THIKA SCHOOL OF MEDICAL AND HEALTH SCIENCES

DEPARTMENT: HEALTH SCIENCE

MAYIAN NTEESE LESAITA

DCHD/S-0092/THI/21

ATTACHMENT INSTITUTION: ONG’ATA RONGAI SUB COUNTY HOSPITAL

TASK: ATTACHMENT REPORT

HOSPITAL SUPERVISOR: HELLEN MATERO

DECLARATION

I hereby declare that the presented report of field attachment is uniquely prepared by me after the

completion of 3 months’ work at Ong’ata Sub county hospital.

MAYIAN NTEESE LESAITA

DCHD/S-0092/THI/21

SIGN…………………………..

SUPERVISOR;

MARY WANGUI NJUGUNA

SIGN ………………………….

DATE …………………………
ACKNOWLEDGMENT

I acknowledge all staff at Ong’ata sub county hospital. lt was a memorable one for me as it was rich in

experience sharing and helped me discover my potential. I have had so many rich experiences and

opportunities that I personally believe will forever shape and influence my professional life while fostering

personal growth development.

This report would not have been possible without the contribution and collaboration of others. My sincere

gratitude:

● To Almighty God who granted me good health during the attachment period

● To the County government of Kajiado for endorsing my application for attachment

● To the Head of Department Mr Mokaya and my supervisor for her technical support and constant

supervision which contributed immensely to my personal development

● To all my lecturers I thank them for their guidance and equipping me with knowledge and skills

● To the public Health department of Rongai led by for giving me a chance to go for field work

where I was able know the community need

● To Ong’ata sub county hospital fraternity led nurse in charge of all students who spared no effort

in ensuring I met my objectives

● To my lovely parents and friends for their ongoing support and love.
LIST OF ABBREVIATIONS

CHW – COMMUNITY HEALTH WORKER'S

CWC_ CHILD WELFARE CLINIC

CCC – COMPREHENNSIVE CARE CENTRE

MCH – MATERNAL CHILD HEALTH

ANC – ANTENATAL CLINIC

FP – FAMILY PLANNING
TABLE OF CONTENTS
THIKA SCHOOL OF MEDICAL AND ............................................................................... i
DECLARATION ........................................................................................................................ ii
ACKNOWLEDGEMENT .........................................................................................................iii
ABSTRACT .............................................................................................................................. iv
CHAPTER ONE ......................................................................................................................... 1
INTRODUCTION ...................................................................................................................... 1
MISSION STATEMENT............................................................ Error! Bookmark not defined.
VISION STATEMENT .............................................................................................................. 2
OBJECTIVES............................................................................................................................. 3
CHAPTER TWO ........................................................................ Error! Bookmark not defined.
WORK EXPERIENCE ............................................................................................................... 4
ORIENTATION ......................................................................................................................... 5
MATERNITY............................................................................................................................. 5
OUT PATIENT .......................................................................................................................... 9
EMERGENCY ROOM ............................................................................................................. 10
GENERAL WARDS ................................................................................................................ 10
COMPREHENSIVE CARE CLINIC ........................................................................................ 12
CHAPTER THREE .................................................................................................................. 15
MY ANTICIPATION AND THE STAFF ................................................................................. 18
ISSUES AND PROBLEMS ENCOUNTERED AND THEIR SOLUTIONS............................. 19
CHAPTER FIVE ...................................................................................................................... 19
EVALUATION OF THE PROJECT ......................................................................................... 20
OBJECTIVES........................................................................................................................... 21
SUCCES /................................................................................................................................. 21
RECOMMENDATIONS .......................................................................................................... 22
REFERENCES ......................................................................................................................... 23
ABSTRACT

The clinical and field attachment I undertook was to enable and orient me as a student on real life situation,

experience and also to know how to solve problems. This consists of the theories I learned in class into

practical real life situation. This exposure not only prepares me mentally as a student but also it's a great

opportunity to gain knowledge. My attachment was based at the Ong’ata sub county hospital. The

attachment process mainly involved all community health concerns and briefing with partners and

stakeholders which I have finalized in my attachment report.

CHAPTER ONE

INTRODUCTION

Ong’ata Rongai sub county hospital is a government hospital located in Kajiado County. It operates both inpatient

and outpatient departments

OBJECTIVES

● Surveillance for communicable disease

● Health education and promotion

● Enhance health and safe housing

● Enforcement of public health and other related laws

● Enhancing healthy and safe working environment

● Ensure safe handling and disposal of waste

● Ehance rehabilitative and supportive system to the community.

