University of Nigeria of... · Cg1 leg12 of Xedicine , University of Nigeria, Z;JUC;U CAKL~US. Dear Sir, Knowing of your wide rangitq experience of medical centres at the University

University of Nigeria Virtual Library

Serial No.

Author 1

NWAKOBY, B.A.N

Author 2

Author 3

Title Feasibility of Establishing a Medical Centre at Premier

Breweries Limited

Keywords

Description

Feasibility of Establishing a Medical Centre at Premier

Breweries Limited

Category

Medical Sciences

Publisher

Premier Breweries Limited

Publication Date

October, 1986

Signature

Industrial Layout, Bridge Head, P.M.B. 1620, Onitshi:.. Nigeria. Phone: (046) 210388 Cables & Telegrams: Prembrew Onitsha

O u r R e f : PBL/GPI/C - 2 3

D r . ... o n i f cce !\JwzkoSy, Kead of Gcpa r t rnzn t of Community M e d i c i n e , C g 1 leg12 of X e d i c i n e , University of N i g e r i a , Z;JUC;U C A K L ~ U S .

Dear Sir,

Knowing of y o u r w i d e r a n g i t q e x p e r i e n c e of m e d i c a l centres a t t h e U n i v e r s i t y o f N i g e r i a and o t h e r l o c a t i o n s , w e humbly w r i t e t o you with t he p,.u-pose of c o n s u l t i n g y o u r p r o f e s s i o n a l o p i n i o n on the F e a s i b i l i t y o f e s t a b l i s h i n g a medical centre a t o u r E r e w r y , w h i c h already has a good n u r s i n g clinic-

- i f you a r e a g r c e a b l e t o t h i s request 35 o u r s , i t would be d e s k r a b l c f o r you t o v i s i t us i n O n i t s h a t o see t h e f a c t ~ r y area and t h e c l i n i c i n p ? . r t i c u l . a r .

I t would be much a p p r e c i a t e d i f you would v i s i t u s either on ::ednesday O c t o b e r 22 or cn Thurscia:y S c t o b e r 2 3 , b u t i f t h o s e dates a r e n o t c o n v 2 n l e n t t c you, n o . d o u b t you w i l l s u g g e s t a n a l t e r n a t ; . ~ ~ .

23rZ December, 1986

Yours fsith*W!.p,

Report of Fcas iL i i i ty Study f o r

the Upgrading of t h e Bzctory

Health C l i n i c , Fremicr

Brewerieo Limited

Onitsha.

December 1986.

.

Table of Content

A. In t roduc t ion

R . Situation Analysle

(a) Services

(b) Staffing

(c) Space Allocation

( d ) Equipment cvld hnli tu r e

(e ) Transport

(f) D w a

C. Recoinmendation

(a) Services

(b) s t a f f i n g

(c) Other Services

(d) Space Allocation

(e) TTanspart

Map of Ground P l a n

- ." T - -. h. L....: . -#A 1- .

( a The main brief is to investigate the f e a s i b i l i t y of

ca t a b l i s h i n g a Medical Centre a t the Premier Breweries

L i a i t e d , Cnitsha which already had a good Nursing Clinic .

(b) It was however obvious from discussions with the

i,:m2gt2cnt of t he Company t h a t the fol lowing arcan were

of s p e c i a l i n t e r e s t t o them:

(i) The es tab l i~hrnen t of a 24-!Iour i4edical Sorvice.

This , i t i s hoped would ].cad to im~rovement of

p r s o n a l s e ~ r i c e s rendered t o staff and family.

(ii) The reduction of excesnive de~endcnca on external

retainership an? consu l t a t ion with i ts resultant c o s t

t o t h e company and. inconvenience to the s t a f f .

( i i f ) The minimisins o f expenditure by staff on

outs ide consultation with doctors not officially retained

by the company.

( c ) Dizcus s lons were carried out with the fo l lowing

members of Ktmagement and R u r s i n g Services:

(i) The Chnirnan of 9oard o f Directors.

( ii ) The General I .<an . z~~r .

(iii) The Fersonnel Officer.

(iv) The Rursine; S i s t e r in charge of the Cliriic.

( d l 2, o l t e visit was conducted estimate nade of the

facilities in s i t e i n t h e present G l i n i r ,

( e ) A prev ious f e a s i b i l i t y study had bccn done d u r i n g

t h e exis tence of the previous Board of ihnagerr,ent b u t *

i t s recornrner,dation had not been implemented.

