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12/15/1970 - Rural Health by George Jones

NOT FOR PUBLICATION INSTITUTE OF CURRENT WORLD AFFAIRS GJ Rural Health December Box Nairobi Kenya R H Nolte Institute Current World Affairs Fifth Avenue New York lOO17 Dear Nolte There approximately doctors Kenya Computed population figure million ratio doctor patient approximately O00 With knowledge ratio States O00 enormity doctor patient imbalance somewhat shocked I called theattention Kenyan medical friends assuming would share concern replied ratio actually represented uniform picture whole country would pleased Kenya development uoting recent survey report prepared medical conference Uganda informed doctor patient average rural areas Of Kenya I Dravel country regions Kenya I longer surprised people never doctor In spite these however people Kenya geographical areas experiencing increase medical services The rural areas especiall experiencing rowth because increase number doCtors coming their locales because increased emphasis training paramedical teams Not surprisingly because their emphasis rural medicine these preprofessionals found effective general practitioner In short delivery services rural areas longer rests solely doctor shared under direct indirect supervision medical officers The usually consists following personnel medical assistant enrolled nurse enrolled midwife health assistant In health centers medical assistant assumes administrative responsibilities organization including coordination activities staff community other major medical facilities As practitioner found patient clinic treatingcases which severe enough admit hospital During crises professional cannot summoned known administer compl treatment including appendectomies tooth extractions In those cases where hospitalization indicated favor medical enerall makes referral GJ After completin seven years formal education having passed East African Certificate Education Examination person eligible begin medical assistant training The program lasts three years Coursework includes anatomy physiology microanatomy physiology pathology microbiology parasitology medicine surgery maternal child health public health I surprised courses administration omitted since great portion medical assistant spent Course content evaluated medical authorities Kenya The program midwife enrolled nurSe lasts thanthat medical assistant In order qualify entry should completed Standard VII passed Certificate Primary Education Examination The enrolled nurse important member medical especially patient follow Nurses people maintain contact patient likel overwhelmed demands associated getting In addition enrolled nurses often callad diagnose treat clinic assist medical assistant during emergencies In special cases unpleasant disposing contaminated refuse added activities The sterilization medical equipment falls under urview The focus enrolled midwife contrastinl being mothers babies Her attention directed prenatal postnatal delivery Over babies Kenya hospital facility considerable change which taken place years This rising percentage account decrease infant mortality which heretofore comparison other countries In addition around birth process midwife gives minor assistance treatment Stressing preventive approach medicine holds educational classes rospective mothers mothers Her training broader extensive Of enrolled nurse The health assistant contrast other members health center group concerned mainly environ mental aspects health The cleanliness enVironment subsequently immunizatio problems challenges He interested seein water available people I couldn think about Bayou project GJ I atched health assistants function Because comes contact general public greater extent health assistant becomes valuable resource towards making referrals different clinics especially cases T B leprosy In order action I spent considerable rural Nairobi different health centers The impressive staffed health center operating basis Karuri National Qeference Health Center Karuri fortunate trained medical officer chare D J Eagia Dr Kaggia raduated medical school akerere Uanda deree trained worked advance medicine England Scotland siderable period He _Karui since inception The original Cnter according Dr Kaggia threefold promote research treat outpatient basis teachin atmosphere prospective medical personnel The Center built funds Kenyan Government supplemented funds Rockefeller Foundation UNIEF The Service Unit which prominent current affairs Center built monev Kiambu County Council local legislative The Cnte operational funds solely Government The staffing Karuri approaches almost ideal situation curentl medical officer health inspector medical assistant enrolled nurses health visitor enrolled midwife hospital administrative assisant Clerks drivers cooks The Karuri Health Center actualit clinic clinic other health centerswhen faced organiza tional functional problems encourage present Karuri assistance resolution This Center Kenya The Center onda2 hrough Friday until Saturdays Emergencies since medical officer student personnel grounds Special clinics handicapped children antenatal tuberculosis interspersed throughout Unlike clinics rural areas Earuri building designed specifically delivery health services The problem which constantly however space Under extenuating circumstances clinic seems service oriented originally planned The research aspect especially developed magnitude oiginal plans The teaching Center routinely includes student nurses health visitors health inspectors medical assistants They required government regulation spend designated period Center learn about operaion clinic Well garner practical enceworking wananchi country I learn great being observer clinics around rural Kenya Driving centers mornin I usuall women infants strapped their backs frequently accompanied toddlers walking gingerly clinics hopes getting quick servic bybeing first queue Some ladieswalk miles receive service themselves their children On occasion wearing white original color cloth around secured pieces ngcasually strolled clinic waited several hours gresented problem medical assistant Although casual medical assistant described scene surface situation being serious Thi woman suffering panda which quite severing blood vessels process In addition blood there danger infection It amazing without collapsing The patient least excited explained local healer already taken reason visit child coughing quite severely Sickness rural areas social economic problem physiological Young instance rarely frequent Center