KEY PLAYERS

The major players that I got an opportunity to interact with and helped me in one way or another include;

Nutritionist…their main roles were:

● Administering nutritional supplements

● Conducting nutrition counselling

● Carrying out nutrition assessment

● Developing a follow up plan for patients

● Creating awareness on lifestyles diseases like diabetes, obesity and others

Nurses…their main roles were:

● Continuation of clinical care of stable patients

 ● Training of community and home treatment support counselling

● Taking care of the sick

● Giving medication to the patients

● Injecting the sick

● Vaccinating children and pre natal mothers

● Family planning

● Operation of teenage clinic

Community Health Workers…their main roles were:

● Inspection of premises if its compliance with public health requirement

● Enforcing laws and regulation that protect health and ensure safety

● Identify and investigate health issues and health hazards in the people

● Surveillance for communicable diseases

● Ensure safe handling and disposal of waste

● Enhance health and safe housing

● Enhance rehabilitative system and supportive system to the community.

CHAPTER TWO

WORK EXPERIENCE

The hospital operates from all through from Sunday to Saturday. The doctors and nurses alternate in shifts

depending on the timetable set by the management. The hospital staff holds a CME meeting every Thursday from

8.00am to discuss their state problems that occur in the institution amongst themselves and they come up with

recommendation for the hospital. Health practioners from the facility give health talks on what they are best at to

improve the services and practices done in the hospital.

MISSION

To provide effective leadership and participation for quality health and sanitation services that are for quality

health and sanitation services that are equitable response accessibility and accountability to Kenyans.

CHAPTER TWO

AREAS COVERED DURING ATTACHMENT

ORIENTATION

I was taken through orientation in various departments including various sections in the hospital.

The objectives of here included;

 To gain experience in my career of choice as a scientist, area ofspecialization being in the

laboratory.

 To get exposure on the kind of tools used in laboratory and field works.

 To put into practice the theoretical knowledge gained at school.

 To be well braced with the challenges that come within the career and sharpenproblem solving skills
while mitigating and dealing with them.

 To make contacts with prospective future employers.

OUT PATIENT
I went to the outpatient department where I was posted at the triage.

At the triage I basically took vital signs and clinical history of patients who were coming in. vitals of a person tells

a lot about how they are feeling and can be treated. I also learnt to differentiate patients who are at risk and require

immediate care through their vitals. I learnt about the following vitals

 Blood pressure ( days 100 –130 is normal) ( sys 60—80 normal)

  Blood sugar ( 4—8 normal)

 Temperature ( 36—38 normal)

 Pulse rate ( 65—80 normal)

 Respiration ( 18—22 normal)

 Sp02 ( 90—100 normal)

EMERGENCY ROOM

I also went to the emergency room where casualties and patients who need urgent medical care are received.

In the emergency room I learnt how to:

 Administer and perform first aid to patients

 Administer drugs to patients who are unconscious

 Perform CPR

GENERAL WARDS
During this period I was sent to participate in the generals which include:

 Female ward

 Male ward

The wards were more challenging than I expected because I was dealing directly with sick people that were unable

to do anything, in the wards I encountered people with different diseases, and this opened my mind on the

prevention, treatment and management of different diseases

Being community health worker diseases prevention is my area of specialization. I interacted a lot with the doctors

during the ward rounds where we exchanged questions and curiosities

I also acquired skills of assisting the sick and making their life bearable.

The following skills were taught:

  Bed making

 Bed feeding

 Bed bath

 How to insert the N,G tube

 How feed the patient using the N,G tube

 Drug administration

 How and where to inject insulin

 CPR

 How to prevent bed sores

 Bed care, mouth care

 Functions and how to use the ECG machine

 Vital signs

 How to use the manual blood pressure machine

HEALTH RECORDS DEPARTMENT

This department keeps the record of out-patients and in-patient in files and daily register book for Patients. I also

learnt different MOH tools used in hospital including; MOH S14, MOH SI5, MOH S16 and MOH 100. The

department also helps in data management in the hospital. The importance of data management are helps in planning,

for future reference whereby the information can be traced in the records, enhances budgeting whereby the hospital

management is able to know the equipment required in the hospital, helps in forecasting where hospital management

is able to predict needs of the hospital in the hospital.

