MUDANDALA ALL SOCIOLOGY SLIDE SEASON ONE

for DR.GIBOLE

Appreciation to all BSC-N 1 2022/2023

QUESTION:
To describe how medical sociology has developed
and evolved as a field of study.
INTRODUCTION
Medical Sociology: Is the branch of sociology that is concerned
with the study of the social factors /facts ,health and illness and
the social behavior of health personnel and all those who are
consumers of health . Medical sociology is also refers as health
sociology. Social factors may include , class ,race ,gender ,religion
ethnicity , kinship network , marriage , educational
status ,age ,place , cultural practice.
Sociology: Is an academic discipline which is concerned with
the function, structure and the roles of social institutions and
social processes.

It is interested on analyzing how human beings interact

with one another and the forces that determine social
order/harmony in human interactions
EVOLUTION OF MEDICAL SOCIOLOGY

 Medical sociology was evolved in the late of 1940’s and early 1950’s
as a new social logical specialty field of study. This specialty like
theory, social stratification, urbanization, social changes and religion
had directed it’s roots. The early work in medical sociology were
carried out by physicians in the united states and not sociologists.
 After the close of World War II in mid of 19th century the expansion of
the National institutes of health and interest of private foundations in
interdisciplinary research stimulate and supported the growth of
medical sociology as an area of research and teachings.
 The major areas of investigation were sociology in medicine
where sociologists perform applied researches and analysis
of medical problems and on the other hand there was sociology
of medicines where the sociologists deal with research and
analysis of health from a social logical perspective.
 Finally
between 1970 and 2000 medical sociology emerged as a
mature sociological sub discipline.
THE RELATIONSHIP BETWEEN SOCIOLOGY AND MEDICINE

 The incidence of illness is to a larger extent determined by

social and cultural factors.
 It involves the study of social factors in disease aetiology ,
incidence, prevalence ,distribution , social response to
health and illness , therapeutic process and community
health needs
 Sociology provide a carefully study of all those who are
relevant in providing support during post treatment phase.
 It help to bring into focus understand and appreciate various
actors in the treatment setting such as physician,
pharmacists, nurses.
MAJOR CONCERNS /PERSPECTIVES OF MEDICAL
SOCIOLOGY
 It addresses how social stratification (gender, class, ethnicity and age) affects
patterns of health and illness behavior, illness risk, disability and other health
care outcomes.
 Social behaviors of patients and health care providers
 Include the study of health care organization and provision, encompassing the
changing structures of health care organizations and the social psychology of
health and health care.
 The health patterns of health services and their utilization
 The relationship between the healthcare delivery system to their health
policy and other social system.
THE IMPORTANCE OF MEDICAL SOCIOLOGY
 The following are the importance of developing medical sociology as a field of
study
 Critical rule social factors play in determining or influencing health of
individuals, groups and large society.
 Enhancement of social factors on the aspects of disease prevention and
health maintenance.
 Helps in assessing and describing the way individuals react to illness in order
to anticipate how they will be defined from the view point of their social and
cultural group in society.
 Enable us to understand how much cultural values affect health.
 Aids at looking the role of social institution in medical care to the illnesses.

QUESTION
With examples discuss how each of the
following influence the socialization process in
children.
• Family
• Peer groups
• Media
 SOCIALIZATION
Is the process of making someone social and fully human or more
appropriate. OR
Is the process beginning during childhood by which individual acquires
the values, habits and attitudes of a society.
Socialization process becomes possible due to the presence of some
agents that help to socialize people in different situations and places,
these agents are known as socializing agents.
Socializing agents, are combination of social groups and social
institution that provides the first experiences of socialization, these
groups include families, schools, social media, religious groups and
peer groups.
The following are the factors that influence
socialization process in children
FAMILY
Is the group of people who are closely related to each other. The family
members may include mother, father, children's and other closely
relatives.
 Therefore children's can socialize from these members of the family in
different ways so as to be accepted in the society .
 Childrenlearn how to be social through listening, hearing and adopting
from family members in their actions and activities they do.
 The following are ways in which family influence socialization in
children
 Infamily children learn to speak mother tongue from the
family members for example in Sukuma tribe childrens
are taught to speak Sukuma language since they are
young
 Family enhance personality of children through behaviors
expressed by family members
 Children can know their culture, norms and values
through learning daily from their family members.
 Family teach children to know their responsibilities
according to their gender.
 PEER GROUPS
Are the groups of people who are similar in age, social status
and who shares the same interest.
Peer groups influence socialization in children as follows
 Peer groups foster self exploration, children begin to make
decision and participate in activities that allows them to
express who they are.
 Peer groups also affect children's interest, beliefs, speech
and behavior. If the child interacts with good peer groups
with good behaviors and skills then the child will tend to
develop those good behavior and skills and will practice bad
habit if he contacts bad peer group.
 SOCIAL MEDIA
Media distribute information to wide audience via mobile phones,
television, newspapers and radio.
 Social media plays a wide range of socialization through listening
and watching these medias.
Media play role in socializing children in different ways including
the following
 Through watching television programs children can learn different
things and become knowledgeable.
 Social medias like watsapp, facebook, twitter and Instagram also
plays an important role in socializing children where they find new
friend from different places in the world who interect with and gain
experience in their life
Cultural factors that influence ill health
and illness behavior

 To start by defining culture according to WHO;- is the

state of complete physical, mental and social
wellbeing and not merely the absence of disease
illness and infirmity.
 But illness is the abnormal functioning of the human
body without pain.
 It may be due to disease or infection.
 While culture is the total way of life.
 The health status of the people in certain specific
society is purely determined by their cultural
practices in such society.
 In some societies, people practices cultural practices
like food taboos which involve restricting certain
members of the society from eating certain kind of
food, so due to this reason it may lead to health such
group members becoming weak and hence illness.
Food taboos;-
 It is cultural practice that refers to restricting people
of certain kind For Example, pregnant women,
children or girls and boys from eating specified foods.
 For Example some societies restrict women from
eating fish, because they believe that the fish are
only for men. Some restrict meat eating .
 Restricting people eating such kind of food will make
such group suffer from certain disease hence illness.
 Factors cont.….
Umbilical cord treatment;
 After delivery the umbilical cord treatment varies from
society to society.
 Some uses the cow dung to clean the umbilical cord. For
example among the Sukuma and maasai people

 This
is not healthier since it can cause infections like
tetanus to young babies hence illness.
Factors cont.…..
Polygamy;
 This refers to the act of legally possessing multiple sexual
partners. It is common in many societies across.
 For Example in India and almost across all African societies.
Polygamy is taken as a cultural practice that give a sense of
honor or respect.
 This cultural practice is not good since it may lead to sexually
transmitted diseases like gonorrhea, syphilis and HIV Aids.
 Therefore ill health and illness behavior.
 Factors cont.….
Female genital mutilation;
 This
is a cultural practice that involves partial or total
removal of female genitalia part by using knives or razor
blades.
 Eventhough it is not still common, there are still societies
practicing it secretly.
 Actuallyit is not a good cultural practice since can also
lead to STIs and other infections hence ill health and illness
behavior.
 Factors cont.….
Forced and early marriage

 Early marriage is any marriage conducted below the age of

18 years , while forced is a marriage where young girls are
forced to get married for the purpose of acquiring wealth
or bride price.
 It is normally taken as a practice that gives respect to the
girl family.
 Thispractice is not good because it can cause health
complications to the young ones.
INTRODUCTION
Ill health Is the state of having a poor physical or mental condition.
This can be contributed due to Intrinstic or Extrinstic factors that can
be biological, psychological or social. Example stres,lack of sleep,
anger issues,anxiety,addiction,parasomnia,panic,depression,phobia
etc. Ill behaviour this is referred as the behaviours that an individual
engage in once they believe that they are ill in order to overcome that
situation. For instance when an individual feels sick, the process that
involves interpreting symptoms evaluating possible responses and
finally deciding on whether to try to alleviate those symptoms or to
ignore them.
The following are the social factor that influence Ill health.
 Poverty
Is a social condition that is characterized by the lack of resources
necessary for basic survival or necessary to meet a certain minimum
level of living standards expected for the place where one lives.
Lack of enough money to meet someone’s needs is a cause to ill
health since the person will be stressed on how to survive, and when
faced with sickness it become a challenge for medication. There
different levels of poverty and each individual in his or her own level
face ill health such as stress, anxiety and anger. For instance people
with absolute poverty face malnutrion diseases.
 Unequal access to health care
We can see that people living in rural areas and people living
in urban areas have different access to health care facilities.
This can be due to number of health facilities found in those
place and also we can see that some place there are plenty
health facilities but there is less number of health personnel
to meet the needs of the patient. Example shortage of
rehabilitations center for addicted people who use drug and
alcohol or shortage of counseling services to the depressed
people with anxiety and anger issues.
 Lack of health education
We speak of lack of health knowledge, experience and
information. Many of health as result of goes on and on, For
example breast cancer for women in Africa the statistics have
drastically increased especially the young girls living in the rural
areas, where they find for ignore as it is at an early stage because
they lack knowledge of how hard it is to treat it at late stage
many people live with ill health not knowing that they not fine
because they lack health education.
 Stigma
Can be defined as the state when someone views you in a
negative way because you have a distinguishing
characteristic or personal trait that is taken as an
disadvantage. For instance people suffering from HIV̸̸ AIDS
they get ill health due to the stigmatization from the society
they live in. Also many youth suffer much when hence
leading to anxiety, stress and anger another example can be
the albinos some societies isolate them and hence
experience depression and public embarrassment.
The following are the social factor influencing illness behaviour
 Age
Illness behavious is the undertaken by an individual who feels ill to
relieve that experience, it might be seeking for medical help other
strategies or dismissing the symptoms. Age is a factor influencing
ill behaviour they way 18years old will react different to how an
80years old person will react when they are sick, aged people take
immediate measures compared to a teenager. This because aged
person immune system is not the same as youth hence different
measures undtaken.
 Gender
In ill behavious men tend to tolerate and some time they tend to completely
dismiss the symptoms compared to women who immediately seek for
medication care. And this is due to the ideas that people have, men are seen
weak when they seek for medical help at an instant step.
 Family structures
How people are raised as grow up, there are various types of family that exist
in today society some family take immediately measure when a member is
sick this can be due to ability of easily afford medication or awareness of the
importance of being health. And there are some families that dismiss the
sickness until its critical.
 Social economic status
Wealthier society seek for medical care immediately after they
notice symptoms of sickness, compared to poor society this is
also due to ability of afford medication and the awareness of the
importance of being health.
 Education
When people have the knowledge experience and they correct
information on the importance of being health they take the
correct measure in overcoming the state of being ill. When people
are not aware of health education they tend to dismiss and ignore
the symptoms of sickness.
 Personal altitude
People differ in altitude when they found that they are
ill. this can be influenced by the either environment,
culture and personal behaviour or the role of
education for example one after noticing that is ill
can opt to attend at hospital because of awareness
possessing but another can use local medicine to
overcome illness he or she may suffer.
 QUESTION:

"The disadvantaged groups are more

vulnerable to health problem such as
heart disease or obesity, agree or disagree
this statement and discuss your answer "
 Introduction
Disadvantaged groups are the groups of people that experience a
higher risk of poverty, social exclusion, discrimination and violence
than the general population including, but not limited to ethnic
minorities, migrants, people with disabilities, isolated elderly people
and children.( Historical moments in medication psychology
(Framingham study in 1948)(
These groups are vulnerable to discrimination and moralization is a
consequence of social, cultural, economic and political conditions
and not a quality inherent to a certain groups of people.(National
health interview survey 2014-2016
)
 Cont...

