its own vital medicine, the Clinic’s pharmacy also provided of medicines to five student camps along the border for a few years, until they got support from their own donors.

In 1998, with the assistance of the Mae Sot Hospital, the Clinic began to purchase supplies from medical companies in Bangkok. All pharmaceutical services were performed by a pharmacy attached to the Medical Outpatient Department (OPD), with a small storeroom, supplying medications to all departments. Each department had their own area in the storeroom and placed a quarterly order.

In 2008, an old kitchen space was renovated, providing an office with a large storage room for a new central pharmacy. A network computer allows our pharmacist to have up to date information on the amount of supplies available and medication orders from each department.

A networked computer system was developed which now allows for each department to order medications from the Central Pharmacy on a weekly basis, resulting in efficient and accurate delivery of supplies to each department. This also means a more accurate inventory system and simplified quarterly supply orders to wholesalers in Bangkok. This system helps to save money and prevent the medication shortages that occurred frequently in the past; shortages which required expensive emergency medication purchases to be made from pharmacies in Mae Sot.

All of this work is coordinated by a dedicated group of medics who have all been trained in pharmacy management.  They are responsible for keeping track of inventory levels, ensuring the medications are of good quality, and verifying that the medications are used for the proper illness, in the proper doses.  The staff of the Central Pharmacy is in a unique position because, unlike the other clinic departments, which work relatively independent of each other on a day-to-day basis, the pharmacy is linked to nearly every department.  The pharmacy staff can be looked to as a valuable source of medication information; they are always willing to discuss how a medication is properly used and any precautions that should be observed.  The hope for the future is that more medics will utilize this valuable support.

The medication used at the clinic follows the Burma Border Guidelines, a publication put together by the health organisations working along the border to standardise care services offered.

You can see these guidelines here. Link

You can see our pharmacy wish list here, Link

Challenges

Just as in any health care setting, there is a challenge in ensuring patient understanding of their medication and treatment.  After the clinic had identified difficulties with the patients’ understanding of both their ailments and treatments, a protocol was established whereby the medic who sees the patient also prescribes and explains the medications.

The Communication and Language Assessment Research Project launched in 2005 provided insight that lead to improvements. The research revealed that patients usually understand their diagnosis, but mix up doses of their medications. This led to establishment of a new system which created medicine bags marked with dosage and time of day indicated in pictorial form.  Staff with additional language skills was also added at this time to avoid language barriers.  Pharmacy staff members need to speak various languages – the estimated breakdown of patient languages is 52% Burmese, 34% Karen, with the remainder speaking other ethnic languages.