June 2018 FOHG Trip to Professor Johannes Hospital & Soe

The trip comprised teams in dermatology, oncology, microbiology/infectious diseases, pathology, pharmacy, and was made up of both scientific laboratory staff, clinicians, nursing and pharmacists.

11 FOHG participants, incl. 5 first timers to NTT*

Dr Gill (team leader) – Dermatologist, Adelaide
Prof David – Anatomical Pathologist, Adelaide *
Elizabeth – Anatomical Pathology Technician, Adelaide *
Christie – Anatomical Pathology Scientist, Perth
Dr Aaron – Doctor/Pharmacist, Adelaide
Dorsa – Pharmacist, Adelaide *
Dr Brendan – ID Physician, Adelaide *
Dr Smathi – Clinical Microbiologist & ID Physician, Perth
Ms Trish – Microbiology Scientist, Perth
Dr Ganesh– Oncologist, Adelaide
Janet – Oncology Nurse, Adelaide *

It was a busy week with the election for the Governor in the middle, causing some hiatus in clinical activities.

Highlights were the Dermato-pathology seminar and Pharmacy/Infection Workshops.

Dermo-pathology (skin diseases) seminar

The Dermpath seminar was extremely successful. The FOHG and local dermatologists and histopathologists presented cases of interest for discussion. The FOHG dermatologists and pathologists also spoke on the role of the clinician and the pathologist, in diagnosing skin disease. The joint presentation of clinical with pathology, reinforced the utility of a multidisciplinary approach.
The seminar included the induction of the local anatomical pathologist’s Dr Heni, Dr Ratno, and Dr Sebin from Johannes Hospital into the IAPI (Indonesian Association of Pathologists) and the inaugural meeting of the Kupang branch. It provided an opportunity to network with the President of the IAPI and advocate for Johannes Hospital Anatomical Pathology Lab.
Pharmacy Seminar

The Seminar was organised by the Johannes Hospital Pharmacy Department led by Ibu Nelci and sponsored by FOHG. It consisted of workshops on Heart disease, Kidney disease and Antibiotics, to increase the pharmacists’ background knowledge and enhance their understanding of the medications available, with talks from Dr Aaron, Dorsa and Dr Smathi.
Pharmacists from across NTT participated. Feedback was excellent.

Johannes Hospital

We met with Dr Minah Sukri, Deputy Medical Director in Johannes Hospital. A round-up of the upskilling support and capacity building priorities for Johannes Hospital in the medium term include:

Emergency Department
Haematology (Clinical & Laboratory)
Cancer Services
Pharmacy
Paediatrics and obstetrics
Laparoscopic surgery

Infection Control Johannes Hospital

Preliminary visit & introductions with Dr Brendan.
Assessment of issues with NICU (Neonatal Intensive Care Unit) areas, floor & ceilings.

Laboratory

There was an active programme in the micro and history labs. As always, the presence of clinical and scientist teams in both areas worked really well to facilitate relevant and timely suggestions for improvements to the functioning of the labs and workload outcomes.

Microbiology Lab

Staff were as always enthusiastic and grateful for all help and support provided. Work flow in the lab was reviewed, and staff were given an extensive tutorial on antibiotic resistance mechanisms. Specimen numbers, isolates and resistance patterns were analysed. Environmental swabs were taken from the NICU for analysis for infection control surveillance purposes.
Anatomical Pathology (AP) Lab

Case discussion (on the Election Day Public Holiday) at the Multi-head microscope at the Public Health Lab were useful for the Pathologists. Challenging cases were reviewed with Dr Heni, head of Anatomical Pathology at Johannes Hospital. The laboratory set-up and resources were also examined to further identify needs.

Quote from Prof David Astill, “Having experienced Kupang I now have an appreciation of the situation & needs of the local pathologists allowing me to be better prepared and more able to provide focused resources next time.”

Teaching

Grand Round Prof Johannes Hospital

Dr Brendan and Dorsa presented at the Thursday morning Grand Rounds for doctors and allied health workers on Sepsis and Antimicrobial Stewardship.

A very challenging paediatric case of cutaneous necrosis was presented by Dr Alders (General Surgeon) with discussion and comments by Dr Gill, Dr Brendan and Dr David.

Polytechnic visits

Microbiology – Kupang Health Polytechnic (Ms Trish, Dr Smathi)
Pharmacy – Dorsa
Nursing – Janet. Topic Oncology Nursing

Continued teaching with students from Undana Medical School

Dr Gill
Dr David
Dr Brendan

Health Commission meeting with Dr Dominikus Mere “Dr Domi”, new head of Health Commission in NTT & acting head of Prof Johannes Hospital and nominees from the public health unit of the Dept of Health.

Dr Domi has suggested that with the success of a number of programs at Johannes, that FOHG consider rolling these out into the Province in other areas including Soe and Kefamenanu.

Announced that a new Hospital will be built by the central Ministry of Health (along the model of central funding of Sanglah Hospital in Bali). Johannes Hospital (funded at Provincial Level) will work cooperatively.
The Radiotherapy Unit, the first and only one in NTT will be built at the new as yet un-named Hospital.

Meeting with Communicable Diseases head of NTT Provincial Health Commission, Dr Theresia Rallo.

Dr Gill, Dr Brendan, Ms Trish and Dr Smathi
Dr Samson Teron and Dr Ita

This revealed a number of issues with regards to laboratory diagnosis and recording of malaria, leprosy and other infectious diseases.
Johannes Hospital have agreed to work out a way of improving Leprosy notifications to the NTT Health Dept and discussed improving malaria diagnosis in the context of malaria eradication aimed for 2023. A train-the-trainer workshop will be considered in conjunction with the Public Health Lab who have the responsibility for training of lab analysts across NTT.

Muder Ignacia Hospital (RVM), Soe Visit – on the Election Day Public Holiday

We also had a chance to visit Soe and review the Muder Ignacia Hospital progress. Things were well run and in the capable hands of Sister Bernadette and Sr Lani. It was good to meet the doctors working in the clinics including Dr Andre, who first met FOHG as a medical student at Undana Med School. A healthy baby boy was born just as we walked into the Hospital!

As always dinners and time to network and build relationships.

All up, this was an extraordinarily successful, although short week, and a number of new clinicians and professionals joined the FOHG team, and we are most grateful for their enthusiasm and commitment, especially considering the vagaries of travel inflicted by the activities of Mt Agung in Bali on our homeward leg.