Decade In Review: A Walk Down Memory Lane by Turks and Caicos Islands Hospital

Inter iew

The Ezine for Interhealth Canada TC Staff

ISSUE 01 | DECEMBER 2010

Hospital praised for high standards

IAMONDS might be a girl’s best friend, but they are equally important to Interhealth Canada TC. The precious jewel, along with gold and platinum, represents a job well done when it comes to standards set by Accreditation Canada (AC). As staff will no doubt be aware, AC inspectors visited Cheshire Hall Medical Centre and Cockburn Town Medical Centre between 24 October and 3 November. Interhealth Canada TC is both contractually and professionally committed to ensuring that the TCI hospitals become accredited

Delighted: Interhealth Canada TC CEO Roger Cheesman

by AC at, or before, the end of the second contract year. CEO Roger Cheesman ex-

plained: “The recent survey visit was a preliminary review of our activities to present us with feedback on our current status in respect of the standards issued by AC. “It also provided us with some education on the needs of AC and on some of the primary issues we need to address. “Remember, we are a new organisation comprised of staff from the two former hospitals in the TCI, new staff from a significant number of countries and a small proportion of people who have worked for and with Interhealth

“A

working overseas in warmer climates for many years but last year was my first Caribbean Christmas – and it was great fun! We will ensure that as many of you as possible can be away from work on Christmas Day and with your families. For some that will be on island and for others it

Ho,ho,ho: Father Christmas dropped in to the Cheshire Hall Medical Centre the other day. But can you guess which member of staﬀ is under the white beard? Find out on page 6.

Inside SERVICE WITH

A SMILE

PAGE 5

CONTINUED ON PAGE 3

A Christmas message to you all lthough some of you have been here for many years or, indeed, all your life, for quite a large number of our team, this is your first Christmas in the beautiful Turks and Caicos Islands. Coming from a cold country myself – Wales - I have enjoyed

WHAT'S

will mean flying out to wherever home and family may be. Unfortunately, being acute care hospitals, there will need to be those on both sites who must work on Christmas Day. I extend a very special thank you to those people for spending this special time with our patients and not at home. We will ensure that you too get some festive food, courtesy of our award-winning Refresh restaurants. Wherever you will be on the day, I take this opportunity of thanking each and every one of you for all your dedication and commitment during what has been an amazing year for healthcare in the TCI. Can I wish you all a very Merry Christmas and a prosperous New Year - may your time with those you love be all you could wish it to be.” Roger Cheesman, CEO, Interhealth Canada TC

JOE TOUCHES

DOWN IN EUROPE

PAGE 3

DOUBLE JOY FOR SHAMIRE PAGE 5

HITTING THE RIGHT NOTE

PAGE 4

Inter iew

Not such a g’day mate W

ith so many people from so many different places, things occasionally get lost in translation here at the TCI hospitals. Take one of our Australian members of staff for instance, who had our beloved leader spurting coffee all down his nice clean shirt with an early morning tale of woe. Passing the CEO’s open door, our friend from Down Under popped her head around to say ‘g’day’. “How are you?” enquired the chief. “Not bad mate”, came the reply, “although I’m having trouble with my thong today. It keeps riding up.” On hearing this bizarre and totally unexpected answer, out came the coffee all over the shirt. Realising what she’d done, our Aussie friend quickly set about sparing the CEO’s blushes further. “Oh crikey”, she exclaimed, “I’ve just rememberd thongs mean something very different where you come from! Where I come from it’s another name for a flip flop!” IT’S A DOG’S LIFE! On the subject of poor commu-

nications, what about this little beauty….. When the editor of this newsletter was chasing a photograph to go with a story about a member of staff giving birth to twins, he wrote the following email to the new mum, copying in her boss in the process: Hi. Hope you and your babies are well? I have a pic of your babies for the newsletter story but not one of you. Is there any chance you can email me of pic of yourself? Deadline for newsletter is this week so I need it asap. Thanks Fair enough you’d think. However, imagine the editor’s shock and concern when the following arrived in his inbox from the mother’s boss: The babies have gone. The owner turned up yesterday and took them!!!! Will tell more when we next speak!!!! Suddenly the editor had the greatest story of his career on his hands. At least he did until he emailed back to double check the facts. Turns out the intrepid boss thought the editor was talking about a dog that had recently

turned up on her doorstep and given birth to a litter of puppies!!!! SHOULD HAVE STAYED IN BED! When Beaches holds it annual 70s and 80s night next year, one person who won’t be dressing up as David Bowie, Boy George or any other glam rock star, is assistant facilities manager, Don Wilson. If this year’s event is anything to go by, the likeable Scot will never go near the place again. Having taken full advantage of the free bar, Don proceeded to get himself in trouble with those nearest and dearest. Nothing new in that I hear you cry, but wait….it gets worse, much, much worse. Having been forced to spend the night on the sofa, our hero set off next day to play golf at Provo Golf Club. En route he gets news of a tragic result for his beloved football team, Celtic. Still feeling the effects of the night before, the usually Tiger Woods-like king of the swingers hit his first three shots off the first tee into the bushes and, after his 10th go, he picked up his ball and made his way to the second, cussing as he went.

The Ezine for Interhealth Canada TC Staff

The World According to

Matron

His round didn’t get much better after that but at least he had a trip to the 19th hole (the bar) to look forward to afterwards. Alas, a glance at the watch revealed Mr Wilson was soon required at the airport where he’d promised to pick up a returning colleague. But what do you need to drive a truck? Keys of course and poor Don’s were nowhere to be found. More than a hour later and with daylight long gone, the search finally ended when the man with the key to the shed that housed the golf buggies turned up and there were Don’s in the drinks holder of the cart he’d used earlier. Not the greatest day of the wee man’s life, that’s for sure. Good luck to the person brave enough to whistle 70s and 80s hits within earshot of him! AND FINALLY……. During a walkabout the other day, I overheard a nurse talking to a doctor about a patient she had just seen. Nurse: “The patient has had no rigors or shaking chills, but her husband states she was very hot in bed last night.”

Refresh taste success at conch festival

HO said hospital food wasn’t tasty? Not Interhealth Canada TC patients, that’s for sure. They, along with staff and visitors, enjoy great nosh from our Refresh restaurants in Provo and Grand Turk on a daily basis. But the food is not just great any more…it’s actually awardwinning. Last month, chefs Anish Thomas, Keron Waugh and Michael Williams went head to head with the best eateries in TCI at the 7th Annual Conch Festival. And the hospital trio beat all

but one of them at their own game, by claiming second spot in the overall Best Conch Dish category. Decided by the general public, Refresh were just a paltry seven votes behind Bay Bistro, who took top spot for the fifth year running. Nonetheless it was a great effort by the Interhealth team, who surely would have carried off first prize had there been a competition for the best looking stand. Interhealth’s Fiona McDonnell, said: “We are proud and

delighted to have been part of the Conch Festival and coming second in the overall event was a fantastic achievement. “There are a lot of jokes about hospital food, but this just goes to show how good our catering is. Congratulations go to our chefs, Keron, Michael and Anish, and to all our staff and volunteers who made the event such a success. “Our stand certainly looked fantastic and there is no doubt in my mind that Interhealth Canada were the best in every department.”

Tasty: The Refresh team take a break from serving up delicious conch at the 2010 Conch Fes val

The Ezine for Interhealth Canada TC Staff

Inter iew

Hospitals receive pats on the back

RAISE for the two hospitals has been coming in from a variety of sources, some of which has a little unexpected. Doug Parnell, leader of the People’s Democratic Movement (PDM), has never been shy when it comes to ensuring islanders are receiving value for money from their healthcare service. But as well as being an outspoken critic, the politician has also given ‘credit where credit is due’ as demonstrated recently. Speaking at Cheshire Hall Medical Centre Christmas lights switch on, Doug said: “I would like to congratulate Interhealth

Canada on a truly stunning facility. The hospitals in Provo and Grand Turk must be doing a great job because I look around and see so many healthy people. “I have heard many good stories about the hospitals and its dedicated staff.” Meanwhile, the state of the art facilities at Cheshire Hall and Cockburn Town Medical Centres are helping boost tourism numbers, according to Turks and Caicos Hotel and Tourism Association’s CEO Caesar Campbell. He explained: “As a tourist destination, one of our focuses is to ensure that all tourists who visit

Interhealth praised for high standards

Con nued from page 1

Canada in the past. “We all of us bring to the hospitals our cultures and, given the very short time we’ve been a ‘family’ with differing needs and hopes. it was to be expected that our ‘score’ on this preliminary survey might not be high. “However, we were all very pleasantly surprised to find that, despite our short life as a cohesive group, we actually did extremely well and were warmly congratulated by the surveyors for our achievements, which were also above their expectations of a new system.” Although subject to small changes, the results show that the two new medical centres are already compliant with approximately 75 per cent of all standards applicable. The standards are at Gold, Platinum and Diamond levels with Diamond being the highest. “I am pleased to say that we gained 17 Gold, 29 Platinum and 17 Diamond”, revealed Roger, “with just 21 standards not yet met. We do not know how far we are from achieving these remaining standards but we do know that we cannot afford to rest on our laurels.

“We must work hard at improving those standards we have gained and achieving the remainder.” Among the key issues noted are that a new Interhealth Canada culture appropriate to the TCI Hospital should be developed. Roger added, “this will require each and every one of us to begin to move forward from our current cultures and adopt what is good and reject what is not good in order to develop a true corporate and clinical cultural identity.” “We must also work in a holistic manner with respect for each other’s professional abilities and requirements. We cannot work in silos.” While delighted by the findings, Roger was quick to point the finger of success at the staff at the two centres. He said: “The success of this organisation in this preliminary survey is down to you all and I therefore wish to thank each and every one of you for a job well done. “I would also like to take this opportunity to encourage you all to move forward to an even better future.”

our shores have access to the best healthcare, if needed, and that’s something they now have. “Medical services in the TCI have evolved tremendously in recent years with the construction of two state of the art medical centres, currently being managed by Interhealth Canada, a reputable global healthcare medical firm.” And visitor Mark Recornas from Los Angeles, is one of those

who checked out the medical facilities before booking his holiday in Provo. “It’s the first thing I did,” added Mark. “I have a wife and young children and you need to know you are in good hands medically wherever you chose to go on vacation. “Interhealth Canada are a huge name in medical services and so I had no hesitation in coming to the TCI.”

Interhealth surgeon on the world cup trail

ANADA’S Rugby World Cup preparations received a boost during a recent warm-up tour of Europe. The North Americans won three of their four fixtures as they continue to build towards the sport’s biggest competition, which takes place in New Zealand next autumn. And helping the team stay fit and healthy on their travels was a orthopedic surgeon Joe Lemoine. When he’s not fixing patients at the Cheshire Hall Medical Centre, he’s looking after his country’s rugby players. Joe, who used his own vacation time to travel with the side, said: “The trip went well. We hit the ground running in Brussels with twice-a-day training sessions to get the team ready. “But all the hard work paid off with victories over Belgium, Spain and Portugal. The only defeat came against Georgia.” As head of medical staff, Joe has a busy schedule on tours, with little time for fun or sightseeing. “During the first days on tour the medical staff reviews the status of the athletes”, he explained, “with most of the professionals usually playing while recovering from some minor injuries. “A typical day would be to

Touch down: Joe Lemoine is helping prepare Canada for next year’s Rugby World Cup

discuss with the medical team, therapists and strength and conditioning coach the health of our sick or injured players and what activity in training they can do that day “Sometimes we have to set up a special session for them such as working in a pool or gym, so they can get some training in without aggravating their injury. “On match days we then set up medical facilities at the stadium, planning for any type of injury scenario. During this tour we had one significant injury in each game and so we were kept very busy.” He added: “All in all it was a good tour both from a fitness point of view and results. We were also able to blood some new players and so it was excellent preparation ahead of next year’s World Cup. “I was able to squeeze in a tiny bit of sightseeing, but the cold of Europe had me missing TCI.”

Inter iew

Members of the Staﬀ choir entertain guests at Cheshire Hall.

Interhealth’s Roger Cheesman, le , and George Commander, with youngsters from the Provo Children Home.

Kathleen Bree, centre, hands over a cheque to representa ves of the Ona Glinton Primary School.

The Ezine for Interhealth Canada TC Staff

PDM leader, Doug Parnell, meet Santa Claus at the Cheshire Hall switch on

Cockburn Town choir in good voice.

Christmas lights up for needy TCI youngsters C

HRISTMAS came early for children in Provo and Grand Turk, thanks to big-hearted Interhealth Canada TC staff. Special youngsters from both islands were given the all-important job of helping switch on the festive lights at Cheshire Hall Medical Centre and the Cockburn Town Medical Centre. In Provo it was members of the island’s Children Home who did the honours, while pupils from the recently fire-ravaged, Ona Glinton Primary School, were on hand to assist in Grand Turk. Both organisations were presented with cheques for $500

while in Provo, Interhealth Canada’s international CEO, George Commander, matched that figure with $500 from his own pocket. Interhealth Canada TC CEO, Roger Cheesman, said: “Both Christmas Lights switch ons were wonderful events and I’d like to thank everyone who attended. “In Provo we had guests such as Elmo from Sesame Street and PDM Party leader, Doug Parnell, while in Grand Turk were honoured to be joined by Consultative Forum chairman, Lillian Missick, and Ona Glinton Primary School head, Gwen Harvey. “But our really important

guests in both centres were all the children. Christmas is about giving and remembering those less fortunate than ourselves and so it was pleasure to celebrate with our great friends from both Provo Children’s Home and Ona Glinton Primary.” He added: “Seeing their faces light up when Santa turned up with his sack full of presents was priceless.” Meanwhile, facilities director, Fiona McDonnell, was full of praise for what turned out to be the star attraction at the Provo event. She explained: “When we decided to have a choir singing

carols, we went to head physiotherapist, Debbie Findlay-Clayton to see if she knew of one. Well that was on the Monday lunchtime and by Wednesday we had a fabulous collection of singers. “Their performance was fantastic and really made the night special. Well done to Debbie for all her hard work and to the entire choir, who gave up their free time to entertain others. You were marvelous!” She added: “And the same goes to all the guys in Grand Turk who also formed a choir at very short notice and were just as fantastic.”

The Ezine for Interhealth Canada TC Staff

Family joy: Proud parents Shamire and Conroy with the twins

Double joy for delighted Shamire LIKE most twins, Zaden and Zyere Jackson will share a lot of things in their lives. But bizarrely, the siblings will never celebrate their birthdays on the same day. They might have been born only two minutes apart, but those two minutes were the difference between night and day. Mum, Shamire Moore, receptionist and administration supervisor at the Cockburn Medical Centre in Grand Turk, gave birth to son Zayden at 11.59pm on August 7 with daughter Zyere arriving at 12.01am on August 8. Now while Shamire and dad, Conroy, have been blessed with two beautiful and healthy children, they’ve also been landed with a huge dilemma. “It’s strange having their birthdays on two separate days,” admitted Shamire, “because I’m not sure whether I will have two separate parties. And if I have one party for the both of them what day will we celebrate on? “But being born on different days is good in one way because they could not be any more different and have completely different personalities. “Zyere is so happy and doesn’t mind playing alone, whereas Zayden is the serious one who always wants to be the centre of attention. They also look completely different. I call them my night and day babies.” Despite wanting her babies born on her home island of Grand Turk, Shamire had to be flown to Florida where Zayden and Zyere arrived more than a month premature. Shamire explained: “Although I came to the hospital for my regular visits I made the decision to have my babies in Florida because I was told I would not be going full term. I have a small frame and so carrying two babies was tough. “But it wasn’t a surprise because I come from a family of twins on both my mum and dad’s side. “My family have been so supportive and I would also like to thank my doctor, Dr Luis Gullien, who made house calls when I was stuck at home with chicken pox. “Also thanks to my boss Fiona McDonnell who, with many others, made sure I was well taken care of and had me smiling on a regular basis. Conroy and I are so grateful.” She added: “Zayden and Zyere are blessings from God and I am so happy to be their mum. It’s double trouble and double noise, but I also get double love which is great.”

Inter iew

Winter wonderland: The snow lays deep and even outside Bill’s co age in Canada

We’re dreaming of a white Christmas WHILE TCI basks in glorious sunshine this Christmas, spare a thought for some of our recently departed members of staff. Take ex-procurement consultant Bill, Rosenitsch, for instance who spends most mornings shoveling the snow from the pathway of his beautiful cottage in Ontario. “It’s pretty cold up here now”, reports Bill “and I do wake up some days dreaming of Grace Bay beach and the swimming pool at Flamingo Park. “The cottage is situated on the lake and even that has now frozen up because it’s so cold. But it does make for a beautiful scene especially with Christmas on the way.

“Talking of which, Merry Christmas to all my friends down there in TCI!” Another country in grips of one of it’s coldest spells for years is Great Britain, where life has ground to a halt on occasions due to heavy and unexpected snow falls. Maternity consultant, Lesley Heelbeck, who spent a month in TCI earlier this year, said: “Living in the north east of England I am used to a bit of snow but I can’t remember it being this bad so early in the year. “The whole of Britain has been suffering and it certainly makes me think of TCI when I’m shivering in the cold!!”

Presents: Santa hands out gi s to the children of staﬀ members

Smile: It’s fun for everyione at the staﬀ party

Festive Fun at the ho ho ho-spitals STAFF have been in festive mood at the Cheshire Hall and Cockburn Town Medical Centres. More than 300 of them and their families, enjoyed special Christmas parties thrown by bosses, Interhealth Canada. Attractions included childrens’ games, bouncy castles, bbqs and special visits from Santa Claus, who handed out gifts to all the youngsters.

Chief executive, Roger Cheesman, explained: “Every single member of staff has worked so hard this year to get the hospitals in Provo and Grand Turk up and running. “Therefore it was our absolute pleasure to throw Christmas parties in their honour. “Also it gave us a chance to thank family members who have supported our staff in every possible way.”

6 FINANCIAL TIMES

Inter iew By Lauren O’Hanlon

E Payslips D

uring the busy Holiday season you may have found yourself wondering where have the payslips gone? During November the finance team worked hard to move from a paper-based payroll system to an upgraded electronic system so you can view your pay details online on the intranet. We’ve had a few hiccups and it’s taken a bit longer than expected, but we’re absolutely thrilled to report that by January 2011 we’ll be fully electronic. That means no wasting paper, no carbon footprint, no room for confidentiality breach with payslips lying around and on time, real time, pay information. Reimbursements: Know Your Code Ever asked yourself why you have to fill in so much paperwork? And surely you’ve wondered why is finance asking me to fill in all of these codes? Well for one thing, it will help

you get reimbursed faster if we have the correct information. If we know how to contact you, which department (cost center) you are in, your extension and your line manager, then it will help to create a better work flow and you will ultimately receive your reimbursement faster. We do our best to process reimbursements as quickly as we can. However sometimes there are levels of approvals that need to take place before we can release the payment. Sometimes these take weeks to process! Please always be patient and to follow up directly with your manager first, and then with finance if there are any problems. While we can’t guarantee a one-week turn around, we strive to make that happen and do our best to ensure at least a two-week workflow. Happy Christmas and a prosperous New Year to all from the finance team.

Café Corner By Anish Thomas

Conch Festival 2010 IT WAS hard work, but it was worth it. I’m talking about the 2010 Conch Festival in Blue Hills. We knew when we entered Refresh, we’d be up against it and that was certainly the case. There were some fantastic restaurants and eating places that took part and so to come away with second place overall, was fantastic. Well done to all the Refresh staff and also to the Interhealth staff who helped out on the day. Our stand was without question the best in show and long queues of people lining up to taste our Conch shows just how good we are when it comes to catering.

Christmas parties While on the subject of thank yous, can I also say a big one to all the Refresh staff following the recent Christmas events and parties.

The Ezine for Interhealth Canada TC Staff

Feedback from both the Christmas lights switch ons and the staff Christmas parties has been fantastic with the food and refreshments having proved a tasty hit in both Provo and Grand Turk. Thanks again to everyone who worked so hard to make these functions such a success.

Festive menu With Christmas just around the corner, the kitchens in both Provo and Grand Turk are taking on a festive feel. The menus leading up to the big day will include traditional seasonal fare, with roast ham, roast turkey and Christmas cake to mention but three delicious options. Check our daily menu boards for more details.

Foods from around the world

Our themed Fridays have proved a big hit among diners with Indian, English, Jamacian, Canadian and Australian menus so far. We will be continuing the international flavour in the new year and so again, check our menu boards on a regular basis.

Ladies man: Marlon is heading for pastures new

‘Magic’ Marlon’s moving on CHESHIRE Hall’s physiotherapy department is losing one of its most popular members of staff. Marlon Uy, affectionately known as Magic Marlon, is heading off for a new life in Vancouver, Canada. Boss Debbie Findlay-Clayton, said: “It’s a real shame to be losing Marlon because he’s a great physio and a great member of the team. He is popular with both

colleagues and patients and his experience and skill will be badly missed. “In the end I don’t think he could cope with working with three Jamaican women if the truth were known, but we were always very gentle on him. “But seriously, we thank Marlon for all he’s done and wish him much luck and love in the future.”

Behind the beard

So did you guess who that was playing Santa Claus on the front cover? That’s right, it was popular chef, Keron Waugh who got all dressed up to wish everyone a very merry Christmas and a happy new year. And that’s also the message from me and all the refresh team at Cheshire Hall and Cockburn Town.

Inter iew

The Ezine for Interhealth Canada TC Staff

GETTING TO KNOW YOU

Debbie Findlay-Clayton I

F IT’S service with a smile you want then look no further than Cheshire Hall’s physiotherapy department. Sure, you hear a lot of screaming coming from behind those closed treatment room doors, but rest assured the physiotherapists are happy in their work. And when you meet their boss, it’s not surprising there’s a lot of smiling going on. Head of department, Debbie Findlay-Clayton, wears the sort of infectious grin that rubs off on all she meets. “Smile and the world smiles back at you” is one of her mottos. Born in Jamaica, Debbie left school and began working in a bank. But it wasn’t long before she began to gain an interest in physiotherapy. “There were four reasons for wanting to become a physiotherapist”, she explained. “First my mother said that working in a bank was a job and that what I actually needed was a career. “Then a friend from high school started studying physiotherapy and telling me all about it, and the romantic book I was reading at the time featured a physiotherapist as the main character. “And when I watched the film, Regarding Henry, which also has a physiotherapist in it, I figured that someone was trying to tell me something and so that was that.” Debbie left the bank and spent the next few years studying at the Caribbean’s only English-speaking school of physiotherapy in Kingston. And after graduating with flying colours, she landed a position at Jamaica’s Mandeville Public Hospital. In 2001, Debbie, who is married with three young sons, spotted an advert online from the TCI Ministry of Health.

– HEAD OF PHYSIOTHERAPY

Service with a smile: Debbie Findlay-Clayton

Chorus line: The physio girls, from le , Shareel, Debbie and Natoy

She said: “It was advertising for someone to go to Grand Turk and set up a physiotherapy service over there and so I applied and got the job.” After three years, she was transferred to Provo before returning to the Mandeville Public Hospital for 18 months in 2005. Then it was back to the Myrtle Rigby Medical Centre until the arrival of Interhealth Canada earlier this year. “I love my work”, she added. “The feeling you get when you help put someone back on the road to recovery is fantastic. “I’m also lucky to be part of a great team which features Netoy Dilworth and Shareel Dixon-Anderson in Provo and Camille Marshal in Grand Turk”. Q & A If I weren’t talking to you right now I’d be… Seeing a patient I expect. If not I’d probably be catching up on some paperwork. A phrase I use too often… Oh dear Lord! I say it all the time and don’t realise I’m doing it. I wish people would take more notice of…

People less fortunate themselves. Instead of turning the other cheek, we should all make time to speak to those who are not as privileged as we are and listen to and understand their needs and requirements. The other thing I wish people would take notice of is the sign in our reception area asking patients to turn off their mobile phones during treatment! The most surprising thing about me is… That I can’t ride a bicycle. When I was young I thought I had nice legs and didn’t want to cut or graze them and so I refused to learn to ride a bicycle just in case I fell off A common misconception about me is… That I’m a soft touch, a push over. I might come across as a happy, smiley person but I can be very tough when I have to be and very stubborn, especially when I am right. I’m a doer, the sort of person who can be relied on to get things done. And you don’t get things done by being a soft touch. I’m good at… My job – that’s what I pride myself on. But everyone who knows me would probably say

I’m pretty good at talking too! My ideal night out would be… Watching a good play, movie or musical with family or friends, especially period dramas such as Pride and Prejudice. What’s also nice is meeting up with my really close friends and just sitting and chatting over ice cream. In moments of weakness I… Escape in a trashy chick flick or romantic comedy. You know me best as a physiotherapist but in truer life I would have been… A housewife. I grew up with this idealistic dream of settling down, having children and baking cakes all day. The realities of life are a little harsher than that but it was a nice dream while it lasted. The best age to be is… The age you are now In a nutshell, my philosophy is… Trust in God, let and let live and be kind to everyone you meet. Always remember that what goes around comes around and smile and the whole world smiles back at you. I’ll tell you a joke… A doctor is talking to a car mechanic: “Your fee is several times more per hour then we get paid for medical care.” “Yeah, but you see, doc, you have always the same model, it hasn’t changed since Adam; but we have to keep up to date with new models coming out every month.”

Inter iew

WE’RE NEW Peter Nicholson TITLE: HR manager HOME: Edinburgh Scotland CAREER TO DATE: Bri sh Army oﬃcer; HR manager Capel-Cure-Myers, City of London; HR manager RR Donnelly Printers, Gateshead; change consultant, Standard Life, Edinburgh; HR manager Airwork Vinnel Muscat Oman; group HR manager Al Faisal Holdings, Qatar, HR director Royal Hayyat Hospital Kuwait; senior manager compensa on and beneﬁts EMAL, Abu Dhabi; freelance change consultant, Edinburgh. INTERESTS: Squash, tennis, skiing, rugby, golf, travel, reading, music OBJECTIVES: To support the CEO in making the TCI hospitals the leading medical facili es in the region by u lising its people skills.

Barbara Ferguson TITLE: Catering supervisor, Refresh HOME: Bahamas. Moved to TCI in 2003 CAREER TO DATE: Worked in restaurants in the Bahamas before becoming a chef here at Beaches. I have also worked as a chef on Ambergris Cay INTERESTS: Track and ﬁeld, basketball, mee ng people and cooking. OBJECTIVES: My aim with Refresh is to help maintain the excellent standards and make improvements where I can. My long-term goal is to one day become a nurse and help save people’s lives. Hopefully, an opportunity may arise in the future, but in the mean me I am just so grateful Interhealth and Refresh have put their faith in me and I am determined to reward that faith.

Mary-Jo Bryant TITLE: Purchasing manager HOME: Born in Dearborn, Michigan. Family moved to Mississauga, Ontario, when young, and have lived in Oakville, Ontario for 25 years, raising two children. CAREER TO DATE: Have worked in the materials management healthcare sector for over 30 years, predominately in management posi ons throughout the Greater Toronto area. Have been part of implementa on team for three large regional hospital groups in Ontario, the most recent being Shared Service West (SSW), which is comprised of eight hospitals INTERESTS: Golf, concerts, gardening and travel. Volunteer for dog rescue group in Ontario and also have been on the Mul ple Sclerosis Walkathon Commi ee in Oakville for more than 10 years. OBJECTIVES: My goals while working for Interhealth Canada (TCI) Ltd is to reduce costs that are associated with the consumables that are required for pa ent care, without compromising quality. Also maximise and stabilise on logis cal rela onships to ensure mely receipt of our orders.

The Ezine for Interhealth Canada TC Staff

Say hello and wave goodbye I

NTERHEALTH Canada TC extends a warm welcome to all those members of staff who have arrived in the TCI over the past few months. Among them are purchasing manager, Mary Jo Bryant and HR manager, Peter Nicholson. Others include general surgeon Christopher Valentine, pediatrician Lorena Soler, ER physician Duayne Storm, radiographer Jose Abaya, physiotherapist Shareel Dixon, RN Simone Ruddock, PA to CM Carol Theophanous, chef Andre Smith and catering supervisor Barbara Ferguson. There have also been a number of locums and consultants who have spent time in the islands, such as maternity expert Lesley Heelbeck, laboratory officer Peter Anderson and paramedic Pat Riel, from EMS, to name but three. Meanwhile the last couple of months have also seen us say goodbye to a number of personel. And sadly there are more departures on the horizon. Among those heading to pastures new is popular senior phys-

iotherapist, Marlon Uy. “I have enjoyed my time in TCI,” said Marlon, who leaves Provo on December 22, “and I have made a lot of friends who I am going to miss. “Hopefully I’ll be coming back to visit in the future but until then, I’d like to thank everyone for their kindness and wish you all well for Christmas and the new year.” Others who have moved on include dentist, Dr Bruce Robertson, pathologists Dr David Harris and Dr Michel Trudel, general surgeon. Dr Roger Mason, internist Dr George Northrop, RN Ricardo DeBelen, physiotherapist Elizabeth Fennel, radiographer Christina McDavid, telehealth officer Lynn Guscott, patient services, Cyre Ferguson and HR manager, Nick Ofield. From the catering department we have lost Celia Parnell, Loathe Arming, Sydney Steward and Grace Mallory while porter Sebastian Pennant and clerical assistant, Daphne, Alcime, have also left.

Inter iew The Ezine newsletter for the Interhealth Canada TCI Staff

Editor: Paul Baker Telephone: 431-1066 Email: paul.baker1066@hotmail.co.uk or pr@interhealthcanada.tc Photographs: Paul Baker and Steve Gill Submissions, story ideas, le ers and comments are welcome and encouraged. This newsle er is for and about the staﬀ of Interhealth Canada TC. Please email the editor, a aching photographs in a jpg format if applicable. Please also include your email address and a day me telephone number.

Inter iew

The Ezine for InterHealth Canada TC Staff

ISSUE 02 | JANUARY/FEBRUARY 2011

Great work

WHAT'S

Inside

– keep it up! BY JUDITH CAMPBELL

PERMANENT SECRETARY, TCI MINISTRY OF HEALTH AND HUMAN SERVICE.

“A

S WE embark on a fresh new year, I embrace this opportunity, on behalf of the Ministry of Health and Human Services, to wish the management and staff of the Cheshire Hall and Cockburn Town Medical Centres a blessed and peaceful year. I also extend my thanks and appreciation to the entire staff, for their commitment and persever-

Girls just want to have fun

HERE’S an unwritten rule at InterHealth Canada – work hard, play hard. And these beautiful ladies know exactly how to do both. The fun-loving quintet were part of a Cheshire Hall Medical Centre girls night out in January. Admin manager, Mita Saxena, explained: “A few of us got dressed up and had a night out at Hemmingways. It was fantastic with great food and great company. “There’s nothing better than a good girls night out and a fun time was had by all.” Pictured partying the night away are, back left to right: Donna and Shakara. Front, left to right: Kerry, Kimberley and Sheryl.

ance during the past 12 months. Undoubtedly 2010 was a year of change with a new Interim Government and a shift in priorities. Economies worldwide receded, and the Turks and Caicos Islands suffered the same fate. Despite this we were able to open two extraordinary healthcare facilities, which demonstrate the Government’s continued support for high quality healthcare to the people of the Turks and Caicos Islands. The seeds of your labour,

Full of praise: Judith Campbell

planted in the previous year, are now bearing fruit and you have accomplished so much in such a short time. There is hardly a day that passes that I do not receive phone calls and commendations from persons throughout the islands applauding the work of the CONTINUED ON PAGE 5

INTERHEALTH FLAG FLIES NEAR AND FAR

page 3

GETTING TO KNOW

LADARNYA

SMITH – SENIOR HR OFFICER page 6

NEW

AMBULANCES

FOR TCI page 13

WIN A HARRODS HAMPER page 8

Inter iew

The Ezine for InterHealth Canada TC Staff

Oh dear what can the matter be?

ACILITIES guru Donald Wilson will soon be holding a training session with his team, entitled Round Pegs, Square Holes. The need for such educating arose following the long-waited delivery of the air condition air filters. Donald’s hard-working department set about the job of replacing the old filters with the same vigor and enthusiasm with which they tackle all tasks around the Cheshire Hall and Cockburn Town Medical Centres. Unfortunately, one team member was possibly a little too keen and got him stuck in one of the air vents. Thankfully the sight of two legs dangling helplessly from the unit was shielded from public view due to this particular vent being in a staff only location. Donald said: “It really was like trying to get a round peg into a square hole. I personally took the decision that I was too big for the vent and so I’d hoped that would act as a gauge for others. “But these things happen when you have such a dedicated team – all the guys just want to work hard and get stuck in. It was just one of those really.” CANDY PROVIDES MIRIACLE CURE THEY say nurses are the least sympathetic beings on earth. Well is it any surprise? On Christmas day I was stand-

The World According to

Matron

ing chatting to Shakara who was covering the Cheshire Hall reception while a colleague took a comfort break. We watched as a gentleman strode towards the dentist door, only to find it locked. The man then made his way to the reception desk clutching the side of his mouth, claiming he was in agony. “Sorry”, said Shakara, “the dentist is closed for the holidays. Is it an emergency case?” The agitated toothache sufferer’s eyes suddenly clocked a dish full of Christmas candy on the counter. “Can I have one please?” he asked, pointing at the sugar-laddened goodies. “Help yourself”, said Shakara. With that, the gentleman stuffed three candies in his mouth and another handful in his pocket. “But sir”, shouted a concerned Shakara. “What about your bad tooth?” “Yum yum yum”, came the reply, which we assumed was short for ‘it’s much better now thank you’! SHE’S A GOOD SPORT! HERE at InterHealth Canada TC, we can boast an array of sporting

talent. We have an international rugby physiotherapist on the staff, a former semi-professional footballer, an ex-soccer referee and a onetime international female basketball player. No names, no pack drill, but we also have a piece of sporting equipment on the pay role. Asked if she plays any sport, one well known and much loved, employee, replied: “Not really, but my older brother and his friends used to use me as a football goal post when I was younger!” Anyone fancy a kick about in the car park?

YOU MUST BE POTTY CAN anyone explain to me why the chief of medical services has taken to driving with a saucepan on her passengers’ seat? Is there a hole in the car roof or is she so busy these days she has to peel the potatoes for tea while driving home? If you know, be sure to let me know too.

IT’S GOOD TO TALK! THERE’S no escape from InterHealth……….just ask infection control nurse, Alison ‘Granny’ Pyper. Having received a call from work while on a flight to Grand Turk recently, the energetic Aussie decided to get well away from it all by taking a trip around Grace Bay on a submarine. But alas, the guys at Cheshire Hall are not easily beaten and managed to track her down. “Struth”, said Alison, “I couldn’t believe it. There I was admiring the underwater delights of Grace Bay on this magnificent vessel and my phone started ringing. “This weekend I’m planning a pot holing trip. Let’s see if the hospital can get hold of me when I’m 10 foot under!’ UNDER THE THUMB I was chewing the fat to Giuseppe, InterHealth’s dashing dentist, the other day when a vacating woman and her husband interrupted us. “I want a tooth pulled, and I don’t want any pain relief because I’m in a big hurry,” the woman said. “Just extract the tooth as quickly as possible, and we’ll be on our way.” An impressed Giuseppe said: “You’re certainly a courageous woman, now which tooth is it?” The woman turned to her husband and said: “Show him your tooth, dear.”

Impressive performance

HE Training rooms in both Provo and Grand Turk have been busy places over the past month. All staff have been taking part in a course covering the Performance Management System that is being introduced at both centres. HR manager, Peter Nicholson said: “This the first step leading to a change of culture to be based on continuous improvement and contribution management. “All staff have undertaken a one day training course with managers and supervisors do-

ing an extra half day. “Fortunately we have be able to benefit from the skills of leading consultant Bill Atkinson who has been course tutor for these sessions. “The Performance Management System we have designed is simple but effective and the aim is to remove any concerns about performance management and make all levels of staff comfortable with the process. “ The course will support a series of management development workshops covering a wide area of management/supervisory skills.”

Pointing the way: Consultant Bill Atkinson

The Ezine for InterHealth Canada TC Staff

Inter iew

New year, new culture BY ROGER CHEESMAN

CEO, INTERHEALTH CANADA TC

APPY new year – did you make any resolutions? Traditionally, we make new year resolutions and, full of good intent, most of us have broken them by the time we get to the end of the month. I have been watching very carefully for the first signs of weakening amongst those who have foresworn the very dubious pleasure of smoking cigarettes . Sometimes, a new year’s resolution is a good thing for some and a bad thing for others. Take these brave smokers who are going to kick the habit after many years of inhaling the ‘evil weed.’ For those who succeed it is a major achievement to be applauded by all and definitely one of the good things to happen. However, there is another side to this. Giving up what seems to be a pleasant addiction is hard and can cause the person who is foregoing these pleasures to become moody and cranky with all around. Take pity on the poor spouse who makes a wrong comment at the wrong time when the resolver is suffering from nicotine withdrawal,

because he or she is going to get a mighty blast from a massively irritable person. Never underestimate the power of addiction or the irritability of the brave person giving up a pleasure he or she has enjoyed for many years. Here at Cheshire Hall and Cockburn Town, we are giving up a great deal for the new year too. We have resolved to give up our old

cultures, brought with us from the last places we worked, and take on board a whole new culture. This is manifested in the Performance Management regime recently commenced by the human resources team. Giving up our familiar and cosy cultures is hard. Some staff will feel threatened despite the fact that this should be seen in a very positive light. I would ask that we all see what is happening in house in the next few months as a new way forward where we all start on the same footing and all aim for the same goals. Everyone of us is giving up our comfortable old ways and moving into a new era with new philosophies and a determination to ensure that Cheshire Hall and Cockburn Town Medical Centres become bywords synonymous with efficient and caring services and quality outcomes. I hope the transition to and achieving of our collective new year resolution is as painless as possible for us all. However, if you have concerns or worries I would urge you to talk with Peter Nicholson or your director/manager, and bring your concerns to their attention. Let’s all work together for the common good!

InterHealth flag flies near and far

LOBAL Health Solutions – that’s how InterHealth Canada describes its work. And with good reason too. The company continues to lead the way when it comes to providing quality healthcare worldwide, from North America to Europe, the Caribbean to the Middle East. And with a number of new projects in the pipeline, the InterHealth flag is set to fly even further afield. InterHealth Canada international CEO, George Commander, explained: “There is a lot going on around the world and I’m delighted to be able to offer an update for staff. “InterHealth continues to be the preferred bidder for a Private Public Partnership (PPP) with the Government of the Maldives to carry out a healthcare renewal programme of the southern region of the country, around the Hithadoo Regional Hospital

“We have also been selected by the Government of the Republic of Georgia to privatise the Republic Hospital in Tbilisi, which is a general facility with 240 beds.” George also revealed that InterHealth is looking at projects in Poland, Russia, the Middle East and Africa. “We are one of three shortlisted bidders to reach the final bid stage of a PPP constructive dialogue with the Zywiec Municipality in south west Poland”, he added, “for what will be a 350-bed general hospital “InterHealth has also been invited to hold discussions with the Municipality of St Petersburg in Russia regarding a PPP project for a 250-bed children’s hospital “Other activisites include being invited to bid for the management of the Princess Noura University Hospital in Riyadh. “This is a 350-bed teaching hospital on the campus of Princess Noura Womens University in Riyadh. “On top of that, we have also been ap-

Delighted: International CEO, George Commander.

pointed by Reliance Referral Hospitals Ltd to commission and operate the Reliance Referral Hospital in Abuja, Nigeria. “This is a 250-bed private hospital and is the largest in Sub-Saharan Africa.”

Inter iew

The Ezine for InterHealth Canada TC Staff

Students perfect their trade in TCI

OUR trainee doctors will be thanking InterHealth Canada when they graduate from university next year. Canadians Lauren Katz, Eric Carpenter, Stephanie Wong and Elsie Boulanger have recently undertaken work experience at the Cheshire Hall Medical Centre. And the quartet, all students at the famous McGill University in Montreal, claim their time in the Caribbean has been ‘invaluable’. Lauren, explained: “It’s been brilliant and we have learnt so much. We are all in our third year of studies and part of our course involves getting out and working in a real hospital. “It was Eric who approached InterHealth Canada about coming to TCI and straight away they agreed to our request. Being a new hospital means we are the first students ever to do work experience here and that’s a tremendous honour.” Despite being a small community compared to Canada, Eric, insists working in the TCI has ‘broadened’ their professional experience. “The Caribbean throws up different medical challenges compared to other places in the world”, he said, “and so from that point of view, the trip has been invaluable in terms of our development.

Girls on Film: Medical students Stephanie Wong, right, and Elsie Boulanger tell PTV’s Easher Parker all about life at the Cheshire Hall Medical Centre.

“We’d like to say a huge thank you to InterHealth Canada, the TCI Ministry of Health and islanders themselves, for hosting our visit.” InterHealth chief of medical services, Dr Robyn Barnes, explained: “We are delighted to be hosting students from McGill University – an institution with a reputation second to none.

“The guys have been a pleasure to work with and they are very dedicated and committed medical students with good careers ahead of them. “It is vital that we offer these sort of opportunities and we will soon be welcoming students from other countries including the UK. “

It’s never too late to learn

RAINING opportunities continue to be snapped up by InterHealth Canada TC staff. Recently more than 30 people attended a Aesculap Academy-sponsored workshop in Provo, entitled Current Issues in Instrument Processing. Held at the Brayton Hall, guest speaker was Cynthia Spry, RN, MS, MA, CNOR, CIS, and independent consultant. Topics covered included international standards, infection transmission and prevention, various methods of sterilisation, risk analysis, instrument cleaning methods, equipment testing, product testing, quality monitoring, accreditation, shelf life and teamwork. Susan Borden, InterHealth Canada TC’s medical device reprocessing manager, said: “A total of 33 people attended including nursing, dental and medical device reprocessing staff from Cheshire Hall and Cockburn Town Medical Centres, along with Ministry of Health and associated medical employees. “Each participant received a certificate of

Learning: Delegates on the Current Issues in Instrument Processing workshop.

completion with 5.5 continuing education units.” She added: “I would like to thank everyone who took part, with special mentions to Aesculap Academy, Cynthia Spry, the MDR team, David Banton, Indeira Harris and Bridget Wil-

liams, InterHealth Canada, TCI Ministry of Health and staff at the Brayton Hall. “For most of the participants this was done on their day off and the positive feedback clearly shows dedication to your profession and patient safety.”

The Ezine for InterHealth Canada TC Staff

Inter iew

Charity provides expert help for disabled youngsters

LEADING youth charity has been helping disabled children in the TCI. The One World Foundation sponsored a visit from two learning difficulties experts who held consultations at the Cheshire Hall Medical Centre. Speech therapist, Debbie Venditti, and oc-

Great work

– keep it up! CONTINUED FROM PAGE 1

staff of the new hospitals. Here are just a few of the comments I have received: “I got first-class treatment”, “The nurses are so professional”, “Had it not been for expertise of the ER staff, my child’s life would have ended”, “That’s the best physiotherapy department, I have ever seen”, “The food in the restaurant rivals any 4-star restaurant”. I must single out the nurses and other staff who transferred from the former Government hospitals. You exemplify the cliché’, “not just practice, but care”. Many of you have left the Government Service, after working up to 20 years, without any sort of compensation to date. Yet you continue to demonstrate true signs of love and passion for your work. We are also grateful to those staff members who have joined from other countries to assist us in the delivery of health care in the TCI. We appreciate your sacrifice and patience as we try to develop our health care system. Finally, the success of this hospital is dependent on the collaborative efforts of everyone, particularly the Ministry, National Health Insurance Plan, the private health care practitioners and the public. It was a good year, we have held fast our footing in a shifting landscape, and we are cognizant that we have a long road ahead, but with your professionalism and steadfast focus, we are confident that we can achieve a premium health care system. Again have a safe and productive new year.”

cupational therapist, Dr Claire Richardson, have spent two weeks working with youngsters suffering a range of disabilities including autism, cerebral palsy, epilepsy, learning difficulties and Down syndrome And the self-funding trip, supported by InterHealth Canada, the Sands Resort and Rotary Clubs in TCI and New York, has been hailed a ‘huge success’ by InterHealth Canada consultant pediatrician, Dr Helen Leonard. Helen explained: “The One World Foundation is a fantastic charity that, among many other things, offer support for disabled children all over the world. “It has a group of experts who volunteer their services and we have been really fortunate to have Debbie and Claire with us. “Both are leaders in their field and so parents and children have benefited hugely from their experience and skills. “These sort of services have been limited in the TCI and we see this as the start of better things to come. InterHealth Canada is working closely with the Ministry of Health to further develop these services and to ensure long term progression and sustainability.”

Toronto-based Ms Venditti has been ‘encouraged’ by the ‘positive’ attitude of parents. “It’s been a really fulfilling trip”, she explained, “and I have been very impressed by the facilities here at the Cheshire Hall Medical Centre. “I have also been very encouraged by the positive approach from parents and their willingness to learn new skills to pass on to their children. “We have been impressed by the way parents and guardians have embraced the activities and exercises we have demonstrated and their determination to continue to work with their children at home. “It’s been fantastic and we look forward to returning soon.” One youngster who has benefited from the visit is two-year-old, Tania Alutten. Mum, Lathia, said: “This has been a wonderful opportunity for Tennia to work with two leading specialists and she has made great progress. “Their methods and ways are really inspiring and can see the difference it’s making.”

Expert help: Dr Claire Richardson and Debbie Venditti, seated, work with two-year-old Tania

Inter iew

The Ezine for InterHealth Canada TC Staff

GETTING TO KNOW YOU

Ladarnya Smith – SENIOR HR OFFICER

O YOU think you know a thing or two about the Turks and Caicos Islands, do you? Well whatever it is you think you’ve learnt, there’s one member of staff who has forgotten more about the place than most of us will ever know. Ladarnya Smith is like a walking encyclopedia when it comes to the TCI – not a bad asset to have considering her job. As senior HR officer, she has been and continues to be many people’s first contact with InterHealth Canada. And it’s a role she relishes. “I’m a straight talker”, admitted the 25year-old, “but I think that’s the best way to be. I’m here to help and I enjoy that part of my job and if I can do it, I will do it. “But I think it’s important to be honest with people. For those who have come from overseas, moving to a new country is tough and the last thing people want is to be given the run-around. Straight answers to straight questions is my philosophy.” Born and bred in Salt Cay, they don’t come any more local than Ladarnya. And if ever there were such a thing as an idyllic childhood, she had one. She explained: “It was a wonderful childhood. The whole time was spent outdoors, having fun and living every day to the full. “There were about 200 people on the island and everyone knew everyone and looked out for each other and there was never a need to lock your doors and windows. “Life was basic in many respects but that was part of the charm. For instance, people knew not to get seriously ill on a Tuesday, Thursday, Saturday and Sunday because there were no flights off the island.” So how did this happy-go-lucky Salt Cay child grow up to become an integral spoke in the InterHealth Canada wheel? Ladarnya explained: “I first came to Provo when I was 11 because my mum had moved over. From 12 to 14 I lived in South Caicos and then came back to Provo to complete high school. “I enjoyed school and was quite academic. I was captain of the debating team and did lots of things like spelling bees. “I wanted to be a lawyer but ended up going into insurance at 17. I used to work 9am

to 5pm every day and then I’d go to college until 9.30pm to do business studies. “This went on for three years and was a tough time for me and I also started my insurance exams during that period too.” After graduating with her business degree, Ladarnya left insurance for a spell working for the Ministry of Home Affairs. It was after that that she became one of InterHealth’s first employees in the TCI when she joined in 2009. “It was very different back then”, she explains. “At that time InterHealth had turned a room at Trade Winds into an office and there was basically just two of us there. “We then moved across the road from where the hospital is now and we basically kept growing as new people arrived. “Watching the hospital spring up was amazing because I don’t think any of us really knew what to expect. We have come from having very basic medical facilities in the TCI to now having these amazing centres in Provo and Grand Turk. “It took a bit of getting used to and I think locals still don’t know how to use the centres to their full advantage. But things are improving all the time and they are facilities to be proud of. “For me it’s been like watching night turn to day.” Since joining InterHealth, Ladarnya has welcomed more than 200 staff members to TCI, many of whom have arrived from farflung corners of the globe. She is proud they have chosen to live and work in her country and does all she can to make their stay in her motherland both a happy and fulfilling one. “I love my country”, she said, “and I want those who come to live here to enjoy it too. And so however we as a department can help, we will help and do all we can to ensure that everyone is happy. “Different people have different needs and so we have to be understanding, flexible and respectful. Hopefully that’s how people see us and, as I’ve said before, if we can help then we will.” Away from work, Ladarnya enjoys the simple things in life – family, friends and watching television. Wearing her trademark cheeky smile, she explained: “I’m not a big one for partying and

going out. I prefer to spend time at home and I love to watch television. In fact I live for television and I love to spend time with my family and friends too. “I’m a happy person and I love life. I still have ambitions and maybe one day I’ll go on and become a lawyer like I dreamed about. This year I hope to pick up my insurance studies and get them completed, but for now I’m very happy with life and working for InterHealth.” The fact that Ladarnya is happy in her work will be a relief to InterHealth’s hierarchy. Replacing her certainly wouldn’t come easy! With that mischievous smile, that famous laugh and that dry sense of humour, she’s an institution in her own right. And as the saying goes in HR, ‘if Ladarnya doesn’t know it, it’s not worth knowing’. Q & A If I weren’t talking to you right now I’d… Probably be gossiping with Donneka! A phrase I use too often… Your end of service bonus will be paid at the CONTINUED ON PAGE 7

The Ezine for InterHealth Canada TC Staff

Inter iew

end of your service – that’s something I seem to say an awful lot!!! I also say ‘seriously’ a lot. I’ve picked it up from Grey’s Anatomy. It’s my favorite TV programme – 9pm every Thursday, I never miss it! I wish people would take more notice of… The wording in their contracts. If they did my life would be a whole lot easier! The most surprising thing about me is… Probably the fact that I was captain of my school debating team and that I’m pretty good at public speaking. I’m also a fairly decent cook, which surprises some people. Also the origins of my Christian name are unusual. My mum had been watching tennis on the TV just before giving birth to me and one of the Chinese players was called Ladarnya. When mum was asked what she was going to call me it was the first thing that popped into her head. A common misconception about me is… People think I’m a middle-aged white woman, which I am clearly not! I’ve dealt with many people by telephone and email across the world and when they arrive here in the TCI and I meet them, they often look at me very confused. They question whether I’m the Ladarnya they’ve been dealing with because in their minds they had a picture of this middle-aged white woman. I guess having Britain’s most common surname doesn’t help. I’m good at… It’s hard for me to say. But my colleague Donneka says I’m a good mentor, which is nice. I’m probably a bit strict with her but I mean it in a good way. I’m just one of those kind of people who says things once and expects results. It’s the way I was taught and I think it’s the right way. My ideal night out would be… A barbecue at home with close family and friends. Some ribs, some rum and plenty of good music. We’d sit around telling stories about the old days, which is something I love to do. Yes, that would be a perfect night for me. In moments of weakness… I’m left speechless. That’s probably hard to believe but it’s true. I end up with nothing to say and start to over think. I’m a bit of a deep thinker if the truth were known. You know me best as a senior HR officer but in truer life I would have been… A Lawyer. It’s all I wanted to do when I was young but unfortunately when it came to my turn, the Government had stopped giving out scholarships to law school. Who knows, one day I might do it. The best age to be is… About nine or 10 I guess. That was the sort of age when everything was so special. When you’re a child you are carefree and innocent and there’s no greater feeling. In a nutshell, my philosophy is… Live, learn, laugh. I’ll tell you a joke… A man applied for a job. After filling out the application form, he waited anxiously for the outcome. After considering his application, the HR manager called the hopeful man to inform him “we have an opening for people like you.” “Oh, great,” he said, “What is it?” “It’s called the door!” replied the HR manager.

Café Corner BY ANISH THOMAS

VALENTINES DAY Firstly, on behalf of all of us at ReFresh, can I wish readers a very happy new year. Well, love is in the air with Valentines Day just around the corner and we’ll be celebrating in style in the restaurants. We will be producing a special menu for the big day and I want to see both venues packed full of happy couples. So, make a date in your diaries – lunch at ReFresh on Monday February 14. INTERNATIONAL DAYS Our popular international days will be returning on the Friday after Valentines Day. Previous themed events have featured the culinary delights of India, Australia, England and Jamaica. But our journey around the world has only just begun so keep an eye out on the menu boards for our next destination. PANCAKES GALORE Shrove Tuesday falls on March 8 this year and we’ll be marking the occasion with a fabulous selection of mouth-watering pancakes. TABS AND BILLS Can I remind anyone who has a tab running in the restaurants that our terms are strictly one month only. All bills must be settled at the end of each calendar month and credit will cease until such time. Thank you in advance for your co-operation. SUGGESTIONS We do our best at ReFresh to provide exactly what you, our customers, want. But we can’t always get it right and that is why we are open to suggestions. If there is something you want to see sold or on the menu,

then let us know. If it’s possible, we’ll do it. Either let me know or fill out one of the new comment cards in the restaurants.

Birthday girl: Dorothy enjoys a well-earned break with chef, Michael Williams.

HAPPY BIRTHDAY DOROTHY We love birthdays here at ReFresh because it gives us an excuse to eat cake. Celebrating on January 18 was popular Grand Turk cook, Dorothy Been. We hope you had a great day Dorothy – we certainly enjoyed the party! SALADS Our new salad selections are proving a hit with dieters and non-dieters alike. Every day there is a different one on the menu and they are both healthy and great value at only $7. WARREN ADAMS RIP On behalf of everyone at InterHealth Canada, I would like to send our deepest sympathy to Barbara Saunders, who works at ReFresh in Grand Turk. Barbara lost her brother, Warren Adams, recently and so our thoughts and prayers are with her and all her family and friends at this difficult time. AND FINALLY Judith Campbell’s story on the front page makes for interesting reading – especially the bit about the positive feedback she regularly receives about the hospitals. For people to describe our restaurants as four-star is a great honour and a huge pat on the back for all ReFresh staff. Well done!

Inter iew

The Ezine for InterHealth Canada TC Staff

Elinore makes her move

Here to help: Staff Communications Committee chairman, James Hayward

Ideas welcomed by committee

MPLOYEES are reminded that InterHealth Canada TC operates a Staff Communications Committee. The committee exists to promote effective communication and consultation between the senior management team and all members of staff. Communication is about the interchange of ideas and information using all available means, whereas consultation is about the seeking and taking account of staff views and opinions before taking decisions. The Staff Communications Committee activities covered, include: Dissemination of Company policies, procedures, systems and processes, and any changes there of Activities to improve communication Matters relating to health and safety at work Matters relating to the general dayto-day running of the business Meanwhile the committee will not consider the following: Matters relating to the pay, grade, status or job title of an individual employee Matters being dealt with under the company’s grievance or disciplinary procedures Each department within the hospital has a representative sitting on the committee. To raise a point at this committee please talk with your department representative. Alternatively you can contact chairman, James Hayward, or secretary, Meta Saxena.

R ELINORE Zaguirre is on the move. The popular GP has transferred to the outpatients department at the Cheshire Hall Medical Centre on a full-time basis. Previously, Elinore split her time between outpatients and ED. Chief of medical services, Dr Robyn Barnes, said: “We are delighted to have Elinore in the outpatients department on a permanent basis. “She is a highly respected and popular GP and this helps improve our services in many different ways. “One important factor is that Elinore will be working alongside Dr Roger Callaghan and so this gives the public the choice of seeing a male or female doctor.”

Moving: Dr Elinore Zaguirre

Win a harrods hamper

ED up with paying inflated prices for luxury foods? Well here’s a chance to get your hands on some delicious goodies, without spending

a dime. InterHealth Canada TC has a food hamper from exclusive London department store, Harrods, up for grabs in a special staff competition. The basket, modelled in the photograph by Zena, is packed full of mouth-watering treats such as loose-leaf tea, chocolates and biscuits. To win this luxurious prize, all you have to do is guess the weight of the hamper and it’s contents. A couple things to bear in mind when guessing are that the hamper is made of wicker and measures 10 inches wide by 13 inches deep. To enter, simply email your guess (in pounds please) to Zena at ztrainor@interhealthcanada.tc with the word ‘hamper’ in the subject box. If you don’t have access to email then please ask a colleague who does to send one on your behalf, clearly stating whose entry it is. All entries must be with Zena by 9am on March 1.

Bridget switches sites

HESHIRE Hall’s medical device reprocessing team has a brand new member. Belonger Bridget Williams has transferred from the Cockburn Town Medical Centre in Grand Turk. Medical device reprocessing, Susan Borden, explained: “Bridget had lived on Grand Turk for eight years and she used to work for the previous medical centre there.

“She has now concluded her medical device reprocessing technician course and will challenge the international certification exam early this year. Bridget is transferring to Provo to support the increase in service provided by the department and to continue her technical training and development.” Susan added: “On behalf of everyone at Cheshire Hall, I welcome her to the team.”

The Ezine for InterHealth Canada TC Staff

Inter iew

NEWS IN BRIEF GET WELL DORIS

ORIS Nsanta is making good progress following her recent illness. The Cheshire Hall dialysis nurse was admitted to hospital after falling poorly in December. Doris is now at home recovering and is due back to work in February. Everyone at InterHealth Canada is looking forward to her return.

BERGETTE IS SET TO JET OFF

ERGETTE Sampson (pictured above) is celebrating following the Grand Staff Christmas Raffle. The registered nurse, who works at the Cockburn Town Medical Centre in Grand Turk, scooped the top prize of a trip for two to Miami with flights and accommodation included. The raffle was packed full of fantastic prizes and InterHealth Canada TC would like to thank all those businesses, suppliers, staff relatives and staff who donated to this fantastic cause. Other big winners were: 6 months TV and Internet service from WIV worth $660 – Darren Bassett $200 spa voucher for Grace Bay Club Percy Joseph 2 nights accommodation at Bohio – Indira Harris 2 nights accommodation at Trade Winds – Teresa Hall Grace Bay Car Rental $250 voucher – Richard Jandug Alcatel OT808A mobile phone – Wendy Cook

IT’S THE REGGAE GIRLS!

HE rehabilitation department in Grand Turk has a new physiotherapist. Connie McLaughlin has arrived from Jamaica and brings a wealth of knowledge

and experience with her. Head of department, Debbie FindleyClayton, said: “We are delighted to welcome Connie to Grand Turk, where she will work with Camille Marshall. She has been employed to replace Natoy Dilworth, who is now working at Cheshire Hall in place of Marlon Uy, who left us just before Christmas. “Connie is a first class physio and patients in Grand Turk will benefit hugely from her skills.” Connie’s arrival means it’s now an allJamaican female team with Cheshire Hallbased Shareel Dixon completing the line up. “Patients have a new name for us”, smiled Debbie. “They call us the Reggae Girls!”. Meanwhile Debbie has expressed her thanks to colleagues following the recent passing of her grandmother, Ohme Roberts in Jamaica. She said: “I would like to say a heartfelt thank you to everyone who sent their best wishes and condolences. It has been a tough time but your love, support and prayers have been a real comfort to both me and my family. “Everywhere I have gone in the hospital, people have stopped me and expressed their sympathy, and I am really grateful to you all.”

THANKS EVERYONE

HILE tapping away on his laptop in the ReFresh Restaurant at the Cheshire Hall Medical Centre, the editor of this publication was approached by a complete stranger enquiring as to whether the hospital had a ‘customer comments’ procedure. After explaining about the newsletter, the editor was asked to include the following in the next available edition. “I am here on holiday from Canada”’ explained the man, “and I had to pop into the hospital after injuring my foot while snorkeling. “I never thought a visit to hospital would be a pleasant experience, but this one was. From the reception staff and security guys who showed me the way to the emergency department through to the nurses who checked and treated me, I was highly impressed. “Then to top it all I have enjoyed a lovely meal in the restaurant!” He added: “Thank you all very much indeed. You should be proud of yourselves.”

Fired up: The incinerator was installed by the Department of Public Works along with help from a representative of the manufacturer, Inciner8tor, Jason Heaven (pictured).

Burning issue solved

NEW medical waste incinerator is up and running in Providenciales. The facility is located behind the old Myrtle Rigby Clinic, just yards from the Cheshire Hall Medical Centre. The top load burner was installed by the Department of Public Works along with help from a representative of the manufacturer, Inciner8tor, Jason Heaven. The incinerator is designed to burn disposables including infectious and contaminated “red bag” surgical dressings, plastic test devices and other wastes produced in a hospital or medical facility. The high-tech machine has a burn rate of 100 kilograms per hour and can operate up to 24 hours a day. Incinerating the waste requires temperatures up to 900 degrees, leaving only a small amount of ashes to be disposed of. The model also benefits from a heavy duty secondary chamber and burners allowing a two-second gas residence time, which ensures a complete reburn of any smoke and emissions, dioxins and fumes. The island of Providenciales has been without a medical incinerator for approximately 15 years, meaning medical waste was being sent to the landfill.

Inter iew

The Ezine for InterHealth Canada TC Staff

How old are you now? – Tell the truth!

HRISTMAS might be a distant memory but the party season has continued unabated, thanks to a host of January birthdays. Among those celebrating was senior radiographer, Philippa Boland, who was 21 yet again on the 17th. Being an all-action Aussie, she was never going to settle for a nice meal and a bottle of wine – not on your life. Instead, Philippa marked the occasion with a spot of diving and whale watching off Salt Cay with fellow adventurer, Karen Bredell. Karen said: “We had a wonderful weekend celebrating Philippa’s birthday and it’s not one she’ll forget in a hurry. “There’s a lot I could tell you but it’s probably best I say nothing. Suffice to say a great time was had by all.” Another birthday girl during January was seamstress, Marie Wilson. She too was 21 again on the 20th, although her celebrations were a little less energetic than Philippa’s. And completing the hat trick was Laura Hall who works in housekeeping. She reached the big 50 on the 25th with colleagues baking her a special cake to mark the occasion. Laura said: “It was so kind of everyone to think of me and make me such a lovely cake. God bless you all and thank you.”

Splash: Philippa cools down after diving off Salt Cay.

Birthday girl: Marie Wilson

COMINGS

GOINGS

HERE have been a number of staff changes since the last edition of InterView in December. Among those who have departed is Dr Duayne Storm. Also due to leave soon is senior radiographer, Philippa Boland. Meanwhile there are plenty of fresh faces around the centres, such as radiographers, Jose Abaya and Wayne Anderson, and physiotherapist, Connie McLaughlin. Others who we welcome to InterHealth Canada TC are Lucinda Everett (registered nurse), Tyrone Bishop (porter) and Georgina Chambers (patient services).

Celebration: Colleagues join Laura for a slice of cake to mark her big day

International log on now available

ITH people regularly leaving the islands, either on business or for vacations, the IM&T department has enabled the ability to check emails from any Internet enabled device. However, please be advised that the version of Outlook that can be viewed in other locations, does not have all of the functionality of a full Outlook client. To access emails outside of the hospital sites, please follow the instructions below: 1. Go to - www.interhealthcanada.tc 2. Click “Home””

3. The link for “Outlook Web” should now appear. Click on link. 4. Select type of security (public means internet cafe etc, private means personal pc/device). 5. The “light” option is for slower internet connection speeds. 5. Enter user credentials, i.e. windows password and username, please note that username must be pre-fixed with ihctci\ Please note that if you are accessing emails in a public place you must take precautions to ensure that your passwords and email content is secure at all times.

The Ezine for InterHealth Canada TC Staff

Inter iew

Accreditation Canada update H

OW time flies! It seems like only last week when we first discussed doing Accreditation Canada. Yet amazingly, here we hard in the third phase of the cycle - the ‘Self-Assessment’ phase. This phase lasts for a year, but don’t be fooled. Twelve months sounds a long time, but there is a lot of work to be done during that period. Team leaders will be asking staff to complete the questionnaires, the instruments and indicators, and work together as teams with other staff to get the tasks completed.

Art launch a huge success I

NTERHEALTH’S Hospital Art programme has been launched. Artists from across the TCI are being invited to submit work to be hung in the corridors and waiting rooms at the Cheshire Hall and Cockburn Town Medical Centres. The aim is to both brighten up the hospitals, offer therapeutic art for patients to enjoy and to support local talent. Chief of support services, Jim Trainor, said: “We made a public appeal for art a few months ago and the response has been great. We now have some beautiful paintings in the corridor between the restaurant and the general ward in Provo and it looks fantastic. “The plan is to do similar in Grand Turk and it definitely helps brighten the place up. “I often see patients enjoying the art, which is what it is all about, and it’s great to support local artists in this way. “All the paintings are up for sale and the artists contact details can be found with their work.” The launch, held at the Cheshire Hall Medical Centre, attracted huge media interest with TV, radio and print journalists in attendance. In the news: Pictured at the Art Project launch are, left to right, InterHealth’s Kathleen Bree, artists Alexis St Justin and Annie McLeod, and InterHealth’s Fiona McDonnell.

With Linda Gill If you are asked to fill out a questionnaire, you will do so on-line. It’s easy when you get going. Don’t worry if you do not have a computer all to yourself at work as there will be designated computers in the entrance section to the HR department in Cheshire Hall and the entrance section to administration in Cockburn Town. These computers will be only for Accreditation Canada work, nothing else, and you will not be disturbed whilst you are on-line. The team leaders will be responsible for

requesting and monitoring the completion of the questionnaires and will send you either a verbal or e-mail request when it’s your turn to do one. Completion of the questionnaires will take about 30 minutes and I respectfully request that staff members be released from their roles to complete these in one go. If any member of staff is unsure of what to do or experiences any difficulty, give me a shout on 2324025 and I will do my best to help out. During March, InterHealth Canada will be receiving further education from Accreditation Canada. This is to be confirmed so keep your eye open for further news.

Inter iew

The Ezine for InterHealth Canada TC Staff

It’s a dog’s life W

HEN InterHealth Canada opened the doors of its new medical centres last April, it wasn’t just the TCI public who breathed a sign of relief. The islands’ dog and cat population were also pleased to see an influx of health professionals from all over the world. With lots of staff having to leave their pets behind, one of the first things many did after arriving in the TCI, was to set about acquiring new ones. For many, the starting point was CEO, Roger Cheesman, whose wife, Jenny, volunteers for the Turks and Caicos Society for the Prevention of Cruelty to Animals (TCSPCA). Through Jenny and the TCSPCA, a number of cats and dogs have found loving homes with InterHealth Canada folk – cats and dogs that otherwise would probably have been put down. Take Big Guy for instance. Big Guy by name, a big guy by nature, this beautiful Potcake was found dying beneath a car. Sick and covered in hundreds of ticks, his days were certainly numbered. After being rushed to the TCSPCA, the vet was all ready to have him put down. But a fighting look on the dog’s face persuaded the vet to give him a second chance. More than a year later, Big Guy is now doing very nicely thank you, living the life of a lord with new owners Stephen and Fiona McDonnell. Fiona explained: “He was a really sad sight that day he went to the vet and no one thought he would make it. But the vet did a marvelous job and Big Guy had a great will to live. “We can’t thank TCSPCA enough. I re-

Before and after: Big Guy close to death and covered in ticks, and now, living the life of luxery.

member Jenny had the job of removing the ticks and the love and care she and her colleagues showed to Big Guy was amazing. “Now he’s a huge part of the family and we couldn’t imagine life without him.” Others who have given homes to rescued cats or dogs are Roger, Dr Helen Leonard, Dr Robyn Barnes and Nicki Mullins, while Big Guy is one of three dogs living with the McDonnells. Some, such as MJ Bryant and Suzanne Hatt, brought their dogs with them, but that doesn’t mean the TCSPCA doesn’t benefit from their animal-loving natures. MJ explained: “There are lots of animal lovers within InterHealth and all of us support the TCSPCA. The work they do is fantastic

and we all salute people like Jenny Cheesman and her fellow volunteers. “Whenever there is an event in aid of TCSPCA we are there and all of us use its services from time to time.” TCSPCA has links to the RSPCA in Britain and if 250 sign up for membership, the charity will receive extra funding courtesy of the parent organisation. TCSPCA not only has an adoption scheme but it also plays a major role in feral dog population control by neutering and spaying potcakes. To find out how you can adopt an animal, for membership details or for information about supporting the TCSPCA, go to www.tcspca.tc

All change at Cheshire Hall

UZANNE Hatt is the new operating department manager at the Cheshire Hall Medical Centre. She takes over from Tish Little, who will now concentrate solely on managing the emergency and outpatients departments. Suzanne brings a wealth of experience to the post having previously managed operating departments in Canada. Meanwhile her former position as nurse educator is being taken up by Nicki Mullins. Nicki is moving from the emergency department, where she has been nurse practitioner

since the hospital opened in April. Kathleen Bree, chief of clinical services, said: “As we develop our services and staff, changes are being made to ensure that we utilise our resources, especially manpower skills and experience, in the best interests of serving the community and to provide the highest standard of care that we can. “The knowledge, skills and expertise of these three senior members of our health professional team are being used to ensure best practice, as well as cost effectiveness and efficiency.”

Teacher: Nicki Mullins is the new nurse educator

The Ezine for InterHealth Canada TC Staff

Inter iew

New ambulances for TCI T

WO brand new ambulances have hit the streets of Provo. The state of the art vehicles, purchased by TCI’s Ministry of Health, are packed full of the very latest in modern medical equipment. Ministry of Health, permanent, Judith Campbell, said: “We are delighted to have obtained these two brand new vehicles, which will be a huge asset to heath care in the TCI. “It’s a key milestone for the Ministry of Health and a positive outcome to what has been a priority issue. “But more importantly it’s about the benefits the ambulances bring to the people of the TCI. “Modern, extensively equipped vehicles such as these will ultimately help save lives – something that is simply priceless.” The purchase of the ambulances, which cost $85,000 each, brings to an end an embarrassing chapter for the TCI Government. Over recent months, the country’s existing medical response

Ready to go: Pat Riel shows off one of the new ambulances

vehicles have been beset by mechanical problems, forcing them off the road for long periods. In fact, as recently as December, a hired mini-bus with blacked out windows was being used. “These have been trying

Special delivery cheers Michael

RAND Turk ReFresh chef, Michael Williams, is wearing a proud smile these days. And it’s not surprising really – he recently became a grand father for the first time. Michael’s daughter, Samapha, gave birth to a bouncing baby boy, Christopher, in Jamaica, just before Christmas, He said: “He’s a beautiful boy and I am so pleased and proud. There is something very special about having a grand child and I am delighted.”

times for the Turks and Caicos Emergency Medical Services (EMS)”, said Judith, “and I’d like to thank Pat Riel and all his staff for their hard work and patience over recent months. Also thanks to staff at InterHealth Canada for their understanding and support. “We have all been frustrated by the lack of working equipment, but we can now look

forward with confidence and pride.” The flame red Ford diesel E350’s, which are both under 12 month warranties, had originally been ordered from Canadian suppliers, Demers, for military duty in Morocco. But after the customer changed its mind, the TCI Government was able to snap them up at a much-reduced price.

Rodney Hall Jnr RIP

Proud: Michael, left, with daughter, Samapha and grandson, Christopher

TAFF at InterHealth Canada TC have paid tribute to Rodney Junior, who was tragically killed in a road traffic accident in Provo on January 29. Rodney Junior, 23, was the partner of Cheshire Hall Medical Centre HR assistant, Donneka Hall. The couple have a young son, Rodney Adams III. He was also the son of assistant police commissioner, Rodney Adams senior. InterHealth Canada TC CEO, Roger Cheesman, said: “The news of Rodney Junior’s passing is truly shocking and, on behalf of all of us at InterHealth Can-

ada, I send my sincere condolences to his family and friends. “In particular we offer our love and support to Donneka at this difficult time, and to his parents too. Rodney Senior is a close friend of InterHealth Canada and we are truly devastated by his loss.” Roger has also sent his condolences to InterHealth Canada TC procurement manager, Mary-Jo Bryant, following the recent loss of her mother. He said: “All of us here at InterHealth send our deepest sympathies to MJ at this sad time. You are in our thoughts and in our prayers.”

Inter iew

The Ezine for InterHealth Canada TC Staff

Cockburn Town celebrates new year birth

IHANNA Virgil has a very special claim to fame. The beautiful baby girl will be able to tell her friends when she’s older that she was the first person to be born on Grand Turk in 2011. Little Rihanna arrived at the Cockburn Town Medical Centre in the early hours of January 13, to proud parents, Franklyn Virgil and Carmen Beriguete Diaz. To mark the occasion, nurses from the maternity department presented Franklyn and Carmen with a layette, packed full of gifts for their new born daughter.

Bouncing baby: Parents Franklyn Virgil and Carmen Beriguete Diaz with daughter Rihanna and staff from the Cockburn Town Medical Centre.

Have you got a story to tell?

F YOU come across an interesting story during the course of your work with InterHealth Canada TC, why not let us know about. The hospital is always looking to promote itself in a positive way, especially its staff. Maybe it’s a tale of a job well done or something medically incredible. It could be that you helped deliver twins or triplets or nursed someone particularly poorly, back to health. Perhaps one of your patients spoke highly of our staff and facilities or maybe you or a colleague has achieved something amazing outside work. Whatever it is, tell us. And who knows, your story or idea could soon be seen and heard by thousands in newspapers, on TV and radio and on Internet sites. Contact our press officer, Paul Baker on 431 1066 or paul.baker1066@hotmail.co.uk

Happy couple: Sandra and Orville celebrate their marriage with family and friends.

Sandra ties the knot

REGULARS at ReFresh in the Cheshire Hall Medical Centre may have noticed something missing of late. The big friendly smile of Sandra Hawthorne has not been there to greet hungry customers very much since Christmas. But everyone’s favourite catering assistant has had good reason to be absent from duty. Sandra returned to Jamaica where she married fiancé, Orville Walker on January 23

in Moneague. ReFresh boss, Anish Thomas, said: “We send our warm regards to Sandra and Orville and congratulate them on their wedding. “Sandra is a really popular member of our staff and she was certainly missed while she was away. We are delighted to have our new bride back and we wish her and her husband a long, happy and fun marriage together.”

The Ezine for InterHealth Canada TC Staff

Inter iew

Word perfect - Midwife, Shantell Gardiner presents a gift to New Year’s Day parents, Charles and Angeline Etherard following the birth of their son, Badson.

Special delivery: The spotlight falls on mum Jasmine Georges and her baby, Jayden Sampson, who was born on Christmas Day.

Roger and out: PTV’s Ange Toussaint talks to Dr Roger Callaghan.

In focus: Lab consultant, Peter Anderson with Easher Parker from PTV

Lights, camera, action! C

HESHIRE Hall Medical Centre is beginning to resemble a film set. Our two local television networks have been regular visitors over the past few weeks, as have the newspapers and radio stations. Recent features filmed include Christmas and New Year’s Day babies, Christmas in the hospital, cholera, diabetes, hospital art, students on work experience and visiting occupational and speech therapists. The news gathers have also been around,

chasing stories about specific incidents such as road traffic accidents. CEO Roger Cheesman, said: “We have received some really positive publicity recently, particularly on the two television stations, PTV and WIV4. “I’d like to say a big thank you to all those who have represented InterHealth by being interviewed. Your efforts are much appreciated.” One person who deserves special praise is midwife, Shantell Gardiner.

Shantell had a microphone thrust at her without warning and was asked to do a speech on behalf of InterHealth while handing over a gift to the mother of the baby born on New Year’s Day. Needless to say she was brilliant, delivering a word-perfect performance for the cameras! Thanks also goes to Fiona McDonnell, Kathleen Bree, Peter Anderson, Dr Robyn Barnes, Dr Roger Callaghan, Dr Dawn O’Sullivan and Dr Helen Leonard.

Inter iew

The Ezine for InterHealth Canada TC Staff

Recipe of the

Month

EVERY month we will be featuring a recipe in the newsletter, submitted by a member of staff. And todayâ€™s delicious offering comes from medical device reprocessing manager, Susan Borden. Susan brought a tray loaded with triple layer bars to one of the staff Christmas gettogethers and guests are still talking about them now! Here, she shares her secret with you all. If you would like a recipe featured in InterView, email it to paul.baker1066@hotmail.co.uk, along with a photograph of your dish if possible.

Triple layer bars

INGREDIENTS:

Graham wafers Âź to Â˝ cup butter (melted) 1 can sweetened condensed milk (additional half can if large pan) 1 bag flaked coconut (large bag if large pan) 1 bag chocolate chips (additional half bag if large pan) Âź cup crunchy peanut butter (1/2 cup if large pan) Crush wafers and mix with melted butter. Spread on bottom of lightly greased pan (9in x 13in). Sprinkle coconut over base (large bag for big pan). Pour can of condensed milk over coconut (one can plus half can for large pan), Bake at 350 degrees for about 20 minutes or until edges are lightly brown and milk has set. Melt choc chips (one bag and a half for large pan) with peanut butter and pour this over top of base. Let cool then set in fridge to set. Enjoy!

Getting in the swing: New HR manager, Peter Nicholson.

Open door policy in HR

VER stood outside someoneâ€™s office not wanting to knock for fear of interrupting the occupantâ€™s busy schedule? Truth is weâ€™ve all done that, and the reason we hesitate is because weâ€™ve been snapped at before. However, thereâ€™s one door you can knock knowing a cheery welcome awaits and thatâ€™s the one leading to the human resources (HR) department. In fact new HR manager, Peter Nicholson, has laid down a challenge to staff in Provo and Grand Turk. He said: â€œFind me a friendlier, more welcoming and approachable department and lunch is on me.â€? Peter arrived at InterHealth Canada in late October, since when his feet have hardly touched the ground. â€œSince the hospitals opened the emphasis of HR has been on recruitmentâ€?, he explained. â€œHowever we are now entering a new phase and that emphasis is moving from recruitment - although that remains a high priority - to the other areas such as staff reten-

tion, management style, continuous improvement, leadership, managing learning and knowledge, people development and performance management to name but a few â€œWhat was an already busy department will become even busier with our office lights burning well into the night. â€œBut however busy we get, one important fact must never be forgotten. HR must be the most approachable department in the company. We will not always be in a position to give positive answers to peoplesâ€™ queries, but if it is negative then the HR department must be in the position to clarify why and, where possible, produce an alternative possibility. â€œThe HR team is itself going through a change period due to the shift of emphasis, but we are still here to support you as best we can, in line with Policies and Procedures. â€œSo when it comes to HR myself, Ladarnya and Donneka offer a friendly, helpful, people-focused department, which supports you in an equal and ethical manner. If the department does not live up to those standards and your expectations, then let me know.â€?

Inter iew The Ezine newsletter for the InterHealth Canada TCI Staff

Editor: Paul Baker Telephone: 431-1066 Email: paul.baker1066@hotmail.co.uk or pr@interhealthcanada.tc Photographs: Paul Baker and Steve Gill Submissions, story ideas, letters and comments are welcome and encouraged. This newsletter is for and about the staff of InterHealth Canada TC. Please email the editor, attaching photographs in a jpg format if applicable. Please also include your email address and a day time telephone number.

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

,334%$56$7$89:1.$;5<<

!"#$%&

!"#$%& !"#$!%&$ '$(%&)

!"#$%&

!"#$%&% '()*

!"#$%'

!"#$"%&"'' ()*(%+%,-((

!"#$%)

!"#$%$%&' ()**+(( !"#$%((

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&'()$*++&'),-.$/&$/"#$0*/'&!"#$!%"&'#((')*+,-

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

*++%.%"&',*/)

U!J$<VW' 0)' +1*' +1*4*' 0@' +-4*' C**?-).A'<'1(3'+0'/(8.1'(+'('60)5 D*,2(+-0)'<'0D*,1*(,3'7*+=**)'(' 4*47*,'0@'2+(@@'()3'+1*'*3-+0,'0@' +1-2')*=2/*++*,; !1*' *4?/0>**' ,821*3' -)' +0' 2**' +1*' *3-+0,' =(D-).' (' 2874-25 2-0)'@0,'?87/-6(+-0); E"(2' -+' .0)*' X(4GHA' 21*' *)5 Y8-,*3;' E!1(+' =(2' +1*' 3*(3/-)*A' =(2)%+'-+GH; E<+%2' =(>' ?(2+' X(4HA' 2(-3' +1*' *3-+0,;'E<+%2'+=0'4-)8+*2'+0'ZM;H E!1(+%2' -4?022-7/*HA' 21*' 2(-3;' E<'30)%+'2+(,+'=0,C'8)+-/'X(4;H E<)' +1(+' 6(2*A' >08%,*' ()' 108,' /(+*HA'(33*3'+1*'*3-+0,; F-+1'+1(+A'('/00C'0@'8++*,'60)5 @82-0)' *).8/@*3' +1*' /(3>%2' @(6*;'

!1*)' 2833*)/>A' -+' 3(=)*3' 0)' 1*,; EN1')0S'!1*'6/06C2'=*)+'@0,5 =(,3' 0)' U(+8,3(>' )-.1+A' 3-3)%+' +1*>GSHA'21*'*I6/(-4*3; [*2+'?(,+'=(2'+1(+'+1-2'60)D*,5 2(+-0)' +00C' ?/(6*' 0)' (' !8*23(>' 40,)-).A'4*()-).'08,'?00,'2875 B*6+'1(3'2?*)+'+=0'3(>2'()'108,' 7*1-)3'+1*',*2+'0@'+1*'=0,/3S

(#0+1,)&&)2 30+&)#"

<' FJU' -)' V*=' $0,C' (' 608?/*' 0@' =**C2'(.0'()3'=1-/*'=0)3*,-).' (,08)3'+1*'2+,**+2A'<'6(4*'(6,022' +1-2'2-.)'@0,'('91-)*2*'"02?-+(/; \0)%+' +1-)C' <%3' @()6>' 1(D-).' 4>' +0)2-/2' 08+' +1*,*A' +1()C' >08' D*,>'4861S

#4'(,#5)+ #('3$#/,*"2

"J]<VW' =0,C*3' (//' (,08)3' +1*' =0,/3A'<%D*'1*(,3'4()>'(482-).' 2+0,-*2' 7(2*3' (,08)3' ?*0?/*%2' 3-@@*,*)+'68/+8,*2; <%D*' 3*6-3*3' +0' 21(,*' (' @*=' =-+1' >08' 0D*,' +1*' 604-).' 40)+12A' 2+(,+-).' =-+1' +1-2' 0)*' (708+' ()' #)./-21' 306+0,' =10' -2' 7*-).' 210=)' (,08)3' (' U60++-21'

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`(+1/**)A'a*+*,'0,'b(4*2;

2#$/#+6'2#$/#+7

J'Wc$'?0??*3'-)+0'@(4-/>'?,(65 +-6*'-)'W,()3'!8,C'+1*'0+1*,'3(>' ()3'2(-3'+0'0)*'0@'4>'306+0,'60/5 /*(.8*2^' E\06+0,A' =1*)' <' ?,*22' 4>' /*.' -+' 18,+2;' ' !1*)' =1*)' <' ?,*22' 4>' 61*2+' -+' 18,+2A' =1*)' <' ?,*22'4>'1*(3'-+'18,+2A'()3'=1*)' <'?,*22'4>'2+04(61'-+'18,+2;''<%4' =0,,-*3' 306A' =1(+%2' =,0).' =-+1' 4*GH E#(2>HA' 2(-3' +1*' 306+0,A' E>08%D*'.0+'('20,*'@-).*,SH'

&)//%"&'%"'/4)'35%"&

VNF'<%4')0+'0)*'+0'*)608,(.*' .(47/-).A' 78+' ()' -)+*,*2+-).' 7*+' =(2'2+,86C',*6*)+/>'-)'+1*',*2+(85

!"#$%&'()*)+,'-./ <V!#&"#Je!"' 9()(3(' 1(2' ?(-3' -+2' 60)30/*)6*2' +0' +1*' @(4-/>'0@'[*,>/)':-2-6CA'=10' =(2' ,*6*)+/>' C-//*3' @0//0=5

-).' (' 40+0,6>6/*' 60//-2-0)' -)' a,0D0; [*,/>)'=(2'+1*'@(+1*,'0@'+=-)2' =-+1'91*21-,*'"(//':*3-6(/'9*)5

+,*'3-(/>2-2')8,2*A'&*))(>'&07-)5 20); 9#NA' &0.*,' 91**24()' 2(-3^' EF*'2*)3'70+1'08,'3**?*2+'2>45

,()+'(+'91*21-,*'"(//; !=0')0D-6*'.0/@*,2'=*,*'+,>-).' +0' 3*6-3*' =10' =(2' 7*++*,' +1()' +1*'0+1*,; <)' +1*' *)3' +1*>' 2*++/*3' 0)' (' 60)+*2+' +0' 7*' ?/(>*3' 7*+=**)' +1*4'7>'+1*'*)3'0@'J?,-/'(+'a,0D0' W0/@' 9/87A' =-+1' dZAMMM' +0' +1*' =-))*,; !1*' .003' )*=2' -2' +1(+' 70+1' ?/(>*,2' 1(D*' (.,**3' +0' 30)(+*' 1(/@' +1*' =-))-).2' +0' (' 61(,-+>' 0@' 4>'610-6*A'2108/3'+1*>'604*'08+' 0)'+0?; 91*6C')*I+'40)+1%2'<)+*,]-*=' @0,'+1*',*28/+;

3038)"2)2'%"'9%21*%+

N"' \#J&' =1(+' 6()' +1*' 4(+5 +*,' 7*A' \0))*C(' ()3' b8)-0,' .0+' 2+86C'-)'+1*'/(D(+0,>; F*//A' +1(+%2' )0+' Y8-+*' +,8*' 5' +1*>'(6+8(//>'.0+'2+86C'-)'+1*',*5 6*?+-0)'*/*D(+0,; \8,-).' (' )847*,' 0@' ?0=*,' 08+(.*2'*I?*,-*)6*3'(+'91*21-,*' "(//' ,*6*)+/>A' +1*' ?(-,' =*,*' ,*5 +8,)-).' +0' +1*' @-,2+' @/00,' =1*)' 2833*)/>' +1*' */*D(+0,' .,08)3' +0' ('1(/+; E<+'=(2'('7-+'0@'('2106CHA'2(-3' \*))*C('E()3'=1*)'-+'@-,2+'1(?5 ?*)*3A' +1*' */*D(+0,' 3,0??*3' (708+' +=0' 0,' +1,**' @**+' ()3' b85 )-0,'+108.1+'=*'=*,*'1(D-).'()' *(,+1Y8(C*; EF1(+'4(3*'-+'=0,2*'=(2'+1(+' 4>'?10)*'=08/3)%+'=0,C'()3'20A' @0,'('4-)8+*'0,'+=0A'<'=(2'=0)5 3*,-).'-@'=*%3'*D*,'7*'@08)3;H _0,+8)(+*/>' @0,' 08,' 380' +1*-,' 3-/*44(' 3-3' )0+' /(2+' /0).' ()3' +1*>'=*,*'200)'7(6C'30-).'+1*-,' 7-+'-)'+1*')(4*'0@'"&'()3'<!; \0))*C(' (33*3^' E<' C)0=' b85 )-0,' =(2' D*,>' 26(,*3' 78+' <' =(2' +1*,*' +0' /00C' (@+*,' 1-4' ()3' (25 28,*' 1-4' +1(+' *D*,>+1-).' =08/3' 7*'0C(>;H;

?(+1>' ()3' 60)30/*)6*2' +0' (//' [*,/>)%2' @(4-/>' ()3' @,-*)32;' <)' ?(,+-68/(,A'=*'*I+*)3'08,'/0D*' +0'&*))(>'()3'+1*'61-/3,*)'(+' +1-2'D*,>'3-@@-68/+'+-4*; E$08'(,*'(//'-)'08,'+108.1+2' ()3'-)'08,'?,(>*,2;H

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

(

!"#$%&&&'$(

9$0/2=$*)$>+#/-$?*@+/># !

