KUMI HOSPITAL - ONGINO

“WE TREAT, GOD HEALS”

ANNUAL REPORT 2011


TABLE OF CONTENTS PAGE

TABLE OF CONTENTS:2

ACRONYMS AND ABBREVIATIONS:3

EXECUTIVE SUMMARY:4

GOVERANCE:5

ADMINISTRATION DEPARTMENT:6

NURSING:8

OPD:9

ANC & PHARMACY:10

ART CLINIC:11

LABORATORY:12

ORTHOPAEDIC:14

PHYSIOTHERAPY:15

NUTRITION UNIT:16

MEDICAL SOCIAL DEPARTMENT / LEPROSY CARE:17

FARM:19

FINANCIAL REPORT:22

HOSPITAL STATISTICS:27

GRAPHS:29

Acronyms and Abbreviations

ART:Anti-Retrieval Therapy

CBM:Christoffel Blinden Mission

CP:Cerebral Palsy

CTEV:Congenital Talipes Equino varus

DTLS:District Tuberculosis and Leprosy Supervisor

EDP:Essential Drug Programme

FOAG:Farmers Overseas Action Group

GLRA:German Leprosy Relief Association

HIV:Human Immune Virus

HMC:Hospital Management Committee

HOD:Heads of Department

I & D:Incision and drainage

IOL:Intra ocular lens

JMS:Joint Medical stores

MSD:Medical Social Department

NGO:Non-Government Organization

NSSF:National Social Security Fund

OPD:Out Patient Department

PAF:Poverty Alleviation Fund

PAYE:Pay as you earn

PMTCT:Prevention of Mother to child Transmission.

PPP:Post-Polio Paralysis

PRS:Preventative and Rehabilitation surgery.

TLMI:The Leprosy Mission International

UPMB:Uganda Protestant Medical Bureau

VCT:Voluntary counseling and testing.

VVF:Vesico Vaginal Fistula.

EXECUTIVE SUMMARY

The year under review saw many huddles overcome and many challenges met and we thank the almighty God for his unfailing mercy and faithfulness.

We are forever grateful to our partners who have much faith in us and have taken great courage to continue supporting us despite our fragile situation at that time- indeed a friend in need is a friend indeed.

All appreciation goes to

  • FOAG
  • CBM
  • Kumi Hospital Dutch foundation
  • Kyoga foundation

We also thank the visiting surgeons through the Kumi Hospital Dutch foundation (Dr. Ton, Bass and Carole), AMREF (Dr. Kirya, Wachira and Dr Davis) and Dr. Charles Viva for providing highly specialized services that our people would have not otherwise accessed.

The year was full of new beginnings. With open minds the Board of Governors and management team worked hard to begin the process of making a five year strategic plan. This plan will serve to help the hospital remain focused on progress in certain key areas. The support from CBM and UPMB was of a great help to the development of this document.

The key strategies in the next five years include;

1)KH Institutional Strengthening (Governance and Management) and motivating our human resources to depict a well governed/managed health facility with adequate resources and quality healthcare

2)Improved KH Clinical performance and service delivery to contribute to having a healthy population in a healthy environment by targeting the most vulnerable, stigmatized and disabled persons

3)KH improved relations and image within the local communities - “the community identifies with KH as their health facility”

4)KH institutional Resource Mobilization for sustainability; and improving the hospital financial management/ accounting/ procurement and records management systems

5)Develop new/refurbish existing hospital infrastructure for improved quality of healthcare

6)Develop financial plan to meet the hospital medical, administrative and personnel needs

We are hopeful for a bright future in the event that these strategies are adopted over the next five years.

I therefore welcome you to look into the data, activities, achievements and challenges of the year under review.

Dr. Ruth Obaikol

Medical Director

Kumi Hospital

GOVERNANCE

Members of Board of Trustees

His Grace The Archbishop of CoU-Chairman AGM

Mrs. Okiria Gladys

Canon Thomas Mugoya

Canon Pauline Magomu

Members of Board of Governors

Rt. Rev. Dr. Nicodemus Okille:Bishop of Bukedi Diocese: Chairman

Rt. Rev. Patrick Gidudu:Bishop of Mbale Diocese

Rt. Rev. Thomas Edison Irigei:Bishop of Kumi Diocese

Mr. Sylivanue E. Isiagi:Nominee CoU

Mrs. Wakumire Edith:Nominee Mbale Diocese

Mrs. Emoit Salome:Nominee Bukedi Diocese

Ms. Rose Ochom:Female Representative

:District Health Officer Kumi

Mr. Bataringaya Willy:CAO – Kumi

Dr. Okia David:Medical Superintendent Ngora

Dr. Ruth Obaikol:Medical Superintendent: Secretary.

