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31 october 1991
Doc. 6522
1403-15/10/91-3-E
Report on priority needs of the Paediatric Institute of Tirana
(Rapporteur: Mrs LENTZ-CORNETTE, Luxembourg,
Christian Democrat)
I. DRAFT RECOMMENDATION
1. The Assembly refers to its Resolution 970 (1991) on the situation in Albania, notably in respect of technical assistance in the medical field and humanitarian aid.
2. It recalls Order No. 461 (1991) on the situation of hospitals in Albania, instructing its Social, Health and Family Affairs Committee to explore ways of meeting the most urgent needs of certain hospitals.
3. It notes action taken by this committee in commissioning an expert study on priority needs of the Paediatric Institute in Tirana, and welcomes the humanitarian initiatives which are being taken by Luxembourg and Switzerland.
4. The Assembly recommends that the Committee of Ministers refer the question of evaluation of priority needs of the Paediatric Institute in Tirana to the European Health Committee for consideration at its next meeting and for action as soon as circumstances permit.
II. EXPLANATORY MEMORANDUM
by the Rapporteur
1. Delegations of our Assembly observed the elections in Albania 28 March-1 April and 11-15 April 1991. I had the honour of leading the first delegation and the opportunity of witnessing the distressing conditions of the Paediatric Institute in Tirana.
2. The Director of the Institute, Dr Genc Sulcebe, made a favourable impression on our delegation and subsequently on Mr Victor Ruffy, a member of our second delegation, in the course of a breakfast meeting on 15 April in Tirana. This meeting enabled a first preliminary list of priority needs to be drawn up, on the basis of which I was able to initiate some preliminary action with the help of the Centre Hospitalier de Luxembourg (Dr Guy Glaesener).
3. On 26 April Mr Ruffy and I sponsored a motion in the course of the debate on concerted European policies for health, which opened the way for action by the Social, Health and Family Affairs Committee. At its meeting in Dublin 13-14 June, our Sub-Committee on Family Affairs, Health and Bioethics, on a proposal by its Chairman, Mr Palacios, recommended the appointment of a consultant-expert for a study-visit at the earliest possible opportunity.
4. Thanks to various contacts and interventions by Mr Ruffy, the study-visit was made by Dr Daniel Beck of the Paediatrics Department of the Centre Hospitalier Universitaire Vaudois (Director: Professor Emile Gautier). His report is joined as an Appendix to this explanatory memorandum. The purpose of the draft recommendation which I propose to the committee is to get this report on the agenda of the Council of Europe's Steering Committee for Health - even in advance of Albania entering into formal relations with our Organisation, so that preparations can be made for action and in order that action can be taken immediately once this relationship is established.
5. Meanwhile, Mr Ruffy and I have pursued contacts at the highest levels of our governments, and can report that there is great receptiveness to the problems of this specific institution, and readiness to release resources for action - preferably within a European framework - subject to our assurances that supplies can be properly conveyed and put to immediate good use once they arrive.
6. Since Dr Beck completed his report, Dr Sulcebe has been removed from the directorship of the Institute. However, neither in Dr Sulcebe's opinion nor in the opinion of a medically-qualified member of the mission sent to Albania earlier this month by the Corps suisse pour l'aide humanitaire en cas de catastrophe who met Dr Sulcebe's successor, should this event be interpreted as weakening the Institute's capacity to receive and make immediate good use of supplies.
A P P E N D I X
Concerted European policies for health:
follow-up to Recommendation 1153 and Order No. 461
PRIORITY NEEDS OF THE PAEDIATRIC INSTITUTE OF TIRANA
Report on an evaluation mission carried out in Tirana
from 8 to 11 July 1991
by Dr Daniel Beck
Consultant expert for the committee
(Paediatric Service of the Centre Hospitalier
Universitaire Vaudois)
TABLE OF CONTENTS
A. INTRODUCTION
- Background and democraphic data
- Current political and economic situation
B. NATIONAL ORGANISATION OF PAEDIATRIC CARE
C. THE TIRANA PAEDIATRIC INSTITUTE
C.1 General
C.2 Survey of services provided by units
C.3 Medical and administrative organisations
C.4 Budget
C.5 Staff
D. AID REQUESTED
E. RECOMMENDATIONS
F. CONCLUSION
Annexes
A. Presentation of the Institute by Dr Genc Sulcebe,
Director 1988-1991
B. Staff: Doctors according to service and their
training abroad
C. Priority needs - equipment
D. Priority needs - consumer items
E. Participation in international and humanitarian activities
of the consultant expert
F. Order No. 461 (1991) of the Assembly
A. INTRODUCTION
Background and demographic data
1. The Albanians claim descent from the ancient Illyrians and live in a small mountainous country between Yugoslavia and Greece. Albania's population is approximately 3 million. The Albanian language is a wholly separate offshoot of the Indo-European group. Situated on the border between the two old Roman empires, the country was under Turkish rule from the 15th century until 1912; in religious terms, approximately two-thirds of Albanians are Muslims, the remainder being more or less equally divided between Catholics and Orthodox, although all religions were suppressed by the communist regime established after the second world war, which destroyed places of worship and banned religious practises.
Current political and economic situation
2. Albania is currently ruled by a "transitional" government, following the holding of elections in spring 1991. The Socialist (formerly Communist) Party has a majority in parliament, with 75% of the seats; the remaining seats are divided among the Democratic Party (centre) the Republican Party and other smaller groups. Further elections may be held in autumn, but no date has so far been decided.
3. The economy is still entirely state organised and centralised. The country's economic difficulties are considerable, with a steady deterioration in the last two years or so. Where foodstuffs are concerned, there is now no fruit in the shops and milk (1 litre per person per month) and meat (1 kilo per person per month) are rationed; only a few vegetables are freely available.
