Prevenzjoni u Kura G˙alina

Issue 14 PRIMARY HEALTH CARE DEPARTMENT April 2017

Updates from the CEO’s OfficePrimary Health Care Department Call CentreThe month of March saw the official launch of the Primary Health Care Department Call Centre. This project required a substantial investment in the technical infrastructure of the Primary Health Care Department w i t h a c o n s e q u e n t c a p i t a l expenditure of around € 75,000. This had to be supported with an adequate manpower planning, with the recruitment of staff to manage over 1,200 calls that are received on a daily basis. The call centre staff were also provided with the necessary training in telephone handling skills, communication skills, as well as training on the software and hardware that is being utilised in the call centre. The call centre is the first of its kind in Malta’s public health sector and has the scope of centralising appointments and providing the necessary information regarding primary care services to the public. The number, 21 231 231, is easily remembered so that members of the public wishing to set an appointment in the health centres may do so in a quick and efficient manner. This initiative has also alleviated the health centre reception staff from an excessive amount of calls, thus allowing them to focus more on the clients attending the health centres.

New Paola Regional HubThe Paola Regional Hub project has been allocated 80% of funding through the European Regional Development Funds. The total investment in this project will be around €40 million and will include the consolidation of present services as well as the introduction of new services such as: an emergency operating theatre, minor surgery facilities, mental health services, a dental clinic, a sexual health clinic and various other new services. An estimated 125,500 persons will benefit from this regional hub which will cater for the southern region of Malta. It is estimated that by 2023, around 6,000 day care surgeries would be taking place annually at the regional hub, alleviating Mater Dei Hospital from a substantial part of the minor surgery list.

Expansion of the GP role in Primary CareFrom the 7th December 2016, a GP run cardiology outreach clinic is being held on a weekly basis at Birkirkara Health Centre. This clinic has developed from a joint collaboration with the Cardiology department at Mater Dei Hospital. A similar project is also currently being run jointly by the Orthopaedic department at Mater Dei Hospital and the Primary Health Care Department. An orthopaedic clinic is being held

Welcome to this first edition of the Primary Health Care Department newsletter for 2017 which brings us to the fourth year from when this newsletter was first issued. The newsletter continues to be a link for the large number of employees who form part of the Primary Health Care Department family especially when considering that the services delivered by this department are so widely spread both in terms of accessibility as well as geographically. The newsletter also serves to inform those using our services of how our department continues to develop whilst also providing a brief entertainment break.

This edition includes a few interesting pieces written by some of our colleagues which include a very interesting article on the health and social care needs of migrants, the new physical activity programme launched and coordinated by the Physiotherapy department and the value of the Naqra Naqra application which was launched with the support of the Vodafone Foundation and the Speech and Language Department. This month we can get to know Dr Stephen West, clinical chair a bit better although some of us may have worked with him for a number of years. The usual items of the entertainment and recipe pages are a reminder of the change to the Spring season which brings with it longer, warmer and brighter days which is a pleasant change to the rather wet season that we have experienced over the past few months.

This newsletter also includes the first announcement for the 9th biennial Primary Health Care Department conference which shall be held on the 6th of October 2017, so remember to save the date and to send in your abstracts once the official call is made. Your participation is a chance to voice your knowledge and experience and to give the vast work that is carried out in the department a fitting platform for dissemination.

Any suggestions to the contents of this newsletter are most welcome and any articles or material can be sent to the undersigned for discussion with the editorial team.

Editorial

Rebecca Cachia FearneDorothy Scicluna

continues on pg 2

Prevenzjoni u Kura G˙alina2weekly at Qormi and Mosta health centres and clients are being seen by GPs in liaison with orthopaedic specialists.Another initiative that is expanding the role and functions of the general practitioner in primary care is that of the issuing of Schedule V permits for clients who suffer from dyslipidaemia. This initiative was introduced last December. Furthermore, from January of this year, GPs can utilise an online ticket of referral when referring clients who require services in the secondary care sector. This new system decreases the bureaucracy of the referral pathway whilst also decreasing the risk of tickets of referral being lost.

S i g n i n g o f M e m o r a n d u m o f Understanding - Down Syndrome ClinicDuring the month of March, which also marks World Down Syndrome Day, a memorandum of understanding was signed between representatives of the Primary Health Care Department, Down Syndrome Association and A©enzija Sapport. The signing of the Memorandum of Understanding (MoU) was witnessed by the Minister for Health and by the Hon. Parliamentary Secretary for Rights of Persons with Disability and Active Ageing. The dedicated staff that run the clinic are giving a sterling service to our clients and their carers. This MoU formalises the joint collaboration between the above mentioned entities in order to further

strenghthen the services being offered by the Adult Down Syndrome Clinic at Birkirkara Health Centre.

