ANNUAL REPORT
KSM, VIJER
5,DOLPO, 2013
Submitted By:Tashi Bhuti
Gurung
Staff Nurse,
KSM Vijer, Dolpo, Nepal
Staff
of KSM, 2013 AD
Acknowledgement
Objectives
Introduction
The
Annual reports of lab.
Activities
of the annual year
Budget
Mortality
rate
Evaluation
My
experiences/learning from job.
Recommendation
Conclusion
Thanks
Letter from Saldang VDC
Chandra
Bahadur Gurung Tashi Bhuti Lama,Staff nurse(Incharge)
(Programe
Co-ordinator)
Tashi
Bhuti Gurung, Staff Nurse. Toran Jiral, Lab Technician
Sagar
Maharjan, H.A. Aitey Tamang, Cook and Helper
The
department of KUNPHEN SHOGTSO MENKHANG ( K.S.M), Veijer 5, Dolpo, Nepal
expresses sincere thanks and acknowledge the support and contribution extended
by the below for the following people below for their continue, smooth running
and complete generous aids :
The
Roncoroni’s Family; the founder of K.S.M who gave their untiring support,
showed their generous involvement for the overall development of the village.
Chandra
BahadurGurung; Who led and helped us in each and every day of our work by
giving timely feedback, the lovable way of pointing out our mistakes has really
made us feel millions of thanks would be less for him.
Hospital
Member; The members of K.S.M deserve special thanks for their practical task
and others they have completed in various aspects of health affairs, specal
thanks goes to Tashi Bhuti lama(incharge) for complete orientation and hand
over of equipments and related things in k.s.m.And Sagar Maharjan(H. A) for
helping me to brings this report in your hand.
Helper;
K.S.M extends thanks to AitayTamang for his whole hearted co-operation and did
not let us feel lack of anything
Care
seeker; Also thanks for allowing us to give care, treatment , counseling,
service et cetera by giving valuable time, Co-operation and maintaining good
inter-personal relationship.
My
thanks expressed in words do not adequately convey my gratitude but it’s only
words and words which I have to show my gratitude to everybody.
General
objectives:
To
provide holistic nursing care to the patient with comprehensive knowledge of
the physical, mental, social, and spiritual status within the hospital setting.
Specific
objectives:
Ensure
access to care and treatment of assured quality and With appropriate waste
management.
continue
to expand awareness, and health promotion.
to
provide immunization according to national protocol.
to
continue the services with the fullest like, OPD services 24 hrs,to keep the
case under close observation, to perform routine lab investigation, antenatal
care, postnatal care and conduct delivery.
Administration
of medicines according to prescribed.
INTRODUCTION:
The
time has come for assessment of what we have achieved in the past years and
what we have yet to achieve. KUNPHEN SHOGTSO MENKHANG has come for the honor of
presenting the annual report of 2013 which holds a mirror to the totality of
UPS and DOWNS achieved by the staffs for the village people. As we all know
K.S.M runs its 5th
year by working for common good and serving its smallest to the highest level
care and treatment as far as we can. Our patient department runs from 10 A.m-4
pm and 24 hours service for emergency cases for those who came/seek for our
treatment and services.
Inspired
by the counseling, care, encouragement, good IPR maintain, best responses and
impression by the staffs towards the client is gradually bringing positive
aspects or better changes, less ignorant towards health care and health rights.
We
are trying our best to stand, going towards destiny and it is bringing by
awareness, faith, giving care, treatment and better health facilities to the
people of Dolpo Village.
