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 Gambo Hospital is a General Rural Hospital; it has 135 beds allocated as follows: Internal Medicine Ward (33 beds), Tuberculosis Ward (12 beds), Leprosy Ward (30 beds), Surgical Ward (12 beds), Maternity Ward (12 beds), Paediatrics Ward (36 beds), Out Patients De-partment (OPD), Radiology - Echography, Pharmacy and Laboratory. It has also a service of Vaccination and Antenatal Care that pays daily attention to nine peripheral centers covering 19 villages with a population of 78,711 inhabitants.
The Hospital is located in the territory of Arsi province, 245 km. Southeast of the Country Capital city, Addis Abeba; it is 2,200 meters above the sea level, 18 km. from the nearest city through an all weather road. Arsi province has a population of 2,698,370 with a density of 114 inhabitants per sq km. In Arsi there are only two Hospitals, the Regional at Asella and Gambo, 280 km. apart; 40 km. away from Gambo there is the Shashemane Regional Hospi-tal for the province of East Shoa. As far as Health Stations is concerned there are two in Arsi some 40 km. away and two in the bordering province of East Shoa at about 20 km.
The year 2004 has had a regular activity, as on the previous, the renovation of the buildings keeps on going now is the turn of the Operating Theater and the beginning of the new staff quarters. The Administration offices are fully functioning and a new informatics system has started for the control and calculation of salaries as well as for the statistics of the hospital. Thanks to MSF-Holland we have started to use the new protocol for Severe Acute Malnutri-tion, according to the standard of UNICEF and the Ministry of Health.
The horses of the vaccination team have been changed because they were too old.
Two new candidates have entered the Nursing School of Woliso and two have started to work.
A new volunteer surgeon and an obstetric nurse have joined while the orthopaedics team and the oculist continue their short but intense visits helping so many patients.
Personnel movement
This year two new nurses from Woliso School have started and two Junior Nurses from other schools. One surgeon and one obstetric nurse from Italy have come. Two Ethiopian doctors have left for personal reasons.
Personnel formation
During 2004 the hospital staff has participated in:
- Update on Measles Surveillance, 3 days workshop organized by MOH. One nurse partici-pated.
- Integrated Diagnosis and Management of STD and Opportunistic Infections, one-week training course organized by ECS. One doctor and 2 Health Assistants participated.
- HIV-AIDS counseling, 3 weeks training course organized by ECS. 2 Health Assistants par-ticipated.
- HIV-AIDS Disease Management Focused on ARV-PMTCT, one-week course organized by CRDA. One doctor attended.
- Diagnosis and Management of Severe Acute Malnutrition, 2 days in-service training by MSF-Holland. All the staff of Pediatrics, OPD and MCH participated.
- Update on HIV surveillance, 3 days workshop organized by MOH.
One nurse attended.
- Planning for Sexual and Reproductive Health Services, one day workshop organized by CRDA. One doctor and one nurse participated.
Restructuring
The process of restructuring is reaching its closing stages with the renewal of the Operating Theater; it should be operational by the middle of next year. At the same time have started the new staff quarters. With these the buildings should be finished remaining only the water and sewerage system, which is still on study and can take more than one year to start.
New equipment
The Administration building has been equipped with 3 computers, and all the necessary ac-cessories for courses and presentations. For the cashier there is a new Cash Registering machine, it helps on keeping the accounts and allows giving a receipt to every payer. Thanks to the help of the friends of the Hospital, we have been able to buy a new incubator for the Pediatric Ward, an automatic film dryer and an interlocked cassette exchange box for the X-Ray room.
 National Immunization Days
The campaign against Neonatal Tetanus has continued this year also. Hospital staff and volunteers have covered with extra doses of Tetanus vaccine nearly 80% of the women be-tween 15 and 45 years of age belonging to our area.
HIV/AIDS
Gambo Hospital is a Surveillance Sentinel Centre in the National Surveillance System for HIV/AIDS because it is representative of the rural population. The sample for the surveil-lance is taken from the women attending the Antenatal Clinic and the survey is done once a year.
The Hospital offers also the service of Voluntary Counselling and Testing for HIV, this is usually requested by young couples.
Curative Services
Out Patients Department
The attendance in OPD was of 67,600 patients: 32,172 were new cases and 35,428 repeat-ers; the daily load of patients to the OPD was of 225, an increase of 7.30% from last year. The distribution by sex of the attendants was: Male = 51.28%, Female = 48.72%.
Radiology service
In 2004 were taken 1,519 radiographs, a 42.09% more than last year; the 51.48% for out patients, the principal study was of chest (64.05%).
The number of echographies was of 515, a 38.07% more than last year, the 33.01% for ob-stetrical-gynecological diagnosis and the 52.23% for abdominal exams. Table C, page 10, shows the data.
Laboratory
The total number of exams was 46,317 for this year, a 34.36% more than the total of the last year, of them 86.63% for out patients.
Among patients the proportion of positives is of 29.75% for the 316 patients examined; from the positives the 43.61% has between 25 and 35 years of age and the 55.32% are women.
For those requesting the test voluntarily the results are 11 positives out of 38 tested (28.95%), of the positives 63.64% women but of the tested only 44.74% were female. The 45.45% of the positives are 20 to 30 years old.
The Disease Prevention and Control Department of the Ministry of Health have not yet pub-lish the percentage of infection with HIV among antenatal clinic attendants at the date of compiling the report.
Regarding the screening of blood donors the 2.04% was positive, from the 687 tests, the 28.57% female. The 86.03% of the donors were male.
The main cause of blood transfusion was the malaria, the 84.41%.
In patients
General medicine
To the Hospital wards 4,430 patients were admitted, a 0.29% more than last year. The bed occupation rates have been of 88.99%. The average length of stay has been of 9.89 days, little less than last year. The gender proportion has been Male = 47.77%, Female = 52.23%.
