OCT 2016
DEC 2016
NEWSLETTER INTERHEALTH CANADA TCI
THE
INTER-VIEW
BEHIND THE DOUBLE DOORS: THE OPERATING ROOM Welcome to the December 2016 edition of TCI Hospital Newsletter, which features stories from across the healthcare organization. A new edition is published at the end of every quarter.
Inside the Issue
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Quote of the Quarter
“The Good Physician Treats The Disease. The Great Physician Treats The Patient Who Has The Disease.” -William Osler
Chief Executive Officer, Daniel Carriere reflects on the hospital’s achievements in 2016 and outlines his expectations for 2017. TCI Hospital seeks to join the Baby-friendly Global Hospital Initiative in the near future. PAHO and CARPHA officials conduct appraisal.
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A day in the life of the Operating Team, a high stress working environment where every movement is critical.
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The launch of Operation Gratitude showers every patient at TCI Hospital with care-packages on Christmas Day.
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Governor of Turks and Caicos Islands, His Excellency Dr. John Freeman conducts tour of TCI Hospital on Christmas Eve.
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BREAST-FEEDING GLOBAL INITIATIVE The first appraisal exercise to assist Government Primary Healthcare Services and TCI Hospital in the implementation of the Baby-friendly Hospital Initiative (BFHI) global program has been completed following a country visit by representatives from the Pan American Health Organisation (PAHO) and Caribbean Public Health Agency (CARPHA) on November 7th – 11th, 2016. The Baby-friendly Hospital Initiative (BFHI) is a global effort launched by the World Health Organisation and UNICEF in 1991 to implement practices that protect, promote and support breastfeeding. It aims to encourage hospitals to implement the 10 Steps to Successful Breastfeeding and to practice in accordance with the International Code of Marketing of Breast-milk Substitutes. In addition, a maternity facility can be designated ‘baby-friendly’ when it does not accept free or low-cost breast-milk substitutes, feeding bottles or teats.
praisal examined current practices and policies in the Maternity Departments at Cheshire Hall Medical Centre, Cockburn Town Medical Centre and Government Primary Health Care Clinics to formulate suggested actions/recommendations to meet BFHI’s 10 Steps.
The appraisal was conducted by Christine Bocage – CARPHA Senior Technical Officer and Dr. Audrey Morris, PAHO Food and Nutrition Advisor. A total of 43 persons were interviewed using the UNICEF/WHO Self-Appraisal Questionnaire based on revised Global criteria for BFHI Recommendation, 2009. The ap-
The BFHI program is implemented over several years, using a staged approach. Phase one is a country visit and baseline assessment followed by recommendations; Phase two consist of training of key staff on the BFHI program followed by an organisational based training program, development and
L-R: Lakeisha Wilson - MOH Nutritionist, Christine Bocage- CARPHA Senior Technical Officer, Dr. Audrey Morris, PAHO Food and Nutrition Advisor, Charlene Higgs - MOH Director of Education and Training; Douglas Moore - IHC Chief of Clinical Services, Mikette Been - IHC Deputy Chief of Clinical
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implementation. The third phase is the BFHI accreditation request, which is granted after all stages and steps are passed in an external assessment conducted by a BFHI Coordinator. A 40-hour workshop on Breast-Feeding and BFHI will be held in February 2017 to train medical staff in Maternity Care at both TCI Healthcare agencies.
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There are many advantages of extended breastfeeding. Breast-milk is perfectly designed for babies.
“...This shows a commitment by the facility to offer the highest quality of maternity care.” More than 152 countries around the world are implementing the BFHI initiative. Research shows the initiative has increased the likelihood of babies being exclusively breastfed for the first six months, without any formula, which supports optimum health and development. Breast milk contains antibodies with disease-fighting substances that protect babies from illness. The implementation of the program may also generate significant cost savings for mothers and the healthcare sector. A report titled “Preventing Disease and Saving Resources” commissioned by Unicef UK found for just five illnesses, moderate increases in breastfeeding would translate into cost savings for the NHS of £40 million and tens of thousands of fewer hospital admissions and GP consultations.
SUCCESS STORIES FROM UNICEF In Cuba, where 49 of the country’s 56 hospitals and maternity facilities are baby-friendly, the rate of exclusive breastfeeding at four months almost tripled in six years - from 25 per cent in 1990 to 72 per cent in 1996. • In the first two years of BFHI implementation at the Central Hospital of Libreville in Gabon, cases of neonatal diarrhoea fell by 15 per cent, diarrhea dehydration declined by 14 per cent and mortality fell by 8 per cent. • In China, which now has more than 6,000 Baby-Friendly Hospitals, exclusive breastfeeding in rural areas rose from 29 per cent in 1992 to 68 per cent in 1994; in urban areas, the increase was from 10 per cent to 48 per cent. • The Catholic University of Chile, Santiago, initiated one of the first baby-friendly hospitals. As a result, initiation of breastfeeding within the first two hours increased. With a strong Step 10, a monthly clinic, exclusive breastfeeding at 6 months increased from approximately 20% to over 60%. 3
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10 STEPS TO BABY-FRIENDLY Have a written breastfeeding policy that is routinely communicated to all health care staff.
