Saturday, 24 August 2013 00:00
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Following is the presentation made by Deputy Minister of Civil Aviation and Coordinating Committee for the Development of the Seethawaka Divisional Secretariat Area Chairman Gitanjana Gunawardena at the International Forum for the seventh anniversary of the Korean Foundation for International Healthcare on 21 August in Seoul, Korea, on the significance of the PCU program in Sri Lanka
First of all, let me offer my sincere congratulations on this seventh anniversary of the Korean Foundation for International Healthcare and my best wishes for the continuation of the successful services it renders in improving healthcare services for needy communities worldwide.
Also, let me extend my profound thanks to the President of KOFIH Dr. Lee Soo Ku and Secretary General Dr. Sir Won-Seok for kindly inviting me here to address this prestigious International Forum. It gives me immense satisfaction to be here in Seoul since my first visit to the Republic of Korea in 2006, then as the Deputy Speaker of the Parliament of Sri Lanka.
It was during that visit I had the opportunity to acquaint myself with Korean Foundation for International Healthcare, where I presented a proposal for the Avissawella Base Hospital and sought assistance for the improvement of the hospital services; thus initiated interest in Sri Lanka PCU, also known as the Accident and Emergency Care program.
Sri Lanka’s healthcare system
Before I present my views on ‘The significance of the PCU program in Sri Lanka,’ which is the topic assigned to me, I would like to say a few words about Sri Lanka, its people and the healthcare system and practices.
Sri Lanka is a tropical island nation in the Indian Ocean, with an area of 65,620 square kilometres and a total population of approximately 21.5 million according to the 2012 census. Our country is roughly two-thirds the size of Republic of Korea, and our population is less than half of the Republic of Korea’s total population.
It is also a country that has a legacy of over 3,000 years of healthcare practices based on Ayurveda and other hallowed traditions of indigenous medicine that preceded the introduction of western healthcare practices by colonial powers in the 19th Century. Even today, Ayurvedic practices flourish side by side with the Western medical system with equal vigour and vitality.
Today, Sri Lanka is one of the few countries in the world that provides free healthcare and education, both of which have been national priorities for decades. Our healthcare system is distinctive in that one can go directly to the hospital with no references from a third party. Let me read an extract from the Annual Report 2011 of the Central Bank of Sri Lanka (http://www.cbsl.gov.lk/pics_n_docs/10_pub/_docs/efr/annual_report/AR2011/English/17_Appendix.pdf) so the distinguished participants can gain a fair idea of the status of the healthcare services in Sri Lanka.
To quote: “…There were 592 Government hospitals with 69,731 beds in the country, which amounts to 3.3 beds per 1,000 persons by end of 2012, excluding beds in private hospitals. There were 16,384 qualified doctors in the state health sector: a doctor for every 1,274 persons, and 29,101qualified nurses: 13.9 nurses for every 10,000 persons, by end of 2011…”
And then to quote from the 2011 Vital Statistics of Sri Lanka from World Health Organization (http://www.who.int/gho/countries/lka.pdf): “…Maternal mortality rate 35 per 100,000 live births, Infant Mortality Rate 9.2 for every 1000 live births Life expectancy at birth 75 years…”
Emergency care
Even with these impressive achievements as evinced in low maternal, infant mortality rates and high life expectancy that are comparable with developed countries, emergency care in Sri Lanka requires improvement.
The out patients departments of Sri Lankan hospitals, which were the entry points for major episodic illnesses and trauma, lacked effective mechanisms to stabilise and treat patients. This lacuna was recognised by President Mahinda Rajapaksa’s vision for health care and policies in the ‘Mahinda Chinthana 2005’. The establishments of Preliminary Care Units (PCUs) were made available to health sector administrators utilising Government funds during the last decade.
Suffice to say, hospital emergency care prior to the introduction of PCUs was limited to basic intervention to contain affliction at entry point prior to transfer to curative wards. The change aspired through PCUs is to ensure substantial inquiry into afflictions with on the spot urgent laboratory investigations, stabilisation of the patient whatever the emergency, treatment of lesser degrees prior to transfer to curative wards or discharge from the unit.
In other words, a Preliminary Care Unit conceptually in the Sri Lankan context is traditionally an outpatients department, but with the old OPDs rudimentary emergency unit improved with expertise and equipment to be able to immediately treat patients with any major episodic illnesses and trauma.
