Monday, 13 June 2016
I HAVE A DREAM
I HAVE A DREAM
That dream is to one day see Swaziland as a country where even the ordinary person’s story matters, where quality education is not a matter of affordability and where families no longer need to send their children out to beg on the street and become invisible to the successful eye. I want to be part of Swaziland where the world’s greatest inventors and solution makers are birthed, where entrepreneurship is valued and people’s dignity is restored through work.
I have a dream
Each Scholar comes with a story that is reflective of the Swazi reality. They come broken, they come as adults denied the chance to be a child and they come carrying the dream of a better future for their families. In their brokenness there lies hope; in their adult-like minds lie the ability to innovate. I believe that “development work … can never and should never be planned or executed
without the young minds of a nation.”
Lets empower our black youth !!!!
I have a dream ......
This dream is driving me to leave a mark or footprint in the African soil
By Wiseman Dlamini
Inspired by Martin Luther King "I Have a Dream"
"IF THEY WERE TO TELL MY STORY"
Mshengu High School
If they were to tell my story, let them say I walked with giants,I marched with leaders in the making, the likes of Frans, Zizwe, Lucky, Melusi, Masuku,to mention but a few. if they were to tell my story let them say I marched by the side of powerful, strong women, the likes of Betty, Tem'landvo, Moletsane, Lwazi, Ngetiwe etc; let them say I lived in the time of Frans, shy yet so mighty, the crowd mover, a visionary born leader. These names are names of legends, these names document history because these names are big names, these names we hear in movies, these names are what authors will write stories about, because these names will never die....
..and if they were to tell Wiseman's story let them say he went to MSHENGU HIGH SCHOOL !!!
I MIC MY SCHOOL
Inspired By: Isaac Newton
"If I have seen further than others, it is by standing upon the shoulders of giants"
Monday, 25 April 2016
SITHOBELA (SITHOBELWENI) COMMUNITY REPORT
Please note that names used in this report are fictitious.
COMMUNITY
Introduction
Over the course of our nursing studies, we were assigned to the community of Sithobela, to do a community diagnosis over a 5 kilometre radius from the Sithobela Rural Health Care Centre, for a period of 4 weeks, commencing on the 8 June, 2015 to the 03rd July 2015. Study done by Dlamini Wiseman. During the study, we toured around the community, mix and talk with community members usually at the Sithobela Rural Health Care Centre. Other data collection method include observation.
The objectives of this study included the following;
Sithobelweni, a remote village located in the Lubombo region (about 160 km east of Mbabane). Sithobela community consists of three chiefdoms: the Luhlanyeni, the Nkonjwa and Mamisa chiefdom.
This community has gently undulating topography with flat topped mountains. The community is currently languishing in drought as a result it has very short dry grass, short and thorny umbrella like trees and infertile sandy soil. There are seasonal rivers flowing through the area, however our local water company (SWSC) provides water from Mhlathuze River that is believed to be clean. A local community garden is irrigated by a nearby dam known as kaMlotsa Dam. The climatic conditions for this area do not favor the crop production as there is little rainfall and high temperatures especially during the summer season. The residents in this area therefore do not grow maize instead they grow cotton which is sold to the cotton refinery in Big Bend. The area is accessible as there is a main motorable road connecting the area with other areas and towns. This road is not tarred though.
Description of Population
Its total population as of the 2007 census was 30 332. Most of the population are Swazis who are descendents of the Mamba clan, who were given the authority to rule the area. It was discovered that there were more females than males (approximately 58.6 % of the total number of population were females). In search of greener pastures most community members have migrated to Siphofaneni and Manzini.
Economic Situation of the Community
There is high rate of unemployment in this community therefore poverty is a challenge of great concern in this community. Most of the residents in this community are unemployed and the HIV burden worsens the situation. Most of the older people depend on their children who in most cases work in textile factories and in sugar cane fields.
Most community members have occupations such as; teachers, nurses, farmers, hawkers or vendors and cleaners. Most of the women are hawkers, cleaners or unemployed whilst the men were mostly either farmers, office clerks in Mbabane or Manzini, bus drivers, bus conductors or unemployed. Men were found to be the breadwinners of the families that make up the community, suggesting that most women are financially dependent on the men.
Cultural Life of the Community
People of this community fall under the Mamba sub-kingdom and their religions are mainly Christianity and Swazi traditional religion. Christianity is the most dominant religion in the community. There are about three hundred and thirty Rural Health Motivators in the community of Sthobela. The members of this community speak SiSwati, and some speak English.
Maloyi primary and high school are the nearest schools in the community, other schools include Nkonjwa high school, Mabhesane School and Mpompotha primary and high school. These community schools were built from collaborative labour and financial contribution of the community members, most who have fallen victims of HIV / AIDS. As a result the schools are struggling to offer the most essential courses such as agriculture, which forms the core of the households, the village and the whole country’s economy. The government of Swaziland is building a sports centre at Sithobela, where community sports games will be played. There are also two football pitches.
Political Activities
The community is under the leadership of prince Phinda, from Mamba clan. There are quite a number of civil servants in the community, such as nurses, teachers and doctors. Community members have the right and they are encouraged to participate in political activities such as elections, community meetings and many more.
