Wednesday, April 12, 2017

Annual Report of Kunphen Shogtso Menkhang 2013




 ANNUAL REPORT

KSM, VIJER 5,DOLPO, 2013




Submitted By:Tashi Bhuti Gurung


Staff Nurse, KSM Vijer, Dolpo, Nepal


CONTENTS




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


STAFF OF KSM, 2013



                                             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


ACKNOWLEDGEMENT

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.


OBJECTIVES



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 Annual Report of Lab:

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







Illustration of different lab tests.



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


DIGESTIVE PROBLEMS

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


OPTHALMIC PROBLEMS

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







Activities of the Annual Year2013:

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:


11. PATIENT CARE:

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


God, She was safe.

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.

Taking picture with patient after controlled the epidemic


After conducting the check-up and Lab test are as below ,


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
-





3
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






BUDGET

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 .


Mortality rate of hospital=2.16%
MOTALITY RATE























 DEATH RATE

 TOTAL NO. OF PATIENTS





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.


RECOMMENDATION





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.