Clinical report: community health assessment,cse of muhima villaga
par community clinical KHI student team
khi - bsn level 3 2009
FACULTY OF NURSING SCIENCES
DEPARTMENT OF GENERAL NURSING A0
ACADEMIC YEAR: 2009
REPORT OF CLINICAL PLACEMENT DONE
AT MUHIMA HEALTH CENTER
FROM 28 SEPTEMBER TO 23 OCT, 2009
SUBJECT: COMMUNITY HEALTH ASSESSMENT
Case of MUHIMA VILLAGE
SUPERVISORS: Chairman Kabile Museme
Kigali on23 Oct, 2009
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 enable preventive treatment and/or education to be provided.
-To help target prevention programs, identify care needs, and use scarce prevention resources efficiently.
-To evaluate the success of long term control efforts.
-To facilitate epidemiologic research to uncover a preventable cause.
-To assist with national and international disease surveillance efforts. For some diseases that are unusual
III.DESCRIPTION OF MUHIMA HEALTH CENTER
1. General description
Muhima health center is situated in Nyarugenge district, Kigali town
And is one of health centers that transfer patients to muhima hospital.
2. Technique and material resources
This health center receives resources from Rwanda ministry of health and non gornmental organization.
And care according to minimum activity packet as other health centers.
3. Human resources
We find medical staff and non medical staff with certicates
And no certified personnel are available.
IV.DESCRIPTION OF DUTY AND RESPONSABILITIES
Normally the work starts at 7:00 a.m by praying then nursing staff .the students have respected hours of work as following:
NB: - Pause I hour from 12:00 to 1:00 p.m
-student worked according to their clinical objectives
-both student and nursing team work together to care for the client
-they respected the HEALTH CENTER rules
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...
VI.DESCRIPTION OF TECHNIQUE: HOW WE HAD PROCEDED
To complete a community health assessment of the Muhima area.
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.
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.
The approach to this survey included the following specific activities:
1. Meet with community health agent (abajyanama b'ubuzima) in order to:
.Obtain input in developing the interview and focus group discussion guides
.Identify potential groups and individuals from whom to gather input
.Assist in survey coordination and scheduling
3. Based on the discussion, it was subsequently agreed that multiple methods of data
Collection would be utilized for the survey, including:
.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.»