June 2018Issue 17 Primary HealthCare Newsletter

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These have been an amazing

and rewarding 9 months! Your

hard work, client commitment,

and contributions to the Primary

HealthCare initiatives have been

indispensable to our success. We

have had a lot of change and while it

may seem chaotic at times, the goals

are always to add value to our services,

create an outstanding workplace,

and seek opportunity for professional

growth, as we continue to address

challenges head on. In the coming

months, we shall continue to invest

in our infrastructure and information

communication technology, provide

additional training opportunities,

and enhance our approach towards

exceeding our clients’ needs. As

we do this, I encourage everyone

to look for ways to increase your

participation in helping to make the

Primary HealthCare more effective,

efficient, and sustainable for the

future.

Message from

RoseanneCamilleri - CEO

Paola Regional Hub

The Paola regional hub is the most challenging project that the Primary health care has ever embarked upon. The Paola regional hub shall provide all the services that are currently being

offered to the public, as well as other new services. The Paola hub will also include an entire floor dedicated to day surgery operations. The project comprises 23 work packages, ranging from the design and building of the premises, the procurement of the required medical equipment, medical furniture and other furniture, IT systems, landscaping etc. Appointed evaluation boards are evaluating work package tenders, and the respective successful bidders will be selected. A number of tenders have already been published, while other tenders are being compiled by the Foundation of Medical Services. The Paola hub is proposed to be fully operational by 2023.

Gżira Health Centre Refurbishment

The Gżira health center [GHC] refurbishing project will upgrade the present premises and improve patient accessibility. A PA permission application has been successfully submitted for the proposed refurbishment. Preparatory work is being carried out in commencement of the project. The respective layout plans indicating necessary structural changes within the premises, and the various tender documents are being prepared. The project will involve the installation of a new passenger lift accessible to both wheelchair and stretcher users.

Operational Programme I – European Structural and Investment Funds 2014-2020“Fostering a competitive and sustainable economy to meet our challenges”

Project part-financed by the European Regional Development FundCo-financing rate: 80% European Union; 20% National Funds

PARLIAMENTARY SECRETARY

MINISTRY FOR HEALTH

FOR EUROPEAN FUNDS AND SOCIAL DIALOGUE

ERDF.08.032 -PAOLA PRIMARY HEALTH CARE SOUTHERN REGIONAL HUBWILL SERVE AS A ONE STOP FACILITY FOR COMMUNITY CARE

PROJECT PART-FINANCED BY THE EUROPEAN UNION

P:\Projects Office\Projects\Health Centres\Gzira HC\GHC18-01 - ref of clinic NEW SCOPE\Arc\dwgs\GHC18-01 - furn layouts.dwg, Model, 28/05/2018 07:59:03, ISO expand A3 (297.00 x 420.00 MM)

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continued from page 1

Kirkop Health Centre

The Refurbishment programme of the Kirkop Health Centre is nearing completion. The Kirkop HC will be providing services in line with the other Health Centres to a catchment area of circa 30,000 population covering Kirkop, Qrendi, Mqabba, Safi, Luqa, Żurrieq (Ħal-Far) and Ħal-Farruġ. It is expected to open its doors for the public in September 2018.

Inauguration of the Xewkija Berġa, Gozo

The Xewkija Berġa was inaugurated on the 18th May 2018 by the Deputy Prime Minister and Minister for Health, the Hon. Chris Fearne, and the Minister for Gozo, the Hon. Justyne Caruana. Besides the daily GP Clinic Services, the Xewkija Berġa will be offering 2 NEW services which include, the Nutrition and Weight Management Programme Service, which will be available forthnightly and the Speech and Language Pathology Service, which will be available on a daily basis. An innovative addition to the Services in the Xewkija Berġa is the Blood Donation Unit.

Phlebotomy Service in the Community Clinics

In the coming months the Primary HealthCare will be launching its first Phelebotomy Service from the Żabbar Community Clinic. This is a pilot project and it is expected that it will also be expanded to other Community Clinics. This initiative is being carried out in liaison with the Pathology team-Mater Dei Hospital.

Training in Infection Prevention and Control in Podiatry PracticeMr. Adrian Pace, Senior Practice Nurse, PHC

An educational session in Infection Prevention and Control has been organised for Podiatry and Podiatry assistants. The sessions, including an assessment, were held on the 20th and 21st June at the Mount Carmel Training centre, Attard. The sessions were held by Mr. Adrian Pace, Senior Practice Nurse Infec-tion Prevention and Control, Primary HealthCare.