Launch of a new physiotherapy programmeThe physiotherapy department has launched a new mobility programme for older persons with the scope of maintaining a person’s strength, mobility and balance. The programme consists of six morning sessions that are held at Birkirkara Health Centre physiotherapy department. The sessions are aimed at encouraging patients to take an active role in maintaining their own health and mobility.

Floriana Health CentreIn January of this year, in line with the strategy of upgrading and refurbishing the health centres, new plastering, wound care and phlebotomy clinics were opened at Floriana Health Centre. This has led to the development of a better working environment for our staff, besides offering a better experience to our clients.

Primary Health Care Department 2016 AwardsDecember 2016 saw the conferring of the Primary Health Care Department awards for 2015. The event was held at the Valletta University Campus and it also included an exhibition of artwork

executed by employees of the department, as well as a live band of healthcare professionals and singers who animated the evening. There were three categories of awards this year with the new addition of the Section/Unit of the Year award. The category of Worker of the Year was won by Mr Mario Scalpello from the accounts section, the Unit/Section of the Year award was won by the Speech and Language Department, and the Health Centre of the Year award was won by Paola Health Centre. The CEO Award went to the organising committee of the Primary Health Care Department Awards. Certificates of appreciation were also awarded to members of staff who retired during the year.

Port-a-cath ServicesAfter the introduction of Port-a-cath line maintenance at Birkirkara health centre, the service has also expanded to Cospicua health centre. In order for this service to commence, nurses were given theoretical training as well as hands-on practical training and assessment of skills at Sir Anthony Mamo Oncology Hospital. This project is part of the ongoing initiatives to expand the primary health care services and promote nurse-led services. This project was a joint collaboration between the Directorate for Cancer Care Pathways, Sir Anthony Mamo Oncology Centre and the Primary Health Care Department.

The Physiotherapy department within Primary Health Care are organising an exercise class programme for people with mobility problems. Movement and activity classes will promote generalised exercises to decrease stiffness and prevent falls due to lack of balance, mobility and strength. These classes will help keep senior citizens mobile and active as well as enabling them to prevent falls which is a major health hazard. The programme will also empower clients and their carers to take initiative in their own care.

The client will be given an appointment to assess their level of mobility and fitness using a standardised assessment. If the client is eligible and suitable for the classes he/she will be invited to join the programme. The programme will comprise of 6 morning sessions which will be delivered in groups of 10 clients over the span of 6 consecutive weeks. The exercises are carried out in sitting and in standing postures and will address flexibility, strength, balance and cardiovascular health. Each session will be around

Launch of a Mobility ProgrammeJacqueline Sciberras Allied Health Practitioner / Mariella De Gaetano Allied Health Practitioner

45minutes to an hour long. These classes are being held at the Physiotherapy Clinic at Birkirkara Health Centre.

Clients may be referred if they are exper iencing general decreased mobility and balance difficulties of a musculoskeletal origin that has no profound neurological cause. Clients suffering from other musculoskeletal conditions will continue to be referred for physiotherapy treatment. General Practitioners, Lifestyle clinic nurses and

Primary Health Care physiotherapists can refer clients through a formal ticket of referral (TOR), an online TOR or by sending an email to: physicalactivity.phc@gov.mt

14.You are alone in a deserted island and you can have only one object with you. What would it be? Definitely a knife because of its versatility

15. If you could meet any celebrity or personality in the world (living or dead), who would it be and why? Adolf Hitler maybe I would have convinced him to stop the cycle of misery he had initiated.

16. Is there a particular saying that inspires you? You’ve got to take the good with the bad, smile with the sad, love what you’ve got, and remember what you had. Always forgive, but never forget. Learn from mistakes, but never regret.

KURA PRIMARJA TAS-SAÓÓA 3Interview with Dr Stephen West

1. Can you please tell us something about yourself? I was born in Sliema in 1957 happily married with 3 adorable children. As you have probably realised I am 60 years old but this does not put me back as I feel that age should never be a constraint in what one can achieve and deliver in one’s life. I graduated MD in 1983 and after doing the 2 year housemanship at St Luke’s I decided to move to Primary Health starting off as a General Practitioner and gradually moving up to my present position as Clinical Chairman. I have always been a doer in any field of my life and strongly believe that to achieve success one has to commit himself to hard work and dedication with no short cuts. I enjoy life to the fullest, love humour and consider myself as a progressive thinker and respect each person’s space and values.

