Midega Tolla Hospital

Proposal

Fund raising Proposal for Midega Tolla Hospital

windows 10
5/21/2024

Submitted by:

This proposal is intended to seek foreign/local grant for service and quality improvement of Midega
Tolla Hospital.
Contents
1. Introduction.........................................................................................................................................4
2. Objective of the Paper.........................................................................................................................6
3. Hospital Catchment population geography and topography...............................................................6
4. MIDEGA HOSPITAL CURRENT HUMAN RESOURCE PROFILE................................................................7
5. Midega Hospital General infrastructures.............................................................................................8
6. Trends of outpatient visits monthly/2015...........................................................................................8
a. Annual Outpatient Department Visits 11712...................................................................................8
7. Emergency, Injury and Critical Care unit..............................................................................................9
7.1. Facility...............................................................................................................................................9
a. EICC Services/2015 EFY..................................................................................................................10
8. The Common Causes of Death at Emergency unit.............................................................................10
9. The Common medical Conditions Caused death at BPH Emergency unit..........................................11
a. Causes encountered according to our review...............................................................................11
10. Surgical and Anesthesia Services...................................................................................................12
10.1. The most common reasons for surgical referral from our Hospital are;................................12
10.2. The leading causes of EESC interruption................................................................................12
10.3. EESC Challenges.....................................................................................................................12
11. TOP 10 LEADING CAUSES OF ADMISSION (EFY, 2015....................................................................13
12. TOP 10 CAUSE OF DEATH (EFY, 2015)............................................................................................13
13. Prevention and control of major diseases.....................................................................................13
14. Communicable Diseases Overview................................................................................................14
14.1 Facts...............................................................................................................................................14
14.2. Hepatitis B and C Services.............................................................................................................15
14.3. Challenges with Hepatitis B,C virus...............................................................................................15
15. Non-Communicable Diseases and Injuries.....................................................................................16
15.1. Facts.......................................................................................................................................16
15.2. Hypertension and Raised BP Screening service2015 EFY.......................................................16
 15.3. NCD Disaggregated................................................................................................................17
15.4. Challenges with NCDs............................................................................................................17
16. Hospital Maternity Services/2015EFY............................................................................................18
16.1. Monthly trends of SBA/2015 EFY...........................................................................................18
16.2. Referral out by cases,2015 EFY( N= 178)...............................................................................19
16.3. Trends of Maternal deaths in the last five years in Hospitals Since 2011..............................20
16.4. The 7 causes of maternal death.............................................................................................20
16.4.1. Immediate Causes of Maternal death from MPDSR..........................................................20
17. NICU Facility...................................................................................................................................21
18. Service/2015EFY............................................................................................................................21
18.1. Summary of NRU Challenges.................................................................................................21
19. Summary........................................................................................................................................22
20. Referral Issues...............................................................................................................................22
20.1. Facts.......................................................................................................................................23
21. Neonatal Care Bottlenecks............................................................................................................24
22. Hospital Imaging Service/2015EFY.................................................................................................25
22.1. The Major Bottleneck of Imaging Services.............................................................................25
23. Medical products and supplies......................................................................................................26
23.1. Challenges....................................................................................................................................26
23.2. Medical Laboratory Services Challenges.......................................................................................26
24. Midega Hospitals` Current Challenges...........................................................................................26
24.1. Top Priority needs..................................................................................................................27
25. Conclusions....................................................................................................................................28
 1. Introduction
Health system consists of all organizations, people, and actions whose primary
intent is to promote, restore or maintain health

Health systems have a responsibility not just to improve people’s health but also
to protect them against the financial cost of illness and to treat them with dignity
(WHO, 2000)

HS has three fundamental objectives;

 Improving the health of the population

 Responding to people’s expectations (Responsiveness)
 Providing financial protection against the costs of ill-health (Risk Protection)

In Ethiopia, use of health services is low, especially among rural dwellers,

socioeconomically deprived groups such as pastoralist communities, and those
without formal education (Alene M, 2019)

Midega woreda is located in Oromiya region, East Hararghe Zone, 56km from
Harar town and 576 km from Addis Ababa. (What makes it worse is that Road is
so ragged, rough, sloppy, Muddy, Disrupted and Dangerous)

Midega Hospital is established and started service provision on February /20016

E.C. It serves more than 3 Projected populations of Midega, Fadis, Mayu and
other neighboring woreda like Fik. The great deal of our catchment population are
pastoralist communities, Semi-nomads,100% Rural Dwellers, and Majority of
households are Farmers in drought stricken area and supported by governmental
and non- governmental organization, therefore almost all households are at risk
of catastrophic health expenses.

