Page 10 - Learnwell EVS
P. 10
roduction
P ro to co ls m ust tak e into acco unt the cultural co ntext (e.g. to d isco urage co vering a
febrile ch ild if th at is th e cultural p ractise) and th e enviro nm ent ( avo id th e classic
m istak es, e.g. reco m m end ing that w ater be bo iled w hen fuel o r firew o o d is scarce).
T h e p ro to co ls m ust tak e into acco unt d rug sup p ly ( w h at is th e availability? ) and
p resentatio n (e.g. are the antim alarials labelled in salts o r base? ).
P ro to co ls m ust facilitate co m p liance. S h o rt treatm ents w ith few d o ses are
reco m m end ed . S ingle d o se treatm ent, w hen ind icated , is the best cho ice. T he num ber
of
d ifferent d rugs p rescribed m ust also be lim ited w h enever p o ssible. F o r sim ilar
effectiveness o ral o r rectal d rugs are p referred o ver injectio ns in o rd er to red uce
co m p licatio ns, co st, risk o f transm issio n o f hep atitis B , H IV etc.
Diagnostic methods
T he m etho d s used d ep end o n the services available and the technical level o f the staff.
T hey have a d irect influence o n the establishm ent o f p ro to co ls and the co ntent o f the
d rug list. U sually d iagno sis is m ad e o n a basis o f histo ry tak ing, clinical exam inatio n
and basic labo rato ry tests (as d efined by the W H O).
A - History taking
A m ed ical co nsultatio n is a sp ecial o ccasio n to listen to the p atient and to ask relevant
questio ns to d eterm ine the cause o f the co m p laint.
D uring the interview , the histo ry o f the current illness, the signs and sym p to m s, p rio r
illness and any treatm ent alread y received are sp ecified .
Only by listening attentively is it p o ssible to p ut the p atient‟s co m p laint in a larger
co ntext o f suffering. F o r exam p le, d uring a co nsultatio n, p h ysical vio lence, sexual
vio lence o r abuse m ay co m e to light, w hile this typ e o f co m p laint is rarely exp ressed
sp o ntaneo usly by the victim . It is the clinician‟s resp o nsibility to tak e a glo bal view o f
the situatio n that includ es: p sycho lo gical, legal (co m p leting a m ed ical certificate) and
so cial asp ects and d irect clinical care.
B - Clinical examination
C linical exam inatio n is essential: the d iagno sis and treatm ent d ep end d irectly o n it‟s
quality. It is im p o rtant to k no w o r to learn a technique o f clinical assessm ent that is bo th
co m p lete and rap id , k eep ing in m ind the need fo r quality and efficiency. A technique, o r a
strategy, is even m o re im p o rtant in field co nd itio ns as the num ber o f p atients o ften
stretch es th e m ed ical p o ssibilities and ap art fro m basic labo rato ry exam inatio ns, the
co m p lem entary exam inatio ns are o ften no nexistent.
T he fo llo w ing exam inatio n fram ew o rk is an exam p le that sho uld be ad ap ted to each
case.
It em p hasises the ad vantages o f a system atic ap p ro ach.
Context of the examination
– R o utine exam inatio n: e.g. p renatal co nsultatio n o r M o ther and C hild H ealth (M C H ).
T h e em p h asis o f th e exam inatio n is p red efined by th e p ro gram m e o bjectives
(nutritio nal state, anaem ia, p reventio n o f tetanus etc.).
– A s a result o f a co m p laint: th e usual situatio n at a d isp ensary. T he m o st co m m o n
co m p laints are fever, p ain, d iarrho ea and co ugh.
10
P ro to co ls m ust tak e into acco unt the cultural co ntext (e.g. to d isco urage co vering a
febrile ch ild if th at is th e cultural p ractise) and th e enviro nm ent ( avo id th e classic
m istak es, e.g. reco m m end ing that w ater be bo iled w hen fuel o r firew o o d is scarce).
T h e p ro to co ls m ust tak e into acco unt d rug sup p ly ( w h at is th e availability? ) and
p resentatio n (e.g. are the antim alarials labelled in salts o r base? ).
P ro to co ls m ust facilitate co m p liance. S h o rt treatm ents w ith few d o ses are
reco m m end ed . S ingle d o se treatm ent, w hen ind icated , is the best cho ice. T he num ber
of
d ifferent d rugs p rescribed m ust also be lim ited w h enever p o ssible. F o r sim ilar
effectiveness o ral o r rectal d rugs are p referred o ver injectio ns in o rd er to red uce
co m p licatio ns, co st, risk o f transm issio n o f hep atitis B , H IV etc.
Diagnostic methods
T he m etho d s used d ep end o n the services available and the technical level o f the staff.
T hey have a d irect influence o n the establishm ent o f p ro to co ls and the co ntent o f the
d rug list. U sually d iagno sis is m ad e o n a basis o f histo ry tak ing, clinical exam inatio n
and basic labo rato ry tests (as d efined by the W H O).
A - History taking
A m ed ical co nsultatio n is a sp ecial o ccasio n to listen to the p atient and to ask relevant
questio ns to d eterm ine the cause o f the co m p laint.
D uring the interview , the histo ry o f the current illness, the signs and sym p to m s, p rio r
illness and any treatm ent alread y received are sp ecified .
Only by listening attentively is it p o ssible to p ut the p atient‟s co m p laint in a larger
co ntext o f suffering. F o r exam p le, d uring a co nsultatio n, p h ysical vio lence, sexual
vio lence o r abuse m ay co m e to light, w hile this typ e o f co m p laint is rarely exp ressed
sp o ntaneo usly by the victim . It is the clinician‟s resp o nsibility to tak e a glo bal view o f
the situatio n that includ es: p sycho lo gical, legal (co m p leting a m ed ical certificate) and
so cial asp ects and d irect clinical care.
B - Clinical examination
C linical exam inatio n is essential: the d iagno sis and treatm ent d ep end d irectly o n it‟s
quality. It is im p o rtant to k no w o r to learn a technique o f clinical assessm ent that is bo th
co m p lete and rap id , k eep ing in m ind the need fo r quality and efficiency. A technique, o r a
strategy, is even m o re im p o rtant in field co nd itio ns as the num ber o f p atients o ften
stretch es th e m ed ical p o ssibilities and ap art fro m basic labo rato ry exam inatio ns, the
co m p lem entary exam inatio ns are o ften no nexistent.
T he fo llo w ing exam inatio n fram ew o rk is an exam p le that sho uld be ad ap ted to each
case.
It em p hasises the ad vantages o f a system atic ap p ro ach.
Context of the examination
– R o utine exam inatio n: e.g. p renatal co nsultatio n o r M o ther and C hild H ealth (M C H ).
T h e em p h asis o f th e exam inatio n is p red efined by th e p ro gram m e o bjectives
(nutritio nal state, anaem ia, p reventio n o f tetanus etc.).
– A s a result o f a co m p laint: th e usual situatio n at a d isp ensary. T he m o st co m m o n
co m p laints are fever, p ain, d iarrho ea and co ugh.
10
