Ilondola

Ilondola Rural Health Centre

Ilondola Mission Rural Health Centre
P.O. BOX 480 197
Chinsali

1. General informations

1.1 Background

The centre, founded by theWhite Fathers, started as a dispensary in 1956. It has been extended to a rural health centre (RHC) in 1976. Since 1968 the Sisters of the Child Jesus are running the institution. The centre is situated at Ilondola, St Maria Madgalena de Pazzi Parish ( founded in 1934), about 40 km West of Chinsali, in Chinsali District. Hospital of reference is Chinsali District Hospital (sometimes they do refer cases to Isoka or Mpika). Ilondola is a referal centre for patients from nearby Health Centres namely: Mwika, Konja, Kabanda and Chilanga. The Catchment area has around 13 300 people.

1.2. Posts/Out-centres

The RHC has six out-centers:

• Masongo
• Mapampa
• Ketani
• Mwalala
• Mungulube
• Thomashi

1.3. Managment

There are the following internal meetings

• staff meetings (monthly) : problems faced, how to reach sustainability, how to go forward…
• CDEs meetings (monthly): general work
• Neighbourhood meetings (quarterly) : problems faced by the community
• Health Advisory Committee (monthly) : income generating projects, help of the community to the RHC etc.

External meetings

• Sr. Elisabeth, the Sister-in-Chargerepresents the three Diocesan Health Centres of Ilondola, Mulanga and Mulilansolo in the Chinsali District Health Management Team.
• Sisters-in-charge meetings : the four sisters-in-charge together with the representative of Chilonga Hospital meet twice a year with the diocesan health coordinator and other members of the diocese.
• Diocesan Health Board : Sr. Elisabeth represents the four mission RHCs in the Diocesan Health Board.

Administration:

Sr. Elisabeth Mutale, sister-in-charge, is responsible for the administration and the finances, she is helped by Sr. Julian. There is no accountant, only a cashier who collects the medical fees. There is one office for the sister-in-charge.

2. Buildings

2.1. The centre

The centre is very well maintained, it consists of three separate wings.

• wing A: OPD (registration room, screening room, dressing & injection room, laboratory, pharmacy, room for the solar fridge, office and duty room) and the Maternity Ward
• wing B: children ward, male ward and female ward
• wing C: dining room, kitchen, laundry, drugs store room, room for supplementary food and room for MCH activities.

The RHC has 42 approved beds, each bed is protected by a mosquito net

2.2. Facilities, equipment…

Electricity

Ilondola is the only centre which is connected to the national grid. The centre has a “normal” fridge and a solar fridge. The generator is disconnected. The District pays part of the electricity bill. The RHC used to have a mortuary fridge, but it has been taken away.

Water

The water supply is good, there is no shortage in the dry season. The water needs to be boiled. The centre has no hot water, this would be needed in the laundry and the maternity.

Communication

They have daily radio communication with the diocese and with the District via short wave radio at fixed hours.

2.3. Staff accomodation

There are only four staff houses which is not enough. More are needed, but there is no money for this for the time being.

2.4. Shelters for relatives

The relatives’ shelter is in a very bad state. The sisters would like to build a new one. At the moment, the relatives have to stay in the wards. The community agreed to make bricks but some others materials will be needed.

3. Staff

3.1. In the centre

Ilondola has one Sister in Charge (ZEN), three qualified nurses (ZEN), one EHT and seven general workers (3 dressers, 1 cashier, 1 driver, 1 cook, 1 watchman). The center has no midwife.

The total number of staff is 12 in comparison to 20 in 1990. The proportion of staff to approved beds is 12 staff for 42 approved beds.

Remarks :

• critical shortage of staff : in January 2002, only 2 qualified nurses, 1 EHT and 6 CDEs were working in the centre. In February, only the sister-in-charge was remaining as a nurse. But in April 2002, there will be 3 nurses (Sr Elisabeth, Sr Julian and Sr Gertrude). Sr Elisabeth is on call every night !
• there is no clinical officer

3.2. Neighbourhood health committees : CHW’s AND TBA’s

The number of CHWs is low, four only, therefore, the centre would like to train some more and they would like to do it locally. The District is not funding this training, so Sr. Elisabeth has asked for assistance to Irish Aid : she has to wait for the answer.

TBAs : 8 woman were trained in 1999 but they are not very active.

