COMMUNITY MEDICINE CURRICULUM FOR UNDERGRADUATE MEDICAL EDUCATION
Item
- Title
- COMMUNITY MEDICINE CURRICULUM FOR UNDERGRADUATE MEDICAL EDUCATION
- extracted text
-
i
|
f 11
1
Mj t
* i ■
.
....................................
■■
.
'
Cr.
. 4
Gg®
(Siei^w)iL
i
■
tt■•■..•;'.'
I
/G&> G-G’ -G.;<
;
'■.
ft- / <
iiio <®iif
MP r-
'<■/
r
•,ft >
n
<ft®i
■'A-_ .
•{<»'" s? ‘.'iWff
■ ft® ftft
■>
;
;
ft -«
■
•
.-
-‘
■
.
-
•
w
X’;
■
.
'■■'p
IfOS®
■ -f"'
,>^0® 6*";
u
!-■
I:
p
I
;‘-
b
s
'■
:
i
i Cor nmunity Medicine Curriculum
i
i
Undergraduate Medical Educati on
r
t:
h
G
!
i
£
1
i
■;
I
I
Revised by
M e dical Colles
V di
•O
1
eachers
4
mw-»
FIMC
h
F.
232
u
H
ii
Revised
Community Medicine Curriculum:
Contents, Learning Objectives
and
Teaching/Learning Experiences
with
Time Allocations
Published by:
Further Improvement of Medical Colleges Project
Bangladesh
<
FIMC, Health Projects Office
A-104 Park Road
New DOHS
Dhaka 1206
Bangladesh
/ ft- 13 o
FIMC, Project Director's Office,
Plot No. 15
Pastern I lousing Project-1
Kalyanpur, Dhaka 1216
Bangladesh
Facilitated and Compiled by:
Dr A Latif Bhuiya
Project Teacher FIMC
Max- 1997
Any part of this publication may be reproduced, stored in a retrieval system or transmitted in any
form or by any other means, electronic, mechanical, photocopying, recording or otherwise, without
prior permission, but acknowledgement will be appreciated.
11
iii
Preface
This proposed Community Medicine Curriculum is the result of a systematic revision and
development of the existing curriculum. It has been produced by the present teachers of
Community Medicine in the Medical Colleges who based their work on modern educational
principles. In many instances practical and experiential learning methods have been substituted for
classroom teaching, as a result of which the number of lectures in the course has been reduced by
more than 30 per cent. Undoubtedly students will benefit form this and will more readily acquire
the skills they require to practise Community Medicine. This commendable achievement deserves
high appreciation.
Some aspects of this curriculum will require ratification by higher level curriculum committees and
later by the Bangladesh Medical and Dental Council. These include the suggested changes in the
assessment system. However other changes which are merely a development of the present
undergraduate curriculum or just specify a different teaching method may be implemented
immediately.
It is hoped that the incorporation of learning objectives, teaching methods and details of the
assessment system will be useful to both teachers and students.
Finally I would like to offer my thanks to Dr A Latif Bhuiya who, on behalf of FIMC Project,
undertook the task of organising the running of the series of meetings and workshops required.
Professor M Muzaherul Huq
Project Director FIMC
iv
PROCESS OF CURRICULUM DEVELOPMENT
This commumry medicine curriculum for undergraduate medical students was developed by teachers of the medical
colleges between April 1996 and January 1997. This included a revision of the Residennal Field Site Training Course
originally written in 1994.
The curnculum development process was performed systematically on the basis of curriculum design as suggested by the
World Health Organisarion.
Curriculum Design
Situation
- health needs
- resources of health system
- job description
situation analysis
—„ I
•------ 4-
Ust of tasks
task analysis
Learning objectives
- list of skills
- facts, attitudes needed
<■
1
-—J
curnculum design
Curriculum + lesson plans
- objectives
- teaching methods
- assessment methods
- timetable
- evaluation
WHQSliU
A needs analysis was first conducted, the views of teachers, students and young graduates being obtained. Next the
curriculum development group carried out a task analysis on the basis of what use a young graduate would make of
teaching in Community Medicine. During the development of the core contents the learning objectives were set out and
both core and additional contents were listed. A review of the community health or community medicine curricula in
other countries was also performed. With this background the group carried out their work in accordance with the terms
of reference they had set themselves. These included.
Reviewing teaching methods in particular with a view to
- creation of the appropriate altitude.
- the development of skills^
- promotion of a habit of self-learning.
The final outcome is dependent on the extent to which the teachers in individual colleges can deliver the course as
as
planned increasing the level of community-oriented and community- based learning activities. To some extent this itself
depends on the degree of success with which
urban demonstration1 areas within easy reach of the colleges can be
--------------------------developed as sites for day visit learning activities.
H
I
V
Once the course is implemented no time should be wasted before planning an evaluation of the course, to uncover any
unidentified defects and to learn whatever might enable it to be improved further.
Members of the Curriculum Working Group
During the curriculum development process the following teachers have at some time been a member of the curriculum
working group
I
Professor A Khalique Barbhuiyan, Head of Community Medicine, Dhaka Medical College
2.
3.
Professor M Sultan Ul Alam, Head of Community Medicine, Chittagong Medical College
Professor Arunodaya Barman, Head of Community Medicine, Rajshahi Medical College
Dr Mahfuzar Rahman, Head of Community Medicine, Rangpur Medical College
4.
5.
Dr Dilara Begum, Head of Community Medicine, Sir Salimullah Medical College
6.
Dr Md Abdul Jabbar, Head of Community Medicine, Sir Salimullah Medical College
7
8.
Dr AKM Ruhul Amin Khan, Head of Community Medicine, Mymensingh Medical College
9.
Dr Shibbir Ahmed, Head of Community Medicine, MAG Osmani Medical College
Dr Oyes Ahmed Chowdhury', Lecturer, MAG Osmani Medical College
10.
11
12
13.
14.
Dr UK Taufiqun Nessa, Asstt Prof of Community Medicine, Mymensingh Medical College
Dr Maksumul Hakim, Lecturer of Community Medicine, Dhaka Medical College
Dr Aminur Rahman, Lecturer of Community Medicine, Dhaka Medical College
Dr K M Asaduzzaman, Asstt Prof of Community Medicine, Faridpur Medical College
15.
Dr Hafiza Arzuman, Lecturer of Community Medicine, Sir Salimullah Medical College
Dr Rafiqul Alam, Assoc Prof of Community Medicine, Rangpur Medical College
16.
17.
Dr Mahmuda Chowdhury-, Asstt Prof of Community Medicine, Dhaka Medical College
Dr Aftabuddin, Head of Community Medicine, Sher-e-Bangla Medical College
18.
Dr Swapan Kumar Chowdhury, Lecturer of Community Medicine, Chittagong Medical College
The following Resource Personnel attended some meetings of the group:
1
2.
Professor M H Molla, Director, Centre for Medical Education
Professor Rashid-e-Mahboob, Centre for Medical Education
3.
Professor Falahuzzaman Khan, Director, NIPSOM
Professor Mahmudur Rahman, NIPSOM
4.
5.
Professor Khabir Uddin, Bangladesh Medical College
6.
7.
Professor Sadiqua Tahera Khanam, NIPSOM
Dr Zakir Hossain, Director, Primary Health Care
8
9.
Professor Myo Thwe, Consultant, World Health Organisation
Professor Muzaherul Huq, Project Director FIMC
Dr Colin Bullough, Project Manager FIMC
10.
11.
12.
Dr A Z M Iftikhar Hussain, Project Teacher FIMC
Dr A Latif Bhuiya, Project Teacher FIMC (attended all meetings)
The Further Improvement of Medical Colleges Project provided logistic and technical support.
H
I
vi
Acknowledgments
I
i
'I he contribution of the following four short term consultants of the F1MC Project is acknowledged.
In mid 1994, Dr Syed Ahmed, Consultant in Public Health Medicine of Lanarkshire Health Board, UK, worked ’ villi
the teachers of the Department of Community Medicine of Dhaka and Chittagong Medical Colleges. Some skills
undergraduates need to acquire to practise Community Medicine were identified. He also proposed a daily schedule
for the community placement week of the Residential Field Site Training Course.
Professor Abraham Joseph, of Christian Medical College, Vellore, carried out an appraisal of the Residential Field
Site Course in 1995 making some suggestions which were adopted by the group.
Professor D K Srinivasa, of Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry spent
four weeks working with the members of the curriculum development group in 1996 making a valued contribution to
the process of curriculum development. Along with Professor Srinivasa, Dr Mahfuzar Rahman of Department cf
Community Medicine of Rangpur Medical College carried out a four week consultancy to promote the curriculur i
development exercise.
I he support and encouragement of Professor AKM Nurul Anwar and of Professor Shah Monir Hussain, the past and
present Directors of Medical Education during the conduct of this work are highly appreciated.
Dr Colin Bullough
Project Manager, FLMC
u
vii
CONTENTS
Pane
Departmental Objectives
1
Part I - Course Contents
Introduction to Community Medicine
Behavioural Sciences
Biostatistics
2
4
7
Part 11 - Course Contents
Epidemiology
Epidemiology of Common Health Problems
Public Health Nutrition
MCH-FP and Demography
Health Education
Medical Entomology
Environment and Health
Occupational Health
Primary Health Care
I
8
12
13
15
19
20
21
23
24
Evaluation of Community Medicine
25
Time Allocation for Community Medicine
26
List of Contributors and Resource Personnel
27
Annex 1:
Residential Field Site Training Course
Community Placement Week
Primary Care Week
30
34
54
Annex 2:
Objectives of Day Visits
80
Annex 3:
An Example of Clinico-Social Case Study
Epidemiological Exercises: Filariasis; Malaria
Communication Skills: Checklist; Rating Scale
Group Interaction Observation Guide
Impressions of Village People
89
93
95
98
99
h
Departmental Objectives of Community Medicine:
The objective of teaching by the Department of Community Medicine
is to produce basic doctors towards fulfilment of community health
needs of the country.
To achieve this the department will provide medical students with
learning experiences:
1.
for comprehensive health care,
2.
to develop insight into concept and practice of primary health
care,
3.
for carrying out epidemiological studies for community health
problems,
4.
in organising and practising health education programmes in the
community,
5.
for developing appropriate attitude to deal with common health
problems,
6.
to work as a member of health team, and
7.
to participate in national health programmes.
Community Medicine Curriculum
Teaching/ Learning experiences
Learning Objectives
Contents
Class-room
1. Introduction to Community Medicine
Students will be able to:
CORE
1.
Practical/visit
Aids
Expected
hours
/days
Assess
ment
Lecture
define community, community medicine,
comprehensive health care
Concept of community medicine
2.
Concept of health and disease.
Health and social problems in
Bangladesh.
define health and disease, public health,
preventive medicine, social medicine
Identify the factors influencing health and disease
• Video
• Written
• Handout
• Oral
• Self study
• Short presentation
• Question answering
session
L-2.00h
4.
understand and appreciate the multifactorial
aetiology of disease
• Discussion
5.
identify social factors related to health
• Short presentation
6.
demonstrate awareness of different levels of
health care delivery and their organizations &
functions
• Demonstration
7.
demonstrate awareness of different types of
organisations providing health care in Bangladesh
both in rural & urban areas
Organization and health care delivery
system of Bangladesh.
T-4.00h
Health Team Concept.
L = Lecture, T = Tutorial, V = Day Visit
• Day visit
• Charts
• Check-list
2
A
Community Medicine Ciiriiciilum
Teaching Learning experiences
Contents
I. Introduction to CM (cont'd)
Learning Objectives
8.
understand health services are delivered by medical, health
and other allied personnel
9.
describe the composition of health team at different levels
e,g. thana & union
10. describe the type and range of work undertaken by
different categories of health workers
11. state the role of doctor in hospital setting, health centres
setting and community setting
12. Describe common health & social problems of Bangladesh
Class-room
Practical/visit
Aids
• Lecture
• Day Visit
• Video
• Short
presentation with
video
• Reading
materials (eg.
Expected
hours
Assess
ment
■days
• Written
L-l.OOh
Thana manual)
• Oral
• Check-list
• Discussion
• Classroom
exercise
• Case
presentation
• Paper cutting
T-2.00h
• Assignment
V-l day
• Role play
ADDITIONAL
History of public health.
Multi-sectorial responsibility
of health.
Disease profile.
L = Lecture, T = Tutorial, V = Day Visit
3
Community Medicine Cuii iciiliim
Teaching/ Learning experiences
Learning Objectives
Contents
Class-room
II. Beha\ioural Sciences
Practical/visit
Aids
Ex peeled
hours
da\ s
Assess
ment
Concept of sociology, social psychology and social
anthropology
CORL
Students will be able to:
Concept of sociology, social
psychology and social anthropology
A.
Define terms:
Family, Society, Sociology, Humanities, Social
psychology and Medical Anthropology, Socio
economic stratification
The family in health and illness
Cultural and social factors in health
and illness.
B.
Illness behaviour and its management.
Doctors-patients communication.
• Lecture
Explain the principles of sociology and its application
in understanding human behaviour
C. Describe the elements of normal psychology and social
psychology
Family Health
Intelligence.
D.
Leadership.
Types of Personality.
2.
Appreciate the role of family in health and illness
List various social and cultural factors which
influence health of:
Ul
(b)
(c)
L = Lecture, T = Tutorial, V = Day Visit
• Oral
• Handout
• Short
presentation
with video
• Textbook
• OUT
L-2.0011
• Other reading
materials
T-2.00h
• Video
L-2.00h
• Reading
materials
T-2.00h
• Discussion
• Lecture
• Short
presentation
with video
• Family
attachment
(As per
situation
permits 1st/
2nd year)
Family attachment.
• Film strip
illness
With the knowledge of the above and at the end of
instruction (in behavioural science), the student should
be able to:
I.
• Written
• Self-study
Steps of learning and motivation.
