Travel story: 09-04-2013. From Russia With Love

Moscow, Sheremetyevo Airport 09-04-2013

Dear all,

It’s almost over again! I’m waiting at gate 40 of Moscow’s airport Sheremetyevo. On Monday evening April 1st I arrived safely here and was received by Mrs. Elena, the lady with whom I was in touch during the past two years on the Russian translation of the book on sterilisation.

OLYMPUS DIGITAL CAMERA Elena works as the product manager for Pharmstandard/DGM, on of the largest manufactures of sterilization equipment and supplier of related products for the Central Sterilization Department of hospitals. She is a very charming, enthusiastic lady who really goes for it! Moscow, there I am, suddenly in this chic hotel Sovietsky (Photo1) that still breathes the atmosphere of Soviet times. With real paintings of Breznjev, Lenin and other great leaders. A hotel that was visited by some of the great people of this earth: Margeret Thatcher (she died recently), Lenonid Breznjef, Pierre Cardin, etc. It’s really very special that I can stay in such a historical place!

OLYMPUS DIGITAL CAMERATogether with Elena I take dinner and discuss the plans for the coming days. While enjoying Borsch, a Russian soup with red beets.
Followed by a main dish with a kind of minced-meat dumplings: A dinner in an atmosphere where even the Tsar of Russia would have felt at ease. With life piano music in the background, under chandeliers; the magnificent ceiling and of course an excellent dinner! (Photo 2)

Visit to the company Pharmstandard/DGM

OLYMPUS DIGITAL CAMERA The following morning Arthur, the taxi driver, collects me for the first meetings in the office of Pharmstandard/DGM, the company that invited me. The offices are located virtually in the centre of the city.
OLYMPUS DIGITAL CAMERA On the way the famous White House appears (on the left of the map on Photo 3), currently it is the Russian Government’s building. Under the regime of Boris Jeltsin, in 1993, during the big constitutional crisis, this – at the time parliament building – was shelled by artillery fire (Photo 4).Unbelievable what has happened here! It is cold! Along the side the roads there are still mountains of snow: memories of a long, cold winter. Also here people really are longing for spring!
OLYMPUS DIGITAL CAMERA From the office one of the 7 characteristic skyscrapers can be seen; they were built on the command of Stalin in the period of 1947-1953. Wherever you are in Moscow, if you look around a bit, you will see one of these colossuses with the so characteristic pointed tower and the red star on top (Photo 5)

The office is situated in a renovated, old Soviet-time brewery building (Photo 6). The morning starts with an introduction to the company and its’ activities. Then it is my turn. With 3 presentations: About standards related to sterile supply, my experiences in Africa and a virtual tour through the CSSD of the hospital in Ede (in The Netherlands, near the village I live).


At the end of the day in the hotel a dinner with Elena, Vladimir (head project management) and Petr. Petr is head of the CSSD of hospital Nr. 4. Very sober! Hospitals have no name; they have to cope with a number. Petr is considered an authority on sterilisation in Russia. Really great that I have a chance to exchange ideas with this group of people! That evening in the hotel at work to prepare the presentation for the congress that is scheduled on Thursday April 4th. The congress takes place in the Moscow municipality building! It is located near the White House (seat of the Russian Government). I only have 30 minutes, including translation! In that short time I need to convey my message! My head is dizzy. What for God’s sake I should tell in 15 minutes? Finally we choose for the central theme: the need of education: the presentation of the book fits into this topic seamlessly. The next day we worked out the presentation; together with Elena and Ekatarina; Ekaterina will do the translation during the presentation.

Sterilisation congress

On Thursday then to the tower of the Moscow municipality. Lots of security. However without problems we get in. Bizarre: in the building is an exhibition of outdoor products. With the emphasis on knives. In all shapes and sizes. First you need to pass extensive security checks in order to get in and  subsequently one ends up in an exhibition with gruesome knives and daggers.