Our Hospital has only 44 functional beds for admission, about 8 admission room
inpatient block, 8 functional Oxygen Concentrator, 3 Oxygen Cylinder all kinds
combined, and only One Major OR table with these it serves as referral center for
9 catchment Health Centers from the 2 woredas.
It has a total of 143 staffs/workers, of which 74 are health professionals and 78
administrative staffs, to provide preventive, curative and rehabilitative services
for the Catchment community.

As a hospital, Midega Hospital Health work force and management have made
significant efforts to make essential health services available, accessible,
acceptable, and affordable to the community, since 2013 EC. Midega Hospital has
been struggling to render essential health service package (EHSP) that include
health promotion, disease prevention, curative, and rehabilitative services
(Specifically Nutritional Rehabilitation). Therefore, as PHCU Hospitals need to be
capacitated despite all the odds numerous factors combine to limit service use; of
which the following are our hospital (Midega) experience.

 Misperceptions regarding the causes, outcomes, and remedies of diseases

contribute to low health-seeking behavior.
 Facility-related factors such as poor client satisfaction due incomplete
service package,
 Poor geographical accessibility,
 Stock outs of medical supplies and lack of model medical equipment.
 Lack of cleanliness at facilities (Lack of latrine, clean water and waiting
areas), and long travel time due to high patient burden and temporal
flooding of client’s limit use of health services

2. Objective of the Paper

 The main objective of this proposal is to seek and raise fund for the
improvement of poor infrastructure of Midega Tolla Hospital, for
enhancement of quality service provision to the needy poor communities of
the woreda.

3. Hospital Catchment population geography and topography

Midega Tola district lies between and N latitude and and ' E longitude to the south
of Harar town.
This assessment mainly focuses on the kebels, which are significantly affected by
the drought and have a critical water supply problem in the area. The district is
classified into tropical rain climates (Woina dega) and tropical arid climates (Kola),
which cover about 5% and 95% of the total area of the district, respectively.

It has 19 kebeles including 18 rural and 1 urban kebeles. The population of our
district is 66762 males 61720 total 128,482.The number of households in our
district is 21,064 males and 4624 female totally 25,688 Of these, 49.7% were
children aged 0-14, 49.1% were between 15-64 and 1.2% were people aged 65
and above.

The district is bounded by Fadis district to the north and region five Fiki zone,
Mayu muluke and region five to the south, Babile and region five to the east and
Girawa district to the west. Our district is located 585 km from the country's
capital, Addis Ababa, and 56 km from the zonal capital Harar.

The main livelihood zone is based on agricultural production of major crops such
as maize and sorghum and livestock and livestock products.

Of the total number of households 34% are engaged in agriculture, 65% in

livestock breeding and 1% in trade and 75% are in people under poverty line
account, currently due to famine More than 87% of the existing population is food
insecure HH. The total land area of the district is 173124 hectares or 1731.24km2
while the altitude above sea-level between 800-1500 is 93%, and only 7%
between 1501 and 1636.

The total area under cultivation is 22051 hectares of which 9317 hectares (42%)
are under spring cultivation and hectares are under summer cultivation. 12,734
(58%) share of spring agricultural land (42%) and summer agricultural land (58%),
according to the overall data of the District. The people of our District have been
affected by the drought at various occasions and have been living with assistance
for a long time.

4. MIDEGA HOSPITAL CURRENT HUMAN RESOURCE PROFILE

No Profession Number
 1. Anaesthesia staff 2

2. Radiology technician and technologist 4

3. Lab technician and technologist 7

4. Nurse staff 35

5. Midwifes 14

6. IESO 1

7. Physician 4

8. Pharmacy staff 14

9. Supportive staff 67

10. Health Professional 81

Total staff 148

5. Midega Hospital General infrastructures

Effective and Complete facility enables institution to stand internal and external
emergencies thereby ensure that the hospital is adequately prepared to deal with
such events and minimize their impact.

Even if our catchment is high TB Burden and there is enough space to build
blocks, we have no isolated TB block which is highly needed to stop TB.