&<[c!#U' 1(D*' 7**)' ?08,-).' -)' @0/5 /0=-).'+1*'2(3'3*(+1'0@'08,'60//*(.8*A' e(8,('"(//; !1*'?0?8/(,'1082*C**?*,'/02+'1*,'/0).'()3' 7,(D*'7(++/*'=-+1'-//)*22'-)'+1*'*(,/>'108,2'0@' :(,61'fA'LMZZ e(8,(A' =102*' 1*(/+1' 1(3' 3*+*,-0,(+*3' 3,(4(+-6(//>' -)' 1*,' @-)(/' =**C2A' ?(22*3' (=(>' ?*(6*@8//>' 0)' +1*' .*)*,(/' =(,3' (+' +1*' 91*21-,*'"(//':*3-6(/'9*)+,*A'28,,08)3*3'7>' @(4-/>'()3'@,-*)32; <)+*,"*(/+1'9()(3('!9'9#N'&0.*,'91**25 4()'2(-3^'EJ/+108.1'+1*'?(22-).'0@'?(+-*)+2'-2' ()'-448+(7/*'?(,+'0@'102?-+(/'/-@*'()3'204*5 +1-).'=*'(//'+(C*'-)'08,'2+,-3*A'=1*)'-+'-2'g0)*' 0@'08,'0=)%'=*'(//'2+()3'7(6C'()3',*@/*6+'0)' 1(D-).'('/02+'@,-*)3'()3'60//*(.8*;'' E\*2?-+*'1*,'-//)*22A'e(8,('=(2'2+0-6A'210=5 -).'.,*(+'?(+-*)6*'()3'608,(.*'-)'+1*'@(6*'0@' 2-.)-@-6()+'(3D*,2-+>;'U1*'=(2'()'*I6*//*)+'*I5 (4?/*'+0'82'(//;'' Ee(8,('=(2'70+1'/0D*3'()3',*2?*6+*3'()3' =-//' 7*' ,*4*47*,*3' 7>' (//' @0,' 1*,' =(,4+1;' N8,'/-D*2'(,*'2(33*,'@0,'1*,'?(22-).'()3'=*' 0@@*,'60)30/*)6*2'+0'+102*'=10'=*,*'6/02*2+' +0'1*,;H e(8,(A' =10' ,*6*)+/>' 6*/*7,(+*3' 1*,' KM+1' 7-,+13(>A' =(2' 70,)' -)' :-33/*' 9(-602;' U1*' .,*='8?'-)'_,**?0,+A'[(1(4(2'7*@0,*'40D-).' 7(6C'+0'a,0D0;' U1*'40D*3'(6,022'+0'91*21-,*'"(//'-)'J?,-/' @,04'+1*':>,+/*'&-.7>'"*(/+1'9*)+,*A'=1*,*'

21*'1(3'=0,C*3'@0,'40,*'+1()'@08,'>*(,2;'a,-5 0,'+0'+1(+A'21*'=(2'*4?/0>*3'7>'9/87':*3; ' EU1*' =(2' (' ,*4(,C(7/*' ()3' 608,(.*082' ?*,20)' ()3' (' .,*(+A' /0>(/' @,-*)3' +0' (//' +1(+' C)*='()3'=0,C*3'=-+1'1*,HA'2(-3'<)+*,"*(/+1' @(6-/-+-*2'3-,*6+0,A'_-0)(':6\0))*//; EU1*'/0D*3'1*,'B07'-)'+1*'102?-+(/'()3'=(2' 20'?,083'0@'+1*'@(6-/-+>;'U1*'00h*3'+*(4'2?-,-+' ()3'@8//>'*)30,2*3'+1*'68/+8,*'0@'<)+*,"*(/+1' 9()(3(;

'E\*2?-+*'7*-).'D*,>'-//A'e(8,(')*D*,'6045 ?/(-)*3;'U1*'2-4?/>'.0+'0)'=-+1'/-@*'()3'3-25 ?/(>*3'.,*(+'608,(.*'-)'30-).'20; E<' (4' +,8/>' ?,083' +0' 1(D*' C)0=)' e(8,(' ()3'+0'1(D*'1(3'+1*'?/*(28,*'0@'=0,C-).'=-+1' 1*,;' U1*' =(2' (' .,*(+' -)2?-,(+-0)' +0' (//' =10' C)*='1*,'()3'4>'+108.1+2'()3'?,(>*,2A'(/0).' =-+1' +1(+' 0@' *D*,>0)*%2' (+' <)+*,"*(/+1A' (,*' =-+1' 1*,' @(4-/>' ()3' @,-*)32;' ' W03' 7/*22' >08' 4>'@,-*)3;H N)*' ?*,20)' =10' C)*=' e(8,(' 7*++*,' +1()' 402+'=(2'1*(3'0@'1082*'C**?-).A'\0))('!(>5 /0,; U1*' *I?/(-)*3^' Ee(8,(' =(2' 0)*' 0@' +102*' ?*0?/*' =10' (/=(>2' =()+*3' +0' 1*/?;' <@' +1*,*' =(2)%+'()'07D-082'=(>'+0'30'-+A'21*%3'.0'+1(+' *I+,('4-/*'8)+-/'21*'@08)3'0)*; Ee-@*' -2' D*,>' 2+,().*' =-+108+' 1*,' (,08)3' +1*'?/(6*'()3'=*'(//'4-22'+1(+'/0D*/>'24-/*'()3' (4(h-).A'?02-+-D*'(++-+83*; E#D*,>0)*' /0D*3' e(8,(' ()3' =*' 4-22' 1*,' 3,*(3@8//>;'[8+'<'C)0='21*%2'8?'+1*,*'/00C-).' 30=)' 0)' 82' ()3' 4(C-).' 28,*' +1*' 91*21-,*' "(//' 2+(>2' 2?-6C' ()3' 2?()A' B82+' +1*' =(>' 21*' /-C*3'-+;H N)*' .,08?' 0@' ?*0?/*' e(8,(' =(2' 18.*/>' ?0?8/(,' =-+1' =(2' 61-/3,*);' g:>' /-++/*' ().*/2%' 21*' 6(//*3' +1*4A' =1-/*' 21*' =(2' C)0=)' (2' gJ8)+-*'e(8,(%; e(8,(' -2' 28,D-D*3' 7>' @08,' 61-/3,*)A' @08,' .,()361-/3,*)A' )-*6*2A' )*?1*=2' ()3' 0+1*,' ,*/(+-D*2;

!"##$%&'$()*%+),-./'$),")0%'-% F1-/*'=*'(,*'408,)-).'+1*'/022'0@'08,'3*(,' 7*/0D*3'@,-*)3'()3'605=0,C*,A'0+1*,2'(,*',*5 B0-6-).' +0' 4**+' 1-4' 7*1-)3' +1*' D*-/;' e*+' 82' 61*,-21' +1*' /0D-).' 4*40,-*2' +1(+' e(8,(' 1(2' /*@+'82'(//'=-+1'()3'@-)3'604@0,+'-)'+1*'@(6+'+1(+' (/+108.1'21*'-2'(72*)+'@,04'1*,'?1>2-6(/'703>A' 21*'-2'-)'W03%2'?,*2*)6*;'U/**?'0)'08,'3*(,' e(8,('()3'<'=-//'28,*/>'4-22'>08,'?,*2*)6*'-)' +1*'/8)61',004;' !"#"$%"& <'4-.1+'1(D*'0)/>'C)0=)'e(8,('@0,'('>*(,A'78+' <'1(D*'20'4()>'@0)3'4*40,-*2;'F*'21(,*3'20' 4861' i' 2+0,-*2A' ,*6-?*2A' =(>2' 0@' 30-).' +1-).2A' +-?2' ()3' 4861' 40,*;' U1*' =(2' /-C*' (' 484' +0' 4*'()3'=(2'20'1*/?@8/'=-+1'+1-).2'/-C*'-)@0,4(5 +-0)'(708+'+1*'-2/()3;'<%4',*(//>'?,083'7*6(82*' <'+(8.1+'1*,'10='+0'30'4(21'?0+(+0A'204*+1-).' 21*%3'(/=(>2'708.1+'-)'('?(6C*+'?,*D-082/>;'U1*' (/=(>2'2(-3'21*')*D*,'+108.1+'21*%3'2**'+1*'3(>'

=1*)' +1*,*' =(2' (' 102?-+(/' /-C*' +1-2' 0)' a,0D0' ()3'21*'=(2'20'?,083'+0'=0,C'1*,*;'e(8,('=(2' ('2?*6-(/'@,-*)3'()3'('@,-*)3'+0'(//'4>'@(4-/>'()3' .,()361-/3,*)'+00A'=10'21*'2?0C*'+0',*.8/(,/>' 0)'UC>?*'=-+1'4*; '"()* !1*'?1>2-0+1*,(?>'3*?(,+4*)+'=08/3'/-C*'+0' *I?,*22'08,'20,,0='(+'+1*'?(22-).'0@'08,'@,-*)3' e(8,(;' j8-*+A' C-)3' ()3' 4-/354())*,*3A' 21*' =08/3'.0'+1*'*I+,('4-/*'+0'*)28,*'+1(+'>08'.0+' =1(+' >08' )**3*3;' F*' =-//' 4-22' 1*,' 604-).' 30=)' +1*' 1(//=(>' =-+1' +1*' +,0//*>A' 2+0??-).' @0,'('404*)+'+0'*)Y8-,*'10='=*'(,*'()3'-@' 08,'@(4-/-*2'=*,*'0C(>;':(>'21*',*2+'-)'?*(6*;' U1*'=-//'7*'.,*(+/>'4-22*3; +*,,)*-&$%"(**.-&!"#/0-& 1/!!)*&"!+&1"')..* ' :-22'>08'e(8,(;':-22'>08,'8)-Y8*'2*)2*'0@'

18408,'()3'>08,'3*+*,4-)(+-0)'+0'g30%;''&*2+' -)'?*(6*'@,-*)3; $#*2*&"!+&.)!+" <'@-,2+'4*+'e(8,('-)'+1*':>,+/*'&-.7>'6(,'?(,C' 210,+/>'(@+*,'<'B0-)*3'+1*'102?-+(/'-)':(>'LMMf;' F*'61(++*3'+1*'?,0.,*22'0@'+1*')*='102?-+(/' +1(+'=(2'7*-).'78-/+;'e(+*,'=*'4*+'(+'+1*'0@5 @-6-(/' 0?*)-).' 0@' 91*21-,*' "(//' ()3' 7*6(4*' .003' @,-*)32;' "*(D*)' -2' (' ?/(6*' )*(,7>A' 20' +1*,*%2')0')**3'+0'2(>'.0037>*; .*)." e(8,('=(2'('D*,>'2?*6-(/'?*,20)'=10'@08.1+' 1*,'-//)*22'=-+1',*(/'608,(.*'()3'3-.)-+>;'"*,' 7-.' 7,-.1+' 24-/*' (/=(>2' 7,-.1+*)*3' 4>' 3(>S' <'(4'?,083'+0'1(D*'C)0=)'1*,'()3'+0'1(D*' 6(//*3'1*,'('@,-*)3 ')#" $#"/%"0)2'#"'8*&)':

)

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

122-$3.,%,."4 !%4%3%)'*3%,$ !"#$%&"'()%*"++ !1()C'>08'+0'*D*,>0)*'=10'1(2'20'@(,'6045 ?/*+*3'('Y8*2+-0))(-,*'0,'('U(@*+>'U8,D*>;''F*' (,*' 40D-).' @0,=(,3' =-+1' +1*' J66,*3-+(+-0)' 9()(3(' lJ9m' ?,06*22' 0@' U*/@' J22*224*)+' 78+' +1*'=1**/2'(,*'+8,)-).'2/0=/>'()3'+1*'+-4*'-2' ?(22-).'Y8-6C/>;'' U*D*,(/' +*(42' (,*' )0=' =0,C-).' =-+1' +1*' j8(/-+>' a*,@0,4()6*' &0(34(?' lja&m' ()3' +1*,*'-2'('/0+'0@'=0,C'+0'7*'604?/*+*3;''

!1*' .003' )*=2' +108.1' -2' +1(+' (2' -)@0,5 4(+-0)'-2'?(22*3'+1,08.1'+0'J9A'=*'1(D*'(' .003',*2?0)2*'5'('7(/()6*'0@'.,**)A'>*//0=' ()3',*3'@/(.2;''U0'=*'(,*'30-).'/0+2'0@'+1-).2' =*//'78+'0+1*,2')**3'(33,*22-).'+1,08.1'+1*' +*(42; ' <@' ()>0)*' =08/3' /-C*' @8,+1*,' -)@0,4(+-0)' 0,' 28??0,+' =-+1' ()>+1-).' J9' ,*/(+*3A' ?/*(2*' 30')0+'1*2-+(+*'+0'(2C'4*;''<'=-//'./(3/>'604*' ()3'2-+'=-+1'>08'()3'=*'6()'21(,*'-)@0,4(5 +-0);' !1()C'>08'(//'0)6*'(.(-);'

!"#$%&'()*+,&#,%'-... #D*,>3(>'e(8,('=08/3'604*'-)+0'+1*',*2+(8,()+' @0,'1*,'7,*(C@(2+'0,'/8)61'()3'+1*'?/(6*'B82+'-2)%+' +1*' 2(4*' =-+108+' 1*,' 24-/*' ()3' =(,4+1;' U1*' =(2'()'-)6,*3-7/*'/(3>;'&<a'e(8,(; "!)$% U1*' =(2' 0)*' 0@' +1*' 2=**+*2+' ?*0?/*' <' 1(D*' C)0=);'<+%2'1(,3'C)0=-).'+1(+'21*'-2')0'/0).*,' =-+1'82;'<'4-22'1*,'3,*(3@8//>; e(8,('=(2'/-C*'4>'0+1*,'40+1*,;'U1*'C*?+' +*//-).'4*'+0'@-)3'(')-6*'4()'()3'2*++/*'30=)' ()3' 1(D*' 61-/3,*);' [8+' 21*' (/20' 82*3' +0' 2(>' +1(+' 21*' =08/3' 7*' 61*6C-).' +1*' 4()' @0,' 28+(7-/-+>'@-,2+S U1*' =(2' (' D*,>' 2?*6-(/' ?*,20)' ()3' +1*'

?/(6*'B82+'-2)%+'.0-).'+0'7*'+1*'2(4*'=-+108+' 1*,; $%"(V"(" !0' 4*A' e(8,(' =(2' /-C*' (' 7-.' 2-2+*,' i' (/=(>2' 61*6C-).'<'=(2'0C(>'()3'1(??>;'<'6()%+'Y8-+*' 7*/-*D*' +1*' ?(-)' ()3' 28@@*,-).' 21*' *)38,*3' ()3'>*+'<')*D*,'0)6*'1*(,3'1*,'604?/(-); U1*' =(2' (' +,8/>' 4(.)-@-6*)+' ?*,20)' ()3' <' =-//')*D*,'@0,.*+'1*,; $#*W%*! e(8,(A'('7,(D*'/(3>'=10'60)2-3*,*3'0+1*,2' 7*@0,*'1*,2*/@;'a,083'+0'1(D*'C)0=)'1*,; ".)$/!

!*+!,-./%0*%1+*-23%4+,-*

!"#$%#&&% #'()*%+* <V!#&"#Je!"' 9()(3(' !9' 2+(@@' 1(D*' 7**)' 4(C-).'1*(3/-)*2'(,08)3'+1*'=0,/3; 91-*@'*I*68+-D*A'&0.*,'91**24()A'=(2',*5 6*)+/>'@*(+8,*3'-)'(')*=2?(?*,'-)'1-2'F*/21' 104*/()3A' =1-61' 6()' 7*' 2**)' (+' 3445677 88898:;<=>?;@?<9A>9BC7?<8=7;>A:;D?<8=7 5>?4E5F@GG7HIJJ7IH7IK73>=5@4:;D=BAA<==D L>FDG>A4>FDMJNOODHPIMOQKO7 J)0+1*,'?*,20)'-)'+1*')*=2'7(6C'-)'+1*-,' 40+1*,/()3'-2'?*3-(+,-6-()A'\,'e0,*)('U0/*,; e0,*)('1(2'7**)'?,0@-/*3'-)'+1*'J,.*)+-)*' 4*3-6(/'4(.(h-)*A'&*D-2+('J470'34456778889 F<R@=4::ST>9A>S74:5:=7JJ95GL J)3',*4*47*,'+1*'7,-//-()+'=0,C'30)*'7>' /*(3'?*3-(+,-6-()A'\,'"*/*)'e*0)(,3A'=-+1'+1*' N)*'F0,/3'_08)3(+-0)A'=1-61'-)D0/D*3'61-/5 3,*)%2'2?**61'+1*,(?-2+2'()3'7*1(D-0,'*I?*,+2' D-2-+-).'+1*'102?-+(/G F*//'+1(+%2'7**)'@*(+8,*3'-)'+1*'J4*,-6()' a,*22' (+' 34456778889@?=@G<3:;4>?9A>S7A>SD SB?@4E7:F4@A;<7MOHMOODD=5<<A3D;:?UB:U<D 5:43>;>U@=4DR>;B?4<<F=D@?D4BFC=D:?GDA:@A>=

!"#$%&$'()*%*)$% +,*$-.$/0*)%&/1 "J]#'>08'2?*)+'+00'4861'+-4*'2(4?/-).'+1*'3*5 /-.1+2'0@'&*_,*21G J,*'>08'/00C-).'+0'21*3'('@*='?08)32'7*@0,*' 2844*,G <@'20A'+1*)',*(3'0)k;; J' =*-.1+' =(+61-).' 608,2*' -2' 604-).' +0' +1*' 91*21-,*'"(//':*3-6(/'9*)+,*'D*,>'200)'()3'*D5 *,>0)*'-2'-)D-+*3'+0'B0-); U+(,+-).'-)':(>A'4**+-).2'=-//'7*'1*/3'0)6*'(' =**C'(@+*,'=0,C'(+'('+-4*'()3'D*)8*'+0'7*'()5

)08)6*3; &*.(,3/*22'0@'>08,'21(?*A'2-h*'()3'+1*'(408)+' >08'=()+'+0'/02*A'=*-.1+'=(+61-).'.*+2',*28/+2; U0A'=1>')0+'2-.)'8?'()3'+(C*'+1*'2+,*22'08+'0@' /02-).'=*-.1+'7>'30-).'-+'=-+1'+1*'1*/?'()3'28?5 ?0,+'0@'>08,'@,-*)32'()3'60//*(.8*2; <@' >08%,*' -)+*,*2+*3A' ?/*(2*' ?8+' >08,' )(4*' 30=)'0)'0)*'0@'+1*'?02+*,2'+1(+'6()'7*'@08)3'-)' +1*'2+(@@',0042'(+'91*21-,*'"(//'0,'60)+(6+'3-*+-5 +-()A'b()*+'W,**)A'@0,'40,*'3*+(-/2;

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

0-,<I-*<26/%",<9+2%*-A-<I-9%8-*%-:3<,H

90'A*(BA$ >')-$*)$0')# Je<UNV' a>?*,' ,*6*-D*3' +1*' ?*,@*6+' ?,*2*)+' =1*)' 21*' 6*/*7,(+*3' 1*,' no,3' 7-,+13(>' 0)' _*7,8(,>'Lo; <)+*,"*(/+1%2' -)@*6+-0)' 60)+,0/' )8,2*' /*(,)*3'+1(+'1*,'0/3*,'2-2+*,'1(3'28,D-D*3'+1*' 3*D(2+(+-).'*(,+1Y8(C*'+1(+',06C*3'V*='p*(5 /()3'+1*'3(>'7*@0,*; J/-20)'.0+'+1*')*=2'21*%3'7**)'()I-082/>' =(-+-).'@0,'7>'*4(-/; !1*'V*='p*(/()3*,'*I?/(-)*3^'E<+'=(2'+1*' =0,2+' 608?/*' 0@' 3(>2' 0@' 4>' /-@*;' !1*' *(,+15 Y8(C*' 2+,86C' +1*' 6-+>' 0@' 91,-2+618,61' =1*,*' ('/0+'0@'4>'@(4-/>'/-D*'()3'20'<%3'7**)'+,>-).' +0'60)+(6+'*D*,>0)*'+0'4(C*'28,*'+1*>'=*,*' 0C(>; E!1(+'=(2)%+'7**)'*(2>'7*6(82*'+1*'?10)*' /-)*2' ()3' 604?8+*,' /-)C2' 1(D*' 7**)' 30=)' ()3'20'-+'=(2'?,*++>'4861'7**)'('6(2*'0@'B82+' 2-++-).'+-.1+'()3'10?-).'@0,'+1*'7*2+; EJ//' 20,+2' 0@' +1-).2' .0' +1,08.1' >08,' 1*(3' ()3'07D-082/>'>08'2+(,+'=0,,>-).'+1(+'-+%2'.05 -).'+0'7*'7(3')*=2;H b82+'=1*)'J/-20)'=(2'7*.-))-).'+0'.-D*'8?' 10?*A'1*,'=0,C'604?8+*,'?-).*3'+0'2(>'21*' 1(3'(')*='4*22(.*; E<+'=(2'4>'7-,+13(>HA'21*'*I?/(-)*3A'E78+' <'=(2)%+',*(//>'-)'+1*'4003'@0,'6*/*7,(+-).;'<' 1*(,3'+1*'?-).'0)'+1*'604?8+*,'+0'(/*,+'4*' 0@'()'*4(-/'78+'<'B82+'+108.1+'-+'=(2'B82+'204*5 +1-).'+0'30'=-+1'=0,C; EF1*)'<'0?*)*3'-+'8?'<'608/3)%+'7*/-*D*'4>' *>*2;'!1*'*4(-/'=(2'@,04'4>'2-2+*,':(D0)%2' .,()33(8.1+*,;' <+' =(2' D*,>' 7,-*@;' <+' B82+' 2(-3' g=*'(,*'(//'@-)*'78+'+1*'1082*'-2'=,*6C*3%; E<'=(2'20'1(??>'<'B82+'78,2+'-)+0'+*(,2;'<%3' 7**)' (7/*' +0' +,(6C' 30=)' 4>' 7,0+1*,2' ()3' 0+1*,'@(4-/>'4*47*,2'78+')0+':(D0)'()3'1*,' ,*/(+-D*2; EU0'+0',*6*-D*'+1(+'*4(-/'=(2'@()+(2+-6'()3' 3*@-)-+*/>' +1*' 7*2+' 7-,+13(>' ?,*2*)+' <' 608/3' *D*,'1(D*'=-21*3'@0,;H

5+6-*%78--9:32;%*<68=;%32.%>2=-*?-3,=8@9%$*<A%!3*9+29;%,- ;%A-,-B*3=-% =8-%+C-2<26%+D%=8-%E7>%?+9C<=3,%3=%:<.2<68=%+2%"C*<,%(F;%,39=%G-3*H

!"##$%&'()*"$%)+%,-. ;-'+#&)+'$4))39*" $)#6'%"/)+4)*,/4'$*"*2*'/$

V'Ja&<e'ZM'+1*'!8,C2'()3'9(-602' <2/()32'"02?-+(/'6*/*7,(+*2'-+2'@-,2+' 7-,+13(>;' e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l)0+' (//' 0@' +1*4' 8?1*/3Sm' ()3' +1*' 1-.1' ,*?8+(+-0)' =*' 2**4' +0' 1(D*' 3*D*/0?*3' -)' +1*' /06(/' 60448)-+>;'' <' 1(D*' 7**)' 3*/-.1+*3' +0' ,*6*-D*' 8)20/-6-+*3' @-,2+'()3'2*60)3'1()3'6044*)+2'0)'+1*'1-.1' Y8(/-+>' 0@' 6(,*' +1(+' =*' ?,0D-3*' +0' +102*' =*' 2*,D*'()3'+1*,*'-2'('D*,>'6/*(,'-)3-6(+-0)'+1(+' =*' 0@@*,' 1-.1' 6(/-7,*' 6(,*' =-+1-)' +1*' ,().*'

0@' =0,C' =*' 8)3*,+(C*;' ' b82+' +1-2' 40,)-).' <' ,*6*-D*3'('g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

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&$'(#&)!*)+,-./

,*"X#)YX.6'!1*2*'/0D*/>'/(3-*2'/00C'@8//'0@'*(2+*,)'?,04-2*A'+1()C2'+0':-+('U(I*)(;' :-+(A'()3'1827()3'J)-21A',*6*)+/>'102+*3'()'<)3-()5+1*4*3'?(,+>A'=1*,*'+1*'.-,/2'=*,*' -)D-+*3'+0'3,*22'8?'-)'2(,**2'@,04':-+(%2'2+8))-).'60//*6+-0); e00C-).'+1*'?(,+A'/*@+'+0',-.1+A'(,*^':(,-*'F-/20)A'9(,0/'!1*0?1()082A'V-6C-':8//-)2A'J/-20)' a>?*,A':-+('U(I*)('()3'J))':(.8-,*;'U+()3-).'-)'@,0)+'-2'\(-2>':8//-)2;'<)2*+^'`(+1/**)'[,**;

1"(**(&1%/)1*6'!9<'>08).2+*,2'1(D*'7**)'+(C-).'('6/02*,'/00C'(+'/-@*'-)'+1*'91*21-,*'"(//' :*3-6(/'9*)+,*; U+83*)+2'@,04'+1*'9/*4*)+'"0=*//'U6100/'D-2-+*3'+1*'102?-+(/'(2'?(,+'0@'+1*-,'6(,**,2' 40)+1; !*(61*,A'9/(83*//'U*>408,A'2(-3^'EU+83*)+2'=-//'7*'D-2-+-).'(',().*'0@'*2+(7/-214*)+2'38,-).' +1*'40)+1A'+182'(//0=-).'+1*4'+0'.*+'('@**/'@0,'=0,C-).'-)'+102*'?/(6*2;'j8-+*'('@*='=()+'+0' .0'-)+0'4*3-6-)*'()3'20'+1-2'=(2'('?(,+-68/(,/>'?0?8/(,'D-2-+; EF*'+1()C'<)+*,"*(/+1'@0,'-+2'102?-+(/-+>'()3'+1()C'e-)3('W-//'()3'V-6C-':8//-)2'=10' 210=*3'82'(,08)3;'"0?*@8//>'204*'0@'+1*'>08).2+*,2'=-//'7*'7(6C'(2'*4?/0>**2'0)*'3(>;H'

+(*$$)!Z&XW6'#D*,'=0)3*,*3'=1(+'3-3' 7-.'U+*D*':6\0))*//'=()+*3'+0'7*'=1*)'1*' .,*='8?G'"*,*%2'>08,'()2=*,;'!1*'@(6-/-5 +-*2'*).-)**,'(/=(>2'=()+*3'+0'7*'('7,(-)' 28,.*0)S E<'(/=(>2'@()6-*3'4*3-6-)*HA'1*'(34-+5 +*3A'E()3'=08/3'/0D*'+0'1(D*'7**)'('7,(-)' 28,.*0);'[8+'=0,C-).'-)'('102?-+(/'-2'.003' 7*6(82*'<'.*+'+0'3,*22'8?'(2'0)*'@,04'+-4*' +0'+-4*;H U*,-082/>'+108.1'+1*,*q2'('.003',*(20)'@0,' U+*D*'+0'7*'=*(,-).'('28,.-6(/'4(2C;'"*'()3' +1*',*2+'0@'+1*'@(6-/-+-*2'+*(4'1(D*'7**)'782>' 30-).'0)*'0@'+1*'3-,+-*2+'B072'-)'+1*'78-/3-).2' i'6/*()-).'08+'+1*'(-,'@-/+*,2;

*'*(".+&YX!6'"*,*%2'('?-6+8,*'+1(+'=-//' 4(C*'>08'.,**)'=-+1'*)D>; N8,'/0D*/>'@-)()6*'.-,/2'.0+'(//'3,*22*3'8?' +0'6*/*7,(+*'U+'a(+,-6C%2'\(>'0)':(,61'Zn; e*-/('e(=,*)6*A'_(-+1'!(/(,0'()3':(,-*' b(.060>'3-3'+1*'<,-21'?,083'-)'+1*-,'=-.2A' (?,0)2'()3'1*(37()32; EF*%3'1*(,3'+1(+'b-4'!,(-)0,'=(2'3,*22-).' 8?'(2'('/*?,*61(8)A'2(-3'('@-)()6*'3*?(,+5 4*)+'2?0C*24()A'E20'=*'3*6-3*3'+0'B0-)'-)' +1*'@8); EU(3/>'b-4'608/3)%+'.*+'-)+0'1-2'602+84*' 78+'=*'1(3'('.,*(+'3(>'(//'+1*'2(4*;H

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

!"#$%!&'()' ;-'*"%34'/4#9*3

!1()C2' +0' *D*,>0)*' =10' 28??0,+*3'70+1'08,'U+'a(+,-6C%2' \(>A' U10D*' !8*23(>' ()3' J21' F*3)*23(>'*D*)+2;

3<=GHD>I@F'J='BI@'KJ

!0'2?**3'+1-).2'8?'('/-++/*A'=*' (,*' )0=' 2*//-).' ,*(3>54(3*' 2()3=-61*2'()3',0//2; !1*2*'6()'7*'/06(+*3'-)'+1*' 3,-)C2' @,-3.*' ()3' @/(D08,2' -)5 6/83*'+8)('2(/(3A'61**2*'2(/(3' ()3'1(4'2(/(3;

!5-.()6'4."-7() (%8$)%--.9%#

!"#&#'1(D*'7**)'('@*='2/**?/*22')-.1+2'-)'+1*'](/*)+-)*'1082*10/3' 0D*,'+1*'?(2+'608?/*'0@'=**C2; [8+' .*)*,(/' 28,.*0)' 91,-2' ()3' =-@*' U1*-/(' (,*' 6*,+(-)/>' )0+' 6045 ?/(-)-).; !1*' 608?/*' (,*' +1*' ?,083' ?(,*)+2' 0@' (' 7*(8+-@8/' 7(7>' 70>A' 91,-2' b(-3*)A'=10'=(2'70,)'(+'+1*'91*21-,*'"(//':*3-6(/'9*)+,*'0)'_*7,8(,>' XA'=*-.1-).'2*D*)'?08)32; 91,-2'2(-3^'EU1*-/('()3'<'=08/3'/-C*'+0'2(>'('7-.'+1()C'>08'+0'(//'+1*' 2+(@@'(+'91*21-,*'"(//'@0,'+1*'D*,>'?,0@*22-0)(/'6(,*'(@@0,3*3'+0'82;'<)' ?(,+-68/(,A'=*'+1()C'+1*'+*(42'-)'N&'()3'4(+*,)-+>; EJ/20'+1()C'>08'+0'*D*,>0)*'=10'1(2'=-21*3'82'=*//'()3'60).,(+85 /(+*3'82'@0//0=-).'+1*'2(@*'(,,-D(/'0@'7(7>'91,-2'b(-3*);H

!"#$%&'"$()$&*+()$*",&-.+"). !"#&#' (,*' )*=' @-).*,2' 0)' 0)*' 0@' +1*' (34-)-2+,(+-0)' 3*?(,+4*)+' C*>5 70(,32; `(>']()*2A',-.1+A'1(2'B0-)*3'<)+*,5 "*(/+1' 9()(3(' !9' 0)' (' +*4?0,(,>' 7(2-2' (2' 60D*,' @0,' 9(,0/' !1*0?1(5 )082; 9(,0/' -2' 68,,*)+/>' 0)' 2-6C' /*(D*' ()3'20'`(>'=-//'7*'(6+-).'(2'?*,20)(/' (22-2+()+' +0' \,' &07>)' [(,)*2A' b-4' !,(-)0,'()3'`(+1/**)'[,**A'7(2*3'(+' 91*21-,*'"(//; E<%4'?/*(2*3'+0'7*'(+'<)+*,"*(/+1HA' 2(-3'`(>A'E(/+108.1'<'=-21'-+'=(2'8)5 3*,'3-@@*,*)+'6-,6842+()6*2;' E9(,0/'-2'07D-082/>'('D*,>'1(,3'(6+' +0'@0//0='78+'<'=-//'7*'30-).'4>'7*2+' -)'1*,'(72*)6*'()3'20'@(,'*D*,>+1-).' 1(2' .0)*' =*//A' =-+1' *D*,>0)*' 7*-).' ,*(//>'1*/?@8/'()3'@,-*)3/>;H `(>A'=10'=(2'70,)'-)'V-.*,-('()3'7,08.1+'8?'-)'W*,4()>'()3'#).5 /()3A'1(2'/-D*3'-)'!9<'@0,'40,*'+1()'+1,**'>*(,2; a,*D-082/>'21*'1(2'=0,C*3'-)'?8,61(2-).A'4(,C*+-).'()3'+1*'102?-5 +(/-+>'-)382+,>;'

$JLD=K'FJJ=

78-D%J-*+2%98+K9%+ï¬€%8<9%C32A3L-9

8<=><?@'2<A

U10D*' !8*23(>' ?,0D*3' 782>' @0,'&*_,*21; !0' 6*/*7,(+*' +1*' 066(2-0)A' =*'6(4*'8?'=-+1'204*'@()+(25 +-6' ?()6(C*' ,*6-?*2' +1(+' =*,*' *)B0>*3' 7>' 2+(@@A' ?(+-*)+2' ()3' D-2-+0,2' (/-C*A' 70+1' -)' W,()3' !8,C'()3'a,0D0; !1*2*'-)6/83*3'2(D0,>'2?*5 6-(/2' @0,' 7,*(C@(2+' ()3' /8)61A' (/0).'=-+1'204*'408+15=(+*,5 -).'3*2*,+'?()6(C*2'+00;' :*()=1-/*' 0)' +1*' @0//0=5 -).' 3(>A' J21' F*3)*23(>A' =*' 2*,D*3' 8?' @-21' +0' (//' 102?-+(/' ?(+-*)+2' ()3' +1*,*' =*,*' (/20' /0+2' 0@' @-21' 0?+-0)2' 0)' +1*' 4*)8;

3B'8<BCD>?EF'2<A

J)0+1*,' 066(2-0)' 4(,C*3' 7>' &*_,*21'=(2'U+'a(+,-6C%2'\(>;' J.(-)A' =*' 6(4*' 8?' =-+1' (' 2?*6-(/'4*)8',*@/*6+-).'(//'+1(+' -2'.003'+1(+'604*2'08+'0@'<,-21' C-+61*)2; #D*,>+1-).' =*' 3-3' =*)+' 30=)' (' +,*(+' 78+' -+' =(2' +1*' /(47'2+*='+1(+',*(//>'.0+'?*05 ?/*' +(/C-).;' F*' 1(3' /0+2' 0@' 604?/-4*)+2' @0,' +1-2' ()3' 20' =*'10?*'+0'.*+'-+'7(6C'0)'+1*' 4*)8'(.(-)A'D*,>'200);

$08' =-//' 1(D*' )0+-6*3' (' @*=' )*=' ?,0386+2' -)' +1*' ,*2+(85 ,()+2A' ()3' +1*,*%2' 40,*' +0' 604*'200); a()-)-' ()3' @/(+' 7,*(3' =-+1' 3-?2'@0,'('2+(,+'()3'0+1*,'3*/-5 6-082'.003-*2; <@' +1*,*%2' 204*+1-).' >08' =()+'+0'2**'82'2+06C'0,'2*//'+1*)' /*+'82'C)0='7>'@-//-).'08+'('6825 +04*,' 6044*)+' 6(,3' +1(+' 6()' 7*'@08)3'0)'+1*'3-)-).'+(7/*2;

,<FB'><MM'NJC'MJOFB@C

N8,' /072+*,' 2?*6-(/2' 1(D*' ?,0D*3' (' 7-.' 1-+' ()3' =*' 1(D*' 20/3'08+'0)'*D*,>'066(2-0)'=*' 1(D*'30)*'-+; J)3' -+%2' )0+' B82+' /8)61' 6825 +04*,2' =10' 1(D*' 7**)' *)5 B0>-).' +1*' 3-21' i' Y8-+*' (' @*=' ?*0?/*' 1(D*' 7**)' 2)(??-).' -+' 8?' +0' +(C*' 104*' ()3' 1(D*' (+' +1*-,'@(4-/>'3-)-).'+(7/*2'-)'+1*' *D*)-).; U(3/>A' +1*' /072+*,' 2*(20)' -2' )0='604-).'+0'()'*)3'l(+'+1*' *)3' 0@' :(,61m' ()3' 20' -+' =-//' 7*'604-).'0@@'+1*'4*)82'@0,'(' =1-/*;

5@EP@'KJB'BI@'QJH@C'

J'7-.'=*//'30)*'()3'+1()C'>08' +0'08,'&*_,*21'+*(4'-)'W,()3' !8,C; _0//0=-).' (' ,*6*)+' ?0=*,' 68+'0)'+1*'-2/()3A'+1*'6(+*,-).' 2+(@@' B0-)*3' @0,6*2' =-+1' 0+1*,' 102?-+(/' *4?/0>**2' +0' *)28,*' (//' ?(+-*)+2' =*,*' @*3' 0)' +-4*' ()3'=-+108+'@822; J'.003'B07'7>'(//'-)D0/D*3;

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

1'##-$"&23,/*($'*,2#2$+*2"$4&'$!56$7&8-.2/#'2 !Nc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c)-+*3'U+(+*2'=1*,*'+1*>'(,*'708.1+'7>'(' ,*6>6/-).'604?()>; <)+*,"*(/+1'9()(3('!9'<!'4()(.*,A'b(4*2' "(>=(,3'*I?/(-)*3^'E&*6>6/-).'-2'204*+1-).' <)+*,"*(/+1' 9()(3(' (2' ()' 0,.()-2(+-0)' +(C*2' D*,>'2*,-082/>;' E!1*' 604?()>' -2' (68+*/>' (=(,*' 0@' -+2' ,*5 2?0)2-7-/-+-*2' ()3' +1(+' -2' =1>' =*' (,*' (/=(>2' /00C-).'@0,'=(>2'+0'*-+1*,',*386*'+1*'*)*,.>' =*'82*'0,'+0',*6>6/*'()>'=(2+*'?,0386+2'=*' 6,*(+*; E!1*' ,*6>6/-).' 0@' +1-).2' /-C*' ?,-)+*,' -)C'

6(,+,-3.*2' -2' D*,>' 7-.' -)' ?/(6*2' /-C*' J4*,-6(A' 9()(3(' ()3' #8,0?*' ()3' -+%2' .003' +1(+' -+' -2' )0='(D(-/(7/*'1*,*'-)'+1*'!9<;'!1-2'?(,+-68/(,' 2*,D-6*'=*'82*'-2'.,*(+'7*6(82*'-+%2'(//'30)*'7>' D0/8)+**,2'()3'+1*'?,06**32'(,*'30)(+*3'+0' 26100/2'()3'>08+1'6/872'(6,022'+1*'-2/()32; E<)+*,"*(/+1'-2'?/*(2*3'+0'7*'30-).'-+2'7-+'

70+1'-)'+*,42'0@'?,0+*6+-).'+1*'*)D-,0)4*)+' ()3' 28??0,+-).' /06(/' 26100/2' ()3' >08+1' 0,5 .()-2(+-0)2;H "*'(33*3^'E"0?*@8//>',*6>6/-).'=-//'60)5 +-)8*'+0'7*'('.,0=+1'-)382+,>'-)'!9<'()3'+1(+' =*'6()'30'40,*'-)'+1*'@8+8,*'+0'28??0,+'*)D-5 ,0)4*)+(//>57(2*3'?,0B*6+2'()3'2*,D-6*2;H

M-K3*-/%N3A<,< -9%-26<2--*;%5<O3,.G%E-9=+2%-*-A=9%=8-%2-K%C3*L<26%9<629

U<V9#' /(2+' 40)+1%2' <)+*,]-*=' 1-+' +1*' 2+,**+2A'=*'1(D*'2(-3'.0037>*'+0'+=0' 0@'08,',(3-0.,(?1*,2; a1-/-??(' [0/()3' 1*(3*3' 7(6C' +0' J82+,(/-(' -)' +1*' 4-33/*' 0@' _*7,8(,>A' @0//0=*3'7>'60//*(.8*A'U+*?1*)'&-).5 =003A' =10' 1(2' 3*?(,+*3' @0,' V*=' p*(/()3; J/20',*+8,)-).'\0=)'c)3*,'=(2'/(7' 60)28/+()+A' a*+*,' J)3*,20)A' (/+108.1' 1*%//'7*',*+8,)-).'/(+*,'-)'+1*'>*(,; U00)' +0' 7*' 3*?(,+-).' @0,' ?(2+8,*2' )*='(,*'#\'28?*,D-20,A'`(,*)'[,*3*//A' ()3'()*2+1*+-2+A'W-)('U61=(,+h*,; :*()=1-/*A' (' =(,4' <)+*,"*(/+1' =*/604*'+0'+1,**')*='?*,4()*)+'2+(@@' 4*47*,2A' J))' :-2-6C' l&VA' a,0D0mA' e(D**)(' &03,-.8*2' l&VA' a,0D0m' ()3'' J/*I-2'\8,1(4'l&VA'W,()3'!8,Cm;

C*@$?/(B-$D/+E$"#+#F aJ&`<VW'?,07/*42'=-//'10?*@8//>'7*'('+1-).'0@' +1*'?(2+'(+'+1*'91*21-,*'"(//':*3-6(/'9*)+,*; V*='2-.)2'1(D*'7**)'*,*6+*3'(+'+1*'@,0)+' 0@'+1*'102?-+(/'=(,)-).'3,-D*,2')0+'+0'?(,C'-)' +1*' 3-2(7/*3' h0)*2A' 8)/*22' 3-2?/(>-).' (' D(/-3' ?*,4-+; _(6-/-+-*2' 3-,*6+0,A' _-0)(' :6\0))*//A' *I5 ?/(-)*3^'E!1*'@,0)+'?(,C-).'2?(6*2'6/02*2+'+0' +1*'91*21-,*'"(//'78-/3-).'1(D*'(/=(>2'7**)' @0,' 1()3-6(??*3' ()3' 3-2(7/*3' 3,-D*,2' ()3' +1*,*'1(D*'(/=(>2'7**)'2-.)2'2(>-).'20'0)'+1*' 2?(6*2'+1*42*/D*2; Ec)@0,+8)(+*/>' +1*2*' 1(D*' 7**)' -.)0,*3' 7>'4()>'?*0?/*'()3'20'=*'1(D*'3*6-3*3'+0' ?8+'8?'1-.1'D-2-7-/-+>'2-.)2'-)2+*(3;

E"0?*@8//>'+1*2*'=-//'30'+1*'+,-6C'()3'3-25 608,(.*'?*0?/*'@,04'?(,C-).'-)'+1*2*'2?(6*2' ()3'/*(D*'+1*4'@,**'@0,'+102*'=10'.*)8-)*/>' )**3'+1*4;H U1*'(33*3^'EF*'(,*'(//'.8-/+>'0@'7*-).'('7-+' /(h>'@,04'+-4*'+0'+-4*'()3'-@'?*0?/*'(,*',8)5 )-).'/(+*'+1*,*%2'('.,*(+'+*4?+(+-0)'+0'?(,C'(2' 6/02*'+0'+1*'102?-+(/'(2'+1*>'6();' E[8+' <' =08/3' 8,.*' *D*,>703>A' -)6/83-).' 2+(@@A'+0'+1-)C'0@'+102*'-)')**3'()3'?(,C'*/2*5 =1*,*A' /*(D-).' +1*' 402+' 60)D*)-*)+' 2?(6*2' @0,'+102*'=10',*Y8-,*'+1*4;H !1*' @(6-/-+-*2' +*(4' 1(2' ?8+' 8?' (' +0+(/' 0@' *-.1+' 2-.)2A' 7*(,-).' +1*' 4*22(.*' g"()3-5 6(??*3'a(,C-).A'a*,4-+'&*Y8-,*3%;'

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

!"#$%&'()&*#+$%$%&',

!*<O-/%P<:%E*3<2+*%C*-9-2=9%73*+,%K<=8%8-*%?3:C-*

!"#$%&'()&*+,'-.)&/012)3& 4(/'&)5/,'67&+8&+9:), 19&,19'.16&9-.8);&<6+819&=7*).;&8/7+9>&'1&="?&.)*1.').;&@/8().&=/.A).B C:&71-&'(+9A&71-&A91D&'()&/98D).;&D(7&91'&)9').&1-.&,/* 19&,1E*) 193 !+E*67&F1'&G1D9&D(/'&71-&.),A19&+8&0)+9>&8/+G&/9G&)E/+6&+'&'1&*/-630/A).HIJJK(1'E/+63 ,13-A&07&L19G/7&<*.+6&M3 "().)&D+66&0)&/&*.+N)&:1.&'()&0)8'&8->>)8 193&

0'2:+)!%-"#) 2%--.$()"88) ."#2'*/0%3'*%3"-%/%!"-4 ,5$)*-.;$ 9J&Ne'b02*?1'=-//'7*'*(+-).'/-C*'('j8**)'@0,' +1*')*I+'@*='=**C2; !1*' U&VA' =10' =0,C2' -)' 4(+*,)-+>' (+' +1*' 91*21-,*'"(//':*3-6(/'9*)+,*A'=(2'+1*'/86C>' =-))*,'-)'08,'"(,,032'"(4?*,'604?*+-+-0); &*(3*,2'=*,*'(2C*3'+0'.8*22'+1*'=*-.1+'0@' +1*'1(4?*,A'=1-61'=(2'?(6C*3'@8//'0@'/8I8,>' @0032'()3'?,*2*,D*2; 9(,0/A' =102*' .8*22' 0@' ZT/72' =(2' B82+' ZM' 08)6*2'0D*,'+1*'(6+8(/'=*-.1+A'2(-3'21*'=(2' ?/*(2*3'+0'1(D*'604*'08+'0)'+0?; E<%4'3*/-.1+*3HA'21*'*I?/(-)*3;'E<'2(='"(,5 ,032' 38,-).' (' +,-?' +0' e0)30)' 0)6*' ()3' 20' <' C)0='=1(+'('?,*2+-.-082'2+0,*'-+'-2; E!1*'1(4?*,'-2'.,*(+'()3'<'=-//',*(//>'*)B0>' -+2'60)+*)+2;H :0,*'+1()'LK'?*0?/*'*)+*,*3'+1*'604?*5 +-+-0)A'=1-61'(??*(,*3'-)'+1*'b()8(,>r_*7,85 (,>'*3-+-0)'0@'<)+*,]-*=; p*)('!,(-)0,A'aJ'+0'&0.*,'91**24()'2(-3^' EF*'1(3'('.,*(+',*2?0)2*'()3'+1*,*'=*,*'(' /0+' 0@' *)+,-*2' -)' ()3' (,08)3' +1*' ZLA' ZoA' ZT' ()3'ZK'?08)3'4(,C; E[8+'9(,0/%2'=(2'+1*'6/02*2+A'B82+A'()3'=*' 60).,(+8/(+*' 1*,' ()3' 10?*' 21*' *)B0>2' +1*' 1(4?*,;H

!9<%U')*='102?-+(/'()3'-+2'2+(@@'1(D*',*6*-D*3' ?,(-2*'-)'1-.1'?/(6*2; <)+*,"*(/+1' 9()(3(' =(2' 60).,(+8/(+*3' 38,-).' ()' ND*,2*(2' !*,,-+0,-*2' 3*7(+*' -)' +1*' [,-+-21'"082*'0@'e0,32; e0,3'V-.*/'b0)*2A'D-6*'61(-,4()'0@'+1*'J//' a(,+>'!9<'W,08?A'+0/3'+1*'"082*^'E<'60).,(+85 /(+*' +1*' !9<' W0D*,)4*)+' ()3' <)+*,"*(/+1' 9()(3(' 0)' +1*' )*=' 102?-+(/2' -)' W,()3' !8,C' ()3'a,0D-3*)6-(/*2;'!1*>'=-//'6*/*7,(+*'+1*-,' ())-D*,2(,-*2' 0)' J?,-/' ZM' ()3' 1(D*' 4(3*' (' 18.*'3-@@*,*)6*'-)'+1*'-2/()32; E<'(4'+0/3'+1(+'4()>A'4()>'/-D*2'1(D*'7**)' 2(D*3' +1(+' =08/3' ?,*D-082/>' 1(D*' 7**)' /02+;' !1*'@(6-/-+-*2'(,*'2+(+*'0@'+1*'(,+'()3'('4-//-0)' +-4*2'7*++*,'+1()'=1(+'=(2'(D(-/(7/*'7*@0,*;H <)' ()' *4(-/' +0' <)+*,]-*=' e0,3' b0)*2' ?(-3' +,-78+*'+0'+1*'2+(@@'(+'70+1'6*)+,*2A'?(,+-68/(,/>' +102*' =10' 40D*3' 0D*,' @,04' +1*' ?,*D-082' 102?-+(/2; E_,04'=1(+'<'8)3*,2+()3HA'1*'(33*3A'E<)5 +*,"*(/+1'9()(3('70(2+2'204*'@()+(2+-6'?,05 @*22-0)(/2'()3'+1-2'-2'07D-082/>'('18.*'(22*+'+0' +1*'-2/()32; E!1*,*'(,*'204*'1-.1/>'2C-//*3'?*0?/*'=10' 1(D*'604*'-)'+0'1*/?',8)'+1*'102?-+(/2A'(/0).' =-+1'204*'*Y8(//>'2C-//*3'?*0?/*'=10'=0,C*3'

(+'+1*'?,*D-082'6*)+,*2; E!0.*+1*,'(2'('+*(4'+1*>'(,*'4(C-).'('7-.' 3-@@*,*)6*'+0'?*0?/*%2'/-D*2'()3'<'60).,(+8/(+*' +1*4'(//'()3'=-21'+1*'102?-+(/2'('1(??>'@-,2+' 7-,+13(>'-)'J?,-/;H

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

/"01"(++%2"(3%&+,043-%'0)+%526 J' W&NcV\57,*(C-).' -)-+-(+-D*' +1(+' 608/3' 2(D*' +1*' /-D*2' 0@' )*=70,)' 7(7-*2' 1(2' 7**)' /(8)61*3'-)'+1*'!9<; <)+*,"*(/+1'9()(3('1(2'-)+,0386*3'`().(5 ,00'9(,*'(+'-+2'4*3-6(/'6*)+,*2'-)'a,0D0'()3' W,()3'!8,C; _*=' +1-).2' (,*' 40,*' )(+8,(/' -)' /-@*' +1()' ('40+1*,'10/3-).'1*,')*=70,)'-)@()+'-)'1*,' (,42' @0,' +1*' @-,2+' +-4*A' ()3' `().(,00' 9(,*' +*(61*2'?(,*)+2'()'(/+*,)(+-D*'4*+103; !1*'60)6*?+'-)D0/D*2'+1*'?,(6+-6*'0@'?,05 D-3-).' 2C-)5+052C-)' 60)+(6+' +0' ()' -)@()+' -45 4*3-(+*/>' (@+*,' 7-,+1;' !>?-6(//>A' +1*' 7(7>' -2' ?/(6*3'-)'()'8?,-.1+'?02-+-0)'0)'+1*'40+1*,%2' 7(,*'61*2+A'20'+1*,*'-2'(2'4861'2C-)'60)+(6+'(2' ?022-7/*'i'1*)6*'`().(,00'9(,*; J)3'=1-/*'+1*'4*+103'1(2'7**)'?,0D*3'+0' -4?,0D*'+1*'70)3'7*+=**)'?(,*)+'()3'61-/3A' -+%2'(/20'1*/?*3'2(D*'/-D*2; <)+*,"*(/+1'9()(3('?*3-(+,-6-()A'\,'e0,*5 )(' U0/*,A' =10' 1(2' 1*/?*3' -)+,0386*' +1*' -)-5 +-(+-D*A'*I?/(-)*3^'E<)'ZXfoA'+1*'?,(6+-6*'=(2' -4?/*4*)+*3'@0,'+1*'@-,2+'+-4*'-)'[0.0+(A'905 /047-(;'V*0)(+0/0.-2+2'#3.(,'&*>'()3'"*6+0,' :(,+-)*h' ?,0?02*3' +1-2' 4*+103' 0@' 6(,*' (2' (' 4*()2'+0'6047(+'+1*'/(6C'0@'2?(6*'()3'+*615 )0/0.>'-)'+1*'/06(/'102?-+(/2;' EU+83-*2'-)3-6(+*3'+1(+'+1*'-4?/*4*)+(5 +-0)' 0@' `().(,00' 9(,*' ,*386*3' +1*' -)@()+' 40,+(/-+>' ,(+*' @,04' nM' ?*,6*)+' +0' oM' ?*,' 6*)+; E`().(,00'9(,*'-2'204*+1-).'+1(+'(')845 7*,'0@'<)+*,"*(/+1'9()(3('2+(@@'1(D*'82*3'-)' 0+1*,' 608)+,-*2' ?,-0,' +0' 604-).' +0' +1*' !9<' ()3'20'-+'2**4*3'(')(+8,(/'?,0.,*22-0)'+0'-)5 +,0386*'-+'1*,*; EU0' @(,' -+' =0,C*3' 08+' ,*(//>' =*//' ()3' 1(2' 7**)' *47,(6*3' =(,4/>' 7>' ?(,*)+2;' J/,*(3>' =*'1(D*'2**)'-+'1*/?'70)3'?(,*)+2'()3'+1*-,' 7(7-*2'()3'-)'204*'6(2*2'-+%2'3*@-)-+*/>'.,*(+/>' 1*/?*3' -4?,0D*' +1*' 1*(/+1' ()3' =*//)*22' 0@' -)@()+2;H F-+1' +1*' 2C-)5+052C-)' 60)+(6+' *)608,(.*3' 7>'`().(,00'9(,*A'('10,40)*'6(//*3'0I>+05 6-)'-2',*/*(2*3A'=1-61'6(/42'40+1*,'()3'7(7>' ()3'6()'(22-2+'=-+1'2(+-2@(6+0,>'4-/C'?,03865 +-0); J)3'+1*'70)3-).'7*)*@-+2'0@'+1-2'4*+103'0@' )*=70,)'6(,*'(,*')0+'*I6/82-D*'+0')*='40+15 *,2' =-+1' @(+1*,2' (/20' *)608,(.*3' +0' 7*604*' (6+-D*'?(,+-6-?()+2; V*0)(+0/' )8,2*A' U82()' "0=*A' =10' /(8)61*3'+1*'?,0B*6+'=-+1'\,'U0/*,A'2(-3^'EF*' 1(D*'2**)'204*'@()+(2+-6',*28/+2'=-+1'`().(5 ,00'9(,*'1*,*'-)'+1*'!9<'()3'-+%2'204*+1-).' +1(+' -2' 7*-).' *47,(6*3' 7>' 40+1*,2' ()3' @(5

!<A=Q*-.%<9%R3.-,3<2-%$.-S-*%K8+%C*3A A-.%J3263*++%73*-%K<=8%8-*%.3Q68=-*%!+* 3% R<*3A,-%7,<:+;%K8+%K39%B+*2%3=%=8-%78-98<*-%?3,,%R-.<A3,%7-2=*-%<2%!*+I+H

+1*,2'(/-C*; EJ/,*(3>' =*' 1(D*' 2**)' (' 608?/*' 0@' 7(5 7-*2%'1*(/+1'-4?,0D*'3,(4(+-6(//>'7*6(82*'0@' +1*' ?,(6+-6*' ()3' +1(+' -2' 07D-082/>' D*,>' .003' )*=2;

EF1*+1*,'7(7>'-2'@8//>'1*(/+1>'0,',*Y8-,-).' *I+,(' (++*)+-0)A' `().(,00' 9(,*' 6()' 4(C*' (' 18.*'3-@@*,*)6*'()3'-+%2'204*+1-).'=*'-)+*)3' +0' 0@@*,' +0' +*(61' (//' ?(,*)+2A' 2108/3' +1*>' 7*' -)+*,*2+*3;H

0&'#$)#(*72$4&'$5*'&( \Np#VU'0@'>08'1(D*'*)Y8-,*3'(@+*,'9(,5 0/'!1*0?1()082A'=10'@/*='104*'+0'#).5 /()3',*6*)+/>'+0'8)3*,.0'4(B0,'28,.*,>; c)@0,+8)(+*/>' +1-).2' 1(D*)%+' *I(6+/>' .0)*'+0'?/()'20'@(,A'(2'e-)3('W-//',*?0,+2; e-)3(' 2(-3^' E]*,>A' D*,>' 2(3/>A' ?00,' 9(,0/'()3'_-D02'(,*'3-2+,(8.1+'(+'+1*'@(6+' +1(+A'>*+'0)6*'(.(-)A'28,.*,>'?/())*3'@0,' /(2+'!18,23(>'=(2'6()6*//*3'@0,'+1*'+1-,3' +-4*;'' E!1*'28,.*0)'()3'()*2+1*+-2+'70+1'7*5 /-*D*' +1(+' +0' 8)3*,.0' 28,.*,>A' 9(,0/' 1(2'

+0'7*'-)'+-?5+0?'21(?*'()3'2(3/>A'+1(+'=(2' )0+'+1*'2-+8(+-0)'/(2+'!18,23(>; ' E!1*' .003' )*=2' -2' +1(+' 28,.*,>' -2' )0=' ?/())*3' @0,' J?,-/' n' ()3' <' (4' 28,*' +1(+'(//'0@'82'(,*'=-).-).'08,'7*2+'=-21*2A' +108.1+2' ()3' ?,(>*,2' +0' 70+1' 9(,0/' ()3' _-D02' (+' +1-2' D*,>' 3-@@-68/+' +-4*;' ' J' @/0,(/' 708Y8*+' 1(2' 7**)' 2*)+' 0)' 7*1(/@' 0@' (//' +1*'2+(@@'0@'<)+*,"*(/+1; ' E<@' ()>0)*' =08/3' /-C*' +0' 2*)3' +1*-,' 0=)' -)3-D-38(/' .*2+8,*2A' <' 1(D*' +1*' (35 3,*22'+0'=1-61'+0'2*)3'6(,32;H''

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

)$*'+$ ,-&#.$

/,"#. !"#"$%"&' !()*'+,$%*(&

4QAA-99/%C<A=Q*-.%K<=8%=8-<*%A-* !A3=-9%3*-;%,- %=+%*<68=;%>2.-*<3;%03I<.%32.%M*<.6-=H

>X#5$0>"XE4 Q& H&'/06)8*119&>.1-9G&/668*+,)& Q& H&'/06)8*119&G.+)G&'(7E)& Q& H&HRS&')/8*1198&P/7)99)&*)**).& Q& H& HRS& ')/8*1198& :.)8(67& >.1-9G& 06/,A& *)*T *).& Q& H&HRS&')/8*1198&>.1-9G&8/>)& Q& URV&')/8*119&>.1-9G&9-'E)>& Q& URV&')/8*119&>.1-9G&,+99/E19& Q& S&'/06)8*1198&>/.6+,&*1DG).&1.&:.)8(& Q& H&'/06)8*119&8->/.& Q& HRV&,-*&16+2)&1+6& Q& HRV&,-*&817&8/-,)& Q& URV&,-*&D(+')&?+9)>/.& Q& HRS&,-*&1./9>)&F-+,)& Q& H&6+E)&F-+,)& Q& H&!,1',(&0199)'&*)**).&W(/0/9).1X& Q& U&>.))9&19+198&TT&!9)67&,(1**)G&

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

<$*-"2$((.4&),-.")*%(() =.,5)8#+.4&)2"#"'-( WNN\'0/35@(21-0)*3'1(,3'=0,C'1(2'?(-3'0@@' @0,'+1,**'<)+*,"*(/+1'9()(3('!9'*4?/0>**2; :*3-6(/' \*D-6*' &*?,06*22-).' +*(4' 4*47*,2A'\(D-3'[()+0)A'<)3*,-('"(,,-2'()3' [,-3.*+'F-//-(42'1(D*'2866*22@8//>'604?/*+5 *3' +1*' n+1' *3-+-0)' 9*)+,(/' U*,D-6*' !*61)-5 6-()'608,2*; <)' ?(22-).' +1*' -)+*,)(+-0)(/' 6*,+-@-6(+-0)' *I(4'+1,08.1'+1*'<)+*,)(+-0)(/'J2206-(+-0)'0@' "*(/+16(,*'9*)+,(/'U*,D-6*':(+*,-(/':()(.*5 4*)+'l<J"9U::mA'+1*-,'?,0@*22-0)(/'2+(+82'-2' )0='9&9U!;' :*3-6(/'\*D-6*'&*?,06*22-).'4()(.*,A'U85 2()'[0,3*)A'2(-3^'EJ'18.*'60).,(+8/(+-0)2'+0' \(D-3A'<)3*,-('()3'[,-3.*+;'!1*>'1(D*'=0,C*3'

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l9<Um;'

!"#$%&&&'$( !"#$%&'(#$(#GA0#--#+$)*+$-"#$,(-#+.#/0-"$1/(/2/$!1,$3-/))

$.<=+*/%!3Q,%M3L-* E-,-C8+2-/%T)(U(FVV $:3<,/%C3Q,HB3L-*(FVVW8+=:3<,HA+HQL%+*%C*W<2=-*8-3,=8A323.3H=A !8+=+6*3C89/%!3Q,%M3L-*%32.%4=-I-%#<,, & !-0E+88+198;&8'1.7&+G)/8;&6) ).8&/9G&,1EE)9'8&/.)&D)6,1E)&/9G&)9,1-./>)G3&"(+8&9)D86) ).&+8&:1.&/9G& /01-'&'()&8'/ï¬€&1:&C9').O)/6'(&P/9/G/&"P3&=6)/8)&)E/+6&'()&)G+'1.;&/ /,(+9>&*(1'1>./*(8&+9&/&F*>&:1.E/'& +:&/**6+,/06)3&=6)/8)&/681&+9,6-G)&71-.&)E/+6&/GG.)88&/9G&/&G/7& E)&')6)*(19)&9-E0).3

The Ezine for InterHealth Canada TC Staff

Inter iew

New year, new culture BY ROGER CHEESMAN

CEO, INTERHEALTH CANADA TC

InterHealth flag flies near and far

Delighted: International CEO, George Commander.

Inter iew

The Ezine for InterHealth Canada TC Staff Up and away: InterHealth's Holgar Haessler gives away a balloon during the year anniversary celebrations in provo. See our birthday special starting on page 8.

ISSuE 04 | MAY/JuNE 2011

What's

Inside OUT OF AFRICA

page 17

BIRTHDAY CELEBRATIONS

IN GT

page 7

THANK YOU

NURSE

page 14

Inter iew

The Ezine for InterHealth Canada TC Staff

The world according to the Matron

paT ON THe BaCK FOR DIaLYSIS STaFF

A big hats off to those unsung heroes and heroines in dialysis. The whole team does a fantastic job but rarely receive the credit they deserve. Well today they do, thanks to a patient who I got chatting to recently in the reception area. The gentleman dropped some paperwork and so I helped pick it up for him. We started talking and he said he had just finished one of his regular dialysis sessions. “Man it’s a pain coming to the hospital so often”, he explained, “but I know it’s keeping me alive. And what makes it a little more bearable is all the girls and boys who work in the dialysis department. “They are so kind and caring and they are now my friends, my family almost. They are wonderful people and I ask God to bless them all.” When I asked the gentleman his name he just laughed and said ‘they’ll know who I am, I’m the one with the biggest smile’. So to all the guys in dialysis – well done and keep up the good work!

Why is it most supermarkets insist on having fruit and vegetables as the first thing you come to when you go food shopping? You fill up your trolley with lots of healthy and colourful goodies, only for them to be squashed and ruined by all the other things that go on top. It drives me crazy! In a bid to buck the trend I decided to go the other way around in IGA the other night. I started down at the drinks section and ended up in fruit and veg. It wasn’t easy I have to tell you and I must have crashed my trolley 100 times. But I went home with fresh, unbruised produce so I was happy!

HaIR TODaY, gONe TOMORROW

a MOUNTaIN OF papeRWORK

Now I’ve heard of getting one’s self buried in paperwork, but this is ridiculous. Come on Roger, you have to get yourself more organised. If this is what happens when Zena goes to lunch, just imagine what it’s going to be like when she goes on holiday in the summer!

a FRUIT aND Veg CaSe!

This has nothing to do with the hospitals, but I’m going to mention it nonetheless.

They say that working in facilities can be a hair raising experience….just ask Richard. InterHealth Canada’s resident electrician has been contemplating growing his hair ready for his next trip back to the Philippines. But before he does, he’s decided to try out a few colours and styles. InterView’s photographer came across Richard trying on wigs in the staff canteen and I’m sure you’d agree the one featured above probably suits him best.

ONe IN THe eYe FOR JaMaICaN paTIeNT

Remember me telling you that I’d worked all over the world? Well here’s another true story I picked up on my travels, this time from when I was in Jamaica. A Jamaican country doctor running a clinic in Mocho wanted to take a day off work to

go to Kingston, so he called his dispenser to take over. ”Obediah, Ah ha’ fi go a Kingston today, Ah want you to keep the clinic open, in case any patients come in. You t’ink you cyan handle it?”, he said. ”Yes, sah, yes sah!”, answered Obediah, thrilled to be put in charge. The following day the doctor returned to work. He asked Obediah: “So how t’ings went yesterday?” ”I had was to treat t’ree patients,” said Obie proudly. ”De fuss one seh ‘im have a bad ‘eadache, so mi give ‘im two Tylenol. ”De second one seh ‘im belly a hut him bad, bad, so mi give him some Maalox.” ”Good work, good work”, said the doctor, “And de t’ird patient?” ”Well, sah, suddenly dis ooman bust inna de door. And she tear off all she clothes sah! Me seh, every last piece of she clothes, sah. An’ she jump up on the examination table, lie down and den she shout out, ‘Help mi! Fi five years now mi never see any man!’’ ”Lawd, god man”, exclaimed the doctor, “is weh you do?” ”Mi put drops inna her eye dem”, replied Obie proudly.

JaMeS aND RICKY pLOT CHaRT aTTaCK

If you thought IT guru, James Hayward, was walking with an extra swagger these days, you’d be right. Our lovable Scot has been mixing it with the rich and famous. On a recent flight from Puerto Rico, James traveled with singer, Ricky Martin, whose best-known hit is probably, She Bangs. The two chatted and exchanged a few ideas for future calibrations. “It wasn’t easy talking”, explained James, “as I was upgraded to first class and Ricky was back in economy. However, we managed to lay down a few ideas and we’re hoping to do a duet later in the year.” James remained tight-lipped as to what they’d be singing although rumour has it will either be that Scottish classic Donald Where’s Your Troosers? or Kraftwerk’s: Computer Love.”

NO CHaNge

I was asking one of the doctors how the man who swallowed a $50 note was doing? “No change”, she said!

The Ezine for InterHealth Canada TC Staff

Inter iew

Face in the crowd: Roger Cheesman poses with pupils from the Holy Family Academy during the birthday celebrations at Cheshire Hall

The party’s over By RogeR Cheesman

ur first Birthday Party is over and finished and was most enjoyable, with a special event and cake at both Cockburn Town Medical Centre and Cheshire Hall Medical Centre. With performances by the Ona Glinton School and the Clement Howell School, it was a day to remember. A special gift of artwork by the Holy Family Academy School will be a permanent reminder, as the excellent paintings now form a super gallery in the corridor leading to ED. As we move forward into the last seven months of preparation for Accreditation Canada submission and get ready for the final visit in nine months time, I would like to invite every member of staff to become involved with the project and have input wherever possible. I know that many are committed to the project

but commitment is not involvement. So what is the difference between the two? There is an old business saying about the difference between them, which uses a traditional breakfast of bacon and eggs as an example. The difference is that the chicken is committed to the breakfast and provides the egg but the pig is involved and is part of the breakfast.

I see a group of the same people doing the work on this but accreditation belongs to us all. May I therefore ask you to become involved and provide the bacon for our ‘accreditation breakfast?’ If you want to know how you can be involved, please speak with Linda Gill. Let’s have Accreditation Canada certification to celebrate at our next birthday.

Wedding bells ring out INTERHEALTH Canada CEO, Roger Cheesman, has performed a few important tasks in his time. But nothing compares to the job he had to do in his Welsh homeland on May 29. That was the day Roger gave away his

daughter Elizabeth, who married Andrew Beadle at St Donat’s Castle, Llantwit Major Many will remember Elizabeth and Andrew helping set up the staff Christmas party in Provo last year. Everyone at InterHealth Canada wishes the couple a long and happy life together.

Inter iew

The Ezine for InterHealth Canada TC Staff

Book early for acls and pals ARE you up to date with Advanced Cardiac Life Support (ACLS)? Do you require ACLS certification or re-certification as part of your job role? If so then you’ll be pleased to hear that John and Mary Bovia will again be visiting the TCI to deliver two separate courses. One takes place on Tuesday 25 and Wednesday 26 October with the other planned for Thursday 27 and Friday 28 October. Both will be held at Cheshire Hall in room 12.22 between 9am and 5pm. Head of training, Linda Gill, said: “John and Mary are excellent tutors and we are very lucky to have them returning in October. “If you want to attend then please agree your place with your line manager and then submit your request for a reservation to me no later than Thursday September 1. “Please be aware that only in very exceptional circumstances will

year one stats

THERE’S been a lot said and written about our first year of operation in the Turks and Caicos Islands, but one thing is for sure – it’s been a very busy 12 months as our patient figures set our below demonstrate. In fact, judging my the number of patients seen, it’s been nothing short of phenominal . a big thank you to all those departments who helped produce the relevant data, thus allowing us to provide this fascinating statistical record.

late requests be considered and that non attendees will be charged per course place fee.” Meanwhile a Paediatric Advanced Life Support (PALS) course will take place at the same location between 9am and 5pm on Saturday October 29. Anyone interested in attending should again talk to their line manager and then reserve a place with Linda. Linda can be contacted by email at lgill@interhealthcanada.tc

The Ezine for InterHealth Canada TC Staff

Inter iew

Belongers make up more than quarter of hospital staff AS INTERHEALTH Canada enters its second year of operation in the TCI, the company can look back with pride at its achievements. From groundbreaking neuro surgery to a 99.5 per cent reduction in overseas referrals, there is a lot to be proud of. One achievement that out weighs many is the amount of Belongers employed at both the Cheshire Hall and Cockburn Town Medical Centres. With locals making up round 25 per cent of the TCI’s population, Belongers account for more than 25 per cent of InterHealth Canada’s workforce. “It has always been our aim to employ as many Belongers as possible”, explained InterHealth Canada TC CEO, Roger Cheesman, “and so reflecting on the first year of operation has been encouraging. “More than 25 per cent of our staff are local people and that bodes well for the long term future of the hospital.” Belongers hold some of the key positions at the two medical centres including the head of Provo’s Emergency Department and the deputy chief of medical services. And there are also on-going plans to attract qualified Belongers back to the islands from

In charge: grand Turk-born, Dr Denise Braithwaite, head of eD, is one of many belongers working for InterHealth Canada

around the world. Mr Cheesman added: “ We have Belongers in very senior positions at the hospital and we hope to attract more in the near fu-

ture. “InterHealth is also offering a wide and varied programme of educational support to all Belongers and we are currently investigating Canadian links for training jobs for TCI doctors. “If we are able to tap into this resource, this could provide us with a whole new generation of Belonger consultants in due course.” Aside from medical posts, TC islanders also occupy a wide range of positions both in support services and administration. In fact 62 per cent of all staff in these departments are Belongers, something the company is particularly pleased about. “These are key departments in terms of the every day function of the centres”, said Mr Cheesman, “and therefore it’s tremendous that so many Belongers are employed. Obviously the long-term plan is for the TCI hospital to be run by TCI people and, as we enter year two, the signs are very encouraging. “On top of this, we regularly welcome youngsters from local schools who come into the hospital on work experience exercises and I am confident we will see a number of these students back here as members of staff in the not too distant future.”

By Royal appointment! FIONA McDonnell proved she is the hostess with the mostest on Friday April 29. While most of the country slept, our facilities queen was busy preparing food and cocktails for a very special party. Fiona hosted a ladies-only gathering to celebrate the wedding in London of Prince William and Kate Middleton. The festivities got underway at 4am (9am London time) and most of the girls

were still at it deep into the night. Fiona said: “It was a lovely party and I’d like to thank all those who got up early to attend. We had a great time and everyone really enjoyed themselves. “We watched the wedding live and there were more than a few tears in the house. Kate looked stunning while William was so handsome and dashing. They make a lovely couple and there’s talk of them visiting TCI soon

Beautiful: The girls are glued to coverage of the Royal Wedding.

which will be great.” One person who didn’t appreciate the event was Fiona’s husband, Stephen. “I got woken up at about 3.30am and was told to get out of the house”, he moaned. “I wasn’t even allowed to take a bacon sandwich with me!”

Tuck in: guests line up for breakfast

Inter iew

The Ezine for InterHealth Canada TC Staff

Pharmacy news and views HIGH alert medications - as defined by the Institute for Safe Medications Practice (ISMP)are drugs that carry a heightened risk of causing significant patient harm when they are used in error. Mistakes may or may not be more common with these drugs but the consequences of an error are significantly more devastating to the patient. ISMP developed a list of these drugs (see table 1) based on error reports to the United States ISMP programme, literature review, practitioners and safety experts and is periodically reviewed for relevance and completeness. The list is grouped according to drug categories with examples and is intended to be a guideline to facilities for use in determining medications that require special safeguards to reduce the risk of errors. Error reduction and error prevention strategies can then be developed according to the determined risk. Some strategies include improved access to information about the drug, limiting access, use of auxiliary labels, standardizing the ordering, preparation and administration of the products and automated or independent double checks. Over the next few months we will look at

the high alert drugs available in Cockburn Town and Cheshire Hall Medical Centres and review the policies and error prevention strategies surrounding their use.

Institute for Safe Medication Practices

ISMP’s List of High-Alert Medications

igh-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Although mistakes may or may not be more common with these drugs, the consequences of an error are clearly more devastating to patients. We hope you will use this list to determine which medications require special safeguards to reduce the risk of errors. This may include strategies like improving access to information about

these drugs; limiting access to high-alert medications; using auxiliary labels and automated alerts; standardizing the ordering, storage, preparation, and administration of these products; and employing redundancies such as automated or independent doublechecks when necessary. (Note: manual independent double-checks are not always the optimal error-reduction strategy and may not be practical for all of the medications on the list).

Classes/Categories of Medications

Weight watchers latest

Specific Medications

adrenergic agonists, IV (e.g., epinephrine, phenylephrine, norepinephrine)

colchicine injection***

adrenergic antagonists, IV (e.g., propranolol, metoprolol, labetalol)

epoprostenol (Flolan), IV

anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine)

insulin, subcutaneous and IV

antiarrhythmics, IV (e.g., lidocaine, amiodarone)

magnesium sulfate injection

antithrombotic agents (anticoagulants), including warfarin, low-molecular-weight heparin, IV unfractionated heparin, Factor Xa inhibitors (fondaparinux), direct thrombin inhibitors (e.g., argatroban, lepirudin, bivalirudin), thrombolytics (e.g., alteplase, reteplase, tenecteplase), and glycoprotein IIb/IIIa inhibitors (e.g., eptifibatide)

methotrexate, oral, non-oncologic use

cardioplegic solutions

nitroprusside sodium for injection

chemotherapeutic agents, parenteral and oral

potassium chloride for injection concentrate

dextrose, hypertonic, 20% or greater

potassium phosphates injection

dialysis solutions, peritoneal and hemodialysis

promethazine, IV

epidural or intrathecal medications

sodium chloride for injection, hypertonic (greater than 0.9% concentration)

hypoglycemics, oral

sterile water for injection, inhalation, and irrigation (excluding pour bottles) in containers of 100 mL or more

inotropic medications, IV (e.g., digoxin, milrinone) liposomal forms of drugs (e.g., liposomal amphotericin B) moderate sedation agents, IV (e.g., midazolam) moderate sedation agents, oral, for children (e.g., chloral hydrate) narcotics/opiates, IV, transdermal, and oral (including liquid concentrates, immediate and sustained-release formulations) neuromuscular blocking agents (e.g., succinylcholine, rocuronium, vecuronium) © ISMP 2008

CLINICAL dietitian, Janet Green, has developed a Wellness Programme for staff working at Cheshire Hall and Cockburn Town. The programme has actually been running for more than a year now and provides private consultations for those with nutritional-related disorders or who want to lose or gain weight. Anyone who recently signed up to join the hospital Weight Watchers club will be enrolled on the Wellness Programme. Janet explained: “We are planning to upgrade the programme with the inclusion of planned exercises at a later date.” Anyone interested in the Wellness Programme should contact Janet on 70509.

In a new monthly column, staff from InterHealth Canada’s pharmacies will be passing on important information about medications available in both Cheshire Hall and Cockburn Town Medical Centres. Today, pharmasist MeLROSe WRIgHT looks at high alert medications.

radiocontrast agents, IV total parenteral nutrition solutions

opium tincture oxytocin, IV

***Although colchicine injection should no longer be used, it will remain on the list until shipments of unapproved colchicine injection cease in August 2008. For details, please visit: www.fda.gov/bbs/topics/NEWS/2008/NEW01791.html.

Background Based on error reports submitted to the USP-ISMP Medication Errors Reporting Program, reports of harmful errors in the literature, and input from practitioners and safety experts, ISMP created and periodically updates a list of potential high-alert medications. During February-April 2007, 770 practitioners responded to an ISMP survey designed to identify which medications were most frequently considered high-alert drugs by individuals and organizations. Further, to assure relevance and completeness, the clinical staff at ISMP, members of our advisory board, and safety experts throughout the US were asked to review the potential list. This list of drugs and drug categories reflects the collective thinking of all who provided input.

The Ezine for InterHealth Canada TC Staff

Inter iew

Café Corner By anish Thomas

patrell Jenning

akela Forbes

Birthday girls looking great SOMEONE must have slipped an anti-ageing drug in water in Grand Turk. Two ladies at Cockburn Town Medical Centre celebrated their birthdays in May, but neither looks a day over 19!

Truth is Akela Forbes (May 1) was 31 while Patrell Jenning (May 18) was 28. Here’s hoping both enjoyed their special days. Now what’s your secrets for looking so young?!

here’s been plenty of celebrating going on in the ReFresh Restaurants both in Provo and Grand Turk. From Royal Weddings to staff birthdays, we’ve been doing our bit to ensure the occasions have passed with a bang. And then there was the small matter of the hospital’s first birthday, which was celebrated in style. Other high-profile birthdays included the boss, Fiona McDonnell, and chief of medical services, Dr Robyn Barnes. We hope you both enjoyed your cakes while celebrating your 21sts all over again! If there are any special events, anniversaries or occasions coming up that you feel we should know about, speak to me, Michael, Keron, Barbara or any other member of the ReFresh staff and we’ll see what we can do.

who has outstanding accounts, please ensure these are settled at the end of each month. The facility is there to assist staff, especially when the restaurants are busy or perhaps we don’t have enough change in the tills. But please, please, pay up on time otherwise we will have to think about ending this privilege. Thank you.

CaLLINg aLL gaRDeNeRS

Watch the birdie WHERE is the best place for an expectant mum to hang out? At the hospital of course and that’s exactly what one young lady is doing right now. The mum we’re referring to is a little dove that has built a nest on the wooden framework in one of the healing gardens at Cheshire Hall.

Ironically its about as close to the maternity department as is physically possible and our feathered friend can been see sitting on her eggs from the window directly outside the entrance to ReFresh. STOP PRESS: The eggs have now hatched and our feathered friend and her two chicks have now flown the nest.

Do you have green fingers? If so, ReFresh needs you! Over the coming weeks we are planning to create kitchen gardens at both sites and we are looking for volunteers to help. The plan is to locate and develop a plot of land, which may also include erecting a greenhouse. We will then set about growing fruit and vegetables that we will use in the restaurants. The benefits are obvious and so anyone who wishes to get involved, either speak to me in Provo or Michael in Grand Turk.

SeTTLe THOSe BILLS pLeaSe

A polite reminder to anyone

TROLLeY DOLLIeS

If you think the stewardesses on British Airways are good, you ain’t seen nothing! InterHealth has two new glamorous trolley dollies who are serving drinks to the patients. Seamstress Marie Wilson and laundry assistant, Justina Skippings, are delivering tea, coffee and biscuits with beaming smiles. One male patient said: “These young ladies are wonderful and when they bring the tea around it’s the highlight of my day.” Marie and Justina are doing the ward rounds as part of a cross-departmental initiative at Cheshire Hall.

Happy

Inter iew

Birthday

The Ezine for InterHealth Canada TC Staff

HAppy bIRTHdAy to you and you and you…. CheshiRe hall piCTuRes By JessiCa JoRdan

STAFF, wellwishers and dignitaries gathered at the new hospitals on Monday April 11 to celebrate InterHealth Canada’s first year of operations. Youngsters from Provo and Grand Turk marked the special occasion through song, dance and the donation of artwork.

And on hand to cut the celebratory cake at the Cheshire Hall site was Diovanni Fulford, the hospital’s first trauma patient who was rushed in hours after the facility opened last year. The basketball mad youngster defied all the odds by fighting his way back to health after being knocked down by a car. Creative pupils from the Holy Family Academy Catholic school donated art pieces

they had designed depicting a year in the life of the hospital. Students said they were “honoured and humbled” that their work will be placed on display in the foyer at Cheshire Hall. Solos by young musicians and songbirds at Clement Howell High School moved the crowd to tears while visitors to Grand Turk’s hospital were entertained by the Ona Glinton Primary School Choir.

Happy

The Ezine for InterHealth Canada TC Staff

Judith Campbell, permanent secretary for health, praised medical staff at the helm of what she described as a “transformational year” for health care in the TCI. “Never before has health care been so visible and subject to such public review,” she said. “On the very first day of operation the life of a major trauma patient was saved. I believe this speaks volumes for the hospitals, Interhealth Canada and the Ministry of Health.

Inter iew

Birthday

“We can all be justifiably proud of this first year,” she added. Also offering remarks was John Smith, chairman of the National Health Insurance Board (NHIB), who urged staff to keep up the good work. Roger Cheesman, CEO of Interhealth Canada TC, also praised employees who have contributed to the hospitals’ success. And he paid tribute to the “courage and

tenacity” of young Diovanni, who was invited to cut the birthday cake. At the Cockburn Town Medical Centre in In Grand Turk, special guests were the parents of twins born two months prematurely. The tiny tots’ early arrival in December sparked alarm for mum and dad Juliet Arthur and Derron Thelwell. Little Derron Jnr and Derronique eventually pulled through thanks to the expertise of medics.

Happy

Inter iew

Birthday

The Ezine for InterHealth Canada TC Staff

Happy

The Ezine for InterHealth Canada TC Staff

Inter iew

Birthday

Happy

Inter iew

Birthday

The Ezine for InterHealth Canada TC Staff

Happy

The Ezine for InterHealth Canada TC Staff

Inter iew

Birthday

Happy

Inter iew

Birthday

The Ezine for InterHealth Canada TC Staff

Happy

The Ezine for InterHealth Canada TC Staff

Inter iew

Birthday

Inter iew

The Ezine for InterHealth Canada TC Staff

NursesWeek ‘Dedicated’ nurses get deserved recognition IT WAS National Nurses Week recently, with the Cockburn Town Medical Centre leading the InterHealth celebrations. A range of events were held in Grand Turk including social evenings, lunches, a staff charity concert and a special church service. There was also a nurses lunch at the Cheshire Hall medical Centre and a church service. National Nurses Week begins each year on May 6. It ends on May 12, which is known as International Nurses Day and is the birthday of the most famous nurse of all, Florence

Nightingale. Kathleen Bree, chief of clinical services at InterHealth Canada, said: “Nurses Week, especially Nurses Day, although an international celebration, proved an ideal opportunity to give recognition to all the nurses working in the TCI. “Whether in the hospital, community, public health or private organisations, we thank them for their hard work, professionalism and dedication. “It is through their continued efforts, teamwork and mutual support that we are able to maintain and develop the delivery of high stan-

dards of nursing care to the community of TCI. “The nursing staff in TCI come from a wide variety of cultures and nationalities, which brings with it a wonderful opportunity for learning in care and life experience. The potential to grow and develop together is immeasurable.” She added: “The services and work achieved by the nursing staff in the TCI are to be proud of and this is a wonderful opportunity to recognise their continued efforts to ensure high standards of care and to thank them for all their hard work.”

The Ezine for InterHealth Canada TC Staff

Inter iew

NursesWeek

Inter iew

NursesWeek

The Ezine for InterHealth Canada TC Staff

Inter iew

It’s home from home for Liesl SHE might be a long way from her South African home, but Liesl Roome couldn’t be happier. InterHealth’s newest ER doctor is loving life in the TCI, with her three children. And that will be music to the ears of department head, Dr Denise Braithwaite, with Liesl having proved a big hit with both patients and colleagues since arriving at the end of February. “I enjoy living life close by the sea”, explained Liesl, “ and I love the warmth and sunshine. For those reasons TCI is an idyllic place for me to work and live.” Born in South Africa, Liesl trained at Pretoria University. She set up a GP practice in Durban and also started a cosmetic and carboxy therapy clinic in the city, which is still operating.

Getting down: Karen Bredell, hooped top, dances the night away.

In her ‘spare’ time, she also did ER work in the local hospital. Liesl added: “ I have three children – Shani (8), Miki (6), Zack (5) – and they were a big part of the motivation for me to come to the TCI. “It’s proving a great way of offering them the opportunity of an international experience and exposure to a different culture and way of life, and that is something that is priceless. “ She added: “The children are loving the beaches and already Sapodilla Bay is a firm favourite. They are also loving life at Provo Primary School and so we couldn’t be happier.” In terms of her working life here in the Caribbean, Liesl is equally contented. She said: “I enjoy diversity and a challenge

Liesl Roome

and I am finding that working for InterHealth at Cheshire Hall is giving me both.” When Liesl is not being a doctor or a mum, her interests include scrapbooking, painting, sewing and hitting the gym.

Bye, bye: Karen, front second left, says goodbye to her InterHealth colleagues at a party hosted by eR nurse, Kadeisha Fletcher.

say hello, wave goodbye INTERHEALTH Canada extends a warm welcome to five new members of staff. Raymond Yip (anaesthetist), Francita Ebank (registered nurse), Bettina Katterman (general internist), Sherry Fulford (registered nurse) and Donna Bisuna (medical coder) have all joined the team here in the TCI. CEO Roger Cheesman said: “We are obviously delighted to welcome our newcomers

who will, I am certain, prove huge assets to the hospital. “When you’re new it can be a little daunting but we’re a friendly lot here and so if you have a question, problem or need some information about work or the island, just ask.” Meanwhile we have also had to say goodbye to a number of employees in recent

weeks. Those departed for pastures new are Karen Bredell (registered nurse), Susan Wilkes (senior registered nurse), Laveena Rodgriuez (registered nurse), Lenka Snajdrova (general practitioner), Janet Akinwale (registered nurse) and Regina Schwartzer (anaesthetist). We thank them all for their hard work and wish them well for the future.

Inter iew

The Ezine for InterHealth Canada TC Staff

MdR news By susan BoRden

I thought I’d take this opportunity to give an introduction to the Medical Device Reprocessing (MDR) department, which is commonly referred to as CSSD or CS (Central Service). The term ‘central’ suggests that services are centralised. The term “service” is the key to what central service is all about. It occurs when CS personnel help or

assist their patients and others, including healthcare peers. MDR or CS is an integral part of quality patient care. Proper workflow in the MDR is important. A one-way workflow of materials from dirty to clean to sterile storage is required. Below is a chart that will help you understand the exact procedures and work flow within MDR. Across the top is the order in which we do things while below each heading is the things that fit into the category.

Decontamination

Preparation /packaging/sterilization

Sterile Storage

Soiled items

Clean items

Sterile items

Receiving

Inspection

Staging

Sorting

Assembly

Distribution

Soaking

Packaging

Dispatch

Cleaning

Labeling

Rinsing

Sterilization

Each month in the newsletter I will be explaining a different subject and what it actually means, starting with decontami-

nation. Decontamination: The physical or chemical process that makes an inanimate object

such as a medical device that may be contaminated with harmful microorganism safe for further handling. And for those of you who like quizzes and testing your knowledge, here’s a question for you: QuESTiOn: How is decontamination achieved? Answers, and any other enquires and questions about MDR, by email please to sbordon@interhealthcanada.tc

Health screening in paridise IF SOMEONE offered you a day trip to Parrot Cay, you’d probably jump at the chance. What could be better than a relaxing few hours surrounded by all that sand, sea and luxury? Well unfortunately a recent trip to the island didn’t turn out that way for three members of InterHealth Canada staff. Instead, Dr Denise Braithwaite, infection control supervisor, Alison Pyper, and nurse educator, Nicki Mullins, worked flat out, screening more than 56 patients. Their trip was to celebrate World Health Day in April and is part of an initiative between InterHealth and the Parrot Cay Resort. Denise explained: “There are more than 300 people who work over there and obviously it would be difficult for them to all visit the Provo or Grand Turk to undergo general health screening. “So what we have done is formed a partnership with the resort where we go over and screen for things like diabetes and hyperten-

sion. A day out in Parrot Cay sounds ideal but I can assure you it’s hard work. “Nicki and I saw and screened 56 patients

while Alison worked with the management team and staff advising about infection and hygiene. All in all it was a very successful trip.”

Testing: Nicki Mullins and Dr Denise Braithwaite hard at work in Parrot Cay

The Ezine for InterHealth Canada TC Staff

Inter iew

lifting experience for InterHealth staff

MIND your backs! That’s a phrase you’ll be hearing a lot around the hospitals these days. A group of InterHealth Canada TC staff from both Grand Turk and Provo, have successfully completed a high level Manual Handling Key Trainer course. The eight participants, whose roles vary from physiotherapists to engineering assistants, are now fully-qualified to advise colleagues on the correct way to lift, push, pull and carry in the workplace. Head of education at InterHealth Canada TC, Linda Gill, explained: ‘Firstly congratulations to the eight members of staff who took part. “Being qualified means they are now able to support their colleagues in any given manual handling task. “This means any job that requires pushing, pulling, carrying or lifting has to be assessed, planned and operated efficiently and effectively, but most of all safely. “It’s an approach that affects every single member of staff throughout the hospital from lifting a ream of photocopying paper or moving a patient from one place to another.” Group tutor was Jan Crawford from Centaur Training, based in the UK. “Jan is a leading authority when it comes to manual handling and we were very lucky to have her here”, added Linda. “Again it underlines our commitment to provide the very best qualified staff here in

Smile please: The successful candidates show off their certificates

the TCI.” The successful candidates were Kadesha Fletcher, Constance McLaughlin, Pheona

Brown, Onia Jackson, Stephen McDonnell, Natoy Dilworth, Nicki Mullins and Peggy Samuels.

cheaper calls to North america MAKING cell calls in North America has just got a lot cheaper for InterHealth Canada staff. Employees in Provo and Grand Turk are being offered a special deal when it comes to talking on the phone. For years, mobile phone roaming charges have been huge for those traveling to the US and Canada. But thanks to a Provo-based company, inflated telecom bills are now a thing of the past. Ambiance, the boutique and gift shop located in the foyer of Graceway Gourmet, is offering mobile calls for InterHealth staff at just 49c a minute. That’s on average $2.50 a minute less than

other providers, according to co-owner, Arlene Jennings. She said: “For too long now, people visiting North America and other Caribbean countries have had to fork out huge sums of money when it comes to using their mobile phones. “So much so that the costs have actually put people off doing business, which is very sad. “But at Ambiance we can now offer a special service where we provide telephone hand sets and SIM cards that can be used abroad for a fraction of the price, and we’re delighted to offer this service to InterHealth staff. “Once in America, Canada or any-

where else in the region, the phones will link into to service providers in that particular country and all calls made are charged at just 49c per minute, anywhere in the world, as opposed to the $3 most firms charge. “There’s no rental fee, People simply take the handset and SIM card with them and then we charge for the calls made when they return. It’s cheap, simple and also a great tool for business.” Having proved such a big hit in the Americas, the service will soon be available to those traveling to Europe and beyond. For more information about the service, either call into Ambiance or contact 231 1873.