07 RUS Moscow Municipality 20130404 Exhibition PHS Booth Vladimir Elena Jan VladimirOn the floor higher-up are the booths of the companies for our sterilization congress: with sterilizers, control materials, packaging materials, etc. Where also PHS/DGM has its booth. A warm encounter! Everybody is ready for it. People stroll in between the stands. The congress hall: that huge theatre! With on the sides of the large stage paintings with Orthodox-Russian scenes. The for me intimidating pulpit with 4 microphones and alongside the presidium with the large leather armchairs for the congress panel. Help! It’s here where I will be standing in a few moments from now!

08 RUS Moscow Municipality 20130404 Congress Presentation Team Jan And E ShibanovaBookPresentingThe opening of the congress is by the highest responsible for infection prevention of the Russian Ministry of Health. State awards are presented. Also the director of “our” company, PHS/DGM gets an award for the groundbreaking work related to infection prevention. I am the 4th speaker. Mr. Dimitri, manager of DGM introduces the activities of the company. Then it’s my turn. I feel the increasing tension inside myself. A kind of feverish feeling. The hall is filled about 2/3rds. Ekitarina takes her position behind the pulpit (Photo 08). I feel terrible to stand there. After some negotiating I received a wireless microphone, which gives me some freedom to move around (Photo 9).

First a short history of the last decennia of sterilization in the he Netherlands and Europe. The deadly accident due to non-sterile intravenous fluids in a Dutch Hospital as the trigger for regulations. The European unification, the coming into being of European cooperation related to sterilization. The first standards. The pioneering role that The Netherlands had in this. A look into the CSSD of a Dutch Hospital (Ede). The introduction of ever new and ever more complex instruments. The need for quality assurance; in all steps of the sterile supply cycle. With as an important key: Education. Through education the link to the book is made easily. Here I am, in front of a public coming from large parts of Russia. In the Moscow Municipality hall. I have a chance to be here. I am allowed to contribute. Feel very much honoured! And thank everybody who was involved in the realization of the book. I thank for the invitation for coming here. Ekaterina does really a great job. Is a very nice feeling presenting something in this way as a very close team!ational Gallary of Russia. I get to know the Russian masters: Vroebel, Surikov, Repin. The essence of Russia. The enormous sufferering of the people here. The beauty of the land. Emotions have been documentented. Such as the painting called The Demon, painted by Vroebel (1856-1910). What a power! The sitting rugged appearance; the emotion of evil; but also the sadness, the pain, the tear under his right eye. The female touch (Photo 10). Or the intriguing painting of the arrest of Morozova, accused of heresy during the reformation of the Russian Orthodox Church (1675). The church penetrated everywhere in society. The split-up of society based on religious convictions: An issue that is still marking tragic major events and developments upto today.


The tension fades away from me. Its over. It went OK. With Olga and Sacha, both employees of the company, we now go into the city. To the Tretyakov Gallery. The National Gallary of Russia. I get to know the Russian masters: Vroebel, Surikov, Repin. The essence of Russia. The enormous sufferering of the people here. The beauty of the land. Emotions have been documentented. Such as the painting called The Demon, painted by Vroebel (1856-1910). What a power! The sitting rugged appearance; the emotion of evil; but also the sadness, the pain, the tear under his right eye. The female touch (Photo 10). Or the intriguing painting of the arrest of Morozova, accused of heresy during the reformation of the Russian Orthodox Church (1675). The church penetrated everywhere in society. The split-up of society based on religious convictions: An issue that is still marking tragic major events and developments upto today.


We walk to the Boshoi Theatre, a bit further on (Photo 11). Built at the occasion of the coronation of Alexander II in 1856. We can attend an opera of the Italian composer Verdi: the Traviata (the Wanderer; in 1853 it had its first performance). Here in the largest cultural temple of Russia. It is the 1752nd edition and the 237rd season(!). We go inside. Grand baroque halls. The building just has been renovated. The glitter of gold; the chandeliers with the splendour of their crystals. Large paintings. And then the theatre itself. Fully in style. We have a very good view on the stage. The golden ornaments. The red velvet. The whole entourage of luxury of the high society of old-Russia.

