Indonesia

Indonesia: The tsunami project of Medecins du Monde Canada-Italy final report

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LOCALISATION
Sumatra island, Indonesia
Aceh area, East coast
Pidie district

Sub-districts assigned to MDM Canada:
- Meuredu
- Ulim
- Jangka Buya
- Kuta Kreung
- Meurah Dua
- Mila

PERIOD: February through May, 2005. MdM closed its mission on May 31st, 2005

COLLABORATORS

Keutapang: a local medical NGO based in Sigli The main members comprise:

- President: Dr. Cut Fera Rachmawati, +6281360088551, office: +6265351023

- Secretary: Dr. Dwi Widjaya, +628126981358

OBJECTIVES

- Evaluate the needs of the internally displaced and general populations in the post-emergency/resettlement phases of the Tsunami crisis

- Gather data on local, common health problems

- Put into place health programs to respond to the needs and problems of the population

- Assist in reorganizing puskesmases

- Train local staff and collaborate with local doctors

- Coordinate with other relief organizations operating in the district.

- Report to the district health authorities and work in close collaboration with them.

In accordance with the philosophy of MdM, all projects were conceived so as to be perennial and eventually taken over and developped by the local people.

SANITARY PRIORITIES

1. Scabies treatment program

- Prevalence of scabies: 30% of consultations.

- Treatment with Benzyl Benzoate 10%. Training using poster presentations to staff in all assigned puskesmases and to affected patients and their families (Cf. Scabies treatment, a Power Point presentation).

- Treatment with benzyl benzoate was not part of the national protocol. We gained the approval for the use of this drug in assigned puskesmas.

- Efficacy of treatment: 50% (corresponds to data from medical litterature).

- We met with the WHO and with local NGO Keutapang in view of implementing a large-scale treatment program. WHO can offer logistic support but not financial help, because the project was judged too small. We suggested a joint venture with other NGOs and come back to WHO with more detailed proposal; this should be taken care of by Keutapang, who is now responsible for this project.. Contacts:

- WHO information manager: Sanjay Kumar tel: 081585310692, kumars@aceh.who.int

- WHO Field Operation Manager: Dr. Anshu Banerjee tel: 08121064878, banerjeea@aceh.who.int

- CARE, Jannis, is interested in our program and the poster: jkopinak@hotmail.com

- Dr. Fajriman in KB Tanjong, this doctor has experience in trying to eradicate scabies two years ago. To Do:

- Obtain follow-up data on effectiveness of treatment and disease evolution

- Test the possibility to start treatment with Invermectin (MsF Belgium is awaiting a shipment of this medication).

2. Tuberculosis program

- Tuberculosis is on an endemic level since 1991

- There is a national program for diagnosing and treating tuberculosis

- This program is not uniformly and faithfully applied in the puskesmases in the whole of Pidie district, the sputum collection is not well done and the follow-up of treatment is practically inexistent, as is the follow-up of complications of treatment.

- The puskesmases are ill-equiped

- Protective measures are lacking because of lack of equipment, of a ventilation system, and of sensitization of the healthcare staff.

- The nursing staff need training on tuberculosis, the diagnosis and treatment.

- The national protocol and the WHO/MSF protocol differ on several points. Contacts:

- Dr. Zainudin at the Dinas Kesehatan, tel: 081360049485 To Do:

- The project has been stopped as the local health authority do not apply the WHO protocol and insist on the national protocol being applied exclusively.

3. Basic Life Support training

- Staff of all assigned puskesmases have been trained in BLS in 3-4 hour theoretical and practical sessions.

- Issues addressed: BLS for adult, children, newborn, chocking (adult, children), neonatal asphyxia, drowning, mouth-to-mouth respiration, cardiac massage, anaphylactic shock, upper airway foreign body removal, recovery position, ventilation via Ambu-bag and facial mask.

- Participants were given a certificate in BLS (196 nurses and midwives).

To Do:

- Training in first aid in case of accidents and trauma (immobilizing fractures, wound dressing, especially in cases of burns)

- Follow-up for BLS

- Revise anaphylactic shock based on flow chart given to each puskesmas, discussion about this issue has to be done.

4 Triage

- A triage system was implemented in all assigned puskesmases (BP, Temp., RR, Pulse, body weight are taken in all patients before medical consultation).

- This should be continuously verified and reinforced. This system is very well established in Jangka Buya.

5 Wound dressing and sterilization

- Training on how to debride and dress wounds has been done, and should be supervised periodically and with insistence.

- Proper sterilizing techniques have been taught. All the puskesmases are now equiped for sterilization. We provided pots, electrical stoves and linen for this purpose, as well as sterilization fluids. We trained the staff in their use.