Members of Appointments Board

Rt. Rev. Dr. Nicodemus Okille:Chairman

Personnel Officer – Kumi

Sr. Jane Edyegu (PNO) Kumi

Dr. Ruth Obaikol:Medical Superintendent/Secretary

Mr. Edmond Emokol

Mr. Okula Charles

Finance Committee:

Mr. Sylivanus E. Isiagi:Chairman

Dr. Ruth Obaikol

Mr. Okula Charles

Mr. Etiang D.:Secretary

Hospital Management

Dr. Obaikol Ruth:Chairman

Mr. Okula Charles

Mr. Etiang D.

Mr. Emokol Edmond Obuku

Sr. Odikor Margaret

Ms. Isangu Rose

ADMINISTRATION

Many of the difficulties we experienced in the previous year followed us into the year 2011

The normal functioning at the hospital continued though with difficulty. A lot of strain was still realized in the areas of Human Resource, Financing and Medical supplies. However, the later part of the year showed signs of positive recovery.

Routine meetings were held during the year as follows:-

  1. Board of Governors Meetings-2( with one board retreat)
  2. Hospital Management meetings-8
  3. Heads of department meetings-2
  4. General Staff meetings-3
  5. Interested stake holders meetings-2

Achievements

  • Energy Project was launched with the arrival of the Project Manager Mr. Ouke Dijkstra with his wife Hanneke Dijkstra as shown in picture below during the ground breaking ceremony of the ESCo office at Kumi Hospital.


  • Umeme bill of Shs. 71Million was paid with the help of the Government of Uganda and the Kyoga Foundation of Holland.
  • Power was reconnected to the hospital.
  • Renovation of stone/children’s ward was accomplished as shown in picture below.


  • 15 Salaries (including 3 arrears of 2010) were paid.
  • Donors continued to support the Hospitals namely

- The Dutch Foundation

-The Kyoga Dutch Fund

-FOAG

-Elspeth Robinson

-Rev. Benwell

  • We managed to continue funding the training of the Orthopaedic surgeon and 3 Nurses.
  • Our Gynaecologist Dr. Ntege completed training and resumed work.
  • Auditing was carried out successfully for both 20009 and 2010.
  • The Five year strategic plan was initiated.

Challenges

  • Staff attrition continued though at a reduced rate.
  • Tightening in internal controls led to abrupt departure of Accountant, Cashier and Accounts Assistant leaving only one Senior accounts Assistant to manage the department.
  • Reduced funding was received from our major donors CBM and none from TLMI creating difficulty in management of resources.
  • Salary payments were irregular and unpredictable.
  • The hospital continued running without the services of a Human Resource Manager and a Farm Manager because of failure to identify a competent farm manager and lack of resources to pay for a human resource manager.
  • Though now reduced, the hospital still has a challenge of meeting 2 Months’ Salary arrears and backlog of NSSF and PAYE remittances.
  • Staff houses are getting dilapidated and require urgent repair.
  • Reduced support from Government, increased poverty levels among our Clients leading to inability to pay hospital bills.

Staffing

During the year staffing levels reduced with the total staff at 170 broken down as follows:-

  • Doctors:06 (one at School)
  • Clinical Officers:04
  • Registered Midwife Nurse:10
  • Enrolled Nurse:13
  • Enrolled Midwife:03
  • Nursing Assistants/Aids:23
  • Laboratory staff:05
  • Ortho. Technicians:06
  • Orthopaedic Officer:01
  • Physio/Social Workers:06
  • Administrative Staff:08
  • Support Staff:85

TOTAL : 170

Recommendations

  • Intensify public awareness on services offered by the hospital to improve utilization.
  • Continue to lobby for increase in Government support both in funding and staffing.
  • Enhance collaboration with other Agencies/Organizations both internal and external.
  • Continue lobbying for funds to revamp the Farm.
  • Increase utilization of Farm land by tree planting.

NURSING

The department improved in the handling and management of patients and other clients. The Staff turnover reduced due to encouragement from the Management and payment of salaries.

