Memoire Online - Clinical report: community health assessment,cse of muhima villaga

Clinical placement is an occasion to verify whether the person who studies in order to work in a domain will be able or want truly to deal with an employment in one of possible areas of work. At the end of clinical placement, a student has to do a clinical report that has an objective of presenting facts and reflexions on learning clinical placement that generally has been done in professional training program (Raymond Robert et al, 2006)

This serves as an essential instrument for the rapid and accurate dissemination of epidemiological information on cases and outbreaks of diseases under the national Health Regulations and on other communicable diseases of public health importance, including emerging or re-emerging infections.

Reporting of suspected or confirmed communicable diseases was paramount although physicians have primary responsibility for reporting, school nurses, laboratory directors, infection control practitioners, daycare center directors, health care facilities, state institutions and any other individuals/locations providing health care services are also required to report communicable diseases.

Reports should be made to the local health department in the county in which the patient resides and need to be submitted to local, regional and national administrative authority. However, some diseases warrants prompt action and should be reported immediately to local health departments by phone.

We had many objectives both general and specific, the main general objective was to express an Attitude of behavior worthy of profession ethics and to show respect to people, medical team and patients

Help community to work together to identify risks and act to contain and control them. The regulations are needed because no single community, regardless of capability or wealth, can protect itself from outbreaks and other hazards without the cooperation of others. The report says the prospect of a safer future is within reach - and that this is both a collective aspiration and a mutual responsibility

Health care providers are required to report communicable disease for several reasons. The most common reasons are listed as follows:

-To identify outbreaks and epidemics. If an unusual number of cases occur, local health authorities must investigate to control the spread of the disease.

-To help target prevention programs, identify care needs, and use scarce prevention resources efficiently.

-To assist with national and international disease surveillance efforts. For some diseases that are unusual

This health center receives resources from Rwanda ministry of health and non gornmental organization.

Normally the work starts at 7:00 a.m by praying then nursing staff .the students have respected hours of work as following:

		Arrival hour	Leaving hour
Morning		7:00 a.m	12:00p.m
Afternoon		1:00 p.m	7:00 p.m
Night	17:00 p.m		7:00 a.m

This H.C receives people of MUHIMA SECTOR and people from other sector and districts. We found all kind of people: neonates, children, adult, old, men, and women. With almost disorders: MALARIA, TB, diarrhea, mental disorders, GI, bone, skin disorders...

The decision was made, early on, to involve other major health care professionals. To this end, support was obtained from representatives of muhima community area, namely abajyanama b'ubuzima

In addition, a nursing team working at muhima health center provided more information for input of assessment and implementation

This report presents the findings of the community assessment, including a discussion of the methodology employed, assessment findings and conclusions.

METHODOLOGY

The assessment completed in one month focused primarily on two types of data gathering, and related specifically to indigent populations:

.Quantitative information regarding national, regional, state and local health care issues, for such populations; and

.Quantitative and qualitative input, gathered by survey and interviews, from a sample group from community regarding health care needs for the indigent and related programmatic or service initiatives in muhima area.

.The study was relatively rigorous in terms of the techniques used to ensure the scientific/statistical validity of both sampling and results regarding the population studied.

.For this study, a different approach was used. The decision was made to gather data from a considerably larger group of individuals and house, attempting to gather information related to needs of all populations (rather than focusing on the indigent), with less attention being paid to scientific or statistical «rigor,» per se.

In addition, a decision was made to broaden the information gathering to include input from both actual «consumers» of services provided by muhima health center and human service agencies, and the «general public.» This new methodology was employed in order to ensure the widest possible range of responses and to reach as many people as possible while still completing the assessment within community.

Qualitative research, as completed in this survey, is designed to obtain maximum input regarding opinions, attitudes and beliefs of a population; this is particularly useful in generating and testing ideas related to new program and service design. It needs to be pointed out, however, that the results from focus groups and one-on-one interviews do not necessarily represent the perspective of non-participants. In addition, the results reflect the observations and attitudes of participants at the time they were collected. Obviously, individual perspectives may change, and the reader is cautioned against assuming that the views expressed are immutable over time.

3. Based on the discussion, it was subsequently agreed that multiple methods of data

.Interviewees were asked to answer to a key health or social issues within the community area (discussed and referenced later in this report).

This section of the report details the key findings of the analysis. To facilitate the document's organization, the contents of this section follow the topics covered in the interviews and focus groups, in the order in which they were covered. The analysis indicates where it is useful, whether the feedback came from a particular individual or group; e.g., physicians or clients. In addition, where illustrative, several quotations from the focus group discussions have been included. In some cases, the quotations have been edited slightly, to remove extraneous comments, and to clarify grammar and sentences. In no case, however, was the substance of any quotation changed.