Health and Safety Course organised for Principal General Practitioners and Charge Nurses, Primary HealthCare

A health and safety risk assessment was carried out during the months of May and June 2018 at Paola Health Centre. The exercise was carried out with a view to evaluate what can affect the health and safe-ty of employees and to identify sensible measures to control the risks at the workplace. A risk assessment looks at what could go wrong, what is needed to stop it from going wrong and assesses the effectiveness of any control measure in place. Recommendations for extra control measures can then be made on the basis that they are ‘reasonably practicable’.

Following this drive, two separate courses in Health and Safety were organized by the Occupa-tional Heath and Safety Authority [OHSA] , for Pri-mary HealthCare Principal General Practitioners and Charge Nurses. A representative from the workforce has been identified to work in close liaison with the Principal General Practitioners and Health Centre management. The worker’s representative will be at-tending a couse organized by the OHSA in the com-ming months.

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VolHealth Volunteering Service

A Memorandum of Understanding has been signed between SOS Malta and the Primary HealthCare in May 2018 for the introduction of the volunteering service - VolHealth. The service will be jointly administered by the Chief Executive Primary HealthCare, on behalf of the Ministry for Health, and SOS (Malta). The Service will initially be piloted in the Floriana Health Centre and later it will be extended to the Health Centres operating on 24/7 basis namely Paola and Mosta Health Centres.

During the event, the Deputy Prime Minister and Minister for Health, Hon. Chris Fearne commented that the Floriana Health Centre is one of the largest Health Centres on the island with an annual footfall of

200,000 patients. This load is expected to decrease once the Kirkop Health Centre opens its doors later in the year. In her comments CEO Primary HealthCare, Ms Roseanne Camilleri thanked all the team that provided their input and support for the realization of this project and emphasized that VolHealth will complement the attention and sterling service being given to patients by medical / technical professionals.

VolHealth volunteers will be providing a meet and greet service, and perform other non-medical, non-clinical services at the Floriana Health Centre, the ultimate aim being to enhance overall patient satisfaction.

Mosta Health Centre

A refurbishment pro-gramme at Mosta Health Centre has just been fi-nalized. This included the upgrading and modernisa-tion of all the General Prac-titioner rooms, Podiatry, Physiotherapy rooms and Waiting areas. Plastering and painting was also car-ried out all over the health centre premises and in all the rooms and cubicles. In some places gypsum wall covering was applied. New LED lighting was also in-stalled.

In addition, the old lift has been replaced with a new

passenger lift which is also wheelchair and stretcher accessible. In the coming weeks the Mosta Health Centre will also be benefitting from the introduction of a new queuing ticketing system, similar to the ones already available in other Health Centres.

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an update on the National Cancer Screening Programmes

Screening for Breast, Cervical and Colorectal Cancer

All three National Cancer Screening Programmes are

guided by the principle that if cancers are detected at an early stage or even in the pre-cancerous stage, treatment will be less invasive and survival rate is improved. As outlined in the European Code Against Cancer, regular participation in breast, cervical and colorectal Screening Programmes is one of the ways to reduce your cancer risk.

The National Screening Unit continues to expand

the three National Screening Programmes. Since the initiation of the Breast Screening Programme (2009), 448 cases of breast cancer have been diagnosed. The second programme introduced in 2013 was for Colorectal Screening and has been gradually expanded. To date 117 cases of colorectal cancers have been detected. The last programme to be rolled out was that of Cervical Screening in March 2016, with 4 cases of cervical cancer being diagnosed.

Dr. Stephanie XuerebConsultant Public Health Medicine

Head, National Screening Unit

Who is being invited to participate?

Screening Test Screening Interval

Breast Screening Women 50-68yrs of age Mammogram 2 years (DOB 1968-1950) Cervical Screening Women 28-38yrs of age Pap Smear 3 years (DOB 1990 – 1980) Colorectal Men & Women Faecal immunochemical 2 yearsScreening 57-69yrs of age test (FIT) (DOB 1961-1949)

June will herald the summer season,

warm weather, longer days, sea and

vacations. One must take care in the sun

to avoid sunburn. It is important to wear

sunscreen, sunglasses and a hat. The

Melanoma article tackles one negative

effect of too much sun.

This issue features new

developments that have taken place in

Primary Healthcare since last December,

together with many interesting articles.

As the month of June commemorates

Refugee week, Ms. Marika Podda

Connor, Transcultural practice nurse has

written an article on what her duties as

a nurse who works in this specialist area

involve.

An article on domestic violence

will make one aware of this important

public health issue. Primary health care

professionals are currently undergoing

an intensive course in recognising

and dealing with domestic violence

issues. Other articles discuss the

Cancer Screening programmes and the

newly introduced Weight Management

programme.

Any feedback or suggestion

regarding the newsletter are welcome.

