REPORTS ON DAY VISITS

SECOND PROFESSIONAL MBBS EXAMINATION

MAY, 2018

ROLL NO :

REGISTRATION NO :

SESSION : 2015-2016

DEPARTMENT OF COMMUNITY MEDICINE

DHAKA MEDICAL COLLEGE

 TABLE OF CONTENTS

SL. Date of Visit Place of Visit Page No

Number
1. 20.11.2017 One Stop Crisis Centre (OCC), DMCH, Dhaka 1-8

2. 21.11.2017 Radda, MCH-FP Center, Mirpur, Dhaka 9-19

3. 23.11.2017 School Health Clinic, Azimpur, Dhaka 20-25

4. 23.11.2017 Office of Civil Surgeon, Azimpur, Dhaka 26-31

5. 25.11.2017 Oral Rehydration Therapy (ORT) Corner, 32-35

DMCH, Dhaka

6. 25.11.2017 DOTS Corner, DMCH, Dhaka 36-40

7. 26.11.2017 Model Family Planning Clinic, DMCH, Dhaka 41-46

 ONE STOP CRISIS CENTRE (OCC)
Room # 97, Emergency block, DMCH

Visit no : 01

Date of Visit : 20.11.2017

Type of the Organization : Government Organization

Date of establishment : 19 August 2001

Briefed by : Dr. Bilkis Begum , Consultant,

One Stop Crisis Centre (OCC),DMCH

Objectives of the Organization :

1. To prevent and redress the violence against women and children in the society.

2. To create or increase awareness among the people against violence both in the
country and in abroad.

3. To provide comprehensive medical care to the victims of physical assault, burn and
sexual assault.

4. To provide public services such as health, police assistance, criminal justice and
social services such as counseling and rehabilitation that are to be utilized by women and
children who are victims of violence.

Page No-1
Existing resources:

1. Manpower :

OCC working group:

Chairman: Director, DMCH

Member-Secretary: Coordinator , DMCH

Member :

 Head of the Department of Gynecology and Obstetrics

 Head of the Casualty Department, DMCH

 Head of the Radiology Department, DMCH

 Head of the Department of Forensic Medicine, DMCH

 Medical Officer, Emergency Department, DMCH

 Project Director, Burn and Plastic Surgery, DMCH

 Resident Surgeon, Gynecology and Obstetrics, DMCH

 Resident Surgeon, General, DMCH

 Nursing Superintendent, DMCH

 Lawyer, BNWLA

 Counselor, Breaking the Silence

 Social Welfare Officer, DMCH

 Doctor, OCC, DMCH

 Nurse, OCC, DMCH

 Police, OCC, DMCH

Page No-2
2. Financial Support :

1. Fund from government of Bangladesh through the following ministries :

 Ministry of Women and Children Affairs

 Ministry of Home Affairs

 Ministry of Health and Family Welfare

 Ministry of Law, Justice and Parliamentary Affairs

 Ministry of Information

 Ministry of Social Welfare

 Ministry of Education

 Ministry of Religions Affairs

2. Funded by mainly The Government of Bangladesh. Infrastructural development in

done by DANIDA from the Government of Denmark.

3. Logistics/ Other Resources :

All 45 wards and different specialties of Dhaka Medical College Hospital (DMCH) offer
medical help. The center gets its medical resources from DMCH on priority basis.
Alternatively, resources are also available from Social Welfare Department and Ministry of
Women and Children Affairs. Naripokkha and BNWLA (Bangladesh National Women
Lawyers’ Association also provide services in carrying out its activities.

It has-

 One ward consisting of 8 beds.

 Emergency oxygen supply facilities.

 One conference room.

 Proper space for physical examination and counseling.

 It has one freeze which can preserve DNA for several years.

 Other supporting logistics like computer, overhead projector (OHP), fac, phone,
photocopy machine etc.
Page No-3
Activities of the Organization :

i. Medical treatment of the victim : A comprehensive medical care is provided to the

victim through history taking, clinical examination, laboratory investigations and
follow up. It provides emergency contraceptive post-coital pill to the patients of
sexual assault. But, if an ultrasonogram establishes pregnancy, then the OCC
provides the victim with all types of antenatal, intranatal and postnatal care. OCC
refers the victim to appropriate department with “NOD” (No Official Delay) basis
for proper management. The patients referred by OCC are the first priority to the
doctors and they are dealt with accordingly.

ii. Legal support by police : Bangladesh Police provides security to the victim and
takes proper actions according to the law of the land regarding the crime. A general
diary (GD), first information report (FIR) is opened with the help of OCC.

iii. Legal counseling by lawyer : OCC provides facility of legal counseling through
BNWLA (Bangladesh National Women Lawyers’ Association). Although, the case
will be conducted by public prosecutors for the victim, BNWLA provides assistance
to Public Prosecutor (PP) in this regard. OCC also provides the resources for a closed
door trail.

iv. Psychological support : This unique facility of OCC helps the victim to recover
from psychological shock of being battered and prevents further deterioration of her
mental conditions. For this , OCC takes help from –

 Breaking the silence

 BNWLA
 Psychiatry department of Dhaka University

v. Social Welfare service : Free supply of food, cloth, medicines are ensured for the
victims and their children.