Inter iew

The Ezine for InterHealth Canada TC Staff

accREdITaTION UpdaTE

Please forgive me for being unavailable and unable to support you during the planned AC meetings in April. But I am now back with vengeance and remind everyone that the May support meetings will take place as planned. It is imperative that all team leaders rally their team members into the meetings to ensure steady progress.

With Linda Gill We have made a start to the evidence submission through the Quality Performance Roadmap (QPR) but there is still a lot of work to do to ensure that all the criteria, thus Standards, have been fully met. Time is passing very quickly and we are

approaching nearly the half way point for the Self Assessment Phase. I expect to shortly announce a deadline for submission in respect of the gold and platinum Standards to ensure that we complete on time. Please do not hesitate to ask for help in any respect of AC. If I can’t help, I’m sure to know someone who can. Thank you for all the work to date – keep it going.

Carol’s on the comeback trail

IT’S great to be able to report some good news about Carol Theophanous! She has not only received confirmation that all went exceptionally well with her surgery back in the UK, but also that the problem was such that she requires neither chemotherapy nor radiotherapy. Fivos returned to Provo in early May and it’s good to see his big smile around the cor-

ridors of Cheshire Hall once more. Hopefully Carol will coming back either at the end of June or beginning of July. As far as work is concerned Carol will be returning to duties once she is feeling fit and strong again although it’s likely to be on a part-time basis to begin with. Our best wishes go out to Carol and we look forward to seeing you soon.

lorena’s ‘basketball’ bounces in PAEDIATRICIAN Dr Lorena Soler has lost her famous basketball. But in it’s place she now has a beautiful bouncing baby boy by the name of Francisco Astesiano. ‘My basketball’ was how Lorena affectionately referred to her bump throughout her pregnancy. Lorena said: “My husband Mariano, son Manuel and daughter Emilia would like to extend our heartfelt thanks to the maternity team at Cheshire Hall for the first rate care received before, during and after the birth of our baby boy. “I have received exceptional care and attention during my stay in hospital. We are so glad we decided to have our new baby in TCI. ”We want to say a big thank you for every-

Picture shows Lorena’s children, Manuel and Emilia with little Francisco

thing you all did for us, especially to Dr Perry, Dr Anara, Dr Yip, Dr Dizon, Dr Leonard and all the midwives and nurses. “Also to all the staff in OR for allowing

Mariano to be by my side for that beautiful moment when Francisco arrived.” Francisco was born at 3pm on Tuesday May 31, weighing in at 6lb 3oz.

Inter iew

The Ezine for InterHealth Canada TC Staff

special delivery for suzanne and Rick CONGRATULATIONS to Suzanne and Rick Hatt on the birth of their new grand daughter. Ella Lucille arrived at 3.15pm on May 9 in hospital in Lethbridge, Alberto , Canada, weighing in at 6lb 3oz. Daughter-in-law Sarah, son Keane and Ella Lucille are all doing fine. Suzanne said: “Little Ella Lucille is beautiful and we are so happy and proud. We have

Beautiful: Baby Ella Lucille

six sons and four grand children – all of whom are girls.” Unfortunately nanny and grandad will have to wait a while before meeting the newest member of the Hatt clan.

“We won’t see her until we go home in August”, added Rick, “and we can’t wait. But we’ve seen her on Skype which was fantastic but it’s not the same as holding Ella Lucille in our arms.”

Your chance

to rel ax with

interVeiw

IT’S competition time again folks and this month’s prize is a cracker. Up for grabs is a gift certificate entitling the winner to two free massages. Just imagine it…you’ve had a hard week going about your business at Cheshire Hall or Cockburn Town Medical Centres and you need to relax. What better way than taking the weight off your feet and letting someone else pamper you?

Well that’s exactly what will be in store for the lucky reader who scoops this prize. And with two massages available, you can take your spouse, partner or a friend with you. The certificate, which is valid for six months from May 27, is for Spa Sanay, which is located in Grace Bay Court in Provo. To win, all you have to do is answer the following question. The answer is in the newsletter somewhere.

Which school donated art to InterHealth canada depicting a year in the life of the hospital? a) clement Howell b) ashcroft c) Holy Family academy

To enTeR Simply write your answer in an email, along with your name, the department and hospital you work in and a daytime contact number, and send it to paul. baker1066@hotmail.co.uk all entries must arrive by June 25, 2011.

Up FOR gRaBS: InterHealth’s Nikel Valbrum shows off the gift certificate

The winner will be The firsT correcT enTry drawn ouT of a haT on June 21!

Inter iew

The Ezine for InterHealth Canada TC Staff

Recipe of the

Month

Cottage Pie Serves 4. Oven Temperature 400ºF/200ºC/gas Mark 6

Meet the doctors: Bella and alex meet Kindergarten students at provo primary School

INgReDIeNTS • • • • • • • • • • • • •

1 lb minced beef 2 onions finely chopped 1 clove garlic – crushed 2 carrots – diced 2 tbsp plain flour 2 tbsp Worcestershire sauce 1tbsp tomato paste 2 beef (or chicken) stock cubes made up with ½ pint of water 1 ½ lbs potatoes peeled and chopped 2 oz butter 4 tbsp milk Salt and pepper 1 oz cheddar cheese grated (optional topping)

MeTHOD • Place mince, onion, garlic and carrot in a frying pan and gently fry with a little butter for 8-10 minutes. • Blend in the flour and add the Worcester sauce and tomato paste. Slowly stir in the stock, season to taste and simmer for 15-20 minutes. • Meanwhile boil the potatoes for 20 minutes until soft. Drain then mash them with the remaining butter and milk until smooth. Season to taste. • Place the mince mixture in an ovenproof dish or foil tray and spread the potato on top. • Sprinkle with salt or the cheese and cook in the centre of a preheated oven for 25-30 minutes until golden brown. • Recipe supplied by Kay Vanes

“What’s the pay like doc?” YOUNGSTERS at Provo Primary cut straight to the chase when a pair of newly-qualified doctors visited their school in Flamingo Park. Bella Stewart and Alex Dudley-Cooke spent a month working with InterHealth Canada at the Cheshire Hall Medical Centre after graduating from medical school in England. As part of their work experience, they went into the community to explain to pupils what it takes to become a doctor. And despite being bombarded by questions, there was one enquiry that proved more popular than most. Bella explained: “We had a wonderful time at Provo primary and it was the highlight of our visit to TCI. And the kids there are

already thinking about their futures because they the question we were most asked was ‘how much do doctors get paid’.” During their visit, Dr Stewart and Dr Dudley-Coake showed students how to tie bandages, check pulses and recognise when an illness or injury requires emergency treatment. They also demonstrated various gadgets and equipment, including stethoscopes, reflex hammers and ear torches. “We spent time with children of all ages and they were a pleasure to work with”, added Alex. “We would like to say a big thank you to Provo Primary School and to InterHealth Canada too.”

Inter iew The Ezine newsletter for the InterHealth Canada TCI Staff

editor: paul Baker Telephone: 431-1066 email: paul.baker1066@hotmail.co.uk or pr@interhealthcanada.tc photographs: paul Baker and Steve gill Submissions, story ideas, letters and comments are welcome and encouraged. This newsletter is for and about the staff of InterHealth Canada TC. Please email the editor, attaching photographs in a jpg format if applicable. Please also include your email address and a day time telephone number.

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

,334%$56$7$84943!:3%;!%<=%>$?5@@

!"#$%&'()& *+$,-.+%&/'

!"#$%&

!"#$!"#$ %&'()##* !"#$%&

!"#$%&'($ %&'$)!*+'" !"#$%&

!"#$%&''($(#)$(*&'$+,-$",.# !"#$%()%*%((

!"#$%&'($%&'$ %'"$!"#$!)*+' !"#$%'

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&'()$*++&'),-.$/&$/"#$0*/'&-

!"#$%&'(%&()*+($%&,

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

+*"0&K$-&(#6,07&(1&"'(&-6&)30;*8L >,(*&(*'(<&%*"&4,%'22"'#"4&,0(1&(*"&"-2(6& %*"))<&01(&(1&?"&%""0&'7',0&51#&"O';()6&RS&-,0E 3("%@@@@

&1/2+(!%)+3(

K&'(("04"4&'&)";(3#"&(*"&1(*"#&4'6&7,/"0&?6& K0("#!"')(*$%&4'%*,07&4"0(,%(<&T,3%"22"8 !"&+'%&(")),07&(*"&'34,"0;"&'))&'?13(&(*"& 5114%&'04&4#,0.%&(*'(&;'3%"&-1%(&4'-'7"&(1& 13#&(""(*<&%3;*&'%&%14'%&'04&;'0468 K0& '& ?,4& 51#& ,0("#';(,10<& T,3%"22"& '%."4& 4")"7'("%H&IQ1+<&,%&'0610"&*"#"&'?)"&(1&("))& -"&+*'(&5114&,(&,%&(*'(&;'3%"%&(*"&-1%(&7#,"5& '04&%355"#,07&51#&6"'#%&'5("#&"'(,07&,(UL& P0"&15&13#&-1#"&-'(3#"&03#%"%&%,((,07&,0& (*"& 5#10(& #1+& %(114& 32& '04& %',4H& I>"44,07& ;'."@L&

"%&,.42(/+2%'&.)%#&("+))+/

-+&(.)($#/0(

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

K$-&01(&01#-'))6&10"&51#&#"'4,07&1(*"#&2"1E 2)"$%& 2#,/'("& "-',)%& ?3(& K& ;13)40$(& *")2& ?3(& 01(,;"&%1-"&;1##"%2104"0;"&?"(+""0&D,04'& T,))& '04& V17"#& N*""%-'0& 10& D,04'$%& ;1-E 23("#&%;#""0&+*"0&K&+'%&,0&*"#&155,;"&#";"0()68 :*"& *'4& "-',)"4& V17"#& *"#& #"%,70'(,10& %'6,07&%*"&+'0("4&(1&#"(,#"&?";'3%"&%*"&+'%& 7"((,07&1)48&V17"#&*'4&#"2),"4&'%.,07&*1+&%*"& .0"+&%*"&+'%&7"((,07&1)48&

*565(789(":;<849(65=>?@

W8& >*"0& 613#& 5#,"04%& ;1-2),-"0(& 613& 10& 613#&0"+&')),7'(1#&%*1"%&'04&613X#"&?'#"E 511(8 Y8& >*"0& 613#& 41;(1#& 41"%0X(& 7,/"& 613& OE #'6%&'06-1#"&?3(&G3%(&*1)4%&613&32&(1&(*"& ),7*(8 R8& >*"0& '& 61307& -'0& ;'(;*"%& 613#& 5'0;6& '04& 613#& 2';"-'."#& 12"0%& (*"& 7'#'7"& 411#&0"'#"%(&6138 Z8& >*"0&613&#"-"-?"#&+*"0&(*"&="'4&:"'&

+'%&10)6&%,;.8 [8& >*"0& 613#& *3%?'04& %'6%<& \D"(X%& 71& 32E %(',#%& '04& *'/"& %1-"& 530\& '04& 613& '0E %+"#<&\*10"6<&K&;'0X(&41&?1(*@\ ]8& T1,07&?#'E)"%%&23))%&'))&(*"&+#,0.)"%&13(&15& 613#&5';"8 ^8& >*"0&613&410X(&;'#"&+*"#"&613#&%213%"& 71"%<&G3%(&'%&)107&'%&613&410X(&*'/"&(1&71& ')1078 _8& `13&'04&613#&(""(*&410X(&%)""2&(17"(*"#8 a8& `13#&?';.&71"%&13(<&?3(&613&%('6&*1-"8 WS8&K(&('."%&(+1&(#,"%&(1&7"(&32&5#1-&(*"&;13;*8 WW8&`13#& ,4"'& 15& '& 0,7*(& 13(& ,%& %,((,07& 10& (*"& 2'(,18 WY8&!'226&*13#&,%&'&0'28 WR8&`13#&,4"'&15&+",7*(&),5(,07&,%&%('04,07&32 WZ8&K(& ('."%& )107"#& (1& #"%(& (*'0& ,(& 4,4& (1& 7"(& (,#"48 W[8&`13#& -"-1#6& ,%& %*1#("#& '04& 613#& ;1-E 2)',0,07&,%&)107"#8 W]8&M*"&2*'#-';,%(&*'%&?";1-"&613&0"+&?"%(& 5#,"048 W^8&K(&('."%&(+,;"&'%&)107&(1&)11.&*')5&'%&71148 W_8&M*"&(+,0.)"&,0&613#&"6"&,%&10)6&(*"&#"5)";E (,10&15&(*"&%30&10&613#&?,51;')%8 Wa8&`13& )11.& 51#& 613#& 7)'%%"%& 51#& '& *')5& '0& *13#<& '04& (*"0& 5,04& (*'(& (*"6& +"#"& 10& 613#&*"'4&'))&(*"&(,-"8 YS8&`13&7,/"&32&'))&613#&?'4&*'?,(%&'04&613& %(,))&410X(&5"")&71148 YW8&`13&%,(&,0&'.,07&;*',#&'04&;'0X(&7"(&,(& 71,078 YY8&`13&410X(&.01+&#"')&"-?'##'%%-"0(&30(,)& 613#&*,2&%"(%&155&'&-"(')&4"(";(1#8 YR8&D"(X%&5';"&,(<&(#'/"),07&G3%(&,%0X(&'%&-3;*&530& +*"0& '))& (*"& *,%(1#,;')& %,("%& '#"& 61307"#& (*'0&613&'#"8 YZ8&b/"#6& (,-"& 613& %3;.& ,0& 613#& 73(<& 613#& '0.)"%&%+"))8 Y[8&`13#&,0/"%(-"0(&,0&*"')(*&,0%3#'0;"&,%&5,E 0'))6&?"7,00,07&(1&2'6&1558

)1/&()*.)(A*#&+(#BB3

c'(,"0(%& '04& (*",#& -1?,)"& 2*10"%dd88410$(& 613&G3%(&)1/"&e"-U K&+'%&+'(;*,07&'&+1-'0&?",07&(#"'("4&,0& (*"&"-"#7"0;6&4"2'#(-"0(&(*"&1(*"#&4'6&'04& '))&15&'&%344"0&*"#&(")"2*10"&%('#("4&(1&#,078 K0%("'4&15&,701#,07&,(<&(*"&2'(,"0(&#"';*"4& 41+0&,0(1&*"#&*'04?'7&'04&'0%+"#"4&,(8 >*"0& (*"& ;'))& *'4& "04"4& (*"& 03#%"& 21E ),(")6<&'04&f3,("&#,7*()6<&'%."4&(*"&)'46&(1&(3#0& ,(&1558& J5("#& -3;*& *355,07& '04& 2355,07& %*"& #"E )3;('0()6& '7#""48& M*"& 03#%"& (*"0& '%."4& *"#H& IN'0&613&01(&),/"&+,(*13(&613#&9)';.?"##6UL M*"&)'46&)11."4&*"#&%(#',7*(&,0&(*"&"6"&'04& #"2),"4H& IK$4& #'(*"#& ),/"& +,(*13(& 10"& 15& -6& )"7%&(*'0&+,(*13(&-6&9)';.?"##6@L

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

(

!"#$%&&&'$(

%65;5(F55=9(G9(H;(HG6(IH59 !C(/#'+/(D*++2-.&( D+#E(%&)+/*+.")*(D.&.,.()D

>,04%(1#-%H&&>"&'#"&,0&(*"&-,44)"&15&(*"&*3#E #,;'0"& %"'%10& '04& '5("#& b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g&5)114"4&*1-"%<& %1-"&15&613&f3,("&%"/"#")68&&M*'(&613&#"(3#0"4& (1&+1#.&'04&;10(,03"4&(1&)11.&'5("#&(*"&*1%E 2,(')&'04&,(%&2'(,"0(%&4"%2,("&2#1?)"-%&'(&613#& *1-"%&-"'0%&(*'(<&'%&(*"&BC&21),(,;,'0<&&D1#4& Q,7")&h10"%&%',4<&*"')(*;'#"&2"12)"&'#"&%2"E ;,')8&M*"&2"12)"&15&(*"&M3#.%&i&N',;1%&K%)'04%& '#"&,04""4&51#(30'("&(1&*'/"&%3;*&+104"#53)& ("'-%&)11.,07&'5("#&(*"-8 K&*12"&(*'(&+"&7"(&(*#137*&(*"&#"-',04"#& 15&(*"&6"'#&+,(*13(&'06&53#(*"#&,%%3"%&?3(&(*"&

%"0,1#& -'0'7"-"0(& ("'-& '04& (*"& 4,%'%("#& ;11#4,0'(1#%& +1#.& *'#4& +*"0"/"#& (*"#"& ,%& '& 4"2#"%%,10&51#-,07&,0&(*"&J()'0(,;&'04&51))1+& ,(&%"/"#')&(,-"%&'&4'68&&>*"0&(*"&4"2#"%%,10& ?";1-"%& '& (#12,;')& %(1#-& +"& +'(;*& (*"& 21E ("0(,')&(#';.&'04&,5&0";"%%'#6&?"7,0&13#&2#"2'E #'(,10%&51#&?1(*&*,7*&+,04%&'04&*"'/6&#',0%8 K5& (*"& %(1#-& )11.%& ),."& #"';*,07& (*"& M3#.%& i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j&(*"&;130(#6&0""4%&613&'))<& "%2";,'))6&'(&;#,(,;')&(,-"%&),."&%(1#-%&g&*3##,;'0"%8

J8K59()68:;H6@((

`13&+,))&*'/"&'))&#";",/"4&(*"&0"+%&(*'(&h,-&*'%& ?""0&4,'701%"4&+,(*&-3)(,2)"&-6")1-'8&K&;'0& ("))&613&(*'(&*"&*'%&?""0&-1%(&2)"'%"4&+,(*&(*"& 5)114&15&"0f3,#,"%&'?13(&*,%&*"')(*8&!"&(*'0.%& "/"#6?146&51#&(*",#&.,04&(*137*(%&'04&';(,10%8

K& '-& "O(#"-")6& *'226& (1& ?"& '?)"& (1& %'6& (*'(&*"&'22"'#%&+"))&'04&,%&%(,))&(*"&*'226&h,-& (*'(&+"&'))&.01+8&&!"&,%&%(,))&G1.,07&'04&%-,),07& 4"%2,("& -'06& (*"#'2,"%& *"& ,%& 304"#71,07& (1& #"(3#0&*,-&(1&7114&*"')(*8&&h,-&*'%&%',4&(*'(& *"&,%&)11.,07&51#+'#4&(1&?",07&?';.&,0&MNK&'04& '(&+1#.&'7',08&!,%&-'G1#&;1-2)',0(&,%&(*'(&*"& ,%&?1#"4&'04&%1&*"&,%&+1#.,07&5#1-&*1-"&,0& (*"&BC<&+*"#"&*"&("))%&-"&,(&,%&;1)4&'04&+"(&@ K&'-&%3#"&(*'(&(*"&-"%%'7"&+"&'))&%"04&*,-& ,%<&TbM&>bDD&:PPQ<&hKA8

.LL65<:I8I:H;(D8;8<8@

>"$/"& *'4& (*"& %";104& #1304& 15& "43;'(,10& '04& '))& %""-%& (1& *'/"& 710"& +"))8& & >"& *'/"& ')%1&?""0&"O;""4,07)6&51#(30'("&(1&*'/"&?""0& '?)"& (1& 1?(',0& h'0"& A"')"6$%& ,023(& ,0(1& (*"& 2#1;"%%H&!"#&#";"0(&/,%,(&(1&3%&+'%&,0/')3'?)"8&& h'0"& ,%& '0& J;;#"4,('(,10& N'0'4'& %3#/"61#& '04& %1& *"#& ;1--"0(%& (1& (*"& ("'-%& '#"& 15& 7#"'(&'%%,%('0;"&,0&73,4,07&(*"-&51#+'#48&&:*"& ,%&/,%,(,07&'04&+1#.,07&+,(*&3%&10&'&#"73)'#&?'E %,%&(*#137*13(&)'("&5'))&'04&+,0("#&'04&%*"&+,))& ?"&;1043;(,07&'&-1;.&%3#/"6&,0&"'#)6&YSWY&(1& ')"#(&3%&(1&'06&'#"'%&+*"#"&+"&0""4&(1&('."& '44,(,10')&';(,108&&=#&b#,;&c'#%10%&+,))&2#1?E '?)6&G1,0&*"#&,0&(*'(&2#1;"%%<&'%&*"&(11&,%&'0& J;;#"4,('(,10&N'0'4'&%3#/"61#8 >,(*& %3;*& *")2& K& '-& %3#"& +"& +,))& ';f3,(& 13#%")/"%&+"))&'04&7',0&(*"&';;#"4,("4&%('(3%& +"&;1/"(8&!1+"/"#<&(*'(&+10$(&;1-"&+,(*13(& "/"#6?146&,0&(*"&*1%2,(')&?",07&e10&("'-$&'04& +1#.,07&+,(*&(*"&("'-%&(*'(&'#"&('%."4&+,(*& "0%3#,07&(*'(&+*'(&0""4%&(1&?"&410"&,%&410"8& C""2&32&(*"&7114&+1#.8

,-./0.12$345$6.78$94.:7;71.<758= KQMbV!bJDM!$:&;1--,(-"0(&(1&"-2)16E ,07& (*"& /"#6& ?"%(& f3'),5,"4& %('55& *'%& ?""0& 53#(*"#& "0*'0;"4& ?6& (*"& 2*'#-';6& 4"E 2'#(-"0(8 Q'('%*'& A155"((& '04& V'0G,& b?'0.%& *'/"& ?1(*&%3;;"%%53))6&1?(',0"4&f3'),5,;'(,10%&,0&'& 03-?"#&15&%2";,'),%(&5,")4%<&,0;)34,07&Kk&'4E -,O(3#"%g&%("#,)"&2#"2'#'(,10<&"O("-21#'0"E 13%&;1-21304,07&'04&;*"-1(*"#'268& M*"& 2*'#-';6& (";*0,;,'0%& *'/"& +1#."4&%32"#&*'#4&(1&';*,"/"&(*",#&71')%& '04&'#"&4"),7*("4&(1&*'/"&7#'43'("4&+,(*& 5)6,07&;1)13#%8 Q'('%*'& %',4H& IV'0G,& '04& K& '#"& ,04""4& ";%('(,;& (1& *'/"& ?""0& 7,/"0& (*"& 1221#(3E 0,(6&(1&53#(*"#&13#&.01+)"47"&,0&(*"&5,")4& 15&2*'#-';68 IJ%& (*"& "/1)3(,10& 15& K!N& ;10(,03"%<&

#"%(&'%%3#"4&(*'(&(*,%&),5"&;*'07,07&"O2"#,"0;"& +,))&2)'6&'&/,(')&2'#(&,0&('.,07&3%&(1&(*"&0"O(& )"/")<& ?6& "0%3#,07& (*'(& (*"& "%%"0(,')& ?')'0;"& ?"(+""0& (*"& (";*0,;')& '04& 2#15"%%,10& %.,))%& +,(*,0& (*"& 4"2'#(-"0(& ,%& "%('?),%*"4& '04&

-',0(',0"48& I!'(%& 155& (1& 13#& -'0'7"-"0(& ("'-& 51#& #";170,%,07& (*,%& 0""4<& '04& %322)6,07& (*"& 0";"%%'#6& #"%13#;"%g'%%,%('0;"& 51#& ,(& (1& ?"& -"(8L

)

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

'68;<()G6F(<HLIH6( IG6;9(MG>>(L:6L>5 PQb&15&T#'04&M3#.$%&-1%(&2123)'#&4'37*("#%& ,%&#"(3#0,07&(1&*"#&#11(%8 =#& ="0,%"& 9#',(*+',("EM"00'0(& +,))& *"'4& ?';.&(1&*"#&*1-")'04&0"O(&-10(*&(1&#30&(*"& ,%)'04$%&*1%2,(')8 l1#& (*"& 2'%(& W_& -10(*%& %*"& *'%& ?""0& ,0& ;*'#7"& 15& K0("#!"')(*& N'0'4'$%& "-"#7"0;6& 4"2'#(-"0(%&?'%"4&'(&(*"&N*"%*,#"&!'))&A"4E ,;')&N"0(#"8 J04&,($%&'&#1)"&=#&9#',(*+',("EM"00'0(&+,))& 01+& ;1-?,0"& +,(*& *"#& 0"+& '4-,0,%(#'(,/"& 21%(&'(&(*"&N1;.?3#0&M1+0&A"4,;')&N"0(#"8 M*"& ;10%3)('0(& 2*6%,;,'0& *'%& (3#0"4& 53))& ;,#;)"&'5("#&7',0,07&(*"&T1/"#01#X%&:;*1)'#%*,2& 51#&J;'4"-,;&b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h'E -',;'8 !"#&;'#""#&*'%&%""0&*"#&+1#.&'(&*1%2,(')%& ,0&9'#?'41%<&N100";(,;3(&'04&"/"#6&)"/")&10"& 5';,),(6&,0&h'-',;'8 M*"&(#'3-'&"O2"#(<&+*1&,%&;3##"0()6&%(346E ,07& 51#& '& A'%("#%& ,0& *"')(*& %6%("-%& -'0'7"E -"0(&'(&(*"&B0,/"#%,(6&15&D,/"#211)<&%',4&%*"& ,%& )11.,07& 51#+'#4& (1& 53#(*"#& ,-2#1/,07& (*"& *"')(*;'#"&%"#/,;"&,0&T#'04&M3#.8 IM*,%&;130(#6&*'%&-'4"&%,70,5,;'0(&%(#,4"%& ,0&(*"&,-2#1/"-"0(&15&*"')(*;'#"&+,(*&(*"&"%E ('?),%*-"0(&15&(*"&Q!Kc&'04&(*"&K0("#!"')(*& N'0'4'&*1%2,(')L<&%*"&'44"48& IK& '-& "O(#"-")6& *'226& (*'(& K0("#!"')(*& *'%&7,/"0&-"&(*"&1221#(30,(6&(1&%"#/"&,0&(*,%& ;'2';,(68&A6&4"4,;'(,10&(1&(*"&,-2#1/"-"0(& 15& (*"& %";104'#6& *"')(*& ;'#"& %";(1#& ,%& 71,07& (1&?"&(*"&,-2"(3%&(*'(&4#,/"%&-"&(1&53)5,))&(*,%& #1)"&(1&(*"&?"%(&15&-6&'?,),(68& IK&'-&4"4,;'("4&(1&+1#.,07&+,(*&'))&%('."E *1)4"#%&;#"'("&f3'),(6&%"#/,;"%&(1&'))&+*1&';E ;"%%&%"#/,;"%&'(&(*"&N1;.?3#0&M1+0&A"4,;')& N"0(#"&'04&(*"&MNK&*1%2,(')%&'%&'&+*1)"8L& A"'0+*,)"& K0("#!"')(*& N'0'4'$%& NbP<& V17"#& N*""%-'0<& 4"%;#,?"4& =#& 9#',(*+',("E

>76-$?/.7=@ ;5/$&A@$.83$15 M"00'0($%& -1/"& '%& ec#1/1$%& )1%%& '04& T#'04& M3#.$%&7',0$8 !"&%',4H&IK(&,%&+,(*&-,O"4&5""),07%&(*'(&+"& '))& %""& ="0,%"& -1/"& 5#1-& (*"& N*"%*,#"& !'))& A"4,;')& N"0(#"& (1& N1;.?3#0& M1+0& A"4,;')& N"0(#"8&!1+"/"#<&51#(30'(")6&(*,%&*,7*)6&212E 3)'#<& (')"0("4& '04& ,0%2,#'(,10')& 61307& )'46& +,))&?"&%2"04,07&(,-"&+,(*&3%&10&c#1/1&10&'& #"73)'#&?'%,%&'%&2'#(&15&*"#&#1)"&'%&*"'4&15&(*"& "-"#7"0;6&4"2'#(-"0(8 I>"& *'/"& '))& +,(0"%%"4& *"#& "O2"#(,%"& ,0& (*"&"-"#7"0;6&4"2'#(-"0(&'04&01+&+"&'#"& %3#"&(1&%""&(*1%"&%.,))%&;1-"&(1&(*"&51#"&10;"& -1#"8&& I!"#&0"+&21%(&,0&T#'04&M3#.&+,))&?"&;*')E )"07,07<&?')'0;,07&),5"&'%&'&-3-&'04&+,5"&'%& +"))&'%&#300,07&b=&%"#/,;"%<&304"#('.,07&'4E -,0,%(#'(,/"&43(,"%&'(&N1;.?3#0&M1+0&A"4,;')& N"0(#"&'04<&(1&;'2&,(&'))&155<&+1#.,07&(1+'#4%& '0&'4/'0;"4&-'0'7"-"0(&4"7#""8 IP3#&?"%(&+,%*"%&71&+,(*&="0,%"&'04&+"& )11.&51#+'#4&(1&+1#.,07&+,(*&*"#&,0&(*,%&0"+& 21%,(,108L =#& 9#',(*+',("EM"00'0(& ,%& %""0& '%& ?1(*& '0& ,0%2,#'(,10')& 5,73#"& '04& '& #1)"& -14")& (1& 61307%("#%&,0&T#'04&M3#.8 M""0'7"#<& C"06'& h10"%<& +*1& ,%& %(346,07& -"4,;,0"&,0&(*"&BC&'04&#";"0()6&%2"0(&(,-"& 10& +1#.& "O2"#,"0;"& +,(*& K0("#!"')(*& N'0'E 4'<& %',4H& I=#& 9#',(*+',("EM"00'0(& ,%& '& *37"& ,0%2,#'(,10&(1&3%&'))8& ID,."& -"<& %*"& ,%& 5#1-& T#'04& M3#.& '04& K& (11& +'0(& (1& %(346& (1& ?"& '& 41;(1#& '04& ;1-"& ?';.& '04& %"#/"& -6& 2"12)"& ,0& (*"& %'-"& +'6& %*"&*'%8L&

J&AbA9bV&15&(*"&K0("#!"')(*&N'0'4'& ;)"'0,07& %('55& *'%& #";",/"4& %1-"& *,7*& 2#',%"&,04""48 J04&(*"&2'(&10&(*"&?';.&*'%&;1-"& 5#1-&(*"&?"%(&%13#;"&21%%,?)"&j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`/"#0'#4& N'-?"#0"& +*1& "/"#6& (,-"&K&%'+&*"#"&+'%&+1#.,07&*'#4<&21)E ,%*,07& '04& ;)"'0,07& '04& -'.,07& (*"& 2)';"&?"'3(,53)8 I!"#& +1#.& '04& 2"#%10'),(6& +"#"& '& #"')& ;#"4,(& (1& *"#& '04& K$4& ),."& (1& ('."& (*,%&1221#(30,(6&(1&(*'0.&'04&;107#'(E 3)'("& *"#8& K$-& %3#"& K0("#!"')(*& ,%& /"#6& 2#134&15&,(%&("'-8L

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

!"#$%&'()*+%,"--&*.%/"#%0)1,($$*%1,$%)+2$*13#$# KQMbV!bJDM!&N'0'4'&,%&?,44,07&'&5104&5'#"E +"))&(1&10"&15&,(%&)107"%(&%"#/,07&"-"2)16""%& ,0&MNK8 N*,"5&15&;),0,;')&%"#/,;"%<&C'(*)""0&9#""<&,%& *"'4,07&?';.&(1&*"#&:;1((,%*&#11(%&,0&:"2("-E ?"#&'5("#&(+1&6"'#%&,0&(*"&N'#,??"'08 C'(*)""0&G1,0"4&K0("#!"')(*&,0&:"2("-?"#& YSSa&'%&'0&"'#)6&-"-?"#&15&(*"&;1--,%%,10E ,07& ("'-<& 2#,1#& (1& (*"& *1%2,(')& 12"0,07%& ,0& J2#,)&)'%(&6"'#8 I!',),07&5#1-&P#.0"6&K%)'04%&,0&:;1()'04L<& "O2)',0"4&NbP<&V17"#&N*""%-'0<&IC'(*)""0& ;'-"&(1&(*"&M3#.%&'04&N',;1%&K%)'04%&*'/,07& -'4"& 4"(13#%& ,0(1& Q"+& m"')'04& '04& M*"& l').)'04%&10&(*"&+'6<&'%&+"))&'%&'&03-?"#&15& 1(*"#&2)';"%&,0&(*"&BC8 I:*"& ?#137*(& +,(*& *"#& %(#"07(*%& ,0& 2)'0E 0,07&'04&23?),;&*"')(*<&'04&*'%&?""0&'(&(*"& 51#"5#10(& 15& (*"%"& (+1& '#"'%& +*,)%(& '(& (*"& N*"%*,#"& !'))& '04& N1;.?3#0& M1+0& A"4,;')& N"0(#"%8& I!'/,07& ?""0& (*"& "O";3(,/"& #"%210%,?)"& 51#&*"')(*;'#"&,0&(*"&l').)'04%<&C'(*)""0&(,#"4& 15&2"073,0%&'04&%*""2<&4";,4"4&(*'(&'&e+""& ?,(&15&%30$&'04&%1-"&%;3?'&4,/,07&+13)4&41& (*"&(#,;.&'04&%1&%*"&%"(&155&51#&MNK&/,'&P#.0"6<& +*,;*&,%<&15&;13#%"<&01(&(*"&-1%(&4,#";(&#13("<& ?3(&C'(*)""0&,%&01(*,07&,5&01(&'0&,0(#"2,4&(#'/E "))"#8& IJ%& %*"& *"'4%& 51#& 2'%(3#"%& 0"+& /,'& *"#& *1-"&,%)'04%<&+"&'))&+,%*&*"#&'&5104&5'#"+"))&

'04&7114&)3;.<&+*"#"/"#&*"#&(#'/")%&-'6&('."& *"#8L b/"#610"& '(& K0("#!"')(*& N'0'4'& ";*1"%&

V17"#$%& ?"%(& +,%*"%& '04& +"& )11.& 51#+'#4& (1& %"",07&C'(*)""0&+*"0&%*"&;1-"%&?';.&(1&41& '&%21(&15&4,/,07&,0&(*"&53(3#"8

"8G65;49(*HK5786<(!HG;< :bcMbA9bV&%""-%&(1&?"&'&-10(*&15&4"2'#E (3#"%&51#&-'0'7"#%&'(&(*"&*1%2,(')8&& V'(*"#& 30"O2";("4)6& +"& %'6& 5'#"+"))& (1& D'3#"0&PX!'0)10&'(&(*"&"04&15&:"2("-?"#&'%& 2#"%%,07&-'(("#%&,0&91%(10&-'."&,(&0";"%%'#6& 51#&*"#&(1&#"(3#0&*1-"8 D'3#"0& *'%& ?""0& +,(*& 3%& %,0;"& (*"& "'#)6& 4'6%& '(& N'#,??"'0& c)';"& '04& *'%& ?""0& (*"& )60;*2,0& ,0& "0%3#,07& '))& 13#& 5,0'0;"%& '#"& %(#',7*(8&& NbP<&V17"#&N*""%-'0<&%',4H&IM*"#"&*'/"& ?""0&-'06&,%%3"%&(1&4"')&+,(*<&2)'00,07&(1&41& (1& 4"/")12& %6%("-%& '04& '))& (*"& 2#1?)"-%& 15& ,-2)"-"0('(,108 IM*,%&*'%&-"'0(&-'06&)'("&0,7*(%&51#&D'3E #"0<& -'.,07& %1-"& 15& 3%& 5"")& 73,)(6& (*'(& %*"& +'%&%"04,07&"E-',)%&'(&W'-&+*,)"&-1%(&15&3%& '#"&'%)""28&& ID'3#"0& *'%& ('."0& ,(& '))& ,0& *"#& %(#,4"& '04& +,(*13(&'&7#3-?)"&'(&(*"&-'06&"O(#'&*13#%8L !"&'44"4H&IK&'-&%3#"&+"&+,))&'))&-,%%&D'3E #"0&'04&+,%*&*"#&+"))&51#&*"#&53(3#"&,0&91%(108&&

I!1+"/"#<& %*"& +,))& 01(& 4"%"#(& 3%& "0(,#")6& '%&%*"&+,))&?"&'&#"73)'#&/,%,(1#&(1&c#1/1&(1&%""&

*3%?'04&M,-&+*1&,%&%('6,07&10&'(&'&)1;')&)'+& 5,#-&51#&'&+*,)"&)107"#8L

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!5;(8;<(.>:L5(N:<(M86575>>(IH()D%

#&(.(!%DCD"+(-.,+(B#/()$#

KM& >J:& )'("& A'6& +*"0& +"& '##,/"4& ,0& (*"& M3#.%&'04&N',;1%8 >"&4,4&%1&/"#6&"O;,("4&'?13(&(*"&(3#f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k'0"%&'04&D,04'&T,))&*")2"4&3%&(1&%"(()"& ,0& %(#',7*(& '+'6& '04& *'4& C'6& 01(& *'/"& .,04)6& )"0(&3%&*"#&,05'-13%&('04"-<&+"&+13)4&0"/"#& *'/"&?""0&'?)"&(1&"0G16&%1&-3;*&15&(*"&,%)'048& =3#,07&13#&(,-"&'(&N*"%*,#"&!'))&+"&-'4"& 13#& +'6& (1& (*"& b=& '04& (*"'(#"%& +*"#"& (*"& 41;(1#%& +"#"& ?#,)),'0(& '(& 7"((,07& 3%& ,0/1)/"4& '04&%*'#,07&(*",#&+,%41-8& >"& 2'#(,;3)'#)6& "0G16"4& 13#& 2*6%,1)176& )"%%10%&+,(*&V'6&43#,07&-'06&12"#'(,10%8& c'3)& 9'."#& '44"4& %1-"& ?#"'4(*& '04& ;1E )13#&(1&13#&"O2"#,"0;"%&?6&%"04,07&3%&155&(1& ("';*& '(& '& )1;')& 2#,-'#6& %;*11)& +*,;*& +'%& 7#"'(&530&'04&'&#"')&2#,/,)"7"8 !"& ')%1& 71(& 3%& ,0& '))& (*"& 0"+%2'2"#%& '04& 10&(*"&(")"/,%,10<&'%&+"))&'%&5';,),('(,07&9"0X%& 5,#%(& G1?& '%& '0& ,0("#0'(,10')& %21#(%& 2*1(17#'E

2*"#&'(&(*"&MNK&/&9'*'-'%&>1#)4&N32&511(E ?'))&-'(;*@& =#& D1#"0'& :1)'& (11.& 3%& 304"#& *"#& +,07& "0%3#,07&+"&*'4&'))&(*"&)"'#0,07&1221#(30,E (,"%&+"&;13)4&+'0(&'04&21,0("4&3%&(1+'#4%& '&2#1G";(&,0&*62"#?'#,;&-"4,;,0"<&'%&+"))&'%& ?",07& '& 7#"'(& %3221#(& 13(%,4"& 15& (*"& *1%E 2,(')8& P(*"#& (*'0& 4"/")12,07& %.,))%& 51#& 13#& 53E (3#"&-"4,;')&;'#""#%&+"&*'/"&')%1&';f3,#"4&'& +"')(*&15&%.,))%&,0&,0/"0(1#6&('.,07@& J&5"+&530&4'6%<&,0;)34,07&J),;"X%&?,#(*4'6<& %2"0(& ,0& (*"& %(1#"#11-%& 4"-10%(#'("4& 13#& %(1;.& ('.,07& (')"0(& %355,;,"0()6& (1& 7"(& 3%& 2#1E -1("4&(1&*")2,07&10&T#'04&M3#.8& >"& "0G16"4& '& 5"+& 4'6%& %('6,07& 10& (*"& ?"'3(,53)& %)""26& ,%)'04<& -'.,07& (*"& -1%(& 15&

(*"&91*,1&'04&:'04&9'#&,0&13#&(,-"&1558& >"&+,))&0"/"#&51#7"(&13#&5,#%(&"O2"#,"0;"&15& '&-'0&2)'6,07&'&%'+&%1&(30"53))6@& =3#,07& 13#& (,-"& ,0& MNK& +"& 5")(& (1('))6& '(& *1-"&')(*137*&,(&*'%&(1&?"&%',4&(*'(&+"&0"/E "#& 4,4& f3,("& 7"(& (1& 53))6& 304"#%('04& (*"& 4"),& -"03&,0&V"l#"%*@ M*'0.&613&(1&V17"#&N*""%-'0&51#&'))1+E ,07& 3%& (1& G1,0& (*"& K0("#!"')(*& N'0'4'& ("'-& '04&(1&"/"#610"&+*1&*")2"4&-'."&13#%&%3;*& '&?#,)),'0(&"O2"#,"0;"8 93(& 2'#(,;3)'#& 7#'(,(34"& (1& V1?60& 51#& 1#E 7'0,%,07&'04&1/"#%"",07&13#&2)';"-"0(8 M'."& ;'#"& "/"#610"& '04& +"& +,))& %""& 613& '7',0&%1108 !"#$%"&'("$)#*$)+&("$!'&("

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%!&'()' !"#$%&'(#)(*+,'

! !

" ! !

! !

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

01+#$(2'$,'*&3$%+#'3&4$%&' .&".5%&66$,7'3&"+.(*&,( ,0&-14"#0&A=V&2#,0;,2)"%8&c1),;,"%&'04& 2#1;"43#"%&'#"&(*"&5,#%(&%("2%&,0&;10(#1)E ),07&+1#.&('%.%&'04&'%%,70-"0(%8& E 51#-"4

!"')(*;'#"& ;10%3-"#%& "O2";(& 01(*,07& )"%%&(*'0&(*"&?"%(&51#&(*"-%")/"%&'04&(*",#& )1/"4&10"%8& A"4,;')& ="/,;"& V"2#1;"%%,07& nA=Vo& 2"#%100")&-3%(&"%('?),%*&'22#12#,'("&f3')E ,(6&)"/")%&51#&(*"&2#143;(%&'04&%"#/,;"%&(*"6& 2#143;"& (1& '%%3#"& (*"%"& )"/")%& '#"& ;10%,%E ("0()6&'((',0"48&A=V&,%&'0&,0("7#')&2'#(&15& f3'),(6& %"#/,;"& (*#137*13(& (*"& *"')(*;'#"& ,043%(#68 p3'),(6&4"5,0"4&,0&(*"&;10("O(&15&A=V& 12"#'(,10%& ,%q& IM*"& ;10%,%("0(& 4"),/"#6& 15& 2#143;(%& '04& %"#/,;"%& ';;1#4,07& (1& "%('?E ),%*"4& %('04'#4%8& M*"& ;10;"2(& 15& f3'),(6& #")'("%&(1&(*"&4"7#""&1#&7#'4"&15&"O;"))"0;"& 15&'&2#143;(&1#&%"#/,;"L& >*6& A=V& f3'),(6& ;10(#1)& ,04,;'(1#%U&& M1& 4"("#-,0"& *1+& +"))& (*"& 4"2'#(-"0(& ,%& -""(,07&,(%&71')%8& !1+&41"%&A=V&,4"0(,56&f3'),(6U&c#14E 3;(%& '04& %"#/,;"%& *'/"& (1& 41& +*'(& (*"6& %*13)4& 418& l1#& "O'-2)"H& "f3,2-"0(& %3;*& '%&'&+'%*"#&4,%,05";(1#E&+*"0&'&+'%*&;6;)"& ,%&;1-2)"("<&'#"&(*"&,0%(#3-"0(%&;)"'0&'04& )3?#,;'("4U&K0&1(*"#&+1#4%&*'%&(*"&+'%*"#& 2"#51#-"4& (*"& +'6& (*"& AlT& %'6%& ,(& +,))U& N10%,%("0(& '04& %'5"& "f3,2-"0(& 12"#'(,10& ,%&"%%"0(,')8& A=V& pJ& ,04,;'(1#%& '#"& '4-,0,%(#'(,/"<& ;3%(1-"#&%'(,%5';(,10&'04&(";*0,;')&,04,;'E (1#%8&

;*"-,;')& '04& ?,1)17,;')& n"f3,2-"0(& 2#,0(&13(%<&;*'#(%&'04g1#&7#'2*%<&;*"-,E ;')& '04& ?,1)17,;')& ,04,;'(1#%& ,0& #"7'#4%& (1&%2";,')&,04,;'(1#%&4"%,70"4&51#&,0("#E 0')<&"O("#0')&2';.%<&,0%(#3-"0(%&1#&-"4E ,;')&4"/,;"%&'04&"f3,2-"0(&-10,(1#,07o V"-"-?"#& f3'),(6& ,%& (*"& #"%210%,?,),(6& 15& "/"#6& "-2)16""& '04& "/"#6& "-2)16""& -3%(& ?"& ,0/1)/"4<& -1(,/'("4& '04& .01+)E "47"'?)"&,5&(*"&A=V&1#&1(*"#&4"2'#(-"0(%& '#"&(1&2#143;"&;10%,%("0(&f3'),(6&2#143;(%& '04&%"#/,;"%8&& l1#& (*"& 23#21%"& 15& (*"& 0"+%)"(("#& (*,%& ,%& '& /"#6& %*1#(& '04& ;104"0%"4& /"#%,10& 15& f3'),(6& ,0& (*"& A=V8& K& *'/"& 2#"2'#"4& '& 21+"#& 21,0(& 2#"%"0('(,10& K$))& %*'#"& ,0& (*"& 0"'#&53(3#"&51#&(*1%"&(*'(&'#"&,0("#"%("48&

%32"#/,%1#%& '04& )"'4& (";*0,;,'0%& -3%(& ?"& (*1#137*)6& (#',0"4& '04& ;1-2"("0(&

,-,)#$!.'*"# /)#)0"'$/*'

51#&'0&3#7"0(&-"4,;')&,("-&2#1/,4"4&,0&'& %"(&(,-"U&N1043;(&;3%(1-"#&%3#/"6%8&J;E .01+)"47"& '04& '44#"%%& ;3%(1-"#& '04g 1#&%('55&;1-2)',0(%8 %*""(%&(1&';;1-2'06&%3#7,;')&%"(%8&

"GLF?(,H;;5F8( I8F59(:I(589? !Jkb& 613& 01(,;"4& *1+& #")'O"4& =100".'& !'))$%&)11.,07&(*"%"&4'6%U >"))&,($%&01(&%3#2#,%,07&(*"&N*"%*,#"&!'))E ?'%"4& *3-'0& #";13#%"%& '%%,%('0(& ,%& (*"& 2,;E (3#"&15&*"')(*&'04&?"'3(68 =100".'& +'%& (*"& )3;.6& +,00"#& ,0& 13#& ;1-2"(,(,10&,0&(*"&)'%(&"4,(,10&15&K0("#k,"+8 B2&51#&7#'?%&+'%&'&7,5(&;"#(,5,;'("&"0(,(),07& (*"&*1)4"#&(1&(+1&5#""&-'%%'7"%&'(&:2'&:'0'6& ,0&c#1/18 >"& '%."4& +*,;*& %;*11)& *'4& 410'("4& (*"& %"#,"%&15&2',0(,07%&10&4,%2)'6&,0&(*"&;1##,41#& ?"(+""0& #";"2(,10& '04& (*"& OE#'6& '04& "-"#E 7"0;6&4"2'#(-"0(%8& M*"&'0%+"#&15&;13#%"&+'%&(*"&!1)6&l'-E ,)6&J;'4"-6&'04&+"&#";",/"4&)1(%&15&;1##";(& "0(#,"%&+,(*&=100".'$%&?",07&(*"&5,#%(&4#'+0& 13(&15&(*"&*'(8&&

B2:@/$7=$".8.$CDE=$ ?/73@$.83$F52 NPQTVJMBDJMKPQ:&(1&A'#6Eh1&nAho&9#6'0(& +*1&*'%&?";1-"&'&7#'04&2'#"0(&51#&(*"&/"#6& 5,#%(&(,-"8 K& .01+& +*'(& 613$#"& '))& (*,0.,07& j& K0("#E !"')(*&N'0'4'$%&23#;*'%,07&-'0'7"#&41"%0$(& )11.&1)4&"0137*&(1&?"&'&7#'006@& >"))<&?"),"/"&,(&1#&01(<&%*"&,%@ P0&h30"&RS&'(&W8W]'-<&Ah$%&4'37*("#&h"%E %,;'&9#6'0(Eb'#)"&7'/"&?,#(*&(1&M6)"#&b),F'?"(*& 9)'."<&+*1&+",7*"4&,0&'&*"')(*6&^)?%&R1F8 91#0& '(& :(& h1%"2*$%& !1%2,(')& ,0& M1#10(1<& N'0'4'<& ?1(*& -3-<& ?'?6& '04& 4'4<& N#',7& b'#)"&'#"&'))&41,07&G3%(&5,0"8 Ah<& +*1& 5)"+& *1-"& (1& %2"04& (,-"& +,(*&

*"#&5'-,)6&51))1+,07&(*"&?,#(*<&%',4H&IM*,%&,%& -6& 5,#%(& 7#'04& ;*,)4& '04& '& 5,#%(& 7#"'(& 7#'04& ;*,)4#"0&51#&9"((6&'04&h'."&9#6'0(&15&C,07%E (10<&P0('#,1&'04&+"&'#"&'))&%1&2)"'%"4&'04& 2#1348 IM*"#"& '#"& 01& +1#4%& (1& 4"%;#,?"& (*"& G16&

15&?",07&'&7#'042'#"0(<&'04&K$-&)11.,07&51#E +'#4&(1&*'/,07&-1#"&+104"#53)&"O2"#,"0;"%& (1&%*'#"&+,(*&*"#8L Ah<&+*1&+,))&?"&.01+0&'%&Q'0'<&(*'0."4& '))& *"#& ;1))"'73"%& '(& K0("#!"')(*& N'0'4'& 51#& (*",#&.,04&-"%%'7"%&51))1+,07&M6)"#$%&'##,/')8&

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

*:PQ(8>56I(K5<:L8I:H;9

2'(,"0(%<& 51#& ,0%('0;"& "#6(*#121,"(,0& (1& #"0')& 4,')6%,%&2'(,"0(%&10)68 c123)'#& 4#37%& (*'(& 5'))& ,0(1& (*,%& ;'("71#6& ,0;)34"&12,14%<&-"(*'410"<&"#(*#121"(,0&J)E 2*'&n2#1;#,(o&'04&?32"01#2*,0"&8&J&#"73)'("4& #"%(#,;("4& ';;"%%& 2#17#'-& ,%& #30& ?6& (*"& B:& 5114&'04&4#37&'4-,0,%(#'(,10&nl=Jo&'04&'&),%(& 15&(*"&4#37%&;)'%%,5,"4&,0&(*,%&2#17#'-&;'0&?"& 51304&10&(*",#&+"?%,("8&

!C(-+"/#2+(($/%'*)O#)1#&C+

M*"& ("#-%& 413?)"& /"#,5,;'(,10<& #"%(#,;("4& ';E ;"%%& '04& ,04"2"04"0(& 413?)"& ;*";.& +"#"& ,4"0(,5,"4& ,0& -6& 2#"/,13%& '#(,;)"& '%& "##1#& 2#"/"0(,10& '04& #,%.& #"43;(,10& %(#'("7,"%& %3#E #1304,07& (*"& 3%"& '04& -'0'7"-"0(& 15& *,7*& ')"#(&-"4,;'(,10%8 93(&+*'(&"O';()6&,%&-"'0(&?6&413?)"&/"#,E 5,;'(,10<& #"%(#,;("4& ';;"%%& '04& ,04"2"04"0(& 413?)"&;*";.U

,#1!"+(R+/%B%D.)%#&

%&,+A+&,+&)(,#1!"+(D*+D0

M*"& K0%(,(3("& 51#& :'5"& A"4,;'(,10& c#';(,;"%& nK:Aco&4"5,0"%&'0&,04"2"04"0(&413?)"&;*";.& 15&'&*,7*E&')"#(&-"4,;'(,10&&'%&'&2#1;"43#"&,0& +*,;*&(+1&&;),0,;,'0%&%"2'#'(")6&;*";.&E&')10"& '04&'2'#(&5#1-&"';*&1(*"#<&(*"0&;1-2'#"&#"E %3)(%& E& & "';*& ;1-210"0(& 15& 2#"%;#,?,07<& 4,%E 2"0%,07<&'04&/"#,56,07&(*"&*,7*j')"#(&-"4,;'E (,10&?"51#"&'4-,0,%("#,07&,(&(1&(*"&2'(,"0(8&M*"& 2#1;"43#"&%"#/"%&(+1&23#21%"%H&M1&2#"/"0(&'& %"#,13%& "##1#& 5#1-& #"';*,07& '& 2'(,"0(& '04& (1& ?#,07&'(("0(,10&(1&(*"&%6%("-%&(*'(&'))1+&(*"& ,0(#143;(,10&15&*3-'0&"##1#8 +

A./)()$#

(*'(&#"f3,#"&4"-10%(#'(,10&15&;),0,;')&,04,;'E (,10&'04&(*#137*&;10%3)('0(&10)6&2#"%;#,?,078& =,%(#,?3(,10& #"%(#,;(,10& ;'0& ?"& 410"& ?6& #"E %(#,;(,07&3%"&(1&;"#(',0&%2";,5,"4&2123)'(,10&15&

N"#(',0& 4#37%& #"f3,#"& ?6& )'+& (*'(& '& %";104& 2"#%10& +,(0"%%"%& (*",#& 2#"2'#'(,10& '04& '4E -,0,%(#'(,108& M*"& 2#1;"%%& ,%& #"5"##"4& (1& '%& 413?)"& /"#,5,;'(,10& n')%1& ;'))"4& '& 413?)"& ;*";.o& '04& 1;;3#%& +*"0& '& %";104& ;),0,;,'0& ;*";.%&'04&41;3-"0(%&j&3%3'))6&?6&2*6%,;')& 1#&")";(#10,;&%,70'(3#"&E&(*"&2#"2'#'(,10&'04& '4-,0,%(#'(,10&15&(*"&4#378&N10(#1))"4&4#37%& 3%3'))6&5'))&,0(1&(*,%&;'("71#68 c'#(&(*#""&15&(*,%&,%%3"&+,))&)11.&'(&%2";,5,;& 4#37%& '04& *1%2,(')& %2";,5,;& "##1#& 2#"/"0(,10& %(#'("7,"%8

!&"+.+(&3'+('8$.()/

/+2)/%D)+,(.DD+22(,/1'2

V"%(#,;("4&';;"%%&4#37%&'#"&(*1%"&+,(*&'&),-,E ('(,10&15&'&%2";,5,;&(62"&,-21%"4&10&(*",#&3%"& 1#& 4,%(#,?3(,108& M*,%& ),-,('(,10& ;'0& ?"& ,-E 21%"4&'04&#"73)'("4&?6&)'+&1#&?6&'0&,0%(,(3E (,10&,0&#"%210%"&(1&;10;"#0%&#")'(,07&(1&'?3%"& 21("0(,')<&%"#,13%&'4/"#%"&"55";(%&%3;*&'%&("#'E (17"0,;,(6<&'04&'&4"%,#"&(1&"0%3#"&'22#12#,'("& 2#"%;#,?,078 K0%(,(3(,10')&#"%(#,;(,10&15&;"#(',0&*,7*&;1%(& 1#& )'%(& #"%1#(& -"4,;'(,10%& ;'0& ?"& 410"& ?6& ),-,(,07&2#"%;#,?,07&(*#137*&;),0,;')&2#1(1;1)%&

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

9:5()&.')&,;'".&"+.&6'(5'<#2'()&',&6( M!b`&%'6&(*'(&'))&7114&(*,07%&-3%(&;1-"&(1& '0& "04& '04& (*'($%& %'4)6& (#3"& *"#"& '(& K0("#E !"')(*&N'0'4'8 K($%&+,(*&*"'/6&*"'#(%&(*'(&+"&'#"&*'/,07&(1& +'/"& 7114?6"& (1& (+1& 15& (*"& *1%2,(')$%& -1%(& 2123)'#&;*'#';("#%8 J2'#(& 5#1-& (*",#& *37"& ;10(#,?3(,10& +1#.& +,%"&*"#"&,0&(*"&MNK<&D,04'&'04&:("2*"0&T,))& *'/"& ?";1-"& -'06& (*,07%& (1& -'06& 2"12)"& 1/"#&(*"&2'%(&;132)"&15&6"'#%8 l#,"04%<&%3##17'("&2'#"0(%<&7#'04&2'#"0(%&j& 613&0'-"&,(<&(*"6$/"&?""0&,(@& M1&4"%;#,?"&D,04'&'%&(*"&),5"&'04&%13)&15&(*"& 2'#(6&,%&'&*37"&304"#%('("-"0(&'04&*"#&,05";E (,13%&)3%(&51#&),5"&,%&71,07&(1&?"&%1#")6&-,%%"48& J%&51#&:("2*"0<&+"))&*"$%&(*"&%"0%,?)"&10"&15& (*"&(+1&'04&*,%&5'(*"#E),."&;')-&'04&2'(,"0;"& *'%&2#1/"4&%3;*&'&;1-51#(&(1&%1&-'068 M*"& 2',#& '#"& *"'4,07& ?';.& (1& (*"& BC& 51#&

'& +"))E"'#0"4& #"(,#"-"0(& ')(*137*& %1-"E (*,07&("))%&3%&(*"&7)1?"E(#1((,07&431&+,))&?"&51#& >"40"%4'6&0,7*(&#,?%&'(&(*"&M,..,&!3(&,0&(*"& 01(&(11&4,%('0(&53(3#"8 NbP& '04& 5#,"04<& V17"#& N*""%-'0<& %',4H& ID,04'& '04& :("2*"0& G1,0"4& 3%& ,0& (*"& "'#)6& 4'6%&15&;1--,%%,10,07&?';.&,0&:"2("-?"#&15& YSSa& '04& +*,)%(& :("2*"0& +1#."4& 5#1-& (*"& *1%2,(')&%,("<&D,04'&-1/"4&,0&+,(*&(*"&("'-&'(& N'#,??"'0&c)';"8 ID,04'& +'%& 01& %(#'07"#& (1& K0("#!"')(*& N'0'4'<&*'/,07&%"(&32&'04&-'0'7"4&(*"&;10E (,03,07&"43;'(,10&%6%("-&'(&13#&1#(*12'"4,;& ;"0(#"& ,0& b07)'048& & >,(*& '& ?';.7#1304& ,0& 03#%,07&'04&f3'),5,;'(,10%&,0&("';*,07<&D,04'& *'%&-1#"&(*'0&%*1+0&*"#&'?,),(,"%&,0&;),0,;')& "43;'(,108& & :("2*"0& +'%& '0& "07,0""#& +*1& *'4& -1/"4& ,0(1& (*"& ';'4"-,;& '#"0'& '04& ('37*(& "07,0""#,07& 51#& -'06& 6"'#%& '(& '& ;1)E

)"7"&,0&D,/"#211)8 I!'/,07&,043;"4&D,04'&(1&;1-"&'04&+1#.& ,0& c'#'4,%"<& +"& ')%1& 4";,4"4& (*'(& +"& +13)4& 4#'7& :("2*"0& 13(& 15& #"(,#"-"0(& n+"))<& (*"%"& ';'4"-,;%&41&#"(,#"&%1&/"#6&"'#)6o&'04&7"(&*,-& 41,07&%1-"&#"')&+1#.&'7',08L V17"#&'44"4H&I91(*&15&(*"-&*'/"&,0("7#'(E "4&+"))&,0(1&(*"&%1;,')&),5"&15&(*"&N"0(#"&'04& '#"&15("0&%""0&,0&(*"&-,44)"&15&'06&e530$&(*'(& +"& *'/"<& %3;*& '%& (*"& N*#,%(-'%& c'#(68& D,04'& ,%& e5'-13%$& 51#& *"#& ?10*1-,"& '04& ,%& ')+'6%& (*"#"&51#&'&%-,)"<&'&7,77)"&'04<&+*"#"&0""4"4& (*"&%3221#(&15&eA1(*"#&!"0$8 I91(*&*'/"&;10(#,?3("4&7#"'()6&(1&(*"&%3;E ;"%%&15&(*"&*1%2,(')&'04&,(&,%&+,(*&7#"'(&%'40"%%& (*'(&+"&%""&(*"-&-1/,07&?';.&(1&%3006&V30E ;1#0&'04&+"))E"'#0"4&#"(,#"-"0(8 I>"& +,))& -,%%& (*"-& '04& +,%*& (*"-& ?1(*& (*"&/"#6&?"%(&'04&K&;'0&'%%3#"&(*"-&+"&+,))& ?"&(*,0.,07&15&(*"-&+*"0&+"&#"'4&15&%01+E %(1#-%&,0&(*"&BC8L J04&%1&%'6&'))&15&3%@

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

4*)--$#%41$-,$*5'%)%,)#+%)61%1"%/"(("7 J:& >bDD& '%& ?",07& '& /"#6& 7114& "07,0""#<& :("2*"0&T,))&*'%&'01(*"#&*,44"0&(')"0(8 !"$%&'&-'4&.""0&2*1(17#'2*"#&'04&'0& "O(#"-")6&';;1-2),%*"4&10"&'(&(*'(8 K0& 5';(& '06+*"#"& :("2*"0& 71"%<& *,%& (#3%(6&;'-"#'&71"%&+,(*&*,-<&,0;)34,07&(*"& -'06&K0("#!"')(*&"/"0(%<&?1(*&155,;,')&'04& 30155,;,')8 >"$#"&'))&71,07&(1&-,%%&*,-<&"%2";,'))6&3%&

*"#"&'(&K0("#k,"+8 P/"#&(*"&2'%(&6"'#<&:("2*"0&*'%&';(E "4& '%& (*,%& 23?),;'(,10$%& e155,;,')$& 2*1E (17#'2*"#<& '04& +"& '#"& 7#'("53)& 51#& *,%& "551#(%8 J%& (*,%& %(300,07& 2,;(3#"& 15& =#& V1?60& 9'#0"%$&4'37*("#%<&M"7'0&'04&J)"O<&;)"'#)6& 4"-10%(#'("%<& *"$%& 71,07& (1& ?"& '& *'#4& ';(& (1&51))1+8

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&# '$(&&$'#!)# *(+",#$-(.

A#+!

D,5"$%& #"5)";(,10%

-55I(HG6(%;M5LI:H;( DH;I6H>(:;(A868<:95

=&2,5(&' 6"&+>&.

!"#$%"&'(#)'*&+'& #

! !

h1*0&PO51#4&,%&2#15"%%1#&15&k,#1)176&'(&:(&9'#E (*1)1-"+$%&'04&(*"&V16')&D10410&!1%2,(')<& p3""0&A'#6$%&:;*11)&15&A"4,;,0"&'04&="0E (,%(#68&!"&,%&2#"%,4"0(&'04&%;,"0(,5,;&4,#";(1#&15& V"(#1%;#""0&k,#1)176&D(48& !"& *'%& ;1E'3(*1#"4& (+1& %('04'#4& ("O(%H& eK05)3"0F'<&(*"&k,#3%"%&'04&(*"&=,%"'%"$&+,(*& :,#&N*'#)"%&:(3'#(E!'##,%&'04&T8N8&:;*,)4&'04& -1%(&#";"0()6&e!3-'0&k,#1)176<&'&M"O(&51#&:(3E 4"0(%& 15& A"4,;,0"<& ="0(,%(#6& '04& A,;#1?,1)E 176$& 01+& ,0& ,(%& 513#(*& "4,(,10<& 23?),%*"4& ?6& PO51#4&B0,/"#%,(6&c#"%%8& c#15"%%1#& PO51#4& *'%& ')%1& 23?),%*"4& Y[S& %;,"0(,5,;& 2'2"#%8& !,%& #"%"'#;*& ,0("#"%(& ,%& (*"& 2'(*17"0,;,(6& 15& ,05)3"0F'<& ,0& 2'#(,;3)'#& (*"& WaW_&:2'0,%*&K05)3"0F'&%(#',0<&+*,;*&*"&;1-E ?,0"%&+,(*&;1043;(,07&;),0,;')&(#,')%&3%,07&0"+& ,05)3"0F'& /';;,0"%& '04& '0(,/,#')& 4#37%8& M*,%& #"%"'#;*& *'%& ?""0& 5"'(3#"4& 10& %;,"0;"& Mk& 2#17#'--"%& #";"0()6& ,0& (*"& BC<& B:J<& T"#E -'06&'04&!1))'048 !"& +'%& '+'#4"4& ;1--30,;'(1#& 51#& (*"& 6"'#& 51#& (*"& 5)3& 2'04"-,;& ?6& (*"& :1;,"(6& 15& J22),"4&A,;#1?,1)176&'04&(12&;1--30,;'(1#& ?6&(*"&:1;,"(6&15&h13#0'),%(%8 !"&*'%&#";"0()6&?""0&'+'#4"4&'&=8:;&51#& *,%&#"%"'#;*&+1#.&10&/,#1)176&'04&'%&'&%;,"0;"& ;1--30,;'(1#8

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

?@A'(5')56('7.51,3-.&+>$,7' $,<&%($5,'%5,(.5#'%5,<&.&,%& MBVC:&'04&N',;1%&K%)'04%&,%&2#"2'#,07&(1&*1%(& ,(%&?,77"%(&"/"#&-"4,;')&;105"#"0;"8 =")"7'("%&5#1-&'#1304&(*"&7)1?"&+,))&5)1;.& (1& c#1/1& )'("#& (*,%& 6"'#& 51#& K05";(,10& N10(#1)& K0&c'#'4,%"8 M*"& (+1E4'6& "/"0(<& 1#7',0%"4& ?6& K0("#E !"')(*&N'0'4'&nMNKo<&('."%&2)';"&10&Q1/"-E ?"#&W_&'04&Wa&'(&9#'6(10&!'))8 M*"& ;105"#"0;"& ,%& ?",07& %210%1#"4& ?6& '& *1%(&15&1#7'0,F'(,10%&,0;)34,07&D,-"<&A'%("#%<& J-"#,;'0&!1%2,(')&:322)6<&:("#,%&'04&Jb:NBE DJc8 K05";(,10&;10(#1)&,%&10"&-"4,;,0"$%&;3##"0(& *1(&(12,;%<&"%2";,'))6&,0&(*"&N'#,??"'0&+*"#"& 4,%"'%"%&%3;*&'%&;*1)"#'&'04&4"073"&5"/"#&'#"& +,4"%2#"'48 N105"#"0;"& 1#7'0,%"#%& *'/"& '((#';("4& %1-"&15&(*"&+1#)4$%&)"'4,07&'3(*1#,(,"%&10&(*"& %3?G";(<&,0;)34,07&."601("&%2"'."#%&c#15"%%1#& h1*0&PO51#4&5#1-&(*"&V16')&D10410&!1%2,(')<& '04&51#-"#&T)1?")&!"')(*&D"'4"#%*,2&'+'#4& +,00"#<&=#&M"#"%"&A',()'048 IM*,%& ,%& '& +104"#53)& 1221#(30,(6& 51#& (*"& MNK&'04&,($%&-"4,;')&2#15"%%,10')%L<&"O2)',0"4& K0("#!"')(*& N'0'4'& -"4,;')& 4"/,;"& #"2#1E ;"%%,07&-'0'7"#<&:3%'0&91#4"08 IK05";(,10&;10(#1)&,%&'&*37"&(12,;&#,7*(&01+& '04&K0("#!"')(*&N'0'4'&,%&/"#6&2)"'%"4&'04& 2#134&(1&?"&*1%(,07&%3;*&'0&,-21#('0(&;10E 5"#"0;"&*"#"&,0&c#1/18L J0610"&+,%*,07&(1&#"7,%("#&1#&+'0(,07&-1#"& ,051#-'(,10&%*13)4&;10(';(&:3%'0&91#4"0&10& aZWY_SS&1#&YZ]aRR^8&J)("#0'(,/")6&613&/,%,(& +++8,0("#*"')(*;'0'4'8(;g,04"O8*(-)

%(<H(98?9(2G5 `PBQT& )1/"8888(*"#"X%& 01(*,07& f3,("&),."&,(8 J04&,5&"/"#&2#115&+"#"&0""4"4<& G3%(&*'/"&'&7114&)11.&'(&(*,%&2*1(1E 7#'2*&(*'(&*'%&-"'4&,(X%&+'6&(1&(*"& K0("#k,"+&,0?1O8 V";170,%"& (*'(& )1/")6& )'46& 4#"%%"4& ,0& +*,("U& P5& ;13#%"& 613& 41<&,(X%&:3%'0&>,)."%8 :3%'0<&+*1&*',)%&5#1-&(*"&01#(*& 15&b07)'04<&4"2'#("4&(*"&N*"%*,#"& !'))& A"4,;')& N"0(#"<& +*"#"& %*"& +1#."4&'%&'&03#%"&%32"#/,%1#<&?';.&

,0&J2#,)8 :*"&)"5(&(1&71&'04&),/"&,0&J-"#E ,;'& +,(*& *"#& 5,'0;"<& h';.& :3)),/'0<& +*1&%*"&-"(&,0&'&#"%1#(&)1??6&*"#"& ,0&(*"&MNK8 >"))<&'%&613&;'0&%""<&)3;.6&h';.& ,%& 01& )107"#& :3%'0X%& 5,'0;"<& *"X%& 01+&*"#&*3%?'048 M*"& )1/,07& ;132)"& (,"4& (*"& .01(& ?';.& ,0& (*"& %3--"#& '04& "/"#610"& '(& K0("#!"')(*& N'0'4'& +,%*"%&(*"-&'&)107&'04&*'226&),5"& (17"(*"#8

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&''()

)$*'+$ /,"#. ,-&#.$

*"+&$,((-.#&

!"#$%&'()*+,(-.+,(+*/0-*

cDbQM`& 15& *"))1%& '04& 7114?6"%& %,0;"& (*"&)'%(&0"+%)"(("#&+,(*&%1-"&*,7*E2#1E 5,)"&4"2'#(3#"%&10&(*"&*1#,F108 J-107& (*1%"& )"'/,07& 51#& 2'%(3#"%& 0"+&'#"&:("2*"0&'04&D,04'&T,))<&C'(*E )""0&9#""&'04&D'3#"0&P$!'0)10&8 >"&+,%*&(*"-&'04&'))&(*1%"&4"2'#(E ,07&(*"&/"#6&?"%(&15&)3;.&'04&+");1-"& '))&13#&0"+&-"-?"#%&15&%('55&(1&K0("#E !"')(*&N'0'4'8

!"#$"%$& #."/&)$-+&,,", E&#"7,%("#"4&03#%"g-,4+,5"<&c#1/1 /)0*)+"#)$1)+*#"' E&12"#'(,07&#"7,%("#"4&&03#%"<&T#'04& M3#. ,2)'.#$.'&" E&03#%"&%32"#/,%1#<&c#1/1 1&++"/$!),3&))# E&%"0,1#&#'4,17#'2*"#<&c#1/1 ,2"''4$5-+5.'* E&#"7,%("#"4&03#%"<&c#1/1 '&()'*.$/(&#3.,2 E&2'(,"0(&%"#/,;"%&'%%1;,'("4<&c#1/1 3)/),$'"0.(6& E&7"0"#')&%3#7"10<&T#'04&M3#. &

'%#(%$&

!$%&$'(

! ! !

!"33&#)$7)33"'/)# E&7"0"#')&,0("#0,%(<&c#1/1 )+8&#$0)'+)#* E&2'(,"0(&%"#/,;"%&'%%1;,'("4<&c#1/1 (2'&,3.%2"'$/)',2 j&21#("#<&T#'04&M3#. &(4+"#"$/.''&, E&#"7,%("#"4&03#%"<&T#'04&M3#. ,)#*"')$/.3&"+)+ EV"7,%("#"4&Q3#%"<&T#'04&M3#. +&#*)$0&++ j&*"'4&15&(#',0,07 ,3"%2"#$0&++ j&"07,0""#,07&%32"#/,%1#<&c#1/1 !),3&))#$*&97/)# j&%"0,1#&#'4,17#'2*"#<&c#1/1 7)32+""#$!'"" j&;*,"5&15&;),0,;')&%"#/,;"% +)-'"#$.:2)#+.# j&*"'4&15&5,0'0;"

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&$'(#&) *'"'+'

!"#$%&'

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

B$7)'".+$6&'<5.'@5%>-1.,'?5C, T#'04& (3#.& *1%2,(')& *'%& #";",/"4& %1-"& *,7*& )"/")&2#',%"8 M*"& N1;.?3#0& M1+0& A"4,;')& N"0(#"& +'%& 4"%;#,?"4& '%& e"O(#"-")6& ,-2#"%%,/"$& ?6& 0"+& Q!Kc&?1%%<&m'0"('&J44"#)"6E93#(108 !"#&;1--"0(%&;'-"&43#,07&'&5';(E5,04,07& /,%,(&(1&(*"&K0("#!"')(*&N'0'4'E#30&5';,),(68 J5("#& ?",07& %*1+0& #1304& ?6& 03#%"& -'0E '7"#<& A")";.& N3--,07%<& %*"& %',4H& & IM*,%& ,%& '0&"O(#"-")6&,-2#"%%,/"&*1%2,(')&'04&(*"&5'E ;,),(,"%&'#"&"O;"))"0(&(118&K&*'/"&')%1&"0G16"4& )30;*&,0&(*"&*1%2,(')&#"%('3#'0(&+*,;*&K&*'/"& (1&%'6&+'%&+104"#53)8& Ib/"#610"&K&*'/"&-"(&43#,07&-6&(13#&*'%& ?""0& ?1(*& 5#,"04)6& '04& /"#6& .01+)"47"'?)"& '04&(*"&21("0(,')&*"#"&,0&T#'04&M3#.&,%&*37"8 IJ%&(*"&%"#/,;"&2#1/,4"#<&K&'-&)11.,07&51#E +'#4& (1& +1#.,07& ;)1%")6& +,(*& K0("#!"')(*& N'0'4'& (1& "0%3#"& (*'(& +"& '))& -""(& 2"12)"$%& "O2";('(,10%& 15& (*",#& ;130(#6$%& 0"+& *"')(*E ;'#"& %6%("-& '04& 2#1/,4"& f3'),(6& *"')(*;'#"& (1&'))8&

IK&'-&')%1&)11.,07&51#+'#4&(1&%"",07&*1+& (*"& N1;.?3#0& M1+0& A"4,;')& N"0(#"& ;'0& ?"& 3(,),F"4&53#(*"#&1/"#&(*"&;1-,07&-10(*%&'04& 6"'#%&(1&(*"&?"0"5,(&15&(*"&;1--30,(6&'%&+"& +1#.& (17"(*"#& (1& 2#1/,4"& '& ;"0(#"& 15& "O;")E )"0;"&*"#"&,0&T#'04&M3#.8L A"'0+*,)"& K0("#!"')(*& N'0'4'& ;*,"5& "OE ";3(,/"<& V17"#& N*""%-'0<& +");1-"4& A#%& J44"#)"6E93#(10& (1& *"#& 0"+& 21%(& '04& 2',4& (#,?3("&(1&*"#&2#"4";"%%1#<&9#,'0&!17'08 !"&'44"4H&IJ%&NbP&15&K0("#!"')(*&N'0'4'& '04&'&4,#";(1#&15&Q!K9<&K&+");1-"&A#%&J4E 4"#)"6E93#(10&10&?1'#48& I9#,'0&!17'0&*'%&304"#('."0&%("#),07&+1#.& 10&;#"'(,07&(*"&%6%("-%&15&Q!Kc&'04&%(""#,07& (*"&1#7'0,%'(,10&(*#137*&(*"&"'#)6&4'6%8&A#%& 93#(10&?#,07%&'&0"+&%"(&15&%.,))&%&'04&'&0"+& ;10;"2(3')&5#'-"+1#.&(1&(*"&21%(&15&NbP&15& Q!Kc&'04&+,))<&K&'-&%3#"<&?3,)4&10&(*"&%1),4& 51304'(,10%&A#&!17'0&*'%&;#"'("48&& IK0&-6&-""(,07%&+,(*&A#%&J44"#)"6E93#(10& K& *'/"& 51304& *"#& (1& ?"& '& /"#6& 460'-,;& '04& 2#17#"%%,/"&)'46&'04&K&)11.&51#+'#4&(1&+1#.E ,07&+,(*&*"#&,0&(*"&;1-,07&6"'#%8L&

+@487<@3$.6.78G

!$($6&)%)*+%8$9:*+#)$%1"-%"/%1,$%6()'' AbDbNC&'04&='((""&N3--,07%&'#"&?#,--,07& +,(*&2#,4"8 M*"& 2#134& 2'#"0(%& *'/"& G3%(& %""0& (*",#& 4'37*("#&A")";,'&7#'43'("&5#1-&%;*11)&+,(*& %1-"&5'0('%(,;&"O'-&#"%3)(%8 M*"& 61307%("#& +'%& '& %(34"0(& '(& (*"& P0"& T),0(10& c#,-'#6& :;*11)& ,0& T#'04& M3#.& '04& ';*,"/"4&'0&13(%('04,07&_[8_]&2"#;"0(&,0&*"#& TE:'(&"O'-8 N1;.?3#0& M1+0& A"4,;')& N"0(#"& 03#%"& -'0'7"#<&A")";.<&%',4H&I>"&'#"&%1&2#134&15& 13#& ?"'3(,53)& 4'37*("#& '04& ;107#'(3)'("& *"#&

10&7#'43'(,10&'04&"O'-&#"%3)(%8L A")";,'&,%&01+&)11.,07&51#+'#4&(1&G1,0,07& *"#&?#1(*"#&'04&5#,"04%&'(&!&h&V1?,0%10&!,7*& :;*11)8 N107#'(3)'(,10%&'#"&')%1&43"&(1&="EJ04#'"& 9#1+0<&%10&15&T#'04&M3#.&03#%"<&K0"(("&9#1+08 M*"& WWE6"'#E1)4& %;*1)'#<& +*1& ,%& (*"& /')"E 4,;(1#,'0&51#&Q"+&A'0X%&c#"2'#'(1#6&:;*11)<& +'%& '01(*"#& 61307%("#& +*1& 7#'43'("4& +,(*& 13(%('04,07&#"%3)(%8 ="EJ04#'"& ,%& '0& '%2,#,07& %;,"0(,%(& '04& *"& 7,/"%&;#"4,(&(1&T14&51#&*,%&';*,"/"-"0(8

c!JVAJN`& (";*0,;,'0<& V'0G,& b?'0.%& ;'0X(&%(12&%-,),078 J5("#& -10(*%& ),/,07& 10& *,%& 1+0& ,0& T#'04& M3#.<& *"& *'%& 01+& ?""0& G1,0"4& ?6&*,%&5'-,)6&10&'&2"#-'0"0(&?'%,%8 >,5"& l#'0;,('& l#'0;,%Eb?'0.%& '04& 4'37*("#%& V"0"%"& n^o& '04& V"0'"& nWo& *'/"&'##,/"4&5#1-&:(&N'(*"#,0"&h'-',E ;'8 \K(X%&7#"'(&(1&*'/"&-6&5'-,)6&*"#"&'(& )'%(\<&%',4&V'0G,8&\J?%1)3(")6&5'0('%(,;8\

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

,-./0123$.1244$5-67$1-$208$-4$9:;;052<7$=05106. J& TVPBc& 15& K0("#!"')(*& N'0'4'& +1#."#%& *'/"& ?""0& *")2,07& +,(*& (*"& ;)"'#E32& "551#(& 51))1+,07&!3##,;'0"&K#"0"8 =1;(1#%<& 03#%"%<& 5';,),(,"%& '04& '4-,0,%(#'E (,10&%('55&7'/"&32&(*",#&+""."04&(1&/1)30(""#& +,(*&(*"&MNK&V"4&N#1%%8 M*"& ?,7E*"'#("4& ?30;*& *"'4"4& (1& l,/"& N'6%&(1&'%%"%%&4'-'7"&(1&2"12)"$%&*1-"%&'04& *'04&13(&',4&+*"#"&0""4"4&'04&155"#&-"4,E ;')&'4/,;"8 b07,0""#,07& '%%,%('0(<& :("2*"0& A;=10E 0"))<&%',4H&I!'/,07&71(&(*#137*&(*"&*3##,;'0"& 30%;'(*"4<&K&(*,0.&-'06&15&3%&G3%(&+'0("4&(1& *")2&(*1%"&)"%%&51#(30'("&(*'0&13#%")/"%8 I=1,07& /1)30(""#& +1#.& 51#& (*"& V"4& N#1%%& +'%&G3%(&10"&%-'))&+'6&+"&;13)4&'%%,%(&'04&K& (*,0.&+"&+"#"&'))&/"#6&*3-?)"4&?6&+*'(&+"& %'+8 Ic"12)"$%& ),/"%& *'/"& ?""0& (3#0"4& 32%,4"& 41+0& ?6& !3##,;'0"& K#"0"& '04& ,(& ;"#(',0)6& -'."%&613&'22#";,'("&+*'(&613&*'/"8&93(&,(& +'%& 01& %3#2#,%"& (1& %""& %1& -'06& K0("#!"')(*& N'0'4'&%('55&13(&(*"#"&*")2,07&?";'3%"&*1%2,E (')&2"12)"&'#"&;'#,07&2"12)"8L J-107&(*1%"&'%%,%(,07&(*"&',4&"551#(&+"#"& =#&V1?60&9'#0"%<&c"("#&Q,;*1)%10<&C'(*)""0& 9#""<&Q,;.,&A3)),0%<&l,10'&A;=100"))<&m"0'& M#',01#<&c'3)&9'."#<&:("2*"0&A;=100"))<&J),E %10&c62"#&'04&Q1"#0,'&B),%%"%8

!"#$%&$'(#&) *'"'+'

!"#$%&'

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

D51,7&6('-+-2'3&#$4&.&3'+(' @)&6)$.&'B+##':&3$%+#'@&,(.& DKMMDb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nQKNBo8& 93(&51#(30'(")6&%*"&+'%&/"#6&';(,/"&'04&'))&(*"& %,70%&+"#"&/"#6&"0;13#'7,078 IJ07")& ,%& '& ?"'3(,53)& ),(()"& 7,#)& '04& 4"%2,("& +",7*,07&G3%(&_WS&7#'-%&nW)?&_1F%o&%*"&*'%&'& *,7*&;*'0;"&15&),/,07&'&2"#5";()6&01#-')&'04& *"')(*6& ),5"<& (*'0.%& (1& ?1(*& (*"& "O2"#(,%"& 15&

K0("#!"')(*& N'0'4'& %('55& '04& (*"& 5'0('%(,;& -"4,;')&5';,),(,"%&*"#"&,0&(*"&MNK8L J5("#& %2"04,07& *"#& 5,#%(& 5"+& *13#%& ,0& (*"& QKNB<&J07")&+'%&5)1+0&+,(*&-3-&(1&Q'%%'3& 51#&53#(*"#&(#"'(-"0(8 IJ07")&+,))&01+&304"#71&'0&"O("0%,/"&2"E #,14&15&;'#"&,0&(*"&9'*'-'%L<&'44"4&=#&:1)"#<& I'5("#& +*,;*& %*"& +,))& ?"& '))1+"4& (1& #"(3#0& +,(*&N1))"0"&(1&N*"%*,#"&*'))8 IK(& ,%& ),.")6& %*"$))& ?"& ,0& Q'%%'3& 51#& 5,/"& +"".%&'04&%*"&+,))&10)6&?"&'))1+"4&?';.&(1& c#1/1&10;"&%*"&,%&?#"'(*,07&30',4"4&'04&"'(E ,07&?6&-13(*8 IK0&(1(')&%*"&+,))&2#1?'?)6&%2"04&'?13(&WS& +"".%&,0&*1%2,(')&?"(+""0&(*"&9'*'-'%&'04& *"#"8L P0;"& ?';.& '(& N*"%*,#"& !'))<& N1))"0"& +,))& ?"& ('37*(& (*"& #"/1)3(,10'#6& C'07"#11& N'#"& 2#1;"43#"&(*'(&+'%&,0(#143;"4&(1&(*"&MNK&?6& K0("#!"')(*&N'0'4'&"'#),"#&(*,%&6"'#8 =#& :1)"#& "O2)',0"4H& IC'07'#11& N'#"& ,%& '& +'6& 15& ("';*,07& 2'#"0(%& (1& ?104& +,(*& (*",#& ?'?,"%&(*#137*&(13;*,07&%.,0&(1&%.,08&

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e?#,)),'0(& +1#.$8 :*"&%',4H&\K&'-&%1&2#134&15&13#&"-"#7"0;6& ("'-<&+*1&+1#."4&%1&*'#4&43#,07&J07")$%&5,#%(& 5"+&-,03("%&15&),5"8 IM*1%"&5,#%(&-,03("%&'#"&2'#(&15&(*"&e71)4"0& *13#$<&+*,;*&*'%&'&4,#";(&,-2';(&10&(*"&?'E ?6$%&f3'),(6&15&),5"8 IM*"6&'#"&30%307&*"#1"%&'04&*"#1,0"%&,0& '04&K&+13)4&),."&(1&(*'0.&'))&(*"&("'-<&"%2"E ;,'))6&03#%"&:"#7,1&JF"/"41<&A'#'&:'04"#%10<& :3"&!1+"&'04&=#&9#,47"(&l#""-'08L

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

D51'+$,;(',5()$,7' -1('+'<51,3'357

B/@.<0@8<$<.H:@=$-.A@$ H@@8$<4/8@3$;5/$#@HH7@ JlMbV&6"'#%&15&2'-2"#,07&'04&23--")E ,07&(*"&7114&2"12)"&15&MNK<&(*"&('?)"%&'#"& '?13(& (1& ?"& (3#0"4& 51#& ="??,"& l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j& (*'0.&6138 I:*'#"")& ,0/,("4& -"& #1304& (1& *"#& 2)';"& '04& %1& K& +"0(& 1/"#& (*,0.,07& ,(& +13)4&?"&-"&'04&*"#&;*'((,07&1/"#&%1-"& G"#.&;*,;."08&K0%("'4<&(*"#"&+"#"&)1(%&15& 2"12)"& (*"#"& ;")"?#'(,07& -6& ?,#(*4'6& '04&,(&+'%&'&#"'))6&%2";,')&%3#2#,%"8 IM*"&7,5(&+'%&'&+104"#53)&7"%(3#"&(11& '04&K&'-&%1&)11.,07&51#+'#4&(1&*'/,07&-6& (#"'(-"0(8& K& +,))& (*,0.& 15& 613& '))& +*"0& K& 41&'04&'7',0<&K&(*'0.&"';*&'04&"/"#6&10"& 15&613&51#&-'.,07&,(&'&?,#(*4'6&(1&#"-"-E ?"#8L

KM&>J:&?1304&(1&*'22"0<&+'%0$(&,(U K5&,(&*'40$(&?""0&A'#6&h1&,(&;13)4&+"))&*'/"& ?""0&V17"#8&J04&,5&01(&V17"#&(*"0&2#1?'?)6& l,10'&1#&:3F'00"8 >*'(&'#"&+"&(').,07&'?13(<&K&*"'#&613&;#68 c1(;'."%&15&;13#%"8&:2"04&(11&-3;*&(,-"& ,0&(*"&;1-2'06&15&(*"&'?1/"&0'-"4&f3'#("(& '04&;*'0;"%&'#"&613$))&"04&32&5,04,07<&5')),07& ,0&)1/"&+,(*&'04&1+0,07&'&;3("&),(()"&232268 J04& (*'($%& "O';()6& *1+& ,(& +'%& 51#& :'#'*& !"(*"#,07(10<& +*1& #";"0()6& %2"0(& %,O& +"".%& +1#.,07& 51#& K0("#!"')(*& N'0'4'& MN& ')107E %,4"<& '04& ;1/"#,07& 51#<& Ah& ,0& -'("#,')%& -'0E '7"-"0(8 M*"&2',#&'#"&51#-"#&;1))"'73"%&,0&N'0'4'& '04&+*"0&Ah&'##'07"4&(1&#"(3#0&*1-"&51#&(*"& ?,#(*&15&*"#&5,#%(&7#'04&;*,)4<&%*"&,--"4,'(")6& ;'))"4&10&:'#'*&51#&*")28 IK&+'%&4"),7*("4&(1&#";",/"&Ah$%&;'))L<&"OE 2)',0"4&:'#'*<&I'04&+'%&(*#,))"4&'04&"O;,("4& (1&?"&155"#"4&(*"&;*'0;"&(1&;1-"&(1&MNK&'04& +1#.&51#&K0("#!"')(*8 IAh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b/"#610"& .01+%& Ah& )1/"%& 417%& '04& ,(& -3%(&155&#3??"4&155&10&-"&?";'3%"&K&*'/"&'4E 12("4& '& c1(;'."& ;'))"4& M3#.8& !"$%& 7#"'(& 530& '04&*"&+,))&#"-,04&-"&15&-6&(,-"&,0&MNK&"/E

"#6&%,07)"&4'68L :'#'*<&+*1%"&*3%?'04&='0,")&'04&WWE6"'#E 1)4&%10<&C6)"<&%2"0(&%1-"&(,-"&,0&c#1/1&(11<&,%& *12,07&(1&#"(3#0&(1&(*"&,%)'04%&+*"0&Ah&0"O(& 4";,4"%&%*"$%&43"&'&/';'(,108