Dorothy Scicluna

E: dorothy.scicluna@gov.mt

FB page: Primary Health Care

Department Malta

Editorial

Welcome toissue 17 of the Primary HealthCare newsletter

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an update on the National Cancer Screening Programmes

Screening for Breast, Cervical and Colorectal Cancer

What’s new at the National Screening Unit?

• Shortening of the screening interval for breast screening from 3 years down to 2 years

• In addition to our late afternoon clinics, we have now introduced Breast Screening Clinics on a Saturday morning

• The Unit is sending reminder letters to persons who had previously ignored their screening invite

• A new information booklet for Colorectal Cancer screening

• Persons in the screening age cohorts who have not received an invite are encouraged to contact our Unit

People are now well informed and aware of various cancer issues, however data shows that on average only half of the people that we invite to participate in Cancer Screening actually attend. People fear finding a cancer and prefer to remain in blissful denial even if it means diagnosing the cancer at a later stage and a worse prognosis.

Primary HealthCare Professionals have a pivotal role in the success of our population-based Screening Programmes, empowering people to take ownership of their health and overcome unfounded fears.

Visit to the National Screening Unit byMs. Roseanne Camilleri, Chief Executiveand Dr. Stephen West, Clinical Chair

The PHC Weight ManagementProgramme

Ms Fleur BugejaNutritionist, Primary Health Care

Overweight and obesity are a growing

concern among all age groups in the

Maltese population.

As from March 2018, the Primary HealthCare

has initiated a weight management service that

focuses on the prevention and management

of overweight and obesity. The aim of this

programme is to support and help overweight

and obese individuals lose weight, prevent

weight regain and avoid further weight gain for

life. The programme will help meet a range of

public health goals, including the reduction of

major non-communicable diseases associated

with obesity.

The programme consists of two sessions per

week for a period of 12 weeks. Each session is

of 2 hours duration, various topics relating to

healthy nutrition and weight loss are presented

and discussions take place in a group setting

During each session, anthropometric

measurements (weight and waist circumference)

are taken for each participant in private.

Individual progress is reported to enable the

facilitator to monitor outcomes and advice

accordingly. Handouts and printed material are

distributed during sessions. Participants are also

encouraged to do moderate intensity physical

activity for a minimum of 30 minutes five times

per week. Sessions will take place in the health

centres either in the morning or in the evening.

All individuals over 18 years of age, who

have a body mass index (BMI) of >25 kg/m2

can be referred. Clients suffering from a chronic

condition might be referred to a dietitian by the

nutritionist.

Referrals by General Practitioners, Lifestyle

clinic nurses and dietitians in Primary HealthCare

and from Mater Dei hospital are made by sending

an email on ‘nutritionist.phc@gov.mt’. Clients can

also self-refer by contacting their local health

centre.

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The month of June commemorates Refugee Week. People on the move may experience chal-lenges in adjusting to new environments. Dif-

ficulties include language barriers, loss of family and community support, lack of recognition of professional qualifications and trauma, experienced before or after migration. Challenges are inter-related and overlapping, trapping those who face them into a vicious circle lead-ing to more isolation and loneliness and further damag-ing their health. The complex dynamics of migration af-fect women, men, unaccompanied minors and families in different ways and have a negative impact on their health and well-being as in the case of victims of traf-ficking.

The challenging role of the Transcultural Practice Nurse within Primary HealthCare and in the communi-ty includes the promotion of cultural competence and training on Cultural Diversity for health professionals.

The Transcultural Practice Nurse coordinates other activities in the community:

Health Orientation Programme This programme gives detailed information to new arriv-als on how to access health care services.

Health education sessions Involve the assistance of a cultural mediator and focus on different health topics, generating interesting discus-

sions on traditional ways of health behaviours and the challenges of adapting to a healthy lifestyle.

Outreach services Migrants who have or are newly diagnosed with a chron-ic health condition need to be informed on a one-to-one basis in a language that they understand on how to cope with treatment, prevent complications, hospital visits, etc. They need to voice their concerns and be understood.

Promotion of Cultural Competence Cultural competence sensitises professionals to re-spond to the needs of patients coming from different backgrounds. Health and social care professionals, ed-ucators and students regularly request training on this topic.

Training Programme for ‘Cultural Mediators in Health Care’ The development of the training programme has gener-ated an interest amongst migrants. A cultural mediator is not simply an interpreter but a team member who pro-vides relevant information about the patient’s culture. The training programme delivered to migrants coming from all walks of life together with the setting up of a Cultural Mediators Service is regarded as a good prac-tice by organisations abroad including the European Website for Integration (EWSI).

Migrant Health Matters Primary HealthCare

Marika Podda ConnorMSc Transcutural Health (London); BSc Nursing Studies, Dip. Social Studies: Gender and Development, RN

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Migrant Health Matters Primary HealthCare Melanoma is a type of skin cancer, which

can spread to other parts of the body. Melanoma can appear as a new mole or

change in an existing mole. In women melanoma is more common on the legs, and on the back in men.