Toilet Facility in the hospital is far below the Minimum standard--IPPS is in

trouble, Our labor and Maternity unit has only 5 rooms with delivery room
included, it needs expansion and new construction, our Hospital is in need of
standardized Adult ICU
 6. Trends of outpatient visits monthly/2015
a. Annual Outpatient Department Visits 11712

The trend shows upward spike indicating medical Service consumption of the
community is increasing from day to day.

There is Quarterly surge of client which is explained by intermittent availability of

medical supplies in after quarterly CBHI reimbursement. And According to this
statistic with 3 full-time attending physician equivalence

One physician had served about 16,147 patients/year.

7. Emergency, Injury and Critical Care unit

7.1. Facility
Midega Hospital EOPD has one block, which is about 264m2 area with accessory
room (emergency, pharmacy, duty rooms, nonfunctional toilet and waiting
rooms), traig room, examination, observation and procedure room.

Very poor floor- IPPs at great risk

 a. EICC Services/2015 EFY

8. The Common Causes of Death at Emergency unit

 Trauma
 Shock
 Acute Abdomen Sepsis
 9. The Common medical Conditions Caused death at BPH Emergency
unit
a. Causes encountered according to our review

Poor floor tiling- All the beds at emergency have no wheel hence static. There is
no single stretcher at Emergency except wheelchair, so patient transportation is
cumbersome and it hinders smooth flow of patient and impedes urgent
interventions - transfer and transportation of critical patient who may need live
saving and urgent care while still with wheelchair is not appropriate- it is
imperative that standards be maintained!

Urgent needs!

 Mechanical Ventilator for Emergency ICU

 Oxygen Concentrator
 Patient Monitor
 Stretcher
 Ultrasonography
 Lack of Basic Equipment’s like Wall mount monitors, Aeroid BP Cuffs, ,
Medical Beds, Cardiac Beds, Examining Boards, and Minor Surgical Sets,
10. Surgical and Anesthesia Services
 We have done about 649 Operations/year
 11% of our emergency referral was surgical patient.
 33% of our all referral was surgical patient.
 Our Catchment population lack access to safe, affordable, and timely
Emergency and Essential Surgical Care (EESC), leading to preventable
mortality and morbidity and avoidable disability and deformity.
 Provision of essential surgical care is among the most cost-effective of all
health interventions and would avert a significant portion of preventable
deaths.
 There is a huge unmet need for basic surgical care in our hospital.
 Midega is a watershed area for public service.
 Major elective operation services is not being given.
 We have only one OR table and a theatre.

10.1. The most common reasons for surgical referral from our Hospital
are;
 Lack of diagnostic modalities
 lack of skilled professionals
 lack of equipment/instruments
 lack of Adequate blood and lack of supply/medication.

10.2. The leading causes of EESC interruption.

 Electric power interruption
 laundry/Central Sterilization Room dysfunction due to power and water

10.3. EESC Challenges

 Single OR Table
 Single Anesthesia machine
 Lack of adequate patient monitor at recovery and surgical wards.
 Extreme shortage of beds in whole wards of hospital.
 Lack of backup water reservoir to prevent unnecessary service interruption.
 Lack of basic ICU equipment
 Lack of blood and blood products
11. TOP 10 LEADING CAUSES OF ADMISSION (EFY, 2015
 Complicated SAM
 Pneumonia
 CHF
 CLD
 Complicated TB
 Meningitis
 Renal problems
 COPD
 Sepsis of GI Focus
 Diabetes

12. TOP 10 CAUSE OF DEATH (EFY, 2015)

 SAM with diarrhea
 Pneumonia
 Other organ Sepsis
 Childhood Diseases
 Heart Failure
 Tuberculosis
 Injuries
 Acute Hepatitis
 Gastrointestinal bleeding
 Renal diseases

13. Prevention and control of major diseases

 We have Cases of HIV/AIDS
 Malaria is endemic and has intermittent outbreak
 Acute Diarrhea due to protozoa parasite like Amoeba and Giardia is
prevalent
 Midega is a Tuberculosis high burden woreda and Leprosy
 Hepatitis B and C is very common.
 Our catchment population is at continuous risk of Diarrheal diseases
  Intestinal Parasitosis is very high almost everyone has either of (Ascariasis,
Enterobiasis, Strongloidosis , H.nana, Tinea spacies or Hoock worm)
 There is schistosoma endemic Kebele- Haradenabe and neighboring
kebeles