!"#$%&&&'$( !"#$%&'(#$(#AB0#--#+$)*+$-"#$,(-#+.#/0-"$1/(/2/$!1,$3-/))

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

,334%$56$7$8%1%9:%;$<5==

!"#$%&

!"#$%& !"!#$%&"!'!%()*'

%(%+!',-+'%#!.' $%/0%#1)"+!"#$%&

!"#$%&"' ()*+,% ' -*%##'./)'012'

% $ # # " ! ,)+ * ) ( # ' &

!"#$%&#'($&)*&+,$%#-+(+.+#!-#/$+00

.31'4566'.)&$/')7' +/)1%'(&%23$ !"#$%'(

!"#$%&'()*+,)-) .%/%!&$!/)/#$, !"#$%')

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&'()$*++&'),-.$/&$/"#$0*/'&45'6%'%6/+7$,)

!"#$%&'#$()

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

*+,%-$."+$%,"/%-/,)

M",($ *99$ ,()$ B(+"7,1*7$ D*+,")7$ /&1"5.$ 'D=$ 2$ #)/"#)#$2$5))#)#$*$5):$D*+,%$#+)77<$ 25$&5)$&0$,()$/9&,("5.$7,&+)7$"5$A*9,1"997$,()$ &,()+$#*%=$2$*76)#=$G1*%$2$,+%$&5$,(*,$#+)77$"5$ ,()$:"5#&:=$D9)*7)4H GB)+,*"59%$ 5&,=$ 1*#*1H=$ +)7D&5#)#$ ,()$ 7*9)7."+9=$ G%&'N99$ (*;)$ ,&$ '7)$ ,()$ 0",,"5.$ +&&1$ 9"6)$);)+%&5)$)97)<H

0$1%(/+2$"3

2$7*:$!+$K&-%5$O*+5)7$,()$&,()+$$5".(,$*5#$ *76)#$()+$:(*,$&'+$5):$D9*7,"/$7'+.)&5$:*7$ 9"6)< A()$7*"#$()L#$+*"7)$*$0):$)%)-+&:7<

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

89%:$'("3(%6"% ;$<"#$%'%0/+($

U<$ S*%7$ -),,)+$ ,(*5$ 0*7,$ 0&&#=$ ,(&'.($ ,()$ (&'+7$*+)5N,$*7$.&&#<$ ]<$ ^*7("&5*-9)$ 7(&)7$ *5#$ 7)[%$ :(",)$ '5"@ 0&+17<$ _<$ C))#9)7F$2,N7$-),,)+$,&$.";)$,(*5$,&$+)/)";)<$ `<$ K)*77'+)$ %&'+$ D*,")5,7$ ,(*,$ *99$ -9))#"5.$ 7,&D7<<<<);)5,'*99%<$ a<$ I[D&7)$%&'+7)90$,&$+*+)=$)[&,"/=$b$)[/","5.$ 5):$#"7)*7)7<$ c<$ 25,)+)7,"5.$*+&1*7<$ d<$ !&$ )5&'.($ /(*+,"5.$ ,&$ 5*;".*,)$ *+&'5#$ ,()$:&+9#<$ e<$ B)9)-+*,)$ ,()$ (&9"#*%7$ :",($ *99$ %&'+$ 0+")5#7<<<<<*,$:&+6<$ f<$ 3*6)$ /&10&+,$ ,(*,$ 1&7,$ &0$ %&'+$ D*,")5,7$ 7'+;";)$5&$1*,,)+$:(*,$%&'$#&$,&$,()1<$ UV<$B&'+,)&'7$ *5#$ "50*99"-9)$ #&/,&+7$ :(&$ *9@ :*%7$9)*;)$/9)*+$&+#)+7$"5$D)+0)/,9%$9)."-9)$ (*5#:+","5.<$

=">$+%/?%?@$'($)

!'+"5.$1%$+&'5#7$*,$,()$B()7("+)$?*99$1)#"@ /*9$B)5,+)$,()$&,()+$#*%=$2$"#)5,"0")#$*$#)0"5",)$ ,+*"5"5.$5))#< O',$5&,$&5)$0&+$7,*00gg0&+$D*,")5,7< 2$ 0&99&:)#$ ,("7$ D&&+$ .)5,9)1*5$ #&:5$ ,()$ /&++"#&+$*5#$2$(*;)$,&$7*%$2$:*7$-9'7("5.$-%$ ,()$,"1)$2$+)*/()#$1%$#)7,"5*,"&5\ X)1&$,&$7)90F$S+&#'/)$*$9)*09),$"57,+'/,"5.$ D*,")5,7$(&:$,&$D',$&5$.&:57$D+&D)+9%\\

AB:CD%EFGF90

87$ );)+%&5)$ 65&:7=$ ()*9,(/*+)$ /&7,7$ (*;)$ -))5$ ,()$ 7'-R)/,$ &0$ 1'/($ #)-*,)$ "5$ +)/)5,$ :))67=$()+)$"5$,()$3B2< 25$0*/,$,()$.&;)+51)5,$()9#$*$D'-9"/$/&5@ 7'9,*,"&5$)[)+/"7)=$"5;","5.$+)7"#)5,7$,&$/&1)$ 'D$:",($1&5)%$7*;"5.$"#)*7< h&,7$&0$7'..)7,"&57$:)+)$+)/)";)#=$:",($,()$ -)7,$5&:$'5#)+$/&57"#)+*,"&5< O',$&5)$,(*,$D+&-*-9%$:&5L,$.&$*5%$0'+,()+$ "7$*$D+&D&7*9$0&+$+)0&+17$"5$,()$(&7D",*9$+*#"@ &.+*D(%$#)D*+,1)5,7< 8$7&'+/)$/9&7)$,&$,()$.&;)+51)5,$,&9#$25@ ,)+E"):F$ GM()5$ :)$ &D)5)#$ &5)$ &0$ ,()$ )5@ ;&9D&)7$0+&1$,()$D'-9"/$,()+)$:*7$*5$*#;)+,$ P7))$*-&;)Q$)5/9&7)#< G2,$:*7$0&+$iU$[@+*%$7D)/7$:",($*$5&,)$7*%@ "5.$ ,()$ (&7D",*97$ /&'9#$ '7)$ ,()7)$ "57,)*#$ &0$ )[D)57";)$)Y'"D1)5,$7'/($*7$XK2$7/*55)+7<H 87$ 2$ 7*%=$ ",L7$ *$ D+&D&7*9$ ,(*,$ "7$ '59"6)9%$ ,&$ 7))$,()$9".(,$&0$#*%gg<&+$:"99$",4$M*,/($,("7$ 7D*/)\

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

(

!"#$%&&&'$(

!""#$%&'()**+',&--"'()*('. ;D%:9HI:%=!IIGJC0% =I9K%F0*I:!ICL*!%=C0CMC%*=

2,L7$!)/)1-)+$*5#$B(+"7,1*7$"7$0*7,$*DD+&*/(@ "5.<$$2,$/)+,*"59%$#&)7$5&,$7))1$9"6)$*$%)*+$(*7$ D*77)#$7"5/)$:)$*99$1),$"5$,()$/*+$D*+6$0&+$*$ OOj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eVV$.1$PU<dc$9-7Q$5)&5*,)<$$B&5.+*,'9*@ ,"&57$.&$,&$,()$5)&5*,&9&.%$,)*1<$$M)$(*;)$ *97&$-))5$;)+%$*/,";)$"5$+)#'/"5.$,()$5'1-)+$ &0$D*,")5,7$.&"5.$&;)+7)*7$*5#=$"5$,()$+)/)5,$ D*7,=$ +),*"5)#$ *$ D&,)5,"*9$ 5)'+&7'+."/*9$ D*@ ,")5,$&5$"79*5#$-%$/9&7)$/&&+#"5*,"&5$:",($,()$ 5)'+&7'+.)&5$ "5$ ,()$ O*(*1*7<$ $ 87$ :)$ 9&&6$ ,&:*+#7$]VU]=$,()$3'+67$b$B*"/&7$279*5#7$.&;@ )+51)5,$ *DD)*+$ ,&$ -)$ 7,+&5.9%$ /&57"#)+"5.$ *##","&5*9$"5;)7,1)5,$"5$7)+;"/)7$*,$,()$3'+67$ b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k)*+$ ]VUU$ *5#$ ,()$ .*"5"5.$ &0$ k)*+$ ]VU]$ :"99$ -+"5.$ :",($ ",$ 5):$/(*99)5.)7$*5#$,+"'1D(7<$$8,$,("7$7,*.)=$ ",$ 9&&67$ *7$ "0$ )*+9%$ ]VU]$ :"99$ -+"5.$ :",($ ",$ *$ 5'1-)+$&0$()*9,($,&'+"71$*5#$+);)5')$.)5@ )+*,"5.$D+&R)/,7$,&$,()$3'+67$b$B*"/&7$279*5#7<$$ 3("7$:"99$"5;&9;)$-&,($B()7("+)$?*99$X)#"/*9$ B)5,+)$*5#$B&/6-'+5$3&:5$X)#"/*9$B)5,+)<$ S)+(*D7$&5)$&0$,()$1*R&+$);)5,7$"5$]VU]$ :"99$-)$,()$.*"5"5.$&0$8//+)#",*,"&5$"5$X*+/(F$ !&$5&,$#&'-,$,(*,$:)$:"99$.),$",<$$J5)$&0$&'+$ 5):$ D)&D9)=$ !&55*$ ?',,&5$ "7$ :&+6"5.$ :",($ '7$*99$,&$)57'+)$,("7$(*DD)57<$$M)$1'7,$*97&$

+)1)1-)+$,()$)[,+)1)9%$(*+#$:&+6$&0$o)5*$ 3+*"5&+$ *5#$ >*5)$ X)*9)%$ "5$ ,("7$ *+)*$ &0$ &'+$ :&+6< 3()$.*"57$1*#)$"5$,()$9*7,$%)*+$*+)$#&:5$ ,&$ ,()$ )00&+,7$ 1*#)$ -%$ %&'$ *99<$ $ 3()+)$ "7$ "5@ /+)#"-9)$ ,)*1:&+6$ .&"5.$ &5$ ,(*,$ 1*6)7$ 1)$ D+&'#$,&$-)$*,$,()$()*#$&0$&'+$71*99$-',$#%@ 5*1"/$ (&7D",*9<$ 3(*56$ %&'$ &5)$ *5#$ *99$ 0&+$ %&'+$ */,";",")7$ *5#$ 7'DD&+,$ "5$ */(");"5.$ ,()$ *"17$&0$,("7$(&7D",*9<$

2$:&'9#$9"6)$,&$:"7($*99$,(&7)$&0$&'+$5'1@ -)+7$:(&$/)9)-+*,)$",$*$;)+%$1)++%$B(+"7,1*7=$ :()+);)+$,()%$1*%$-)$/)9)-+*,"5.$",<$$3&$&5)$ *5#$*99=$2$:"7($%&'$*$;)+%$(*DD%$*5#$D+&7D)+@ &'7$]VU]< M)$7*%$.&&#-%)$,&$]VUU$-',$9&&6$0&+:*+#$ ,&$,()$/(*99)5.)7$*5#$7'//)77)7$,()$5):$%)*+$ :"99$-+"5.< ?)99&$]VU]$\\

01234567)25688)69:)513)18)5;:)<7622 8$lKJmS$&0$()*9,(/*+)$D+&0)77"&5*97$*+)$ /)9)-+*,"5.$D)+0)/,$)[*1$+)7'9,7< 3()$ 25,)+?)*9,($ B*5*#*$ :&+6)+7$ 7/&+)#$ UVV$ D)+$ /)5,$ D*77)7$ "5$ ,()"+$ 0"+)$ 7*0),%$,)7,7< 899$7,*00$*,$-&,($,()$B()7("+)$?*99$*5#$ B&/6-'+5$3&:5$X)#"/*9$B)5,+)7$*+)$'5@ #)+.&"5.$ 7D)/"*9"7,$ ,+*"5"5.=$ '5#)+$ ,()$ )[D)+,$,'","&5$&0$3B2$^"+)$*5#$K)7/')=$#"@ ;"7"&5*9$7'D)+;"7&+=$n);"5$3'009)%< ?)$ )[D9*"5)#F$ G25,)+?)*9,($ +)Y'"+)$ ,(*,$ *99$ ",L7$ D)+7&55)9$ *+)$ ,+*"5)#$ "5$ 0"+)$ 7*0),%$ 76"997$ *5#$ D+&/)#'+)7<$ 3()$ 7,*5@ #*+#7$,*'.(,$*+)$;)+%$(".($*5#$"5$*//&+@ #*5/)$:",($8//+)#",*,"&5$B*5*#*=$:("/($ ,()$(&7D",*97$*+)$:&+6"5.$,&:*+#7< $ G3()$ *"1$ "7$ ,&$ )57'+)$ ,(*,$ (&7D",*9$ 7,*00$*/(");)$'5"0&+1",%$"5$,()"+$*DD+&*/($

,&$ &D)+*,"&5*9$ +)Y'"+)1)5,7$ *5#$ ,(*,$ ,()"+$ /&99)*.')7$ *5#$ ,()$ .)5)+*9$ D'-@ 9"/$ +)/)";)$ ,()$ -)7,$ D&77"-9)$ .'"#*5/)$ 7(&'9#$*5$"5/"#)5,$);)+$&//'+< G3()$ +)7D&57)$ ,&$ ,+*"5"5.$ (*7$ -))5$ *-7&9',)9%$ ,+)1)5#&'7$ *5#$ 2$ :&'9#$ 9"6)$ ,&$ /&11)5#$ *99$ ,(&7)$ :(&$ (*;)$ ,*6)5$ D*+,$7&$0*+<H 3(&7)$ 7/&+"5.$ ,&D$ 1*+67$ "5$ ,()"+$ )[@ *17$ :)+)$ I9)*5&+$ ?*99=$ C&)1"*$ ^"9"D)$ m9"77)7=$ 85,&"5),,)$ !*;"7@3+*"9=$ A*5#")$ M"99"7=$ >)55"0)+$ X*7/"9*,=$ ?*%#))$ K*;"W$ !*%'D*%$*5#$X*.#*9)5*$M*9#5)+< S"/,'+)#$ +)/)";"5.$ ,()"+$ /)+,"0"/*,)7$ 0+&1$ 25,)+?)*9,(L7$ n*,(9))5$ O+))=$ 7)/@ &5#$ 9)0,=$ *+)=$ 9)0,$ ,&$ +".(,=$ I9)*5&+$ ?*99=$ 85,&"5),,)$!*;"7@3+*"9$*5#$C&)1"*$^"9"D)$ m9"77)7<

)

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&$'(#)*'""+,"-$*-+.#/-,##0"1*2%+2+.'(. 2C3IK?I8h3?$B*5*#*$:"99$-)$#&"5.$*99$",$/*5$ ,&$()9D$+)#'/)$()*9,(/*+)$/&7,7$"5$,()$3B2< 3()$ D9)#.)$ /&1)7$ *0,)+$ ,()$ l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l&;)+51)5,$ "7$ :&+6"5.$ '5#)+$ 7);)+)$ 0"5*5@ /"*9$/&57,+*"5,7$*5#$+)7,+*"5,7< GM)$ *//)D,$ *5#$ */65&:9)#.)$ ,(*,$ ,()7)$ /&57,+*"5,7$*5#$+)7,+*"5,7$*97&$*DD9%$,&$()*9,(@ /*+)$*5#$7&$:)$*+)$:&+6"5.$:",($,()$l&;)+5@

1)5,$ &5$ D&,)5,"*9$ /&7,$ /',,"5.$ *5#$ +);)5')$ 1*6"5.$1)*7'+)7$,(*,$/*5$-)$"1D9)1)5,)#$"5$ ,()$5)*+$0','+)$*5#$"5$,()$9&5.)+$,)+1< G3()+)$ 7(&'9#$ -)$ 5&$ #&'-,$ ,(*,$ 25,)+@ ?)*9,($ B*5*#*=$ ,()$ l&;)+51)5,=$ ,()$ X"5@ "7,+%$ &0$ ?)*9,($ *5#$ C?2S$ *+)$ :&+6"5.$ (*+#$ ,&.),()+$,&$()9D$+)#'/)$,()$.9&-*9$()*9,(/*+)$ /&7,7$"5$,()$3B2< !)7D",)$ 7,*,)1)5,7$ "5$ ,()$ 1)#"*$ 7'..)7,@ "5.$ ,(*,$ ,()$ /&5,+*/,$ -),:))5$ ,()$ l&;)+5@ 1)5,$*5#$25,)+?)*9,($B*5*#*$/&'9#$-)$+)5)@ .&,"*,)#=$!+$B())71*5$+);)*9)#$,("7$:*7$5&,$ *5$&D,"&5< G2,$ (*7$ -))5$ 0+)Y')5,9%$ *76)#$ "5$ +)/)5,$ :))67$ :(),()+$ ,()$ /&5,+*/,$ -),:))5$ ,()$ l&;)+51)5,$*5#$25,)+?)*9,($B*5*#*$"7$.&"5.$ ,&$-)$+)5).&,"*,)#H=$()$7*"#<$G2L1$*0+*"#$,("7$ "7$/&1D9),)9%$,()$:+&5.$D(+*7)$-)/*'7)$,()$ /&5,+*/,$(*7$5);)+$-))5$'D$0&+$+)5).&,"*,"&5<$ GM(*,$#&)7$)["7,$:",("5$,()$*.+))1)5,$"7$ ,()$0*/"9",%$,&$+)Y')7,$/(*5.)$*5#$,(*,$"7$:(*,$ :)$*5#$,()$l&;)+51)5,$*+)$#&"5.$p$+);"):@

*$++%,-.$/

(89:;<=>?<=@89A'<9B'CD?DE;<=@89A 2^$kJm$(*#5L,$.')77)#$",$*9+)*#%=$&'+$0*;&'+",)$ :&+#$()+)$*,$25,)+E"):$"7$/&5.+*,'9*,"&57< M)$ 9&;)$ 7*%"5.$ ",$ *5#$ ()+)L7$ *5&,()+$ &DD&+,'5",%$,&$#&$7&< B&5.+*,'9*,"&57$ ,&$ 25#"+*$ ?*++"7$ 0+&1$ ,()$ X!K$ #)D*+,1)5,$ 0&+$ +)/)5,9%$ *,,*"5@ "5.$()+$B)+,"0")#$257,+'1)5,$AD)/"*9"7,$7,*@ ,'7$*,$,()$+)/)5,$)[*17<$

BIJ=$ K&.)+$ B())71*5=$ 7*"#F$ G25#"+*L7$ 7'//)77$"5$,("7$"7$*5$)[*1D9)$,&$'7$*99$&5$ ,()$ ;*9')7$ &0$ ,*+.),)#$ )#'/*,"&5$ ,&$ 5&,$ &59%$ ,()$ D)+7&5$ -)"5.$ )#'/*,)#$ -',$ *97&$ ,()$/&1D*5%$,()%$:&+6$:",(<$ G?)+$*/(");)1)5,$-+"5.7$/+)#",$,&$-&,($ ()+$*5#$,()$/&1D*5%$*5#$:)$/&5.+*,'9*,)$ ()+$&5$()+$7'//)77<H<

"5.$:(*,$/(*5.)7$/*5$-)$1*#)$,&$-)5)0",$,()$ /&7,$*5#$#)9";)+%$&0$()*9,(/*+)<H ?)$ *##)#F$ G3()$ 7/&D)$ &0$ :&+6$ "5$ -&,($ /)5,+)7$ p$ S+&;&$ *5#$ l+*5#$ 3'+6$ p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l+*5#$ 3'+6$ (&7D",*9$ :&'9#$-)$/9&7)#$"5$*$-"#$,&$7*;)$1&5)%$(*;)$ *97&$-))5$#"71"77)#< G3()$ B&/6-'+5$ 3&:5$ X)#"/*9$ B)5,+)$ "5$ l+*5#$3'+6$:"99$+)1*"5$&D)5$*5#$&D)+*,"&5@ *9H=$7,+)77)#$!+$B())71*5< GM)$(*;)=$(&:);)+=$*9:*%7$*//)D,)#$,(*,$ ,()+)$"7$,()$/*D*/",%$,&$',"9"7)$,()$/)5,+)$0'+@ ,()+$,(*5$"7$-)"5.$#&5)$7&$*,$,()$1&1)5,$*5#$ +);"):7$*+)$/'++)5,9%$'5#)+:*%< GA)+;"/)7$,(*,$*+)$-)"5.$/&57"#)+)#$"5/9'#@ )#$ ()*9,($ ,&'+"71$ *5#$ ,()$ D+&;"7"&5$ &0$ 9&5.$ ,)+1$/*+)< G8.*"5=$,()7)$"#)*7$*5#$D+&D&7*97$*+)$-)@ "5.$ #"7/'77)#$ -%$ 25,)+?)*9,($ B*5*#*=$ ,()$ l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

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

(89FD;D9CD'G8H'F8;'39=D;/D<?=I 8$?ml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h&,7$ &0$ D)&D9)$ D',$ *$ 9&,$ &0$ (*+#$ :&+6$ "5,&$ ,("7$ /&50)+)5/)$ *5#=$ &5$ -)(*90$ &0$ 25,)+?)*9,($ B*5*#*=$ 2$ ,(*56$ ,()1$ *99H=$ 7()$ *##)#< G3(*567$ ,&$ &'+$ 7D)*6)+7$ *5#$ D+)7)5,)+7=$ &'+$ #)9).*,)7=$ 7D&57&+7$ *5#$ *99$ ,(&7)$ #&5*,)#$ D+"W)7<$ G85#$ ,(*567$ *97&$ ,&$ *99$ *,$ O+*%,&5$ ?*99$ *5#$ ,&$ O)*/()7$ 0&+$(&7,"5.$&'+$0*5,*7,"/$);)5"5.$ );)5,7<H$ B&5.+*,'9*,"&57$,&$A'7*5$*5#$ ()+$,)*1$0&+$*$R&-$:)99$#&5)<

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&# '($)#"*$+ 3?Ik$ 7*%$ ,(*,$ :&1)5$ *+)$ )[D)+,7$ *,$ 1'9,"@ ,*76"5.ggR'7,$*76$*5%$:&1*5\ 85#$&5)$1)1-)+$&0$,()$0*"+)+$7)[$:(&$"7$ 9";"5.$D+&&0$&0$,(*,$"7$855)$X*9)7< 855)$ +)/)5,9%$ *++";)#$ "5$ 3B2$ ,&$ -&,($ +)@ D9*/)$ n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fd_<$80,)+$:&+6"5.$"5$,()$,&:5$(&7D",*9$0&+$ *$ 5'1-)+$ &0$ %)*+7=$ 7()$ 1&;)#$ ,&$ ,()$ X"#@ 9*5#7$*5#$,()5$&5$,&$25,)+?)*9,($B*5*#*$"5$ K'5/&+5< ?)+$ 0"+7,$ ;"7",$ ,&$ ,()$ 3B2$ /*1)$ -)0&+)$ ,()$ (&7D",*9$&D)5)#$:()5$855)$#"#$7&1)$D+&R)/,$ :&+6$0&+$25,)+?)*9,($B*5*#*$3B2$()+)< G2$*1$*$5'+7)$0"+7,$*5#$0&+)1&7,H=$7()$)[@

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

3+2*)+"+,%*4+%*5$50-'#$5*6'7"* !JB3JKA=$ 5'+7)7$ *5#$ /9"5"/*9$ 7,*00$ *99$ (*;)$ &5)$ ,("5.$ "5$ /&11&5$ p$ ,()%$ *+)$ *99$ 7D)/"*9=$ /*+"5.$D)&D9)<$ 20$,()%$:)+)5L,$,()%$:&'9#5L,$*5#$/&'9#5L,$ #&$,()"+$R&-7=$7"1D9)$*7$,(*,< A&1)$.&$);)5$0'+,()+$-%$'7"5.$,()"+$76"997$ ,&$()9D$&,()+7$"5$,()$/&11'5",%$&5$*$D'+)9%$ ;&9'5,*+%$-*7"7< M(%4$ M)99$ &5)$ ,("5.$ "7$ /)+,*"5q$ ,()%$ #&5L,$ #&$",$0&+$D+*"7)$*5#$+)/&.5","&5<$25$0*/,$,()+)$*+)$ *$ 5'1-)+$ &0$ /9"5"/*9$ 7,*00$ ()+)$ *,$ 25,)+?)*9,($ B*5*#*$ :(&$ .";)$ ,()"+$ ,"1)$ &',7"#)$ (&7D",*9$ (&'+7$0+))9%$:",(&',$*5%$&5)$);)+$65&:"5.< O',$ :()5$ */65&:9)#.1)5,7$ #&$ /&1)$ *9&5.=$,()%$*+)$*9:*%7$,(&+&'.(9%$#)7)+;)#< C&5)$ 1&+)$ 7&$ ,(*,$ ,()$ +)/&.5","&5$ +)@

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

BIJ=$ K&.)+$ B())71*5=$ 7*"#$ 25,)+?)*9,($ B*5*#*$ :*7$ D+&'#$ &0$ !*:5L7$ T*1*W"5.L$ */(");)1)5,7< GM)$*+)$:)99$*:*+)$&0$!*:5L7$9&5.$7,*5#@ "5.$/&11",1)5,$,&$,()$0".(,$*.*"57,$82!A$"5$ ,()$3B2H=$()$*##)#=$G*5#$,()$(*+#$:&+6$7()$ (*7$D',$"5$&;)+$1*5%$%)*+7< GM)$*+)$;)+%$D+&'#$&0$()+$*5#$/&5.+*,'@ 9*,)$()+$&5$,("7$,+'9%$*1*W"5.$*/(");)1)5,<H

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%!&'()' !"#$%&'(#)(*+,'

3-%*-"9%&:)++&?%6"$)+&3%#,9%&"#&D9/8/1&,-%&"*5 +)#6&(-%9%&*-%&()*&C/9#&)#6&C9%6>

5 79%%#>

!"#$%& '& ()*& +)*,& (",-& ./01& ,-%& 23'& -)*& )45 4/"#,%6&)&#%(&7/8%9#/91&:"*&;<$%++%#$.1&="$& 2/66> ?9& 2/66& *0$$%%6*& 7/96/#& @%,-%9"++&

:)++/(%%#> -)++&?%6"$)+&3%#,9%>

B%9/#& )+*/& C"6& )#& %<$%++%#,& 4"%$%& /8%9& ,-%& ,%+%4-/#%& (",-& =)6"/& 23'1& )++& )C/0,&

*%)*/#>

5 5 4+)"#%6>& A:/*4",)+& "*& #/,& )& #"$%& 4+)$%& ,/&

@%++&6/#%&,/&%8%9./#%&"#8/+8%6> &

)#6&'#,%9:%)+,-&3)#)6)1&4)**&/#&/09&$/#5 !)#69)& *)6+.& +/*,& -%9& *"*,%9& 9%$%#,+.& "#& )().>

='+N--$'3%4$@@3$((%4$$7% '3O%4"+@O%!$'+6%M', 2-%*%&(%9%&,(/&%8%#,*&,-),&(%9%&$%+%C9),5

5 5 4-.&49/$%609%>

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

/&01&2,'3&-&$145&2'0&25674-'06125 ?JAS238h$ 0&&#$ (*7$ 9&5.$ -))5$ ,()$ -',,$ &0$ R&6)7$*5#$(&++&+$7,&+")7$,()$:&+9#$&;)+< O',$,(*,L7$/)+,*"59%$5&,$,()$/*7)$()+)$"5$,()$ 3'+67$*5#$B*"/&7$279*5#7< K)^+)7(=$ 25,)+?)*9,($ B*5*#*L7$ /*,)+"5.$ *+1=$(*7$)*+5)#$+*;)$+);"):7$0&+$",7$,*7,%$&0@ 0)+"5.7$ 0+&1$ 7,*00=$ D*,")5,7$ *5#$ ,()$ .)5)+*9$ D'-9"/$*9"6)< 85#$,(*,$)[/)99)5,$+)D',*,"&5$(*7$-))5$0'+@ ,()+$)5(*5/)#$0&99&:"5.$,()$D&D'9*+$*55'*9$ B&5/($^)7,";*9$"5$S+&;&< m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r$*5#$%),$:)$*+)$/&1D),"5.$*.*"57,=$ *5#$ -)*,"5.=$ +)5&:5)#$ *5#$ )7,*-9"7()#$ 3B2$ +)7,*'+*5,7$ *5#$ +)7&+,7=$ *99$ &0$ :(&$ (*;)$ (*#$ %)*+7$&0$)[D)+")5/)$:&+6"5.$:",($/&5/(<

GJ'+$ 7'//)77$ '5#)+9"5)7$ ,()$ 7,+)5.,(=$ #)D,($*5#$Y'*9",%$&0$7)+;"/)7$D+&;"#)#$*,$,()$ (&7D",*9<$2,$:*7$*$0*5,*7,"/$)[*1D9)$&0$,)*1@ :&+6$*5#$2$*1$D+&'#$&0$);)+%$1)1-)+$&0$,()$ K)^+)7($,)*1<$ G2,$:*7$*$.+)*,$#*%=$*$.+)*,$*,1&7D()+)$*5#$ *$:&5#)+0'9$/+&:#<$S)&D9)$0+&1$*99$#"00)+)5,$ #)D*+,1)5,7$&0$,()$(&7D",*9$/*1)$&',$,&$()9D$ *5#$7'DD&+,$'7$*5#$2$*1$+)*99%$.+*,)0'9$0&+$);@ )+%&5)L7$0*5,*7,"/$7'DD&+,<H

85%&5)$:(&$#"#5L,$.),$/(*5/)$,&$;"7",$,()$ 0)7,";*9=$:)99$#&5L,$:&++%<$85"7($(*7$D+&1"7)#$ ,&$D',$,()$:"55"5.$#"7()7$&5$,()$+).'9*+$K)@ ^+)7($1)5'< 3()7)$"5/9'#)$,()$1&',(:*,)+"5.$7D)/"*9@ ",%$)5,+%=$B&5/($?*R"$:",($+)#$&5"&5$*5#$7D"5@ */(=$7)+;)#$:",($1"5,$*5#$/&+"*5#)+$/(',5)%$ *5#$O*1-*+*$+'1$7*'/)< B&5.+*,'9*,"&57$ ,&$ 85"7(=$ n)+&5=$ X"/(*)9$ *5#$*99$,()$K)^+)7($,)*1$&5$*$0*5,*7,"/$+)7'9,\

,!-).*/012#3&40/-&/#0-5&6)#'&).*$(7#$&8/ G8$3Kmhk$"1D+)77";)$(&7D",*9<H 3(*,L7$ (&:$ ,()$ 3B2L7$ 5):$ l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l&;)+5&+$"57D)/,)#$*$+*5.)$&0$#)D*+,@ 1)5,7$ "5/9'#"5.$ ,()$ )1)+.)5/%$ +&&1=$ +*#"@ &.+*D(%=$#"*9%7"7$*5#$,()$&D)+*,"5.$,()*,+)7< ?)$ *##)#F$ G2,L7$ -))5$ *5$ )5R&%*-9)$ *5#$ )#'/*,"&5*9$;"7",$0&+$1)<$2$(*;)$&59%$-))5$"5$ ,()$ /&'5,+%$ R'7,$ &;)+$ *$ :))6$ *5#$ );)+%&5)$ (*7$1*#)$1)$;)+%$:)9/&1)< GJ5)$,("5.$,(*,$7,*5#7$&',$"7$,()$0+")5#9"@ 5)77$ *5#$ )[D)+,"7)$ &0$ ,()$ 25,)+?)*9,($ B*5*@

#*$ 7,*00<$ 2,L7$ *5$ "5,)+5*,"&5*9$ &D)+*,"&5$ :",($ D)&D9)$(*;"5.$-+&'.(,$76"997$0+&1$*99$&;)+$,()$ :&+9#$ ,&$ :&+6$ *9&5.7"#)$ 9&/*9$ 1)#"/*9$ )[@ D)+,7<H l&;)+5&+$ 3&##$ :*7$ 7(&:5$ *+&'5#$

B()7("+)$ ?*99$ -%$ *$ .+&'D$ &0$ 7)5"&+$ 1*5*.@ )+7=$ "5/9'#"5.$ 25,)+?)*9,($ B*5*#*$ BIJ=$ !+$ K&.)+$ B())71*5=$ /(")0$ &0$ 1)#"/*9$ 7)+;"/)7=$ !+$K&-%5$O*+5)7$*5#$()*#$&0$I!=$!+$!)5"7)$ O+*",(:*",)<

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

9&--(#5&*-)#$'0#(::/01*$($*&-#.8)' 8A$ 2C3IK?I8h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l+*5#$3'+6=$0&+$*$/(*,<

PQC%1N65%M"33'%!/66"3

25,)+E"):F$$?)99&$!&55*<$M)9/&1)$,&$25,)+@ ?)*9,($B*5*#*$3B2<$M)$(&D)$%&'+$7,*%$()+)$ "7$*$(*DD%$*5#$7'//)770'9$&5)< !&55*F$ 3(*56$ %&'<$ 2$ *1$ #)9".(,)#$ ,&$ -)$ ()+)< !"#$%&'$()**A&$!&55*=$:(*,$)[*/,9%$"7$8/@ /+)#",*,"&5$B*5*#*$"7$*5#$:(%$",L7$7&$"1D&+@ ,*5,4 +,""-)$ G8//+)#",*,"&5$ B*5*#*$ "7$ *$ 5&,@ 0&+@D+&0",=$ "5#)D)5#)5,$ &+.*5"7*,"&5$ *//+)#@ ",)#$ -%$ ,()$ 25,)+5*,"&5*9$ A&/"),%$ 0&+$ j'*9",%$ "5$ ?)*9,($ B*+)$ P2Aj'*Q<$ 2,$ D+&;"#)7$ 5*,"&5*9$ *5#$ "5,)+5*,"&5*9$ ()*9,($ /*+)$ &+.*5"7*,"&57$ :",($ *5$ )[,)+5*9$ D))+$ +);"):$ D+&/)77$ ,&$ *7@ 7)77$*5#$"1D+&;)$,()$7)+;"/)7$,()%$D+&;"#)$,&$ ,()"+$D*,")5,7$*5#$/9")5,7$-*7)#$&5$7,*5#*+#7$ &0$)[/)99)5/)< !"#$%&'$()$$?&:$9&5.$(*7$",$-))5$.&"5.4 !&55*F$ 8//+)#",*,"&5$ B*5*#*N7$ D+&.+*17$ *5#$.'"#*5/)$(*;)$()9D)#$&+.*5"7*,"&57$D+&@ 1&,)$Y'*9",%$()*9,($/*+)$0&+$&;)+$aV$%)*+7<$ 25,)+E"):F$$M(*,$"7$%&'+$-*/6.+&'5#4 !&55*F$ 2L1$ *$ +)."7,)+)#$ 5'+7)$ :",($ `V$ %)*+7$&0$)[D)+")5/)$"5$()*9,($/*+)$"5$B*5*#*<$$ 2$ (*;)$ ()9#$ 1*5%$ D&7","&57$ "5/9'#"5.$ 7,*00$ 5'+7)$"5$J+,(&D)#"/7=$2Bm=$B9"5"/*9$257,+'/,&+$ "5$C2Bm=$BE2Bm=$B&+&5*+%$m5",=$C)'+&$2Bm$ *5#$l)5)+*9$A%7,)17$2Bm<$$2$:*7$,()$!"+)/,&+$ &0$ C'+7"5.$ *,$ ,()$ m5";)+7",%$ &0$ 89-)+,*$ ?&7@ D",*97$*7$:)99$*7$,()$B+&77$B*5/)+$257,",',)<$2$ :*7$ *97&$ ,()$ BIJs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

!)55"7=$ "7$ *97&$ *$ /&57'9,*5,$ *5#$ D+&;"#)7$ /&1D*5")7$ "5$ :)7,)+5$ C&+,($ 81)+"/*$ :",($ 2AJ$fVVV$/&57'9,*,"&5$"5$/&5R'5/,"&5$:",($*$ /&1D*5%$"5$,()$mn<$$ !"#$%&'$()$ $ A&$ :(*,$ *+)$ %&'$ #&"5.$ ()+)$ "5$3B24 +,""-)* 87$ *$ /&57'9,*5,$ :",($ 1*5%$ %)*+7$ &0$ )[D)+")5/)$ "5$ /&1D9),"5.$ 8//+)#",*,"&5$ B*5*#*$7'+;)%7=$2$*1$"5$S+&;&$*5#$l3$,&$7'D@ D&+,$25,)+?)*9,($B*5*#*L7$7,*00$,&$7'//)770'99%$ /&1D9),)$ ,()$ +)Y'"+)1)5,7$ 0&+$ *//+)#",)#$ 7,*,'7<$$$ !"#$%&'$()* * 85#$ (&:$ #&$ %&'$ .&$ *-&',$ */(");"5.$,("74 +,""-)$2$*1$1)),"5.$:",($7,*00$*5#$,)*17$ ,&$"#)5,"0%$:(*,$7,"99$5))#7$,&$-)$D',$"5$D9*/)=$ +)"50&+/)$ ,()$ "1D9*5,*,"&5$ &0$ D+&/)77)7$ ,(*,$ *9+)*#%$ )["7,$ *5#$ ()9D$ ,)*1$ 1)1-)+7$ *#@ #+)77$ ,()$ Y')7,"&57$ ,()$ 7'+;)%&+7$ 1*%$ *76$ :()5$ ,()%$ ;"7",$ "5$ X*+/(<$ $ X'/($ :&+6$ (*7$

*9+)*#%$-))5$#&5)$*5#$,()7)$,("5.7$5))#$,&$ -)$ 7(*+)#$ :",($ );)+%&5)$ 7&$ ,(*,$ :)$ *+)$ *99$ *:*+)$&0$:(*,$,()%$1)*5<$$B&11'5"/*,"&5$"7$ ,()$6)%$*5#$"50&+1*,"&5$:"99$-)$0&+,(/&1"5.$ ,(+&'.($,()$5):79),,)+$7&$7,*%$,'5)#$*5#$-)$ D*+,$&0$,()$D+&/)77< !"#$%&'$()$$27$",$R'7,$%&'$:&+6"5.$7&9)9%$&5$ 8//+)#",*"&5$ B*5*#*$ 1*,,)+7=$ &+$ *+)$ ,()+)$ &,()+74 +,""-)$2$,("56$);)+%&5)$"5$,()$(&7D",*9$"7$ :&+6"5.$ &5$ 7&1)$ *7D)/,$ &0$ 8//+)#",*,"&5g<$$ 3()$/&5,*/,$D)&D9)$"5$,()$(&7D",*9$*+)$o)5*$=$ >*5)$X)*9)%$*5#$1%7)90<$$ !"#$%&'$()$$?&:$9&5.$:"99$%&'$-)$()+)$0&+$ *5#$ (&:$ 9&5.$ "7$ ,()$ 8//+)#",*,"&5$ B*5*#*$ D+&/)774 +,""-)$2$*1$()+)$'5,"9$,()$)5#$&0$X*+/(<$ 3()$7'+;)%&+7$:"99$-)$()+)$0+&1$X*+/($Ue$p$ ]`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

8&94145&#'45':615,.

3)#&./0&,%++&(-/&"*&(-/E&

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

1!"#2344#$-# .!+5#'&56!*# !"#$%&#'(&!)*+,)#-!.+#/%!0 12"..

#%(&.%)9>

(3-

& & & &

& & & @%%&@"++. &

& & 3-%8.&3-)*% & &

& & & @-",% &

%)!'(#)

4566 (-+&3'-,

& & & &

7#/" /#)2&". 5

& & F%,-)+&@%)4/# & &

./0E 5 @%++&-%9%&(%&49/06+.&49%*%#,&'#,%95

& & & & 3+)9%#$%

5 ./0&-)8%&,/&6/&"*&,%++&0*&(-/&,-%.&)9%&,/& 5

& & F%,-)+&@%)4/# & & 5 & & ?"9)$+%&/#&GH,-&!,9%%, & & 2-%&!)#,)&3+)0*% & & !)#,)&@-/E

-/09*>

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&$'(#&) *'"'+'

#),-$2.

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&# '$(&&$'#!)# *(+",#$-(.

*-/0+6&-)8%&8)+0%> 5 %*4%$")++.&,-%&/#%*&,-),&./0&*04%98"*%&6"9%$,5

8'"'1$9$"#::;<)'#*0.*0#= 5

/#%> 5

5 5

5 )C+%&9%*/09$%*&(",-"#&,-%&"#,%9#)+&)#6&%<,%9#)+& 5

5 )#6&C/,-&)9%)*&)9%&$+/*%+.&"#,%9,("#%6&)*&,-%&

5 5

./0&$)#&C%&(-%#&./0&$)#1&(-%9%8%9&./0&$)#&

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

;01#<877#$*/0)#=&7>0/#&8$+

J@;=IB<H'=;D<=' F8;'KDAA@C<

h233h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

3?I$ /*+$ ,"+)$ 7(&D7$ &0$ ,()$ 3B2$ :"99$ 5);)+$ -)$ ,()$ 7*1)$ 0&99&:"5.$ 5):7$ &0$ *5$ 25,)+?)*9,($ B*5*#*$#)D*+,'+)< C)['7$ 1*5*.)+$ ?&9.)+$ ?*)79*+$ "7$ +),'+5@ "5.$,&$("7$(&1)9*5#$&0$l)+1*5%$*,$B(+"7,1*7=$ *0,)+$1&+)$,(*5$Ue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l8$ );)+%$:))6<H J5$ *$ 7)+"&'7$ 5&,)=$ >*1)7$ D*"#$ ,+"-',)$ ,&$ ?&9.)+L7$ T"11)57)$ ,*9)5,L$ *5#$ T0+")5#9%$ 5*@ ,'+)L< ?)$*##)#F$GM)$*+)$*99$;)+%$#"7*DD&"5,)#$ ,(*,$ ?&9.*+$ "7$ .&"5.<$ m50&+,'5*,)9%$ ("7$ #*#$ (*7$-))5$"99$-*/6$"5$l)+1*5%$*5#$()$5))#7$,&$ -)$:",($("7$0*1"9%< G?)$ "7$ &5)$ &0$ ,()$ 5"/)7,$ .'%7$ %&'$ /&'9#$ :"7($,&$1)),$&+$:&+6$:",(=$*5#$()$(*7$-))5$*$ ('.)9%$D&D'9*+$*5#$"1D&+,*5,$1)1-)+$&0$,()$

23$,)*1<$?"7$"11)57)$,*9)5,$*5#$)[D)+")5/)$ :"99$1*6)$("1$*$(*+#$1*5$,&$+)D9*/)< GJ5$ -)(*90$ &0$ *99$ ("7$ 0+")5#7$ *5#$ /&9@ 9)*.')7=$:)$:"7($("1$:)99$*5#$D+*%$,(*,$("7$ 0*,()+$1*6)7$*$0'99$*5#$7D))#%$+)/&;)+%<H 25#))#=$,()$3B2$:"99$-)$*$D&&+)+$D9*/)$:",(@ &',$ ?&9.+$ *5#$ 7&$ );)+%&5)$ *,$ ,()$ B()7("+)$ ?*99$ *5#$ B&/6O'+5$ 3&:5$ X)#"/*9$ B)5,+)7$ :"7($("1$*99$,()$;)+%$-)7,$0&)+$,()$0','+)<

85&9,&;<2';"5'&;"=>,'5"' ?&&9'@6;#4'A41B'6;'$&# h2C!8$ l"99$ (*7$ -))5$ "5$ ,&'/($ ,&$ 7*%$ T()99&$ *5#$ ,(*56$ %&'L$ ,&$ ()+$ )[@/&9@ 9)*.')7< 89&5.$ :",($ ('7-*5#=$ )5."5))+"5.$ *77"7,*5,=$ A,)D()5=$ ,()$ 0&+1)+$ ,+*"5"5.$ 1*5*.)+$$+),"+)#$0+&1$25,)+?)*9,($B*5@ *#*$3B$"5$A)D,)1-)+< 3()$ D*"+$ *+)$ 5&:$ )5R&%"5.$ 9"0)$ -*/6$ "5$ h*5/*7("+)=$ I5.9*5#=$ *9,(&'.($ ",$ (*7$ /&1)$*,$*$()0,%$D+"/)< h"5#*$ 7*"#F$ G2,L7$ :),$ *5#$ 0+))W"5.$ /&9#$ *5#$ :)$ *+)$ '7"5.$ ,:&$ #';),7$ &5$ ,()$ -)#\$ E)+%$ #"00)+)5,$ ,&$ ,()$ 3B2$ -',$ ",L7$.&&#$,&$-)$(&1)< GM)L+)$ 1"77"5.$ %&'$ *99$ *5#$ ,("56$ *-&',$%&'$*99$/&57,*5,9%<$$$3(*56$%&'$7&$ 1'/($ 0&+$ *99$ %&'+$ 7'DD&+,$ @$ %&'$ 1*#)$ &'+$,"1)$"5$,()$3B2$;)+%$7D)/"*9<$3(*567$ ,&&$0&+$&'+$-)*',"0'9$."0,7$:("/($:)$:"99$ /()+"7(< GM)$ :"99$ *9:*%7$ +)1)1-)+$ 3B2$ 0&+$ ,()$:&5#)+0'9$D)&D9)$%&'$*99$*+)<$h&;)$ ,&$%&'$*99<H

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&''()

)$*'+$ /,"#. ,-&#.$

*"+&$,((-.#&

!"#$%&'(%)*(+,)-.)/0$%")1"2'(%

8$ CmXOIK$ &0$ 5):$ D)+7&55)9$ (*;)$ R&"5)#$ ,()$ 25,)+?)*9,($ B*5*#*$ 3B2$ 0*1"9%$"5$+)/)5,$:))67< 3()7)$ "5/9'#)$ !&55*$ ?',,&5=$ :(&$ "7$:&+6"5.$*7$*$/&57'9,*5,$&5$8//+)#"@ ,*,"&5$B*5*#*$-'7"5)77=$*5#$8'7,+*9"*5=$ !)*5$!".(,=$:(&$(*7$R&"5)#$,()$D(*+@ 1*/%$,)*1< A*#9%=$ !)/)1-)+$ 5&,$ &59%$ 7))7$ '7$ 7*%"5.$ .&&#-%)$ ,&$ ]VUU=$ :)$ *+)$ *97&$ :*;"5.$ *$ -&5$ ;&%*.)$ ,&$ C)['7$ 1*5@ *.)+$?&9.*+$?*)79*+<

!"#$"%$& ./0!1*2!33.45/6 p$K)."7,)+)#$C'+7)

17!67/31*10/317! p$I!$S(%7"/"*5 5

+/881*2944/8 p

+:18:*+!;24 p$S(*+1*/"7,

13!<!1*.4977. p$B*,)+"5.$877"7,*5,$h)*;)+7$ 5

2/3;15*21:3.315 p$C)['7$1*5*.)+

*"+8%9&C)++*1&,/&6%$/9),%

(/0+6& -)8%& *%%#& ,-%& #%(& $/+/09%6& 5 5

5 5 5

I?'/@$66$(%2/NO$R

7)*&I>

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

>*?2$-0'(* @)%0.#9'.* @$($A%'#0+" B(+"7,1*7$"7$'7'*99%$*$,"1)$&0$/)9)-+*,"&5$*5#$ *$,"1)$&0$7(*+"5.<$3("7$B(+"7,1*7=$:)L99$7(*+)$ &'+$7D)/"*9$."0,7$:",($,()$25,)+()*9,($B*5*#*=$ 3B2$ 0*1"9%$ p$ ."0,7$ ,(*,$ :)+)$ #)9";)+)#$ ,&$ '7$ ,(+&'.($ ,()$ D*+,"/"D*,"&5$ &0$ ,)*17$ &5$ -&,($ 7"#)7$&0$,()$0)5/)<$ 3()$9&5.$(*'9$"5$l+*5#$3'+6$,&&6$,()$)0@ 0&+,7$&0$D)+7&57$*/+&77$,()$)5,"+)$7,+*,*$&0$,()$ B&/6-'+5$ 3&:5$ 0*1"9%$ 9)#$ -%$ *$ :&5#)+0'9$ &-7,),+"/"*5=$!+$l'"99)5=$:(&$5);)+$:*";)+$"5$ ("7$#),)+1"5*,"&5$,&$.),$'7$,(+&'.($*$,+)*/(@ )+&'7$D*,(<$ 3()$;"/,&+%$9*D$,&&6$'7$"5,&$B()7("+)$?*99$ :()+)$*5&,()+$.+)*,$,)*1$9)#$-%$!+7$85*+*$ b$ S)++%$ 7,))+)#$ '7$ ,(+&'.($ ,()$ ;*99)%$ *5#$ "5,&$*$:&5#+&'7$9".(,$p$&'+$,:&$-&%7$1*#)$ ",$,(+&'.($*5#$2$0&99&:)#$/9&7)$-)("5#< X%$('7-*5#$9"6)5)#$,()$);)5,$,&$*$7/)5)$ 0+&1$,()$IK$7)+")7$&5$,)9);"7"&5<$?)$:*7$"1@ D+)77)#$ *,$ ,()$ 9);)9$ &0$ D+)D*+)#5)77$ :()5$ :)$.&,$"5,&$B()7("+)L7$IK$*5#$&5:*+#<$87$*$ 1)1-)+$ &0$ 7,*00sD*,")5,=$ 2$ (*#$ ,()$ &DD&+,'@ 5",%$ ,&$ *77)77$ D+*/,"/)7$ *.*"57,$ D&9"/")7$ *5#$ 0&'5#$ ,(*,=$ *D*+,$ 0+&1$ *$ 7"5.9)$ "5/"#)5,$ ,(*,$ ,(+)*,)5)#$,&$1*+$1%$)5,"+)$)[D)+")5/)=$7'+@ ;)%&+7$ 1".(,$ (*;)$ *:*+#)#$ *$ #"*1&5#$ *7$ *$ +)7'9,$&0$'7"5.$1%$/*7)$*7$*$,+*/)+< X%$ 0*1"9%$ :"99$ -)$ 0&+);)+$ .+*,)0'9$ ,&$ *99$ ,(&7)$:(&$D*+,"/"D*,)#$"5$,()$:*96$:",($'7$ p$,()$#&/,&+7=$9*-&+*,&+%$7,*00=$$5'+7)7=$"1@ *."5.$7,*00=$D(*+1*/%$7,*00=$+)/&+#7$b$+)/)D@ ,"&5=$ (&'7)6))D"5.$ 7,*00=$ D&+,)+7=$ *#1"5@ "7,+*,";)$ 7,*00=$ /*0),)+"*$ 7,*00$ *5#$ &0$ /&'+7)$ ,(&7)$:(&$7'DD9")#$1)$:",($1%$#*"9%$7,*7($ &0$"/)< 3("7$ %)*+$ B(+"7,1*7=$ 0&+$ '7=$ :"99$ ,*6)$ &5$ *$ 5):$ 6"5#$ &0$ /)9)-+*,"&5<$ l&#$ (*7$ "5#))#$ 0&'5#$ 0*;&+$ :",($ '7$ p$ &'+$ 9",,9)$ 0*1"9%$ (*7$ R'1D)#$0+&1$,(+))$,&$0";)<$2,$,&&6$'7$0"0,))5$ %)*+7$ ,&$ .),$ ,()+)$ *5#$ :)$ *+)$ ,+)1)5#&'79%$ (*DD%< M)$(&D)$,(*,$);)+%$1)1-)+$&0$,()$25,)+@ ?)*9,($B*5*#*L7$0*1"9%$(*7$7&1),("5.$7D)/"*9$ ,&$/)9)-+*,)$,("7$%)*+$p$"0$5&,$,()5$,()+)$"7$*9@ :*%7$5)[,$%)*+<

!"#$%&&&'$(

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

A,)D()5=$ :(&$ (*#$ 7'+.)+%$ &5$ ("7$ 9).7=$ 0"+7,9%$,(*56)#$!+$B(+"7$E*9)5,"5)=$9&/'1$!+$ h"5#*$?*#0")9#$*5#$!+$n)5$k"D< GB(+"7=$h"5#*$*5#$n)5$:)+)$0*5,*7,"/H=$()$ )[D9*"5)#<$ G3()%$ D',$ 1)$ *,$ )*7)=$ )[D9*"5)#$ );)+%,("5.$0'99%$*5#$);)5$7(*+)#$*$0):$R&6)7$ #'+"5.$,()$*/,'*9$7'+.)+%< G85#$2$1'7,$*97&$1)5,"&5$,()$,()*,+)$."+97$ :(&$,+)*,)#$1)$:",($7&$1'/($/*+)$*5#$*,,)5@ ,"&5<$3(*567$,&$)*/($*5#$);)+%$&5)$&0$%&'<H $G3()$7)+;"/)$2$+)/)";)#$:*7$,+'9%$*1*W"5.$ *5#$2$#&'-,$2$:&'9#$(*;)$-))5$-),,)+$,+)*,)#$ *5%:()+)$"5$,()$:&+9#<$X%$#)/"7"&5$,&$(*;)$ 1%$7'+.)+%$()+)$:*7$,()$+".(,$&5)$*5#$2$/*5$ 5&:$7D)*6$0+&1$)[D)+")5/)$:()5$2$7*%$,("7$"7$ *$,+'9%$1*.5"0"/)5,$(&7D",*9<H !)7D",)$("7$7*,"70*/,"&5=$A,)D()5$#&)7$(*;)$ &5)$+).+),< ?)$R&6)#F$G2$,)5#$,&$-9'7($*$-",$5&:$:()5$ 2$ 7))$ ,()$ ,()*,+)$ .'%7$ -)/*'7)$ ,()%L;)$ 7))5$ D*+,7$&0$1)$,(*,$);)5$2L;)$5&,$7))5\H !&5L,$ :&++%$ A,)D()5=$ %&'L+)$ 7)/+),7$ *+)$ 7*0)$:",($,()$,()*,+)$/+):\$

*&,!"!"7#6,*5)# -$&#8$%&##6,!&8 MI=IJ;I:

&C0SC:D

TI;:SC:D

!"##$%&'()*+"$

,"(-.

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

?9;#$0(@#)'&%:()0#$'0*/#)A*77) E2A232Cl$ ,()$ (&7D",*9$ /*5$ D+&;)$ *5$ )59".(,@ )5"5.$)[D)+")5/)< >'7,$*76$,(&7)$+)7"#)5,7$:(&$/*99)#$"5,&$,()$ B()7("+)$ ?*99$ X)#"/*9$ B)5,+)$ #'+"5.$ X)#"@ /*9$ !);"/)$ K)D+&/)77"5.$ PX!KQ$ K)/&.5","&5$ M))6< X!K$ 1*5*.)+=$ A'7*5$ O&+#)5=$ *5#$ ()+$ ,)*1=$ D',$ &5$ *$ 7D)/"*9$ #"7D9*%$ ,&$ 7(&:/*7)$ ,()$:&+6$,()%$#&$()+)$"5$3B2< 85#$ ,()$ D'-9"/$ :)+)$ 0*7/"5*,)#$ -%$ :(*,$ ,()%$7*:$*5#$-%$:(*,$,()%$9)*+5,$*-&',$&5)$ &0$,()$(&7D",*9L7$9)77)+$65&:5$#)D*+,1)5,7< A'7*5$)[D9*"5)#q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

()99&<H X)*5:("9)$,()$X!K$,)*1$/&5,"5')$:",($ ,()"+$D+&0)77"&5*9$#);)9&D1)5,$*5#$:"99$7&&5$

#=<FF'L;<@ADB' B>;@9:'+2!'M@A@= 2C3IK?I8h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

-)$'5#)+,*6"5.$9);)9$,:&$&0$,()$"5,)+5*,"&5*9$ )[*1$ 0&+$ B)+,"0")#$ A'+."/*9$ 257,+'1)5,$ AD)@ /"*9"7,7<$l&&#$9'/6$,&$,()1$*99<

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

!"#$%&&&'$(

0N<"@'U(%(/?$+5/#'3%$.."+6) 8A$I!23JK$&0$,("7$D'-9"/*,"&5=$2$#&5L,$&0,)5$ 7)90@"5#'9.)<$25$0*/,=$&,()+$,(*5$/+&:"5.$*-&',$ *$ +*+)$ .&90$ ;"/,&+%$ &;)+$ !&5*9#=$ 2L;)$ 5);)+$ #&5)$",< 85#$ -)0&+)$ ()$ 1)5,"&57$ *5%,("5.=$ ",$ :*7$ &59%$*$(&9)$2$:&5$*5#$5&,$*5$*/,'*9$.*1)\\\ O',$ ,&#*%$ 2$ *1$ .&"5.$ ,&$ -&*7,$ *-&',$ 1%$ :"0)=$ ,+*"5"5.$ 1*5.)+=$ C"/&9*$ X'99"57=$ -)@ /*'7)$7()$/)+,*"59%$:&5L,< 2$ (*;)$ :+",,)5$ #&W)57$ &0$ 7,&+")7$ &;)+$ ,()$ D*7,$ Ue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a=VVV$ 1"9)7$ *:*%$ ,&$ ,()$ &,()+$ 7"#)$ &0$ ,()$ :&+9#=$ 7,*+,)#$ *$ 5):$ 9"0)=$ -).'5$ *$5):$R&-=$-))5$*$0*5,*7,"/$1&,()+$,&$,(+))$ /("9#+)5$p$!*"7%$*5#$M"99"*1$:(&$*+)$()+)$"5$

,()$3B2$*5#$.+&:5$'D$7&5$>*1)7$-*/6$(&1)$p$ -))5$*5$*1*W"5.$:"0)$,&$*5$)[,+)1)9%$5))#%$ ('7-*5#=$/(*5.)#$R&-7$*5#$,*6)5$&5$*##","&5$ 7,'#")7$*5#$,+*"5"5.$/&11",1)5,7< C&:$ *.*"57,$ ,(*,$ -*/6#+&D=$ 1&7,$ D)&D9)$ :&'9#$-*+)9%$(*;)$(*#$,"1)$,&$-+)*,()\ O',$ 7&1)(&:=$ C"/&9*$ (*7$ 1*5*.)#$ ,&$ 7,'#%$:(*,$"7$*5$)[,+)1)9%$,&'.($7'-R)/,$*5#$ /&1)$,(+&'.($:",($09%"5.$/&9&'+7< A()$ #)7)+;)7$ ()+$ 7'//)77<$ A()$ (*7$ 7D)5,$ ('5#+)#7$&0$9&5.=$9&5)9%$(&'+7$*,$()+$9*D,&D$ ,*DD"5.$*:*%=$&0,)5$7*/+"0"/"5.$);)5$,()$7"1@ D9)7,$ D9)*7'+)7$ "5$ ,()$ D+&/)77<$ 2$ +)1)1-)+$ :)99$ &'+$ ,(+))$ :))67$ (&1)$ "5$ I5.9*5#$ 9*7,$ 7'11)+$ :()+)$ 7()$ 7D)5,$ *91&7,$ );)+%$ :*6@ "5.$ (&'+$ 7,'#%"5.$ *5#$ 7",,"5.$ )[*17<$ A&1)$

;*/*,"&5$,(*,$:*7$0&+$()+\$ A&$C"/&9*=$&5$-)(*90$&0$);)+%&5)$*,$25,)+@ ?)*9,($B*5*#*=$/&5.+*,'9*,"&57<$J5$-)(*90$&0$ 1)$*5#$,()$6"#7$*5#$*99$,()$0&967$-*/6$(&1)$ p$:)99$#&5)$%&'=$:)$*+)$*99$7&$D+&'#< C&:$2$/*5L,$.&$*5#$*76$()+$(&:$7()$0))97$@$ 7()L7$.&"5.$,&$6"99$1)$0&+$#&"5.$,("7$*7$",$"7<$O',$ 2$65&:$7()$:&'9#$:*5,$,&$,(*56$);)+%&5)$0&+$ ,()"+$7'DD&+,=$D*+,"/'9*+9%$()+$-+"99"*5,$1)5,&+=$ ?)9)5$h)&5*+#< 897&$ ,(*567$ ,&$ K&-%5$ O*+5)7=$ !*:5$ JLA'99";*5=$!)5"7)$O+*",(:*",)$*5#$*99$,()$IK$ ,)*1=$*5#$*99$,(&7)$:(&$(*;)$-))5$,()+)$0&+$ ()+$:()5$,"1)7$:)+)$,&'.(< K".(,$)5&'.($&0$,("7<$?)%$C"6$/*5$%&'$+)/&1@ 1)5#$*5%,("5.$0&+$,("7$D*"5$"5$1%$5)/6$D9)*7)4$$

CDE',"29654-'6;2961&2'C16;6#4#'4;#'C"$4>" 8$hJB8h$7'//)77$7,&+%$"7$-)"5.$()9#$'D$*7$ *5$)[*1D9)$,&$,()$+)7,$&0$,()$B*+"--)*5< 3()$3B2$(&7D",*9$*,$B()7("+)$?*99$X)#"@ /*9$ B)5,+)$ *5#$ B&/6-'+5$ 3&:5$ X)#"/*9$ B)5,+)$:)+)$-'"9,$,(+&'.($*$D'-9"/s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

/*5$ /&1)$ ,&.),()+$ *5#$ 7'//))#$ 0&+$ ,()$ .&&#$&0$,()$:(&9)$/&11'5",%<$2,$,()+)0&+)$ /&1)7$*7$5&$7'+D+"7)$,(*,$:)$*+)$*.*"5$-)@ "5.$()9#$'D$*7$*$+&9)$1&#)9$,&$&,()+7<H 25,)+?)*9,($B*5*#*$*5#$,()$3B2$l&;)+5@ 1)5,$ (*;)$ +)/)";)#$ /+","/*9$ *//9*"1$ 7"5/)$ &D)5"5.$,()$1)#"/*9$/)5,+)7$"5$8D+"9$ ]VUV=$ :",($,()$(&7D",*97$-)"5.$5*1)#$"5$,()$:&+9#L7$ ,&D$UVV$SSS7$-%$*//&'5,"5.$."*5,7=$nSXl< 85#$ ",L7$ 5&,$ R'7,$ ,()$ B*+"--)*5$ ,(*,$ "7$ 9&&6"5.$,&$0&99&:$7'",$p$*$5):$SSS$-),:))5$ 25,)+?)*9,($ B*5*#*$ *5#$ ,()$ l&;)+51)5,$ &0$S&9*5#$:"99$7&&5$7))$*$`VV@-)#$(&7D",*9$ &D)5$"5$/",%$&0$o%:")/< 3()+)$ "7$ *$ 5):$ SSS$ #);)9&D1)5,$ ,(*,$ 25,)+?)*9,($B*5*#*$"7$#);)9&D"5.$"5$3"-"9"7"$ "5$,()$K)D'-9"/$&0$l)&+."*< G3()$ 3'+67$ *5#$ B*"/&7$ (&7D",*9$ "7$ /)+@ ,*"59%$*$('.)$7'//)77$7,&+%$*5#$",$"7$()9#$'D$ *7$ *5$ )[*1D9)$ *+&'5#$ ,()$ :&+9#=H$ *##)#$ !+$B())71*5< GM)$ (*;)$ (&7,)#$ *$ 5'1-)+$ &0$ ;"7@

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

!"#$%&&&'$(

!"#$%&'(#$)*+$,(-#+.#/0-"$1/(/2/$!1$3-/))

(89:;<=>?<=@89A'N@OED;?H

!"#$%$%&'!#()'

!"#$%&'(()*+%&$&&"),&%% -%."/%&'00$&& 5

3%#,9%> 5 5 5

5 6/&*/&#%<,&.%)9> 5

CJM$);)+%&5)$:"99$65&:$n"1-)+9%$M"99"*17$ *7$ &5)$ &0$ ,(&7)$ -".$ 71"9"5.$ 0*/)7$ &5$ ,()$ +)@ /)D,"&5$ #)76$ *,$ ,()$ B()7("+)$ ?*99$ X)#"/*9$ B)5,+)< O',$ ,()+)L7$ 1&+)$ ,&$ ,("7$ ,*9)5,)#$ %&'5.$ 9*#%$,(*5$1)),7$,()$)%)< 8D*+,$ 0+&1$ 1)),"5.$ *5#$ .+)),"5.$ D*,")5,7$ *5#$;"7",&+7=$n"1-)+9%$"7$*97&$*5$*/,";)$;&9'5@ ,))+$"5$,()$/&11'5",%< 87$ *$ 1)1-)+$ &0$ ,()$ ^";)$ B*%7$ !"7*7,)+$ B&11'5",%$l+&'D=$7()$D9*%7$*$;",*9$+&9)$D+)@ D*+"5.$,()$*+)*$0&+$);)5,'*9",")7$7'/($*7$('+@ +"/*5)7$*5#$1*R&+$"5/"#)5,7< 85#$,&$0'+,()+$)5(*5/)$()+$76"997=$n"1-)+9%$ +)/)5,9%$ *,,)5#)#$ B&11'5",%$ I1)+.)5/%$ K)7D&57)$ 3)*1$ PBIK3Q$ ,+*"5"5.=$ (&7,)#$ -%$ ,()$3B2$!)D*+,1)5,$&0$!"7*7,)+$X*5*.)1)5,$ *5#$I1)+.)5/")7$P!!XIQ<$ !!XI$ #"+)/,&+=$ >*1)99$ K&-"57&5=$ )[@ D9*"5)#F$ G!"7*7,)+$ /&11'5",%$ .+&'D$ 1)1@ -)+7$D9*%$*$/+'/"*9$+&9)$"5$,()$+)7D&57)$)00&+,7$ 0&99&:"5.$,()$"1D*/,$&0$*5%$7,&+1$&+$(*W*+#@ &'7$"5/"#)5,=$7'/($*7$?'++"/*5)$2+)5)< GS)&D9)$9"6)$n"1-)+9)%$*+)$,()$0"+7,$D)+7&57$ &5$7",)$:(&1$:"99$-)$"5$*$D&7","&5$,&$.";)$*7@ 7"7,*5/)$ *5#$ +)D&+,$ "50&+1*,"&5$ ,&$ +)9);*5,$ *',(&+",")7$ 7'/($ *7$ ,()$ !!XI<$ 3()$ BIK3$ ,+*"5"5.$"7$&5)$&0$1*5%$7,)D7$-)"5.$,*6)5$,&$ 7,+)5.,()5$*$/&11'5",%L7$*-"9",%$,&$-)/&1"5.$ 7)90@7'00"/")5,<H 3()$0&'+@#*%$/&'+7)$7*:$n"1-)+9%$,*/69)$*$ +*5.)$ &0$ 7'-R)/,7$ :("/($ 25,)+?)*9,($ B*5*#*$ ,+*"5"5.$1*5*.)+=$C"/&9*$X'99"57=$+)/6&57$:"99$ -)$&0$.+)*,$-)5)0",$,&$,()$(&7D",*9< G899$,+*"5"5.$"7$.&&#H=$7()$)[D9*"5)#=$G-)@ /*'7)$ :()5$ 7,*00$ )5(*5/)$ ,()"+$ 76"997$ ",$ -)5@ )0",7$,()$(&7D",*9$,&&< GB&5.+*,'9*,"&57$,&$n"1-)+9%<$3("7$:*7$*5$ "5,)57)$ /&'+7)$ *5#$ 7()$ /)+,*"59%$ )*+5)#$ ()+$ /)+,"0"/*,)$*,$,()$)5#$&0$",<H$

!"#$%&&&'$( !"#$%&'(#$(#>?0#--#+$)*+$-"#$,(-#+.#/0-"$1/(/2/$!1,$3-/))

0*> &

INSIDE THIS ISSUE: Accreditation 2 pictures Donna and Jane

Lab poem

School visit

Competition

V O L U M E

2 ,

I S S U E

A P R I L

2 0 1 2

Credit where it’s due

Mass casualty 9 Comings & goings

Kay’s wedding

Susan Borden 12

Comings & goings 2

ReFresh

by Roger Cheesman

It must be seen as our commitment to achieving the It was a long time in the making but we got there in the best we can within the limits of the project and accreditation is end – and in fine style. On 4 the validation of our work to April the news came through that Interhealth Canada TCI, in date. the shape of the Cheshire Hall The entire hospital staff has and Cockburn Town medical been involved in some way or centres, had been awarded not another with the process, just accreditation but the which has been underway for highest level possible through some considerable time. It is a the surveying organisation, credit to your determination Accreditation Canada. and tenacity to provide excellent service to those who This is an incredible achievement, especially given rely on us for care. Long hours have been worked but the that the centres have only entire team has come through been open for two years and it all with this amazing result. brought together people from many different areas of the world to work as a team.

Thank you one and all.

VOLUME

ISSUE

PAGE

Celebr ati on ti me Celebr ati on ti me Celebr ati on time

EAT, DRINK AND BE MERRY: The good times roll at Cheshire Hall and Cockburn Town.

â€˜This is a remarkable and well deserved achievement for the company and at the same time puts the whole Caribbean region firmly on the map for innovative partnerships between public and private sectors in the integrated delivery and operating of healthcare infrastructure. Our hope is that other governments, both regionally and internationally, will now be able to benefit from the knowledge acquired in the Turks and Caicos Islands and will see this as an example of how the aspirations of their citizens to receive world class healthcare can be fulfilled.â€™ George Commander, President and Chief Executive, Interhealth Canada

This newsletter is edited by Chris Morvan. Any ideas, contributions or queries please contact me on 344 2806 or email chrismorvantci @gmail.com

PAGE

Celebration time Celebration

VOLUME

ISSUE

PAGE

Friends who helped us along the way How lucky I am to have something that makes saying goodbye so hard. Over the past several months I have been fortunate to have worked with each of you as we pursued our goal of International Accreditation. I have experienced your enthusiasm, shared your concerns and celebrated your successes. I am truly fortunate to have had the opportunity to know each and every one one of you and grateful to Roger and the Senior Management Team for their leadership and confidence.

GUIDING LIGHTS: Donna Hutton and Jane Mealey

I would like to thank each one of you for your outstanding work throughout the accreditation preparation process and the on-site survey. It has been a privilege and pleasure to work with each of you as we prepared for accreditation. And I am delighted to congratulate you on achieving diamond level. This is a tremendous accomplishment and positions you in a place of strength as you move forward on your journey of continuous improvement in the provision of high quality safe care and service delivery. I look forward to working with you as you move forward on this journey. Also, thank you for the beautiful photo album and warm messages. I shall always treasure this book and my memories of colleagues and friends in the TCI. Many thanks for your hard work and congratulations on a job well done! I look forward to seeing you all in the near future. Jane

I would ask only that you continue to work together to always strive to be the best you can be. I look forward to hearing of your progress and achievements as I know there will be many that you will share with your colleagues near and far. Keep in touch. You can reach me at donnahut@telus.net. As Charlie Brown in the comic strip said: ‘Why can’t we get all the people together in the world that we really like and then just stay together? I hate good-byes. I know what I need. I need more hellos.’ Take Care, Donna

HERE, THERE AND EVERYWHERE: Donna and Jane met just about everybody. Here’s Donna with surveyor Murielle Provencher and Jane with stores assistant Kirk Reyes

POETRY FROM THE LABORATORY: ACCREDITATION

SAGA

by Dionne McGregor

Row, row, rowing the boat gently down the stream, enjoying the ride, and the tide, to the Turks and Caicos Islands. From the four corners of the earth we hail, holding the rail on the trail to the GT/Provo new hospitals. We meet, we greet, and set the treats for the forward plan over the two year span. One aim, one plan to give this land the world–stand, to showcase its beauty, its potential and its versatility. Each team got busy with all hands on deck, rowing upstream towards the home of accreditation. Team Clinical Labs rowed for a mile, when the tide got rough and threatened the voyage to the homeland. The captain called for backup to guide our path through the choppy waters of uncharted seas. From the land down under, on his high powered steamer, the consultant arrived. “Hi I’m Peter”, you need my help? He latched his steamer to the boat and selecting high gear, he sped off to challenge the railing tide. The course is set, we will have no regrets. The team stared at the steamer in amazement as he jetted off into the deep blue sea, carrying us along with him. “Follow me and you will see” he assured. “Don’t take no for an answer, there is a way around this” “You have a good framework, you can make it”, he reminded us. “I don’t know”, sighed one of the rowers, “Are we up to scratch?” “Have we done what we are supposed to do?” echoed another. “I have good news” interrupted Peter. “I have a chant that can help us through. The name of the song is SOP! SOP! Have I done my SOP? As you chant this song, row hard all in the same direction. I am not going to take any scrap - you can do it! Push! Push! Sing that song! Gold, Platinum, and even Diamond are awaiting you all in the home of accreditation. These procedures will ensure that you get there safely. Make sure everyone is rowing in the same direction,” the consultant bellowed above the wailing seas. “I think I’m getting a fever!” One of the members moaned, “It feels like dengue but the symptoms are weird. I don’t know what it is, but it is a fever for sure! “I know what it is,” another team member interjected, “It’s accreditation fever - a new world thing, but it is curable. Don’t worry! Keep on rowing and by the time we get there, the fever will be gone.” “I can’t believe it! I see land up ahead! Look, everyone! It’s beautiful! It’s exciting. Oh my!” sighed another member. “I knew we could do it. It’s easy once you know what to do.” “I am so proud of you all” comforted Peter, you guys have done a great job, give yourself a pat on the shoulder.” In unison, the team shouted, “you did a great job, Peter! Thanks for coming and helping us to reach accreditation home safely. We could not have done it without you. We thank you! We thank you! We thank you! You are inspirational!” As Peter unlatched his steamer from our boat, he cautioned us to remember the chant that carried us along: maintain the procedures and work together to keep the beautiful home beautiful. “I enjoyed the ride,” chuckled Peter. “I have been there before, so I knew you could do it. So long guys and if you ever need my help, don’t hesitate to get me at Peter.com.”

PAGE

Healthcare: the next generation

n early March, Denise Braithwaite organised a visit to Cockburn Town Medical Centre by children from Newman’s Preparatory School.

School Principal Tracy-Ann Rowe-Blythe brought nine students aged between eight and eleven, and they thoroughly enjoyed their tour of the hospital. The tour took the children from the reception area through departments including the laboratory, surgical suite, radiography, physiotherapy and the emergency room. Along the way they met key staff members, each of whom said a few words about their job and what happens in their department, telling their young audience basically what is involved in the work and what they would need to concentrate on at school if they wanted to have a career in that particular area. ‘The idea was to show them that there are many more roles in a hospital in addition to doctors and nurses,’ Dr Braithwaite said. ‘For instance, we have a lot of equipment, from medical hardware to computers, so we need engineers and IT Specialists to operate and maintain it. We emphasised that there’s a lot more to a hospital than meets the eye.’ The visit took place on Career Day, part of Education Week, which encourages youngsters to think about what they want to do with their lives, and judging by the response among this group, there is considerable interest in healthcare. One young lad came along in a white doctor’s coat with a stethoscope that dangled down to his knees, while one of the older girls caught the eye in a bright pink nurse’s uniform.

AMBITIOUS: Noel Benjamin with Dr Henry Blythe

One of the highlights of the tour was a demonstration by Emergency Medical Technicians of the ambulance and its functions, and how one becomes an EMT. Two volunteers experienced being secured on a stretcher and loaded into an ambulance, to the envy of their friends. The event finished in the ReFresh canteen, where Executive Chef Michael Williams emphasised the importance of a healthy diet and showed how the food served at the hospital takes this into account. It was informative, entertaining and the children all went away with a healthy snack and a smile.

VOLUME

ISSUE

PAGE

Students in Grand Turk get a glimpse of what could be their future (contd.)

WELCOME: Denise Braithwaite sets the scene for the tour of the hospital.

MAYBE ONE DAY: Shamaya Butterfield will need to tone down the uniform to be like Dian Tucker.

‘The idea was to show them that there are many more roles in a hospital in addition to CONFINED SPACE: Students experience working in an ambulance with Blaine Lettice.

STAIRS THAT LEAD NOWHERE: The strange world of physiotherapist Camille Marshall

doctors and nurses’

NO LAUGHING MATTER: The lucky winner of the load-me-intoan-ambulance competition.

VITAL KIT: Radiographer Joseph Semanda explains the technology.

PAGE

The light-headed page

s the world invents ever more terms to describe things, we’re abbreviating them as acronyms and running out of letters. The effect on acronyms is simple: it means duplication, as I found when reading a submission to this newsletter and coming across a medical abbreviation, SOB. Son of a bitch? No, a nice girl like the writer of that piece wouldn’t use such language, even disguised in an abbreviation. So I looked it up and this is what I found. South of the border: a dismissive geographical description favoured by Scottish people who will take any opportunity to insult the English. Smelling of booze: a general gossipy putdown used by tittle-tattlers in any English-speaking country - TCI equivalent: BBB (Bambarra breath) Sick of Bush: (former political slogan in the US) Silly old b***er: almost-affectionate UK description of person whose mistakes etc. may or may not be due to the aging process. Silly old b****ard: Australian equivalent. But no, in this case it was none of the above, and all you health professionals will probably have got there 10 minutes ago: shortness of breath. However, it does illustrate the danger of assuming other people know what we’re talking about when we use what to us is a perfectly simple technical term. There are people out there who don’t know MRI from KFC, so if you’re going to use medical terminology without explaining it, don’t be surprised if you find someone expecting their scan to come with fries and a Coke.

The world’s smallest hospital was built by a spiritual organization, Dera Sacha Sauda, located in Haryana, India. The hospital is mobile. Initially, it was built in a Tata 407 van but was later upgraded to a Trax Cruiser (about the size of a large Land Rover) because the Tata was slow. The size of the hospital was deliberate, so that it can be easily taken into any of the remote areas of India, including small villages that have narrow mud roads. It claims to have almost all the modern facilities that are available in big hospitals and the doctors can allegedly perform any type of operation or surgery with the equipment that it has. It has an operating theatre, labor room, medical store and intensive care unit. It was named Nanha Farishta (in Hindi, ‘small angel’).

COMPETITION Win a $250 car rental/service voucher Here is your chance to win $250-worth of car rental or service kindly donated by Grace Bay Car Rentals and Sales. To enter, just answer these questions: What is the capital of Canada? What is the capital of the USA? What is the capital of the Turks & Caicos Islands? Send you answers by email to chrismorvantci@gmail.com. Entries must be received by 5pm on Friday 27 April. All correct answers will be collected and a winner drawn at random.

VOLUME

ISSUE

Prepare for the worst hope for the best

hile a group of islands such as the Turks & Caicos might justifiably be considered a great place to live – and in countries like the UK and USA the word ‘paradise’ is bandied about whenever the Caribbean is mentioned – they are not immune to trouble. It could be natural (a hurricane, a tsumani) or man-made - a terrorist attack shook the idyllic island of Bali in 2002. Whatever form

PAGE

WAKE UP AT THE BACK: Dr Denise Braithwaite-Tennant’s lively presentation ensured the message got across it takes, disaster can strike anywhere, and when it does, who is in the front line, picking up the pieces? The hospitals and the emergency services. So it makes sense to prepare for bad scenarios, and a recent seminar did just that. The ‘Introduction to Mass Casualty Management’ event was held at the Airport Hotel in Providenciales and among the speakers was our own Dr Denise Braithwaite-Tennant. Introduced and coordinated by Nurse Charlene Higgs, undersecretary of the

ialysis patients at Cockburn Town Medical Centre received a welcome treat when representatives of the charity Rotaract arrived, bearing gifts of fruit. A catering trolley laden with presentation fruit baskets provided delicious extra nutrition for several days, while the day’s immediate needs were met by containers of fresh chilled fruit. The presentation was made at the dialysis unit by Rotaract President Deandra Mills and member Shanna Ebanks. The organisation is the youth wing of Rotary, with members aged from 18 to 30. The Grand Turk branch has 24 members. Ms Mills made a short speech before she and Ms Ebanks presented the fruit to the patients. ‘We are very grateful to Rotaract for this kind gesture,’ said Meleck Cummings, Nurse Manager at the hospital. ‘Diet is extremely important in healthcare and although our patients are very well looked after by the hospital catering department, encouraging people to eat more fruit can only be a good thing.’

Ministry of Health and Human Services, the event looked at potential calamities from hurricanes, earthquakes and tsunamis to bioterrorism and, far from being the sit-back-and-listen/snooze that such things can be, actively involved the medicos, police officers and firefighters who attended. Among the other speakers were Ministry of Health Disaster Coordinator Mary Forbes and Health Educator Imterniza McCartney.

Fruity day in Dialysis

VITAMIN BONUS: With the patients in the picture are (from left) Dialysis Nurse Julie Togi, Deandra Mills, Dialysis Nurse Babatumbi Ajimoti, Shanna Ebanks

PAGE

Comings & Goings

he Bohio restaurant was the setting for a farewell party for two popular doctors who left us in March. Gideon ‘Deon’ Human and his wife Stephanie had become fixtures in the local community, Deon carrying out his duties at Cockburn Town Medical Centre with great professionalism and an easy charm, while animal-lover Stephanie devoted herself to the welfare of the many creatures that roam Grand Turk, vulnerable and fending for themselves. The couple have returned to Canada, where they will live on Vancouver Island. Meanwhile, Obstetrician/ gynaecologist Luis Guillen was last seen loading a container with guitars, drums and paintings by his wife Carmen. It’s back to Puerto Rico for the Guillens.

INTO THE SUNSET: Deon and Stephanie Human and (below) Luis Guillen enjoy that Grand Turk feeling one last time

woman in the late stages of pregnancy was involved in a bad car accident and was in a coma for several weeks, during which time she gave birth to twins. When she came out of the coma she asked the doctor how it had gone. ‘Oh, fine,’ he said. ‘Caesarian section, pretty straightforward and we didn’t even have to give you an anaesthetic. It’s a boy and a girl. But I hope you don’t mind – because we didn’t know if you would survive, I took the

liberty of asking your brother to give the children names.’ ‘My brother!’ the woman gasped. ‘Of all people! He’s a bit simple. What did he call them?’ The doctor smiled and said, ‘He called the little girl Denise.’ The woman beamed. ‘Perfect,’ she said. ‘I might have chosen that myself. And what did he call the little boy?’ The doctor took a deep breath and said, ’Your son is called Denephew.’

VOLUME

ISSUE

PAGE

From Cheshire UK to Cheshire Hall

It was going to be just the two of them and a couple of friends in a simple ceremony on the beach at Grace Bay, but the two friends turned into a crowd and the table for four at Nix was hastily expanded into an area for 32. The bride and groom made the trip to the restaurant in the unusual confines of a stretch golf cart.

familiar figure around Cheshire Hall has gone from temporary to permanent. Kay Vanes, P.A. to Dr Robyn Barnes, first made an appearance here in February 2010 as a temp covering for Carol Theophanous. Now that Carol has decided to retire, Kay was able to hit the ground running. A native of Cheshire, UK, Kay first came to

Providenciales in 2008 to work in the catering/entertainment world, before returning to her professional roots with Interhealth Canada. Now firmly ensconced in the TCI, last year she married Kennedy, a local man born and bred in Provo, and the two enjoyed a beautiful wedding day that turned out differently from what they were expecting.

mar Sterling is the new acting head of IMT. Omar has spent over 11 years in the IT industry, seven in management/consulting posts. He has a solid background in project management as well as technology consulting /technology infrastructure systems. Omar has been in the TCI since April 2007 and

engineer. Slowly rising through the ranks, he was recently promoted to acting IMT manager. Omarâ€™s leisure interests include (you might want to sit down while you read previously worked at The this) squash (former Computer Guy (Four Leaf national representative for Solutions), Ambergris Cay, Jamaica), tennis, Hunter Development and badminton, diving, Computer Telephony. volleyball, basketball, He came to InterHealth flying, computing & Canada TCI in December technology and spending 1, 2009 as a systems time with his family.

PAGE

o it’s farewell to Susan Borden, MDR manager, who bowed out during accreditation week, bound for a new chapter in the Middle East. Susan sent an email around, expressing her feelings on leaving TCI, and for anyone who missed it, here it is: ‘As you all know we will be busy with the accreditation survey all next week so I would like to take this time to bid you all a fond farewell. I am off to the other side of the world (Dubai UAE) to take a new and challenging position, which I am very grateful to have been offered. It has been an interesting, sometimes challenging time for me here on island but it has been a sincere pleasure meeting and working with all of you. I am especially proud of the MDR team, David Banton, Inderia Harris and Bridget Williams. They worked exceptionally hard and put up with many demands from me but have achieved so much within these two years; achieving two international levels of certification not to mention a well run department and a professional attitude. It is with pride and confidence I leave them in charge and can ensure you all they will continue to provide you and our patients with quality services adhering to best practice. (I did tell them don’t let me

have to come back because they got slack! LOL) Thank you InterHealth Canada for inviting me to be part of this project. I wish each and every one of you good health, success and a positive life. My personal email is haligonians@yahoo.com or sueb38@hotmail.com if you wish to be in touch.’ And just to add the personal touch, Susan leaves us with the recipe for her signature dish. TRIPLE LAYER BARS Ingredients: Graham wafers ¼ to ½ cup butter (melted) 1 can sweetened condensed milk (additional half if large pan) 1 bag flaked coconut (large if large pan) 1 bag chocolate chips (additional half bag if large pan) ¼ cup crunchy peanut butter (1/2 cup if large pan) Crush wafers and mix with melted butter. Spread on bottom of lightly greased pan (9x13) Sprinkle coconut over base (large bag for big pan). Pour can of condensed milk over coconut (one can plus half can for large pan) Bake at 350 deg for about 20 min or until edges are lightly brown and milk has set. Melt choc chips (one bag and a half for large pan) with peanut butter and pour this over top of base. Let cool then set in fridge to set.

VOLUME

ISSUE

PAGE

He leaves and he returns

ames Hayward (below, left) left his post as IMT Manager recently to return to the UK. However, he will soon be back on a temporary contract, as interim head of IM&T and to take charge of a special project.

ou can’t rest on your laurels in the world of healthcare these days. Continuous professional development (CPD) is the name of the game and that is where our new Education Manager, Janette Vaughan, comes in. ‘I oversee the educational needs of the staff,’ Jan said when we grabbed her just a week after her arrival. ‘I will source and commission specific training.’ This can involve either bringing experts here or arranging for staff to travel to centres of excellence. The Turks and Caicos Islands might be very different from her native Yorkshire, but Jan is well used to adapting to new ou can’t turn an old sea dog environments and cultures. Married to into a landlubber, and so it is Alan, a military man, she has lived in with a sense of inevitability that the Gambia and Cyprus as well as we wave goodbye to Tim Germany and various parts of the UK, Callaghan (above, right) after two years including Hampshire and Edinburgh. The with us as a GP and head of family couple have two adult daughters, both practice. married and having long-since flown the A life on the ocean wave clearly has its nest, so Jan had the flexibility to attractions and Tim has taken up a new consider the TCI. post as Senior Ship’s Physician. We wish As befits someone in her job, Jan has him well. qualifications coming out of her ears: two first degrees in Social Policy and And it’s bye bye Beatrice... Community Nursing and a master’s in Beatrice Gardiner left Refresh Grand Health Sciences. Turk in April after two years of service.

The sea calls Tim back

A life on the ocean wave

café corner

with anish thomas

As usual, the world’s leading hospital caterers, Refresh (branches in New York, London, Paris, Cheshire Hall and Cockburn Town) marked special dates with carefully-chosen menus. They included Valentine’s Day and St. Patrick’s Day. Good news for shellfish lovers is that the Turks & Caicos Lobster Season has been extended until April 30th. Lobster is very

Anguilla lunch

And okay, Easter has gone for this year, but here is a recipe for a cake that happens to bear the name but is equally delicious at any time. Easter Bun · Prep Time: 15 mins · Total Time: 1 hrs 15 mins · Serves: 6-8, Yield: 1.0 loaf Ingredients o 3 cups flour o 3 teaspoons baking powder o 3/4 cup brown sugar o 2 eggs, beaten o 1 tablespoon browning sauce o 1/2 pint milk o 2 tablespoons melted margarine o raisins ( approx 1 cup or amount to your taste) o mixed peel ( approx 6oz or amount to your taste) o 1 tablespoon mixed spice o 1 tablespoon cinnamon 1 tablespoon nutmeg

Directions popular, particularly in Grand Turk, 1. Measure all ingredients in a bowl where the CEO of the government, and mix well. Patrick Boyle, lives, and he visited 2. Pour into bun shaped baking pans Refresh for a special Lobster Lunch. (long loaf pan), and bake in a The Chief Minister of Anguilla visited moderate 350 degree oven until both hospitals and can’t fail to have well done. been impressed by the catering. 3. Glaze with sugar and water or Accreditation success saw parties in both pancake syrup and serve. islands with sumptuous food and drink.

TCI HOSPITAL LAUNCHES ‘READY’ PROGRAM Students across the Turks and Caicos Islands will soon pick up internships in all areas of health care, thanks to TCI Hospital’s ‘Ready!’ program that is being developed in conjunction with the Ministry of Education faculty in the Science and Business Studies Departments and the Guidance Counselors in all TCI schools. The goal of the program is to educate students about the complexities of a healthcare delivery system and the many jobs that are available within these settings. The program was rolled out October 8th, 2014, beginning with the H. J. Robinson High School on Grand Turk, will run in two phases. Phase One includes school tours, presentations and discussions on the wide range of careers in both clinical and non-clinical areas. In Phase Two, students who have shown a serious desire for a career in healthcare and have selected subjects in these disciplines for completion in their senior year, will be selected to participate in an intensive mentorship, coaching and practical application experience involving senior level staff at the Hospital. Selection will be based upon criteria developed together with the schools.

Continued on Page 4

Mission To provide the community and its visitors with high quality healthcare.