6 Clinical training for nurses

- Subjects discussed were: scabies, respiratory diseases, rheumatic diseases, diagnosis and treatment of malaria, malnutrition, antibiotic use and abuse, BLS, training for midwives (mainly about prolonged labour and postpartum haemorrhage), tetanus prevention in wounds, anaphylactic shock, sterilization of medical instruments.

7 Emergency room in Meuredu

- The ER was cleaned and renovated, walls painted; two emergency beds were set up (one for deliveries); the equipment was upgraded..

- Staff was trained on sanitation of the ER (mosquito nets, ventilation via fan).

- The old equipment cupboard was upgraded: drugs, wound care, IV injection, fluids, rescue breathing sets (ambu-bag, facial mask, Venturi-mask, Guedel cannula).

- A new equipment cupboard was set up for deliveries with material donated by UNICEF.

- A checklist for equipment and drugs was typed and posted.

- If this is continued, we would suggest to contact WHO division of Laboratories and Hospitals that is involved in upgrading healthcare facilities. This can be done through WHO coordination team (Dr. Muhammad Asan) (see WHO website).

- We invited the other NGOs doing clinical work to use this emergency room for stabilization and referral.

8 Leprosy

- We visited the leprosy camp with doctors from Save the Children (Dr. Juju).

- To be done: gather statistics, evaluate problem, evaluate protocols for diagnosis and treatment.

- This part of the project was not at this time pursued further because of the uncertainty of the continuation of our presence in Indonesia.

9 Clinical training for doctors

- Contacted Dr. Dwi, who expressed an interest in organizing educational sessions for all the doctors of the Pidie area.

- This project is still awaiting the approval of Dr. Hamid, who seemed interested.

- This is a very interesting project to follow up on.

10 Malaria

- New cases are reported daily. A spread of malaria is expected due to the approaching of the rain season. By now the cases are mostly imported (by displaced people from the coast) and concentrated in the mountains. Some cases were reported in Sigli area. Falciparum M. is predominating

- To be done: training in hygiene and protective measures against malaria.

- N.O.W. (Binax) Quick-test for malaria that distinguishes between P. Falciparum and other types of plasmodium, can be obtained from WHO in Banda Aceh free of charge through Mr. Putut (you have to go to WHO office, write an official request which must be approved, and then go with this approval to the WHO warehouse, so count at least 2 hours for the whole process). Contacts:

- MENTOR: Joaquim (Kim) Canelas, country director +628121037127

11 Midwives training

- Training for midwives was approved and done in the puskesmases of Jangka Buya, Mila, Kuta Krueng, Meurah Dua and Meureudu.

- According to the initial wishes of the midwives, training was focused on postpartum haemorrhage and prolonged labour.

- We ascertained wishes for future training: normal delivery, pre-eclampsia, and spontaneous abortion.

- Were given to each puskesmas: 1 speculum; 1 manual suction device (2 in Jangka Buya and Kutakrueng) and 1 measuring tape for uterine height. Umbilacal tape was given in Jangka Buya and Kutakrueng.

- Basic and general knowledge of the midwives was found to be good.

- General questions were answered about pregnancy and delivery.

- Some ampoules of oxytocin were also distributed.

12. Tetanus prevention in wounds

- Training was given, with approval from Dr. Hamid, in Jangka Buya, Mila, Kutakrueng, Meurah Dua and Meureudu.

- Antitetanus immunoglobulin was distributed to the puskesmases and the staff was trained in its use.

SUGGESTIONS FOR THE FUTURE:

1. We think that evaluation of the situation in the IDP barracks could be a next step to implement because there seems to be reduced focus on this problem -- we already visited one IDP barracks camp and found many cases of scabies, some cutaneaous mycosis and skin allergy. This could be done in coordination with the puskesmases.

2. Mobile clinics run by locals. A program in the form of periodical visits by local nurses to the villages and barracks in order to evaluate the state of health of the population, catch early manifestations of disease, care for bedridden or handicapped patients, and to promote health. This is already started in Jangka Buya.

3. Periodical training for the staff of the puskesmases could still be done since this is a recurring suggestion from the staff.

4. Since the emergency period is officially over, WHO asks that we stop giving medication to the puskesmases and ask them to use the national mediation list (LPLPO) (available through WHO) and order directly from the district warehouse.

5. Malnutrition is an issue that should be assessed. We found that children were often malnourished: low weight, low height, glossitis, skin and teeth problems, diarrhea. This could be done through the schools together with English teachers. This should also be addressed in pregnant women and families.

6. If further training for the midwives is intended (and this is a wish that was expressed by the midwives), we recommend that a family doctor experienced in obstetrics and follow-up of pregnancy and delivery be sent; we also very strongly recommend that this doctor be a woman since men cannot attend deliveries in Aceh.

7. Training about personal hygiene could be an interesting topic to pursue since we found that some basic knowledge was sometimes lacking in this area.

8. Scabies treatment and training could be done in the villages. A large-scale eradication program should be set up.