The department did perform to its full capacity as recent better health information and promotion messages dissemination.

Out reaches services were regularly performed because of the assurance of the availability of PHC funding.

Staffing

Management has done a lot in improving the staffing levels in the department. This includes:-

-Increase in number of Nurses and training and it continues to train and give professional development Continuing Medical Education Workshops and Seminars for Special service delivery points.

-The friends of Kumi, UPMB and other Partners are hereby thanked for this immense contribution towards staff development.

Staffing levels

Table 1

Out / Training
PNO - 01
SNO (RCN) - 01
RN/MW - 03
RN - 08
RMW - 01
E/N - 08
E.M - 02
ECN - 16
N/Assistants/Aids - 25
Opth/Assistants - 03
Vaccinators - 02 / 04
02 / 02
TOTAL 70 / 05 / 02

The Vaccinators are not nurses but Community volunteers who were working with us. They have made a tremendous improvement to the PHC Component of the hospital work and improved more on relationship with the village health Teams and Community.

Support supervisors/visitors to the department

The Department received a number of mentors from the Hospital, District and Ministry of Health and other Partners who contributed towards the improvement of health Care Delivery. The department also received a number of nursing students/Medical students from various Institutions who equally helped a lot in its activities as they also gained experience.

Achievements

-Staff development through short courses and Workshops and others got Sponsorships for their Children through Kumi Hospital.

-Staff motivation and a spirit of togetherness was achieved during the end of year Party.

-Team work was also achieved.

-Some Nurses were recruited to lessen work load.

Challenges

-Inadequate number of nurses in the Ward to meet the demand.

-There were some gaps in the Nursing skills and documentation of data.

OPD

The Out-Patient Department is a starting point for all Hospital departments. It is an area where patients are received and handled according to the severity of their sickness/conditions (triage). Deciding who to be managed as an Emergency (triage), who to be admitted to which ward and who to be managed as an Out-Patient.

Activities

  • Receiving and recording patients
  • Health education
  • Diagnosis, Treatment and Monitoring
  • Referral to appropriate units for definitive care

Achievements

  • Many staff attended workshops that helped in improving the way patients are handled
  • Two members of staff were deployed to OPD improving the staffing and efficiency

Challenges

  • There is lack of equipment for examination; Bp machines, books
  • There is difficulty in transferring patients to the wards and to the sites of investigation because of lack of a mobile wheel chair.
  • Delays within the different functional units increasing waiting time
  • Challenges in storage as the cupboards cannot be kept under key and lock

Recommendations

  • Avail equipment and books to aid diagnosis.
  • Improve on storage
  • Improve on staff efficiency at OPD

ANC

  • Health education talks to all the clients every morning
  • Pre test counseling and post test counseling for all pregnant women
  • HIV testing
  • History taking and examination
  • Providing mothers with ITN
  • Provision of drugs for PMTCT
  • Identification of complication of pregnancy and referring mothers appropriately
  • Attending to mothers post natally
  • Preparing patients and providing family planning

Achievements

  • There is an improvement in male involvement from 20% to 90 %
  • Provision of ITN has reduced the prevalence of malaria in women
  • Provision of ART services in the ANC has provided for an opportunity for holistic care for HIV patients hence instilling confidence in the health service

Challenges

  • Occasional Stock out of test kits

Recommendations

  • There is need to develop a means of sustaining test kits.

PHARMACY

Activities

  • Organizing the department
  • Placing orders early enough to prevent stock outs
  • To scrutinize the prescriptions in order to prevent stock outs
  • Dispensing in well labeled envelopes
  • Control drug flow right to the actual consumer who is the patients
  • Prevent irrational drug use
  • Prevent drug theft

Achievements

  • There has been improvement of rational drug prescription
  • Issue forms were designed and in use to monitor drug flow
  • Envelopes for dispensing were designed and now in use
  • The drug store was arranged and all the leakages were sealed

Challenges

  • Adhering to pharmacy policy remains a challenge to many staff especially the procedures of ordering drugs
  • A few new leakages are starting to show with need of re sealing the roof
  • The student bills are not met this need to be clarified
  • There is delay in other OPD procedures making patients exit late.

Recommendations

  • Discharge forms should be filled before the billing is finalized
  • The leakages should be sealed
  • The dispensing with envelopes should be sustained as it is presentable.