ADDITIONAL
• Video
• Written
• Oral
• Check-list
• OUT
V-2 days
• Brain
storming &
discussion
individual,
family and
community
4
Coinmunily Medicine Curriculum
leaching/ Learning experiences
II. Behavioural sciences (confd)
Class-room
Practical/visit
Aids
Expected
hours
/days
• Lecture
• Student
project
(Clinicosocial case
study)
• Video
L-LOOh
Learning Objectives
Contents
Assess
ment
• Written
Cultural & social factors in health and illness
3.
4.
Classify cultural factors (such as beliefs, customs,
practices) into those beneficial, those harmful and
those neither beneficial nor harmful for maintenance
of health
• Discussion
Collect data on socio-cultural status of the community
such as:
• OUT/ slides
• Prepared
questionnaire
• Oral
T-2.00h
• Check-list
V-2days
• Handout
education, income, occupation, housing, tradition,
culture, beliefs, customs and practices of an individual
or a family relating to health and illness giving due
respect to respondents to understand the objectives 2,
3, 5, 7 and 8 above.
5.
• Study
instrument
Assess socio-cultural factors which act as barriers
leading to good health and recovery from illness
Appreciate the impact of urbanisation on health and
disease
6.
Illness behaviour and its management
7. State behavioural changes during illness of an
individual
• Short
presentation
• Video
L-LOOh
• Written
• Oral
• Films trip
• Discussion
8.
Identify and explain the impact of behaviour (habits,
customs) on health maintenance and illness on
individual and family
L - Lecture, T = Tutorial, V = Day Visit
• OHT/ slides
T-2.0011
• Check-list
5
Community Medicine CuiTiculiim
’reacliing/ Learning experiences
Learning Objectives
Contents
Class-room
11. Beha\ ionral sciences (cont’d)
Praclical/visit
Aids
Expected
hours
/days
Assess
ment
Doctor-patient relationship
1.
Appreciate how the doctor-patient relationship may be
influenced by the behaviour of either the patient or the
doctor
Doctor
• Lecture
• Video
• Short
presentation
• Posters
Patient
* Slides
• Observational
check-list
• Discussion
-emotional involvement
-sentimentality
-avoidance of giving bad news
-offending the patient
-attention
-compassion
2.
-denial of illness
-manipulation of doctor
-using doctor for emotional
support
-respect
-confidence
Recognise and demonstrate the body language which
reflects common emotions
• OHT
• Role play
• Observation
barriers of
communication at
THC/ OPD/ IPD
V-l dav
• Demonstration
Learning and Motivation
The student will be able to:
1.
State the learning theories
• Written
2.
Narrate the application of learning theories in changing
health or illness behaviour
• Lecture
• Handout
L-l.OOh
• Oral
• Discussion
T-2.00h
Describe the types of motivation and their application in
health education
L
Lecture. T
Tutorial, V = Day Visit
6
L
£
. 4
k:.
.i
[
I
4
4
Community Medicine Curriculum
Teaching/ Learning experiences
Contents
Learning Objectives
Class-room
III. Bio-statistics
Bio-statistics
COKE
1.
Introduction to biostatistics.
Uses of biostatistics.
Define terms:
- biostatistics
Practical/ visit
• Lectures
Aids
Expected
hours
/days
• Handout
Written
Oral
• Discussion
2.
Aware about the importance of birth, death, marriage and
sickness registration
Vital statistics.
• Classroom
exercise
Assess
ment
• Data
processing.
• Computer
L-8.00h
Interpret the effects of:
Methods of collection and
classification of data.
T-8.00h
(a)
(b)
(c)
(d)
Presentation of statistical data.
Frequency distribution, measures of
central tendency, measures of
dispersion.
4.
Sampling techniques.
5.
ADDITIONAL
Calculate a given data to interpret:
(a)
(b)
(c)
(d)
Analysis and interpretation of data.
universe / population in a study design
sampling
bias
variation
mean
median
mode
standard deviation (SD)
Present a given statistical information by
(a)
(b)
(c)
(d)
tabulation
bar diagram
line diagram
pie diagram
Research methodology.
Information Technology (IT)
L
Lecture, T = Tutorial, V = Day Visit
7
Community Medicine Curriculinn
Teaching/ Learning experiences
Learning Objectives
Contents
Class-room
IV. Epidemiology
Concept of epidemiology
core:
Students will be able to:
Concept of epidemiology.
Epidemiological triad.
Praclical/visit
Aids
Expected
hours
/days
Assess
ment
• Lecture
• Text book
• Written
Define and explain epidemiology
• Self learning
• Reading
materials
• Oral
State the use and aims of epidemiology
• Discussion
State the components of epidemiology
• Problem
solving exercise
Types of epidemiological studies.
• OHTZ slides
Community diagnosis.
• Video
L-3.00h
• Film strip
T-2.00h
Define different terms related to epidemiology
Investigation of an epidemic.
Tools of epidemiological
measurements.
Measurement of morbidity and
mortality.
Communicable diseases, Non-communicable diseases,
Infectious diseases, Contagious diseases, Period of
communicability, Period of infectivity, Incubation period,
Infection, Infestation. Sporadic diseases, Endemic
diseases, Epidemic diseases, Pandemic diseases, Zoonotic
diseases, Disease prevention, Disease control, Elimination,
Eradication, Isolation, Quarantine
Mode of transmission and principles
of control of communicable diseases.
Epidemiological Triad
Natural history of disease.
• Lecture
Classify agents for causation of diseases
Indicators of health and their
measurements.
• Self study
List the host factors responsible for diseases
• Discussion
Levels of prevention of diseases.
Identify the environmental factors of disease causation
Explain epidemiological triad in causation of disease
L = Lecture, T = Tutorial, V
Day Visit
• Problem with
scenario
exercise
• Video
• Film strip
• OF1T/ slides
• Handout
• Reading
materials
• Written
L-l.OOh
• Oral
T-2.00h
8
Coniinunily Medicine Curriculum
Teaching/ Learning experiences
Contents
Learning Objectives
Class-room
IV. Epidemiology (Conl'd)
Aids
Assess
ment
Types of epidemiological studies
Classify epidemiological studies
Describe descriptive epidemiological studies
Describe analytical studies
Distinguish between prospective and retrospective studies
Design and carryout a simple descriptive study
Investigate an epidemic outbreak
Define and calculate rate, ratio, proportion
Define screening for disease, types of screening and
diseases to be screened in our country perspective.
Explain the uses of screening on prevention of diseases.
Identify the criteria for screening of a disease and for
selecting a test.
Define specificity, sensitivity, validity, reliability and
predictive value of a screening test.
Explain different modes of transmission of diseases
Explain the principles and different methods of control of
communicable diseases
recognise the different phases of natural history of disease
describe the different levels of prevention and recognise
(heir importance
list important indicators for measuring health status in a
community and mention their uses
L = Lecture, T = Tutorial, V
Practical/visit
Lxpccted
hours
/days
Day Visit
• Lecture
• Short
presentation
• Discussion
• Classroom
exercise
• Self study
• Writ ten
• OUT
L-3.00h
• Study
reports
* Oral
T-6.00h
• REST
• Lecture
• Self study
• Classroom
exercise
• Discussion
• Problem
solving
exercise
L-LOOh
Handout
T-2.00h
• Video film
or slide tape
• Posters eV
diagram
L-2.00h
‘ Written
T-2.0011
• Oral
9
Community Medicine CuiTiculum
Teaching/ Learning experiences
Class-room
Practical/ visit
Aids
Expected
hours
/days
Define community diagnosis
• Lecture
• Computer
T-4.0011
Report
State different steps of community diagnosis
• Classroom
exercise
• Community
survey
RFSTP
• Photocopier
L-I.OOh
Oral
V-3 days
written
Contents
IV. 1 Epidemiology (Cont’d)
Learning Objectives
Assess
ment
Community Diagnosis
Select a topic
Select and construct objectives
Design methods
Select study population and determine sampling size
Choose appropriate sample
Construct questionnaire
Collect data
Interview the target population for data collection
Analyse the collected data
Construct tables and prepare graphs for presentation
Identify different methods of data presentation
State different headings of a scientific report
Write a report
L = Lecture, T = Tutorial, V = Day Visit
10
1
Community Medicine Curriculum
Teaching/ Learning experiences
Assess
ment
Aids
Expected
hours
/days
• Handout
T-4.00h
• Check-list
Learning Objectives
Contents
Class-room
Practical/visit
IV. Epidemiology (Confd)
ADDITIONAL
Clinico social case study.
Monitoring.
Surveillance.
Need and uses of screening tests,
e.g. validity, reliability, sensitivity
and specificity.
Conduct epidemiological case study to understand the need for
surveillance of disease by following steps:
Select a priority case
• Short
presentation
•Classroom
exercise
Construct questionnaire putting clinico-social variables as
much as possible
• Discussion
Interview
• Self study
• Prepared
questionnaire
• Assignment
• OHT
Describe the case, taking care of all the variables studied
Write a report
L = Lecture, T = Tutorial, V = Day Visit
11
1
Community Medicine Curriculum
Teaching/ Learning experiences
Contents
V. Epidemiology of common health problems
The students will be able to:
CORE
1.
Epidemiology and management of diseases of
public health importance:
2.
EPI diseases, diarrhoeal diseases, •
malaria, kala-azar, enteric fever, leprosy,
rabies, viral hepatitis, chicken pox,
mumps, filariasis, helminthiasis, food
poisoning, STDs & AIDS, scabies.
Class-room
Practical/visit
Aids
Expected
hours
/days
•Lecture
•Student project
•Video
L-16.00h
•Tutorial
•Visit to
Leprosy
hospital, T.B.
clinic, ORT
corner, ID ■
hospital, dist.
hospital
•Film strip
Learning Objectives
Describe the epidemiological determinants
(agent, host and environmental factors) of
common health problems of Bangladesh.
Illustrate the measures for prevention of common
health problems in the community specially EPI
diseases, Helminthiasis and Diarrhoeal diseases.
2
Develop skills to identify common health
problems in the community.
Epidemiology of common non-communicable
diseases:
4.
Develop understanding to manage common
health problems in the community.
•Group
discussion
cancer, diabetes, hypertension, IHD,
RHD and rheumatic fever.
5.
Appreciate the importance of epidemiological
basis for causation and prevention of common
communicable and non-communicable diseases in
Bangladesh.
•Problem
solving exercise
minor injuries, poisoning, disaster, snake
bite, drowning.
6.
Understand (explain) the importance of first aid
in initial management of emergency case.
7.
Develop skills for management of emergency
cases in the community.
•Symposium
(integrated)
•Real
patient
Assess
ment
•Written
•Oral
Checklist
V-4 days
•Visit to Cancer
Inst/ward,
Diabetic
Hospital
L-8.00h
•REST (THC)
T-8.00h
V-3 days
ADDITIONAL
Yellow fever.
Geriatric problems.
L
Lecture, T = Tutorial, V = Day Visit
12
Community Medicine Curriculum
Teaching/ Learning experiences
Learning Objectives
Contents
VI. Public Health Nutrition
Class-room
Practical/ visit
Aids
•Classroom
exercise
•REST/ MCH
clinic
•Handout
•Reading
material
•Weighing
machine
•Sakip’s tape
•Measuring
tape
•Growth chart
Expected
hours
/days
Assess
ment
Students will be able to assess nutritional status
& identify required measure by:
CORE
Proximate principles of food.
Balanced diet.
Vitamins and their deficiency diseases.
Trace elements: iron, iodine, fluorine.
Pasteurization
Assessment of Nutritional status.
Calorie requirements of different groups.
Dietary composition of common food items.
Preparation of suitable diet for expecting
mother & malnourished child
Protein energy malnutrition.
Food borne diseases
Milk borne diseases
Different types of hospital diet
(1)
Record the data on Road to Health Card
(2)
Aware of normal values and range of
indices used for assessment of growth,
nutritional status and grades of
malnutrition
(3)
Interpret data and arrive at nutritional
status of the child
(4)
Diagnose different types.of malnutrition
e.g. (Vitamin deficiency, PEM)
(5)
Outline a plan for dietary management
of malnourished child
•Lecture
•Tutorial
•RFST (children
outdoor/school)
•OSPE
L-6.00h
T-lO.OOh
V-l day
•Written
•Oral
•Practical
exam.
(spotting)
•Measuring
nutritional status
•Group
discussion
• Self study
L = Lecture, T = Tutorial, V = Day Visit
•ANC/ MCH
clinic/ RFST
•Video show
•Checklist
13
Community Medicine Curriculum
Teaching/ Learning experiences
Contents
Learning Objectives
Class-room
Practical/visit
Aids
• Group
discussion
• Survey
• Poster
• Charts
• Slides
Expected
hours
/days
Assess
ment
VI. Public Health Nutrition (cont’d)
(6)
Assess the prevalence and types of
malnutrition in the community by different
methods:
(i) dietary survey
(ii) anthropometry
• Oral
• Assignment
(iii) clinical examination
(7)
Identify the groups most seriously affected by
malnutrition
(8)
List the food borne and milk borne diseases
• Problem
solving class
• Questionnaire
Define pasteurization and identify different
methods of pasteurization
(9)
ADDITIONAL
• Food additives and preservatives.
• Trace elements except iron, iodine,
fluorine
• Food adulteration and food
fortification
L = Lecture, T = Tutorial, V = Day Visit
14
i
Community Medicine Curriculum
Teaching/ Learning experiences
Learning Objectives
Contents
Class-room
VII.
Practical/visit
Aids
Expected
hours
/days
Assess
ment
MCH- FP & Demography
Students will be able to:
CORE
Importance of antenatal care, antenatal
advice and antenatal investigations.
1.
Identification of high risk cases and
appropriate referral.
2.
Explain the magnitude of maternal
mortality and morbidity in Bangladesh
•Lecture
L-S.OOh
•Reading
materials
Identify factors influencing maternal health
•Oral
T-14.00h
List factors responsible for high maternal
mortality and morbidity in Bangladesh
Immunization of children & women.
IMR, MMR and causes of infant mortality
and maternal mortality
4.
Identify the measures for reducing maternal
mortality and morbidity in Bangladesh
Breast feeding and weaning
5.
Identify the organisations for providing
maternal health services rendered by them
in urban and rural area during
Concept of family planning
Different contraceptive methods.
