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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.