Due to the harsh conditions they suffers they

become vulnerable to the health problems. We
agree the statement that states that
"disadvantaged group are more vulnerable to
health problems such as heart diseases or
obesity” by the following reasons;
 Cont..
• Disadvantaged groups have poorer self-reported health
and greater health risks. The disadvantaged groups have
low access to health checkup and hence they live without
knowing their health status and hence are in greater risk to
face health problems. One -fifth of low income adults
report as fair or poor, compared to only five percent of
higher income adults. Rates of obesity are also higher
among low income adults about thirty six percent compared
to higher income adults which are about twenty eight
percent
 Cont....
• Have more mental health problems. Based on a widely
used screening tool for identifying symptoms of depression
and anxiety(the k6 distress scale), low income people are
much more likely to be serious in psychological distress
about seven percent compared to one percent of higher
income people. This is because the low income people and
disabled people are unable to meet their needs they
become psychologically unstable and hence the chance for
mental health problems and due to prolonged distress may
led to heart problems.
 Cont....
• Family history, If you have a family health history of
heart diseases you are more likely to develop heart
diseases yourself. Different types of heart diseases
and related condition, like high blood cholesterol can
run in the families for example children and elderly
people. Also genes gives the body instruction for the
body to respond to change in the environment, studies
they resembles and differences among family
members, weight due genetic factors such as in obesity .
 Cont...
• Social stigma, The disadvantaged groups have
feelings of shame, hopelessness, and fear and
may feel reluctant to ask for help and lack of
understanding by family members bring about to
suffer from illness such as stress which is
predisposing factors of hypertension. Limited
membership of multiple high stigmatized groups
for example people with disability.
 Cont...
• Lack of quality education, Researchers found that people
with lower education have significant higher probability of
being overweight or obese (body mass index>25).This effect
identified for group of people that are much more likely to
come from low background.
Limited access to health care, Insurance companies now
•
have a higher cost of care in treating the health conditions of
overweight or obese individual may experience. This includes
the cost of care for their chronic conditions such as heart
diseases, diabetes that require expensive surgery devices and
drugs.
 Generally; the disadvantaged groups often they suffers
because they can't afford adequate basic needs like food,
shelter and clothes. Through those living conditions they
end up on getting depression. Hence can lead to higher
rates of tobacco and alcohol use and increase the risk of
health problems developing or worsening overtime. In
order for the disadvantaged groups to be helped the
government should help to improve their standard of life
and improving the health care access to the disadvantaged
group so as to minimize the risk of health problems.
QUESTION:
It has been said that ‘‘we are
what we eat’’ discuss
 WE ARE WHAT WE EAT’’
It’s a philosophical phrase stated by a Germany
Anthropologist and philosopher called Ludwing Feuerbach
(1804 - 1872). It has been used in conversations about
health, wellness as undeniable connection between food, our
bodies and culture.
‘‘We are what we eat’’ This statement is true since the
phrase reflects that the physical, mental and emotional
wellbeing of an individual is determined by the type of food
they eat and how they consume it as part of our culture. The
food becomes our self-identity
 FOOD AND ITS RELATION TO HEALTH
 The human body is made up of food substances which are
proteins, glucose, lipids mineral salts and vitamins which are
mainly the building blocks of the body. All these nutrients are
obtained from the food we eat and can identify the status of our
health.Thus having all these nutrients in the food leads to super
provision of such essential nutrients and hence proper building
and the physiological functioning of the body and hence good
health.
 An individual who takes a balanced diet will always result to
good health. If an individual takes too much or less than the
recommended quantity and quality can result to be unhealthy.
 If you eat a lot of junk food, your body becomes
unhealthy. It can lead an individual to suffer from
chronic diseases like :-
Obesity
Type II diabetes
Heart diseases
Physical weakness
Malnutrition
Cancer
 Modern life styles involve the eating of many junk foods
that are not necessary health. This might cause many
diseases as stated above and conditions that would have
otherwise avoided if a healthy diet we are adopted.
It’s important to eat foods rich in nutrients in proportional
to the requirement of the body, so that you can have higher
energy, a better mood and regulate hormone for better
growth and development of our body
 FOOD CULTURE IN RELATION TO HEALTH
Healthy eating goes a long way. It even extends and
touches our values and norms. When people look at eating
food, even processed food, how it’s harvested, grown, and
even sold to the public, can be a critical reflection of our
values, life style and health.
If you consume food produced in an immoral or unethical
way, you are not impacting the planet or animals in a way
that reflects your values. \
 FOOD CULTURE THAT IMPROVE HEALTH

1. Prolonged food cooking – Refer to the process at which some food are
cooked for a long time making it safe for consumption.
This tendency of cooking food for long time enhances the health status of
an individual in the way that the germs / micro-organisms that could be
contained in the food substance are totally destroyed. Example food like
meat when cooked for a long time to kill out the micro-organisms like
taenia sagnata and taenea solium
i. Prolonged breast feeding of children
In some Tanzanian societies it is a common practice for the mothers to
breast feed their children for the long period of time. For example the Haya
people from Haya land in the North- western part of Tanzania particularly
in Kagera region breast feed their children for two to three years of age.
This is a good cultural practice in the society for the
health status of the children since the milk from the
mother is more nutritious especially during the first six
months after delivery. Thus the child will grow well both
physically and mentally, while a child who is not
breastfed in a recommended time will have stunted
growth.
Through this practice also the family planning process is
also promoted since it takes time for the mother to
conceive again.
 FOOD CULTURE THAT HINDER HEALTH
Food taboos – refer to a deliberate avoidance of a food item
for reasons other than simple dislike from food preference.
These are the strong prohibitions of certain individuals from
food eating among different societies.
In some societies for example women and children are
prohibited from eating eggs.
Also among the Sukuma people children are not allowed to eat
meat from the reticulum (honey comb like stomach) of the
ruminants with the fear of developing skin rashes on the heads
and scabies.
In Coastal regions some fish are prohibited to be consumed
by people for some reasons; fish like “Kapungu” not eaten
by pregnant women as they believe that the infant will be
born with skin rashes it also cause death to mother after
giving birth.
In societies like Nyaturu foods such as eggs are not
allowed to be eaten by pregnant women because they
believe that the child will be born with alopecia ( absence
of head hair)
Lake Zone societies children were not allowed to eat
gizzard this is to show respect to the elders such as father,
 These foods are more nutritional and delicious and not harmful like how
these people believe because they contain proteins in large proportions for
the health of the people

CONCLUSSION
The best thing to do is to ensure that you eat healthily.
The best way to do this is to understand food and food consumption. Eating
intentionally, meaning eating with purpose to serve your body with nutrition
and to fuel it with good intentions. Not because you are bored or stressed.
Simply put in mind that “ you are what you eat” you eat what you are, and
you will definitely become what you put in your body from a moral stand
point and a physical stand point.
 INTRODUCTION
Food habit; refers to why and how people eat, which food they eat
and with whom they eat as well as the ways people obtain ,store,
use and discard food .OR
Refers to the way in which people select, cook, serve and eat foods
that are available to them and at what time they eat. Examples;
eating too fast, eating while standing, skipping meals, eating while
not hungry. Factors influencing food choice are not only based
upon individual preferences but are constrained by circumstances
that are social, cultural and economy. Based on the following
Gender, ethics and class difference influence the food habit as
follows.
Gender; is the relationship between male and female both
perceptual and material. Gender is not determined
biologically as a result of sexual characteristics of either
women or men but is constructed socially.

OR
Gender refers to socially constructed characteristics of
women and men such as norms, roles and relationship
between groups of women and men.it varies from society to
society and can be changed.
Women tend to eat light food while men tend to eat heavy food.
Women mostly tend .to follow diet in order to maintain their beauty
and shape women tend to eat light food due to their belief to their
society that women are supposed to consume less food compared to
men. Men tend to eat heavy food compared to women due to the
reason of hormonal differences men produce the hormone called
gonadal testosterone hormone which has immediate effect on heart
rate and respiration rate this tend men to have higher metabolic rate
hence influence to more use of food but also men’s bodies are
composed of more muscle tissues compared to women since more
muscle tissues require more energy from food which contain more
carbohydrate such as stiffed porridge(ugali),potatoes ,cassavas.
Ethnics; common racial, nationality, tribal and religion are the most
component of ethnics that influence the food habit as follows;
 Religion; is a belief in God or gods and the activity connected to
this belief .example Islamic religion ,Christian religion and
Hinduism
Various religion show different food habit .Example the Jewish
religious people do not eat pork also the Muslims do not eat pork
too such food habits terminate them from getting some important
nutrients which are more important as the building block of the
body. Also Rastafarians don’t eat meat thus missing important
nutrients in their bodies such as protein and lipids which are key
essentials to build up their bodies
 Common racial; refers to a sense of identity and membership in a
group that share common language and cultural traits .Example
values, beliefs, food habits, customs.
Each ethnics group has their own traditional manner of preparing
food people who belong to ethnic group will have been raised and
brought up in a certain style and manner thus the recipes for each
and the way that it’s cooked will affect the level of nutrients.
According to the race people tend to eat food which are commonly
eaten basing on their race for example Asians prefer sea foods like
fish, American prefer eating Junk foods, Africans prefer to eat
carbohydrate rich food but also prefer to eat insects like
grasshopper.
 Tribe ;is defined as social composed chiefly of numerous families
,clans or generations having a shared ancestral and language each
tribe have their own common food basing on their ancestor likes
and dislikes .Example in Tanzania tribe like chagga like eating
banana ,coastal areas prefer spice food and food made with
coconut
 Class difference; in most society according our level of economy
there are existence of upper and lower classes .Upper classes tend
to eat balance diet (food of higher quality) such as canned
food ,fried foods since they can afford the cost while lower class
tend to eat low quality food with large quantity.
 According to French sociologist Pierre Bourdieu said that the
food consumed by the upper classes reflect taste of refinement
and its perceived value in the society [1986].
CONCLUSION
Generally food habits identify specific groups of people basing on
their gender, ethnic groups, race and classes. However the food
choices and eating practices were dependent on current living
status. Sensory appeal and health were the most important food
choices motives among male and female respectively. This study
conclude that there is gender difference in different ethnics and
groups in food choices and eating practices.
 Patient-nurse relationship
Is the interation between patient and
nurse aimed to work together for the
good health of the patient .
communication is the cornerstone of
the nurse-patient relationship .the
focus of communication in nurse-
patient relationship is the patient
needs I.e patient-centered care.
Patient-nurse relationship

To meet these needs the nurse must take into

consideration multiple factors including;-
 Patient’s physical conditions
 Emotional state
 Cultural preferences
 Values
 Needs
 Components of the nurse-patient relationship
There are five components of the patient-nurse
relationship which are; trust , respect, professional
intimacy , empathy and power .
1.TRUST
 Trust is the critical in the patient-nurse relationship
because the patient is in a vulnerable position.
Initially , trust in a relationship is fragile so its
especially important that a nurse keeps promises to
a client. If trust is breached it becomes difficult to
re-established.
2.RESPECT
 Respect is the recognition of the inheront dignity
worth and uniquiness of every individual
regardless of socio-economic status,person
attributes and the nature of the health problems.
3.PROFESSIONAL INTIMACY
 This is inherent in the type of care and service
that nurses provide. It may relate to the physical
activities such as bathing that nurse performs
and with the patient that create closeness.
4.EMPATHY
 Empathy is the expression of understanding , validity and
resonating with the meaning that the healthcare
experience holds for the patient. In nursing empathy
includes appropriate emotional distance from the client to
ensure objectivity and an appropriate professional
response.
5.POWER
 The nurse-patient relationship is one of unequal power .
Although the nurse may not immediately perceive it , the
nurse has more power than the patient. The nurse has
more authority and influence in the healthcare system.
Phases of patient-nurse relationship
1.Pre-interactive phase and orientation phase
 Begging the nurse-patient relationship requires unique
communication skills.Everyday people communicate
with those around them by
listening,talking,sharing,laughing,reasoning and caring
2.Identification phase
 The patient and nurse work together to identify
problems and set specific problem oriented
goals.Forexample, patient expressed fear about pain
during the breast biopsy.
 The nurse said you are concerned about the pain during the breast
biopsy will talk with the surgeon about medications during the
procedure, also I will be with you during the biopsy in the case you
have any questions or you begin to feel comfortable.
3.Exploitation phase
 The patient uses the nurses services and other resourses on the basis
of his or her needs. The active work of the relationship happens
during exploitation. Also during this phase a patient uses identified
strengths and resources to regain control and develop solutions.
4.Resolution phase
 During this phase the patient`s old needs are resolved and more
mature goals emerge. Some of the most satisfying parts of a nurse`s
job are caring relationship with patients.
Benefits 0f nurse-patient relationship
 It create trustfully condition
The nurse-patient relationship it comprises trust
between nurse and the patient, so this situation
create a trustfully condition between nurse and
patient.
 It brings hope to the patient

This happens during identiification phase in which

a patient problems are identified thus a patient
get hope of being cured.
 It increases quality of care for patients.
Through nurse-patient relationship, the intended
service to the patient from a nurse is fully
provided, so this happens because of the
communication between a patient and a nurse.
 Challenges for nurse-patient
relationship
 Language barrier
The Major means for nurse-patient relationship is
communication, thus due to differences in language may
affect the nurse-patient relationship. Language barrier
results ies misunderstanding can occur between a patient
and a nurse hence tends to be a challenge.
 Altitude of the patient.
into the failure of communication hence no nurse-patient
relationship.
 Culturalaspects
 There some community do not believe on the
use of medicine, this is a problem in case a
patient is adviced to use medicine. Sometime
 Also the altitude of the patient towards a
certain diseases may affect the nurse-patient
relationship. Forexample some patient believe
that headache always is a sign of malaria, so it
can be diffucult to convice such kind of
altitude.
 It has been said that ‘culture and
health cannot be separated’
Introduction
 Culture
Is the total way of human life.
It’s comprised of norms, values, language, customs, mores, folkways
and symbols
 Health
Is a state of mental, social, and physical wellbeing of an individual.
• Culture affects and influences health of an individuals both
negatively and positively, directly and indirectly as follows;

Positive cultural influences

 Prolonged breast feeding
Here mothers take time to feed their newly born babies
improving the health of both mother (by reducing chances of
maternal diseases) and child.
 Male circumcision
The removal of the skin covering of the penis is mostly done to
the newly born babies. It reduces the chances of sexually
Continue.……

 Post delivery care

This involves the care for mother and the child after birth
improving mothers health and the child’s health.

