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[Sunday Observer EXTRA]

10-year master plan to be launched shortly:

National Hospital to be a centre of excellence

By Manjula FERNANDO

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A section of the National Hospital of colonial vintage

The National Hospital, Colombo caters to people from all walks of life. Rich or poor, almost everyone has been there, at least once in their lifetime, visiting a loved one or as a patient.

Not long ago the atmosphere and the experience there sent chills up the spine. But the place is on the way to a great transformation, into a tranquil haven, a trusted healer, as the head of the institution Dr. Hector Weerasinghe reveals to the Sunday Observer this week.

First established in 1964 with only 100 beds, the hospital treats over 2.25 million citizens of this country a year today. It has grown into a fully fledged state-of-the-art centre of healthcare that cures the critically ill performing over 70,000 surgeries in addition to 1,000 complicated heart operations annually.

Dr. Weerasinghe says his dream is to make this largest teaching hospital in the region into a Centre of Excellence in healthcare, with its exceptionally skilled team of doctors and specialist consultants.

“We should be the leader in healthcare which takes over the challenging and the complicated medical cases referred by the peripherals instead of being another ordinary general hospital,” he bared his mind.

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Dr. Hector Weerasinghe

The National Hospital of Sri Lanka takes pride in its long history. It was set up in 1864 as a basic hospital with about 100 beds. It was located initially at the Hospital Street in Fort and later shifted to the present place somewhere around the 1900s.

We still have ancient colonial time buildings in existence within the premises.

The beautiful red brick building you see on the town hall side is the first building constructed at the hospital in its new location. At the time it served as an eye hospital - Victoria Memorial Eye hospital. The building was built in 1903. Today the building’s ground floor house the Coroner’s Courts. There are two operating theatres as well.

Once the eye hospital was shifted to its new location the red building accommodated the first ever accident service in Sri Lanka. That was in 1965. Earlier all the patients - accident victims as well as the general patients called over at one place.

Some buildings here are as old as 1906 and 1907. These still emanate its ancient grandeur. We intend to renovate and preserve these buildings for future generations.

The hospital’s capacity has now increased to 3300 beds. The hospital, a mini village in its own terms houses training centres, libraries, staff quarters and kitchens in addition to medical wards and numerous medical units. The entire complex spreads over an extent of 35 acres.

Till about last year our capacity was 3000 beds. The Neuro-trauma unit opened recently by the President added 300 more beds.


A staffer preparing meals in the new kitchen


The red-brick colonial building
Pix: Saman Sri Wedage


The new Neuro Trauma Unit
 

A landscaped building of the colonial era


The new Neuro Trauma Unit

This is the largest teaching hospital in the country as well as in the region. It is one of the largest hospitals in the world. There are larger hospitals operating in clusters but the national hospital house all its different units under one roof.

Altogether there are about 7000 people employed here, doctors, nurses, paramedics, minor employees, ambulance drivers and cooks. There are 100 specialist consultants. They are the most experienced doctors as they have to serve and gain experience in other parts of the country before receiving a posting to the National Hospital.

Before 1996 the hospital was called the General Hospital in Colombo. Other hospitals cater to patients in and around a particular city. But here we have no geographical demarcation. Anyone from any part of the country can come and get admitted.

It caters to the entire population of the country.

To give recognition to our national service the hospital was renamed as National Hospital of Sri Lanka in 1996.

We have another 600 doctors in various units. We have 250-300 doctors undergoing training at any given time. They are learning to become specialists under the Post-Graduate Institute of Medicine. They are all local doctors. We do not train foreign doctors here.

The workload

Annually about 2 million patients at the Out Patient Department (OPD) and nearly 250,000 inpatients receive treatment at the hospital. Our calendar exceeds 70,000 scheduled operations, 40,000 CT scans and 8,000 MRI scans. Other than thousands of medical investigations, over 3 million lab tests are performed here each year. That’s a huge amount of work.

We do about 1000 open heart surgeries a year. Ten years ago we had the capacity to perform only one third of this. We have four units for Cardiothoracic surgeries.

The success rate of heart surgeries can be compared with any developed country. A surgery like this cost at least 600,000 rupees in the private sector. We perform 1000 of those free every year. In addition thousands of complicated surgeries such as Neuro surgery, general ENT, genito urinal, and gastro intestinal surgeries are performed at the national hospital. This is actually a huge number.

Last year we performed the first ever liver transplant in Sri Lanka. In fact we did two surgeries and both were successful.

It was a milestone in the history of the national hospital. Quite a big team was involved in making it successful. Earlier patients who needed to undergo a liver transplant had to go to India or Singapore for treatment.

This was the situation with the heart surgeries sometime back. But now we have the most experienced consultants, doctors and supporting staff to perform heart surgeries.

About three open heart surgeries are performed under this roof every day. When I say we treat 2 million patients a year, this excludes the patients who seek treatment at the out patient department for minor ailments. Nearly 4000 such patients show up at the hospital on a daily basis in addition to those seeking follow up treatment at out patient clinics.

Kitchen

It will come as a surprise to some if I say that we prepare meals for three thousand people three times a day at the hospital. That is altogether nine thousand meals per day. We get the provisions from contractors and there are people inside to cook.

Vegetables and fish are brought on a daily basis. The meals are prepared under the supervision of diet stewardesses and dietitians under extremely hygienic conditions. Although some patients prefer outside food, the majority of patients have to be fed by the hospital.

