Innocent T
Innocent T
BY
TUMUSHABE INNOCENT
UAHEB/DCM/121/20
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DECLARATION
I TUMUSHABE INNOCENT hereby declare that this health service management report
done at Kamwenge Health Centre III is my original work and it has never been submitted by
any other person or institution for academic purposes.
Signature................................................. Date................................................
TUMUSHABE INNOCENT
(Student)
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APPROVAL
This is to certify that the Health Service Management report at Kamwenge Health centre III
in Kamwenge town council, Kamwenge District done by TUMUSHABE INNOCENT
has been under my supervision and I hereby endorse it for submission to Medicare Health
Professionals College.
Name of supervisor:…………………………………………
Signature:……………………………………………………
Date:…………………………………………………………
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DEDICATION
This HSM report is dedicated to my parents (Mr. Sunday John and Mrs. Namatovu Mary
Teopista), my sisters and brother, friends and tutors for being such great companions during
my studies. This work would have not been a success without your enduring company, thank
you for the help, continued encouragement and advice during the entire academic journey.
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ACKNOWLEDGEMENT
I acknowledge the DHO of Kamwenge District, the in charge of Kamwenge health Centre III,
the clinical officer together with all the health workers at Kamwenge health Centre III for
their professional knowledge, support and guidance they offered to me during my stay at the
unit.
I thank the Almighty God for the protection, love and guidance who has always been with me
from the beginning of the program till now.
Great thanks go to Mr. Sunday John and Mrs.Namatovu Mary Teopista and family members
at large for the continued financial support and my friends and classmates for useful help
given to me.
Lastly I thank the school administration for scheduling this time for us students to acquire
knowledge and training opportunities in preparation for further academic experiences in our
medical profession.
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TABLE OF CONTENTS
DECLARATION....................................................................................................................................... ii
APPROVAL…………………………………………………………………………………………………………………………………………….iii
DEDICATION.......................................................................................................................................... iv
ACKNOWLEDGEMENT..........................................................................................................................v
ABSTRACT ...............................................................................................................................................x
CONCLUSION ........................................................................................................................................14
RECOMMENDATION............................................................................................................................14
APPENDICES………………………………………………………………………………………………………………………………………..15
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LIST OF ABBREVIATIONS
HTN Hypertension
DM Diabetes Mellitus
TB Tuberculosis
LAB Laboratory
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LIST OF FIGURES AND PICTURES
Figure 1: Shows the view and location of Kamwenge Health Centre III ................................1
Figure 2: Shows when filling the HIV exposed infants register ................................................4
Figure 3: Showing Immunisation...............................................................................................5
Figure 4: Showing clerking a of patients. ..................................................................................5
Figure 5: abdominal palpation and Listening to fetal heart rate ................................................6
Figure 6: Dispensing drugs ........................................................................................................7
Figure 7: showing damp dusting…………………………………………………………........8
Figure 8: Sorting different drugs and objects at MCH ………………………………………..8
Figure 9: Measuring blood pressure and pulse rate ...................................................................9
Figure 10: showing triaging exercise.......................................................................................10
Figure 11: showing counselling session at OPD …………………….……………………………10
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OPERATIONAL DEFINITION OF TERMS
Care: In medicine and public health a general term for the application
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ABSTRACT
Kamwenge Health Centre III was established due to the increased population in the parish
and the nearby villages in early 1990s to reduce on the transport and time burden faced by
patients who had to travel to Rukunyu Health Centre IV.
The health center has 15 government registered workers and it offers routine health services.
The health Center III serves several villages such as Rwemirama, kanyegaramire, masaka 2,
kaburaishokye, nsorora and kamwenge town parish.
During my stay at the health center, I was able to carry out the following activities; data entry
in to the HMIS record books, health education, dump dusting, immunization, administering
family planning methods, booking dispensing drugs, ordering relevant investigation,
delivering mothers, clerking and treating of patients among others. All these are clearly seen
in Chapter three of the report.