4. The local unit of currency is the lek. The bank exchange rate is 20 leks to the dollar, the tourist rate 10 leks to the dollar, and the black market rate 30 leks to the dollar. Doctors in the hospital earn between 600 and 900 leks a month.
B. NATIONAL ORGANISATION OF PAEDIATRIC CARE
5. Forty per cent of the Albanian population are under 15; the infant mortality rate stands at 31 per thousand, and has recently been rising in rural areas. The Ministry of Health has a mother and child health department. Activity is divided into prevention and treatment. Prevention is the responsibility of the mother and child protection centres (MCP). 93% of the population have been compulsorily vaccinated against BCG, Di-Te-Per and polio.
6. Treatment in rural areas is organised on a pyramidal pattern. Every village has a health centre run by a nurse or midwife, which provides primary care. Each group of 4-5 villages has a larger health centre, with general practitioners, dentists and pharmacists.
7. Secondary treatment is organised at district level (there are 26 districts in Albania). Each district has approximately 5 area or rural hospitals, each one having a maternity and sometimes a paediatric unit; every district also has a general hospital, and this normally has a paediatric unit headed by a paediatrician. In five districts, there are separate paediatric hospitals, where all the staff have paediatric training.
8. Primary and secondary care in urban areas is provided by out-patient poly-clinics (10 in Tirana), each with a team of 5 to 8 paediatricians. Primary care is also provided in mother and child protection centres (MCP or health centre).
9. Paediatricians often work both in poly-clinics and in hospitals.
10. In a few districts, there are separate children's hospitals treating malnutrition.
11. Tertiary care: the Tirana Paediatric Institute serves as a reference hospital for the whole country, with a director and a team of paediatricians specialising in all branches of paediatrics.
12. In general, according to Dr. Solcebe, there are enough nurses and doctors, and accommodation is sufficient. Three crucial problems remain to be solved:
i. the level of training of doctors and nurses is often
insufficient;
ii. equipment is old and in short supply;
iii. transport facilities are completely lacking, and
communications seriously underdeveloped.
13. In the whole country, there are only two rehabilitation centres for handicapped children. Where mental handicap is concerned, there is a special school in Tirana for slightly handicapped children, and there are institutions in Tirana and in Skoder for the most seriously handicapped.
C. THE TIRANA PAEDIATRIC INSTITUTE
C.1 GENERAL
14. The Institute is located in a hospital centre to the east of the city. It consists of a three-storey building completed three years ago, the old hospital, which is used to house infectious patients, and a recent extension, which contains an immunology and a genetics laboratory. The laundry is shared with the adult hospital; it is equipped with old washing machines, and drying is done out of doors.
15. Hypodermics, needles and perfusion tubes are sterilised in a cramped room in the old hospital, using a small autoclave. Before being sterilised, equipment is washed in distilled water from a distilling plant in the hospital.
16. The pharmacy, which is beside the sterilisation room, has a wide variety of medicines, but stocks are very variable. A consignment of medicines sent by the Italian government was being sorted when I was there.
17. The new building comprises a reception area, out-patient poly-clinics and wards. Most of the wards consist of small rooms which can take up to 6-8 beds. The children are accommodated in metal frame beds of the right size, with mattresses and sheets which are usually clean. The walls are unpainted. I saw the occasional cockroach. Cloth nappies are used on the babies. Hypodermics and needles are of the old reusable metal type. Perfusion fluids are contained in bottles prepared by a central pharmacy for all hospitals, and administered through broad tubes which must be resterilised after use. Very broad gauge metal needles are inserted in veins and held in place with cloth bandages.
18. The wards are specialised, and each has a separate room with a limited range of emergency medicines and sterile equipment in reserve. There were few basins for hand-washing, and very few in the rooms.
19. The biochemistry and haematology laboratories have old measuring equipment and a very few modern devices for automated measurement. Even the commonest reagents are sometimes lacking and stocks are very old. Microscopes are in short supply and are very old-fashioned. The microbiology laboratory, which is in the old building, has a few drying ovens and refrigerators and a deep-freeze. Its equipment is slightly more modern and plentiful than that of the other laboratories, but reagents are also in short supply.
20. The immunology laboratory, which is directed by Dr. Solcebe, has become a national reference laboratory. It shares spacious premises with the genetics laboratory. Most of its equipment is very modern, having been purchased recently with the help of a grant from the United Nations Fund for Population Activity (UNFPA), comprising a sum of 600 000 dollars, payable over 4 years, to cover equipment and 1-3 month training courses for 20 doctors in France and Italy.
21. The hospital has 500 beds, and the occupation rate is some 60-70%. Obtaining food supplies has so far been possible, but is becoming increasingly difficult. The kitchen is very badly equipped, there is no milk, and babies are fed on yoghurt in the country's traditional manner. A lack of variety in the foodstuffs available suggests that vitamin deficiencies may occur. Some 20% of hospitalised patients are suffering from malnutrition. The hospital devotes some 60% of its activity to the Tirana district, and 40% to the rest of the country.
22. No provision is made for mothers wishing to remain with hospitalised children during the day or at night ("rooming in"). I saw few parents with their children in the rooms. There is no play room, and there are hardly any toys.
C.2 SURVEY OF SERVICES PROVIDED BY UNITS
23. Intensive care
In the intensive care unit, there are only one or two patients per room. The unit has 15 beds, and each nurse usually attends to one or two patients.
It has only one mechanical ventilator, a modern cardiac monitoring device, a few perfusion pumps, and some older inhaling and suction devices; some patients are on drips, there are one way plastic central venous catheters.