Page No-4
vi. Temporary Shelterhome Services : This is for the victim and her children. The
victim is employed in several income generating activities conducted by OCC. OCC
provides basic education to the illegitimate child of the victim and gives them a place
to call home. OCC can also recommend the qualified victims to different ministries
for government employment.

vii. Hotline services

viii. Medico-legal examination : Medico-legal examinations and Tests are conferred out
the forensic experts of Forensic Medicine Department, DMCH.

ix. Academic activities of OCC :

(a) Research
(b) Training

Achievements of the Organization :

1. OCC has provided services to victims of sexual assault, physical assault and burn. At
its inception in 2001, OCC started off with 44 victims. The number of victims treated has
gradually increased. From 19 August 2001 to 2014, OCC has dealt with following number of
victims :

Types of assault Number of Victims

Physical assault 3021

Sexual assault 1744

Burn 222

Total 4987

Page No-5
2. Establishment of DNA laboratory in Forensic Medicine department, DMCH in 2005.

3. Helped in revision of Women and Child Act 2002, which was again revised in 2003.

Problems/ Constraints of the Organization :

1. It is a new concept in our country. So, majority of people are not aware of its
activities and services provided by them.

2. Lack of cooperation (in terms of truth hiding) by the victim is another hindrance.
Absence of witness protection law in our country is responsible for this to some
extent.

3. False cases are becoming a big problem for OCC.

4. Besides, the service to be provided by this organization are hampered frequently due
to :

 False certificate by the physicians due to ignorance or dishonesty.

 Faulty investigation by the police officers due to negligence or corruption.

 Misinterpretation of facts by the pleaders.

 Manipulation by the people involved in public administration due to

corruption.

 Negligence of public prosecutor.

Page No-6
Personal Observation :

Conclusion :

Signature of the teacher Signature of the student

Date : Date :

Page No-7
 Organogram

Director of DMCH

coordinator

Computer
Operator-1 Police Officer-2
Not Below the Doctor-3
rank SI

Senior Staff
Nurse-6
Police
Constable-2
Social
Welfare
Legal and counseling
Officer-1
support by 600
lawyers all over the Cleaner-3
country

Signature of the teacher

Date :

Page No-8
 RADDA MCH-FP CENTRE

Plot # 324, Block # 6, Section # 10

Mirpur, Dhaka-1216, Bangladesh

Visit No : 02

Date of Visit : 21.11.2017

Type of the Organization : Non- Government Organization (NGO)

Year of establishment : 1973, as Radda Barnen (the then Swedish “Save the
Children”)

The centre was registered with Ministry of Social

Welfare in 1974 and with NGO affairs Bureau and
Family Planning in 1978.

The management of the centre was handed over to a six

member Board of Trustees under the name of “Radda
MCH-FP Centre” in September 1994.

Briefed by : Dr. Rezwana Zaman ,Coordinator

Radda MCH-FP Centre

Page No-9
Objectives of the Organization :

The objectives of the organization are as follows:

 Promote and protect health and wellbeing of mother and children especially those
belonging to the poor and disadvantaged section of the society.

 Provide a comprehensive range of MCH-FP services.

 Provide adolescent reproductive health services and counseling.

 Provide health education to all clients visiting the hospital.

 Provide health care services, including treatment of RTIs (Respiratory tract

infections)/STIs (Soft tumor infections) and health education on prevention of
HIV/AIDS to mothers and children including adolescents.

 Provide health care services to the entire family including old and disabled member
of the family.

 Provide comprehensive health care services through initiation of Community

Managed Health Care through Child Centered Community Development Approaches.
(CCCDA).

 Provide safe home delivery by trained traditional birth attendants (TTBAS).

 Undertake community based MCH-FP activities and health education.

 Offer training in maternal and child health to the health professionals, health workers
including community health workers, traditional birth attendants (TBA) and others
involved in the area.

 Conduct operation research.

 Provide nutritional support to the undernourished children of poor and marginalized

group of the community of the greater Mirpur area.