OLYMPUS DIGITAL CAMERA It breathes the atmosphere, the allure. Verdi’s opera is about, what else could it be, the tragedy of love. The drama, the emotion of relations, intrigues, families, sickness and finally the death of the lady, due to tuberculosis. Followed by the grief of the belover. A performance with ever changing backgrounds. It became an overwhelming cultural evening!
The cityscene. Heavy traffic as in every large city. Maintenance on the roads is crucial. The tough cold Russian winters demand their toll. In convoy large trucks with high pressure water guns clean the streets. The greyish urban areas. On several buildings there are still large paintings that remind to the Soviet times. The stereotypes of the ideal socialistic society. (Photo 13: written: Together we make communism). We pass the statue of the proud farmer and his wife with their hammer and sickle. A bit outside the old city centre a new business centre is whipped up. Futuristic skyscrapers will dwarf the old Stalin buildings in the city skyline. OLYMPUS DIGITAL CAMERA
OLYMPUS DIGITAL CAMERA RUS-Moscow City Red Square 20130406 Close To Red Square prepare for 2014 Olympics Sochi

Epicentre of Russia: the Red Square


The weekend: Olga, employee of DGM, collects me already at 9 am in the hotel. To the city centre. Moscow, as is Amsterdam, is built in concentric circels. With the Kremlin and the Red Square as its centre. It’s coooooollldddd. We take a coffee in the Mac Donalds, with a view on the Kremlin wall. It was opened during the period of Glasnost (openness) and Perestroyka (restructuring) in Gorbachov’s time (nineties of the previous century). It became a symbol of great changes in Soviet Russia. We also meet Sacha, the PR-person of DGM; we cross to the entrance of the Red Square. The huge square stretches out in front of us (Photo 15). On the right the wall and towers of the Kremlin. In front of the wall the Mausoleum of Lenin, now hidden under a huge white inflated hall; it is being renovated.

Right in front of me in the distance the Cathedral of Prokrovsky, of which the colourful domes resemble the shape of a soft ice. The cathedral was built upon the order of Ivan the Terrible and was inaugurated in 1561.Olga Tells. Our guide (Photo 16) The whole scene reminds me of song of Gilbert Becaud: Natalie: la Place Rouge…. This feeling expressed so powerful in this song. On the left a large shopping mall in old Russian style. The police is present on the background. It’s quiet on the square. The cold wind cuts in the face. It really feels like Russia. Olga points at the execution place, just in front of the cathedral. Here decrees were read and people were executed. Churches and executions: intensely intertwined. OLYMPUS DIGITAL CAMERA
That cathedral: highlight of Russian religion, art and culture (Photo 16). The National symbol in which everything Russian seems coming together. National icon. Inside are the fantastic frescos in the so typical style of the Russian-Orthodox church. Gold in abundance everywhere. It reflects the great beauty and splendour the church wanted to convey (Photo 17). OLYMPUS DIGITAL CAMERA
OLYMPUS DIGITAL CAMERA From one of the towers we have a fantastic view onto the square (Photo 19). Olga tells about Ivan the Terrible, who killed his son. About Peter the Great. About Lenin’s October revolution of 1917; the time of the cold war. Gorbachov, who made an end to the old Soviet time. Oh, my brain is whirling. So much has happened here. So much grief, so much history was made here!
OLYMPUS DIGITAL CAMERA In the afternoon a boys’ dream comes true: a visit to the Space Travel Memorial Centre! (Photo 19). Where everything is shown about Russian space travel. The early developments, the launch of the first Sputnik in 1957 (Photo 20), the race for space between Russia and the USA. Yuri Gagarin, in 1961 the first man in space, absolute hero of the Soviet era. Visitors are mainly school children. Russia wants to transfer some of the great excitement of the era that mankind, for the first time, left its planet. And of course it also nurtures national pride (Photo 21)
OLYMPUS DIGITAL CAMERA  RUS-Moscow Space Exploration Memorial Museum 20130406 Russian kids introduced to space travel watching capsule

 Soviet Sunday.