ART CLINIC

Activities

  • HIV counseling and testing
  • Comprehensive palliative care services +
  • Provision of anti- retroviral service
  • HIV AIDS prevention

Achievements

  • More clients were tested compared to the previous year
  • Availability of ARVs for eligible clients
  • Improved and prolonged life of People living with HIV AIDS
  • Easier follow-up of clients due to availability of motor-cycles.
  • Assistance to the poorest of the poor in management of OIs and the transport facilitation.

Challenges

  • High expectation by clients
  • Inability to fully investigate patients because they cannot pay.
  • Occasional stock outs of test kits and septrine
  • Lack of nutritional support for clients especially children

ART Clinic Output

Activity / 2009 / 2010 / 2011
No Counseled & Tested / 4766 / 6051 / 2895
No +ve / 302 / 241 / 128
Enrolled for HIV/AIDS Care / 295 / 287 / 196
On ART (ARVs) / 142 / 197 / 106
TB/HIV / 42 / 49 / 35
TB/HCT / 61 / 128 / 77
HBC/Home Visiting / 177 / 177 / 134
CD4 Count / 824 / 1109 / 633
PCR/DNA / 166 / 180 / 145
ITNs-IRCU / 12 / 388 / 228
PACE / 0 / 0 / 406

LABORATORY

Activities

Clinical laboratory helping with diagnosis has six sections:

  • Hematology
  • Blood transfusion
  • Parasitology
  • Microbiology/ virology
  • Clinical chemistry
  • Serology

Specimens for histology are sent to Mulago National Referral Hospital.

Other specimens as for CD4 P.S.A. etc. are still on referral.

Laboratory Statistics for the year 2011 in comparison to 2010

Section / 2010 / 2011
Haematology / HB Est / 9811 / 5663
ESR Est / 2809 / 626
CBC Total / 3810 / 597
Differential / 3810 / 597
Film Comment / 3810 / 597
Sickling Test / Total +ve
504 162 / Total +ve
137 03
Bleeding & Clotting Time Est: 16 / Bleeding & Clotting time Est:12
Blood
Transfusion / 2010 / 2011
Grouped Total : / 4846 / 2050
Transfusion: / 2844 / 1050
Children / 2610 / 605
Male Adults / 97 / 156
Female Adults / 137 / 289
Parasitology
Clinical chemistry / B/S – mps / Total +ve
19710 9412 / Total +ve
12916 4998
Microfiliria / 16 00 / 23 00
Trypanosomes / 19710 00 / 12916 00
Stool Microscopy / 873 58 / 1334 27
Modified ZN-stain / 12 00 / 16 00
Concentration Method / 44321 / 349 06
Celebral spinal fluid (CSF) / Total Abnormal
106 06 / Total Abnormal
112 08
Urinalysis / Total: 4956
Protein: 639
Sugar: 1
Deposit: 388 / Total: 2455
Protein: -1335
Sugar: -04
Deposit: 750
Blood Sugar (RBS) / Total Abnormal
1778 34 / Total Abnormal
2003 154
HCG (Preg. Test) / 398 +ve: 34 / 402 +ve: 36
LFTS/RFTS / 258 63 / 19 09
Bacteriology / Sputum: ZN-stain / Total +ve
337 48 / Total +ve
355 36
Skin scrape (F1) / 2350 787 / 2650 802
Skin smear (Lep)
(BI & MI) / 132 08 / 121 04
H.V.S. Swabs
(Gram stain) / 14 14 / 26 26
Wound Swabs (G/Stain) / 123 63 / 19 17
Culture/Sensitivity / 04 04 / 00 00
Serology / RPR/VDRL / 1796 13 / 1011 20
HEP.B / 397 25 / 515 22
WIDAL TEST / 4180 120 / 2078 483
Brucella B.A.T / 287 10 / 898 111
Rhematoid Factor / 49 1 / 48 02
Virology / HIV TEST / 4180 209 / 8822 370
PCR/DNA / 162 12 / 108 03
CD4 Samples Referred / 00 / 771 Male: 294 Female: 477

ORTHOPEDIC WORK SHOP

Activities

  • Fabrication and fitting of Orthopedics appliances
  • Repair of Hospital equipment.

Achievements

  • Department received a new Orthopedics Technologist

Challenges

  • Need for one carpenter to meet rising demands for Crutches and C.P. Chairs.