24. Endocrinology
Hormone doses can be administered and functional tests carried out. No human insulin is available for diabetics.
25. Pneumology
No equipment for functional tests. Bronchoscopies can be carried out, but the lack of rigid bronchoscopes limits this to older children.
26. Gastroenterology
No equipment for gastro-duodenal or recto-intenstinal endoscopy.
27. Neo-ology
There is only one isolette, which is in the intensive care unit. No warming beds.
28. Nephrology
No equipment for haemodialysis, although peritoneal dialysis can be improvised.
29. Haematology
There is a special room, which is bright and cheerfully decorated, for out-patients in need of regular transfusions.
30. Surgery
The new hospital contains an operating theatre and surgical ward for paediatric surgery, but these are at present unused, essentially because the theatre equipment cannot be sterilised. Operations on children are currently carried out in the general surgical hospital, by a team of 4 surgeons and 4 anaesthetists.
31. Hepatitis department
Only serological diagnosis of Hepatitis B is possible.
32. Infectious diarrhoea department
Patients suffering from salmonellosis or shigellosis are isolated in 6-10 bedrooms, accommodating patients infected with the same bacteria.
33. Allergology
Deals with asthmatic patients, has no inhaling or vaporising equipment.
C.3 MEDICAL AND ADMINISTRATIVE ORGANISATION
34. Director: Professor Genc Sulcebe. Graduated from medical school in 1977. Studied paediatric and general immunology in Paris from 1983 to 1986 and undertook research on the sub-classes of immunoglobulins. Appointed director in 19881.
35. He is assisted by two deputy directors, one responsible for clinical work and the other for research. A chief administrator (economist) is in charge of finance.
36. The Institute also serves as a teaching hospital for medical students and postgraduates. It has a chair of paediatrics, which has connection with management of the hospital and carries a separate salary. As in the Soviet Union, professors are paid by the faculty and do not necessarily have hospital functions.
C.4 BUDGET
37. Management of the budget is centralised within the Ministry. No information is available on the hospital's income, since treatment is free. The total budget of expenditure for 1991 is 9 557 000 lek, or approximately 500 000 dollars at the official rate. This covers salaries (680 staff), equipment (paid for in lek, although it comes entirely from abroad), investment, travel, premises, medicines and food. The hospital is not given an overall budget allocation; the various items are separate and are decided by the Ministry. The Ministry insists that equipment requirements be planned two years in advance; in 1991, allocations covered 0% of the equipment, 40% of the medicines and 100% of the salaries requested.
C.5 STAFF
38. A list of doctors in the Institute's sub-specialisations, giving details of their training abroad, has been supplied by the deputy medical director and is appended to this report (Annex B).
39. Posts at the Institute would seem to have often been awarded on the basis of membership of the communist party or of nepotism. This means that the quality of the medical team is variable. Many members of staff have attended relatively short-term training courses in other countries (principally France and Italy). The list reflects some overstaffing with doctors, partly intended by the Ministry as compensation for lack of equipment. Appointments are for life.
D. AID REQUESTED
40. In support of the application for assistance presented by the director of the Institute, the following documents have been sent to the Council of Europe: a summary description of the Paedriatric Institute by Dr. Sulcebe (Annex A), together with a list of the equipment required by the various units and a list of the most essential consumer items (Annex B).
41. These lists have been discussed with Dr. Sulcebe, and the various requirements have been ranked in order of priority from P1 (top priority) to P3 (bottom priority). All the doctors in charge of the various departments were also invited to a discussion, at which they were able to state their requirements.
42. Comments
Several kinds of financial aid can be envisaged: one would cover basic equipment, which would improve the treatment provided for a great many children, but would have to be constantly replaced, since most of it is disposable. The other would cover specialised equipment in one or two units, removing the need to send some children abroad and allowing the hospital to make certain economies. This type of aid would benefit a limited number of children, and the hospital's centralised budget structure would not allow it, for example, to use the money saved to purchase equipment. A third type of aid would cover the training of Albanian doctors through the medium of two-way courses: foreign experts would visit Albania for periods of two to four weeks, or Albanian doctors would be sent abroad for specialised training determined by the hospital's priorities and by their own capacities and qualities.
E. RECOMMENDATIONS
43. The exact cost in western currency of all the equipment requested will have to be calculated by a specialised governmental or non-governmental agency, with help from me if problems arise. The Council of Europe will then have to decide on the validity, urgency and priority of the aid requested, and to assess the possibility of obtaining ongoing credit as long as the hospital's economic and budgetary situation remains unchanged. Discussion with Dr. Solcebe and the main doctors in charge has confirmed that the requests match real needs, allow for the training of the specialists involved and will directly benefit the children treated by the Institute. Seen in broad terms, aid should also include grants to cover bilateral training courses.
44. Various factors tell in favour of the kind of aid envisaged: the requirements have been assessed by an expert on the spot, the aid is aimed at a specific hospital, we are dealing with a stable, responsible and reliable partner, and we can monitor the use actually made of the help provided. Dr. Solcebe has also requested that an expert on hospital management visit Albania to provide instruction in modern techniques.
F. CONCLUSIONS
45. Having entered an unstable phase of political transition, Albania is suffering from a serious general shortage of foodstuffs and equipment, and this affecting is the Paediatrics Institute in Tirana, a unique centre for third level care. A request for emergency assistance with medical and technical equipment has been submitted to the Council of Europe, on the basis of a list supplied by the director of the Institute, with priorities defined in discussion with the persons in charge. A brief visit to Tirana made it possible to assess requirements on the spot, thanks to the helpfulness of Dr. Genc Solcebe and the excellent personal contacts which were established.