After and during these activities, I was able to obtain different skills, benefits, experiences
and lessons for example I was able to learn the HMIS books practically which are used to
capture data at the health facility, I was also able to learn more on how to administer family
planning methods, I improved on my clerking skills, immunization skills, treating different
diseases among others. These are stated clearly in chapter three of the report.
I faced various challenges throughout my stay at the health facility including hunger, long
distance from home to the health facility, traffic jam, harsh unfriendly health workers, denial
to work in some areas, bad weather among others. All these challenges with respective
solutions and my recommendation to various bodies including the facility and the
government are seen in chapter three of this report.
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CHAPTER TẀO: REPORT ANALYSIS
2.0 Introduction
This chapter consists of the following: back ground, location of the facility, vision and
mission of the facility, goals and objectives and the structure of the facility.
The facility didn’t have maternity services in the beginning due to the limited space, but after
land was acquired by the government with assistance from non-governmental organizations
like Baylor, this was added in 2020.
Currently, the health facility stands on about (3) Acres of land that were donated by
government funds and this has been fenced. Kamwenge Health Centre III serves all villages
in the parish and neighboring parishes.
The facility serves a catchment area of about 25000 people, treating up to about 30 patients
on average daily at outpatient department.
Figure 1: Shows the view and location of Kamwenge Health Center III
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2.3 Vision of the facility
Promoting quality health care to the community for a better health among people.
INCHARGE (SCO)
Assistant nurse 2
Support staff
2.8 Patients’ Flow Chart at Kamwenge Health Centre III
GATE
GBV OFFICE
IMMUNISATION
YOUTH
AREA
OFFICE
AREA
OPD WAITING
AREA
MCH AND INPATIENT
DEPARTMANT
STORE LABORATORY
ROOM
DISPENSARY
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CHAPTER THREE: REPORT DISCUSSION
3.0 Introduction
This chapter consists of all the activities that are carried out at the health Centre during my
attachment period. These include all the activities done by me in various departments I was
allocated in and also all the departments in the facility and the respective services provided
there.
Maternity
At the maternity ward, I assisted midwives during delivering and was given opportunity to
deliver some of the mothers, cannulated and resuscitated mothers before and after delivering,
health educated mothers on breast feeding, treated mothers who had various medical
conditions after proper history taking and investigation, attended CME meetings and
departmental meeting in maternity wing.
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Immunization
During my stay at the health Centre, I got involved in administering different vaccines to
babies for example rotavirus vaccine, measles-rubella vaccine, oral polio vaccine and others
especially on the day of mass immunization which was a Thursday. I was able to immunize
babies at birth and other neonates who were being delivered on the way as mothers came to
the facility for delivery.
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Health education
I was tasked to conduct health education talk for patients in the triage area on common ways
of disease transmission and control for infectious diseases. This improved my interaction
abilities with the patients.
The ART Clinic, I performed counseling sessions with the patients privately under guidance
of a counselor especially with the patients who were in default of poor adherence over the
ART drugs therapy. Due to the high level of privacy required, no photos were taken.
At the antenatal care unit
I did abdominal palpation for mothers to assess the fundal height, lie, presentation,
position and fetal heartbeat plus taking their vitals which included blood pressure,
temperature, and blood sugar levels.
I was involved in health educating mothers the necessary items that are needed to be
with during the time of labor, educated them to use family planning, having sex
during pregnancy, and reporting to the hospital in case of any danger signs plus
encouraging them to complete all the four antenatal visits.
I booked mothers on their first antenatal visit plus immunizing them against tetanus
those who had to get and recording them in the antenatal register book.