Output of Orthopedic Work shop

Section / Appliances / 2010 / 2011
Foot wear /
  • Open Sandals
  • Plastazote
  • Orthopedic Boots
  • Shoe repairs
  • Shoe raise
  • Hospital equipment repairs
/ 75 Pairs
18 Pairs
14 Pairs
252Pairs
21 Pairs
71 / 84 Pairs
03 Pairs
19 Pairs
268 Pairs
34
66
S/TOTAL / 451 / 474
Orthotics /
  • AF0 Splints
  • KAFOS Splints
  • A.K Calipers
  • Knee Caps
  • T. Straps
  • Arch Supports
  • S.FABS
  • Lumber Corsets
  • Wooden Crutches
  • Wooden cane
  • Cervical collars
  • Hand Splints
  • C.P. Chairs
  • Head support
  • Corner seat
  • Wooden walker
  • Standing Frame
  • Splints Repairs
  • S.FABS Repair
  • Caliper Repair
  • Wheel Chair repairs
/ 334
55
13
14
05
08
102
11
35 Pairs
04
19
13
37
11
09
37
12
126
17
19
130 / 283
41
12
28
04
27
119
22
59
30
20
27
19
19
06
11
12
31
26
12
135
S/TOTAL / 1009 / 988
Prosthetics /
  • Symes
  • Transtibial
  • Knee Disarticulation
  • Transfemoral
  • Prostheses repair
/ 11
55
28
83
40 / 06
29
20
14
35
S/TOTAL / 217 / 104
Grand Total / 1677 / 1566

PHYSIOTHERAPHY

Activities

  • Outreach clinics
  • Managing surgical camps
  • Performing physiotherapy for patients
  • Offering social support for patients with disability

Challenges

  • lack of adequate funding reduced the bulk of the much needed help
  • staffing was low

Recommendations

  • There is need to re-establish support for the disadvantaged disabled children
  • As the new orthopedic surgeon comes the next year it is advisable to recruit a physiotherapist and an occupational therapist.

Summary of Patients seen in the Disability Outreach Clinic from January to December 2011

Adults / Children
Male / Female / Total / Boys / Girls / Total / Grand Total
Hearing Impaired / 45 / 47 / 92 / 92
Cerebral Palsy / 10 / 11 / 21 / 166 / 120 / 286 / 307
Epilepsy / 61 / 53 / 114 / 200 / 224 / 424 / 538
No. of individuals screened / 144 / 185 / 329 / 1040 / 1067 / 2107 / 2436
No. of individuals screened entering CBR services / 1040 / 107 / 2107 / 2107
No. of individuals screened referred to other services / 116 / 142 / 258 / 105 / 128 / 233 / 491
Leprosy / 3 / 3
5974

Summary of Patients seen in the Rehabilitation department from January – December 2011

Adults / Children
Male / Female / Total / Boys / Girls / Total / Grand Total
Physiotherapy / 8 / 3 / 11 / 114 / 104 / 218 / 229
Club foot manipulation / 160 / 70 / 230 / 230
P.I.P & Gluteal fibrosis / 10 / 30 / 40 / 327 / 328 / 655 / 695
Epilepsy / 106 / 89 / 195 / 382 / 346 / 728 / 923
Fractures / 42 / 32 / 74 / 74
Others / 26 / 33 / 59 / 25 / 20 / 45 / 104
Cerebral Palsy / 22 / 27 / 49 / 49
Cleft Lip and Palates / 14 / 12 / 26 / 26
V.V.F / 63 / 45 / 108 / 108
TOTAL / 2438

Nutrition Unit

This has been a most challenging year for the department but nevertheless, with the little/limited resources realized the department was able to provide initial feeds to malnourished children/patients.

The department was rim by one staff (Social worker).

Activities

-Feeding

-Daily weighing (growth monitoring)

-Health and Nutritional education/counseling

-Playing therapy

Recommendation

-There is a need to extend nutritional education and counseling to the community for early diagnosis and referral of malnourished children to reduce on the complication of malnutrition.

Output of the Nutrition Unit

Type of PEM / S T A T U S A T D I S C H A R G E
Improved / Died / Escaped / Transferred / Total Number
Kwashiorkor / 18 / 3 / - / - / 21
Marasmus / 53 / 1 / - / - / 34
Marasmus Kwashiorkor / 33 / 4 / 1 / - / 38
Total number of Patients / 94 / 8 / 1 / - / 93

Medical Social Department: