Statement to Parliament by Minister of Health Hon. Dr. Fenton Ferguson Tuesday, October 27, 2015 Outbreak of Bacteria At UHWI & CRH Special Care Nurseries

INTRODUCTION

MR. SPEAKER, THANK YOU FOR THE OPPORTUNITY TO SPEAK TO A VERY IMPORTANT AND EMOTIVE ISSUE THIS AFTERNOON. I WANT TO EXPRESS CONDOLENCES TO THE PARENTS OF THE BABIES WHO DIED FROM INFECTION AT THE UNIVERSITY HOSPITAL OF THE WEST INDIES AND THE CORNWALL REGIONAL HOSPITAL.

WE RECOGNISE THAT THIS IS A TRAUMATIC EXPERIENCE THAT THE PARENTS AND FAMILIES HAVE UNDERGONE AS A RESULT OF THE LOSS OF THEIR LOVED ONES. THE HOSPITALS WILL CONTINUE TO PROVIDE COUNSELLING AND OTHER PSYCHOLOGICAL SUPPORT TO THE AFFECTED FAMILIES WHO HAVE ACCEPTED THIS OFFER DURING THIS DIFFICULT PERIOD.

 

JAMAICA’S GLOBAL POSITION

ACROSS THE WORLD OVER 6 MILLION BABIES DIE AT BIRTH ANNUALLY AND 3 MILLION OF THESE ARE NEONATES. (UNICEF 2014 PROFESSOR    JOY  LAWN). MR. SPEAKER, JAMAICA IS A PART OF A GLOBAL MOVE TO IMPROVE MATERNAL AND CHILD HEALTH. IN FACT WE HAVE MADE IMPORTANT GAINS OVER THE YEARS.

WHILE THE UNITED NATION’S GOAL FOR 2030 IS TO REDUCE NEONATAL MORTALITY RATE TO 12 PER 1,000 LIVE BIRTHS, JAMAICA’S NEONATAL MORTALITY RATE HAS MOVED FROM 21 PER 1000 LIVE BIRTHS IN 1990 TO 12 PER 1000 LIVE BIRTHS SINCE 2013. SOME OF THE COUNTRIES WHICH RANK LOWER THAN JAMAICA INCLUDE INDIA, BRAZIL, PANAMA, HONDURAS, DOMINICA, DOMINICAN REPUBLIC, ST. VINCENT & THE GRENADINES, TRINIDAD, HAITI AND GUYANA. SOME OF THE SMALLER COUNTRIES WITH LOWER RATES DO NOT TREAT THEIR PATIENTS AT HOME BUT FLY THEM TO OTHER COUNTRIES FOR TREATMENT.

 

THE 2015 OUTBREAK

  1. TOTAL ADMISSIONS TO SPECIAL CARE NURSERIES – 483
  2. TOTAL NUMBER OF SEPSIS CASES – 45
  3. SEPSIS RATE – 45/483 (9.3%)
  4. TOTAL DEATHS FROM SEPSIS -19
  5. SEPSIS CASE FATALITY RATE – 19/45 (42.2%)

 

MR. SPEAKER, THE COMPARISON TO LOWER AND MIDDLE INCOME COUNTRIES IS:

GENERAL          5.7 – 19.1%

NEONATES                 UP TO 54%

 

ACTIONS TAKEN DURING OUTBREAK

MR. SPEAKER, MOST OF THE BABIES WHO DIED AS A RESULT OF KLEBSIELLA AND SERRATIA BACTERIA WERE LESS THAN SEVEN MONTHS PREMATURE, LESS THAN TWO POUNDS AND IN MANY CASES VERY ILL.

MR. SPEAKER, I KNOW THAT EVERY LIFE IS PRECIOUS WHEN DEALING WITH PREMATURE BABIES WHOSE IMMUNE SYSTEM IS NOT FULLY DEVELOPED, IT LEAVES THEM SUSCEPTIBLE TO OPPORTUNISTIC INFECTIONS OUTSIDE OF THE STERILE WOMB.