Avissawella Hospital
Avissawella Hospital was established long before independence of Sri Lanka, and at the time of my abovementioned initial visit to Seoul in 2006, had been expanded and improved to be included in the Base Hospital category. But at that time did not have a PCU due to constraints of Government funding. It was lagging in facilities for handling emergency care at the Out Patient Department, leading to ward overcrowding and patient congestion, causing an unduly high number of avoidable deaths and general decline at that time.
This was the situation at Avissawella Base Hospital when KOFIH commenced its project to replace the admitting room and small emergency unit at the hospital’s Out Patient Department (OPD) with a Preliminary Care Unit (PCU) in 2009 with a generous grant of US$ 1 million. KOFIH provided a generous grant for the design and construction of the new PCU with state-of-the-art equipment and a purpose-oriented training program. While expressing my gratitude to KOFIH I would also like to extend my sincere thanks to the present Overseas Manager Hyun Kyong Kim who has been encouraging and supportive of this project since its initiation in 2006.
Currently there are training programs provided yearly for doctors, nurses and technical personnel of both PCUs in Avissawella and Tangalle by the Dr. Lee Jong-wook Fellowship, which have been immensely beneficial to the PCU program. I hope that KOFIH and the government of the Republic of Korea will continue this assistance in training biomedical, nursing and technical staff.
The Base Hospital located at Avissawella which is situated at the border of Colombo District is a transport hub and also is a gateway to the South, East and Central Provinces. The Base Hospital of Avissawella benefits a population of over 650,000 people in the catchment area.
Fulfilling experience
I’m very pleased to have the opportunity to participate in this symposium. Our presence here is a result of the close cooperation of KOFIH, the Sri Lankan National and Provincial Health Services and Base Hospital Avissawella. I’m also joined by the Provincial Director Dr. Amal Harsha De Silva, who signed a Memorandum of Understanding in 2009 between KOFIH and the Provincial Health Department and since he has been very active in promoting the development of the PCU and coordinating various sectors to achieve this goal.
The fulfilling experience I gained in assisting the implementation of the KOFIH funded PCU program at Avissawella Base Hospital, as well as the PCU Program at the Tangalle Base Hospital of the Southern Province of Sri Lanka has been incomparably satisfying with all of my other engagements in public affairs throughout my political career.
The establishment of Tangalle Base Hospital PCU was funded by KOFIH with the assistance of the Government of the Republic of Korea with a grant of US$ 1.3 million. The Base Hospital commenced work on 30 June 2011 and was inaugurated on 6 November 2012 with the gracious support and blessing of First Lady Shiranthi Rajapaksa. The Tangalle hospital and community is currently benefitting from the newly-established PCU and has already become a focal point of the area.
It gives me immense joy that in recognition of such long years of my involvement in facilitating two of KOFIH-funded PCU programs in Sri Lanka, I am invited to address this distinguished and learned audience of International Symposium for the seventh anniversary of KOFIH and present my views on the topic of ‘The Significance of the PCU Program in Sri Lanka’.
PCU Program in Sri Lanka
The national PCU Program in Sri Lanka is still in the preliminary stages of development because of limited national coverage. KOFIH investments contributed to the implementation of the PCU program at Avissawella Base Hospital have helped the hospital facilities become much more satisfactory and proficient, allowing the personnel to treat additional patients competently. Once fully implemented, PCU programs are seen to fulfil long-felt needs of their respective communities and sometimes even attract others from beyond the intended coverage area on account of particularly the following:
Immediate attention given to emergencies during the critical hour therefore largely eliminating avoidable deaths and minimising complications from injuries or diseases, thus reducing the risk and fatality rate when transferring emergency patients to other hospitals.
Significant reduction of unnecessary admissions to indoor facilities wards reducing pressures of overcrowding. At the Avissawella Hospital, the PCU now is reported to be admitting only about 30-40% of the visits as against 90% in year 2008. This reduction of ward admissions has contributed towards improvement in quality of attention given to a single patient by the hospital personnel and a more conducive and orderly environment in the hospital wards.
The PCUs have also contributed to reducing costs of patient care by reducing the number of admissions to hospital wards, simultaneously improving the public perception of quality of care provided by the hospital.