Vision To improve the nation’s health through the development of a substantial and accessible health care system

Values We value ethical and respectful behaviour, honest, accountability and excellence in all we do.

TALKS WITH TCI POLICE “It is very encouraging how both parties have embraced the opportunity to meet and it is hoped that this dialogue further augments the collaborative relationship between the hospital and the Royal Turks and Caicos Islands Police Force”. Dr. Denise Braithwaite See Page 3

Page 1

VERNESSA FORBES AND MARYLEE WILSON to be certified Medical and Billing Coders. The demand for billing and coding professionals is growing throughout the healthcare industry and TCI hospital is making that dream a reality for our patient services administration staff. Hats off to Vernessa Forbes and Marylee Wilson, who have completed a billing and coding course through Ashworth College in the USA. Both Forbes and Wilson have completed the six months course in record time, and obtained a perfect 4.0 grade point average. It was an opportunity Forbes was glad she took. She said, “It’s all about balance. Working full-time while also studying full-time clearly requires a lot of effort. There are times when you feel exhausted and stressed out while studying and working fulltime, but it’s important to evoke your motivations for taking this approach, and continue the journey and never give up. Winners never quit and quitters never win.” Provisions for study time are currently being worked out for the ladies to for their certification exam, through the National Health Career Association in the USA. Once successful, Forbes and Wilson will be certified as Medical and Billing Coders.. Patient Administration Manager Straudy Jackson said, “In keeping with the global standards and accreditation in healthcare, a certified billing and coding professional is the first line of defence within the hospital against noncompliance, helping to prevent legal difficulties with the

medical records department within the hospital. This person ensures accuracy in the billing system providing correct procedure codes as well as “accuracy of diagnosis coding” by collecting and analyzing vital statistical information that is necessary to the delivery of quality healthcare”. Jackson went on to express pride in her team ending with words of encouragement, “I am extremely proud of Vernessa and Marylee as they have shown that determination and hard work really pays off, they both play an integral role in the department’s success as they continue to work hard, embrace change, take on additional responsibilities and challenge themselves to think outside of the box and beyond their normal comfort zone. They are to be celebrated for their accomplishments especially since they have only been here for just over a year. I am looking forward to the other Patients Services Associates who will also embrace the opportunity to enrol in the billing and coding course.”

GOOD LUCK AND CONGRATULATIONS FROM EVERYONE AT TCI HOSPITAL.

Page 2

CTMC gives back to the H. J. Robinson High Our team at the Cockburn Town Medical Centre recently presented the Helena Jones Robinson High School in Grand Turk, with over $1500 dollars in cash, towards the purchase of an electric school-bell. The much needed funds were raised during this year’s Nurses’ Week celebration, a “Nurses in Concert” event, where nurses displayed their talent through dance and song. The nursing staff was well supported by Primary Health Care and Wellness Centre teams. Site Director at the Cockburn Medical Centre Meleck Cummings said, “We would like to use this opportunity to express appreciation to everyone who made contributions towards the concert; they include our MC, Huntley Forbes JR, Father Mark Kendall and the Anglican Church Family for providing the venue.” Principal Rienwald Lewis said, “The delivery came as so much of a surprise. We are extremely grateful to Mr. Cummings and the TCI Hospital team, for taking the time to get to know the students of the H. J. Robinson High School, recognize our needs, and embrace our mission.”

TALKS WITH TCI POLICE Positive talks are currently in place with officials of the Royal Turks and Caicos Islands Police and Senior Management at TCI Hospital in support of creating a safe, inclusive and secure environment for staff, patients and visitors, so that the uninterrupted delivery of quality healthcare can be guaranteed at all times. Ideas on how to better manage crowd control, and concerns of verbal and physical abuse against hospital staff were discussed.

Police Commissioner Colin Farquhar said, “I am looking forward to working closely with TCI Hospital to ensure that it is a safe and secure environment for staff, patients and visitors. These talks also reflect the strengthening of cooperation between TCI Hospital and the Royal Turks and Caicos Islands Police Force to provide a safe environment and a high standard of care to the communities of the Turks and Caicos Islands.” Discussions are ongoing.

Speaking on the discussions, Chief of Medical Services Dr. Denise Braithwaite said these talks are headed in the right direction, which can only benefit the community, of which the hospital is a key part. Dr. Braithwaite added, “It is very encouraging how both parties have embraced the opportunity to meet and it is hoped that this dialogue further augments the collaborative relationship between the hospital and the Royal Turks and Caicos Islands Police Force especially in the area of relevant protocols for the Emergency Department”.

IM&T TEAM GETS ADDITIONAL TRAINING The IM&T team is stepping up their game. If you’ve done your research into current IT certifications, you’ll see that Information Technology Infrastructure Library, or ITIL, is near the top of the list. The IM&T teams at the Cheshire Hall Medical Centre and the Cockburn Town Medical Centre have successfully completed the first level of ITIL qualifications. Congratulations to IM&T Manager Ryan Smith and his team: Lovell Ingham, Detorrie Tennant, Nerissa Lewis, and Perfecto Sevillejo. “This level of ITIL qualifications introduces standards to IM&T, and allows us to maximize product effectiveness and reduces response time”, said Ryan Smith, IM&T Manager. He added, “ITIL is so important because it provides a framework to identify, plan, deliver and support IT services. We are proud to be a part of an organization that is always looking to improve its IT operations management. It is important to continuously make these strategic investments in tools that lower management costs, boost service quality and reduce risks.” ITIL is proven and used worldwide, to improve customer satisfaction and relationship, to better reliability and quality of service, to enhance the optimization of service delivery across the supply chain and create a competitive advantage through value creation and agile change.

Page 3

Continued from Page 1

MESSAGE FROM THE GENERAL MANAGER As an organization in early development, Hardwiring Excellence gives us an insight on how we can create the opportunity for sustaining a culture of service and operational excellence. By implementing small but simple changes within our organizations we can ensure better customer service; build strong leadership, align our organisational values, goals, and results; increase communication; reward and recognize individual success while also requiring accountability of our actions. For many who work in health care, overwhelming business pressures and perceived barriers to change have nearly extinguished the flame of passion to help others but by making some simple changes we can succeed in SERVICE, QUALITY, PEOPLE, FINANCE and GROWTH.

Education and Training Manager Mrs. Jacqueline Moe- Cox said, “I am extremely pleased to be associated with this internship program ‘Ready’ where the TCI Hospital is partnering with the education stakeholders to provide the youth of this nation with all the information that they need to prepare them to exploit job opportunities in clinical and nonclinical services in the Hospital. The launch session at the H.J.H Robinson High School on Grand Turk yesterday has emphasized the need for this exposure so that students in the upper school fully understand that careers in health care expand beyond generalist roles like nursing and doctors.

“I fully endorse this partnership with TCI Hospital” Hon. Akierra Missick Also making a presentation and a part of the team visiting the schools, Chief of Medical Services, Dr. Denise Braithwaite-Tenant said, “The ‘Ready!’ program is a critical component of our strategic plan goal to attract and retain top talent. I believe the program presents an ideal opportunity and major advantage of starting a career with TCI Hospital to develop practical skills in a wide variety of specialties; it is a great start.” Praising the initiative was the Minister of Education, Youth, Sports and Culture, Hon. Akierra Missick. Hon. Missick said, “I fully endorse this

Martin Dawtry, GM

Page 4

partnership with TCI Hospital. I am thrilled to see students from every community given the opportunity to receive the practical and theoretical insight into working and learning within a hospital setting. This is a valuable educational experience for those students who are interested in the healthcare field and an excellent launching pad for the healthcare workforce of the future”. Also making presentations were Human Resource Manager of TCI Hospital, Edwin Taylor and Site Director at the Cockburn Town Medical Centre, Meleck Cummings. The second phase of program “Ready” is set for summer 2015.

BIRTHDAY CORNER Jyothi George, Carmette James, Aneka Dean, Lennessa Comrie, Beanca Clare, Isableo Cuadras, Denwell Cox, Barbara Ferguson, Donneka Hall, Oneil Ruddock, Veronica Rigby, Shantell Gardiner, Basillia Otuonye, Aileen Cagauan, Renay Robinson, Soliman Raafat, Elinore Zaguirre, Lorena Soler, Tamara Johnson, Clarita Tucker, Magdala Hyppolite, Shamire Moore, Barbara Saunders Venice Brooks, Julie Togie, Martin Wintz, Rafeeza Seecharan

SUCCESSFUL FLAG RISING AT CTMC

On Tuesday 30 September 2014, dignitaries, staff at TCI Hospital and members of the Grand Turk Community gathered at Cockburn Town Medical Centre to witness for the first time, the national flag hoisted as part of TCI Hospital’s four year anniversary celebration. The ceremony attended by His Excellency, Governor Peter Beckingham and his wife Mrs. Jill Beckingham and invited guests, were given the opportunity to unite in celebration, while witnessing a unique display of the country’s flag flying high. Our Chief of Medical Services, Dr. Denise Braitwaite said the Flag rising at both the Cheshire Hall Medical and the Cockburn Town Medical presents a chance to build community pride. Dr. Braithwaite added, “The TCI Hospital is a product of the vision of the leaders and people of the Turks and Caicos Islands. It is our desire for excellent health care for its citizens, residents and visitors that come to our beautiful shores. We have an investment interest in insuring the sustainability of these services, excellence in service, value for money and the growth of our local health care capacity.

His Excellency, Governor Peter Beckingham in bringing remarks, praised the Cockburn Turk Medical Staff for the quality of care he had received in the past. Governor Beckingham added, “This hospital obviously is a really important arena for Turk and Caicos, for Grand Turk in particular; especially for the local community and visitors. It’s a pleasure to meet people from InterHealth Canada and thank you for inviting us”

CEO Commends new Pavisse System Also in attendance was the Honorable Hugh Derek Taylor, Mrs. Portia Clark- Deputy Permanent Secretary and Director of Health Planning, Dr. Therese Maitland. The ceremony wrapped up with a tour of the Cockburn Town Medical Centre, led by our CEO Jill Magri, Chief of Medical Service, Dr. Denise Braithwaite, and Meleck Cummings, Cockburn Town Site Director; followed by refreshments catered by ‘Refresh Café’. After announcing the implementation of Pavisse™, a cutting-edge electronic incident management

Page 5

system in August at both Cheshire Hall Medical Centre and Cockburn Town Medical Centres, CEO of TCI Hospital, Jill Magri has commended all staff who are reporting incidents. “After a thorough review and feedback, it was determined that Pavisse was the right system to leverage our patient safety initiatives.” Since implementation, we have already seen a four-fold increase in the numbers of incidents reported, which means we have a four-fold increase in learning opportunities to make our organization safer for our patients and for our staff. TCI Hospital is the first in the Caribbean region to adopt the unique IT system which is designed to support the hospital’s goal to continuously enhance its delivery of high quality patient care. “Pavisse will help us better track and manage incidents, develop corrective action plans, determine the root cause of incidents, conduct peer reviews and perform audits. All of these activities will help us to investigate promptly and resolve any concerns our patients may have and improve the quality of care provided to them.” said CEO Magri.

MESSAGE FROM THE CEO waters will (and did) recede! My Welcome to another edition of Quality thanks go out to each of you our Employee newsletter. I want 1. We will complete the OB/ who did everything possible to to reinforce some messages GYN and Family Practice get to work and help others get from our September Town Hall service reviews and initiate to work, so we could care for our meetings and share what we reviews in Physiotherapy, patients and our Hospital during are doing with our Strategic Diagnostic Imaging, the the recent flooding. You all came Plan. We are now breaking Visiting Consultant program together as an incredible team all of our operations plans into and laboratory and I continue to be inspired by five important Pillars: Service, Quality, People, Finance and 2. We will develop a culture each and every one of you! Growth. For today I’ll describe of safety (a “Just Culture”) One final quote, from a gentleman throughout the organization, what we are doing in the first two named Jared Kintz: “I love it supported by the pillar areas, Service and Quality: when the streets near my house implementation of the Pavisse get flooded, because it’s the only risk management/incident time I can go out and walk my reporting system Service fish!” 3. We will train all departments 1. We will launch mandatory on use of the Rapid Cycle customer service training for Improvement process all staff 4. We will update the Quality 2. We will develop a Leadership Framework and Risk Register Development Institute for managers, to occur two 5. We will develop care pathways WHAT’S HAPPENING times/year for common critical diagnoses 3. A multidisciplinary staff team 6. We will strive to develop a will develop our TCI Hospital culture of continuous quality “Standards of Behavior” improvement throughout our Hospital. This will begin 4. We will do “Hiring for Service” with two courses in October: training for our managers “Advancing Quality through Measurement” and “Physician 5. We will begin a process of Engagement in Quality “Rounding for Outcomes” Improvement”. for managers, senior leaders and ancillary/support Yes, TCI Hospital family, as departments. Charlie Brown said, the flood Page 6

October 16th – Fitness Challenge October 23rd – Affiliation Agreement Ceremony October 25th- Footsteps for Good TCI November 1st- Corporate Fitness Challenge December 16th- Staff Party

TCICC & TCI Hospital Signing Ceremony

Mission To provide the community and its visitors with high quality healthcare.

Vision To improve the nation’s health through the development of a substantial and accessible health care system

Values

he Turks and Caicos Islands Hospital and the Turks and Caicos Islands Community College (TCICC) have signed an affiliation agreement November 12th, 2014, aimed at creating synergistic opportunities for Turks and Caicos Islanders, through the development of instructional programs to support a variety of health care careers for local students. The agreement, the first of its kind for TCI Hospital, will also garner opportunities for students in fields of study such as business and engineering, in addition to programs in nursing and medical sciences.

“This is a win-win situation” Jill Magri

This is a win-win situation, says TCI Hospital CEO, Jill Magri. “Hospital staff will have the opportunity to

impress upon young, bright minds that TCI Hospital is a great place to practice, while the Country will benefit from having more Turks and Caicos Islanders employed at both of our facilities.” She added, “These programs will also develop nursing candidates that can support the Ministry of Health’s clinics, in addition to private community provider clinics”. Mr. Lee Ingham, President of the TCICC, is extremely pleased with the affiliation agreement which formalizes the College’s relationship with TCI Hospital. “Through this agreement with TCI Hospital, we can offer our students an even wider range of learning opportunities. The Turks and Caicos Islands Community College has been committed to building partnerships with community providers; the TCI Hospital is a welcomed partner. Their physicians

Page 1

We value ethical and respectful behaviour, honesty, accountability and excellence in all we do. and health care practitioners and other professionals will be excellent mentors for our students.” Also bringing remarks was the Minister of Education, Youth, Sports, Culture and Library Services, Hon. Akierra Missick. She said, “There is more than doctors and nurses that make up the core staff of a Hospital; this will now open the eyes of our students of the other career aspects in the medical field. We’re looking forward to all residents who are interested in any sort of employment that can benefit from this agreement take advantage of it”. The next phase will see the developing of a committee comprising members from both organizations.

November 2014

MESSAGE FROM THE CEO • For our two beautiful hospitals that exist to maximize the health and well-being of the people of the Turks and Caicos Islands and its visitors, all of whom we are here to serve; • For the visionary leadership of the InterHealth Canada Board of Directors, who dreamed dreams big enough to allow the Turks and Caicos Islands Hospital to one day become a reality.

s we approach the upcoming Thanksgiving holiday, I am reminded of the abundance of life’s blessings that are bestowed on each of us. This holiday, I am overwhelmingly thankful: • For my two wonderful children, Michele and Nicholas, who regularly send the warmth of their love from sunny California, several thousand miles and another ocean away; • I am thankful for every single staff member at Cockburn Town and Cheshire Hall Medical Centres, for each of you is vital to and are helping us fulfill our Mission: “To provide the community and its visitors with high quality healthcare”; • For our many patients, young and old, who have entrusted their lives and spirits to our caring hands;

Last, but not least, I’m thankful for Accreditation Canada International, a global organization which has provided hospitals world-wide with a criticallyimportant roadmap (“standards”) for how to best serve our patients and one another. With each mile we travel, we get closer and closer to our goals: achievement of the very highest quality of care possible for everyone who walks through our doors, whether they are patients, their friends and loved ones or our own valued staff. We are a Diamond-level accredited Hospital giving Diamond-level care – let’s continue to keep that diamond well-polished! Ask your manager today how YOU can help support our re-accreditation efforts. Happy Thanksgiving to all of you!!! Jill Magri CEO

Page 2

WHAT’S HAPPENING December 11th – Christmas tree lighting CTMC December 12th- Christmas tree lighting CHMC December 16th- Staff Appreciation Party CHMC December 20th – Staff Appreciation Party CTMC

November 2014

PREPARATIONS FOR EBOLA TCI

Hospital is developing and implementing Ebola treatment and training protocols . The strategies are related to early recognition and identification of a suspected patient, patient isolation, strict adherence to infection control protocols, appropriate donning and doffing of PPEs (Personal Protective Equipment) and supportive medical care.a The protocols for management are based on Center for Disease Control (CDC), World Health Organization (WHO) and the Pan American Health Organization (PAHO) guidelines. Recently, the TCI Hospital was visited by consultants from PAHO who reviewed the protocols and inspected the facilities at both sites. They expressed confidence with the hospitals preparedness efforts and pledged ongoing technical support through the Ministry of Health and Human Services. TCI Hospital is demonstrating significant and proactive leadership to help our country prepare for and effectively manage any outbreak of Ebola within its many borders says CEO Jill Magri. She added, “We are working closely with national and global agencies to develop evidencebased international treatment and case management protocols. We have already placed orders for the required supplies and materials to protect our patients and our care providers and a training plan for all staff has been developed. ”

Planning is key according to our Chief of Medical Services, Dr. Denise Braithwaite-Tennant. She added “We have to plan so we can be prepared and mitigate the risk of our health care workers becoming infected and avoid transmission of the disease within the community by isolating and effectively treating suspected cases. Part of our training program involves the identification of a rapid

Page 3

response team that can be activated to care for suspected patients. We continue to revise protocols as new updates are published by the CDC, PAHO and WHO.”

November 2014

TCI Hospital “Ready!” Program in Full Swing TCI

Hospital’s “Ready!” Program is successfully moving ahead. The program is in conjunction with the Ministry of Education and faculty in the Science and Business Studies Departments and the Guidance Counselors in all TCI schools and aims to educate students about the complexities of a healthcare delivery system. Most recently teams have visited the Clement Howell High School and TCIPS, while the Raymond Gardiner High school visited the Cheshire Hall Medical Centre November 20th. Education and Training Manager Mrs. Jacqueline Moe- Cox said, “The students are the future of health care in the Turks and Caicos Islands. We plan to touch every high school in the Country. In phase two students will participate in an intensive mentorship, coaching and practical application experience involving senior level staff at the Hospital.” She added, “ A special thank you to all are playing a key role in this project”

Page 4

November 2014

JOURNEY TO DIAMOND – 4 Months to Go! T

he Accreditation Canada survey date is confirmed for 23-27 March 2015 so we will provide you with regular updates on progress and preparation suggestions. So far, nine of the 15 Accreditation Teams have completed at least five selfassessment questionnaires. This is excellent progress as it is an increase of eight since the end of October. Thank you to all who made this possible. Please get in touch if you have any questions or concerns regarding The following are ways to prepare yourself for your part in retaining Diamond Accreditation preparation. Accreditation: Joanne Kinborough Mata 1. Have your manager review with you the list of potential questions Quality, Risk & Patient Safety specific to your area of work that the Surveyors could ask you; Manager Ext. 71216 2. Familiarise yourselves with the content of the “Quality” site on the JKinboroughmata@ hospital intranet (click on “Departments” and then select “Quality” interhealthcanada.tc from the drop-down list); 3. Record any quality improvement initiatives in which you have been involved in the past 12 months or have plans to implement on the “Quality Improvement Charter” (also found on the Quality site);

NOVEMBER

4. Invite me to deliver a session on Accreditation and/or implementation of Quality Improvement initiatives;

Happy Birthday to Voneric Forbes, Shevaughn Annikkie, Shawna-Kay Hewitt, Whitney Jeanty, Straudy Jackson, Girum Mussie, Oluwayemisi Olugbanmu, Lenroy Bryan, Babatunde Ajimoti, Elizabeth Mckenzie, Orlane Jolly, Leila Lawrence, Wayne Anderson, Dionne Mcgregor, David Banton, Sharon Orie, Sabrina Pedican, Ranji Ebanks, Camille Marshall, Bridget Williams, Lesly JeanBaptiste, Schiler St. Juste, and Dian Tucker!!!

5. Know the answers to the following questions which the Surveyors will potentially ask you: How would you report an incident? What would be your role if there was a major disaster on the island that resulted in 50 casualties being transferred to the hospital? What outcomes do you measure to determine whether you are doing a good job? How do you ensure that you are competent to undertake your role? How does your team communicate changes?

BIRTHDAY CORNER

What would you consider to be the most significant quality improvement initiative in your area of work in the last 12 months and why? 6. If you don’t know the answers to all of the above questions, get together with your colleagues to agree responses / come up with ways to address any issues.

Page 5

November 2014

Nurse Manager Mikette Been announces Ward Nurse of the Month

ST. Kitts Prime Minister and Team to visit TCI Hospital

ongratulations to our Nurse of the month for November 2014. The nursing profession provides us nurses with the unique opportunity to help others at times when they most need our help, according to Nurse Sylvain of the General Ward. Trained in Georgetown, Guyana, Nurse Sylvain’s professional qualifications include Registered Nurse, Registered Midwife (obstetric nurse) and Registered Nurse Anaesthetist. In October he celebrated 36 years as a nurse. He was a part of the TCI Hospital team involved in the inception in 2010, transferring from the Myrtle Rigby Clinic where he worked for two years. “My greatest satisfaction is seeing patients get well and knowing they are satisfied. I am blessed in having a lovely wife and two beautiful daughters”, says Nurse Sylvain.

he has over 40 years experience as a Registered Nurse/ Midwife in the Nursing profession; Nurse Clarke was trained in George Town Guyana and worked at the University Hospital of Jamaica for three years, prior to coming to the Turks & Caicos Islands. “I have enjoyed the nursing profession and if I had to do it all over again, I would not change it for any other profession”, say Nurse Clark. The mother of two and a grandmother of four, said she enjoys working in the Maternity unit. She added, “It gives me great joy to see the smiles on the mother’s face when she holds her new born. It was a privilege to serve as supervisor and share my knowledge with colleagues. Nurse Clarke worked at Myrtle Rigby health Complex before joining the TCI Hospital Team. Congratulations Nurse Clarke.

Page 6

It was indeed an honour for TCI Hospital to host Prime Minister of St. Kitts and Nevis the Rt. Hon. Dr. Denzil Douglas, his Minister of Health and other government officials. The tour was led by our Chief of Medical Service Dr. Denise Braithwaite, along with InterHealth Canada CEO Dr. Zahid Al Sabti, TCI Hospital CEO, Jill Magri and Chief of Clinical Services Ann Males. The St. Kitts and Nevis delegation expressed appreciation for the opportunity to tour our state of the art facility; the group was quite impressed. St. Kitts is presently considering a project with InterHealth Canada. Thanks to all staff who made this day possible.

November 2014

SMALLEST BABY BORN AT TCI HOSPITAL

tiny baby girl born on October 22nd 2014, at 5:14 am, became the smallest baby born at TCI Hospital and she is doing well. Proud mother Suzellie Joseph is amazed at her daughter’s dramatic and surprise entrance into this world, with the baby weighing in at an astonishing 700 grams at the time birth. Baby Shekina is now 37 days old, is stable and she is breathing on her own. Thanks to the team who pulled together and carried out this extraordinary delivery. A special thank you to Dr. Soler, the staff on maternity ward, and the pharmacy team. This precious angel is growing and getting better every day!

he Medical Device Reprocessing (MDR) department recently celebrated MDR International Week, under the theme “The Team That Gets It Clean. To kick off the event, students of the Clement Howell High School attended a grand exposition. There were presentations, educational interactions by the MDR team, displays, games and prizes for the students. It was a complete success according to David Banton, MDR Manager. He added, “This annual event provides interactive learning opportunities for students and creatively gives a deeper look into one of the lesser-known careers in the health sector. It was a pleasure presenting our department to the public, staff and also students of the Clement Howell High School, who were the highlight of the day. This was yet another opportunity for TCI Hospital to show students that there is more to health care than just becoming a nurse or a doctor”.

MDR WEEK

Page 7

November 2014

CONGRATULATIONS TO OUR IM&T MANAGER

ongrats to our IM&T Manager, Ryan Smith. He’s a new dad!!! We are delighted to know that you have become the proud father of a baby boy, named Carter. Please accept this heartiest congratulation. May god bless your son with good health and a king-size fortune! Please convey our congratulations to your family from the IM&T crew and the entire TCI Hospital staff.

NEWS FROM ELSEWHERE

– InterHealth Canada’s Latest Project

he InterHealth Canada office in Riyadh, Saudi Arabia has recently completed its latest project, master planning for the Prince Mohammed Medical City (PMMC) in Al Jouf, KSA, with an anticipated start date in the first quarter 2015. PMMC is one of five medical cities planned as part of the Royal Mandate plan to establish 5100 tertiary care medical cities throughout the Kingdom of Saudi Arabia. The hospital located in Al Jouf will provide tertiary care services for Al Jouf and the Northern borders. The hospital will consist of three hospitals contained on a single site and is expected to employ over 9,500 staff.

TCI HOSPITAL

FITNESS CHALLENGE

he first Annual TCI Hospital Fitness challenge encourages staff to pursue a healthier and more active lifestyle. The Games provides the opportunity for anyone, regardless of their sporting ability, to get fit and remain active. Human Resources Manager Edwin Taylor said, “It is important to promote wellness and encourage employees to maintain a healthy lifestyle. This will also boost morale; build teamwork, and company pride among employees. Congratulations to everyone for taking the first step, which is to start, and like the saying goes , ‘Now the real work begins.’ We promise this journey will be very rewarding.” The program began 16th October and is expected to wrap up on 11th December. Activities include weekly boot camp, training at the national stadium, and access to Graceway sports centre. The countdown is on and good luck to all competing in the fitness challenge!

Page 8

November 2014

COMMUNITY HEALTH AND GIVING T

he Turks and Caicos Islands Hospital appreciates the importance of corporate giving, by assisting organizations who are directly involved in health and wellness. Over the past few months we have played a key role in providing much needed funds to a number of charities. It is our aim to collaborate with most, if not all local health and human service organizations and also the government to make our community even healthier, not only though monetary donations but also by being a key player in bringing awareness to health matters. Our most recent community beneficiaries include the following: • National Cancer Society – Cancer awareness month •

Nutrition and Demand

•

SNAP Centre (Special Needs)- Footsteps4Good in TCI

•

Turks and Caicos Aids Awareness Foundation

•

Crime Stoppers (a safe community is a healthy community!)

DID YOU KNOW- HEALTH TIP OF THE MONTH

tay healthy for Christmas, wash your hands often! Wash your hands when preparing that good holiday food and wash them frequently if anyone in the household has not been feeling well. Wash your hands well after going shopping – don’t let illness be the “gift that keeps on giving”! Many succumb to flu and stomach bugs over the holiday season, so keeping your hands clean is the best defense. We wish you good health this holiday season! From the Infection Control Department

Page 9

November 2014

TCI Hospital

Turns on the Lights

o start out the holidays, Cockburn Town and Cheshire Hall hosted their annual Christmas Tree Lighting Ceremonies on Thursday 11th December and Friday 12th December respectively. The staff event featured musical performances and culminated with the lighting of the Christmas tree and the opportunity for the children to take their picture with Santa. ”We have people that work so hard at both sites. So anytime that we can show any kind of support for them and their children, I think it’s a wonderful thing for our them and their families”, says Martin Dawtry, General Manager. The lights at CTMC were switched on by the oldest resident on the Island of Grand Turk Mrs. Eudora Williams, while the guest of Honor at the CHMC was the first local Doctor, Mrs. Hamilton. See highlights on Page 8.

Page 1

Mission To provide the community and its visitors with high quality healthcare.

Vision To improve the nation’s health through the development of a substantial and accessible health care system

Values We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

December 2014

MESSAGE FROM THE CEO M

y message this December is to wish all of you the many blessings of this wonderful holiday season. This year I am reminded of the story of the three Magi, as described in the Gospel of Matthew in the Christian tradition. These three Kings came from all over the world – Melchior from Persia, Caspar from India and Balthazar from Arabia – to bring their gifts of gold, frankincense and myrrh to the baby Jesus, as a gesture of their consummate honour and respect. So, too, the staff of the Turks and Caicos Islands Hospital have come from all over the world, to bring their

GREETINGS FROM DR. BRAITHWAITE

appy Holidays TCI Hospital Team. My continued prayer for you is peace, health and happiness. Thank you for your service and commitment. Your hard work does not go unnoticed and I am proud to be a part of the TCI Hospital team. Together we have faced challenges and successes. Let us continue to work together and always look for the good in life and in what we do. Not everyone says thanks, but your service adds much value. Let us continue to strive for excellence and be proud of the work we have done and continue to do for the community. There would be no TCI Hospital without your contribution. I wish you and your families all the very best for the New Year and I am thoroughly excited for the achievements to come - DIAMOND. Happy Holidays and God bless you.

many gifts to the patients we serve: their gifts of compassion and sensitivity, their gifts of warmth and tenderness, their gifts of skill and competence, their gifts of warm hands and gentle hearts in the dark of night. On behalf of the entire Senior Management Team, we thank you all for your gifts of service in 2014 and we wish you all the very happiest and healthiest of New Years in 2015. Let’s all keep our fingers crossed for a special gift after our March accreditation survey – the gift of DIAMONDS! Very best regards. Jill Magri CEO

GREETINGS FROM JOHN HYLAND

very Happy Christmas to everyone and couple that with the earnest hope that 2015 will be a year when the company’s operation in the TCI goes from strength to strength and that each of you and your families, whether they be large or small, enjoy good health and the prosperity for which all of you have worked so hard. Our overall success depends upon the work of everybody throughout the organisation. A very large “thank you” to each and every one of you for the support and friendship which you showed to me during my stay in the TCI this year – I know that at times it must have seemed as though I had nothing better to do than ask questions, prod and prompt, but it was well meant and all in a good cause – and certainly you made my stay not just bearable, but actually very enjoyable. All the best for 2015.

Page 2

December 2014

TRAINING INITIATIVES TO BE ROLLED OUT IN JANUARY A

ccording to Training and Education Manager Jacqueline Moe-Cox, in the first quarter of 2015 TCI Hospital’s Education Department will roll out a number of Personal Development initiatives. These have been specifically designed in response to our recently concluded training needs analysis across the Hospital and include subject matter that falls in line with the Accreditation standards for learning and development. The learning objectives for each session are designed to ensure information transfer and will stimulate the participants to consciously examine their current personal development and commit to improving performance. Most of the sessions will be delivered by inhouse facilitators so that the subject matter in each session is relevant and transferable to our day to day functions.

Customer Service in Health Care/ Quality Framework

Building Effective Interpersonal RelationshipsA practical approach to Supervisory Management

Budgeting for Department Heads

Organisational Ethics

The Education Department is also working with the IT Department to develop training sessions in Miscrosoft Word, Excel and Power Point. We are hoping to deliver these in Basic, Intermediate and Advanced levels. All Heads of Departments are asked to ensure that the required team members attend the sessions when they are scheduled. Some mandatory sessions will be run on a monthly basis to accommodate the full complement of staff.

Medical Coding

MANDATORY TRAINING:

Inter-Office Communication Protocol/ Report Writing

We are also in the process of revising the current structure of the Mandatory Training and you will be informed of any changes early in the New Year.

These CPE sessions will include:

The Department of Education extends a Merry Christmas to you all and the hope of a purposeful and prosperous 2015 for you and your families!

Page 3

December 2014

Medical Technologist Lessonjulle Lyons-Dobney Reports on Antimicrobial Resistance Conference

lobally, antimicrobial resistance (AMR) has been recognized as a significant threat to population health as bacteria, fungi, viruses and parasites will no longer respond to standard treatment making common infections harder to control. Poor control could lead to increased spread of infections, longer period of illness, longer hospital stays, increased economic and social costs and increase risk of death (WHO, 2014). According to the World Health Organization (WHO, 2014), antimicrobial resistance threatens the achievement of modern medicine and could easily propel the world into “a post-antibiotic era in which common infections and minor injuries can kill”. The WHO (2014) revealed that:

investigation

• Common bacteria that cause health-care associated and communityacquired infections such as urinary tract infections, wound infections, bloodstream infection and pneumonia has shown very high rates of resistance in all WHO regions. • There are significant gaps in antimicrobial resistance surveillance, and a lack of standards for methodology, data sharing and coordination.

Caribbean Public Health Agency (CARPHA) in partnership with Public Health England hosted the “Commonwealth Laboratory Twinning Workshop: Combating Antimicrobial Resistance in the Caribbean” on December 9-10, 2014 in Port of Spain, Trinidad. Eighteen Caribbean countries, including TCI, were represented at the workshop that sought to: 1. Raise awareness of AMR and strengthen liaison and coordination with key stakeholders in the Caribbean 2. Determine opportunities to build and strengthen networks 3. Build a shared understanding of the AMR situation in the Caribbean 4. To strengthen public health microbiology laboratories, lab based quality, surveillance capacity, epidemiological expertise, prevention and control of health care associated infections and antimicrobial stewardship

It was recognized that contributors to AMR in the Caribbean are multifactorial and as such requires collaborative effort among policymakers, technical and tactical teams and society as a whole to successfully address the problem. TCI Hospital, as the lead health care team in the Turks and Caicos, is able to contribute to the reduction of antimicrobial resistance through multiple pathways which will be discussed in addition to the findings of this workshop and an analysis of antibiotic resistance in the Turks and Caicos Islands at a CME will be announced.

5th year Anniversary Announcement

CI Hospital is turning 5 next April!!! To commemorate this achievement, the celebrations will run for the entire month of May 2015 following accreditation. Those who have volunteered to sit on our anniversary planning committee, the first meeting will convene the second week of January; a time and date to be announced.

5. To develop a practical roadmap for implementation and coordination of activities to combat AMR in the Caribbean.

Page 4

December 2014

JOURNEY TO DIAMOND – 4 Months to Go! T

he Accreditation Canada Survey date is rapidly approaching (23rd – 27th March 2015) and things are heating up! I appreciate that you’re all extremely busy but if you get a free moment please take a look through the content of the Quality site on the intranet (from the “home” page, click on “Departments” and select “Quality”). Particularly important is that you read through the “key organisational documentation” section. I have saved the profiles of the Surveyors into the folder entitled “Survey Preparation” so that you can get to know them before they even arrive at the hospital! You will also find in there the survey schedule, to enable you to see when they will be visiting your area of work.

Please do get in touch if you have any questions or concerns regarding Accreditation preparation. Joanne Kinborough Mata Quality, Risk & Patient Safety Manager Ext. 71216 JKinboroughmata@interhealthcanada.tc

ACCREDITATION CERTIFICATE FEATURE A ccreditation Canada International has recently concluded a three part educational series for TCI Hospital managers and doctors. In session one- ‘Health Care leaders of Tomorrow’, managers were introduced to the leadership attributes required to perform in an organization delivering quality and safe care. Participants were guided through interactive exercises enabling them to directly experience and reflect on their practice of self-leadership, interpersonal leadership and strategic leadership. The second session was primarily for physicians, under the topic ‘Physician Engagement for Quality Improvement’. This two day workshop explored many ideas on the quality improvement efforts in health organizations. ‘Advancing

Quality through Measurement’ was the topic of discussion for session three. Participants discussed in detail, quality from a systems perspective, quality as a framework, defining quality from TCI Hospital’s perspective and data collection and sampling. Chief of Clinical Service Anne Males said, “The training delivered was logical and relevant and allowed the team to see ways to make an immediate difference in our work practices. It dovetailed with the knowledge base available and the further in house training that has been arranged”.

Page 5

December 2014

TCI HOSPITAL MOURNS THE DEATH OF NURSE SHIRLEY WALKIN

he TCI Hospital community is still trying to cope with the death of Nurse Shirley Walkin on Thursday December 18th 2014. â€œWe are extremely saddened to hear about the death of one of our beloved nurses. May her star continue to shine brighter than it did when she was still with us, may her spirit continue to be with us at the Cheshire Hall Medical Centre as we move the organization forward. May her soul rest in peaceâ€?, says Jill Magri CEO- TCI Hospital.

Page 6

December 2014

How to Make a Turkey – the Simplest Method Ingredients •

1 tablespoon smoked paprika

•

1-1/2 teaspoons garlic powder

•

1-1/2 teaspoons onion powder

•

1 teaspoon cayenne pepper

•

1 teaspoon dried thyme

•

Kosher salt and freshly ground black pepper

•

One 14 -pound turkey, giblets removed, washed and dried

•

Extra-virgin olive oil, for drizzling

•

Fresh thyme, for garnish

HAPPY BIRTHDAY

TO OUR DECEMBER BABIES Directions

ix the smoked paprika, garlic powder, onion powder, cayenne pepper, dried thyme, 1 tablespoon salt and 1-1/2 teaspoons black pepper in a bowl. Sprinkle some of the spice rub inside the cavity of the turkey. Separate the skin from the breast meat with your fingers, starting at the top of the breast and sliding to the right and left, then working down. Massage some of the rub onto the meat under the skin. Sprinkle the remaining rub on the turkey’s skin. Place the turkey on a sheet tray and cover with plastic wrap. Refrigerate overnight or up to 24 hours so the flavors can marry. Set a rack at the lowest position in the oven and preheat to 325 degrees F. Remove the turkey from the refrigerator to bring to room temperature. Tie the legs together and tuck the wing tips under. Place the turkey in a roasting pan. Drizzle the outside of the turkey with a few tablespoons of olive oil and sprinkle with salt and pepper. Roast the turkey about 3 hours, or until a thermometer inserted into the thickest part of the thigh registers 165 degrees F. Transfer the turkey to a platter, cover loosely with foil and let rest 30 minutes before carving.

Anne Males, Jacqueline MoeCox, Yashmah Adams, Glenroy Dick, Manuela Cundangan, Valerie Outten, Jervis Mclean, Dorcen Adley, Jaxon Charles, Darrett Lynch, Marie Joseph, Debbie Williams, Theresa Hall, Shirley Walkin, Karen Abril, Antionette Davis-Trail, Kadesha Fletcher, Ferdinand Gaspar, Haydee Dayupay, Doris Nsanta, Brenda Adolph, Detorrie Tennant, Nalthia Norman, William Henry, Sharanna Simmons, Karen Rose

Recipe courtesy Pat Neely for Food Network Magazine

Page 7

December 2014

TCI Hospital

Turns on the Lights

Page 8

December 2014

HEALTH TIPS OF THE MONTH ‘Tis the season to be jolly--and to gain weight. Here are a few tips to maintain your healthy diet and stay active through this time of temptation. • Most holidays are associated with certain foods. Christmas at your house might not be the same without your mum’s special dish, but that doesn’t mean food has to be the main focus. Instead, throw yourself into the other rituals a holiday brings, whether it’s caroling or taking a drive to see the Christmas lights.

NURSE SHIRLEY

WALKIN- GONE TOO SOON As a tribute to your nursing All the care that you bestow High above this earthly planet Now hangs a Nurse Rainbow We don’t want to say goodbye don’t want you to see us cry But in the end, that sweet by and by We will meet again. -

The General Ward

• Skip the store-bought cookies at Christmas, but do save some calories in your ‘budget’ to sample treats that are homemade and special to your family. Training yourself what to indulge in and what to skip is much like budgeting your money. • The habit: staying physically active during the holidays. The result: gaining less weight over the years. • Everyone’s overly busy during the holidays, and most of us want to spend our time shopping, decorating, or seeing friends and family, which leaves less time to cook healthy meals. Take defensive action several weeks ahead of time by cooking meals intended specifically for the freezer. You’ll be thankful later. • You may not be able to control what’s being served at a holiday meal, but you can make the turkey, roast beef, and even mashed potatoes and stuffing much healthier by foregoing the sauce or gravy or spooning on just a small amount. • Take the focus off food and drinks this holiday season by embracing a project that will have lasting meaning: organizing clutter. Dispensing of clutter will be stress relief in itself.

A TRIBUTE TO NURSE SHIRLEY WALKIN Let me dedicate my life today to the care of those who come my way. Let me touch each one with healing hand and the gentle art for which I stand. And then tonight when day is done, O let me rest in peace if I have helped just one.

• Toast the New Year with just one glass of bubbly. You may be celebrating, but that doesn’t mean that that you should send your meal plan (and your judgment) on holiday. 89 calories per glass of white wine or champagne, 55 calories in a shot of vodka, and 170 calories in a pint of stout beer.

Page 9

December 2014

Mission To provide the community and its visitors with high quality healthcare.

Vision To improve the nationâ€™s health through the development of a substantial and accessible health care system

Values We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

STAFF APPRECIATION

HIGHLIGHTS Page 10

Page 1

In Memory of Nurse Sheryl Walkin Page 7 January 2015

MESSAGE FROM THE CEO

• Accreditation validates to our community that we are providing our patients with high quality care and that we are all working (and being cared for) in a healthy and safe environment.

appy 2015 to all our excellent staff of Turks and Caicos Islands Hospital! It seems like Christmas was just yesterday, but January is gone, February is here and - before we know it - it will be March and the start of our second accreditation survey with Accreditation Canada International. Our goal? More diamonds!! Why is accreditation important?

• Accreditation sends a message to international visitors and potential private-pay (medical tourism) patients that a Hospital exists here that meets global healthcare quality and safety standards, a Hospital where they can feel comfortable bringing themselves and their money to help support our local healthcare economy.

• It is a mandated requirement under the terms of our Project Agreement with the Turks and Caicos Islands Government, so our future depends on it! The stakes are high. Please ask questions, get involved, get informed, get ready to put your very best work on display and show our surveyors, our patients, TCIG and THE WORLD how wonderful Turks and Caicos Islands Hospital is! If we can see it, we can be it!

Jill Magri CEO

• Accreditation is a requirement in most contracts for provision of medical tourism care at the Hospital – it is our “ticket” to get into the medical tourism “dance”.

EDUCATION/TRAINING DEPARTMENT WHAT’S HAPPENING? Save the dates and register! DATES

TIME

ROOM

Session

Audience

Mar 30th 9:00 am – 1:30pm 12:22 (VC) CUSTOMER SERVICE TRAINING* Non-management *Register by March 25th

Page 2

January 2015

MESSAGE FROM JOHN HYLAND LEGAL COUNSEL AND DIRECTOR

TCI Hospital in the COMMUNITY

s I write, we are 8 weeks from the start of the Accreditation Canada survey and 10 weeks from the 5th Anniversary of the opening of the Hospital and therefore it is a good time to take stock of where we are and what we have achieved together. All of us, whatever be our position and whether we are Belongers or holders of Permanent Resident Certificates or, like me, periodic visitors to the TCI Hospital, can feel justly proud. We are able to work in modern, well designed and well maintained buildings with up to date and well maintained equipment and a supply chain which ensures access to the requisite drugs and other pharmaceutical products. That is an enviable position which a great many healthcare professionals elsewhere in the Region would dearly like to en joy – but we have to remember always that healthcare is a “people business”. The buildings and equipment are really no more than the “tools” which are maintained by Martin Dawtry and his team and which allow those of you directly involved in clinical care to treat patients with the attention and skills which they require and deserve. Our patients come to us for care when they are vulnerable; it is their well being and the support which we give to them and their families that has to be our paramount concern. Accreditation is the internationally accepted benchmark against which our performance in meeting the revised Vision, Mission and Values Statements adopted last summer and the international standard of healthcare promised to the Government and the people of the TCI has to be measured.

Under the leadership of Jill Magri and with the support of the Senior Management Team, great progress has been made over the last two years. The many developments and improvements to policies, procedures and protocols, are all now embedded into working practises and being reinforced through the work of the entire management team and supported by the leaders of the various accreditation work streams. In parallel, the Board has been reviewing its Governance policies, amending them as appropriate and adding new ones to accommodate Standards introduced since April 2012. I and my co-directors are confident that the efforts which all of you have and are continuing to make, will result in our Accreditation status being renewed.

urks and Caicos Islands Hospital is proud to be part of the TCI community. The hospital generously supports a number of organizations in the community. Here are just a few recently supported: • The H. J. Robinson High School • Footsteps for good TCI – SNAP Centre • Nutrition in Demand • National Cancer Society • Crime Stoppers TCI • TCI Aids Awareness Foundation

side from the appearance of new diseases, the constant introduction of new drugs and new ways of providing treatments means that the provision of healthcare can never be static and in all countries it is always open to challenge and criticism. That is something which we as a company and you as our staff, have to accept and live with. However, I take this opportunity to assure you that the company recognises, supports and thanks you for the efforts which each of you continues to make to ensure the Hospital’s success and future. Working together, we can and will succeed in making what is already a very good Hospital into a great Hospital.

Page 3

January 2015

Nurses of the Month – CHMC RN Asha Jose General Ward

sha Jose had her professional training as a nurse in Amala Institute of Medical Sciences [AIMS], Kerala, India. Her long-term dream was to be a professional nurse working with a multi-cultural team anywhere in the world. That dream has come true at Cheshire Hall Medical Centre in Turks and Caicos Islands. Nurse Asha said she has been practicing as a nurse for seven years and her training goes on especially on the job, which boosts her knowledge and experience. Nurse Asha Jose is currently furthering her nursing studies with the University of West Indies. According to Nurse Asha, “Nursing is a noble and divine profession. Nurses are God’s angels without wings and this is a golden opportunity to help and

make changes in the lives of others, especially at the time of sickness and suffering. I am proud to be a nurse and I long for the day when the world will be fully staffed with competent and compassionate nurses - God’s Angels”. Nurse Asha is blessed with a loving husband, Jom, and a

RN Jacqueline Fiedtkou - Maternity Ward

Page 4

five-year old son Aatish (another one is on his way). She has expressed sincere thanks for all the support and encouragement and wishes for all staff a successful and pleasant 2015.

acqueline Fiedtkou is a Registered Nurse and Registered midwife. Nurse Fiedtkou has been with us at Cheshire Medical Centre since the opening of its doors in 2010. She received her nursing certification in Guyana commencing in 1989. Nurse Fiedtkou said, “I have since remained in nursing and never regretted being in this profession because there is true job satisfaction in having the privilege to contribute in a meaningful way to my fellow human beings. Nursing has definitely changed my life. I feel that I have learned so much more from my patients than I have ever given to them. It has made me humble and grateful. It is the big and small daily happenings that make nursing such an interesting and rewarding profession.”

January 2015

JOURNEY TO DIAMOND T

here’s a lot of work going on behind the scenes to get everything ready for the Survey during the week commencing 23 March. But any day now I will be emerging from my office (a bit like a hibernating bat from Middle Caicos Caves!) and it will be all systems go. Donna Hutton is back with us and we’re in the process of confirming which staff members Surveyors will be interviewing. Donna and I will then meet with each of them to do “mock” surveys to ensure that they are comfortable with the process and that we’ve identified any additional information needed. Eleanor Hall will complete the list on the Quality portal which identifies where each of the documents essential to the Survey can be found so that you can read up on them and stun the Surveyors with your knowledge. We are developing several presentations for you about the ethics framework, the quality framework and plan and other key pieces of work, and will be attending departmental meetings so that we can tailor information specific to your areas of work to ensure that they are relevant to you.

Leonard Smith Certified as an Instrument Specialist

You will all have received an email regarding the Institute for Healthcare Improvement (IHI) passport membership and a number of people have already enrolled in some of the available programmes. If you require any help with this, you are very welcome to drop by my office. Please also do get in touch if you have any questions or concerns regarding Accreditation preparation. Joanne Kinborough Mata Quality, Risk & Patient Safety Manager Ext. 71216 JKinboroughmata@interhealthcanada.tc

eonard Smith, from our Medical Reprocessing Department, is now certified as an instrument specialist through the International Association of Healthcare Central Service Material Management. With this certification, Smith will now be able to demonstrate the knowledge and recognition of medical instruments and instrument support system functions necessary to help ensure the safe and timely delivery of surgical instruments to patients. A very ambitious Smith said, “It was through hard work and dedication, while juggling work and other extracurricular activities. I am never satisfied and I am always trying to get more”. Achieve more, do better, be better - is his motto, one that he lives by day to day. David Banton, MDR Manager praised Smith for his commitment over the last several months. “This was a self study course which Leonard was

Page 5

very committed to, and because of his hard work and sacrifice, he managed to pass the exam. This accomplishment will benefit both Leonard and the Turks and Caicos Islands Hospital. Banton added, “Leonard will be more equipped to carry out his duties, by identifying the importance and impact that surgical/medical devices have on patient safety. He can now speak to the impact that instrument quality and instrument systems have on physician satisfaction and also the financial impact that poor handling and management can have on facility.” According to Smith, some day in the near future he sees himself completing a Bachelor of Science degree in Registered Nursing, specializing in Surgical Nursing.

January 2015

LABORATORY HEADS ATTENDS ABBOTT DIAGNOSTICS WORKSHOP

athologist Larry Godfrey, Chief of Allied Services Eleanor Hall and Clinical Lab Manager Carol Robinson have recently attended the Ecosystem Innovation Workshop – Driving Change through Value and Creating Innovation, December 9th and 10th, 2014. The Abbott group realized that the healthcare landscape is more complex than ever before and in our increasingly interconnected world, the decisions made can lead to new and unforeseen outcomes, not all of them positive. To meet the challenge of offering the highest quality of care while working to reduce costs, every level in the healthcare system must work in harmony, like an ecosystem.

The overall objective of the workshop was to provide all persons involved in healthcare with a deeper understanding of the healthcare ecosystem and innovation processes as it relates to developing projects or executing any desired “value creating” innovation project in the organization. According to the Lab Manager, the workshop introduced the “Innovation Toolkit,” which consists of three phases (define, solve, implement/execute), each of which carries you through steps to capture value in our healthcare ecosystem and identify new strategies in order to maximize opportunities while tackling threats.

Page 6

January 2015

In Memory of Nurse Sheryl Walkin M

any gathered at Cheshire Hall and Cockburn Town Medical Centres on Friday January 9th, 2015 to honor the memory of Nurse Sheryl Walkin. Nurse Walkin was remembered as a caring person and devoted colleague. The event saw tributes from colleagues, our Chief of Medical Services Dr. Denise Braithwaite, our Chief Executive Officer Jill Magri and Minister of Health Hon. Porsha Stubbs Smith. Family and friends of Nurse Walkin were also in attendance. See highlights from the memorial service below.

Page 7

January 2015

TCI HOSPITAL SUPPORTS THE GEEMS PROJECT O

n January 22nd, Barbara Handfield, Founder of Geems Project TCI, in bringing awareness to domestic violence, was able to put on display in Cheshire Hall Medical Centre’s foyer the details of her latest fundraising effort . GEEMS Project TCI is a registered Non-Profit Organization aimed at motivating and inspiring residents to a healthy and productive lifestyle and has been in operation for three years. The

1st Annual GEEMS Project TCI fundraiser will be held on Saturday, February 28th at Blue Haven’s Salt Bar & Grill in Providenciales. On February 27th and February 28th, a bin will be located at the Cheshire Hall Medical Centre reception area to collect donations of brand new pairs of shoes, which will be auctioned off at the fundraiser. GEEMS stands for “Gender, Empowerment, Endurance, Moderation and Survival.

Page 8

January 2015

Human Resource Department - We are here for you!!

he Human Resource Department continues to provide support to the staff at TCI Hospital. After receiving feedback from the last employee satisfaction survey, we decided to develop a plan that we hope will serve you better. We intend to change policies and procedures that best suit all employees and to also help the organization to function efficiently. Below are some of the changes being made: 1. Ticketing: Starting 1st January 2015 staff will have the ability to purchase their own tickets and have it reimbursed. However, we require that these tickets be bought at least three (3) months in advance in order to take advantage of the best rates available. For those who need assistance, the HR staff will be happy to walk you through your options.

2. Wellness: We are continuing to build off the wellness program that we started in 2014 by soon providing you with a wellness news letter on a monthly basis. This newsletter will help support you to reach your fitness goals for 2015. 3. Training: The Education Manager along with the Human Resource Department have made some changes to the mandatory training and the staff induction process. All team members will be notified soon of the details. 4. Employee Recognition: The Communication Committee is helping to finalize the employee recognition policy which is expected to be completed by the end of

February. The organization has planned two annual staff functions. One will be a family picnic in the beginning of the summer, and the other will be an employee appreciation dinner at the end of the year. We are also planning quarterly fun days for both sites. This new initiative will be organized by the various departments throughout the organization. Remember we are here to support you and the organization by continuing to promote and maintain a happy and healthy workforce, in order for you to provide the TCI and its visitors with high quality healthcare.

HEALTH TIP OF THE MONTH W

e are still in the flu season!!!!!!! The flu is spread by droplets as those infected with it cough, sneeze or talk. These droplets can land on surfaces that others touch and people then touch their noses or mouths. The flu can vary by individual and can range in severity from very mild to very severe, even causing death. Here are five simple steps you can take to reduce your chances or getting – or spreading – the flu: 1. Get vaccinated. 2. Wash hands frequently. 3. Cover coughs and sneezes. 4. Stay home if you are sick. 5. Convince those around you to follow steps 1 – 4.

Page 9

January 2015

Welcome to the TEAM!!! M

eet Lorlean Wilson, our new Employee Relation Officer. She has over two years in Professional Human Resource Management. Prior to joining InterHealth Canada, she worked at Club Med Turkoise as Human Recourse Assistant Manager. Wilson is a graduate of Georgia State University with a BA Degree in Managerial Sciences. Her passion and drive is to accomplish any task big or small.

orenzo Seymour, originally from the Island of South Caicos is one of our new Employee Relation Officers. Lorenzo completed his studies at Barry University, graduating with Bachelor of Science Degree in Management. Mr. Seymourâ€™s career thus far has been immersed in the Hospitality industry working at the Turks & Caicos Islands Tourist Board and most notable Beaches Turks & Caicos Resort Villages & Spa.

ay hello to Ivis Taylor who was born on Conch Bar Middle Caicos!! She attended the Raymond Gardiner High School and The Turks and Caicos Business College on Grand Turk, where she obtained her academics in Accounting and Computer Technology. For 14 years, Taylor held the position as Retail Store Manager at LIME TCI, then venturing into the legal field at Law Firm Swann & Swann in 2011. Ivis is now the Executive Assistant to the CEO and CMS.

Page 10

January 2015

HIGHLIGHTS OF DECEMBER STAFF APPRECIATION

Page 11

January 2015

Page 12

January 2015

FM HONORS STAFF Page 4

Mission

Vision

Values

To provide the community and its visitors with high quality healthcare.

To improve the nationâ€™s health through the development of a substantial and accessible health care system

We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

Page 1

February 2015

MESSAGE FROM THE CEO

him, a promise I would soon come to almost regret. The further I got into my shift, the more chaotic things got and one thing after another sprang up to demand my attention. The constant nuisances were interrupted by Mr. Milney’s call button. As I arrived, he asked if I had found a little time for that walk yet. Looking at my watch, I realized two hours had flown by. I talked with him briefly and reassured him we’d get to it, there were just a few more details to clear up, and then I was off in a flash.

Mr. Milney’s Walk

– a story from a former colleague “One night, six years ago, I arrived at the hospital to work an overnight shift. I made my rounds, checking in with each patient before beginning the other responsibilities of my shift. Mr. Milney, a kind, elderly gentleman, was one of my assigned patients. When I entered his room, I introduced myself and asked if there was anything I could get for him before I got busy with other duties. “No”, he told me, “but there’s one thing I’d like for you to do for me.” “No problem”, I said, “What is it?” “Well, sometime tonight while you’re here, I’d like for you to come get me up out of this bed and I want to take a walk around the place. You know, just get up and move for awhile.” I assured him that could be done. As soon as I got things rolling and found a lull in the schedule I would come take him for a walk. I promised

An hour later, a nurse’s aide came and said she’d answered another call from Mr. Milney and he was asking for me. I sent back the message I would be there soon. It seemed the only thing better than his persistence was his patience. No complaints, just continued requests. An hour later another came, and finally, before 5:00 a.m. I answered his fifth call of the night. When I entered his room he was serious, but pleasant. “Could we please go on that walk now?” he pleaded. I began to apologize and tried to explain how busy the night had been and all the things that had happened. “That’s fine, not a problem,” he cut me off politely. “It’s just that the walk is really important to me and I’d like for you to help me. Could we do it right now?” The tone in his voice and look in his eyes said something I didn’t understand. “Mr. Milney, what is it?” I asked. “You see”, he started, “I’m going in for surgery this morning in about an hour. They are going to amputate both of my legs just above the knee and I’d like to take a nice walk on them one last time. It would really mean a lot to me.”

Page 2

MESSAGE: Let’s not get so caught up in the tasks and the business of care-giving that we forget those people in our care. Our patients come to us for guidance, support, encouragement, counseling, nurturing, compassion and care. They put their trust in us and depend on us to ease their pain and promote their growth. Sometimes we need reminding of who we are, whose we are, and what our purpose here really is. When all is said and done, all that really matters is how we treat each other. February is “Heart Month”. Let’s focus on giving our hearts to others.

Jill Magri CEO

NEWS FROM ELSEWHEREInterHealth Canada to construct medical facility in Kazakhstan InterHealth Canada Global is planning to build hospitals in the south of Kazakhstan. The size of funding and construction start date has yet to be announced. The construction of the facilities is planned in the framework of public-private partnerships. According to a Press Release, the parties also discussed a possibility of giving existing hospitals to investors’ trust management teams on condition of keeping the entire scope of free medical care. Foreign managers intend to share the knowledge and experience and improve the quality of health care services.

February 2015

Healing garden

and Quiet Contemplation Room

he quiet contemplation rooms at the Turks and Caicos Islands Hospital meet spiritual and religious needs of patients, relatives and staff of all faiths.

The Quiet Contemplation room at Cheshire Hall Medical Centre is adjacent to the lab, on the ground floor. It is open 24 hours, and has washing facilities.

The healing gardens at both facilities are also an option for space to support spiritual thought.

TCI HOSPITAL STAFF RECEIVES TRAINING FROM THE AMERICAN HEART ASSOCIATION

he American Heart Association recently facilitated a three-day training session at the Cheshire Hall Medical Centre on January 27th, 2015. The three day course provided staff with refresher instructor training and student instructors teaching staff through Nurse Meleck Cummings, Dr. Denise Braithwaite-Tennant, Dr Dionne Lightbourne, Dr. Vancelee Forbes, Nurse Carl Lewis, Nurse Michael Williams, and Nurse Mikette Been. Chief of Medical Services, Dr. Denise Braithwaite-Tennant said, “We need to ensure that we in the community

too, know how to save lives.” Dr. Braithwaite- Tennant added, “By becoming certified as American Heart Association Instructors, and then in the long-term becoming a training centre, we want to extend this program to the community as there is a wide scope of persons who can benefit from the program of CPR”. Some of the benefits for this training are the possibility of increasing the local capacity of American Heart Association Certified instructors, providing a resource for training both within TCI Hospital, the Ministry of

Page 3

Health and Human Services and the community, and to save lives - facilitating frequent training and competence maintenance among health care providers locally. “It is not only important to practice the skills, and to conduct the drills as we are doing here, but also to train future instructors that are able to serve their community’s needs and cater to the hospital’s needs on a regular basis”, says Gustavo Flores, Regional Instructor- American Heart Association.

February 2015

FM HONORS STAFF

ongratulations to Facilities Management staff who were honored at their annual award ceremony held in January at the Cockburn Town and Cheshire Hall Medical Centres. General Manager Martin Dawtry expressed appreciation to all hard working staff. The categories included employee of the year award for outstanding contribution, employee of the month awards, Above and Beyond the call of Duty award, Personal Growth and Development awards, and Customer Perception award. Congratulations to Linvel Seymour who received the employee of the year award. Employee of the month awards went to Dorothy Bean of CTMC and

Rosette Voltaire, CHMC. Good job and congratulations to the above and Beyond the call of Duty awards, Clyde Jalosjos of CTMC and Hillary Jules of CHMC. The Personal Growth and Development awards went to Tamara Johnson of CTMC and Donique Pinnock of the CHMC, while the Customer Perception award went to Dicke Kumar. FM Staff also received their certificates for Manual Handling Training, Health and Safety, Train the Trainer and the catering department received their food Hygiene certificates. See highlights below.

Page 4

e are gearing up for the celebration of the year! TCI Hospital is turning 5! To mark the special day, staff will invited to a number of activities where they will be thanked and celebrated. This year, TCI Hospital celebrates five years of serving the community with high-quality care. Over the past five years, weâ€™ve seen incredible growth in the expertise and education of our staff, and the expansion of our specialty services. Thanks to all of you who have made this happen. A Calender of events will be published soon.

February 2015

JOURNEY TO DIAMOND T

Please also do get in touch if you have any questions or concerns regarding Accreditation preparation. Joanne Kinborough Mata Quality, Risk & Patient Safety Manager Ext. 71216 JKinboroughmata@interhealthcanada.tc

I have saved the profiles of the Surveyors into the folder entitled “Survey Preparation” so that you can get to know them before they arrive at the hospital! You will also find there the survey schedule so you can see when they will visit your area of work.

HOSPITAL GARDENING CLUB The FM team will be launching a Gardening Club for InterHealth employees to develop a piece of land at the rear of the hospital. Once the area is established, our aim is to develop this space into a community garden and open it to the public. Interested Club members will have the opportunity to be the organizers and educators for the project. This is a new and exciting project, and we are looking for volunteers prepared to give their time of two hours or more each week . This should appeal both to people who are either interested in a few hours of gardening and also those who would like to participate in a more involved project. The aim is to develop our area from its humble

beginnings all the way through to full launch to the community!

• Networking with others interested in gardening

The club is free, and offers the following benefits:

• Seed and scheme

• Opportunity to be either part of the group responsible for planning and shaping the project…….. or simply to garden in your spare time • Regular exercise without a trip to the Gym • A chance to meet new people and start a new hobby

cutting

• Access to expertise from DEMA representatives • Involvement in up and coming projects including keeping chickens and beekeeping If you are interested please contact Karen at 232-4017 for more details

• To learn about native plants and cultivation of crops • Gain gardening skills that you will keep for life

Page 5

February 2015

Special Delivery at CTMC

Page 6

February 2015

ongratulations to Nurse Rosheda Malcolm affectionately known as Nurse Neat, on the birth of her twin daughters. Prior to the delivery of her beautiful babies, the team at the Cockburn Town treated nurse Neat to a surprise baby shower.

“Nurse Neat is a valuable member of our team and a wonderful team player. We were happy to be able to show her appreciation as she ventures further into the world of parenting. We bid her love, success and God’s continuous blessings on her journey of motherhood” CTMC

BIRTHDAY CORNER Happy Birthday to Jose Abaya, Henry Blythe, Philip Burgess, Gary Fine, Melanie Gibson, Devon Grant, Dionne Lightbourne, Moira Scott, Tesha Thompson, Inette Webster-Brown, Monique Williams, and Lorlean Wilson!

Page 7

February 2015

HUMAN RESOURCE MANAGEMENT The Human Resource Department has been given the responsibility to support the drafting of the standards of behavior for the organization. In order to accomplish this, a cross section staff was selected to be part of a committee. The members are Yasmah Adams, Natoy Dilworth, Valerie Outten, Carol Robinson, Gururaja Basavaraj, Percy Joseph, Inette Webster-Brown, Andrea McIntyre and Nerissa Lewis. Please review the draft standards of behavior and provide feedback to members of the committee. These standards will be the benchmark for the services and behavior expected at Turks and Caicos Islands Hospital. 1. Attitude: a. We treat every person who walks through our doors as if he/she is the most important person in our work place, because we understand that our behavior and attitude plays a significant role is our patient’s experience. b.

We treat people as they would like to be treated. We attend to our customers’ needs with the knowledge this may be their worst day ever. We make everyone feel welcome and comfortable. We are kind to our customers and their families, we are kind to our coworkers, and we are kind to ourselves. We make each interaction an opportunity to assist. • Welcome everyone with a eye contact, a smile and a friendly introduction • Use open body language and a handshake • Address everyone by his/her name • Listen with care and empathy, avoid interrupting and confirm what we have heard • If someone looks confused we will ask how we can help. •

If someone is lost or needs directions, we will take them where they need to go.

• If someone requires an escort to their vehicle, we will assist with a willing attitude. 2. Respect: Respect yourself, your surroundings, the organization, our mission, and let that respect be seen every day. We strive to respect customers’ confidentiality and privacy in all situations. We will: • Wear neat, appropriate clothing, jewelry and tastefully applied scents, following the organization’s dress code. • Treat everyone with fairness, honesty and compassion. • Use good personal hygiene. • Knock and announce ourselves before entering a patient’s room, close doors and pull curtains to respect privacy.

Page 8

February 2015

• Work to ensure that our work areas and meeting rooms are clean, clutter-free and safe. • Keep patient, physician and proprietary organizational information private. 3. Teamwork: As a team our purpose is to serve and we demonstrate TEAMWORK by being receptive to one another and embracing our differences as a means to achieving greatness. We treat others the way in which they wish to be treated, every time. We will: • Respect all individuals’ personal and cultural beliefs and ideas. • Look beyond our assigned tasks, assist co-workers when possible or find resources when necessary. • Resolve conflicts respectfully, directly and promptly with the individuals involved and strive never to chastise or embarrass. • Be tasteful and appropriate in all interactions. • Be accountable for our actions, comments and demeanor. We will be equally accountable to all members of our team. We accept responsibility for the team’s actions. We will hold our teammates accountable through constructive feedback. • Ensure that all team members feel safe to express opinions without fear of recourse. 4. Customer Service: We demonstrate kindness and respect through our behaviors and interactions with our customers, their families, and one another. We put our customers first by empathizing wholly with those we serve. We will: • Pledge to always provide exceptional care by exceeding the expectations of our customers, patients and co-workers. • Promote an inclusive environment in which clients are treated with acceptance and respect. • Work to identify patient needs and demonstrate respect, sensitivity and care throughout their experience. • Keep patients and families informed about time delays, and if possible, offer the opportunity to reschedule appointments if needed. • Promise to acknowledge any wait time, thank the patient for waiting and apologize for excessive delays.

5. Continuous Improvement: Turks and Caicos Islands Hospital works to ensure all staff has the opportunity to grow professionally while employed with our organization. We encourage professional development and we are aware that this will only improve the efficiency and effectiveness of the organization. We will:

Page 9

February 2015

• Ensure each staff is given a development plan with clear results-oriented performance expectations. • Monitor all training and development exercises to ensure our staff maintains the level of competence needed to perform well on the job. • Develop coaches and mentors that will share knowledge that will help others be successful. • Create development action plans that will guide employees and provide opportunity for improvement. 5. Confidentiality: We will ensure we keep the information of our patients, visitors and employees private and confidential. We will be sensitive to the personal nature of their information and do everything in our power to gain and maintain their trust. • We will not use or disclose confidential records of friends, relatives, staff members, volunteers or any other person unless authorized to do so. • We will never share access codes or passwords or leave our computers unattended. • We will always be discreet in telephone conversations with or about patients and with their personal information. • We will never discuss confidential information involving patients or staff in public areas. • We will never share computer or telephone passwords or codes or leave computers unattended.

6. Accountability: We are accountable for our actions, comments and demeanor. We will be equally accountable to

all members of our team. We accept responsibility for the team’s actions. We hold our teammates accountable through constructive feedback. We will:

1. Ensure requests are responded to in a timely manner. 2. Ensure outcomes agreed upon are achieved. 3. Follow through and deliver on what was promised, by holding each other accountable for results. 4. Ensure deadlines are met. 5. Always look for opportunities to improve the quality, service and efficiency of the organization. 7. Recognition: We will express gratitude and appreciation to all of our colleagues by celebrating their

accomplishments and hard work, which allows the organization to maintain high standards of its services and care. We will:

• Recognize and celebrate each other’s accomplishments. • Recognize those who go above and beyond the call of duty. • Openly acknowledge those who uphold and exemplify the service standards of the organization. • Recognize those who consistently meet expectations.

Page 10

February 2015

FROM THE EDUCATION DEPARTMENT TO YOU! Training Initiatives Continue at TCI Hospital The Education Department of the Turks and Caicos Islands Hospital has launched a series of training initiatives for staff. Mandatory Training in Building Effective Interpersonal Relationships – A practical approach To Supervisory Management and Customer Service in Healthcare continues into the month of March. In the Customer Service Sessions, participants focused on the Four Pillars of Customer Service, Effective Methods of Communicating with Difficult Customers, Using Key Words at Key Times, Effective Listening. The Supervisory Management Sessions covered Emotional Intelligence, Effective Interpersonal Skills, Effective Communication Skills, Delegation, Feedback, and Conflict Management. The discussion covered a lot of ground work. The way Mrs. Moe Cox approaches customer-service training was the best I’d seen because it was tailored to the task environment,” says Leticia Hall. “There were specific guidelines and scenarios about what customer service means in the work people do day to day,” she says. All staff are encouraged to register for these highly interactive sessions. We use role play and case studies to make the sessions relevant and practical to our team environment. Email JCox@interhealthcanada.tc.

“10% of conflicts are due to difference in opinion -90% are due to the wrong tone of voice!”

EDUCATION DEPARTMENT QUOTE OF THE MONTH: Even though you have communicated a great deal by your professional appearance and body language, it is important to complete your most effective communications skills by selecting the right words to say, and saying them in the right tone of voice.

Page 11

February 2015

HEALTH TIP OF THE MONTH B

reakfast is the BEST way to start your day. How about making a plan with a friend to eat breakfast every day! Ideas include: •

Whole wheat toast + peanut butter + banana

•

Cereal + 1% milk + your favorite fruit

•

A breakfast sandwich

Eating breakfast can help you achieve a healthy weight. Some people skip meals to lose weight, but it’s not a smart choice and can actually cause you to gain more weight. Start your day the right way? Have some breakfast today!

Being Fit Being “fit” is a way of saying a person eats well, gets lots of physical activity, and has a healthy body weight. If your fit, your body works well, feels good, and can do all the things you want to do. Get FIT by:

1. Get your body moving 60 minutes every day 2. Limit the sugar and fat and try more fruits and vegetables for snacks

3. Eat just enough to “feel full”, not stuffed Being FIT means more than exercising and eating right, it also means getting enough sleep. Set a goal to get 9 to 11 hours of sleep each night. www.balancemindbodysoul.com

Page 12

February 2015

MAR. 2015

MEET THE ‘WISE OWL’ Page 6

Mission

Vision

Values

To provide the community and its visitors with high quality healthcare.

To improve the nation’s health through the development of a substantial and accessible health care system

We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

Page 1

March 2015

MESSAGE FROM THE CEO S

“At times our own light goes out and is rekindled by a spark from another person. Each of us has cause to think with deep gratitude of those who have lighted a flame within us.” - Albert Schweitzer

o much of our ongoing accreditation survey preparation process has been like this – one person tiring and another cheering him/her on, each time the spark igniting a flame. We are very grateful for everyone’s help to not just prepare for our Accreditation Canada survey, but to prepare for the next patients who walk through

our doors….the patient who comes to us struggling and in pain, having lost their light until a smile, warm touch and encouraging word provide a ray of hope. Is there someone you know who can benefit from your spark today?

Jill Magri CEO

5TH YEAR ANNIVERSARY UPDATE T

he Turks and Caicos Islands Hospital will celebrate 5 years of serving the community with high-quality care on April 10th. Over the past 5 years, we’ve seen incredible growth in the number of patients we have served, the expertise and education of our staff, and the expansion of our specialty services. Thanks to all of you who have supported this growth. Please see list of activities below. April 10 – Anniversary Ceremony - CTMC April 10 – Anniversary Ceremony –CHMC May 12th, 2015 - Staff appreciation ceremony at the Cheshire Hall Medical Centre May 19th, 2015 – Staff appreciation at the Cockburn Town Medical Centre We are planning a year-long celebration, much of which will be communitybased; we will also reach out to the sister islands. Follow the Newsletter to hear about these exciting events to come.

Page 2

March 2015

Healing garden

and Quiet Contemplation Room

LOOKING FOR THE LATEST EVENT? See here!! April 2nd, 2015 – Light it up blue, Autism Awareness Day (call 2323117 for shorts) April 10th, 2015 – Anniversary Ceremony - CTMC April 10th, 2015- Anniversary Ceremony –CHMC May 12th, 2015 - Staff appreciation ceremony at the Cheshire Hall Medical Centre May 19th, 2015 – Staff appreciation at the Cockburn Town Medical Centre

he quiet contemplation rooms at the Turks and Caicos Islands Hospital meet spiritual and religious needs of patients, relatives and staff of all faiths.

The Quiet Contemplation room at Cheshire Hall Medical Centre is adjacent to the lab, on the ground floor. It is open 24 hours, and has washing facilities. The healing gardens at both facilities are also an option for space to support spiritual thought.

Page 3

March 2015

OPEN FORUM A SUCCESS

n early March, the Quality, Risk and Patient Safety Department hosted an Open Forum for staff at both the Cheshire Hall and Cockburn Town Medical Centres. The overall aim of the forum was to showcase all the hard work staff has been involved in recently and to communicate changes in policies. There were booths to provide information on Pressure Ulcer Prevention, Patient Bill of Rights, Falls Prevention, Emergency Preparedness, Healthy Eating, Disclosure Policy, Quality Framework, Complaints policy and incidents policy. Staff was also given information on hypertension and diabetes care guidelines, and the Health Stand was set up for blood pressure and blood glucose checks.

Each attendee was provided with a plastic wallet with an attendance register to be signed by those manning the stands once they had been visited. Staff with a full attendance sheet was given a raffle ticket for a prize draw. Congratulations to winners,

“The Open Forum has been wellattended at both sites and I would like to thank everybody who has taken the time to visit the stands, and also all of those who have worked hard to prepare and deliver the sessions”, says Joanne Kinborough Mata, Quality Risk and Patient Safety Manager. A total of 128 staff took part.

Page 4

March 2015

HOSPITAL GARDENING CLUB T

•

Gain gardening skills that you will keep for life

•

Networking with others interested in gardening

The club is free, and offers the following benefits:

•

Seed and cutting share scheme

•

Access to expertise from DEMA representatives

•

Involvement in up and coming projects including keeping chickens and beekeeping

he FM team will be launching a Gardening Club for TCI Hospital employees to develop a piece of land at the rear of the Hospital.

in a more involved project. The aim is to develop our area from its humble beginnings all the way through to full launch to the community!

Once the area is established, our aim is to develop this space into a community garden and open it to the public. Interested Club members will have the opportunity to be the organizers and educators for the project. This is a new and exciting project, and we are looking for volunteers prepared to give two hours or more each week of their time to support. This should appeal to both people who are either interested in a few hours of gardening, and also for those who would like to get involved

•

Opportunity to be either part of the group responsible for planning and shaping the project…….. or simply to garden in your spare time Regular exercise without a trip to the Gym

•

A chance to meet new people and start a new hobby

•

To learn about native plants and cultivation of crops

If you are interested please contact Karen on 232 4017 for more details

FM STAFF RECEIVE INFECTION CONTROL TRAINING T

he Infection Control Department recently provided a refresher course for The Facilities Management staff that are in the areas of catering, domestic, porters, supervisors and managers and biomedical engineering. The topics covered many infection prevention control issues such as the correct hand hygiene techniques, wearing of personal protective equipment when working with patients with infections and how those patients are identified in clinical areas, correct waste disposal, biohazard exposure management and what to do with biohazard spills in healthcare settings. Staff were asked to participate in the training by joining in with the hand hygiene demonstration and contributing in the discussions.

Kerry Reid, FM Supervisor at Cheshire Hall Medical Centre assisted with the training by demonstrating the correct method of putting on personal protective equipment and removing it safely. General Manager Martin Dawtry said, “This is the first of its kind for our FM staff; this program is expected to run quarterly”. Dawtry added, “We are working closely with the Infection Control Department to make sure TCI Hospital meets its obligations”.

Page 5

March 2015

Staff Feature of the Month

MEET THE ‘WISE OWL’ and also being taken to Trafalgar Square, to see Nelson’s Column in London where myself and all of the other Brownies were delighted to have pigeons flying all around us and landing on our Brownie Berets!” said Carol.

id you know that our Infection Control Manager, Carol Evans is Former Girl Guide Leader? As a young girl, the only thing she wanted was to be a Girl Guide. At age 7 she enrolled in the 1st Crawley Down Brownies in West Sussex in UK. At age 11 she joined Guides and went on to be a young leader and then an adult leader, dedicating several decades of her life to influencing, by example, the young women under her guidance. Carol’s father (who was a Scout Leader) was keen that all his four daughters be involved in the scout and guide movement. “My earliest memory is of visiting Kew gardens, a huge botanical garden in London, with the Brownies

Carol was previously District Commissioner for Ripley Girl Guiding and a leader with 1st Ripley Girl Guide Unit, a unit of 40 girls in Derbyshire in the UK and a leader for 1st Langley Mill Brownies where she was known as “Wise Owl”. All Brownie leaders in the UK are known by Owl names, i.e. Brown Owl, Tawny Owl, Snowy Owl etc. “I have been involved in many different activities such as camping, running cooking competitions, running large Thinking Day events (the founders birthday) for 400 children and leaders, taking girls on hikes in the Derbyshire hills in the UK and going on international trips with leaders and girls including visits to Mexico and Switzerland, all of which have taken a huge amount of planning and fundraising”, says Carol. Carol has plans to assist with the local Brownies and Guides groups.

Page 6

BIRTHDAY CORNER!! A special Happy Birthday to those staff who celebrate their birthdays in March. Birthday greetings are extended to Artlaine Adams, Rosamma Antony, Wendy Cooke, Edwin Taylor, Karleen Dyer, Dieufort Francois, Kedesha Gabbidon, Maria Jagocoy, Salomon Jeanty, Fiona JohnnyBurnett, Bonnie Mauchaza, Divya Panajickal-Poulose, Tanya Parker, Margaret Saunders, Leonard Smith, Ryan Smith, Jody SpenceGrant, Ileen Williams, and Yanique Woolery.

March 2015

CAREER DAY AT H. J. ROBINSON HIGH SCHOOL

orenzo Seymour from our Human Resource Department spent the day with senior students of the H. J. Robinson High School on Grand Turk in late February, speaking to students about the various fields in health care and shared TCI Hospital’s

employee’s passion and commitment to their chosen occupations within the hospital. In addition, Seymour provided students valuable tips on how to prepare for careers in a hospital setting.

CAREER DAY AT CLEMENT HOWELL HIGH SCHOOL O n the heels of Education Week 2015, a team from the TCI Hospital took part in a career day at the Clement Howell High School on Providenciales on March 4th. The TCI Hospital team shared career information and interactive activities in the various specialties of Nursing, Laboratory Science, Radiology, Rehabilitation and medicine, to name a few. Presenting on behalf of TCI Hospital were, Chief of Medical Services Dr. Denise Braithwaite-Tennant, Training and Education Manage, Jacqueline Moe-Cox, Senior Physiotherapist Debbie Findley-Clayton, Medical Technologist Andrico Garland, and Detorrie Tennant, of IM&T.

“The Students enjoyed learning about the vast number of careers available in healthcare, both clinical and nonclinical. We informed students of the technical aspects of their career possibilities, like years of education, but we enjoyed sharing about our passion for healthcare in the Turks and Caicos Islands”, says Andrico Garland, Medical Technologist.

“we enjoyed sharing about our passion for healthcare in the Turks and Caicos Islands” Andrico Garland

Page 7

March 2015

WORLD KIDNEY DAY AT CHMC AND CTMC O n March 12th, The Turks and Caicos Islands Hospital in conjunction with the Turks and Caicos National Kidney Foundation, and the National Health Insurance Board observed World Kidney Day at CHMC and CTMC. An informational booth was set up for staff, visitors and patients. Blood pressure monitoring was done and educational material on healthy kidneys, diabetes, blood pressure and dialysis were handed out.

Did you know? Major risk factors for kidney disease include diabetes, high blood pressure, family history of kidney failure and being age 60 or older.

Page 8

March 2015

FROM THE HUMAN RESOURCE DEPARTMENT Work Life Balance!

n 2015 the Human Resource Department is continuing its focus on the work life balance of staff. The initiative started last year with the fitness challenge, which we intend to make an annual event, and we plan to introduce our monthly wellness newsletter during the month of April. Every month we plan to host a scheduled health and fitness run/ walk - more details are to come. At the end of the year we plan to award lucky staff members with special recognition for their participation in wellness activities.

Throughout the year we also plan to have guest speakers hosting information sessions on various topics e.g. yoga, injury prevention, meal planning and stress management to name a few. We know finding that proper work life balance can be challenging, and we recognize the effect this can have on your emotional and physical wellbeing. That is why we are dedicated to providing you with the tools to make this less of an issue. Every year we plan to review all the activities we offer and we look forward to your feedback, as we provide you with

the knowledge and the ability to find a balance in your work and home life. To coin a phrase; “Health for today, helps give life for tomorrow.” Remember we are here to support you.

TCI Hospital attends NEONATAL RESPIRATORY SYMPOSIUM

ecently, a team from the TCI Hospital attended a Neonatal Respiratory Symposium in Washington DC, hosted by Fisher & Paykel Healthcare. The event featured discussions on current and emergent non-invasive respiratory support strategies. The conference provided participants with a fresh perspective on quality and safety initiatives for the care of the neonate. Innovative approaches to improving care and implementing change were highlighted. Opportunities were given to participants to further develop and customize improvement and data analysis tools which can be applied to multidisciplinary continuous improvement programs at their home institution.

of health problems in neonates”, said Dr. Lorena Soler, Neonatologist and Paediatrician. “Attending a conference such as this only shows TCI Hospital’s commitment to support the training needs for staff in our NICU, to ensure the provision of the best standards of health care and treatment for children from birth to various advanced ages.” This conference was intended for the entire neonatal critical care team practicing in the neonatal intensive care arena and for those interested in improving respiratory care outcomes in neonates.

“We’ve had talks and discussion on the newest research on the diagnosis, prevention and treatment

Page 9

March 2015

TCI INTERNATIONAL SCHOOL STUDENTS TOUR TCI HOSPITAL

reschoolers from the Turks and Caicos Islands International School visited Cheshire Hall Medical Centre on February 25th, to learn about the role the hospital plays in the community. Dr. Lorena Soler, our Neonatologist and Paediatrician, based at CHMC said, “It’s important to expose young children to the hows and the whys of health care to enrich their knowledge”. Dr. Soler added, “Children often fear these professionals because the situation is new and they don’t know what to expect. I am happy that we were able to accommodate the little ones; they were excited and happy to tour the facilities and pay a special visit to our NICU”.

“It’s important to expose young children to the hows and the whys of health care to enrich their knowledge” Dr. Lorena Soler Page 10

March 2015

NURSE OF THE MONTH For TCI Hospital

MICHAEL WILLIAMS M

ichael G Williams, a Registered Nurse, is stationed at the Cockburn Town Medical Centre’s General Ward. Michael is a Nurse with approximately 35 years of experience with a humble beginning as a Nursing Assistant from June 1980. Although he holds a Postgraduate Degree in Health Education, his passion for Nursing is unsurpassed. He views the profession as far more than a career opportunity; it is his mission field. It is a high calling for which he must walk worthy. His Work Ethic: “I come to work happy every day because caring for people is what I love doing. No situation is too much for me to handle because I come with a positive attitude”. His Motto: “Give and share all that you can and as much as you can, because what you don’t use, you’ll lose”. His recipe for success: “I trust not in my own strength or ability. I always pray for divine enablement for even the simplest of tasks. In addition, I study to show myself improved. In other words, occupy your time wisely”. A Word to the Wise: “If you know that your ancestors were eagles, don’t behave like a yard fowl. Spread your wings and soar to heights where you can see things from a different perspective.”

DONNETT HUTSON R

egistered Nurse and Registered Midwife Donnett Marva Hutson began her nursing career in Guyana in September 1984 at the Georgetown School of Nursing. “My experience as a nurse has been very dynamic. I have worked in a Level 5 health care system for seven years. I work in special areas like Maternal and Child health, Gynecology Clinic, Theatre – recovery area, Pediatric ward, Surgical and Medical Ward, Psychiatric Hospital”, says Nurse Hutson. Donnett came to the Turks and Caicos Islands in January 2007 and was assigned to the Grand Turk Hospital as a Registered Nurse and Registered Midwife; now she is stationed at Cockburn Town Medical Centre. According to Nurse Hutson, “Nursing is a noble profession and I love it with a passion and hope to continue doing this as long as my health and strength prevails by the grace of God. I work in General and Maternity wards, mostly of which I enjoy seeing the babies being born and know that maybe I am holding the future leaders of Turks and Caicos Islands.”

Page 11

March 2015

JOLLY KURIEN N

urse Jolly Kurien of the CHMC’s Maternity ward was born in the southern part of India, Kerala. Growing up with her grandparents in the village on a big farm, pets were everything in her early years. “We had lots of rabbits, chickens, dogs, cows, goats, cats. I enjoyed my childhood with my grandparents”, said Nurse Kurien. The eldest of five siblings, Nurse Kurien is now married and has two children, Jinila and Jasmine. She studied and worked in Mumbai, India and also in Muscat, sultanate of Oman, Middle East. Kurien has 25 years in the field of nursing. She is a Registered Nurse /Midwife and critical care nurse, anesthetic nurse and Nurse Preceptor. She has spent the last 12 years in the Turks and Caicos Islands, and is now based at the CHMC’S maternity ward. “I love my profession and I enjoy especially taking care of critically ill patients and the elderly. I am happy when my patients are happy, satisfied and get well. I also love gardening. I consider myself to be a team player and a leader who communicates and works well with other colleagues in my immediate work environment and in other departments. I am very much pleased to be a part of the TCI Hospital team”.

BRENDA ADOLPH B

renda Adolph of the Cheshire Hall Medical is a hardworking, dedicated and compassionate Nurse with forty-six years of nursing experience. Trained in Guyana as a Registered Nurse/Midwife and Operating Room Scrub Nurse, Nurse Adolph worked at several hospitals in Guyana and in St Vincent and the Grenadines. After receiving the award for Valued and Dedicated Service from the Guyanese Government, she Came to the Turks and Caicos Islands in 1994 and was placed at Blue Hills Government Clinic. It didn’t end there for Nurse Adolph, in 1995 she moved to the Myrtle Rigby Health Complex for 16 years as a Registered Nurse/Midwife and Operating Room Nurse. Nurse Adolph was a part of History in the Turk and Caicos Islands, a part of the operating team, under the leadership of The honourable Dr. Rufus Ewing, (now Premier) and Dr. Dawn Perry-Ewing, that preformed the first Surgery on the Island of Providenciales at Myrtle Rigby Health Complex. Now employed at the Turks and Caicos Islands Hospital, Nurse Adolph is Nurse in charge of the Pre-natal Clinic and one of the Midwives on the Maternity Ward. “This is the most enjoyable part of my quest in Nursing. I love being with the expected parents on their arrival of their special gift from God, seeing the joy on their faces-even though I also sometimes shed tears. I take pleasure and pride in Teaching, counselling advising and congratulating my Parents”, Says Nurse Adolph.

Page 12

March 2015

HEALTH TIP OF THE MONTH How to Manage Stress?????

veryone experiences some level of stress on a daily basis. Because you cannot control every situation, stress is inevitable. So don’t STRESS about stress, learn ways to manage and deal with it!

Don’t know why you’re stressed? It’s a good idea to identify your stressors so you know how to deal with them. You may find that some of the things that create stress are unnecessary and may be able to be eliminated—which gives you more energy to focus on more important things. One way to identify stressors is by keeping a journal. When you start to feel overwhelmed by a situation, make note of it and you can come up with a plan the next time you encounter a similar situation.

Daily relaxation will also help you deal with stress. Making time for yourself is key to combating fatigue from stress. Whether it’s reading a book, taking a walk, meditation, or anything else that relaxes you, take time for YOU!

Learn ways to manage stress. Positive self-talk will gear your mind for positive thinking and will help prevent you from getting stressed out. Avoid the stressor whenever possible. Alter the situation—managing your time and planning ahead will cut down on some stress as well.

Page 13

www.albright.edu

March 2015

APR. 2015

TCI HOSPITAL TURNS 5!

Page 3

Mission

Vision

Values

To provide the community and its visitors with high quality healthcare.

To improve the nationâ€™s health through the development of a substantial and accessible health care system

We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

Page 1

April 2015

GOODBYE FROM THE CEO ALOHA!!

ost foreign languages have a word for “goodbye”: zai jian (Mandarin Chinese), adieu (French), auf wiedersehen (German), shalom (Hebrew), arrivaderci or ciao (Italian), adios (Spanish), hejda (Swedish),

dag (Dutch), ja mata ne (Japanese), babay (Haitian Creole), kwaheri (Swahili) and totsiens (Afrikaans). But the language I like best is Hawaiian. Why? Because the word “aloha” not only means goodbye, it also means hello. In Hawaii it also stands for an emotional state – for love, affection, peace, compassion, mercy and mutual regard. “Aloha” extends warmth in caring, with no obligation in return. You have all been a wonderful part of my life for the past 2-1/2 years, and you will be greatly missed. You have

also been a wonderful part of the Turks and Caicos Islands Hospital. I have great confidence that you will keep taking it in a positive direction, enhancing this great organization with a collective spirit of continuous quality improvement. To all of you, I say “Aloha” (goodbye). I pray that you each will have nothing but love, affection, peace, compassion and mercy in your lives; until we meet again, when I can say, “Aloha” (hello)!!!