2. Can you describe yourself in a single sentence ?‘Never, never, never, never give up’

3. What would you have liked to have become when you grew up? /Did you always want to be a medical doctor? Yes becoming a Medical Doctor was always my first choice as I was inspired by my family General Practitioner.

4. If you had to change your career, what would it be? An airline pilot is my favourite as flying really fascinates me. To be more practical I would definitely opt for a Chef.

5. How would you describe your management style? I do my best to adapt to the characteristics and different opinions of all employees working in Primary Health. As a rule I have an affiliative style of management trying as much as possible to create harmony and consensus in the process ensuring consensus. One should never think about the good or bad, right or wrong but the task, the people and the situation to be managed.

6 . What personal qual i t i es or characteristics do you value most in your colleagues? Dedication, compliance, credibility, motivation and commitment.

7. What do you see as the most important opportunities in Primary Health Care? I strongly consider that by empowering Primary Health professionals patients are moved away from secondary care enabling us to focus on one of our key goals-prevention.

8. Are there any weaknesses in your department that you seek to improve? The present infrastructure worries me as I consider that most of our service outlets are either just adequate or frankly not acceptable. Fortunately the department is steadily gaining momentum and there is a general consensus and financial backing from the respective authorities to enable us to reach our goals.

9. What are the most important issues that you are currently focusing on? Unfortunately in the past primary health was not put on a level playing field as secondary care pushing patients to seek care at MDH in the process creating a multitude of problems related to patient care. I firmly believe in empowering Primary Health professionals on all aspects and giving them the necessary tools to carry out Primary Care in our communities. This has been proven many a time with the introduction of the various innovations and investment that has been put in place these last few years.

10. What are your hobbies? Gardening, cooking and anything related to nature. 11. Who is your favourite author and your favourite book? No particular author as I prefer to read magazines and books related to nature and general knowledge such as National Geographic, Time magazine etc

12. Any favourite movies / songs? Regarding movies I like historical /epic and war/action films such as Ben Hur and Top Gun but anything goes as long as the subject makes sense and in good company. I love music but obviously the 70s and 80s have left their effect on my preferences with the Bee Gees and the Rolling Stones topping my list.

13. Do you practice any sports? During the 70s and 80s I played 1st division basketball, hockey and amateur football but reluctantly not anymore.I still try to remain active with daily walking but adore swimming and aquatic snorkelling.

Prevenzjoni u Kura G˙alina4

World Kidney Day 9th March 2017, Paola Square

Signing of Memorandum of Understanding

for Down Syndrome Clinic – March 2017 Holistic Cancer Care Seminar – February 2017

Primary Health Care Department Awards 2016

KURA PRIMARJA TAS-SAÓÓA 5

Migrants who survive the journey across the Mediterranean on rickety sea vessels and other means of transport prove to be very resourceful and resilient, at least on arrival. Despite these strengths in 2016 the death toll in the Mediterranean soared to five thousand (UN Agency, 2017). Fleeing from raging wars, conflicts and violence in their country of origin to a safer country does not shield migrants from the associated complex challenges they are confronted with in the destination country (UNHCR, 2014). Indeed evidence shows that resiliency seems to wear out during the process of adapting to the destination country (Riosmena & Jochem, 2012). To say that, ‘they were never invited’ is a common hearsay that is boldly provoked as a result of the sheltered life that most of us have taken for granted living in a safe country. The migrants’ long and arduous journey combined with a sense of loss and a living situation of uncertainty is only the beginning of a long struggle for ‘normalisation’ which in many cases remains unaccomplished.

Migrants are not a homogenous group. When we speak about people coming from a different background we need to understand who we are talking about: Are we referring to women, pregnant women, men, children, families, unaccompanied minors or the vulnerable ones? Age, gender and diversity have a direct impact on the factors that are influenced by migration. Despite the fact that the majority of migrants are granted legal protection they often experience unemployment, under-employment, reside in deprived neighbourhoods, and have an increased risk of cultural and social vulnerability influencing their health negatively.

According to WHO (2010) failure to examine potential indirect effects of the social determinants of health of migrants explains the depth of marginalisation and social vulnerability in which asylum seekers and refugees dwell. These characteristics lead to a number of complex challenges which are not present to the same degree in the case of other types of migrants such a students, migrant workers and foreign spouses. Due to the forced nature of their migration experience, compared with other migrant groups, refugees will often have specific needs that have to be met in order to support their integration. Vulnerable migrants may lose their resilience due to the experiences they have been through before, during and after their arrival in the country of destination. It is therefore important that the special needs of migrants are recognised and addressed.