14. Communicable Diseases Overview

14.1 Facts
 In 2015EFY Of 4182 client PITC done ,no patients were positive-
Positivity rate 0%
 We have About 98 HBV Positive Patients Newly Diagnosed
 There are 12 Newly detected HCV Positive patients
 There were 5 HBV Positive pregnant mothers linked
 In 2015EFY Only We have Diagnosed about 123 Patient with TB of which
72 are U5 Children.
 There are about 5 Newly Diagnosed Leprosy patients
 We have 33 malarias positive patient this year only /2015EFY
14.2. Hepatitis B and C Services

14.3. Challenges with Hepatitis B,C virus.

 Most patients in our Catchment do not know their hepatitis B or C infection
status and only very few people take is seriously after status known and we
are not sure how many of those positive Cases actually access treatment
because we have no therapy.
 The hepatitis prevention and control program remains under-resourced,
which accentuates the challenges of access to diagnosis, treatment, and
preventive measures. In addition, low coverage of hepatitis vaccine for
newborn babies, the high cost of diagnostics, the slow scale up of diagnosis
and treatment services are among the major challenges
 Despite Targeted malaria elimination program malaria case incidence is
surging in our catchment population.
 There is frequent reagent stock out; we have no independent Microscope
for BF. So we cannot continuously do surveillance and tests.
 Malaria test and treatment supplies are always interrupted.
 Many Complicated Severe Malaria Cases need organ function test which is
lacking in our case.
15. Non-Communicable Diseases and Injuries
15.1. Facts
 We have 425 Registered Diabetes Mellitus Patients and 97 newly Diagnosed
in 2015EFY only.
 Chronic kidney Diseases- We have Many Patients with Persistent
Proteinuria and Many of them were Referred and transferred to other
facilities
 Hypertension is common that we have 485 Hypertensive patients on
Chronic Follow up.
 There are 157 Heart Failure patients on follow up at our Hospital
 There are 117 COPD patients
 After Covid Pandemic, acute exacerbations of Chronic Pulmonary Diseases
become routine.

15.2. Hypertension and Raised BP Screening service2015 EFY

15.3. NCD Disaggregated

15.4. Challenges with NCDs

 Despite the increasing burden of NCDs, available health services are very
limited at our hospital.
 We can offered diagnosis and treatment for diabetes, cardiovascular
diseases, chronic respiratory diseases, and cervical cancer if overall
readiness of the Hospital for these services is improved.
 Even though we have 117 clinically diagnosed COPD Patients on follow up
we have no Chemistry Machine, Spirometer, No well-equipped and
accommodative ICU in case of critical illness like RF, MOF and no enough
Cylinder-it is probably a tragedy to be in such an environment with no
electric power, no power back up system- So patient and Clinician suffers
the most- That is why Continuous and Sustainable Oxygen supply is
mandatory!
 In setting like our Offering appropriate follow up cares is almost impossible
due to lack of facilities like Chemistry machine (where clinical chemistry is
must to steer care package), multi- disciplinary consultation, specialty clinic
and special equipment like Fundoscope.
16. Hospital Maternity Services/2015EFY
16.1. Monthly trends of SBA/2015 EFY
16.2. Referral out by cases,2015 EFY( N= 178)
16.3. Trends of Maternal deaths in the last five years in Hospitals Since
2011

16.4. The 7 causes of maternal death

16.4.1. Immediate Causes of Maternal death from MPDSR
 Pulmonary Edema

 APH

 PPH

 Eclampsia

 Amniotic Embolism

 Acute Pyogenic Meningitis

 17. NICU Facility
In our NICU

There are two heaters, No incubator, 3beds and Single CPAP.

We serve all 210 neonates without Radiant warmer, Adequate Heater,

phototherapy machine, and Incubator, patients are on the floor (20 children at
once), With only too old and second hand beds.

18. Service/2015EFY
18.1. Summary of NRU Challenges
 The flow of Complicated SAM Children is very high and it seems as though
Malnutrition Prevention Interventions has failed at national level

 Since our catchment population has been suffering from drought for the
last 3 years and Currently Summer has come and just in the last 3weeks we
received 72 SAM children with Medical Complications for which we have no
adequate feeding, room and supplies (Blanket, sheets, beds, Mattresses
and heater)

 About 12 children passed away in SC, all the dead children had Severe
anemia with Hb=2-3g/dl and Superimposed Sepsis-- In need of Immediate
Blood Transfusion which is not available per need

 If u might have seen on NRU Unit overview above, all the SC admission
were not on beds but on PVC floor that is not because we love floor rather
due to lack of medical Beds-Signaling pressing appeal for assistance!