A N N E X E S
Annex A Presentation of the Institute by Dr Genc Sulcebe,
Director 1988-1991
Annex B Staff: Doctors according to service and their
training abroad
Annex C Priority needs - equipment
Annex D Priority needs - consumer items
Annex E Participation in international and humanitarian
activities of the consultant expert
Annex F Order No. 461 (1991) of the Assembly
A N N E X A
PRESENTATION OF THE INSTITUTE BY DE GENC SULCEBE
DIRECTOR 1988-1991
The Tirana Paediatric Institute is the reference paediatric centre for the entire country. Its activities fall into 3 main categories:
- clinical work
- teaching and training
- research
Clinical work
The Paediatric Institute is a teaching hospital with 550 beds. It comprises the following departments and units:
1. Paediatric ear, nose and throat unit
2. Neo-ology care unit
3. Allergology unit
4. Pneumology unit
5. Neurology unit
6. Cardiology unit
7. Haematology unit
8. Chronic gastro-enterology unit
9. Endocrinology unit
10. Nephrology unit
11. Rheumatology unit
12. Intensive care unit
13. General paediatrics unit
14. Unit for intestinal complaints of known origin (salmonelloses,
shigelloses, etc)
15. Acute hepatitis unit
16. Acute diarrhoea unit
17. Aerogenic infections unit (meningitis, septicaemia, measles, etc)
18. Reception and emergency department
19. Paediatric surgery department (not yet operational, owing to lack of equipment)
20. X-ray department
21. Pharmacy and sterilisation
22. Preventive paediatrics and child care unit
23. Physiotherapy unit
24. Dietology department
25. Statistics unit
26. Bacteriology laboratory
27. Biochemistry and haematology laboratory
28. Immunology laboratory
29. Genetics laboratory.
The last two laboratories also serve as national centres for adult medicine. Every clinical unit also provides out-patient consultation via our Institute's dispensaries.
The Paediatric Institute is the only paediatric hospital in the entire Tirana district.
Some 40% of its activity is also devoted to caring for children from other parts of the country, who are referred by local paediatric hospitals or departments for more specialised treatment. These include children with diagnostic or therapeutic problems which cannot be solved in outlying facilities, or who require third-level treatment in paediatric sub-specialisations which are available only in our Institute. The various sectors of our institution employ a total of 94 doctors and biologists, 395 nurses and 88 medical auxiliaries.
The average number of patients hospitalised every year is 9 000 (0-14 years), of whom 40% are less than 12 months old, 40% between 1 and 4 years old, and 20% between 5 and 14 years old.
Among the main sicknesses, pneumonia and other lung complaints account for approximately 30% of hospitalisations, acute hepatitis for 15%, acute diarrhoea for 15%, and various infectious diseases for 10%, while specialised paediatric problems account for 20%.
Malnutrition affects 17% of all hospitalised children.
The average stay in hospital is 13 days. The day hospital treats 3 700 children every year. The out-patients' department provides 12 800 consultations every year.
The annual hospital mortality rate is 1,5%. The main causes are respiratory complaints (pneumonia, etc) 35%, severe diarrhoea 10%, severe septic conditions 25%, meningitis and encephalitis 9%, viral hepatitis 5%, cardiopathies 3%, leukaemia 2%, with other causes less than 1%.
Teaching and training are the second aspect of the Institute's activity. It provides training for medical students and postgraduate training in the various paediatric specialisations. Regular seminars are held with paediatricians from all parts of the country to improve and standardise paediatric diagnosis and treatment.
Our research activity covers 3 main programmes at national level:
- Research on nutrition and growth in children below the age of 4;
- Research on the prevention and cure of acute respiratory diseases;
- Research on the prevention and cure of diarrheal diseases.
Every specialisation also has its own research programme, which extends to national level.
Our main problems are connected with lack of medical equipment, since the equipment we have is both very old (dating from the 1960s and '70s) and unsuited to our needs.
This sometimes obliges us to send children abroad for diagnosis and treatment, and the cost of this is considerable.
The lack of disposable, one-way items such as nappies, needles, hypodermics, perfusion and transfusion items, etc, is responsible for a high rate of hospital infection.
We enclose a list of the equipment needed in our various departments.
We also add a list of the most essential hospital supplies - Annex D.