Health Services
The available health centre is the Sthobelweni health centre. The community has 8 clinics that the community members may access, depending on which one is closer to them. There is the Nkonjwa clinic, the Gucuke, Sinceni, Lubuli, Gilgal, Sphofaneni, Bholi and Ndzevane clinic. Sthobelweni health centre has a maternity department with ten beds. There are no private doctors in the community. The Sthobela health centre has three pharmacies, and the community at large has about 330 health motivators. There is only one private pharmacy located outside the health facility, just a few hundred meters away.
Nutrition
The temperatures are exceptionally high in summer, reaching temperatures of 40o C therefore this weather conditions are not conducive for food production. The community’s overall nutrition is generally poor and most people depend food donations from the World Food Programme. Records from the ART department in the local health facility show that about 30% of the people on Art treatment are malnourished. The nutritional status in the health facility is measured using the body mass index and mid-upper arm circumference for children. The WHO has also introduced a program where these people are also given food hampers. The main source of carbohydrates is mealie-meal from maize.
Environmental sanitation
General sanitation in this community is good. There is no litter found in roadsides or family compounds. Buildings in homesteads are made of cement and some stick and mud. The community does not have any waste management system instead almost every homestead has a rubbish pit where they dispose their domestic waste, and also no sewer system hence the community uses pit latrines for disposing human excreta. The toilets a properly built and almost every homestead has a pit latrine. This is due to a recent project by World vision Swaziland which was aimed at ensuring that every homestead has a proper toilet. The community experience water scarcity due to geographic location and characteristics. The main source of water in this community is the water system provided by the Swaziland Water Services cooperation. This water service can only be accessed be the economically stable families. The water supply may sometimes be cut for a period up to a week. This leaves the community with no alternate source of water. They usually turn to unprotected sources of water usually wells. This leads to gastro-intestinal infections.
Epidemiological description
The main diseases diagnosed in this community are HIV, hypertension, diabetes meliitus, dog bites and tuberculosis. Malaria is an endemic disease. Epidemic diseases are hypertension, HIV and diabetes mellitus. Communicable diseases are tuberculosis and HIV.
ANALYSIS AND INTERPRETATION OF DATA
Analysis of the health needs of the community
- Women- culturally, they are independent, they depend on their husbands, even on health related issues, they have to consult with their partners and it will be the husband’s word that will stand.
- Children- also children are dependent to their parents on their health, so if the parents are not aware of issues related to health, then the children’s health is at risk.
- Youth- the youth is also less aware especially on HIV related issues, this is seen on the higher prevalence of HIV on the youth.
Community diagnosis
Generally the health status of the community is extremely poor, this is evident by the high prevalence of diseases such as HIV, hypertension, diabetes, diarrheal diseases, rabies and tuberculosis. Also the poor supply of clean water is a contributing factor to the poor health status.
CONCLUSION
After having done the community study and diagnosis, I can then conclude that the community is vulnerable to a lot of health risks and thus there is a need for assistance especially on food, water and education on common community diseases.
REPORT ON FACILITY
Introduction
From the 8th of June to the 3th of July 2015 we as a group of nursing students were assigned to do our nursing practice for three weeks at the Sithobela Rural Health Centre, a hospital in the Lubombo region. We were expected to at least have a week of practice in three different departments: the Out Patient department (OPD), the Public Health Unit (PHU) and the Anti-retroviral therapy department (ART). It was unfortunate that we did not have an experience of working in the wards since our time was limited. The following is a report on the heath care facility.
General
The hospital was built with help from a South African mining company which was as a form of giving back to the Mamba community after having realized that a large portion of the company’s staff (miners) were from the Mamba sub-Kingdom. The health care center started operating in 1978. It is of great help not only to the local community members but to other residents of other neighbouring communities.
Referrals
Sithobela is a referral point for most clinics which on the south of Lubombo, about eight clinics. These clinics are Nkonjwa, Gucuka, Sinceni, Lubuli, Gilgal, Siphofaneni, Bholi and Ndvevane clinic. On the other hand, Sithobela Health Centre refers its patients to Hlathikhulu hospital and Raleigh Fiktin Memorial hospital, sometimes Mbabane Government hospital.
Infrastructure
As much as the hospital is of great help, it does have challenges; it is small in size, wards cannot accommodate everyone who needs to be admitted for further care, and also the road to it is long, bad and untarred being disadvantageous during transportation of patients who need more medical attention and care than they can offer. The hospital, as small as it is, has almost all the departments that are necessary in a hospital: there are two wards (the male and the female wards); the Public Health Unit which consist of the Out Patient Department, the Maternal and Child Health department; there is also the Antiretroviral department where HIV care and support is offered. There is the radiography department where X-ray screening is done; there is also the laboratory where specimens are tested and analyzed. There is the pharmacy where drugs are taken from according to prescription and also a conference room where meetings are held. Also there are the laundry, catering and biomed departments. There is a football pitch, volleyball and basketball courts where staff can partake in physical activities in the form of sports every Wednesday afternoon or anytime they are off-duty. This is good for the health of the healthcare workers since physical activity protects one from developing illness such as hypertension and osteoporosis to mention a few. There is a mobile house where community issues are dealt with. There are also staff houses where workers live in.