Jill Magri CEO

MELECK CUMMINGS FAREWELL

Dear All, As you already know I resigned from the position of Site Director, Cockburn Town Medical Centre. My resignation is effective from April 29th 2015. I must say that such a decision was hard for me but it was a step I had to take. I am presently in Providenciales preparing to leave the Islands on Tuesday, April 28th 2015. I decided to pen down this letter to let you know that these 5 years of our association is an unforgettably wonderful experience of my life. If not

for your support and co-operation, we couldn’t have made it to where we are this day. Please continue to remember your job purpose and let that be your drive. For those not in the know, I had an opportunity to work at the old hospital (which was known as Grand Turk Hospital) with some staff members presently serving at TCI Hospital. It was there where the foundation stone to my career and life in Beautiful by Nature Turks and Caicos Islands was carved. The days at Grand Turk Hospital was shaped with due respect for each other regardless, along with many other qualities that encourages staff. My time at TCI Hospital was also rewarding in many ways. I was able to work closely with most of you and together we were able to achieve positive outcomes. May I use this means to express my appreciation for opportunities and exposure I’ve

Page 2

received in all these years. I’d like to thank all of you, especially my nurses for their commitment and support. The nurses I worked with in TCI are simply the best group I have ever met. They are all so talented and not afraid to display their talents. The empathy you’ve shown when I had to take decisions that weren’t much in favor of you and so much more that you’ve done to make my life easy and stress free was always appreciated. The kind of professionalism and discipline you’ve always maintained at work made my work life easier. No matter where I am, wherever I be, in my heart you’ll always remain my family. Do be in touch and please feel free to reach me at my personal e-mail which is meleck_c@yahoo. com. My prayer will always be for God to Bless and Guide everyone.

April 2015

TCI HOSPITAL TURNS 5!

n April 10th, the five-year anniversary of the Turks and Caicos Islands Hospital was marked by a small ceremony in the lobbies of the Cheshire Hall Medical Centre in Providenciales and the Cockburn Town Medical Centre on Grand Turk.

The event was also attended by the Deputy Premier, Hon. Akierra Missick a number of community partners, representations of the National Health Insurance Board, The Ministry of Health and Human Services and the Hon. Derek Taylor and Shadow Minister of Health, the Dubbed a success on both sites, Honorable Edwin Astwood. See Chief Executive Officer Jill Magri, in highlights below. her speech to those in the audience, recounted the successes and achievements of TCI Hospital over the last five years. Magri also spoke to the importance of building local career capacity in the future. She said, “We will continue to work with TCI schools to provide information about the broad range of careers in healthcare and have recently signed an important affiliation agreement with the TCI Community College to further train and build local career capacity. She added, “We look forward to Honourable (Akierra) Missick continuing to build scholarships to help support further career building within the TCI’s healthcare industry.” During his remarks, Premier of the Turks and Caicos and the Minister of Health, Hon. Dr. Rufus Ewing encouraged TCI Hospital to continue to promote partnerships with the community and other relevant bodies as well as with the Government. He added, “In the Ministry of Health we are partners with you, the ones who were contracted to deliver service on behalf of the Government. Sometimes it may get rough, sometimes it may get rocky, and sometimes we may agree to disagree, but that’s how it goes in partnerships, good times and bad times but at all times we must keep our eyes on the goal and on the prize as to why we are here.”

Page 3

April 2015

INTERIM CEO

DR. ERIC PARSONS Dr. Eric Parsons has been appointed to the position of Interim CEO while a permanent CEO is recruited. Dr. Parsons is InterHealth Canada’s current Group Chief Medical Officer and a former Group Chief Executive, and he is very knowledgeable of the Turks and Caicos Islands Hospital

organization, having been involved in some of the early contract design work here with TCIG. Please extend to him a very warm and enthusiastic welcome.

FM EMPLOYEE OF THE MONTH B

eyond the call of duty… Facilities Management is recognizing Amos Carice as its Employee of the Month for March at the Cheshire Hall Medical Centre. Amos has been working with the FM team for the past five years as a Porter. He is an outstanding and hard working member of the Portering team. Amos earned this important award by showing how reliable he is. Amos never says no when asked for assistance. He is respectful and supports his team without hesitation. During the month of March Amos worked extremely hard, and was reliable to cover shifts for staff who called in sick. Amos covered six sick days, suspension days and even pulled a double shift. Congratulations to Amos Carice from Facilities Management and staff of the Turks and Caicos Islands Hospital.

Page 4

April 2015

SHOUT OUT

TO ANDRESHA GARDINER FOR HER GREAT CUSTOMER SERVICE SKILLS The Turks and Caicos Islands Hospital would like to salute Andresha Gardiner for her great customer service skills. See testimonial below:

HOSPITAL GARDENING CLUB T

•

Gain gardening skills that you will keep for life

•

Networking with others interested in gardening

The club is free, and offers the following benefits:

•

Seed and cutting share scheme

•

Access to expertise from DEMA representatives

•

Involvement in up and coming projects including keeping chickens and beekeeping

he FM team will be launching a Gardening Club for TCI Hospital employees to develop a piece of land at the rear of the Hospital.

in a more involved project. The aim is to develop our area from its humble beginnings all the way through to full launch to the community!

•

Opportunity to be either part of the group responsible for planning and shaping the project…….. or simply to garden in your spare time Regular exercise without a trip to the Gym

•

A chance to meet new people and start a new hobby

•

To learn about native plants and cultivation of crops

Page 5

If you are interested please contact Karen on 232 4017 for more details

April 2015

VERNESSA AND MARYLEE, OFFICIALLY RECEIVE MEDICAL CODERS CERTIFICATES

ongratulations to Patient Service Associates Vernessa Forbes and Marylee Wilson, who have received their certificates of completion in Medical Billing and Coding from Ashworth College. Forbes said that medical coding is like learning a whole new language and it could get difficult, but she knew accuracy is critical for patient records, treatment and insurance purposes. That inspired her to work hard and excel in her studies. “It was a challenge to study while having a full time job, but now I feel like I can do anything. I am happy for the opportunity and I’m looking forward to more opportunities,” said Forbes. “It was meant to be!”

Marylee Wilson (who graduated with honors) said, “Learning something new is always hard, but I knew that the skills we were developing would have a positive impact on my life and the lives of patients entering the Turks and Caicos Islands Hospital. I am more than grateful for this opportunity to study and hope to put the knowledge learnt into practice”. It is a proud moment according to Wilson, “I feel a sense of pride as we have increased the numbers of locals who specialize in the medical billing and coding area”

She added, “ I am proud that these ladies have stepped up to the plate and excelled.”

“Medical Billing and Coding is a critical function in the healthcare industry today”, says Patient Services Manager Straudy Jackson.

Straudy Jackson

Marylee Wilson

Both ladies are currently preparing for the medical bill and coding certification exam in the coming weeks.

“ I am proud of these ladies have stepped up to the plate and excelled.”

Vernessa Forbes

Page 6

April 2015

SUCCESSFUL ACCREDITATION SURVEY

he Turks and Caicos Islands Hospital has been successful in being granted Accreditation for three more years. Though there is further follow-up we must still do, this represents a significant achievement for our organization. This was the first triennial re-survey following our initial accreditation in 2012 and it involved an assessment of the hospital’s performance against over two thousand (2,189 to be exact!) quality and performance standards. Many of these standards had been enhanced since 2012 and 361 were completely new from any standards identified earlier. This addition or enhancement of standards is further demonstration of Accreditation Canada’s (and our Hospital’s) commitment to the process of continuous quality improvement. Our success in this process is indicative of all the hard work done by you, the dedicated staff of the hospital, in the delivery of healthcare on a continual basis; you and the nation of the Turks and Caicos Islands should feel justly proud. We are one of only 2 hospitals in the entire Caribbean that enjoys international accreditation, so we can feel very special!

We are still awaiting clarification from ACI regarding our performance at either a gold, platinum or diamond level. They have told us that process may take up to thirty business days before a decision is rendered, but the IMPORTANT message is that we retained our accreditation, which is a requirement we have under the terms of the Project Agreement with the TCIG. What is important now is that we do all we can do to ensure we are always in a state of continuous readiness. The accreditation process is ongoing, it doesn’t stop and then restart 3 years later! Remember, we are not preparing for the next survey, we are always preparing for the next patient who comes in through our door! – CEO Jill Magri

Page 7

April 2015

Page 8

April 2015

MEDICAL TECHNOLOGIST WEEK OBSERVED AT TCI HOSPITAL

very day, medical decisions are based on data generated by highly skilled Laboratory Professionals who take pride in the work they do. The Turks and Caicos Islands Hospital, in conjunction with the National Public Health Laboratory and Accu Diagnostics, joined the rest of world in observing Medical Laboratory Professionals Week April 18th – 25th, under the theme “Laboratory Professionals Get Results”. The focus of this year’s event was to educate the general public about the profession and provide continuing education. “This is also a time to highlight all laboratory professionals in the Turks and Caicos Islands who play a very important role in every aspect of health care, often working behind the scenes. A few people know about the critical testing we perform every day”, says Carol Robinson, Clinical Laboratory Manager at TCI Hospital. She added, “Laboratory professionals are the foundation of diagnosis and an integral part of the larger patient care team, directly contributing to preserving and enhancing patients’ lives.”

To commemorate the event, on Saturday, April 18th, a church service and social was held for Medical Laboratory Professionals on Providenciales. On Sunday, April 19th, a church service was held on Grand Turk, and there were displays and Laboratory tours for high school students and the general public at the Cockburn Town Medical Centre and the Cheshire Hall Medical Centre, on April 21st to 22nd. Medical Technologist teams were also featured on the Breakfast Club morning show. The week wrapped up with a blood drive on Grand Turk, a visit to the TCI Wellness Centre and a closing out dinner. Director of the National Public Health Laboratory under the Ministry of Health, Agriculture and Human Services, Peggy Samuels, said, “This week is very important to us as we celebrate our vital contribution to healthcare”. She added, “It is important to foster a sense of unity and integration with all Medical Laboratory Professionals across the Turks and Caicos Islands so we can operate with one common direction of providing quality laboratory services to all users.”

Page 9

The Turks and Caicos Islands Hospital salutes all medical professionals for the valuable contributions they make to the quality and high standard of medical care in the Turks and Caicos Islands.

April 2015

FROM OUR EDUCATION DEPARTMENT TO YOU

YOU WANT GREAT MANAGERS? FOCUS ON THE FUNDAMENTALS.

et’s be honest, managing people is no simple job. In fact it’s one of the most difficult roles to excel in, and there is no single recipe for success – no book, no program, no “silver bullet” that can prepare someone to master the skill-set quickly. Why? Because we are talking about leading human beings and the wonderful inherent complexity that they bring to the workplace. In addition, managers rarely have the luxury of just managing people – they often have their own functional responsibilities to take care of as well as leading a team. They have to hit deadlines, achieve goals and targets, write reports, fight fires, deal with customers, and these days often lead change in an ambiguous and uncertain marketplace. It’s no wonder they feel under pressure! Well-intentioned organizations often fight complexity with complexity in the form of an infinite menu of disparate training programs that promise solutions: •

Accelerated Decision Making

•

Thriving in Chaos

•

Resolving Workplace Conflict

•

Maximizing Team Performance

•

Building a Service Culture

processes to follow, more surveys to complete. More! So what is the key to being a great manager and how can we prepare our managers for success? The answer is to focus on the fundamentals, the core elements or levers (tasks and behaviors) that will create the most impact on your team and the business. To boil it down to the fundamentals, the most successful managers are able to do two things well: •

Inspire and motivate their people and

•

Focus them on the things that are most important.

This requires an understanding of your business and how your team contributes, and a mastery of some core skills: engaging your people to bring their best ideas, efforts, and passion into their jobs; building

great working relationships; being clear; coaching and developing; and following up to ensure execution. Mastery of the basics is not that elusive silver bullet either – it requires an openness and willingness to learn and a commitment to deliberate practice, but it does provide a solid foundation on which to layer new skills, and is an often-overlooked prerequisite for success as a leader. The message here to managers and those responsible for training or developing great managers is that mastery and consistent application of the basics is the best way to build a leadership capability that can deliver for your business. Ensure that your managers can walk, on all terrains with ease and confidence, before asking them to run…. and signing them up for a marathon!

In our experience this can create more pressure for managers – more programs to attend, more stuff to learn, more frameworks or

Page 10

April 2015

PATIENT SERVICES EMPLOYEE OF THE MONTH MAGDALA HYPPOLITE-HARVEY COCKBURN TOWN MEDICAL CENTRE Magdala has been working at Cockburn Town Medical Centre since the facility opened in April 2010, in the capacity of Patient Services Associate. During this period she has gone beyond the call of duty to get her job done in a timely and professional manner. Happily married and the mother of a beautiful little girl Arielle who she adores, Magdala definitely has a love her job. She says, “I am always willing to go the extra mile for the patients and making sure that they are completely satisfied with their visit here at CTMC.” According to PSA Manager, Straudy Jackson, “Magdala is a committed and dedicated worker who has exceeded the expectations as a PSA. She is capable of working all of the different departments and when asked to take on additional projects, she is always willing to assist. Madgala has set a record for encounter closing by closing 8,000 encounters in one month. Madgala is to be complimented for being an outstanding PSA.”

CHRISTINA CHARLES CHESHIRE HALL MEDICAL CENTRE Christina Charles is a Patient Services Associate at the Cheshire Hall Medical Centre since April 2010. Over the past five years, Christina has taken the initiative to learn how to work in all of the various departments and become versatile in those areas. Manager Straudy Jackson said, “An employee such as Christina is an asset to the department and it is a pleasure working with her. Christina can be called upon at any time to work any department and she is always willing and ready to assist. She take ownership and pride in the work that she does as a PSA and is always looking for ways in which she can improve her skills and education here at CHMC. Christina’s goal for the future is to become a nurse and I am continually encouraging her to move forward in that direction.” Christina says she enjoys her job on a daily basis, and added, “I love serving the patients and I always go the extra mile for the patients to make sure that their visit here is a pleasurable experience”. Christina is the mother of a beautiful little girl Marie.

Page 11

April 2015

HEALTH TIP OF THE MONTH

t’s been pretty warm over the last few weeks so stay hydrated!

Water is essential to the human body. In the summertime, our body loses a lot of water without even doing anything. Water should be consumed every day (91 oz for women; 125 oz for men) to replace

the amount lost during everyday activities. If you are exercising, you should consume even more. You can consume water through many fluids and foods including juices, smoothies, tea, lemonade, soups, fruits and vegetables.

AN ANGEL IN DISGUISE... Over the past three year, Mrs. Cheryl Forbes has been donating baby knitted caps and bibs for our Neonatal Intensive Care Units, NICU. All items are given free to infants and their parents. “I’m just lucky that I have a talent and happy to share it with the Hospital”, says Cheryl Forbes. During her annual vacation in Canada, Cheryl says she knits with her elderly mother.

Page 12

BIRTHDAY CORNER!! Happy Birthday wishes to: Martin Dawtry, Jacqueline CampbellBrown, Lorna Mills-Evans, Lynvel Seymour, Wilnick Mompremier, Wlodzimiers Zarow, Howard Wilton, Marylee Wilson, Gemma Williams, Faith Talaro, Jestina Skippings, Hubert Skippings, Eric Stoll, Dr. Dawn Perry Ewing, Lorna Mills-Evans, Rosheda Neat, Carol Mills, Lessonjulle LyonsDobney, Jovelyn Boston, Ronald Cagauan, Jacqueline Campbell-Brown, Christina Charles, Martin Dawtry, Phulmatee Durham, Celeste Hunte, Nenita Jalosjos, Carl Lewis, Janelyn Lomase.

April 2015

Mission To provide the community and its visitors with high quality healthcare.

Vision To improve the nationâ€™s health through the development of a substantial and accessible health care system

Values We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

STAFF APPRECIATION

HIGHLIGHTS Page 10

Page 1

In Memory of Nurse Sheryl Walkin Page 7 January 2015

MESSAGE FROM THE CEO

• Accreditation validates to our community that we are providing our patients with high quality care and that we are all working (and being cared for) in a healthy and safe environment.

Jill Magri CEO

• Accreditation is a requirement in most contracts for provision of medical tourism care at the Hospital – it is our “ticket” to get into the medical tourism “dance”.

EDUCATION/TRAINING DEPARTMENT WHAT’S HAPPENING? Save the dates and register! DATES

TIME

ROOM

Session

Audience

Mar 30th 9:00 am – 1:30pm 12:22 (VC) CUSTOMER SERVICE TRAINING* Non-management *Register by March 25th

Page 2

January 2015

MESSAGE FROM JOHN HYLAND LEGAL COUNSEL AND DIRECTOR

TCI Hospital in the COMMUNITY

Page 3

January 2015

Nurses of the Month – CHMC RN Asha Jose General Ward

RN Jacqueline Fiedtkou - Maternity Ward

Page 4

five-year old son Aatish (another one is on his way). She has expressed sincere thanks for all the support and encouragement and wishes for all staff a successful and pleasant 2015.

January 2015

JOURNEY TO DIAMOND T

Leonard Smith Certified as an Instrument Specialist

Page 5

January 2015

LABORATORY HEADS ATTENDS ABBOTT DIAGNOSTICS WORKSHOP

Page 6

January 2015

In Memory of Nurse Sheryl Walkin M

Page 7

January 2015

TCI HOSPITAL SUPPORTS THE GEEMS PROJECT O

Page 8

January 2015

Human Resource Department - We are here for you!!

HEALTH TIP OF THE MONTH W

Page 9

January 2015

Welcome to the TEAM!!! M

Page 10

January 2015

HIGHLIGHTS OF DECEMBER STAFF APPRECIATION

Page 11

January 2015

Page 12

January 2015

OCT 2016 CORPORATE NEWSLETTER

THE

OCT 2016

INTER-VIEW

EVOLUTION OF HEALTHCARE IN TCI: A WALK DOWN MEMORY LANE Welcome to the October 2016 edition of Turks and Caicos Islands Hospital newsletter, which features stories from across the healthcare organization. A new edition will be published every two months.

Inside the Issue

01 02

Nurse Cindy Durham

“Nurses dispense comfort, compassion, and caring without even a prescription. When you’re a nurse you know that every day you will touch a life or a life will touch yours.” -Val Saintsbury

One of the oldest nurses at TCI Hospital reflect on healthcare in the past, working at the old Blue Hills Clinic in the 1980’s. TCI Hospital attends the World Medical Tourism Congress -- one of the largest conferences in the Medical Tourism sector.

Med Tech Lessonjulle Lyon-Dobney becomes a published researcher following findings on Antimicrobial Resistance in TCI.

Unsung Heroes: Behind the scenes of the Medical Device Reprocessing Department and a look at the meticulous tasks involved.

Breast Cancer Survivor, Dr. Denise Braithwaite-Tennant shares how her battle with cancer shaped her style of patient care.

NEWSLETTER

FEATURE: Senior persons in the community are natural historians having witnessed dramatic changes in our way of life including access to healthcare. “All the necessities or conveniences we take for granted were not available back then,” remarked Nurse Cindy Durham as she recollects the challenging crossover from a hospital setting in the United Kingdom to the old Blue Hills Clinic in the 1980’s where she worked as a Staff Nurse/Midwife. The miniature building contained two small rooms, a bathroom and small reception area with an outside porch. Imagine working in a tiny clinic with no running water or telephone, limited supplies, no ambulance or modern equipment available? Fortunately, there was electricity in those days as opposed to the 70’s where nurses used oil lanterns to deliver babies and coal stoves to sterilize instruments. Nurse Durham describes the contrast between health care in her days and healthcare in the present as the difference between night and day. “…A person was hired to fetch water from the well, which thankfully was located on the clinic compound. Later on a tank was built to catch the rain- water and then this would be pumped through the pipes. All linens like sheets and pillow-cases etc. had to be hand washed

Nurse Cindy Durham in the 80’s wearing her nursing uniform and badges. The government owned mini Dihatsu car was used to transport patients.

and this was a big challenge without running water. There was a person hired to do this and to clean the compound. All instruments had to be sterilized in the clinic by boiling and with so few instruments available, we found ourselves waiting patiently for this process to finish so we can use the instruments,” said Nurse Durham. Essentials such as medication, bandages, antiseptic solutions, materials for dressing wounds, sutures, disposable sterile syringes and needles were ordered and brought in from Grand Turk hospital by the visiting doctor in limited amounts. Nursing on

Providenciales and the Caicos Islands in the olden days were very laborious since Grand Turk was the main hub for healthcare. In-order to contact a doctor in Grand Turk or contact the airport to secure arrangements to fly a critically ill patient out to the capital island, nurses had to commute to the Police Station located on old Airport Road to use the telephone. Making the journey was never an easy ride. There were no paved roads, and the sandy paths were rocky and clustered with potholes. “…We did not have an ambulance on island so I had to transport the patient in the government’s vehicle which I was allowed to use. I could not drive any faster than 15 to 20 miles/hour… it took forever to get from Blue Hills to the airport or any other part of the island. Never the less, my patients survived the ride and so did the vehicle!” Motorized transportation was even limited in the 70’s. We understand from senior residents that persons such as Anna Borne, a Voluntary Services Overseas Nurse from the United Kingdom, would commute to various settlements via bicycle to administer care. Patients were required to pay 50 cents to access government

NEWSLETTER

The Old Blue Hills Clinic underwent multiple changes over the past few decades. The above photo was taken in the mid 90’s after renovations.

“...All the necessities or conveniences we take for granted were not available back then.” clinical services. Since there were no resident government doctors on Providenciales in the 80’s. The doctor from Grand Turk visited once a week and stayed only for a day. These clinics were conducted by Nurse Durham, a clinical nurse and the visiting doctor at the Provo Health and Medical Clinic (PHMC) building located on Airport Road, which is now the old post office. TCI Native, Doctor Hugh Malcolm was among the first batch of persons to graduate from the University of the West Indies in Jamaica. Dr. Malcolm also visited Providenciales once a week. The then estimated 700-800 residents from the three settlements of Blue Hills, Five Cays, and the Bight could easily access PHMC due to itscentralized location. This facility was more modern than the Old Blue Hills Clinic. Trained

Public Health Nurses would also conduct frequent visits to carry-out immunization programs. In the late 80’s, Nurse Durham left the Government service to work part time at Menzies Medical Private Practice for a few years. By then, Providenciales was beginning to see improvements in infrastructure, an increase in visitors and eventually the Myrtle Rigby Health Complex was constructed. After a hiatus from her nursing career to raise her children, she re-entered healthcare in 2013 at Cheshire Hall Medical Centre where she has a unique appreciation for the availability of modern technology and a secondary-acute healthcare system. “…this makes my nursing job easier, less time consuming and I was able to learn about modern

medicine and upgrade my training. However, the basicnursingcareandsome techniques have not changed. It was very easy for me to adjust to the modern medical setting once I got into my nursing uniform (even though I missed my nursing cap which we wore in the old days.” “…My goal now, in this the latter part of my life is to see the patient as a person and to take time away from the state of the art medicine to talk, laugh and build a relationship as in the days gone by at the old Blue Hills Clinic.”

A brief timeline on the evolution of healthcare in TCI is provided on the next page (4).

NEWSLETTER

IN THE SPOTLIGHT: DR. DENISE BRAITHWAITE-TENNANT BREAST CANCER SURVIVOR Doctors dedicate their lives to caring for others, but even they often find themselves in need of intense medical treatment. TCI Hospital Chief of Medical Services, Dr. Denise BraithwaiteTennant vividly remembers the moment doctors delivered the shocking news that she had Breast Cancer back in April 2013.

a definitive diagnosis. As a married, mother of three young children she was shocked, but determined to beat it through faith and determination.

Luckily, she was able to detect the cancer at an early, She noticed abnormalities treatable stage. She underwent treatment in one of her breasts during chemotherapy a routine self-assessment at at Turks and Caicos Islands and radiography home. A mammogram and tissue Hospital sampling conducted at Cheshire treatment in the Bahamas for Hall Medical Centre returned at-least 9 months. 4

...“HOW CANCER SHAPED MY STYLE OF PATIENT CARE” Treatment Schedule:

Dr. Braithwaite believes cancer treatment plans should be tailored to the patient’s lifestyle (wherever possible) to maintain some sense of normalcy and provide minimal disruptions to their life. Her chemotherapy sessions were scheduled at the end of the week, which allowed her to report to work as normal instead of staying at home. She utilized the weekend to recover from any side effects of the therapy.

Deeper Empathy

Even as a doctor, she was shocked by her cancer diagnosis. Fear of the unknown grabs people mentally. She is now a firm believer of giving patients bad news in smaller, manageable chunks to allow them to process the information.

Family Support System

She encourages patients to embrace supportive family members, which was extremely helpful in her case. Her family made her days much easier and would even prepare her meals at home. Patients are sometimes reluctant to share their diagnosis with relatives for a number of reasons. Cancer has a stigma, and being surrounded by positive people is important. Her employer was also very supportive during her 6-9 month battle.

Trusting Local Doctors

The competency of regional doctors is sometimes underestimated, however, she trusted every member of her medical care team with her life. Having been trained in the region, she knows the vast amount of talent and their capabilities. As a cancer patient with the medical expertise to critique a doctor’s every move, she was satisfied with the quality of care rendered by teams in both Turks and Caicos and Bahamas.

Financial Safety Net

Chemotherapy is an extremely expensive treatment. Dr. Braithwaite was grateful for the National Health Insurance Plan and the financial support it gives to persons with chronic illness that require extensive time off from work. Such treatments can leave families in a financial black hole. Thankfully, this was the least of her worries, and her mental energy was primarily focused on remission.

Perception of Chemotherapy

Some patients misunderstand the benefits of Chemotherapy due to lack of information. Breast Cancer has been heavily studied. There are many treatment modalities in existence. Following her cancer battle, she is now able to better inform patients using first hand experience, instead of patients rejecting the treatment due to fear. “He who feels it, knows.” Every October, Dr. Braithwaite reflects on her difficult journey and how blessed and fortunate she is to have won a battle that so many people have sadly lost. While awareness-raising initiatives focus on the negative impact of cancer, she provided insight into her life-changing brush with the deadly disease and how it has positively transformed her outlook on life, forever. 5

NEWSLETTER

MINISTRY OF HEALTH CLINIC REDUCES WAITING TIME Waiting times at Cheshire Hall Medical Centre reduced significantly following the launch of an extended hours clinic on-site by the Ministry of Health, Agriculture and Human Services in July.

A DAY IN THE LIFE OF A MEDICAL DEVICE REPROCESSING SPECIALIST A patient recovering from a trauma surgery is unlikely to think about the people behind the scenes who are central players in their healthcare. Medical Device Reprocessing Professionals are one of the unsung heroes of every hospital operation due to their critical role in the sterilization and decontamination of reusable patient care items, medical and surgical instruments. More than 3,000 instruments are centralized and reprocessed every month by MDR Specialists inside the Cheshire Hall Medical Centre through a strict organized process. The detailed-eyes of these individuals coupled with the latest sterilization methodologies reduce the risk of patients acquiring healthcare associated infections.

The new working hours are: Mondays – Fridays 8:00 am 9:00 pm, and Saturdays 9:00am - 1:00pm. ED Physicians at CHMC have since referred hundreds of level 4 and 5 patients with non-emergency medical conditions to the MOH section for primary health care services, which declutters the ED and increases efficiency. This has ultimately enhanced the patient experience.

It’s more than soap and water. MDR technicians are well-versed in the powerful antiseptics and hightech devices that thoroughly clear equipment of all living microorganisms. These specialists follow an exhaustive list of protocols for Infection Prevention and Control wearing mandatory Personal Protective Equipment. Each stage of the process is critical and cannot be fast-tracked or skipped. These stages include Usage, Disinfection, and Transport to Central MDR Department, Sorting & Cleaning, Reassessment, Packaging and then Sterilization.

Similar to a Laundromat, powerful Steris double-chamber washers are used to disinfect each medical instrument. A special device is tossed into the machine to gauge the efficacy of the cycle and ensure instruments are cleared of all blood remnants. Medical instruments are washed for 1 hour, disinfected at nearly 90°c and then dried at 100 °c. They are then removed from the washer, reassessed using magnifying glasses and special light, carefully packaged and then sterilized. The sterilization cycle takes about 1 hour and 30 minutes in Steam Autoclave Machines at a temperature of 134 °c.

NEWSLETTER

Certain types of instruments must undergo a slightly different procedure. For example, complex medical devices with mechanical or electrical components cannot be fully immersed due to sensitivities to water, chemicals and high temperatures, and therefore require special manual cleaning techniques. Other complex devices contain numerous tiny components and must be dismantled, cleaned, reassembled and made ready for patient contact. Every medical device must be manually double wrapped using non-woven fabric, special tape, and a specific packaging technique. Imagine wrapping hundreds of Christmas gifts in a single day with perfectly folded edges and no room for peek-a-boos? Without these special technicians, doctors would not be able to carry out medical procedures and patients would not be able to receive certain treatments. These unsung heroes monitor their inventory of reprocessed devices, and are always on-call in the event their services are needed to save the day, as they do, everyday.

GROOMING THE NEXT GUARDIANS OF HEALTHCARE TCI Native Coral Pratt, 20, studies Medicine at Bristol University in the United Kingdom. Pratt concluded her two-week mentorship at TCI Hospital in late August. She gained invaluable firsthand exposure to internal healthcare operations. Pratt is now eager to crossover into her second year of university.

NEWSLETTER

FROM MEDICAL TECHNOLOGIST TO STAR RESEARCHER: Abstracts from a groundbreaking research conducted by a TCI Hospital Medical Technologist on ‘Antimicrobial Resistance in the Turks and Caicos Islands’ has been published in a supplement of the West Indian Medical Journal. Lessonjulle Lyons-Dobney presented her findings at the CARPA Conference this past June after being advised by one of the main facilitators at the 2014 Antimicrobial Resistance Regional Conference in Trinidad that TCI indeed had publishable data. The research examined antibiotic resistance data from 1,343 anonymous swabs from wound infections processed between Jan 2013 and November 2015 at Cheshire Hall Medical Centre. The most frequently isolated organisms along with the antibiotic resistance patterns were documented. Frequently classified among the group of “flesheating bacteria” is Methicillin resistant Staphylococcus aureus (MRSA), which accounted for 9% of the 1687 isolates recovered from wound infections over the period. Other frequently isolated organisms included non-MRSA, Pseudomonas, E coli and Acinetobacter species. Although overall antibiotic resistance rates were below 50%, individual isolates exhibited much higher resistance rates when exposed to some antibiotics. The research also revealed that antibiotic resistance patterns differ from region to region. According to the World Health Organization, patients with infections caused by multi drug-resistant species are generally at increased risk of worse clinical outcomes and death, and consume more health-care resources than patients infected with the same bacteria that are less resistant. Patients are treated at TCI Hospital using laboratory analysis performed by Medical technologists to ensure the best clinical outcomes. The rapid development of antibiotic resistance by bacteria may be a significant cause of the major

drought and disinterest in the discovery of new antibiotics by Pharmaceutical companies worldwide. There are high economic and other costs associated with the research and development of new drugs. Some bacteria have developed resistance within one year of a counter-antibiotic being introduced. The problem is so significant that the UK’s Chief Medical Officer, Sally Davies placed antibiotic resistance on the government’s national risk register, alongside terrorist attacks and pandemic flu. Colistin, frequently called “the last-resort antibiotic” has been toppled by some strains of bacteria such as E coli and Salmonella species. Top officials from Centers for Disease Control and Prevention have expressed serious concerns about these “super bugs”. Some mainstream news outlets have even referred to these strains as “Nightmare bacteria”. Fortunately, these strains have not been isolated in the Turks and Caicos Islands.

POISED TO BECOME ONE OF TCI’S FIRST RADIOGRAPHERS

Mentee Adresha Gardiner on rotation CHMC.

Andresha Gardiner and Latavia Ingham study Diagnostic Imaging (Radiography) at University of the West Indies in Jamaica, while Paul Lewis is pursuing his degree at the University of Guyana. The three students are poised to become one of few certified local Radiographers in the near future. Each mentee spent at least two full weeks at Cheshire Hall Medical Centre.

Multiple change enquiries submitted by Interhealth Canada (TCI) Ltd were recently approved in principle by Cabinet, pending confirmation that funds are available in the Ministry of Health budget. Each enquiry was supported by detailed clinical data and research to justify a sustainable service model. Below is an overview. A request has been made for the National Blood bank to be managed by TCI Hospital for a period of two years. The National Blood Service is currently managed by the Government in accordance with the Project Agreement. TCI Hospital draws blood units from the bank in order to comply with requirements for on-site blood bank storage for the delivery of care. The hospital operates a full service accredited laboratory.

A second proposal has been made to introduce cost-effective technology such as Tele-radiology services to cater to the increasing demand for diagnostic imaging, which is presently covered by a single Consultant Radiologist at TCI Hospital. Tele-radiology improves patient care by allowing radiologists to provide services without actually having to be at the location of the patient. Tele-radiology also allows for trained specialists to be available 24/7.

Patient images such as radiographs (X-rays), CT’s, and MRI’s will be transferred via a secure system to a remote company of radiologists and physicians for professional analysis. The implementation of hysteroscope technology at the Turks and Caicos Islands Hospital is also being sought. This will allow specialists to evaluate the cavity of the uterus in female patients using a thin tube-like telescope with a built-in video camera giving doctors a

“Keeping pace with technology and increases in patient volume.” more direct visual of the uterus prior to removing any tissue, as opposed to D&C where the tissue is removed without direct visualization. The technology not only enhances the diagnosis and management process, but also supports service delivery that aligns with advancements in technology and minimally invasive approaches to care. Both D&C and hysteroscope are outpatient procedures where the patient usually does not require admission to hospital upon completion. A fourth proposal has been made for additional equipment in the Dialysis Unit along with a full-time Nephrologist due to an increase in Dialysis patients at both TCI Hospital sites. TCI

Hospital presently employs a General Internist who is a cross-trained Nephrologist. A Consultant Nephrologist also visits the hospital every three months. While the number of machines have remained the same since commencement of clinical operations (CTMC – 3 machines, CHMC – 6 machines), the number of patients on dialysis machines for Grand Turk has increased by 50% and Providenciales by 65% since 2010. The inclusion of a full-time Nephrologist will enable care to be managed more proactively with an emphasis on preventing the progression into kidney failure. A fifth proposal has been made for the procurement of special blood screening

equipment which will reduce the cost of oversees screening and allow for swifter results. In accordance with recommendations issued by the Food and Drug Administration (FDA), TCI Hospital screens donated blood for Zika virus using an overseas reference laboratory. TCI Hospital will continue to ensure the safe delivery of appropriately screened blood to patients in light of confirmed local transmission of the virus with the procurement of a Polymerase Chain Reactor Machine and Associated Equipment for Human Pathogen Detection.

NEWSLETTER

A E L I SM HILE W Dr. Roxanne Allen Emergency Department Physician

Dr. Monifa Wilson Obstetrician & Gynaecologist

TCI HOSPITAL ATTENDS WORLD MEDICAL TOURISM CONGRESS A delegation from Turks and Caicos Islands Hospital attended the 9th World Medical Tourism & Global Healthcare Congress in Washington D.C. at the Gaylord National Resort & Convention Centre from September 25-28th, 2016. The congress is one of the most comprehensive international healthcare conference and trade show in the medical tourism industry and attracts up to 3,000 participants, 400 qualified buyers of healthcare along with industry forums and executive summits. TCI Hospital Chief Executive Officer, Daniel Carriere and Chief of Medical Services, Dr. Denise Braithwaite-Tennant participated in the 2016 Global Medical Directors Summit (Invitation Only Summit) and the Caribbean Round-table Forum. Both forums encouraged countries to collaborate, network, and discuss emerging ideas, share best practices and obstacles related to the medical tourism sector. Other members of TCI Hospital delegation were Marketing and Public Relations Manager, Nikira John and Visiting Consultant Coordinator, Kay Vanes-Williams. Attendees participated in a series educational break-out sessions and presentations from global innovators in medical tourism and healthcare.

WMTC Delegation (L to R): Dr. Terese Maitland - TCIG National Epidemiologist, TCIH Chief Executive Officer - Daniel Carriere, TCIH Chief of Medical Services - Dr. Denise BraithwaiteTennant, Premier and Minister of Health - Honorable Dr. Rufus Ewing, TCIH PR/Marketing Manager - Nikira John, TCIH Visiting Consultant Coordinator - Kay Vanes-Williams.

The TCI Hospital delegation met with TCI Minister of Health and Premier, Hon. Dr. Rufus Ewing and other government stakeholders during the congress. According to a recent report issued by VISA and Oxford Economics, the Medical Tourism industry was valued at USD 439 billion, with a projected growth rate of up to 25% year-over-year for the next 10 years. The report forecasts an estimated three to four percent of the world’s population will travel internationally for healthcare and health-related treatment. Canada is ranked the top medical tourism destination overall for 2016, followed by the United Kingdom, Israel, Singapore and India, respectively.

NEWSLETTER

Dr. Sani Amatti Consultant Paediatrician & Neonatologist

Douglas Moore Chief of Clinical Services

Dr. Deonne Ranglin-Robinson Anaesthetist

TCIH LIFE SAVER TRAINING CENTRE EXPANDS TRAINING DISCIPLINES TCI Hospital recently added a new discipline to its in-house Life Saver Training Centre following a Paediatrics Advanced Life Support (PALS) Course facilitated by the American Heart Association. Five employees - two Paediatricians and three Emergency Medicine Physician Specialists - are now certified to train other healthcare providers in these resuscitation procedures. The pass mark to become a certified PALS Trainer is 84%. Other participants included EMTâ€™s from the government. Lead Instructor for Life Saver Training Centre at TCI Hospital, Dr. Denise Braithwaite-Tennant stressed the importance of maintaining the competency of health professionals. The course was assisted by Dr. Gustavo Flores, Senior Instructor from the American Heart Association. Previously, the Life Saver Training Centre provided training in the areas of CPR, Basic Life Support and Advanced Cardiovascular Support. TCI Hospital continues to increase the number of certified training instructors in various fields across the organisation. This eliminates the need to outsource instructors to deliver training and refresher courses.

Above: Participants of Pediatric Advanced Life Support (PALS)

community interaction

The facebook posts above are apart of IHCâ€™s #ThankfulThursday Marketing initiative. All employees are encouraged to participate. Itâ€™s simple. Just write what your thankful for on a sticky pad, and give us your best smile. Snap Snap.

NEWSLETTER

EMPLOYEES BECOME CERTIFIED MANUAL HANDLING TRAINERS

Eight newly certified Manual Handling Trainers have been added to TCI Hospitalâ€™s compliment of Mandatory Training facilitators following a 3-day Load Management & Client Handling Techniques course held at Cheshire Hall Medical Centre in early September. Veteran Trainer and Registered General Nurse, Jan Crawford of Centaur Training Centre in England, returned to the facility after five years to train a new batch of enthusiastic health professionals.

Participants were from Inpatient Services, Emergency, Facilities Management, Dialysis, Medicine and Physiotherapy. Crawford trained her first batch of TCI Hospital employees in 2011. A wide variety of patient handling techniques were examined to increase participantâ€™s knowledge and understanding of safe handling procedures. These included rolling and turning a patient in bed, inserting side sheets, repositioning patients in a chair, theatre techniques and emergency techniques.

Certificates are renewed every two years. Every 6 months trainers must undergo an assessment which will be marked to ensure the standard is maintained. These individuals are now equipped to impart their knowledge into other members of their various departments. 13

DEVELOPMENT OF DISEASE Symptoms and signs typically occur within 2 to 12 days after the mosquito bite. The illness is usually mild. Symptoms usually resolve within 2 to 7 days. Asymptomatic infection is common. Symptoms develop in 20 to 25 percent of individuals . Zika virus infection has been associated with congenital microcephaly and fetal losses among women infected during pregnancy. An increase in the rate of Guillain-Barré syndrome has been observed in association with Zika virus infection.

MICROCEPHALY

Zika is a Public Health Emergency of international concern Eleven cases of Zika have been recorded in the Turks and Caicos Islands as of October 6th, 2016. Three cases are confirmed to be imported and the others are attributed to incountry transmission. All specimens are based in Providenciales and include one pregnant female.

GEOGRAPHIC DISTRIBUTION There are two major lineages of the Zika Virus -- the African Lineage and the Asian lineage. Zika virus is named after the Ugandan forest where it was first isolated in a rhesus monkey in 1947. The virus spread to Southeast Asia and the first major outbreak occurred in the Yap Islands of Micronesia in 2007. Another large outbreak occurred in French Polynesia in 2013, where public health officials estimated infection rates of 70 percent on some islands. Zika is transmitted from mother to child, sexual intercourse and blood transfusion.

The Brazilian paediatric neurologist Vanessa Van Dor Linden is one of the first researchers to link Zika virus to microcephaly. She has seen microcephaly babies with 24hr crying bouts, spasms, extreme irritability, difficulty swallowing, hearing loss, seizures, and joint contractures. There is still a big unknown because it can take years to find out about other neurological disorders such as learning disabilities or developmental delays.

GUILLAIN-BARRE This is a rare condition in which the body’s immune system attacks part of the peripheral nervous system. People of all ages can be affected, however it is more common in adults and in males. Even in the best of settings, 3%-5% of GBS patients die from complications, which can include paralysis of the muscles that control breathing, blood infection, lung clots or cardiac arrest.

Zika is currently spread by two species of mosquitoes, Aedes aegypti and Aedes albopictus mosquito. The latest studies conducted in China, Canada and Brazil are showing the possibility of adding the Culex mosquito which is prevalent in the northern section of North America.

CURRENT INTERNATIONAL STATISTICS

EMERGENCY FUNDING

To date 73 countries and territories have reported evidence of mosquito-borne Zika virus transmission since 2007. 56 reported outbreaks from 2015 onwards. 5 have possible endemic transmission or evidence of local mosquito-borne Zika infections in 2016. 12 with evidence of local mosquito-borne Zika infections in or before 2015. 12 countries reported evidence of person to person transmission of Zika virus since February 2016. 21 countries or territories have reported microcephaly and other CNS malformations. 4 out of 21 countries reported microcephaly babies born from mothers in countries with no evidence of Zika virus transmission but who reported recent travel history to Zika affected countries. 19 countries and territories have reported an increased incidences of GBS and/or laboratory confirmation of a Zika virus infection among GBS cases.

On September 30, 2016 the U.S. congress passed $1.1billion dollars for Zika funding. $394 million for mosquito control efforts. $397 million to assist in the development of a vaccine against the virus and to improve Zika testing. $66 million to Puerto Rico to ease the healthcare burden Zika has inflicted upon the island territory.

Contributor SRN Subrena Pedican

NEWSLETTER

DOCTOR’S ORDER: PLAY GOLF!

IT’S THE CLIMB! Grand Turk Native, Janelle Hamilton, is one example of how mentees can become official position holders in the very same organization that inducted them into the specialty area they once dreamed of mastering. Hamilton was employed as the sole Pharmacist at the Cockburn Town Medical Centre in February 2016 after years of shadowing professionals in practice. She worked part-time at the Government clinic and later the Grand Turk hospital as a pharmacist assistant from 2001 – 2013. She then decided to formalize her training and pursued her Masters in Pharmacy at Keele University in the United Kingdom. During summer breaks, she would return to the Grand Turk Clinic/Hospital and community pharmacy to capitalize on summer internships. As a part of the organization’s succession plan, Hamilton is now the sole person responsible for medication top-ups at Cockburn Town Medical Centre and all clinical checks for prescriptions. She is now holding the position she once dreamed of and is grateful to have amassed such valuable experience in the field over the years, which made settling into her big role much easier.

A team of golf fanatics from TCI Hospital secured third place at the 2016 Premier’s Cup Golf Tournament which raised $50,000 for TCI’s Cadet Corp. During the annual sporting event held at the Provo Golf Club in July, Team Interhealth Canada won a $1,600 cash prize. After a long period of squinting in the sun clad in polyester slacks, TCI Hospital returned to the wards as the real winners — not in the test of sportsmanship, but in their showcase of charity. The hospital team was one of few top finishers to donate 100% of their winnings back to the TCI Cadet Corp. The TCI Cadet Corp seeks to promote the core values of leadership, discipline, voluntarism and patriotism among high school students between the ages of 12-18.

@TCIHOSPITAL Be sure to follow our page, like and share our posts. If there is anything exciting you think is worth sharing, feel free to contact PR/Marketing Manager, Nikira John. Your feedback is important to us. 15

NEWSLETTER

Welcome to the first edition of ‘Safety First’ produced by Interhealth Canada’s Health & Safety Committee.

Our aim is to provide useful tips and information to help improve our workplace safety. This month our message will focus on easy steps to reduce workplace related illnesses and accidents, which we hope you will find informative and useful. Quite often, injuries on the job result in employees being out of work for long periods of time. This creates a financial strain on the employee, impacts his/her colleagues and generates overtimes costs for the organisation due to additional hours worked. Although Interhealth Canada TCI has very low rates of workplace related accidents and illnesses, these issues are common around the world. By raising awareness of preventive measures, it can be easy to avoid these issues, and work together to further improve our position. Below are 10 workplace safety tips that every employee and employer should know to avoid and reduce the possibility of accidents in the workplace.

1. Know the Risks Certain tasks have associated risks. It is important that we understand these risks and follow the training and advice given in relation to the task at hand. Only then will we be better prepared to take the appropriate steps to avoid a work-related injury. This is important for all roles and tasks, but even more crucial if you are working with dangerous or heavy equipment, chemicals or biohazards. Remember, if in doubt, seek advice from your Line Manager and never attempt a workplace task that you are not trained to do. 2. Reduce Stress in the Workplace The connection between workplace stress and work-related injuries and illness is often overlooked. Circumstances that can create workplace stress include: working extended hours, increased workload, insecurity on the job, and conflicts in the workplace. If you have experienced any of these issues, please speak to 16

your Line Manager or Human Resources representative to resolve your concerns. 3. Take Breaks It is important that you take breaks as they are scheduled. This will help you stay alert, and avoid stress and injuries. Try to schedule the toughest tasks for a time of day when you have the best concentration level. Some employees are more proactive during the early morning hours. 4. Be Careful When Lifting If your job involves heavy lifting or any other laborious task, please ensure you execute these duties in a safe manner. Use the right equipment, ergonomically set furniture, and make sure items can be easily reached. Ensure that you have completed our in-house Manual Handling Training. If you have any questions related to this tip or wish to complete further training, please contact the Education Department.

NEWSLETTER

5. Use Mechanical Aids

7. Know Your Surroundings

Mechanical aids are there to help us, so we should take advantage of them! Use trolleys, pallet trucks, hoists, wheelbarrows, etc. when lifting heavy items to avoid injuries on the job. Gauge the weight of an item prior to lifting. If mechanical aids are not available, request assistance from trained personnel.

It is important to know your surroundings in the workplace so you can assess any possible risks. Once you are aware of areas considered to be hazardous such as specialist clinical areas, kitchen areas, steam rooms, plant rooms, utility rooms, areas with potential wet surfaces or hot areas, you can potentially avoid these situations. Be careful around machinery as inattention can lead to serious injury.

6. Check out Safety Resources It is always a good idea to check out tips on various safety resources from time to time. There may be new information available that can help you stay even safer in the workplace. Some of the safety resources include: • • • • •

Health & Safety Portal Education Portal Health & Safety Notice Boards Health & Safety Bulletins on Snap Coms Health & Safety page in IHC Newsletter

8. Keep Good Posture Remember to maintain a good posture on the job. This will prevent back, neck, and shoulder pains, and help to avoid back injuries. It is easy to stay in perfect posture. Simply shrug your shoulders, move them back, and then drop them, and you are in perfect posture. 9. Have Accessible Emergency Exits All emergency exits are easily accessible. Ensure you are aware of all escape routes from the building. There should be no equipment or other items blocking these exits. 10. Report Unsafe Conditions to Management or utilize Pavisse It is imperative that your supervisors are aware of any unsafe conditions in the workplace. It is their job to correct these issues, but if they are not aware of them, nothing will get done. The more they know, the safer your workplace will be. This includes reporting ‘Near Misses.’ According to statistics, one workplace accident or injury is prevented for every 10 ‘Near Misses’ reported, investigated and resolved. Thank you for reading our first submission, and we hope you enjoyed. Together we can build a safer Working Environment! The Health & Safety Committee 17

NEWSLETTER

FAREWELL FROM JOANNE KINBOROUGH MATA QUALITY RISK AND PATIENT SAFETY MANAGER I am still struggling to believe that exploring opportunities in other parts of Friday 21st October will be my last work- the world. ing day after two incredible years on I leave with great confidence in the the Turks and Caicos Islands. I people here, knowing that you are would like to thank each of capable of overcoming you for every amazing exany hurdles that will perience shared, friendcome up and offer“I have had ship made, opportuing excellent quality nity offered and good two incredible years, care in a first class times had during this environment to everytime. I have learned one who walks through now it’s time to a great deal from my the door. Between friends and colleagues us we have laid the say goodbye.” and will miss your foundation of something company. I do hope that very special and I am sure the feeling is mutual, although that you will build upon this I do appreciate that I have been a bit to ensure that the Hospital receives of nag at times! accreditation at Diamond Level for the third time in a row. This provides me I think it was the toughest decision with a great sense of pride and gratiof my life not to renew my contract for tude. It has been a great pleasure workanother two years. I will take with me ing with you. I wish you all the very best some fond memories of the islands and in the future. Do keep in touch - joanne. the people who live here while I am off mata@sky.com

upcoming events internal & external OCT 16TH MDR Week Employee Church Service Start time: 10:30 am Bethany Baptist Church Blue Hills, Providenciales

OCT 8TH In The Pink Charity Event The Regent Palms Start time: 7 pm

OCT 18TH MDR Week Grand Exhibition 10am - 12 pm CHMC Main Lobby

OCT 17TH Interhealth Canada Press Conference on latest Cancer statistics and trends in TCI -- 1:00pm - 1:30 pm at CHMC. A media circuit involving appearances on radio shows will also be conducted the same week.

OCT 19TH MDR Special Symposium 4:30 PM - 6:00 PM Cheshire Hall Medical Centre

OCT 22ND Breast Cancer Luncheon Beaches Resort Start time: 1pm Ticket: $65.00 each

“Nursing is a calling, a lifestyle, a way of living.” Nurse Renay Robinson died on Wednesday, September 14th, 2016 at Princess Margaret Hospital in Nassau Bahamas where she was receiving care. She had more than 16 years of experience working in the Dialysis Unit. TCI Hospital held a moment of silence and made a special donation to the National Kidney Foundation in her honor. Vice President of the NPO, Leon Wilson, raved about Nurse Robinson’s contribution to kidney patients and expressed gratitude. She will be remembered in a memorial planned by TCI Hospital Human Resource Department.

RIO OLYMPICS WITH A TWIST As the world turned its attention to the Olympics in Rio De Jenario, TCI Hospital held its own track meet at the Providenciales National Stadium on Friday, August 12th. Chief of Medical Services, Dr. Denise BraithwaiteTennant spoke to more than 30 children from Little Ladies and Gents Summer Camp about the importance of healthy eating and exercise. The athletic activities planned by the Marketing Department included relay races, bum-a-balloon, an inflatable tug-of-war challenge and a watermelon eating competition. Highlights below.

BIRTHDAY CORNER October: Jyothi George, Aneka Dean, Beanca Clare, Isableo Cuadras, Denwell Cox, Barbara Ferguson, , Oneil Ruddock, Veronica Rigby, Shantell Gardiner, Basillia Otuonye, Aileen Cagauan, Soliman Raafat, Tamara Johnson, Clarita Tucker, Magdala Hyppolite, Shamire Moore, Barbara Saunders, Venice Brooks, Julie Togie, Martin Wintz, Rafeeza Seecharan November: Voneric Forbes, Shevaughn Annikie, Shawna-Kay Hewitt, Whitney Jeanty, Straudy Jackson, Girum Mussie, Oluwayemisi Olugbanmu, Babatunde Ajimoti, Elizabeth Mckenzie, Orlane Jolly, Wayne Anderson, Dionne Betty, David Banton, Surbrena Pedican, Bridget Williams, Lesly Jean-Baptiste, Schiler St. Juste, Michael Williams, Dian Tucker, Georgia Brown 19

Infection Prevention and Control Team prepares for Caribbean Week 2016 A TCI Hospital delegation is scheduled to travel to Barbados this month to attend the Infection Prevention and Control Caribbean Week. Healthcare organizations from across the region were asked to submit fun photos of their infection prevention and control teams. The adjacent image was submitted by TCI Hospital’s link champions.

A TOAST TO QUALITY HEALTHCARE! Do you often find yourself using words such as ‘umm….’ or ‘ahh...’ as you crossover to your next sentence when conversing with others? Even some of the greatest oratorians still experience an onslaught of nerves and butterflies before taking centre stage to give high-profile speeches. Speakers may appear confident because they have simply mastered the art of ice-breakers and other self-calming tactics, or in the case President Barrack Obama -- they are masters of the art. Overcoming such emotions can start with practicing a 3-minute spontaneous speech about a completely random topic and opening yourself to frank criticism from peer evaluators. This is a strategy commonly used by Toastmasters during regular meetings, one of which was recently held at Cheshire Hall Medical Centre. Effective communication is important in every healthcare organization. Contact Jacqueline Moe-Cox of the Education Department to learn more about how you can join. Toastmasters is a non-profit organization developing public speaking and leadership skills through practice and feedback in local clubs across the world since 1924.

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

01 02

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.

A day in the life of the Operating Team, a high stress working environment where every movement is critical.

The launch of Operation Gratitude showers every patient at TCI Hospital with care-packages on Christmas Day.

Governor of Turks and Caicos Islands, His Excellency Dr. John Freeman conducts tour of TCI Hospital on Christmas Eve.

NEWSLETTER

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

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.

NEWSLETTER

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

NEWSLETTER

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.

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.

NEWSLETTER

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

NEWSLETTER

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 familyâ€™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

NEWSLETTER

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 â€“ 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

NEWSLETTER

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.

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

Sincerely,

NEWSLETTER

Operation Gratitude

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.

NEWSLETTER

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

NEWSLETTER

Tip!

Laughter is infectious and soothes the soul.

A pleasant surprise! Patricia Dunne made the hottest Mrs. Claus.

Employees at Cockburn Town Medical Centre enjoying a holiday ‘selfie.’

NEWSLETTER

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.

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.

NEWSLETTER

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 E V E Governor of the Turks and Caicos Islands, His

October 2016. Prior to this, H.E. Freeman served

Excellency Dr. John Freeman along with his wife,

as British ambassador to Argentina from June

Corinna Freeman and son visited TCI Hospital

2012 to October 2016. He joined the Foreign and

on Christmas Eve. Chief Executive Officer of the

Commonwealth Office in 1986. He has previously

Hospital, Daniel Carriere and Chief of Medical

served in a wide range of appointments in London

Services, Dr. Denise Braithwaite-Tennant led the

and overseas dealing with countries as varied

tour.

as South Africa, Germany, and Singapore; and with a wide range of international issues, includ-

The hospital was less busier than usual on

ing non-proliferation, international terrorism, and

Christmas Eve, however staff members were elat-

drugs policy. He has also covered economic and

ed to see the de-facto head-of-state on the wards

commercial issues in posts overseas.

during the peak of the season with his family. The Governor visited the Out-patient Department, Emergency, General Ward, Maternity, Laboratory and X-Ray Department. Dr John Freeman CMG was appointed Governor of Turks and Caicos Islands in succession to Mr Peter Beckingham and took up his appointment in

NEWSLETTER

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.

“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.

NEWSLETTER

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 organizationâ€™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.

NEWSLETTER

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

ANY

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.

NEWSLETTER

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

NEWSLETTER

community interaction

NEWSLETTER

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.

NEWSLETTER

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.

NEWSLETTER

Nurse Renay Leshurn Robinson Sunrise: Oct 02,1978 Sunset: Sept 14th, 2016

Reflections from Nurse Renay Robinsonâ€™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 Renayâ€™s family by TCI Hospital during the memorial, which was somber but also celebratory of her life.

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.

QUICK FACTS

Working with Hazardous Substances

Dusty or fume laden air can cause lung disease e.g. in welders, bakers, quarry workers or woodworkers

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: •

To individuals who may lose their jobs due to ill health and disability

•

To society in disability allowances and medicines

•

To industry costing to recruit replacement employees

Metalworking fluids can grow bacteria and fungi which cause dermatitis and asthma Flowers, bulbs, fruit and vegetables can cause dermatitis

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.

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

Types of Exposure

1 22

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.

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.

By contact with the eyes - Some vapors, gases and dusts are irritating to the eyes. Caustic fluid splashes can damage eyesight permanently.

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 last option

To comply with the Regulations the employer must assess the risks to health from hazardous substances created by the work task, and decide what precautions

2. Substitution - replacing the hazard with a non hazardous replacement

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.

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 â€“ 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.

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

NEWSLETTER

COCKBURN TOWN MEDICAL CENTRE

Christmas Tree Lighting 2016

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 canâ€™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 donâ€™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 DECEMBER

Employees

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

OCT 2016

MAR 2017

NEWSLETTER INTERHEALTH CANADA TCI

THE

INTER-VIEW

AN INVESTMENT IN THE EDUCATION SECTOR Welcome to the March 2017 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

Quote of the Quarter

“To know even one life has breathed easier because you have lived. This is to have succeeded.” -Ralph Waldo Emerson 1

An in-depth analysis of patient activity levels at Turks and Caicos Islands Hospital six years later.

TCI Hospital received the highest ranking “Category A” by PAHO officials under the Safe Hospital Index.

Interhealth Canada Corporate invests $6000 in new computers for the country’s National Library Service.

A fundraiser created by a late cancer patient raise funds to purchase an MRI Sound System.

Mass casualty incident drill challenge local disaster response agencies with 7.0 earthquake scenario.

‘My Kidney Story’ event raises awareness of Renal Failure as patients and special guests share heartfelt stories about their lives.

Patient volumes for certain services offered at TCI Hospital have reached peaks 17 years earlier than projected.

it's about growth. It is impossible to accurately predict the number of persons who will require medical care in any given year, and therefore patient volume projections can exceed expectations. An increase in patient load is intricately connected to changing healthcare needs, shifts in life-style habits, immigration, population growth and the onset of major local developments, thereby affecting the cost of health care. TCI Hospital is the National Health Insurance Boardâ€™s preferred healthcare provider. 70% of patients treated in the inpatient units of the hospital are covered under the National Health Insurance Plan while the remaining 30% are self-payers. These private/self-pay patients may be visitors to the island, Resident Certificate holders, or persons presumed to be undocumented or without legal status in the country. Projections were made and the hospital anticipated at least 20,000 visits to the Outpatient Department (OPD) between April 2010 and April 2011. However, 31,884 visits were recorded during the period under review. Â

ithin 12 months of operation, this figure had already surpassed the 30,000 OPD visits projected at the close of April 2033. By 201 , the number of outpatient visits climbed to 2,433 visits. A larger number of persons are accessing acutesecondary healthcare services far beyond what was predicted. These volumes are in eeping with international healthcare facilities, which see to continuously develop Outpatient Department services as opposed to costly Inpatient care. However, as the data will indicate, even with over 2,000 Outpatient visits, the Inpatient Department is still actively utilised.

s r i a sio .

By April 2033, a total of 2 ,000 visits to the mergency Department was projected. ithin the first year, the mergency Department at TCI Hospital had already recorded 2 ,378 visits. ith the exception of 2014, which recorded an unusual swell of 31,48 visits, the number of D admissions only moderately fluctuated since the inception of the hospital in April 2010.

TCI Hospital has een accredited at the iamond level since arch 1 y ccreditation Canada.

These fluctuations in mergency Department visits are attributed to pea s in communicable diseases and other disease related surges. The Blue Hills Clinic and the introduction of the inistry of Health extended clinics in uly 201 have also contributed to shifts in patient levels at TCI Hospital. 3

ore than 2,000 inpatients who require hospitalisation are cared for during most years and some inpatients are spending even longer periods of time at TCI Hospital after their acutecare has ended. The number of inpatient days climbed from 7,4 0 days in 2010 to 8, 2 days in 2014. ast year patients accumulatively spent 11,0 0 days at TCI Hospital facilities.

th h a th ar a statisti a rs

s a ti The number of dialysis patients have nearly doubled over the past six years from 23 in 2010 to 41 patients in 201 .Â Â At least five patients are being diagnosed with chronic renal failure every year. The dialysis unit is quic ly approaching the figure projected for April 2033 which is 48 patients. Persons in younger age-brac ets are also being diagnosed with chronic renal failure with the predominate associated illness being diabetes and hypertension. The strengthening of primary health care and preventative medicine continues to be a national priority.

The num er of dialysis patients have nearly dou led over the past si years. t least five patients are ein dia nosed ith chronic renal failure every year. By the year 2033, it was estimated TCI Hospital would perform between 2,100 to 2,700 surgeries in a single year. urgical and ndoscopy teams performed over 1, 41 surgeries last year compared to 7 in 2010. Between the years 2011 and 201 , surgery volumes remained over 1,000 surgeries per annum with an additional 100 surgical operations performed in some years.Â

The pecial Care Baby nit ( CB ) is monitoring new borns for even longer periods of time recording 812 days in 201 , compared to 7 days in 201 and 2 8. 7 days in 2010. Birth tatistics show that 3 1 babies were delivered at TCI Hospital in 2010 six years later 18 babies were delivered. Premature babies may remain in the CB for long periods to ensure close monitoring of their growth and manage any complications. 4

b o u a waiti g ti s

An inpatient recently spent 27 days at TCI Hospital while some current long stay-patients have been in a hospital bed since mid 201 , and have surpassed 327 days under inpatient care. Interhealth Canada continues to wor with the inistry of Health, Agriculture and Human ervices and ocial ervices to support their efforts to address these opportunities for social development and support effective discharge planning.

An analysis of the full spectrum of hospital capacity is conducted once volumes exceed those previously experienced. or certain services, these figures have prompted the need to see approval from TCI overnment for adjustments to staff complement, consumables and operational costs through a process called Change nquiry’ in-order to continue providing quality health care. There has been Change nquiries approved over the past six years in response to service expansion and increasing activity with additional staffing inclusive of medical, nursing and ancillary. The increase in patient volume is good news, as it reflects the hospital’s growing role in providing quality patient care to residents who are actively utilising the services, but it has its share of challenges, which are connected to bed occupancy and waiting-times. The issue of bed shortage is affecting hospital’s worldwide. A recent analysis by BBC showed 137 out of 1 2 hospital trusts in ngland have been overcrowded since the start of December 201 . The same trend is apparent in Canada. Historically, on several occasions, bed occupancy at TCI Hospital is aligned with internationally recognised levels that hospitals are advised to retain in-order to manage the ris of infection and to ensure there is spare capacity to deal with major on-the-day emergencies. However, due to increasing patient volume, there is an ongoing challenge to find beds for patients who need to be admitted. A second variable which creates bed bloc ages is delayed discharges after treatment, which are beyond the hospital’s control. ulnerable patients cannot be released from hospital after acute-care has ended if there is inadequate social support in the community and limited beds in external long-term care facilities.

Commenting on patient activity levels, Chief xecutive Officer, r. Daniel Carriere said Although there was paucity of data available in the past to accurately predict future volumes, Interhealth Canada and the then Tur s and Caicos Islands overnment included a shelled space in the planning parameters for future growth and expansion of both facilities. The greater than expected change in patient volume has been the catalyst for accelerated discussions with the previous and current overnment regarding the operationalisation of this enclosed space, which requires retrofitting, equipping and staffing in its current form. He continued e recognise the importance of TCI Hospital to the population and its significant role in the overall health care system. The increased patient activity has affected our staff and the community as a whole. I am proud of our dedicated clinical and non-clinical personnel who, despite the increased wor load, continue to exemplify commitment, dedication and most importantly, care and compassion. I wish to also than the wider community for their patience and understanding as we wor with the Tur s and Caicos Islands overnment to even better accommodate, safely and effectively, the needs of our patients and their families.

Both the Cheshire Hall Medical and the Cockburn Town Medical Centres are structurally engineered to withstand a Category 5 level storm.

SAFE, SMART HOSPITAL

Healthcare stakeholders also participated in a training workshop on March 14-17, 2017 at the DECR conference Room in Providenciales facilitated by PAHO instructors.

More than half of the16,000 hospitals in Latin America and the Caribbean are in areas at high risk for disasters such as hurricanes, earthquakes or flooding. The Safety Index score places a health facility into one of three categories of safety, to help authorities determine which facilities most urgently need interventions: • Category A is for facilities deemed able to protect the life of their occupants and likely to continue functioning in disaster situations. • Category B is assigned to facilities that can resist a disaster but in which equipment and critical services are at risk. • Category C designates a health facility where the lives and safety of occupants are deemed at risk during disasters. According to PAHO’s website, the Hospital Safety Index provides a snapshot of the probability that a hospital or health facility will continue to function in emergency situations, based on structural, nonstructural and functional factors, including the environment and the health services network to which it belongs. By determining a hospital’s Safety Index or score, countries and decision makers will have an overall idea of its ability to respond to major emergencies and disasters. The PAHO team visited the Cheshire Hall Medical Centre to make observations and recommendations where necessary. During a round-table discussion,TCI Hospital was also said to have one of the most detailed Disaster Emergency Response plans representatives had ever seen. The Turks and Caicos Islands Hospital maintains an updated and effective, all hazards, Emergency and Disaster Preparedness and Response Plan to respond to both internal and external emergencies and disaster situations. 7

mployees and patients were elated to meet and greet the countryâ€™s new leader and inister for Health during an official tour of Cheshire Â Hall edical Centre on Providenciales and Coc burn Town edical Centre on rand Tur a few wee s into their first term as overnment of the Tur s and Caicos Islands. 8

TCI PREMIER AND MINISTER OF HEALTH WITH EMPLOYEES

Hon harlene Cartwright Robinson B P (born 1 71) hails from the Island of outh Caicos and though she is a lawyer by profession called in 1 8, she has spent a great deal of her time in service to her Country.

The newly-elected Premier of the Tur s and Caicos Islands, Honourable harlene Cartwright-Robinson and inister of Health, Agriculture and Human ervices, Honourable dwin Astwood conducted their first official tour of TCI hospital visiting Coc burn Town edical Centre in rand Tur and Cheshire Hall edical Centre during the wee of 24th anuary 2017. Hon. Cartwright-Robinson became the first female Premier of the Tur s and Caicos Islands after leading the People’s Democratic ovement to victory in the country’s eneral lections on December 1 th, 201 . Hon. Cartwright-Robinson became the first female Premier of the Tur s and Caicos Islands after leading the People’s Democratic ovement to victory in the country’s eneral lections on December 1 th, 201 .

Commenting on the official visit, Chief xecutive Officer, Daniel Carriere said

TCI Hospital enior anagement Team and staff are extremely grateful to Premier of the Tur s and Caicos Islands, Honourable harlene Cartwright-Robinson and inister of Health, Agriculture and Human ervices, Honourable dwin Astwood for visiting Cheshire Hall edical Centre and Coc burn Town edical Centre in the midst of their busy schedules. Both ministers too the time to interact with our staff members, patients and visitors. Interhealth Canada is loo ing forward to wor ing with the newly-elected government in the spirit of collaboration. Our company will render assistance, wherever possible, to help create solutions and further enhance the health care system in the Tur s and Caicos Islands.

idne stor 10

an ounce of prevention is worth a pound of cure.

turnin the spot i ht on ena ai ure

RE A A MI ISTER OF IMPLEME TATIO TO RS HESHIRE HALL ME I AL E TRE

PROFESSIONAL DE ELOPMENT Dr. Dionne Lightbourne is a highly-experienced health professional and a native of the Turks and Caicos Islands who is training to become a Certified Medical Examiner.

eneral Practitioner, Dr. Dionne Lightbourne is currently participating in an overseas Forensic Medical Examiner’s Course for Rape and Sexual Assault sponsored by Interhealth Canada - TCI Hospital. This one year course is being offered by St Mary’s Sexual Assault & Rape Centre (St Mary’s SARC) in Manchester, United Kingdom. Dr. Lightbourne will travel to the UK four times this year for in-person sessions and SARC visits. Upon completion of the course, the TCI Native will become a certified Forensic Medical Examiner for Rape and Sexual Assault cases.

At least three other clinicians at TCI Hospital have obtained this certification in recent years, however two of these individuals are no longer with the healthcare institution. Doctors assigned to the Emergency Room currently address these sensitive cases, however, TCI Hospital will have a new specially trained doctor to handle these delicate and time consuming examinations.

The mission of the Turks Islands Hospital is to provide the community and its visitors with high quality healthcare. 14

In order to ensure that it delivers on this promise, the office of education invests much time in supporting this mission by ensuring that the clinical and nonclinical human resources of the Hospital are afforded the opportunity to develop and enhance their technical skills and abilities. The Office of Education, which is a division of the Human Resources Department, is mandated with co-ordinating and administering a robust suite of programs which include Soft skills workshops, in service training Continuing Professional Education, Web-casts, Online Learning and Professional Re-Certification.

1 Isabelo, more commonly known as illy ust reached another level in his career. He completed his Masters in Nursing program. Congratulations is extended from the Surgical Services team.

2 enifer completed an introductory course in Infection Prevention in the Ambulatory Surgery Care setting. This introductory course, opens up new knowledge and resources for continuing her education in Infection Prevention. enifer is an Infection Control Link Champion at TCI Hospital.

The Information, Management and Technology Department at TCI Hospital participated in the HIMSS Conference & Exhibition at Orange County Convention Centre in Orlando, Florida on February - , . HIMSS means Healthcare Information and Management Systems Society. IM&T Manager, Ryan Smith and HIS Manager Detorrie Tennant were in attendance. The conference brings together , health IT professionals, clinicians, executives and vendors from around the world. Exceptional education, world-class speakers, cutting-edge health IT products and powerful networking are hallmarks of this industryleading conference. More than education programs feature keynotes, thought leader sessions, roundtable discussions and workshops, plus a full day of preconference symposia. Topics discussed included Clinical and usiness Intelligence, Cybersecurity and Privacy & Security, Innovation Entrepreneurship and enture Investment, Health Information Exchange, Interoperability and Data Access and Health IT Public Policy. Detorrie Tennant said he was most enthused by ...The unrelenting engagement of the Federal government in the development of Information and communications technologies in the Healthcare Sector the innovative products and solutions by wide group of private investors, clinicians, engineers and information specialists experts academics the keen interest and contribution by professional women in the industry.

Shawna, a Lead nurse in the Surgical Suite, attended a Laparoscopic Conference in amaica where she was able to share some techniques and processes used at TCI Hospital, as well as learn about new procedures and equipment.

-R ayatri Reilly - IHC isiting Ophthalmologist Dr. Ram i Hemady - IHC isiting Ophthalmologist Douglas oore IHC Chief of Clinical ervices IHC Chief of edical ervices - Dr. Denise Braithwaite-Tennant IHC urgical Care ervices anager - Pheona Brown.

The riendship urgery Centre in Chevy Chase, aryland has donated a special medical equipment, which will advance the level of Cataract surgical procedures conducted at TCI Hospital. The Advanced Retinal itrectomy achine valued at around 0,000 will expand the ability to provide retinal surgery in the near future. The centre specialises in eye procedures including Cataract urgery and have state-of-the-art equipment. The donation was facilitated by a duo of IHC isiting Ophthalmologists, Ram i Hemady, .D. and ayatri Reilly, .D. who are based in aryland.

Dr. Ram i Hemady and his team have been visiting the Tur s and Caicos Islands for more than 1 years providing tertiary eye-care to patients since the yrtle Rigby Clinic era. His team performs an estimated 1 surgeries per wee and provides Ophthalmology care for more than 40 patients daily during specialist clinics held at TCI Hospital on a quarterly basis. Discussions have been ongoing for several years to acquire the special medical equipment and shortly after the new year the equipment arrived on island for a special hand-over to TCI Hospital held on 1 th an, 16 2017.

atara t urgi a ro ur s a ow b a a .

NEWSLETTER

KNOWLEDGE IS POWER.

Interhealth Canada Corporate invests US$6000 in modern computers for public libraries country-wide.

nterhealth Canada Corporate has delivered on its commitment to invest US$6000 in the education sector with the procurement of eight HP ProDesk 400 G3 Small Form Factor Desktop PC’s for the National Library Service of the Turks and Caicos Islands. The pledge was originally made during TCI Hospital’s anniversary celebration last year. A press conference was held at Cheshire Hall Medical Centre on Thursday, February 9th 2017 to formally handover the much-needed modern computers to the country’s public libraries. The team from Interhealth Canada led by Chief Executive Officer, Daniel Carriere included Chief of Medical Services, Dr. Denise Braithwaite-Tennant and Hospital Information Systems Manager, Detorrie Tennant. Minister for Education, Honorable Josephine Connolly accepted the donation on behalf of the Turks and Caicos Islands Government and praised the company for its consistent investment in community projects. Other corporate companies were encouraged to make similar investments as part of their social responsibility. Head of the National Library Service, Cecil Graham who was accompanied by Library Assistant, Sharene Gibbs said the computers were highly-anticipated as the five branches across the country are in dire need of functional and modern computers. These libraries are located on Providenciales, Grand Turk, South Caicos and two branches can be found in North Caicos. Plans are underway to introduce computer classes for library users on everyday software packages such as Microsoft Office. 17

u it

Everyday we touch lives in the medical setting, but our impact surpasses our four walls.

a th air

o sor

a i

a arita

u it

Everyday we touch lives in the medical setting, but our impact surpasses our four walls.

utis

a i

WENDY HAYWARD

"EVERY TIME A SONG IS PLAYED, WENDY’S LOVE FOR MUSIC WILL BE REMEMBERED BY OUR TEAM.” 20

WENDY LOST HER BATTLE WITH CANCER IN .

MUSIC IS POWERFUL.

GIVING BACK.

oad to ia ond

ANTIMICROBIAL RESISTANCE

CLINICAL RISK MANAGEMENT

Lorenzo Seymour PROMOTED TO HUMAN RESOURCES MANAGER I wish to express my heartfelt than s and appreciation to the anagement and staff at InterHealth Canada TCI td for the awarding opportunity of being promoted to Human Resources anager. The word award was deliberately used as it is an honour to serve in such a capacity. I have wor ed with the company for over two years and have been with employees during the smiles and tears. I will continue to do my utmost best to ensure that the company continues to move forward with improvements to the services that we currently provide, while also loo ing to find new ways to recognise, motivate, educate and develop our human resources. As there is no I in team, please note that the Human Resources and ducation team is committed to refocusing our view of customer service to a more customer care approach. I understand this will not be easy, however this can be accomplished with the assistance of employees. The Human Resources ducation Department exists to serve employees and we loo forward to forging an even stronger relationship.

Seymour brandishing his thankful thursday note reflecting what he is grateful for.

oren o eymour

World Kidney Day at CTMC After visiting two schools in recent years, the Dialysis Team at Coc burn Town edical Centre made a presentation to Ona linton Primacy chool on Renal ailure, which was greatly received. 25

An information boot was set-up in the hospital foyer with information material. taff members from acilities anagement and Dental Clinic were given a special educational session on prevention of Renal ailure.

SAFETYFIRST

SAFETY TIPS FOR LONE WORKERS ON THE JOB Know Your Risks Employees also have a duty of care to look after their own health and safety. Employees should review all the risks identified in their areas and work within the established guidelines. Line managers should be notified if there is a possible risk that could put employees in harm’s way. For TCI Hospital staff members, these risks may be reported via an internal system called Pavisse. Employees are trained on how to respond to emergencies and have clear action plans. Should a medical condition arise that could put an employee at risk working alone, line managers should be notified immediately.

Dealing with the Public Healthcare professionals are subjected to unpredictable situations. Employees should always be attentive and aware of their surroundings. Always note where a security officer is located. Read the verbal and non verbal signals being shown by a patient. Ensure there is clear access to an exit door. All sharps should be stowed away in a locked cabinet, i.e. scissors and scalpels. Panic buttons are easily accessible and should be tested regularly to ensure they are functional.

Alert Security Once security is notified, the frequency of patrols can be increased to look after the safety of a lone employee.

SAFETY FIRST T E

R ER

Welcome to the second edition of Safety First’ created by the Health & Safety Committee at TCI Hospital. Each edition seeks to provide useful tips and information to help improve safety in the workplace. This article focuses on lone working and outlines six ways for employees to keep safe. Who is considered a lone worker Lone workers are people who work by themselves without close or direct supervision. One example may be a person working alone in a small workshop. Persons working alone outside of the normal working hours may also fall into this category. These individuals may be healthcare workers, security personnel, housekeepers, porters or even engineers. Employers have a duty to assess the risks associated with lone workers and ensure steps are taken to avoid or prevent risks where necessary. We hope you found this information useful. Together, we can build a safer working environment.

Your Limitations

CCTV in the employees specific work area will also be closely monitored. If an employee should leave for any reason, the security department should be advised of the length of time.

It is important to know your physical limitations. Do not perform tasks such as heavy lifting or moving mechanical devices alone. Employees should ask for assistance. Injuries may occur and it may be a considerable length of time before someone is aware of the injury.

Build Contact Lists As employees begin their shift, landlines should be checked to ensure they are working. The security department should be on speed dial and contact numbers for persons working within the same hospital should also be saved.

Giving Back.

NEWS

lo erm was used to demonstrate how germs can quickly spread from one person to another during a special hand hygiene workshop held in mid anuary. There were a total of participants across the two hospital sites. The liquid product contains proven safe ingredients formulated to be the same si e as bacteria, basically microns in si e. To demonstrate proper hand washing, employees were instructed to rub lo erm lotion on their hands. This simulates the spread of thousands of tiny plastic fluorescent germs on their hands. Then, each employee was asked to wash their hands as they normally would. Finally, a fluorescent ultraviolet flashlight was used to spot the remaining germs . Under the lamp, the plastic germs glow brightly so that they may be easily seen by the employee.

Members of the Facilities Management team at Cockburn Town Medical Centre have successfully completed training in Cardiopulmonary Resuscitation also known as CPR instructed by Nurse Michael Williams. The group consisted of FM Management, Heads of Department from Administration, Security, Engineering and Soft Services.

The training will allow persons to take immediate action in the event of a cardiac arrest in non-clinical areas and in the community until a medical team arrives. It is an essential life-saving skill. Members of the team were thrilled to participate in the training, and have encouraged their FM colleagues to participate in the next session scheduled for April . 29

oth clinical and non-clinical staff were found to be following the proper technique for hand washing, which is particularly important for healthcare workers to prevent the spread of health care related infections or bacteria.

SUPER UG RES STED ANT OT CS

E W

M T C C I

B N S M C

R I

C N

C C

AB A

S I

I L C R

C MM R R

I T

N B T

T T

I R

I CRE 30

T K

S T

THE DANGERS O

NCURA T

E N ECT ONS T

C C C

S T I

C CRE C C

ST CRE

A T CRE T C

CRE

CRE I

B S

CRE

t's start r sh E Refresh features a wide variety of international and Caribbean inspired dishes. Refresh is known for its shake and baked chicken, vegetable spring rolls, blackened Mahi Mahi with tropical fruit salsa. Our homemade baked cheese-Cake is the envy of the island. Refresh is open for breakfast, lunch and light meals throughout the day with a wide variety to tantalise all taste buds.

Refresh restaurant is open daily and offers an extensive range of snacks, beverages and hot food services to visitors and members of the local community. The menu selection covers traditional local fare, Caribbean, and international cuisine at highly competitive prices. e additionally have extensive Hospitality Services, able to cater and accommodate for internal and overnment meetings and conferences within the facilities.

The Catering Department works to deliver nutritious balanced and appetising quality food to our patients and external customers. 32

OCT 2016

JUN 2017

NEWSLETTER INTERHEALTH CANADA TCI

THE

INTER-VIEW

PARTNERSHIPS FOR COMMUNITY SERVICE Welcome to the June 2017 edition of TCI Hospital Newsletter, which features stories from across the healthcare organization. A new edition is published at the end of every quarter.

Our Mission To provide the community and its visitors with high quality healthcare.

Our Vision To improve the nation’s health through the development of a sustainable and accessible healthcare system.

“To know even one life has breathed easier because you have lived. This is to have succeeded.” - Ralph Waldo Emerson

Our Values We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

CLEAN HANDS PROJECT

LITERACY BEGINS AT BIRTH LAUNCHED

Health care professionals visit public schools to promote hand hygiene and donate essentials.

Mothers receive a board book and literacy tips for babies to encourage early learning intervention.

PAHO BREASTFEEDING COUNSELOR TRAINING An in-depth breast feeding trainer workshop brings TCI closer to a pursuit of 'Baby-Friendly' certification.

FALL PREVENTION PROGRAM REVISED

MANAGERS PATIENT SAFETY CHALLENGE

New measures to reduce the incidence and severity of patient falls.

Managers compete for the title of Patient Safety Champions in a game-based initiative.

COMMUNITY CONNECTED

Good will is given and received. Read a collation of community initiatives involving TCI Hospital.

DIONNE WARNER'S CANCER STORY

BUILDING TCI'S PERINATAL DATA HISTORY

Dionne is an eight-time cancer survivor who inspired TCI residents during a recent Cancer Walk on Providenciales.

Obstetric Providers in TCI are trained on Maternal Surveillance to build clinical history of Women and Neonatal Health.

FREQUENTLY ASKED QUESTIONS

PROFILES: FACILITIES MANAGEMENT

Answers to common questions asked by patients to enhance patient education.

Meet employees from the Support Services arm of TCI Hospital in our feature section.

It is often said that change is the only constant in life. This is certainly true as our quarterly newsletter has undergone a number of changes in design, layout, writing style and target audience since being relaunched in July 2016. In the past, The Interview was an employee newsletter filled with engaging, fun and social content solely for internal distribution. Today, we’ve broadened our communication objectives to also provide our patients and the community at large with a high quality publication, which is available in digital and print form. Nikira John is an enthusiastic Communications Professional

As the sole Editor and Publication Designer, our fourth

and Multimedia Specialist with

edition is filled with interesting news collated over the past

vast knowledge and experience.

three months and covers a wide variety of departments and

She is a well-known face in the

subjects. We have fused these articles with the inclusion of

local community having

human interest profiles to showcase our employees from

practiced as a Journalist and

both clinical and non-clinical departments. It is important to

Television News Presenter for

reinforce the complexity of hospital operations and the

the past eight years, prior to

hidden professions, which contribute to the patient

joining Interhealth Canada (TCI)

experience, although indirectly in some cases.

Ltd in July 2016 as Manager of Public Relations and Marketing.

The Hospital has been bustling with activity from April 1st,

She holds a first class honours

2017- June 30th, 2017 as you will shortly discover. These

degree in Media, Communication

activities included press conferences, community

and Journalism from the

engagements, a record number of school visits, facility

University of Buckingham in the

tours, speaker opportunities for health promotion and

UK and is a Certified Medical

perhaps the most significant, continuous initiative of them

Tourism Professional.

all is re-accreditation preparations. Our goal is to retain

E: njohn@interhealthcanada.tc

are captured in the succeeding 40-pages, which are brimmed

‘Diamond’ Accreditation status. All of these items and more with visuals, magazine-style design concepts, and lots of colour, which reflects the vibrance of the organisation. Due to the time-sensitivity of some stories and our energised Public Relations and Marketing Department, some of these stories may have already been covered in the mainstream media or conservatively shared on our @TCIHospital Facebook page. Whether you are an employee of Interhealth Canada’s Global Network of healthcare institutions, our beloved patient or an omnivorous reader from the Turks and Caicos Islands or abroad, we hope you find our newsletter informative as we mirror the latest news from behind our four walls. Remember to follow us on social media via the aforementioned Facebook account and subscribe to our newsletter.

NEWS

TCI HOSPITAL LAUNCHES THE 'CLEAN HANDS PROJECT'

Phase One Hailed A Success

STRENGTHENING CUSTOMER SERVICE Customer service excellence has always been and will always be one of the critical competitive advantages for any business.

Being on par in terms of price and quality only gets you into the game. Service wins the game.Â

EFFORTS TO TAKE CUSTOMER SERVICE TO NEW HEIGHTS.

SAINT LUCIA MINISTER TOURS TCI HOSPITAL

AERIEL VIEW OF OWEN KING EU HOSPITAL

FIRST HAND LOOK AT TCI HEALTHCARE FACILITY MANAGED BY INTERHEAL TH CANAD A. Public Private Partnerships for the provision of healthcare services is a model being explored by other countries due to funding limitations currently experienced by Government’s across the Caribbean. Honourable Guy Joseph, Minister for Economic Development, Housing, Urban Renewal, Transport and Civil Aviation accepted an invitation on May 24th, 2017 to tour Cheshire Hall Medical Centre to learn more about TCI’s Healthcare Framework.

PRI VATISATION OF SOME SERVICES AT OWEN KING EU HOSPITAL The Government of Saint Lucia, acting through the Ministry of Health and Wellness, is preparing for the opening of the Owen King European Union Hospital and

recently invited expressions of interest for the provision of services. The Government has given consideration to partnering with private sector service providers through the outsourcing of some of the services required at the EU Hospital and associated medical facilities. The objective of this approach is to ensure that the required services are delivered to the health care system with maximum efficiency and at affordable cost.

FLAGSHIP E U INFRASTRUCTURE PROJE CT The Owen King European Union Hospital is an ultra modern treatment and care facility funded by the European Union to the tune of EC $167 million dollars. This new hospital represents the largest infrastructural project ever executed by the EU in the Eastern Caribbean.

SAINT LUCIA RESIDENTS EAGERLY AWAIT THE OFFICIAL OPENING OF THE NEW HOSPITAL. 8

Macho Macho Men.

MEN'S HEALTH MONTH

If you take better care of your car or favorite gadget than your body, remember you only have one. June is observed as Men's Health Month and male doctors at TCI Hospital were busy with several speaker opportunities to provide education on the importance of knowing your health status and how you can reduce your risk of common conditions facing men.

TCI Hospital has partnered with veteran local yoga instructor, David Bowen, to deliver an online video series of basic and advanced techniques to promote healthy lifestyles and overall wellness. Watch our Yoga Zone technique of the month on Facebook @TCI Hospital.

L-R: Doctor Henry Blythe supported a Men's Health Conference on Friday, June 16th in Providenciales, while Doctor Ravindra Gajendragadkar engaged the men of Grand Turk in a similar conference on Thursday, June 15th organised by TCI Ministry of Health. Doctor Devon Grant participated in a Men's Health Fair at Beaches Resort on Tuesday, June 20th to offer advice and answers to any questions employees may have about gender-specific health ailments.

Yoga has been around for more than 5,000 years. The exercise program does more than burn calories and tone muscles. It's a total mind-body workout that combines strengthening and stretching poses with deep breathing and meditation or relaxation. There are more than 100 different forms of yoga. Some are fast-paced and intense. Others are gentle and relaxing. Betters your bone health. Increases your blood flow. Prevents cartilage and joint breakdown. Builds muscle strength. Improves your flexibility. Regulates your adrenal glands. Relaxes your system. Releases tension in your limbs. RESOURCES: WEBMD; YOGAJOURNAL

LITERACY BEGINS AT BIRTH LAUNCHED

BY AGE 3, ROUGHLY 85% OF THE BRAINâ€™S CORE STRUCTURE IS FORMED.

SCIENTIFIC TRUTHS

BABIES LEARN THE PATTERNS AND INTONATION OF LANGUAGE. 11

POWER OF LANGUAGE

CEO HOSTS TOWN HALL MEETING WITH STAFF Employees at Cheshire Hall Medical Centre Town Hall meeting.

CI Hospital, Chief Executive Officer, Daniel Carriere held a town hall meeting on May 31st and June 1st, 2017 at both hospital sites to directly engage employees on a range of organisational matters. The special forum was well-attended by employees who comfortably engaged in dialogue with the company’s leadership team. Staff members were updated on the latest trends in patient volumes, outstanding and upcoming change enquires to address staff complements, an ongoing financial reconciliation exercise, the future introduction of medical tourism and operationalisation of the expansion space inside the hospital, upcoming

changes to the organisation's strategic plan, re-accreditation and challenges in healthcare. Internal Communication Building The Town Hall format is en effective method of strengthening internal communication and employee moral, and is used to both to educate staff on prominent matters and canvass views and concerns.

PAHO/WHO BREAST FEEDING TRAININGÂ OF TRAINERS SESSION

BREAST IS BEST.

PHYSICIAN CORNER: GLUTEAL FAT GRAFTING

FALL PREVENTION

'FALL FRIDAY'

physicians and nonclinical staff have also been sensitised. A total of 75 clinical and 38 Facilities Management staff have received training. Mechanisms have been developed for departments to identify and communicate if a patient is at high risk for falls. Every Friday will be observed as “Fall Prevention Friday” at TCI Hospital to ensure every in-patient receives a fall risk assessment. This initiative will be enforced in addition to the completion of fall risk assessments upon admission, upon unit transfer if there is a significant change in the patients status and post fall.

TCI HOSPITAL IMPLEMENTS NEW INITIATIVE TO PREVENT FALLS Turks and Caicos Islands Hospital has implemented a revised program of best practices in fall prevention to help minimise the incidence and severity of falls. While not every patient fall is preventable, the health care facility has utilised a combination of steps, care processes and precision to prevent falls. Fall Prevention Expert based in Canada, Elaine Fockler RN, has updated and customised the internal program and conducted various training sessions. The sessions included education on the tools and interventions used to assess and reduce the risk of falls and injury from falls in adults and children. Professional disciplines beyond nursing staff including rehabilitation services, pharmacy,

Green armbands will be applied to all patients who are identified to be at risk of a fall. In-patients found to be at risk will receive a green triangle placed on the door of their assigned room and above their bed. Patients in the Operating Room will have green socks applied. These green identifiers will alert hospital staff members that the patient is at risk of falling and requires special assistance.