The smxnry of t bc p o i n t s ~iresented i n t ha t

f e a s i b i l i t y s t u d y wzs however a v a i l a b l e and has been studied

foz t h e purpose of the resent pronosals.

B. SITUATION N,IALYSIS

(a) Services

(i) Cl in i c s

Only OFD (out P a t i e n t s ~ e ~ a r t m e n t )

consul ta t ions arc offered. Treatment is given in the

form of dispensing of d-, adminis t ra t ion of injectlans

and dressings. There axe no Gynaecological, Ante-Natal

01- special Faediatric Services. S u r g e r y i s not

~ r a c t i c e d . C l in i c hours a r e from 7.30 a.m. t o 10.00 F,m.

There are no f a c i l i t i e s for in-patient8 treatment er over-

night oboemat ion .

( ii) Pa t i en t s Attendance

Average monthly e--ttend=mce based on

previous 3 months i s about 1,200 per month.

The propor t ion of s t a f f t o family t r e a t e d

i s approximately 3:1, and for adult t o children also

about 3:l. Industrial injuries treated in last 3

~ o g t h s were 15, i O and 9 respect ively .

(iii) Xeferral Facilities

Facilities for outs ide consultation and

ref e r r n l exist i n five ( 5 ) hosp i ta l s wi thin Onitsha.

Thcve a r e the official retainers of the company(

( a ) Sf. Luket s Bosp i t a l , Onitsha,

(b) Toronto k iosp i ta l , Onitsha,

/ ' CI Pladonna Hospi ta l , Onitsha.

( d ) Vesta Hospital , Onitsha.

(e ) Menu Hospital , Onitsha.

l?eferrals from t he Clinic ta theac r e t a ine r

h o s p i t a l s number approximately 23 p e r month.

However, referral by staff to hospitals

other than these officially designated units were

* 226 and 110 for the months of September and October.

These numbers c l e a r l y indicate a preference of the

staff f o r hospitalo outside the designated five.

Main reasons f o r referral^ arc:

Surgery

Laboratory investigation

Bonthly b i l l s for re fe r ra l s i s about

NS ,000.00 ( ~ i v e ThousLmd ~aira) . (b) - S t a f f i n e

Total nmber of s t a f f i n the Centre is nine

made up as, fol lows:

1 hrsing S i s t e r

1 Sen io r Staff Nurse

1 Staff Nurse

I I C l i n i c Attendants

1 Clerk

k Nedical Cff icer i s retained part-time f o r

consultstion during the morning hours from 0.30 a.m. to

10.30 a.m.

( c) Spa:? Allocation

The p e s e n t structure contains eight (8)

rooms allocated as follows:

Doctor's consulting room

- 4 -

: .:-xicg Zic. te,-% itf i'ir:c-

Senior S t a f f Nurse's Office

Manager' s Waiting Room

Lhergency Recovery Room

Injection Room

Sterilization Room

Dressing Room

The disposition of room8 is as shown in the

d i q p m page 13.

( d ) Zquipntnt and Furniture 1

S t m d v d conoulting room furniture and

equipment are ~ r o v i d e d . Dressing room/injection rooms

&re f a i r l y w e l l furnished.

Fac i l i t i e s f o r X-ray, Finor Surgical Operations,

laboratory investigations and pa t i en t observations and

rcsuscit~tion a r e n o t available.

(e) T r a m p o r t

One an!bulance covem n 24-hour a h i f t using two (2)

d r i v e r s .

( f) Drugs ,and consumables a r e available in reasonable

r jum.ti t i ts and arc purchased by tender through a Purchasing

Officer. 12 Pharmacist is n o t available e i t h e r f u l l time

o r p a t timc.

Two major op t ions present themselves for 4

consideration:

To upgrade the f a c i l i t i e s e x i a t i n ~ at the moment In the Clinic without providing a 24-hour service

To so modify the services as to provide a 24-hour s e n i c e cover thereby convert ing t h e present Clinic into a full m e d i c a l centre or a mini-hospital.

I n choosing which option i s more appropriate to the

zircusstcmccs of the company, consideration haa been given to

the following factors:

( i) The present level o f out-patient ' s attendance.

( i The present need for in-pat ient f a c i l i t i e s based

on the number of referrals to the retainer hospitals

a t the noment.

