Introduction:i

Goa Medical College is the successor of the 'Escola Medico Cirungica de Goa'(Medical-Surgical
School of Goa) established by the Portuguese in the year 1842. It is one of the oldest medical
colleges in Asia teaching medicine. Its motto is Truth is Eternal and Beautiful. Originally
located in Panjim, the college was moved to Alto-Bambolim in 1993. The college has been under
the Goa University since 1986 before which it was under the Bombay University. ii
GMC admits 100 students for undergraduate M.B.B.S. Course, while 72 Post - Graduate are
admitted every year. The Goa Medical College Hospital were initially operating from Panaji and
Ribandar, shifted to Bambolim in the year1991, has presently 1000 beds, whereas 80 bedded TB
and Chest Disease Hospital functions from St.Inez, Panaji. Similarly, a 20 bedded Rural Health
and Training Centre is situated in Mandur. The entire complex at Goa Medical College,
Bambolim is spread in an area of 11, 34,798 Sq Mts.
Departments involved in Teaching, Training and providing Patient care. iii
General Medicine
General Surgery
Orthopedic
Ophthalmology
Ear Nose & Throat
Skin & V.D.
Pediatrics
Obst. & Gynecology

Preventive & Social Medicine

Nephrology
Neurology
Neurosurgery
Urology
Plastic Surgery
Anesthesiology
Radiology & Radiotherapy

Anatomy
Physiology
Biochemistry
Pharmacology
Microbiology
Pathology
Forensic Medicine
Psychiatry

Goa Medical College subordinate offices

T.B. & Chest Diseases
Primary Health Centre,
Urban Health Centre, St. Cruz
Hospital, St. Inez,Panaji Goa
Mandur, Tiswadi
Infrastructure:iv
There are total 1100 beds at the hospitals of Goa Medical College. The Out-Patient-Department
is run by the Clinical Departments from 9.00 A.M to 1.00 P.M. on all working days, while
special Clinics are conducted in the afternoon by these departments. The Casualty runs for 24 hrs
on all days proving Emergency and Trauma services. Pre Hospital emergency care is provided
by the 108 ambulance service. There are 12 Routine and 6 Emergency Operation Theaters, which
conduct major to minor operation routinely and in emergency X-Ray, Ultra-sound, CT Scan and
MRI facilities are available ECG, Stress - Test and Colour Doppler facilities are available.
Radiotherapy
facilities
are
available
for
cancer
patients.
Haemodialysis is provided for renal failure patients. Pediatric Surgery, Urology, Plastic surgery
is being developed. Similarly, Cardiology and Cardio Thoracic Surgery is also under
consideration.

General Surgery
The department of General Surgery is a special branch which has the scientific knowledge and
clinical expertise for the management of adults across the spectrum for a variety of
communicable as well as non communicable disease. People with diabetes, hypertension, heart
disease, malaria, and stroke would be managed by the department of internal medicine.

General Surgery Wards

Male General Surgery
Male General Surgery
Female General surgery

Ward 110
Ward 111
Ward 109

Patients Flow
Patient from OPD Block
Patient from Causality

Registration OPD

General Surgery OPD (OPD is only

open on Wednesday/Saturday

Registration OPD @ Causality

Same day admission to

IPD @ patients Condition.

Consultant Doctors/Residents involve in decision making process for admitting the patient to the Gen.
Surgery y IPD ward depending upon the patients condition.

Patient Admission form is filled at OPD

Admission form is handed over to

IPD staff and the patient is admitted.

Discharge of patient is purely based on the consulting

doctor. Discharge form and all the reports are handed
over to patient before discharging

Patient is shifted to Gen. Surgery OT

as per his/her condition

Ward layout of IPD

Size of Staff in IPD

30 Beds (divided into 2 Units)

2 Consultant Doctors

2 Sr. Resident Doctors

Unit I

Unit II

15 Beds

15 Beds

3 Jr. Resident Doctors

10 Nurses

2 Nurses per shift. There

are 3 shifts of 6, 6 & 12
hours.