PATIENT SAFETY CHALLENGE

UNITED FOR PATIENT SAFETY

In observance of Patient Safety

Multiple employees across each

Month celebrated at TCI Hospital

department were given token

during the month of April,

tickets in random amounts.

Managers and Supervisors were

Separated into teams of four,

pitted against each other in a

participants were required to

Patient Safety Challenge dubbed

engage employees within a 20-

"Leaders Lightening Rounds” held

minute time frame and obtain as

on April 10th, 2017 at Cheshire

many token tickets as possible.

Hall Medical Centre and April 26th, 2017 at Cockburn Town Medical Centre. 18

PATIENT SAFETY

STIFF COMPETITION AMONG MANAGERS FOR THE TITLE Once a ticket holder was engaged in a warm patient safety brief discussion, the Manager/Supervisor was rewarded with a token ticket. The primary objective of the activity was to strengthen communication and face-to-face engagement between management and staff and encourage a culture of patient safety. The ways or types of cooking also depend on the skill and type of training an individual cook has. Cooking is done both by people in their own dwellings and by professional cooks and chefs in restaurants and other food establishments. The activity was raved by participants as an effective initiative for large organisations such as TCI Hospital, which can be implemented on a quarterly basis. Some participants were able to engage as many as 30 employees within such a short timeframe, particularly employees who are not apart of their immediate departments. Team Root Cause, which consisted of Juneth Reynolds, Carol Reid and Dr. Csaba Nagy who collectively amassed 167 token tickets were declared the 2017 Patient Safety

The 2017 Patient Safety Champions at Cheshire Hall Medical

Champions for Cockburn Town Medical

Centre was Team Communication, which consisted of Martin

Centre. Tamara Johnson of Facilities

Dawtry, Lorenzo Seymour, Mikette Been and David Mechan,

Management was also praised for single-

who collectively amassed a whopping 72 token tickets.

handedly collecting 73 tickets, which was

Nurses Manager, Mikette Been also single-handedly

the highest of all participants. Johnson

collected 26 tickets, which was the highest of all participants.

surpassed her nearest competitor, Carol

United for Patient Safety badges were also donned by all

Reid by a single ticket in a razor-thin victory.

staff across both sites to show commitment to patient safety. 19

community connected Everyday we touch lives in the medical setting, but our impact surpasses our four walls.

MRI Sound System Installed

01 Clinic Exploration 2017

02 Church deliver staff lunches

03 TCIPS Career Day

04 Trophy's for Science Stars

05 20

community connected Everyday we touch lives in the medical setting, but our impact surpasses our four walls.

Leading by example

06 Teeing for a cure

07 Child Abuse Prevention

08 Help for fire ravaged Library

09 Mentorship Support

10 21

THE DIONNE WARNER STORY

QUIRKY COSTUMES

Over the years, Dionne Warner and her husband have worn more than 130 costumes and t-shirt themes to her chemotherapy treatments.

CONTINUES...

NEWS

Obstetrics Service Providers in the Turks and Caicos Islands received training on June 1st-2nd 2017, to upgrade the current Perinatal Information System (SIP) in the Turks and Caicos, which collects data on pregnant women and their children from the first prenatal visit until after delivery. The last SIP training conducted in the TCI was in 2006. The training held at Cheshire Hall Medical Centre, was facilitated by the Latin American Centre for Perinatology, Women and Reproductive Health (CLAP/WRH), which is a center and technical unit of PAHO/WHO that provides technical assistance to countries in Latin America and the Caribbean on sexual and reproductive health. Since its creation in 1970, it was worked to improve perinatal health in the region. According to the PAHO/WHO, an average of approximately 16 women die every day in Latin America and the Caribbean from complications of pregnancy or childbirth, while 250 babies die each day before having reached 28 days of age.

To gather information on the causes of these deaths and contribute to policies for their prevention, the Pan American Health Organization/World Health Organization (PAHO/WHO) launched the CLAP Network of Latin American and Caribbean Centers for Maternal Surveillance and Research on Women and Neonatal Health. The CLAP Network plays an important role in helping to further reduce maternal and neonatal mortality in the region by collecting data on the causes of maternal and neonatal death as well as on the causes of complications that leave women seriously affected following childbirth. Maternal and newborn health are closely intertwined. Approximately two out of three neonatal deaths occur during the first week of life, and the main causes include prematurity, congenital anomalies, asphyxia, sepsis and other infections, states PAHO/WHO. The full application of this system also allows its users to conduct periodic, targeted, large-scale studies on specific topics recognized as priorities in the area of maternal and perinatal health. With system upgrades over time in the TCI, perinatal information25will be accessible via the web for the end users of the system.

As a teenager, life is never easy after losing both parents. Having recognised this, the Dialysis Unit at TCI Hospital tried to ease some of the burden for the twin children of their late colleague, Nurse Renay Robinson through a financial donation to help purchase necessities for back-to-school during the summer. On Monday June 19th, 2017, members of the Unit headed by Chief of Allied Services, Eleanor Hall, presented a personal donation to a representative of Renay's family along with a plaque of appreciation, which Renay never got the opportunity to collect. Renay passed away on the afternoon of Sept 14th 2016 with a rare and aggressive form of cancer. Her twins, Renarge and Nia Missick were her treasured blessings. She was the Supervisor of the Dialysis Unit at Cheshire Hall Medical Centre at the time of her passing.

DR. KENNETH CONNELL OF 'UWI' VISITS TCI HOSPITAL CHMC

INPATIENT SERVICES MENTORSHIP

CTMC

Hoop-Dee-Doo!

"We can't thank the staff at Cockburn Town Medical Centre enough for the care and attention they gave JhaunaLee while in their care for five days. This was a very difficult time for our family, but it could have been much worse without the dedication and expertise of the staff. The Reynolds family is truly grateful for the level of care that the staff was able to administer to our daughter. We are also grateful for the time the staff took to talk with us to help us to better understand her illness. It was a great comfort.    T he competency of the team was awe inspiring, and we couldn't have been more blessed with such a great team. A big thank you to the Clinical and FM team, we could not have made it without you."

the Interview

IN THE NAME OF NURSING

TCI HOSPITAL CELEBRATES Medical Laboratory Professionals - get results

special ceremony

schools visit tci hospitalÂ laboratory

THE INTERVIEW

FREQUENTLY ASKED QUESTIONS Here are some answers to questions frequently asked by patients to enhance their understanding of services offered by TCI Hospital and the country's healthcare system.

DIFFERENCES: NHIB & TCI HOSPITAL The National Health Insurance Board (NHIB) is the entity responsible for the management of all activities involving the TCI’s National Health Insurance Plan ( NHIP). TCI Hospital, managed by Interhealth Canada, is an entirely independent organization. It provides patient care to NHIP beneficiaries as the National Insurance Board’s preferred provider. TCI Hospital is not responsible for determining copay fees. These fees are dictated solely by the National Health Insurance Board. The Hospital collects co-pay fees on behalf of NHIB.

GOVERNANCE STRUCTURE TCI Hospital has two main governance structures: The Service Review Board is responsible for reviewing complaints, potential or existing litigations and key performance indicators with a clinical view. The board meets quarterly and consists of eight senior healthcare representatives from Turks and Caicos Government, Interhealth Canada TCI Ltd and an independent clinical chairperson.

CO-PAY FEES Co-pay is a common feature of many healthcare insurance plans, where the insured pays a set out-of-pocket amount for health care services. If you are NHIPeligible, the co-pay fee is $10. Between the hours of 11 pm and 7 am, the co-pay fee is $50 for non-emergency care. Additional diagnostic tests will incur an additional $10 co-pay fee. If you do not have NHIP, you will be billed at established rates. All NHIP co-pay fees are paid over to NHIP and are not retained by the Hospital. Co-pay fees are non-refundable.

The Contract Management Committee works collaboratively with Interhealth Canada to review performance and discuss strategic initiatives related to any changes in good clinical practice or good industry practice. The committee also reviews trends, new technology and relevant innovations in the health care Industry along with key performance indicators.

SERVICE EXPANSION

OVERSEAS TREATMENT

Since opening in 2010, additional services have been introduced and the Hospital remains eager to bring more services onisland to lower the cost of sending patients overseas for treatment.

Turks and Caicos Islands Hospital is an acute-secondary health care facility, and therefore complex tertiary level care is provided overseas through the National Health Insurance Board’s Treatment Abroad Program. If the Hospital clinical staff finds that a patient’s medical care needs cannot be provided at our facility, the NHIB is advised and takes over the management of the overseas transfer process. The NHIB is solely responsible for deciding the country and healthcare facility where the patient will be transferred. TCI Hospital is not involved in the decisionmaking process.

Under the Project Agreement, changes made to existing clinical services must undergo a Change Request Procedure seeking pre-approval from government. Change enquiries are submitted to TCI government once patient volumes and patient demands reach the necessary levels to create a sustainable service model.

Diamond

Senior employees are held accountable for the processes used in the healthcare system to ensure quality and patient safety, hence, their support and commitment is essential to the organisation’s overall success. During the second quarter of 2017, managers participated in Patient Safety Leaders Lightening Rounds.

Topics covered under the patient safety umbrella included safety checklists, safe surgical practices, infection prevention control measures, safety hazard signage, mental assessment, patient education, slip and fall safety and personal protective equipment. The next stop on the organisation's journey was a preassessment visit, which highlighted the progress in each department’s adherence to a list of Required Organisational Practices (ROPs). It was keenly noted that teams are working in harmony to achieve Diamond status once again. The ROPs reviewed were Suicide Prevention, Antimicrobial Stewardship, Infusion Pump

Training, Antibiotic Prophylaxis during surgery, Venous Thromboembolism (VTE) Prophylaxis and Falls Prevention Strategy. Standard team meetings will continue throughout the next quarter of the year and team members are working through their respective standard requirements to ensure the organisation remains on par with international best practices. The Senior Management Team would like to thank hospital staff for their involvement in accreditation initiatives. There is no limit to excellence and the organisation is looking forward to a display of continuous passion towards quality and service improvement.

IHC TCI Hospital and the MOHAHS continues to strengthen their collaboration and shared services in learning and development to maximise health care, system efficiency and reduce redundancy. Turks and Caicos Islands Hospital and the MOHAHS conducted separate Mandatory Training for its staff since inception. However, after discussions with MOHAHS representatives it became clear there were opportunities to collaborate and maximise training efficiency. The Mandatory training schedule was reviewed and a number of courses were deemed applicable to the MOHAHS. These courses included Customer service in health care, Equality and Diversity, Health & Safety and Fire Safety (Primary Health Care Staff operating at CTMC and CHMC only), Medication Management and Drug Calculation, Manual Handling, Heart Saver CPR, BLS and ACLS.

The first complement of MOHAHS Nurses were enrolled during the Month of May 2017. TCI Hospital looks forward to continuing these collaborations with the MOHAHS, which provide opportunities for knowledge sharing and promotion of best practices within the TCI Health Care system.

SECOND QUARTER REVIEW

Congratulations to TCI Hospital teams for completing another phase of the re-accreditation journey. The key to another successful international assessment is the continued support and commitment from Senior Management, Staff and Patients.

PROFILES: FACILITIES MANAGEMENT

We are the Patient Experience

Longest Serving Housekeeper

PAHO TOURSÂ CHESHIRE HALL MEDICAL CENTRE

Turks & Caicos Islands Accident and Emergency Surgical Services Â High Dependency Unit Obstetrics and Gynaecology Orthopaedics Family Practice Medical Oncology Physiotherapy Internal Medicine Secondary Dentistry Outpatient Haemodialysis Diagnostic Imaging Ophthalmology Pharmacy Nephrology Urology Neurology ENT

CALL US TODAY! +1 649-941-2900 +1 649-941-2800

Putting the heart into healthÂ care. 40

OCT 2016

J U LY- S E P T 2017

NEWSLETTER INTERHEALTH CANADA TCI

THE

INTER-VIEW

RESTORING HEALTH CARE AFTER THE STORM Welcome to the September 2017 edition of TCI Hospital Newsletter, which features stories from across the healthcare organization. A new edition is published at the end of every quarter.

Our Mission To provide the community and its visitors with high quality healthcare.

Our Vision To improve the nation’s health through the development of a sustainable and accessible healthcare system.

“In an emergency, what treatment is given by ear? Words of Comfort.” - Abraham Verghese, MD

Our Values We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

FOOD FOR THOUGHT

THANK YOU MESSAGE FROM TCI HOSPITAL CEO

SURVIVING HURRICANE IRMA AND MARIA

TEACHERS LEARN A LIFE SAVING SKILL

17 2

InterHealth Canada - Turks and Caicos Islands Hospital sponsored 10 children in a charity breakfast program.

Mr. Daniel Carriere sends a thank you message to clinical and facilities staff for their hardwork during recent storms.

A general editorial acknowledging the challenges faced by healthcare institutions located in zones of natural disasters.

Over a dozen educators are certified in bystander CPR in recognition of CPR Month.

FOOD BANK RESTORATION PROJECT InterHealth Canada restocks a critical food bank in the sister island during the peak of the Hurricane Season.

ROAD TO DIAMOND

A closer look at the standards and organisational practices required for Diamond Accreditation.

THROMBOSIS AWARENESS

DIPLOMATIC TOUR POST HURRICANE IRMA

TCI Hospital devise plans to raise awareness of Venous Thromboembolism in the local community.

High ranking diplomats with ties to the Foreign and Commonwealth Office tours TCI Hospital post-Hurricane Irma.

THE PLANK - EXERCISE OF THE QUARTER

BREASTFEEDING ROOM UNVEILED AT CHMC

The Physiotherapy Department educates readers on The Plank in our featured exercise.

TCI Hospital opens a special room for mum's in observance of World Breast Feeding Week.

daily dose FOOD FOR THOUGHT BREAKFAST PROGRAM InterHealth Canada - Turks and Caicos Islands Hospital sponsored 10 children in a charity breakfast program operated by Food-For-Thought for the second consecutive year. The sponsorship will cover the cost of breakfast for a great portion of the school year. According to Food For Thought, more than 2,000 children currently attend public primary schools in the Turks & Caicos Islands, however, as many as 20% of school age children in the country do not have breakfast before school. The absence of this important meal can affect the physical and mental development, concentration and ultimately the overall academic performance and future earning potential of these children. The non-profit-organisation provides free breakfast to approximately 300 children in North Caicos, Middle Caicos, South Caicos and Salt Cay every school day.

Caption (L-R): Karen Savory - Founder of Food for Thought & Nikira John - IHC PR and Marketing Manager

The menu is designed to provide a nutritious and balanced breakfast. After the Breakfast Program commenced in September 2016, school teachers reported an improvement in the students’ attention, focus and attendance. The charity's website states: “the latest Turks & Caicos Islands Poverty Assessment Survey in 2012 showed that 16% of households live in poverty. Households with children accounted for over half of those poor households. It also showed that 60% of households have problems paying for at least one essential household expense, including food. Many families simply cannot afford to provide proper nourishment for their children. Not only is the earning potential of children likely to be hindered due to the difficulty to learn if not properly nourished, but the cost of lost productivity to the economy is substantial.” To learn more about the program and donate, visit www.foodforthoughttci.com.

[04]

TURKS & CAICOS ISLANDS HOSPITAL Turks and Caicos Islands Hospital opened on 10th April 2010 and consist of Cheshire Hall Medical Centre and Cockburn Town Medical Centre. The health care provider offer a number of specialized services for NHIP members and

TCI Hospital has been Diamond Accredited by Accreditation Canada International since 2012.

self-paying patients throughout the Turks and Caicos Islands. The Cockburn Town Medical Centre is located on the island of Grand Turk and Cheshire Hall Medical Centre is located on the island of Providenciales. Both sites serve the local population and visitors across the Turks and Caicos Islands chain and have built-in capacity to double in size. The facility is a public hospital managed by InterHealth Canada TCI Ltd on behalf of the Turks and Caicos Islands Government through a Public-Private Partnership agreement. Services provided at both locations include Accident and Emergency care, General Surgery, Obstetrics and Gynecology, Orthopedics, Family Practice, Medical Oncology, Internal Medicine, Secondary Dentistry, Acupuncture, and Outpatient Hemodialysis.

Visiting consultants from North America and the Caribbean region also provide periodic care in the specialties of Nephrology,

Urology,

Oncology,

Neurology,

ENT,

High

Ophthalmology and Plastic Surgery. Cheshire

Hall

Medical

Centre

has

two-bed

Dependency Unit for patients requiring more intensive monitoring, and a Special Care Baby Unit or neonatal intensive care unit for infants in need of specialized care. Our diverse and experienced team of doctors, nurses and physicians are always committed to providing compassionate care to patients, and delivering service with a smile.

ABOUT US

INTERHEALTH CANADA

Established by an initiative from two Provincial Canadian Governments, InterHealth Canada was created to export Canada’s intellectual expertise in healthcare to an expanding international market. With the mandate to deliver the greatest benefit to communities, InterHealth Canada brings to its clients the internationally recognized quality and efficiency of the Canadian healthcare system, while maintaining cultural sensitivity and tailoring its solutions to the local need. InterHealth Canada is a world leader in healthcare operations and management with diverse activities in planning, management and consulting. We deliver cost-effective, culturally sensitive solutions that meet international quality standards in both the public and private sectors. As recognized pioneers in healthcare Public Private Partnerships (PPPs), we are

Our vision: “Strength is our people and sustainability is our focus.” THE MANAGEMENT COMPANY InterHealth Canada’s aim is to be the first choice partner for the operation and management of healthcare projects and facilities worldwide, providing superior clinical outcomes for patients, and commercial success for our clients. We ensure that every one of our projects are underpinned by these values, and leverage the best of our core strengths. The InterHealth Canada team is prepared and engaged to discover

new

opportunities

delivering healthcare demonstrating

our

services, and looks forward strengths

in to

and values to all

clients we partner with.

able to deliver innovative financial solutions to enable access to effective

OUR MISSION

healthcare.

Enabling evidence-based solutions across the globe applying cultural sensitivity and corporate sensibility by fostering the collaboration of talented minds to deliver results that bring positive change to communities

CORE VALUES Since our values constitute the very make-up of our mission, we are committed to stand by the four core pillars of our values: Skill, Motivation, People, and Practice.

HELLO Dear Valued Staff in Clinical and FM services, Thank you for your continued support. You are all outstanding professionals.

Daniel Carriere Ch i ef Exec u t i ve O ffi cer

THE MESSAGE Our deepest appreciation to all the teams who worked around the clock to ensure a seamless secondary care emergency response during the passing of hurricane Irma. I wish to express gratitude to all staff who were on standby, ready to respond, if needed. Your dedication is so “AWESOME”. You will set the standard with this type of focus and determination for the entire organisation in the years to come. I’ve frequently conducted rounds throughout CHMC and hope to do more in Grand Turk. I know that behind your brave smiles, you are worrisome of the impact of Irma and what the future may bring for your family and friends. But remember, you are not alone! I have no guarantees for the future. I will continue, everyday, to focus my attention and that of our Senior Team, on helping our people in every way we can. At times, that help may seem painfully slow in arriving for some, and others might think that the help is just not enough, but my commitment to you is that we will not stop trying, readjusting and stretching our minds and resources to determine ways in which we can offer you support and relief in these trying times.

Above all, stay strong and positive and enlist the help of the BIG GUY above who has been watching over us since the storm struck. Thank you for your tremendous efforts for our patients and for making a measurable difference.

MEET

OUR SENIOR MANAGEMENT TEAM The Senior Management Team is the top leaders of various departments, clinical and non-clinical, across Turks and Caicos Islands Hospital.

Dr. Denise Braithwaite- Tennant Chief of M e d i c a l S e r v i ce s

Martin Dawtry

Facilities General Manager

Douglas Moore C h i e f o f C l i n i c a l S e r v i ce s

Terrell Kuula Fi n a n ce M a n a g e r

Eleanor Hall

Ryan Smith

Lorenzo Seymour

Chie f o f Allied S er vices

IM&T Manager

H u ma n R e s o u rce s M a n a g e r

Celebrating Our Doctors Our patients are treated with expertise, precision and tender care by experienced and highly-trained board certified doctors from across the globe that specialize in a wide range of healthcare disciplines.

Specialists in the area of Plastic Surgery, Urology, Neurology Ophthalmology, Oncology and ENT offer specialty clinics and conduct surgical procedures at TCI Hospital. These specialty consultants visit the island on a quarterly basis; however the frequency of some specialist visits is dependent upon demand and availability of the specialist.

Natural disasters pose a whirlpool of challenges to even the most world-renowned, robustly engineered health care infrastructures while wreaking havoc over entire cities. In some cases, even the best disaster preparedness plans have been foiled. The impact of Hurricane Harvey on medical centres in Houston Texas, United States is only one example.

SURVIVING

IRMA & MARIA

The health infrastructure in Puerto Rico was already in crisis before Hurricane Maria – now a majority of the island’s 69 hospitals are without electricity or fuel for generators, according to the US Department of Defense. The island’s few functioning hospitals are at capacity and face frequent power outages. Despite a ripple effect of other challenges alongside roof damages sustained at both Cockburn Town Medical Centre on Grand Turk and Cheshire Hall Medical Centre on Providenciales, the Turks and Caicos Islands Hospital successfully protected its occupants during Hurricane Irma, one of the most powerful Hurricanes ever recorded, which battered the country on September 7th - 8th, 2017. The Hospital Emergency and Disaster Preparedness Response Plan was activated within 48 hours of Irma's impact, and non-emergency services and clinics were immediately cancelled until further notice. The hospital provided refuge for over 30 antenatal patients, geriatric and elderly patients from the Grand Turk Wellness Centre and other high-risk groups. Essential staff members including Emergency Room physicians, nurses and Operating Room teams remained on site to ensure the continuity of patient-care and manage any incoming emergent cases. Fortunately, there were no fatalities recorded in the low-lying cluster of islands, which was visibly more prepared for Hurricane Irma’s wrath than previous storms.

As Hurricane Irma roared through the world famous archipelago, several surgeries were performed and two healthy babies were delivered by medical teams at the local hospital. The resilience and dedication displayed by clinical and nonclinical teams who remained on-site at both medical centres before, during, and after the storm is exemplary. Although more than 20 healthcare workers endured significant personal losses and infrastructural damages to their homes, these warriors remained patient-focused and selfless. TCI Hospital also provided tangible support to displaced employees. Essential services such as electricity, telecommunication, internet, city water and even domestic and international air travel were hampered country-wide for several days, weeks and potentially months, for some services. In the absence of these necessities, both generator-powered hospital centres strived to maintain emergency services and enforce contingency plans as restoration efforts progressed. The ultimate challenge for each healthcare facility during a disaster is the onslaught of occurrences, some beyond human control or prediction, which can impact the integrity of the physical building, mechanical and operational equipment such as chiller machines and water pump systems, which are just as intricately linked to service delivery as the need for an uninterrupted electricity supply. In some areas of a hospital, an air conditioning system isn’t just a welcome luxury – it’s nigh-on indispensable. These areas include operating theatres, where precise control of the humidity, the temperature, and the filtration is highly desirable. The same is true to a lesser extent of other sensitive parts of the hospital, like the intensive care ward, delivery rooms, X-ray, MRI, and CAT departments, or even IM&T Server Rooms. In addition, a sufficient and well pressurised water supply is an essential component of Haemodialysis, which uses up to 0 litres of water for each patient.

It only takes several hours for a hurricane to decimate structures in its path and uproot people’s sense of normalcy, but it can take a country, its residents and institutions, several months, and even years to recover and rebuild. Health care facilities are no exception. More than half of the 16,000 hospitals in Latin America and the Caribbean are in areas at high risk for disasters. Two weeks after Irma, Hurricane Maria impacted the Turks and Caicos Islands. All patients were transferred overseas from Cockburn Town Medical Centre as a safety precaution, following an assessment of provisional roof repairs, which were conducted after Irma. Grand Turk is traditionally among the hardest hit islands and was once again, earmarked for the strongest conditions. It must be stressed: Times of crisis, emergency and challenges have a way of bringing people together and can push people to excel at what they do. A contingent of consultants from Cheshire Hall Medical Centre travelled to Grand Turk to remain on stand-by to provide emergency services in the wake of Maria. First responders – police, fire, EMS with support from the British Military and Bermuda Regiment – banded together from all over the country and their immeasurable hours of work is commendable. The gradual resumption to routine services across both medical centres under the Turks and Caicos Islands Hospital umbrella is owed to a spirit of teamwork amongst the managerial teams and employees, other internal and external healthcare stakeholders, and restoration efforts from the country’s utility service providers who recognise and prioritise the hospital as a provider of essential services. Both Hurricanes left an atmosphere of vulnerability in the peak of the 2017 Atlantic Hurricane Season while countries limp towards recovery. As the new common mantra reads: 'The Turks and Caicos Islands, as a destination, may have been bruised, but is certainly not broken.' 11

THANK YOU TO THE BRITISHÂ MILITARY HURRICANE IRMA RECOVERY SEPT 2017 12

INSIDE THE MEDIA

Health Education

REGISTER TODAY! TCI Hospital offered training in Heartsaver CPR/AED for the month of September and onwards at an affordable cost of $80.00 per person, which includes a student manual, snack break, face mask, and a course completion card. To register for future training sessions email: Michael Williams via mgwilliams@interhealthcanada.tc at Cockburn Town Medical Centre Jacqueline Moe-Cox via jcox@interhealthcanada.tc at Cheshire Hall Medical Centre 14

The American Heart Association

establishments on a regular basis.

(AHA) designated the month of

Since cardiac arrest can occur at

September as CPR

any time and anywhere, it is the

(Cardiopulmonary Resuscitation)

hospital’s corporate responsibility

month with a goal to partner with

to make TCI a safer place for all

other stakeholders to train 25,000

who live in as well as visit these

persons in life-saving CPR in

beautiful by nature islands.

September 2017. The Turks and Caicos Islands Hospital Life Saver Training Centre announced its partnership with the AHA to provide training to as many persons as possible. Various companies, schools and banking institutions were invited to capitalise on the course by reason of the large number of

The AHA Certified training centre also offer additional courses such as Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS).

people that access these 15

LIFE SAVING SKILLS.Â

Nineteen teachers and administrators from Precious

Treasures International School Turks and Caicos enrolled to learn the lifesaving skill at TCI Hospital's Training Centre, which is certified by AHA. Graceway IGA has also scheduled a large group of employees to receive training. Successful completion and skills testing with an AHA Certified instructor can earn an American Heart Association Heartsaver First Aid CPR & AED Course Completion Card, valid for two years. Each year, more than 350,000 out-of-hospital cardiac arrests occur in the United States. This is an electrical malfunction in the heart that causes a disruption of blood flow to the brain, lungs and other organs. Despite the important advances in prevention, cardiac arrest remains a substantial public health problem and a leading cause of death in many parts of the world. In a cardiac arrest, seconds count. According to AHA, almost 90 percent of people who suffer out-of-hospital cardiac arrests die. CPR, especially if performed in the first few minutes of cardiac arrest, can double or triple a personâ€™s chance of survival. Sadly, many persons witnessing someone who has collapsed are often unable to help because they do not know what to do. Individuals or employers can seize the opportunity to provide their staff with the necessary life-saving skills to enable them to respond in a timely and appropriate manner should the need arise. Remember - no one can place a value on life. You can save a life today.

n io t a r o t s e r k n a Food b

ROAD TO DIAMOND

*Reviewing Client Safety Quarterly Reports *Ensuring Safe Surgical Practices *Transfer of Patient Information *Narcotic Safety *High Alert Medications *Heparin Safety *Infection Control Guidelines *Infection Rates *Safe Injection Practices *Pressure Ulcer Prevention *Client Safety Prospective Analysis *Dangerous Abbreviations *Training on Patient safety *Preventative Maintenance * Suicide Prevention *Home Safety Risk Assessment *Antimicrobial Stewardship

Thrombosis Awareness 20

Turks and Caicos Islands Hospital is planning to join the global movement to raise awareness of venous thromboembolism (VTE). Recognised on 13 October, World Thrombosis Day (WTD) focuses attention on the often overlooked and misunderstood condition of thrombosis. WithÂ thousands of educational events in countries around the world, WTD and its partners place a global spotlight on thrombosis as an urgent and growing health problem.

WWW.TCIHOSPITAL.TC

VTE is often fatal, but the good news is that many, if not most cases are preventable.

stop the clot Thrombosis refers to abnormal, lifethreatening blood clots that form in the artery or vein. A clot in the vein (usually in the leg or pelvis) is known as a deep vein thrombosis (DVT) and a clot that breaks off and travels to the lungs is known as a pulmonary embolism (PE). Together, DVT and PE make up venous thromboembolism (VTE). TCI Hospital will seek to increase local awareness of thrombosis, including its causes, risk factors, signs/symptoms and evidence-based prevention and treatment. There will be specific focus on underscoring the unrecognised threat and serious consequences (morbidity and mortality) related to venous thromboembolism (VTE). One in four people worldwide die of conditions caused by thrombosis. Thrombosis is a leading cause of death throughout the world. Initiatives being planned include an educational exhibition in the main foyer and community walk hinged on the popular theme, ‘Stop the Clot’. Stay tuned for the dates and additional information. 21

2017 CLINIC EXPLORATIONÂ

Post Hurricane Irma

eat your veggies. eat them often. Eating vegetables provides health benefits people who eat more fruits and vegetables as part of an overall healthy diet are likely to have a reduced risk of some chronic diseases. Vegetables provide nutrients vital for health and maintenance of your body.

E X P L O R E

H E A L T H

C A R E

NursingÂ Observership A nursing student from Turks and Caicos who is pursuing tertiary level studies overseas spent portions of her summer break at the Cockburn Town Medical Centre in Grand Turk shadowing physicians in practice.

Shekia Francis, 18, is currently pursuing a Bachelor of

On the final day, Francis gave a presentation on the

Science in Nursing at University of the West Indies in

different roles of nursing with special emphasis on

Jamaica. Francis gained invaluable firsthand exposure

Patient Safety and Fall Prevention initiatives within

to internal healthcare operations during a near two

the healthcare centre. The presentation was well-

week observership, which commenced on August

received by clinicians and Francis expressed

14th.

gratitude for the unique opportunity. Upon completion of tertiary level studies and the required

Of all the departments explored, she favoured the

credentials, she will start off as a generalist and then

Dialysis Unit, particularly the level of Human and

likely develop a specialty during her nursing journey.

Social Biology involved in the nursing spectrum, and

We wish her all the best.

the close bonds between patients and nurses due to the frequency of treatments, typically 3 times per week for each patient diagnosed with chronic renal failure. 25

E X P L O R E

| H E A L T H

C A R E

O B S E R V E R S H I P S

Finance Observership Former graduate of British West Indies Collegiate A-Level Program, Lawrence Saintange, 20, concluded a three month observership at TCI Hospital’s Finance Department on August 31st. The accounting and economics lover who spent his summer working alongside the Finance team has absorbed a wealth of knowledge in the field of business and financial management.

“People don’t normally think about the corporate side

…Every company has an accountant, sometimes it is

of hospital operations. I realized this during my first

very typical for graduates to go for the obvious

tour while visiting departments such as Purchasing

companies, but if they go out and network, they

and Human Resource Management," said Saintange.

would meet people and possibly venture into companies where they don’t typically go for

He continued: "Working alongside Terry, Marie, Faith

experience.”

and Guru in the Finance Department, I was able to learn about technical terms, financial systems and

Saintange has been accepted into the University of

processes. It made me more excited to learn about

Lincoln in Lincolnshire, England.

finance. Image Caption (L-R): Terry, Faith and Marie of TCI Hospital Finance Department alongside Mentee 26

Saintange.

BASKETBALL TEAM SECURED 2ND PLACE IN PUERTO RICO TOURNAMENT

A delegation from Interhealth Canada – Turks and Caicos Islands Hospital will be attending the 10TH World Medical Tourism & Global Healthcare in Los Angeles, California on October 2-4, 2017 as exhibitors and a bronze sponsor of the global leading medical tourism event. The healthcare organisation participate in the forum every year in some capacity, and utilise the platform as an opportunity to market the InterHealth Canada brand, healthcare services, available surgeries and the country at large, in an effort to pave the foundation for a potential medical tourism sector and inbound patients. The delegation will consist of IHC Chief Executive Officer, Daniel Carriere, IHC Chief of Medical Services, Dr. Denise Braithwaite-Tennant, IHC Visiting Consultant Coordinator, Kay Vanes-Williams and myself as IHC Manager of Marketing and Public Relations – all Certified Medical Tourism Professionals. The congress is one of the most comprehensive international healthcare conference and trade shows in the medical tourism industry and attracts up to 3,000 participants, 400 qualified buyers of healthcare along with industry forums and executive summits.

EXERCISE TIDBIT

Exercise of the Quarter The Plank

TC I HOSPITAL UN V E ILS B R E A ST FE E D ING RO OM

BREAST IS BEST. ALWAYS.

ON THE ROAD TO BABY-FRIENDLY

Turks & Caicos Islands Accident and Emergency Surgical Services High Dependency Unit Obstetrics and Gynaecology Orthopaedics Family Practice Medical Oncology Physiotherapy Internal Medicine Secondary Dentistry Outpatient Haemodialysis Diagnostic Imaging Ophthalmology Pharmacy Nephrology Urology Neurology ENT

CALL US TODAY! +1 649-941-2900 +1 649-941-2800

Putting the heart into healthÂ care. 32

OCT 2016

OCT-DEC 2017

INTERHEALTH CANADA TCI

THE

INTERVIEW

HEALTHY LIFESTYLES: LEADING BY EXAMPLE Welcome to TCI Hospital Newsletter, which features stories from across the health care organization. A new edition is published at the end of every quarter with news collated over three months.

Our Mission To provide the community and its visitors with high quality healthcare.

Our Vision To improve the nationâ€™s health through the development of a sustainable and accessible healthcare system.

Our Values We value ethical and respectful behaviour, honesty, accountability and excellence in all we do.

Educational Development

ADVANCED WOUND CARE

NURSES ATTEND SAWC CONFERENCE IN LAS VEGAS, UNITED STATES.

ABOUT THE EDITOR

NEWS

ROCHE PHARMACEUTICALS DONATE $16,000 WORTH OF MIRCERA DRUG TO TCI HOSPITAL

(L-R): TONY WILTON - IHC PHARMACY MANAGER; CHANTA WILLIAMS-GRAY ROCHE COUNTRY COORDINATOR FOR BAHAMAS, BERMUDA AND TURKS AND CAICOS ISLANDS; DOCTOR VANCELEE FORBES - IHC NEPHROLOGIST; DR ESTEBAN COTO - MEDICAL MANAGER FOR ROCHE PHARMACEUTICALS IN COSTA RICA; DAGNI PROSA - MEDICAL REPRESENTATIVE FOR ROCHE PHARMACEUTICALS; LEVY SALVE - IHC PHARMACIST.

INTERHEALTH CANADA HOSTS SUCCESSFUL MULTI ISLAND 'STOP THE CLOT' FITNESS EVENT

SCORES OF RESIDENTS ATTEND 'STOP THE CLOT' PROVO

WORLD THROMBOSIS DAYÂ

'TIS THE SEASON TO BE JOLLY. The Senior Management team at Turks and Caicos Islands Hospital would like to extend special wishes for a happy Christmas holiday to its devoted employees.

cheshire hall medical centre

cockburn town medical centre

TCI Hospital introduces ECFMG’s Primary-source Credentials Verification to Physician Assessment Process Joint Press Release Turks and Caicos Islands Hospital, InterHealth Canada (TCI Hospital) and the Educational Commission for Foreign Medical Graduates (ECFMG®) are pleased to announce that TCI Hospital has incorporated ECFMG’s Electronic Portfolio of International Credentials (EPICSM) into its process for assessing the medical credentials of physicians seeking employment at the health care facility. TCI Hospital is a Diamond-accredited public hospital managed by InterHealth Canada TCI Ltd on behalf of the Turks and Caicos Islands Government through a Public-Private Partnership agreement. The Hospital’s primary goal is to ensure that patients receive highquality care, delivered within a safe, reliable, and patient-friendly environment built on the values of ethical and respectful behavior, honesty, accountability, and excellence. The Hospital deemed its partnership with ECFMG to be necessary for the continued improvement of the health care facility’s recruitment process.

ECFMG is proud to partner with TCI Hospital to enhance its recruitment process by adding primary-source verification—a best practice and the best protection against fraudulent credentials—to the Hospital’s tools for evaluating the qualifications of its physician applicants.

In the past, medical credentials were verified by TCI Hospital primarily via a robust internalised process, which include verification through medical councils and letters of good standing from previous and/or present employers. 14

Physicians interested in employment at the health care facility must first apply to the Hospital through its Human Resources department. Successful candidates will be directed by the Hospital to have their required credentials primary-source verified through EPIC. Physicians can find complete instructions on using EPIC in support of their applications at www.ecfmgepic.org/instructionsturks-caicos.html.

About ECFMG Established in 1956, ECFMG is a private, nonprofit organization based in Philadelphia, Pennsylvania, with more than 900 full- and part-time employees. ECFMG is a world leader in promoting quality health care—serving physicians, members of the medical education and regulatory communities, health care consumers, and those researching issues in medical education and health workforce planning. ECFMG’s program of certification evaluates whether international medical graduates are ready to enter U.S. programs of graduate medical education, where they provide supervised patient care. ECFMG offers a variety of other programs for the world’s physicians and the entities worldwide that educate, train, register/license, and employ them.

About EPIC EPIC offers primary-source verification of medical credentials to organizations and physicians worldwide. In verifying the authenticity of physician credentials related to medical education, training, and registration/licensure, EPIC employs the same world-class, primary-source verification process used by ECFMG to verify credentials for other ECFMG services, including ECFMG Certification, the standard for international physicians entering the U.S. health care system. For organizations that are responsible for evaluating physician qualifications, EPIC provides secure, no-cost access to primary-source verification—verifying the authenticity of a credential directly with the issuing institution—for the purpose of evaluating their applicants’ credentials.

ECFMG’s organizational members are the American Board of Medical Specialties, American Medical Association, Association of American Medical Colleges, Association for Hospital Medical Education, Federation of State Medical Boards, and the National Medical Association. For more information, visit the ECFMG website at www.ecfmg.org. About Turks and Caicos Islands Hospital

For the world’s physicians, EPIC is an innovative way to build a digital career portfolio of the credentials related to their medical education, training, and registration/licensure—a portfolio that can grow with their careers. Using EPIC, physicians can send their credentials, and reports verifying their authenticity, to organizations worldwide. For more information, visitwww.ecfmgepic.org.

Turks and Caicos Islands Hospital consist of two state-of-the-art secondary health care facilities equipped with the very latest medical technology and highly experienced multinational doctors. The public facility, managed by InterHealth Canada (IHC), is one of few Diamond-accredited health care providers in the Caribbean region. For more information, visit the TCI Hospital website at www.tcihospital.tc. 15

CANCER STATISTICS

world medical tourism congress

Grace Bay in Turks and Caicos is the world's No. 1 beach.

HURRICANE RECOVERY EFFORTS

CHILLER SYSTEM RESTORED AFTER MAJOR STORMS

While 95% of clinical services

The chiller system at Cockburn

offered at both TCI Hospital

Town Medical Centre on Grand

medical centres resumed some

Turk was eventually fully repaired

weeks following the passage of

and operated within the standards

Hurricanes Irma and Maria in

of the building. As a result, the

September, the restoration of

Operating Theatre was able to

other departments with

accommodate elective surgeries,

temperature-sensitive equipment

and most of the remaining routine

was dependent upon the

services resumed shortly

stabilisation of the hospitalâ€™s

thereafter.

chiller systems. 20

HURRICANE RECOVERY

THE CHILLER SYSTEM IS ESSENTIAL TO SOME CLINICAL SERVICES. The chiller system for Cheshire Hall Medical Centre arrived at the health care facility on Thursday, 02 November 2017. The installation and commissioning spanned three days with a full restoration of 100% cooling capacity. Overseas engineers arrived in country to assist local teams in the installation process. The industrial chiller system arrived on island inside a 40 foot container. A 60 ton crane was sourced to offload the system. The chiller generates 370 tons of cubic cooling for the Cheshire Hall Medical Centre facility, which spans 11,500 square meters in size. Cheshire Hall Medical Centre on Providenciales is the largest of the two medical facilities. An additional chiller system was also ordered. However, the newly arrived system operated within the standards of the building and exclusively produced the cooling capacity required. Specialist engineers also worked expeditiously and repaired any outstanding mechanical issues at Cheshire Hall Medical Centre in late November sustained as a result of Hurricanes Irma and Maria. These issues were connected to water pressure, internal supply and return feeds, which support the cooling system within the facility.

INTERHEALTH NEWS FROM ELSEWHERE

HEALTH CARE PIONEERS

RDIF TOGETHER WITH INTERHEALTH SAUDI ARABIA TO INVEST IN THE CONSTRUCTION OF A HIGH-TECH MULTIFIELD PEDIATRIC REHABILITATION CENTER IN THE REPUBLIC OF TATARSTAN

Source: www.interhealthsaudiarabia.com

INWARD PHILANTROPHY InterHealth Canada shares US$30,000 donation of Pharmaceuticals with Government Ministry of Health, Primary Health Care Department for Hurricane Relief. Direct Relief, a U.S. based non-profit medical relief and health assistance organization donated US$30,000 worth of pharmaceuticals to InterHealth Canada - Turks and Caicos Islands Hospital following a successful application by the healthcare management company.

The Director of TCI’s Department of Disaster Management and Emergencies also provided guidance.An application process was completed by the local hospital management team and pharmaceuticals of value were selected from the organization’s inventory via a collaborative effort with Primary Health care. The donated pharmaceuticals will be provided to patient’s free of charge and will not be billed to the National Health Insurance Plan.

During a media briefing held on Monday October 16th, 2017 at Cheshire Hall Medical Centre, InterHealth Canada graciously handed over a portion of the supplies to the Ministry of Health to support and bolster the Primary Health care Department’s inventory. The World Health Organization also donated a supply of items via the British Military. The donation helps to reduce the operational expenditure of TCI Hospital and Primary Health care.

Direct Relief is dedicated to serving the poor and victims of natural disasters and civil strife in the United States and throughout the world. Assistance is provided by distributing donated medical goods to charitable health care institutions and organizations. The World Health Organization is a specialized agency of the United Nations that is concerned with international public health.

Daniel Carriere - TCI Hospital Chief Executive Officer, Doctor Denise Braithwaite Tennant - Chief of Medical Services and Tony Wilton – TCI Hospital’s Pharmacy Manager were in attendance. Doctor David Bernardo, a Medical Officer within the Primary Health care Department, accepted the supplies on behalf of the Ministry of Health and Human Services.

TCI Hospital Chief Executive Officer, Daniel Carriere said: “Direct Relief has been used in conjunction with InterHealth Canada in Sub-Saharan countries in Africa for humanitarian relief purposes. Hence, the company was familiar with the organization and the application process commenced. During any natural crisis, collaboration, cooperation and communication is essential among stakeholders. This is just one successful example of how these efforts can benefit both partners and the community at large.”

InterHealth Canada Corporate Board referred the international charity to the Turks and Caicos Islands Hospital following the passage of Hurricane Irma. 26

VIRGINIA DOCTOR AND PARTNERS DONATE RELIEF SUPPLIES TO TCI HOSPITAL STAFF Healthcare workers from Turks and Caicos Islands Hospital were among the persons affected by Hurricanes Irma and Maria while working immeasurable hours providing essential services to the country, before, during and after storms last month.

Board Certified Emergency Medicine Physician, Doctor Stephen Brock Blankenship, MD, FAAEM, based in Abingdon Virginia, United States contacted the healthcare facility expressing interest in volunteering his services for any mass casualty scenarios. Since there were no reported casualties in the Turks and Caicos Islands, Blankenship and his wife Jennifer partnered with other donors namely Highlands Fellowship Church, Chad and Amanda Rowland, Brian and Mary Dawson, Ron and Camille Sewell along with Michael and Cynthia Hackett to organize relief items deemed essential. A shipment was promptly received containing 59 battery operated fans including 50 packs of batteries, 46 bed linens/sheets, 53 packs of tarpaulin, 12 children-size inflatable beds, 36 adult size inflatable beds for usage in emergency lockdown cases and/or personal homes, 1000 sqft of roof plastic sheet, 19 inflator pumps along with LED headlamp sets.

The items were distributed among Emergency Department workers along with other clinical and support services staff based on the need and severity of damages sustained as identified by the Management of Human Resources and Facilities. TCI Hospital Chief of Medical Services, Doctor Denise Braithwaite-Tennant expressed endless appreciation for the unexpected philanthropic gesture displayed by the aforementioned overseas donors, and Doctor Blankenshipâ€™s willingness to provide his services in a catastrophic scenario, if needed, as an act of community service. InterHealth Canada, the management company of TCI Hospital, formed a staff welfare and relief committee immediately following Hurricane Irma to also provide tangible assistance and counseling to employees who were displaced and distressed after recent storms.

HIRTAC (Hurricane Irma Relief Turks and Caicos donates relief items to hospital staff and patients Turks and Caicos Islands Hospital wishes to express heartfelt appreciation to members of HIRTAC (Hurricane Irma Relief Turks and Caicos) for the donation of relief items received on Friday, October 13th 2017. HIRTAC is a non-profit relief initiative founded by UKbased Turks and Caicos Islanders and past residents, which seeks to establish a mode of reputable, transparent funding to support the humanitarian response in the TCI following Hurricane Irma. The packages contained a cross-section of infant care and adult care items. As desired, these items will benefit patients who are expectant mothers in need, and other items were distributed among healthcare workers who sustained severe losses during recent storms. Thank you for your thoughtfulness.

A SPECIAL THANK YOU NOTE FROM TCI HOSPITAL TCI Hospital Team would like to thankÂ the following companies for their generous donation of pharmaceuticals: - Johali Medical Inc. - Quantum Pharmaceuticals - Alium Pharmaceuticals - Loweâ€™s Pharmaceuticals It is kind actions such as what you did for us that has been a great source of assistance in maintaining the services we provide to the community following the hurricanes in September 2017. 28

NEONATAL RESUSCITATION PROGRAM TRAINING

ediatricians, NICU Nurses, midwives and other healthcare providers who initiate and direct advanced life support in neonates at Turks and Caicos Islands Hospital are staying at the forefront of neonatal care with refresher and certification renewal courses.

The training was facilitated by Doctor Samuel Julian, Neonatologist and Assistant Medical Director of Neonatal Intensive Care Unit at St Louis Children’s Hospital and Barbra Garrison, a 27-year Neonatal Intensive Care Unit Nurse at St Louis Children’s Hospital in Missouri, United States.

The Neonatal Resuscitation Program (NRP) course was held in early December at Cheshire Hall Medical Centre with ten health care professionals in attendance. The daily occupations of participants demand proficiency in neonatal resuscitation.

The Neonatal Resuscitation Program® (NRP®) course conveys an evidencebased approach to care of the newborn at birth and facilitates effective teambased care for healthcare professionals who care for newborns at the time of delivery.

The program is based on the American Academy of Pediatrics (AAP) and American Heart Association (AHA) Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care of the Neonate. NRP utilizes a blended learning approach, which includes online testing, online case-based simulations, and hands-on case-based simulation/debriefing that focus on critical leadership, communication, and team-work skills. Additional 20-year-old training sessions are being scheduled Marianne Teigen for other medical published specialties at TCI recently Hospital. her first young adult novel, and in only a month, it has reached the New York Times Bestsellers list.

Congratulations to employees of

Grace way IGA recognised the

Graceway Supermarkets who

importance of such training and

successfully completed training in

made an investment to educate its

by-stander CPR (Cardiopulmonary

staff. Due to recent hurricanes,

Resuscitation), which was

some training sessions were

facilitated by trainers from Turks

rescheduled for November.

and Caicos Islands Hospital during the month of November.

The Turks and Caicos Islands Hospital Life Saver Training

The American Heart Association

Centre partnered with the AHA

(AHA) designated the month of

during CPR month to provide

September as CPR

training to as many

(Cardiopulmonary Resuscitation)

persons/organizations as

month with a goal to partner with

possible.

other stakeholders to train 25,000 persons in life-saving CPR in September 2017. 31

The AHA Certified training centre also offer additional courses such as Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS).

THE INTERVIEW

FREQUENTLY ASKED QUESTIONS Here are some answers to questions frequently asked by patients to enhance their understanding of services offered by TCI Hospital and the country's healthcare system.

SERVICE EXPANSION

OVERSEAS TREATMENT

Since opening in 2010, additional services have been introduced and the Hospital remains eager to bring more services onisland to lower the cost of sending patients overseas for treatment.

World Quality Day is celebrated every year around the world in November. The day was designed to increase worldwide awareness of the important contribution that quality makes towards both organisational and national growth, and prosperity.

BILLBOARD SHOWCASE World Quality Day is an opportunity to celebrate the achievements of the organisation, and recognise those that demonstrate leadership to sustain and improve performance every day of the year. Attendees were asked to develop their personal brand of leadership and imagine themselves as a billboard. Here is a preview of some billboards: Name: Lessonjulle Lyons-Dobney Billboard title: “Driven by purpose, not merely by success” NAME:- Surbrena Forbes-Pedican BILLBOARD TITTLE:- Caring and Kind NAME: - Moira Scott BILLBOARD TITTLE:- I’ll take care of your worst day NAME:- JACQUELINE MOE-COX BILLBOARD TITTLE:- I ASPIRE TO INSPIRE BEFORE I EXPIRE!!! Name:- Douglas Moore Billboard Title: Quality = Keeping the End in Mind NAME: - Tony Wilton BILLBOARD TITTLE:- Quality Service, Everyday Name:- Mikette Been Billboard:- Extremely organized person, Pay attention to details. Name:- Lurline Burnett Billboard;- I exchange I ILLNESS for WE wellness. Name:- Denise Braithwaite Billboard:- Leadership you can depend on! Name:- Isha Honore Billboard:- Here’s to Being better than yesterday! Name:- Juneth Reynolds Biilboard:- information is power, time is money documentation must be complete and accurate... records should earn their keep!!!

ROAD TO DIAMOND ROUND THREE

This annual process takes three days to complete fully, and the team work extensive hours through the night as required.

AIR P A RTI CUL A TE TESTI N G A T COCK B URN TOWN ME D I CA L CEN TRE

Congratulations to the Engineering, Housekeeping and Duty Management team for once again delivering the highest standards of hygiene and air quality supporting clinical partners in the delivery excellent standards of patient safety.Â

During the weekend of 26th August 2017, both Facilities Management teams worked with HEPA accredited technicians on annual air testing of the Operating Suites, High Dependency Unit, Medical Device Reprocessing Department, Neonatal Intensive Care Unit and Post-Anesthesia Care Unit.

HEPA stands for high-efficiency particulate air. A HEPA filter is a type of mechanical air filter; it works by forcing air through a fine mesh that traps harmful particles.

Following the deep cleaning, plate testing and swabbing regime, Facilities Management was pleased to be notified that all areas passed the required standard. Â

Fire Extinguisher Training at Cheshire Hall Medical Centre STRENGTHENING FIRE SAFETY AND RESPONSE COMPETENCIES The Providenciales Facilities Management Fire Warden team were able to complete the first pilot session of fire extinguisher training supported by the Local Fire Service on 4th November 2017. The Facilities Management team is pleased to announce that all persons completed and passed the course, and were issued with certificates of competency.

Advanced Medical Post Training at Cheshire Hall Medical Centre

Further sessions will be completed at both medical centres in early 2018 to ensure that all registered Fire Wardens have completed these sessions and are fully conversant and confident in fire management and the use of an extinguisher.

The Facilities Team at Cheshire Hall Medical Centre completed Refresher training relating to Advanced Medical Post (AMP) set up and Mass Casualty on 12th August 2017. The team of Engineers, Porters and Duty Managers set up external AMP areas and completed training with regards to triage areas, flow and clinical support in the event of a disaster. Internally, a second session took place setting up the main reception with oxygen lines, emergency cots and standard equipment required in the event of an incident. The session included some new members of the team, who were trained and supported by coworkers relating to set up and expectation of support services to our Clinical partners during an emergency incident. Repeat sessions will be completed in Grand Turk in January 2018. 41

MAR 2018

THE

INTER-VIEW

TCI HOSPITAL LEADERSHIP FORUM - 'A SUCCESS' Welcome to the January - March 2018 edition of Turks and Caicos Islands Hospital Newsletter, which features stories from across the health care organisation. A new edition is published at the end of every quarter.

INSIDE THE ISSUE

In an emergency, what treatment is given by ear? Words of Comfort. - Abraham Verghese, MD

Turks and Caicos Islands Hospital welcomes new Chief Executive Officer.

Revised Strategic Plan 2017-2020 launched across the hospital in a series of meetings.

Over 50 hospital managerial staff convene for leadership forum at The Palms Resort.

Employees compete for $3,000 prize pool in a Diamond Challenge.

Family of accident victim shares emotional testimonial of son's life-saving surgery.

Cosmetic Surgery ENHANCE YOUR CONFIDENCE 1

US BOARD CERTIFIED SURGEONS

Call +1 649 941 2800

Other speakers included members of the company’s senior management team along with present and former Minister of Health and Human Services, Honorable Edwin Astwood and Honorable Doctor Rufus Ewing, respectively.

InterHealth Canada - Turks and Caicos Islands Hospital hosted a leadership forum for over 50 internal staff at the Messel Ballroom of the Palms Resort on March 9th, 2018 under the theme “Beyond the Boundaries - Elevating Leadership through Excellence & Innovation”.

The format included a plenary session and half-day workshop to afford organizational leaders and middle management staff the opportunity for exposure to different models, best practices and application of leadership principals in an effort to stimulate self reflection and skill enhancement.

The forum featured a line-up of organizational and external speakers, which included Ambassador Joan Underwood of Antigua who is a veteran senior management consultant, policy advisor and expert in training programmes for public and private sector executives. 2

Participants were also exposed to the principles of Emotional Intelligence (EI). The EI workshop facilitated by Ambassador Underwood was designed to bridge the connection between leadership styles and the manner in which individuals recognize, connect with, and learn from their own mental and emotional state, and those of others.

During the presentations, references were made to situational leadership and the importance of morality, citing examples of prominent persons in history who used their position of authority for both positive and negative objectives. It was stressed that leadership should not be perceived as a position of authority, but rather a personal attribute which transcends hierarchy.

Leaders can be found at all levels within an organization and there is a difference between ‘managers’ and ‘leaders’ Manager of Education at InterHealth Canada – TCI Hospital, Jacqueline Moe-Cox said: “The sessions were interactive and informative; participants took the opportunity to engage in stimulating intellectual discussion with the facilitators on various aspects of leadership."

John C. Maxwell

"The facilitator of the EI workshop used practical examples, exercises such as the Johari window and team activities to deliver an invigorating session on how Emotional Intelligence principles can be used to positively impact leadership.” She continued: “Comments made during the session and written evaluations indicate that both sessions were well-received by participants and they left invigorated and inspired to implement some of the techniques to enhance their personal leadership skill sets to the organization’s advantage.”

BON

VOYAGE Employees from across the Turks and Caicos Islands Hospital bid farewell to then Chief Executive Officer of InterHealth Canada TCI Ltd, Daniel Carriere who resigned for family reasons, effective January 31, 2018. During the sendoff event, managers and frontline staff reflected on their best moments in the work environment, and extended good wishes to the hard-working health care boss. Gaston Levac, a former Chief Executive Officer of hospital operations within Ontario Canada was appointed as interim CEO and immediately assumed the post following Carriere’s departure earlier this year.

John Hyland, InterHealth Canada Legal Director

Speaking on behalf of the InterHealth Canada Board, John Hyland said: “Daniel’s contribution to the success of the TCI Hospital and its increasing international recognition as an example of how even small hospitals in the region can and should perform, cannot be overstated. Since joining us in September 2015, he has strengthened the administration, overseen the company’s policy of continuing improvement in performance in all departments, continued the programme of promoting Belongers to positions of greater responsibility within the Hospital, encouraged the attendance of staff at Seminars and other Continuing Education courses, played a leading role in the preparation of plans for the strategic development of the Hospital over the coming years. 4

"Importantly and perhaps for him most memorably, through his leadership by example and with the support of his Senior Management Team, he was able to ensure the continued operation of the Hospital through Hurricanes Irma and Maria and the implementation of the necessary recovery programme. He leaves with our hopes and very best wishes for the future.”

Daniel Carriere said: “It has been an enormous privilege to have led the organization over the past two plus years. I have immensely enjoyed my experience in this beautiful country with such talented hospital personnel. I have met such great people both inside and outside the hospital and have experienced so many new and exciting challenges that have enriched my personal and professional life. I have benefitted from the wisdom obtained from professional colleagues and historical guidance from IHC Board members, many of whom are legacy participants in the original development of the two hospitals in Providenciales and Grand Turk; they remain committed to the hospital and the country of TCI.” Mr. Carriere is a veteran in the health care industry having joined InterHealth Canada as Chief Executive Officer in September 2015. Carriere had previously held several senior administrative positions in Ontario’s health care sector and is recognized for his accomplishments in advancing services and quality of care.

NEW CEO APPOINTED TO TCI HOSPITAL Professional Background Gaston Levac formerly served as President and Chief Executive Officer of various health care entities such as the Canadian College of Health Service Executives, Thunder Bay Regional Hospital, Laurentian Hospital and West Nipissing General Hospital in Canada. As a former Surveyor of the Canadian Council on Health Services Accreditation, Levac boasts over 20 years of experience in numerous surveys in Canadian and international health care organizations, including health services offered in various military bases in Canada and several hospitals in the Caribbean. Levac has been involved in numerous professional activities. These include: Member - Board of Directors of Ontario Hospital Association, Member and Chairman - Canadian Hospital (now Healthcare) Association (OHA), Founding Member - Joint Priorities & Planning Committee with Ontario Ministry of Health and OHA, Member and Chairman of Board of Directors – Cambrian Community College and Chairman of the “Access to Care in the North” provincial Task Force.

BY NIKIRA JOHN

"The consumer demand for accredited facilities and quality health care services continues to increase globally due to various industry factors including medical tourism. Therefore, accreditation acts as a quality assurance mechanism for patients, an emblem of distinction for the health care organization, and also ensures that we play our expected role in the national health care system.” - Gaston Levac, Interim CEO, InterHealth Canada (TCI) Ltd Turks and Caicos Islands Hospital has been accredited at the Diamond level since March 2012 and is currently one of the few Diamond accredited hospitals in the Caribbean. This is the highest level achievable under the international accreditation program.

Turks and Caicos Islands Hospital is scheduled to undergo a robust independent reassessment of its performance against recognized standards of best practice outlined under the Accreditation Canada International (ACI) Qmentum Program on June 11th -15th 2018.

During an ACI assessment, an external survey team dedicates five days to survey the Cheshire Hall and Cockburn Town Medical Centres. The three surveyors were recently declared to the organization. These trained peer reviewers will examine the hospital’s internal systems and processes, observe activities and gather data through interviews with patients and staff. A full-site survey is carried out every three years to retain accreditation status.

ACI is one of only three accreditation bodies in the world, which focuses exclusively on health care services, and is acknowledged as the most-sought after accreditation organization for demonstrating a high level of compliance with rigorous standards. Successful facilities are awarded Gold, Platinum or Diamond status in accordance with the quality of service and care delivered to patients.

The performance of the health care facility is measured against 15 service standards and 32 required organizational practices (ROP's) with an exhaustive criteria. These performance benchmarks focus on quality and safety throughout all aspects of the organizationâ€™s services including clinical care, governance, leadership and infrastructure.Â Several readiness assessments were conducted within the past 12 months by an overseas independent consultant specializing in health care accreditation. These are periodically initiated by the local health care organization as an invaluable tool to provide an official measurement of its preparedness and progress related to standards, audits and action plans.Â

UNDERSTANDING OUR ACUTE SECONDARY HEALTH CARE SYSTEM

DID YOU KNOW?

For more answers to frequently asked questions, visit our website FAQ section: www.tcihospital.tc

CHAD ROSOW'S STORY

When I got up around 3 am, I realised my son Chad and nephew Collin weren't home. The next day they were scheduled to return to New York. I went back to sleep until 6 am when my wife woke me saying Chad and Collin were in a car accident. I got up, called the Emergency Room and headed over to Cheshire Hall Medical Centre, not sure where it was located or what I would find. Both were in the Emergency Room. Our son Chad was complaining of extreme stomach pain. He’d already had one dose of morphine and asked for more. This was around 6:30 am. The emergency room doctor, Dr Doshia Auguste called the Head of Surgery Dr. Bonnie Mauchaza (left), who was on his way. After reviewing the CT scan Dr. Mauchaza recommended emergency abdominal surgery to determine the cause of Chad’s severe pain.

The father of an accident victim shared a testimonial on the care received at Cheshire Hall Medical Centre on Providenciales.

Dr. Mauchaza then cleared the surgical schedule and immediately set the wheels turning to help Chad.

"THERE WERE MANY LONG MOMENTS WHEN I PREPARED MYSELF FOR THE WORST." Chad's father, Joel Rosow returned to Turks and Caicos Islands Hospital during the month of March, several weeks after his son's accident to conduct a two hour workshop on Stress Reduction. Rosow reflected on how he personally managed his son's encounter with a life and death scenario. A number of health care staff who were a part of his son's care team were present during the emotional session.

Waiting almost four hours while Chad was being reconstructed afforded time for continual prayer. There were many long moments when I prepared myself for the worst. Mercifully, Dr. Mauchaza and Dr. Burgess saved my son Chad s life. Had this unfortunate accident occurred before Cheshire Hall Medical Centre was built Chad would have had to have been airlifted to Miami and who knows what the outcome might have been. Dr Mauchaza exudes professionalism and experience. We, Chad and I were confident Dr. Mauchaza would put him back together.

Chad and his cousin Collin were drunk from a long night of drinking. They hitched a ride from the bar in Salt Mills to their intended destination, The Somerset on Grace Bay. The driver, another guest at the resort, was also inebriated and wrecked the car at the IGA roundabout on Leeward Highway. The car was totalled. The driver failed to circle the roundabout. Instead he went through the centre landing into the white concrete wall on the other side. Driver and cousin Collin were protected by their seat belts and air bags. Chad in the back had a seat belt fastened but no air bag.

Dr. Mauchaza, Dr. Burgess and the entire High Dependency Unit nursing staff delivered the highest level of professional care around the clock for over two weeks healing Chad back to health. The physicians, nurses, and support staff including the custodial staff and cafeteria personnel all contributed to Chad’s recovery.

Sadly, Chad was nearly cut in two by the crash impact. Dr. Mauchaza and Dr. Phillip Burgess (right) worked for about four hours putting Chad back together. His abdominal muscles were cut right through, there was small and large intestine damage and muscles needing repair. Because of the involvement of the intestines, risk of infection was a serious concern. The CT scan showed only the possibility of a small tear in the small intestine. Dr. Mauchaza wisely recommended emergency surgery.

We remain eternally grateful to the Cheshire Hall Medical Centre and especially Dr. Mauchaza and Dr. Burgess for saving Chad’s life and returning him to health. Sincerely Joel Rosow

WORLD KIDNEY DAY WALK Health care professionals from TCI Hospital provided complimentary health checks to attendees during the World Kidney Day walk held on Saturday, March 10th at Butterfield Square in Downtown Providenciales.Â In support of the National Kidney Foundation, the event was hosted by the Ministry of Health, Agriculture, Sports and Human Services in collaboration with and under the sponsorship of Graceway IGA.

CHRONIC KIDNEY DISEASE (CKD) AFFECTS APPROXIMATELY 195 MILLION WOMEN WORLDWIDE AND IT IS CURRENTLY THE 8TH LEADING CAUSE OF DEATH IN WOMEN, WITH CLOSE TO 600,000 DEATHS EACH YEAR. This year, the main focus is on women and chronic kidney disease. The International Federation of Kidney Foundations (IFKF) states the risk of developing chronic kidney disease is just as high in women as in men, and maybe even higher. Studies have shown that CKD is more likely to develop in women when compared with men, with an average prevalence in women of 14% when compared to 12% in men.

know your numbers BUILDING A MORE HEALTH CONSCIOUS SOCIETY

OVER 160 SCREENINGS recorded AT FORTIS FUN RUN Doctors and Nurses from TCI Hospital provided complimentary health checks to attendees during the Fortis TCI 10th Annual Fun Run held on Saturday, March 17th in Providenciales. Be encouraged to 'Know Your Numbers' and be aware of key numbers such as Cholesterol, Blood Pressure, Blood Sugar/Glucose and Body Mass Index (BMI). By keeping those numbers within a healthy range, you can greatly improve your health and reduce your risk for various health ailments.

Move-A-Thon 2018 Health Fair

TCHTA Wellness Exposition

Global Youth Day Outreach Initiative

Move-a-thon is an annual event and a major fundraiser for Nutrition in Demand. Nutrition in Demand is a non profit organization aimed at raising awareness of healthy eating through a variety of projects. TCI Hospital is among other medical companies who support the event on an annual basis.

WWW.TCIHOSPITAL.TC • 14INFO@TCIHOSPITAL.TC

REVISED STRATEGIC PLAN LAUNCHED The Senior Management Team under the direction of the Chief Executive Officer introduced InterHealth Canada - TCI Hospital's new Strategic Plan 2017-2020. A total of 10 sensitisation sessions were held in late February across Cheshire Hall and Cockburn Town Medical Centres to launch the organisation's Strategic Plan 2017-2020. Gaston Levac, Interim Chief Executive Officer at TCI Hospital reinforced the hospital's revised mission, vision, values, pillars and priorities to reflect the direction of the organisation. The Operating Plan 2017-2020 is a much more comprehensive

structured framework, which supports the Strategic Plan, and is scheduled to be internally launched in another series of upcoming company wide meetings to ensure and encourage staff engagement and feedback at all levels. A strategic plan typically covers a three to five year period. The document is updated to reflect changes in the population, acuity of patients, staffing and programmes.

"The feedback received was positive and staff were appreciative of the opportunity for engagement."

The Turks and Caicos

OUR MISSION

Hospital, by nature, will exceed expectations through its commitment to professional excellence, safety to all and continuous quality improvement. Our innovative and learning environment shall deliver efficient and effective services providing value for money.

InterHealth Canada TCI Ltd Strategic Plan 2017-2020

Persons may experience situations every now and again that can impact their general wellbeing. InterHealth Canada - Turks and Caicos Islands Hospital has recognised these challenges and has introduced an Employee Assistance Programme to offer practical, real-world solutions to employee life issues that may derail productivity and satisfaction in the home and work environment. The support program is operated by Inova, a comprehensive, top-ranked international provider of employee assistance services with a team of Master’s level counsellors. Inova offers the services of 60,000+ counselling providers in the U.S. and more than 10,000 providers in over 200 countries around the world. The Employee Assistance Programme was formally launched on March 1st 2018 and provides an independent, impartial source of information and support. The service will also be accessible to household members close to employees, such as a partner or family member.

Information can be provided over the phone, via email, or by post; and counselling is offered at a time and location convenient to the employee. The complimentary service is available 24 hours a day, 7 days a week, 365 days a year and there is no cost to the employee. Each employee has access to 5 counselling sessions per issue, per year and confidentiality and privacy is guaranteed. Personal information will not be disclosed and InterHealth Canada will only receive utilisation statistics and general information about work related issues to guide quality improvement initiatives. The Employee Assistance Programme will provide counselling and advice on a wide range of work and personal issues. Some of these issues may include, but are not limited to: - Improving relationships - Parenting - Couples’ support - Managing stress - Managing life changes

- Career success - Surviving the loss of a loved one - Managing workplace pressure - Improving esteem and confidence - Referrals to local financial or legal resources - Pursuing personal interests ·- Maintaining physical health Counsellors will provide an assessment of the issue, recommend a short or long term solution, offer a referral (if necessary) to local or national based resources and follow-up with the employee and/or user. In addition to contacting the service via telephone, employees can also access online information and support. InterHealth Canada Turks and Caicos Islands Hospital employs nearly 300 persons.

NATURALLY EXCELLENT, WHERE EVERYONE IS ENVIOUS OF OUR CULTURE AND CUSTOMERS RECEIVE THE FULL BENEFIT OF OUR OBSESSION WITHÂ QUALITY. OUR VISION

InterHealth Canada TCI LTD Strategic Plan 2017-2020

Parliament Speakers tour TCI Hospital

(L-R): Gaston Levac - IHC CEO, Hon. Dwayne Taylor and Hon. Buck Watts Speaker of the Turks and Caicos Islands House of

Hon. Francis (Buck) Watts was elected to the

Assembly, Honourable Dwayne Taylor along with

Legislature of Prince Edward Island in the

Speaker of the P.E.I. (Prince Edward Islands)

provincial election held on May 28, 2007, and was

Legislature, Buck Watts and Clerk of P.E.I,

re-elected on October 3, 2011, and May 4, 2015.

Legislative Assembly, Charles MacKay conducted a tour of Cockburn Town Medical Centre in

A Liberal Member of the Legislative Assembly, he

Grand Turk on Tuesday, 06th February 2018 and

represents the constituency of Tracadie-

Cheshire Hall Medical Centre in Providenciales

Hillsborough Park, a unique riding comprised of

on Thursday, 08th February 2018.

both urban and rural elements. Honourable Taylor was elected to the Legislature in 2003 representing the constituency of West Road, Grand Turk. He was then elected Deputy Speaker of the Council. Taylor was recently elected Speaker of the Turks and Caicos Islands House of Assembly in 2016 under the current PDM Administration.

SURPRISE BIRTHDAY PARTY FOR YOUNG PATIENT FEB February 13th 2018 marked a special day for one of our younger patient's who celebrated her 5th birthday.

TICKLED PINK 08

Zharyia Stubbs was tickled pink after a surprise gathering from our health care team. Despite her lung condition, the little princess was enveloped with hugs, warmth, her flashy tiara and a barbie castle to brighten her day.Â

THE INTERVIEW www.tcihospital.tc | info@tcihospital.tc

ONCO LOGY

the diamond challenge Employees at Turks and Caicos Islands Hospital are being pitted against each other in an incentivebased competition for a prize pool of US$3,000 to spotlight the most exemplary quality improvement initiative introduced over recent years. ‘The Diamond Challenge’ was announced as the health care organisation prepares for another accreditation assessment in June 2018. Accreditation is an independent assessment of a health care organisation’s performance against internationally recognised standards of best practice. The Turks and Caicos Islands Hospital has been accredited at the Diamond level since March 2012, which is the highest level achievable under the ACI Qmentum International Accreditation Program. A full-site survey is carried out every three years by independent overseas assessors to retain accreditation status.

Hospital employees may enter individually or as a team of no more than five persons. However, initiatives must show elements of the team dynamics. The quality improvement initiatives submitted must have been implemented between the years 2015 – 2018 and must show measurable impact or evidence of improvement in the practice environment.

The primary objective of the competition is to recognize health care professionals and encourage teams to evaluate and audit the output of their respective quality improvement initiatives in conjunction with the company’s strategic plan to continuously improve the delivery of health care services. The winners will be revealed on June 8th, 2018.

Submissions will be in poster format with strict guidelines, success factors, supporting literature/research and evidence coupled with a fast paced 3-5 minute in-person presentation before a diverse panel of judges.

InterHealth Canada - Turks and Caicos Islands Hospital is seeking to form a standing committee to improve stakeholder engagement and ensure the inclusion of public opinion in future service improvement initiatives. The private health care management company released a public request for applications to become a member of the Community Advisory Committee (CAC) as an act of community service and devotion to volunteerism. Interested persons should provide information demonstrating that he/she has the experience, attributes and insight to deliver relevant and rational suggestions and perspectives on health care matters of general interest to the community. The CAC shall bring together individuals with a variety of experiences with IHC - TCI: • To provide feedback on, and ideas for, initiatives and programs that enhance, ensure and embrace the model of patient-centered care; •To be a collaborative, positive and rational champion for the enhancement of high-quality patient-centered care at IHC - TCI; • To advance patient engagement and patient-centered care principles and practices at both medical centres;

Other duties may be assigned from time to time by the committee. Stakeholders are defined as the patients, staff, volunteers, healthcare providers and residents served by Turks and Caicos Islands Hospital. The attention of interested applicants is drawn to a section of the Terms of Reference setting forth the guidelines of the Community Advisory Committee. The committee shall comprise of the following: • A Co-Chair model by the end of the first year; • A minimum of ten general (non- IHC - TCI) members; • Two ex-officio members, which will be the CEO and Manager of Public Relations and Marketing whose roles help to enhance CAC activities; • Any other attendees will be by invitation only based on the agenda; In order to ensure a balanced representation, at least 50% of the members of the CAC shall be family/patient/community representatives who are not directly affiliated with InterHealth Canada – Turks and Caicos Islands Hospital. The term for general members is two years, renewable for a maximum of 2 terms (4 years). The CAC shall meet every second month or at the call of the Co-Chair(s). Persons of varying professions and skill sets were encouraged to apply for membership. However, potential applicants should possess the following core qualities:

• Pre-existing passion for causes including health care matters • Eagerness to participate at every meeting • Dependable and consistent • Strong desire for stewardship to others • Supportive, but willing to express their own opinion • Willing to learn as much as possible about health care operations • Community-connections; knowledgeable of community concerns • Uphold a positive reputation in the community and good character Applications were accepted in the format of a letter containing the following information: Description/personal background of the applicant; Details of previous or current civic-involvement or affiliations; Professional/educational credentials. Members will be selected in accordance with a process set out in the CAC terms of reference. The deadline for expressions of interest was announced as April 6th, 2018. Turks and Caicos Islands Hospital Public Relations & Marketing Department; PO Box 1044, Providenciales, Turks and Caicos Islands, BWI; Office Phone: +1 649941-2800 Ext: 71223; E-mail: info@tcihospital.tc

THEINTERVIEW

HAPPENINGS FROM ACROSS OUR HEALTH CARE FACILITIES Career's Day at Enid Capron Primary "What do you want to be when you grow up?" It's a fun and common question posed to kids to gauge and tickle their interests.

Job Readiness Mock Exercise Representatives from the Human Resources Department traveled to HJ Robinson High School on Grand Turk to participate in the Exit Readiness Mock Interview Exercise. The exercise was held on February 21st to sensitize upper level students on the expectations of applying for a job. Students were interviewed by members of the HR team to create a real-life scenario and given recommendations on how they can improve.

Grand Turk VTE Survey Winner The Venous Thromboembolism (VTE) Quiz was one of the initiatives launched during the hospital's VTE awareness month in October 2017. World Thrombosis Day was also observed during this period. The first two staff members across both hospital sites to achieve a score of 100 % received a $100.00 USD gift certificate. Physiotherapist based at Cockburn Town Medical Centre, Marsha-lee Whitlock, won the competition on Grand Turk. Winners of the Cheshire Hall Medical Centre Quiz were announced in the most recent newsletter edition.

THREE NEW YEARS DAY BABIES The first baby of 2018 born at Cheshire Hall Medical Centre on Providenciales was delivered in the early afternoon hours of the New Year. The 2lbs, 2oz girl entered the world at 1:17 p.m., born to mother Esther Duveau and father Nicolas Dieuffrant. Just over six hours later, another baby girl weighing 6lbs, 6oz was delivered at 7:35 p.m., to mother Jean Louis Meritable and father Norcillien Doreus. The third baby delivered on New Year’s Day at 11:37 p.m. altered the pattern of baby girls being recorded as the special day nearly came to a close. A bouncing baby boy named Bradley Arthur was born to mother Nanoune Celestine and father James Arthur. Little Arthur weighed 6lbs, 4oz at birth. The parents received a gift bath tub stuffed with infant-care items such as diapers, clothes, bibs, baby wipes, and more, courtesy of Turks and Caicos Islands Hospital. Commenting on the birth, Deputy Chief of Clinical Services at TCI Hospital, Mikette Been said: “Congratulations to each parent on their new born. Our doctors and nurses are always happy to share in this very special moment. In 2017, there were no babies born on the actual first day of the year at our health care centres, hence, we were hoping for a new year’s baby, and surprisingly there was a trio. This is the first year since opening in 2010 that as many as three babies were delivered on January 1st at our health care facilities."

JAN - MAR 2018 | ISSUE

During the Enid Capron Primary School Career Exposition on Thursday, February 1, medical and clinical staff at TCI Hospital were happy to provide students with insight into the various careers in health care and the qualities required for students who may desire to join the field in the distant future.

THE INTERVIEW

CODE BLUE DRILLS Teams participate in a refresher session on responding to a code blue scenario.

EDUCATION DEPARTMENT:

Every second counts. Over a dozen random code blue drills are scheduled for 2018 across various departments at TCI Hospital as part of the health care facilities robust continuous professional education program to ensure staff are always refreshed on the response and procedures expected in a code blue scenario. Code Blue is an emergency hospital code used to indicate a patient requiring immediate resuscitation.

The Office of Education, which is a division of the Human Resources Department, is mandated with co-ordinating and administering a suite of mandatory and optional programs, which include soft skills workshops, in-service training, continuing professional education, web-casts, online learning and professional recertification for staff. The department invests much time in ensuring that the clinical and non-clinical human resources of the Hospital are afforded the opportunity to develop and enhance their technical skills and abilities. Drills are also conducted for other codes throughout the year.

DOCUMENTATION & ROOT CAUSE ANALYSIS Special CME Presentation CNA Hardy, a leading specialist commercial insurance provider, conducted a two-day workshop at Turks and Caicos Islands Hospital on March 13th-14th, 2018. The company is also the health care organisationâ€™s insurer and due to this connection has provided various educational sessions.

Root cause analysis (RCA) is a structured method used to analyse events. Initially developed to analyse industrial incidents RCA is now widely deployed as an error analysis tool in health care. Quality and patient safety are central to the values of the Turks and Caicos Islands Hospital. As a result, the organisation continues to focus initiatives on further strengthening these areas. Isha Honore, IHC Quality Risk and Patient Safety Manager said: "We are grateful for the opportunity to learn from, and exchange knowledge with experts in the field. We wish to extend a big thank you to CNA Hardy for another excellent workshop."

CNA Hardy International Risk Director, Caroline White who is also a registered nurse, presented on the topics of Incident Management, Root Cause Analysis and Documentation. Health care organisations must dig deep to unearth the root cause(s) and develop solutions that address the problems from a systems perspective.

Caroline White and her two colleagues visited the Turks and Caicos Islands Hospital in 2017 to provide a special presentation on risk analysis and risk registers. White also met with various clinical teams last year.

STABILISATION OF COMMON NEUROLOGICAL CONDITIONS Dr. Nicholas Qandah DO, FACOS, Director of Neurological & Spine Surgery atÂ Mohawk Valley Health System, St. Luke & St. Elizabeth Hospitals conducted a special presentation at TCI Hospital on March 8, 2018. 29

The CME was titled Emergency Stabilisation of Common Neurosurgical Conditions. Many neurosurgical conditions present and inorder to provide an optimal outcome, prompt recognition and response is required.

HEALTH PROMOTION

CANCER: COMMON QUESTIONS Interview with Gemma Watson Oncology Specialist Nurse

In observance of World Cancer Day marked on February 4, 2018, Oncology Specialist Nurse at Turks and Caicos Islands Hospital, Gemma Williams-Watson answered some common cancer questions. For educational purposes, these questions and answers are simplified below. 1. What is cancer? Cancer is when cells in the body divide and grow in an uncontrolled manner. These cells then form lumps or tumors. Cancer can spread to other areas of the body and therefore early detection and treatment is essential to cure. 2. What causes cancer? We canâ€™t say what causes cancer but we do know many risk factors or lifestyle choices that can increase your risk of getting cancer.Â By minimizing or eliminating these factors you can then decrease your risk. For instance, we know smoking, lack of exercise and obesity, and a poor diet are all risk factors for cancer. We also know that if you have a strong family history of cancer it can increase your own risk. This is a risk that is uncontrollable so it is even more important to make a conscious effort to decrease your risks and attend regular screening. 3. How is cancer diagnosed? Different cancers are diagnosed in different ways, and therefore a range of screening techniques are recommended.

TREATMENT OPTIONS AND RISK FACTORS Screening is designed to detect cancer at its earliest stage, and then further testing is done to understand the individual’s cancer in more detail. Screening methods include mammograms, colonoscopies, pap smears and certain blood tests. If a tumor is identified following a screening then further tests must be performed such as a tissue biopsy and scan to give the doctor additional information.

6. Which type of cancer is most severe? The majority of cancers, if detected in the early stages, can be treated effectively and are potentially curative. Cancer that is diagnosed in an advanced stage, meaning when it has spread to other organs or parts of the body, makes cure less likely and sometimes not possible at all. In these cases the focus of treatment then shifts from cure to controlling the spread of cancer and increasing a patient’s quality of life. To say one cancer is worse than another is not really possible. All cancers are serious conditions and must be treated quickly to get the best results.

4. How is cancer treated? Treatment is specific to the type of cancer and the individual patient. Modes of treatment include surgery, chemotherapy, hormone therapy and radiotherapy, but not all patients will require all of these treatments. The treatment plan is based on the individual patient and their clinical picture.

7. Can injuries cause cancer? No, there is no evidence to show that previous injuries can be a direct cause of cancer.

For example, how well the patient is and if he/she has any other health problems. This information is reviewed along with lab reports and scans etc. Treatment is tailored to an individual. This is why not all breast cancer patients will receive exactly the same treatment. There are many different types of breast cancer and each requires a specific treatment plan.

8. Can stress cause cancer? What we do know is that chronic stress or high levels of stress maintained for long periods of time can have an impact on your immune system. For example, you may feel more exhausted and be more susceptible to coughs and colds. We also know that high levels of stress can cause an imbalance in the body’s naturally produced hormones and that some cancers are hormone driven, so this means there is a possible link between the two, but we can’t state that stress directly causes cancer.

Doctors around the world in the field of Oncology follow international treatment guidelines. These guidelines direct the treatment plan; identify a particular type of surgery or specific drug regimen. The treatment is not solely chosen by the doctor, the decision is directed by these international treatment guidelines.

9. What are the risk factors for cancer? Some risk factors include smoking, high alcohol intake, lack of exercise and obesity, and poor diet. These risks can be managed and decreased by sensible life choices. Making the right choice and making a concerted effort to ‘live well’ is incredibly important for your own wellbeing. Also, if you have a strong family history of cancer this can increase your own risk so regular screening and self checks are extremely important.

Cancer treatment is now becoming more personalised due to gene and hormone profile testing, whereas before it was almost ‘one size fits all’. In some cancers these tests can help to identify exactly which drugs will help a particular patient’s type of cancer. When a treatment decision is being made, many pieces of information must be assessed to build a clinical picture of the patient. For instance, the scan report, lab report, blood tests and hormone receptors plus the patient’s medical history, current health status and personal preferences are all taken into account. This clinical picture is then compared to the guidelines and a particular treatment plan is decided specific to the patient.

10. Is cancer contagious? No, cancer is not contagious. Cancer is formed due to a malfunction in cell growth; it is not passed on via bodily fluids or touch. 11. Can cancer be prevented? We’ve spoken about the risks and how to minimize your own cancer risk but unfortunately we are unable to completely prevent it which is why screening and early detection is so important.

Some of these examples include: every breast cancer patient do not require a mastectomy; every breast cancer patient do not require radiotherapy; Some breast cancer patients will require hormone therapy after they have completed chemotherapy, and some patients will not require any hormone therapy. It is very specific to the individual, which is why patients should not compare themselves to other patients, even if they appear to have the same diagnosis.

12. What are the side effects of cancer treatment? There are different modes of treatment and each of these have their own possible side effects. Chemotherapy alone has many different potential side effects but not all chemotherapies have the same ones.

5. What are the different types of Cancer? There are more than 100 types of cancer, but some are more common than others. The most common cancers seen in the Turks and Caicos are breast, prostate and colorectal.

For instance, not all chemo drugs result in hair loss. Radiotherapy, depending on where the patient’s cancer is located, will result in different side effects because the rays are being aimed at different parts of the body. Before a patient begins any form of treatment, the side effects are discussed so they are able to make an informed decision about commencing treatment.

17. Has there been a large number of deaths in the TCI due to cancer? As we know, a number of patients passed away in 2017 that had been diagnosed with cancer and as a result of this, it was important to review the data about these patients. Upon reviewing the data, some really important related factors were highlighted. Some of the patients that passed away succumbed to other health issues rather than the cancer. So although the patients did have cancer, that is not why they passed away.

13. Are the symptoms of cancer treatment severe? All types of treatment have side effects so it is important that the advantages are weighed against the disadvantages before commencing any sort of treatment. It is also important to say that not all patients respond in the same way. For instance, 100 patients with breast cancer could be given the same drug, but each patient will report a different side effect profile. This is because we are all individuals and therefore, patients are all different in how they cope with different situations. Some patients do find the side effects difficult to deal with and when that happens we discuss all possible options available.

Some patients even at diagnosis have advanced cancer so cure becomes almost impossible. In this group of patients, our aim is to ensure they feel as well possible for as long as possible. We aim to minimise symptoms such as pain or nausea and continue to care for them based on their personal preferences and individual needs. Another key point to make is that cancer cells are very clever and often stop responding to cancer treatment especially if the patient has an aggressive cancer or they have had a lot of previous cancer treatment. Medical science is providing us with new treatment possibilities every day through research and drug trials, but unfortunately even medical science cannot always offer the cure or answer we would hope for.

14. What happens when cancer goes into remission? Complete remission means there is no sign of the cancer on physical examination, on a scan or in any other test. Some doctors may use the phrase ‘no evidence of disease’. It is also important to say that remission and cure is not the same thing.

We are very lucky in the Turks and Caicos because we have virtually unlimited access to medications whether it’s chemotherapy or supportive treatments. This allows us to offer multiple treatments if these are what the patient require. Some patients do decline treatment due to personal beliefs or concerns; some make a decision between the family that acute medical treatment is not what suits them or their wishes. In these cases, we continue support the patient and offer other forms of assistance and care wherever we can.

If the cancer is in remission it does not mean the cancer is cured. If the cancer does come back it is usually within 5 years of the original diagnosis. After that 5 year period, if there is still no sign that the cancer has returned, some doctors may say that the patient is then cured. 15. Can cancer be cured? Yes, many cancers can be cured if they are diagnosed early. This is why regular screening is so important. When cancer spreads to other areas of the body it makes it very difficult and often impossible to cure. If people attend screening regularly, tumors can be identified early – this gives the patient the best chance for a positive outcome. 16. Is there a concern for cancer diagnosis in the TCI? The hospital cancer registry collates data on all patients diagnosed by or referred to the hospital. The trends formed by the data can then help plan care for the future. From this data we found that in 2015 there was a large increase in the number of cancer diagnoses, but since then the annual number of cases diagnosed at the hospital have decreased. In 2016, there was a drop in annual numbers compared to 2015, and again in 2017, there was a decline in the annual number of cases diagnosed compared to 2016. The number of patients diagnosed with cancer feels high because it is such a small community and for many people these patients may be friends or even relatives so it is understandable that it feels very personal and close to home. Cancer is certainly in the forefront of everyone’s mind which is good. Cancer is an extremely important disease to be actively aware of as it is increasing globally and we should be making a conscious effort to live healthy and get screening when recommended.

OPERATING ROOM NURSES BECOME CERTIFIED TRAINERS

Two Operating Room Nurses at Turks and Caicos Islands Hospital are now certified trainers for Endoscope Reprocessing following the completion of a course offered by the Society of Gastroenterology Nurses and Associates (SGNA). Senior Registered Nurses, Haydee Dayupay and Jenifer Masiclat, recently travelled to Plymouth, Minnesota to complete the training requirements.

While the transmission of infectious organisms during gastrointestinal endoscopy is considered low, the prevention of infection through increased vigilance and continuous training is imperative. Therefore, TCI Hospital has sought to ensure an astute investment in maintaining the competencies for the Surgical Services team on an annual basis. Chief of Clinical Services, Douglas Moore said: “The inclusion of international best practices in the area of Infection Prevention is a key principle in reprocessing surgical endoscopy devices. Jenifer and Haydee have gained the knowledge and skills necessary to develop and implement a continuing education and quality assurance program for our facility as trainers. These leadership qualities demonstrate our true commitment towards setting the bar higher for quality improvement at Turks and Caicos Islands Hospital.”

The Society of Gastroenterology Nurses and Associates (SGNA) is a professional organisation of nurses and associates dedicated to the safe and effective practice of gastroenterology and endoscopy. SGNA is accredited as a provider of Continuing Nursing Education by the American Nurses Credentialing Centre’s Commission on Accreditation. The certification allows the Surgical Services Department at Turks and Caicos Islands Hospital to incorporate the latest international standards, guidelines and techniques to ensure endoscopes are cleaned safely and effectively. Endoscopic diagnostics and therapeutics continue to expand as new technology enable minimally invasive techniques and endoscopic equipment to improve clinical outcomes and also reduce risk. The organization’s commitment to keep pace with these improvements provides the opportunity to offer a wider range of endoscopic services.

H E A L T H

HEALTH

PROMOTION |

THE

P R O M O T I O N |

INTERVIEW

T H E

I N T E R V I E W

in the media WORLD CANCER DAY In anticipation of World Cancer Day, Doctor Phillip Burgess - General Surgeon at Turks and Caicos Islands Hospital and Gemma Watson - Oncology Specialist Nurse appeared on 'Health Matters' to discuss the topic of cancer. Radio Turks and Caicos 107.7fm aired the show on Monday, Jan 29th. World Cancer Day is an international day marked on February 4th to raise awareness of cancer and to encourage its prevention, detection, and treatment.

