Outpatient

OUTPATIENT SECTION

The services are scheduled to commence as soon as the required resources and manpower is available.Currently the outpatient section is under renovation at about 70% complete.

Once the facility is complete,then the hospital will have the outpatient services up and running.Including:-

REHABILITATIVE SERVICES

Comprises of three major departments:

  1. Physiotherapy department

Concerned with women who have gone through C-section due to birth related complications.

2.Occupational therapy department

Majors in children with slow growth or non-progressive growth e.g when a child takes longer than expected to learn how  to walk.

This is achieved through therapy.

3.Orthopaedic technology department.

Facilitates support through:  plaster procedures, support structures e.g crutches,

Substitutes for amputees can be done ;such include prostheses.

Biomedical Engineering Department

At Pumwani maternity hospital, the engineering department is concerned with:

Preventive Management

  • Servicing medical equipment.
  • Repair of medical equipment.
  • Training nurses who handle the hospital medical machines.
  • Maintain the oxygen generating plant

Other services

  • Ensure availability of oxygen for the theatre, new born and intensive care unit (ICU)
  • Procure new medical equipment as per the requirements and specifications of the hospital.
  • Ensure the availability of nitrous gas for an aesthetic value

THE CHAPLAINCY DEPARTMENT

Started in the year 2008. With a few members. The department has currently grown to a greater level,through enrolment of new members.

Services

  • Spiritual counseling and prayers.
  • Bible study
  • Encouragement to the sick and all members of the institution
  • Spiritual nourishment through the word of God.

Time

The services mentioned above are always done on; Tuesdays, Wednesdays and Thursdays.

                        RECORDS           

PMH has a records department which is concerned with storing patient records.Among the records stored include;

  • Report records
    • Birth records
    • General files
    • Birth notifications
    • Coding and Indexing
  • Admission records: – Generation of patient files.

                -Documenting in the admissions book

  • Birth records: – Issuance of birth notifications of all babies.

                                         -Processing of late birth registration for those not issued with birth notifications.

  • General files;- Filling all the patient files after being discharged

                                        -Filling all maternal death files.

  • Coding and indexing; – Coding and indexing of patient files before filing.

Reports records: – Uploading data into (DHIS) on monthly basis.

            -Doing data cleanup

          – Doing data validation.

  • Clinic preparations –preparing ANA files and booking of files.

COMPREHENSIVE CARE CENTRE (CCC)

This is a comprehensive unit for patients with HIV/AIDs.

PUMWANI  MATERNITY HOSPITAL  VCT  CENTER

The center for voluntary counseling and testing is partnered with The University of Nairobi –Center of Excellence in HIV Medicine{CoEHM}.

All our services run under Comprehensive Care Clinic{CCC}.

CCC Overall Goal:

To support Pumwani Maternity Hospital(PMH) develop a comprehensive HIV Care and Treatment program that will expand and enhance current HIV care and treatment capabilities at designated facilities in PMH

Objectives:

  • To provide sustainable support for the provision of quality comprehensive HIV care and treatment for adults
  • To provide sustainable support for the provision of quality comprehensive pediatric HIV care and treatment
  • To support the implementation of quality TB/HIV collaborative activities
  • To support provision of quality Prevention of Mother to Child Transmission of HIV(PMTCT) services and keeping Mothers Alive
  • To support the provision of quality HIV Testing and Counseling (HTC) services
  • To strengthen systems for pharmaceutical commodities to support adult and pediatric HIV care and treatment.
  • To strengthen laboratory systems to provide laboratory support for HIV prevention, care and treatment
  • To supplement the human resource capacity and support the PMH, Ministry of Health and partners to manage HIV prevention, care and treatment activities.
  • Plan and conduct regular CME sessions to enhance the knowledge of the service providers at Project-supported facilities
  • Establish and strengthen on-job training

Number of clients enrolled= Over 7,000 patients

  • Services include;

1. Counselling

2. Health education advice

3. Reference of clients to other clinics

4. Nutrition Canceling

4. TB treatment for hiv patients

Clients

Those referred from other hospitals

Those referred from VCT

Categories of patients / Clients

Adults

Adolescents

Children

The clinic has a team of able staff who include:

3 COUNSELLORS, 2 CLINICIANS, 1 PHARMACY TECHNICIAN,1 NUTRITIONIST,4 NURSES,1 LAB TECHNICIAN.

                PUBLIC HEALTH OFFICE

Services:

  • Hospital sanitation food and water quality control.
  • Pest and vermin control
  • Structural maintenance
  • Solid and waste management.