Department/Units within Gen. Surgery Ward

1.
2.
3.
4.
5.
6.

Bed accommodation area

Nursing Station/area
Doctors room
Medicine & supplies room
Washroom
Housekeeping closet

Staffing compared with MCI Guidelines

S.no

Number of

MCI Guidelines

No. In GMC

Beds in the ward

180

90*

Professor/Consultants

12

12

Sr. Residents

Jr. Residents

18

18

Staff Nurses

1 : 3 (1 nurse per 3
patients)

1 : 7.5 (1 nurse per

7.5 patients)

*as per our sightings. There were 150 beds mentioned in the GMC website.
The only drawback is the inadequate staff nurses. More nurses are required mainly in the evening
and night shifts. The wards are moped twice a day. The washrooms are just adjacent to the few

corner beds and its best to increase the gap between those. In case the number of patents referred to
IPD increase, few extra beds will be added accordingly, this may cause spacing and traffic
movement problems within the ward. The double door system is in place, but the doors were always
open. There was no security/guard on the watch and anyone can enter/leave the ward.

Layout of General Surgery Ward

Medicine/su
pplies room

Nurses Desk

ENTRAN
CE

Doctors room

Wash
Room

HKC*

Nephrology
The Nephrology ward provides care for men and women requiring treatment for a range of
common conditions affecting the urinary tract. These can involve the following

kidneys
ureter
bladder
prostate
urethra

The nephrology department is located in the second floor of the main OPD block.
Patients with problems relating to kidney function are referred to the department. After an initial
review by the consultants they were required to undergo mandatory diagnostic tests such as
blood tests, urine tests, ultrasonography, kidney biopsy etc. Based on the test results obtained
they were given the respective treatment.
The Nephrology ward is similar to that of General Surgery in the process of patient admission
from OPD wards. Few differences can be noted as follows.

Ward layout of Nephrology

Size of Staff in Nephrology

28 Beds (divided into 2 Units)

1 Consultant Doctors

1 Sr. Resident Doctors

Unit I

Unit II

14 Beds

14 Beds

2 Jr. Resident Doctors

8 Nurses

2 Nurses per shift. There

are 3 shifts of 6, 6 & 12
hours.

Department/Units within Nephrology Ward

1.
2.
3.
4.
5.
6.

Bed accommodation area

Nursing Station/area
Doctors room
Medicine & supplies room
Washroom
Housekeeping closet

Most of the wards have the same layout. There is a double door system at the entrance to reduce
the level of contamination.

Wash

ENTR
ANCE

Room
Medicine/supplies room

Doctors room
Nurses Desk

HKC*

Comparison of
Layout of Nephrology Ward

Wards: General Surgery vs. Nephrology

S.No
1
2
3
4
5
6
7
8
9
10

Comparison Factor
No. of beds in each ward
Beds occupancy rate
Consultants
Consultant to beds ratio
Sr. Residents
Jr. Residents
Staff Nurses to beds ratio
Dress Room
Patient/attendant traffic
Cleanliness/Hygiene

11
12

Double door entrance

Location

General Surgery
30
100 %
4
1 : 7.5
2
6
1 : 15
Yes
More
Cluttered, cotton/bandage
pieces on floor
Doors are almost kept open
1st Floor of OPD block

Nephrology
28
100 %
1
1 : 28
1
2
1 : 14
No
Normal
Normal
Remain closed
2nd Floor of OPD Block