A DAY IN THE LIFE OF THE OPERATING ROOM TEAM In other areas of healthcare, physicians have a chance to walk away from their tasks for a few minutes. It’s a completely different world in surgery. Members of the Operating Room Team deal with patients who are asleep, and there are no ‘breaks’ once a surgical procedure commences. At Cheshire Hall Medical Centre in Providenciales --a level-two trauma center offering services 24 hours a day, seven days a week--the operating-room staff consists of 10 Medical Physicians, which include Doctors and Anesthesiologists and 12 Nursing staff.
Train all health care staff in skills necessary to implement this policy. Inform all pregnant women about the benefits and management of breastfeeding. Help mothers initiate breastfeeding within one half-hour of birth. Show mothers how to breastfeed and maintain lactation,even if they should be separated from their infants. Give newborn infants no food or drink other than breast milk, unless medically indicated. Practice rooming in that is, allow mothers and infants to remain discharge from the hospital or clinic.
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Over 1000 surgeries are performed annually. These range from minor surgeries to more advanced surgeries covering everything except Cardiology. On a typical day, members the OR team will process a number of cases. Each patient undergoes a pre-operative, intraoperative and post-operative assessment during the surgical experience. Although most of the daily cases are elective procedures, the team is always on standby for emergencies, which may be a motor-vehicular accident, or even a paediatric case. For example, a 5-year-old child presented with a coin lodged in the upper part of the throat, which doctors attempted to remove without causing any damage to the throat. The procedure took slightly longer than usual, but it was successful. The duration of each surgery is dependent upon the type of surgery and the patient’s specific clinical manifestation. However, the longest procedure ever performed inside Cheshire Hall Medical
Centre’s OR Room spanned five hours. But this duration is just a conservative indication of how much emotional and physical stamina and dedication is required in this high-stress environment. Let’s look beyond our shores. One of the longest surgeries on record in recent times occurred in 2001 and lasted 103 hours or four straight days. A team of 20 doctors at a hospital in Singapore worked in shifts to separate two 11-month-old conjoined twins who shared a cranial cavity and their brains were partially infused. Doctors initially projected the surgery to take 30 hours but once underway - discovered that the toddlers’ brains were even more enmeshed than expected. It is a common philosophy in the surgical world to approach every procedure with an open-mind and never underestimate the patient. Two patients may have the same diagnosis with different clinical outcomes.
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Surgery is a very intellectually demanding area - a patient’s life is in the hands of OR Team Members. The surgeons’ and nurses among the OR team, must know how to operate complicated equipment and have a vast knowledge of literally hundreds of operative procedures as well as surgical instruments and supplies. Anaesthesiologists often describe their role as, “We put people to sleep, ’ but these individuals constitute a major component of critical care medicine. Patients depend on these individuals and surgeries do not happen without their presence. Teamwork, leadership, team member competencies and communication are integral to conducting a successful procedure. Operating Room Nurses are the backbone of the surgical team. There are different classifications of operating room nurses, all of which have different responsibilities during surgery. The Medical Device Reprocessing (MDR) Department and the auxiliary staff are also apart of the OR team. In the case of the MDR Department, the exact number of surgical sets sterilized and available for patient use determines whether the surgery can take place. Before any procedure can begin in the theatre, the area must be thoroughly cleaned by auxiliary staff in accordance with Infection Prevention and Control Protocols to any prevent bacteria transmission and surgical site infections. TCI Hospital’s surgical site infection rate is below 2%, which is aligned with the national hallmark of best practices. Sufficient blood supplies are also needed from the National Blood Bank, which rely on donors from the community to provide blood to facilitate transfusions during surgery. A day in the life of the Operating Room Team may be longwinded but it is extremely gratifying. Of all the different team members in the hierarchy, the most important person in the theatre is the patient. Healthcare is an industry hinged on accountability now, more than ever before. It is the processes, and the players which contribute to optimal patient outcomes, and reaching these achievements is not a one-man assignment. It requires teamwork! 5
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LETTER FROM THE CEO Daniel Carriere
Christmas is upon us which means that another year has gone by and if you are like me, things have gone by much too quickly. It only gets worse as you get older and you sit there wondering where has the time gone and how will we recapture those great moments. As CEO of InterHealth Canada TCI, we truly have experienced some great moments during 2016 and we should all, as a team, celebrate our achievements. We continue, through the Grace of God, and due to our great staff, to deliver compassionate attention to our patients and great care despite the many challenges we all face. Healthcare is a complicated profession since not everything always goes according to plan when caring for patients presenting themselves with complicated illnesses and difficult personal situations. Yet, we must always strive to accommodate their needs as well as the family’s special circumstances. We can only accomplish this as a team, working together to achieve the goals and objectives of the organization and live up to the high standards expected by the population of Turks and Caicos and the Ministry of Health. And as a true team, every department and employee contributes to our vision of achieving excellence for our patients and is involved in the patient experience. Some may feel disconnected or marginalized because they do not always have direct contact with our patients, but nevertheless, the people behind the scenes are equally as integral to our success as those who are by the patient bedside or delivering direct services to our patient population. 2016 enabled us to continue promoting personal improvement and growth amongst our staff with opportunities to improve and educate themselves through mandatory training and special opportunities. Our goal is to build local capacity 6