 Promote the spirit and value set out in the Convention on the Rights of Child adopted
by the UN General Assembly on November 20, 1989 and ratified by the Government
of Bangladesh in August 1990.

Page No-10
Existing Resources :

 Manpower :

Staff position of Radda MCH-FP Centre, 2008.

 MCH-FP department : 99 in number

 Community Health Department : 33 in number
 Training and Research Department : 07 in number
 Strengthening ARH project : 26 in number
 Administration and Accounts Department : 13 in number
 Total : 178 in number

Financial Support :

Funding sources are :

 Income from contribution of the clients.

 Collaboration support by Plan International , Canadian International Development

Agency ( CIDA) and international centre for diarrhoeal diseases research,
Bangladesh (icddr,b).

 Zero Foreign Donations.

 There is a sustainability fund which can contribute if total expenditure exceeds total
income. In 2008, no contribution was needed from this fund.

 Other facilities/logistics :

 The NGO is using Government land on lease.

 It has its own building
 Static clinics at:
 Khan Bahadur Ahsanullah Road, Mirpur
 Section no-1, Mirpur
 Section-12, Mirpur
 Section-14, Vashantek, Mirpur.
 Block-C, Bowanibandh, Mirpur
 Bliok-E, Bowanibandh, Mirpur.
 Office tek, slum-4, Vashantek.
Page No-11
  There are satellite clinics in wards 02, 03, 04, 05, 08 and 15 under zone 8 of Dhaka
City Corporation.
 A full-fledged training unit with 30-bed hostel facility is available.
 Pathological laboratories at 3 main static clinics.
 Sonogram facility at 3 of its static clinics.
 Other than EPI vaccines are available at the static clinics.
 There are seven drug stores at the seven static clinics.
 Crèche for the female employees of Radda MCH-FP Centre for children up to the age
of 2 years.

Activities of the Organization :

 Area of operation : Dhaka Metropolitan City (Mirpur, Pallabi & Kafrul)

 Population covered : 2 million
 Targeted population : 1 million
 Service components :
 It has four main components :

o MCH-FP service
o Community Health Services
o Training and Research
o Administration and Accounts

Service levels :

MCH-FP service delivery takes place at three levels :

 The Centre (Static clinics)

 The outreach sites including UDC (satellite clinics) in wards 2, 3, 5, 8 and 15.
 The households (Community)

Page No-12
Services delivered at Radda MCH-FP :

 Comprehensive Reproductive Health care:

 Antenatal care with Tetanus Toxoid (T.T).
 Postnatal care with Vitamin-A for lactating mothers.
 Health and nutrition education for women and their family members at the clinics
and household levels.

 Treatment and management of Respiratory tract infections (RTIs) and Soft tumor
infections (STIs).

 Family planning motivation, counseling and provision of contraceptives to the

eligible couples.

 Tetanus Toxoid (T.T) vaccination of women.

 General treatment to the women of all age groups.
 Supervision and monitoring of trained Traditional Birth Attendants (TBA) for safe
home deliveries through regular monthly meeting and refreshers courses.

 Advocacy and counseling on prevention of Human Immunodeficiency Virus

(HIV)/Acquired immunodeficiency Syndrome (AIDS), Respiratory tract
infections (RTIs) and Soft tumor infections (STIs).
 Promotion of breastfeeding.
 Provision of Adolescent Reproductive Health (ARH) care services.
 Treatment of general ailments.
 Supporting all government health service initiatives.

 Child Health Services :

 Growth monitoring of children aged 0-5 years.

 Nutrition rehabilitation of the third degree undernourished children aged up to 5 years
at the nutrition rehabilitation unit of the centre.
 Immunization against 8 communicable diseases, Hepatitis-A and B vaccine for all age
groups, Typhoid vaccine for children aged 0-5 years, MMR, Chicken-pox and MR
vaccine for all age groups.
 Curative care for the children of 0-5 years.
 Treatment for vitamin-A and other micronutrient deficiencies among the children
aged below 5 years.
 Treatment of common and minor ailments (ARI, xerophthalmia, diarrhoeal diseases)
of children between 6-18 years.

Page No-13
Community Health Program :

 Provision of contraceptives for eligible couples and counseling on family planning.

 Awareness development on prevention of Soft tumor infections (STI) and Human
Immunodeficiency Virus (HIV)/Acquired immunodeficiency Syndrome (AIDS).
 Promotion of breastfeeding.
 BCC(Behavioral Change Communication) activities at the community level.
 Supportive static and satellite clinics.
 Adolescent Reproductive Health Services and counseling.
 Contact and communicates with Traditional Birth Attendants (TBA) for the
improvement of their home delivery performance.

