Completion of the new Operating Theatre Block

Transcription

1 Completion of the new Operating Theatre Block

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3 The new theatre block was formally opened on 29 August This was a major building project, which took approximately 28 months to complete (from May 2010 to August 2012), and involved employment of approximately 35 local workers. The theatre block was designed to provide facilities lacking at the hospital, which had been built in Some of the problems identified which lead to the development of the new theatre block included a) Having only one operating theatre. This caused a problem when major operation was being performed and another patient requiring emergency surgery (usually a caesarean section) presented. Although we had developed a system for transforming the delivery suite into an emergency theatre room, a more permanent solution was needed. b) The theatre built in 1956 was clean, and was adequate for most of the operations being performed. However the tendency for dust to come through the ceiling meant that it was not sterile enough to safely insert foreign bodies such as plates and rods (for orthopaedic surgery after difficult fractures) or shunts (for hydrocephalus). In these operations any contamination during surgery will cause infection, often with disastrous results. This meant that it was safest to avoid doing these operations. c) Again the wards were adequate for most patients. However when a patient was very sick and needed extra care, it was difficult to provide such care in the wards. The short term solution had been to look after very sick patients in the nursing station. There therefore needed to develop a well equipped and monitored high dependency unit to help medical and nursing staff to look after the sickest patients in the hospital. d) There was also a significant shortage of storage space around the hospital. This meant that medical equipment which should have been in the hospital was often stored in containers. At times this lead to problems medical items such as monitors collecting too much dust (it is impossible to keep dust out of your house in Africa!) e) There was no hospital chapel, and no space inside the hospital for running functions, or for staff education. f) There was a shortage of office space in the hospital g) There was a need to help modernise and upgrade the hospital. The new theatre block therefore includes three operating theatres, sterilising rooms, three storerooms, staff changing areas, a tearoom, a 7-bed high dependency unit, two offices and staff toilets and a hospital chapel/ education room seating up to 200 with integral kitchen facility. The initial donation from Beit Trust of UK 50,000 provided the impetus and financial funding needed to start the project. However as is often the case the cost of such a large project is often larger than the initial estimated budget. In this context we would like to acknowledge many other groups and people whose donations made the completion of this project possible. These included generous donations from Medical Missionary News, Echoes of Service, CMML USA and MSC Canada, plus donations from many other church groups and individuals worldwide. Producing finished dust-free Operating theatres required a higher standard of building than previous Kalene building projects, such as extra sealing above and below the ceilings to stop dust. The high quality finish was made possible by UK missionary Paul Hannay who ran and supervised the completion of the project. Without his commitment and expertise over the last three years: including in the planning, ordering of equipment and the leadership of the work,

4 this project would not have been possible. The local building staff and those who supervised the work at critical times, such as Gordon McKillop, (welding the trusses) and Brass Tacks workers from the UK deserve special thanks. Design: while the initial sketches were drawn up by Paul Hannay, Richard Reed and John Woodfield, the formal plans were drawn up by David Thorpe a building engineer and a volunteer with Brass Tacks in the UK. The theatre block was planned to be a T shape with the theatres being in the horizontal limb and the high dependency unit and the chapel in the vertical limb of the T. This was placed into the open quadrangle between women s ward and maternity. As all the internal walls in the horizontal limb (including the theatres) were based on plasterboard and were not designed to carry weight this meant that all of the weight of the roof, which was 15m wide, would be supported on the outside walls. Sam Philip engineering company helped with the design of the roof. Foundations Digging and laying the foundations was commenced in May The channels for laying the foundation under the walls were dug using only manual labour, with picks, shovels and wheel barrows. As we had only two concrete mixers the foundation area had to be divided into about eight areas, with each area being laid as a separate slab, thus creating expansion joints. The whole area inside each slab had to be reinforced with mesh and filled completely with concrete, and the concrete surfaced had to be rubbed up before any of the concrete dried out. Supervision was provided by Brass Tacks, mainly by Colin Breeze, Paul Dodds and Jim Smith.

5 Walls As the external walls provided all the structural strength for the roof, special attention was paid to the quality of the bricks and the walls were reinforced by the use of a ring beam. The bricks, which were designed to fit in with the surrounding hospital brick work, were produced locally. This therefore provided local employment and was a cost saving measure. Mr Kasongu Muke who supervised the purchasing of bricks. Mr Jim Smith helped with the supervision of the brick work. At the height of the work of laying bricks there were 10 bricklayers at work. Roofing Gordon McKillop (from Nyangombe) provided much needed expertise and supervision with the production and placement of the 18 steel roof trusses and Robert Woodhouse from Brass Tacks came out to help and supervise the roofing. Forty-two tonnes of steel and roofing went into this construction. This part of the project was perhaps the most technically demanding, and we are particularly grateful to those who helped. A triangular jig was built to act as a template for the formation of the trusses. Once one side of the metal truss was welded, a group of approximately 30 workers would lift the truss off the jig, and turn it over and then place it back on the jig so that the second side could be welded. [Picture of truss being turned] Once all the trusses were completed a small truck with a crane to lift the ½ tonne truss was provided by Ross Ferguson (Zengamina Hydro and NWZDT North West Zambia Development Trust). This was used to help place the trusses in position, which were then welded in place. Each truss was then joined with C section channel to support the 8M long IT roof sheets. The placement of the roofing sheets was not without risk because of the height involved. There was initially some resistance from local staff to wearing a safety harnesses, but this improved after visiting a paraplegic man in the hospital who had fallen out of a tree. We are thankful that there were no accidents.

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8 Internal work hanging ceiling, painting, floor tiles, walls and finishing. This part of the project was supervised by Paul Hannay. Extra sealing of the roof was provided by foil-backed 12mm taper edged plasterboard (tin foil) attached to metal hangers and rails, and by plastering the joints and painting below the hanging ceiling. Ceramic tiles were used in the floors of the theatres and high dependency unit with the help of Paul Dodds and Gavin and Adam Martin from NI. Thermoplastic tiles were used in the offices, toilets and in the chapel. Wiring, plumbing and tubing for the anaesthetic machines and power tools were brought through the roof space and into the plasterboard walls before the walls were sealed, by plastering the taper edged joints. Shelving in the three large storage areas was built by Paul and his co-workers. The shelving in the theatres, which was make out of melamine faced chipboard and glass doors were fitted in front of the selving which was incorporated into the plasterboard walls. The medical air compressors and air conditioners were stored in a small room next to the theatre block, with positive pressure and compressed air being brought into the theatres though the roof space ducts and pipes.

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10 Preparations and opening day Once everything was in place all the equipment from the old theatre and from a number of containers was moved into the new operating theatre block complex. The new storage areas were particularly useful, with space for storing the image intensifier, laparoscopic tower and disposable medical and surgical equipment, and the electronic equipment store room enabled all the electronic medical equipment, spare parts and manuals to be brought together in one room. Beds were moved into the HDU and a medical library was moved into the theatre tearoom. Following the first theatre list on Tuesday 28 th of August the opening ceremony was held the next day. This was attended by local dignitaries including the chiefs, district and provincial health directors and the District Commissioner for the Ikelenge District.

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12 The completion of the theatre complex has equipped the hospital to perform a major operation and a caesarean section at the same time, has provided an environment where sterile procedures can be safely performed, has provided an area where electronic medical equipment can be safely stored, and includes a high dependency ward where sick patients can be closely monitored. It is our prayer that this complex will help the hospital to both attract and retain well trained medical and nursing staff who will be able to use the facility to its full potential, and that this will in turn help with the future development of the hospital