patient usually complains backache enjoys sitting around conversing people surrounding areas doesn often GJ Dr Kaggia Health Assistants attending refresher seminar GJ Young seriously injured The possibility their losing being absent gives sickness secondary priority In mothers reluctant visit Center their knowledge familiarity clinic increases hesitancy abates As I asked about health problems different groups I found different those ailments found rural States Children between suffer mostly congenital coughing diarrohea vomiting The group between affected kwashiorkor malnutrition worms accidents infection worms The school child generally plagued coughs Colds abdominal The total group share trouble conjunctivitis trouble tonsillitis During puberty adolescence there significant areas complaint Tere noticeable increase gonorrhea other venerealdiseases people frequenting urban areas victims venereal diSeases remain unaware source Karuri recently launched program education conjunction local school hopes increasing knowledge these future visitors Of disconcerting problems faced Karuri nutrition perplexing The number under children clinic constantly large Fre quently children being something immunizations general checkdp problem malnutrition detected During coffee harvest problem highest surrounding Karuri The cycle mother variable associated nutritional neglect children others generally considerable distance their leave early result breakfast often meagre sometimes The lasts until around evening which results preparation evening Subsequently order quiet hungry children eaten mother often stops local shops picks bread snack After oetting water necessary aration finally after prepaing almost The children exhausted general activity tired missed opportunity substantial This procedure continues daily until child noticed someone familiar symptoms kwashiorkor This living pattern echoed repeatedly centers I visit In addition logistical factors ignorance important element contr butin malnutrition mothers importance feeding child something enjoys uSually sweets instead maintainin novel practice balanced Consequently children limited source Poverty contributing factors malnutrition syndrome There wananchi Who compelled exist daily mouth basis The three shillings barely enough children anythin alone rounded cuisine This especiall holds those people children school School quite often uniforms budoeted duing course To casual observer problem malnutrition might appear minor other exigencies developing country alnutrition nevertheless singled three killers children East Africa The priority given clinics Karuri founded In order motivate teach different styles preparing encourage foods Center gives families stock basic ingredients monthly It consists pounds bulgar wheat cooked pounds The amoUnt given based number children household Although everyone recognizes gesture token momentary relief proper nutrition needy families One newer programs incorporated health centers around Kenya Family Planning Duing course travels Family Planning program which I followed continued interest Three clinics I visited different staes proress respect their Family Planning pogram At Karuri program established functionin smoothly The program Tigoni health center rural within commuting distance Nairobi functioning several months A shortage staff limited effectiveness The newest clinic which I traveled openin located Kamae Forest approximately fifty Nairobi bamboo forest region highlands The Nutr tionist The desire learn strong How GJ Family Planning methodological chalIenge medical authorities philosophical obstacles mainly because understanding basic behind planning people including those ultimately responsible instituting peogram family planning method strictly people having children because space Kenya whole means populated these sceptics estioned necessity program The burden selling Family Planning program actual teaching pocess involved fallen mainly shoulders expatriate doctors doctors undercontract UNICEF International Planned Parenthood Federation Once doctor playing major bringing family planning information skills rural health centers Dr Fitzroy Joseph Dr Joseph English American trained physician responsible fourteen health clinics where practices family planning He numerous classes where expresses philosophy behind planning process teaches techniques depending level Of experience personnel Thus I attended lectures given nurses training school students medical assistants Dr Joseph called visiting physicians different parts Kenya abreast latest techniques supplies conncted Family Planning Kenya going through natural evolution attempt adopt Family Planning national basis H0wevee point development appears selling preceded implementation great margin ihenever I visit health centers Dr Joseph often hundreds women aiting served Sometimes I think because Of newly persuaded husbands change their minds At Kamae forest example constant vigil outside clinic enever would appear outside would immediaely escorted husband seemingly bombarded questions VeF often because eagerness really works females themselves pregnant because heeded caution especially operates cycle basis initiate process certain period The whole question prefer I U D injection contraceptive means interesting GJ Righ Belo Dr Fitzroy Joseph miles Above Left Treating ladies Kamae Forest GJ The monthl injection apDears pooular methods because follow regular basis being offered women urban The needle attraction people East Africa would interesting study Many nothing really accomplished until stuck harde better The ranks second priority listing It however drawbacks heavy schedule erratic daily patterns women routine taking somewhat difficult In order compensate errors associated stoppin starting during month olacebos added which means taken every The I U D becoming popular women exper ience their friends Usually adventurous woman The simplicity countered bleeding which sometimes occurs during initial stages The assurances however doctor midwife dispelled anxiety associated occurrence It obvious Family Planning still infancy hopefully attention receiving great gains experienced distant future The whole topic rural health interesting pursuit number months which never quite complete Each I filled interesting information I shall certainly continue explore facets Hearin concern interest Flying Doctors Association Kenya invited accompany month their round missions AfSer stocking supply Dramamine pills mosquito repellant I shall eagerly sieze opportunity Sincerel George Jones Received New York January