        FINANCE

Performs the task of managing the income and expenditure of PMH.

        PROCUREMENT

  • This department supports supply chain management
  • It provides tendering services and opportunities.

In procurement you can get;

  • Quotations
    • Registration of supplies
      • Qualification of supplies

MATERNAL NEONATAL CHILD HEALTH, POST NATAL AND FAMILY PLANNING

SERVICES OFFERED

Pumwani maternity hospital MNCH/FP/PN department caters for preventive, promotive services to Nairobians. Curative services are limited to under five since we do not offer outpatient services.

The clinic runs from Monday to Friday. The immunization services continue throughout the weekend and public holidays in the wards.

The facility is headed by a Nursing officer and has the following staffing: –

10 Registered Nurses

  1. 1 RCO
  2. 3 counselors
  3. 1 Pharmacist
  4. 5 Nutrionist
  5. 2 Mentor Mothers
  6. 1 Lab Technician
  7. 1 Support Staff
  8. 1 CHC
  9. Consultant paediatrician/Medical Officer attended to the babies daily
  10. Consultant Obstetrician/Medical Officer attends to the Ante natal Mothers and post natal mothers as well.

CHILD WELFARE CLINIC

This is where all the babies are seen and triaged. Those attending well baby clinic have their growth monitored and counselling done accordingly. Those due for immunization are attended to. Those attending POPC and also growth monitored and screened for any conditions and then are attended by a Paediatrician.

Any baby screened for nutrition review are also attended and supplemented accordingly.

BOOKING AREA FOR ANC CLIENTS

All mothers attending our ANC Clinic are triaged hare. Booking for ANC clinic is also done here. They are registered in our MOH register for ANC.

FOCUSED ANTE NATAL CARE

All mothers are attended to here. Vital signs are taken and recorded in the files and mother child booklets. Any deviation from normal attended to accordingly.

Clients due for HIV testing and counselling are attended to and interventions done accordingly.

Fetal monitoring is also done here by the midwifes and appropriate measures taken. Focused Antenatal Care is given according to the stipulated MOH guideline. Preventive services given according to schedules and gestation e.g. IFAS, Tetanus, Toxoid vaccine. An appointment date is given before the clients go home.

F/P/ POSTNATAL SERVICE

Post natal

Services are given to all postnatal mothers who have delivered in our hospital, other hospitals and those who deliver at home. The wellbeing of both the baby and mother are catered for. Nutrition services are also provided and breastfeeding encouraged up to six months exclusively and up to two years with replacement feeding.

Postnatal clinic

Here mothers come for post-delivery checkups and follow-ups which include;

  • Nutrition Status
    • Baby check up
      • The wellbeing of mothers

Family planning

All clients of reproductive age 15 – 49 years seeking reproductive services are attended to. They are counseled on available methods and helped to make an informed choice. Cervical screening is also done to women of reproductive age. Follow up is maintained.F

Provides advice to clients on various methods of family planning

And advice clients accordingly by helping them choose the family planning method that best suits them.

Some of the family planning methods include:

  • Combined oral contraceptive(coc)
  • Injectables
  • Implants
  • IUCDs – 12yrs
  • Jadeles – 5 yrs.

The mothers who wish to get pregnant after the method are counseled on pre-conception care. This help in prevention of neural tube defects of the fetus when she conceives.

IMMUNIZATION

All babies from birth to 18months are given immunization according to our EPI programme. Health education is also given vaccines are monitored in our meter fridge according to the MOH guidelines – temperature maintained at +2, +8. MOH registers are used in capturing the data. All mothers and caregivers are counselled before vaccination and after vaccination and given a return date according to schedules.I

Administers vaccination to babies to the age of 5 yrs.

Among the immunization vaccinations administered include:

                                                   1. Oral Polio Vaccine (OPV)

                                                   2. BCG

                                                   3. Pentavalent injection

                                                   4. Measles.


NUTRITION DEPARTMENT

Deals with advising mothers on the feeding criteria of children (Babies) and themselves(Mothers).