The
tests that we have undertaken in the villages are Parasitological, Hematology,
and Bio-chemistry, Serology and Micro-biology,
The
number of total test that we have undertaken in KUNPHEN
SHOGTSO
MENKHANG:
S.N Name of Lab Test No. of Remarks
patients
1
|
Hematology
Test
|
||||
(a)
Total count (T.C)
|
101
|
||||
(b)
Differential Count(D.C)
|
101
|
||||
(c)
|
Haemoglobin
( Hb)
|
129
|
Z20%
low Hb
|
||
(d)
|
Erythrocytes
|
09
|
|||
Sedimentation
Rate(E.S.R)
|
|||||
(e)
|
Platelates
|
06
|
|||
(f)
|
Bleeding
Time (BT)
|
09
|
|||
(g)
Clotting Time (CT)
|
09
|
||||
(h)
|
Blood
Grouping ( Rh Typing)
|
12
|
|||
2
|
Bio-Chemistry
|
||||
Random
Blood Sugar ( RBS)
|
151
|
||||
Urea
|
21
|
||||
Creatinine
|
21
|
||||
Bilirubin
|
24
|
||
Uric
Acid
|
110
|
35
patient
|
|
Arthrities
|
|||
Lipid
Profile
|
06
|
||
3
|
Serology
Test
|
||
HIV
|
27
|
||
HBSAG
|
29
|
6
of them
|
|
positive
|
|||
HCV
|
18
|
||
VDRL
|
12
|
||
4
|
Parasitology
Test
|
||
Urine
Routine Microscopic
|
103
|
UTI
56
|
|
Examination(RME)
|
patients
|
||
Urine
Pregnancy Test (UPT)
|
17
|
3
Positive
|
|
patients
|
|||
Stool
Routine Microscopic
|
83
|
Giardiasis
42
|
|
Examination(RME)
|
patient
|
||
Amoebiasis
|
|||
38
patients
|
|||
Occult
Blood
|
09
|
||
5
|
Micro-biology
Test
|
||
Montoux
test
|
10
|
||
Sputum
for AFB(Acid Fast Bacilli)
|
12
|
||
After
conducting the check-up and Lab test , the result or diagnosis and number of
patients are mentioned below:
RESPIRATORY
PROBLEMS
Upper
respiratory tract infection[URTI]=78
Pneumonia=13
Common
cold=38
Asthma=3
Chronic
obstructive pulmonary disease=7
Cough=35
Diarrhoea=113
Acute
peptic disease[APD]=55
Constipation=6
Loss
of appetite =32
Vomiting=9
Abdominal
distension=12
Abdominal
pain=35
Piles[1st degree]=2
3.CARDIOVASCULAR
PROBLEMS
Hypertension=14
Myocardial
infraction[MI]=1
4.GYANAE
PROBLEMS
Pelvic
inflammatory disease[PID]=4
Cervicitis
=3
Vulvitis=1
Lower
abdomen pain=15
Per
vaginal bleeding=5
Breast
lumb=1
ENT
PROBLEMS
Tonsilitis=42
Sinusitis=13
Epistaxis=6
Foreigh
body=8
Diminished
of hearing=12
Tinnitus=5
Ottitis
media=23
Throat
abscess=2
ENDOCRINE
PROBLEMS
Diebetic
mellitus(DM)=9
TRAUMA
Cut
injury=7
Fall
injury=5
Soft
tissue injury=5
HEPATIC
PROBLEMS
Alcoholic
liver diseases(ALD)=7
Hepatitis
B=7
URINARY
PROBLEMS
Urinary
track infection(UTI)=56
DENTAL
PROBLEMS
Dental
carries=36
Gum
bleeding=7
Gingivitis=12
SKELETAL
PROBLEMS
Lower
back pain=19
Arthritis=35
Hip
dislocation=1
Elbow
dislocation=3
Conjunctivitis=35
Ptyrigium=5
Dry
eyes=2
Sticky
eye=1
SKIN
PROBLEMS
Chicken
pox=92
Skin
allergy=7
Acne
vulgaris=4
Ring
worm=7
Wart=3
Celluitis=1
Pruitis=2
OTHERS
Syncope=1
Headache=20
Oedema=5
Orchitis=1
Fever
under evaluation=15
Anaemia=33
Angular
stomatitis=7
Cyst=2
Corn=3
Dizziness=10
Whole
body pain=25
It
is a record of activities during the year of 2013. We try to give new shape to
the people in health affairs and in-spites of difficulties, we achieved.
The
overall total flow the patients including health camp is 1459 among them 800
are female and 659 are male. Out of these 31 are in-patient and rest are
out-patient. Formally the activities we have performed are listed below:
Infection
Prevention:
Cyst
extraction (Procedure):
Chieme wangmo Age/sex=37years/female Address=KU Vijer 9
Choeyang
lama Age/sex=32years/male
Address=saldang 4
Immunization:
We provide immunization according to national protocol, but we are not able to
complete the immunization doses,because we the staffs roll down to kathmandu
after 6 months.
4.Suturing:
5.Family
Planning Services: IUCD, DMPA, CONDOM, PILLS are provided and norplant removed
of three patients.
