Community sheet # 2 - SARI ADEL MAHASNEH

[Shadi Jarrar]

بسم الله الرحمن الرحيم

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community 2.doc

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In the last lecture the dr mentioned the strategies of the PHC; the dr also mentioned that the strategies were declared by the WHO (world health organization) in the 1978.
The declaration stated that the health is not the absence of the disease; the health is living a life in good quality in which a good physiological, psychological and social life is guaranteed.
-The family health care is a set of activities in which they are divided into clinical activities and non-clinical activities:
-Health education is not a clinical service, it increases the awareness of the population and to let them live in a healthy life style.
Also, adequate nutrition, environmental factors (safe and clean water) are not a clinical service.
-Maternal and child health includes both clinical and non clinical services:
Non-clinical include awareness of the mother about pregnancy (related information and needs).
-prevention and control of endemic diseases.
-basic treatment of health problems.
-provision of certain drug users (follow up and rehabilitation)
Clinical services of PHC:
It's not only a clinical service but a multipurpose step.
When we discuss health we are concerned with education, income and many other things other than clinical services or physical health.
As we mentioned maternal and child health care includes a clinical part.
PHC has 3 stages:
1. Primary health care, it the stage that precedes the disease (how to prevent the disease).
2. Secondary health care, the disease is there and we have to treat, control and stop the complications.
3. Tertiary health care is disease is a complicated one and we have to do an incentive medical intervention.
So the PHC includes the preventive and the management of the primary problems of the diseases.
Treatment of illness using stand-verts treatment protocols (not sure of spelling), 24hour emergency care should be part of PHC.
The emergency care is the 1st aid care but not the PHC.
1st aid care is a part of PHC and not the main objective of PHC.
Provision of essential drugs is a very important point in which essential drugs should be available for all community members (poor and rich people) and it should be supported financially.
Continuing management of chronic illnesses (ex. Diabetes, hypertension, COPD and asthma)
Usually these diseases affect patients in their middle age and the patient dies with the disease.
If diagnosed early and treatment follow the disease is usually benign while if the treatment didn't start immediately the disease will become severe and complications might occur which will end up with premature death.
These days the chronic diseases are getting more important because they are main causes of death in both developing and developed countries.
In PHC we are concerned with how to control, early diagnose and how to rehabilitate the patient in case of complications.
Preventive care such as immunization.
Antenatal care: pregnant women care.
Appropriate screening and early intervention: undiagnosed hypertension might be diagnosed after an ischemic heart disease or a heart failure.
The hypertension is called the silent killer because usually it's silent, which means that u can't conclude that u r hypertensive if u have a headache so the screening procedure is very important in PHC.
Screening should be done throughout life even in the early age so it's recommended that all students should be screened at the 4th, 7th and 10th grade.
Screening usually includes measuring of blood pressure and the blood sugar level.
Babies screening include Growth monitoring. (From birth to 5 years of age)
Screening include: immunization, health education and nutritional counseling.
There is something called women's clinic at which they follow up the health of women with different reproductive age and even menopausal women.
At every age there are special tests for the screening. (Ex. osteoporosis test for Menopausal women, usually it's tested at the age of 40years).
Another important screening examination for women above 40 years of age is breast examination.
Important screening examinations for men are hypertension and cardiovascular diseases.
STDs (sexually transmitted diseases) screening is important for married couple and in some unmarried people.
STDs are a cause of morbidity and mortality especially if we are talking about HIV.
They start as vaginal discharge and range from mild cases (ex. Gonorrhea, syphilis) to severe cases (ex.HIV).
So every couple should test for STDs before marriage and after marriage.
The 2nd level after screening is to prevent the complication of the disease
if the patient suffers from hypertension we have to prevent the complications of hypertension.
If the patient suffers from diabetes we have to prevent the complications of diabetes.
If the patient suffers from STDs (especially women) we have to prevent the complications of STDs, the most important complication is the pelvic inflammatory disease which will lead to infertility.
To achieve these functions there are also needs for comprehensive health information system which include the population register (every patient reports his disease), chronic disease registrations.
Patient with diabetes should report that they have diabetes.
In a community like Jordan the percentage of people with diabetes mellitus is very high, it's estimated that 27% of people in middle age suffers from diabetes mellitus.
So we have to minimize the complications of diabetes which can cause blindness, renal complications and amputation.
Collection of data is very important because it indicates the needs and the priorities of a certain community.
Support services related to a good staff so if we have a poor staff then the services will be poor and vice versa.
We have to update the working staff (medical and paramedical staff) knowledge so that they are up to date with the newest medical science.
Orientation of new staff in the management:
When it comes to new staff u should have a training program which is essential in PHC.
Why is health management important in PHC???
Because all of the services depend on the policy, which means that the policy helps to provide the different types of services such as the preventive services.
Population health demographical survey is a survey done every 5 years by the government with the help of the WHO.
Ex. Vaccination: in JORDAN according to the population health demographical survey
In early 1980s they found that only 40% of children pass their childhood without taking the vaccine.
However, the last survey was published in 2007 and it shows that 98% of the children's were vaccine and they pass their childhood without having a problem.
This progress was achieved by applying a policy before 15years for vaccination.
Financial support is one of the most important factors that determine the policy and how much of the services are given for free.
Political factors are important factor in PHC.
Ex. in some western countries there are family plan services and you are not allowed to have more than a 3 children's, if you have more than 3 children's then u will have to pay a tax for the 4th child, so this is an example of a political policy.
Adequate infrastructure at the community level:
Functional transport facilities should be efficient and easily reachable.
Appropriate visiting specialists: in certain developed countries the specialists visit the patients at their home because the patient can't go to the hospital
Ex. Bleeding of a pregnant woman
-medical adequation and excessive hospital facilities should be found in every hospital so that the patient is treated as fast as possible.
There are other special programs in the management of PHC
Resources should be made available for the community.
Substance misuse: ex. Smoking
Substance abuse: ex. Addiction
Nutrition: in Jordan it's mainly obesity.
Obesity is mainly due to life style
Environmental health factors: water and air pollution and how to make the environment less hazard for the people's health.
YOUTH CARE:
IN USA there are youth clinics, they are concerned with adolescence health
The most frequent problem is smoking, depression and Obsessive–compulsive disorder OCD.
OCD is a disabling neurotic disease.
A patient with OCD might be clever and very efficient.
Depression is becoming a common thing but at least depression is diagnosed more often these days but there is under estimation of the problems because of the social stigma.
ELDERLY are more suspected to diseases because of the degenerative changes because of the age.
The older you are the more risk to suffer from chronic diseases.
Young mothers are not a priority in Jordan because the average age of marriage is 24years.
Pregnancy of a teen is a high risk.
CONCLUSION of PHC:
working together for a better health of all public members.
Another important principle is that PHC providers should work as a team, i.e. the system can't be held by one person.
PHC is provided by community health survey, GP (general practitioner), dentists, pharmacists.
The policy in Jordan is that once you have finished your residency u r a licensed GP but in UK u have to finish 4 years of training before becoming a licensed GP.
The community doctors, dentist's nurses and pharmacists are professional PHC providers.
Physiotherapists are essential part of medical services; if a patient survived a cardiovascular accident then the next step is to rehabilitate the patient.


DONE BY: SARI ADEL MAHASNEH
DATE OF LECTURE: 13/FEB/2011

[Shadi Jarrar]

فيه حدا عرف شو الـ
stand-verts

00Treatment of illness using stand-verts(??) treatment protocols (not sure of spelling), 24hour emergency care should be part of PHC.