THE DIAMOND CHALLENGE TCI Hospital Quality Risk and Patient Safety Manager, Isha Honore sat down with PTV to discuss “The Diamond Challenge”. Hospital employees are being invited to showcase a quality improvement initiative in a competition to win a prize pool of US$3,000. Staff members are excited and gearing up for the competition.

FLU SEASON - HEALTH EDUCATION General Practitioner, Doctor Henry Blythe sat down with PTV News to discuss the flu virus -- signs, symptoms, prevention and flu treatments. Influenza (Flu) season reoccurs annually during the cooler months and is characterized by a prevalence of outbreaks of Influenza. Seasonal flu outbreaks can happen as early as October, however, most of often flu activity peaks between December and February.

H E A L T H

P R O M O T I O N |

T H E

I N T E R V I E W

QUALITY RISK AND PATIENT SAFETY ROUNDS

Quality Risk Patient Safety Walk Rounds were launched at Cheshire Hall Medical Centre during the latter weeks of March and will be conducted by an assigned Senior Manager supported by a team on a quarterly basis. The initiative seeks to demonstrate senior managers’ commitment to quality and safety for patients, staff and the public; Increase staff engagement and develop a culture of open communication; Identify, acknowledge and share good practice; Support a proactive approach to minimising risk, timely reporting and feedback; Strengthen commitment and accountability for quality and safety.

'GUESS WHO IS THE BABY' CONTEST? The Public Relations and Marketing Department at TCI Hospital is currently devising a fun 'Guess who is the baby contest?' Participants will be invited to submit a baby picture of themselves to one person who will keep track of their identities. The pictures will be shared with staff via notice boards and other mediums inviting persons to make their official guesses via ballots. The ballots will be tallied on a designated day and the person with the most correctly guessed pictures will win a prize.

ABOUT THE EDITOR

JUNE 2018

THE

I TER IE Diamond Challenge

T I OSPITAL A AR E A

IA O

A T IR TI E

I A

INSIDE THE ISSUE

T T

Dysport.

•

Turks and Caicos Islands Hospital undergoes a third accreditation survey.

•

Digicel donates free high speed internet for dialysis and oncology patients.

•

Special ceremony held to mark eight years of hospital operations in Turks and Caicos.

•

TCI Hospital hosts Diamond Challenge finale and announce the winners.

•

Patient shares a testimonial of the care received at TCI Hospital.

US BOARD CERTIFIED SURGEONS

LIVE ABOVE THE LINES. 1

Call +1 649 941 2800

THE INTERVIEW

CONTENTS 03 06 09 12 14

AN EMBLEM OF MEDICAL EXCELLENCE The Turks and Caicos Islands Hospital, privately managed by InterHealth Canada, remains among the elite 37% of an estimated 243 ACI internationally accredited medical facilities currently listed as Diamond accredited, and the only facility in the Caribbean region. It is an extraordinary accomplishment for a hospital in such a small, developing country to receive Diamond status in three consecutive surveys. The receipt of such an award proves that the standard of secondary health care services provided at TCI Hospital is comparable to facilities in countries such as Brazil and United Arab Emirates, which have a concentration Diamond accredited medical centers under the ACI International Program. 3

The Turks and Caicos Islands TCI

Organisational Practices. These

safety of patients; the

Hospital has participated in the

standards and practices are based

environment; the assurance of the

Accreditation Canada

on initiatives to safeguard patients

quality of results and appropriate

International ACI

against adverse safety incidents.

interventions.

The accreditation of the TCI

The coordination strategy utilized

Hospital under the Health

by TCI hospital involved the

Standards Organization s

commissioning of an Accreditation

mentum

program on three occasions since opening in April 2

. The facility

received two consecutive Diamond awards in March 2 and March 2

5, and completed

mentum International program

committee chaired by the uality

its third successful accreditation

is pursued every three years to

Risk Patient Safety Manager and

evaluation in une 2

ensure a continuous culture of

the appointment of team leaders

a three month extension due to

quality improvement remains in

responsible for the

ma or hurricane recovery efforts.

the hospital s management

implementation of service

The results were released several

system. The process also helps to

requirements in their respective

weeks after the survey.

maintain international

units. The committee convened on

requirements of technical

a monthly basis to discuss the

Accreditation is a formal and

competence. The Accreditation

progress of each team, and

internationally recognized

assessment system of quality

collaboratively charted action

process conducted by an

management and technical

plans to address areas for

established external organization

competence is comprised of the

improvement, where necessary.

to assess the technical

following areas: competence of

Prior to the official survey in une

competence and reliability of a

personnel; methods validated and

health care organization against

verified; traceability of

internal readiness assessments

fourteen

measurements; calibration and

were completed to ensure any

maintenance of equipment; the

existing gaps were closed.

, following

International

Service Standards and thirty three 33 Required

, a series of rigorous

E E

STAFF ATTEND PRELIMINARY DEBRIEFING

As part of the accreditation process, the organization reviewed and updated over 5

It truly takes a TEAM to undergo such a rigorous assessment. Let us staff continue to be naturally excellent in everything we do. e can ustifiably be proud of what we have achieved and InterHealth Canada is proud of you all.

policies and

procedures, implemented a new policy management software and management structures to improve workflow. In addition, the company increased the frequency of quality rounds undertaken by senior leaders and upgraded the orientation and mandatory training programmes to incorporate blended learning. The Emergency and Disaster Response Plan was also updated following an analysis of the previous hurricane experience in September 2

. The survey team were

impressed by the quality initiatives and technical upgrades implemented across all levels of the organisation. The recently launched Diamond Challenge initiative, which showcased eight

quality service improvement

programmes with measurable impact in the practice

GEORGE COMMANDER, CHAIRMAN OF IHC BOARD MARTIN DAWTRY, FACILITIES GENERAL MANAGER GASTON LEVAC, CHIEF EXECUTIVE OFFICER

environment, also reflected the organizations commitment to quality improvement.Â

ANNIVERSARY CEREMONY

THE INTERVIEW

STAFF APPRECIATION WEEK Employee recognition knows no calendar it s an important part of company culture all year long. However, the Human Resources Department in con unction with the staff welfare committee at Turks and Caicos Islands Hospital utilized the hospital s eight anniversary to show appreciation to staff for their efforts and immeasurable impact on the delivery of health care services.

i Di

ion CT C

The week of April th commenced with a formal ceremony during which the leadership team expressed their heartfelt gratitude for the commitment of staff. This ceremony set the stage for a series of exciting events.

C l

al E

o i ion The Turks and Caicos Islands Hospital has over 2 nationalities represented in the workforce. The organisation embrace employees with different backgrounds who can bring together a variety of perspectives and international experience to enhance the delivery of health care services. It was only fitting to celebrate such a diversified workforce in the form of a cultural exposition held on the property of both medical centres. Employees of different nationalities were invited to display their culture in the form of music and dance performances, traditional attire and native cuisines. Both events yielded a great success in the level of attendance and participation. The relaxing atmosphere promoted cultural awareness, and persons from the community were also present to witness the hidden talent.

THE • INTERVIEW

M Staff members of Cheshire Hall Medical Centre were also treated to gift bags with tokens of appreciation. Â The Chief Executive Officer accompanied by other managers toured the hospital with filled carts. In con unction with nurses week, nurses also received platters of fresh fruit from managers of the nursing divisions.

T L P

P T

Image o

ome

inne

R Congratulations to the winners of TCI Hospital's Staff Appreciation Raffle 2 . The raffle tickets were drawn from a sealed container on ednesday April th at designated times by random persons during a video cast across both medical centres. The lucky winners across Cheshire Hall Medical Centre and Cockburn Town Medical Centre were as follows: GRA D PRI E

ERS

yothi George Emergency Outpatient Department st Prize Round trip ticket to Florida MIAMI OR FORT A DERDA E inclusive of a three night stay valued at 5 . per night Phara ean Facilities Management Catering 2nd prize Samsung S Courtesy of Flow 2nd Prize Royal ewels Gift Certificates valued at

5 .

Mr. Tramieal Smith Catering Department urse enesha Tavares Emergency Department 3rd Prize Gift Certificates valued at 5 : Mrs. Patricia Dunne Facilities Management Catering Dr. Dionne ightbourne Medicine Mr. Gurura a Basavara Finance Mrs. ay anes illiams Administration

Congratulations to the winners of the family feud competition, which was referred to instead as organisational feud given the context of the competition. Teams from each medical centre were pitted against each other. The answers to the questions were unique in that they were based on the most popular answers sourced via an employee survey, which was conducted on employment related matters.

THE I

Contestants were challenged to provide the most popular answers to each question, which were placed on the game board and revealed as teams made a submission.

TER

It was an intense battle across both sites. The team representing the Cockburn Town Medical Centre amassed the highest score and comprised of employees Simone Powell, erissa ewis, Tamra Brown, anelle Hamilton, Margaret Saunders and urse. O.O.

The udges were Dr. Hamlet ation Acting Chief Executive Officer of the ational Health Insurance Board, Mrs. Ruth Forbes Senior ice President of Fortis TCI and Dr. Marcella Malcolm of Carolina Private Clinic. The challenge was spearheaded by Isha Honore, uality Risk and Patient Safety Manager.

Eight teams of health care professionals showcased their best quality initiatives in a unique competition held on ednesday May 3 th inside the main foyer at Cheshire Hall Medical Centre for a prize pool of S 3, sponsored by InterHealth Canada Corporate, the private health care management company. The Diamond Challenge spanned five months of team preparation, and the finale featured a poster and oral presentation by each team leader before a panel of external udges. Each initiative submitted must have been implemented between the years 2 5 2 and reflect measurable impact or evidence of improvement in the practice environment.Â

The Best uality Improvement Initiative for building a Culture of Safety recorded a tie between the Baby Friendly Initiative and the Competency Mandatory Training Initiative. The first initiative was led by Dr. Dawn Perry Head of Obstetrics and Gynecology and Mikette Been Chief of Clinical Services. The latter Initiative was led by acqueline Moe Cox Education Manager and urline Barnett urse Educator. 12

The top award for the categories of Best uality Improvement Initiative towards Safe Medication Practices and Best Overall uality Improvement Initiative, were captured by the Medication Reconciliation Pro ect, which secured a double win. The pro ect comprised of Dr. Sani Amatti Head of Pediatrics, Dr. Ravindra Ga endragadkar General Internist, Detorrie Tennant Hospital Information Systems Manager and Tony ilton Pharmacy Manager.

The pro ect comprised of Dr. Sani Amatti Head of Pediatrics, Dr. Ravindra Ga endragadkar General Internist, Detorrie Tennant Hospital Information Systems Manager and Tony ilton Pharmacy Manager. The title of the overall competition derived from the hospital s quest to receive diamond status once again. Turks and Caicos Islands Hospital underwent a third accreditation assessment on une th 5th 2 .

A full site survey is carried out every three years by independent overseas assessors. The acute secondary health care facility has been accredited at the Diamond level since March 2 2, which is the highest level achievable under the ACI mentum International Accreditation Program. Accreditation is an independent assessment of a health care organization s performance against internationally recognized standards of best practice.

CH ISTY DEMPSY

TCI Hospital Chief Executive Officer, Gaston evac commented on the internal competition. evac said: “The excellent work presented by Diamond Challenge team members is a reflection of the quality work delivered by all hospital personnel. It bodes well for the TCI Hospital receiving an unprecedented third straight Diamond Accreditation award. To obtain a Diamond Award from Accreditation Canada International demonstrates that the hospital is in compliance with the world s most rigorous standards of care, service and performance.”

Dialysis and Oncology patients receive free high speed internet during treatments at TCI Hospital, courtesy of Digicel.

e e ei e e ti i ati n t mana e t in em hi ia a e

Issue 27 | 234

COMMUNITY CONNECTED RAISI G A

ARE ESS OF HEA TH CARE OPERATIO S

CLEMENT HOWELL HIGH SCHOOL CAREERS DAY 2018 Health care professionals from Turks and Caicos Islands Hospital participated in Clement Howell High School Career's Day 2 held on Thursday May 3rd at the Graceway Sports Complex, Providenciales. The theme for this year is “Building our Future by Guiding the Present.” The departments represented were doctors, laboratory, nursing and paediatrics. Students were very keen on learning more about the intricacies of each health care discipline.

'MED REC' AWARENESS

SCHOOL TOURS HOSPITAL hurricane awareness

The Medication Reconciliation Med Rec team continued initiatives on May th 2 to educate patients on the importance of knowing their medication history. Medication Reconciliation is a formal process in which healthcare providers partner with patients and their families to ensure an accurate and complete medication information transfer at interfaces of care.

Biology students from Holy Family School conducted a tour of Cheshire Hall Medical Centre on May th 2 . The group explored the behind the scene operations of the Emergency Department, Surgical Suites and Diagnostic Imaging Department. Health care professionals from TCI Hospital raise awareness of medical professions via periodic site tours and outreach initiatives.

.TCIHOSPITA .TC 18 I FO

In preparation for the 2 Atlantic Hurricane Season, TCI Hospital showcased the hospital's emergency and disaster response plan s and other related items at a Business Fair and Exhibition hosted by the Department of Disaster Management and Emergency DDME on Providenciales and Grand Turk on May th th, 2 .

TCIHOSPITA .TC

FEATU

LIVING WITH LUPUS

There is a popular quote that reads, Everyone you meet is fighting a battle that you know nothing about. For erissa ewis, Health Information Systems TeleHealth Administrator based at Cockburn Town Medical Centre, coping with upus is one of her biggest silent battles, until now. upus is a chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs. Inflammation caused by lupus can affect many different parts of the body. Doctors could not determine the cause of ewis s sudden symptoms back in 2 . upus can be difficult to diagnose because its signs and symptoms often mimic those of other diseases and upus presents very differently for each individual. â€œMy hands were swollen, my oints were stiff, and my heart was racing. I could barely make it out of my vehicle. My symptoms worsened over the following days. There was a consistent weird pain in my foot. I didn t understand what was happening to me, but I knew something was wrong,â€? said ewis.

Nerissa Lewis Story

IT IS I P T NT S SU VIV S T N V L L U S LV S S SU S In lupus, something goes wrong with the immune system, which is the part of the body that fights off viruses, bacteria, and germs foreign invaders, like the flu . ormally our immune systems produce proteins called antibodies which protect the body from these invaders. Autoimmunity means your immune system cannot tell the difference between these foreign invaders and your body s healthy tissues auto means self . As a result, it creates autoantibodies that attack and destroy healthy tissue. These autoantibodies cause inflammation, pain, and damage in various parts of the body.

ewis eventually secured a ob at TCI Hospital in 2 3. The biggest irony about her decision is the reality that hospitals generally are the place where she would be most vulnerable. Due to her overactive immune response, she is more susceptible to pathogens and illness, and her ob would require her to maintain computer systems across a facility established to care for ill persons. “Does that make me courageous or crazy she responded when asked why she decided to take the risk. She continued: “ hat uplifts me every day is being fortunate to work in an environment where my supervisor and manager are super supportive and would even volunteer to venture into areas of the hospital that may be too risky for me. They also allow me to reboot when I feel an onslaught of symptoms, and take breaks if I need to. If I have to work inside some patient areas, I would occasionally wear a mask as a precaution. However, I am comforted by the exhaustive and strict infection prevention and control procedures practiced across the facility.”

After eight months of exhaustive medical testing overseas to eliminate a long list of other diseases that doctors suspected could explain her sudden illness, a Rheumatologist provided a definitive diagnosis on her 25th birthday. It was upus a disease she had no knowledge of, and therefore she scurried to find useful medical literature to learn more. By then, she had already visited an overseas eurologist, Hematologist, and underwent a bone marrow biopsy to eliminate the possibility of eukaemia.

ewis may not be able to control her body, but she has mastered the art of controlling her thoughts and is now committed to raising awareness of upus. TCI Hospital has become ewis s unexpected place of refuge and safe haven as she is luckily surrounded by an army of doctors everyday who not only understand her condition, and can render medical advice if needed, but are within arm s reach in a case of emergency. She also wears a butterfly chain around her neck, which is the national symbol for lupus and reflects one of the more common symptoms, the butterfly rash.

Her diagnosis forced her to reconsider her preferred specialty in the field of Information Management and Technology. At the time, she was pursing her Bachelor s Degree in Telecommunications Management with a strong focus in networking. But this would require her to crimp wires and climb into ceilings, which was clearly going to be difficult, and sometimes impossible. As a result, she redirected her career path towards the management of IT systems and applications, which was less strenuous than her previous specialty area and more systems based.

“Persons who have lupus tend to hide their diagnosis. It s not communicable, or contagious. upus may sound like a scary thing but it should never be viewed as a death sentence. It is important as survivors to never label ourselves as sufferers, but instead serve as supporters with a positive attitude. ou can still have a relatively normal life. By sharing this story, perhaps I can help someone who may have the same condition to look on the bright side of life as I have chosen to do.”

“I have to see a doctor on a quarterly basis; I didn t know how that would affect my prospects of being employed after returning to Turks and Caicos from the nited States. However, I decided to be very open about my diagnosis during ob interviews, because the side effects would be visible in my preferred field, and may even occasionally affect my efficiency. The first ob obtained after leaving university and after being diagnosed with upus was heaven sent because it was a guarantee attached to my tertiary education scholarship. The hunt for my second ob was not so easy. I searched for two years.”

The upus Foundation of America estimates that .5 million Americans, and at least five million people worldwide, have a form of lupus. Although lupus can strike men and women of all ages, percent of individuals diagnosed with the disease are women. Systematic upus has also been diagnosed in 5, to , children and teenagers in the nited States alone. To learn more, visit www.lupus.org.

IT'S THE

NURSE TO

CHIEF

ABOVE

I S

T I

PROMOTION I

"I AM HUMBLED

I T I L

TO HAVE BEEN I

S S S

GIVEN THIS OPPORTUNITY TO SERVE THE

I S

COMMUNITY IN SUCH A CAPACITY." 21

OUR

STORY

THE INTERVIEW

I CARE. A

WORLD NURSES WEEK 2018 THE VARIOUS SPECIALTIES REPRESENTED INCLUDED NURSES FROM THE EMERGENCY DEPARTMENT, SURGICAL SUITES, MATERNITY, OUTPATIENT AND INPATIENT DEPARTMENTS, ONCOLOGY AND DIALYSIS UNIT.

P S

S T

I I

S S

T T T T

S I E

L E

THE INTERVIEW 23

LAB WEEK

FEATURE

PROFILES

PHLEBOTOMY: BEYOND THE NEEDLE

THE INTERVIEW

New Local Pharmacist The Pharmacy department wishes to welcome a new member to the team. Kennita Myers officially joined the organization on 18th June 2018 and has transitioned from working in a community pharmacy to a hospital setting. Kennita, a native of the islands, has obtained a Bachelors Degree in Biology from the University of Tampa in Florida and a Masters degree in Pharmacy from Keele University in England. Following tertiary level studies, she conducted a one-year internship at the Robert Jones and Agnes Hunt Orthopedic Hospital and is registered with the General Pharmaceutical Council in England.

Certification: Congratulations to Erika Williams

Kennita is excited about the cross-over to inpatient pharmacy as she believes it represents the best of both worlds. She is given the opportunity to dispense prescription medications similar to her role in the community pharmacy, but most importantly, she can now apply more of her clinical knowledge, directly interface with a multidisciplinary health care team, and spend time with patients to better understand their condition.

The Medical Device Reprocessing Department at TCI Hospital wishes to congratulate Erika Williams on becoming a Certified Instrument Specialist. Erika has worked in the department for over two years. The 10 month course was pursued at the Universidad Instituto Cultural Dominico Americano in the Dominican Republic on April 16th 2018, and funded by InterHealth Canada. The university is one of two prometric test centers in the Caribbean. All staff members in the MDR Department are now in receipt of the certification, which provides additional reassurance that employees the latest competency to provide quality, efficient and effective medical reprocessing service to its customers.

Overseas Conference Turks and Caicos Islands Hospital, Quality Risk and Patient Safety Manager, Isha Honore attended a conference on Health Care Quality hosted by the University of the West Indies, Faculty of Medical Sciences on 21st April 2018 in Trinidad. The conference focused on models of best practice with topics related to health care policy, systems, education and diagnostic services. InterHealth Canada sponsored the conference.

The reprocessing of medical instruments is a complex process. Technicians must possess an in-depth understanding of the components, dynamics and diversity of medical instruments.

By Mr. Ed Forbes, President of Exclusive Escapes Tours: “Please allow me to convey my gratitude to your staff who has provided my medical care over the past 2 years. I'm fully aware of how the media are sometimes quick to remind us of the shortcomings in the services provided by many government agencies and private sectors; nevertheless, I am extremely pleased and grateful to be able to confirm that reports such as these were not indicative of the services I received in both Grand Turk and Providenciales. I want to offer my heartfelt thanks to them and many others whose work is driving innovation and improving the lives of our people in the Turks and Caicos Islands. From the strong network of specialists and clinicians collaborating in both Grand Turk and Providenciales, to the organizations and InterHealth Canada who play such an important role in bringing new discoveries from labs to patients' bedsides; to the advocates, government representatives and donors who pave the way for expanding the knowledge of medicine.

They have come a long way since I left the Turks and Caicos Islands over 35 years ago. I have been in the care of many Doctors and Specialist abroad and there is not much comparison to the great service I have received here. Thank you for the unwavering dedication, the talents, skills and compassion that brings hope to our people and families. I am truly grateful for your enduring commitment to serve our communities. Furthermore, it is amazing to see the efficiency and patience that takes place within the hospital walls. A special thanks to internist Dr. Ravindra for his positive engagement and thoroughness with me. On a side note, I realize that in the Turks and Caicos Islands we have limited skills in this area of expertise; however, to ensure we have the needed maturity levels and tenure, the selection process should be vetted a bit more carefully when it comes to primary Doctors. I would be grateful if this letter could be forwarded to the relevant departments as I know it is always good to receive positive feedback when carrying out a difficult and challenging role.”

I an o ommend and a a ig han o o he n e and do o ho e e on d a he eme gen oom hi mo ning I needed lood o o m on i h addi ional need he e e no a le o ge he lood a a i a e lini ea lie ha mo ning o he do o o e a e e al o o go o he eme gen oom o o i l e eda ed i needed n e he e I a in o med he ill no e doing ill ge he an eda ion and he lood i h hei aining and e e i e a ell a all hand on de he e e a le o ge he lood he needed and m on a no a all a ma i ed I a e ia e hem o eing o nde anding and e e i ing em a h o a d in a i a ion ha a a ig deal o ee he g ea o do o and n e ih om a ion o

Chemotherapy If you think you know all about chemotherapy, it is important to separate fact from fiction. In this educational article, Gemma Watson - Oncology Specialist Nurse at Turks and Caicos Islands Hospital, provides the answers to the most common myths about chemotherapy.

✓What is chemotherapy? Chemotherapy (or chemo) is a type of medication that treats cancer. The goal of chemo is to stop or slow the growth of cancer cells. Chemotherapy is considered a systemic treatment – this means it treats the whole body and this is why patients get side effects. ✓What does it do to my body? Chemotherapy medications attack rapidly growing cancer cells, but they can also affect healthy cells that grow rapidly. The effect of these medications on normal cells can cause chemo side effects. These side effects are expected and in most cases and can be minimised to make the patient feel better. ✓What are the common side effects with chemotherapy? Different chemotherapies are used for a range of cancers and each has their own specific side effects. Also, if 10 patients were given the same medication each patient would respond differently. Patients are often encouraged to be mindful of making comparisons between themselves, other patients and their respective treatments. The most common side effects include: · Nausea (feeling of sickness) · Tiredness · Changes in bowel habits

✓Do I have to stop my natural treatments if I have chemo? No, we encourage patients to take an active role in helping themselves to feel better during their cancer journey and for many people that includes using natural treatments. The doctor should be informed of any treatments being taken to in order to gather a patient’s medication history. ✓Does everyone with cancer need chemotherapy? No, not all patients with cancer require chemotherapy. The same principle applies to surgery and radiotherapy. Every patient and every cancer is different. If chemotherapy is recommended, it means that this particular treatment is best suited to treat the cancer. ✓What can I do to help keep my body strong during chemotherapy treatment? Keeping your body as healthy and strong as possible is the best thing you can do to help yourself. Eating a healthy diet full of fruits and vegetables plus cutting out sugar, will help to make you feel better and minimize the side effects of your chemotherapy. Drinking plenty of water and going for a brisk walk 3 to 4 times a week – this will also increase your energy levels.

All of these easy changes will help to boost your immune system and keep you feeling as well as possible during treatment. MYTH BUSTING ✓“Chemotherapy kills people” – Chemotherapy does not kill people, chemotherapy aims to cure or control the cancer. If patients have a very aggressive cancer, cure may not be achieved but chemotherapy may help to slow down the growth of the disease to give the patient more time. ✓“It is dangerous for me to be around people if I’m having chemotherapy” – It is completely safe for your family and friends to be near you. There is no risk to your children or other adults even on the same day as your chemotherapy treatment. ✓“I’ll lose my hair” - Not every chemotherapy medication causes hair loss, and some only result in hair thinning. It depends on the type of chemotherapy you receive. ✓“My cancer must be really bad if my doctor ordered chemo” Chemotherapy treatment is given for many reasons and for many different types of cancer.

FACT VERSUS FICTION Sometimes chemo is given to shrink a tumor before surgery. Sometimes it is given to control disease and keep a patient stable. Many times it is given after surgery to help minimize the risk of the cancer returning. Doctors take many factors into consideration when developing the treatment plan for each patient, so comparisons should not be made between different patients. ✓“My life will be drastically interrupted while I have chemo” – This is not true. Many people continue to go to work and live their lives as normal. Patients may have a day or two after each chemotherapy when they’re not feeling like their normal selves, but that could happen to anyone if they had the flu or upset stomach. ✓“There is only one kind of chemotherapy, and it can treat any kind of cancer” - Many people believe all types of cancer are treated with the same chemotherapy medication but that is not the case at all. Different drugs target different types of cancer and work in different ways: to destroy cancer cells, to shrink tumours and to relieve symptoms of advanced cancer. These drugs may be given before, after or in combination with other treatments. ✓“Chemotherapy causes severe nausea and vomiting” - Just 20 years ago, chemotherapy was associated with intense nausea and vomiting but these days many chemotherapy drugs are in part designed to prevent nausea and vomiting, or reduce their severity. The anti-sickness medications that patients receive before chemotherapy plus the tablets they take afterwards, are very effective at minimising those bad feelings.

Some patients may still have some nausea for a couple of days, but vomiting is rare. ✓“Chemotherapy causes weight loss” – Usually the opposite is true! Many patients expect to lose weight during chemotherapy, and they’re surprised when they gain weight. Sometimes patients have lost a lot of weight prior to their diagnosis so gaining weight is actually often a good sign during treatment. ✓“Chemotherapy is only given to people who are dying” – Many years ago this was true. Chemotherapy used to be seen as the last resort. But now it can be used as a preventative measure after other primary treatments. For example, a cancer patient might have chemotherapy after a surgery as an added measure to reduce the risk of the cancer from coming back. ✓“Chemotherapy ruins your life” – Like every medication for every disease, medications have side effects that can make you feel unwell for a short time. If chemotherapy is suggested by your doctor, it means there are clinical benefits. Chemotherapy may mean that you won’t feel your usual self for a few months but once chemotherapy is completed, the side effects will stop and you can return to your normal daily life. ✓Chemotherapy is only recommended to patients that will benefit from the treatment. It is not offered to everyone. If the advantages do not outweigh the disadvantages, then chemotherapy will not be suggested.

H E A L T H

P R O M O T I O N |

T H E

I N T E R V I E W

in the media HEALTH

PROMOTION |

THE

INTERVIEW

INTERNATIONAL NURSES WEEK RADIO INTERVIEW Registered Nurses from Turks and Caicos Islands Hospital appeared on Health Matters Radio Show to discuss the various specialties in nursing; how nursing has changed over the years and opportunities for growth.

PORT-A-CATH TRAINING INTERVIEW Nurses Carl Lewis and Kurien Jolly sat down with PTV News to share more about their training in Port-a-Cath Medication Administration conducted at Sick Kids Hospital, a paediatric facility based in Canada. Both nurses received a certification in the specialist competency to care for paediatric Hemophilia cases. The training was funded by InterHealth Canada.

ONCOTYPE DX TEST INTERVIEW Doctor Larry Godfrey and Oncology Specialist Nurse, Gemma Watson conducted an interview with PTV News on Oncotype DX®, a tumor profiling test that helps determine the benefit of using chemotherapy in addition to hormone therapy for some estrogen receptor-positive (ER-positive) breast cancers. A recent study has found that genetic profiling on certain breast tumours may help to identify women who would have no additional benefit receiving chemotherapy. Instead, this group of patients would receive hormone therapy, which is administered via a tablet taken daily for 5 – 10 years. The Oncotype DX test eligibility criteria are early-stage breast tumors measuring one to five centimeters; Not spread to lymph nodes (glands under the armpits); Estrogen positive tumour and HER2 negative tumour. A patient must fit all four criteria, as stated by the genetic testing centre in the United States, to be eligible for the test. The test is available for eligible patients in Turks and Caicos Islands.

Educational Development

THE NTE

TO LET P PE D E OMPET T ON ED TO E N O E P T ENT M T T ON D N T N N E

In some parts of the world toilet paper wedding dresses can earn up to . In fact, a local florist and designer won the amount last month during the th Annual Toilet Paper edding Dress Contest hosted in ew ork. Â The Turks and Caicos Islands Hospital uses a similar theme to reinforce concepts of teamwork, communication, risk assessment and customer profiling in mandatory training sessions on uality Risk and Patient Safety.

Teams were asked to create a toilet paper dress, which was modelled by a chosen member of the team. The dress is made only using toilet paper and tape provided. During the debrief and presentation segment, the teams were asked to explain how the task was accomplished via teamwork, what customer information was gathered before making the dress, identify the risks associated with the dress, and how were these risks were mitigated. The exercise was considered a creative learning experience, which emphasized the strategies outlined in the course programme.Â 31

BO T THE ED TO

THE

Clinical Ethicist

INSIDE THE ISSUE •

Turks and Caicos Islands Hospital unveils state of the art ventilator equipment.

•

Interim CEO Gaston Levac completes his assignment as Daniel Carriere returns.

•

Employees compete in a weight loss challenge for the biggest loser title.

•

Facilities Management introduce more ecofriendly practices at TCI Hospital.

•

Two highly skilled doctors share their love story and passion for patient care.

US BOARD CERTIFIED SURGEONS

LIVE ABOVE THE LINES.

Call +1 649 941 2800

THE INTERVI EW

Energy efficiency is particularly important in Â hospital settings with 24 hours a day, 365 days a year services.

Ecofriendly Decisions Â Hospitals consume large amounts of energy due to the nature of their operations and high utilization by employees, patients and visitors. Sophisticated heating, ventilation, and air conditioning systems control the temperatures and air flow. Several energy intensive activities also occur within the building. These include laundry, medical and lab equipment use, sterilization, computer and server usage, food services, and refrigeration. The concept of Corporate Social Responsibility upholds that companies have a degree of responsibility not only for the economic consequences of their activities, but also for the social and environmental implications. The department responsible for the physical infrastructure at InterHealth Canada - Turks and Caicos Islands Hospital adheres to numerous environmentally friendly practices. In recent months, more robust energy-efficient measures were introduced to save on health care expenditure. Thousands of traditional light fixtures have been replaced across both medical centers with safer, cooler and energy efficient LED incandescent alternatives.

THE INTERVIEW

the adoption of more sustainable practices. New industrial chilled-water systems were installed last year, which helps to reduce the hospital’s carbon footprint by a large percentage compared to its predecessor. These systems provide air conditioning across the hospital’s two medical centers.

Energy efficiency reduces running costs for hospitals, lowers carbon emissions and shows the public that a company is environmentally aware. Operating rooms are typically among hospitals’ heaviest users of supplies and a large producer of waste. Creative ideas are being sought to recycle sterile wrappers and other items in an effort to promote environmental stewardship in the coming years. One of the most cost effective means of reducing energy consumption is by setting the temperature back on air handling units when a department is unoccupied or closed.

The same best practice is enforced at TCI Hospital along with conservation efforts to encourage staff to turn off lights and any equipment after use. The hospital’s industrial plant has stringent planned preventative maintenance strategies to ensure any equipment used is the most efficient possible and there are several contractual requirements to monitor the building’s utility efficiency as part of the project agreement between InterHealth Canada and the Turks and Caicos Islands Government.

Additional practices implemented to create a more eco-friendly operation include the selection and use of cleaning products with minimal environmental impact. The chemicals in many cleaners are common pollutants. The company has also switched from conventional products to locally produced recyclable toilet paper and hand towels.

InterHealth Canada - Turks and Caicos Islands Hospital hosted a Medical Ethics Symposium for nearly 70 health care professionals at the Cheshire Hall Medical Centre on September 14th, 2018 under the theme â€œInformed Consent - Recommended Best Practices.â€?

Claire Horner, a Clinical Ethicist, Lawyer and Assistant Professor at the Centre for Medical Ethics and Health Policy at Baylor College of Medicine gave a keynote presentation. Horner stressed that informed consent is a process and not simply a form. This process involves several critical elements including disclosure of information, effective documentation, a patientâ€™s right to refuse treatment and exceptions to the informed consent rule in cases of emergency, incapacity, waiver or therapeutic privilege. The presentation provided an overview of the ethics of informed consent, shared decisionmaking, cognitive biases, decision aids, the difficulties associated with hard cases and what health care professionals should avoid.

Informed consent is based on the moral and legal premise of patient autonomy and their right to make decisions about a particular treatment or test with an understanding of the risks and benefits. The symposium was developed to exchange knowledge on the latest best practices, common challenges and pitfalls associated with soliciting informed consent from patients.

Other speakers based at the medical facility included Dr. Henry Blythe, General Practitioner who provided a regional perspective in partnership with Dr. Dionne Ranglin-Robinson, Anesthesiologist, who evaluated several key findings from a unique study on informed consent. The event was chaired by TCI Hospital Chief of Medical Services, Dr. Denise BraithwaiteTennant. ADVANCE HEALTHCARE DIRECTIVES, OR A LIVING WILL THAT PRE-DOCUMENTS A PATIENT’S WISHES CONCERNING MEDICAL TREATMENTS AT THE END OF LIFE OR INCAPACITATION IS A GROWING PRACTICE IN MANY JURISDICTIONS. Persons are encouraged to make decisions ahead of time so their care is aligned with their preferences and/or nominate a relative or friend to be their alternate decision maker in cases where informed consent is required. During the visit to the medical facility, Horner also conducted a special CME session and reviewed the hospital’s current policies and standards of practice related to informed consent. The expert’s recommendations will be used to further strengthen the existing framework. Other areas examined included practices related to Do Not Resuscitate (DNR) Orders and the withdrawal of LifeSustaining Care. The symposium is held every two years, and is extended to health care practitioners from across the country to promote standardized practices across community medical facilities to benefit the patient’s continuum of care.

"AS PART OF OUR QUALITY IMPROVEMENT, WE WANT PATIENTS TO BECOME MORE INVOLVED IN THEIR CARE. IT IS OKAY TO ASK WHY, OR DISAGREE WITH A PROPOSED TREATMENT. IT IS IMPORTANT TO REQUIRE FULL DISCLOSURE. MEDICAL CARE SHOULD NO LONGER BE APPROACHED IN A PATERNALISTIC MANNER AND PATIENTS HAVE THE RIGHT TO QUESTION THEIR CARE."

DR. HENRY BLYTHE CHAIRMAN OF THE MEDICAL ETHICS COMMITTEE AT TCI HOSPITAL

THE INTERVIEW

Informed consent represents one of the major tenets of medical ethics. This consent may be in the form of a consent document, verbal or implied. There are some cases that require written consent such as invasive procedures. It is important for our staff to be knowledgeable of the different scenarios where each of these cases apply.

INTERHEALTH CANADA A MAJOR SPONSOR OF CLINIC EXPLORATION PROGRAM 2018

TCI HOSPITAL TRAINING CENTRE

THE INTERVIEW

TCI Hospital has been tasked with providing a series of refresher training in CPR and First Aid to members of the Royal Turks and Caicos Islands Police Force. The sessions are scheduled to continue into October 2018. Participants have displayed great care and competence in the application of these life saving skills.

inspiration

THE BIGGEST LOSER MATCH The Human Resources Department at the TCI Hospital

EACH DAY IS A NEW OPPORTUNITY TO IMPROVE YOURSELF. TAKE IT AND MAKE THE MOST OF IT.

launched several initiatives during the third quarter of 2018 to promote continuous learning, health and wellness among employees. ‘Lunch and Learn’ is an informal opportunity for employees to learn at work. It is a one-hour session comprised of interactive discussions over a

The program is a combination of healthy eating tips,

complimentary lunch. The program was officially

weekly aerobic sessions held on property and group

launched on June 24, 2018 and is held twice per quarter.

exercises. All registrants were provided with a Biggest

The topics covered include an introduction to the

Loser Fact File, which include information on their

Employee Assistance Program called Inova, eating for a

personal weight loss record, healthy meal choices and

healthy life, work station ergonomics and building a

additional tips to accelerate weight loss.

culture of trust. In addition, the program is supported by the Facilities The second initiative launched is a resurrection of a

Management division of the company, which has

weight loss challenge dubbed the Biggest Loser. The

agreed to offer discounted low calorie meals on Trim

initiative was launched on July 2, 2018 and will conclude

Down Thursdays in the hospital’s cafeteria. The first

on October 5, 2018. The primary objective of the

place prize is $500.00 and $200.00 for the second

program is to help employees reach their individual

participant to lose the most weight.

fitness goals and maintain a healthy eating ritual as part of a permanent life style change.

ST KITTS AND NEVIS DELEGATION TOURS HOSPITAL

delegation from the Government of St. Kitts and Nevis visited the Turks and Caicos Islands Hospital on August 14, 2018 to learn more about the health care facility in pursuit of a similar National Health Insurance (NHI) program. The group conducted a tour of the Cheshire Hall Medical Centre and met with the senior management team to discuss the benefits and lessons learned from the perspective of the preferred acute secondary healthcare provider.

The delegation included the Permanent Secretary in the Ministry of Health and Gender Affairs and Chairperson for the National Commission for Universal Health Care in St Kitts and Nevis. The NHI is a proposed national system of shared contributions and prepayment by all persons for a package of health services to meet the health needs of the population. The Government of St. Kitts and Nevis unveiled a National Health Insurance Commission earlier this year.

Discussions with representatives from the National Health Insurance Board in the Turks and Caicos Islands was a major part of the exploration. The St Kitts and Nevis Ministry of Health is the national entity charged with the responsibility for the organization and management of health services and for formulating health policy. The public sector provides both population and personal health services through its subsidiary 20-year-old Marianne Teigen divisions. recently published her first young adult novel, and in only a month, it has reached the New York Times Bestsellers list.

NEWS

TCI HOSPITAL UNVEILSÂ NEW STATE-OF-THE-ART VENTILATORS The ventilator improves the ease of breathing and has additional safety features.

advanced, safe, and smart design.Â The software is a breath type that better manages a patientâ€™s work of breathing and supports more natural breathing compared to conventional mechanical ventilation.

. e v o l y it n u m Com

Thrombosis Awareness

THE INTERVIEW

STAFF BI D F AREW ELL TO

GASTON LEVAC, INTERIM CEO THE INTERVIEW

BEST WISHES.

APPREC I ATI ON G ATHERING F OR OUTG OING CEO

"I want to thank all TCI Hospital partners for having made my stay an interesting and learning experience. I wish you all the best.â€?

Love and Medicine

The promotion is as a result of ongoing succession planning within the nursing division and recognition of their hard work and dedication. The lead nurses will be coached and mentored, and will gain support from the team in their new role.

By Mikette Been Current Chief of Clinical Services Since Anne's departure to the UK three years ago, she had been doing well until four months ago when she was diagnosed with a terminal illness and was given 4 months of survival. On August 24th 2018 at 6:00am UK time, Anne passed away peacefully surrounded by family members. On behalf of all of us here at TCI Hospital, I have taken the liberty of sending our most heartfelt condolences and sympathy to Anneâ€™s family. The InterHealth Canada board of directors have also conveyed their heartfelt sympathy to the family. Anne Males will be deeply missed here and now leaves behind only those fond memories we have of her. Prior to her eminent death, she had asked me to congratulate the team on gaining diamond accreditation status for the third time and indicated that she was happy for TCI Hospital on such an achievement. Anne always enjoyed working here and also enjoyed snorkeling in the turquoise water of the Turks and Caicos Islands. She certainly lived life to the fullest with a positive outlook, which she even said was contagious. She was a woman of valor and was committed to ensuring that nurses maintain high standards of practice. She was highly regarded by everyone who ever had the opportunity to work with her.

REMEMBERING ANNE MALES ANNE MALES SERVED AS CHIEF OF CLINICAL SERVICES AT TCI HOSPITAL DURING THE PERIOD APRIL 2012 MARCH 2016. SHE PASSED AWAY ON AUGUST 24TH 2018.

Back in 2012, after the departure of Kathleen Brea, the Chief of Clinical services at the time, Anne was appointed to the position where she worked tediously with the Nursing staff and provided coaching and mentoring to myself and other managers and staff until her departure in March 2016. Regardless of the challenges she might have had along the way, everyone who have ever had the privilege of working with her, always deemed it a special pleasure to work with Anne. Anne was such an extraordinary person. This is truly a great loss to our Nursing profession, a friend and to our InterHealth community as a whole. Anne will be profoundly missed by everyone whose lives she have touched.Â

THE INTERVIEW

PROFESSIONAL DEVELOPMENT

Thank you for your service.

The Interview

THEINTERVIEW

BUILDING LOCAL CAPACITY THROUGH SUMMER OBSERVERSHIPS Glenae Stone Nursing Student and Providenciales Native, Glenae Stone recently participated in an observership at Cheshire Hall Medical Centre. Glenae gave a presentation on ‘reducing the prevalence of kidney disease’ to highlight why the kidney’s are important and how the organ functions. She is currently pursuing a Bachelors degree in Adult Nursing at The University of Southampton in the UK, and intends to specialise in dialysis nursing thereafter.

Danielle Baptiste Science student and Grand Turk Native, Danielle Baptiste recently participated in an observership at Cockburn Town Medical Centre.

RYESHA HIGGS

MENTORING THE NEXT GENERATION Science Student and Providenciales Native, Ryesha Higgs recently participated in a two-week observership at Cheshire Hall Medical Centre. Ryesha gave a presentation on ‘Establishing an organ donor network in the Turks and Caicos Islands’. The growing number of patients currently on Haemodialysis in need of a kidney transplant inspired the topic. Several areas were highlighted during the presentation. These included the different type of organ donations, benefits and risk analysis, network development and the importance of developing an organ procurement and transportation network. She is currently pursuing a Bachelors degree in Neuropharmacology at Kings College in England.

The enthusiastic learner selected Antibiotic Associated Encephalopathy, a medical condition associated with abnormal brain function due to its connection with antimicrobial resistance, which is a global health care concern. Danielle is currently pursuing a Bachelors degree in Psychology with Cognitive Neuroscience at Leicester University in England.

Dasheya Been Biomedical Science student and Middle Caicos native, Dasheya Been recently participated in an observership at Turks and Caicos Islands Hospital. On her final day, the inquisitive student gave a visual presentation to members of the hospital’s clinical team on the knowledge she has garnered about Haemodialysis during the observership. The presentation was titled “United, Believe in Cure to Promote Kidney Donations”. Been is currently in pursuit of a Bachelors degree in Biomedical Science at the University of Sheffield in England.

SANADIA FORBES Former participant of the TCI Clinic Exploration Program (TCICEP) and Biomedical Science student, Sanadia Forbes recently participated in an observership at TCI Hospital. Forbes gave an impressive presentation on Fetal Surgery inside a board room of health care professionals on Friday. She provided a step-bystep overview of the surgical procedures involved in open fetal surgery, the conditions treated via this procedure with a focus on Myelomeningocele, post-operation recovery, and the future of fetal medicine. Forbes is pursuing a Bachelors degree in Physiological Science at the University of Bristol in England.

"PERFECT FOR PARTIES AND CELEBRATIONS"

WORLD BREAST FEEDING WEEK

"BREAST MILK THERE IS LOVE AND THE PERFECT NUTRITION IN EVERY DROP"

THE

Story on Page 18

INSIDE THE ISSUE •

Turks and Caicos Islands Hospital to launch Emergency Department triage first system

•

IHC Infection Prevention and Control Program presented at global conference

•

Cockburn Town Medical Centre dialysis patients receive free Wi-Fi internet access

•

Information Technology Department acquires new governance certifications

•

Pictorial highlights from InterHealth Canada's Staff Diamond Accreditation Celebration

US BOARD CERTIFIED SURGEONS

LIVE ABOVE THE LINES. 1

Call +1 649 941 2800

THE INTERVIEW

Table of Contents InterHealth Canada - Turks and Caicos Islands Hospital wishes to pause and take advantage of the holiday season to express gratitude and appreciation to our patients for entrusting us with their care. We wish to also extend greetings to our beloved readers. May happiness, good health and joy be with you this season and throughout the coming years.

Triage First System scheduled for 2019 in the Emergency Department

TCI Hospital Clinicians continue to produce published research

InterHealth Canada hosts second Stop The Clot Fitness Run across main islands

Over 30 emerging leaders undergo leadership training at special 'boot camp'

Surgical Suites host Minimally Invasive Workshop with global partners

Employees rank TCI Hospital as 'a great place to work' with strong confidence in health care system

WWW.TCIHOSPITAL.TC • INFO@TCIHOSPITAL.TC • FACEBOOK: @TCIHOSPITAL

THE INTERVIEW

Under the new system, patients in the waiting area will be called by a triage nurse in the order of arrival. Patient verification will also be conducted during the triage assessment. Following the assessment, the triage nurse will direct the patient to the registration window to complete the registration, NHIPeligibility verification, and payment process, and then wait to be seen by an emergency doctor, if clinically necessary.

InterHealth Canada - Turks and Caicos Islands Hospital continues to encourage efficient use of the emergency department (ED) and is seeking to improve patients’ access to urgent medical care with the introduction of a triage first system in 2019. In accordance with international best practices, the new system features a slight adjustment to the current process that patients are required to undergo prior to accessing treatment by a medical doctor.

Patients who present to the emergency department will be assessed first by a triage nurse to determine their triage level prior to registration and payment. Under the current system, patients are triaged after registration. Each patient will continue to be seen by a doctor based on their triage score, which may range from Level 1 – 5 based on the severity of their condition. The Canadian Triage Acuity Scale (CTAS) is a five-level scale with Level 1 (Resuscitation) representing the most critical patients and Level 5 (Non urgent) representing the least ill.

The Emergency Department at Turks and Caicos Islands Hospital treats cases of various acuity levels, including benign conditions, which can be treated by a primary care doctor.

THE INTERVIEW

A pilot of the triage first system is expected to be launched within the first six months of 2019 after a series of public sensitisation efforts. Â

Faster Access In order to provide non-urgent patients with faster access to the most appropriate care, patients may be transferred to the Ministry of Health Clinic from the Emergency Department after triage and registration. These transfer decisions will be further strengthened by the EDâ€™s triage first system, which will provide clinicians with faster medical evidence to determine the most appropriate type of care shortly after a patientâ€™s arrival. Patients are therefore encouraged to consider the seriousness of an illness or injury in advance and determine the most beneficial and appropriate place for care, where possible. Primary care clinics operated by the Ministry of Health are primarily free of charge with shorter waiting times than an emergency department, and is conveniently open during extended hours. Medical conditions suitable for treatment at a primary care clinic include common illnesses, such as colds, the flu, earaches, sore throats, migraines, low-grade fevers, prescription refills and limited rashes. Minor injuries, such as sprains, back pain, minor cuts and burns, minor broken bones, or minor eye injuries. 4

is it an emergency? SOMETIMES IT IS OBVIOUS THAT A SITUATION IS AN EMERGENCY.Â

NEWS

TCI HOSPITAL INFECTION PROGRAM PRESENTED AT GLOBAL CONFERENCE Nursing World Conference (NWC) 2018

SURBRENA PEDICAN

Preventative measures implemented were shared with

The presentation was also shared at a Sub-Regional Meeting on Infection Prevention and Control (IPC)

attendees of the conference. These included changes

and Hospital Acquired Infection Surveillance (HAI)

in the skin preparation solution, surgical site dressing,

held in Castries St. Lucia on October 15-17, 2018. The

monthly surveillance data sharing, pre-operative clinic

Pan American Health Organisation (PAHO) facilitated

screenings, pre-antibiotic initiation and a

the three (3) day Castries meeting.

decolonization program. Institutional regulated practices were also incorporated in accordance with

The program sought to achieve a 50% reduction in the

evidence-based information to ensure consistency

number of Dialysis-catheter and line-associated

among diverse practitioners.

bloodstream infections (D-CLABSI) and Lower Segment Cesarean Sections (LSCS) healthcare-

The IPC Department performed active surveillance of

associated infections (HAIs).

all positive laboratory cultures on a daily basis. The culture reports showed bacterial isolates in the

Interventions included staff education and

bloodstream and surgical sites of the reported D-

competency assessments, point of care hand

Clabsi and LSCS Cases. The LSCS infection rate was

sanitizers, hand hygiene audits, PPE enforcement and

5% in 2014, 2% in 2015/16 and 1% IN 2017, which is

swabbing for Multiple Drug Resistant Organisms. Pre

positively consistent with international benchmarks.

and post treatment abroad swabbing was also initiated and monitored to prevent the spread of MDROs within

Commenting on the IPC program’s success, Pedican

the Dialysis Unit.

stated: “The TCI Hospital operated by InterHealth Canada is obsessed with quality. We are committed to

The D-CLABSI infection rate was 12% overall among

good quality care for all of our patients whom we

dialysis patients in 2014 and 2016. After the

consider family. Education formed the foundation of

implementation of various measures, the Dialysis

this change process along with collaborative efforts

infections dropped from 6 per year to 2, which is a

across the various departments and disciplines.”

67% decrease. 7

THE INTERVIEW

TCI HOSPITAL CLINICIANS CONTINUE TO PRODUCE PUBLISHED RESEARCH THE INTERVIEW

Research conducted on ‘Bacteriology and Antibiogram of Pathogens Isolated from Wound Infections’ at Cheshire Hall Medical Centre’s Laboratory has been published in a second globally recognised journal.

The findings provide unique insight into the degree and types of antimicrobial resistant species in the Turks and Caicos Islands. The aggressiveness and characteristics of resistant bacterial species can differ across countries and regions.

Lessonjulle Lyons-Dobney, Medical Technologist at Turks and Caicos Islands Hospital, conducted the research, which has been shared in the Journal of Nutrition and Health Sciences under Annex Publishers in November 2018, after a previous publication in The West Indian Journal. The research seeks to identify pathogens that are frequently isolated from wound infections in the Turks and Caicos Islands and formulate antibiogram based on their patterns of antimicrobial susceptibility.

Bacteriology and antimicrobial susceptibility data from 1343 wound swabs cultured at the Cheshire Hall Medical Laboratory between January 2013 and November 2015 were retrospectively analyzed. The Kirby-Bauer disc diffusion technique was used to perform antimicrobial susceptibility testing. The study found that overall antibiotic resistance rates were below 50%, however, some isolates show resistance rates of up to 95.9%. Sharing of information concerning the antibiogram, as well as, future updates with community physicians is recommended. 8

Other clinicians at the InterHealth Canada managed facility have also recently participated in research published with similar global companies. Springer publishes books, e-books and peer-reviewed journals in science, humanities, technical and medicine. Oncology Visiting Consultant, Doctor Dingle Spence and Oncology Specialist Nurse, Gemma Watson are listed as co-authors in the article ‘Palliative Care in the Caribbean Through the Lens of Women with Breast Cancer: Challenges and Opportunities’ in Current Breast Cancer Reports. The article was published in July 2018.

RESEARCH FINDINGS The research states that too many women are presenting with advanced breast cancer and dying with little or no access to palliative care across the Caribbean. No comprehensive assessment of current capacity to deliver palliative care in the region exists, largely due to limited data. The findings outline ‘an urgent need to improve access to palliative care and pain relief throughout the region. Regional challenges include insufficient healthcare infrastructures to support cancer care, tremendous unmet need for palliative care, pervasive opiophobia resulting in limited access to opioids for pain relief, patients’ reluctance to engage with clinical care, and the widespread use of complementary and alternative medicines prior to the acceptance of conventional care.’ Within the Turks and Caicos Islands, many patients still present with advanced breast cancer, often due to decreased uptake of annual screening (eg. mammograms) and delays in seeking medical assessment.

Fortunately, the population of TCI has considerably better access to palliative care and medications, compared to many other countries within the region. It is hoped that as women start presenting more regularly for their recommended screening, the need for palliative care will decrease. LESSONJULLE LYONS-DOBNEY - TOP RIGHT GEMMA WATSON - BOTTOM LEFT (PINK)

Building

Stop The Clot

2018 FITNESS EVENT

"Staying active may help prevent the formation of blood clots." InterHealth Canada - Turks and Caicos Islands Hospital held a sunrise fitness event on Saturday November 10th, 2018 on Grand Turk and Saturday November 24th, 2018 on Providenciales under the theme: Stop The Clot. The event seeks to raise awareness of Venous Thromboembolism (VTE). A clot in the vein (usually in the leg or pelvis) is known as a deep vein thrombosis (DVT) and a clot that breaks off and travels to the lungs is known as a pulmonary embolism (PE). Together, DVT and PE form Venous Thromboembolism (VTE). One in four people worldwide die of conditions caused by thrombosis. Staying active can help prevent the formation of blood clots. Participants were invited to walk, run or cycle. The event on Grand Turk started from the Cockburn Town Medical Centre to a demarked point on North Ridge road and return. The Providenciales event started from the Lower Bight Kids Park to The Sands Resort roundabout and return. Prizes were awarded to the first male, female, and cyclist to complete the route along with the youngest person to participate in the event. 10

Run, walk, trot.

Building

DIALYSIS WIFI PROJECT

Complimentary high-speed Wi-Fi

Representatives from InterHealth

internet access is now available to

Canada â€“ Turks and Caicos Islands

Dialysis patients who receive

Hospital, Digicel executives and

treatment at Cockburn Town

the Minister for Home Affairs,

Medical Centre on Grand Turk.

Transportation and

Digicel officially launched the

Telecommunication, Honorable

service during a special ceremony

Vaden Delroy Williams were in

held inside the main foyer of the

attendance.

capital islandâ€™s medical centre on Tuesday, 16th October 2018.

GIVING BACK

ENHANCING THE PATIENT EXPERIENCE TCI Hospital Chief of Allied Services, Eleanor Hall who is responsible for the dialysis unit opened the ceremony with a prayer. Honorable Williams expressed heartfelt gratitude to the company for the gesture and commended the organization on its corporate endeavor to provide greater Internet access across the islands. Digicel Head of Business Solutions, Lydia Tucker delivered remarks on behalf of the telecommunications company. Tucker emphasized the companyâ€™s resolve to seek out opportunities to improve the community as a part of their corporate social responsibility. TCI Hospital Chief of Medical Services, Dr. Denise Braithwaite-Tennant, flanked by other senior managers, praised the company for the partnership during the vote of thanks. The company ensured that dialysis units across both medical centres received the service at no cost to enhance the patient experience. Dialysis patients, Linnette Simmons and Austin Robinson gave appreciation remarks and participated in the ribbon-cutting

The free internet access will allow patients to stay engaged,

section. Dialysis treatment for patients with

entertained and connected with their families via their smart

renal failure span several hours during each

phones, laptops and other gadgets during the recurrent

hospital visit and are typically required

treatment periods. The ceremony marked the final phase of

three times per week.

the Digicel free-Wi-Fi project that was launched at the Cheshire Hall Medical Centre earlier this year.

EMERGING LEADERS BOOT CAMP InterHealth Canada â€“ Turks and Caicos Islands Hospital hosted a special workshop for over 30 emerging leaders across the company on October 4th and 5th, 2018 at The Atrium.

Employees are excited about the second instalment of the workshop scheduled for the first quarter of 2019. A review of the post-workshop evaluation forms and the concluding statements at the session suggested that the participants benefited tremendously from the experience. Following the boot camp, attendees were presented with certificates of attendance. The mission of the Turks Islands Hospital is to provide theÂ

LOCAL CHAPEL DONATE FOOD SUPPLIES TO DIALYSIS PATIENTS

eat your veggies. eat them often. People who eat more fruits and vegetables as part of an overall healthy diet are more likely to have a reduced risk of many chronic diseases. Vegetables provide nutrients vital for health and maintenance of your body.

SURGICAL SUITES HOST 'MINIMALLY INVASIVE SURGERY' WORKSHOPÂ

Representatives of the Information Management and Technology (IM&T) Department at Turks and Caicos Islands Hospital have acquired a series of enhanced governance skill sets, which will further

The acquisition of new ISMS certifications is also

strengthen the department’s security practices.

aligned with the department’s continuous quality improvement program. The program seeks to provide

IM&T Manager, Ryan Smith and Health Information

an additional layer to the hospital’s current

Systems (HIS) Manager, Detorrie Tennant, conducted

information security strategy to protect the

IT Governance Training in New York and later

confidentiality, integrity and availability of patient

participated in live webinars for blended learning. The

and company administrative data.

training was held in October and November 2018 and hosted by the Organisation of Information Security

The knowledge acquired will improve the team’s

(ISO).

ability to further comply with contractual obligations under the project agreement with TCI Government

The certifications were acquired in Information

and conduct continuous self and third party audits to

Security Management Systems (ISMS). These are

ensure security controls for the hospital information

entitled: ISO Certification ISMS Foundation

systems remain rigorous.

27001:2013 – ISMS-F and ISO Certification ISMS Lead Implementer 27001:2013 – ISMS-LI. The tech duo also acquired a third credential in ISO Certification ISMS Lead Auditor 27001:2013. The department is now more equipped with the skills and methodologies required to implement security programmes that meet internationally recognised standards established for information systems and security controls to mitigate evolving cyber threats.

IM&T department members with other trainees and trainers. 19

Nurse Joan Clarke (centre) with members of the Human Resources and Education Department

The Outpatient Clinics Department also said farewell to Dr. Candice Price and Dr. Doshia Auguste 21

WORLD QUALITY DAY 2018 INITIATIVES

Network Engineer, Perfecto "Junior" Sevillejo (image) and Housekeeping & Portering Supervisor, Germania Urena (bottom) won the raffle.

orld Quality Day takes place every year on the second Thursday of November. According to the Chartered Quality Institute (CQI), the responsibility of the quality professional can be defined through five main areas – governance, assurance, improvement, leadership and context. The Quality Risk and Patient Safety Department at TCI Hospital observed the occasion on Thursday 8th November 2018 via an ice cream happy hour, tagline competition and raffle. The raffle was drawn on Friday 9th October and one winner from the clinical and non-clinical division of the hospital won a Christmas hamper.

Reputations are built on trust. Trust is a hard-earned commodity, yet one, which can be squandered in a moment. Therefore, in 2018, TCI Hospital celebrated the role of every staff member in building and sustaining trust for all stakeholders: customers, suppliers, staff, regulators, shareholders and society.

The quality management profession is about helping organisations put in place competent systems to ensure that the activity of an organisation consistently delivers on its promises to customers and stakeholders. This includes an assurance framework to help the organisation understand operational risk, and an improvement framework to mitigate it and improve. These systems of governance, assurance and improvement combined with your culture of quality are our investment in trust and reputation.

Congratulations to the winners of

The biggest loser was re-launched

InterHealth Canada - TCI Hospital

on July 2, 2018 and concluded on

biggest loser challenge. Around 50

October 5, 2018. The primary

employees entered the

objective of the program is to help

competition.

employees reach their individual fitness goals and maintain a

The winners were Diagnostic

healthy eating ritual as part of a

Imaging Manager, Sandy Burgess

permanent life style change.

(top left)Â who lost 30 pounds and Quality Risk and Patient Safety

Phase two will be launched in

Manager, Isha Honore (bottom

January 2019.

left) Â who placed second with an 18-pound weight loss. The first place prize was $500.00 and $200.00 for the second participant who lost the most weight during the period.

Winners of the hospital's biggest loser competition 2018 announced.

. e v o l y it n u m Com

hand hygiene awareness While it is impossible to keep your hands germ-free, washing your hands frequently can help limit the transfer of bacteria, viruses and other microbes.

Always wash your hands before: - Preparing food or eating - Treating wounds or caring for a sick person - Inserting or removing contact lenses

Health care professionals at TCI Hospital visited the International School on Providenciales in the last quarter of 2018 to raise awareness of proper hand washing techniques. Effective hand-washing is a simple, cost effective way to prevent the spread of illness and infections.Â

Always wash your hands after: - Preparing food - Using the toilet or changing a diaper - Touching an animal, animal feed or waste - Blowing your nose, coughing or sneezing - Treating wounds or caring for a sick person - Handling garbage - Also, wash your hands when they are visibly dirty.

Members also visited the Mills Institute School to raise awareness of proper hand washing techniques. Handwashing offers great rewards in terms of preventing illness. Adopting this habit can play a major role in protecting your health.Â 25

STUDENTS TO UR MED I CA L D EVICE REPROCESSING D EPARTMENT

THE INTERVIEW

a great place to work Staff Work Pulse Survey reflect positive results

STEEL PAN CAROLLERS VISIT CHESHIRE HALL MEDICAL CENTRE WITH FESTIVE CHEER Students of the Long Bay High School Steel Band Group volunteered to perform a variety of mellow Christmas songs for patients inside the main foyer at Cheshire Hall Medical Centre on Wednesday, 12th December 2018. The performance attracted scores of patients and health care staff to the main foyer who were dazzled by the students' musical talent.

THE FINDINGS InterHealth Canada - Turks and Caicos Islands Hospital has been ranked a great place to work by an overwhelming majority of employees in a recent pulse survey on Work life. The survey was distributed to 214 employees between September and October 2018. The organization received a total of 177 completed surveys, which is aligned with the predetermined sample size of 80-85%. The survey’s confidence level was 99%. 88% of employees positively ranked their experience with the company and nearly 100% of respondents said they would recommend the company to family and friends who require medical care.

An employee pulse survey is a fast and frequent mechanism used to provide quick insight into the health of a company. The survey was administered by the Human Resources Department to solicit valuable feedback on areas for improvement and action plans. The survey seeks to measure employee engagement, provide employees with a voice, increase employee engagement, direct organisational growth and benchmark results. Programs are being developed for any areas for improvement to further enhance the employment experience of the company’s greatest asset. 27

Do you have a topic or story idea that you wish to see featured in our newsletter? Get in touch. Email: info@tcihospital.tc ABOUT THE EDITOR

Nikira John is an enthusiastic Public Relations and Marketing Manager who has worked on a range of multimedia projects. Email: njohn@interhealthcanada.tc for more information.

UNDERSTANDING OUR ACUTE SECONDARY HEALTH CARE SYSTEM

DID YOU KNOW?

For more answers to frequently asked questions, visit our website FAQ section: www.tcihospital.tc

28 9

TCI HOSPITAL WAS RANKED DIAMOND FOR THE 3RD TIME IN 2018 InterHealth Canada’s end of year staff party to celebrate its recent success in the accreditation 2018 assessment and the onset of the festive holidays was held on Saturday, December 1st on Providenciales at The Atrium and Thursday, December 6th on Grand Turk at Bohio Resort’s Red Deck. The celebration featured an explosive performance from the country’s most requested live band, V6 Band Boys along with a delicious array of complimentary hors d'oeuvres and drinks throughout the evening, and a signature welcome cocktail called the 'Blue Diamond'. The company continues to thank staff for their contribution to the process.

THE

Story on Page 5

INSIDE THE ISSUE •

Turks and Caicos Islands Hospital introduce Cardiology to services profile

•

US teleradiology company is contracted to provide specialist radiologist services

•

Native doctor appointed as the country's first dedicated Nephrologist

•

IHC provides an update on diagnostic imaging post Sept 2017 hurricanes

•

Health care staff undergo ACL Risk Management Training

US BOARD CERTIFIED SURGEONS

LIVE ABOVE THE LINES. 1

Call +1 649 941 2800

TECHNOLOGY

Innovative health care solutions. InterHealth Canada - Turks and Caicos Islands Hospital has recently introduced an offshore teleradiology service that is expected to further improve patient care by allowing radiologists to provide services from a remote location other than the health care facility. SERVICE DEVELOPMENT

THE INTERVIEW

Teleradiology involves the secure transmission of

Teleradiology is particularly important when a sub-

radiological patient images, such as radiographs (X-

specialist such as an MRI radiologist, neuroradiologist,

rays), CTs, and MRIs to a remote location where

pediatric radiologist, or musculoskeletal radiologist is

interpretations are rendered and then returned to the

needed. These professionals are generally only located in

requesting care provider. TCI Hospitalâ€™s technology is

large metropolitan areas working during daytime hours.

Health Insurance Portability and Accountability Act (HIPAA) compliant. The processes and technical

The offshore teleradiology service at TCI Hospital is

infrastructure guarantee secure and confidential data

intended to deliver on call coverage Monday through

management.

Friday 10pm to 8am and emergency remote coverage for any unexpected absence of the radiologist such as sudden

The Turks and Caicos Islands Hospital performs in excess

illness or incapacitation. This provides the in-house

of 16,000 diagnostic imaging tests per year. There has

radiologist with on-call relief and strengthens the

been an increase in diagnostic activity consistent with the

hospitalâ€™s current operational contingency plan to ensure

overall increase in patient activity. The on call volumes

continuity of services and mitigation of any disruption on

also indicate an increase in utilization over the years. In

patient care. The single radiologist covers the entire

accordance with the staffing strategy outlined in the

Turks and Caicos Islands as there are no consultant

Project Agreement between InterHealth Canada and the

radiologists within the local private health care sector.

Turks and Caicos Islands Government, there is a sole

TCI Hospital is already reliant on a locum radiologist to

consultant radiologist working for Turks and Caicos

conduct over-reads, peer review and cover planned leave

Islands Hospital. The consultant radiologist provides

periods.

reports for all diagnostic imaging data and covers on-call requests for both medical centres 24/7 except for annual

Teleradiology utilizes standard network technologies

leave.

such as the internet, telephone lines, wide area network(WAN), local area network (LAN) and the latest

InterHealth Canada has contracted a Joint Commission

high tech computer clouds. Specialized software is used to

Accredited Teleradiology company based in the United

securely transmit the images from one facility to another

States with a wide variety of specialist radiologists

and enable the radiologist to effectively analyze the

available 24/7.Â The volume of radiological procedures has

images. Technologies such as advanced graphics

globally outstripped the radiologist population creating a

processing, voice recognition, and image compression are

growing demand for teleradiology services.

also often used in teleradiology.

M&T department members with other trainees and trainers.

Cardiologist Himanshu Shukla, M.D. (Second Right) with IHC, TCIG and NHIP representatives

Based on statistics, Cardiology and Ophthalmology are the two most frequently required medical services under the Treatment Abroad Program (TAP). Hence, the introduction of on-shore Cardiology services will provide high quality and comprehensive care to patients, which reduces government expenditure and the need for patients to travel abroad.

InterHealth Canada - Turks and Caicos Islands Hospital officially announced the commencement of Cardiology services under the Visiting Consultant Program during a press conference on Friday 8th March 2019. The new development will provide incountry access to Cardiology medical care that was previously only available under the Treatment Abroad Program (TAP). Under the Visiting Consultant Program, medical expertise from all-over the world in various specialties visit the island on a periodic basis to deliver services in outpatient clinics and operative procedures, which are not permanently available in-country.

Patients who require Cardiology services will be identified by TCI Hospitalâ€™s Internal Medicine Physician to ensure the referral is clinically necessary and to promote best use of resources. The service will be delivered on a quarterly basis with clinics ranging from 7-10 days based on patient volumes.

Visiting Consultant Cardiologist, Himanshu Shukla, M.D. will deliver adult cardiology non-invasive programs, specifically, echocardiography rhythm monitoring and consultations at a tertiary care level.

An innovative technology has been introduced under the program as an alternative to the a traditional Holter monitor that measures and records a patientâ€™s heart activity (ECG). 5

The stick-on Zio patch empowers patients to maintain a clean, uninterrupted signal with minimal effort or disruption to their lifestyle. The miniature device also gives the assurance of reliable data with a clear and comprehensive look into a patient’s heart rhythm over longer periods for more appropriate diagnosis. There are also no wires to manage, batteries to charge or leads to reconnect. Cindy Durham, a cardiology patient and nurse at the hospital was used to demonstrate the technology.

Visiting Consultant Cardiologist Himanshu Shukla, M.D.

The inaugural visiting consultant cardiology clinic was held last week with overwhelming positive feedback from patients. Dr. Shukla stressed that the technology is also more customized to the patient population, suitable for local climatic conditions, more cost- effective and has minimal hardware. A portal ultrasound has also been used during the consultant visits, which is another innovative expansion to the hospital’s current capacity. During the press conference, Dr Shukla also stated that building a cardiology program is advantageous to the country. Based on population demographics and steady growth, persons may experience a cardiology issue at some point. It is an unfortunate, but a realistic statistic. An increase in diabetes and renal healthrelated conditions across the community can precipitate heart related issues for persons. Therefore, appropriate screening, management and counselling for patients early in the process is invaluable. Dr Shukla also believes the transition and growth of the program will be successful in the long-term since the infrastructure and platform has already been provided. Chief Executive Officer of InterHealth Canada – TCI Hospital, Daniel Carriere stated: “It is great that we can bring this type of talent to the Turks and Caicos Islands. Dr. Shukla’s credentials, experience and qualifications are impeccable and we are very fortunate to have a person of this caliber providing services. This is another example of bringing services close to home, which is always great for the patient and their families. We are always open and willing to work with Ministry of Health - TCI Government in exploring avenues that will ease the burden on government budgets. We recognize that health care is expensive by nature, and anything that the organization can do to lessen the cost and continue to improve services for our patients is something we are interested in doing.” 6

Portal Ultrasound Machine and Zio Patch

Chief of Medical Services of InterHealth Canada – TCI Hospital, Dr. Denise Braithwaite-Tennant stated: “Cardiovascular disease is prevalent in the Turks and Caicos Islands. It is very important for us to support primary health care in preventive measures to reduce the impact on secondary and tertiary care interventions. The Zio technology is new to the country, and Dr. Shukla has also graciously funded 10 Zio patches for local patients at the onset. We are very appreciative of health care providers who view their expertise as a means of delivering a philanthropic service, as opposed to strictly focusing on the bottom line. The introduction of pediatric patients to the cardiology program requires the creation of a business case, which is currently under creation. Our next iteration is to include pediatric patients. Dr. Shukla’s first clinic visit was held on Providenciales due to patient numbers, but this does not eliminate the prospects for future visits to Grand Turk.” Minister of Health, Agriculture, Sports and Human Services, Honorable Edwin Astwood stated: “The launch of the program is very pleasing to all of us. We have heard that Cardiac and Heart Disease are the number one complaint in the Turks and Caicos Islands. To be able to better monitor and control these diseases can go a far way in dealing with the local population… It was also fitting to see the process that is taking place, whereby we are moving one step closer to the ideal situation that we envisioned this facility to be. The introduction of the program is very commendable as we are moving in the right direction. We are extremely happy to see this state-of-the-art technology being introduced in the Turks and Caicos Islands...”

TCI Government (TCIG) Acting Contract Performance Manager, Florinda Talbot delivered remarks on behalf of the Government’s Contract Management Unit, which oversees the partnership agreement between TCIG and InterHealth Canada. Talbot stated that the introduction of cardiology services supports both standards and service development of the hospital.

THE INTERVIEW

Interim Chief Executive Officer of the National Health Insurance Board, Dr Terese Maitland stated:” To date the majority of patients who require cardiology tests and procedures, ranging from non-urgent to life-threatening emergencies, are treated outside of the TCI under the auspices of the Treatment Abroad Program, which is managed by the National Health Insurance Plan. Indeed, cardiology-related referrals, rank second in the total number and accounts for approximately 12% of treatment abroad referrals and a substantially larger percentage in terms of cost. Today officially marks the on-boarding of some of these services. This is expected to provide TCI residents with in country access to a broader range of cardiology related medical procedures…NHIP is excited about this endeavor, which is anticipated to be more accessible to a broader cross-section of our valuable clients and beneficiaries, facilitate prevention and early detection whilst simultaneously being cost effective and allowing us to stretch our health care dollars...”

NEWS

TCI HOSPITAL PURSUES ACCREDITATION TO OFFER MEDICAL INTERNSHIPS The internship program seeks to cover four of the major disciplines.

...creating a pipeline of talent The hospital has acquired three successive Diamond rankings by Accreditation Canada International in 2012, 2015 and 2018. The findings of the recent internship on-site assessment will be reviewed in the next UWI Accreditation Committee meeting in April or March 2019 and later released.

NATIVE DOCTOR APPOINTED AS COUNTRY'S FIRST DEDICATED NEPHROLOGIST CKD is defined as abnormalities of kidney structure or function, present for more than 3 months with health implications. Over 90% of kidney failure in the Turks and Caicos Islands is caused by diabetes or hypertension. Most diabetes and hypertension can be prevented through healthy lifestyles. CKD is irreversible and tends to be progressive.

InterHealth Canada – Turks and Caicos Islands Hospital is pleased to announce the appointment of Grand Turk Native, Doctor Vancelee Forbes as the country’s first full-time Nephrologist. Dr Forbes is specialized in renal and general internal medicine and has served across both medical disciplines at the health care facility since 2014. In recent years, she adopted a part-time Nephrology Consultant role. The introduction of a dedicated Nephrologist is a strategic initiative facilitated by InterHealth Canada in partnership with TCI Government, to strengthen the prevention and management of Chronic Kidney Disease (CKD).

The last stage of CKD is kidney failure. Once a person develops kidney failure, he/she will require renal replacement therapy in order to survive. Three renal replacement therapies are currently available. These are renal transplantation, haemodialysis and peritoneal dialysis.

The number of patients diagnosed with the condition has increased over the years. In order to further enhance the quality of care and mitigate these trends, the private health care management company submitted a multifaceted, evidence-based proposal to TCI Government requesting support to develop the renal service.

A stakeholder meeting was held on Wednesday, February 13th 2019 with dialysis patients and other health care stakeholders.

The meeting was well-received and patients expressed optimism about the future strategic advancement of renal services and transplantation opportunities. Dr. Forbes outlined the process and challenges encountered with the current renal transplantation program and potential solutions, which require a multisectoral approach. Dr Forbes also announced the development of a Peritoneal Dialysis program, which is a homebased form of renal replacement treatment for interested and eligible patients. The treatment option will be covered under the National Health Insurance Plan. Nearly 50 patients are currently required to visit the country’s Outpatient haemodialysis Centres at TCI Hospital as frequent as three-times per week to undergo lifesaving treatment for kidney disease. Dr. Vancelee Forbes 12

The first haemodialysis unit was opened in Grand Turk to accommodate six patients in 1995 followed by a second unit on Providenciales in 2006. InterHealth Canada assumed the management of the countryâ€™s renal services in 2010 with two modern outpatient haemodialysis units across both islands.Â

There were 25 patients undergoing dialysis treatment upon the commencement of services in 2010, and the number of patients has since doubled. Dr Forbes is the daughter of Mr Darius Forbes and Retired Chief Nursing Officer, Pastor Mary Forbes who pioneered the development of the renal services within the Turks and Caicos Islands over two decades ago.

Cheshire Hall Medical Centre

THE INTERVIEW

Overview of Diagnostic Imaging Services Post 2017 Hurricanes

All of these conditions, when combined have led to premature component failure, significant increase in downtime and potentially shortened the expected lifecycle of the diagnostic imaging equipment.” INTERIM CORRECTIVE MEASURES

Similar to other major service providers across the country, InterHealth Canada - Turks and Caicos Islands Hospital received significant damages during the hurricanes in September 2017. These included latent damages to the electrical circuitry of medical equipment that only became apparent over time. The total cost of repairing the damages to the hospital’s physical infrastructure and medical equipment is estimated to be USD$16 million.

Biomedical Engineers employed at the facility assisted by overseas specialists worked assiduously to resolve any emerging technical issues. To date, all diagnostic imaging machines are fully operational. The intermittent downtime experienced in previous months with CT and Mammography machines were minimal. The MRI machine was operational, but with limitations on the type of radiological scans that could be performed at the time.

The majority of the equipment in the hospital is highly sophisticated and extremely sensitive. The environment of CT, MRI and Mammography machines require tight control over temperature and humidity. An independent review of the Diagnostic Imaging infrastructure at Cheshire Hall Medical Centre was conducted by XRCT Limited, a physics consulting company based in Ontario.

“Despite the high temperatures and lack of humidity control present in the facility, the records show the hospital continued to make every effort to operate the equipment under these extreme conditions in the interest of providing vital and medically necessary patient care,” stated XRCT Consultants in an official report. These efforts sought to ensure the continuity of high-quality care and to minimize the number of patients who require treatment abroad. Patients were categorized based on clinical priority and the equipment up-times were maximized by increasing the volume of radiological scans performed per day.

The report stated: “In the wake of the storms, the lack of air conditioning lead to ambient air temperature and humidity conditions within the facility that were outside of the manufacturer requirements. This created a severely hazardous environment for electronic components. In addition, the restoration of power to the island created multiple daily power outages, surges and brownouts.

THE COMMUNICATION PROCESS

THE MAINTENANCE PROCESS CT, MRI and Mammography machines generate significant heat while in use and at rest. Therefore, operating temperatures within these areas are closely monitored, checked and reviewed regularly to ensure temperature and humidity is within the guidelines established by the manufacturer. Any changes in these precise specifications can create the risk of overheating and damage to internal components. Monitoring the relative humidity of MRI rooms is also crucial to avoid the risk of moisture damage to very delicate electronic components such as electronic expansion boards, cables, and connectors. XRCT Limited also performed an extensive review of the service records for the Diagnostic Imaging department and stated: “Over the months/years preceding the storms in 2017, the service history for all the equipment was excellent. In fact, with the exception of a few random downtime events and planned maintenance, the uptime of all clinical systems was quite good, in excess of 99%.” Based on these expert findings, the technical issues experienced over previous months were evidently not attributed to inefficiencies in the maintenance or management processes established by InterHealth Canada, but were connected to acts of nature, beyond human control.

InterHealth Canada has continued to abide by the terms of the Project Agreement and meet the extensive reporting and service standards detailed in the contract. As partners in health care, InterHealth Canada is contractually mandated to submit monthly reports to the Turks and Caicos Islands Government (TCIG) related to over 48 clinical key performance indicators, including Diagnostic Imaging services. These key performance indicators seek to demonstrate how effectively the management company is achieving pre-established targets. InterHealth Canada fully supports and complies with these accountability mechanisms. The TCI Government via the Contract Management Unit has been kept informed, at all times, where services have required expansion or, where challenges such as the 2017 hurricanes have caused damage to equipment, resulting in some delays to services. Representatives of TCI Government’s Contract Management Unit and Fortis TCI also conducted a physical inspection of the UPS and surge protectors in the Diagnostic Imaging Department. THE LIFE CYCLE PROGRAM Managing the lifecycle of medical equipment from planning to purchase, installation, operation all the way through decommissioning and disposal helps medical institutions improve operational efficiency, enhance quality and reduce service-related cost. The purchase of capital equipment is covered under a life-cycle program, which is a reserve fund established under the contract between TCI Government and InterHealth Canada for equipment replacement. The decision to purchase equipment involves several key considerations. These include: Equipment Specifications and Suitability, Procurement and Logistics, Available Financial Resources, Prospects for Maintenance, Repair and Life expectancy InterHealth Canada has filed a short term and long-term recovery plan with TCI Government and are actively considering replacement possibilities for key modalities in diagnostic imaging. Negotiations are also underway with the insurance companies relative to the damages ensued.. 15

NATIVE RADIOGRAPHERS APPOINTED TO TCI HOSPITAL

Recently employed Radiographers, Latavia Ingham (L) and Andresha Gardiner (R)

duo of trainee radiographers who conducted observerships at InterHealth Canada - Turks and Caicos Islands Hospital over recent years have returned to fulltime employment with the institution. Latavia Ingham and Andresha Gardiner are the latest TCI citizens to be added to a specialist area of health care and have simultaneously filled a longstanding skills gap in the domestic labor market. Both radiographers graduated from the University of the West Indies, Mona Campus in Jamaica with a Bachelor of Science in Diagnostic Imaging with Radiography in 2018.

Ingham also holds a Bachelor of Science in Diagnostic Ultrasound Technology from Barry University. The duo conducted integrated clinical rotations across various hospitals in Jamaica to acquire the required practical experience of diagnostic imaging equipment, system and processes. Diagnostic Imaging Manager at TCI Hospital, Sandy Burgess expressed excitement about their return and the opportunity to utilize their competency, energy and enthusiasm to enhance radiological services in the local community alongside the existing team.

Commenting on the appointment, Chief of Allied Services, Eleanor Hall said: “It is such a pleasure to welcome both radiographers who were mentored by us during their training, and are therefore very familiar with the work processes and personnel in the department.” She continued: “As they begin their professional life in this organization, the opportunities ahead for further training and experience can only enhance and increase their skills in the various modalities available within the department.”

RISK MANAGEMENT

Health Care Practitioners undergo ACL Risk Management Training The sessions were also designed to equip participants with practical techniques, skills and strategies for effective use of risk management tools, developing a risk management plan to respond to identified risks, evaluating the effectiveness of the risk management plans, and integrating risk management plans with other organizational plans and frameworks.

A two-day interactive workshop facilitated by Accreditation Canada representatives was held on February 19th, 2019 at Turks and Caicos Islands Hospital, which targeted health care professionals in leadership and management roles who are responsible for identifying and mitigating risk in the organisation. The training also covered peoplecentred care and improving safety in facilities management.

Health care teams practiced and applied the presented techniques, skills and strategies by analysing case studies and examples. The agenda topics included:

The audience included senior and middle management, quality improvement team leaders and clinicians in both formal and informal leadership roles in the organisation. The training provided participants with guidance on evaluating risks for health care organisations and its link to the HSO standards, defining different types of risk, creating an accurate map of risks, and preparing risk response strategies. HSO stands for Health Standards Organisation.

- Risk in Complex Health Care Organisations - Conducting Root Cause Analysis - Incident Reporting System - Prospective Analysis - Sector Specific and Functional Risks - ERM Infrastructure - When Things Go Wrong 17

NEWS

THE INTERVIEW

REFRESH

Level 2 and 3 Certification in Food Hygiene and Safety Catering

Employees of Refresh, the catering division of the hospital have acquired a Level 2 and 3 Certification in Food Hygiene and Safety based on UK and EU standards. InterHealth Canada - Turks and Caicos Islands Hospital has a responsibility to provide the highest level of care possible for their patients and this, without question, includes the quality and nutritional value of the food that is provided. InterHealth Canada Construction and Services division are ultimately responsible for ensuring that patients have a positive experience during their stay, which includes their dietary and nutritional requirements.

Congratulations!

All Catering staff receive regular training to ensure they have the skills, qualifications and competencies required to achieve the highest standards in Food Hygiene and Food Safety which include the control of food safety hazards, temperatures, safe storage of goods, food preparation, personal hygiene and premises cleaning. Staff are also fully compliant with the current Food Hygiene Legislation. The picture shows the Catering team based at Cheshire Hall Medical Centre with certificates for their successful completion of Level 2 and Level 3 Basic Food Hygiene. 18

Building

building healthy communities

HEALTH BOOTHS

"Right time...Right patient... Right drug...Right Dose...Right Route." InterHealth Canada doctors and other clinicians held an information booth on February 23rd 2019 outside an actively traversed grocery store on Grand Turk to offer on-the-spot advice and raise awareness of medication reconciliation. Medication reconciliation is the process of creating the most accurate list possible of all medications a patient is taking — including drug name, dosage, frequency, and route — and comparing that list against the physician’s admission, transfer, and/or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital. Persons within the local community were encouraged to keep the most accurate list possible of all medications, especially during transfers across different health care settings. This information helps to improve various important aspects of care transitions and patient safety.

TAKE CARE OF YOUR BODY. ITâ€™S THE ONLY PLACE YOU HAVE TO LIVE.

"PERFECT FOR PARTIES AND CELEBRATIONS"

ECPS Career's Day

Building

Health care professionals from various departments at TCI Hospital participated in the Enid Capron Primary School Career's Day on Thursday 7th February 2019. Â The educational booth featured an array of real surgical instruments, point of care devices, on-the-spot blood group testing with teachers, nutrition and dietetics.Â 21

These demonstrations provided students with a captivating visual of some of the tasks associated with the various medical professions.

BECOMING JOB READY The Human Resources Department at TCI Hospital participated in the H. J. Robinson High School annual Exit Readiness Exercise for 5th form students under the theme, “Laying a Strong Foundation for my future” on Wednesday February 20th.

Science Projects on Display

IHC Deputy Human Resources Manager, Tavardo Reasias and Human Resources Officer, Vernessa Forbes engaged in a series of activities to prepare students for the world of work and offered guidance on their career pursuits in health care. The session featured mock interview sessions with students to evaluate their performance and provide feedback on areas for improvement so they can better prepare themselves for future interviews. IHC Representatives with students

Representatives of InterHealth Canada - TCI Hospital attended the Holy Family Academy Roman Catholic School to serve as judges and support a team of eleventh grade students in the school's science fair. The project focused on Antimicrobial Resistance: A Cause for Global Concern. The science projects on display reflected the creativity and critical thinking of students in the sciences, and proposed practical interventions. Our Education Manager, Quality Risk and Patient Safety Manger and Senior Infection Prevention and Control Nurse were in attendance.

THE • INTERVIEW 22

Students from Providenciales Middle School conducted a tour of the laboratory at Cheshire Hall Medical Centre in February. Medical Technologists at the hospital were excited to provide the curious minds with a behind-the-scenes look at the department's critical role in the patient treatment process. The year 7 students wanted to apply their biology lessons to a real-life-scenario. Here is an excerpt from their blog: "We were treated to an exceptional all-access visit to the histopathology and micro-biology labs at the hospital on Provo. Children learned how doctors receive tissue samples from all patients who undergo any surgical procedures in order to confirm diagnoses or test the outcomes of previous care. Everything from human organs to skin and other tissue is tested and prepared for study under the microscope in the histopathology labs. The work done in this lab not only helps to save lives, by identifying the cause of illnesses on a cellular level, but could also be used to explain how or why a person may have died."

Care packages were delivered to Cheshire Hall Medical Centre to observe International Women's Day 2019. International Women's Day (IWD) is celebrated on March 8th every year and the recognition of women continued on March 9th. The Soroptimist International Club of Providenciales visited the Cheshire Hall Medical Centre to donate surprise infant care items to expectant and new mothers on the maternity unit.Â

General Practitioner, Dr Dionne Lightbourne (Top Left) conducted an interview with PTV News on the signs, symptoms, treatment and prevention of Dengue Fever. Oncology Nurse Specialist, Gemma Watson (Bottom Left) participated in a radio show on RTC 89.1 FM Health Matters, along with National Cancer Society President, Rosemary Jolly to discuss the topic of cancer on World Cancer Day. Dr Vancelee Forbes (Bottom Right) participated in an interview with PTV News inside the Healing Garden to raise awareness of kidney disease and discuss her recent appointment as the country's first full-time Nephrologist. InterHealth Canada physicians participate in various health promotion activities every quarter to educate the community on various ailments.

Reg Warren and his wife Debbie visited the Turks and Caicos Islands Hospital during their recent vacation to express gratitude to the medical team for the care received during a previous encounter. Reg was rushed to the emergency department on February 1st 2018 after a freak kiteboarding accident on Long Bay Beach, which caused a fracture and massive laceration across his face. The injury required surgical intervention and several dozen stitches due to the size. Reg and his wife were grateful for the level of care received at Cheshire Hall Medical Centre, which provided a good foundation for multiple subsequent and successful overseas facial plastic surgeries. The couple delivered a surprise donation of $1000 towards a care package initiative for inpatients at the facility.

Reg and Debbie (centre) with hospital managers

Sassy

Promotions

New Lead Nurses

It's a girl!

The Interview

THE

INSIDE THE ISSUE 02

Turks and Caicos Islands Hospital accredited to offer medical internships.

Thirty modern infusion pumps to be introduced across the medical centres.

Special TV series launched to educate the community on the dynamics of health care.

TCI Hospital team attends SHRM Annual Conference and Exposition in Las Vegas.

InterHealth Canada hosts the launch of TCI's Clinic Exploration Program 2019.

US BOARD CERTIFIED PLASTIC SURGEONS

ENHANCE YOUR CONFIDENCE. 1

Call +1 649 941 2800

ACCREDITED TO OFFER MEDICAL INTERNSHIPS

NE S

INTERHEALTH CANADA TCI HOSPITAL TO INTROD CEÂ MODERN INF SION P MPS Keeping pace with medical technology.

importance of family doctors in health care

carin for yo thro h all sta es of life

InterHealth Canada launched a 9-

management company on a

part TV series on April 24th

unique range of insightful topics

entitled ‘The Interview - Health

with significant public

care on the inside.” The show is

interest. Discussions explored the

intended to enhance the

growth of medical services with

communities understanding of

patient volumes that have now

health care operations along with

surpassed initial projections and

the complex dynamics involved.

some of the factors involved in

Episodes are aired every

striking a balance between

Wednesday at 8pm on PTV

treatment abroad, onshore care

Channel 8 and FLOW TV Channel

and visiting consultant services.

104. Each episode features a 30-