Going out alone. Trying the Metro. Public transport. Metro stations often are in the style of old soviet buildings. They are actually monuments on their own! The nearest station is Dynamo (Photo 22), alongside the large stadium of Dynamo Moscow. At the moment the stadium is undergoing large renovation work. It is still difficult to get used to that Russian script. I wrote down the Russian alphabet in my notebook. Also here, as in Japan, I have that feeling of a child that is just learning to read. There are quite a number of characters that are similar; however also many of them are very different. In that way I always thought that cccp is just cccp; however it is sssr. Practicing also here is the only solution to understanding. Learning to read again as a 59-year old. Never too old! I find out that CCCP is the abbreviation of Союз Советских Социалистических Республик (СССР); in our roman characters: Sojoez Sovjetskich Sotsialistitsjeskich Respoeblik (SSSR), translated: Union of Socialist Soviet Republics: USSR.

The Kremlin: Cathedrals and cannons


The Kremlin, the centre of power of Russia, for centuries. I walk through the gate of the Garden of Alexandrov. On the left side in front of the Kremlin wall: the monument of the unknown soldiers that died during the Second World War. The eternal flame with the ever-present guards honours them. I came at a good moment. A bit further I hear the sound of marching soldiers. In a strict rhythm a group of 3 is coming this way. I am virtually alone. And watch it. The pounding sound of the boots. The elegant but also intimidating movement of the right arm. The rifle pointing up straight, balancing on the palm of the left hand. The black boots reach up to breast-height. A commander walks along side and keeps control. They are marching to the platform with the eternal flame. For a moment they stand still. The rifle on the ground; the head facing the flame. It is quiet on the square. The rifles are picked up again and the soldiers, in the same marching mode, march to their colleagues, who each of them, came from their watch shelter. They are exchanged. The new soldiers take their position. The old group, again in the same tread, comes forward, salute the fire and march away. (Photo 23). Back to their barrack, a few hundred meters further. This ritual is repeated daily, every hour. A place where soldiers and their families can find rest. Where they get recognition for their deeds. Respect for those who died.


From here to the entrance of the Kremlin. Together with an English tourist that I met, I visit the Armoury: it is supposed to be the chamber of arms. However there is incredibly much more: Crowning jewels, gifts of great statesmen from the whole world. Incredible precious treasures; which each of them sealed a landmark of Russian history. The carriages, the arms, the mail armour, harnesses, the kings’ thrones. Tableware of the most precious material. Amazing craftsmanship of the great artists and craftsmen that worked on these objects! It is actually only since recent times that we as ordinary people get access to witness these treasures ourselves!


A bit further on the Kremlin we go to Cathedral Square (Photo 24). The Archangel’s Cathedral (1508), the Cathedral of the Annunciation to the Mother of God (1489), the Cathedral of the Dormition (1479). The bell tower of Ivan the Great (1508). The 12 Apostles’ Church (1653). In front of it is the King of cannons: the Tsar-cannon (diameter of its barrel: 89 cm!) built in 1625 (Photo 25). Alongside of it the barrels of a whole range of smaller sizes. Cathedrals and Cannons. Religion and worldly power are intertwined inseparably.


Sterilising in Moscow

OLYMPUS DIGITAL CAMERABeing in Moscow I had an opportunity to visit some hospitals. Here they are marked by number. More basic it cannot be. The first one is nr. 52; later we visit Nr. 29 and Nr. 4. The entrance of the hospital 52 is as basic as its name. No large patient reception hall as in the health palaces as we are used to in the Netherlands. A very simple entrance building (Photo 26). Isolated warm water pipes are a kind of access gate. Ultimate basics. A hospital with 1500 beds. With 4 operating units, each having 7 theatres. In many buildings reconstruction is going on.



The sterilization department (Photo 27) is a somewhat old, tired building. The iron door. We are welcomed by Nelly, head of the department. She shows her department. We are shown all steps of the reprocessing cycle. This hospital is equipped with modern, double door washer disinfectors and 4 large double-door autoclaves of which 3 are currently used. Each of them 7 cycles per day. Unfortunately we come on the wrong moment.  All instrument sets that were processed this morning are gone out already. The new dirty sets need to come yet. A big pity. The instrument sets are disinfected in the OR and are delivered in containers here at the CSSD.


