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Equipment Purchase For Karwan-e-hayat

 
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Khurram Owais Shah



Joined: 07 Nov 2007
Last Visit: 09 Oct 2010
Posts: 45
Location: Karachi
PostPosted: Wed Jan 23, 2008 4:03 am    Post subject: Equipment Purchase for Karwan-e-Hayat Reply with quote

Project: Equipment purchase for Psychiatric Care and Rehab Center
Organization: Karwan-e-Hayat
Amount Requested: US$ 5,100
Location: Karachi

Overview: Karwan-e-Hayat runs mental health facilities in Karachi and are looking to activate their electroconvulsive therapy (ECT) unit at one such facility in Keamari. For this purpose, they have already been donated an ECT machine in the recent past. They now need $2200 to purchase an ECG machine and ICU monitor to complete the unit.

They have also asked for $2200 to upgrade their kitchen and laundry services at this facility; and $700 to purchase four more beds for the female ward.

Project Team: Khurram Owais, Muheyuddin Sheikh
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Khurram Owais Shah



Joined: 07 Nov 2007
Last Visit: 09 Oct 2010
Posts: 45
Location: Karachi
PostPosted: Thu Jan 24, 2008 3:38 pm    Post subject: Reply with quote

Muheyuddin and I conducted a site visit yesterday (Wednesday, Jan 23rd) to evaluate the proposal. The visit was fairly fruitful and I think it gave us some important leads on how to proceed with this project.

As I mentioned earlier, the proposal entails costs for three different things. We evaluated each of the three requirements separately and here's what we found out:

Electroconvulsive Therapy Unit: ECT is an efficacious way of treating severe depression and schizophrenia, especially in cases where medicines don't work well. For this purpose, Psychiatric Care & Rehab Center has already been donated an ECT machine by Pakistan Petroleum Limited (although we were not shown this machine on account of being locked up somewhere, I am willing to believe they do have one since they mentioned PPL as one of their referees). To bring this machine in use, they say in the proposal, they need an electrocardiogram machine and an ICU monitor to complete the necessary equipment.

Muheyuddin and I, being the med students that we are, raised the issue of anesthesia given the fact that ECT is only given to patients under general anesthesia. For this purpose, they would not only need a full anesthesia machine but also the services of an anesthesiologist. To this the attending staff said they'd be using a "portable anesthesia kit" and will be hiring services of a specialist from a neighboring hospital on a case to case basis. I should mention here that the responses in this case were more speculative and less reaffirming. Hiring an anesthesiologist on a case to case basis makes a weak case in terms of costs for a hospital running on charity as well as in terms of sustainability of a particular service.

Another very important issue was that of critical need. ECT is indicated only in severe cases where medicines have failed to work or cannot be administered as in case of pregnant women. According to the hospital administration, out of the 70 odd patients currently in the hospital, ECT is not indicated for any one of them. Although the doctor in-charge did tell us that this service would be available to out-patients as well, but the fact remains that here is a therapy that, although essential in some cases, is not widely required or expected to have a significant impact on the community.

Kitchen & Laundry services: Karwan-e-Hayat has also requested a considerable amount for their kitchen and laundry services. At present they have a kitchen and a laundry room but these are not equipped with anything. The patients' food is brought from a nearby hospital and for laundry they have an external service employed to take care of hospital linen and patients' clothes. Having their own kitchen and laundry would be of benefit to the hospital and should considerably reduce their costs and make things easier. However, I am yet to receive a break-up on what exactly would be bought with the 1.3lacs requested for this purpose.

New beds for female ward: The hospital has separate male and female wards. The female ward currently consists of about 25 odd beds and we were shown a room which could house four more. These four would be added in the general ward category which takes care of patients on a charitable basis unlike private rooms.

Conclusion & recommendations: On grounds of unsatisfactory arrangements for proper, sustainable functioning of ECT, and its relatively low social return, we concluded that it would be unwise to provide funding for the equipment at this point. However, if the hospital administration improves its plan in future and their ECT plan shows enough promise, funding can be considered in the course of time.

On account of being essential to the hospital's requirement, we concluded that the kitchen and laundry services should be funded. This would improve the hospital's functioning including better food for its patients and reduction of costs for a place run on charity.

