February 8, 2017

Paramedic Services

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Laboratory

The Mae Tao Clinic laboratory enables us to better diagnose and treat our patients. We can test for a variety of medical conditions cost-effectively efficiently.

 

History and services

Mae Tao Clinic first started laboratory investigations in 1992, having 1 staff, 2 microscopes and a freezer. The staff performed malaria screening, haemoglobin testing for anaemia, and blood typing.

Since 2004, malaria and haemoglobin screening is provided to all pregnant women and children under 12 years old suffering from malnutrition. HIV screening started in 2001 as a fixed element of the antenatal care services provided, in collaboration with Mae Sot General Hospital (a Thai Ministry of Public Health institution), to support the prevention of mother to child transmission programme (PMTCT). Two years later, the voluntary counselling and testing unit (VCT) for HIV was introduced. By 2008, the clinic had created a PMTCT programme for quicker results and further counselling of patients.

Today, the laboratory has 3 microbiology microscopes and various lab equipment. Our laboratory testing and screening services include: Haemoglobin, Glucose, Malaria, HIV, Syphilis (VDRL), Hepatitis B, Hepatitis C, Urine analysis, Complete blood counts (CBC), Blood grouping and Bilirubin. In case further investigation is needed, we refer patients to Mae Sot General Hospital for tests, including tests for CBC confirmation, biochemistry, metabolism, and renal function.

For quality control, the laboratory staff coordinates the transfer of lab specimens to Mae Sot General Hospital and the Shoklo Malaria Research Unit (SMRU).

The laboratory has a staff of 13, who work in 3 shifts for 24-hour coverage. In 2017, over 25,000 patients were tested for diagnosis. Malaria microscope slides constitute the bulk of the laboratory’s work. Of the total, approximately 19,600 were tested for malaria, with the remainder being primarily the screening of pregnant women and blood donors, and monitoring the condition of patients admitted in our wards.

(Last Update: 25 May 2018)

Pharmacy

Our Pharmacy provides basic essential medicines to our patients on daily basis. To overcome language barriers due to the variety of different ethnicities and literacy levels of our patients,  all medications are dispensed with pictorial and written instructions.

 

History and services

When MTC first started in 1989, it had no budget to provide medicines to patients. Until 1997 the clinic provided only limited essential medicines to our patients with the support of donors, but it was insufficient. In 1998, with the assistance of the Mae Sot Hospital, the Clinic began to purchase supplies from medical companies in Bangkok.

Since 2008, a pharmacy computer system allows our pharmacist to have up to date information on the amount of supplies available and medication orders from each department. The system allows the out-patient and in-patient departments to order medications from the Central Pharmacy on a weekly basis, resulting in efficient and accurate delivery of supplies. The pharmacy computer system was updated in 2016 with the help of a medical consultant, making it more user-friendly. The 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.

The medication used at the clinic follows the Mae Tao Clinic Medication Essential Handbook 2014, developed by our medical consultants and volunteer doctors. The handbook contains adapted information from WHO’s essential drug list 2013 and Medecins Sans Frontieres essential drug list 2013.

Achievements

Since the clinic’s activities moved to the new premises of MTC in 2016, the pharmacies changed from having one pharmacy per department to having one central pharmacy, one OPD pharmacy, and one IPD pharmacy. As of April 2017, the pharmacy has become a separate department within MTC’s organisational structure. Pharmacy staff’s skills and knowledge can be monitored with Clinical Competency Checklists, which were developed with help of volunteer pharmacist. Bi-annual pharmacy audits showed appropriate management of pharmacy stock, expiry date and pharmacy cleaning.

You can see our medication and supplies wish list here, Link

Challenges

Like in any healthcare setting, there is a challenge in ensuring patients’ understanding of their medication and treatment. After the clinic 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. This protocol has been kept up to date. In addition, MTC conducts annual client exit interviews to ensure the medical treatment is accurate and health education from our staff is delivered to patients well. In the survey conducted in 2017, more than 90% of patients answered ‘they know their disease and 97% understand how to take their medication.’

