Ophthalmic unit Project
Dambadeniya base Hospital
Kurunegala district
North western Province
Sri lanka

BACKGROUND Dambadeniya hospital is a type B Base hospital and the 2^nd largest hospital in kurunegala District under provincial authority. It is situated in North western Province, Kurunegala District and in the Narammala Divisional Secretarial Division, located in Kurunegala Negombo main road and nearest town of Dambadeniya Base Hospital is Giriulla from where there are direct transport facilities to various towns and cities like Kurunegala, Negombo, Colombo, Ja-Ela, Minuwangoda, Nittambuwa, Narammala, Alawwa and Pannala.

Dambadeniya Base Hospital is 35Km away from Provincial General Hospital Kurunegala,40 Km away from District General Hospital Negombo,and 35km from DBH Kuliyapitiya. At present people of Narammala, Alawwa and Pannala Divisional Secretary Divisions and parts of Polgahawela, Weerambugedara, Kuliyapitiya east along with some parts of Gampaha district (Divulapitiya, Mirigama and Katana Divisional Secretariat Divisions) are served by Base Hospital Dambadeniya.

Target population is around 600 000 and majority of the population is living in rural areas. BH Dambadeinya is the largest curative care service provider for these people. As a large hospital in the district, the BH Dambadeniya is providing curative health care to people of the district and also to people from the adjacent districts On the other hand hospital most importantly caters migrant categories of population due to its close vicinity to Mirigama Export Processing Zone, Pannala Slimline Garment, Makandura Industrial Zone, Alawwa Tristar Garment and Brandix and Damro Companies.

Target area of this hospital includes urban areas like Giriulla, Narammala, Pannala, Alawwa and lot of suburban areas with several government organizations like Schools, Banks, Divisional Secretariats, and Zonal Education Offices etc.

Considering statistics from department of census 2020, Total population of 3 Divisional secretory divisions of Gampaha district and migrant population are found more than six hundred thousand population. Due to close distinctly to BH dambadeniya more than 200000 are catered by the hospital. There for our catering population is more than 600000 of population.

POPULATION DISTRIBUTION OF CATERING AREA ACCORDING TO 2020 CENSUS

DISRIBUTION OF SOME KEY INDICATORS IN CATERING AREA ACCORDING 2020 DEPARTMENT OF CENSUS(TABLE2)

According to above census (2020 department of census), population density in catering are is much higher than that of kurunegala district and rate of growing population is also remarkably high. Therefor projected population in 2025 will not be adequately received care with existing facilities. As most population (90%) is rural, with growing of adult population and number of

dependency rate is about 60%, most of patient care services should be expanded and new units should be established to provide comprehensive patient care services for population in catering area.

Present bed strength of hospital is around 300 which will be increased in forthcoming years All major specialties are dedicated for continuous and comprehensive service with international standards and there are 10 wards, OPD, ETU, ICU, PBU, Operation Theatre, Laboratory, Blood Bank, Dental Clinic, Radiology Department with X-ray and ultra Sound Facilities, Labor Room, unit, CKD unit, NCD unit, planning unit, health education unit, public health unit , healthy life style center, library and quality-productivity unit.BH Dambadeniya is a well-known hospital, which was awarded several times in national level and provincial level for quality and productivity on behalf of providing health care with minimal facilities.

Around 369 health workers including 70 graduated medical officers, 5dental surgeons, 9 specialized medical officers and around 140 Nursing officers and 40 paramedical officers are actively involved in providing patient care.

Out- Patient Department is catering its services for around 750 patients per day and around 120 patients seek indoor care in a given day. About 2169 mothers deliver their babies in this institution per year. About 7489 Surgeries including, (1276) major surgeries and Intermediate and minor surgeries are performed for a year while 172701 laboratory investigations are performed in a similar time period. Out patients department and specialists’ clinics of this hospital are providing a great service for patients around the area. Consultants conduct 44 clinics per month and around 93061patients (1^st and 2^nd visits) attend to those clinics per year. This institute gives a major contribution to keep the maternal mortality rate below the national levels. We have been provided appropriate security service and cleaning services by provincial authorities to fulfill basic needs for patients as well as staff and public around the area. Average bed occupancy rate was over 79 (2019).

Dermatology unit, psychiatric unit, family medicine and radiology units are conducted by permanently attached consultants providing excellent patient care services

According to master plan, there are 4 Stages of Development of BH-Dambadeniya which 1^st stage is already implemented, Drugs stores and clinic building is already constructed and functioned. Master plan has been designed to Develop BH-Dambadeniya to upgrade as a type A Base Hospital which develop existing unit’s facilities including ICU, increased bed capacity of wards, toilets, wash room facilities and establishment of new units and wards (Mental Health, ENT, Eye, Dermatology, etc).

Though this is a base hospital including bed strength is nearly 300 and caters more than 600000 population, inadequate subspecialty units, medical equipment’s, human resources and inadequate patient care service area would have been affected to provide comprehensive services for patients. The national ratio of beds per 1000 population is 3.9 and the value for Kurunegala

district is less than the national value .Therefore it should be increased with the future improvements in district curative health care delivering system.

Although specialized consultants are appointed recently to the hospital, infrastructure and facilities are not improved accordingly.

Specially eye unit is very important because lot of patients are referred to TH Kurenegala,it is affected to not only patients seeking eye care but leads to overcrowding and increased waiting time at tertiary care institutions. Furthermore ICU and Theater were designed for 4 beds and 3 tables respectively, services are limited due to inadequate medical equipment’s and human resources specially doctors. Non implementation of annual transfers of medical officers is highly affected to limitation of services and if intern medical officers will be appointed it would be helpful to improve patient care services.