4. Hospital activities

4.1. Curative activities

Top Three Diseases for morbidity and mortality (All ages)

Malaria	2644
Diarrhoea	234
Malnutrition	199

Top Three Diseases for morbidity and mortality (Under 5)

Malaria	1772
Anaemia	86
Pneumonia	109

A. Out Patient Department

Opening hours:

• Morning : 8h00 – 12h00
• Afternoon : 14h00 – 16h00
• Saturday : 8h00 – 12h00
• Closed on Sunday (only emergencies)

OPD attendance in 2001 in detail:

• New cases: 7393
• Re-attendances: 2313
• Admissions: 1003
• Referrals: 22
• Deaths: 38

B. In Patient Department (IPD)

IPD Attendance in 2001:

• Patients admitted: 1003
• In-Patients Days: 3290
• In-Patients daily average: 9
• Occupancy rate (on approved beds): 21,5 %
• Length of stay per admission: 3,3

4.2. Preventive & promotive services

Children’s clinic:

• twice a week (on Wednesdays and Thursdays)
• out-reach activities: once a month

Ante natal care: 5 times in a month

Health Education: everyday

Water and sanitation programme: once a month

Home Based Care & HIV/Aids programmes: there is no volunteers trained at the moment, the Diocesan Aids coordinator is currently implementing the HBC program. For HIV/Aids prevention they give health education.

Natural Family planning: 4 couples have just been trained in Chilonga and the programm re-started in November 2001. They combine it with the outreach activities: Health Education is combined with Natural Family Planning. The trainer couples report every month about the number of clients they had.

• All the out-centres are visited once a month.
• Contribution of the community: The community is involved in providing food for the meals of the patients. Thus the centre can offer 3 meals per day to the patients.

4.3. Supportive medical services

Laboratory & blood transfusions
There is a laboratory (started in 1992) but no trained staff. For anaemia, they have to send the patient to Chinsali District Hospital (patient somtimes die on the way).

Pharmacy & drugs:

• From the District: Ilondola receives 2 drugs kits per month. This quantity of drugs is not enough and, some months, they don’t even receive it.
• From donors : the centre receives some drugs, usually once a year, sent by BOF (Bridge of Friendship in Ebringen/Germany).

4.4. Non-medical support activities

Kitchen & Catering
Number of meals: 3 per day (thanks to the help of the community: in 1999, it was decided that the community sould mobilise itself in order to donate food to the rural health centre. Each household has to contribute).

Laundry & domestic
The laundry doesn’t have hot water and no washing machine. When the number of patients is high, it’s sometimes difficult to cope with it.

Transport
The centre has a new Toyota Land Cruiser, donated by the Archdiocese of Freiburg im Breisgau/Germany), one motorbike and 2 bicycles.

5. A missuib rural hospital

• there is Holy Mass every week at the RHC
• Every morning: prayer in the OPD with the staff and the patients, before beginning the work.
• If there is a dying person, they call one of the White Fathers. For a non-baptized child, the sisters could baptized him in case of an emergency.

6. Finances

Due to the on-going health reform, the center is insuffiently funded. Funds come often late and not in full. The user-fees are very kittle and no real contribution towards the expenses. The salaries for CDEs come via CMAZ but they are often late. Though the government promised to put the remaining staff of CDEs on the governmental payroll, by mid 2002 that has not yet been effected

Food
The average price for a meal (lunch or supper) is K 8000 and K 4000 for the breakfast.

Donations in kind

• drugs (once a year) : through BOF (Bridge of Friendship)
• community contribution : helping by giving some food: for the year 2000, fourty villages helped by giving 661 galons of millet, 224 galons of maize, 12 galons of beans, 39 gal. of cassava, 6 gal. of groundnuts and Kwacha 148500 in cash)

Income generating projects: To be more self-sustainable the RHC has embarked on the following projects:

• 2 fish ponds (started in 2001) : only for consumption at the centre
• vegetable garden: only for consumption at the centre
• maize field: 3 ha
• piggery: 8 pigs
• grinding mill: to grind their own maize but it is also used by external people (they have to pay K 1200 to grind 4 gallons of maize). This project is completely self sustainable (repairs, maintenance, salaries of the workers, electricity for of the mill are paid by the income it produces). It also generates a small benefit for the RHC.
• second hand clothes and sewing (activities which are not permanent) : when they receive some clothes or some materials, they use it to pay the extra-workers.