 Religious practices
Different cultures with different beliefs affect the mental
health of their believers by either allowing or prohibiting the use
of some types of foods and drinks for instance pork and alcohol
usage.
 Language communication
People with the same language for instance Swahili language in
Tanzania, have easier method of solving social, mental and
physical problems as it’s easy to understand each other.
 Prolonged food cooking
This is mainly practiced in African societies as Tanzania. It helps
to kill the disease causing microorganisms improving the health of
a society.
 Virginity test
This is done in African societies where mothers tend to check
the virginity state of their female children. For example safwa,
kurya.
Negative influences
 Female genital mutilation
The removal of female clitoris affects the health of women
negatively as it is associated with the loss of much blood on the
process. This may lead to death, complications during delivery
and spread of infections .
 Polygamies

A state of a man owning more than one wife may lead to spread
of infections and misunderstandings disturbing the mental,
social, and physical health of people. Example the Sukuma ,
Widow inheritance
Mainly practiced in African societies as the Ndali.
The tendency of inheriting the former
person( relative)’s wife may lead to the spread of
diseases as HIV/AIDS weakening the health of an
individual.
Wife beating

Involves intense beating of women. Mainly

practiced by the kurya. This action affects the
physical health of an individual.
Early marriage
This mostly affects the health of girls married
under age both mentally and physically, as it leads to
complications during delivery and sometimes death.
Food taboos

Different societies prefer different kinds of foods

in different situations according to the rules, norms,
and customs. This deprives the individuals with
important body building nutrients as proteins.
INTRODUCTION
Illness behavior refers to any action or reaction of an individual who
feels unwell for the purpose of defining their state of health and
obtaining physical or emotional relief from perceived or actual
illness. According to mechanic and volkart, the American medical
sociologists (Mechanic and volkart 1960; Mechanic 1968) ‘’ illness
behavior can be defined as the way in which an individual
experience, perceive, evaluate and respond to their own health
status.’’
The behavior includes how individuals monitor and interpret bodily
sensation, utilize health care resources, discuss illness of symptoms
with providers and adhere to prescribed medical regimens
Illness behavior can be categorized into two broad categories,
1. Self-care behavior.
This is any action taken to manage or improve a health condition or improve
a health condition in the absence of direct medical attention, it includes
managing symptoms and caring for minor injuries.
2. Health care utilization behavior.
This is involving all the actions that involve the utilization of health care
systems. This includes attending the hospital for medical interventions.
Illness behaviors can be normal or abnormal influenced by age, gender, culture,
education, family structure and social economic status of individuals in the
society.
NORMAL ILLNESS BEHAVIOUR
The use of the term “normal” is intended to convey that the
behaviors is appropriate and adaptive. In this phenomenon the
patient reacts according to the signs and symptoms of the disease
that he or she is suffering. The patient does not exaggerate or
underestimate the signs and symptoms associating with the
disease. An individual seeks medical help as soon as they become
of most minor symptoms.
ABNORMAL ILLNESS BEHAVIOUR.
Issy Pilowsky (1999:25) describes abnormal illness behaviors:
 “This is an inappropriate or maladaptive mode of experiencing,
evaluating or acting in relation to one’s own state of health which persists
despite the fact that the doctor has offered accurate and reasonably lucid
information concerning the person’s health status and the appropriate
course of management to be followed. With provision of adequate
opportunity for discussion, clarification and negotiation, based on
thorough examination of all parameters of functioning (physical,
psychological, and social) taking into account the individuals age,
educational and social cultural background.”
Abnormal illness behavior is characterized by syndrome of excessive or
inadequate response to symptoms. This behavior can be further being
described in biopsychosocial model as a physiological dysregulation,
exaggerated somatic attention, exaggerated sensitivity to pain, and
catastrophizing of medical illness role.”
DIFFERENCES BETWEEN NORMAL AND ABNORMAL ILLNESS
BEHAVIOUR
 Normal illness behavior refers to expected behavior in individual
whereas abnormal behavior refers to behavioral patterns that go
against the social expectations. A behavior becomes normal or
abnormal depending on the cultural context of the individual. A
particular behavior may be normal in one society may not be in
another. In the past abnormality was considered to be effects of
witch craft and demonic possession, today it is considered to be
an illness. The societal treatment of normal treatment of normal
and abnormal is also quite different. People tend to display fear
and even ridicule at abnormal behavior.
In normal illness behavior individual satisfy and respond
positively with the given management regardless of their
traditions. This creates no doubt about treatment and
prescriptions given by the health care provider. While in
abnormal illness behavior health services can cause
different perceptions of each patient as a recipients of
health services. Patient may feel that they are not getting
the appropriate care, and usually these patient tend to
seek other means of solving their problems. E.g. traditional
healers of their ethnic group, church etc
Normal illness behavior is adaptive behavior as it allows individual to
adapt in a positive manner to various. It is functional adjustment to
a particular behavior which makes the individual to develop and
grow. While abnormal illness behavior is maladaptive which is a
negative form of behavior which can harm the individual’s health.
This behavior does not lead to personal growth and development
but causes downfall of human beings. Example in the case of
anxiety, when not dealt with appropriately, one may opt to use
alcohol to gain relief from anxiety. Even though it provides
momentary relief to anxiety, in a long run this is dysfunctional to the
individual as it can lead to severe health conditions.
Maladaptive behavior on one level it hinders the development of the individual
where he or she feels unable to find solution to anxiety experienced. This
inability to accept one’s condition leads t disruptions in person life as well as
professional life, daily chores, as well as difficulties in handling relationships.
 In normal illness behavior health care personnel require less energy in
clarifying the problem to the patient. It is observed that health personnel’s
have used less time and energy in explaining the health condition to
individual with normal illness behavior since they believe on the diagnosis
and care given that will help solve the problem they are facing. While in
abnormal illness behavior health personnel take too much energy to explain
the condition to the individual since he or she is not satisfied with the
doctor’s diagnosis and management given.
 In normal illness behavior, an individual shows the
appropriate condition that is characterized by the
symptoms and are easily understood by an individual and
the society. The health problem associated with a normal
illness behavior can be easily be recognized. While
abnormal illness behavior shows the inappropriate
condition that is characterized by the symptoms that are
not well and easily understood by the society.
QUESTION

Discuss the role of

disclosure on health
status
 DISCLOSURE IN HEALTH STATUS
 Disclosure
is the act of making something known. If you
make a disclosure you reveal information not previously
known either because it’s new information or because it’s
been kept secret.
 Disclosure in health is the process where a person exposes
his or her health information to other people; it is either
to the society, friends, relatives, or health care giver .
Fostering closeness to loved ones and a
feeling of empowerment
By disclosing the health status of an individual
for instance a person living with HIV can
receive effective care from relatives, friend
and health care givers also have a higher
chance of being supported in terms of money,
advice, daily taking of drugs, diet and regular
clinic visit.
Reduce loneliness, stress, denial and
isolation

Though disclosure process a patient identify that

it is not ok to carry the burden alone hence
reveal his or her health status information, this
make a patient feel better about self being
honest and hence relieve their depression and
stress of having such health status or disease. For
example a people having sterility and infertility.
 Promote recovery process
Disclosure of health status allow one to form or join
a self – help group and begin relationships and
conversations needed to construct ones self-image
in a positive light. For example people with mental
health problem benefit on rehabilitation groups by
knowing how to take care of themselves, disease
symptoms and how to avoid complications.
Prevent spread of the disease
Disclose of a certain communicable disease in the
society may help to prevent or reduce number of
contact to a disease. Disclosing personal information
may be justified in the public interest if failure to do
so may expose others to a risk of disease, death or
serious harm. For example in COVID 19 the
disclosure of the first person with disease in
Tanzania keeps people alert and start to take the
preventive and control measure
Serve as disclosure role model for other
people

When a person disclose his or her health status to the

relative and friends, this will make people surrounding
him or her motivated and have that desire of being
open about their health status. For example when a
person disclose that he or she is living with HIV will
make other society member to understand that to be
HIV positive is not the end of life hence influence them
to test and disclose their status.
It provide encouragement to the patient

By disclosing the health status of oneself this

will provide the encouragement to the
patient that he or she has the same status to
other people and also this reduce the
tendency of feeling loneliness more inferior.
 Provide therapeutic relationship
between counselor and the client

The disclosure of a client health status to the

counselor will enable the counselor to
understand the client problem and figure out
the appropriate ways to cure the disease or
solve the health problem.
Play a role on providing health
education

Disclosure of health status to other individual is

important for provision of education of different
disease in the community so as to protect the
health of other people. For example a person
suffering from drug addict will be used to educate
others on the causes, treatment and prevention of
the condition.
Improve social functioning and
school performance
Ifa person or a student disclose his or her
health status to teacher or fellow student it
will help the person build confidence and get
experience from other teacher and student at
school hence will increase her morale of
study
Reduction of myth and misconception

People who disclose their health status

information serve as an example in the
community. Many myth and misconception can
be cleared by. For example the use of family
planning
CONCLUSION

It is suggested that disclosure is not a

one off event and is rather a sequential
process that require enabling opportunity
for individual to access appropriate
physical and psychological support.
 INTRODUCTION TO
COUNSELLING PROCESS
Counselling; is the process where individuals, couples or
family member meet with professional counsellor to discuss
problem in their lives, this problem include health and
psychological problem.

In health counselling involves the process organized in series

of steps aimed to help clients to solve their problem.
 TYPES OF COUNSELLING
Counselling process can involves individual counselling or group counselling.

INDIVIDUAL COUNSELLING

In individual counselling can be done by the medical personnel and only a single client
for example when a client after diagnosis have identified to have positive HIV/AIDS.

GROUP COUNSELLING

Group counselling process is done when the clients have common/same problems for
example children whom suffering from kwashiorkor their parent can gathered and
being counselled how to improves health of their children.
 STAGE OF COUNSELLING IN HEALTH CARE

i. Relationship building,

ii. Assessment,

iii. Understanding and setting goals

iv. Counselling intervention

v. Termination and follow up

 QUALITIES OF GOOD COUNSELLOR

He/she must be a critical thinker and creatively in

order to understand the problem of client and come up
of solution which help to solve the client problem.

He/she must use polite language/humble person to the client

to prevent the existence of gap with the client, do not threat
or intimidation language .
Trust, the counsellor he/she should be trusted by the
clients by ensuring that their private issues are not known
by other people in the society.

 Listening skills,
 Non-judgement,
 Respectful,
 ROLES OF COUSELLING IN PEOPLE’S HEALTH .

 To guide client in their recovery from and adaptation to

difficult situation.

 To reduce worry and other negative emotions.

 To increase working efficiency.

 To assist the client in exploring problems and guiding
them to solution.

 To make the client to be aware about the consequences of

the experiences and situation they have been or going
through .


To bring about the lost hopes.

To reduce medical costs.

 To provide education and teaching skills on how to deals
with emotional, psychological and health problem of
individual(client).
CONCLUSION

 Counselling services to an individual or in group it

improves accountability and performances in working
places.