Counselling in family planning
•Problem
solving class
with scenario
exercise
•Written
•Brain storming
session
(a) antenatal
(b) intranatal and
(c) post-natal period
MCH-FP services in Bangladesh.
6.
Factor influencing deliveries at home and in
hospital.
L = Lecture, T = Tutorial, V = Day Visit
Identify the different categories of health
personnel and their functions for rendering
maternal and child health care both in
hospital and community settings
•REST
•OHP
transparency
15
Community Medicine Ciirriculiim
Teaching/ Learning experiences
Contents
Learning Objectives
Class-room
VIL
MCII-FP &
Demography
(coin’d)
Child care
I.
Aware about the normal birth weight of a baby
2.
Practical'visit
Aids
Expected
hours
/days
Assess
ment
•Lecture
•Oral
•Group
discussion
•OSPE
Identify risk factors for low birth weight
Identify the interventions of low birth weight
4.
Explain the care for the new born
5.
List the conditions for artificial feeding
6.
Design & promote the use of adequate home made weaning foods
•OHT
•Written
Brainstorming
Family planning
1.
State the aims and objectives of family planning
2.
List various contraceptive methods with their advantages &
disadvantages
•Group work
•Class room
exercise
•Video
Identify the factors responsible for high population growth rate in
Bangladesh
4.
Plan and conduct a counselling session for motivation of eligible
& target couples towards following contraceptive methods:
(a) IUCD (Intra uterine contraceptive device)
(b) Oral pill
(c) Condom
(d) Menstrual regulation
(e) Abortion
(f) Permanent sterilization
L = Lecture, T = Tutorial, V = Day Visit
•RFST
(informal
interview)
•Slide
•Different
contraceptives
•Checklist
Role-play
•Model FP
clinic
(counselling)
V-l day
16
Community Medicine Curriculum
Teaching/ Learning experiences
Contents
Learning Objectives
Class-room
VII.
MCH-FP &
Demography
(conf d)
Practical/visit
Aids
•RFST
(interviewing
mothers)
•EPI records at
TH&FPO
Office
•Discussion with
HA, mothers
• Questionnaire
Expected
hours
/days
Assess
ment
Immunization of children in the community
1.
Assess level of immunization of children in the community
by:
(a) Study of records
(b) Enquiry from mother
2.
Find out reasons for low or high immunization status and
drop out cases
•Lecture
•REST (EPI
store-room visit)
• Demonstration
Explain the storing of vaccines and maintaining cold chain
at thana and union level
•Tutorial
4.
Describe the recommended immunization schedule for
infants and children
5.
List the contra-indications for immunization
6.
List the complications for immunization
7.
Plan and organize an immunization session in the
community
•Checklist
•Textbook
•UNICEF/
WHO
publications
•REST (satellite
clinic)
•Oral
•Written
•OHT
•Slide
Breast Feeding
1.
Explain to mothers value of breast feeding, nutritious
weaning foods and frequent feeding of young children
L = Lecture, T - Tutorial, V = Day Visit
•Short
presentation
•Model FP clinic
(interaction with
mothers)
•Vaccines
•Appliances
17
Community Medicine Curriculum
Teaching'' Learning experiences
Contents
Class-room
VII.
MC1I-FP & Demography
Assess
ment
Aids
Expected
hours
/days
• Handout
L-2.00h
•Written
•Posters &.
diagrams
T-4.00h
•Oral
Learning Objectives
Practical visit
Demography
(coin’d)
1.
Define terms:
Demography
Demographic cycle
Demographic indices
Population pyramid
Demography, crude and specific birth, growth and
fertility rates
2.
Explain demographic cycle in understanding various
population trends
2
Describe factors influencing population growth in
Bangladesh
4.
Appreciate factors influencing fertility like:
• Lecture
• Video
age at marriage
breast feeding
contraception
education
religion
5.
Aware age and sex structure and its influence on:
• Discussion
• Classroom
exercise
population growth
health service
disease trends
6.
Demonstrate awareness of different age and sex
structure by interpreting a given data.
L = Lecture, T = Tutorial, V = Day Visit
18
i
Community Medicine Curriculum
Teaching/ Learning experiences
VIII. Health Education
Students will be able to:
CORE
1.
2.
3.
4.
Communications.
Principles of health
education.
5.
6.
Media and methods of
health education.
7.
8.
9.
Planning a health
education programme.
10.
Need for using safe water,
proper nutrition,
contraception and personal
hygiene.
Class-room
Practical/visit
Aids
Expected
hours
/days
• Lecture
• Visit MED
• Video
• Models
T-4.00h
Learning Objectives
Contents
Aware about the elements of communication
Aware about the barriers of communication
Describe the methods of communication
List the aims of communication
Select and use suitable method & media for communication
of individuals and groups
Define health education
Narrate its objectives and principles
State the stages of adoption of new ideas and practices
State the different media in health education
Choose and use of appropriate media and method for
selective health education programmes of individuals and
groups
• Short
presentation
• Discussion
• Project work
• Observation
of barriers of
communication
at THC/OPD/
IPD
• Demonstration
• Role play
• Participate
HE session at
THC
Assess
ment
L-2.0011
•Written
•Oral
•Observational
check-list
• Specimen
• Handout
• Posters
• Flip chart
• Slides
• OHTs
• Family
planning
materials
L-3.00h
T-2.00h
V-l day
11.
12.
13.
(a)
Prepare simple health educational materials
Plan health education session
Conduct health education session on:
use of safer water
(b) proper nutrition
(c)
use of contraceptives
(d)
maintenance of personal hygiene
(e)
breast feeding & weaning
(0
demonstration of ORS preparation
• Assignment
• Conduction
of HE session
•Checklist
T-4.00h
•Checklist
V-l day
(g) benefits of immunization
(h) referrals during emergency
L = Lecture, T = Tutorial, V = Day Visit
19
Community Medicine Curriculum
Teaching/ Learning experiences
Contents
IX.
Medical Entomology
Practical/visit
Aids
•Lecture
•Viewing of
models and
slide under
microscope
•Model
L-2.00H
•Written
•Entomo
logical
slides
T-6.00h
•Oral
Assess
ment
Students will be able to:
CORE
1.
Define and classify arthropods of medical
importance
Role of vectors in causation of diseases.
Arthropod-bone diseases.
2.
State the role of vectors in causation of diseases,
including the bio-nomics of arthropods of medical
importance.
2
Describe the principles of vector control..
•Tutorial with Model
Principles of Vector control.
ADDITIONAL
Class-room
Expected
hours
/days
Learning Objectives
•Tutorial
Commonly used insecticides.
L = Lecture, T = Tutorial, V
Day Visit
20
Community Medicine Curriculum
Teaching/ Learning experiences
Contents
X.
Environment & Health
CORE
Learning Objectives
Assess
ment
Class-room
Practical/visit
Aids
• Self learning
• Lecture
• Short
presentation
• Discussion
• Demonstration
• Visit to PHE
dept.
• Handout
• Written
• Oral
• OHT
• Practical
Students will be able to:
(a)
Define environment and describe its
various types
Introduction to Environment
(b)
State the causes of water pollution
(c)
Explain the methods of purifications of
water in small scale
Water pollution
Water purification on small scale.
Water quality standard.
Expected
hours
/days
(d)
State the criteria for water quality
including WHO standards for drinking
water
Biological process of Septic Tank
(e)
List important water borne diseases
Water seal latrine.
(f)
List the sources of different types of air
pollution and their health effects
(g)
Describe global green house effect
(h)
Describe the essential features of water
seal latrine
(i)
Describe biological process of Septic
Tank
Water borne diseases
•Practical in the
Departmental
Laboratory (to
be developed)
L-2.0011
•Laboratory
equipment (to
be procured
T-4.00h
V-2 days
Air pollution.
Green house effect.
L = Lecture, T = Tutorial, V
Day Visit
21
Comimmiiv Medicine Ciiriiculuni
Teaching/ Learning experiences
Contents
Learning Objectives
Class-room
X.
Practical/visit
Aids
Expected
hours
/days
Assess
ment
Environmental Health (cont’d)
ADDITIONAL
Large scale water purification.
(a)
Describe different types of large scale water
purification plant
(b)
Types of ventilation & effects on health
(c)
State the effects of radiation on health
(d)
State of importance of hospital incineration
and describe the mechanism of incineration
Ventilation: air conditioning
Radiation.
Hospital incineration.
L = Lecture, T
Tutorial, V = Day Visit
22
Community Medicine CurricuIum
Teaching/ Learning experiences
Contents
Learning Objectives
Class-room
XLa) Occupational Health
a. Occupational health
CORE
1.
Define occupational health and its objectives
Introduction to occupational health
2.
Explain various occupational environment
Practical/visit
•Lecture
Occupational health hazards
Occupational diseases
Principles of prevention of
occupational diseases.
5.
List the locally prevailing common occupational
diseases with preventive strategies of:
Pneumoconiosis
Occupational cancer
Anthrax
Occupational dermatoses
Describe the general measures of health protection
in different occupation
• OHP
• Video
List the common occupational health hazards
4.
Aids
Expected
hours
/days
Assess
ment
• Written
L-2.00h
• Oral
•Visit to
• Tutorial
industry
T-4.00I1
V-I day
•Group
discussion
b) School health service
b. School health
ADDITIONAL
Responsibilities of school
health medical officer.
1.
State the objectives of school health programme
2.
State the present status of school health services in
• Lecture
•Day visit to a
L-l.OOh
school
V-l day
• Checklist
Bangladesh
School environment.
L = Lecture, T = Tutorial, V
Day Visit
23
Community Medicine Curriculum
reaching/ Learning experiences
Contents
XlL(a) Primary Health Care
Learning Objectives
CORE
2.
Concept of Primary Health Care and
4.
History of PHC.
Definition of PHC.
5.
Principles and components of PHC.
Strategy of PHC
Define Primary Health Care (PHC) and Health
•Lecture
•Reading
For All (HFA)
•Self study
assignment on
Explain principles of PHC
•Short
publication related
State the components of PHC
presentation
to PHC
Involve community in identifying priority
•Discussion
health problems
(tutorial)
6.
7.
(d) International health regulations.
Describe the organisational structure in delivery
hours
ment
/days
•Oral
•OHT
visits
materials
•Report
writing on
V-4 days
visits
related to
Aware about the goal of Health For All (HFA)
•Visit to health
PHC
in the context of Bangladesh
institutions which
survey
Understand the strategies of PHC in attaining
delivery PHC
the goals of HFA by the Year 2000
•Conducting a
Aware of our national health programmes
survey on PHC
Non-Governmental
9.
Recognise important international health
components
organisations and list their programmes
(RFSTP)
Aware of the application of international health
•Visit to outreach
regulations in our country
centre &. satellite
10.
L- 5.00h
•Written
•Reading
8.
Organisations.
•Handout
•Organising day
ADDITIONAL
National health surveillance
Aids
T-lO.OOh
of PHC in Bangladesh
(b) National health programmes.
(c) International health organizations.
Practical/visit
Assess-
Primarv Health Care
I.
Health for All.
Class-room
Expected
clinic
Note: Residential Field Site Training Course and Day Visits are attached as Annexes.
L = Lecture, T - Tutorial, V = Day Visit
24
H
25
EVALUATION OF COMMUNITY MEDICINE
FORMATIVE ASSESSMENT
Card Completion Examinations: Written/ Oral/ Practical (OSPE)
REST Course Completion Test: Written/ Oral
S U M MATIV1 • A SS ESS M ENT:
Assessment ol the Part One of the Community Medicine Curriculum which is taught in year I and year
2 will be done only by written examination. Marks will be 100. This examination is a part of 1st
Professional M.B.B.S. Examination.
2ND PROFESSIONAL M.B.B.S. EXAMINATION
WRITTEN
100 marks
Multiple Choice Questions
10% (separate Question Paper)
(10-20 questions to be answered)
Long Essay Question
15% (I question to be answered)
Short Essay Questions
75% (12 questions to be answered)
[Group A will contain Multiple Choice Questions (maximum 20 questions) and Long Essay
Question (one out of two questions is to be answered) and Groups B, C & D will comprise Short
Essay Questions (5 questions will be set in each group from which 4 questions are to be
answered)]
PRACTICAL 100 marks
1.
Conventional Practical Examination/ Objective
Structured Practical Examination (OSPE)
2.
Report on a survey/ preliminary research
and
Report on Day Visits
and/or
Assessment on Residential Field Site
Training Programme
4.
ORAL 100 marks
Structured Oral
40
}
60
}
}
11
r
26
TIME ALLOCATION FOR
COMMUNITY MEDICINE CURRICULUM
Students’ Time
SUBJECT
LECTURE
TUTORIAL
DAY VISI T
I.
INTRODUC TION TO CM
3 hours
6 hours
1 day
n
BEHAVIOURAL SCIENCES
9 hours
14 hours
5 days
I
BIOSTATISTICS
8 hours
8 hours
20 hours
28 hours
6 days
IV.
EPIDEMIOLOGY
I I hours
22 hours
3 days
M-
EPIDEMIOLOGY OF COMMUNITY
HEALTH PROBLEM
24 hours
8 hours
7 days
VI.
PUBLIC HEALTH NUTRITION
6 hours
10 hours
1 day
Mil.
MCH-FP & DEMOGRAPHY
10 hours
18 hours
1 day
VIII. HEALTH EDUCATION
3 hours
6 hours
2 days
IX.
ENTOMOLOGY
2 hours
6 hours
X.
ENVIRONMENT AND HEALTH
2 hours
4 hours
2 days
3 hours
4 hours
2 days
5 hours
10 hours
4 days
2ND PART SUB-TOTAL
66 hours
88 hours
22 days
GRAND TOTAL
86 hours
I 16 hours
28 days
1S T PART SUB-TOTAL
XL OCCUPATIONAL HEALTH
—
XII. PRIMARY HEALTH CARE
Expected Teaching Time
1st Part
Lecture
Tutorial
Day Visit
20 hours lecture sessions
14 Tutorial Sessions of 2 hours duration x 6 Batches of
students = 84 tutorial sessions of 2 hours duration
1 week Day Visit x 6 Batches = 6 weeks day visits
2nd Part
Lecture
Tutorial
Day Visit
66 hours lecture sessions
44 Tutorial Sessions of 2 hours duration x 5 Batches of
students = 220 tutorial sessions of 2 hours duration
3 weeks Day Visit x 5 batch = 15 weeks day visits
(includes 2 weeks REST x 5 = 10 weeks day visits)
u
27
List of contributors who participated in the process of
Development of Community Medicine Curriculum
No.
