Outpatients
Routine outpatient consultations are held each morning and afternoon from Monday to Friday. Urgent cases are also seen on
Saturday mornings. At other times the patient is directed to the ward, from where the doctor is called. A gospel service is
held at 07h30 in the waiting room, followed by a health talk by one of the nurses or assistant nurses. The health talks
cover such issues as diarrhoea, personal hygiene, vaccinations, treating a child with fever, worms etc. Patients bring a
small notebook (carnet) which is their health record. They are given a number by the receptionist and then wait to be
called by the doctor. Normally 2 or sometimes 3 doctors do consultations each morning. The doctor may send them for a lab
test, X-ray or ultrasound before prescribing the treatment. The patient then pays his fee to the cashier (consultation fee,
lab & X-ray, and cost of medicines) and picks up his medicines from the hospital pharmacy. Injections and dressings are
done by the nurses in the adjacent dressings room
Inpatients
There is one inpatient ward with 22 beds – 4 intensive care, 8 men’s beds, 8 women’s beds, one private room and one
isolation room. There is usually one nurse and two or three assistant nurses on duty during the day, and one nurse or
assistant nurse at night. A gospel service is held each morning at 07h30, and this is followed by the doctors’ ward round.
There is also a gospel service each evening. Basic care is provided by patients’ relatives – bringing food, bedpan, helping
the patient with walking etc. Most patients are in hospital from 1 to 5 days. Most of the patients are either acute or
routine surgical patients, or acute medical or paediatric patients. The medical conditions include dysentery, typhoid,
meningitis, gastro-intestinal bleeding, pneumonia and occasional psychiatric patients particularly overdoses. The
paediatric patients include children with severe diarrhoea, malaria (particularly cerebral malaria), pneumonia, meningitis,
and Burkitt’s lymphoma.
The ward includes a nurses office, preparation and sluice room and toilet and shower rooms for the patients. A second ward is available for overflow, but is not staffed. Patients often stay in “Betela”, the small houses for patients’ relatives, on discharge, so that they can attend for further dressings or treatment.
The relatives of patients either stay with family nearby, or rent a room in the adjacent village (mostly mud huts, but some are brick houses), or stay in “Betela” (Bethel). This consists of 10 buildings each with 2 rooms. Each room has one bed and mattress and the family will rent one room in which all the relatives will sleep. They cook on wood or charcoal in the area provided. There is a toilet and shower room available, but water must be carried there by bucket.
Surgery
The present operating theatre block consists of an air-conditioned operating theatre, sterilising and preparation room,
anaesthetic room, patient preparation room, changing cubicles, shower, toilet and scrub-up area and staff rest room.
Normal operating days are Tuesdays and Thursdays, Minor ops are done on Friday mornings. There is a theatre nursing team of 4. Three of these are on emergency call at night.
Equipment available in the theatre includes oxygen concentrators, pulse oximeter, electric suction machines and a diathermy machine. There is an overhead theatre light and a standard hydraulic operating table. We do not have anaesthetic gases. Operations performed include hernia, hydrocele, hysterectomy (usually for large fibroids), ovarian cyst, D & C, Caesarean section, ruptured ectopic pregnancy, laparotomy (especially for patients with abdominal sepsis following criminal abortions) vesico-vaginal fistula repair, cleft lip, skin graft etc.
Anaesthesia
There are two anaesthetists – Dr Jeannine and David Mann
For Caesarean section, hernia, hydrocele we use spinal anaesthetic (5% heavy lignocaine)
For vesico-vaginal fistula we use spinal anaesthetic (0.5% heavy bupivacaine)
For minor cases we use local anaesthetic by infiltration
For short cases (D & C, most paediatric cases, skin grafts, some fractures) we use bolus intravenous ketamine with or without diazepam.
For limb surgery we often use intravenous regional block (0.5% lignocaine)
For major abdominal surgery (laparotomy, hysterectomy) we use an intravenous ketamine infusion, paralysis with suxamethonium followed by pancuronium, endotracheal intubation and ventilation with oxygen enriched air. Paralysis is reversed with neostigmine (and atropine) at the end of the operation. Analgesia is sometimes supplemented with iv pethidine.
Laboratory
Equipment included binocular microscopes, centrifuge and haematocrit centrifuge.
Tests performed include:
Microscopy: urine and stools, sputum for Acid Fast Bacilli, gram staining of cerebro-spinal fluid, vaginal flora etc.
Haematology: Haemoglobin, white cell count and differential, red cell morphology, malaria parasites, sickle cell test
Blood grouping and crossmatching for transfusion
HIV testing, RPR for syphilis.
Urine protein and glucose, blood glucose
X-ray
There is one technician – Theophile. We have a modern X-ray machine donated by World Medical Mission (Samaritan’s Purse).
Developing is done by hand in tanks.
X-rays can be taken of bones, chest, and abdomen. Intravenous pyelogram and hysterosalpingogram can be performed.
Ultrasound
We have a fairly old ultrasound machine and can do basic examination of pelvic and abdominal organs. The area of greatest usefulness is in the diagnosis of early pregnancy and identification of pelvic masses.
Eye surgery
As from January 2003 Dr Paul Steinkuller of Christoffel Blinden Mission (CBM) has been training Dr Hanitra to become an eye surgeon at the hospital. Madagascar has the second highest incidence of cataract in the world. In addition to the help of CBM, Lions Sight First Madagascar (LSFM) are providing funds to make cataract surgery available for all.
Dentistry
We have a dental room and equipment, which has not yet been used. We are awaiting the appointment of a dentist. Meanwhile Dr Francis carries out dental extractions on Friday afternoons.
Physiotherapy
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We have a physiotherapy room, but are still looking for a physiotherapist.
Evangelism
The aim of the hospital is not only to minister physically and socially by bringing health and healing, but even more importantly to minister spiritually by spreading the Good News of Jesus Christ and of salvation in Him. This is the reason for the name “Good News Hospital”:
- Gospel services, at which the gospel message is explained, are held each morning in the outpatient department and twice a day in the ward.
- Tracts in Malagasy explaining the way of salvation are available for those interested.
- There are opportunities for personal witness.
- Before each operation, with the agreement of the patient, the surgeon and operating theatre staff pray for the patient and commit the operation to God.
- A weekly Bible study is held with interested hospital workmen after work.