I screened mothers and their husbands on their first antenatal visit for HIV and
syphilis and revealed the results according to there will i.e. how each wanted to
receive his or her results
I measured and recorded blood pressure, MUAC and weight of mothers at their
antenatal visits so as to rule out malnutrition plus eclampsia and pre-eclampsia
administered and also assisted in family planning administration
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Figure 5: abdominal palpation and listening to fetal heart
At the dispensary
I administered drugs to different patients at Out Patient's Department with different medical
conditions, in the ART clinic drugs like tablets antiretroviral drugs, niverapine syrups, tablets
cotrimoxazole for prophylaxis against bacterial infections due to their suppressed immunity
and other drugs. At MCH I administered folic acid, ferrous sulphate, paracetamol and other
vital drugs for example sulphadoxinePyramethimin tablets.
Dump dusting
On a daily basis, I used to do dump dust in every ward that I was put for example in the
maternity ward, in the examination rooms at the OPD, patients ward and the consultation
room there by enabling me to create a clean environment that favors both the health worker
and the patients.
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Figure7: showing damp dusting
Attending CMEs
I attended and participated in the various monthly CMEs with my fellow students with
different qualified health workers and these were on different wards. By the end of the
practicum, I had attained more information about many conditions plus their management.
Laboratory unit
I was able to do different tests during the practice for example a blood slide, hepatitis test,
HTS. On addition blood grouping and other tests like urinalysis and mRDT. I was able to
collect samples from different patients.
Drug administration.
During my placement period I was able to administer different drugs to the patients with
different conditions such as intravenous artesunate to those with severe malaria and
administration IV Ceftriaxone and IV metronidazole to patients suffering from bacterial
infections, Ringers lactate and normal saline for dehydrated patients. However I didn’t get an
opportunity of getting pictorial evidence as most patients did not like it due to privacy
reasons.
Managing medical wastes.
During my stay at the health center, waste segregation was highly observed by the staff. This
enabled me to know which wastes are segregated in different colour coded bins accordingly,
where by the highly infectious were being put in the red bin for example cotton with blood,
less infectious in the yellow one and lastly those which were noninfectious were put in the
black bin. The sharps and ampoules were being put in the sharps box. The wasted drugs and
other pharmaceuticals were segregated into the brown bin.
Managing space.
During my placement I got well conversant with space management since before starting any
activities always I had to first sort, set, shine, standardize and sustain the environment so as it
eases my work when dealing with patients and avoid injuries that could result from
disorganization at the working place. Including also managing space in the drug store room
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Figure8: Sorting different drugs and objects at MCH department before work
Taking Vitals
I was able to take vitals at the OPD for example temperature, blood pressure, heart rate and
respiratory rate.
Triaging patients
At the triaging area patients came with their own books, assessed their conditions, and took
vitals such as temperature and blood pressure. Then triaged them according to severity of
their condition and the extent to which they are infectious as well as first come first serve
criteria.
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Figure10: showing triaging exercise
Counselling patients.
This was more in the ART Clinic and NCD clinic and at OPD where I counselled patients
with life threatening conditions which are for life and drug compliance so as to help them live
better life. I also carried mean mental status exam for the client who was HIV positive.
This handles patient treated coming from their homes thus going back after being managed
without a need to spend a night there.It operates on a 24hr basis and throughout the week. It
is headed by the clinical officer who works together with other clinical officers, registered
nurses, enrolled nurses and other paramedical. The department has other subsidiary clinics
which include;
A) ART clinic
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This is headed by a clinical officer who is assisted by two nurses. These handle patients
living with HIV/AIDS, due to a big number of people, the clinic works from Monday to
Friday every week activities here include Dispensing drugs, Counseling and testing, Treating
opportunistic infections, Order for relevant investigations like viral load, gene-expert and
CD4 cell count among others. The pregnant clients and those lactating are worked on every
Wednesday at the MCH department.
B) MCH clinic
This clinic combines the maternal and child health and it operates from Monday to Friday,
the activities carried out here include counseling, health education, immunization, family
planning and all antenatal services.
In immunization, pregnant mothers are vaccinated against tetanus and neonates and infants
are also immunized against all the killer diseases according to the immunization schedule.
I also managed to administer long term family planning methods like implanon and jadelle to
clients.