 Meeting with Community Development Forum (CDF) members.

 Health check-up for day care centre ; Shishubikash Kendra, Schools etc.
 Planning with Community Development Forum
 Emergency Medical Support (available during working time of the clinics).
 Capacity building training for CDF members.
 Nutrition oriented cooking demonstration at the community level.
 Demonstration of gardening both individual and institutional level for supplemental
nutrition.

 Seed distributions among the community mothers for kitchen gardening.

 Practice of maintaining Food Diversity Dairy (FDD).
 Day observation, organization of display/show/fair and rally on different events.

 Support services :

 A number of laboratory investigations are conducted as per need of the clients,

which includes ;

 Pathological tests
 Biochemical tests
 Sonogram

Page No-14
 Other than vaccines available are :

 Hepatitis-B
 Hepatitis-A
 Hib
 Typhoid vaccine
 MMR vaccine
 Chicken-pox vaccine
 Rotaviral vaccine
 Meningococcal A+C
 Anti-Rabies vaccine.

 Drug stores have almost all the essential medicines required for the treatment of the
clients.

 Training and Research :

 The training unit not only provides training to centers own staff but also runs a
number of courses for other NGO (non-government organization) partners and GoB
(Government of Bangladesh) agencies.

 The courses are on :

 Primary Health Care
 Child Survival Interventions.
 Essential Service Delivery (ESD) package.
 RTI (Respiratory Tract Infection)/STI (Soft Tissue Infection) treatment and
prevention.
 Other reproductive health.
 Medical College Hospital and Family Planning and Clinical Service Delivery.
 Management Course for health professional and paraprofessionals of the government
and non-government organization (NGOs)
 Counseling.
 Infection prevention.
 TOT on TBA (Traditional Birth Attendant) training.
 Basic courses for TBAs (Traditional Birth Attendants) on “Safe home Delivery” and
“Clean Home Delivery”.
 Refresher courses for TBAs are on “Safe Home Delivery”.
 Adolescent Reproductive Health
 Gender issues.
 Rational Drug use.
Page No-15
  Growth Monitoring.
 Nutrition and cooking demonstration.
 BCC (Behavioral Change Communication) and counseling.
 Homestead gardening
 Child centered Community Development Approach (CCCDA).
 Child protection policy.
 Social issues.
 Other training as per requirements of the non-government organization (NGOs).
 Other training as per needs assessment.
 Training unit also establishes and maintains institutional linkage with the Government
institutions and non-government organization (NGOs) on Health manpower
development.

 Research :

 Operational research for the implementation of its own performance is a routine issue.
Besides, a number of research programs which are relevant to the ongoing programs
are also taken in collaboration with different research organizations such as
International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b).

Collaborative Activities :

 Radda MCH-FP centre is partner in collaborative activities with the following

organization :

 Plan international.

 Three Radda Plan joint projects are :

a. Community Managed Health Care.

b. Integrated Food and Nutrition Security Project (IFNSP)
c. Radda-Plan joint project on strengthening Adolescent Reproductive Health
(SARH) project.
 Icddr,b :

 Study on “Day Care Based Management of Severe Pneumonia”.

 Dhaka City Corporation.

 Directorate of Family Planning.
 Directorate of Health Services.
 World Health Organization.
Page No-16
Health Management Information System (HMIS) :

Daily records of users at the service delivery points are compiled to prepare the monthly
service statistics.

Monthly performance/achievement is monitored and compared with the monthly target of

each service site. Monitoring of the activities is accomplished by reviewing the HMIS
indicators generated each quarter. The program personnel at different levels for program
planning, monitoring and management use the HMIS for the evaluation and improvement of
the performance.

Achievements of the Organization :

Radda MCH-FP centre received the best EPI performer organization award in the year 2008.

Limitations of the Organization :

 The land that is being used is government-owned. So expansion, if necessary, is not

possible.

 Some static and satellite clinics are functioning at rented houses, which is proving to
be a reason for their limited range of functions.

 There is no in-patient department.

 There is no emergency department.

Page No-17
Personal Observation :

Conclusion:

Signature of the Teacher : Signature of the Student :

Date : Date :

Page No-18
Page No-19
 SCHOOL HEALTH CLINIC
Azimpur, Dhaka

Visit no : 03

Date of Visit : 23.11.2017

Type of the Organization : Government Organization

Date of Establishment : 1962

Briefed by : Dr. Shamsunnahar, Medical Officer,

School Health Clinic,Azimpur,Dhaka

Objectives of the Organization:

 To promote development of healthful school environment.