 Enable the client whom are suffering from

psychological problem to maintain their normal
situation of life as well and reduces of negatives
emotions like committing suicides.
 "Discuss the
consequences of long
term carrier patients"
 INTRODUCTION
Long term carrier patients: Are patient suffering from a certain
disease for a long period of time without successfully treatment or
cure. Example of diseases which can be associated with long term
carrier patient are HIV/AIDS, diabetes, TB, prolonged injuries, cancer
diseases, and ulcers.so a patient may suffer from such diseases for a
period of time without recovery due to the following reasons;
• Poverty\lack of affordability; a patient normally experiences a
certain type of disease for a long period of time due to lack of
income that will enable him or her to treat the disease associated
with him or her, for example treatment of cancers needs much
money for treatment.
•
Cont...
Low level of science and technology; science and technology
play A great role in health sector, some of disease are not cured
due low level of science and technology, example heart diseases
(cardiomyopathy) may need surgery, such surgery require much
or advanced technology which is normally unavailable hence
patient exist in such disease for a period of time.
•
• Some diseases are chronic; these also leads to the emergency
of long term carrier patient because such disease are not cured
easily for example tuberculosis and diabetes (mellitus and
insipidus).
 Cont...
• Lack of awareness, some people are unaware about the diseases
they suffer from because some diseases may not show clear
symptoms, also some diseases show the similar symptoms of other
diseases in which people may consider there are normal diseases.
Example a person may have HIV/AIDS but he/she can not
recognize it early, this may read him or her to be associated with
the diseases for long period of time. The following are the
consequence of long term carrier patient;
• Cause permanent body disability, existence of some disease for
long time may lead to the disabilities, for example cancer
diseases to some body part may require surgical removal of such
body part is legs, and breasts.
 Cont...
• Weakening body immunity, patient who suffer from a certain
disease for a long time normally the ability of the body to fight
against diseases decreases due to weaker body immunity caused
by such disease a patient suffering from, hence body immunity
function unproperly. For example HIV/AIDS.
• Psychological stresses, patient who suffer from a certain
disease may develop psychological stresses because they think
that their diseases are untreatable for example Diabetes, but
this is wrong since at some stages diseases may be cured, hence
the psychological stresses may lead to severe diseases and
eventually a person can die.
 Cont...
• Difficult in treatment; some diseases are difficult to treat
them because they may become chronic due to the existence
for a long time without any treatment for example cancer
exist in stage, at some stage the disease can be cured but
when at chronic stage may be treated difficultly or not
treated completely hence this led to difficult in treatment.
• Rate of disease transmission become high; a patient
suffering from a certain disease for a long time may transmit
to other people in high rate, for example a patient with
HIV/AIDS may transmit to many people if he or she is not
caring.
 Cont...
• Social discrimination; a patient suffering from a certain
disease can be socially discriminated due to her or his
health condition for example TB and HIV/AIDS patients
found themselves discriminated with the people around
them.

• Death; existence of disease for a long period of time

without successful treatment may lead to death, for
example cancer
 CONCLUSION; although some diseases are
seems to be uncurable but they can be cured at
early stages, also prevention is better than cure
we can prevent the disease by the following;
public awareness should be provided to the
people, school curriculum also should be
modified by including this issues also
advancement of medical technology should be
considered.
 QUESTIONS: Describe the
spectrum of traditional healers and
their roles .
TRADITIONAL HEALERS

Traditional healers: Are the people who do not have any formal medical
training, but are considered (by the local community) as being competent to
provide health care using animal, plant and mineral substances and certain
other techniques based on social, cultural and religious background.
In specific cultures, these people go by their local names, depending on
their tribe, such as Sangoma or Inyanga in South Africa; akomfo,
bokomowo in Ghana; niam-niam, shaman, or mugwenu in Tanzania;
nga:nga in Zambia; shaman or laibon in Kenya; and babalawo, dibia, or
boka in Nigeria
Traditional healers are categorized based on the following
criteria:

 Type of treatment administered

 Type of diagnosis of the cause of illness
 Illness treated
 The healers degree of autonomy
 Agents used in treatment
 Degree of reference to local tradition
Based on the criteria of type of treatment administered,
and the type of diagnosis of the cause of illness above the
traditional healers are grouped into four (4) classes:

i. Herbalists (pure herbalists)

ii.Herbalist-ritualists
iii.Ritualist-herbalists
iv.Spiritualists
I. HERBALISTS (Pure herbalists)
These are the traditional healers who use the herbs, herbal materials,
herbal preparations, and finished herbal products that contain whole
plants, parts of plants or other plant materials including leaves, barks,
berries, flowers, and roots, and/or their extracts as active ingredients
intended for human therapeutic use or for healing. Example of herbs and
their medicinal uses:

-Combretaceae (Nigerian common name: Ikedike) used for Jaundice

treatment.
-Euphorbiaceae (iri, kirni) used for insomnia, mouth wash, and gonorrhea
 -Hypericaceae (Otoro, alilibarrafi) used for piles, trypanosomiasis treatment.

Their roles in the community include the following:

i. Undertaking patient consultations to diagnose illnesses and conditions, and to

select appropriate remedies
ii. Gaining information from patients about previous physical/medical history and
symptoms
I. HERBALIST-RITUALISTS

Are the ones who use plants and rituals either simultaneously or alternately but
they build therapy around the plants or herbs, while the ritual is used as a
peripheral to the therapy.
I. RITUALIST-HERBALISTS

Are the ones whose healing rites are based on the attributes of the specific spirits deemed
responsible for a patient's problem.

Thus, the ritualist-herbalists all use divination, which varies in form according to the rite.

II.SPIRITUALISTS

These are the traditional healers who use or practice divination (ramli) and therapeutic
activities on healing diseases. They practice divination and whose therapeutic activity
extend beyond illness to problems of daily living (such as unemployment and marital
problems).

Some of them include: - witchdoctors, sorcerers, shaman.

Their roles are:

-Predicting and announcing to people about the problems which torture them

-Providing cure and healing the problems in accordance to the command from divination
results.

FURTHER CATEGORIZATIONS

According to the healers degree of autonomy, and the agents used in treatment, we have
two classes of healers, which are:-specialists and generalists.

Specialists: are the ones who treat or deal with the illnesses caused by spirits specific to
one ritual.

Specialists are healers whose practice focuses on a small number of illnesses, such as
infantile asthma and hemorrhoids.
Specialized healing rites include Zebola, Mpombo, Mizuka, Elima,
and Nzondo (in Zaire)

Generalists: are the ones who have a broader therapeutic scope and
are consulted for illnesses not covered by a specific ritual, although
their orientation by nature is toward certain categories of illnesses.

They show no signs of any specialization in their practice.

-General healing rites include Bilumbu, Mikanda-Mikanda, and

Tembu (Zaire).
The existence of the specialist and generalist healers differs in towns from that in rural areas;
that, specialists are mostly found in rural areas compared to urban areas. This is due to the
following reasons:

• Contacts between healers in urban areas enable them to expand their knowledge and
complement their primary practice. In towns there is greater chance of coming into contact
with people than in rural areas.

• People in urban rarely or seldom know the healers in large cities so they cannot select one
on the basis of specialty.

• The healers tend to present themselves more as generalists, partly to respond to the greatest
number of demands and partly to promote the image of a polyvalent healer, owing perhaps to
the influence of dispensaries and hospitals.
CONCLUSION

The practice of traditional healers seem to be the modern

accepted concept, agreed on by the Scientific Technical and
Research commission (STRC), of the African Union (AU).
Generally, African traditional healers provide holistic care
systems organized into three levels of specialty namely,
divination, spiritualism, herbalism.
 ROAD TRAFFIC ACCIDENT

Is an accident involving at least one vehicle on

a road open to public traffic in which at least
one person is injured or killed.
Most of road accidents involve motorcycles,
buses, private cars, bicycles and cart drivers as
well as pedestrians.
 FORMS ROAD TRAFFIC ACCIDENTS

There are many forms of road traffic accidents which includes the
followings
 Rear end collision
 Head on collision
 Rollover collision
 Multivehicle accident
 Single vehicle accident
 Side impact accident
CAUSES OF ROAD TRAFFIC ACCIDENTS
High speed driving
Drunken driving
Careless drivers and pedestrians
Overloading
Poor road conditions
Heavy rains
Mountainous Areas
Car malfunctioning e.g Brake failure, poor motor light
IMPACTS OF ROAD TRAFFIC ACCIDENTS

Causes loss of lives

Increase of dependence
Destruction of properties
Increase of poverty
Permanent disabilities
Loss of productivity of the victims
TREND ON ROAD TRAFFIC ACCIDENTS IN
TANZANIA

According to the Citizen newspaper

wrote by Lilian Ndilwa on 17th December
2020, the Traffic Police Division
expressed its determination to reduce road
accidents, particularly during the end of
the year festive season.
 REPORT OF 2019

In 2019, Tanzania registered 2,519 road

accidents, data from the traffic division show.
The accidents claimed 1,248 lives while 2,462
other victims were injured , Traffic Police
Commander Wilbrod Mutafungwa told the
Citizen newspaper.
 REPORT OF 2020

Mr. Mutafungwa said during the period between January and

October 2020, there were 954 deaths and 1,696 injuries from
1,228 road traffic accidents.
This shows that there was decrease in the number of deaths by
23.6% and in number of people injured by 31.1%.
Most of road accidents in Tanzania were caused by reckless
driving, alcoholism, drivers not complying with traffic laws
and poor infrastructures e.g. presence of rough roads in some
highways and poor bridges.
 CONT………………..

In general, he said, road accidents caused by car

malfunctioning dropped by 23% during the period
between January and October 2020 compared to the
same period in 2019 while those caused by
infrastructure also dropped by 52%.
Accidents caused by human errors decreased by 35%
and other road accidents caused decreased to 51%.
 REPORT OF 2021

 Between July 2021 and March 2022, 1,200 people were killed in
1,594 road accidents that left 2,139 people injured, Masauni told
the house in the capital Dodoma when he tabled his ministry's
budget proposals for the 2022/2023 financial year.
 Statistics indicate that there has been an increase of 366 road
accidents, which is a rise of 29.8%
 Most of accidents were caused by reckless driving, defective
vehicles and bad roads.
 MEASURES OF REDUCING ROAD
ACCIDENTS AND PREVENTING THEM
 The measures of increasing the number of police checkpoints to restrict those
breaching traffic laws, It will also increase traffic inspections and gadgets
including alcohol testers and cameras
 Enforcement of traffic laws including seizing of driving licenses right after the
drivers breach traffic laws.
 Emphasizing on traffic programs including ‘HATA WEWE, AIBU YAKO AND
ABIRIA PAZA SAUTI YAKO’’ which help passengers to be able directly report
reckless drivers.
 Providing educations to bus owners to encourage bus drivers to abide traffic
rules.
 Setting human alarming points among the members of TABOA, to be informed of
a bus violating traffic laws, the bus owner is put up for questioning before getting
THE TABLE SHOWING ROAD TRAFFIC
ACCIDENTS FROM YEAR 2019 T0 2021
 GRAPHICAL BAR CHART PRESENTATION SHOW-
ING ROAD TRAFFIC ACCIDENTS FROM YEAR 2019
3000 T0 2021
2519 2462
2500
2139
2000
1696
1594
1500
1248 1228 1200
954
1000