(iii) The increase o f nursing staff which w i l l be

inevitable in a 24-hour se rv ice almost t o t he l e v e l

of 2 to 3 times the present number.

{ i v j The reSultant cost of maintaining such staff

who may n o t necessarily be fully occupied most of the

t i n e ziven t h e nunber of an t ic ipa ted in-patient

(V) 7 3 ~ n a t u m o f the rclerrals which ind ica te tha t

Fven w i t h a 2b-hour servic? such r e f e r r a l s w i l l s t i l l

be necessary t o a h o s p i t a l which provides more

elizborate surgical and other facilities as well 2s

sui tably txpericncc6 staff t o handle such matters, f o r

example abdominal gurgery and se r ious i n d u s t r i a l

accidents.

... . /6

( v i ) k 2l-hour service a l so implies the cmploymcnt of

no t just one Medical Officer but :.'; least two, for

effective cover. Otnerwir- a s i tua t ion w i l l arise

where the Company's M e d i c ~ l Officer ie technically

on c a l l 24 hours a d ~ y e v e q day of the week.

It has k e n therefore, found more appropriate to recommend

a,n upmading of exist ing services without a 24 hours cover. This will

not materially increase costs but will provide better personal. and

comma1 services for workers anti their families.

E e l o w then is pre~ented the details of the recommendation

for u~grad in 'g the clinic.

(a) Services

(i) Clinlcs

In add i t ion t o t he present OPD

(out Fa t i e n t Dersr tment) consul tat ion on the

fo l lowing ancillizry c l i n i c s are s u ~ g e s t e d :

(a) Ante-l?:~t,al Clinic

(b) Child Velfare Clinic. q '

Such clinics could bc run once a wtek by

staff of the c l i n i c with a Consultant Obstetr icim

and 2 Consultcult, I-aediatrician in attendance f o r not

more than two hourc each week. This w i l l minimize

the r e fe r ra l s t o ou t s ide hospi ta ls o f p a e d i a t r i c and

a d u l t female caces which n a t u r a l l y form an area of

greatest concern t o staff. Maternity delivery

aexvicen, w i l l rexain the responsibility of staff

who may use any venue of their choice without

C ornpany subven t ion .

(ii) Clinic Hours

Cl in ic houra w i l l continue from 7.30 a.m.

to 10.00 p.m. is car r ied out at the moment Monday

t o Friday.

.An additional s h i f t of 7.30 a.m. to 12.00 noon

on Saturday w i l l provide staff with further opportunity

f o r conaultatfon on a day wHen they are free t o bring

their fami l i e s f o r treatment and rninimisc the need 9

for outsida consultations.

(iii) Befcrral and Retainer r 'aci l i t ies

Without prejudice t o the present o f f i c i a l

r c t a i n e m of the company, arrangements should be made

t o spread ou t such hospitals t o cover a l l s ec to r s o f

the tom geonaph ica l l y making access easy t o a l l staff,

'The present l a t i t ude given t o staff t o use non-off ic ia l

hosp i ta l s must be c c q ? : te ly rescinded as this naturally

leads t o misuse a d involves the company in spurious

expenditures. It should be made clear t h a t no expenEes

incurred b y staff using non official retainer-hospi%ls

can be refunded. This w i l l ensure authent ic i ty of a l l

b i l l s s e t t l e d by t h e company i n respect of outside

t rea tment as i t will be assumed t h a t officially retained

h o o p i t a l a will exercise a reasonable degree of honesty Fn

nending their bills t o the company.

A l l cadmissions in <any hospi tal must be reported

t o t h e company d o c t o r w i t h i n 24 hours of mch an admission

in o r d e r t o authent icate whether such a pzt ien t is a bona f i d c

ernplayee o r d e p e ~ d a n t s .

(iv) Occupational Hygiene Servicea

The a e t t i n g up o f a service speci f ica l ly

designed f o r occupational hygiene associated with t h e

brewing indue t r y i s B t rangly advocated and recommended.

Such a s e r v i c e w i l l promote and ma in ta in

the h ighes t poss ib le level of health among the workers

in r e l a t i o n t o their individual occupat ional committments.

The ~ c r v i c e w i l l involve two forms

of monitoring systems.

The former is concerned wi th monitoring

a t the p l a n t level and for speci f ic hazard related

t o t h e work environment e,g. chemical, temperature,

mechanical etc. The la ter monitor8 the effect

of such exposure on thc individual workers at risk

by p e r i o d i c exar;jinations.