 To improve the health status of school children to make them suitable for their entry
into the future life.

 To assist implementation of appropriate measures for prevention and control of

communicable diseases and other conditions towards improvement of health status of
school children.

 To provide early diagnosis, treatment, follow-up care and establishment of a properly

working referral system.

 To enable student to act as a health promoters in community.

Page No-20
Existing resources:

Manpower: Doctors, Pharmacist and MLSS.

 Financial Support :

o Completely government funded organization

Logistics and other facilities:

 Land is owned from the adjacent Azimpur Girl’s School.

 A single- storied buliding
 Medicines.

Activities of the organization :

 School health is the part of preventive medicine that deals with medical inspection
and protection of the health of school children in school environment

 The organization covers 10 schools in Dhaka City.

 Target of School Health Clinic is to give services to 6000 school children and 2000
school teachers.

 The organization has the following activities.

1. Provision of health education :

It is a process that informs, motivates and helps children to adopt maintain healthy
practices and lifestyle, to promote healthy practices in their family and community and to
promote environmental changes to facilitate a healthy lifestyle.

Page No-21

Its objectives are :

  To help students to develop a healthy lifestyle.

 To teach parenting and family life skills.

 To enable students to act as health promoters in the community.

2. Promotion of healthful school environment : By ensuring-

 Supply and use of safe water.

 Adequate sanitation.
 General cleanliness of classrooms and grounds.
 Environment free of violence, drug addiction and substance abuse.

3. School health services :

 Periodic inspection and physical examination of each children.

 Detect causes of abnormality and defect in both body and mind.

 Determine deficiency and defects in vision, hearing or other handicaps.

 Provide first aids and emergency services and measures to control common
diseases like fever, communicable diseases.

 Provide general curative services.

 Ensure treatment of minor ailments like chicken-pox, diarrhoea, scabies, typhoid,

ARI (Acute Respiratory Infection) etc.

 Ensure proper referrals.

 Maintain the activities of the schools, the organization forms committee consisting
of teachers and guardians; teachers and students.

 Arrange teachers’ seminars, health education programme for children.

 Celebrate national days.

 Take part in national crisis situation.

 Arrange essay competition, give prizes during world health day.

 Distribute biscuit, caps ant helminthic and other drugs to the adjacent orphanage
named “Chotomoni Nibash”.

 Perform any duty given by government.

Page No-22
Achievements of the Organization :

1. Improvement of health consciousness among school children regarding personal

hygiene.

2. Awareness among school children about re-emerging disease like dengue, its cause,
mode of transmission, breeding paces of Aedes mosquito and the primary
management of patients with dengue fever has been created.

3. Almost all children can prepare the home based ORS which can reflect its effect in
the reduction of mortality and morbidity to diarrheal diseases.

4. Improvement of healthy environment in the schools.

5. Well establishment of referral system.

Problems/constraints of the Organization:

1. The medicine supply is not adequate.

2. Budget is very small.

3. There is only two medical officers who have to run all activities.

4. The space is not adequate.

5. Lack of transport facilities for medical officers to take prompt action in emergency
care.

6. Improper supervision by the authority.

Page No-23
Personal Observation:

Conclusion:

Signature of the Teacher Signature of the Student

Date : Date :

Page No-24
 Organogram

Director General

Health Services

Civil Surgeon

Medical Officer-2 Pharmacist-1 MLSS-1

Note : MLSS – Member of Lower Subordinate Staff

Signature of the Teacher Signature of the Student

Date : Date :

Page No-25
 OFFICE OF CIVIL SURGEON
Azimpur , Dhaka

Visit no : 04

Date of visit : 23.11.2017

Type of the Organization : Government Organization

Date of Establishment : 01.01.2005

Briefed by : Dr. Md. Ihsanul Kareem, Civil Surgeon

Objectives of the Organization:

 Civil Surgeon is responsible for all health activities, domiciliary and institutional
(except medical college and attached hospitals), postmortem activities in district
hospitals (except in Dhaka) in his district.

 Organize national health programmes eg. EPI, TB control, diarrhoeal diseases control.

 Provide health team with ambulance for the Honorable Prime Minister, President,
international sports events, international conferences, trade fair etc.

Page No-26
Existing resources:

Manpower:

 Doctors
 Health educator
 Health superintendent
 Entomologist
 Member of lower subordinate staff (MLSS)

Financial Support:

 Completely government funded organization.

Logistics and Other Facilities:

 Land is owned.
 A multi storied building
 Medical and surgical equipment’s
 Medicines.
 Ambulance service

Page No-27
Activities of the Organization:

Administrative:

 Supervision and monitoring of health services of respective upazilla.