 In SC room where Diarrhea rules and especially in environment like ours

where safe water and continuously running water is missing, sanitation and
proper hygeine is questionable bed sheets and blankets are always
insufficient!

 Pneumonia is the infamous cause of death in SAM children and

overcrowding in hospital setting leading to HAI- hence unnecessary death-
therefore well-kept and furnished SC Unit is the way out!
  Midega is cold at night and Hypothermia is challenging us in SC room-
Currently Blanket, and Heater is highly needed.

 Malnutrition Supply is in very critical shortage as logistic management is

failing.

19. Summary
The time of childbirth and the period immediately after birth are particularly
critical for maternal, fetal and neonatal survival and wellbeing. Effective care to
prevent and manage complications during this critical period is likely to have a
significant impact on reducing maternal deaths, stillbirths and early neonatal
deaths.

During Childbirth and labor, within a critical period and during antenatal care,
quality of care improvement efforts would target essential maternal and newborn
care and additional care for management of complications that could achieve the
highest impact on maternal, fetal and newborn survival and wellbeing.

Additional to maternal and neonatal mortality burden, the high perinatal and
under five mortalities require attention and need to be addressed

20. Referral Issues

Referral from Midega Hospital is medical, objective and in the best interest of the
patient or client.

The following are the common reasons for referrals: Of course we refer when a
patient needs an expert advice, but mainly we refer for;

 Technical examination which is not available at our facility

 Technical intervention that is beyond the capabilities of the Midega

Hospital

 Patients requiring inpatient care that cannot be given at the Midega

Hospital
We do not refer even when we cannot accept more patients due to shortage of
beds rather we use floor and corridors bcz many of our patients cannot afford
referral!

20.1. Facts
We have about 1200 non- emergency referral, 285 Emergency Room Referral, 164
Obstetric Referral, 22 Neonatal Referral- Total of 1671 Patients this year. Majority
of this referral is due to technical intervention and investigation. It could be
resolved if those equipment’s and facilities are fulfilled and patients referred or
transferred from other facilities causes Mean loss to referring facilities and
patients beyond imagination. The estimated (mean loss) Cost of these referral on
hospital itself is >2.5Million ETB excluding human labor, Frequent Vehicle
maintenance cost, Spare parts replacement and Working hours lost.

The Public Economic catastrophe is surely very high maternal, Neonatal, and Child
Health Services Challenge

We have unmet need of Birthing beds...on many occasions mothers deliver on

medical bed because of coaches are busy. It is very challenging to serve a group of
simultaneously laboring mothers, which is quite a commonplace in hospital
setting, with just 2 coaches. We have single Radiant Warmer at newborn Corner
which is always occupied Indicating urgent need for RW.

We have high IUFD rate hence High Institutional Still birth rate which stand at
96/1000 Life births which is mainly due to poor ANC and Poor intrapartum follow
up resulting from lack of basic obstetric equipment’s like, US per need, and P.
monitor - There is no single HC with Ultrasound service in our Catchment.
Therefore this equipment’s are must, if we are to prevent unnecessary fetal loss
and maternal complications.

According our obstetric team account among the 69 IUFD 52 fetuses had severe
Congenital anomaly and the remaining 17 were due to either IUGR, abruption
placenta, and Cord Disorders- Indicating Absolute necessity of Ultrasound services

Of the 9 mothers passed away (in the last 4 years) - 2 mother had Respiratory
Failure due to pulmonary edema requiring ICU and MV--Which was preoccupied
by another patient- one of them passed on the way to referral facility That is why
we cannot help even 2 patients at the same time, let alone the whole hospital
need.

In the wake COVID-19 many life were lost due to lack of capable ICU facilities it is
our lived experience, It takes>3hrs to reach HFUSH with ambulance from our
hospital.

Strengthen prevention and management of obstetric fistula and pelvic organ

prolapse Strengthen and expand advanced neonatal care, NICU and Essential
New-born Care (ENBC) services.

Strengthen & expansion of services for low birth weight and preterm babies
including kangaroo mother care (KMC)

Strengthen PMTCT- So EPI need to be started in hospital.