Staff
The facility is governed by two Matrons and an administrator. Falling under these are the facility’s Sister Nurses which are 4 in total, 2 senior medical doctors and 2 doctors, senior nurses from the facility’s 5 nurse-run departments and the staff nurses comprising of registered nurses and nursing assistants. In the governance of the facility there is also a community member committee which is the mid man between the hospital and the community serviced by the health center.
The Public Health Unit [PHU]
It consists of the OPD and MCH. There is also the maternity section where child delivery is done by qualified midwifery nurses. Tuberculosis (TB) screening is done here, and also HIV testing and counseling is done. Services offered in the PHU I personally saw that they were of high quality, more especially in the OPD where most of our theory is then put to practice. The way things are done are more exactly what we have been taught in class.
The Outpatient Department (OPD)
Here entire history taking is done, including physical assessment of clients. There is also the treatment room where injections are taken and also dressings are done. It is stocked with drugs that are used to treat conditions that are common at Sithobelweni. Cases that cannot be handled by the nurses, or rather, cases that need the doctor’s attention are referred to the doctor’s consultation room, still in the OPD. A challenge faced by this department is the absence of adequate space. On busy days such as Mondays, the OPD is filled with an influx of patients and there is overcrowding. This is not ideal since it exposes clients to the risk of acquiring other communicable diseases such as tuberculosis and influenza while still waiting for their services.
The Maternal and Child Health Department (MCH)
All child immunizations are done here including the newly introduced pneumonia vaccine. ART refill is done for HIV infected mothers. A challenge faced by this sector is that of shortage of vaccines so sometimes children do not get immunized at their right time, but later when new vaccines are stocked. Family planning services are offered in another sector in this department. Basically all the forms of family planning are done. Also cervical cancer screening is done here. It is encouraging that even in rural areas people are willing and are practicing family planning.
The Anti-retroviral Therapy and care Department
Here antiretroviral therapy is initiated on HIV infected individuals. Drug refill for patients already on ART is done. TB screening is done here since there is a known relationship of TB and HIV, so screening helps detect infection with TB early and treatment started soon. Pill count is also done to enhance patients’ adherence to their therapy. OPD services (history taking and drug prescription) is done here for patients who have come for their refill and this is convenient because a patient does not have to queue for refill and also go and queue in the OPD for treatment. It was worth noting that people receiving services from this department are free and open, seems like the issue of discrimination, self-discrimination especially, is less in this community. Another thing that I noted was that statistics show that the HIV infection rate is high at Sithobelweni.
The Wards
It was unfortunate that we never got the opportunity to work in the wards but we were oriented to them on our first day at Sithobelweni Rural Hospital. They are only two, the male and female
wards. Both surgical and medical patients are kept in one ward only separated by cubicles. In such a situation cross infection is a great issue, but nurses as improvisional as they are, they try to group patients according to diagnosis, trying to minimize nosocomial infection. The shortage of wards is a great challenge that is faced by the hospital.
Conclusion
The facility is very good for its purpose, and it is of great help to the community. It was also very ideal for our training practice since it offered all the services we needed as students for our learning. The facility would have not been ideal without the wonderful staff we were working with.
References
Colgate, S.H., Carriere, J. F., Jato, M & Mouniom, D. (2005). The Nurses and Community Health in Africa (2nd Ed.). China.
Smeltzer. S, Bare. B, Hinkle. J and Cheever. K .(2010). Brunner and Sauddarth's Textbook of
Medical-Surgical Nursing (12thed.). Philadelphia: Lippincott Williams and Wilkins
Weber, J. and Kelley, J. (2010). Health Assessment in Nursing (4thed.) Philadelphia: Lippincott Williams and Wilkins.
WISEMAN DLAMINI
+268 78054848
wisemandlamini20@gmail.com
COMMUNITY
Introduction
Over the course of our nursing studies, we were assigned to the community of Sithobela, to do a community diagnosis over a 5 kilometre radius from the Sithobela Rural Health Care Centre, for a period of 4 weeks, commencing on the 8 June, 2015 to the 03rd July 2015. Study done by Dlamini Wiseman. During the study, we toured around the community, mix and talk with community members usually at the Sithobela Rural Health Care Centre. Other data collection method include observation.
The objectives of this study included the following;
- To assess the characteristics of the community and the factors that influence its health.
- To identify the most common diseases in the community.
- To identify the priority problems and health needs of the community.
- To establish a community health diagnosis.
Sithobelweni, a remote village located in the Lubombo region (about 160 km east of Mbabane). Sithobela community consists of three chiefdoms: the Luhlanyeni, the Nkonjwa and Mamisa chiefdom.
This community has gently undulating topography with flat topped mountains. The community is currently languishing in drought as a result it has very short dry grass, short and thorny umbrella like trees and infertile sandy soil. There are seasonal rivers flowing through the area, however our local water company (SWSC) provides water from Mhlathuze River that is believed to be clean. A local community garden is irrigated by a nearby dam known as kaMlotsa Dam. The climatic conditions for this area do not favor the crop production as there is little rainfall and high temperatures especially during the summer season. The residents in this area therefore do not grow maize instead they grow cotton which is sold to the cotton refinery in Big Bend. The area is accessible as there is a main motorable road connecting the area with other areas and towns. This road is not tarred though.
