Final Reflection Paper and Practicum Evaluations mph 599 Concordia University



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Final Reflection Paper and Practicum Evaluations MPH 599

Concordia University

Practicum position

Name and address of employer: Ibeju-lekki General Hospital, Akodo

Name of supervisor: Mrs Bose O. Osisami







Dr. Adeniyi Mofoluwake A.

12/18/2014






Abstract

This paper is a reflection and evaluation of a 75 hour health promotion practicum conducted over three weeks (five hour on every working day of the week). This health promotion practicum was conducted at various clinics at Ibeju-lekki General Hospital, Akodo (a secondary health care facility located in a rural area in Lagos State Nigeria) using health education, health communication, and social marketing strategies. These strategies enabled this author cum practicum coordinator achieve her goals of improving public health in Ibeju-lekki local government area. I counseled and educated patients attending antenatal, heart-to-heart (HIV/AIDS), family planning, medical outpatient, immunization, and booking clinics at Ibeju-lekki General Hospital, Akodo on health issues of public health concern by translating into public health practice several concepts, theories, and principles I had learnt in school during my Masters in Public Health program.

This provided me with an opportunity to interact with, educate face-to-face, and promote the health of members of Ibeju-lekki local government area at the grass root level.

Introduction

This health promotion practicum addressed several public health issues using health education, health communication, and social marketing strategies. This practicum was conducted over fifteen working days (three weeks) at five hours daily. It addressed public health issues such as diabetes mellitus, hypertension, obesity, prevention of mother to child transmission of HIV, the need for people living with HIV to have protected intercourse even if their partners are living with HIV, modes of HIV transmission, treatment of HIV, caring for oneself if one is living with HIV, breastfeeding, immunization, post natal check, family planning, eating right when pregnant, pregnancy, and antenatal care with an aim of promoting public health in the community in which these health education cum communication practicum was delivered.

Ibeju-lekki General Hospital, Akodo is the only government owned secondary health care facility located at Ibeju-lekki local government area. It was established in 2006 and its catchment population cuts across 78 communities within Ibeju-lekki local government area. Ibeju-lekki local government area is a rural area located on the coastal road in Lagos State, Nigeria. Being a local government area situated in a rural area it is one of the local governments that contribute immensely to the poor health indices of Nigeria.

The mission of Ibeju-lekki General Hospital, Akodo is “to provide qualitative and affordable patient-centered health care services by motivated staff in a clean and hygienic environment.” Its vision is “to be a leading provider of health care delivery services among its contemporaries in the state, in pursuit of excellence, integrity and value for the contributions made by all stakeholders.” Its goal is “to be the hospital of choice in Ibeju-lekki and its environs, providing efficient secondary health care services comparable to what is obtainable in general hospitals in urban centers in Lagos state, Nigeria.”

Ibeju-lekki General Hospital, Akodo renders the following services; general outpatient clinic, 24 hours accident and emergency services, ante-natal and post-natal care, obstetrics and gynecology services, surgical care, laboratory services, radiological services, sonologic services, pharmaceutical services, blood banking services, medical in and out patient care, HIV counseling and testing services. Adult and pediatric ARV care, prevention of mother to child transmission of HIV; and community and environmental health services such as child welfare, food demonstration, immunization, family planning. This healthcare facility funds itself from stipends patients pay to access healthcare services.

This health education cum communication practicum fits into both the mission and purpose of Ibeju-lekki General Hospital, Akodo because it increased awareness and knowledge of health issues that affect patient prognosis, diseases mortality and morbidity rates, and other health indices. Generally, there is a dearth of education on health issues of public health concern in this environment and the nation at large. Since the establishment of Ibeju-lekki General Hospital, Akodo this was the first time it will have a public health physician educate patients and their care givers on health issues that affect them. For example during health education sessions on chronic communicable diseases such as diabetes mellitus and hypertension, I educated the target audience on diabetic and hypertensive diets. Furthermore as a physician at this facility in which majority of the target audience have earned my trust and respect over the years; I applied all the appropriate theories, concepts, and knowledge I have learnt while in school in the last two years to improve on my communication and listening skills; and I framed my health communication sessions to appeal the “core values” of my target audience and position change in their mind. Majority of my target audience showed willingness to adopt the desired health behavior. This health education practicum enabled Ibeju-lekki General Hospital, Akodo provide quality patient-centered health care and preventive health care services to its patients. I bet these health education sessions made Ibeju-lekki General Hospital, Akodo stand out amongst its contemporaries in Lagos state, Nigeria and become the hospital of choice in Ibeju-lekki local government area.