NUTRITION CLININC

My main objectives in this department included to know:

Importance of nutritional screening.

Roles of nutrition in managing non communicable diseases.

The department offers variety of services to patients with nutrition challenges which include overweight,

underweight, and obese and patients with chronic diseases like diabetes and hypertension. All patients with

nutrition challenges are offered with counseling on consuming a well balance diet. The department deals with

screening of children to determine those who at malnutrition risk and those who are not risk.. For children above

six months we advise on complementary feeding. When starting to give food to the child you should start with one

type of food at a time to observe allergy.

MATERNAL CHILD HEALTH CARE

IMMUNISATION

This is a program me in Kenya which deals with the immunization of children. I actively participated in

immunization at the MCH .Immunization is mainly carried out to prevent the young ones from being susceptible

to various diseases or acquiring certain infections.

DURATION TYPE OF VACCINE DISEASE

At birth OPV Poliomyelitis

BCG Tuberculosis

Hep B Hepatitis B

6 Weeks DPT Diphtheria, Pertusis, tetanus

HIB
 Hep B Haemophilae influenza type

Pneumococcal B

Rota Virus Hepatitis

Pneumonia

Rota Virus

10 Weeks DPT Diphtheria, Pertusis, tetanus

HIB Haemophilae influenza type

Hep B B

Pneumococcal Hepatitis

Rota Virus Pneumonia

Rota Virus

14 weeks DPT Diphtheria, Pertusis, tetanus

HIB Haemophilae influenza type

Hep B B

Pneumococcal Hepatitis

Rota Virus Pneumonia

Rota Virus

6 Months VIT A Vitamin A Deficiency

9 Months Measles Vaccine Measles

Yellow Fever Vaccine Yellow Fever

PENTA – Whooping cough, hepatitis B, Diphtheria, tetanus, haemophilus influenza

Vaccine management and storage

Vaccines are stored in a frozen ice pack and are arranged by different colors and according to their required

temperatures from the coldest past downwards. The color is used for easily identification of the vaccine. The order

in which vaccines are stored are as follows;

Blue: oral polio and ipv because it is sensitive to light and heat

Green: measles which is also sensitive to light and heat

ANTENATAL CLINIC

Is a Clinic that helps to detect problems during pregnancy and try to manage so that they do not affect health for

mother to the baby.

1st visit -16weeks

2nd visit-28weeks

3rd visit-32weeks

4th visit-40weeks

Nutritional Counseling That I Administered to the pregnant Mother's Include.

⮚ About taking good nutritious food eg fruits and vegetables.

⮚ Importance of taking IFAS.

⮚ Encouraged them to sleep under mosquito nets

⮚ Importance of exercise

FAMILY PLANNING CLINIC

Is a Clinic that consists of various

Methods of family planning which clients are free to choose eg Injections (Depo),Implants(Jadelle) Pills

and Intrauterine device.

I told clients the advantages of family planning

 ⮚ Helps in spacing children

⮚ Helps in preventing abortion

⮚ Helps in preventing early pregnancy

⮚ Improves family welfare

HEALTH EDUCATION AND PROMOTION

Health education is the act of delivering a talk demonstrating and discussing on health related topics of importance

to an audience which knows little or nothing concerning the given topic. When delivering health talk to certain

issues are observed in order for the content to be understood and comprehended they include;

⮚ Use of simple language which is easy to understand avoiding medical terminologies which can turn off the

audience.

⮚ Loud and clear

⮚ Maintain eye contact with the audience shows you are with the audience and also you get to attract there

attention

⮚ Use of teaching aids such as food models, charts etc. to enhance understanding

⮚ Giving relevant information that will satisfy the need of the audience

⮚ Being time conscious

Example of health talk I was able to deliver at the ANC and MCH include;

Mothers were educated on dangers signs during pregnancy and these are

❖ Vaginal bleeding

❖ Fits

❖ Severe abdominal pain

❖ Very pale

❖ Fever

❖ Reduced or no fetal movement

 ❖ Getting tired easily

❖ Swelling of the hands and face

❖ Breathlessness

Mothers were advised to seek medical help in case they may notice any of the above signs also told to share the

same information to others.

