ATTACHMENT REPORT

RHAMU REFERRAL HOSPITAL

NAME: DAHIR DAUD MUDE

ADM NO: CCH/S-090/THI/18

ATTACHMENT REPORT SUBMITTED IN PARTIAL

FULFILLMENT FOR THE AWARD OF CERTIFICATE

IN COMMUNITY HEALTH SCIENCES IN THIKA

SCHOOL OF MEDICAL AND HEALTH SCIENCES

JANUARY 2020

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DECLARATION
This attachment report is my original work and has not been presented in any other institution.

NAME: DAHIR DAUD MUDE

ADM: CCH/S-090/THI/18

Signature…………………………. Date…………………………….

 Supervisor’s Approval

This attachment report has been submitted for review with my approval as institution supervisor.

Signature……………………………..Date………………………………

Department of Community Health and Sciences.

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DEDICATION
I dedicate this attachment report to my family for their moral, financial support during the
attachment period. I would also like to thank my supervisor for the guidance.

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 TABLE OF CONTENTS
DECLARATION.............................................................................................................................2

DEDICATION.................................................................................................................................3

ACKNOWLEDGEMENT...............................................................................................................4

ABBREVIATIONS AND ACRONYMS........................................................................................5

CHAPTER ONE..............................................................................................................................6

Introduction......................................................................................................................................6

1.2 Mission Statement.....................................................................................................................6

1.4: Organizational Values..............................................................................................................7

1.5: Professional Values..................................................................................................................7

1.6 Core Mandate.............................................................................................................................7

CHAPTER TWO.............................................................................................................................9

2.1 Hospital Departments................................................................................................................9

2.2 Staff..........................................................................................................................................10

CHAPTER THREE.......................................................................................................................11

Job Descriptions And Departments I Was Assigned To:..............................................................11

3.1 Mch /Fp– Maternal And Child Health Services......................................................................12

3.2 Ward........................................................................................................................................13

3.3 Maternity..................................................................................................................................13

3.4 Opd Department.......................................................................................................................14

3.5 Physiotherapy Department.......................................................................................................14

3.6 V.C.T Voluntary Counselling Testing.....................................................................................15

CHAPTER 4.0...............................................................................................................................16

4.1 Knowledge And Skills Learnt.................................................................................................16

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4.2 Challenges................................................................................................................................16

CHAPTER 5..................................................................................................................................18

5.0 Conclusion...............................................................................................................................18

5.1 Recommendations....................................................................................................................18

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ACKNOWLEDGEMENT
I would like to express my sincere gratitude to all those who enabled the success of my field

attachment though it may not be possible to thank you all, however firstly I would like to give

thanks to God for giving me good health during the entire period of my attachment. Special

thanks to my supervisor who facilitated the success of this attachment and the entire nutrition

department from which I have gained tremendous amount of knowledge in my entire stay at

Hola School Medical and Health Sciences and for their help in the support. Secondly I would

like to thank the Rhamu Referral Hospital for granting me an opportunity to be attached at their

institution and especially the nutrition department for the guidance they accorded me. Last but

not least I would like to give my special regards to my family for their invaluable moral and

financial support which has helped me to continue with my academic endeavors. The support

and the inspiration they gave me during the attachment period were of paramount importance.

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ABBREVIATIONS AND ACRONYMS
ANC Antenatal clinic

CCC Comprehensive care center

CHW Community Health Worker

MCH Maternal child health clinic

MUAC mid Upper Arm Circumference

OPD Outpatient clinic

PLWHA People living with HIV/AIDS

VCT Voluntary Testing and Counseling

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CHAPTER ONE

INTRODUCTION
The objective of this attachment report was to outline the objectives achieved in every

department and achieve the specific objectives.

Main objectives

 Learn skills that can be practiced in home based care.

 Offer home based care for the HIV/AIDS patient.

 Identify specific health problems for appropriate action

 Understand the role of community health workers in the society

Specific objectives

 Practically weighing, measuring height and using MUAC (anthropometric)

 Nutrition counselling and medication

 To know the criteria of admission

1.2 MISSION STATEMENT

‘To provide specialized quality health, research, training, and participate in national health
Planning’

VISION STATEMENT

‘A world class referral and teaching hospital’

OBJECTIVES

1. To give opportunity to practice knowledge and skills acquired in real life working
environment.
2. To instill right kind of attitudes and interpersonal skills and professional interaction with
others in the working environment.