Description of Population
Its total population as of the 2007 census was 30 332. Most of the population are Swazis who are descendents of the Mamba clan, who were given the authority to rule the area. It was discovered that there were more females than males (approximately 58.6 % of the total number of population were females). In search of greener pastures most community members have migrated to Siphofaneni and Manzini.
Economic Situation of the Community
There is high rate of unemployment in this community therefore poverty is a challenge of great concern in this community. Most of the residents in this community are unemployed and the HIV burden worsens the situation. Most of the older people depend on their children who in most cases work in textile factories and in sugar cane fields.
Most community members have occupations such as; teachers, nurses, farmers, hawkers or vendors and cleaners. Most of the women are hawkers, cleaners or unemployed whilst the men were mostly either farmers, office clerks in Mbabane or Manzini, bus drivers, bus conductors or unemployed. Men were found to be the breadwinners of the families that make up the community, suggesting that most women are financially dependent on the men.
Cultural Life of the Community
People of this community fall under the Mamba sub-kingdom and their religions are mainly Christianity and Swazi traditional religion. Christianity is the most dominant religion in the community. There are about three hundred and thirty Rural Health Motivators in the community of Sthobela. The members of this community speak SiSwati, and some speak English.
Maloyi primary and high school are the nearest schools in the community, other schools include Nkonjwa high school, Mabhesane School and Mpompotha primary and high school. These community schools were built from collaborative labour and financial contribution of the community members, most who have fallen victims of HIV / AIDS. As a result the schools are struggling to offer the most essential courses such as agriculture, which forms the core of the households, the village and the whole country’s economy. The government of Swaziland is building a sports centre at Sithobela, where community sports games will be played. There are also two football pitches.
Political Activities
The community is under the leadership of prince Phinda, from Mamba clan. There are quite a number of civil servants in the community, such as nurses, teachers and doctors. Community members have the right and they are encouraged to participate in political activities such as elections, community meetings and many more.
Health Services
The available health centre is the Sthobelweni health centre. The community has 8 clinics that the community members may access, depending on which one is closer to them. There is the Nkonjwa clinic, the Gucuke, Sinceni, Lubuli, Gilgal, Sphofaneni, Bholi and Ndzevane clinic. Sthobelweni health centre has a maternity department with ten beds. There are no private doctors in the community. The Sthobela health centre has three pharmacies, and the community at large has about 330 health motivators. There is only one private pharmacy located outside the health facility, just a few hundred meters away.
Nutrition
The temperatures are exceptionally high in summer, reaching temperatures of 40o C therefore this weather conditions are not conducive for food production. The community’s overall nutrition is generally poor and most people depend food donations from the World Food Programme. Records from the ART department in the local health facility show that about 30% of the people on Art treatment are malnourished. The nutritional status in the health facility is measured using the body mass index and mid-upper arm circumference for children. The WHO has also introduced a program where these people are also given food hampers. The main source of carbohydrates is mealie-meal from maize.
Environmental sanitation
General sanitation in this community is good. There is no litter found in roadsides or family compounds. Buildings in homesteads are made of cement and some stick and mud. The community does not have any waste management system instead almost every homestead has a rubbish pit where they dispose their domestic waste, and also no sewer system hence the community uses pit latrines for disposing human excreta. The toilets a properly built and almost every homestead has a pit latrine. This is due to a recent project by World vision Swaziland which was aimed at ensuring that every homestead has a proper toilet. The community experience water scarcity due to geographic location and characteristics. The main source of water in this community is the water system provided by the Swaziland Water Services cooperation. This water service can only be accessed be the economically stable families. The water supply may sometimes be cut for a period up to a week. This leaves the community with no alternate source of water. They usually turn to unprotected sources of water usually wells. This leads to gastro-intestinal infections.
Epidemiological description
The main diseases diagnosed in this community are HIV, hypertension, diabetes meliitus, dog bites and tuberculosis. Malaria is an endemic disease. Epidemic diseases are hypertension, HIV and diabetes mellitus. Communicable diseases are tuberculosis and HIV.
ANALYSIS AND INTERPRETATION OF DATA
Analysis of the health needs of the community
- Diarrheal diseases are common diseases that people present with in the outpatient department of the hospital, this may be due to poor sanitation and hygiene, and also usage or consumption of unsafe water. Hence there is a need for health education on sanitation and hygiene. There is also a need of cheap, safe and reliable water supply that everyone can afford to have and maintain. Also lessons on how to purify unsafe drinking water should be held.
- HIV/AIDS is also more prevalent in this community. Not only does it affect the older generation but it affects the youth too. This is an issue of great concern since the economy of the country is adversely affected. With the high numbers of youth infection, it seems as if the youth is not aware of this disease, so there is a need of health educationon HIV that can be done as campaigns, and also the proper and consistent use of condoms should be emphasized.