The instrument trays that are still here look tired. Due to years of intensive use. Packaging is done in crepe paper, paper bags, peel pouches, cotton and Schimmelbush drums (Photo 28). On the packs a label is attached made of a kind of canvas; the sterilization history is written by ballpoint. However there is no autoclave tape. Before autoclaving an indicator sticker is put on textile packs and after sterilization it is pasted into the autoclave’s logbook. Lots of writing work, checks, as part of quality insurance. All needs to be done manually.



However sterilizing is done in state-of-the-art 600 litre double-door sterilizers (Photo 29). The sterile store is rather small. Virtually all instrument sets are in circulation. Through a counter in the storage area the packs are delivered in bags and distributed to the rest of the hospital departments. The staff canteen is like a cosy living room. With flowers and plants. We drink a cup of coffee with Russian chocolates. The tin with Dutch stroopwaffels she wants to keep for the break time, and eat together with her staff.  The farewell from Nelly. So courageous to run the department! When leaving the department I embrace her. Thank her for her dedication and for everybody that tries their very best to do a good job.


Hospital 29, that we visit later, is dedicated to the Virgin Mary. After the end of the Soviet era, religion was allowed to get a place in society again and churches and other religious symbols were reinstated in large numbers.  The chapel of the hospital can be recognized from far away from its golden dome with the cross. We go inside. An elderly woman is caring for the candle stands; her small shop. I gaze up. The chandelier; the bright, colourful frescos with images of the birth of Christ (Photo 30).

OLYMPUS DIGITAL CAMERA The person accompanying us during our visit, Pavel, lights candles in front of the cross. And stands quiet for a moment. Eyes closed. Throughts travel. (Photo 31). Feel the reverence for the place. A place of consolation, a place of inner tranquillity. Of searching for peace inside oneself.

Goodbye to the USSR

Monday April 8. The last stop before departure in the Office of PharmStandard/DGM. A meeting with Elena and Vladimir (during soviet times he worked as an officer in an atomic submarine(!). We discus the business side of the visit; the settling of finances. There are possibilities for the future! A second print of the book; possible training. A final cup of coffee. Also here the farewell. The embracing; thank for all that I could receive, experience, see!


Now, April 9th on the airport. I am writing the last words of this mail. I am checked in. The plane is ready. A few moments later the roaring engines. Take off; and I see the gigantic city of Moscow drifting away in the east (Photo 32). Already the mind travels to the return of Yoko, my wife, who will return on Thursday after a 3 months travel to Asia!


From Russia, with Love, Jan Huijs



Reisverslag: 11-07-2005: Burkina Faso. Bericht uit Ouagadougou.

Beste allemaal,

Al bijna drie weken ben ik hier in Ouagadougou, Burkina Faso. Het derde bezoek is het alweer. De eerste twee hadden vooral betrekking op de invoering van het geautomatiseerd systeem voor beheer van apparatuur, gebouwen en infrastructuur (PLAMAHS) tbv het Ministerie van Gezondheid. Van de 1300 instellingen is nu ongeveer de helft van de data opgehaald en 40 procent ingevoerd. Een hele grote operatie.Van deze inventarisatie doen we nu een evaluatie, en lever een verbeterde versie van de software. Maar de hoofdtaak was deze keer het presenteren van twee cursussen over sterilisatie: een basis cursus voor de techneuten van de kleinere ziekenhuizen, en een voor de senior-technici.De situatie in veel plaatsen is onvoorstelbaar voor iemand die hier nooit was.Vooral in de kleinere verafgelegen gezondheidsposten. Maar ook in degezondheidscentra in de buitenwijken van de hoofdstad Ouagadougou.