A N N E X B
STAFF: DOCTORS ACCORDING TO SERVICE AND THEIR TRAINING ABROAD
Ear, nose and throat unit - 2 doctors
1 doctor specialised for 3 months in Italy
Allergy unit - 3 doctors
1 doctor specialised for 9 months in France
Neonatal unit - 2 doctors
1 doctor specialised for 3 months in France
Pneumology unit - 5 doctors
1 doctor specialised in bronchoscopy for 3 months in France
1 doctor specialised in respiratory testing for 3 months in France
Neurology unit - 4 doctors
1 specialised in general neurology for 6 months in France
1 specialised in EMG for 4 months in Austria
1 specialised in general neurology for 4 months in Italy
1 specialised in EEG for 7 months in Italy and Austria
Endocrinology unit - 2 doctors
1 specialised in general paediatric endocrinology for 4 months in France
Nephrology unit - 3 doctors
1 specialised for 6 months in Italy
1 specialised for 3 months in France
Rheumatology unit - 1 doctor
who specialised for 3 months in Italy
Haematology unit - 3 doctors
1 specialised for 3 months in Italy
Gastroenterology and Hepatology unit - 3 doctors
1 specialised for 6 months in Italy
Intensive care unit - 5 doctors
1 specialised for 3 months in France
1 specialised for 3 months in Italy
General Paediatric unit - 4 doctors
None specialised
Neuroinfections unit - 3 doctors
1 specialised for 3 months
Infectious enteropathy unit - 4 doctors
1 specialised in fibroscopy for 3 months
Viral hepatitis unit - 4 doctors
None specialised
Acute gastroenterology unit - 4 doctors
1 specialised for 3 months in France
1 specialised for 3 months in Italy
Clinical biochemistry laboratory - 3 doctors
1 specialised for 3 months in France
1 specialised for 3 years in Italy
Bacteriology Laboratory - 4 doctors
1 specialised for 3 months in Italy
Immunology Laboratory - 3 doctors
1 specialised for 3 months in Sweden
1 specialised for 4 years in France
Genetics Laboratory - 3 doctors
1 specialised in France for 4 years
1 specialised in Italy for 3 years
A N N E X C
PRIORITY NEEDS - EQUIPMENT
1. Intensive Care Unit:
- Servo Ventilator 900 c with air compressor Siemens - Elema: Ventilator vivision S-17195 Solna Sweden (P1)
- Inhalator:
Newaerosol. Wipason, Germany or Inhalator "MR 600 Dual Serve OHMEDAS - 42122 VASTRA FROLUNDA SWEDEN 0.31-490540 8 pcs. (P1)
- Enteral nutrition pump:
France Enteral Nutrition pump for pediatrics applications VM 05 10 pcs. (P1)
- Infusions pump:
Vygon Germany, "Amedrop" - Switzerland or Tuv Bayern - Vygon ART. Nr 414600 Infusions Pump Duptrol 10 pcs. (P1)
- Ambu mask:
AMBU INTERNATIONAL Denmark COPENHAGEN SØ NDRE RINGVEJ 49 DK-2600 GLOSTRUP 10 pcs. (P1)
- Laringoscope McIntosh F 8561 A, F8561 B, F8561 C, 5 pcs each. (P1)
2. Gastroenterology
- Fibrogastroscope:
Olympus GIF type X P 10 (with accessories) (P1)
- Fibrocolonoscope:
Olympus CF type P 10 L (with accessories) (P1)
3. Pneumology
- Portable Aspirator for respiratory airways 10 pcs. (1)
- Apparatus for functional respiratory probes:
Spirographes à eau (à cloche) (P2)
Expirographe godash (P2)
Capteur de pression (P2)
Validyne et ASCO pour mesure de la mechanique ventilatoire (P2) Pneumatochographes type Fleisch Nr. 1 et Nr. 2 (P2)
Integrateur (P2)
Enregistreur à trois pistes (P2)
PSC pneumoscope Sp[irometre compact (P2)
MCL - 3 - C "VALIDYNE" Rack 3 emplacements avec alimentation (P2)
CD 18-X-1-J-A "Validyine" Conditionneur capteur à reluctance variable (P2)
Sortie pression differentielle: +/-10 VDC (P2)
CD 18-X-1-J-A "Validyne" Conditionneur pour à reluctance variable (P2)
Sortie débit: +/-10 VDC (P2)
11680 "Validyne" Jeu de connecteur (P2)
DV2 "ASCO" Integrateur (P2)
DP 45-16-A-1-S-4-D Capteur de pression differentielle Entendue de mesure: 3.5 cm H20 (P2)
DP 45-30-A-1-S-4-D Capteur de pression differentielle Entendue de mesure: 88 cm H20 (P2)
- 2228-8134 Embout de pression (P2)
- Ouvre bouche (de Jennings ) 11 cm 13 cm
(Maison Micro France) (P1)
- Pulverisateur de Casteix avec canule droite et coubre petite et grande REF 7735 (maison Micro France) (P1) -
Laringoscopes avec lames droite, 10 ng 11 cm et 8.5 cm (pour enfants et éclairage proximal) + prisme REF 8805 A, 8805 C, 8805 B.
(Maison storz) (P1)
- Siringe laringeale (maison Pouret). Pouret (P1)
- Pince optique à biopsia utilisable avec l'optique Hopkins REF 10375 L (P1)
- Miroir laryne avec manche (Maison Micro France) (P1)
- Pince de Politzer(P1)
- Generateur de lumière Froide LK 3 (P1)
- Cable de lumière flexibles à fibre de verre (P1)