Respondents were asked what they consider to be important when thinking about the level or quality of health of a community and its residents. This question intentionally lacked specific reference to the muhima community, encouraging respondents to think more broadly, and possibly in more «ideal» terms.

Many noted that a key aspect of a healthy community is the notion of an engaged community, one that communicates. As one client focus group participant noted, «it's a community that communicates with itself.» In a related observation, another commented that a healthy community is one «that supports each other... that helps each other out.» As stated by reporter group in an interview, «(in a healthy community) People DO know each other's business.» Another community health agent added when interviewed, «People feel known, and they feel safe.»

An important aspect of this notion is the idea that people need to know where to go to obtain services: «(A healthy community) is a place where it's not a deep, dark secret where you can find the help that you need.» The importance of information availability and communication in general, is perceived by all categories of respondent to be critical; and, as shall be discussed later, this is an area of perceived weakness within the muhima health service area.

Several participants commented that healthy communities need to have places where people come together to talk, to share and to communicate. Examples of meeting places mentioned by respondents include coffee shops, coffee houses, the «corner bar,» and/or community centers. Many commented that the muhima health service area seems to be losing (or lacking) such «coming together» places; examples cited multiple times the lack of a senior center or program in some communities, etc.

Respondents used a fairly broad definition of «health» in speaking of a healthy community. Issues related to physical and mental health were mentioned most frequently (access to providers was seen as key by many participants, notably the physicians), but others mentioned the importance of providing social services, and spiritual support was a key component for a small number of participants.

Many noted that availability and access to services (of whatever sort) were essential components of a healthy community; this availability and access applies to all, regardless of their age, gender or social-economic status. «(A healthy community) is one that offers services to children.» «It is one that supports mothers.» «It cares about treating older people and children.» «Healthy communities care for people without the means to do so themselves.»

Some respondents reported that a healthy community must be a tolerant community, and respect all members even if they hold different values. Examples were cited involving families in which the values of parents are at odds or rival those of their children, particularly teens. Others cited the importance of healthy communities being open to persons whose sexual preferences or gender identity differs from the overall community or «traditional» norms.

Several felt that having a strong economic base as well as controlled/managed growth was essential elements of a healthy community. In this context, several expressed concerns that growth in muhima has taken place in a rapid and occasionally unmanaged manner - these were felt to be potential precursors to an unhealthy community.

In addition, several respondents noted that affordability of services and programs (including housing, health care, social services, etc.) is essential to a healthy community; there was a feeling that several areas of muhima, in particular kabilizi village, were becoming increasingly unaffordable for too many people. Some interviewees expressed the irony that the very people, on whom the City of KIGALI depends for providing services to its residents, businesses, and tourists/diners, are finding it more and more difficult to live in or around the City themselves.

The importance to a healthy community, of strong educational programs and vibrant recreational and arts initiatives was also cited many times.

One community health agent summarized her views of a healthy community in the interview by describing a healthy community as a place where «individuals can have their own pearls of joy.»

Indicators of a Healthy Community

Respondents were asked to comment on what they felt were the signs or indicators of a healthy community; how do you know it when you see it? This question did not generate a wealth of discussion, but some notable contributions were made.

.prevalence rates of healthy behaviors (e.g., use of bicycle helmets or seatbelts, low levels of alcohol or drug abuse)

Two focus group participants were somewhat less «statistically-oriented» in their response to this question. Noted one, «It's when people are walking around with smiles on their faces, «and another, «it's when you walk down the street and people say `hi' to you.»Is This a Healthy Community?

In general, respondents felt that the communities served by the Muhima health professionals are relatively healthy. Several people compared the Muhima region to other communities, often larger, more urban environments, with which they were familiar. The muhima region fared quite well in these comparisons. There is some variation, however, among the communities, and for particular «sub-communities;»

Two basic approaches were employed to gather information regarding perceived program/service gaps. First, interviewees and focus group participants were asked specifically to identify and discuss such gaps. Second, the surveys asked respondents to identify areas where gaps exist. The results of both approaches are discussed in next

By their very nature, interviews and focus groups tend to uncover more negative comments or recommendations for improvement than they do positive statements. This section of the report documents those areas perceived to be gaps or most in need of improvement. In addition, to make the information even more useful for muhima health center, the report presents the findings in three groupings or categories: Primary Perceived Needs; Secondary Perceived Needs; and Other Perceived Needs, based on the level of discussion and interest among respondents.

. Lack of information/education regarding programs and services in service area.