The department is manned by qualified staff who work both at the in and out patient to offer various nutrition services.

Nutrition status plays key role in health outcomes of mother, children and the general population. That is why the department has committed to providing high quality nutrition services so as to ensure our clients get both nutrition treatment and prevention.

The department receives commodities for use from KEMSA and feeds several reports to the National system, DHI. The department is a member in several hospital committees and works hand in hand with the hospital kitchen to ensure that our clients get delicious and nutritious meals. We also play key roles in the human milk bank.

Our services offered by the department include:-

  • Nutrition assessment
  • Nutrition diagnosis
  • Nutrition intervention and education
  • Nutrition supplementation
  • Monitoring and evaluation

All our services are currently covered under NHIF and free for children under five years

Preventive services

  • Tetanus
  • Deworming
  • Nutrition
  • Education on hygiene

SOCIAL WORKER

Under social worker we conduct GBVRC (Gender based violence recovery center). Also called ‘Tumaini clinic’ at Pumwani.

REPORT ON SEXUAL AND GENDER-BASED VIOLENCE AT PUMWANI MATERNITY HOSPITAL

BACKGROUND INFORMATION

Pumwani MaternityHospital is the largest referral maternity hospital in EastAfrica.It’s located in Pumwani ward,Kamukunji SubCounty in Nairobi County serving a population of 60085.The hospital’s main purpose was to be autonomous and provide efficient and comprehensive essential maternity care to all mothers regardless of their status.The Hospital was founded in1926 by a Charitable Organization called Lady Griggs Welfare League and was named Lady Griggs Maternity In 1928 the first permanent building was put up at the Hospital and later some extensions were made to give the Hospital a bed capacity of 27 .The name Pumwani was derived from the Swahili word to breathe/relax. In1969,the late President Mzee Jomo Kenyatta presided over the opening of a newly expanded unit of the Hospital. At the inception of the Hospital, the new block comprised 117 beds,an Operating Theatre and a modern 50bed unit for Neonates,anX-Ray Department,a Laboratory, a Library and a Conference Room.Today it is not only an Obstetric and referral hospital for delivery of expectant mothers within Nairobi and other adjoining counties,but has also integrated other services within the facility which are;

Comprehensive care Clinics(CCC), PMTCTclinics, occupational therapy clinics,adolescent and youth clinic and Gender-based violence(GBV)clinic which is also known as‘tumaini clinic’.

Justification:-Pumwani maternity has been offering reproductive health services to women from all parts of the country ,many cases were reported on defilement,rape,and under age pregnancies amongst them there were traces of SGBV cases being referred to other facilities,as the needs increased there was an urgent need to establish a center/department that will take care of the needs. The GBV (Tumaini)Clinic was established to cater for the needs of Pumwani maternity with an expansion to the community units surrounding the facility. Since the establishment, the clinic has recorded cases of sodomy,rape,defilement,physical assault,sexual harassment,emotional violence,wife battery among others.

Initiative intervention areas

1.Pumwani Maternity Tumaini Clinic It was established in October 2017 to offer services to the survivors of GBV due to the increasing number of physical and sexual abuse particularly to the minors,adolescent girls and pregnant teenagers/women who have experienced violence from their spouses.It has one examination room,waiting bay and a temporary shelter which is at ward 4 annex.The examination room has a couch,table,chairs and a lockable cabinet for keeping the documents safe.The medical social worker is incharge of this clinic and acts as the chaperon to the survivor.They also provide psychosocial support,linkages;followups,referrals to other stakeholders(police,children’s department,legal aid).The clinicians and nurses are not stationed at the clinic but in different departments whereby it’s the duty of the counselor/social worker to walk with the patient and alert the nurse/clinician about the survivor.

2.Training of the SGBV response team at Pumwani maternity.The training was conducted at Pumwani maternity school of midwifery hall with a total of 25 participants for five days(13th-17thAugust2018)

Participants were drawn from the followingdepartments;

LaborwardTheatre,Newbornunit,MNCHclinic,Medical social workCCC,Public health office,Laboratory,Postnatal wards,Health records Information System.The Community Members were also involved,they included;NPS,Religious leaders,Hospital Security and Community Health Volunteers

3.Continuous medical education(CME) SGBV department has been able to sensitize 382 clinical and non-clinical staffs on identification,care and management of survivors.These has a tremendous increase in the number of survivors identified and managed whereas referring cases to non-health actors.