- Petit éclaireur à prisme avec raccord pour cable de lumière froide (P1)
- Optique fibres de verre vision directe REF-10324 A (P1)
- Optique vision foroblique 30o REF 27015 B, 27018 B, 27020 B (P1)
- Optique hopkins vision direct ref 10325 A, 27020 A (P1)
Racord REF 10 338 LO (X 2) (P1)
Racord REF 10 924 D (X 2) (P1)
- Racord special pour sistem de ventilation 10479 (P1)
- Pince à corps étranger 1033849 (P1)
- Pince à corps étranger 10372 N, 10372 K (P1)
- Pince optiques et corp étrangers nors a noy laux utilisable avec l'optique Hopkins 10325 A REF 10375 K 10376 H 10376 K (P1)
- Pince optique a biopsie avec l'optique Hopkins ref 10375 L, 10376 L (P1)
- Masque Minineb REF 00223 Etablissements POURET 9 rue Thenard 75006 Paris 46 rue des Ecoles (5 ème) France 30 pcs (P1)
- Nebulisateur atomisor N.L.5. Nebulisateur atomisor N.L.5 Homologue Nr. 24-AE-78 La diffusion technique française 114 à 120 rue Bergson BP 132 42003 Saint-Etienne Cedex 5 pcs (P1)
- Nebulisator Turusi - 70 Dresden Germany 3 pcs (P1)
- Dren Joly N.12, 14, 16. (P1)
- Storz broncoscope (P1)
tube nr. 2.5 X 20 cm REF 1033 F (P1)
3.5 X 30 cm REF 10338 C (P1)
3 X 20 cm REF 10338 E (P1)
3.5 X 20 cm REF 10338 D (P1)
4 X 30 cm REF 10388 C (P1)
- Halogen lamp Philips 6423 15 V 150 W 50 pcs. (P1)
- Oxygen fluxmeter 6 pcs. (P1)
`4. Neurology
- Electromyographe DISA type 05 A 02 Trolley (P2)
- Portable EEG 1 pcs (P1)
- Ophtalmoscope 2 pcs (P1)
5. Nephrology
- Hemodialysis machine: (P3)
Hospal SPA Via Ferrarese 219/9 40128 Bologna Italia; with accessories
- Dialyze 60 pieces (P3)
F 5 M1591. Dialyseur CA 90 G (Acetate celulose)
- F5M1 592 Dialyseur CA 110 G (Acetate celulose) (P3)
[Source: Baxter S.A. B.P. 56, 78311 Maurepas Cedex France]
- Arterial lines for hemodialysis (60 pieces) } Ampicable to venous lines for hemodialysis (60 pieces) }
Product of Hospal } montreal BSM-22 Address: Hospal SPA Via Ferrarese 219/9 40128 Bologna Italia (P3)
- Fistula Needle arterial (60 pieces) Model green D.1.6. mm code 653 A (P3)
- Fistula Needle venous Model green G.1.6. mm 16 G code 653 (P3) Product of bionic
- Apparatus for peritoneal dialyses (P2)
A pcs. Model 2000 2000 Stedem. Product of Stedim. Address: Département Electronique Medivale Z.I. Enjaca 15, route de la savletat 31770 colometers France with accessories Model: Tenchoff straight Pediatrie code 12321-001.
- Peritoneal dialysis catheters one cuff sumbtaneous position 100 pcs. Product of Bernas Quinton. Address: 2121 Terry Avenue, Seattle, Washington 98121-2791. 206/223-7373 USA (P1)
6. Cardiology
- Ekokardiograf bidimensional Dopler: Packard ou Toshiba ou Siemens (P2)
- EKG Apparatus tip Marquet elektronic (P1)
7. Otorhinolaryngology
- Pediatric Audiometer (P1)
- Impedanemeter (P2)
8. Neonatology
- Air Shields intensive care bassimet 89 with servo- controles and Warmer Maduts Aerosteril. (P2)
- Phototheseine nerco-air shields Model S 400 marritor 126 kontron Medical (P1)
- Kanthel Baby bed 50 W (medical mattress water heating). Bactericidal lamp. (P1)
- DINA MAO Nr. 1,2,3,4, Stethoscope for the newborn (P1)
- Thermometer to oC for the newborn (P1)
9. Nutrition, Dietology
- Balance for children (0-10 kg and 10 fg) 10 pcs each (P1)
- Plicadinameter 5 pcs (P1)
- Electric cooker hospital purposes 2 pcs (P1)
- Refrigerating chamber for food storage 1 pcs (P1)
- Mixer-homogenizer for hospital purposes 2 pcs (P1)
10. Endocrinology
- Insulin pump 2 pcs (P1)
- Insulin syringe 2 pcs (P1)
11. Hematology
- Infusion pump spritzomat; VYGON 4254-00 2 pcs (P1)
12. Cleaning, Sterilisation
- Washing machine for hospital purposes 2 pcs (P1)
- Autoclave for sterilisation 1 pc (P1)
- Apparatus for distillate water production 1 pc (P1)
13. Laboratory
- Refrigerator high capacity for laboratory purposes 5 pcs (P1)
- Laboratory ultracentrifuge 60000 rpm, with swing-out and angular rotors 1 pc (P2)
- Tissue and all homogeneizator (Sorvall) 1 pc (P2)
- Ultra sonifier for cell disrupting 1 pc (P2)
- Laboratory centrifuge (6000 spm) with swing-out and angular rotor 4 pcs (P1)
- Laboratory incubator (for bacteriology) 2 pcs (P1)
- Spectrophometer with from 340 until 1000 mm SPECTRONIC 20 D. Bioblock Scientific. (P3)
- Thermostat for clinical chemistry with temperature range +25o-100oC. (P1)
- Water bath for clinical chemistry. Model G86602+G86656+G86640+G85191 Bioblock scientific (P1)
- Centrifuge type EPPENDORF 29304 with Rotor ependorf 29.307 Micro haematocrit rotor 29.305 (P1)