Furthermore, functional simplifications in building architecture for high management efficiency — including reception areas, emergency facility wards, operating theatres and ancillary facilities such as X-ray rooms — are now complete at both the Avissawella and Tangalle PCUs. These facilities provide not only high quality working environments for the medical officers and personnel of emergency care but also instil confidence in patients and their concerned families who arrive seeking care, comfort and solace in the services provided by the PCUs.
Enriching the PCU experience
Under the benevolent patronage and assistance of KOFIH and its partner institutions of high repute in the Republic of Korea, along with enthusiastic support of the provincial and central health officials of the Sri Lankan Government, the Avissawella Base Hospital is able to venture into sub-programs and projects to enrich its PCU experience.
The world-renowned Inha, Inje and Hanyan Universities of Republic of Korea, invited by KOFIH, have greatly assisted in the training and exchange of expertise with the Avissawella Base Hospital. They have not only provided further training and added confidence to the Base Hospital medical officers and staff, but have also successfully enabled venturing into task-based interventions such as the cleft pallet and lip correction program which has given solace to 30 children of the community to date.
Driven by the strength of the PCU initiative, the Avissawella Base Hospital was in a position to secure seed funding from Sri Lanka’s premier Information and Communication Technology Agency (ICTA), for a computerisation program. We are extremely happy to note that the project continues as a joint program with the cooperation of Inje University and KOFIH to establish a comprehensive and fully-fledged Electronic Record System at the Avissawella Base Hospital. Once completed, this system would be the first-of-its-kind in a Base Hospital in Sri Lanka and will undoubtedly be of invaluable significance to the PCU programs in the country.
In addition, because of the increased capabilities of the staff, Base Hospital Avissawella has now ventured out of its confines to join hands with local-level health officials and the local, non-governmental activist groups. One such group, the Samaja Sahana Padanama (Social Welfare Foundation), helped in carrying out six community-based health screening programs (NCD and other) at different localities over the past year-and-a-half. I have on occasion visited each of this programs that screen between 150 to 200 individuals at a time, and was delighted to witness the tremendous confidence and enthusiasm of the hospital medical personnel as well as the joy of the beneficiaries.
Therefore I am happy to note in particular that a new partnership between the Avissawella Base Hospital and KOFIH is being worked out for curative and public health sector capacity development, targeting peripheral hospitals showing a way forward for optimising the benefits of the new PCU Program to Tangalle and other base hospitals in Sri Lanka.
We are grateful to Prof. Lim and Hanyan University invited by KOFIH for carrying out the External Evaluations of the Avissawella PCU, which is a great encouragement to all of us who have been engaged with its establishment and development to date. The visit last month of the two public health experts from Inje University focusing on the preventive health programs in collaboration with the local health sector was productive. I am confident that findings and the evaluations will be of significant value and contribute to the development of not only the Avissawella PCU but also the development PCU Programs island wide. Hopefully we will be able to share our experiences elsewhere in the South Asian region.
Appreciation and thanks
The PCU Program at Avissawella has attracted visits from high officials of the Ministry of Health to observe its functioning and form a point of view for formulating and furthering policies in the health sector. It also had visits from other hospitals to experience the model of its physical layout and operational modalities.
The Avissawella PCU model has inspired the formation of a Steering Committee for promoting emergency care nationwide and the Committee has utilised in its deliberations the experiences of the Medical Superintendent Dr. Panagoda and staff of the Avissawella Base Hospital in the conceptualisation, implementation, management and steering the progress of its PCU. Such recognition summarises the significance of the PCU Program in Sri Lanka.
The communities in areas of coverage of services of the Avissawella Base Hospital and Tangalle Base Hospital are indeed blessed by the continued generosity of KOFIH. I take this occasion to convey to KOFIH on behalf of the community their deep appreciation and humble thanks.
Finally, allow me in all sincerity to thank the Korea Foundation for International Health Care for providing me this opportunity to personally renew the treasured bonds of our friendship. I also would like to thank President Dr. Lee Soo-ku, Secretary General Dr. Sir Won-Seok, Overseas Manager Hyun Kyong Kim and the Sri Lankan Project Manager Jina Yu for the continued support and assistance. Thank you for graciously hosting me and Provincial Director Dr. Amal Harsha De Silva. It is a privilege to be here today.
I wish this symposium successful deliberations and may the Triple Gem, Buddha, Dhamma and Sangha, bless you all.