Name of'the participant
Institutions
No. of meetings
attended
1.
Professor A K Barbhuiyan
HoD, DMC
9
2.
Professor Sultan Ul Alain
HoD, CMC
7
Professor Arunoclaya Barman
HoD, RjMC
6
4.
Dr Mahfuzar Rahman
HoD, RgMC
8
5.
Dr Dilara Begum
HoD, SSMC
6.
Dr Md Abdul Jabbar
HoD, SSMC
2
7.
Dr A K M Ruhul Amin Khan
HoD, MMC
7 ■
8.
Dr U K TauPiqiin Nessa
Asstt Prof. MMC
9.
Dr Shibbir Ahmed
HoD, MAGOMC
5
10.
Dr Oyes Ahmed Chowdhury
Lecturer, MAGOMC
7
11.
Dr Maksumul Hakim
Lecturer, DMC
4
12.
Dr Aminur Rahman
Lecturer, DMC
13.
Dr A 1< M Asaduzzaman
Asstt Prof. FMC
6
14.
Dr Hafiza Arzuman
Lecturer, SSMC
6
15.
Dr Rafiqul Alam
Assoc Prof, RgMC
4
16.
Dr Mahmuda Chowdhury
Asstt Prof, DMC
1
17.
Dr Aftabuddin
HoD, SBMC
2
18.
Dr Swapan Kumar Chowdhury
Lecturer, CMC
1
u
28
No.
Name of the participant
Institutions
No. of meetings
attended
Professor M H Mol la
Director, CM Ed
I
Professor Rashid-e-Mahboob
CM Ed
1
Professor Falahuzzaman Khan
N1PS0M
2
4
Professor Mahmudur Rahman
NIPSOM
2
5.
Professor Khabir Uddin
Bangladesh MC
I
6.
Professor Sadiqua Tahera Khanam
NIPSOM
1
7.
Dr Zakir I lossain
Director, PI IC
I
8
Professor Myo Thwe
WHO
1
Resource Personnel
I.
—
FIMC Personnel
1.
Professor M Muzaherul Huq
Project Director
5
2
Dr Colin Bullough
Project Manager
7
Dr Iftikhar Hussain
Project Teacher
2
Project Teacher
10
Facilitator
Dr A Latif Bhuiya
A total of 10 meetings were held
u
29
Further Improvement of Medical Colleges Project
Cosensus meeting on Community Medicine Curriculum
Venue:
FIMC Project Office, New DOHS, Dhaka
Dale:
Wednesday 12 &. Thursday 13 March 1997
08:30 a.m. - 02:30 p.m.
lime:
No.
Name
Designation
Institution
Professor A Khaliquc Barbhuiyan
Prof &. Head of Comm. Medicine
DMC
Professor Md Sultan (JI Alam
Prof & Head of Comm. Medicine
CMC
Professor Falahuzzaman Khan
Prof & Head of Comm. Medicine
MMC
4.
Professor Arunodaya Barman
Head of Comm. Medicine
RjMC
5.
Dr Mahfuzar Rahman
Assoc Prof & Head ofCom. Medicine
RgMC
Wednesday 12 and Thursday 13 March 1997
1.
Thursday 13 March 1997
6.
Dr Abdul Jabbar
Assoc Prof of Comm. Medicine
SSMC
7.
Dr U K Taufiqun’nessa
Asstt Prof of Comm. Medicine
MMC
8.
Dr Aftabuddin
Asstt Prof of Comm. Medicine
SBMC
9.
Dr Maksumul Hakim
Lecturer of Comm. Medicine
DMC
10.
Dr Hafiza Arzuman
Lecturer of Comm. Medicine
SSMC
I I.
Dr Swapan Kumar Chowdhury
Lecturer of Comm. Medicine
CMC
12.
Dr Oyes Ahmed Choudhury
Lecturer of Comm. Medicine
MAGOMC
Project Teacher
FIMC
Facilitator for both days
13.
Dr A Latif Bhuiya
L
[ft
&
u.
1 *
u.
r-
§
I
L .^i
l-xsuny
n
u
31
The Residential Field Site Training Course for Fourth Year Students is an integral
part of the curriculum. The way the course has been developed allows many
disciplines to increase the community orientation of their teaching.
The Head of Department of Community Medicine supported by the Field Site Training
Sub-Committee is in overall charge of the programme on behalf of the Principal. The
content and the teaching methods used in the courses involving individual disciplines
is however the responsibility of the head of the Thana Health Complex. The latter ■
are also responsible for staff allocation although this is supervised by the Department
of Community Medicine.
Teaching Programme
Two courses of one week’s duration will run simultaneously.
Twelve students will have a weeks course in Community Placement week and 12 will
have a course in Primary Care week.
In the second week of their course the students will change courses.
The timing of the teaching sessions are as follows:
Session 1
1 Session 2
Session 3
Session 4
08:30 a.m. - 10:30 a.m.
11:00 a.m. - 01:00 p.m.
03:00 p.m. - 05:00 p.m.
07:00 p.m. - 08:30 p.m.
Learning activities
Learning activities
Review of experience
Discussion & Debate
The allocation of the days teaching to the disciplines involved in the "Primary Care"
week is as follows:
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Community Obstetrics
Community Ophthalmology and Otolaryngology
Immunization and Family Planning
Medicine and Microbiology
Community Surgery/Orthopaedics
Community Paediatrics
The programme has been based on the functions of non-specialised doctors in
providing primary health care at community and primary care level. Lesson plans
have been produced and the learning objectives have been derived from an analysis
of the tasks performed by such doctors. Teachers should therefore follow the
curriculum closely and not deviate to teach on other subjects. This is especially
important as the students’ assessment at the end of the course will be based on the
learning objectives.
Mp iao
u
32
From the outset it was felt that the lecture format would be an inappropriate method
of teaching at the field site and it was arranged that any prerequisite knowledge which
copld be taught by lecture should be taught at the Medical College prior to the course
at the THC. At the most a mini-lecture to reactivate existing knowledge can be given
at the commencement of teaching but thereafter it is planned that teaching methods
should consist mainly of observation and participation by the students, plus
discussions and other small group techniques.
Role of the Thana Health Complex Doctors
The doctors stationed at the Thana Health Complex (THC) practise the type cf
medicine on which the course is based. They have therefore been given a role in the
teaching programme which is specified in the lesson plans. They should be involved
in the teaching as much as possible. The doctors of the THC will take care cf
students for Primary Care week. The staff of the THC will be trained up by the
Faculty of respective Medical College. Clinical teachers are also encouraged to
participate in the activities of Primary Care Week where and whenever they feel it
necessary.
Thana Health Complex
The use of the teaching facilities, access to patient areas and employment of THC
staff are all under the control of the Thana Health and Family Planning Officer
(TH&FPO), and teachers from medical college must respect his/her authority in these
matters.
Apart from the outdoor, ward and laboratory area two rooms are available for
teaching sessions. These are the classroom and the Resident Medical Officer’s room.
Transport
Two.microbus of twelve seats capacity would be engaged for taking students from the
College campus to the Thana Health Complex. The bus will leave the Medical
College at 7 o’clock in the morning usually on Saturdays and leave the Thana Health
Complex at 6 o’clock in the evening on Thursdays.
The driver of the micro-bus has a fixed schedule to follow. This is under the control
of the Principal. Any change in the travel schedule at the Thana Health Complex can
only be authorised by the Thana Health & Family Planning Officer, or his/her deputy,
or by teacher from the Department of Community Medicine.
u
33
Accom modation
There are two dormitories both with twelve beds for the students. In each dormitory
there are two single rooms for medical college teachers. Each room has electric lights
& a fan. Sweepers and guards are under the control of the TH&FPO.
Meals for students and staff will be prepared and served by staff working under the
supervision of the TH&FPO.
The THFPO will delegate the responsibility for the management of the
accommodation to one of his administrative officers. Staff members wanting to ask
about anything related to accommodation or meals should speak to the administrative
officer in the first instance.
Food arrangement
Meal schedule would be as follows:
07:00 a.m. to 08:00 a.m.
10:00 a.m. to 10:30 a.m.
01:00 p.m. to 02:00 p.m.
05:00 p.m. to 05:30 p.m.
08:30 p.m. to 09:00 p.m.
Breakfast
Tea & cookies
Lunch
Tea & cookies
Dinner
This timetable may sometimes change for specific work schedule.
Games
Arrangement for badminton, caramboards and volleyballs could be made available
at the dormitories.
Students may take their own music player or Walkman. But no loud music will be
allowed in the dormitories. No music is allowed after 10:00 p.m.
Student supervision
Supervision of the students is the responsibility of the medical college teachers and
TH&FPO. Staff have a particular responsibility to ensure that the students’ behaviour
does not cause any inconvenience or upset to the general public.
Students are expected to raise all problems with the teacher and not with the THC
staff. In the case of illness a student who wishes to go home or who has been
advised to go home by a doctor should obtain the permission of the teacher before
leaving.
>i99M4uauiaoB|d Aiiuniuiuog
n
u
35
I'
Community Medicine Teaching Programme
erm
Residential Field Site Training Course
I
COMMUNITY PLACEMENT WEEK
CONTENTS
Page
Day 1
Supervision of field health workers
36
Community health survey
37
Run MCH Services
38
Day 2
&
Day 3
Day 4
Health Education in MCH
Immunisation
Day 5
Maintain health information records
39
Intra & Inter-sectoral collaboration
Day 6
Promotion of Health
43
Activity Schedule for Community Placement Week.
44
Sample Questionnaire for Field Site Epidemiological Survey
49
Glossary
78
Day 1 -
Supervision of Field Health Workers
Methods
Learning objectives
Prerequisite knowledge
Aids
Teachers role
1.
Organogram of THC, demography of
Thana
Students should have the idea
regarding THC
TH&FPO will prepare lecture
& deliver
2.
Students should be able to list the field
health workers and describe their
activities
Students should know the health
problems and who prevents and
controls them
Teachers will introduce
health workers and their
activities
3.
Student will know how to use a check
list
Should know where & how check
list is used
Teachers help along with
TH&FPO + MO, MCH, TFPO
- do -
Checklist available
from respective
authority
4.
a)
Know how to collect blood slides to
detect M.P., sputum for AFB etc.
and from where
Should know indication of blood
slide & AFB examination
Talk with respective Health
Workers
- do -
Glass slide box,
pot for sputum
b)
Explain how Vitamin 'A' capsules
are distributed and administration
and the scheduled time for this
Function of Vitamin ’A’ and its
potency
Talk with distributor and
administration
- do -
Supply Vitamin ’A*
Information on
target population
c)
Supervise the activities of field
workers who are treating diarrhoea
with ORS
Knowledge about dehydration and
pharmacological action of ORS
Preparation and
administration
- do -
Materials
How to give health education to the
Community
Necessity of health education to
the community
Talk with Health Workers
- do -
OHP, Audio-Visual
Students will be able to name the field level
supervising staff and describe their
supervisory roles
Benefit of supervision of any work
plan
Teachers will introduce the
AHI, HI, & SI and discuss
their supervising methods
- do -
Job manual and
appointing process
by govt.
5.
Assessments
Students role
Students will
participate
-do-
Job manual
Thana map
Blackboard
36
Day 2 & Day 3 Learning Objectives
Design Community Health Survey
Prerequisite knowledge
Methods
Aids
Assessment
Day 2
Students will be able to:
estimate sample size and
identify target population
and study place
identify target population,
visit houses and collect
data
selected a health topic for community
survey by information from hospital
records and personal communication from
local health personnel
formulate general and specific objectives
of the survey
design survey and structure an instrument
Research methodology
Record keeping
Biostatistics
Computer coding
Technique of report writing
Methods of presentation
Routes of dissemination
Day 2
1st session -
Identification of target
population and study site
• Chalk
blackboard
2nd session - Data collection
• Microphone
3rd session - Data collection
• Computer
4th session - Group discussion on
experiences
• Overhead
projector
• MCQ
• Practical
assessment
• Feedback
after each
fraction of
work
Day 3
collect data
compile and analyse data
interpret results
write report
present study findings
Day 3
1st session -
Data collection
2nd session - Compilation and
interpretation
3rd session - Report writing
4th session - Discussion
37
Day 4 - Run MCH Services:
Health Education in MCH
Immunization
Methods
Aids
Learning objectives
Assessments
Prerequisite knowledge
Teachers role
Students role
1.
Students will be able to
describe how the cold-chain is
maintained
Knowledge about cold-chain,
vaccines, ILR, temperature
recording, transportation of
vaccines at out-reach centres
Teachers/M.O.EPI, EPI tech,
will show vaccine store room,
cold-box, ILR, etc. discuss
about cold chain
maintenance at THC
Students will
observe the system
& will participate in •
the discussion
Vaccines, ILR, Refrigerator,
Cold-box, strip thermoscope,
vaccine carrier, blackboard,
OHP, etc.
Practical
Test
2.
Students wiil be able to
vaccinate pregnant mothers,
women of 15-45 years age,
children. They will be able to
identify target population & to
provide health education on
MCH
Knowledge about
immunisation composition of
vaccines, vaccination
technique, contraindication,
side-effects and also
knowledge about health
education on MCH
Respective officer or
Inspector/Health Workers will
show the technique of
vaccination in the out-reach
centre. They will teach the
technique of giving health
education to the mother on
MCH at out-reach centre
Students will
observe the
technique & will
vaccinate. They will
give health
education at the
vaccination site
Vaccines, syringe, needle &
other necessary materials
Practical
Test
3.