According to my colleagues and some of the nurses, the success of these health education sessions was evident in the clinical outcome of majority of my target audience. Doctors have been able to achieve better blood pressure and blood sugar control in hypertensive and diabetes respectively and are recording better hospital attendance and lower emergency room presentation of hypertensive and diabetic emergencies and urgencies respectively. Child welfare clinics are recording more patient attendance during immunization days. So also are the family planning, antenatal, booking, heart-to-heart, and post natal clinics. In the month of December 2014, the president of the HIV/AIDS support group at the heart-to-heart clinic of Ibeju-lekki General Hospital, Akodo wrote to the hospital’s management on behalf of the members of the support group appealing to the hospital’s management to include in the treatment plan of people living with HIV attending its clinic a minimum of a five hour health communication session monthly. As a result of this request, my Medical Director asked me if he could attend my commencement ceremony in Seward next year. I guess he is proud of me and how my health education practicum has benefited our healthcare facility. He also advised me to submit my Masters in Public Health – Health Policy and Administration certificate to our human resources department (the Lagos State Health Service Commission) in order to be considered for a public health position in the future. I politely turned down his advice because I want to pursue my dream of obtaining a PHD in public health.

Discussion

During these health education practicum sessions, I was the public health physician delivering health communication to the target audiences. Activities I was involved in include;



  • Studying of the environmental needs of Ibeju-lekki general hospital, Akodo and Ibeju-lekki local government area. This activity helped me decipher and decide health issues of public health concern I needed to inform and educate my target audience on and motivate them to adopt the desired health behavior.

  • Information dissemination (informing members of staff and patients/ target audience of my activities; dates, topics, venues, and time.

  • Developing theories for the development, implementation, and evaluation of my public health practicum session weekly.

  • Developing a communication strategy for each health education session I conducted in order to ensure I met the goals of my health promotion practicum.

  • Conducting a process and an outcome evaluation measure for each health education session I conducted in a bid to ensure that my health promotion practicum resulted in a stronger intervention.

  • Thinking ahead and planning for how to manage any unintended consequence that arose from each health education session.

  • Developing an action benefit statement for each health communication session I conducted.

  • Developing of a message appeal for my health education sessions weekly.

  • Framing the health education cum communication messages to appeal to my target audience‘s “core values” of freedom, independence, autonomy, and control and position change in their mind.

  • Distribution of fliers, handouts, and brochures to the target audience; and answering of questions from the target audience.

  • Ensuring I got a role model (an individual who is already adopting the desired health behavior but is very similar to the target audience) to mentor the target audience at each health education session.

  • Informing and reminding my practicum supervisor of the need to be present at my health education sessions in order to be able assess me adequately.

  • Reporting my daily activities to my supervisor.

Below is a table showing the days and dates the health education sessions were conducted, the target audience that these health education sessions were administered to, the number of hours in which these health communication sessions took place, and the public health issues addressed.

Table 1:


Summary of public health promotion practicum conducted at the various clinics at Ibeju-lekki general hospital, Akodo.


Days

Dates

Hours

Target audience and venue in which health communication cum education session was conducted at Ibeju-lekki general hospital, Akodo

Public health issue addressed/ health education session conducted

1

27th Oct 2014

5

Parents at the immunization clinic at Ibeju-lekki general hospital, Akodo

Health education session on the essence of immunizing a child

2

28th Oct 2014

5

Patients at the HIV/AIDS (heart-to-heart) clinic at Ibeju-lekki general hospital, Akodo

Health education session on modes of transmitting HIV/AIDS

3

29th Oct 2014

5

Patients at the antenatal clinic at Ibeju-lekki general hospital, Akodo

Health communication session on benefits of ante natal care for both the mother and the baby.

4

30th Oct 2014

5

Patients at the HIV/AIDS (heart-to-heart) clinic at Ibeju-lekki general hospital, Akodo

Health communication session on the treatment of HIV

5

31st Oct 2014

5

Patients at the booking clinic at Ibeju-lekki general hospital, Akodo

Health education session on pregnancy

6

3rd Nov 2014

5

Parents at Ibeju-lekki General Hospital Akodo’s immunization clinic.

Health education session on benefits of breast feeding a child

7

4th Nov 2014

5

Patients at Ibeju-lekki General Hospital Akodo’s antenatal clinic

Health communication session on the need to have protected intercourse (with the use of barrier methods such as condoms) even if one’s partner is living with HIV.

8

5th Nov 2014

5

Patients at the antenatal clinic

Health education session on benefits of having a post natal check.

9

6th Nov 2014

5

Patients at Ibeju-lekki General Hospital Akodo’s family planning clinic.


