February 8, 2017

Paramedic Services

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 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.

Blood Bank

 

Having our own Blood Bank enables us to provide essential blood transfusions quickly, and as needed.

 

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.