Students will be able to
describe the beliefs &
superstitious & attitudes of the
public with respect to maternal
& child health and
immunisation. They will learn
immunisation coverage, target,
dropout motivation and
community participation
Knowledge about problems of
reaching targeted coverage,
motivation, community
participation
Discussion on target
coverage, dropout causes,
side effects of vaccination,
motivation & community
participation by the Teacher/
M.O. EPI / TH&FPO /
Inspector at THC
Students will take
part in the
discussion. They
exchange views,
opinions,
knowledge
gathered from the
field
Blackboard, OHP, AudioVisual Aid
Short
question &
answer
Students will be able to explain
about Role of Health Education
& Vaccination in reducing
maternal and child mortality
Knowledge about health
education and its role in
reducing maternal & child
mortality. Knowledge about
vaccination against six
preventable communicable
disease which may save lives
of mother & children
Discussion on child &
maternal mortality. Merits,
demerits of vaccination of 6preventable EPI diseases by
the teacher/TH&FPO/MO EPI
Students will
participate activity
in the discussion
Blackboard, OHP, AudioVisual Aid
4.
By giving
problem
By giving
problem
38
Day 5 - Session 1 & 2:
Learning Objectives
Maintain Health Information Reep rd s
Prerequisite knowledge
Students will able to:
define data, information
intelligence
locate various sources of
data and select
appropriate method-of
data collection
compile and store data
properly
analyse data adopting
good technical skill
interpret the results of
data analysis
present findings in a
palatable way
Aids
• teacher will inform and orient about the task
• teacher will give information about sources of data in the
thana (EPI, MCH, TFP, OPD, IPD, Emergency registrar,
Hospital record room, Register of statistician)
• teacher will introduce the student M/O EPI, M/O MCH,
TFPO, Record Keeper, Statistical Officer and other
related person who maintain various records in Thana
Level
- Chalk
blackboard
- video
Students activity:
- computer
Assessment
Teachers activity:
Knowledge about data,
information and
intelligence
Sources of data
Various methods of data
collection
Technique of
compilations
- microphone
& overhead
projector
- MCQ
- Practical
assessment
• They will observe and learn
Knowledge about
analysis
Students activity:
Data entry into the
computer
Interpretation and report
correcting
prepare a report
disseminate information to
various levels
Methods
• student will collect data from various sources necessary
for their task, compile and prepare information as model
practice
Teachers activity:
Knowledge about various
channel of
communication
• teacher will guide them and help in the situation where
they face any difficulties
Student activity:
One student will present the information and tell about its
maintenance - according to task given
Teachers activity:
• Assessment of the knowledge and achievements - give
necessary advise to improve.
39
Day 5 (cont’d) - Session 3:
Intra and Inter-sectoral Collaboration
Learning Objectives
At the end of the session the students will be able to
Prerequisite knowledge
Organisational background
of a Thana Administrative
list the government and non-government sectors working at
Thana level
Define, type, methods,
media, leaders
describe the different ways of formal and informal
communication
Intra & intersectoral
programmes, concept of
checklist
use a checklist while visiting a shared activity
list the different methods of information dissemination
write down a summary report on a given topic
Question &
answer
OHP
Question &
answer
OHP
Checklist
Question &
answer
Result from
individual
checklist
OHP
Worksheet
Question &
answer
Result from
individual
checklist
- accompany students while
they pay visit different sectors
The students will:
identify the formal and informal leaders
Information dissemination and reception of feedback
OHP
- take back filled up checklist
from the students for
feedback and assessment.
identify priority sectors to be communicated
list the activities shared by different sectors
Assessment
- divide the students into two
groups
explain informal and formal communication
Participate in shared activities
The teacher will:
Aids
- give a brief lecture to the
.students about the purpose
' and use of the checklist
name different programmes undertaken by the concerned
sectors
Maintain communication with other sectors informal and formal
Methods
Definition of information,
types, target group,
feedback
- participate in the brief lecture
- visit sectors within Health
Complex first, then sectors
outside THC
- hear from sectoral heads or
concerned personnel
- fill up checklist provided with
them
- submit the filled in checklist
back to teacher
- participate in feedback and
assessment session
identify the target groups for dissemination of information
list the different ways of feedback
practice one way of feedback
t
40
H
41
Sample
Check list of Field Site Training
on
Intra and Multisectoral Collaboration
Name
of
sector
Family
Planning
Department
Index
of
linkage
Committee
Logistics
Support Program
Department of
Public Health
Engineering
Committee
Logistics
Support Program
Department
of
Education
Committee
Logistics
Support Program
Department of
Social
Welfare
Committee
Logistics
Support Program
Department
of
Agriculture
Committee
Logistics
Support Program
Department of
Ansar &
VDP
Committee
Logistics
Support Program
Department
of
Cooperative
Committee
Logistics
Support Program
Committee
BRDB
Logistics
Support Program
Yes
No
List out
Personnel
involved
Remarks
Logistics
Support
programme
u
42
Name
of
sector
Index
of
linkage
Committee
Police Station
Logistics
Support Program
Department
of
Livestock
Committee
Logistics
Support Program
Department
of
Fisheries
Committee
Logistics
Support Program
Project
Implementation
Office
Committee
Logistics
Support Program
Local Govt.
Engineering
Bureau
Committee
Logistics
Support Program
Thana
Nirbahi
Office
Committee
Logistics
Support Program
Union
Parishad
Committee
Logistics
Support Program
Committee
NGOs
Logistics
Support Program
Yes
No
List out
Personnel
involved
Remarks
Logistics
Support
programme
—J-
Promotion of Health
Day 6 - Session 1 to 4:
Learning objectives
Methods
Aids
Students will be able to:
Provide health education on pattern of
prevailing communicable diseases in the
Thana and their epidemiology giving emphasis
on prevention and control of communicable
diseases
Flip chart
•
Visiting about 5-6 houses in the villages
Posters
•
Discussion and counselling in presence of
head of the family
Model
•
arrangement of small group session in
presence of local leaders
Use of tubewell water for drinking and all
other purposes
•
give talk to public about specific disease
•
Use of sanitary latrine
•
Maintain personal hygiene specially use of
soap for hand washing
Observation by supervisor
Answer and explanation
of any queries
Asking question
Feedback
Presentation
Water seal latrine
Motivate the people for:
•
Assessment
43
I.
I
u
44
Activity Schedule for Community Placement Week
Day 1
08:00 a.m.
Introduction to RFST Course - objective, methodology, role of
student.
09:00 a.m.
Introduction of Thana demography by TH&FPO
Introduction to health team working in THC
10:30 a.m.
Divide the class into three or four groups and visit the community
along with the community level worker.
Discuss with the workers their job description, records they
maintain (HA / FWA)
12:00 m.d.
One of the supervisors joins the group e.g. Health Inspector/
Assistant Health Inspector. Discuss methods of supervision. The
staff carry out a health education programme in the community.
Students observe the education programme, if any, and use the
check-list.
03:00 p.m.
Class room session. Each group presents their observation so
that whole
class
knows
what each
group
has
learned.
Community medicine faculty members will supplement whenever
necessary.
07:00 p.m. to
Class room session. Review principles of Health education.
08:30 p.m.
Comment on the days education programme. How can it be
improved?
If specimens were collected examine them now.
Report on the days visit to be submitted. This will form part of
the assessment.
i
H
45
Day 2
Community diagnosis.
Assumption - students had lectures on natural history of disease,
epidemiological triad.
08:30 a.m.
Discuss the designed survey to make a community diagnosis.
State objectives,
methodology, discuss the details of the
questionnaire. Provide guidelines for using the questionnaire
(prepared earlier at college).
09:30 - 05:00 p.m. Visit previously identified community.
Allot 5-10 houses per
student. Collect information. (Provide dummy tables. Analysis to
be done as home work).
Day 3
08:30 a.m.
Collect information
11:00 - 01:00 p.m. Complete analysis data
Collate data of all students into one set of table. Present data in
tables and graphs. Draw conclusions.
03:00 - 05:00 p.m. Write report
Community diagnosis
Prioritise health problems and needs of community
Identify topics for health education.
7:00 - 08:30 p.m.
Presentation of report and discussion of major findings.
d
46
Day 4
08:30 a.m.
Continue discussion specially issues related immunisation, ANC,
FP and ORT
10:30 a.m. to
Discuss of cold chain and immunisation strategies by field staff.
01:00 p.m.
Involve in the immunisation program in the out clinic or satellite
clinic.
Students should give injection/ OPV under supervision and also
education to each mother.
03:00 - 05:00 p.m. Identify three topics for health education.
Students working in three groups will prepare for the health
education to be done in the community.
Identify message messenger and media. Encourage students to
use innovative methods and folk media and their own flip charts.
i1
47
Day 5
Health information system and intersectoral collaboration
08:30 a.m. to
Review the information system as identified during the first days
01:00 p.m.
field visit with field staff.
Identify sources of secondary data. Discuss advantages and
disadvantages.
Collect, compile and prepare information from one month data outdoor, indoor and other available data.
Discuss problems encountered. How to improve the
quality of data and to validate (in the class room)
03:00 - 05:00 p.m. Site visit to other sectors in three groups. Each group will visit
one or two sectors.
Discuss in detail the organogram of the sector, activities,
interaction with health sector if any.
If not discuss why and how it can be done. Students will write the
report based on the guidelines given to them
07:00 - 08:00 p.m. Report to the rest of the class their observations.
Finalise health education program.
H
48
Day 6
08:30 - 10:00 a.m. Classroom exercise on investigating an epidemic (if happened in
the locality).
10:30 a.m. to
Carry out health education in the community.
01:00 p.m.
Preferably the community where the survey was done. Out door
clinic and indoor patients may also be used.
02:00 - 04:00 p.m. Sum up session - share learning experiences.
Students assessment.
u
49
Draft Structured Questionnaire
for
Field Site Epidemiological Survey
This questionnaire should be completed by students after interviewing the head of
household or an adult. For some questions, may need to interview an adult female
member of the family.
SECTION A:
GENERAL DETAILS
1.
Name of village
2.
Name of Union
3.
Name of Thana
4.
Name of Head of family
5.
Name of person of interviewed
6.
Date of interview
7.
Name of student (s)
Batch / Group:
SECTION B:
:
Year:
Roll :
HOUSEHOLD DETAILS
Please state number of people in the family (oldest member of family first)
8.
Name
Relationship to
head of family
Sex
Age
Education
Occupation level achieved
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x
9.
Type of housing? Pucca (building) / tin roof / thatched :
H
50
10.
Family income per month :
If landowner, approx, amount of land owned :
11.
Disposal of excreta? Sanitary latrine / Insanitary latrine / Open air latrine :
12.
Source of drinking water? Tubewell / River / Pond / Others
Of others, please specify:
SECTION B:
13.
MATERNAL HEALTH AND FAMILY PLANNING
Any pregnancy in the household ending within the last 12 months (excluding
current pregnancy )
Ye s / N o :
If yes, outcome baby
: normal alive / abnormal alive / dead
Outcome mother
: alive / dead
Was there any complications?
a)
During the pregnancy (before delivery)
e.g. anaemia, pre-eclampsia
Yes / No
If yes, specify :
b)
Yes / No
At the time of delivery
If yes, specify:
c)
After delivery e.g. fever, painful
perineum, urinary incontinence
:
Yes / No
If yes, specify:
14.
Who attended the pregnant woman at the time of delivery ?
TBA / FWV / others
If others, please specify :
If other why did the family not contact a health worker?
a)
b)
c)
d)
Not aware of any health worker (HW) in the village
Aware but did not wish to see the HW
Aware by HW too far to visit and she did not come to the village
Other reasons, specify:
u
51
15.
Where was the place of delivery?
: Home / Hospital
16.
Is there anybody currently pregnant in the family?
If yes, duration :months
: Yes/ No
17.
Any tetanus vaccine (TT) given to women during current or
previous (within last 12 months) pregnancy?
: Yes / No
If yes, numbers of doses :
If not given, because of:
a) Not necessary (already) received 5 doses)
b) Not aware of the need for TT
c) Aware but did not wish to have it
d) Aware but clinic too far away
e) Other specify :
18.
Practice of Family Planning
Male
: Yes / No
If yes, type: Condom / Vasectomy / Other, specify:
Ifno, reason:
Female
: Yes / No
If yes, type: Oral pill / Injection / IUCD / Ligation / Other, specify:
Ifno,reason:
SECTION D:
19.
CHILD HEALTH
Immunisation status of under 5 children (check immunisation card if available)
Child 1
Child 2
Child 3
DPT 1, 2, 3
OPV 1, 2, 3
BCG
Measles
None given
If none given, because of:
a)
Not aware of the need for vaccine
b)
Aware but not wish to have it
c)
Aware but clinic too far away
d)
Other, specify :
Child 4
Child 5
u
52
20.
Breast feeding of under 5
Age
Weaning time
Duration of suckling
a)
b)
c)
d)
e)
21.
Anthropometry of under 5:
Mid upper arm circumference (MUAC) and / or height and weight
Age
Wt in Kg
Ht in Cm
MUAC Cm
a)
b)
c)
d)
' e)
SECTION E:
22.
MORBIDITY
Bellow is a list of diseases. Please indicate if anybody in your household
currently suffers from any of these.
Diseases
No. of persons affected
Age
Diarrhoeal disease
Helminthic infection
Scabies
Other skin infection
Cataract
Eye infection
Vit A deficiency (child night blindness)
Dental caries
Chronic suppurative otitis media
Tuberculosis
Acute respiratory infection
Others, specify :
23.
Any physical disabilities in the family?
if yes, please specify :
: Yes/ No
u
53
24.
Who do you normally contact first if any of your family become ill?
Government doctor / Un-qualified doctor / Homeopath / Hakim (Kabiraj) / Others
Ifother, specify:
If not government doctor, give reason :
SECTION F:
25.
MORTALITY
Has there been any death in the household within the last 5 years?
If yes:
Age at death
Sex
Possible cause of death
a)
b)
c)
d)
e)
SECTION G:
KNOWLEDGE, ATTITUDE AND PRACTICE
26.
Illness related to smoking
27.
ORS and its preparation / use
28.
Personal hygiene
29.
Transmission of infectious disease e.g. malaria, dysentery etc.
