3occupational health – st. johns hospital experience, dr. bobby joseph
TRANSCRIPT
Prof. Bobby Joseph MD DNB Head, Community Health
Head, Occupational Health Services St. John’s Medical College
Bangalore
Brief history of Occupational Health at St. John’s
1972 - Ross Institute of Occupational Health (LSHTM)
perceived the need to shift base from Jorhat, Assam
(North East India)
1974 - After a series of exploratory visits a triangular link
between United Planters Association, Ross Institute and
the Department was created.
1977 - Activities started including industries in the vicinity
of St. John’s - medical check ups.
1981 - Collaboration with the Regional Occupational Health
Centre (Government of India) on studies among
weavers of the silk industry
1984 -
1984 to 2000
The Department continued to work with plantations sporadically
Plantation Health Services
Training Medical Officers
Health and Welfare Audits
Water supply systems
Plantation Health Services
Health and Welfare Audits Self appraisal by the plantation company
Each company has many estates
In Tea Estates – management team and medical team
Walk through inspection (field visit)
Protocol developed by the audit team Initially focus on Primary Health Care
Now, Occupational Health and Safety
The Garment Sector
• Serious work with garment industries started in 2002
• 15 factories were part of the projects
• A variety of training programs held
• Workers provided medical check up
Garment Industry Interventions
Setting up health services
Training clinic staff
Training workers
Annual medical checks
Industrial hygiene interventions
Social compliance audits
Garment Industry Interventions
Achievements of the Project
Ambulance rooms and first aid services set up
Ancillary services re-organized
Medical Officers and Nurses trained in provision of
primary health care
Welfare Officers and Managers oriented to the system
Other Sectors
Stone Quarrying
Construction
Zoo Keepers
What about our own employees?
Ad hoc medical checks for some categories
Background
Indian Factories Act requires industries to provide an
Occupational Health Facility for their employees
A Hospital, however large it is, is not required to
provide an Occupational Health Service (OHS)
In some countries, Occupational Health Services are
part of the requirements for accreditation of hospitals.
Background – Some Studies
Employee Motivation – a study on the factors motivating
employees of a Mission Hospital (2003)
Needlestick injuries among the nursing personnel in a
teaching tertiary care hospital (2005)
Background - Negativity
September 2005: Proposal to start a “Staff Clinic”
What staff clinic?
Why staff clinic?
We have done it before and not succeeded
Who will come to see PSM Doctors?
Background – Some Statistics
August 2008
Category Au
07
Se
07
Oc
07
No
07
De
07
Ja
08
Fe
08
Ma
08
Ap
08
Ma
08
Ju
08
Jul
08
Staff 124 117 133 111 xxx 101 144 139 102 109 109 140
Staff Dpdts 125 161 152 143 xxx 104 98 71 116 89 98 109
Students 215 149 196 196 xxx 139 172 141 165 178 147 159
Total 464 427 481 450 xxx 344 414 351 383 376 354 408
Background – The Turning Point
September 2008
Health needs assessment of employees of a hospital and medical
college in Bangalore, India
Number of employees expressed their dissatisfaction with the
existing system
61% of employees said they would be happy seeing a “general
doctor”
Morbidity
44% of all those surveyed reported suffering from back pain
43% of staff had not been vaccinated for hepatitis B
37% reported stress at the work-place
Fresh proposal for OHS at St. John’s
Internally as an OHS for its employees
Externally as an OHS for industries
Training centre for the students in academic programs
on occupational health and safety
Referral service for other clinical departments in St.
Johns, other hospitals, company doctors and GP's.
Fresh proposal for OHS at St. John’s
Internally as an OHS for its employees
Externally as an OHS for industries
Training centre for the students in academic programs
on occupational health and safety
Referral service for other clinical departments in St.
Johns, other hospitals, company doctors and GP's.
Proposed Activities
Medical Consultations and Examinations for Employees
Primary care
Occupational health specific
Prevention Programmes
Hygiene
Health and safety at the workplace
Needle stick prevention
HIV Post-exposure Prophylaxis Program
Hepatitis B vaccination for employees at-risk
Contribute to the Safety and Health related committees
Proposed Activities – long term
• Hospital rounds to visit admitted employees
• Training programs for specific categories of employees
Staff Clinic
Inaugurated on January 21, 2011
One “permanent” Medical Officer
One Faculty Member at the clinic on a daily basis
One/Two Post Graduate will assist at the clinic on specific
days of the week
One Nursing Aide attached to the clinic for registration
and assistance
Staff Clinic – Personnel
Morning Primary Care Clinic
Morning Pre-placement/ Periodic Medicals
Afternoons Periodic Medicals (for students)
Occasional Training Programmes
Routine Immunisations
Staff Clinic – Timings
Report Card
Proposal Status
Medical Consultations and Examinations for Employees
Primary care
Occupational health specific
Prevention Programmes
Hygiene
Health and safety at the workplace
Needle stick prevention
HIV-Post-exposure Prophylaxis Program
Hepatitis B vaccination for employees at-risk
Other Activities
Hospital rounds to visit admitted employees
Training programs
Primary Care
Pre-placement Medicals Periodic Medicals
Environment and Hygiene Checks
Health Education and Trainings
Hepatitis B Vaccination Programmes
What Drives Us
Staff visit the Staff Clinic for primary care
Staff bring their families too
Retired Staff (including Faculty) drop by at the clinic
The occasional employee who says he has benefited from
the training
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
2011
- 12 315 366 320 352 324 244 288 358 288 265 329 325 3774
2012
- 13 357 476 484 532 382 328 400 433 488 412 351 315 4958
2013
- 14 519 422 524 450 360 316 275 320 457 353 283 331 4610
2014
- 15 357 406 605 336 502 362 344 641 769 540 397 392 5651
Staff Clinic – Statistics
Jul
14
Aug
14
Sep
14
Oct
14
Nov
14
Dec
14
Jan
15
Feb
15
Mar
15
Apr
15
May
15
Jun
15 Total
Sick Leave 45 40 46 37 42 36 27 58 51 20 58 65 525
Pre Employment 46 53 66 38 56 25 15 85 70 132 61 61 708
Annual Medical Check 3 0 0 0 35 114 55 46 57 1 1 0 312
Vaccinations 67 93 172 155 98 23 65 170 334 190 69 59 1495
Proxy Prescriptions 21 15 22 25 16 13 12 16 15 23 25 21 224
Incident Morbidity 175 205 299 81 255 151 170 266 242 174 183 186 2387
Total 357 406 605 336 502 362 344 641 769 540 397 392 5259
Staff Clinic – Statistics
Health Care Research
Occupational health and safety measures in ancillary departments of a private tertiary care hospital
Statutory obligations primary to staff welfare
Morbidity profile among clinical laboratory personnel
A longitudinal study of morbidity among nursing assistants
Morbidity profile of nurses and the effectiveness of educational interventions on their knowledge regarding occupational safety and health
Prevalence of latex glove allergy among nurses
Prevalence of shift work disorder among staff nurses
Prevalence of shift work syndrome among health care professionals
Prevalence, pattern and factors associated with work-related musculo-skeletal disorders among housekeeping staff
What Next?
Computerised data base (Employee Medical Records)
Systematic interventions – training, vaccinations
More core occupational health work – job hazard
analysis, environmental measurements etc
Multi-centric research
What Next?
Computerised data base (Employee Medical Records)
Systematic interventions – training, vaccinations
More core occupational health work – job hazard
analysis, environmental measurements etc.
Multi-centric research
A trained and certified Occupational Health Physician
Thank You!