The Fiji Ministry of Health and Medical Services (MOHMS) has released a World Health Organization (WHO) report on the recent outbreak of Acinetobacter baumannii (A.baumannii) bacterium within the neonatal intensive care unit (NICU) at the Colonial War Memorial Hospital (CWMH), Suva.
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Emergency care at CWM Hospital is provided by a highly skilled team of expert doctors and nurses. They include specialists in emergency medicine – doctors who have completed a four-year Master’s degree in Emergency Medicine at the Fiji National University.
The FNU Masters programme was developed under the guidance of Dr Anne Creaton, an emergency physician from Australia. It is now run by Dr Dennis Lee, who trained in Emergency Medicine in Papua New Guinea with support by visiting specialists from Australia, New Zealand, UK and USA. The first six doctors graduated from the FNU Masters programme in 2016.
Emergencies don’t just happen in our capital city however so the team at CWM Hospital also offers support, advice and training for staff in smaller health facilities around the country. The following case, which took place recently, is not unusual and illustrates how effective teamwork can be.
Josaia (not his real name) is 56 years old. At home one evening he experienced chest pain. The pain gradually eased but in the middle of the night it suddenly got worse again. He felt his heart racing and he was sweating heavily. He rushed to Nausori Health and was assessed by the Medical Officer on duty who found he was critically unwell with a dangerously high heart rate and abnormal heartbeat.
The Medical Officer immediately called the Emergency Department at CWM Hospital for advice and was told that Josaia required cardioversion, a procedure where electrical energy is applied to the heart to return its rhythm to normal. The staff at Nausori were not expert at the procedure but Dr Deepak Sharma, the emergency medicine specialist at CWM Hospital was able to guide them through what was required. The staff at Nausori then explained the procedure to the Josaia and his wife and Dr Sharma remained on the phone to provide continuous support while it was carried out.
The procedure was a success and Josaia’s condition stabilised while he was at Nausori Health Centre. Dr Sharma then sent one of the emergency team to bring the patient back to CWM Hospital by ambulance but when he arrived it became apparent that he was having a heart attack. He was treated with a special clot busting drug after which his condition stabilised and he was admitted to the coronary care unit.
Josaia remains well and was able to leave hospital after a couple of days. His experience is a good illustration of how our locally-trained emergency medicine specialists, their colleagues in CWM Hospital and doctors and nurses elsewhere in the system are working together and using their skills to save lives every day.
During July, its first full month of operation, the Ministry of Health & Medical Services’ Customer Contact Centre handled almost 1,000 calls, emails and text messages from members of the public.
The main areas of concern raised by those who contacted the centre related to staff attitudes or perceived delays and long waits for attention, which together accounted for 23 per cent of the calls received. The next largest group of calls were those where the caller considered their treatment was ‘unsatisfactory’ (four per cent of the total).
Those figures have been noted by the Ministry and, while it is still too early to identify any real patterns or trends in the data, they provide a useful basis on which to monitor future performance. Where possible, additional information on callers’ actual waiting times and the reasons why they considered their treatment to be unsatisfactory will also be obtained. Such concerns may stem from inadequate explanations by staff or unrealistic expectations on the part of patients: both areas where better communication could help.
The Customer Contact Centre received compliments on services delivered in several facilities including Nadi, Navua and Wainibokasi Hospitals and Valelevu, Dreketi, Raiwaqa, Cuva, Natabua, Balevuto and Nasea Health Centres. There were also a significant number of calls (around one in four) which did not relate to health services or where the caller simply hung up without speaking. Those calls may be a result of people wanting to test out the new service or being unfamiliar with its operation. They will, hopefully, reduce over time.
By the end of the month all but a handful of the issues raised by callers had been satisfactorily resolved with the overall average time taken to deal with an issue and respond to the caller being less than 2½ days.
In a typical month more than 80,000 people attend the Ministry’s hospitals and health centres as inpatients or outpatients. The total number of complaints registered by the Customer Contact Centre in July was fewer than 350 which represents just 0.4 per cent or one in every 250 patients.