Ii
54
PRIMARY CARE WEEK
u
55
Outline of Residential Field Site Training Course
Primary Care Week
Session
Day 1 -
Topic
Venue and Activity
Community Obstetrics
1
The epidemiology of maternal mortality and
morbidity.
Strategies for reducing maternal mortality,
- antenatal screening
- emergency obstetric care
- promoting socio-cultural change.
Visit obstetric unit
Visit home of dai
2
Antenatal care - screening for risk factors.
Gynaecological complaints seen at primary
care level.
Women’s views on the maternity services.
Attend in rotation
3
The maternity services in the Thana and its
under-utilisation.
Talk by MO/MCH in class room
small group discussion
Day 2 -
Community Otolaryngology
1 &2
Common infections of the ear, nose and throat
which are treatable at the THC.
Teaching in classroom
Attend outdoor clinic
3
Reasons why patients are late in presenting
with ENT conditions.
Health education concerning ENT infections.
Small group teaching in classroom
antenatal clinic conducted by
FWV
female outdoor clinic
ward visit with MO/MCH or
RMO
Community Ophthalmology
1
The treatment of eye disease by unqualified
doctors.
Collaboration with unqualified doctors.
Visit village doctors home
2
Common eye conditions and their
management at primary care level.
The role of medical assistants in eye disease.
Thana Health Complex
3
Easily detected visual defects in children.
Visit local primary school
Day 3 1
and
2
3
Immunization & Family Planning
Immunisation.
Women’s and men’s attitudes to family
planning.
- Provision of family planning at
primary care level.
Promoting family planning - the role of staff at
the Thana and Union level.
Students will attend
EPI Centre
Family planning clinic
at FWC / THC
Small group teaching in classroom
FPO to take part and give talk
Ii
56
Session
—
Topic
Venue and Activity
Day 4 - Medicine (communicable & non-communicable diseases) and
Microbiology
1
Common medical problems with sequelae,
namely - scabies, hepatitis, tuberculosis,
helminthiasis, diarrhoea, ARI, malaria and
endemic diseases.
Prevention of these conditions.
Communication with patients about these
diseases.
Teaching in classroom MO to take
part in this session
Ward visit
Attend outdoor clinic Teaching by!
MOs
Collection of laboratories specimens
2
Common medical problems continued.
Prevention of long term complications of diabetes, rheumatic fever and rheumatoid
arthritis.
Ward visit
Attend outdoor clinic, with teaching
by MOs
3
Common laboratory tests carried out in the
Thana Health Complex - smear and staining
for AFB, blood films for malaria, chemical and
microscopic examination of the urine, stool,
fungal infection
Practical work in laboratory
4
The effect of illness on families.
Evening ward visit / home visit
Day 5 -
Community Surgery/Orthopaedics
1
Common surgical conditions in the rural
community.
Management of common surgical conditions at
a Thana Health Complex.
Classroom
Ward visit
Visit Emergency room
and theatre
2
Common surgical conditions , continued.
Communication with patients on home care
and prevention.
Treatment of wound infections.
Prevention of tetanus.
Attend outdoor clinics
with teaching by MOs
3
Primary management of a fracture case
Emergency Ward / Classroom
Day 6 -
Community Paediatrics
1
Common paediatric conditions in a rural
community.
History, examination and diagnosis.
Classroom
Visit ward
Attend outdoor clinics
2
.Screening for the child at risk.
Attend in rotation
Child health clinic
Outdoor clinic
RESIDENTIAL FIELD SITE TRAINING COURSE
PRIMARY CARE WEEK
Place - Thana Health Complex.
Day 1:
Session 1:
Community Obstetrics
Topics -
Objectives
The students should be able to:
•
•
Name the major causes of maternal
mortality and morbidity, and in broad
terms explain how death may be
prevented by health promotion,
screening and antenatal care, and
provision of emergency obstetric
care.
Describe the cultural and religious
background of the public which
influences their use of the maternity
services.
and morbidity- Combating it by antenatal screening, providing "Emergency Obstetric Care", and by promoting socio-
Prerequisite knowledge
Methods
Gained by attendance at two
lectures before the field site
training.
Group discussion
1) • Causes of maternal
mortality and morbidity.
• The socio-cultural context
of maternal mortality.
2) • Antenatal care and
screening for high risk
pregnancies.
• The strategy of providing
emergency obstetric care
, at different levels of the
obstetric service.
•
Aids
Assessment
Practical
Visit the obstetric unit of the Thana
Health Complex. Examine the records of
births and transfers. Using these figures
and some national figures do a practical
exercise calculating the number of
women who deliver and die at hom£
without seeking help.
• Examine the records of emergency
procedures performed at THC and the
details of those cases transferred and
calculate how many emergencies are
remaining untreated.
• Visit home of a dai.
• The dai should explain about her work
and the training she has had. The
students should question her about her
beliefs and skills.
•
•
•
•
OHP,
blackboard
Record
books of
births,
obstetric
procedures
and
transfers.
List of
homes of
local dais.
57
Session 2:
Topics - Antenatal care - screening for risk factors
Gynaecological complaints seen at primary care level
Women’s views on the maternity services.
Objectives
Prerequisite knowledge
Methods
The students should be able to:
As in session 1
Classroom - nil
• Describe what measures a doctor
can take at a Thana Health
Complex to reduce maternal
mortality and morbidity.
Gained by attendance at two
lectures before the field site
training.
Practical
• Explain why women choose to
deliver at home rather than in
hospitals, and what are the
constraints preventing them seeking
obstetric help in emergencies.
• Causes of maternal mortality
and morbidity.
• The socio-cultural context of
maternal mortality.
• Antenatal care and
screening for high risk
pregnancies.
• The strategy of providing
emergency obstetric care at
different levels of the
obstetric service.
• Extra ward allocations on
obstetric and gynaecological
history taking for 1 hour
each day for 3 days.
Aids
Assessment
Split into three groups of four and rotate
every 40 minutes.
1 - Attend the antenatal clinic conducted by
the Family Welfare Visitor - Focus on
screening for high risk pregnancy.
2 - Attend female outdoor clinic with the
medical officer responsible for teaching.
The focus should be on obstetric &
gynaecological history taking and the
contraceptive practices of the patients.
3 - Ward visit with the MO MCH or Resident
medical officer. Visit to-any relevant cases.
Individual discussions with some patients or
relatives about their views on home or
hospital delivery.
Questions should be asked about factors
which cause women to deliver at home
rather than come to hospital such as,
Questionnaire
Checklist
finance, husbands authority, religious
belief, spiritual beliefs, distance.
58
Session 3:
Topic - The maternity services in the Thana and its under-utilisation
Objectives
Prerequisite knowledge
Methods
The students should be able to:
As in session 1
Classroom
• Describe the maternity services in the
Thana and the responsibilities of
different personnel.
Gained by attendance at two
lectures before the field site
training.
• Talk by MO MCH on her/his work and
that of the FVW and FWA in relation to
obstetrics
• Explain why the under-utilisation of
the maternity services is a matter
which doctors have to combat by
understanding its causes and by
making the services more acceptable.
• Causes of maternal mortality
and morbidity.
• The socio-cultural context of
maternal mortality.
• Antenatal care and
screening for high risk
pregnancies.
• The strategy of providing
emergency obstetric care at
different levels of the
obstetric service.
• Small group work, buzz groups and
then reporting on the
subject,
"What can doctors, nurse midwives or
family welfare visitors do to ensure that
more women come for hospital delivery
or seek appropriate help in
emergencies?"
• Name the cadres of health personnel
involved in maternity care and
describe their functions, and their
supervisory roles.
Aids
Assessment
• OHP
• Manual of
THC
59
Session 4:
Objectives
The student should be able to:
Explain why doctors and the entire
health service must work to achieve
better utilisation of the maternity
services.
Methods
Prerequisite knowledge
As in session 1 and what
has been learned during the
day.
Group discussion
Gained by attendance at two
lectures before the field site
training.
Debate or Video
• Causes of maternal
mortality and morbidity.
• The socio-cultural context of
maternal mortality.
• Antenatal care and
screening for high risk
pregnancies.
• The strategy of providing
emergency obstetric care at
different levels.of the
obstetric service.
"It is the responsibility of doctors and
other health workers to increase the
utilisation of the maternity services to try
and reduce the high maternal and
perinatal mortality".
Aids
Assessment
Practical
Debate
The motion will be that,
The motion will be proposed by two
speakers and opposed by two speakers.
60
Students will be divided into two groups and they will alternate visits with Community Ophthalmology
Day 2: Community Otolaryngology
Session 1:
Topic -
Common infections of the ear, nose and throat which are treatable at the THC.
Objectives
The student should be able to:
• examine the throats and nose,
tonsils, etc. and recognize common
infections like chronic tonsillitis,
CSOM, etc.
Prerequisite knowledge
By prior lecture at the Medical
College
Three hours teaching on -
1) CSOM
2) Ext. & acute otitis media
3) Tonsillitis acute and chronic
4) Nasal problems including
sinusitis
Methods
Classroom
Initial demonstration of examination
technique and practise in pairs to
recognise normal findings.
Practical
Aids
•
•
•
•
•
Assessment
Auriscopes
Headlight
Tongue
depressors
Nasal
specula
Auralspecula
Teaching in the outdoor clinic using
patients to demonstrate signs of disease
and to teach examination techniques.
61
Session 2
The same as session 1 with practical teaching in the outdoor clinic
Session 3:
Topic -
Reasons why patients are late in presenting with ENT conditions. Health education concerning ENT infections
Objectives
The students should be able to:
Describe the social conditions which
result in late presentation of ENT
infections.
Explain why a doctor’s work includes
health promotion by health education
with respect to ENT disease.
Methods
Prerequisite knowledge
Classroom
Aids
•
Assessment
OHP
Brain storming on the reasons for late
attendance.
Discussion lead by teacher on symptoms
and signs which patients should recognise.
Buzz groups on how FWAs and doctor
should provide health education.
X
62
Two groups of students will alternate visits
Day 2: Community Ophthalmology
Session 1:
Topic -
Easily detected visual defects in children
Objectives
The student should:
Be capable of performing and
interpreting simple tests for visual
acuity.
Session 2:
Topic
Students should be able to:
• Describe the role and the capabilities
of medical assistants in eye disease.
• Examine a patients eye and diagnose
- acute conjunctivitis,
- disorders duo to Vilumin A
deficiency
- contract
Topic -
Practical
Demonstration of tests of visual
acuity and performance of these by
students in local primary school
Assessment
Vision Testing Charts
for near & distance
(Bengali, English &
illiterate)
Ophthalmoscope
• 1 Loope
• 1 torch light
• 1 tape measures
- Common eye conditions in Bangladesh which can be diagnosed at primary eye care centres.
- The role of medical assistants in the management of eye disease.
Objectives
Session 3:
Common conditions which
cause visual defects.
The tests for visual acuity
Aids
Method'S
Prerequisite knowledge
Methods
Prerequisite knowledge
Aids
Assessment
Practical
Visit a primary Eye Care Centre/ outdoor clinic
The traditional ways of treating eye disease by unqualified doctors
63
Collaboration with unqualified doctors.
Objectives
The student should be able to:
aware about the traditional way of
treating eye disease by unqualified
doctors
Prerequisite knowledge
Knowledge of common eye
diseases
Methods
Aids
| Assessment
Interview with patients
1) Red eye, watering and
painful eye
2) Ocular injury
64
I Day 3: Family Planning and Immunization
Session 1 & 2:
Topic Women’s and men’s attitude to family planning.
Provision of family planning at primary care level.
Objectives
Students will be able to:
Describe why doctors have a
responsibility for working as a member
of a team in the provision of family
planning.
Name and describe what
contraceptive services can be
provided at Union level.
•
Be able to appraise the sterile
technique used in IUCD insertion at
primary care level.
Methods
Prerequisite knowledge
Knowledge of contraceptive
methods gained in prior
lecture at Medical College.
All lectures on contraception
should be given early in the
4th year.
Name some views and beliefs about
family planning held by the public.
Describe how health workers should
take account of these.
Assessment
Practical
Two groups of six will be formed.
One group will visit a satellite family
planning clinic in session 1, and the other in
session 2. In the other session the groups
will visit an EPI Centre with the paediatric
teacher.
Visit to satellite family planning clinic. Two
hour session.
The session will include:
•
•
Aids
•
•
•
Observation of counselling of patients
and the prescription of contraceptives,
A talk by the FWV on clients attitudes to,
and fears and beliefs about contraceptive
methods,
Observation of the autoclaving process
and the sterile precautions taken in the
clinic,
Discussion lead by the teacher on the
doctor’s supervisory role in such a centre.
65
j Day 3: (Cont’d)
Session 1 & 2
Topic
Objectives
The student should be able to:
Describe the cold chain technique and
explain its importance.
Name the target population for
childhood immunisation.
Supervise the sterile procedures used
in an EPI clinic.
Give appropriate information to mothers
about the vaccination of their child.
Childhood immunisation
Prerequisite knowledge
The Cold Chain
The extended programme of
immunisation.
Methods
Aids
Assessment
Classroom
Practical
The students will attend the EPI Centre in
the THC.
So for as possible they will witness the
cold chain in action.
Overview of the way the clinic functions
will be given.
Students will rotate through the various
components of the clinic, participating
where possible in the work.
66
Day Q
Session 3:
Combined class
Topic -
Promoting family planning and immunization
Objectives
Prerequisite knowledge
The students will be able to:
Describe why doctors have a
responsibility to promote family planning
whether or not they are working in that
area.
Explain why a well spaced family
results in better health for the children,
and give other arguments for promoting
family planning.
Describe the role of the FPO and the
organisation of the contraceptive
services in the Thana.
Describe the role of EPI Technician in
organising EPI clinics.
Methods
Aids
Classroom
Knowledge of contraceptive
methods gained in prior
lecture at Medical College.
Small group session lead by the Family
Planning Officer.
Brain storming on the role of family welfare
assistants in the promotion of family
planning.
Talk by FPO on the family planning
services in the Thana and reasons"for
promoting family planning.