Voorbeeldje: Voor het doen van praktijkwerk waren we op zoek naar een geschikte locatie. Voorgesteld werd de het ziekenhuisje van de wijk Pissy (67 bedden), in het zuid-westen van de stad. Er zou net een nieuwe sterilisator geleverd zijn. We gaan er naar toe.En inderdaad. Een mooi nieuw blauw apparaat: de nieuwe verticale autoclaaf van het Zweedse Getinge, de grootste sterilisatorbouwer ter wereld. Het apparaat werd geleverd via een groot programma ter verbetering van de gezondheidszorg, gefinancierd door Nederland en Zweden. Het gaat hierbij om een budget van miljoenen Euros. Het apparaat is in februari aangekomen. Het blijkt een semi-automaat te zijn, met nogal veel gevoelige elektronica. Met ook nog iets speciaals: De dekselpakking moet onder waterdruk gezet worden om goed af te sluiten. Die moet minstens 2 bar zijn. Zo niet dan weigert het apparaat te starten. Die druk is er vrijwel nergens in het land. Het komt er op neer dat het apparaat nog geen cyclus heeft kunnen draaien.En voorlopig ook niet zal doen. Een oplossing is om een opvoerpomp te plaatsen. Probleem blijft: wie betaalt dat? Het geld voor deze van het project waarmee deze apparatuur is aangekocht is al lang verbruikt.Weer geld los te maken, is een ingewikkelde procedure. Bovendien zijner de wijk waar het ziekenhuisje staat, hele weken achter elkaar dat er geen stromend water is. Het water wordt dan in tonnen aangevoerd. En dan zal een opvoerpomp het probleem ook niet oplossen. Van deze apparaten zullen er op korte termijn 10 geleverd worden. Het is te laat om de zaak terug te draaien. Het komt er op neer dat in vrijwel al deze plaatsen een probleem met dit apparaat zal zijn! Kosten per apparaat: 7.000,– Oftewel EURO 70.000 in de goot… In het betreffende kliniek hadden ze nog een horizontale autoclaaf, maar die is kapot: Problemen met de besturing. Men heeft nu alleen nog een kleine hete lucht sterilisator, waarmee alle werk gedaan wordt, inclusief het textiel. Tijdens het korte bezoek heb ik die niet kunnen controleren.Maar ik vrees dat ook dat niet al te best is. Al met al schiet het op deze manier niet op. Het is echt nodig om met de beslissers en de mensen die de specificaties maken te praten.Verder vind ik dat ook de fabrikant zijn verantwoording heeft, en rekening moet houden met de bestemming van zijn apparaten. Maar helaas blijkt er bij fabrikanten maar verschrikkelijk weinig kennis van de markt hier te zijn. Wat hier gebeurde is een schoolvoorbeeld hoe het steeds maar weer mis gaat. Het wordt echt tijd dat specificaties voor een geschikte autoclaafvoor hier, en de bijbehorende aangepaste technische norm geaccepteerd gaat worden. Het blijkt een lange weg. Soms je het gevoel tegenwindmolens te vechten.

Met de miljarden die de G8 nu vrijmaken moet er op dit terrein toch iets nuttigs te doen zijn:
niet alleen voor sterilisatie, maar over de hele breedte van technologie in de gezondheidszorg; zo verschrikkelijk veel kan verbeterd kan . Technologie moet aangepast zijn naar de omstandigheden hier. Fabrikanten moeten gedwongen worden met regelgeving om voor deze markt geschikte apparatuur te leveren. Ik ben ervan overtuigd dat het kan. Dit bezoek hier bevestigt die overtuiging. En het geld is er: als de internationale donorgemeenschap bereid is (misschien zonder het te weten) geld met bakken door de goot te gooien – en er geen haan ernaar lijkt te kraaien – dan moet het toch ook mogelijk zijn, geld te vinden dat op een nuttige manier gebruikt wordt…