- There is also the problem of hypertension and diabetes prevalence in this community. There is a need for health education to raise awareness to the community on this issue.
- There is a challenge of food shortage in this community due to the lack of sufficient rainfall. This challenge can be met by teaching the community conservative farming which will help boost the farm produce.
- Also the main road is not tarred so it becomes a challenge when patients are being transported to or from the local Sithobelweni health centre.
- Women- culturally, they are independent, they depend on their husbands, even on health related issues, they have to consult with their partners and it will be the husband’s word that will stand.
- Children- also children are dependent to their parents on their health, so if the parents are not aware of issues related to health, then the children’s health is at risk.
- Youth- the youth is also less aware especially on HIV related issues, this is seen on the higher prevalence of HIV on the youth.
Community diagnosis
Generally the health status of the community is extremely poor, this is evident by the high prevalence of diseases such as HIV, hypertension, diabetes, diarrheal diseases, rabies and tuberculosis. Also the poor supply of clean water is a contributing factor to the poor health status.
CONCLUSION
After having done the community study and diagnosis, I can then conclude that the community is vulnerable to a lot of health risks and thus there is a need for assistance especially on food, water and education on common community diseases.
COMMUNITY HEALTH NURSING
REPORT ON FACILITY
Introduction
From the 8th of June to the 3th of July 2015 we as a group of nursing students were assigned to do our nursing practice for three weeks at the Sithobela Rural Health Centre, a hospital in the Lubombo region. We were expected to at least have a week of practice in three different departments: the Out Patient department (OPD), the Public Health Unit (PHU) and the Anti-retroviral therapy department (ART). It was unfortunate that we did not have an experience of working in the wards since our time was limited. The following is a report on the heath care facility.
General
The hospital was built with help from a South African mining company which was as a form of giving back to the Mamba community after having realized that a large portion of the company’s staff (miners) were from the Mamba sub-Kingdom. The health care center started operating in 1978. It is of great help not only to the local community members but to other residents of other neighbouring communities.
Referrals
Sithobela is a referral point for most clinics which on the south of Lubombo, about eight clinics. These clinics are Nkonjwa, Gucuka, Sinceni, Lubuli, Gilgal, Siphofaneni, Bholi and Ndvevane clinic. On the other hand, Sithobela Health Centre refers its patients to Hlathikhulu hospital and Raleigh Fiktin Memorial hospital, sometimes Mbabane Government hospital.
Infrastructure
As much as the hospital is of great help, it does have challenges; it is small in size, wards cannot accommodate everyone who needs to be admitted for further care, and also the road to it is long, bad and untarred being disadvantageous during transportation of patients who need more medical attention and care than they can offer. The hospital, as small as it is, has almost all the departments that are necessary in a hospital: there are two wards (the male and the female wards); the Public Health Unit which consist of the Out Patient Department, the Maternal and Child Health department; there is also the Antiretroviral department where HIV care and support is offered. There is the radiography department where X-ray screening is done; there is also the laboratory where specimens are tested and analyzed. There is the pharmacy where drugs are taken from according to prescription and also a conference room where meetings are held. Also there are the laundry, catering and biomed departments. There is a football pitch, volleyball and basketball courts where staff can partake in physical activities in the form of sports every Wednesday afternoon or anytime they are off-duty. This is good for the health of the healthcare workers since physical activity protects one from developing illness such as hypertension and osteoporosis to mention a few. There is a mobile house where community issues are dealt with. There are also staff houses where workers live in.
Staff
The facility is governed by two Matrons and an administrator. Falling under these are the facility’s Sister Nurses which are 4 in total, 2 senior medical doctors and 2 doctors, senior nurses from the facility’s 5 nurse-run departments and the staff nurses comprising of registered nurses and nursing assistants. In the governance of the facility there is also a community member committee which is the mid man between the hospital and the community serviced by the health center.
The Public Health Unit [PHU]
It consists of the OPD and MCH. There is also the maternity section where child delivery is done by qualified midwifery nurses. Tuberculosis (TB) screening is done here, and also HIV testing and counseling is done. Services offered in the PHU I personally saw that they were of high quality, more especially in the OPD where most of our theory is then put to practice. The way things are done are more exactly what we have been taught in class.
The Outpatient Department (OPD)
Here entire history taking is done, including physical assessment of clients. There is also the treatment room where injections are taken and also dressings are done. It is stocked with drugs that are used to treat conditions that are common at Sithobelweni. Cases that cannot be handled by the nurses, or rather, cases that need the doctor’s attention are referred to the doctor’s consultation room, still in the OPD. A challenge faced by this department is the absence of adequate space. On busy days such as Mondays, the OPD is filled with an influx of patients and there is overcrowding. This is not ideal since it exposes clients to the risk of acquiring other communicable diseases such as tuberculosis and influenza while still waiting for their services.
The Maternal and Child Health Department (MCH)
All child immunizations are done here including the newly introduced pneumonia vaccine. ART refill is done for HIV infected mothers. A challenge faced by this sector is that of shortage of vaccines so sometimes children do not get immunized at their right time, but later when new vaccines are stocked. Family planning services are offered in another sector in this department. Basically all the forms of family planning are done. Also cervical cancer screening is done here. It is encouraging that even in rural areas people are willing and are practicing family planning.