OHP
•
Assessment
Formative
Family
planning
promotiona
I material
Slide
projector
Buzz groups on how they believe family
planning should be promoted by the staff
working in the Thana Health Complex.
67
[—
-------- lzt.------ ;
------- ............. .......... . ...... ........... ...... ....................
. ,.zxrr................. —
■■
—- --------------------------- :------------------------------------------------------------------------------------ ,
■
|Day
Medicine (communicable & noncommunicable diseases) and Microbiology j
Session T.
Topic -
Common communicable diseases with complications
Objectives
The student should be able to:
Name the common medical conditions
prevailing in the community and the
complications which can follow them.
Explain why prevention of these
diseases is one of a doctor’s
responsibilities.
Explain to a patient in appropriate
language how to prevent scabies,
hepatitis, tuberculosis, helminthiasis,
diarrhoea, and malaria, and recognise
ARI and endemic diseases.
By prior lecture at the medical
college or by prior reading,
Genera! background
knowledge about the selected
diseases, complications and
management thereof with
emphasis on prevention.
Interview technique
particularly when giving
advice on prevention or long
term management.
Classroom
Demonstration on disease pattern in
general medicine as seen at the THC
and in the community.
•
Assessment
OHP, slide
projector,
posters,
patient.
Demonstration of an interview with a
patient with a communicable disease.
RMO to select the patient.
MO from THC to take part in this
session.
1) speed of infectious disease
Practical
2) prevention of infectious
disease by health
education
Aids
Methods
Prerequisite knowledge
Ward visit to patients with those
conditions listed. Demonstration and
practice in interview technique and the
giving of information and advice about
communicable and preventable disease
OPD
diagnostic
instruments,
including
magnifying
glass,
specimen
containers.
Outpatient department - students split
into groups to practice under observation
of medical officers.
During this session the taking of
appropriate specimens for laboratory
tests v/ill be included under the
supervision of the microbiology teacher.
68
Session 2:
Topic -
Common non-communicable diseases with sequelae
Objectives
Prerequisite knowledge
Methods
The student should be able to:
As in session 1
Group discussion
Explain what can be done at Thana or
Union level to prevent the long term
complications of some common
diseases diabetes and rheumatic fever
and Rheumatoid arthritis.
By prior lecture at the medical
college or by prior reading,
Practical
General background
knowledge about the selected
diseases, complications and
management thereof with
emphasis on prevention.
Interview technique
particularly when giving
advice on prevention or long
term management.
Ward visit to patients with those
conditions listed. Demonstration and
practice in interview technique and the
giving of information and advice about
long term management and the
prevention of complications.
Aids
Assessment
OPD
diagnostic
instruments
, specimen
containers.
Outpatient department - students split
into groups to practice under observation
of medical officers.
During this session the taking of
appropriate specimens for laboratory
tests will be included under the
supervision of the microbiology teacher.
69
Session 3:
Topic -
Laboratory tests for infectious disease
Objectives
The student should:
Make and interpret an AAFB smear for
tuberculosis.
Perform and interpret chemical and
microscopic examination of the urine.
Collect and make thick and thin blood
films for malarial parasites. Perform a
microscopic examination on a malaria
film and interpret the findings.
Be capable of performing macro and
microscopic examination of the stool.
Be capable of collecting material for
diagnosis of fungal infection, and of
making slides and doing microscopy.
Methods
Prerequisite knowledge
Microbiology: Background
knowledge of the relevant
diseases where
microbiological tests at the
Thana Health Complex will
help in diagnosis or
monitoring. This will include
the prevalence and
microbiology of tuberculosis,
helminthiasis, diarrhoea,
malaria and scabies.
Theoretical knowledge of how
to do the laboratory tests
listed in the objectives which
will be learned practically at
the field site.
■ Aids
Assessment
Microbiology
Practical
•
In the laboratory. Group session
demonstrating the appropriate laboratory
techniques and discussing the interpretation.
Laboratory
. equipment
and
supplies.
Formative
On ”
Students divided into groups for practical
experience.
Practical laboratory work
Make a sputum smear, stain for AAFB,
and perform microscopy.
Perform chemical and microscopic
examination on a urine sample.
Make thin and thick blood films and stain
for malaria parasites. Perform
microscopic examination.
Handout
detailing
methods of
doing
laboratory
tests.
performance
in practical
laboratory
procedures.
Formative
MCQ &
short
answer
questions
70
Session 4:
Topic -
The effect of illness on families
Objectives
The student will be able to:
Explain why family, social and
economic factors must be taken into
account when managing a patient's
illness.
Prerequisite knowledge
Methods
Aids
Assessment
Discussion and debriefing on the sessions
during the day.
Briefing on appropriate behaviour during the
community visit.
Practical
Evening ward round or community visit.
Where possible a visit will be paid to a home
in the vicinity of the THC and discussion will
take place about the family’s experience of
illness.
71
Day 5:
CommLinity Surgery I Orthopaedics
Session 1:
Topic -
Common surgical conditions occurring in the rural community and seen at the THC
The management of common surgical conditions at the THC.
Objectives
The students should be able to:
Name the common surgical conditions
which occur in a rural community.
Explain why it is essential to provide a
curative service for these conditions as
close as possible to the patient’s home.
Describe the surgical skills the THC
doctor has to have to work effectively at
THC level.
Prerequisite knowledge
No special prerequisite
knowledge.
Aids
Methods
Ward visit to see surgical cases.
Small group session on the common
surgical conditions seen at the THC.
Brainstorming on conditions seen daily at
the THC. Discussion lead by THC medical
officer and facilitated by teacher.
•
Assessment
OHP
Practical
Visit to the emergency room and the theatre
and observation of facilities. Observation of
any procedure being carried out.
Classroom
Buzz groups on what surgical conditions can
be dealt with at the THC and which require
referral.
Reporting back and discussion.
Briefing about the purpose of session 2.
72
Session 2:
Topic -
Common surgical conditions occurring in the rural community and seen at the THC, with emphasis on home care and prevention of
complications.
Objectives
The student should be able to:
Explain why health education of the
individual patient and the community is
necessary to prevent unnecessary
complications of minor trauma and
surgical conditions.
Give a patient advice on the first aid
management of minor injuries.
Give a patient advice about the
continued home management of an
injury.
Describe when a soft tissue injury
requires the prescription of antibiotics
and when it does not.
Explain the indications for tetanus
toxoid and anti-tetanus serum.
Methods
Prerequisite knowledge
By prior lecture at medical
college.
Group discussion
Practical
Inflammation and healing.
Infection of injuries.
The prevention of tetanus
Students split into groups and attend the
outpatient clinics run by the medical officers.
Particular attention to be paid to injuries and
soft tissue infection.
MO to give demonstration of advice about
first aid of injuries as appropriate for the
economic status of the individual.
MO to give demonstration of advice to a
patient after prescription of treatment for an
injury or infection.
Aids
Assessment
On
performance
in giving
advice to
patient.
Immediate
feedback to
be given.
MO to teach about the prescription of
antibiotics and of tetanus toxoid or ATS in
the context of particular patients.
Teacher will rotate and facilitate.
Students should be given the opportunity of
giving appropriate advice, under control of
MO or teacher, when they feel ready to do
so.
73
Orthopaedics
Session 3:
Topic -
Primary management of fracture case
Objectives
Manage the case of primary fracture
Prerequisite knowledge
Methods
Observe and practice
Aids
Assessment
Relevant
logistics
74
Dav 6:
Session 1:
Community Paediatrics
Topic -
Community paediatrics - common and important diseases
Objectives
The student should:
Be able to name the common paediatric
conditions which occur in a rural
community.
On the basis of a history and
examination be able to diagnose in
broad categories the following
conditions Protein energy malnutrition, acute
respiratory infection, diarrhoeal disease,
helminthiasis, common skin diseases,
the common infectious diseases,
convulsions, low birth weight, and birth
asphyxia.
Prerequisite knowledge
By prior lecture at the Medical
College,
Nutritional problems, acute
respiratory infections,
diarrhoeal diseases,
helminthiasis, infectious
diseases including
immunisations, convulsions,
low birth weight.
Methods
Aids
Assessment
Classroom
Revision of knowledge.
Way of behaviour with children.
Practical
Indoor case demonstrations of common
diseases listed in the objectives.
Outdoor case demonstrations of the
same diseases.
75
Session 2:
Topic -
Community paediatrics - screening for the child at risk
Objectives
Aids
Methods
Prerequisite knowledge
The student should:
As in session 1
Classroom
Know the value of screening using the
growth chart.
Be capable of weighing a child
accurately.
Be capable of plotting the weight on a
growth chart.
Be capable of interpreting the growth
chart.
Know why Vitamin A prophylaxis is
used and how it is distributed in the
Thana.
Know what laboratory tests are useful in
the common paediatric diseases and be
capable of obtaining specimens.
Be capable of performing a
Haemoglobin test and interpreting it in
the case of a child.
By prior lecture at the Medical
College,
Nutritional problems, acute
respiratory infections,
diarrhoeal diseases,
helminthiasis, infectious
diseases including
immunisations, convulsions,
low birth weight.
Practical
•
Students will rotate between the
MCH clinic
Laboratory
Outdoor clinic
In the MCH clinic they will be shown how
to weigh the child and how to plot the
weight and will thereafter carry out these
tasks.
I Assessment
1_________
Weighing
apparatus
suitable for
children
Growth
charts
•
Appropriate
laboratory
apparatus.
In the laboratory'they will be shown how
to take blood by heel prick and carry out
haemoglobin tests.
In the outdoor clinic they will identify
children who would benefit by attending
the MCH clinic by virtue of being
incompletely immunised or appearing
underweight.
• 76
Session 3:
Objectives
Explain why in Bangladesh it is
important to give priority to common
and preventable childhood diseases.
Prerequisite knowledge
Methods
Classroom
Debate or discussion about one or
more of the issues raised in the
morning session concerning
immunisation
Aids
Assessment
OHP
blackboard.
On the subject of
all the days
sessions - by
MCQ. This will
be seif marked
and immediate
feedback given.
77
u
78
Glossary
AFB
Acid Fast Bacilli
AHI
Assistant Health Inspector
ARI
Acute Respiratory Tract Infection
EPI
Expanded Programme on Immunization
HI
Health Inspector
IPD
In Patient Department
M.P.
Malarial Parasite
MCH
Maternal & Child Health
MCQ
Multiple Choice Questions
MO,MCH
Medical Officer, Maternal and Child Health
OHP
Over Head Projector
OPD
Out Patient Department
ORS
Oral Rehydration Salt
SI
Sanitary Inspector
TH&FPO
Thana Health and Family Planning Officer
TFPO
Thana Family Planning Officer
RFST
Residential Field Site Training
u
79
List of participants in the meeting of
Residential Field Site Training Course
for Community Placement Week
No.
Name of participant
Institution
# of meeting
participate
1.
Professor Jahanara Begum
HoD, MAGOMC
3
2.
Professor A K Barbhuiyan
HoD, DMC
3
3.
Professor Emdadul Hoque
HoD, SSMC
1
4.
Dr Nazim Uddin
Asstt Professor, CMC
3
5.
Dr Swapan Kumar Chowdhury
Lecturer, CMC
3
6.
Dr Md Manirul Islam
Lecturer, DMC
3
7.
Dr Maksumul Hakim
Lecturer, DMC
3
8.
Dr Dewan Md Harun-ur-Rashid
Lecturer, CMC
3
9.
Dr Aftabuddin
Lecturer, SSMC
3
u
/Inn ex-2
p
u
Bl
Objectives of Day Visits
Page
•
•
•
•
•
•
•
■
•
■
•
T.B./ Leprosy/ V.D. Clinic
Visit to an Industry
N.G.O.
Food Product Industry
Water Purification Plant
MCH Centre
School Health Clinic
Urban Health Centre
Urban Slum
BIRDEM
Public Health Institute
I C D D R, B
82
82
83
83
84
84
85
85
86
86
87
87
82
T.B./ Leprosy/V.D. Clinic
At the end of the day visit to the clinic students will be able to:
draw the organogram of the clinic visited
list the programme(s) carried out by the institution
list the local programme(s) carried out by the institution
identify the magnitude of problem in Bangladesh and its public hea’th
importance
list the reporting and information systems from the institution up to the national
head quarter
describe its referral system
list the method of case finding and case holding
list the type of attending patients in terms of age/ sex/ occupation/ clinical
stages.
Visit to an Industry
At the end of the day visit to the industry students should have acquired knowledge
on the following and be able to:
describe common health problem of the employees working in that industry
describe specific occupational health hazards of the working employees
list specific measure to reduce occupational health hazards
explain industrial acts related to the welfare of the employee
• Medical
• Engineering
• Environmental
describe the effect of industry in the environment and community (if any)
learn about any awareness programme against health hazards
know any screening programme is being practised
safety measures are taken during any emergency problems of the industry like
fire, etc.
u
83
I
I
I
I
II
I
N.G.O.
At the end of the day visit to an NGO (Health and Population) students should have
acquired knowledge on the following and will be able to:
describe the aims and objectives of the NGO visited
describe how the NGO has planned and organized its work
describe how it makes its work strategy
describe its programme
explain how it evaluates its programme
explain how it mobilizes the community
explain how its arranges and manages its logistic support
explain how it collaborates with GOB programme.
Visit to Food Product Industry
At the end of the day visit the students will be able to:
learn how the milk is pasteurized
learn how the hygienic condition is maintained
learn how the law (Food Act) is being practised
list the common health problems which may occur in this industry due to
different food/milk production
describe its safety measures taken, if any.
H
84
Water Purification Riant
At the end of the day visit the students should be able to:
describe the bacteriological standard of drinking water
describe the different methods of purification of water on a large scale
list the steps of water purification plant
• rapid sand filtation and/or
• low sand filtation
list the steps of water purification plant on a small scale
list the chemicals commonly used in the water purification plant on a large
scale
list the name of the water borne diseases.
