Towards improved child care

Half a year of overhaul in GB Pant Hospital, Srinagar

CHANGE FOR BETTER

DR. S. MUHAMMAD SALIM KHAN

The hospital whose mention half a year back would bring gory picture of what media termed  a death-trap on May 18, 2012 chief minister visited the hospital. described the situation at GB Pant hospital as grave, he said: ‘There is enormous scope for improvement. Levels of cleanliness are extremely poor inside the hospital…Greater discipline is needed with respect to the presence of attendants accompanying the patients.’  He, however, promised that within 10 days ‘you will see visible improvement not only in respect of the appearance, but in the overall functioning’. ‘My office and I had to step in because of the gravity of the situation,’ the chief minister said. Next day the overhauling of the system started by appointing Dr. Muneer Ahmad Masoodi new medical superintendent. of G.B. Pant Hospital, Srinagar, the only tertiary care hospital catering above 30 lac children.
The support extended by the government initiated a battery of reforms to bring about desired changes visible in short period of time which led to considerable decrease in mortality rates.
The generous funding by government and NRHM funding with improvement of support-service and owning of responsibilities has improved most of the indicators. The utilization of unspent Rs. 25 lacs received for implementing Janani Shishu Surakhsha Karikram (JSSK) brought about radical change in neonatal care especially in NICU, the centre which witnessed most deaths due to deficient staff, ill-equipped stations coupled with very poor infection control measures. Now the air-humidifiers and ventilator tubings attached to the ventilators are changed for every new neonate admitted, which brought about remarkable improvement in neonatal survival. Strict access control in NICU, provision of disposal gowns, mask, caps, shoe-covers, infection-surveillance, using hand-sanitizers and provision of all medicines, consumables etc free of cost made it happen that most of the neonates admitted in NICU are discharged healthy and transported free of cost to their homes. As on now around Rs. 65 lacs have been spent under JSSK out of Rs. 75 lac sanctioned till date by NRHM. Under JSSK free medicines, diet and transport back home are provided to all the beneficiaries which include pregnant and delivered mothers, neonates and mothers of admitted neonates. Even for lactating mothers whose babies are admitted, a separate ward has been put in use for providing secure and cozy environment for breast-feeding their admitted babies.
Over last 07 months, there have been extensive augmentation of equipments which include 06 Bubble CPAP ventilation systems, 17 vital sign monitors, 03 Maquet Ventilators @ Rs. 15 lac each, 10 radiant warmers, 06 LED photo-therapy units for NICU, four vital-sign monitors & cardiac defibrillators for paediatric ICU) 02 mobile X-ray units, two foggers, two ambulances including one air-conditioned, free disposable tubings & humidifier for every new neonate on ventilators @ Rs. 1,850/each and free disposable Unit for Bubble CPAP @ Rs. 2,700/- in NICU, 40 semi-fowlers beds, new beds in most of the wards.
Under NRHM, in addition to JSSK, 10-bedded Nutritional Rehabilitation Centre is being starting  this month for managing severe acute malnutrition. Trainings of doctors & nurses for Facility based Newborn Care (SNCU), INMCI & NSSK for doctors & nurses are being conducted regularly. Further, Rs. 2.00 Crores has been sanctioned & released under NRHM and orders have been issued and supply of equipments etc. Under capacity building, in-house trainings for skill enhancement of nurses, para-medical staff is now carried out regularly, an initiative for the first time by hospital administration.
An assistant professor, registrar and RMO posted is now posted in NICU. During night, 02 registrars are posted. Forty nurses were added to para-medical strength. Two infection control nurses are placed exclusively for infection control.
G.B. Pant Hospital, Srinagar is one of nine hospitals in J&K to be accredited by national accreditation board of hospitals (NABH) for which efforts have been taken to fill the gaps identified by NABH. USG machine in the hospital is registered under PC & PNDT Act. The laboratories are being upgraded with installation of ABG Analyzer in NICU. Blood samples are being collected using vacuutainers. The start-of-art Microbiology lab is being established with installation of automatic culture & sensitivity machine and accessories. The operation theatre in G&O have been air-conditioned. The wards & OPD are provided with 4-5 nebulizers for 24x7 care.
The neonates admitted are tagged with patient identification bands, a pink identity band for girls and blue for boys, a practice that adheres to the identification system used internationally. The water-proof tag carries vital information like a baby's date of birth, sex, mother's name and the hospital MRD number.
Regarding accountability of mortality, daily mortality meeting is conducted by faculty of paediatrics at 9:45 am and monthly mortality meeting is conducted by principal, government medical college, Srinagar or his representative.
Under public private partnership, agreements are with help-poor voluntary trust, NGO for transport and wheel-chair/ trolley services, with taxi stand for free transportation under JSSK, and with Lal Path Lab for complex and sophisticated laboratory tests under JSSK.
G.B. Pant Hospital has acquired drug licenses for setting up of government drug counter in GB Pant Hospital vide License no. SR/18779 and SR/18780 issued by Drug & Food Control Organization, J&K, Srinagar.
Regarding further strengthening, orders have been made for infant radiant warmers, syringe infusion pumps, automatic biochemistry, haematology and bilirubin, analysers. Six specialists lecturers are being appointed by PSC which include paediatric radiologist, ophthalmologist, nephrologist, haematologist, microbiologist, and child psychologist. Three more ventilators are expected also. New ward is being developed for state-of-art 12-bedded PICU. There is a plan to develop nephrology ward with dialysis facility, ophthalmology and paediatric surgery facilities. With all these efforts, the overall situation has improved considerably but there is no place for complacency because there is much more to achieve by putting concerted efforts by all stake-holders. 

 (The author is deputy medical superintendent, G.B. Pant Hospital, Srinagar and can be mailed on msgbphsk@gmail.com)

Lastupdate on : Tue, 1 Jan 2013 21:30:00 Makkah time
Lastupdate on : Tue, 1 Jan 2013 18:30:00 GMT
Lastupdate on : Wed, 2 Jan 2013 00:00:00 IST




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