The number of death was 357, a 9.62% less than last year and the mortality rate has gone down: from 8.94% to 8.06%. Technical problems make impossible this year to offer the whole data for the mortality causes but for the last four months. The detail of the mortality in 24 hours of only the last four months, there were 29 cases with Malaria falciparum as num-ber one.
Surgery
At the middle of the year a volunteer surgeon arrived to stay, and the volunteer orthopaedic surgeons and oculist are coming regularly. With them and attending the emergencies the surgical activity has been a total number of 344 major surgery operations and 890 minor surgery operations; almost a 3 fold increase for major operations but a 31.90% decrease on minor operations compared to last year.
Obstetrics
In 2004 437 deliveries have been attended, a 19.73% more than 2003. 83.98% (367) of them were normal and 16.02% (70) abnormal of these, 25 were caesareans sections.
Out of 482 children born in our Hospital 71 had low birth weight (14.73%); there were 41 still births (8.51%); the previous year were a 18% (79/439) and a 5.47% (24/439) respectively.
Preventive services
Health education
The health education is an important activity both in the OPD as well as in the wards. The topics of the lessons are Hygiene, Nutrition, Tuberculosis, Leprosy, Vaccinations, Diarrhoea, HIV, STD, Pregnancy and Antenatal Care and Malaria. During this year there were 320,015 participants, (49.68% more than the previous year), during the 389 health education ses-sions.
Vaccinations and Antenatal Cares
The vaccination service follows the Expanded Program of Immunization (EPI) of the UNICEF in 19 villages that correspond to the catchment’s area assigned to the Hospital by the Minis-try of Health. The villages belong to three districts of two different provinces, Arsi (Kofale and Munessa) and East Shoa (Neguele), being the Hospital in the border between the three dis-tricts; the results are given differentiated for each province. Of the 19 villages, 2 receive the service in the Hospital because they are nearby; the rest receive it in 12 peripheral centers. On top of it, there are intensive campaigns to vaccinate the women on childbearing age, mainly through school visiting.
Regarding the children under one year of age, the full vaccination coverage (Diphtheria-Pertussis-Tetanus, Polio-3, Measles) has been of the 21.01% for Arsi and of the 24.66% for East Shoa, of the total population; in 2003 E.C. the results were 23.34% and 30.41% respec-tively.
The vaccination program includes also the anti tetanus vaccine for pregnant women and women of childbearing age (WCBA, 15 to 45 years old). The objectives for this year were vaccinating 30% of the women of childbearing age and 95% of the pregnant women, for the East Shoa province the coverage for WCBA reached the 3.94% and for the pregnant women 22.70% (10.97% and 47.67% respectively for 2003). In Arsi, the results were the 2.70% for WCBA and 15.61% for pregnant women (4.97% and 24.47% respectively for 2003).
The percentage of population covered continues to fall; the efforts to reach the planned cov-erage are not working though most of the measures planned have been implemented. The extraordinary campaigns of NIDs for Polio, Measles and Tetanus are not included in the re-sults of the routine activity; this together with political-administrative problems in some vil-lages have contributed to the poor results of this year.
Tuberculosis Control Program
Gambo Hospital participates in the National Tuberculosis Control Program through the re-sponsible department of our province.
This year we have registered for treatment a total of 227 new patients, i.e. 18.85% more than last year. The data of those referred to their centers for treatment are only for the first two quarters, the rest of the data where lost on a computer crash.
The number of positive patients diagnosed was of 325, the 37.99% of the total; 202 were transferred out and 80 were treated in the Hospital, 9 patients disappeared or died before starting treatment. Regarding the results the cure rate was of 73.17% while the defaulter rate was of 7.32%.
The 76.65% of the patients have been treated with the special regime of Streptomycin (2 SRHZ + 6 EH).
 Leprosy Control
This Hospital is also the Leprosy Control Referral Centre in Arsi province for hospital treat-ments. For this service our Hospital provides 30 beds; the occupation rate is 46.98%. The causes for admitting the leprosy patients are: reactions and sores of various types; some cases need surgery to amend defects or, above all, to help the healing of the sores. The average stay of a leprosy patient is of 67 days. This year 69% of the admissions were for ulcers.
GLRA/ILEP have generously supported our service to the leprosy patients, both financially and with medical supplies.
Thanks
We conclude our report by thanking heartily all those who have made all this work possible; we are confident that, together with them, our Hospital will be able to continue to offer a meaningful contribution towards the welfare of the community.
Amici di Gambo, Alpignano (Italy)
Amici di Gambo, Guamo – Lucca (Italy)
Amici di Gambo, Val Susa (Italy)
Arsi Zone Health Department, Asela (Ethiopia)
Ass. Ita. Amici dei Lebbrosi R. Follereau, Bologna (Italy)
Associazione Nuova Famiglia, Padova (Italy)
AVIS, Turin (Italy)
Christian Relief and Development Association (CRDA), Addis Abeba (Ethiopia)
Comunidad Animadora Misionera IMC (CAM) de Madrid (Spain)
Costurero Misionero, Valladolid (Spain)
Ethiopian Catholic Secretariat, Addis Abeba (Ethiopia)
German Leprosy Relief Association (GLRA), Addis Abeba (Ethiopia)
Gruppo Amici Ospedali Missionari (GAOM), Reggio Emilia (Italy)
Gruppo Missionario S. Pietro in Sala, Milan (Italy)
Manos Unidas, (Spain)
Medical Students Overseas Relief, Dublin (Ireland)
Oficina de Correos del Congreso, Madrid (Spain)
Ufficio Missionario Diocesano, Tortona (Italy)
And all the countless friends that are generously supporting us.
Gambo 31 May 2005
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