Of late we focused on creating a friendly and clean environment for the patient. As you could remember the hospital was not a pleasant place a few years back. With the help of the private companies, the hospital committee was able to landscape the entire area. There was very little space available as we have put up buildings all over in this 35 acre land.

The intention was to make a pleasant environment for the patients and the 100,000 visitors who come here every day.

After the landscaping program, I myself have seen the way the patients wander out of their wards and admire the environment seated on garden benches.

We received letters of appreciation and commendation. The general outlook of the hospital was given a major transformation following the project which got off the ground seven years ago. We received a tremendous response from the private sector for the project. We have outsourced security and the cleaning to the private sector. The amount spent is negligible compared to the vast difference it has made. For one thing we have succeeded in eliminating the nauseating hospital-smell that adulterated even the air in the outer environs of the hospital.

We conduct training programs for our staffers and there is an in-house training centre. Some of the recruits to the hospital such as the attendants, labourers and sanitary workers are not pre-trained. Therefore, the hospital conducts in-service training for them. We train them in batches on a regular basis.

The number of complaints we receive is negligible. Most of the time we get letters of appreciation and even letters of gratitude are published in the editor’s columns. Nevertheless, sometimes we receive complaints of negligence and patients not being treated properly.

In such instances we hold inquiries within the hospital. Sometimes we refer the matter to the ministry which appoints an inquiring committee.

Sometimes I receive calls from patients warded in hospitals. I make it a point to attend to all these inquiries or complaints.

Overcrowding

Overcrowding is our biggest challenge at the moment.

The bed occupancy in some of the wards at the hospital is about 200 %. This is because Sri Lanka lacks a referral system.

As I said at the beginning, any person from any part of the country can come to our hospital.

My staff is at the moment overstretched.

There is a staff shortage that needs urgent attention and the Ministry has promised to fill up the vacancies shortly.

If only the patients that cannot be treated by the local hospital are referred to us, we may be in a good position to offer a better service to patients.

I think the solution is to have a referral system and allow the doctors at the local hospital to determine if the patient needs to be transferred to the National Hospital.

Then we can concentrate on patients who require our services and cope with the workload.

The National Hospital should be a centre of excellence in healthcare. We should not offer the services what the other hospitals are able to offer.

We should concentrate on exclusive healthcare.

ICU

We have 35 operating theatres and 20 intensive care units. The maximum you can accommodate in an ICU is about 8 - 10 patients. For one ICU bed, there has to be six nurses in attendance. One Nurse has to be assigned fulltime any given time.

The equipment is very expensive to acquire and maintain. That is the reason why we cannot maintain many number of ICUs inside the hospital. The cost is simply too much to bear.

The Neurotrauma Centre which was opened by the President recently, is a centre of excellence in neuro surgery.

It has the biggest ICU in the entire hospital.

The unit consist of 60 beds. It is a state-of-the-art unit with seven operating theatres with the latest technology and facilities for CT, MRI scan and X-rays.

This is a place for patients with head and spine injuries.

This hospital has been gradually increasing operating theatres and ICUs.

But this is not sufficient as the demand is so high for ICUs.

The people don’t realise how expensive it is to undergo treatment in the ICU.

If they go to the private sector and spend one week, the minimum bill will be Rs. 1 million.

The people who receive treatment in ICUs in private hospitals make requests for transfers to the National hospital. We try to accommodate as many as possible.

Development

We are now in the process of making a master plan for the hospital. There are so many buildings put up in a haphazard manner.

We had discussions with all the consultants, general surgeons, minor specialties and physicians of a way of re-arranging the medical units scattered in a haphazard manner all over the hospital. We will be constructing a multi-storeyed building for the OPD.

At present the OPD is housed in a cluster of single storeyed buildings.

This has taken an entire two acres. We will be using 30 percent of this land to built the new OPD unit.

The balance 60 percent will be landscaped and maintained as a garden in keeping with our goal of making a people-friendly environment.

We have a separate plan for the cardiology and cardiothoracic units to be put up in one complex.

And then all general surgical wards and operating theatres will be set up in one place.

Once the project completes all the buildings and medical units will be rearranged in a convenient and systematic manner to make the visit to the hospital a hassle free experience.

We are having a meeting tomorrow with the Health Secretary and we will be finalising the plan at the end of the month.

Nothing will be constructed outside the master plan in the future.

The Central Engineering Consultancy Bureau will be drawing up the plan on our behalf.

The guidelines will be provided by the hospital management and a team of consultants and architects, etc.

We have had many meetings.

Now we are in the last leg of finalising the master plan. It will be presented to the Secretary tomorrow.

This will be a long-term plan.

The project will take about ten years to be completed as we have to continue with the services uninterrupted.

Some of the buildings have to be demolished. Before that we have to find an alternative arrangement for accommodation. We will complete this in a staggered manner.

The two oldest buildings within the premises, the Victoria Memorial Building and the white colonial era building on the Blood Bank side will be preserved under the project.

The white building was built in 1907 and that is where we found the 106 years old vault.

Initially it has served as an administrative building. But most of the other buildings will be demolished.

The National Hospital bagged the first Health Excellence Gold award in 2007. The 2009 Gold award was also grabbed by us.

The Health Ministry is organising the National Health Excellence award.

This was the first ever competition organised in the health sector. Having this type of competitions motivate hospitals to perform better.

The recognition always drives you toward excellence. We are happy with the progress the National Hospital has made. But we have a long way to go.

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