 Food tender for the indoor patient in hospitals.

 Tender for medical and surgical requisite (MSR).

 Training orientation and workshop for doctors, health personnel and other

professionals.

 Monthly coordination meeting at District and Upazilla level.

 Celebrating important national and international day.

 Leave and transfer of employees.

 Promotion of 3rd and 4th class employees.

 Financial and technical support in Upazilla level.

 Supervision of clinical and field services.

 Disaster management by forming RRT (Rapid response tem).

 Provision of ACR (Annual Confidential Report).

Special function :

 VVIP (Very Very Important Person) duty (primary medical aid).

 Inspection of food hygiene and examination to ensure quality of food.

Page No-28
Achievements of the Organization:

 Improvement of health consciousness among the people.

 Awareness among the people about re-emerging disease like dengue, its cause, mode
of transmission, breeding paces of Aedes mosquito and the primary management of
patients with dengue fever has been create.

 Improvement of healthy environment.

 Create a group during emergency to tackle the situation.

 Inspect food for VIP (Very Important Person) people.

 Prompt response during disaster episode.

 Training of different specialties in medical aspects.

Problems/ Constraints of the Organization:

 The medicine supply is not adequate.

 Budget is very small.

 Shortage of manpower an employee.

 The space is not adequate.

 Lack of transport facilities.

 Technologies and facilities are backdated and poorly maintained.

Page No-29
Personal Observation:

Conclusion:

Signature of the Teacher Signature of the Student

Date : Date :

Page No-30
 Organogram
Civil Surgeon

Personel- 4

Administration-17 Disease Control-11 Programme-11

Personnel-0 Personnel-2
Personnel-2
Medical Officer-2
Office Deputy Civil Surgeon
MLSS
Personnel-11
Administrative Officer
MIS
Chief Assistant
Office Assistant-4 Personnel-2
Health Education
Machine Operator
MLSS-2
Gardener
Statistician Personnel-4
Sweeper Statistician Assistant
Senior Health Education Officer
Junior Health Education Officer
Projectionist
Audio-Visual Helper

Accounts
Microbiology
Personnel-2 Field Service
Accountant Personnel-3
Cashier Personnel-2
District
District Health Administrator
Microbiologist Programme Organizer
Store and Dispensary Ento- Technician-2

Personnel-2
EPI
Medical Officer (Store)
Store Keeper Personnel-2
Public Health

Personennel-1 EPI Supervisor

Security Service Cold Chain Technician
District Sanitary Inspector
Personnel-1
Security Guard
Nursing Service
Lab Service
Vehicle Personnel-1
Personnel-3
Personnel-1 Driver
Senior Medical Technologist (Lab)
Medical Technologist
Driver Lab Attendant

Signature of the Teacher

Page-31
 ORAL REHYDRATION THERAPY (ORT) CORNER
Pediatric Outdoor, DMCH, Dhaka

Visit no. : 05

Date of Visit : 25.11.2017

Type of the Organization : Government.

Date of Establishment : 1995.

Briefed by : Mr. Shahjahan, Technician,

Oral Rehydration Therapy (ORT) Corner, Pediatric
Outdoor, DMCH

Objectives of the Organization:

 To decrease mortality as well as morbidity associated with diarrhoea.

 To make the people aware of the necessity of proper and beneficial feeding practices
for the infants and children during and after diarrhoeal episodes.

 To impart health education among general population on diarrhoea.

Existing resources:

 Manpower: There are some well trained staffs including two senior staff nurses, one
audio visual operator and one analyst. Under the supervision of Resident Physician
(RP) of the Department of Pediatrics who is a qualified child specialist.

 Financial Resources: From the Government of Bangladesh.

 Logistics:For communications and awareness building activities, the ORT (Oral

Rehydration Therapy) corner is enriched with audio visual equipment’s e.g. slide
projectors, movie (VCD) and posters etc. It also has constant supply of ORS.

Page No-32
Activities of the Organization:

 Categorization and treatment of the patients suffering from no dehydration and some
dehydration by oral rehydration saline.

 Provides health education to the mother regarding diarrhoeal diseases.

 Encouraging mothers to continue breast feeding to their children.

 Educating mothers and caretakers about the preparation of home-made Oral

Rehydration Saline (ORS).

 Conducting training program on clinical management of diarrhoea.

Achievements of the Organization:

 Utilization rate of ORS therapy has increased many fold.

 Their great achievement is increased awareness of people about the role of ORS in the
treatment of diarrhoeal diseases.

 A large number of children are treated successfully in the ORT (Oral Rehydration
Therapy) center. Thus by providing treatment, the center is reducing child mortality as
well as morbidity.