The social determinants of the health of migrants at a glanceMarika Podda Connor - Charge Nurse - Migrant Health Liaison Office

Migration is not a cause for mental illness per se however unachievable goals amongst motivated persons who struggle for a decent life result in situations where coping becomes extremely difficult. Experiences of racism and discrimination will promote a sense of living in ‘limbo’ leading to mental distress with the resulting effect of an increased strain on our already stretched mental health services. Health and social care professionals must not forget their moral and ethical obligations not to ‘discriminate amongst patients/clients on grounds of age, nationality, race, sex, gender orientation, religious beliefs, personal attributes, nature or origin of their health problem or any other factor’ and to do no harm (Maltese Code of Ethics, 1997). The concept of cultural competence amongst health and social care professionals is a response to the inequalities and disadvantages experienced by migrants in relation to health and social care services (Szczcepura, 2005). In a similar vein compassion entails notions of doing good and justice without making judgments. On being confronted with the changing face of Europe, health and social care professionals are taken by surprise in how to deal with the communication barriers, cultural differences and socioeconomic challenges of migrants that they come across in their day to day work (Singleton and Krause, 2009). Existing mainstream services, which have been developed for the local population often fail to meet the needs of migrants. Professionals may lack insight into the problems of migrants, while services may be poorly accessible due to language problems or cultural differences even when health services are readily accessible. Consequently, especially in the areas of mental health and reproductive health problems may only get attention at the late stages of disease resulting in unnecessary and costly interventions which could have been prevented. Lack of compliance and/or under-utilization of health and social care services by migrant patients may be due to the unavailability or limited availability of trained cultural mediators.

Migrants who endure hardships may take longer to adjust to the cultural challenges they face and may require more support from local entities and NGOs. Acculturation does not happen overnight; one cannot expect new comers to assimilate immediately and forget who they are and where they come from. The normal process of cultural shock is experienced by most individuals going through the adjusting process to a new culture. It is a method whereby support

and empowerment in the initial stages of arrival would guide migrants to achieve a sense of belonging hence accelerating the acculturation process.

The migrant’s experience which is often tinged by shades of humiliation and despair, necessitates the profound understanding of trained personnel in cultural competence especially amongst those who work in the various areas of the public sector and who have the opportunity to exercise and implement harmonization within diversity (Podda Connor, 2007).

ReferencesMatese code of ethics for nurses and midwives (1997) Issued by the Nursing and Midwifery Board, Malta. Podda Connor, M (2007). The bio-psychosocial impact of forced migration: a participatory approach amongst refugees and asylum seekers in Malta; Journal of Health, Social and Environmental Issues ISSN-1478-5692 Volume 8, Issue No2, Autumn Issue; Middlesex University, London.

Riosmena F, Jochem WC., (2012) Vulnerability, Resiliency, and Adaptation: The Health of Latin Americans during the Migration Process to the United States. Reality, Data and Space : International Journal of Statistics and Geography; 3(2):14-31.

Singleton, K. and Krause, E., (2009). Understanding Cultural and Linguistic Barriers to Health Literacy. OJIN: The Online Journal of Issues in Nursing. Vol. 14, No. 3, Manuscript 4. http://www.nursingworld.org /Vol142009/No3Sept09.pdf

Szczcepura, A., (2005) Access to health care for ethnic minority populations, Postgraduate Medical Journal; 81:141–147.UNHCR, (2014) World at War. Global t rends Report . ht tp: / /www.unhcr.org/556725e69.pdf Accessed on 17th March 2017.

UN News Agency (2017) Lates t Mediterranean tragedy pushes number of people perishing in 2016 beyond 5,000 – UN. http://www.un.org/apps/news/story.asp?NewsID=55868#.WF5tqVN96HsAccessed on 22th March 2017

WHO, (2010). How health systems can address health inequities linked to migration and ethnicity. Copenhagen, WHO Regional Office for Europe.

Prevenzjoni u Kura G˙alina6

KURA PRIMARJA TAS-SAÓÓA 7

Recipes by Yvonne AzzopardiZesty Salmon (serves 4)

Ingredients• 4 salmon fillets

• 1 tbsp olive oil

• Juice of 2 lemons and 2 oranges

• 2 tbsp honey

• 1 tbsp corn starch

• salt and pepper

• lemon/orange slices and basil (to garnish)

Method • Prepare the salmon fillets by sprinkling salt and pepper and brushing the top with the olive oil.

• Heat a large non- stick pan on medium heat. Add the salmon and cover with a lid. Allow to cook for 4 minutes.