C) Pharmacy
This is where drug dispensing is done after diagnosis of patients and respective prescriptions
with different disease conditions are made; the patients normally present their medical forms
and books to the dispenser’s window who then issues the drugs according to the priscription.
The pharmacy also runs the whole week and drugs are free of charge but some people with
more complex conditions are required to buy some drugs that are not available at the facility
from private pharmacies outside the health facility.
D) Antenatal clinic
This is headed by a mid-wife. It operates from Monday to Friday. Activities like Family
Planning, assessing of pregnancies to detect any abnormalities, Pregnant women are given
mosquito nets to sleep in, vaccinated against tetanus, given iron tablets to prevent anemia and
Various tests are performed like urinalysis, RCT, RBS, RPR. Any sicknesses experienced
during pregnancy are treated for example malaria, diabetes, urinary tract infections and
hypertension. Other activities include measuring the fundal height, lie, presentation and
position of the fetus booking mothers, taking and taking vitals.
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CHALLENGES ENCOUNTERED
3.3 Introduction
This section consists of the challenges faced in the facility and how I managed to overcome
them.
Walking long distances to the health facility is a challenge since the health center does
not offer accommodation to students.
Shortage of water for personal use in the area and protective gear like face masks and
gloves at the facility which became a big risk factor to infectious diseases.
Language barrier was also a challenge since the hospital receives some patients who
can’t understand runyakole language and English making communication difficult
during clerking and counseling sessions.
Hostility of some patients who could abuse us when they delay to receive their books
while others were in cooperative with us students plus undermining us.
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Over working was also a challenge due to a big number of patients received on specific
days like Mondays and Wednesdays.
shortage of transport means would delay me on the way hence reaching at the facility
late at times.
Failure to get assistance to take pictorial evidence for some activities and procedure for
example administering family planning methods, conducting health education sessions,
drug administration and conducting deliveries.
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CONCLUSION
During my stay at the facility, I was able to do different activities like data collection,
assisting in deliveries conducting some deliveries, taking patients vitals, health education,
prescribing drugs, administering treatment, clerking and treating patients among others.
My overall experience at the facility was a very good; I was in position to gain more
academic exposure and get friends among the students and staff members who assisted me in
my learning. Am also glad for this time was organized by the school such that we can get
some experience as we reach the climax of our study program that would be very important
in our medical practice after completion of school.
RECOMMENDATION
They should ask the government to increase them on the supplies they are given that is both
drugs and laboratory supplies.
They should put more emphasis on health workers wearing their uniforms and a disciplinary
committee should be put in place for whoever does not follow.
The in charge of maternity should probe the in charge overall for water supply on the taps.
And also if possible the facility should be upgraded to Health center IV due to the increased
excess number of patients received and served.
The institute has to extend the attatchment schedule so that the students are able to visit
deferent departments and be well equipped with experience in the required practical skills.
The institute has to assist its students on choosing better places for carrying out better
internship exercises.
The institute should facilitate the students with some equipment necessary for the internship
exercises at the health Centre they are attached to make sure they are working and being
taught by the health workers there.
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APPENDIX I: MAP SHOWING THE LOCATION OF KAMWENGE HEALTH
CENTRE III
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APPENDIX II: WORKPLAN
OPD
ART
ANC
FAMILY
PLANING
IMMUNISATION
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APPENDIX III: BUDGET
TOTAL 212,400
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APPENDIX IV: INTRODUCTORY LETTER
KAMWENGE DISTRICT,
TO THE INCHARGE
KAMWENGE DISTRICT.
Dear Sir/Madam,
I Tumushabe Innocent a third year student pursuing a Diploma in Clinical Medicine and Community
health at Medicare Health Professionals College.
As part of my training, I am required to carry out health service management training at a health
center and at the end of it submit a detailed report for the award.
I therefore humbly request to be attached at the above health Centre III to be assisted in all ways
possible.
Yours faithfully,
.............................................
TUMUSHABE INNOCENT.
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