ACCORDING TO DATA FROM THE MINISTRY OF HEALTH EPIDEMIOLOGY UNIT, OUTBREAKS OCCUR FROM TIME TO TIME IN SPECIAL CARE NURSERIES AND ICUS IN JAMAICA AND GLOBALLY AS WE HAVE SEEN AT THE CORNWALL REGIONAL HOSPITAL (CRH) AND THE UNIVERSITY HOSPITAL OF THE WEST INDIES (UHWI).

THE COMMONEST CAUSES OF NEONATAL DEATH WORLDWIDE ARE INFECTION, RESPIRATORY FAILURE AND PREMATURITY.

ALLOW ME MR. SPEAKER TO COMMEND THE HARD WORKING HOSPITAL STAFF WHO FACE THESE INFECTIONS FROM TIME TO TIME, AND WORK TIRELESSLY TO CONTAIN THEM. WHEN THERE IS AN INFECTION IN A HOSPITAL, THE HOSPITAL’S LOCAL INFECTION CONTROL TEAM TAKES CHARGE OF THE PROCESS TO CONTROL THE INFECTION. THE LOCAL PARISH HEALTH DEPARTMENT AND THE SURVEILLANCE UNIT IN THE MINISTRY OF HEALTH ARE NOTIFIED THROUGH THE MINISTRY’S SURVEILLANCE SYSTEM.

WHEN THE MINISTRY OF HEALTH IS INFORMED ABOUT AN OUTBREAK SEVERAL STRATEGIES ARE RECOMMENDED TO THE HEALTH FACILITIES UNDER THE MINISTRY’S GUIDANCE TO HANDLE THE ONSET OF THE INFECTION:

  • ENHANCED SURVEILLANCE AND MONITORING OF THE

OUTBREAK – WITH DAILY REPORTING TO THE MOH

  • ISOLATION OF INFECTED BABIES AND PLACEMENT IN
    SEPARATE ROOMS
  • NEW ADMISSIONS PLACED IN A DIFFERENT
    LOCATION
  • INCREASED INFECTION CONTROL MEASURES, SUCH
    AS INCREASED FREQUENCY OF CLEANING, DEEP
    CLEANING, MONITORING OF HANDWASHING AND
    CONSISTENT USE OF PERSONAL PROTECTIVE
    EQUIPMENT
  • ADDITIONAL EQUIPMENT AND SUPPLIES PURCHASED
  • STAFFING LEVELS ENHANCED BY REDEPLOYMENT
    AND ENGAGEMENT OF ADDITIONAL SESSIONAL STAFF
  • TRAINING, RE-TRAINING AND ORIENTATION OF STAFF,
    PARENTS AND GUARDIANS

 

MINISTER’S ACTIONS

UPON BEING INFORMED OF THIS ALLEGED “MYSTERY BUG”, I ACTED PROMPTLY. I SUMMONED MEMBERS OF THE BOARD OF THE UHWI TO AN EMERGENCY MEETING ON OCTOBER 16.

ON OCTOBER 17, I MET WITH A BROADER STAKEHOLDER GROUP INCLUDING THE TECHNICAL STAFF OF THE UHWI. AT THAT MEETING I PLEDGED ALL AVAILABLE RESOURCES.

THE PRESS CONFERENCE ON TUESDAY OCTOBER 20 WAS TO ALLAY PUBLIC FEAR AFTER THE REPORTS OF A BUG KILLING BABIES AT THE HOSPITALS. WE HAD ALREADY IDENTIFIED THE CAUSE AS SERRATIA AND KLEBSIELLA.

 

PLANS TO IMPROVE INFANT AND MATERNAL HEALTH

MR. SPEAKER AND MEMBERS OF THIS HONOURABLE HOUSE, WE HAVE LONG RECOGNISED THE FREQUENCY AT WHICH THESE INFECTIONS OCCUR AND SO WE HAVE BEEN FAR DOWN THE WICKET WITH PLANS TO IMPROVE THE SURVIVAL OF THESE NEONATES.