Melanoma is caused by skin cells that begin to develop abnormally, mostly caused by intense sun exposure that leads to sunburn. but may also be due to sunbed exposure.

People who have lots of moles and freckles, pale skin that burns easily, have red or blond hair and a family member who has had melanoma are all at risk of developing melanoma. Check your skin frequently. If you see any changing moles, report to your doctor immediately. Melanoma is nearly always curable if treated early, but can be fatal if left too late.

Look out for the ABCDE of moles. A – Asymmetry – If a line is drawn through a mole it

should match on either side, in a malignant mole either side will not match (asymmetrical)

B – Border – a normal mole has a smooth, even border. The border in a malignant melanoma is uneven, may be notched or scalloped

C – Colour – most normal moles are in one colour, a malignant melanoma may show various shades of brown, tan, black, white, red or blue.

D – Diameter – Normal moles are usually of a small diameter. Malignant melanomas may also be small when detected, but are usually larger.

E – Evolving – Common benign moles remain the same. Any change in size, shape, colour, elevation or new symptoms such as bleeding, itching or crusting must be reported to the doctor immediately.

Ref: Cancer Research UK. http://www.cancerresearchuk.org/about-cancer/melanoma

MelanomaDorothy Scicluna - Practice Nurse, PHC

Domestic violence (DV) is the occurrence of power and

control tactics used by an individual to emotionally,

physically, sexually, psychologically and/or economi-

cally abuse a past, current or potential romantic partner,

or family member, regardless of gender, age or sexual orienta-

tion. The perpetrator - the person committing the violence - uses

measured, progressive and diverse strategies to exert control

over victims. The abusive relationship goes through cycles of

calm and romance leading to explosive anger episodes and ten-

sion building, gradually leading to the abusive incidences. The sit-

uation becomes more complex when there are children involved,

and/or when the victim is financially dependent on the perpetra-

tor, and/or when there are additional cultural and psychosocial

factors, such as addictions and lack of social support. Leaving an

abusive relationship is not easy.

DV is regarded as a major public health concern. DV is a great-

er health burden than any other risk factor— more than smoking

or obesity

DV victims are present in our daily encounters within the

healthcare system – they visit health centre treatment rooms and

clinics, presenting with different ailments and injuries. Healthcare

professionals (HCPs) are uniquely positioned, and the “first-line

response” in the identification of po¬tential victims.

Since 2017, Primary HealthCare has issued a standard operat-

ing procedure that HCPs undertake when encountering suspect-

ed or alleged, cases of Domestic Violence in the Health Centres.

Where there are grievous injuries or sexual assault, the doctor is

legally obliged to notify the police irrespective of the patient’s

consent, as well as refer the client to the Accident and Emergen-

cy department for further expert assessment. If there are minor

injuries of suspected or alleged domestic violence, the victim is

encouraged to contact the Domestic Violence Unit to get further

support.

Contact number is 22959000. During out of office hours, Help

line 179 is used. Additional information is found at:

https://meae.gov.mt/en/ZeroViolence/Documents/ZV_

CollectionOfServices.pdf

DV is everybody’s problem. As a society, we have the respon-

sibility to take action, support victims and make a difference.

DomesticViolence

Ms Michelle Cilia,A/Charge Nurse School Health services; Adult Down Syndrome Clinic; Scoliosis Review Clinic

The educational sessions given by PHC School Nurses; PHC School Doctors and Medical Students from MMSA, in collabo-ration with the teachers and Head of School, involved games/

songs and dance, and were given to Year 1 children who through-ly enjoyed the learning experience. Educational material relating to the importance of Hand Hygiene, was also given to each child.

In the framework of the current agreement between Barts and The London School of Medicine and Dentistry and the Ministry of Health

Malta, over 40 students from the Gozo campus have presented their projects thus marking the end of their first year. The students were assigned to and worked with Doctors and Clinicians in the Primary HealthCare environment around Malta. Various subjects associated with public health including alcohol consumption, diabetes and other

long-term health conditions were addressed. In her comments, Ms Roseanne Camilleri the CEO Primary HealthCare, expressed gratitude to all who contributed for this successful outcome - “we are focusing on encouraging more GPs and clinicians to work with Barts and The London students in the future. We are confident that this bodes well for a long term professional relationship between the Ministry for Health, the Barts and The London Medical School Malta and the Malta Enterprise”.

Barts and The London Medical School Malta and the Primary HealthCare

Celebrating Hand Hygiene day by the Primary HealthCare School Health Services at Żurrieq Primary School.