During their pregnancy they were advised to;

❖ Eat balanced diet

❖ Eat plenty of fruits and vegetables

❖ Take dietary supplements such as iron and folic acid tablets

❖ Visit ANC clinic at least 4 times

❖ Once they deliver they should bring their babies for immunization

Other health education and promotion activities we conducted in Osupuko village where we taught the community

on the importance of building latrines to avoid the transmission of diseases such as cholera and typhoid. We also

taught the community on the importance of treating water before drinking by boiling or using chlorine or aqua

tabs. We taught the community on the importance of pregnant mothers delivering in hospitals and the different

ways in which we can prevent the transmission of HIV/AIDS. They were also taught the different ways of family

planning and their importance.

In every house hold we placed leaky tins outside every toilet which was to be used for washing hands after visiting

the toilet.

MEDICAL LABORATORY

In the lab section there are different types of test that are carried in the lab i.e. malaria, urinalysis, Hb level, VDRL,

typhoid and pregnancy test. I was able to learn how to perform some of the test including microscopic use and
Pylori. Specimen were being collected from individual examined results and given back to the patient. Waste

segregation and cleaning of the slides is also carried out.

Medical examination of food handlers

Food handlers are individuals employed directly in the production, preparation and service of food stuffs while

medical examination request form is where food handlers are examined to ascertain fitness to work in food

establishment. Investigation being carried out in the lab included;

I. Blood which was a test for VDRL

II. Stool for testing ova/cyst

III. Urine to perform urinalysis

IV. Full haemogram

V. Blood sugar level

Once the medical examination has been carried out food handlers are issued with food handler certificate which is

being renewed after every six months.

COMPREHENSIVE CARE CLINIC (CCC)

Objectives

To reduce morbility and mortality rates related to Hiv/Aids

To create Hiv free generation by 2030

Eliminate mother to child transmission.

During the placement period in ccc I participated in

● Taking diet history

● Giving health talk

● Dietary counseling
 ● Distribution of supplements

● Anthropometric assessment e.g. weight, height by determining the BMI

WASTE MANAGEMENT

Management of hospital waste

Medical waste is infectious and hazardous; posing serious threat to environment and peoples health and requires

specific treatment and management prior to its final disposal. In the facility I was able to visit the waste

management site and involved the following process;

Starts from the source

Segregation of the waste which is basically the separation of entire waste generated in the facility keeping different

kinds of waste separated in defined waste categories. The MOH recommends waste segregation into the four

categories;

▪ General waste – which include things like papers and plastic which were kept in black bin

▪ Highly infectious i.e. anatomical waste, teeth, placenta, sputum container were kept in a red bin

▪ Sharp waste i.e. infusion set, broken slides, scalpels, needles, blades were kept in safety boxes

You collect Labelle then transport to a transfer station where they will latter be incinerated or burned.

Incineration is the process of destroying pathogens and toxins by burning under high temperatures to reduce the

volume of original waste by +95%.waste is converted into ash.

Management of hospital waste is supervised monitored and inspected by public health officers based in the

hospital as well as hospital cleanliness in terms of sanitation and to ensure the safety of the workers their

occupational safety is taken into consideration by provision of protective clothing such as masks, dust coats,

gloves and gum boots. Waste management in hospital is a daily activity and this ensured by the hospital

management.

PROPERTY/PREMISE INSPECTION
Inspection was being carried out for the following reason;

● Routine compliance

● Follow up / re – inspection

● Complaint

● Emergence response

SOLID WASTE

This is the systematic control of generation, collection, storage, transportation, treatment, recovery and disposal of

solid waste. The 3 ‘Rs ‘are important in waste management; Reduce Reuse and Recovery.

Types of solid waste

● Domestic waste

● Commercial waste

● Institutional waste

● Industrial waste

There are many classification of solid waste, but the most common classification of solid waste is as follows;

● Infectious waste

● Noninfectious waste

Noninfectious waste are also non toxic. The waste are collected by small trucks taken to transfer stations which is

easily accessible and slightly closer to residential dwelling.

Infectious waste

They are classified as hazardous waste because they can cause toxicity, harm, severe infections etc.

Example of hazardous waste in a health care facility

⮚ Used syringes, needles and other sharps

 ⮚ Culture stocks and slides of infectious microorganism

⮚ Isolation waste

COMMUNICABLE DISEASES

Communicable diseases are diseases that are transferred from one person to another. They are caused by

microorganisms such as bacteria, viruses, parasites and fungi which can be spread directly or indirectly.