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which in the end will create great opportunities for our staff and also aspiring leaders in the community who wish to pursue a healthcare career. We support those developments and will continue to do so throughout 2017 by offering CME sessions, overseas certification opportunities as well as in-house development and sponsorship support. 2016 also marked a number of important milestones for InterHealth Canada. These achievements include the commencement of the most comprehensive reconciliation exercise conducted thus far in conjunction with TCIG, which will extend into 2017. We are supportive of the analysis and closure this review will bring as it spans several years of operation since the opening of the Hospitals in 2010. We continue to work diligently with our local health care partners and the Medical Tourism Committee to pave the foundation to facilitate a robust Medical Tourism sector in the future. Our international footprint remains steady through our participation in global medical tourism conferences, events and meetings. In addition, our services are continuously reviewed and expanded to keep pace with changing healthcare demands and technology. Multiple proposals submitted by Interhealth Canada were approved in principle by Cabinet this year. Some of these proposals endeavor to see the introduction of tele-radiology services, hysteroscopy equipment, the purchase of special blood screening equipment and more. This year, we also added a number of new highlyexperienced permanent healthcare physicians and specialists in key service areas. One of my key objectives since my arrival to TCI in September of 2015 has been to build a
strong relationship with our healthcare partners – local and abroad. Teamwork and partnership are essential if we are to truly make a difference in the lives of the inhabitants of TCI, and InterHealth Canada must work diligently with the Ministry of Health, Primary Healthcare Department and all other Government agencies and health care providers to render a seamless system that optimizes the limited resources available, and supports our common mission to have a healthier population. 2017 will mark our continued emphasis on patient and staff safety as well as achieving quality in everything we do .We will be promoting new and innovative ways to assist our staff in achieving these requirements. We also hope to address the long-awaited salary review for all staff and medical personnel to ensure that our salary ranges are more competitive and allow us to recruit and retain the brightest and the best talent available.  2017 will also accommodate the full review of our strategic plan that was initiated some time ago in order to ensure that we are focused on the priorities of today and tomorrow in a fast changing environment and that our vision is relevant, unique to our environment and expectations, and is energizing and aggressive for the benefit of our staff and patients. Everything flows from an organizations vision and we want to engage our staff and partners through presentations and involvement. Inclusivity will continue to be the mandate of our managers thereby engaging and invigorating our work force to participate, contribute and lead. Turks and Caicos Islands Hospital will not be a resting place for mediocrity. Despite the many demands on our time and the necessity to deal with the daily ongoing issues that arise, we must afford the time to develop 7
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the vision/strategic plan and contribute to it every day once established. We can’t and won’t let ‘urgent’ dismiss the ‘important.’
community. We, at InterHealthCanada believe our role is multifaceted and we will continue to strive to be a community centered-organization.
2017 will also see the continued emphasis on accreditation preparedness, as this process impacts positively on all facets of the operation and everything we do. We are recognized as a Premiere Healthcare provider and our ability to achieve a Diamond Accreditation ranking on consecutive reviews - the highest possible award from Accreditation Canada International - is a credit to our staff, our managers and InterHealth Canada Board of Governors. However, we shall not rest on what was achieved in the past and we must channel this success into the patients and the care given. Patients depend on us for quality and timely service at all times.
Christmas is a time to rejoice, share in our good fortune and be thankful for what we have. It is a time to reflect and value your family, friends and colleagues for their love, friendship and confidence; this is life’s greatest gift, to love and be loved. Christmas has always been a time for me to step back and acknowledge this through thought and action. Remember that we are blessed to be working in the most noble and honorable of professions, charged with the responsibility of taking care of our brothers and sisters in their greatest time of need. This should be considered an honor but also a reflection of who you are as a person and the career you have chosen; feel good about this, you deserve it. Have a great holiday and take advantage of your time away from work to relax, refresh and to spend some quality time with loved ones. Remember, all is good in moderation and safe travels if you are traveling over the Christmas break. God Bless and Merry Christmas. Sincerely,
Since Christmas is the season for giving, I would be remiss if I didn’t emphasize our intention to continue giving back at a corporate level to the community we serve in 2017. We will continue to sponsor various worthy charities and projects and encourage our health teams’ involvement in various events and discussions about health and wellness to enhance the quality of life in our
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Operation Gratitude
C
are packages stuffed with everyday essentials were distributed to in-patients on Christmas Day at Cheshire Hall Medical Centre and Cockburn Town Medical Centre to spread good cheer across the hospital ward. Members of TCI Hospital Senior Management Team donned in red with Santa Claus at the Providenciales facility and the Grand Turk facility, visited each patient individually to hand-deliver the colorful baskets and offer a jovial happy holiday’s. Members of TCI Hospital Senior Management Team donned in red with Santa Claus at the Providenciales facility and Elves at the Grand Turk facility, visited each patient individually to hand-deliver the colorful baskets and offer a jovial happy holiday’s. Christmas Day in a hospital can be depressing. ‘Operation Gratitude’ was therefore launched to create a tremendously positive and touching experience. Many patients are away from family, friends and neighbours on this special day and it means so much to them to receive a gift. Each patient also received a Christmas card personalized with their individual names along with sentimental, classic board games, like Bingo, Chess and Snakes and Ladders to encourage old fashioned quality time and laughter-filled conversation with their loved ones.