The Anti-retroviral Therapy and care Department
Here antiretroviral therapy is initiated on HIV infected individuals. Drug refill for patients already on ART is done. TB screening is done here since there is a known relationship of TB and HIV, so screening helps detect infection with TB early and treatment started soon. Pill count is also done to enhance patients’ adherence to their therapy. OPD services (history taking and drug prescription) is done here for patients who have come for their refill and this is convenient because a patient does not have to queue for refill and also go and queue in the OPD for treatment. It was worth noting that people receiving services from this department are free and open, seems like the issue of discrimination, self-discrimination especially, is less in this community. Another thing that I noted was that statistics show that the HIV infection rate is high at Sithobelweni.
The Wards
It was unfortunate that we never got the opportunity to work in the wards but we were oriented to them on our first day at Sithobelweni Rural Hospital. They are only two, the male and female
wards. Both surgical and medical patients are kept in one ward only separated by cubicles. In such a situation cross infection is a great issue, but nurses as improvisional as they are, they try to group patients according to diagnosis, trying to minimize nosocomial infection. The shortage of wards is a great challenge that is faced by the hospital.
Conclusion
The facility is very good for its purpose, and it is of great help to the community. It was also very ideal for our training practice since it offered all the services we needed as students for our learning. The facility would have not been ideal without the wonderful staff we were working with.
References
Colgate, S.H., Carriere, J. F., Jato, M & Mouniom, D. (2005). The Nurses and Community Health in Africa (2nd Ed.). China.
Smeltzer. S, Bare. B, Hinkle. J and Cheever. K .(2010). Brunner and Sauddarth's Textbook of
Medical-Surgical Nursing (12thed.). Philadelphia: Lippincott Williams and Wilkins
Weber, J. and Kelley, J. (2010). Health Assessment in Nursing (4thed.) Philadelphia: Lippincott Williams and Wilkins.
WISEMAN DLAMINI
+268 78054848
wisemandlamini20@gmail.com
Friday, 11 September 2015
COMPREHENSIVE HEALTH HISTORY
COMPREHENSIVE HEALTH HISTORY
Biographic Data
Client's name : Mr W. Dlamini
Age : 42 years
Address : Luyengo
Marital Status: Married
Nationality : Swazi
Religion : Zionist
Educational level : Primary School
Chief Complaint: Abdominal pain
History of Present Health Concern
C - severe abdominal pain, sometimes colicky abdominal pain
O - started x 1/12 ago
L - abdomen (Right lower quadrant)
D - one month
S - severe, rating about 8/10 according to pain scale
P - pain severe after eating, over-the-counter analgesics have helped to relieve pain but it always comes back.
A - pain is often accompanied by headache, fever and vomiting which makes the client not able to do some of the activities of daily living.
Past Health History: two weeks ago patient was treated for abdominal pain at Luyengo Clinic with little effect. Client has no BCG scar on the left forearm. Late February this year, the patient was hospitalised for a few days following right arm fracture. The client has no known allergies and he knows his HTC status.
Family Health History: Patient states that there is no family history of appendicitis but his grandmother had peritonitis and diabetes mellitus. His older brother, Mandla have gastric ulcers.
Lifestyle and Health Practices: client is a non-smoker but drinks alcohol (sometimes excessively). Patient stated that he usually eat low fibre diet at work. He sometimes forgets washing hands after using the toilet and before handling or eating food.
PHYSICAL EXAMINATION
General observation: On general observation the client is ill-looking, holding his abdomen and restless. During history taking the patient kept on grimacing.
Inspection: abdomen is asymmetric, bulging on the right lower quadrant (RLQ) without any lesions and or bruising noted. Redness noted on the right lower quadrant of the abdomen. Umbilicus slightly shifted from the midline due to inflammation on the right lower quadrant.
Palpation: the skin is hot on touch (T – 38.2 oC) due to infection on the right lower quadrant. On light palpation tenderness noted on the right lower quadrant. Deep palpation was delayed on the right lower quadrant as the client reported severe pain. No masses noted with light and deep palpation in the other three abdominal quadrants. Liver and spleen were non-palpable.
Percussion: area of dullness percusssed at the right lower quadrant. Tympany percussed over the three other abdominal quadrants. 8cm liver span percussed on the right mid- clavicular line.
Auscultation: Venous hum and friction rub auscaltated over the liver. Diminished bowel sounds and right renal artery bruits auscultated over the right lower quadrant. Bowel sounds low pitched and gurgling at 22/min in the other three abdominal quadrants.