500

0
YEAR 2019 YEAR 2020 YEAR 2021

NO OF ROAD ACCIDENTS NO OF PEOPLE INJURED NO OF PEOPLE KILLED

QUESTION;
Describes the Doctor to
nurse relationships
NURSE; is the person who is physically, psychologically, and physiologically trained to give care to the
people who are sick or injured.
A nurse works with a doctor to make sure that the patient is fit and health.
POSITION/ROLES OF THE NURSE IN THE HEALTH CARE SYSTEM
A nurse as medical personnel has the following roles so as to promote the recovery of the patient;
a) Recording medical history and symptoms.
b) Collaborating with teams for patient care.
c) Performing the diagnostic test.
d) Conducting physical examination of the patient.
e) Providing support and advice to the patient.
f) Educating the patient how to manage an illness.
g) Providing basic bedside care.
h) Training and educating the staff.
DOCTOR; is medical personnel who provides medical health service to the patients or
clients.
POSITION/ROLES OF THE DOCTOR IN THE HEALTH CARE SYSTEM
A doctor as medical personnel has the following roles so as to promote the recovery of
the patient;
a) Doctor is responsible for making diagnosis. By taking the sample of blood, urine and
other body fluid to obtain information about body health.
b) Making treatment to the patients. for example if the doctor diagnoses with heart
condition he may refers you to cardiologists for further treatment
c) Provides advice to the patient. An advice provided by the doctor is based on how to
prevent the diseases.
 DOCTOR-NURSE RELATIONSHIP
Doctor – Nurse relationship; Refers to the interaction that exist between doctor and
nurse in any health care facility/system so as to facilitate treatment and recovery
process of the patient. However this interaction may have positive or negative effects
to the patient depending whether their interaction is good or bad.
TYPES OF DOCTOR-NURSE RELATIONSHIP
The following are the types of doctor-nurse relationship;
a) Collegial relationship
b) Collaboration relationship
c) Guidance relationship
d) Neutral relationship
e) Negative relationship
A. COLLEGIAL RELATIONSHIPS
It is excellent relationship in which a doctor sees a nurse like a friend in providing
medical care to the patient. A nurse spends much of time with patient and notices
any changes/progress of the patient this makes doctors appreciate the working
knowledge of a nurse and establish a good care plan which will decides whether to
discharge a patient or not. Because of all these creates friendly relationship between
a nurses and doctors as they values each other’s opinions, roles and responsibilities.
B. GUIDANCE RELATIONSHIPS
This is type of relationship in which a doctor provides instructions to nurses on how to
establish medical interventions to the patient. In case of absence of a doctor, a nurse
in charge will provides a medical care to the patient by following the instructions given
by the doctor.
A. NEUTRAL RELATIONSHIP
This is characterized by existence of neutral conversation between a nurse and doctor and the use of
polite language. The doctor comes in investigate the patient, write the orders and leave a nurse with
patient for further examination.
B. COLLABORATIVE RELATIONSHIP
In this relationship a doctor and a nurse cooperates and works as a team in dealing with patient.
Cooperative relationship gives a chance for both of them to gives their ideas and opinions to brings
about wellbeing of a patient
C. NEGATIVE RELATIONSHIP
This is poor relationship between a nurse and a doctor characterized by anger and abusive language
which interrupt health care system. This is possible and effective when doctors become more superior
to nurses and nurses become inferior in accomplishing their duties during health care provision.
IMPACTS OF DOCTOR-NURSE RELATIONSHIPS
I. IMPACTS OF POSITIVE DOCTOR-NURSE RELATIONSHIPS.
The following are the positive impacts of doctor nurse relationship;
a) Improves the quality of health care services; Good relationship between doctor and a nurse
facilitates patient to be given better treatment hence early recovery.
b) Improves safety to the patient; good cooperation between nurse and doctor it can eliminates
individual errors which may be caused by either doctor or nurse such as over dosage,
mistreatment
c) Reduces conflicts; due to good relationship it make them to talk to each other in quarrel and
misunderstanding so as to reach better conclusion about patient situations.
d) Creates respect and trust; this is through valuing each other opinions and ideas during provision
medical care.
I. IMPACTS OF NEGATIVE DOCTOR-NURSE RELATIONSHIPS
The following are the impacts of negative Doctor–Nurse Relationship.
a) It may worsen the condition of the patient. This results from lack of enough cooperation, trust and
respect leading to delayed treatment.
b) It reduces quality of health care services. This is due to the fact that poor treatment patterns as the
results of bad cooperation between a nurse and a doctor.
c) It brings conflicts between a nurse and a doctor; this is due to the use of abusive language and
commands from the doctor when a doctor seems more superior to a nurse.
d) It reduces trust and comfortability of patient towards the kind of treatment given to him or her. This
occurs when nurse and doctor display the signs of misunderstanding and quarrels to the patient.
e) It may increase the rate of death; this is as the results of poor treatments accelerated by poor
cooperation of a nurse and doctor which make some important services to fail reaching to the patient
and hence may die.
 THE SOLUTIONS TO IMPROVE DOCTOR-NURSE RELATIONSHIP.
The following are the strategies to improve doctor nurse relationship;
1. Practice empathy
Chances are, empathy for patients comes naturally to you. This same empathy is also
useful when communicating with physicians. In tense situations, try to place yourself in
the other person’s shoes.
2. Be confident
Often, you know your patient and their needs intimately and can serve as an advocate
to help them receive the best care possible. Be assertive about speaking up for them if
you have information that would help – a strong nurse-physician relationship hinges on
this type of communication.
1. Stay involved
Look for ways to stay involved and seek out daily, routine communication with physicians and other
coworkers. Finding a personal connection with each of them, perhaps something unrelated to work,
can also help strengthen your nurse-physician relationships.
2. Take the short view
If you become overwhelmed or irritated at work, take a deep breath and see if you can form a more
microscopic view of the day. Remember that your shift is short-lived. Know that you can refuel your
own emotional and physical health once you get home, so you can come back refreshed tomorrow
5. Be a team player
When it comes down to it, remember that you and the physicians you work with are a team with the
same goal: to provide quality care to your patients. With the health of your patients in mind, be a
team player and make sure your coworkers know they can always ask you for help.
QUESTION
To discuss naturalistic and
personalistic explanation of
illness and their differences.
 INTRODUCTION

Illnes; refers to the human response to disease. It is a feeling of not

being normal and health. what cause illness vary from culture to
culture. Methods considered acceptable for curing illness in one
culture may be rejected by another culture.
Naturalistic explanation of illness
 The naturalistic explanation of illness suggest that illness
is due to impersonal, mechanistic causes in nature that
can be potentially understood and mode of treatment is
based on the application of the scientific method of
discovery.
Naturalistic explanation of illness

Naturalistic explanation of illness suggest

that illness occur by natural means example
invasion by pathogens,viruses, and bacteria
while personalistic explanation of illness is
caused by wishes of other people for
example bewitched, spirit possession and
intrusion of foreign objects
 Naturalistic causes of illness
Obstruction which occur in body organs .i.e kidney
stones and arterial blockage
organic breakdown or deterioration of parts of the
body such as tooth decay, heart failure, and senility.
injuries for example broken bones and bullet
wounds.
imbalance in the body i.e hormones and salt in
blood
cont

Malnutrition
parasites
such as bacteria, viruses, amoeba
and worms.
 Personalistic explanation of illness

Isa medical system in which there is a belief

that causes and cures of illness are not to be
found in the natural means to understand
what is wrong with their patients.
Causes of illness in personalistic
medical systems include;
 Intrusionof foreign objects into the body by
supernatural means. Objects like snakes,rocks,insects
and snakes.
 Spiritpossession, loss or damage. to be witched, it
involves the use of magical acts and supernatural
powers either by humans or supernatural beings.
 Bewitching
Cont…..

An example of illness by

personalistic theory is
Susto(perdida de la sombra
 Differences between personalistic and
naturalistic explanation of illness.

Personalistic naturalistic
 religion and magic are  disease causality has nothing to
inseparable do with religion and magic, are
 cure is by supernatural largely unrelated to illness.
forces i.e sucking of the  cure is made through scientific
foreign object intruded
in the patient`s head methods i.e provision of drugs
by supernatural power. and performing surgery
Cont…..

Personalistic Naturalistic
 A particular illness  The techniques and
can be cured by methods of illness
treatment are uniform
different methods
for a particular disease
and techniques in all places in
depending on naturalistic
culture and places. explanation of illness
Cont..

Naturalistic
Personalistic
 It is necessary to postulate  Naturalistic
at least two levels of
etiologies differ
causality,the ghost or significantly in the level of
witch or any other being causation are much less
on whom ultimate
responsibility for illness appropriate in most cases
rest and instruments used
by such being i.e witch
tend to be collapsed .

craft
Cont….
Personalistic
 It logically require curers
with supernatural and or
magical skills, for the
primary concern of the
patient and his family is
not immediate cause of
illness, but rather who?
Naturalistic
 ItIislogically require a very
different type of cure, a doctor in
full sense of the word specialist in
symptomatic treatment who knows
appropriately.t
Cont….

Personalistic Naturalistic
 Itis rejected by most  In today`s world is
of non-western widely accepted by
countries and today It most of individuals
has remain in some
small-scale societies
and subculture.
Conclusion
Perceptions of illness are highly culture related
thus it is important for healh professionals who
treat people from different cultures to
understand what their patients believe can
cause them to be ill and what kind of curing
methods they consider effective as well as
acceptable.
QUESTION
Illness, disease and sickness are not
the same and they can be differently
assessed and perceived in the society,
describe how each one is differently
assessed and perceived in the society.
objectives
Definition of important terms
Introduction
Main body
reference
Definition of terms
 Illnessis a subjective undesirable state of health ,it consists of
subjectively feelings example pain and body weakness or feelings
of incompetence(twaddle1994).
 Sicknessis a social identity ,it is the poor health problem or
problems of an individuals defined by others with reference to
normal social activity of an individual.
 Disease is the health problem that consist of physiological
malfunction that results in actual or potential reduction in
physical capacities and /or a reduced life expectancy ,it is
independent of subjective experience.
INTRODUCTION

Most people fail to make a clearly difference

between illness, sickness and disease as the
factors that interfere with the health of
human being because they depend on each
other ,infact these three factors are not the
same .
 Illness,sickness and disease can be well differentiated
basing on various aspects
1. Definition (meanings)
2. Main agent
3. Consequences
4. Method of assessment
5. Entitlement
6. Knowledge status
the following are the different between illness, disease
and sickness basing on the above aspects
 Main agent
is the one that defines a condition as either a disease ,illness or
sickness
In disease the main agent is medical professional –In disease a
medical professional is the one who conceive a person to have a
disease after several medical check –up.
In illness the main agent is person experiencing a disease-in
illness a person experiencing a negatively body appearance that
sign and symptoms (pain, body weakness) is the main agent.
In sickness the main agent is the society-the main agent is the
society or institutions which is the one that give a sick role to a
person whom they conceive to have a negative body occurance.
 consequences

 Refers to the first response or result or effect of illness, disease or

sickness to an individual with negative body occurrences.
in illness in illness a person will try to communicate his /her
negative occurrences to others example calling for help .
in disease call for medical professional to identify and treat a
disease.
In sickness involves calling for determination of social status of the
sick deciding who is entitled to treatment and who is to be exempted
from social duties and roles
 Entitlement
-Refers to the fact of having certain right according to certain
situation that you are current having.
 illness- a person explains to himself his/her situation as he/she
feels that there is a need for support as he/she feels
unable to perform the activities of daily life.
 Sickness-the society free a person from duties and gives him or
her the right to economic assistance, sick leaves, discrimination
and stigmatization.
 Disease –a medical professional if able to find a disease then a
person is permitted to follow further medical attention to cure
the disease.
 Method of assessment
Illnesses ;assessment of illness is based on
subjective ,experience and feelings.
Diseases ;assessment of disease is based on various
scientific method such as assessment,observation,medical
examinations and diagnosis.
Sickness-sickness is assessed by measuring levels of
performance with references to expected social activities
when these levels fails to meet standard a person is
termed sick.
 The knowledge status
Illnesses –the knowledge status of illness is subjective, that is
it is based on a person feelings and experience about a
condition or event.

Diseases-the knowledge status about disease is objective that

is it based on medical observation and examinations.

Sickness-the knowledge status about sickness is based upon

society perception about the nature of illness or disease .
  QUESTION;

Underson model of health
utilization
 ANDERSEN MODEL OFHEALTH
SERVICE UTILIZATION
HEALTH; is the state of being well in physical, mental
and social aspects and not only free from diseases and
infections

HEALTH CARE:Is the improvement of health via the

prevention, diagnosis, treatment amelioration or cure of
disease illness, injury and other physical and mental
impairments in people
HEALTH SERVICE UTILIZATION

Health service utilization is the

quantification or description of the use of
service by person for the purpose of
preventing and curing health problems,
promoting maintenance of health and
well-being or obtaining information
ANDERSEN MODEL OF HEALTH SERVICE
UTILIZATION
 This model was developed by RONALD M. ANDERSEN in 1968. He was
a health service professor at University of California,Los Angeles
(UCLA)
 Dfn. Andersen model of health service utilization is conceptual
model that aimedat at demonstrating the factor that lead to the use
of health services,, they may include-
 impatient care,
 physician visit and
 dental care
According to the model ,, Theusage of
health services determined by three
dynamic which are

 A. Pre-desposing factors
 B. Enabling factors
 C. Need factors.
 A. PRE DISPOSING FACTORS

Pre disposing factors are the risk factors that makes a person
more suspectable to developing a disease.these factors can lead
to a disease and but not guarantee to do so . Example are
 Altitude
 Lifestyle/ habbit
 Age
 Traumatic experience
 Stress
 Genetic
 Compromised immune system
 B. ENABLING FACTORS

Refers to individual or structural resources enabling

or increasing the likelihood of service use. In health
care this include aspect like
 Income
 Health insurance coverage
 Availability of health services
 Regular service of Care and
 Means of communication
C. NEED FACTORS
 Need factors are overall health condition as indicated
by chronic illness or not, and it is like having diagnosis
of
 Schizophrenia
 Bipolar disorder or having a substance use disorder
increased likelihood of being categorized as a HU .
 Characteristics with the strongest association with
heavy use of a public mental health system were need
factor
QUESTION
Describe diffusion of innovation
theory and how it can be applied in
health promotion.
 DEFINITION OF TERMS

 Diffusion is a social process that occurs among people in response to learning

about an innovation such as a new evidence-based approach for extending or
improving health care.