Also, on account of addressing the shortage of beds in the female ward and having adequate space, we felt that the provision of beds is a good idea and will directly benefit patients who are being turned away right now because of shortage of space.

Please post your questions/comments if you have any. I also took some photos and have attached a PDF file which you can download to view them. Tarim/Mubarik, we will discuss this further when we talk on the phone tomorrow.

That's all for now.

Best,
Khurram
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Jehanzeb Noor



Joined: 26 May 2005
Last Visit: 25 Jan 2008
Posts: 7
PostPosted: Fri Jan 25, 2008 12:22 pm    Post subject: This will be a go in my mind Reply with quote

A very well thought out project that has potential to deliver high impact.
Good luck,
Jehanzeb
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Mon Jan 28, 2008 8:11 pm    Post subject: Reply with quote

Khurram & Muheyuddin, good work on this. Thanks for making the visit and for a very thoughtful assessment of the project.

- I agree that the ECT does not sound like a critical need based on your findings.

- On kitchen and laundry equipment, Rs. 1.3 lacs sounds high. We should ask for i) a detailed budget and ii) a calculation of the expected savings from bringing these services in-house.

- On hospital beds, I would be supportive if we can confirm i) that there is unmet demand from patients (i.e. people who need to be admitted are being turned away because of insufficient beds) and ii) there are no other bottlenecks (i.e. doctors and staff have enough capacity to deal with more admitted patients). We should of course also make sure that the costs per bed that are quoted are reasonable.

Thanks,
Tarim
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Khurram Owais Shah



Joined: 07 Nov 2007
Last Visit: 09 Oct 2010
Posts: 45
Location: Karachi
PostPosted: Sat Mar 15, 2008 4:47 pm    Post subject: My correspondence with Karwan-e-Hayat on the proposal Reply with quote

Below are a few emails I got in response to specific queries regarding the project. They include some new information! We were earlier told that kitchen and laundry were for in-house services. Now, we've been told, by a higher official, that these services are for their rehab program only.

What is the break-down on the kitchen and laundry equipment
Quote:
Mr Owais

Here are the details you have asked for:

KITCHEN:

Cooking Range with Oven 2 units Rs.30,000
Kitchen Cabinet Rs.21,000
Refrigerator Rs.45,000
Utensils Rs.10,000

LAUNDRY

Washing Machine with Dryer 2 units Rs.24,000

I should like to mention that these items are to be acquired for patients to learn cooking and washing as part of their rehabilitation process so that they become functional and self sufficient.

During your telecon with Mr. Masrur Ahmed, you had expressed a desire to visit our Psychiatric Care and Rehabilitation Centre. Please let us know when you would want to do that.

My residence phone numbers are:584-xxxx and 585-xxxx, and you can call me and let me know about your visit.

Regards. Aslam Khan


On the site, which I had already visited, I was told kitchen and laundry were for provision of services by Dr. Ajmal. Is that the case or not?
Quote:
Dear Mr Khurram Owais

Kitchen and laundry equipment that we are requesting your assistance for will solely be for patient rehab programme.

Catering and laundry services will remain as these are now - contracted out. I believe Dr Imran spoke with you, and I am sorry he gave you wrong information.

Dr Ajmal Kazmi is the Medical Superintendent of PCRC.

Please let me know if you need additional information.

Regards. Aslam Khan


How would you quantify the need for these rehab facilities? Are there any other rehab facilities in place already?
Quote:
Dear Mr Owais

Thank you for your email. Please feel free to ask as many questions as come to your mind.

Psychiatric patients tend to loose touch with reality and with day to day activities. Rehab programme helps them become functional to regularise their activities and to become functional. Such programme gives the patients the domestic skills training; how to for instance manage money or manage leisure by involving themselves in outdoor and indoor activities or how to perform essential chores such as cooking, cleaning, etc. The ultimate aim of rehabilitation is to make patients live independently when the need for that arises.

At present we have 95 registered patients receiving rehab training. We started off with 20 about 3 years ago. The figure of 95 includes inpatients and outpatients both. It must be clarified that not all inpatients(we have 70 at present) receive rehab training because some of them have not stabilised condition.

80 per cent of 95 registered patients are charity cases.

At present we offer the following activities as part of our rehab programme: gardening; music training, computer classes; literary classes; painting sessions and stitching.