6.Foreign
Body Removal:
7.Obstetric care: ANC, baby delivery[,traditional birth attendant or
near relatives conduct delivey,because if new members or new person, come
contact with delivery,it bring bad luck or unhealthy to the baby or mother.so,I
think people should develop a scientific temper to get rid from such negative
thoughts]. PNC.
8.Oxygen
Therapy:
9.
Intra –articular injection: This procedure was provided to 10 arthritis
patients.
10.DEWORMING:
12.
Health Camp in saldang VDC-4,General Check-up,
The
news of epidemic was flash out over karang village we received a call from the
district health office [headquarter, Dunai] to conduct health camp.And did
general check up of different school children from,Namdo,Nisal,Saldang and
Karang,most of them are suffering from upper respiratory infection and
tonsillitis.
ATTENDED
A HAND PROLAPSE AND PROLONG LABOUR.
Happens
knew no bounds! Attended a delivery cases which was in transverse lie and hand
prolapsed at 4:30 am. G9p5, never seen this kind before. Due to prolong and
obstructive delivery the fetus
pass away, where our tear started, the left hand which was prolapsed,
hand was all cyanosed, then we started the procedure and drips continue. First
we attempted to do destructive delivery by cutting off the right hand. After we
did a internal rotation in which now the vertex is presenting part. We tried to
destroy the skull but failed. Again did a internal rotation by bringing the
feet presenting part.So,we delivered the fetus by breech delivery at 5:26am.No
one knew how happy we was the tears rolled down, this was the greatest deed in
life. Mother and her relatives were so happy that even they were unspoken, they
blessed us.
After
the delivery the mother condition was ok. Bp 110/60 mm of hg we continued the
drip and added some prophylaxis in order to prevent infection. We advise the
mother and rest of family to take her higher centre and ultra-sound is must for
the woman. Thank
After
the safe delivery with the mother, Tashi Bhuti Lama
Like
delivery attended, we also carried out diarrhoea management in Saldang VDC-4.
Most of the villagers were in good health but there were some few exceptional
cases which were very critical condition related to diarrhoea. We came across
three severe patient who were suffering from Diarrhoea. When our team
approached in their home, we were so shocked and sad at the same time by taking
their history and physical examination because they can’t even get up or stand
up from their bed. Two of them were mother-daughter relationship who was sick
for the last 2 months and lying on bed since a month with absolutely absence
of hygiene, care and found severe dehydrated. It was un-imaginable.
After giving primary treatment, for all of them we took them in basket to the
care centre which took us nearly 5 hours to reach our destination. Since we did
not carry any equipment. Crossed river with and mountain which was very astray
and difficult to pass.
In
DOLPO, people die of small, simple and easily treatable disease because of
DELAY
IN DECISION TO SEEK CARE
DELAY
IN REACHING CARE AND
DELAY
IN RECEIVING CARE.
With
due respect towards humanity and strength of unity and holistic care night and
day works well in which the patient recovered gradually after infusion of
antibiotics ,and lab test result shows plenty of Amoebiasis and Giardiasis, its
because of lack of hygiene and it is communicable disease through faeco oral
route .
Administered
extra fluids and provided psychological support. With the help of others the
patient gradually was able to walk in 6th days. The result was very cherishing moment for
everybody. This achievement is dedicated to all our team who are so; loyal,
determined and optimistic towards the work that comes on our way whether it’s
challenging or easy.
S.N
|
Name
of Test
|
No.
of patient
|
1
|
Haematology
Test
|
|
Total
Count (TC)
|
20
|
|
Differential
Count(DC)
|
20
|
|
Haemoglobin(Hb)
|
35
|
|
Erythrocytes
|
15
|
|
Sedimentation
Rate( ESR)
|
||
Platelets
|
15
|
|
Bleeding
Time (BT)
|
32
|
|
Clotting
Time (CT)
|
32
|
|
Blood
Grouping (Rh
|
53
|
|
Typing)
|
||
2
|
Bio-chemistry
|
|
Random
Blood Sugar (RBS)
|
35
|
|
Creatinine
|
42
|
|
Sodium
Potassium
|
43
|
|
Bilirubin
|
13
|
|
Uric
Acid
|
50
|
|
Lipid
Profile
|
-
|
|
Serology
Test
|
||
HIV
|
9
|
|
HBSAG
|
9
|
|
HCV
|
7
|
|
VDRL
|
4
|
|
4
|
Parasitology
Test
|
|
Urine
Routine Microscopic
|
52
|
|
Examination
(RME)
|
||
Urine
Pregnancy Test
|
15
|
|
Stool
Routine Microscopic
|
53
|
|
Examination
(RME)
|
||
Occult
Blood
|
-
|
|
5
|
Micro-biology
Test
|
|
Sputum
For AFB (Acid fast
|
3
|
|
Bacilli)
|
||
Montoux
Test
|
||
Kunphen
shogtso menkhang is a non profit organization and as it is according to the
hospital committee member, we charged the NRs.50/ for the vijer people and
NRs.100/ for the outsiders.