Health education session on the benefit of planning one’s family

10

7th Nov 2014

5

Patients at Ibeju-lekki General Hospital Akodo’s booking clinic

Health communication session on the right choice of food while pregnant.

11

17th Nov 2014

5

Patients at the medical outpatient clinic at Ibeju-lekki general hospital, Akodo

Health education session on obesity

12

18th Nov 2014

5

Patients at the HIV/AIDS (heart-to-heart) clinic at Ibeju-lekki general hospital, Akodo

Health communication session on caring for oneself when one is living with HIV

13

19th Nov 2014

5

Patients at the medical outpatient clinic at Ibeju-lekki general hospital, Akodo

Health education session on diabetes mellitus

14

20th Nov 2014

5

Patients at the HIV/AIDS (heart-to-heart) clinic at Ibeju-lekki general hospital, Akodo

Health communication session on prevention of mother to child transmission of HIV

15

21st Nov 2014

5

Patients medical outpatient clinic at Ibeju-lekki general hospital, Akodo

Health education session on hypertension

The goals and objectives of my health education practicum were to inform, educate, and motivate my target audience to adopt the desired health behavior by positioning change in their minds by applying theories, concepts, and knowledge I acquired in all my previous classes as a Masters in Public Health – Health Policy and Administration student at Concordia University, Nebraska. To develop a communication and social marketing strategy for these health education sessions in order to ensure I meet the goals described above. To improve on my communication, listening, and framing skills as a public health physician.

Certainly the goals and objectives of this practicum were appropriate in addressing the public health issue of a dearth of health education and communication on health issues of public health concern at both Ibeju-lekki General Hospital Akodo and Ibeju-lekki local government area.

The only barrier I encountered during this practicum was basically language barrier because of the level of literacy of some members of my target audiences. My familiarity with the terrain in which I conducted my practicum was an advantage to me. I already anticipated this barrier and I prepared well in advance to overcome it. I am aware that majority of the dwellers at Ibeju-lekki local government area are from three ethnic groups and commonly speak three local languages which are; Yoruba, Ibo, and Hausa. Other ethnic groups speak adulterated English called “pidgin English.” I am Yoruba and I speak and write the language fluently. I served as a National Youth Service Corps member in Kano State, Nigeria several years ago where I picked up sufficient Hausa language to enable me take a history from a patient and counsel the patient effectively. I have not lost the little knowledge of the Hausa language I acquired then. However, I was able to communicate to illiterate members of my target audience that could not speak English language and were either Yoruba or Hausa or from other ethnic groups because I speak and understand “pidgin English” as well. In order to ensure I did not leave the Ibos out, I befriended an Ibo nurse who was on her annual leave and paid her a stipend to help me translate English into Ibo and Ibo into English peradventure they had questions for me for the three weeks in which I conducted my health promotion practicum. This worked very well for me and in the process I picked up some Ibo words such as “bia” meaning come, “biko” meaning please, “kedu” meaning how are you, and “odinma” meaning I am fine. Once in awhile I spoke these words to my Ibo audiences when I interacted with them.



Personal Assessment

This practicum has contributed in no small measure to my understanding of public health practice. It enabled me master several concepts, theories, and principles that can be applied to make health education and health communication programs effective. I have realized the essence and significance of strategies such as health education, health communication, and social marketing in promoting public health through behavioral change. This practicum has stirred up in me a new desire to consolidate on my newly improved communication, listening, and framing skills. All things being equal, I have decided to sit for the exam that will qualify me to obtain a Certified Health Education Specialist certificate by April 2015. This new interest was developed during this health promotion practicum.

During this health promotion practicum, I applied knowledge from several of the courses I studied as a MPH student at Concordia University, Nebraska such as MPH 588 Marketing in Public Health, MPH 500 Fundamentals of Public Health, MPH 543 Leadership and Organizational Management, MPH 525 Health Policy and Management, and MPH 515 Principles of Health Behavior. Also, the public health competencies applied during this health promotion practicum include;


  • Public health sciences (Public Health Agency of Canada (PHAC), n.d).

I exhibited knowledge and skills related to behavioral and social sciences, environmental public health, epidemiology, and the prevention of chronic and infectious diseases. I was able to demonstrate knowledge of the health status of the population in the environment in which I conducted my health promotion practicum, their determinants of health and illness, factors that influence delivery and their use of health services, and strategies for health promotion and disease prevention.

  • Public health assessment (PHAC, n.d).

I demonstrated my ability to recognize the existence of a public health issue(s) and determined limitations to addressing these public health issues. I was able to recommend health education cum communication program as an action to address the public health issue(s) recognized.