BEFORE THE OUTBREAK, AS FAR BACK AS 2012, MY TEAM MET WITH THE CONSULTANT FROM THE EUROPEAN UNION WHERE A PROJECT WAS SUBMITTED AND ACCEPTED AND BY NOVEMBER 2013, WE SIGNED OFF ON A GRANT OF 22MILLION EUROS SPECIFIC TO IMPROVEMENT TO THE AREAS OF MATERNAL AND CHILD HEALTH.

MR. SPEAKER, WHILE I DO NOT WISH TO DWELL ON THE NUMBERS, I THINK IT IS IMPORTANT TO ALSO UNDERSTAND THAT WE HAVE SEEN SOME IMPROVEMENT AND HAVE BEEN TRYING VERY HARD TO ENSURE THAT WE PUT MEASURES IN PLACE TO PROTECT ALL OF OUR BABIES AND MOTHERS.

AS PART OF JAMAICA’S COMMITMENT UNDER MILLENNIUM DEVELOPMENT GOALS 4 AND 5, THE MINISTRY SEEKS TO FURTHER IMPROVE MATERNAL AND CHILD HEALTH TO FIRST WORLD LEVEL CONSISTENT WITH OUR VISION 2030. A PART OF THIS EFFORT IS THE PROGRAMME FOR THE REDUCTION OF MATERNAL AND CHILD MORTALITY (PROMAC) UNDER WHICH THE EUROPEAN UNION HAS GIVEN US A GRANT OF €22 MILLION OR NEARLY J$3 BILLION – THE LARGEST EVER GRANT TO THE HEALTH SECTOR.

 

MR. SPEAKER, I USE THIS OPPORTUNITY TO AGAIN THANK THE EU FOR THIS KIND ASSISTANCE TO IMPROVE THIS VERY IMPORTANT AREA. WE WILL BE HOSTING AN OFFICIAL CONTRACT SIGNING ON TUESDAY, NOVEMBER 3, 2015.

A TOTAL OF €1,918,419.40 OR APPROXIMATELY J$253.1 MILLION WORTH OF CONTRACTS HAS BEEN AWARDED IN THE AREAS OF PEOPLE, PLANT AND ENVIRONMENT SUPPORT.

 

PEOPLE

MR. SPEAKER, WE WILL BE BUILDING CAPACITY OF OUR WORKFORCE TO RESPOND EFFECTIVELY TO NEWBORNS, ESPECIALLY PRE-MATURE ONES BY INCREASING THE NUMBERS OF STAFF SPECIALLY TRAINED FOR NEONATAL CARE.

  • 1000 PRIMARY CARE WORKERS
  • 200 COMMUNITY HEALTH AIDES
  • 86 PHYSICIANS AND NURSES
  • 20 NURSES IN NEO-NATAL CARE HAVE ALREADY BEEN DEPLOYED TO THE FIELD AS OF JULY 2015.
  • AN ADDITIONAL 22 NURSES ARE IN TRAINING AND WILL BE DISPATCHED TO THE HOSPITALS IN ANOTHER SIX MONTHS.
  • WE WILL CONTINUE TRAINING UNTIL EVERY HEALTH FACILITY IN JAMAICA WHERE NEW-BORNS ARE WILL HAVE THE REQUIRED NUMBERS OF NURSES.

 

DOCTORS

  • FELLOWSHIPS AWARDED TO 7 CANDIDATES IN NEONATOLOGY, MATERNAL FOETAL MEDICINE AND CRITICAL CARE AT UWI – AN ADDITIONAL 14 CANDIDATES ARE TO BE TRAINED IN THE NEXT FEW YEARS
  • 2 YEAR GRANTS AWARDED TO 9 DOCTOR OF MEDICINE CANDIDATES AT UWI IN ANAESTHESIOLOGY, OBSTETRICS AND GYNAECOLOGY AND PAEDIATRICS AND ANOTHER 27 GRANTS ARE TO BE AWARDED
  • COMPLETED IN-SERVICE TRAINING FOR THE 1ST COHORT FOR NEONATOLOGY (25) AND CRITICAL CARE (32). 2ND COHORT FOR NEONATOLOGY (22) COMMENCED TRAINING IN OCTOBER 2015.