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GRATITUDE
“the quality of being thankful; readiness to show appreciation for kindness.”
Patients are an extended family to us. Gift baskets are also given to the first baby born on Christmas Day and New Year’s Day every year. Employees scheduled to work on these special public holiday’s including Boxing Day are equally treated with delicious complimentary lunches in addition to other annual staffappreciation initiatives.
L-R: TCIH Chief Executive Officer - Daniel Carriere; General Manager Martin Dawtry; Chief of Medical Services - Dr. Denise BraithwaiteTennant; Public Relations & Marketing Manager - Nikira John
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Tip!
Tip!
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Laughter is infectious and soothes the soul.
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A pleasant surprise! Patricia Dunne made the hottest Mrs. Claus.
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Employees at Cockburn Town Medical Centre enjoying a holiday ‘selfie.’
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NEWS FROM ELSEWHERE
The construction of the state-of-the-art Zywiec Hospital located in southern Poland is well under-way. The three-storey, 380 bed General Hospital will significantly improve healthcare provisions for the local community in the Powiat, which predominantly caters to emergency admissions due to limited resources and poor infrastructure. Under the agreement, InterHealth Canada will design, build, equip and operate the hospital for a 30 year period. The modern facility will replace the existing hospital and provide a full range of medical services once completed.
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Patients from Ĺťywiec are presently forced to migrate to neighboring hospitals for medical treatments, which creates a patient safety concern and strains neighbouring hospitals which do not have the capacity to serve patients from both areas.
PPP
Healthcare infrastructure in Poland has progressively degraded in recent decades with around 600 hospitals operating below the standard required under European Union health regulations. Integrated healthcare PPPs in Poland could be the solution to salvage and restore the quality of healthcare that the population deserves.
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on the INSIDE
GOVERNOR OF TCI, HIS EXCELLENCY DR. JOHN FREEMAN T O U R S H O S P I TA L O N C H R I S T M A S A N D N E W Y E A R ’ S E V E Governor of the Turks and Caicos Islands, His
October 2016. Prior to this, H.E. Freeman served
Corinna Freeman and son visited TCI Hospital on
2012 to October 2016. He joined the Foreign and
Excellency Dr. John Freeman along with his wife, Christmas and New Year’s Eve. Chief Executive Officer of the Hospital, Daniel Carriere and Chief
of Medical Services, Dr. Denise BraithwaiteTennant led the tour.
The hospital was less busier than usual on Christmas Eve, however staff members were elat-
ed to see the de-facto head-of-state on the wards during the peak of the season with his family. The
as British ambassador to Argentina from June Commonwealth Office in 1986. He has previously served in a wide range of appointments in London
and overseas dealing with countries as varied
as South Africa, Germany, and Singapore; and
with a wide range of international issues, including non-proliferation, international terrorism, and
drugs policy. He has also covered economic and commercial issues in posts overseas.
Governor visited the Out-patient Department,
The Governor toured Cheshire Hall Medical
and X-Ray Department.
Medical Centre in Grand Turk on the eve of the
Emergency, General Ward, Maternity, Laboratory
Dr John Freeman CMG was appointed Governor
Centre on Christmas Eve and Cockburn Town New Year.
of Turks and Caicos Islands in succession to Mr Peter Beckingham and took up his appointment in
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New Year, Healthier You?
FINDING YOUR PURPOSE Finding one’s passion and purpose is not always a walk in the park. For James Roach, 28, it was a stroll down many paths before realizing medicine could become his forte. James is a final year medical student at St. George’s University of London who spent two weeks at TCI Hospital shadowing doctors in practice. The ardent bibliophile’s favorite novelist is Oscar Wilde, but outside of literature, he has an obvious love for helping people. After working in a community of persons with serious health needs conducting house-to-house visits to help out in anyway he could, he decided to make a lifetime commitment to medicine. “I’ve looked at other careers and there was nothing that I felt offered the same kind of challenges and diversity like the field of medicine.” James is interested in Neurology, but is also fond of General Practice which is useful anywhere in the world. He wants to assume a role that allows him to connect with families and the wider community. James has capitalized on placements outside of the United Kingdom.
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“Going into the medical setting is a really privileged position. My advice to upcoming medical students would be to realize that you are in a very privileged position, and as a result, try to make the most of each placement. Listen to the people around you, and get involved where appropriate.” - Tom & James
Tom Menzies, 29, is a final year medical student at St. George’s University of London. Portions of his 5-week assignment to learn about medicine and healthcare in a different country were spent at TCI Hospital. Despite hailing from a family of doctors, Tom initially chartered his own course and decided to study business, and later worked as a Management Consultant at PriceWaterhouse Coopers in the UK for several years. But five years ago, after his father passed away, he could no longer resist the calling to follow in the footsteps of his father who was a psychologist, grandfather and uncle who are both doctors. “One day I looked at the people at the head of the business and asked myself if I could see myself doing what they were doing for the next 10 years, and the answer was no. I wanted to do something more meaningful.” Tom has since participated in placements across UK hospitals as required under his medicine degree, and also a 4-week stint at a primitive healthcare facility in Tanzania. Tom likes diversity within medicine and is keeping his options open at this stage as to which specialty area he wants to pursue.