MTC has been heavily relying on donors for medicine provision. Nevertheless, as numerous major donors shifted their programs into Burma after the inauguration of new Burmese government in 2016, we foresee that we may not have sufficient funding for medication in the near future.

(Last update: 4th May 2018)

Infection Prevention Unit

The Infection Prevention Unit was officially established in 2008. The new IPU building, which was built in 2018, is isolated from areas where most patients and visitors stay. The IPU team does their utmost to reduce the risk of infection, for both staff and patients.

 

History and Present

All trainings conducted by MTC contains basic infection prevention but monitoring and evaluation system within the departments was not performed yet. In 2000, the blood transfusion, HIV prevention programmes, and medical waste disposal programmes were upgraded with the support of Mae Sot Hospital. A two-year project, The Reproductive Health Monitoring and Evaluation Project, was initiated in 2002. It included an “infection control” section within the monitoring and evaluation training component. The staff began using a monitoring and evaluation checklist. Training also included sterilisation techniques and room safety.

In 2006, it was decided to move towards more standardised protocol for quality assurance. An infection prevention working group was brought together with task being to evaluate the current procedures of each department. And the working group was to focus on improving supplies and logistics. 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.

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, the preparation of bandaging materials, such as gauze, for the clinic departments and the medical waste disposal.

A new IPU was built in 2018 for the following reasons: the previous IPU was not systematically structured, without a logical flow from entrance (used materials) to exit (cleaned materials); the previous IPU was located in the middle of the clinic compound, where patients would often accidentally enter. The new IPU building is more isolated from areas where most patients and visitors stay. A series of workshops was held to standardise the IPU protocols, in cooperation with the nursing unit, aiming to ensure universal understanding of best hygiene practices, sterile techniques and cleaning methods.

Challenges

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 and dry machine due to the large amounts of procedures done in the Clinic.

To ensure the quality assurance, Mae Tao Clinic continuously provides training in safety management systems and risk assessment. Potential physical hazards in departments working with chemicals are consistently assessed whether all are systematically stored and controlled. In addition, whether departments’ staff wear the recommended personal protective equipment are checked on the regular basis.

Staff

There are 4 staff and volunteers from other departments, ensuring quality healthcare service is provided.

(Last update: 18 June 2018)

Blood Bank

Mae Tao Clinic’s on-site Blood Bank enables us to provide essential blood transfusions quickly, and as needed. In 2017, a total of 1,166 units of blood (350 ml) were donated; of them, 788 units were provided to 465 clients, a third of them children.

 

Blood Bank front view

Blood donation Programme

In 1995, Mae Tao Clinic began blood donor screening on a case-by-case basis, but there was no storage facility for donated blood. 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 Mae Sot General Hospital (MSGH). In 1997 MTC began collecting blood from factory workers in order to keep sufficient inventory and stored it in MSGH.

This wasn’t a sustainable or cost-effective approach, so in 2000, MTC with the support of MSGH, 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.

Donated units of blood stored in the Blood Bank

The blood bank service at MTC now encompasses the collection, screening, storage and administration of over 1,000 units of blood each year. In 2017, a total of 1,166 units of blood (350 ml) were donated; of them, 788 units were provided to 465 clients, a third of them children. All donors are volunteers, with the safety of the blood supply ensured through the universal screening of donated blood at our laboratory. All donors are counselled before their blood is screened at the laboratory. 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. Nevertheless, this is also seen simultaneously as a valuable opportunity to provide blood donors with health education and counselling about transmissible diseases, in particular, HIV and hepatitis.

Voluntary blood donors

The blood donation programme 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 and given a health risk assessment and health education on HIV, hepatitis B, hepatitis C, syphilis, and malaria.

(Last update: 8 August 2018)

 

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