By Elijah Banda, Contributor:
It is a regular Monday at Chilomoni Health Centre in Blantyre. At the children’s clinic, four health workers are assessing every child upon arrival. They are using a mobile application to determine the symptoms and enhance treatment in case of emergency.
The system is called Emergency Triage Assessment and Treatment (Etat), also known as Chipatala Robot.
Kefasi Sebe is one of the clinical officers at the facility and he is examining a two-month-old baby brought by its mother. According to Sebe, little babies such as this one do not need to stay on the queue at all before being treated.
“This one is a tiny baby and, therefore, a priority. The baby is a priority because tiny babies are prone to infection. On the queue, they can get infection from other patients, so we treat them as a priority. We put them in front of the queue to be assisted immediately,” Sebe says.
The system of determining the priority given to patients has been operating at Chilomoni Health Centre for over five years.
Etat was introduced to the township by the Malawi- Liverpool Wellcome Trust (MLW) in 2013 through the Aspire Project which has trained health care workers such as health surveillance assistants and patient attendants.
“Their duty is to triage the children once they arrive at the hospital. They use a mobile application on the phone barcode in the health passport book, log in the child’s name, village name and we start asking questions to the mother such as why she has brought the child to the hospital,” Sebe says.
Based on the medical assessment, the child is put in an appropriate category such as E for emergency, P which stands for priority and Q for those who can wait on the queue.
Children exhibiting emergency symptoms such as convulsions or those in a coma are taken to the emergency room where nurses stand ready to assist them.
Children with emergency conditions are taken to the emergency room which is equipped with a bed, an oxygen concentrator, diaphragms, medication and other facilities.
“As we wait for t h e ambulance to take the patient to a referral hospital, we have to stabilise the condition of the child,” Sebe adds.
It is a 20-minute drive from the health centre to the Queen Elizabeth Central Hospital. Based at MLW, which is located within the vicinity of the referral hospital, is project coordinator for Etat, Mtisunge Gondwe.
“Chipatala Robot is simply indicating that sick children have to be triaged once they arrive at the hospital, according to the illness or symptoms that they are showing,” Gondwe says.
She adds that the system is efficient because, on average, sick children showing emergency signs are attended to within 10 minutes, those exhibiting priority signs within 20 minutes while children on the queue are treated within 30 minutes.
In the past, a sick child had to wait on the queue because hospitals were operating on the first come, first served principle.
The majority of primary health facilities currently implementing the Chipatala Robot project are in Blantyre.
“Basically, what this entails is that the hospitals are encouraged to serve the sickest person first. Our health workers, who are equipped with the necessary skills, can identify the people who look to be very sick and isolate them and assist them in time,” Blantyre District Health Officer, Gift Kawalazira, said.
He added that Blantyre District Health Office has taken the initiative positively and that stakeholders such as patients have been supportive.
“They have actually appreciated the fact that it has assisted in averting unnecessary deaths that may occur while someone is already within the vicinity of the hospital,” he says.
With an estimated population of 17 million people in the country’s 28 districts, Malawi is weighed down by a disease burden consisting of major killers such as malaria, HIV and Aids as well as tuberculosis.
In a situation such as this, the Chipatala Robot initiative provides important relief for those in critical need of urgent and emergency health care.
Health and Population Minister, Atupele Muluzi, says the National Health Community Strategy and the Health Sector Strategic Plan for 2017 identify the major challenges that affect patients.
“We find that tertiary level facilities care for patients that have more serious cases. We have the district facility or secondary level and we have the primary facility which caters for patients who have minor conditions and do not require going to central hospitals.
“Patients who have minor conditions who go to central hospitals end up clogging up the system and those that require critical care end up being at the end of the queue,” Muluzi says.
He says in the future, the government wants to shorten the time it takes for patients to be attended to and treated. Against this background, Chipatala Robot is a crucial intervention in achieving this goal.
“So having a proper triage system means that we can identify those that require critical care and get the care that they need and those that need to be referred to other facilities should be referred,” Muluzi says.
Based on the findings of the Chipatala Robot Project, the government will map the way forward on subsequent interventions.
“We hope that by learning from examples of the study, we can begin to see how we can roll this out through all the districts and informing the general public where to go for certain services,” Muluzi says.
Another initiative the government is implementing to ease congestion in hospitals and improve health service delivery is the bypass system where patients are required to seek treatment in health facilities in their communities before going to referral hospitals.
The system could benefit from Chipatala Robot if the country has more district hospitals and other facilities.
“So, we have to look at it in that perspective, for example, the construction of Phalombe District Hospital will assist in reducing some cases which go to Zomba General Hospital and Queen Elizabeth Central Hospital,” Muluzi sayss.