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ROAD TO DIAMOND ROUND-THREE Turks and Caicos Islands Hospital has commenced preparations for the re-arrival of Accreditation Canada in March 2018. The Turks and Caicos Islands Hospital has been accredited at the Diamond level since March 2012. This is the highest level achievable with this internationally recognized accreditation body. The accreditation process is robust and we are proud of our achievement as one of the few accredited hospitals within the Caribbean. An Accreditation Readiness Assessment was conducted by Overseas Consultant, Donna Hutton on 28th Nov 2016 - 10th Dec 2016, which reinforced the more than 30 organizational practices to be examined by an external survey team in 2018. Accreditation is an independent assessment of a health care organization’s performance against recognized standards of best practice.
ACI Qmentum International Accreditation Program is internationally recognized for promoting excellence in healthcare. Successful facilities are awarded Gold, Platinum or Diamond status in accordance with the quality of service and care delivered to patients. A full-site survey is carried out every three years to retain accreditation status. The performance of the health care facility is weighed against the list of organizational performance standards which consist of more than 2000 criteria. These criteria focus on quality and safety throughout all aspects of the organization`s services such as clinical care, governance, leadership and infrastructure.
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According to a December 2015 study published in the Journal of Clinical Psychology by University of Scranton research, the average, self-reported success rate for people in their 20s is a fair 39 percent, while persons over 50 only follow through on resolutions 14 percent of the time. Having trawled through dozens of online articles from experts, below are three extracted tips from various sources on how to apply solid principles of resolution setting to your own goals and aspirations in 2017.
New Year, Healthier You? New Year’s resolutions have a bad reputation and the question of why so many people fail on their commitments to make self-improvements is a curious one. So how about taking a different approach in 2017?
FAIL-PROOFING YOUR 2017 RESOLUTIONS This year, make a New Year’s resolution, resolution. No, that’s not a typographical error. Perhaps the reason why our heartfelt lofty goals collapse by February is entrenched in the way they are created -- poorly crafted and nonspecific. Some of the most popular New Year’s resolutions are hinged on fitness, losing weight and eating an all-around healthier diet. Others include spending less and saving more, living life to the fullest, quitting smoking, helping others, completing a travel bucket-list, spending more quality time with friends and family or maybe even falling in love for the silent romantics.
1. ESTABLISH CLEAR, SPECIFIC AND REALISTIC TARGETS New resolutions should undergo the SMART test. Is the goal specific, measurable, achievable, relevant and time-specific? What do vague terms such as ‘toning up’ or ‘losing weight’ actually mean to you? How will these be measured, why do you want to accomplish these targets, how will you get it and how much is satisfactory in your opinion? Compare ‘I’m going to lose weight this year’ to ‘I’m going to lose ten pounds by March by going to the gym 3 times a week,’ to get an idea of how much more realistic your goal will become. 2. STOP TO CONSIDER POTENTIAL OBSTACLES
Research by experts at the NYC Foundation of Clinical Physiology has shown that mental contrasting — a technique for goal attainment in which you contrast a desired future outcome with challenges that you currently face and may one day encounter in the pursuit of that goal — can help make resolutions stick. This is an essential part of fail-proofing your annualized best intentions. 3. WRITE YOUR TICKET TO SUCCESS People who scribble their goals on paper and other places where they will constantly see it are significantly more likely to achieve them than are those who merely make mental vows; research from Dominican University of 16
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California has shown. This tactic helps to recapture the willpower that existed the moment the resolution was made. The study also found that those who told friends or family about their goals did better than those who didn’t, and people who e-mailed their support team weekly progress updates did best of all. While you shouldn’t typically look to others for validation, an unexpected sincere complement about your results can give you that extra ump.
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TCI HOSPITAL ATTENDS CARIBBEAN INFECTION CONTROL AND PREVENTION WEEK Healthcare professionals participated in a special forum during Caribbean Infection Control Week held in Barbados on October 17th – 21st 2016, to discuss the possibility of forming a Regional Infection Prevention Control (IPC) Association similar to APIC, to ensure protocols are standardized and active data-sharing is encouraged across the Caribbean Basin. The Association for Professionals in Infection Control and Epidemiology (APIC) is the leading professional association for infection preventionists (IPs) with more than 15,000 members. A five member delegation from TCI Hospital was among the near 50 contingents from the Caribbean. Infection Control and Prevention Specialist Nurse Surbrena Pedican led the TCI delegation. The group was impressed by Nurse Pedican’s presentation which highlighted the progress made within the hospital and nationally in the area of infection control. Nurse Pedican volunteered the Turks and Caicos Islands as the host country for the 2017 conference pending Government approval. The groundbreaking regional association for IPC professionals would be officially launched during the conference with support from The Pan American Health Organization and Centres for Disease Control and Prevention. Despite being a new-comer to the annual convention and one of the smallest hospitals based on bed-count, TCI Hospital’s state of the art facility and standards of best practice did not go unnoticed when compared to other countries. Nurse Pedican was one of only two Infection Prevention and Control Professionals present at the conference with IPC Certification. The second individual hailed from Howard University in Washington D.C. with roots in Antigua. “I was so proud because it proved that we are a cut above the rest. We are operating in accordance with PAHO and CDC guidelines. Overall, we are excellent compared to other parts of the region. We are very first world,” said Nurse Pedican.