- Analytical weigh. Sartorius with sensitivity from 0.1 mg until 200 g.(P1)
- PH meter model PHM 84, International radiometer (P3)
- Micro osmometer for clinical purpose model G 85501 with accessory kit for on year Bioblock Scientific (P2)
- Electrolyte analyses for Na+,K+,C1- Nova 6. Nova Biomedical Massachussetts USA (P1)
- Flame photometer FLAPHO 4 CZ JENA Germany (P1)
- Microscope for hematology 4 pcs (Olympus) (P1)
System for production bidistillete water Model G 33914 Bioblock Scientific (P1)
- Flake ICE Machine Model G 78301 Bioblock Scientific (P2)
- Vortex (mixer) model 94323. Top mix with heat model G 94359. Bioblock scientific, with accessesories (P1)
- Varipipette 3000 Pipetman p 20, p 200, P 1000, P 5000, Spike Model C 20, C200, C6000 and filter for P 5000, 4 pcs each (P1)
14. General Paediatrics
- Macroduct US Patent Number 4.542.751 (P1)
UK Patent Number 2.116.850
- Pilogel Discs SS-023 (P1)
US Patent Number 4.383.529
[Source: Wescor Inc 459 South Main Street Logan, Utah 84321 USA]
15. Transport, administration, research
- Electric typewriter 2 pcs (P1)
- Fax machine 1 pc (P2)
- Computer IBM compatible with printer and accessories 2 pcs (P1)
- Autoambulance (diesel) 1 pc (P1)
- Fourgon de transport (diesel) (P2)
- Photocopying machine:
Canon NP 1015 1 pc (P2)
A N N E X D
PRIORITY NEEDS - CONSUMER ITEMS
1. Intensive Care Unit
1 box = 50
Aspiration Catheter (P1) Vygon
Germany 535.05 - 500 copë 10 box
535.06 500 10
535.07 1000 20
535.10 1000 20
535.12 1000 20
535.16 250 5
1 box = 50
Oxygen Catheter (P1) Vygon
Germany 595.08 200 4 box
595.10 250 5
595.12 250 5
595.14 250 5
596.14 250 10 - 1 box = 25
1 box = 40
Stericath twolock (P1) Vygon 130.10 1000 25 box
130.12 2000 50
130.15 1000 25
1 box = 50
Vygoflon, Lock (P1) Vygon 121.08 1000 20
121.10 2000 40
121.13 2000 40
121.16 500 10
1 box = 20
Endotracheal Catheter (P1)
Vygon 516.35 100 5 box
516.40 100 5
516.45 100 5
518.50 60 3
518.55 60 3
1 box = 50
Gastroduodenal Bonde (P1)
Vygon Germany 1391.10 500 10 box 1391.14 500 10
1 box = 20
Trocar Catheter for children 635.12 200 10 box Vygon (P1) Vygon 635.14 200 10
635.14 60 3
Endotracheal catheter (P1) 520.35 5 box x 20
without ballon
Endotracheal catheter (P1) 520.40 5 box x 20
without ballon 520.45 5 box x 20
520.50 5 box x 20
Dexctrostix 2787 miles 5 flakoni (P1)
Ammonia test kit II 30 det. Code U 7215 1 packet (P1)
Suction catheter 2065-2185 1000 copë (P1)
Seldiflex 1.0 mm 6774 J 10 I 100 tipo pediatrico (P1)
Monitoring elektrodes (with micropore TM tape and solid gel) 2248.25 x 50 (P1)
Venflon2 226 cod. 1481-1 1000 copë (P1)
Venflon2 206 1482-9 1000 Sweden (P1)
Oxygen catheter (P1) 595.08 2 box x 50
595.10 2 box x 50
595.14 2 box x 50
Aspiration catheter (P1) 561.12 5 box x 200
531.16 (2 box x 100 cop)
Stericath two lock (P1) 130.10 1000 copë (Vygon)
130.12 1000 " "
Endestahl-Spine (P1) Vygon 8183.97 250 copë, 10 box 1 box = 25 Perfudrop mit bakterien dichter Beluftung (P1) Vygon 147.05 1500 copë
Endotracheal catheter (P1) Vygon 50 copë 2 box
2. Gastroenterology
P1:
2 copë 23.102 gjilpërë record 0.85 x 40 mm 2 " " " " 0.85 x 70
2 " " " " 1.00 x 40 mm
2 " " " " 1.00 x 70 mm
2 " " " " 1.00 x 100 mm
2 " " " " 1.00 x 140 mm
2 " " " " 1.20 x 140 mm
2 " " " " 1.20 x 70 mm
2 " " " " 1.20 x 100 mm
2 " " " " 1.20 x 140 mm
2 " " " " 1.20 x 200 mm
2 " " " " 1.40 x 70 mm
2 " " " " 1.40 x 100 mm
2 " " " " 1.40 x 120 mm
2 " " " " 1.40 x 140 mm
2 " " " " 1.40 x 200 mm
2 " " " " 1.60 x 100 mm
2 " " " " 1.60 x 200 mm
2 " " " " 1.80 x 120 mm
2 " " " " 1.80 x 200 mm
P1:
2 copë 23.101 menghini luer lock 1.00 x 40 mm 2 " " " " " 1.00 x 120 mm
2 " " " " " 1.20 x 70 mm
2 " " " " " 1.20 x 40 mm
2 " " " " " 1.20 x 120 mm
2 " " " " " 1.40 x 70 mm
2 " " " " " 1.40 x 140 mm
2 " " " " " 1.60 x 10 mm
2 " " " " " 1.60 x 200 mm
2 " " " " " 1.80 x 100 mm
2 " " " " " 1.80 x 200 mm
Për punksion asciti (paracent...) (P1)
4 pieces 22.701 age punksioni asciti 200 x 90 mm
[Source: Unimed SA, 80 rue de Geneve Case postale CH 1002 Lausanne Suisse/Switzerland]
3. Pneumology
Sonde ORX four aspiration controlée CRO (P1)
Suction Catheter (P1) - Code 535.08 (1000 cop)
535.12 (1000 cop)
Troakar Joly (P1) copë 100 (10 copë për neonat; 60 copë për latant dhe fëmijë deri 5 vjec, 30. copë për moshën 5-14 vjec)
Kateter PR 2 B (P1) copë 50 (material për fibrobronkoskopi)
4. Nephrology
Disposable biopsy needle 11.4 cm (4-½) camula 50 pieces (P1)
model Tru-cut code 2N2702.