On 21 June 2017, the Ministry of Health and Medical Services (Ministry) alerted the public of four (4) deaths within the Neonatal Intensive Care Unit (NICU) at Suva’s Colonial War Memorial Hospital (CWMH). As of 11 July, a further two (2) deaths have occurred within the NICU.
The NICU is a specialist unit which provides intensive care to ill or premature infants born at CWMH, the national referral hospital of Fiji. Many of the infants who are cared for in this unit suffer significant pre-existing illnesses such as compromised immune systems.
The presence of the multidrug resistant bacteria, Acinetobacter baumannii, was detected by CWMH laboratory services in samples obtained from NICU patients. This bacterium is commonly found in hospital settings and hospital patients around the world. Whilst the bacterium poses very little risk to healthy people, it can be a significant health risk to those with compromised immune systems.
A similar outbreak of this bacterium occurred within the NICU at CWMH between December 2016 and March 2017.
The Ministry and WHO are working together closely with CWMH’s clinicians and Infection Prevention and Control team to respond to this current outbreak and ensure the safety of the hospital’s most vulnerable patients.
As part of the immediate response, CWMH has increased surveillance in the hospital to support early response to new cases of infection; enhanced screening and infection precautions of all new admissions to the hospital and the NICU; and intensified its infection prevention and control measures.
A specialist team has also been deployed by WHO to Fiji to work with CWMH to try and identify a source of the bacteria, in addition to reviewing current infection prevention and control practices within CWMH and, as a further preventive measure, also examine practices in Lautoka and Lambasa hospitals. Based upon their findings, this team will be providing recommendations for ensuring that the hospitals’ current processes are appropriate, and adequate systems are in place to ensure the delivery of quality clinical care and patient safety.
Whilst a common source of the bacteria has not been found, this is not unusual as sources are only identified in 50% of all outbreaks reported globally. As sustained elimination of multidrug resistant bacteria in hospitals is extremely difficult, enhanced prevention, surveillance and early intervention measures are critical to preventing the infection of individual patients and consequent outbreaks.
The Ministry and WHO will continue to provide updates to the public on this issue.
The Australian High Commissioner to Fiji, Ms Margaret Twomey, will hand over to the Ministry of Health and Medical Services (MoHMS) FJD$394,943.60 worth of laboratory equipment to support improved diabetes management in Fiji.
Speaking to invited guests at the Navua Hospital, Ms Twomey said, “Through Australia’s Fiji Health Sector Support Program, I am delighted that our investment in this laboratory equipment, and the ongoing work with the Ministry of Health and Medical Services, will assist diabetic patients to lead full and productive lives. Australia is proud to be associated with efforts to prevent and manage diabetes.”
Results from both the 2002 and 2011 World health organization STEP wise surveys showed high rates of poorly controlled diabetes amongst Fijians. In an effort to better identify and manage people with diabetes, the MoHMS in partnership with FHSSP, launched a diabetes screening program in 2012 and equipped public health nurses with NCD toolkits. From 2014 onwards public health workers have also been upskilled with motivational interviewing techniques so they can more effectively counsel their diabetic clients to make positive behaviour changes and comply with treatment regimens.
This new laboratory equipment will enable the testing of HbA1c at six additional health facilities— Rakiraki, Tavua, Taveuni, Navua and Levuka hospitals and the Seaqaqa health centre. Being able to provide this test at site enables both health workers and clients to improve follow up and better manage their diabetes.
In receiving the equipment, the Minister for Health and Medical Services, Hon Rosy Akbar, thanked the Australian Government and FHSSP for their ongoing support, “This public private partnership is the key foundation to nurture a multi-sectoral approach that is needed to enhance the health services and collaboratively address the challenges relative to Fiji’s health sector development.”
The Minister added, “I am pleased to note that the laboratory and biomedical technicians will receive training to equip them with the skills to correctly operate and maintain the machines. This equipment will make a great impact in terms of providing the ability to better follow up and manage diabetic conditions and adjust treatment as necessary.”
If you think you may have diabetes, please go to your nearest health facility to be checked.
For any further information, please contact FHSSP Office Manager Vasiti Nailele on 9491160 or email vasiti.nailele@fhssp.org.fj