We
did free health camp to the saldang VDC. The total amount of this year was NRs.
27,000/-.
MORTALITY
RATE
In
2013’april to October at kunphen shogtso menkhang,a small boy named Tsering
Dorjee, age 12 from ku-9, who was came at KSM at last stage having diarrhoea
and haemoptysis since, two month and lab test shows
Hb%---
4.5mg/dl Creatinine---2.5mg/dl CBC------------24,000 and
Diagnosed
of AGE with severe dehydration with severe anaemia,?renal failure.
We
refer the patient to higher centre, but, could not approved and support by his
parents. After our better than best we are not succeeded.
And
other was 6months male baby, from veijer. Who was passed away with dysentery
with severe dehydration and pneumonia.
Out of hospital two people, one is age 81, male .His history states
that he passed away because of common cold and another female from Tata. Found
nearby house in field with full of blood from mouth, who was well and fit
before some minutes and known case of APD.
It
is one of the astonishing matter is that ,although we could not save the life
of some people, with the fullest zeal, their concerned people still have strong
positive and felicitation and shows deep respect for our services .
EVALUATION
My
set objectives /goals were partially met, because we succeeded in some, but
some were left undone or incomplete, like we all know that when we try to do
something beneficial for the society, there will be definitely be obstacle that
comes on our way. And for us it’s because of cultural barriers and
superstitious act of of people are very famous. People in Dolpo, mostly believe
in superstitious this is giving a hard time for us, it’s because when we
approach for treatment and care, they make excuses and sometimes argue with us
for different reasons especially related to delivery.
And
one more thing is that immunization is provided according to national protocol,
but we are not successful to complete the doses, because we the staffs roll
down to Kathmandu.
My
experiences/learning from the job.
As
a whole after completion of 6th months, spending at Dolpo, learned /gain many
knowledge, skills about various things and overall evaluation, from the staffs,
patient, villagers, books and got great opportunity to compare the disease,
according to what I have learned and what I see with patient is different, and
consulted books related to it. Creative management from available resources
remains fantastic.
I
came to know that most of treatable disease, which has remain for long time
untreated and later change into severe is common problem, due to lack of
awareness.
And
most important is got opportunity to learn for maintaining interpersonal
relationship and trust worthy relation with patient and know much about the
time management and energy.
Last,
but not least documentation and reporting is very crucial tool, through this
got idea and knowledge for writing and present report systematically.
I
humbly appreciate all the genuine, support that you all have cherished in me
whether it’s directly or indirectly.
All
the achievement that I have acquired from being quality human resource for the
nation is the result of your kindness towards me. And one more thing we, are so
successful in providing quality services, to the people of DOLPA, that even
from the DUNAI [headquarter, which is supposed to be the best service centre,
in district] and peripheral areas people come to seek for the treatment and
care. We are proud of our services.
Although
I feel this is not the end, many things are left and still to be achieved.
In
service education will remain very helpful for us if it can suppor related to
dental because, in DOLPO, most of people are suffering from dental problems,and
most common is diarrhoe and it will remain very helpful if easy lyte lab
machine is available, through that we can calculate the sodium potassium level.
Thank
you very much for your kind consideration.
CONCLUSION
We
have the honour of presenting the 5th issue of our Annual report of KSM 2013 AD, and
working in Dolpo, during 6 months, remain practical training and faced many ups
and down. It was very motivating factors in my life.
During
our session the overall patients flow are 1459.female 800 and rest are male.
And in-patients are 31 and total no.of patient performed lab test are 1517
(Including health camp in Saldang VDC-4) and mortality rates is 2.16%.
Dear
readers, I hope you will enjoy reading and feel it, as much as I have enjoyed
preparing it and working in Dolpa and request to come up with suggestions for
improvement and I feel proud for not allowing your support and contribution in
fruitless exercise.