DATA ANALYSIS AND SYNTHESIS
Identification of Abnormal findings and client strengths
Subjective Data
Abdominal pain
Abdominal pain accompanied by vomiting
Often fever and headache
Colicky abdominal pain
History of diabetes in the family
Excessive alcohol intake
Low fibre diet
Constipation
Objective Data
no BCG scar
temperature 38.2 oC
hot on touch
grimaced face
Diminished bowel sounds on the right lower quadrant
Right lower quadrant dull on percussion
Tenderness palpated on right lower quadrant
Abdomen asymmetric, bulging on right lower quadrant
2. Identification of cue clusters
Cue cluster 1
temperature 38.2 oC
hot on touch
Headache
Cue cluster 2
Severe, colicky abdominal pain
Diminished bowel sounds on the right lower quadrant
Right lower quadrant dull on percussion
Tenderness palpated on right lower quadrant
Abdomen asymmetric, bulging on right lower quadrant
Cue cluster 3
Excessive alcohol intake
Low fibre diet
Constipation
Vomiting for the past two days
Client was able to come for medical attention
3. Drawing inferences
Cue cluster 1
Signs and symptoms may indicate severe pain and, or the presence of abdominal infection.
Cue cluster 2
Signs and symptoms suggest inflammation of the appendix. Client probably needs a medical referral.
Cue cluster 3
These signs and symptoms may not only suggest client’s poor nutritional status, but may also suggest fluid volume deficit.
4. Possible Nursing Diagnosis
Cue Cluster 1
General body discomfort secondary to systematic response to abdominal infection as manifested by elevated body temperature
Cue Cluster 2
Severe abdominal pain secondary to abdominal infection as manifested by the patient grimacing.
Activity intolerance related to severe abdominal pain as manifested by client’s inability to perform some self care activities.
Cue Cluster 3
Imbalanced nutrition less than body requirements related to frequent vomiting as manifested by poor skin integrity.
Constipation related to decreased dietary fiber as reported by the client.
Risk for dehydration related to vomiting
5. Defining Characteristics
Cue Cluster 1
General body discomfort
Major - none
Minor – hot
Cue Cluster 2
Severe abdominal pain
Major – subjective communication of pain descriptors
Minor – grimacing
Activity intolerance
Major – none
Minor – verbalization of inability to cope
Cue Cluster 3
Imbalanced nutrition
Major – reports consumption of low fiber diet
Minor – none
Constipation
Major – none
Minor – abdominal discomfort
Dehydration
Major – none
Minor – nausea and vomiting
6. Confirming or ruling diagnoses
Cue Cluster 2
Abdominal pain confirmed because it meets all the defining characteristics.
Activity intolerance ruled out because it does not meet all defining characteristics.
Cue Cluster 3
Risk for dehydration ruled out because it does not meet all defining characteristics.
7. Documenting Conclusions
Nursing diagnoses that are appropriate for this client include:
Severe abdominal pain secondary to abdominal infection as manifested by the patient grimacing.
Collaborative Problems (Risks for Complications)
RC – Peritonitis
RC – Abscess Formation
RC – Bowel Obstruction
Medical Problems / Nursing Actions
To give analgesics to relieve pain and fever. Also give antibiotics to fight against bacterial infection
To give oral rehydration salt, and monitor vital signs and hydration status or nutritional status. If the client does not recover or show improvement within two hours then initiate IV line.
To refer the client to the hospital for further management.
References
Smeltzer, C. S., Bare, B., Hinkle, J. L & Cheever, K. H. (2010). Brunner and Suddarths Textbook of Medical – Surgical Nursing (12th ed.) lippincott - Raven
Weber, J. & Kelly, J. (2010). Health Assessment in Nursing (4th ed.). Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins.
Biographic Data
Client's name : Mr W. Dlamini
Age : 42 years
Address : Luyengo
Marital Status: Married
Nationality : Swazi
Religion : Zionist
Educational level : Primary School
Chief Complaint: Abdominal pain
History of Present Health Concern
C - severe abdominal pain, sometimes colicky abdominal pain
O - started x 1/12 ago
L - abdomen (Right lower quadrant)
D - one month
S - severe, rating about 8/10 according to pain scale
P - pain severe after eating, over-the-counter analgesics have helped to relieve pain but it always comes back.
A - pain is often accompanied by headache, fever and vomiting which makes the client not able to do some of the activities of daily living.
Past Health History: two weeks ago patient was treated for abdominal pain at Luyengo Clinic with little effect. Client has no BCG scar on the left forearm. Late February this year, the patient was hospitalised for a few days following right arm fracture. The client has no known allergies and he knows his HTC status.
Family Health History: Patient states that there is no family history of appendicitis but his grandmother had peritonitis and diabetes mellitus. His older brother, Mandla have gastric ulcers.
Lifestyle and Health Practices: client is a non-smoker but drinks alcohol (sometimes excessively). Patient stated that he usually eat low fibre diet at work. He sometimes forgets washing hands after using the toilet and before handling or eating food.
PHYSICAL EXAMINATION
General observation: On general observation the client is ill-looking, holding his abdomen and restless. During history taking the patient kept on grimacing.
Inspection: abdomen is asymmetric, bulging on the right lower quadrant (RLQ) without any lesions and or bruising noted. Redness noted on the right lower quadrant of the abdomen. Umbilicus slightly shifted from the midline due to inflammation on the right lower quadrant.
Palpation: the skin is hot on touch (T – 38.2 oC) due to infection on the right lower quadrant. On light palpation tenderness noted on the right lower quadrant. Deep palpation was delayed on the right lower quadrant as the client reported severe pain. No masses noted with light and deep palpation in the other three abdominal quadrants. Liver and spleen were non-palpable.