JUSTIFICATION

Present bed strength of hospital is around 300 and there are 10 wards, OPD, ETU, HDU, PBU, Operation Theatre, Laboratory, Blood Bank, Dental Clinic, Radiology Department with X-ray and ultra Sound Facilities, labor Room. Most of the patients with eye disorders including cataract and glaucoma are referred from following clinics to TH Kurunegala but most patients (especially elderly patient) reluctant to attend there because of distance and overcrowding and long waiting lists for clinics, investigations, procedures and surgical interventions. Most patients of Diabetic, Medical and Family Medical Clinics need Eye examination and Government, private medical examinations and school medical examination as well.

Various clinics for patents requiring eye care are being conducted in this hospital.

• Medical Clinic/Diabetic clinic:- 60,000 Patients in 2019
• Surgical Clinic:- 7000 Patients in 2019
• Mental Health Clinic:- 6000 Patients in 2019
• Anesthesia Clinics:- 1250 Patients in 2019
• Family Health Clinic:- 5600 Patients in 2019(Most patients need eye screening)
• Diabetic eye screening:- ( Recently started 40–60 Patients /month )
• NCD Clinic:- (Recently started 250 Patients /month )

An ophthalmic technician was appointed to this hospital during year 2017 with limited resources she has seen around 1000 eye patient during the year 2019.

There are 09 consultants and 60 Medical Officers. All staff is around 350 with separate security and cleaning services. Admissions are over 33000 per year (2019) and OPD Patient per day are around 600 and Average bed occupancy rate was over 70 in 2019 out of 300 beds.

According to ministry circular 01-18/2020, health care demand in future and re categorization of hospitals, Base hospital type B should be included minor specialty clinics and inward facilities specially eye unit.

It might be upgraded to type A Base Hospital which requires more facilities, increased bed capacity, subspecialty words, subspecialty clinics and supportive services to meet future demand.

Our target is to improve the quality of life of people in Dambadeniya area by providing better health care as same as national and international standards. According to ministry circular 01- 18/2020, Base hospital type B should be included minor specialty clinics, inward facilities and according to need in future and re categorization of hospitals. It might be upgraded to type A Base Hospital which requires more facilities, increased beds with subspecialty words, subspecialty clinics and inward facilities (according to ministry circular 01-18/2020).

In this relatively old hospital, health care team faces several issues due to overcrowding, lack of spaces and outdated engineering systems. It has been worsen recently with the growing patient volume. In present infrastructure, most of the wards are built about 50 – 60 years back especially the surgical ward which is dilapidated and unhygienic.Even though minimum facilities available for major specialties like Medical, Surgical, Obstetrics and Gynaecology. Facilities available for other sub specialties like Eye, ENT, Dermatology, Mental health, Respiratory Medicine, Orthopaedics and Oro Maxillofacial specialty are not adequate to provide required services to target population. Most of the medical equipment which are being used currently are old and do not provide the required services according to the modern technology. Quarters facilities are not adequate for all the categories of staff. There for our main aim is to activate the master plan during year 2021-2025 periord as the BH Dambadeniya needs expansion of its facilities to provide modern health care to target population.

As a major hospital in the district, the BH Dambadeniya is providing curative health care to people of the district and also to people from the adjacent districts. When patients from remote areas are seeking specialized care they are referred to TH kurunegala.BH Dambadeniya has

become best alternative for them to save time and money spend on travelling, and also to prevent long waiting lists.

The hospital require fully functioning Eye unit, ENT unit, Mental health unit OMF unit (Oral maxilla facial), complete maternity unit, Radiology unit with a CT scan, ICU, PBU, Operation Theater and Outpatient clinics to cater this large crowd. Currently there is one ICU with 3 beds and establishment of (Medical ICU) MICU and (Surgical ICU) SICU will provide adequate requirement for patients needing specialized care.

Establishment of new units (according to the circular) at BH Dambadeniya to provide high quality of services to the catering area timely and mandatory due to many reasons. Statistical analysis shows that significant morbidities related to the subspecialties’

Establishment of new units such as Eye unit, ENT unit, Orthopaedic unit ,Mental health unit, Histopathalogy unit,Hematology units will help to provide service to the catering area. Currently patients who need curative healthcare services related to above units are referred to TH Kurunegala hospital. It is inconvenient to patients in turn causes overcrowding at those Hospitals. Therefore establishment of these units in this hospital is a timely requirement..

Population density in catering are is much higher than that of kurunegala district and rate of growing population is also remarkably high. Therefor projected population in 2025 will not be adequately received care with existing facilities. As most population (90%) is rural, with growing of adult population and number of dependency rate is about 60%, most of patient care services should be expanded and new units should be established to provide comprehensive patient care services for population in catering area.(table 1/Table 2).There for activation of next stages of master plan during 2021 to 2025 is highly important.

 GENERAL OBJECTIVE:-

Provide optimum care for the patients with eye disorders, reducing blindness and morbidity of patient in the catering areas of Dambadeniya Hospital.

SPECIFIC OBJECTIVES:-

• Identify acute eye injuries like corneal lacerations.
  • Identify chronic eye diseases like cataract.
  • Identify acute eye diseases like angle closure, Glaucoma.
  • Screening diabetic & hypertensive patient for eye complication.
  • Treat acute minor/major eye injuries
  • Reduce blindness and visual impairments in children and adolescent.
  • Provide awareness in common eye disorders
  • Improve the visual health of people by screening and prevention, early detection, timely treatment and management and rehabilitation.
  • Provision of patient satisfaction by providing slandered eye care services.

MEDICAL EQUIPMENT’S FOR COMPLETE EYE UNIT INCLUDING CLINIC, THEARTE AND WARDS