 Innovation are new products, programs, Ideas or practices that are implemented
adopted or disseminated within groups, organization or networks.

 Health promotion is the process of enabling people to increase control over, and
to improve, their health. It moves beyond a focus on individual behavior towards
a wide range of social and environmental interventions. (WHO)
 DIFFUSION OF INNOVATION THEORY.
 Diffusion of Innovation (DOI) Theory, developed by E.M. Rogers in 1962, is one of
the oldest social science theories.

 It originated in communication to explain how, over time, an idea or product gains

momentum and diffuses (or spreads) through a specific population or social
system.

 The end result of this diffusion is that people, as part of a social system, adopt a
new idea, behavior, or product. Adoption means that a person does something
differently than what they had previously (i.e., purchase or use a new product,
acquire and perform a new behavior, etc.).
 MAIN ELEMENTS OF DIFFUSION OF
INNOVATION THEORY.
There are four main element of the theory;
1. INNOVATION
An innovation is an idea, practice or object that is perceived as
new by an individual or other unit of adoption.

2. COMMUNICATION CHANNELS
A process by which participants create and share information with
one another in order to reach a mutual understanding.
3. TIME
Time does not exist independently or events, but it is an aspect of every
activity.

4. SOCIAL SYSTEM
The fourth and final dimension refers to the groups of people involved in the
innovation adoption process. This could be employees at an institution, a
neighborhood or whole nation.
 Diffusion of innovation decision
process

1. Knowledge
2. Persuasion
3. Decision
4. Implementation
5. Confirmation
There are five established adopter
categories
 Cont…
• Innovators - These are people who want to be the first to try the
innovation. They are venturesome and interested in new ideas. These people are
very willing to take risks, and are often the first to develop new ideas. Very
little, if anything, needs to be done to appeal to this population.

• Early Adopters - These are people who represent opinion leaders. They
enjoy leadership roles, and embrace change opportunities. They are already
aware of the need to change and so are very comfortable adopting new ideas.
Strategies to appeal to this population include how-to manuals and information
sheets on implementation. They do not need information to convince them to
change.
Cont…
• Early Majority - These people are rarely leaders, but they do adopt new
ideas before the average person. That said, they typically need to see evidence
that the innovation works before they are willing to adopt it. Strategies to
appeal to this population include success stories and evidence of the
innovation's effectiveness.

• Late Majority - These people are skeptical of change, and will only
adopt an innovation after it has been tried by the majority. Strategies to appeal
to this population include information on how many other people have tried the
innovation and have adopted it successfully.
Cont…

• Laggards - These people are bound by tradition and

very conservative. They are very skeptical of change and
are the hardest group to bring on board. Strategies to
appeal to this population include statistics, fear appeals,
and pressure from people in the other adopter groups.
APPLICATION OF DIFFUSION THEORY IN
HEALTH
 Adoption and implementation of new medical treatments
and procedures
 Diffusion of telemedicine and digital health services
 Dissemination of evidence-based medical practices
 Spread of health awareness programs and campaigns
 Implementation of health information technology
systems
 Cont…

 Adoption of preventive health measures and screening

programs
 Dissemination of new vaccines and immunization programs
 Implementation of patient-centered care models
 Diffusion
of telehealth and remote patient monitoring
technologies
 Adoption
of health promotion and disease prevention
programs.
 THE TRANSTHEORETICAL
MODEL
Question: Describe the major steps in
the transtheoretical
model and its characteristics.
 INTRODUCTION
 The transtheoretical model is an integrative theory of therapy
that assesses an individual’s readiness to act on new healthy
behavior.
 It provides strategies/processes of change to guide the individual.

INTEGRATIVE THERAPY
.This is the integration of elements from different schools of
psychotherapy in the treatment of a client.
STAGES OF THE THEORY

 The theory comprises of six stages; which are:-

*Precontemplation (not ready to change)
*Contemplation (getting ready to change)
*Preparation (ready to change)
*Action (current action)
*Maintenance (monitoring)
*Termination (successfully quit)
 PRECONTEMPLATION
People don’t intend to start a new healthy
behavior in the near future (within 6 months).
May be unaware of the need to change.
They are encouraged to think about the pros
and cons of their behavior.
For example; an individual who is addicted to
alcohol is not planning to stop drinking.
 CONTEMPLATION
People are intending to start the healthy behavior
in the next 6 months.
They are aware of the pros of changing.
The cons and pros of their behavior are almost
equal.
For instance, an alcohol drunker is informed about
his behavior and is ready to change towards a healthy
behavior.
 PREPARATION
People are ready to start taking action within the next
30 days.
They small steps like telling their friends and family
members that they want to change their behavior.
They learn that the better prepared they are, the more
likely they are to keep progressing.
For example; an individual is in use of alternative actions
in opposition to alcohol drinking and plans actions of a
motivating statement.
 ACTION

 People
have changed their behavior within the last 6
months and need to work hard to keep moving on.
 Theyneed to learn by being taught techniques for keeping
up their commitments that is; substituting the unhealthy
behavior with the positive ones.
 People acquire new healthy behavior.
An individual quits alcoholism and seeks for social support to
substitute unhealthy behavior to positive ones.
 MAINTENANCE
People have changed their behavior more than
6 months ago.
People are aware of situations that may tempt
them to slip back into unhealthy behavior.
People avoid stressful situations and unhealthy
people.
In this case an individual has fully quit alcoholism
and engages in health related behavior.
 TERMINATION
A person has zero temptation.
The victims have successfully quit drugs like alcohol.
A victim is particularly at high risk of relapse depending
on how much was addictive to the behavior.
In this case an individual doesn’t drink alcohol at all and
works hard on seeking support from family members,
healthy coach , a physician or other motivational source.
QUESTION: Describe origin
of traditional medicine in
Tanzania
.
INTRODUCTION
Traditional medicine (indigenous medicine or folk
medicine).Refers to health practices, approaches, knowledge and
beliefs incorporating plant, animal and mineral based medicines,
spiritual therapies manual techniques and exercises applied
singularly or in combination to treat, diagnose and prevent illness
or maintain wellbeing.
Traditional medicine describes medical knowledge system, which
developed over centuries within various societies before the era of
modern medicine. It is sophisticated medical systems whose root
are traditional medicine.
According to World Health Organization(WHO) Traditional
medicine is defined as is the sum of total knowledge, skills and
practices based on the theories, beliefs and experiences indigenous to
different cultures that are used to maintain health, as well as to
prevent, diagnose, improve or treat physical and mental illnesses. It
is also known as indigenous or folk medicine.
Also, Collins English Dictionary defines traditional medicine as
system of medicine developed before the era of modern medicine,
based on cultural beliefs and practices handed down from generation
to generation.
Generally, Tradition medicine is the knowledge and skills based
on cultural beliefs, theories and practices used in diagnosis and
treatment of diseases (maintaining health), that can be handed
down from generation to generation
Examples of traditional system used are;
• Acupuncture- used in china
• Ayurveda – used in India ( historical roots in India )
• Homeopathy- like cures like (Samuel Hahnemann)
Naturopathy- uses neither surgical nor medical agents (diet,
exercise, massage)
 According to World Health Organization(WHO) defines
traditional medicine as the sum total of all
practises ,measures ,ingredients and procedures of all kind whether
material or not which guard against disease illness to alleviate in
suffering and cure himself .Traditional medicine might also be
considered as a social amalgamation of dynamic medical known
how and ancestral experiences.
MAIN BODY
The origin of traditional medicine in Tanzania
Although written records about medical plants ,dated back at least
5,000 years to the Sumerians, described well-established medical
use for such plants as laurel caraway and time archaeological
studies have shown that the practice of herbal medicine dated as far
back as 60,000 years in Iraq ad most famous used traditional
medicine in Tanzania was not originated in Tanzania instead
discovered by ancient people of west countries like Iraq,
china ,Mexico and in early countries before Christ and due to social
interactions and economic demands like trades , colonialism and
interaction tradition medicine from different part of world used in
Tanzania until now days. Example Ayurveda, garlic and valerian .
During early countries in Tanzania which known as Tanganyika mainland and
Zanzibar before the arrival of the white people they had their own system of
traditional medicine designed by traditional healers were using herbal
medicine made from tree, barks , flowers, root, fruit and mineral also used
spiritual and fire system of treatment.

During the period of First World War I in Africa especial in Tanzania usual
Tanganyika and Zanzibar most of pandemic diseases erupted. Example
cholera, tetanus, typhoid, and other which lead majority of people to involve
in usage of traditional medicine to heal victims of those diseases and this
period show high increases of the usage of tradition before first world war,
example during of wars the mosses plant where used as a bandage by the
soldiers in order to cover out the wound that occurs during the war .
Also in 1991 the government established a unit for the coordination of
traditional medicine which is now called Traditional and Alternative Medicine
Directorate. This was followed by the setting up of the food and drugs board in
1992 which among others is to certify the sale of traditional medicine products
to the public.
Traditional medicine are important part of healthcare in sub-Saharan Africa and
building successful disease treatment programs that are sensitive to traditional
medicine practises will require an understanding of their current uses and roles
including biomedical perspective. Therefore we conducted a mixed method
study in Northern Tanzania in order to characterize the extend of and reason for
the use of traditional medicine among the general population so that we can
better inform public health effort in the region .
CONCLUSION
Tradition medicine are the one of the most oldest health
care practised in different parts of the world including
Tanzania, Mexico ,China, Iraq and Sub Saharan African
countries especially among poor and uninsured people
Traditional medicines were commonly used for diabetes
care in Northern Tanzania
Traditional medicine has a lot of advantages such as,
 They are affordable and cheap. Most of traditional medicines are less
expensive since any person can buy.
 They are available and accessible. Most of traditional medicines are
available because they are found in plants such as trees, so because of their
availability this make easy for people to obtain them.
 They provides an error free treatment for those symptoms any side effect.

Additionally, we found traditional medicines use is not limited to lower

income areas or rural settings. After symptomatic ailments, chronic
diseases were reported as the most common reason for traditional
medicines use which may be particularly important in Northern Tanzania
where non communicable diseases are a rapidly growing badly.
Question: Describe
the origin of
biomedicine in
Tanzania.
Learning objectives
1.Introduction
2.Origin of biomedicine
2.1Coming of people from far and middle east
2.2Coming of German and British after the
Berlin conference
3.Factors that led to the achievement of
biomedicine after colonialism
 Introduction
 Before the Tanzania was using the traditional medicine which was
conducted by the traditional healers who follow the ancestor says
and doings
 But nowadays there is the advanced of the technology and people
are using the modern medicine or Biomedicine
 Biomedicine is the branch of medical aspect that involve
psychological and biological applied in treating health desease of
living organism. The other names of the biomedicine are like
covectional medicine, modern medicine and western medicine
 Biomedicine involve injection, surgery, using of pills and also some
medicine faculty involve immunology, biochemistry, virology,
microbiology
Example of modern medicine
2.Origin of the biomedicine ( modern
medicine)

The modern medicine introduced during the coming of the colonialism by the
the time Tanzania was as Tanganyika and Zanzibar the colonial era was as
follows
2.1 The coming of the people from middle and far east
 The interaction of the people from the far and middle east who came for their
trade settlement in Tanganyika and Zanzibar areas about 15thC and 17thC . The
foreigners with their wives and children especially in the coastal region they
faced the problem of some tropical desease such as malaria and so they
established the special buildings with their facilities where families and some
natives were also treated
 Example the hospital introduced was Muhimbili hospital known as Sewa hadji
hospital
Muhimbili hospital during colonialism
was known as sewa hadj hospital
2.2 Coming of the German and British after Berlin(1884-1885)
conference and second world war (1920)
 German took part in Tanganyika after the Berlin conference
and also due to their settlement tend establish the health
services such as vaccine for chicken pox and measles where
also the natives got the service
 Also after second world war the Tanganyika colony was given
to the British also follow the foot-step in the provision of the
health services such anti-malaria drugs and some hospital
 Example of hospitals introduced during the period were like
Ocean road, modification of Muhimbili hospital,
Ocean road hospital during colonialism
 Factors that lead to achievement of
biomedicine in Tanzania after colonialism era
 Development of science and technology this includes the
adaptation of the advanced knowledge of medicine which was left
as colonial legacy by importing the medical drugs and machine
Such as ultra sound machine and increasing number of hospitals
such according to the 2022 health report there about 336 hospitals
and also the teaching facilities of medicine lesson such
universities and colleges for discovering the doctors and other
medical personnel within the country
 Awareness of natives this were given education about the benefits
of modern medicine and abandon the traditional medicine which
always not highly efficient
Nowadays Muhimbili hospital
One of the University which teach
concern the modern medicine in Tanzania
Natives medical professionals
QN;Explain the
stages of becoming a
patient.
 PATIENT
 Isany recipient of health care
service that are performed by
health care professionals.
 The patient is most often ill or
injured and in need of treatment
by health care professionals.
Types of patient
 Outpatient

Is the patient who visits a hospital, clinic or associated facility

for diagnosis or treatment but who is hospitalized for less
than 24 hours.

