A.  Support from AusAID

The Twinning Project has been boosted in the last six months by an infusion of funds from AusAID. AusAID has allocated $135,000 to the expansion of the Twinning Programme.  The funds will be used in two ways.

1.                $ 35,000 to foster the Twinning Programme

2.                $100,000 to purchase new equipment for Vaiola hospital.

A team from St John of God, ( David Quinney (Director of Nursing ), John Macdonald, (Nurse Unit Manager - Intensive Care and Coronary Care ), Rod Brown (Supply Manager) , Cliff Trotman (Radiologist) and Jim Graham (Biomedical Engineer) went to Tonga for a two-week period in early July.  Their brief was to review the clinical aspects of the Twinning Programme and to prepare an operational plan for the next two years.  They also drew up a priority list of new equipment that was needed within the hospital, and did in-service on equipment shipped from St.John of God Hospital.  This included monitors etc., which were purchased with the last Matching Grant.  Their recommendations include:

• Appoint an infection control nurse from the Infection Control Committee

• Review of the supply department and removal of non-useful stores

• Establish an equipment registrar for all biomedical equipment showing the Type, Quantity, Location and Last Service Date.

• Radiology

• Investigate the benefits of teleradiology between Vaiola and St John of GodHospital

• Implementation of a hospital safety committee programme to ensure ongoing quality of radiology film processing
  

• Undertake the following Training Programmes

• ·       An Infection Control person in Australia for two to three weeks

• ·       Medical Ward nurses for four weeks

• ·       Department of Emergency Medicine Nurse Unit Manager or Medical staff for three weeks.

• ·       Fund a member of staff to attend the Public Health Education Services Seminar in Melbourne in February 1998.

• ·         Equipment Management

• ·                The steriliser currently located at Vava'u will be relocated to Nuku'alofa and installed and an appropriate steriliser purchased for Vava'u. 

• ·                An Equipment Committee should be established to coordinate purchase of equipment for donor groups.  An equipment priority list has been prepared.  All equipment should be of a standard variety irrespective of donor, but it should be of low maintenance and high quality, and should not be duplicated by accepting from various donors without review.  A list of all the equipment that had been prioritised is available if anybody would like further information.  It includes equipment for pathology, X-ray, obstetrics, theatre etc.

·         The dental programme will be supported with two half fares for volunteers outside the hospital or Rotary. 

B.  Tonga Health Sector Planning and Management Project:

AusAID, as a consequence of the Twinning Programme, have appointed PW & Associates the successful tenderer to improve the planning, management and delivery of the Government of Tonga's health services.  The Project will be based at the Ministry of Health (MOH) in Nuku'alofa and will involve the health services throughout Tonga.  It is anticipated that the Project will commence in September 1998 and will continue over a four-year period.

As I understand it, this Project envisages that AusAID will appoint a tender who will organise personnel to stand beside people in fairly senior positions in the Health Sector in Tonga.  They will be able to advise and direct them to set up routines and protocols for various management strategies in the areas of Planning, Budgeting, Information Systems, Building & Equipment Maintenance, Communications, Cleaning, Infection Control, and Community Health.

The team leader will be appointed for a 4 year full time position in Tonga, but other technical advisors will be appointed at various strategic times over this period.  For example, the finance and budgeting advisor will be required for 3 months initially and then for one month in each of the remaining years.

St.John of GodHospital will be involved with this project, both by contributing some advisors, but also by being involved in conjoint activities.  This is the best news we have had so far, as the continued presence of these technical advisors will support those Tongans who are striving to upgrade their health system.  The interaction between the successful tenderer, St.John of God Hospital, and the staff of the VaiolaHospital will allow the development of good routines and practice which will carry the Tongan Health Sector into the 21^st century

C.  Liuake Ta'Haafe

Liuake from the Linen Supply dept of Vaiola Hospital spent three months working in CSSD at St.John of God Hospital, and has now returned to Tonga to set into practice the knowledge that he has gained.  The steriliser from Vava'u which is about to be re-installed at Vaiola is the same as Liuake has used at St.John of God.  Liuake will also profit from the resurrection of the Infection Control Committee, and from other recommendations of the Twinning Programme review.

Dr Bernard Tu'inukuafe

Bernard is being sponsored by the Twinning programme to do a presentation on a case of tetanus that he managed at Vaiola, at the combined meeting of the Australian and New Zealand Societies of Anaesthesia in Dunedin in NZ.  Bernard and his team managed this patient on the ventilator for nearly a month, and were eventually very successful in rescuing this man.

Matching Grants

·         #7514 as detailed below, $23,000 has been provided to repair the Nurses' Home .  Funds for this came from our own club, (Ballarat West), the Rotary Club of Ballarat South, the Rotary Club of Torquay, (all District 9780), the Rotary Clubs of Nuku'alofa and of Auckland (both District 9920) and the Rotary Foundation of Rotary International.  This will probably be the last of the Construction matching grants that we will be able to use because of a change in the rules for eligibility for grants.   This change limits their use to a maximum of $2,000 for repairs, and makes projects, which involve construction of schools, hospitals or clinics, ineligible.  FAIM volunteers from New Zealand are joining with our own RAWCS volunteers to complete this project.

·         #6550 .  Awarded at the end of 1996, for $US 24,333, and used to purchase Oxygen saturation monitors, a 6 channel ECG, a resuscitation set and infusion pumps.  This was funded by the Rotary Club of Ballarat West, the Rotary Club of Ballarat South, (including a private donation from PP Geoff Hedditch) the Rotary Club of Ballarat East (all D9780) the Rotary Clubs of Nuku'alofa and Auckland (D9920) and the Rotary Foundation.