Percussion: area of dullness percusssed at the right lower quadrant. Tympany percussed over the three other abdominal quadrants. 8cm liver span percussed on the right mid- clavicular line.
Auscultation: Venous hum and friction rub auscaltated over the liver. Diminished bowel sounds and right renal artery bruits auscultated over the right lower quadrant. Bowel sounds low pitched and gurgling at 22/min in the other three abdominal quadrants.
DATA ANALYSIS AND SYNTHESIS
Identification of Abnormal findings and client strengths
Subjective Data
Abdominal pain
Abdominal pain accompanied by vomiting
Often fever and headache
Colicky abdominal pain
History of diabetes in the family
Excessive alcohol intake
Low fibre diet
Constipation
Objective Data
no BCG scar
temperature 38.2 oC
hot on touch
grimaced face
Diminished bowel sounds on the right lower quadrant
Right lower quadrant dull on percussion
Tenderness palpated on right lower quadrant
Abdomen asymmetric, bulging on right lower quadrant
2. Identification of cue clusters
Cue cluster 1
temperature 38.2 oC
hot on touch
Headache
Cue cluster 2
Severe, colicky abdominal pain
Diminished bowel sounds on the right lower quadrant
Right lower quadrant dull on percussion
Tenderness palpated on right lower quadrant
Abdomen asymmetric, bulging on right lower quadrant
Cue cluster 3
Excessive alcohol intake
Low fibre diet
Constipation
Vomiting for the past two days
Client was able to come for medical attention
3. Drawing inferences
Cue cluster 1
Signs and symptoms may indicate severe pain and, or the presence of abdominal infection.
Cue cluster 2
Signs and symptoms suggest inflammation of the appendix. Client probably needs a medical referral.
Cue cluster 3
These signs and symptoms may not only suggest client’s poor nutritional status, but may also suggest fluid volume deficit.
4. Possible Nursing Diagnosis
Cue Cluster 1
General body discomfort secondary to systematic response to abdominal infection as manifested by elevated body temperature
Cue Cluster 2
Severe abdominal pain secondary to abdominal infection as manifested by the patient grimacing.
Activity intolerance related to severe abdominal pain as manifested by client’s inability to perform some self care activities.
Cue Cluster 3
Imbalanced nutrition less than body requirements related to frequent vomiting as manifested by poor skin integrity.
Constipation related to decreased dietary fiber as reported by the client.
Risk for dehydration related to vomiting
5. Defining Characteristics
Cue Cluster 1
General body discomfort
Major - none
Minor – hot
Cue Cluster 2
Severe abdominal pain
Major – subjective communication of pain descriptors
Minor – grimacing
Activity intolerance
Major – none
Minor – verbalization of inability to cope
Cue Cluster 3
Imbalanced nutrition
Major – reports consumption of low fiber diet
Minor – none
Constipation
Major – none
Minor – abdominal discomfort
Dehydration
Major – none
Minor – nausea and vomiting
6. Confirming or ruling diagnoses
Cue Cluster 2
Abdominal pain confirmed because it meets all the defining characteristics.
Activity intolerance ruled out because it does not meet all defining characteristics.
Cue Cluster 3
Risk for dehydration ruled out because it does not meet all defining characteristics.
7. Documenting Conclusions
Nursing diagnoses that are appropriate for this client include:
Severe abdominal pain secondary to abdominal infection as manifested by the patient grimacing.
Collaborative Problems (Risks for Complications)
RC – Peritonitis
RC – Abscess Formation
RC – Bowel Obstruction
Medical Problems / Nursing Actions
To give analgesics to relieve pain and fever. Also give antibiotics to fight against bacterial infection
To give oral rehydration salt, and monitor vital signs and hydration status or nutritional status. If the client does not recover or show improvement within two hours then initiate IV line.
To refer the client to the hospital for further management.
References
Smeltzer, C. S., Bare, B., Hinkle, J. L & Cheever, K. H. (2010). Brunner and Suddarths Textbook of Medical – Surgical Nursing (12th ed.) lippincott - Raven
Weber, J. & Kelly, J. (2010). Health Assessment in Nursing (4th ed.). Philadelphia: Wolters Kluwer/ Lippincott Williams & Wilkins.
Monday, 23 February 2015
Mashobeni South, Swaziland
Mashobeni South, Swaziland ( Geo-location )
https://www.google.com/maps/search/MASHOBENI++SOUTH/@-27.0131285,31.0934935,709m/data=!3m1!1e3
https://www.google.com/maps/search/MASHOBENI++SOUTH/@-27.0131285,31.0934935,709m/data=!3m1!1e3
Monday, 28 July 2014
Wiseman Nsimbini Dlamini was born on 22 April 1994 at Mashobeni South in Nhlangano, Swaziland. He started schooling at Mashobeni South Primary School in 2001 and sat for an external examination in 2007 where he obtained a first class with merit. He procceded to Mshengu high school in 2008. In 2010 he sat for junior certificate external examination where he also obtained a first class with merit. He passed his SGCSE examination with flying colours in 2012 (the year of success). He was among the country's top pupils. He is currently doing nursing at the University of Swaziland.
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