TCI Hospital was also the only regional healthcare facility represented at the convention to have successfully acquired Diamond accreditation from Accreditation Canada. Belize was hailed as an obvious trend-setter by TCI Hospital delegates, due to the country’s processes and models for outbreak investigations and antibiograms. These models have been shared with TCI Hospital to emulate. “Health care facilities in Belize have a full IPC set-up which includes Infectious Disease Physicians and Hospital Epidemiology. Health professionals in these countries may record diseases and infections in their countries that are not present in the TCI. However, since there are over 71 different nationalities in the TCl population, it is not impossible to encounter diseases that are rare to us, but common in their jurisdiction. Therefore, forging these ties can be useful in such cases to facilitate knowledge-sharing,” said Nurse Pedican. The TCI Hospital Delegation comprised of Eleanor Hall - IHC Chief of Allied Services, Karen Bartholomew – IHC Site Director Grand Turk/ Operations Manager Facilities Services, Rafeeza Seecharan RN Infection Control Link and Antoinette Davis Trail RN Infection Control Link.
The general ward at other health care facilities are retrofitted with screen-less, open windows for ventilation and fresh-air exchanges due to limited resources and lack of air conditioning units in most areas. TCI Hospital has a fully air-conditioned facility with HEPA certified filters and controlled air flow which meet international medical requirements. 17
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community interaction
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EXHIBITION, AND SPECIAL SYMPOSIUM HOSTED TO CELEBRATE MDR WEEK
Medical Device Reprocessing Professionals at Cheshire Hall Medical Centre celebrated International MDR Week during the second week of October under the theme “Quality You Can Count On”. To commemorate this event, TCI Hospital’s MDR Department hosted an exhibition inside its foyer and allowed participating students of Wesley Methodist School to tour the specialized area. The following day healthcare professionals from the public and private sector convened for a special
symposium to reinforce their knowledge of key topics. TCI Hospital CEO, Daniel Carriere gave opening remarks. Dr. Deanne Loague gave a presentation on ‘The importance of quality instruments from surgical perspective; Lessonjulle LyonsDobney - Medical Technologist presented on Medical Device Reprocessing and Infection Control; David Banton – MDR Specialist presented on Patient Care through instrument care; Jamieko Harvey – MOH Dentist presented on Sterilization from a dental perspective.
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TCI Hospital partners with Digicel Health Fair
ADVANCING THE ROLE National Pharmacy Technician Day is observed on October 18th of every year, and TCI Hospital’s Natasha Softleigh-Moffett looks forward to this day to raise awareness of her profession. The theme for this year was “Advancing our ROLE, Supporting our PATIENTS”. Natasha is a PTCB Certified Pharmacy Technician, who has in excess of 15 years working experience. This practical experience covers both the Retail and Hospital settings. Her specialties are the aseptic preparation/ compounding of intravenous admixtures, which includes the preparation of IV’s, chemotherapy preparations, repacking etc. The role of the Pharmacy Technician has changed tremendously. As a professional entity, the Technician is now required to take on roles that were once exclusive to the Pharmacist. For example, the Technician is now involved in patient management/ interviewing, therapeutic monitoring, and medication reconciliation, thus allowing the Pharmacist to concentrate more on his or her clinical responsibilities. It is her belief that one of the greatest challenges facing most Technicians is the lack of standardization within the field especially technicians within the Caribbean region who are not required to be board certified. She hopes to see this fully addressed someday as there is a big difference between Pharmacy Technician and Regulated Board Certified Pharmacy Technician. 20
TCI Hospital Nurses were among fitness and health enthusiasts who participated in the DigiFit Wellness Program held on Friday, November 11th, 2016 with a half-day health fair at the company’s main office on Leeward Highway, Providenciales. The health fair granted employees access to general information on fitness nutrition and medical screenings. Nurses Subrena Pedican and Lurline Barnett conducted basic health screening in the form of blood sugar and blood pressure testing for more than 40 staff members and provided useful counseling on reaching optimal health. The nurses encouraged more companies to embark on similar initiatives. The benefits behind employees’ positive mental and physical well-being are endless, not just in the office but outside, too. Such fairs can inspire even the most unhealthy employees to make smarter, better choices, which ultimately improves their efficiency on the job and reduces the number of sick leavers. Her recommendations to other CPhTs are to never stop learning, always ask questions and never assume. Commit to the profession, join your local and/or national associations and get involved - share your voice.