De mensen die hier aan de cursus mee deden bevestigden de problemen. Zij worden geconfronteerd met al die “mooie” spullen, en worden, als ze een apparaat dan niet aan de praat krijgen daarop aangekeken. Ze zitten in een heel lastige situatie. Als je nagaat wat een techneut ineen districtziekenhuis dan in de maand verdient: 30.000 cfa in de maand! Dat komt neer op nauwelijks 50 Euro! (Een verpleegster ontvangt 70.000; ook niet veel, maar al een stuk beter…). Je kunt hier wel wat meer met een Euro, maar het houdt een keer op… Onderhoudmensen,vooral de techneuten in de kleinere ziekenhuizen, worden nog veel teveel gezien als de jongens die ergens in een smerig hok moeten proberen met vrijwel niks allerlei moderne apparaten aan de praat te krijgen en te houden.
Tijdens deze cursus werd hun officiële titel veranderd van “werklieden”, naar “technicus”. Dat alleen al is een opwaardering. Nu de volgende stap: trainingen en opwaardering van het salaris.
Zoals ik al in mijn verhaal uit Senegal vertelde respecteer echt die jongens, die ondanks alle problemen en beperkingen hun werk proberen te doen…Vrijdagavond hadden we het afsluitende feestje. Echt supergezellig.Dan komen dit soort verhalen naar boven. Men spreekt vrijuit. Het hart wordt gelucht.
De komende week ben ik nog een week hier in Ouagadougou. Dan nog een week naar Ghana! Na 16 jaar terug naar mijn tweede thuis, zo voelde ik het indertijd althans.
Eerst ga ik naar een ziekenhuis (Eikwe, Western Region, aan de kust),waar het prototype van een sterilisator getest wordt, waaraan we de afgelopen jaren in de TU Eindhoven gewerkt hebben. Daarna hoop ik echtenkele oude vrienden en kennissen te kunnen ontmoeten.
Op 29 Juli hoop ik dan weer veilig thuis te komen.
Midden Augustus dan nog 2 weken naar Kaapstad, Zuid Afrika, ook vooreen cursus sterilisatie. Daarna eindelijk weer een tijd thuis. Wat ik het vorig jaar te weinig aan opdrachten had, is er dit jaar eigenlijk wat veel van het goede.. Ik probeer er toch het beste van te maken.Vooral voor Yoko, Mariko en Junko zal het niet makkelijk zijn…Na eind Augustus ben ik er wat langer en hoop ik jullie echt weer te ontmoeten!

Vannacht en vanmorgen regende het hier. Met bakken kwam het naar beneden. De laatste weken was het regelmatig raak. De mensen zijn blij. Er kan gezaaid worden. Met de hoge temperaturen groeit alles supersnel.

Ik hoorde over de aanslagen in Londen. Het feestje dat er gevierd werd met het binnenhalen van de Olympische spelen heeft wel héél erg kort geduurd. Ik heb het gevoel dat dit terrorisme niet met nog strengere maatregelen en controles is op te lossen. De gevoelens van apathie en haat die in de hoofden van mensen speelt, kan niet weg gecontroleerd, opgesloten of zelfs afgeschoten worden. Met de hautaine houding die het Westen vaak neigt aan te nemen zal er vrees ik weinig veranderen. De diplomatie; respect voor elkaar; overleg. Ik denk toch dat het uit die richting moet komen. Een heilige oorlog tegen de “as van het kwaad” lost naar mijn gevoel problemen beslist niet op… Daarmee blijft de veiligheid in westerse steden onder spanning staan. En halen we naar mijn mening ons nog meer ellende op de hals…

De allerbeste wensen uit een goed Ouagadougou.

De laatste tijd liet ik weer weinig van me horen. Weer wil ik hiervoor mijn excuses aanbieden.

Jan Huys

Aftermath of the Ebola Crisis: Liberia Hospitals improving their sterile supply

2014-12-01: JF Kennedy Medical Centre, Monrovia, Liberia: The Maternity Hospital, supported through the Japanese Government

2014-12-01: JF Kennedy Medical Centre, Monrovia, Liberia: The Maternity Hospital, supported through the Japanese Government

The year 2014, Liberia, West Africa. The country is confronted with the most deadly disease in recent history: Ebola. Public life including the health system have come to a standstill. At the time the German Red Cross assists  the national John F Kennedy Medical Centre in Monrovia with the establishment of a triage unit, where all incoming patients are tested on signs of Ebola. The representing officer of the Red Cross is invited to visit the neighboring Japanese-Liberian Friendship Maternity Hospital, attached the Medical Center. The Maternity Hospital has been established in 1983 with the support of the Japanese International Cooperation Agency JICA.

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Report: Liberia, Monrovia 2015. The Maternity Hospital of of the JF Kennedy Medical Centre upgrades its sterilization department

In 2011 the Maternity Hospital received a new Matachana S1000 sterilizer. It was supplied in the context of the rehabilitation of the hospital through the Japanese government.