Laundry
The laundry section is located in the basement of the OPD building.
The employees in the laundry section receive the clothes for laundry at the laundry receiving
area. Sorting of clothes is done here. Each item received is noted down manually along with the
ward number. Management of these clothes is centralized. But the clothes from the OT/
Gynecology department and the clothes with bloodstains are handled / washed separately to
avoid infection. Coloured and white clothes are arranged separately as bleach is used for white
clothes only.
The washing procedure has 4 step:
I. Main washer (Quantity: 4, Capacity: 100Kg/cycle)-The clothes are fed here and are
washed with hot water and Clax. Clax is a liquid laundry detergent specially formulated
for use in specialized laundry applications. The time taken for this activity is 45 minutes15 minutes each cycle. Presently only 3 are functional.
II. Hydro extractor (Quantity: 4, Capacity: 35 Kg)-This activity takes 10-20 minutes.
Hydro-extractors squeeze out the excess water. Clothes include pants, shirts, bed sheets
and towels.
III. Drying tumbler (Quantity: 3)-This activity takes around 40 minutes. Pants, shirts and
towels are dried here. The bed sheets are not dried in the drying tumbler.
IV. Steam press: The pants and shirts are ironed using the steam press.
V. Flatwork ironer: The bed sheets are ironed using this machine. This process takes hardly
2-3 minutes.
After the clothes are ironed, they are brought to the sorting room where they are arranged and put
in the particular shelf according to ward number. The laundry in charge (Mr. Pandurangan)
checks the conditions of the clothes. If they are worn out, they are discarded. And if they are torn
a bit, they are given to the tailor for mending. After that the ward staff collects the laundry as and
when required.

Around 3000 clothes are washed daily. Annual Maintenance Contract (AMC) is given out to a
Mumbai based maintenance company which is responsible for servicing of the machines as and
when required.
The laundry consists of 22 people currently. Goa Medical College facilitates laundry for other
hospitals like Asilo, Institute of Psychiatry & Human Behaviour, District Hospital, etc.
Staffing compared with MCI Guidelines
S.no
1
2
3
Issues:
1.
2.
3.
4.

Laundry Staff
Supervisors/In-charge
Dhobi/Washer men/Women
Packer/Sorter

MCI Guidelines
2
12
12

GMC
1
10
11

The machines, especially hydro-extractors are breaking down due to overload.

Improper water and steam supply which effects the regular washing cycle.
Inadequate staffing
Pending work due to inadequate staffing and improper functioning if machines

Improvements:
1. More people should be employed in the laundry section to segregate work load.
2. Extra linen should be purchased for emergency situations.
3. Old machines need to replace with new advanced machines to improve efficiency.

Central Sterile Services Department (CSSD):

Its also called as Sterile Processing Department and is an integrated department in hospital
which takes care of sterilization of hospital equipment, devices, dressings and linen of hospital.
In hospital the sterilization is mainly done by autoclave process and Steam sterilization. But
other sterilization methods are also followed like Ethylene Oxide sterilization and heat
sterilization which include dry and moist sterilization.
Staffing compared with MCI Guidelines
S.no
1
2
3
4
5
6

Laundry Staff
Matron
Staff Nurse
Technical Assistant
Technician
Ward Boys
Sweeper

MCI Guidelines
1
4
8
8
8
4

CSSD has the following area marked out for its functions:
1) Unsterile load and separating area
2) Linen folding and packing area
3) Autoclave Rooms

GMC
1
4
3
2
4
2

4) Storage area for sterilized load

5) OT lift
Duties:
When load is received on CSSD its sorted out as metal, rubber, plastic, paper, cloth and
glass bottles.
Vessels and liquids are autoclaved separately with extra package to prevent moisture.
Different temperatures are used for different material.
Sets are stacked against each other leaving space for steam to pass through.
Autoclave taps which changes to dark green on completion of sterilization from white.
Clothing:
The personnel working in CSSD have to wear aprons and head coverings so that any minor hair
or anything cant contaminate the sterilization area. That includes Green Gown/Pant, Head
sling/Cap, Masks, Rubber Protective padded gloves, slippers etc.
As discussed above Autoclave is the most preferred method and considered safe which use steam
under pressure in a high vacuum steam sterilization. The steam is used at 30 Kgs/cm3;
Temperature at 120C to 126 C for 55 minutes.
The process of autoclaving includes 4 steps:
Switch on and slow exhaust to build pressure
Sterilization rises to 120 C after half an hour
Fast Exhaust and temperature and pressure drops.
Dry vacuum is installed sets are dried and moisture removed
Precautions:
Use rubber footwear at all times
Dry hands while handling switches
Notify repeated errors of the switches
Close water valves as per the instructions.
Use of padded gloves for handling autoclave
Stay away from machine while opening the door to prevent steam Burns.
After Autoclave is complete the load is separated and is sent to respective wards and separate
register is maintained for receiving and returning load.
Treatment with Linen:
Surgeon aprons, big towels, medium towels and slit towels used for operations sent from
OTs to laundry washing drying, which are in turn sent to CSSD for sterilization.
Torn linen stretched before packing every day.