 In the year 2014, the total 2231 children received treatment from the ORT (Oral
Rehydration Therapy) centre; and till March 2015, 549 children were received
treatment from this ORT facility of DMCH.

Problems/Constraints of the Organization:

 Lack of skilled staffs and adequate manpower like nurses, paramedics etc.

 Inadequate space in comparison to large number of patients attending the ORT corner.

 Lack of proper administration and supervision.

 The treatment centre has no washroom facility which is extremely important.

 The room is ill-ventilated.

 It remains open only during the office hour (8 am to 2.30 pm). So emergency
treatment is not possible. As a result many children may get under treatment or no
treatment at all.
Page No-33
Personal Observation:

Conclusion:

Signature of the Teacher Signature of the Student

Date : Date :
 Director
DMCH

Resident Physician (RP) , Pediatrics Department

ORT Corner

Staff Nurse-2 MLSS

MLSS = Member of Lower Subordinate Staff

Signature of the Teacher

Date :

Page No-35
 DIRECTLY OBSERVED TREATMENT, SHORT COURSE (DOTS), DMCH

Day visit no : 06

Date of visit : 25.11.2017

Type of the organization : Directly observed treatment, short course is the

internationally recommended strategy for TB
control that has been recognized as highly efficient
and cost effective strategy

Date of establishment : 15.06.2004

Briefed by : Heaven Luna, Technician,

Technician ,DOTS corner , DMCH

Objectives of the Organization:

To reduce the incidence of tuberculosis in the country to such a level that it cannot be a
public health problem.

Targets:

DOTS is a strategy to ensure cure by providing the most effective medicine and confirming
that it is taken.

Existing resources:

Manpower :

The manpower consists of a Resident Physician under whom are 3 staffs comprising of 2
Medical Technologist (lab) and 1 senior program organizer.

Page No-36
Financial support:

The organization is funded by the Ministry Of Health And Family Welfare of the
Government of Bangladesh along with BRAC.

Other facilities:

 Pathological laboratory for identification of acid fast bacilli in sputum.

 DOTS room.

Activities of the organization:

 Early detection of smear positive cases by direct microscopy free of cost.

 Passive case finding through screening of symptomatic cases.

 Grading of severity of disease and providing drugs accordingly.

 To make sure that effective chemotherapy is provided free of cost to all patients.

 Constant monitoring and follow-up of therapy via DOTS strategy. It is a WHO

recommended strategy. Here patients are given drugs free of cost and they are
constantly monitored so that they can the drug by swallowing. For this the treatment
compliance is ensured.

 Sputum smears testing for acid fast bacilli during and after treatment.

 Standard registration card has been issued to the patients.

 Dissemination of knowledge regarding TB to patients.

 Outdoor services.

 Statistical record is maintained.

Page No-37
Achievements of the organization:

The achievements of the organization include achievement of an existing case detection rate
of 70% and a cure rate of 80%. The organization has been successfully categorizing the
Tuberculosis patients into different categories and providing appropriate treatment to them. In
addition, the organization has successfully been providing knowledge about tuberculosis to
the patients and their families.

Problems and constraints of the organization:

 No indoor facility.

 Very old infrastructure.

 Administrative facilities are not up to the mark.

 Lack of skilled manpower.

 Lack of protective measures for all the staff that are at constant risk of being attacked

by TB.

 Culture facility for Mycobacterium is not present

 Lack of funding.

Page No-38
Personal Observation:

Conclusion:

Signature of the Teacher Signature of the Student

Date : Date :

Page No-39
 Organogram

Director

Resident Physician (RP)

Total number of 3 staff

Medical Technologist 1 Senior Program Organizer

Signature of the Teacher :

Date :

Page No-40
 MODEL FAMILY PLANNING CLINIC
DMCH, DHAKA

Visit no : 07

Date of visit : 26.11.2017

Type of the Organization : Government Organization

Date of establishment : It was established in February 1978 with the

financial support from Family Planning
International Assistance (FPIA), USA, at April
1981, it was taken over by Government under
Ministry of Health and Family Welfare.

Briefed by : Dr. Rabeya Khatun, Medical Officer.

Model Family Planning Clinic,DMCH

Aims and Objectives:

 The chief objective of the clinic is to provide all sorts of contraceptive services free of
cost to eligible couples with special emphasis on terminal methods of contraception.

 To train the doctors specially those who newly graduated, on surgical procedures of
contraception as well as on barrier methods so as to make them competent enough to
render required services when posted at the periphery centers.