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Nurse Renay Leshurn Robinson Sunrise: Oct 02,1978 Sunset: Sept 14th, 2016
Reflections from Nurse Renay Robinson’s Memorial at CHMC. Renay was the tenth of eleven children. She was born into a large, closely knitted family in Conch Bar, Middle Caicos. She pursued her nursing certification at the Barbados Community College, South Miami Hospital and various courses and conference across the US and as far away as India. Renay commenced work at the Grand Turk Hospital in the year 2000, specialising in dialysis nursing. She relocated to the Providenciales Dialysis Unit located at Airport Plaza in 2006, and then transferred to Cheshire Hall Medical Centre
when the hospital opened. She was the Supervisor of the Dialysis Unit at the time of her passing. Her twins, Renarge and Nia Missick were her treasured blessings. Their father died in a fatal vehicular accident during their early childhood years. Several years ago Renay became a covenant member of Jericho Baptist Church and sang in the church choir. She was a woman of faith. In April 2016, she suddenly took ill and was flown to Doctors Hospital in Nassau Bahamas. She was diagnosed with a rare and aggressive form of cancer.
She was hospitalised for five months with brief visits home. On the afternoon of Sept 14th 2016, she passed away. Colleagues and patients spoke highly of Renay during a special memorial held at Cheshire Hall Medical Centre and it was evident she exuded kindness, compassion and professionalism. Baking was her favourite past time and she would share her baked goodies with nurses and patients. A special memento was given to Renay’s family by TCI Hospital during the memorial, which was somber but also celebratory of her life.
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NEWSLETTER
HEALTH & SAFETY COMMITTEE The Management and Control of Hazardous Substances
Every day, in our home life, and our work life we are exposed to potential risks related to the use of certain chemicals or substances. Some examples are caustic products such as drain cleaners, cleaning products such as bleaches and detergents. Many of them come with hazard signs that we do not observe or pay full attention to. The risk to you and your family members is extensive if you do not safely use and store such products. The mixing of some items can cause hazardous fumes, some can result in skin burns, many can be irritants or be dangerous if they come in contact with your eyes or are ingested. Please pay attention to labels and ensure that you follow the manufacturer’s guidelines to keep yourself and loved ones safe.
Working with Hazardous Substances Every year thousands of workers are made sick by hazardous substances, contracting lung disease such as asthma, cancer and skin disease such as dermatitis. These illness have personal and financial implications:
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To individuals who may lose their jobs due to ill health and disability
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To society in disability allowances and medicines
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To industry costing to recruit replacement employees
Your manager, the organization and yourself as an employee are responsible for your safety by taking responsible effective measures to control exposure to substances, and protect health. There is legislation that covers this important area: Control of Substances Hazardous to Health Regulations 2002 (COSHH). These Regulations require employers to control exposure to hazardous substances to prevent ill health.
Types of Exposure
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By breathing in gases, fumes, mist or dust Once breathed in, some substances can attack the nose, throat, lungs, and in some cases can harm other parts of the body once ingested such as the liver.
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By contact with the skin - By direct contact i.e. dipping in hand, by splashing, by substances landing on your skin e.g. airborne dust, by contact with contaminated surfaces.
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By contact with the eyes - Some vapors, gases and dusts are irritating to the eyes. Caustic fluid splashes can damage eyesight permanently.
QUICK FACTS
Dusty or fume laden air can cause lung disease e.g. in welders, bakers, quarry workers or woodworkers Metalworking fluids can grow bacteria and fungi which cause dermatitis and asthma Flowers, bulbs, fruit and vegetables can cause dermatitis Wet working, e.g. catering and cleaning, can cause dermatitis Prolonged contact with some substances such as wet cement can cause chemical burns and /or dermatitis Many other products
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By swallowing - People can transfer chemicals from their hands to their mouths by eating, drinking, smoking etc without washing their hands first.
NEWSLETTER
COSHH has a ‘Hierarchy of Control Measures’ which looks at substances and provides means of controlling. These controls can be:
Hazardous Substances Include certain chemicals; Bacteria and other micro organisms; Certain dusts; and any other substance which has comparable health effects.
1. Elimination - removing the hazard or changing the process and provision of PPE - always the
To comply with the Regulations the employer must assess the risks to health from hazardous substances
last option
created by the work task, and decide what precautions are needed to prevent or control exposure. Elimination and substitution are the preferred options. Engineering and Supervisory control must only be used after exploring the first two options. The very last control measure should be the use of personal protective equipment.
2. Substitution - replacing the hazard with a non hazardous replacement 3. Adding Engineering Controls - remove people and put in a mechanized process adding enclosure, ventilation or extraction 4. Adding Supervisory Controls - adding people to manage the use of the hazardous item
The employer must make sure that the control measures are properly used and maintained. If necessary they must monitor exposure and under some circumstances health surveillance must be provided i.e. with use of Chemotherapy drugs. So what is available for employees to be safe? Your Line Manager will have completed an assessment for any new process or products that you use or engage in. They will have completed the Hazard Checklist and looked to control the risk through the Hierarchy of Controls discussed above.
They will have trained all employees fully and ensure that any tasks with risks outlined within the COSHH regulations are supervised and will have outlined the controls and safe processes that need to be followed. Additionally they will have guided you through the safe use of PPE should this be required. Ensure that prior to using new substances, or any if you are exposed to any of the risks discussed, that you have completed adequate training to ensure that you are comfortable and competent to carry out the task and understand the associated risks, and how to manage and control them. 23
NEWSLETTER
DOCTORS VISIT SCHOOLS TO DISCUSS SEXUAL EDUCATION WITH STUDENTS Health professionals from TCI Hospital, Ministry of Health and the National Cancer Foundation visited the Clement High School on Providenciales and Helena Jones Robinson High School on Grand Turk during the month of October to discuss Sexual Health Education with 4th and 5th form students. The overall goal was to foster the growth of knowledge, attitudes, skills and lifelong behaviours that will enable students to assume responsibility for healthy living and personal well being. All subject areas pertinent to sexual health were addressed in a way that is both culturally appropriate and age-sensitive with the intent of connecting with students present during the forum.
