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CLINICAL DIARY FOR VEZO HOSPITAL

Computerized management of patient clinical data and computer literacy in Andavadoaka

About the project

The Vezo Hospital is situated in a remote and impoverished region of southwestern Madagascar. The hospital covers an area inhabited by 200,000 people distributed in 18 villages. The nearest town is 180 km away and requires an 8 hour off-road trip by car. To get to the hospital people walk on sandy tracks with ox-drawn carts or by sea with sailing pirogues.

In Madagascar health is expensive as compared to local income: the Vezo Hospital provides services and medicines free of charge and today constitutes a very important point of reference for the entire population. About 100 patients are admitted per day.

The hospital was built and is managed by the Italian Volunteer Organization (NGO) "Amici di Ampasilava" . It is also part of the country's health network as it was donated to the Malagasy community in order to make it an integrated reality.

Currently a major issue is collecting health data and statistics of the local population: pathologies, therapies and drugs supplied, personal data of the patients. These data are essential to know "what is being done", to be aware of the epidemiological situation of the territory and to be able to agree with the Malagasy government on the planning of health actions for the benefit of the population.

To date, data collection is handled essentially by hand. The year 2019 saw a total of 26327 admissions with an increase of 3128 patients as compared to 2018.     

Extract of the first 20 diagnoses for the year 2019.

Extract of the top 10 locations catered by the Vezo Hospital in 2019.

What are the funds for?

The project is managed by the NGO of volunteers "AMICI DI AMPASILAVA - MADAGASCAR" in collaboration with the NGO of volunteers "INFORMATICI SENZA FRONTIERE (ISF)" Association.

The funds will be aimed at financing the different phases of the project, in particular:

  • the organization of training courses, aimed at Malagasy staff and Italian volunteers, on the use of computers (computer literacy) and the "Clinical Diary" based on the software Open-Hospital
  • the functional improvement of the "Clinical Diary" software in order to make it suitable for the growing needs of the hospital;  
  • the purchase of hardware (personal computers, printers and Wi-Fi equipment).

Targets:

  1. Improve the quality of the information collected on the health status of the population, through the introduction of a computerized clinical diary that can represent in a "certain" and reliable way and health conditions, the diagnoses and diseases, the drugs and therapies provided ;
  2. Schedule health interventions aimed at the actual needs of patients, carry out strategic and growth planning of the structure's activities, organize specialist missions for volunteers;
  3. Introduce the WHO standards relating to the diseases treated and the services provided in order to present to the Malagasy Government a precise and reliable situation of the hospital activities and, consequently, demonstrate the hospital management needs and make requests for financing and human resources to the Government;
  4. Allow Malagasy staff, operating at the hospital, to acquire specific expertise on the use of the information systems and on the management of clinical data aimed both at the introduction of a computerized medical record and as personal knowledge of the staff.

History of the projects carried out so far.

October 2008: birth of the project for a new hospital - including the articulation of its various components and in particular the radiology department. Definition of the necessary spaces for the installation of radiology equipment (diagnostic room and control room) and for the development of radio-graphic films (dark room)  according to essential criteria of radiation protection for health-care personnel and patients. Soon the evident repercussions in terms of supplies, as well as environmental protection, makes it necessary to upgrade to  digital acquisition and management of images (computerized radiography). 

May 2012: decision to proceed with the design of an image archiving and communication system. The installed X-ray equipment starts using an open source Picture Archiving and Communication System (PACS), which can be administered remotely from Italy and can therefore be consulted for remote assistance purposes. 

April 2019: implementation of a multispeciality teleconferencing service provided by a team of medical specialists and IT professionals who offer their skills on a voluntary basis to answer clinical questions from  less privileged locations of the world. The telemedicine platform proposed with the cooperation of the Italian Association of Health Information Systems (AISIS) is open, completely modular, web-based, integrated with the PACS and offers e-Learning training opportunities for doctors, radiographers and nurses (in connection with italian and international universities).

Diagnostic services available in digital mode.

Clinical categories for which the telediagnosis service was activated in 2019 thanks to the collaboration with AISIS.

About the project owner

The NGO "Amici di Ampasilava" , registered in Italy, has built the Vezo Hospital and has been managing its activities since 2008. The project was carried out in collaboration with the central and local offices of the Malagasy Ministry of Health and with the Chief of the village of  Andavadoaka near the hospital. Health activities are managed by voluntary health professionals from Italy who, with a high turn over of missions, guarantee an assiduous presence at the hospital aimed at both health activities and the training of Malagasy staff.

The NGO's strategy aims at adequately training local staff in all hospital activities (health care and management), in order to gradually make the structure autonomous by delegating its management to local staff. To this end, a memorandum of understanding has been drawn up with the University of Tulear (second city in Madagascar) and some NGOs that deal with staff training. This agreement allows students to carry out internships and eventually be hired by the hospital.

The hospital covers an area of 700 square meters and includes:

  1. Two hospital rooms with 11 beds (4 for men and 7 for women);
  2. A hospital room for mothers and children;
  3. A multipurpose operating room for surgeries (recently completely renovated);
  4. A sterilization room;
  5. Two generalist clinics;
  6. Three specialist clinics (ophthalmology, gynecology, physiotherapy, dentistry);
  7. A medication clinic;
  8. A diagnostic imaging room (conventional radiology and ultrasound) with teleconsultation / telediagnosis service. The technological equipment consists of two radiology equipment (one fixed and one mobile) and two ultrasound systems with linear, convex and gynecological probes;
  9. A pharmacy with a warehouse and a Galenic laboratory.

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