General State of Pediatric Healthcare in Matara

The existing Matara General Hospital in Matara, Sri Lanka has been, since the tsunami, operating at or above its capacity.  Moreover, it is not currently designed or equipped to handle specialized medical conditions, an increased intensive care needs, or patients necessitating isolation.

WCI conducted a comprehensive clinical needs assessment of pediatric healthcare in Matara, Sri Lanka. After multiple site visits and interviews, we analyzed the healthcare delivery infrastructure from the rural mobile clinics to the tertiary care facilities.  We broke down disease management pathways step-by-step for the most prevalent pediatric illnesses as well as assessed the level of public education on health.  Lastly, we looked at scarce data for health outcomes.

Based on our assessment and analysis, we provide both a summary of operations for the current pediatric facility as well as identification of the general problems with the pediatric healthcare infrastructure in Matara. 

Basic Facts

District General Hospital:   Acute-Care Facility w/Academic Mission - Managed by Ministry of Health

Pediatric Population of Matara Region:  120,000 children (Referral Areas: 1,000,000 children)

• Covers southernmost tip and southeastern region of Sri Lanka (Matara and parts of Hambantota provinces) - Serves as the referral area for this entire region
• Closest tertiary care facility: Karapitya Hospital in Galle - 45 km away / 2 hr bus ride

2 General wards (60 total beds):                  1st ward – 40 beds;   2nd ward – 20 beds

• Diarrhea corner (no isolation units or specialty care units)
• Neonatal ICU unit (6 incubators; 3 ventilators); No pediatric ICU

Patient Census & Volume:   400 inpatients/month; Daily census > 60 pts (capacity)

• Average Length of Hospital Stay:   4 days

Most Common Inpatient Pediatric Diseases

• Respiratory – Bronchiolitis Asthma :  60% of inpatients – 100pts/month
• Gastrointestinal & Diarrheal Diseases: 20% of inpatients
• Hospital-acquired (Nosocomial )Infection rate:  20%

3 full-time pediatric MDs & 1 full-time neonatologist (MD)

• 20 nurses (wards 1 &2); 7 nurses in neonatal ICU

General Problems with Matara Pediatric Healthcare Delivery System

1. Lack of general public education results both to inappropriate identification of disease & unnecessary hospital visits

1. Two primary preventable & treatable illnesses which overburden this facility include:

• “wheezing” (asthma)
• “diarrhea” (gastrointestinal infections)

2. Poor medical training at rural clinics leads to delays in care & inadequate initial, pre-hospital management
   
   
3. Poor design of facility leads to spread of disease (hospital-acquired infections) and prolonged lengths of stay (cramped quarters; poor hygiene; shared bathroom facilities; no isolation units)

Overcrowded Conditions of General Pediatric Ward

4. Lack of skilled nursing and ancillary staff (respiratory therapists) make it difficult to properly execute care pathways resulting in suboptimal clinical management
    
5. Overall:  Operating above capacity, suboptimal facilities, and below standard of care leading to poor pediatric health outcomes
   
   
   1. Strains both the physical and intellectual resources making it difficult for the physicians and ancillary staff to focus and effectively treat patients