MCH Centre
At the end of the day visit the students will be able to:
draw the organogram of MCH centre
describe the activities of
•
•
•
•
Antenatal, natal and postnatal
EPI
Diarrhoeal diseases & ORT
Nutritional education
describe the magnitude of problem of the pregnant mothers and children
describe the intervention plan to decrease the magnitude of problem (mortality
and morbidity)
list the reporting, information and referral system
I
85
School Health CISnic
At the end of day visit to a school health clinic the students should have acquired
knowledge on the following and will be able to:
describe organogram of the school health clinic
list common health problems of school children
list health education programme being practised there
describe the reporting and information system
list the drugs available in the school health clinic
Urban Health Centre (Dispensary)
At the end of visit to an Urban Health Centre students should be able to:
describe the Organogram of the Urban Health Centre and its functioning
describe the job of the staffs of the Urban Health Centre
list the common diseases encountered
list the drugs used in the Urban Health Centre
describe the details of Family Planning and Immunization activities carried out
in Urban Health Centre
describe the records maintained of the referral system.
H.
So
Urban Sium
At the end of the visit to an Urban Slum the students will be able to:
list the common health problems of the sium visited
describe the health delivery system of the slum
describe the existing programmes in the slum in term of
• control of commonable/ non-commonable diseases
• immunization programme
’ MCH & Family Planning programme
describe the environmental conditions -'specially
• water supply
• sanitation
• housing.
BIRDEM (Bangladesh Institute of Diabetic,
Endocrine, Metabolic Diseases & Research)
At the end of the visit/session the students will be able to:
describe the organogram of BIRDEM
describe the follow up system of BIRDEM
describe the record keeping system of BIRDbM
describe the laboratory facilities of BIRDEM
describe its referral system
I
d
87
Public Health Institute
At the end of the day visit the students should be able to:
state the activities of I PH
list the vaccines prepared in the IPH and those are imported
describe the methods of preparation of A.R.V. & T.T. and their storage
arrangement
enlist the names of I.V. fluid produced in the IPH and the different stages of
their preparation and their methods of quality control
express the activities of Microbiology Department:
• water bacteriology
• examination of food sample
• chemical examination of vaccines in medicolegal cases.
CD D R, B
At the end of the visit to the ICDDR, B the students will be able to:
write the organogram of ICDDR,B
list the various types of diarrhoeal diseases from the records
describe the magnitude of problem
describe the management of diarrhoeal disease: moderate & severe
list at least 3-5 research activities conducted by ICDDR,B
list the reporting and information system
H
f
1
Annex - 3
II
p
I
i
I
.i
Page ■:
?l
□
An Example of CHnico-Sccia! Case Study
.4I
□
Epidemiological Exercises: FEariasis; Malaria
93
Communication Skills: Checklist; Rating Scale
95 lj
Group Interaction Observation Guide
93 ;
a
fi
3
□
impressions of Village People
5
I
99.
Is
1
1
i
i
1
I
I
I
I
I
■/
u
89
CLIN1CO-SOCIAL CASE STUDY
21/?. year old female child Sonya coming from Oogonum was admitted in JIPMER hospital
on 7th July, 1995 with the following complaints.
i)
Cough with expectoration
10 days
ii)
Fever
2 days
Hi)
Diarrhoea with vomiting
2 days
History of present illness:
Child was apparently asymptomatic 10 days back but developed cough with expectoration
suddenly. Child had diarrhoea two days back which was of mucoid in nature. Child
passed stools 4 to 8 times per day. Patient also started having fever for two days.
Past history:
Repeated diarrhoea, respiratory infection til! the age of 1 ’A years. Patient also had worm
infestation at the age of 1 '/z years for which she was treated at local hospital. No history
of contact with tuberculosis. History of measles at the age of 10 months. Diarrhoea
mostly treated at home with home remedies. Feeding stopped during diarrhoea.
Treatment history:
The child was taken to a local practitioner for the cough with expectoration, since there
was no improvement, the child was brought to JIPMER hospital.
Health facilities available:
PHC is situated at Vettavalam which is about 2 kms away from her residence,
practitioner (Homeopathy) is also available.
Local
u
90
Family Tree:
Father
Mother
p
Female
4 years (healthy)
Female
2/2 years (Sonya)
Male
12 months (healthy)
Socio-economic history:
The family belongs to Hindu religion, Vanniyar caste. Father illiterate and mother is 3rd
std. Father is an agricultural labourer earning Tk 300/- per month and mother is a house
wife. Father smokes/drinks occasionally.
En vi ron men ta 1 h is to \y:
The family lives in a house with a built in area of 375 sq feet of which living area is 225
sq.feet and rest is kitchen. Floor and walls are made of mud and roof is thatched (Kutcha
house). House does not have electricity supply. Water supply is from tap which is 20
mts. away from the house. Waste water from the house drained into open street drain
which runs along the street. Solid waste is thrown behind the house. There is no latrine
in the house. AH family members practice open air defecation.
Antenatal history:
She had taken two doses of tetanus toxoid injection at Vettavallum. No other check up.
Natal history:
Child was born full term, Spontaneous Vaginal Delivery at 1 indivanam hospital. Child was
of average size at birth.
Developmental history:
I
(
Child had social smile at two months of age, started crawling from 7th month, starting
sitting without support from Sth month onwards. He cannot walk without support even
now. At the moment child can speak only few words amma, appa.
Immunisation history:
Child was immunised with a single dose of BCG vaccine at the age of three months. She
was given three doses DPT and three doses of OPV with one month interval at home by
health worker from third month onwards. The child has not received booster doses of
OPV
DPT.
I
I
u
91
Dietary history:
Child was breastfed from first day of delivery. It was given sugar water on the first two
days. Supplementation started from I 1th month with diluted cow's milk. Later, at first
year biscuits, rice and fruits were added.
Child's Intake
935 calories
Energy
Protein
1 4 gms
Normal requirements
1200 calories
1 9 gms
Examination:
General examination: Child is moderately built but poorly nourished, tachypneic,
emaciated, irritable. Pallor present. No icterus, cyanosis, clubbing, pedal oedema,
generalised lymphadenopathy. Depigmentation of hair is present. Conjunctival xerosis
is present.
Vital signs:
Pulse rate
RR
BP
1 20/min
40/min
90/70 mmHg
Anthropometric measurements:
Weight
Height
Mid arm circ
Head circ
Chest circ
Actual
9.0 kg
80.0 cm
10.5 cm
44.5 cm
47.0 cm
Expected
12.9 kg
91.3 cm
1 3.0 cm
47.7 cm
50.1 cm
Systemic Examination:
Cardio vascular system - normal
Respiratory system - bilateral crepitations present
Per abdominal examination:
Abdomen distended, liver is palpable (1 cm) below the right
costal margin. Spleen not palpable.
PROVISIONAL DIAGNOSIS: Grade II Protein Energy Malnutrition with Broncho
pneumonia.
u
92
Discussion points for clinico-social study
on natural history of the disease
A-
I
5
’
y
C
' 1
V °
QI.
Till what age do you think the child was apparently
normal and what factors (favourable) were
responsible for it?
Q2.
What factors in the family might have played a role
in the development of this condition in the child?
Q3.
Classify the factors you have identified into host
agent, socio-economic and environmental factors.
4.
Is there one factor responsible for development of
this condition or more than one?
Q5.
Was it possible to prevent this child from developin cr
this condition?
If so, where was the failure?
93
EPIDEMIOLOGiCA L EXERCISE ON FiLARiASIS
PART A
A filaria survey was carried out in an area having a population of 30,000 in the year
1 990. Approximately, 20 cmm. of blood was collected by finger prick from 4,200
people between 8 PM and 12 PM. Smears were prepared. I he smears were examined
for micro-filariae. It was found that 420 persons were carrying micro-filaria.
QI.
Q2.
Q3.
Q4.
What type of smears should be prepared?
What is the appropriate stain used for detecting Mf?
Which species of Mf would you expect?
V/hat further information do you need to answer this?
On physical examination 357 persons showed possible chronic manifestation of
filarial diseases.
What type of survey would you cal! this? Comment on the sample
Q5.
size.
Enumerate and calculate the possible filarial indices for the area.
Q6.
PART B
1 400 Mosquitoes were examined for the presence of larvae.
What are the common vector species in India?
Qi.
How will you detect the larvae in the mosquito?
Q2.
Which
part of the mosquitoes would you examine for the presence
Q3.
of larvae?
In ail 1 4 mosquitoes were positive for the developing larvae and 7 of these were found
to contain infe-ctive stage larvae.
Q4.
Which stage of larvae is infective?
Q5.
What is extrinsic incubation period?
PART
After collection of base line data HCH spraying was undertaken along with anti larva!
measures in the area as a control measure. Ail the dwellings and cattle shed were sprayed
four times a year. Filaria survey were conducted eveiy year. In 1993 i.e. after 3 years,
the following were the findings of the re-survey.
a)
b)
c)
d)
e)
f)
1600
Number of persons examined
40
Number of persons positive for Mf
32
Number of persons with chronic manifestation of filarial diseases
2000
Number of mosquitoes dissected
2
Number of mosquitoes positive for developing larvae
Number of mosquitoes containing 3rd stage larvae
QI. Comment on the changes in the filarial indices from 1990 to 1993.
Q2. What other control method could have been adopted?
u
94
EPIDEM10LOGICAL EXERC1SE ON MALARIA
in the year 1987, Basic Health Workers of a Community Health Center (CHC)
covering a population of 1,00,000 collected 5800 blood smears during their home
visits and administered 4 tablets to those who gave a history of fever. 1 800 blood
slides were collected from fever cases attending the outpatient services of the PHC.
1.
2.
4.
5.
6.
7.
What are the types of malaria surveillance ?
What percentage of blood slides were collected in each type of
surveillance ?
What type of smear should be collected ? What is the method of
staining ?
Calculate the Annual Blood Examination Rate (ABER).
V/as the ABER, in conformity with the recommended target ?
What tablets was the 3HW expected to administer ?
What is the dose and what would you call this treatment ?
On staining and examination of the blood slides, 250 were found to be positive for
Plasmodium vivax, and 1 1 5 were positive for P. falciparum.
8.
8 a.
9.
10.
What is API ? Calculate it.
What other rates can be calculated ?
What does this API rate signify ?
Taking into consideration the API, suggest steps to be taken under the
Modified Plan of Operations.
In 1991, the HW's collected 9ICO blood slides from the same PHC area durin j
their visits, and 3200 slides were collected from fever cases attending the PHC out
patient services.
1 1.
Calculate the ABER and comment.
When the smears were examined, 1 1 5 slides were found to be positive for P.vivax,
and 75 were positive for P.falciparum.
12.
12a.
What treatment would you give these cases ?
What steps would you take under the modified plan of operations 7
Of the 75 persons positive for P.faiclparum, 41 continued to have fever inspite of
treatment given.
1 3.
14.
1 5.
What could be the reason for this ?
How will you treat these cases ?
What prophylactic measures will you recommend to some-one who is to
live in the area ?
u
95
Observation c-f cornmi’nication skill
Was ilic interviewer:
Manner
Friendly
bossy
2.
Rude
police
*•7
Sympathetic
unsyrnpadietic
anguage
4.
Using simple language
5.
Avoiding technical terms
6.
Which words did he use which respondent might not understand
e.g.
Techniques
if
Yes
rr
Was the explanation logical?
!
, 8.
Did he respond to questions?
9-
Was he pursuative?
I !CL
Did he use any Visual aid?
Was it appropriately used?
No
96
TYPE - li
Check list for
Observation of a Communication or a Role Play
Is the client greeted?
2.
Is the client spoken by name?
3.
Is the client's existing knowledge explored?
4.
Are the client's beliefs respected?
5.
Is the explanation logical and structured?
6.
Are the facts accurate?
7.
is enough detail given?
8.
Are simple and familiar terms used?
9.
Is credit given for appropriate action?
10. Is blame and condemnation avoided?
1 1. Is concern shown to client's problems?
12. Is the client encouraged to voice his or her concern?
1 3. Are appropriate visual methods used?
1 4. Is the communication brief?
15. Is the communication unhurried?
1 6. Any solution offered?
1 7. Is the persons asked to come back?
i I
97
TYPE - HI
An Interview rating scale
e.g. establishing a relationship
Instructions
Tick (/) in the appropriate box the performance of the interviewer.
Read the key before ticking.
The interviewer
1.
Appears friendly St welcoming
2.
Greets patient st introducers himself
3.
Uses the clients name
4.
Shows concern for the client
5.
Uses appropriate gestures and body
posture
2
1
Key:
3
1.
Done well
2.
Done poorly
3.
Not done
4.
Not applicable
4
u
98
GROUP INTERACTION OBSERVATION GUIDE
Gives information
2.
Asks for information
3.
Gives opinion or suggestion
4.
Asks for opinion
5.
Gives suggestion; direction to others
6.
Asks for clarification
7.
Shows antagonism, defends or asserts self
8.
interferes group work by diverting discussion
9.
Gives help, acceptance, positive reinforcement (verbal or non
verbal)
10. Shows satisfaction; laughs or jokes appropriately (verbal or non
verbal)
11. Disagrees, shows rejection (verbal or non-verbal)
12. Withdraws from group discussion (verbal or non-verbal)
13. Records the ideas/suggestions
14. Summarises.
99
IMPRESSIONS OF VILLAGE PEOPLE
Please give us your general impressions of village people by checking an appropriate
space between each pair.
For example
B
A
C
D
Unkind
Kind
If yon think villagers are generally veiy kind you would tick 'A' if somewhat kind 'B'
somewhat unkind 'C' and if you think they are unkind then 'D' please indicate even if
you are not certain.
A
B
C
D
Clean
Dirty
2.
Unhealthy
Healthy
3.
Friendly
Unfriendly
4.
Co-operative
Un-cooperative
5.
Lazy
Industrious
6.
Well-informed
Poorly informed
7.
Undependable
Dependable
8.
Wise
Foolish
9.
Suspicious
Trusting
10.
Poorly fed
Well fed
1 1.
Cheerful
Unhappy
12.
Honest
Dishonest
13.
Non-religious
Religious
14.
Rational
Superstitious
1 5.
Pessimistic
Optimistic
You have been asked to make a community diagnosis. Mention the points you will
take into consideration.
- Media
4795.pdf
Not viewed