 Inpatient

Is the patient who visits a hospital or any other associated

facility for diagnosis or treatment but hospitalized for more
than 24 hours.
 FACTORS THAT LEAD TO A PERSON TO BECOME A PATIENT

 Social factors
This involves unhealthy cultural practices e.g female
genital mutilation and other negative cultural
practices.

 Psychological factors
This is due to mental ill (stress and depression) but not
necessarily show the physical result of some types of
illnesses and infections.
 Biological factor
This is due to the invasion of certain pathogens like
bacteria, viruses, fungus and parasites that limits
person’s health from being normal.
STAGES OF BECOMING A PATIENT
Abnormalities of health status
 This is the change of normal health status or
is the change of normal body functioning.
 Can be due to the invasion of pathogens to
the immune system of an individual, or
stress/depression and other mental illness.
Assumption of the sick role
A person accept that he or she is sick and
seek for confirmation from family and
friends.
 It is characterized by certain exemptions,
rights, and obligations, and shaped by
the society, groups, and cultural tradition
to which the sick person belongs.
Medical care contact(seeking medical
care)
This is described as the point at
which an individual sought
professional medical care.
In this stage the client seeks
expert acknowledgement of the
illness as well as the treatment.
Dependent patient role

 The person is expected to make every effort to get

well, some people may tend to benefit from this
role (e.g increased attention and escape for work,
studying responsibilities) and attempt to malinger.
Recovery and rehabilitation

 The final stage depends on the type of illness.

 Foracute patients the process is one of the
relinquishing the sick role and moving back to normal
role obligations.
 Forchronic patients, the extent to which prior role
of obligations may be resumed ranges from those who
forsake the sick role to those who will never be able
to leave it.
 Some of the societies perceive the diseases
and illnesses in form of rituals that maybe
someone is sick and may be bewitched by his
or her neighbors, this act may hinder the
person to reach the medical centers
immediately.
 These people may be exposed to permanent
disabilities or prolonged sick period.
 Introduction
Public health:
-According to the world health Organisation (WHO), this can be
defined or refered to as all organized measures (wether public
or private) to prevent disease, promote health and prolong
life among the population as a whole.

•Road traffic accident;

 -This refer to the an unexpected event leading to presonal
injury or damage to property that has taken place in an area
that is intended for public transport.
 Intro...
Road;
- is the way that leads from one place to another built for
vehicles, pedestrians, cyclists etc.
Note:
 -Thismeans that the act must involve a vehicle, hence the
falling down of pedestrian can not be termed as a road
traffic accident, but that of a rider of a bicycle or a motor
cycle is a road traffic acccident due to the presence of
(bicycle /motor cycle)which are vehicles.
 Intro...
According to the World Organization Global status on
road safety 2016 statistics, each year approximately
1.25 million people loss their lives, 1 million bear
injuries and with suffering of long hospital stay or
live with the permanent disabilities. Contrary to
that the World Health Organisation (WHO) has
forcasted that by the year 2030, fifth leading causes
of death will be road traffic accidents.
 Causes of road traffic accident
Over speeding
Drunken drivers(alcoholism)
Distraction of the driver
Avoiding the use of road safety gears
Lack of proper knowledge on road safety signs
Bad weather conditions
Fatigue of the driver
Recklessness of the drivers
Overloading
 Car impairment
The public health importance of road
traffic accident (RTA's)
Reduces loss of lives
- This is by giving the immediate care or help to the victims of road
traffic accidents thus increasing there chance of survival.

• Permanent disabilities
 -The proper care provided by the public health professions, help to
prevent the wound infections and other possible ways that would
interfer with wound healing and hence leading to permanent
disabilities.
 Cont...
Minimize the destruction of properties
-The public health together with other organizations
have developed policies and rules that help to reduce
the occurrence of road traffc accidents.
-The policies and rules may include; the speed limit,
wearing seat belt and helments also building some
meters away from the roads.
 Cont...
Reduces dependence
- With proper care given to the victim before or after reaching the hospital
will give the victim a greater chance to heal and recover and thus the
victims can proceed with there day to day activities after being discharged.

Lessen poverty
Though the comprehesive measures to prevent road traffic accidents and
implementation done by the public health have helped to reduce the
occurrence of road traffic accidents. This has also reduce the number of
people who lose there jobs due after road accidents this thus lessens
poverty mostly at family level.

 Cont...

Reduce loss of productivity

-Although the main goal of public health is to
prevent injuries from happening in the first
place, much has been done including first aid,
prehospital care, facility based emergency
unit care, and early critical care and operative
care if needed.
QUESTION:

Name ten folk illness from your community,

describe the signs and symptoms of that illness
and describe the local remedy used to treat
illness.
INTRODUCTION

Folk illness: Is defined as a combination of

psychiatric and somatic symptoms that are
considered to be a recognizable disease only within
a specific society or culture.

Some of these illness includes the following;

I . MKOMO.

This is an illness that occurs in coastal regions of Tanzania specifically in Tanga region.It is
believed that the disease is caused by making eye contact with a person having genie/ghost.

Signs of Illness

 A person having this illness loose his/her ability to see properly

 And if not treated a person becomes blind.

Local Remedy of Mkomo

 Boiling of the root of a plant called Msaji tree using ocean water then apply it to the
affected eyes.

 Also the disease may be treated by witchdoctors.

i. ULEZI.

This disease occurs in southern parts of Tanzania specifically in Ruvuma region.

The disease is common to children under 5 year’s age.

Signs of disease.

 Occurrence of small rushes throughout the body of a child which are associated with pain.

Local Remedy of Disease

 Soaking of the mixture of sardine (dagaa), dried wheat and some other grains then, apply
it to the body of affected child soon after bath twice per day.
i. ZONGO

This disease is commonly found in northern parts of Tanzania especially in Tanga region.

It is believed that the disease is caused by being looked by a person with an evil eyes.

Also a can get disease by drinking and eating food looked by evil eyes.

Signs of disease

 A person with Zongo experience swelling of the stomach, the stomach becomes larger than normal.

 Also the disease shows symptoms like vomiting, headache and Fever.

Local remedy of disease.

The disease is treated by using traditional medicine known as MAKATA which is powdered and mixed with
Tea or Porridge then affected person drinks it.
i. KAJIRITA

This is an airborne disease which occurs in lake zone regions especially in Kagera region
.

Signs of disease

 Rushes in mouth and Anus occurs in affected person in 5 days after being infected.

 Also the Mouth and Anus of affected person become red in colour.

Local remedy of kajirita.

 Kajirita can be cured by making a mixture of ginger , cooking oil and whitebites then ,
a patient hsve to drink it.

 Also boiling of the roots of BUHAYA plant the giving a patient to drink.
i. IVARI

This disease is found in Kilimanjaro region especially in Machame district.

It is believed that disease is caused by taking contaminated food and water.

It affects both adults and children.

Symptoms of disease

 Abdominal pain i.e. a person experience ache and serious cramps in abdominal region

 Loss of appetite.

Local remedy of disease

 This disease is treated by using a plant called IKINGILI plant which is famous in
Chagga land.
i. NG’WANJI

This disease is found in Sukuma tribe particulary in Shinyanga region.

It believed that the disease is caused by stress and impurities in blood.

Symptoms of disease

 A person having this disease experiences headache in forehead region.

Local remedy of disease

 Disease is treated by soap of leave ( KOMANENDE ) tree mixed with

Mbisu (insect species ).

 Also it is cured by using smoke of dry leaves of MANJE and IWEJA tree .
i. LIKATUKATU

This disease occurs in southern parts of Tanzania especially in Ruvuma region.

This disease affect skin of a person in which a skin becomes like a burned one.

Signs of disease

 The skin of affected person becomes like the one burned by fire.

 Also some small rushes occurs to the skin of affected person.

Treatment of disease
The disease is treated by a plant called LIKATUKATU in which leave and roots
are burned together to produce ashes which are applied to the affected skin
i. OREIROBI

This disease is commonly found in maasai society such as Arusha region. It is believed that
the disease is caused by poison ingested together with some kinds of food such as Rice and
Maize.

Symptoms of illness

 A person with this disease experience high fever throughout the course of suffering.

 Also a patient experience headache and dehydration.

Treatment of illness

 This disease is treated locally by taking boiled milk together with leaves of species of
plant called LUSUKI and MOKOTANI.
i. IJONGO

This is a disease commonly found in Pare society example in Same district.

It is believed that the disease is caused by looked with a witcher when eating.

Signs of illness

 The patient experience severe stomach pain throughout the course of suffering.

Treatment of illness

 The disease is treated by a powder made from dried roots of a plant called KIVIJA.

 The powder is mixed with hot water then a patient drinks it but soon after drinking a
patient vomits all eaten food as how he/she eats (without being digested
i. NDWALA NKULU

This disease occurs in Haya tribe specifically in Bukoba district. It is believed its
cause is when a person is bewitched.

Signs of illness

 Inflammation over the whole body

 A patient experience weakness in legs i.e. loss of energy.

 If not treated for a long time the skin of a patient become like a skin of snake.

Treatment of disease

 The disease is treated by drinking a mixture of water and powder made from the
root of a plant called NKWIMONGO
 Question;
Explore and describe ten local remedies that
has been claimed to treat corona virus disease
in Tanzania and describe their
application/used
 introduction

 Corona virus disease (COVID-19) is a

contagious disease caused by a virus, the
severe acute respiratory syndrome corona
virus 2 (SARS-COV-2). The first known care
was identified in Wuhan China, in December
2019. The disease quickly spread quickly
spread worldwide, resulting in the COVID-19
pandemic.
 SIGNS AND SYMPTOMS

Less common symptoms

 Sore throat
 Headache
 Aches and pains
 Diarrhea
A rash on skin
 Red or irritated eyes
A rash on skin associated with discoloration of fingers
or toes
 SIGNS AND SYMPTOMS

Most common symptoms:

Cough
Fever
Tiredness
Loss of taste or smell
 COVID-19 IN TANZANIA

 The COVID-19 pandemic was confirmed to

have reached in Tanzania in march 2020
specifically in Arusha. The COVID-19 related
shocks are quite harsh in Tanzania economy.
It resulted in tourism, decrease in exports,
differing worlds prices and declared
remittances I=in Tanzania local remedies
were used to fight against COVID-19.
 TREATMENT

Until today there is no known cure for the infected

patients of COVID-19. where as the disease seemed to
have more ways of preventing it rather than focusing on
the true cure for the infected. For preventive measures
there were two main ways, being:
 Hospital treatment and
 Local remedies

We shall focus on local remedies

 LOCAL REMEDIES

Refers to treatment of diseases by

using local or domestic ways. For
example, herbal remedy. In Tanzania
local remedies based on stand
therapy infused with herbs and fruits
to quash deadly virus etc.
 LOCAL REMEDIES THAT CLAIMED TO
TREAT CORONA VIRUS IN TANZANIA

Steam therapy
In Tanzania the majority way used to treat
corona virus was “steam therapy”. It was
suggested that steam therapy was an
efficient way to flush off the viral infection.
Also steam inhalation was applied to fight
against respiratory infection
 LOCAL REMEDIES THAT…

The use of traditional herbs

Traditional herbs such as
mwarobaini, green tea, lemon
grass and ginger were used as
the ways to treat COVID-19 in
Tanzania.
 LOCAL REMEDIES THAT…

Quelling fear paradigm and embrace

hope
The late president of Tanzania, Dk. John
Joseph Pombe Magufuli while addressing
emphasized on quelling fear and
embraced hope to the Tanzania by
letting them work and take it easy.
 LOCAL REMEDIES THAT…

The role of religions.

