Project Peds: Sri Lanka

With our maiden initiative, PROJECT PEDS: Sri Lanka, WCI designed and developed a new 155-bed, tertiary care, childrens hospital in an area of southern Sri Lanka devastated by the Asian Tsunami.  This new pediatric facility houses specialized intensive care units for children and infants, will be used to train future pediatricians, and will be a model for further pediatric healthcare delivery in the country. The facility was designed in consultation with medical facility design experts, and healthcare professionals from leading U.S. teaching institutions, but tailored to the needs, resources, and cultural standards of the local Sri Lankan patient and health worker population.

Project Peds was initiated with seed-funding from the Bush Clinton Tsunami Fund, adminstered by former Presidents George H.W. Bush and Bill Clinton. After raising approximately $1,000,000 (USD), designing the facility, and then overseeing its construction, in August 2010, WCI negotiated a successful transfer of the children’s hospital to the Sri Lankan Ministry of Health for day to day operations.

Integration of Resources 

From the beginning, WCI has worked with the local Matara healthcare providers and administrators as well as the central Sri Lanka government to identify the primary issues affecting the pediatric population.  The identification of asthma as the primary burden and its associated spectrum of factors was originated by the local pediatricians and public health officials of Matara.  They have played and integral part in working with us to develop the “smart” solution.

Sri Lanka Ministry of Health                                                                                                                       

Matara Regional Preventive Sector / Epidemiology Branch

Matara General Hospital

Measure of Change

WCI has identified two clear health indicators to measure the change / impact of our “smart” solution

       1.   Reduction in Asthma-related hospitalizations     

• Directly measures how effectively we alleviated the pre-hospital factors

       2.   Decrease in Asthma-related morbidity and mortality

• Directly measures how effectively we resolved the hospital factors

           

Primary Disease Burden

Respiratory Diseases / Asthma – the primary burden to Matara’s pediatric healthcare infrastructure
Sri Lanka, like many other developing nations, is facing a rising prevalence of asthma with urbanization. The 2001 ISAAC (International Study of Asthma and Allergies in Childhood) found in Sri Lanka:

• One-third of all children experience “wheezing” at some point
• Asthma was responsible for 160,000 hospital admissions annually
• Asthma claims the lives of more than 1000 children annually

WCI’s Comprehensive Resource and Clinical Needs Assessment found the following:

• Respiratory diseases represent nearly half of the inpatient hospitalizations in Matara’s existing pediatric facility
• Most of the hospital-acquired infections (nosocomial rate of 20%) are a direct result of either respiratory or diarrheal diseases.

Asthma is one of the top three illnesses that concern pediatricians at Matara General Hospital. With increasing industrialization brought by highway construction and new seaport facilities, the burden of asthma will only continue to spread and increase amongst children in this region of the country.

Smart Solution

Physical Elements

Goal:    To build a pediatric facility that is both “resource efficient” and “clinical flow smart” in managing disease

Utilizing charitable services from healthcare construction architects and engineers in the US from both of our partner pediatric hospitals, we created a “smart” design.  To ensure the applicability and practicality of these solutions, we included Matara pediatricians and administrators in the process and tailored proven models to local-specific issues. 

• Expanding the hospital both in size and # of beds to alleviate overall spatial concerns
• Creating  disease-specific units, as well as physically separate isolation units to prevent the spread of contagious diseases
  • Disease-specific resources and specially trained staff will be focused in these particular units
  • As units become specialized and focused on a system such as respiratory, then staff will become proficient and better trained in managing these specific subset of illnesses and diseases
• Incorporating the “clinical pod” concept to optimize resources as well as nursing and ancillary staff care
  • Each unit is subdivided into pods, usually 4-8 beds, with a wash basin and routine, basic supplies, creating a controlled, manageable environment
  • Nurses and ancillary staff would be designated to pods as their point-of-care areas
  • This would help staff focus on a subset of patients, streamline clinical workflow and limit patient-patient contact
• Building a pediatric intensive care unit to manage the ventilator-dependent asthma patients
• Augmenting facilities for the general public and creating distinct patient and non-patient areas because Sri Lanka’s family-oriented culture tends to brings several visitors to patient areas often adding to the confusion, clutter and overcrowded conditions
  • A Mother’s area with 40 cots, general public bathrooms (separate from patient bathrooms) and proper waiting areas

New Matara Pediatric Facility:  Size – # of Beds by Unit

155-bed Pediatric Facility will be approximately 25,000 sq. ft area and two floors.

Ground floor

• 4 General Pediatric Units
  • Unit 01 – Respiratory (16)
  • Unit 02 – General  (20)
  • Unit 03 – Gastrointestinal (16)
  • Unit 04 – General (20)
• Isolation unit (20) & High Dependency Unit (HDU) (10)
• Emergency care room

First Floor

• Pediatric ICU(12) & Neonatal ICU (10)
• Nursery & Neonatology unit w/Incubators (15)
• Premature baby unit –PBU (16)

Spectrum of Factors

The asthma epidemic among children in Matara has three roots: the disease prevalence is under-recognized, asthma education is poor, and asthma is not being properly treated in the outpatient or inpatient settings.

Pre-Hospital Factors – general lack of understanding and recognition of the disease

                     Environment

1. Industrialization and development in the Matara region, a growing economic hub
2. Improved insulation of living conditions (traps mice dust)

1. Community awareness of asthma is poor
2. “Wheezing” an early sign of asthma is not recognized by parents and therefore the disease is not identified early
3. Cultural stigma on use of inhalers – as a result, children, who have been identified with asthma, do not use them

1. Medications – Inhalers are available, however, they are not used properly
2. Rural clinics are not adequately outfitted to treat minor, outpatient symptoms of asthma

1. Overcrowded, unsanitary conditions
2. Open, disorganized general units (no disease-specific units) without haphazard arrangement of supplies and equipment
3. No isolation units for patients with infectious diseases