Interactive sessions with senior students of HJ Robinson High School.
Presenters were Doctor Angeleen Trowers, Doctor Mamadou Bah, Doctor Henry Blythe, Senior Infection Prevention and Control Nurse, Surbrena Pedican, MOH Care and Treatment Nurse, Noir Tyndall, Hon. Lillian Missick – President of National Cancer Foundation and Tiara McTaire from the Department of Mental Health and Substance Dependence. Guidance counsellors at the institutions expressed gratitude for the initiative organised by TCI Hospital and emphasised the importance of continuing the educational process to increase the impact. Students were left with a lot of food for thought, and expert answers to burning questions about their health.
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NEWSLETTER
FAREWELL MESSAGE: EDWIN TAYLOR HUMAN RESOURCES MANAGER The last four years have been an amazing and humbling experience. Together, we’ve ensured that our Hospital facilities have not only touched the lives of those whom we have served but also of those who are serving. As someone who has had a front row seat and front line responsibility in keeping our staff morale high and our systems well oiled, I believe we have overcome odds and started great work towards the dream of better healthcare in these Turks and Caicos Islands. It is not lightly that I leave this organization which has archived six years with Diamond status, not once but twice and which has become a model of a successful Public Private Partnership for the region and the world. But there is always more to be done to satsify our clientele and the vision for quality, affordable healthcare in the TCI. And so I borrow a sobering thought from author of best selling Seven Habits of Highly Effective People, Stephen R. Covey, who says the seventh and most important habit is to ‘Sharpen the Saw.’
AUTISM Spectrum Disorder
Consulting School Physiologists, G. Terrence Ryan, MA, LMHC and his wife Jeanne P. Ryan, PHD gave a presentation on Autism Spectrum Disorder at TCI Hospital. In the past, Asperger’s syndrome and Autistic Disorder were separate disorders. They were listed as subcategories within the diagnosis of “Pervasive Developmental Disorders.” However, this separation has changed. The latest edition of the manual from the American Psychiatric Association, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), does not highlight subcategories of a larger disorder. The manual includes the range of characteristics and severity within one category. People whose symptoms were previously diagnosed as Asperger’s syndrome or Autistic Disorder are now included as part of the category called Autism Spectrum Disorder (ASD).
“Moving along the upward spiral requires us to learn, commit and do on increasingly higher planes. We deceive ourselves if we think that any one of these is insufficient.” My prayer is that the Turks and Caicos Islands Hospital will exceed expectations because of the commitment of its’ managers and health practitioners to learn more about TCI people and their needs, and do more to become an even more trusted and respected place for health services for the people of the Turks and Caicos and beyond. 25
NEWSLETTER
CHESHIRE HALL MEDICAL CENTRE
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COCKBURN TOWN MEDICAL CENTRE
Christmas Tree Lighting 2016
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NEWSLETTER
WELCOME MESSAGE: ISHA HONORE NEW QUALITY, RISK & PATIENT SAFETY MANAGER Salutations to all! Thank you for the opportunity to join your team at Interhealth Canada TCI. I embrace this position and welcome new quality experiences in the health care industry. I can’t emphasis enough that health care is all about people and organisations with the best talent win. Joining Interhealth Canada TCI was an easy decision, because the strength of the organisation and talent of the entire team is apparent.
TCIHospital
I don’t have all the answers. But I hope that we can challenge each other to think beyond the borders of our constraints, and continue to excel in the world of quality healthcare. I am visualising that we can produce the most compelling, safe and reputable user experience in the world. The opportunities are limitless and I am excited to take this journey with you.
BIRTHDAY CORNER Employees
DECEMBER Jacqueline Moe-Cox, Yashmah Adams, Manuela Cundangan, Valerie Outten, Jervis Mclean, Dorcen Adley, Jaxon Charles, Darrett Lynch, Marie Joseph, Debbie Williams, Theresa Hall, Karen Abril, Antionette Davis-Trail, Kadesha Fletcher, Ferdinand Gaspar, Haydee Dayupay, Detorrie Tennant, William Henry, Sharanna Simmons, Karen Rose JANUARY Andre Carline, Jenny Cuenco, Vernessa Forbes, Clarabell George, Leticia Hall, Derek Jennings, Percy Joseph, Barbara Lewis, David Mechan, Giuseppe Pitassi, Janice Rose, Simone Ruddock, Levy Salve, Perfecto Sevillejo, Natasha SoftleighMoffett, Christa Teves, Erika Williams, Nicola Macfarlane, Roxanne Allen, Ivis Taylor FEBRUARY Jose Abaya, Henry Blythe, Philip Burgess, Gary Fine, Melanie Gibson, Devon Grant, Dionne Lightbourne, Moira Scott, Tesha Thompson, Inette Webster-Brown, Monique Williams, Lorlean Wilson, Simone Powell. 28