Kilimanjaro Christian Medical Center (KCMC)

Sunset view of Mount Kilimanjaro 8/10/2018

Format

• In each section below there is bulleted information with some bolded terms

bolded terms have additional information found at the bottom of the section.

Hospital Fast Facts / Background

• Kilimanjaro Christian Medical Centre (KCMC) is located in Northwest Tanzania, in the foothills of Mount Kilimanjaro.

• The hospital serves a catchment area of about 15 million people.

• KCMC is a private hospital but the government is also involved.

• About 2/3 of patients are without insurance.

• KCMC is one of four referral hospitals in Tanzania.

• The hospital is switching to an electronic medical record (EMR) in September.

• Hospital bed capacity is 650.

• There are five operating theatres.

• The ICU capacity is 6-7

• There is a radiology department with one CT. A CT costs $250,000 shillings or $125 USD.

• There is an intensive care unit (ICU). They have one ventilator so ICU capacity is one.

KCMC - is the last referral stop for most patients. In rare cases, KCMC will transfer complicated case to Darr or Nairobi. KCMC never transfers a trauma patient.

15 million people - The hospital experiences high patient volumes.

Government - Some nurses and doctors are government employees.

EMR There was EMR training for each department in August. KCMC has tried EMRs in the past without success. ICU Capacity - ICU is consistently full. In some cases, patient is manually bagged for hours in ED while waiting for ICU bed to open. The decision to send patient to ICU, and to downgrade patient from ICU to make room is not completely evidence based.

$125 USD - This price is very expensive for patients. They will ask patients first if they can afford a CT. In some serious cases, the team will order a CT even before asking patient/family. Patients must pay CT fee before discharge. Many patients will elope to avoid CT fees.

Neurosurgical care at KCMC

• There are no neurosurgeons at KCMC.

• Neurosurgical operations are limited to burr holes.

• Additional feedback from staff

Operations - They wont touch intraparenchymal lesions. They do not perform craniotomies/ectomies. General surgeons complete 3-8 burr holes per week. Cases needing more advanced neurosurgical care are referred to Dar es Salaam 6 hrs away.

Feedback -

• “Patients are discharged to quickly after surgery, especially TBI patients. There is nothing we can do special for them anyways so we discharge early.”

• “TBI patients dont get the care they need, we struggle with specialized care.”

• “GCS varies between doctors.”

#Emergency care at KCMC * The emergency department is new, well equipped, and clean.

• Almost every patient in the ED has their vitals taken.

well-equipped - There is a desktop computer in the ED with consistent internet access. There are sufficient stores of gloves, gauze, syringes, needles and other basic medical supplies.

#IT Infrastructure * There are working computers in each department of the hospital

• KCMC is rolling out an EMR system September of 2018.

• Personal modums or mifi devices are used at the hospital.

rolling out - training occurred in each department in the months prior to rollout.

mifi devices - Tigo is reported to have better connection than vodafone at the hospital.

Dr. Kondo meeting

• Dr. Kondo is a general surgery consultant at KCMC.

• He is greatly interested in improving the quality of care at KCMC.

• We discussed a possible DGNN-KCMC collaboration.

• In a collaboration, managing transparency is important.

• Dr. Kondo is worried about their dependency on one CT scanner.

quality of care - Dr. Kondo described the desire to improve brain injury patient care multiple times in the conversation, “The number of head injuries are alarming and increasing. General surgeons are responsible for treating head injury patients, we have no help from neurosurgeons.” A general surgeon with skill to perform burr holes is not always present. Some cases we simply cannot do and the patient then has a 6 hour journey to Dar es Salaam.

DGNN-KCMC collaboration Dr. Kondo was keen on the training and education of attending and resident surgeons in neurosurgical care. This collaboration would be a welcome “forum for KCMC surgeons to improve their skill.” He believes there would be learning for both sides of the collaboration through the sharing of experience. Dr. Kondo suggested an exploratory visit for DGNN to KCMC to investigate the feasibility of a surgical camp.

managing transparency - There have been experiences in the past were KCMC PIs and local doctors were left off publications when collaborating with high resource partners. Dr. Kondo acknowledges that previous bad experiences should not prevent future collaborations.

CT scanner - The CT scanner is the care team’s only diagnostic too (no MRI, no decision support tool). The CT scanner is running non-stop, day and night, to support the hospitals demands. Occasionally, patients are sent from hospitals in other cities (e.g. Arusha) to use the CT machine. Dr. Kongo is worried that the scanner will break down due to the high volume. Technical repair of the CT is a challenge (i.e. obtaining parts and skilled technicians). The machine needs maintenance occasionally for a couple days at a time. There have been instances in the past where the surgery team will operate on a patient without first obtaining a CT. I explained our work with GRYMTR and the Infrascanner, Dr. Kondo was interested in learning more about both.