In 2010, Doctors Without Borders/Médecins Sans Frontières (MSF) set up a programme in Mon, a remote district of Nagaland, to support the District Hospital there.
A culture of self-medication, the presence of neglected diseases like scrub typhus, the lack of healthcare options, and a general disregard for this only government-run secondary healthcare provider bred a complicated context.
The District Hospital also had insufficient human and technical resources to respond to emergencies.
MSF partnered with the state government to revitalise the hospital. During the four years, the hospital was refurbished, new equipment was brought in, and its staff were trained.
MSF will be leaving Mon this July with the hope that the hospital will continue to be of relevance to the people.
To prioritise patients who need urgent medical attention, a colour-based triage system was introduced. It sorts patients on the basis of their medical needs when they arrive at the hospital and has streamlined the patient flow, making the OPD efficient and responsive.
MSF provided a good quantity of gloves and masks- basic measures to control the spread of infection.
A committee dedicated to hygiene was also formed to ensure that simple infection control tasks like regular cleaning of the hospital floor and furniture were done. Buckets have been placed all around the hospital for better waste management, and protocols to ensure that equipment is sterilised before performing any medical procedure have been put in place.
Nyuphen, a cook at the District Hospital, says there wasn’t enough water to prepare meals and clean utensils before the MSF programme started. Since there was no dietary plan for patients, she would mostly make ‘daal’ and rice every day. Meat or eggs were a delicacy served on special occasions.
“A lot has changed after MSF came in. The adequate water supply has made both cooking and cleaning possible. We provide meat thrice a week and eggs for TB patients on a daily basis and even serve tea! It’s easier to work in this fully-equipped kitchen with bowls, cookers, fridge, almirah for storage, gas cylinders and much more!”
Before a comprehensive laundry section was built as part of the MSF programme, the laundry of the entire hospital was left to one person. He would visit the hospital twice a month to collect the dirty linen, and it took him time to deliver the washed sheets. He would often clean the laundry by the riverside, exposing himself and the people living around the river to infection.
After MSF started working in the hospital, two industrial-grade washers and dryers were installed and a separate laundry room was created. Staff were also appointed for timely delivery while making sure that hygiene and infection control measures were adhered to.
Daily health promotion sessions were held in the OPD and IPD. These were usually one-on-one interactions or group discussions that covered important issues. These included tuberculosis prevention, general hygiene, family planning, and risk factors during pregnancy.
An integrated laboratory has also been constructed and the expertise of lab technicians from different programmes like NLEP for leprosy or NVBDCP for malaria, NSACS* for HIV and many more has been pooled in. This laboratory now performs all necessary tests. This integration was necessary to facilitate regular IPD and OPD tests which were earlier not being conducted in the hospital.
A simple stock card system was started to ensure regular inventory entries and exits were made of the stock of medicines. This was done for easy monitoring of monthly consumption patterns, to preempt future needs and so that orders for new medicines were made in time. MSF also provided most of the medicines and lab reagents free of cost in the last four years.
MSF also introduced another important aspect of stock management- sustaining the “cold chain”. A cold chain is the controlled transport of vaccines and medicines, which are temperature sensitive, from the factory to the hospital.
The MSF programme laid emphasis on sexual and reproductive health, and also on providing quality antenatal, prenatal, postnatal and neonatal services. MSF contributed a lot towards infrastructural development of delivery rooms. The hospital now has a central operation theatre where C-sections and other surgeries can be performed.
Under its TB project, MSF built a separate isolation ward for patients with multidrug-resistant tuberculosis (MDR-TB ) to prevent the spread of infection. MSF worked on patient education and counselling to keep them motivated to continue the demanding treatment that can take around 14,600 pills, countless injections and about two years to be cured.
A vacant building in the hospital premises has also been converted into a Designated Microscopy Centre to aid in the treatment of such patients.
Left to right: Konyak Union president: Mr Manlip Konyak, MS MDH: Dr Leamnyei, Principal Director DoH&FW: Dr Neiphi Kire, Minster for DoH&FW: Mr Imkong L. Imchen, MSF Mon Project Coordinator: Ms Beatrice Barbot, MSF Mon project medical coordinator: Dr Rey, MSF Country Director: Mr Luke Arend
During the handover ceremony, Mr Imkong L. Imchen (Minister of Department of Health &Family Welfare) said “I would like to thank MSF for the exceptional and wonderful services rendered to our people and bringing Mon hospital to a reasonable standard of healthcare delivery system. If we compare pre-2010 to today, there is an ocean of change!”
MSF has now handed over the hospital to the Department of Health and Family Welfare, Government of Nagaland. As MSF departs, it hopes that the facilities at the hospital will continue to serve the people of Mon.
*NLEP is the National Leprosy Eradication Programme; NVBDCP is the National Vector Borne Disease Control Programme and NSACS is the Nagaland State AIDS Control Society.