The sterilizer was installed under the responsibility of the Liberian branch of UNOPS. All utilities were connected and test runs took place. However by the time the machine was to be taken to use the compressor broke down. At the time the engineer in charge of the installations fell sick and was repatriated. Since that time the machine has never been used. In 2014, at the height f the Ebola crisis a representative of the German Red Cross visited the Maternity hospital and was also shown the operating theatres with its sterilization department with the broken down autoclave. The delegate offered to have a consultant assessing the status of the machine and possibly recommission it. The assessment visit took place in Dec 2014. He positively advised on the repair, of which the request by the hospital was approved by the German Red Cross. In the months of January-March, preparations took place for the recommissioning: Spare parts were ordered; and a training on the S1000 autoclave was attended at the Matachana headquarters in Barcelona. By the middle of may the consultant came for the actual repair and commissioning. During the visit also the sterilization department of the nearby St. Josephs Catholic hospital was put back to service again by repair of equipment and installing new sterilizers: an activity supported by the German organizations Misereor and the Medical Mission Institute. The activities in both hospitals took place between May 15th and July 17; a month longer then originally planned.

A major problem related to the autoclave in the CSSD of the maternity was the water supply which caused severe sedimentation in the autoclave components. Hardness was within limits. thus a filtering system was installed ensuring sufficient quality water. As the pressure regulator for the compressor was not available in town a new compressor was procured. It was made available through UNOPS. Several technician problems were resolved, such as air leakage to the door seal, date time setting of the processor. All components were thoroughly cleaned. The efforts resulted in  a first success performance test. It made clear that recomissioning was feasible and the new compressor was bought, the water filter installed. With the fluctuating power supply and regular brown and black outs, a UPS was installed, which ensures that during brief black and brownouts, the power on the processor remains available, and upon resumption of power within a limited period of time the interrupted cyle can just continue. It saves enormous efforts and resources. Also the UPS was provided through UNOPS. On xx the first independent performance test was done using the full Bowie and Dick steam penetration test with dataloggers measuring inside the test pack. The Performance proved to be passing the stringent requirements. This made the way free for commissioning the autoclave. On Staff was trained and since then the autoclave is in use again. Although not the main objective of the visit also related activities of the sterilization department were observed and initial recommendations are presented.

Also the CSSD of the main hospital was visited. The only autoclave that was in use was the same model as was procured as a backup sterilizer for the nearby St. Josephs Catholic Hospital. Due to space limitations in that hospital, it was decided to do the practical training in the much more spacious CSSD of JFKMC. Before the training the department was visited and the sterilizer tested. It was found to have several major shortcomings which would actually require the closing down of the department until these were resolved. With essential spares available, the autoclave was repaired on the spot, in collaboration with a technical and CSSD staff. It could be recommissioned again and used during the training. Also the activities of the CSSD of the main hospital were observed and recommendations given for improvement. Note that the main objective of the mission was the recommissioning of the Matachana S1000 sterilizer, which was achieved. The observations are not claiming to be comprehensive nor complete. They however can be an onset for improvement within the departments. It is still recommended to do a thorough evaluation of the full sterile supply cycle of the CSSD in the Maternity Hospital as well as the Main Hospital.


The situation with the new autoclave not being used during a period of almost 3 years reveals problems of communications and managerial and technical skills. For some reason neither the CSSD, the Hospital management, JICA nor UNOPS signalled the problems or acted effectively on the issue. The same was observed in the CSSD of the main hospital, where the only sterilizer in use was in a state that would have required the department, and thus also the operating theatres to close down until the problems were resolved. The line of communications between departments and relevant organizations needs to be strengthened. Introducing an equipment management system can be an essential tool to monitor and signal the status of equipment and used as source of information for the hospital management, the maintenance department and related organizations in assuring the up time of essential medical equipment, that is crucial for adequate care of our patients. It is however crucial that such a system is updated at a regular basis and that the information will be transparent and analysis will be available all relevant departments such as the maintenance department, the head of the departments and the hospital management. There is much potential of the staff of the maintenance department which is currently seems under utilized. An assessment of the activities and the positioning of the maintenance department within the hospital is recommended.