Achievements

Anumber of 3 meetings with the hospital management at the medical superintendent office to secure GBV room and overnight shelter for survivors inside the maternity.

Provision of equipment including the examination couch for the head to survivors’ examination by the hospital management team which was a plus to the clinic.This would enhance service delivery to the survivors.

Provision of GBV reporting tools and Standard Operating Procedures(SOPs).

Community awareness and mobilization on availability of GBV services at Pumwani Maternity Hospital through community dialogues,chiefs Barraza’s and door to door campaigns where the local administration is able to help in domestic violence cases and also referrals of those injured to the facility.

Staff capacity building through participatory methodology training and Continuous Medical Education sessions done at the facility and more staff have opened upon sexual harassment and are even more aware on the human rights and sexual offences act.They are even able to share stories of their neighbors and are able to refer appropriately

Training of 38 Community Health Volunteers and GBV Defenders on GBV prevention.This has made the volunteers to follow upon cases in the community and court proceedings and also check on the adherence issues of survivors.

Roll out of GBV prevention program in Kamukunji SubCounty reaching over1,800 community members where targeted areas include school children,womenatANCclinics,football grounds where we target the footballers,waterpoints,churches etc.and sensitization was successful.In this we were able to attend to young men who had been sensitized and oneself-referred himself and later confessed to have been having sex with dogs.Counseling is still ongoing.

382 clinical,non- clinical staff from all departments and police from various stations and posts sensitized on GBV for 6 days.

Training of 10 community leaders and religious leaders where it came out clearly that some religious leaders were among the perpetrators since most people trusted them and they ended up taking advantage of their vulnerability.

Challenges

The clinic is still offering services to the servicesonacallbasis which sometimes is so challenging because of the work schedule.This has been attributed to the shortage of staff and some related to resources but the hospital is still working on them by planning to have a clinician/nurse who will be attached to the clinic.

Inadequate PRC kits.

The hospital is not attached to any community unit hence poor followup.

Community leaders are being compromised hence cases end up at the kangaroo courts(maslah)and the survivors don’t get treated and justice. Public stigma and discrimination is an obstacle to the uptake of postrape care services.

Way forward/Sustainability plan :The clinic has had so many success stories and has been able to reach not only girls and women but has also helped with them but this being a unique clinic within a maternity referral hospital,more on job trainings,CMEs

Make the Tumaini clinic to be a one stop Center

A nurse/clinician to be assigned duty at the clinic

Create a hotline number

Avail postrape care kits and toys

FormationofaGBVsurvivorssupportgroup

Have a community unit linked to the facility.Annex1–documentary evidence

After a 5 days training of the response team,who comprised of nurses,clinicians,public health officers,medical social workers,medical officers,police officers from various stations at the school of midwifery,referrals of survivors by the police increased and one success story is when we had a survivor who works as a taxi driver in Kapenguria was sodomised and by people who posed as clients, they later dumped him in Nairobi and was rescued by the police.The clinic attended to him and he was given clothes to change and the staff contributed his fare back home.He was very thankful and has been going for followup at Kapenguria hospital.

At Tumaini clinic, we offer the following services to persons who have been sexually violated. These services are:

  1. Medical management

Medical management of sexual violence survivors is aimed at managing any life-threatening injuries and providing any post rape services to reduce the chances of the survivor contracting any sexually related infections and pregnancy. The procedures for medical management are stated bellow:

  1. Obtaining consent
  2. History taking and examination
  3. Management of physical injuries
  4. Post Exposure Prophylaxis
  5. Management of sexually transmitted diseases
  • Psycho social support

Survivors of sexual violence react differently to the ordeal, e.g. psychological distress either long-term or short term. Efforts to facilitate such support include;

  1. Survivor-Concentrated Approach to counseling
  2. Trauma counseling
  3. Counseling environment.
  4.  
  5. Forensic Management of sexual violence.

Is the process of taking survivors of the sexual violence to access justice through judicial processes? This entails:

  1. Forensic examination
  2. Medical examination
  3. Legal procedures (COURT)

                   d)  Humanitarian issues.

                   e)   Quality assurance and quality improvement