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 3. To still in students the right kind of work attitude, collaborative and independent skills, as
well as professionalism through interaction with the other in a working environment.
4. To boost the student competency in their respective areas of specialization to shorten the
on-job training requirement in future.

1.4: ORGANIZATIONAL VALUES

- To advance and protect the public image of the Hospital at all times.

- To be sensitive, discerning and attentive in serving our clients.

- To observe and maintain high standards at all times.

1.5: PROFESSIONAL VALUES

- We exercise our professions to the best of our knowledge and ability for the safety and welfare
of all persons entrusted to our care.

- We shall not knowingly or intentionally do anything or administer anything to the persons

under our care to hurt or prejudice.

- We shall maintain confidentiality of information that we have learnt in our professional

capacities.

- We shall not employ any secret method of treatment or keep secret any method, which may be
beneficial to patients.

- The Hospital shall not be advertised for undue commercial gains.

- We shall conduct ourselves honorably.

1.6 CORE MANDATE

The functions of the Hospital as enumerated in the Legal Notice No. 78 of 12TH June, 1998 of
the State Corporations Act (Cap 446) are:
- To receive patients on referral from other Hospitals or institutions within or outside Kenya for
specialized health care
- To provide facilities for medical education for learning institutions and for Research either
directly or through other co-operating health institutions
- To provide facilities for education and training in nursing and other health and allied
professions

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CHAPTER TWO
Rhamu Referral Hospital is a government referral hospital that serves the entire of Mandera

County. It is located within Mandera town. Mandera town is in Mandera County. It is the largest

referral hospital in the County. It sits on a 23 acres piece of land and offers research facilities, in-

patient and out-patient services. It started in the 1997 and has developed into a referral hospital

over the years. It has a bed capacity of 380 in-patients with wards for every department.

2.1 HOSPITAL DEPARTMENTS

 Psychiatric Department

 Physiotherapy Department

 X-Ray Department

 Pharmacy Department

 Laboratory

 Nutrition Department

 Gynecology, Obstetric Department

 Intensive Care Unit

 Orthopedic Therapy Department

 Maternity

 Medical

 Mother and Child Health Department

 Casualty Department

 Comprehensive Care Centre

 Dental Department

 ENT Unit

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  Pediatrics Department

2.2 STAFF
The staff establishment comprises the core personnel who contribute directly to the realization of
the mandate of the Hospital and the support staff that provides the support services required to
accomplish the functions. There is a total of 254 permanent staff as at 30TH June, 2019. Among
the 254 staff, 100 are medical specialists while 154have been seconded to AMPATH project
which is run under collaboration of Rhamu Referral Hospital. The Hospital has various
Divisions, Departments and units. The Hospital also has the physical infrastructure and facilities
including personnel to enable it to meet the standards required of a referral facility.

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CHAPTER THREE

JOB DESCRIPTIONS AND DEPARTMENTS I WAS ASSIGNED TO:

This chapter will highlight the objectives achieved in the various departments.
Main objectives
 Carry out defaulter tracking
 Understand the role of community health workers in the society.
 Offer home based care for the HIV/AIDS patients.
 Learn skills that can be practiced in home based care.
Specific objectives
 Nutrition counselling and medication
 To know how to monitor and do practically weighing, measuring height and using
MUAC.
 To know the criteria of admission

3.1 MCH /FP– Maternal and Child Health services.

The staff in MCH is committed to enhancing the health of mothers and children under the age of
five years.
Duties and responsibilities
i Orientation and familiarization with the department.
ii Orientation on how to admit a client with malnutrition by use of height , weight and
MUAC.
iii Orientation on criteria on MUAC criteria middle arm circumference.
iv Orientation on how to measure height, weight and the MUAC of children under 5
months.
v Diagnosis oon how to measure weight, height on children above 6 months.
vi Leanrt how to plot weight, height on tallying sheets.
vii Diagnosis on how to fill CWC register, monitoring boys and girls category.
viii Practical on how to measure the MUAC of a lactating mothers that is supposed to be
above 21 MUAC criteria.

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3.2 Ward
The ward is where in-patients are admitted as per the doctor’s recommendation for effective
monitoring of the progress.
Each department has its own wards to cater for the different kinds of illnesses.
Duties and responsibilities
i Doing ward rounds.
ii Checking on patients regularly.
iii Ensuring the patients take their medicine at the right time as prescribed by the doctor.
iv Filling the admitted and discharged forms daily.
v Keeping records of the progress of each patient in the ward.
vi Answering any emergency calls.
vii Helping the patients in the wards.