 

DESIGN OF HDUS

  • 470,000 – J$61.9 MILLION TO DESIGN ELEVEN (11) HIGH DEPENDENCY UNITS (HDUS) IN TOTAL (5 MATERNAL AND 6 NEONATAL) FOR VICTORIA JUBILEE, MANDEVILLE REGIONAL, CORNWALL REGIONAL, SPANISH TOWN, ST. ANN’S BAY REGIONAL HOSPITALS AND BUSTAMANTE HOSPITAL FOR CHILDREN. A TOTAL OF 45 NEONATAL AND 23 MATERNAL BEDS WILL BE PROVIDED ACROSS THE SIX INSTITUTIONS. THIS WILL ENHANCE VENTILATOR SUPPORT.

 

EQUIPMENT

  • €724,000 – J$95.5 MILLION FOR EQUIPMENT FOR MANDEVILLE REGIONAL HOSPITAL’S NEONATAL HDU AND
  • ARRANGEMENTS BEING MADE TO PROCURE EQUIPMENT FOR THE TEN REMAINING HDUS

 

MR. SPEAKER, IT IS AGAINST THIS BACKGROUND THAT I AM ANNOUNCING TODAY THE SETTING UP OF A SPECIAL UNIT WITHIN THE MINISTRY OF HEALTH TO MONITOR BOTH PRIVATE AND PUBLIC SECTOR FACILITIES FOR NEW BORN BABIES. THIS IS IN KEEPING WITH THE UNITED NATION’S “EVERY NEWBORN ACTION PLAN: A CALL TO ACTION 2014” WHICH IS A PART OF THEIR VISION 2030 AGENDA.

THE UNIT WILL BE HEADED BY DR. MICHELLE-ANN RICHARDS DAWSON, A NEONATOLOGIST AND COMPRISES DR. JACQUILINE BISASOR MCKENZIE, DR KAREN SHAW, DR. SIMONE SPENCE WITH SUPPORT FROM THE MINISTRY’S EPIDEMIOLOGIST, DR. KAREN WEBSTER AND THE CHIEF NURSING OFFICER.

AS I SAID BEFORE MR. SPEAKER, IT IS INTERNATIONALLY RECOGNISED THAT NEONATAL MORTALITY IS TOO HIGH AND SO STRINGENT ACTIONS WILL HAVE TO BE TAKEN TO PRESERVE AND SAFEGUARD THE FUTURE HUMAN RESOURCE OF THIS COUNTRY.

 

CONCLUSION

UNFORTUNATELY KLEBSIELLA AND SERRATIA ARE AMONG THE LEADING CAUSES OF INFECTION AND MORTALITY OF PREMATURE BABIES WORLDWIDE. I KNOW THAT EVERY CHILD LOST IS DEVASTATION FOR ANY FAMILY AND SO WE WOULD LOVE TO BE ABLE TO SAVE ALL OUR CHILDREN.

I WANT TO ASSURE YOU MR. SPEAKER THAT WE WILL CONTINUE TO DO ALL WE CAN TO PROVIDE THE BEST CARE POSSIBLE AT OUR FACILITIES. IT IS UNFORTUNATE AND REGRETTABLE THAT THIS SITUATION AROSE AT THIS TIME.

FINALLY, MR. SPEAKER, I CALL ON PERSONS TO ACT AND SPEAK RESPONSIBLY AND STOP TRYING TO ACHIEVE POLITICAL GAINS FROM THE DEMISE OF BABIES AND THE TEARS OF MOTHERS AND FATHERS.

THANK YOU.