Obstacles

All respondents (i.e., focus group participants, interviewees, respondents) were asked to identify obstacles to services. A relatively short and consistent list of responses emerged. The most critical obstacles are perceived to be:

. Difficulty in getting an appointment with providers, programs or services (second most frequent survey response)

It is evident from this study, that although residents are generally satisfied with health services within the muhima health service area, gaps do exist. Muhima decision-makers need to be aware of these reported gaps in making future funding decisions, whether they are real or simply strongly perceived. The following listing reflects a summary of the recommended priority action areas within the community area, based on the analytical summary of the findings of the study. It takes into account the myriad observations and findings, and identifies those areas perceived to be the most in need of attention within the next two-to-three years.

It must also be noted that while it is important to address selected gaps, at the same time, it is essential that adequate support be maintained for existing services and programs that are doing a good job, and without which additional service gaps would emerge. A careful balance of needs should be maintained.

. Enhance mental health services, particularly for persons aged 0-12 and 65 and above.

. Increase the number, quality and «reach» of after-school programs, including enhanced recreation options.

. Increase advocacy and public/provider/policymaker educational efforts in pertinent areas (e.g., affordable prescription drugs, affordable housing, improved availability of health insurance, improved transportation, promoting healthy behaviors).

.Enhance coordination of community organizational efforts (e.g., leadership training, inter- organizational collaboration).

This is to emphasize the importance of strengthening health systems in building global public health security. To argue that many of the public health emergencies described in this report could have been prevented or better controlled if the health systems concerned had been stronger and better prepared. Some community find it more difficult than others to confront threats to public health security effectively because they lack the necessary resources, because their health infrastructure has collapsed as a consequence of under-investment and shortages of trained health workers, or because the infrastructure has been damaged or destroyed by armed conflict or a previous natural disaster. With rare exceptions, threats to public health are generally known and manageable.

Global cooperation, collaboration and investment are necessary to ensure a safer future. This means a multisectoral approach to managing the problem of global disease that includes governments, industry, public and private financiers, academic, international organizations and civil society, all of whom have responsibilities for building global public health security.

In achieving the highest level of global public health security possible, it is important that each sector recognizes its global responsibility.

In the spirit of such partnership, ministry of health urges all involved to acknowledge their roles and responsibilities for global public health.

The protection of national and global public health must be transparent in government affairs, be seen as a cross-cutting issue and as a crucial element integrated into economic and social policies and systems.

Global cooperation in surveillance and outbreak alert and response between governments, private sector industries and organizations, professional associations, academic, media agencies and civil society, building particularly on the eradication of diseases ,.. to create an effective and comprehensive surveillance and response infrastructure.

Open sharing of knowledge, technologies and materials, including viruses and other laboratory samples, necessary to optimize secure global public health. The struggle for global public health security will be lost if vaccines, treatment regimens, and facilities and diagnostics are available only to the wealth.

National systems must be strengthened to anticipate and predict hazards effectively both at the international and national levels and to allow for effective preparedness strategies

Professionals and policy-makers in the fields of public health, foreign policy and national security should maintain open dialogue on endemic diseases and practices that pose personal health threats, including HIV/AIDS, which also have the potential to threaten national and international health security.

Meeting the requirements is a challenge that requires time, commitment and the willingness to change.

VIII.IDENTIFICATION OF PLOBREMS &ANSWERS TO IMPROVE HEALTH CENTER RELATED ACTIVITIES

IDENTIFIED PLOBREMS

ANSWERS TO IMPROVE

· Insufficient qualified nurses

· Lack of knowledge concerning nursing process

· Insufficient materials

· Very Small health facility.

· Decreased minimum packet of activities.

· Short time of clinical practice this contributes to unaccomplishment of all objectives.

· Insufficient follow up of students due to low number of Kigali Health Institute supervisors.

· Problems related to accommodations.

· Increase a number of qualified nurses by recruiting others.

· Recruit other qualified nurses including those of high level and skills (nurses A1, A0).

· Continuous formation on medical innovation and new national protocols.

· Avail all basic materials by regular supplying.

· Request support from the sponsors especially ministry of health.

· Extension of health center thereby building unavailable accessory services.

· Facility extension, sufficient personnel and materials can be answers of this issue.

· Increase days i.e. duration of clinical placement so to allow students attain almost or even all their clinical objectives.

· Supervisors are overloaded due to follow up of many students at different sites i.e. students are not attended on time therefore they lost assistance from supervisors.

· Add to usual offered money for clinical placement.

· Give on time scholarship money.

First of all, we give thanks to the ministry of education, sciences technology and scientific research that always planifies the clinical placement for student future nurses.

For this, we greatly thank the Kigali Health Institute that sent us in clinical placement, muhima health center that received us kindly as well as our supervisors who were always available to support us.

This clinical placement passed well in warm & understood climate towards clients frequenting the health center, medical and non-medical team as well as our supervisors.

It was very important because it allowed us not only to attain almost our objectives but also to gain new theorical knowledge and practice in regard of nursing practice

According to clinical objectives, we gently inform you that some of them were not attained independently to our will.