Laundry will train patients in how to wash clothes, how to dry them and iron them. Kitchen will help patients to learn cooking and prepararation of meals.

Trust these detail will help with your evaluation.

Regards. Aslam Khan


Are there any similar figures for the ECT program?
Quote:
Dear Mr Owais

Thank you for email.

I am not a doctor but I have spoken to Dr Ajmal Kazmi in the hope that I can answer you query.

ECT procedure is not as widely practiced as in the past but any psychiatric facility of repute must have the equipment, and we have a portable ECT machine.

Dr Kazmi's assessment is that around 5 per cent patients admitted in PCRC would need to undergo ECT procedure. So when we have all 100 beds in operation the number of patients administered ECT procedure would be around 5.

We feel that for such limited use we can acquire the required medical support services form across the street - Ziauddin Hospital with whom we have an ongoing cooperative arrangement.

If the above does not satisfactorily answer your query I would suggest that you talk to Dr. Ajmal Kazmi at 285-xxxx or 0321xxxxxxx.

I may mention that big hospitals like AKU or Ziauddin can fford certain equipment and medical support staff which we cannot.

Yes, the room where you saw the prayer mats is indeed the female ward where the additional beds would be located.

Regards. Aslam Khan


That is all. I believe most of the issues have been taken care of as far as the evaluation goes. According to my judgment, I would fund the beds; not fund for kitchen and laundry, and encourage them to improve their ECT facility and show us a more critical need in time (perhaps as the patients increase, so would the need) before we can take this up again and possibly fund it somewhere down the line.
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Tarim Wasim



Joined: 28 Jan 2005
Last Visit: 17 Apr 2011
Posts: 160
Location: San Francisco
PostPosted: Fri Mar 21, 2008 12:56 pm    Post subject: Reply with quote

Tarim wrote:

On hospital beds, I would be supportive if we can confirm i) that there is unmet demand from patients (i.e. people who need to be admitted are being turned away because of insufficient beds) and ii) there are no other bottlenecks (i.e. doctors and staff have enough capacity to deal with more admitted patients). We should of course also make sure that the costs per bed that are quoted are reasonable.


Khurram, any further work to be able to answer the questions on hospital beds that I had asked for in my previous post? Also, if we're going to do an EC on this, can you please fill out the project summary form for the hospital bed donation?
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Khurram Owais Shah



Joined: 07 Nov 2007
Last Visit: 09 Oct 2010
Posts: 45
Location: Karachi
PostPosted: Thu Mar 27, 2008 10:22 pm    Post subject: Reply with quote

Tarim wrote:
On hospital beds, I would be supportive if we can confirm i) that there is unmet demand from patients (i.e. people who need to be admitted are being turned away because of insufficient beds) and ii) there are no other bottlenecks (i.e. doctors and staff have enough capacity to deal with more admitted patients). We should of course also make sure that the costs per bed that are quoted are reasonable.


Karwan-e-Hayat wrote:
Dear Mr Owais

Thank you for your email. I am well, and hope you are well also.

1) I can answer your first question as follows.

When the inpatient facility was commissioned in 2005, we had 35 beds. As the demand increased, we increased the number of beds first to 45, then to 65, and then to 75, which is the present number. We thus followed a deliberate gradual progression policy.

We dont keep any statistics of the unmet demand but we handle the demand by keeping a waiting list, which as of now is for 10 beds. As the beds become available, patients on the waiting list are accommodated.

Another way to look at the unmet demand is that our occupancy varies from 80% to 100%. I t varies because of an ongoing process of admissions and discharges.

In the female wing, the number of beds is 20, and as of this morning we had 19 patients.

2) The capacity of PCRC is 100 beds. When we reach that level, we will assess the requirements for medical and para-medical staff. Right now, in preparation of 2008-09 budget we developing our plans and objectives, which we hope to finalize before the end of April.

Existing staff, etc are adequate, however, if 4 beds are added in the female wing.

All the best. Aslam Khan

About the price, I checked with a couple of senior students here at AKU and they seemed to agree with the price. In fact, hospitals bed can be pretty darn expensive I've learnt!
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Khurram Owais Shah



Joined: 07 Nov 2007
Last Visit: 09 Oct 2010
Posts: 45
Location: Karachi
PostPosted: Mon May 05, 2008 6:31 am    Post subject: Reply with quote

Summary attached
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