Also the late president and the religious
leaders played an important in role in
emphasizing and influencing people to pray
“prayer of protection” for at least three
days and reminding the Almighty God to
protect Tanzania from the corona virus
disease.
 LOCAL REMEDIES THAT…

Washing hands with flowing water

The use of flowing water with soap was
also used as the way to fight against
corona infections in Tanzania. The
government emphasized people to wash
hands commonly especially in common
places like hospitals shops and markets.
 LOCAL REMEDIES THAT…

The use of coconut oil

In most places like Kilimanjaro and
others people used to wash their hands
with coconut oil instead of sanitizers.
The other modern stuffs it was claimed
that coconut oil can act as antiviral to
flush away viral infections.
 LOCAL REMEDIES THAT…

Drinking warm water

Also warm water was claimed to be one
among local remedy to treat corona
virus when in primary stage. Warm
water suggested to flush away the virus
infection in the mouth before affecting
the respiratory surface.
 LOCAL REMEDIES THAT…

Social distance
This involves maintaining the distance
of about 6 feet from one another when
in a larger population. Social distance is
crucial for preventing the spread of
contagious illness such as COVID-19
(corona virus disease).
 LOCAL REMEDIES THAT…

To avoid unnecessary gathering

 As it is, so true that the disease can be
transferred from one person to another so
the larger the population the greater the
chances of being infected from other
people. So avoiding unnecessary meetings
and gatherings helped to reduce the rate of
spreading.
 LOCAL REMEDIES THAT…

Quarantine and lockdown

 Quarantine was used to isolate those people who
were suspected to be affected or suffering from
the disease and those who were already affected,
by doing this; the health people were prevented
from being affected. Lockdown helped to close
the borders of Tanzania so that to reduce the
spread of the disease from outside.
 APPLICATIONS…
 Steam therapy and steam inhalation was applied to flush off viral
infections and fight against respiratory infections.
 Traditional herbs such as mwarobaini, green tea, lemon tree leaves
and ginger were used to boost the immune system and fight
against viral infections.
 Quelling fear paradigm and embracing hope helped to reduce the
effect f the transmission since fear may affect the immune system.
 Also religious groups embraced hope among people.
 Washing hands, prevented further spread of the infections among
people and from any contaminated part.
 APPLICATIONS…
 Insanitizer scarce areas, coconut oil was used on behalf,
and of course it was useful and preventive. Drinking
warm water helped to kill germs which have just entered
the respiratory and digestive system.
 Avoiding populating by reducing unnecessary movements,
quarantine, lockdown and social distance also reduced
contact between the infected and the non-infected and
hence, at large helped to reduce the spread of the
disease.
 CORONA AS A PANDEMIC .To discuss social
impact of Corona as a PANDEMIC?
Coronavirus is any virus belonging to the family Coronaviridae. Club-shaped glycoprotein
spikes in the envelope give the viruses a crown like, or coronal, appearance; hence, the name.
The coronavirus genome consists of a single strand of a positive-sense RNA [ribonucleic
acid].Coronaviruses cause SARS [severe acute respiratory syndrome], MERS (Middle East
respiratory syndrome), and COVID-19(coronavirus disease 2019, it was named covid-19 due
to the year occurred 2019). The virus named severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) belongs to the coronavirus family and is closely related to the SARS
coronavirus. Severe acute respiratory syndrome coronavirus (SARS-CoV-2) causes an illness
known as COVID-19, which is similar to SARS and is characterized primarily by fever and
respiratory symptoms and likewise highly contagious.
Infectious disease pandemic, including severe acute respiratory
syndrome (SARS) and COVID-19, demand intrapersonal behavior
change and present highly complex challenges for public health. A
pandemic of airborne infectious, spread easily through social
contact, assails human relationships by drastically altering the
ways through which human interact. The COVID-19 pandemic led
to a prolonged exposure to stress .As consequence, researchers
showed an increased interest in measuring social and community
uneasiness in order to psychologically support the population. This
increased attention might help in managing the current situation
and
other epidemic and pandemics. The security measures adopted
in managing the pandemic had different consequences on
individuals, according to the social role invested. Some
segments of the population seem to be more exposed to the risk
of anxious, depressive and post-traumatic syndromes because
are more sensitive to stress.
Corona affected many areas in the world, first it occurred in
Wuhan, China. In United Republic of Tanzania, from 3 January
2020 to 6 December 2022, there where been 40,656
confirmed cases of COVID-19 with 845 deaths, reported to WHO. But on 27
November 2022, a total of 32,893,229 cases occurred this shows how Corona
spread in a wide area over a short period of time. Also England and Wales, in
March-May 2020 reported deaths of people approximately to 100,000 people.

These coronavirus when one affected shows symptoms like fever or chills,
cough, shortness of breath or difficulty breathing, fatigue, muscle or body ashes,
headache, new loss of taste or smell and sore throat.

Although COVID-19 affecting many countries but it has social impact as

pandemic virus. The following are the social impact of corona virus pandemic,
by beginning with the negative social impact;
loss of man power; Many people in the society died due to
the infection of COVID-19, important people in many
countries died these leads reduce the production and
manufacturing of goods in the society. as we know that the
youth are man power of any society in producing goods, the
arise of Corona led to loss of many youth hence the society
man power of producing decrease and these lead to
starvation and poverty in the family and society at all. Also
many elders of age 45-70years died due to Corona as their
immunities are low to handle the Corona virus .
Religious impact; The pandemic has impacted religion in various ways,
including the cancellation of the worship services of various faith, the
closure of Sunday Schools, as well as the cancellation of pilgrimages
surrounding observations and festivals. Many churches, temples, mosque
and synagogues have offered worship through live stream amidst the
pandemic. Relief wings of religious organization have dispatched medical
supplies and other aid to affect the areas. Adherents of many religious have
gathered together to pray for an end to the pandemic for those affected by
it also they believe to give scientists the wisdom to combat the disease.
 Educational impact; The pandemic has affected educational systems
worldwide, leading to the widespread closures of schools and universities.
According to data released by UNESCO on 25 March, schools and
universities closures due to COVID-19 were implemented nationwide. This
affects over 1.5 billion students worldwide and those with higher education
universities have also impacted their students by deciding not to stop classes
but rather migrate everything to virtual. In Tanzania Dr. Kassium Majaliwa
announced for closures of schools and universities when COVID-19 in
Tanzania spread very rapidly, these affected students which had final
examination on November 2019 for advanced level and universities.
Domestic violence; Many countries have reported an
increase in domestic violence and intimate partner
violence attributed to lockdowns amid the COVID-19
pandemic. People affected by COVID-19 were taken to
special areas called Quarantine and there were
separated by others such family, friends, society and
schools for special healthcare. Financial insecurity,
stress and uncertainty have led to increased aggression
at home, with abusers able to control large amounts of
their victim’s daily life
Restrictions on gathering; The impact on personal
gathering has been strong as medical experts have advised
and local authorities often mandated stay at home to
prevents gatherings of any size , also COVID-19 prevents
people from different areas to meet such as football, happy
birth day part, burial ceremony and weddings, this leads to
the societies to fail affording there basic needs such foods
as no any business conducted to that areas. Replacements
for gatherings have been seen as significant to mental
health during crisis and also positive social impact of
coronavirus pandemic as follows;
Source of income; Although COVID-19 had affected many
areas and people in worldwide but it leads to some people
and countries making vaccine for reducing the virus of
COVID-19. Many people in Tanzania made masks special
for preventing coronavirus, antiseptics for washing hands
before and after entering in any work areas such hospital,
hotel, banks, airports and schools, also safety tanks were sold
for keeping clean water.also in arts many artists such as
Diamond platinum make a song of Quranteen and Roma
made a song of kaka tuchati all these song were speaking on
prevention of Corona virus.
Employment; Many people in the societies had
employed by other people either to sell masks, tanks and
antiseptics. Apart from that many health care workers
were employed by different institutions and their
government to work on people whom will suffer from
corona, doctors and nursing had large opportunities to be
employed these due to knowledge of health caring
people. Majority in the worldwide were employed to take
care corona victims and making vaccine for coronavirus.
Although Coronavirus had effects in the societies but
many people come with some prevention and measures to
take. Like in Tanzania there use to make liquid mixture of
lemon, ganger and water, also used to wear mask, clean
your hands, avoiding crowds and keep safe distance.
Getting vaccinated and boosted is the best way to reduce
your risk of symptoms, especially becoming severely ill, if
you get COVID-19. But right along with vaccination are
steps you can take to both avoid getting infected and help
prevent spreading the virus to other.
 QUESTION: Describe the economic impacts of Corona
virus Pandemic.
 INTRODUCTION TO THE HISTORICAL BACKGROUND OF CORONA VIRUS
PANDEMIC.
 Corona virus pandemic was firstly reported in Wuhan,China and it is
when now it became spreaded all over the world in 2019.This made
Corona virus pandemic to be named as COVID-19.
 Corona virus pandemic is transmitted easily and fast spreaded from
one person to another through direct contact with infected people
and also is transmitted as an airborne disease as people
talk,breathe,cough,sneeze or sing while close to each other
 An infected person shows some of symptoms including fever or
chills,cough,fatigue,muscle, body aches,headache,nausea and
vomitting,diarhoea,sore throat and shortness of breathe or difficulty
in breathing. But the list does not include all possible symptoms,these
symptoms varies due to the changes in the structure of Corona virus .
PICTURE OF CORONA VIRUS
 POSITIVE ECONOMIC IMPACTS OF CORONA VIRUS PANDEMIC.
 a)Innoviation of new technology,due to the wide spread of Corona virus
pandemic disease many people died of disease and so it led to
depopulation .Hence due this,scientists discovered so many
technological instruments which became a help in fighting against the
Corona virus.Example of the technological instruments for fighting
against Corona are dispenser , PCR-kits , Ventilators ,Nebulizers,Oxygen
therapy machines and respirators.
 b)Improved online trading and marketing ,due to many government
policies introduced so as to fight against Corona virus pandemic disease
for example "Stay home stay safe" policy which made people not having
access to buy and sell goods . Hence due to this many people bought and
sold goods through online trading website such as Alibaba and Amazon .
 c)Creation of job opportunities,as Corona virus pandemic was
spread all over the world,some of people took an advantage to
them and hence they made medical instruments which helps in
fighting against Corona virus pandemic and hence they earned
much money through this.Example many industries made
ventilators,respirators,PCR-kits and Humidifiers .

 NEGATIVE ECONOMIC IMPACTS OF CORONA VIRUS PANDEMIC

 In fact Corona virus pandemic virus led to many effects around
the world which led to economic drop of many countries.Some
of economic negative effects of Corona virus pandemic are as
follows below.


Market supply crisis , due to lockdown principle and policies like" stay home
a)

stay safe“ ,movement restriction of people and goods , border closures,

logistical constraints as well as slow down of trade became the cause of great
drop of market supply . This was due to the slow down of industrial production
and transportation example in main exporting countries like USA , Germany and
China is estimated that the market supply dropped by 9.4% compared to the
years before effects of COVID-19.
 b)It led to the decline of tourism , due to lockdown policies many people
became restricted from moving from one country to another and hence this has
made these countries which depends on tourism as the basic sector of economic
development which increase their national domestic and foreign currency to
drop economically . In case of the least developed countries and the developing
countries, tourism has contributed to about 9.5% of economy that is why after
the spread of Corona virus pandemic they experienced economic drop down
Example in Croatia ,Greece , Thailand and some of Africa countries a great
economic drop occur due to fall of tourism sector .

It led to unemployment , due to Corona virus pandemic in the world ,
c)

many people became unemployed .Example of people who became

unemployed were young people , young women and hence around 2020
youth employment dropped by 8.7% and so many of them were those
working in transport industry since during 2019 up to 2020,the was a
great failure of transportation due to the wide spread of COVID-19.
 d)It lead to the unplanned budget to the government , due to the
COVID-19 so many great countries were forced to set up some projects
which were out of the annual government budget so as to fight against
the effects of COVID-19.Example of countries suffered from the effects
of unplanned budgets were Italy and France because they had
experienced many effects of Corona virus pandemic.
 e)Corona virus led to fall of Gross Domestic Product(GDP) in some countries, due
to the fall of some important sectors like trade,industrialization and
transportation which led to the great fall in the the Gross Domestic Product of
countries.Hence approximately there was a fall of Gross Domestic Product(GDP)
by 2% below the benchmark of the world, 2.5% for developing countries and 1.8%
for industrial countries in 2020.
 CONCLUSION
 As Corona virus pandemic which is also known as COVID-19 led to many social
effects like depopulation as many people died and so many others and hence each
country did the best to prevent the effects of COVID-19 and also preventing its
transmissions so as to rescue the life of people in the world.Though the countries
in the world have fought against Corona virus pandemic but still COVID-19 is
existing in some countries like Canada,Mexico and India though the effects are no
longer excessive as compared to previously effects due the use of special vaccines
proved by WHO hence these countries are supposed to be careful of it so as to be
safe from effects of COVID-19.
Thank you , see you next semester .
PROVERBS 4:13 Keep hold of instruction , do
not let go , Guard her for she is your life