Strengthen and expand contextualized integrated community case management

of new-born & childhood illness and quality Integrated management of newborn
and childhood illnesses services.

21. Neonatal Care Bottlenecks

Lacking Basic and Fundamental Medical Equipment’s are: In Urgent need!!

 Infant Radiant Warmer

 Phototherapy Machine

 Baby Monitor

 Neonatal BP Cuff

 Incubator

 Baby Cribs

 Medical Beds for KMC Mother

 Oxygen Cylinder
  CPAP

 Oxygen Concentrator

 Heater

 IV stands

22. Hospital Imaging Service/2015EFY

Medical imaging we have encompasses technologies like x-rays

No mammography,

Medical imaging is crucial in a variety of medical settings and at all major levels of
health care. The use of diagnostic imaging services is essential in confirming,
assessing and documenting the course of many diseases and response to
treatment. So Continuum of care is at stake in our setting where there is high
power fluctuation and out.

22.1. The Major Bottleneck of Imaging Services

Frequent Power interruption and System failure- due Dead UPS and it leads to
service delay with catastrophic health results to community.

 Lack of Portable X-ray

 Lack of Ultrasonography
 Lack of mammography
 Absence of shields

23. Medical products and supplies

23.1. Challenges
 Lack of EPI Service-Just bcz we have no Freezer.
 Extreme Shortage of Blood and blood product.
 Quantification-forecasting-supply mismatch.
 Frequent Pharmaceutical product stock out.
 CBHI Reimbursement lead supply procurement plan.
23.2. Medical Laboratory Services Challenges
 Midega Hospital Central lab offers about 22 essential tests.
 Single Microscope
 Clinical chemistry is not available even if burden of chronic diseases is high.
 There is closed system CBC machine with incomplete reagent package and
it interrupt services frequently. It is not dependable.
 Frequent Power interruption.

24. Midega Hospitals` Current Challenges

 Lack of Basic and essential medical equipment’s
 The hyper inflated catchment population expectation.
 The slow scale up of changes at sectorial level.
 Weak/poor infrastructure such as road, water supply, ICT, electricity
 Hospital poor infrastructural quality (Floor, room, roof and setting) • Heavy
Infectious Disease burden and Diabetes
 Geographic marginalization.
 Lack adequate rooms and blocks for service to flourish.
 Lack of separate toilets for patients and health professions
 Lack of separate block for patient with TB.
 Rising cost of pharmaceutical supplies.
 Poor health literacy and health system literacy.
 Triple Burden epidemiology area (Malnutrition, Infectious disease and NCD)
 Very poor political commitment toward health service.
 Public Trust with the best possible care closest to home.
 Escalated and unregulated service and supply cost at private sectors.

24.1. Top Priority needs

Since our hospital is young and starter so baseline needs were not exhausted.
Therefore almost everything (i,e basic medical equipment’s) are our priority!

List

 Operation Table
 Anesthesia Machine
 Radiant warmer
 Incubator
 ICU Beds
 Mechanical Ventilator
 Chemistry Machine • Medical Beds with Mattresses
 Patient Monitor.
 Oxygen Concentrator • Delivery Coaches
 Stretcher.
 Laparotomy sets.
 Mobile Ultrasound and Diagnostic Ultrasound.
 Continuous Topography Machine (Monitor)
 Suction Machine
 ECG Machine
 Fund scope
 Ophthalmoscope
 Microscope
 Laryngoscope
 CTG
 Nebulizer
 CPAP

25. Conclusions
 Assisting Midega Hospital is helping More than half a Million devastated
populations.
 Donating Medical equipment to Midega hospital is preventing death of
needy mothers.
 Helping Midega hospital saving lives of hundreds of sinless dying newborns
 Your donation will alleviate suffering of pastoralist.
 Your donation would save hundreds from unnecessary disabilities.
 Availability of ME can save 15.4% of Hospital budget for focus area
renovation, redesign and betterment.
 With just single Mechanical ventilator we can sustain lives of tens of
distressed human beings.
 If we just get one additional Operation table, we can almost solve issues of
LUST due to prostatic Hyperplasia.
 If we just acquire one additional anesthesia machine we can almost abolish
emergency referral due to Acute Abdomen which the top 3 causes of death
in our emergency,
 With availability of Radiant warmer perinatal death in our hospital will be
minimized to best possible state!