• Following 4 minutes flip the salmon and cook for another 3 minutes. Remove the salmon from the pan and set aside.

• In the same pan add the lemon and orange juice and the honey. Cook for 2 minutes, stirring frequently.

• In the meantime, dissolve the corn starch in a small amount of water and add it to the pan. Allow to cook for 1 minute.

• Add the salmon to the pan, skin side up, and turn off the heat. Cover the pan with the lid and allow to rest for 3 minutes.

• Flip the salmon and serve garnished with lemon/orange slices and basil.

Literacy begins from birth in the home. Family members who read to and with their children promote their children’s literacy by increasing understanding of stories, enhancing oral language, and building vocabulary. In order to be able to read, your child needs to:

•Learn the alphabet•Understand that letters and words mean something•Build a listening and speaking vocabulary•Have many different experiences to relate to new words and ideas•Connect drawing and writing to reading

In light of the above, literacy relies on the development of 5 key skills:

1. Phonological Awareness

2. Phonics

3. Comprehension

4. Fluency

5. Vocabulary

The Maltese Application Naqra NaqraDr Rita Micallef - Professional Lead - Speech Language Pathologist

Ms Gertrude Mizzi - Allied Health Practitioner - Speech Language PathologistEvery child must show knowledge in all of these five skills in order to progress successfully in their development of literacy.

The Maltese Application Naqra Naqra focuses on the development of the first key skill: Phonological Awareness, particularly at a Phonemic, Syllabic and Word Level of awareness. It is targeted for children between the ages of three and five. As a key literacy skill Phonological Awareness is one of the building blocks of literacy development. Children need to be aware of the first, middle and final sounds of words. They have to be aware that words are made up of building blocks too; syllables. Word-to-picture matching is another important tool, easing the child towards more confidently identifying words whilst reading. Rhyming also helps the child attain a greater familiarity with different words whilst recognising that different words can have certain similarities in sound. Through the use of this application, children learn these fundamental literacy skills in a fun and

engaging way.

The application adopts a ‘no-points system’: children are neither rewarded nor penalised for their answers but are instead allowed to keep trying until they select the correct choice before being taken on to the next task. Positive reinforcement is used throughout. The voice over chosen was that of a child, to further motivate the user.

The development of Naqra Naqra would not have become a reality without the help of Vodafone Malta Foundation, who also donated 40 tablets enabling our Speech-Language Community Clinics to access the technology and our app more effectively.

Prevenzjoni u Kura G˙alina8WORDSEARCH - HERBS AND SPICES ANISE

Level: Very Hard

SUDOKU

Contact the editorial team on 25576183 / 25576186 or on e-mail address below:• Rebecca Cachia Fearne (rebecca.cachia-fearne@gov.mt) • Mariella Bombagi (mariella.bombagi@gov.mt)• Sonia Azzopardi Axiak (sonia.azzopardi-axiak@gov.mt) • Yvonne Azzopardi (yvonne.a.azzopardi@gov.mt)• Dorothy Scicluna (dorothy.scicluna@gov.mt)

Join us now on Facebook• Primary HealthCare Department Malta• Lifestyle Clinics - Primary Health Care Department

Joke of the DayHarry was working at a construction site when he came across a bottle. He popped it open and out came a Genie. “I must warn you,” said the Genie “I’m not that powerful but I’ll try my best.” “Well” said Harry, “I’m trying desperately to start a new business and I have a very important meeting tonight with a potential investor…” “I’ll tell you what,” said the Genie, “and this is the best I can do. I’ll give you a one time good luck charm. To start it say, 123. When you’re done, say 1234.” And with that the Genie was gone in a puff of smoke. Harry couldn’t believe his good luck. As he nervously tied his tie in front of the mirror, he kept on repeating over in his head 123, 123, 123. Harry nervously knocked on the potential investor’s office door. “Come in,” said the man in a deep imposing voice. OK, here goes thought Harry to himself as he sat down across from the man. Before he started he muttered to himself “123”, suddenly he knew everything would be OK. He opened up his mouth to start speaking but before he could say anything the man behind the desk pleasantly asked, “What did you say 123, for?”

Famous Quote:‘You must be the change that you wish to see in the world’

Mahatma Gandhi

BASILBAYLEAFCARDAMOMCHICORYCHIVESCINNAMONCURRYDILLFENNELFANUGREEKGARAMMASALAHORSERADISHJUNIPERBERRYLICORICEMACEMINTMIXEDSPICEMUSTARDOREGANOPARSLEYROSEMARYSAFFRONSAGESPEARMINTSZECHUANPEPPERTERRAGONTHYMEVANILLAWASABI