Where ex-pcrtise f o r such R atmice does

::ot, exist (as is the case at the moment) the

serviccs o f a consu l t an t u n i t should be engaged.

A Univers i ty Department of C o m i t y Medicine would

be i n a p o o i t i o n t o provide such a con~u l t ancy service.

But it is also mandatory t h a t serving medical and

nursing staff of the company hea l th service should

have t r a i n i n g in occupational hygiene t o essist

i i l t h e day t o day monitoring process.

(b) S t a f f i n g

(i) Doctor

One full time Medical Officer should

be employed. Such a Medica l Officer should have

rsssonabXe experience in the m i n g of a clin3c

related t o indus t ry . lkpcriencc i n maternal and c h i l d

hea l t h w i l l also be an advaqtage. E i s du t i e s apart

from routine clinic ahould include the ensuring of

i ndus t r i a l safety within the f a c t o r y as w e l l as

monitoring of hcalth hazard t o s t a f f . H e w i l l be

the liaison with the official retainer-houepitala

and other health institutions and shall arrange

referrals where necessary.

(ii) Fart-time C o n s u l t a t

A part-time Obotetrician may be retained

f o r 2 horns each week f o r ante-natal services .

A P a e d i a t r i c i a n may also be re ta incd on a similar

basis f o r pa td ia t r i c casea. For convenience, sue5

consultants should idealiy come from the o f f i c i a l

retained hospi ta l s of the company and such services

should then be negotiated f o r as an extent ion o f the

o r i g h s l services . Where t h e company Medical Officer

deeas himself competent t o handle cases, the services

of a consult:s?t i n t h a t f i e l d need not be retained.

(iii) Nursing Sta f f

Staff strength should be augmented to at

l e a s t f o u r n u r s i r r ~ staff to cope wi th t h e Increased

c l in ic serviccu m d cxtcnaion of work ing hours Lo

Saturday morning, Training in occupational hygfene

is reconncnded f o r serving staff.

Faxa-medical Staff , (iv) ,

h pharmacy technician will be needed

man the drug store. The present system of

drug acqufsiticx sEems adequate a d w i l l be

supervised by the company doctor. A laboratory

technician may be needed should laboratory service5

as suggested be provided. Pour (11) Clinic attendants

as at the present seem adequate.

(v) Clerical Staff

A Iqedical Records Clerk as well as a

~ l e r k / ~ ~ ~ i s t will be required. Two cleaner/

Messengers are needed who will a l s o serve ar

Orderlies in other service arcas.

(vi) Given t h e present staff strength of about

1,000 and an average f a m i l y s ize per married

staff of 5, the pogdation served by the service

w i l l be 5,000 giving a doctor:patient ratio of

1 :5,000 a d nurse:patient r a t i o o f 1 : 1,250.

c . &her Services

( i) Laboratory

A mini laboratory will greatly reduce

the present number of referra ls f o r laboratory

services. Su.ch a laboratory can handle the

Tollowing inventigation:

Ilaemoglobiii

E H

Blood films

Routine Urine analyais

Stool Microscopy I

Sputum exanination ctc,

Outlay on equfpmcnt w i l l be minimal and

staff required will be at the technician level. More

elaborate investigations should be di rec ted t o designated

j l r ivate laboratories rather than t o p s iva t e hosp i ta l s .

(ii) X-rax

The inotallation of X-ray Unit is not

justifiable. Radiological investigations can be

directed t o the private X-ray Units. Such u n i t a

should provide the services of a radiologist for

f i l m i n t e rp re t a t i on and reports.

(iii) Winor S u r g e q

A minor surgerr theatre should be provided

f o r surkmy as may be required by the company doctor.

'?he observation warci will be used as a recovery ward alao.

( iv) Cbservation W a d

A four-bedded sbscrvat ion nard should be

opened for day-time observation and treatment of

z; .proprizte cases c . g . diarrhoea. This emcrKency

room should be opcn during normal hol:rs 7.30 a.n. t o

j d ) Spacc Al-locati on 4

J i a g r a m p<age 13 shows the p x o e n t space ava i l ab l e

in the exis t i n & building and the sugges ttd extention/modification,

1

(t) Transport

The present arrangencnt of one ambulance,

tuc dr ive r s and a 24-hour cover seems adequate,

23rd December, 1986 Dr. B, A, N, Nwakoby.