 To provide both antenatal and postnatal services to the mother, thus ensuring a safe
motherhood.

Page No-41
Existing Resources:
 Total post : 40
 Existing staff : 31
 Well-equipped operation theater for sterilization operation.
 Postoperative ward with five beds.
 Resuscitation apparatus with trained medical personnel.
 Overhead projector and audiovisual appliances, such as slide.
 Separate Norplant implantation and training center.
 Separate RH-step centre, for menstrual regulation and menstrual induction.

Activities of the Organization:

A. Contraceptive services

 All sorts of temporary contraceptives are provided by the clinic free of cost. Condoms
are, however, now supplied to clients at Tk. 1.20 per dozen as fixed by Government.

 Surgical sterilization is done in the clinic’s own equipped operation theater.

 Facilities for laparoscopic ligation are also available.

 From July 1992, Norplant services has been incorporated here as an important
program, but recently it is not available.

 All the patients taking permanent contraceptive measures are rewarded with money
and clothes. As for example, patient having ligation are given Tk. 1000 and a saree or
lungi.

 Patient taking IUCD are given Tk. 100 and Tk. 125 for Norplant users, for
transportation purposes.

 All the antibiotics and vitamins are given free of cost.

 Follow-up of all sorts of contraceptive recipients.

 The clinic also manages the contraceptive complications, missing threads of Cupper-
T.

Page No-42
B. Antenatal and Postnatal Services:

 From mid-1992, antenatal services are being completely given by this clinic. At
present the clinic is following the new protocol of antenatal care.

 Counselor, Family Welfare Visitors (FWV), motivators and nursing staffs with
special emphasis on safe motherhood, takes antenatal classes for pregnant mothers
everyday postnatal classes are also held on very Thursday.

 Pregnant women are provided with antenatal card, antenatal advice sheet and
supplemented with iron tablets.

 Postnatal patients are provided with postnatal advice sheet and breastfeeding advice
sheets.

 Pregnant women are routinely screened for HBs Ag free of cost.

 Supplementation of lactating mothers with high potency vitamin ‘A’ capsule.

C. Training services:
It provides training services for intern doctors, Medical Officers (MCH and FP) and doctors
from different non-government organizations (NGOs), research fellows from different
medical institutes and Dhaka University, medical students, B.Sc. and diploma nursing
students, students of Social Welfare Department of Dhaka University and students from
different Medical Colleges (both private and Government).

Achievements of the Organization:

 Motivation of the patients to adopt contraceptive methods and antenatal care is the
most important achievement of this clinic.

 There is a marked reduction of septic abortion from 21% to 14%, maternal mortality
rate from 26% to 19%, eclampsia from 16% to 11%, puerperal sepsis 11% to 8% and
obstructive labor from 8% to 6%.

 Through extensive contraceptive services it contributes much in reducing population

explosion.

 Its antenatal services are playing an important role to reduce maternal and infant
mortality, perinatal mortality and postnatal complications.
Page No-43
Future Plan:

 Reduction of Infant Mortality Rate(IMR) and Maternal Mortality Rate (MMR).

 Rendering gender equity and female education.

 Providing female education up to primary level.

Problems and Constraints:

 Acute shortage of space that badly hampers delivery services and training.

 Inadequate financial and logistic support from Government.

 Lack of trained Medical Officer. For example, the clinic has a laparoscope (received
from BIRPERHT) for tubal ligation, but as there is no trained surgeon the equipment
is lying unused.

 Lack of proper administrative supervision.

Page No-44
Personal Observation :

As a member of the day visit team, I visited the model Family Planning clinic in DMCH. The

key aim of the clinic is to provide contraceptive advices to eligible couples. The activities of

the organization and wide ranging. It includes counseling of couples about the various

methods of contraception and then allowing them to choose (cafeteria approach) is the most

prominent one. Moreover, the clinic also provides antenatal and postnatal services.

Conclusion:
MFPC is contributing by providing counseling to eligible couples about the methods of
family planning which is a basic human right. Family planning is not synonymous with birth
control, it is more than that. The clinic is providing services that falls within the purview of
family planning. However, lack of space and improper supervision impedes the activities of
the clinic. The concerned authority should take adequate steps to address the limitations of
the clinic.

Signature of the Teacher Signature of the Student

Date : Date :

Page No-45
 Organogram

Family Planning Model Clinic

Director General of Health

Services

Director of Dhaka Medical

College and Hospital

Senior Consultant or
Administrator

Medical Manager Counselors Nurses Family Other

Officer Welfare Supporting
Visitor Staff
06 (FWV)
06 01 02 ,,

24
02

Signature of the Teacher

Date :
Page No-46