  • Public health policy program planning, implementation, and evaluation (PHAC, n.d).

I was able to plan, implement, and evaluate a health promotion program to address specific public health issues. I also demonstrated an ability to set and follow priorities, and to maximize outcomes based on available resources.

  • Communication (PHAC, n.d).

I was able to mobilize my target audience and communicate effectively to them benefits of adopting desired health behaviors

  • Leadership (PHAC, n.d).

I was able to describe the mission, vision, and goals of my job and apply them to my health promotion practicum. Also, I improved on performance standard at my job and enhance the quality of the working environment.

This health promotion practicum enabled me improve the three Nigeria public health system’s domains; health improvement, health services, and health protection. I conducted this health promotion practicum in an interactive manner. This enabled me assess the knowledge deficits of the public health issues I communicated to my target audience from the questions my target audience asked, their contributions, and their willingness to adopt the desired health behaviors. Also, I specifically addressed their knowledge benefits and I believe this not only further endeared them to me; it will contribute in no small measure into improving both their health status and clinical outcomes in the short and long run. Furthermore, I perceived that my interaction with my target audiences at the grass root level and the health promotion practicum I conducted enhanced my in-depth understanding of my specialization area which is Health Policy and Administration. With the knowledge and skills I improved on during this practicum, I improved on my ability to develop and implement health and public health policies. I feel I have become a better public health physician after all.



Conclusions and Recommendations

In conclusion, there is a poor knowledge of diseases, the means of preventing it, and attitudes towards preventing it amongst the community dwellers of Ibeju-lekki local government area. This is attributable to the dearth of public health professionals in Nigeria and the lack of political will to prevent diseases and promote public health. Hence, the Nigerian public health system needs to empower itself, improve its personnel, and re-distribute both its resources and personnel to focus on health promotion by effectively preventing both infectious and chronic communicable diseases at Ibeju-lekki local government area and in the Nigerian society at large.

There is a need for the Nigerian public health system to develop and implement health education and health communication programs tailored at environmental needs of each community and aimed at promoting health and preventing disease in each community. The objective of the nation-wide health promotion and disease prevention programs should be to focus on improving the level of knowledge of both communicable and non-communicable diseases and means of preventing diseases and promoting health amongst the population. The Nigerian public health system should maximize its time and effort by ensuring funding towards these nation-wide health promotion and disease prevention programs that focus on the deficits in knowledge amongst the population specifically including the causes, treatment, and prevention of diseases. Development and implementation of appropriate and effective health education, health communication, and social marketing strategies to public health issues in this community and Nigeria as a nation will improve the attitude of the public towards adoption of desired health behavior, disease prevention and health promotion.

Also, the Nigeria public health system should strengthen its health promotion and disease prevention efforts by using appropriate health education, health communication, and social marketing strategies. This can be achieved by developing and implementing nation-wide health care and public health professional provider education courses on disease prevention and health promotion programs. The objective of the health care provider education courses should be to teach health care providers and public health professionals what to discuss with their patients or clients that are at risk of developing chronic non communicable diseases, communicable diseases, how to counsel these at risk population, and educate patients and or clients during clinic visits.

There should be a policy in place to ensure public health professionals are employed as health educators at all government owned primary, secondary, and tertiary health care facilities to attend to the health education and health communication needs of the population served by the health facility.

These recommendations will enable the Nigerian public health system bridge the gap on the knowledge of diseases and willingness of the population to take measures to prevent diseases and promote health.




Reference

Public Health Agency of Canada. (PHAC). (n.d). Core competence for public health in Canada.

Retrieved from http://www.phac-aspc.gc.ca/php-psp/ccph-cesp/pdfs/zcard-eng.pdf

Appendices

Appendix 1: October 27 handout on the essence of immunization.

Appendix 2: October 28 and 30 and November 4, 18, and 20 fliers on HIV/AIDS; treatment of HIV, tips on how to care for oneself if one is living with HIV, modes of HIV transmission, the need to have protected intercourse with a barrier method even if ones’ partner is living with HIV, prevention of mother to child transmission of HIV, and the story of Bola (a mentor mother).

Appendix 3: October 29, 31, and November 7 handout on pregnancy, benefits of ante natal care for both the mother and the baby, and the right choice of food while pregnant.

Appendix 4: November 17 handout on obesity.

Appendix 5: November 19 handout on type 2 diabetes.

Appendix 6: November 21 handout on hypertension.

Appendix 7: November 3, 5, and 6 handout on breastfeeding, benefits of post natal check, and benefits of family planning.



Appendix 8: My supervisor’s evaluation.


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