[Source: Travenol Laboratories Inc, Deerfield, Illinois 60015 USA]
Pediatrie
- Urinocal for boys and girls product of Biotral pharma 1000 pieces. Address: rue de Foin, 75140 Paris Cedex 03 (P1)
- Bandeletles reactives pour analyse d'urine Model: Multistex 8SG code 2304 100 pieces Product of viles, address: Laboratoires Miles Division Ammes tour Bayer 13, rue Jean Jaures 92807 Puteaux Cedex (P1)
- Dialiseur en fibre Baxtyer CA 90, CA 110 (P3)
- Lignes Hospal BSM PAG (erterial line) BSM V82 p (venous line) (P3) - Aiguille à fistule veineuse D 1.6 mm/16 G code 653 V (P3)
- Aiguille à fistule arterielle D 1.6 mm/16 G code 653 A (P3)
- Fibla antibakterial 0.22 (Millipor) 50 copë (P3)
- Rubimeta në 3 dhe 2 kalime 50 copë (P3)
- Katatere Nigron Ø 0.5 (P3)
5. Neonatology
- Thermometer to 25-36oC for the newborn (P1)
Room thermometer male and female (for the newborn) (P1)
Plastic syringe with needles for the newborn (P2)
Needles of lumbal punction for the newborn (P2)
Catheter poliedyleni for aspiration of the newborn (P2)
6. Endocrinology
- Haemoglucotest BM 100 fl (P1)
- Keto- Diabus Tet BM 100 fl (P1)
- Monolet model pediatric 100 pcs (P1)
7. Mise au point des karyotypes après amniocentèse pour des femmes ayant plus de 35 ans
1. Boîtes de Petri "Falcon" Ø 60 mm x 15 mm ... Code 19002 F 3002
2. Tubes coniques "Falcon" Ø 17 mm x 115 mm ... Code 19259 F 2O95
3. Pipettes sérologiques "Falcon" 5 ml 1/10 ... Code 19051 F 7543
4. Pipettes sérologiques "Falcon" 10 ml 1/10 .. Code 19057 F 7551
[Source d'approvisionnement éventuelle : "Polylabo - Paul Block & Cie" 305, rue de Colmar, 67100 Strasbourg - Meinau (France)]
A N N E X E
PARTICIPATION IN INTERNATIONAL AND HUMANITARIAN ACTIVITIES
BY CONSULTANT EXPERT,
DR. DANIEL BECK, PAEDIATRIC UNIT, VAUDOIS UNIVERSITY HOSPITAL
Experience in administration and staff management
- Medical and technical preparation and management of humanitarian assistance for leukaemia-suffering children in Minsk hospital No. 1. Joint action SPOG - Chaine du Bonheur - Clinique La Source. Orders and deliveries to Minsk of medical and technical equipment and medicines programmed for two years. Sending of specialised medical and technical teams to Minsk from Swiss centres in rotation for six months. (1.10.90 - 24.3.91)
Membership of medical societies and scientific committees
- Member of the Swiss Paediatric Society (SSP)
- Member of the Swiss Haematology Society (SSH)
- Member of the American Association for Cancer Research (AACR)
- Member of the International Society of Paediatric Oncology (SIOP)
- Member of the Scientific Committee of the Muschamp Foundation, Lausanne
National Activities
- Member of the Swiss Group for Paediatric Oncology (SPOG)
- Member of the SIAK (Swiss Group for Epidemiology and Clinical Cancer Research) as elected representative of the Swiss Group for Paediatric Oncology
International Activities
- Member of the United States Paediatric Oncology Group (POG)
- Principal investigator in the above-mentioned SIOP international multi-centre study
Humanitarian Activities
- Mission to Mali to organise a mass vaccination campaign against yellow fever, with the Corps Suisse d'Aide en cas de Catastrophe - October-November 1987
- Evaluation mission in Namibia for the Corps Suisse d'Aide en cas de Catastrophe, February 1990, and preparation of medical action by the Corps in Bushman Land, currently in progress
- Humanitarian assistance for leukaemic children in Minsk hospital No. 1. Joint action SPOG - Chaine du Bonheur - Clinique La Source. Evaluation visit to Minsk, participation in the Chaine du Bonheur "Children of Chernobyl" on 26.6.90 and preparation and management of assistance which consisted in the sending Swiss specialists in rotation for six months and tested supplies of medical and technical equipment (still in progress).
Awards
Prix Guido Fanconi 1982 from the Swiss Paediatric Society, awarded to the SPOG.
Reporting committee: Social, Health and Family Affairs Committee.
Budgetary implications for the Assembly: None.
Reference to committee: Recommendation 1153 (1991) and Order No. 461 (1991).
Draft recommendation: adopted unanimously by the committee on 25 September 1991.
Members of the committee: Mr Pini (Chairman), Mrs Håvik, Mr Rathbone (Vice-Chairmen), Mrs Albrink, MM. Banks, Beix, Bowden, Diaz de Mera, Elmas, Eser, Fiandrotti, Foschi, Gouteyron, Gusenbauer, Mrs Haarstad, Mrs Haglund, Mrs Haller, Mrs Halonen (Alternate: Mrs Dromberg), MM. Jurgens, Koehl, Koulouris, Liapis, Joaquim Marques, Menzel, Meyer zu Bentrup, Mikan, Monfils, Palacios, Pasquino, Psaila Savona, Mrs Ragnarsdottir, MM. Regenwetter, Reimann, Roseta (Alternate: Mr Conceiçao), Mrs Rossi, Mrs Rothmayerova, Mr Schwimmer, Mrs Staels-Dompas, MM. Taylor, Ternak, Mrs Ugrin (Alternate: Mr Hörcsik), Mr van Velzen.
NB. The names of the members present at the meeting are underlined.
Secretaries of the committee: Mr Hartland and Ms Meunier.
1 1 Secretariat Note: Dr Sulcebe was replaced in August 1991 by Dr Gazmeld Drishti.