3.3 Maternity
This department caters for pregnant mothers who are about to deliver.
Duties and responsibilities
i Performing routine checkups on the pregnant mothers
ii Counselling and educate women, the family and the community, in relevant areas of
health and provide a programme of parenthood preparation and a complete preparation
for childbirth including advice on hygiene and nutrition.
iii Giving support and advice on the daily care of the baby, including breastfeeding, bathing
and making up feeds.
iv Providing all non-surgical methods of family planning, and counselling for surgical
methods.
v Following established health center policies, procedures and objectives; continuous
quality improvement initiatives; safety, environmental, and infection prevention
standards.
vi Help decrease risk of needing a caesarean and reduced rates of labor induction and
augmentation.
vii Helping to decrease infant mortality rates and preterm birth and take all initiatives which
are necessary in case of need and carry out where necessary immediate resuscitation.

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3.4 OPD Department
This is the Outpatient Department. Outpatient Department treatment refers to those cases when
the treatment and diagnosis of the ailment is done on advice of a medical practitioner or doctor,
by simply visiting their clinic or any other consultation room.

Duties and responsibilities

 The center's location. Is the

facility close enough that if you
need to return for additional
i Early diagnosis, curative, preventive & rehabilitative care on ambulatory basis
ii Effective treatment on ambulatory basis
iii Screening for admission to hospital
iv Follow up care & care after discharge
v Promotion of health by health education
vi Rendering of preventive health care
vii Promotion of health through health education
viii Training of medical / nursing students
ix Keeping up to date records for future treatment, medical education, epidemiological and
social research

3.5 Physiotherapy department.

Physiotherapy department is dedicated to restoring, maintaining, and promoting the best
physical function possible. Its staff diagnoses and treats movement dysfunction.

Duties and responsibilities

i Giving functional training

ii Offering therapeutic exercise.
iii Offering airway clearance.

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 iv Splint fabrication.
v Manual therapy.
vi Equipment prescription.
vii Skin care for burns,
viii Physical agents such as ultrasound and electrotherapy for pain reduction.

3.6 V.C.T Voluntary Counselling Testing

VCT includes both voluntary pre- and post-test counselling and voluntary HIV testing. The key
word is ‘voluntary’: those concerned about their HIV status initiate the service, without coercion.
But currently, most HIV testing is initiated not by the client but by employers, insurers, or (for
students) institutions of higher learning.

Duties and responsibilities

i Counselling of particular groups, such as families, discordant couples, adolescents and

children
ii Assurance of competent counselling and testing, including counsellor support and
supervision
iii Standardization of data collection
iv Criteria for recruitment and training of counsellors

v Offering VCT services to patients

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CHAPTER 4.0

4.1 Knowledge and Skills learnt

 Professional Connections
During my Attachment I had an excellent opportunity to build professional connections.
 New Skills
I was able to learn using a new software program (health information system) for the
hospital.
 People skills: I was able to demonstrate interpersonal skills by communicating
effectively (in writing and in person) and by participating in team activity.
 General skills: I was able to demonstrate flexibility and a problem solver and well
utilized my IT skills.
 Specialist skills: this was achieved through having experience or understanding of how a
particular organization is structured or how it survives commercially.
 Self-reliance skills: I was able to work independently by knowing where my strengths
are and organize myself and prioritize through rearranging commitments to get the job
done.

4.2 Challenges
Some of the main challenges included;
1. Not Enough Work
2. Too Much Work
3. Afraid to Ask Questions
4. Supervisors Forgetting That am New to the Field
5. Competition with Other Attachees
6. My Work Is Not Used
7. Adapting to a New Lifestyle

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CHAPTER 5

5.0 Conclusion

In conclusion, the attachment was a success and vey educative. I was able to learn of the various
hospital processes.
It was a chance for me to learn from other staff while still offering my skills and knowledge to
members of the society.

5.1 Recommendations
I would recommend the hospital to be conducting an orientation for the attachees before the start
of the attachment process so that they familiarize themselves with the activities and departments
that are there in the hospital.
I would recommend the hospital to be offering stipends to the attachees as this would motivate
them and also enable them handle a few financial challenges.

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