·         A new matching grant Is being negotiated to purchase and install a Laser for use in ophthalmology, and several other items to a total value of $40,000, in conjunction with several Rotary clubs in our area.  In particular the Rotary Club of St. Arnaud has put in $12,000 for this project.

Installation and in-service for equipment purchased through these matching grants, and other equipment shipped at the same time, (Operating Table, Operating Ophthalmoscope, backpack Defibrillator, Xray equipment and dental paraphernalia) was provided by the twinning programme team in July, and the dental FAIM team.

With Matching Grants  #3263, July 1994 ($US 40,116)  #5499, December 1995 ($US 4,175), this brings the total grants awarded over the last three years by the Foundation to over $123,000

FAIM (Rotary Australia World Community Service Volunteers)

A.  Nurses' Home

FAIM are planning to send a number of teams to renovate the Nurses' Home at Vaiola, from Easter 1998.  Funding for the materials was obtained by a Matching Grant #7514 from the Rotary Foundation of Rotary International.  The roof will be replaced, all shower/toilet blocks renovated and the upper floor painted.  These teams will also inspect the hospital at Vava'u with a view to upgrading the water supply.  The dental team that visited Vava'u commented that it would not be possible to improve infection control in the hospital without clean hot and cold running water.  The FAIM team that goes to Vava'u will also checkout the new electrical steriliser to replace the previously donated steam steriliser.

B.   Dental Programmes

The dental programme continues with a further visit from Dr David Goldsmith and his team ( Rod McLean, (microbiologist and senior lecturer in infection control at RMIT), Peter Copp, (Dental equipment technician), and Camille Lewis (dental nurse) in July this year.  They installed and provided in-service training for the very large amount of equipment they had procured and shipped this year, and they followed up on recommendations and initiatives from last year.

Their current recommendations include:

·         A dental nurse be appointed to oversee infection control procedures in the dental clinic.  Robyn Scanes , an Australian dental nurse has started work at the Dental Clinic (18^th of November), to, I gather, run a dental therapist course, and supervising infection control as part of that.  A great opportunity and it has arisen because of the tremendous rapport between David's teams and the dental department at Vaiola.

·         A distiller be purchased $550, and two more autoclaves found in Australia and shipped over.

·         Staff should be immunised against Hepatitis B

·         A further team should go next year to follow up on the initiatives set in train so far.

A full report is available for anyone who would like more information at http://www.ballarat.net.au/rotary_west/

or by contacting David Goldsmith a dgold@netconnect.com.au

C.  Trevor and Wanda Chapman

Trevor and Wanda spent yet another few days in Tonga in October to receive the shipment of donated goods, inc the Matching Grant equipment. They, with Robert Bolouri made sure all reached its intended destination.

D.  Greg Henderson

Dr. Greg Henderson (consultant anaesthetist in Ballarat ) spent two weeks in Tonga subsequently.  Greg went with three briefs.

1.       To review the stores .  Greg looked at the Pharmacy building which had been cluttered up with equipment, provided by well meaning donors from many parts of the developed world.  There was so much equipment that could never be used, (eg. renal dialysis kits) that it not only prevented access to more useful equipment, but made such equipment almost impossible to find.  Greg selected out a container load of surplus stock.  This cannot be disposed of in Tonga, but will need to be disposed of in Australia.  It will probably cost $4,000 to bring these stores back.

Equipment sent to developing nations needs to be targeted.  It must be asked for first, and then sought, and supplied in good working order, with in-service instruction wherever appropriate. Sending goods, which MIGHT be useful, adds an unnecessary burden on developing nations.

2.       To lecture at the annual Australian Society of Anaesthetists / Pacific Society of Anaesthetists annual refresher course , which this year was being held in Tonga.  This programme is part of an initiative of the ASA to develop the standards of anaesthesia in the Pacific, and is usually run in conjunction with the Fiji School of Medicine. The ASA have also developed an anaesthesia training programme, ( Diploma of Anaesthesia, Fiji School of Medicine ), a two year course supported by all the countries of the Pacific to train medical practitioners in anaesthesia.  This course can progress for a further two years with experience in a developed country to do a Masters degree.  Accreditation after completion is for the Pacific only, but trainees will be accepted as specialist anaesthetists by their governments Ministry of Health.  The concept, aimed at reducing the drain of specialist anaesthetists from PacificIsland countries, is being used as a template by other colleges in Australia to develop similar programmes in conjunction with the Fiji School of Medicine.  One can only hope that Surgery will not be far away.

3.       To provide relief for the consultant anaesthetist Dr Bernard Tu'inukuafe to attend the Refresher course , and subsequently to have a weeks holiday.  Bernard has been the only anaesthetist on Tonga for all this year.

THE FUTURE

With an expansion of the twinning programme, the AusAID plan to assist the Tongan Health Sector, and the arrival of the FAIM teams following Easter, it looks as though we are on the verge of a very significant development of the project to revitalise the Vaiola Hospital. 

The Dental programme running conjointly threatens to set a standard that the Twinning Programme may even now have difficulty staying with.  We are building up better and better relations with the staff of Vaiola and other agencies such as the WHO and AusAID. We could not have imagined that we would be in a position to achieve so much, five years ago.

Saturday, December 20, 1997

J ohn Oswald

Vaiola Hospital Project Coordinator,

Ballarat West Rotary Club,  PO Box 92  Ballarat VIC 3350