Examples of communicable diseases are;

❖ TB

❖ HIV

❖ Flu

❖ Hepatitis B

❖ Ebola

CAUSES

✔ Direct contact physical or direct contact with an infected person such as touch (staphylococcus) sexual

intercourse (gonorrhoea, HIV) fecal /oral transmission (hepatitis A) or droplets (influenza)

It might be through person to person, animal to person or mother to unborn child.

✔ Indirect contact- contact with a contaminated surface or object may cause the disease. It may also be

caused when touching contaminated handles and doorknobs.

✔ Food contamination ingestion of contaminated food or water may cause diseases e.g. food (salmonella

,E.coli) or water (cholera)

✔ Insect bites or animals which may cause diseases e.g. mosquito which cause malaria and vector for yellow

fever and flea which cause plague.

✔ Travel through the air such as tuberculosis or measles.

PREVENTION

● Always wash your hands

● Handle and prepare food safely

● Clean and disinfect commonly used surfaces

● Sneeze or cough into your sleeves or handkerchief

● Get vaccinated

● Don’t share personal items

● When infected take medications and eat healthy

● Use protection when having sexual encounters to prevent HIV or abstain

● Sleep under treated mosquito nets

TREATMENT

Use antibiotics for bacterial infections

OCCUPATIONAL HEALTH

Occupational health focuses on the physical and mental wellbeing of employees in the work place. It prevents

workers from work – related illness and injury that may occur during working hours. Its main objectives are;

1) Maintenance and promotion of workers health and working

2) Improvement of working environment environment into a conducive safe and healthy environment

3) Develop work organization and working cultures

MEASURES TAKEN AT WORK PLACES TO PREVENT INJURIES AND DISEASE ARE;

▪ Wearing of gumboots if you are working at factories to help prevent injuries to them, and reduce the

severity of injuries that may occur in the workplace. The foot is the most valuable part of your body

subjected to injury in industry.

 ▪ Wearing of masks and gloves when handling equipment and surfaces. Gloves prevent infection that may

enter through your hands especially if you are working in a hospital laboratory may prevent you from

contracting infections when handling specimen.

Masks prevents inhalation of harmful gases that may arise from chemicals or fumes from machines hence

preventing yourself from respiratory infections.

▪ Wearing of protective gear e.g. apron which may prevent chemicals from slitting onto your clothes or even

skin which may cause corrosion to your skin.

▪ Workers who work at factories where there are rotating turbines are

▪ Recommended to wear tight clothes because when the turbines from machines rotate it may cause injury

when rotating by catching your cloth leafing to injury or even death.

CHAPTER THREE

CHALLENGES ENCOUNTERED

1. Unfriendliness and lack of cooperation from the public. At times some clients fail to cooperate with the

health officers by refusing to pay the revenue or even failing to comply with the public health laws and

regulation such as the public health act cap 254 food hygiene act and act 242 among other laws of Kenya

but the solution to this is enforcement of the laws as it required and needs total seriousness and strictness of

public health officers in their duties.

2. The cost of travelling to and from home was expensive at the long run.

3. Waste water management has been a major problem in the entire county due to lack of a sewerage plant but

the solution to this problem is to ensure that each person contain their own sewage by constructing a septic

tank as well as a soak pit to prevent causing nuisance to the public.

 4. There was limited activities in the area of field work hence did not get that much activities in the field and

due to being many students we had to rotate going to field work thus limiting students to less fieldwork

activities.

CONCLUSION
The project was a success learning process where I learnt through tutorials, direct learning, simulation and case

studies .I is able to;

 Conduct community entry

 Carry out community diagnosis

 Learn and implement community health strategies in the prevention and control of diseases

 Carry out referral services for disease prevention and control

RECCOMMENDATION

1. I would like recommend that the health officers in Ong’ata Rongai sub County to discuss with their leaders

so as to establish a conventional sewage treatment plant to minimize liquid waste problems and establish of

a recycling plant to manage the waste produced and better methods of waste management because it is not

the problem of an individual rather a public problem.

2. I would also recommend that attachment students should be given a transport system so as to reach out to

the people of community and to create awareness of various issues affecting them.

3. I would also recommend for the introduction of more field work activities so as to enable more exposure

and experience to the students especially community health students who need the outside and community

exposure
REFERENCES

 College Logbook

 National school health policy handbook by ministry of public health and sanitation and ministry of

education

 Mother Child booklet

 Ong’ata Rongai Sub county Archives