Casualty Ward
The Casualty ward in Goa Medical College is a medical treatment facility specialized in care of
patients who come without prior appointment, either by their own means or by an ambulance.
The department is well equipped to deal with any kind of injury of the patient as the injury is un
planned and they cannot decided the course of treatment of the patient beforehand.

Registration
Types
Plain White
Paper (Rs.20)

Free Paper
(for BPL)

Pink Paper
(MLC)

The department is open 24hours in a day and the staff works in 2 shifts, 12 hours per shift. The
department is situated on the ground floor with a dedicated entrance and the staff, which includes
nurses and doctors who are available round the clock for patient care. The cases are prioritized
on the basis of their clinical needs and this procedure is called a Triage. In GMC the patients
who come to the emergency ward are taken to a room dedicated for the procedure of triage, there
the patients are examined by a doctor who then further gives directions to which department the
patient should be taken. The priority is decided on the basis of severity, first priority is given to
Myocardial Infarction patients or severe accident cases with neurological damage and then other
patients are provided with a treatment.
As soon as the patient arrives in the Casualty ward he/she is taken directly for an examination
and after the patient is provided with the immediate aid then the registration process follows. The
registration is divided into three categories, first is a plain registration paper which has the basic
information about the patient like name, age, religion, contact number of a relative etc. The plain
paper is for 20 rupees. The second category for registration is a free paper which is provided to
people who cannot afford to pay 20 rupees for the registration process. The third category is a
MLC paper, it covers the medico legal cases like assault, rape cases, domestic violence cases, hit
and run cases etc which has any kind of legal proceedings involved in it. In case of a medicolegal case a MLC paper is made which is free of cost and is maintained by the hospital. Medico
Legal services are registered at the registration counter next to casualty
There are around 180 patients admitted in the casualty ward every day on an average. On an
average there are 15- 18 cases of accidents registered every day.
Observations:
The ward is a little under staffed, especially at the reception counter, where only one attendant is
present for night duty.
Units in Casualty
1. Reception
2. Public Relation office
3. Medico-legal office

4.
5.
6.
7.

Waiting area
Washrooms
Triage room
Diagnostic Services CT Scan, X-ray

Ambulance
An ambulance is a vehicle used for moving of sick or injured people to, from or between places
of treatment for an illness or injury, v and in some instances will also provide out of hospital
medical care to the patient.
Basic Life Support (BSL)
Other Equipments
Equipments
O2 cylinder
heck saw blade
wheelchair
hammer
scoop
gloves
spine board
masks
stretcher
Sphygmomanometer
Suction machine
needles and syringes
fire extinguisher
Ambu bag
Emergency Drugs
Atropine
Avil
Magnesium Sulphate
Disprin
Deriphylline
Frusemide
Etophylline

Equipments inside an Ambulance

"Goa Medical College, Panaji at Medical Council of India Website". View details of college Goa Medical College,
Panaji. Retrieved 25 June 2011.
ii
Faridah Abdul Rashid (July 2012). Research on the Early Malay Doctors 19001957 Malaya and Singapore. Xlibris
Corporation. pp. 27. ISBN 978-1-4691-7243-9. Retrieved 6 April 2013.
iii
http://www.gmc.goa.gov.in/index.php/en/departments.
iv
http://www.gmc.goa.gov.in/index.php/en/about-us
v
Skinner, Henry Alan. 1949, "The Origin of Medical Terms". Baltimore: Williams & Wilkins