This training program is meant to facilitate in the training of native Namibians who wishes to become paid workers of one of the three mobile clinics that shall operate across the country. The idea is to enable the creation of multifunctional clinics that shall seek to attend to the medical needs of the rural population in Namibia.
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Rural population in Namibia has been shown to be more vulnerable to certain specific diseases, in comparison to those people who are living in less remote areas (Barnum 1993). In addition, there is also the issue of a limited access to health care, seeing that the nearest health care centers are few and far between.
There is therefore a dire need to bring such services closer to the population who are at a higher risk of suffering from these vulnerable diseases. Moreover, the biggest challenge to rural health care in Namibia seems to be the limited health care facilities especially in the rural communities.
This implies that there are only limited health services for large population. As a result, the number of health amenities in the rural areas per person seems to be overstretched (Casey et al 2001). As a result, no adequate health care can be given to such a population. There is also the issue of a chronic shortage of physicians, as well as assistant nurses.
More often that not, the few medical workers that are there have to struggle in a bid to ensure that the rural populace in Namibia are able to acquire all the medical attention that they might be in need of, within the reach and capability of such a health facility of course. Often, exiting facilities tends to be deficient both in supply and personnel (Rickets, 2000).
Frequently, a majority of the rural folk in Namibia have had to settle for the referral services offered by non-medical providers, thereby further exacerbating the risk to their health. Usually, poverty levels force the rural population to resort to such affordable yet risky medical interventions (Mills, 1990).
Access to medical care is another issue for these members. There is a need therefore to institute a mobile health clinic to bridge these gaps, and hence reduces the risk levels of the community. Some of these risks that pose a challenge to the rural poor in Namibia could as well be contained through early intervention mechanisms, such as bringing health care facilities closer to the community.
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A rise in health risk
By and large, rural population ends to be older, and this in itself is a risk factor to chronic diseases such as heart diseases and diabetes (Hourihan et al 2003). There is thus a need to have medical support services closer to this kind of population, if at all we are to offer a relief to their risk factor.
Besides, government health statistics in Namibia indicates that rural residents have a higher chance of reporting poor health incidences ion comparison to their counterpart residing in less remote areas. The main economic activities of the rural population includes agriculture, Forestry, mining and to some extent, fishing.
Consequently, this population gets exposed to such health hazards as pesticides, toxic dust that they inhale, and the risk of operating dangerous machinery. As a result, injury and health-related complaints tend to be higher (Mills, 1990).
Additionally, the education levels in rural Namibia tend to be lower than average, meaning that the per capita household income also tends to be lower, as there is a direct correlation between education status and levels of incomes.
The implication here then, is that poverty impacts on access to medical attention by the poor members of a community. Towards this end, government statistics in Namibia have revealed that poverty levels in the remoter rural areas are way below the national average (MMHS 2003). Provision of free medical attention then comes as a great relief to such communities.
Reduced access to health care
The rural population experiences less accessibility of such primary health care providers as physicians, nurses and community health workers (Ormond et al, 2000).
Besides, their chances of obtaining such health care on time are also extremely remote (Casey et al 2001).
There is also the issue of health insurance, with a very large population of rural populations in Namibia, and indeed the whole of Africa lacking a health insurance cover. This is in comparison to the residents of major towns, who are more likely to have better means of income, thus affording medical care services. Additionally, they are also capable of accessing better health services (El Obeid et al, 2005).
External support needs
The dependency ratio of health care systems in rural areas is quite high. A majority of these are often supported by donor funds (Stratton et al 2003). Without this kind of donor support, it would otherwise be very difficult to deliver sound health care to this population.
The training and use of the local community members to assist in the provision of better health care services further boosts the success of such a program. For example, according to (Stratton et al 2003), it has been shown that the use of trained community pharmacists in the provision of screening services leads to enhanced health care accessibility in health care provision.
Description of the mobile clinic program
The idea behind the choice of a mobile health clinic in rural Namibia is with a view to ensuring that rural communities have access to emergency health care. Three mobile clinics are set to be established at different geographical locations of rural Namibia.
One of these mobile clinics shall be based at the refugee camp in Osire, home to 6,500 refugees. The areas around Osire have one of the largest populations in Namibia, thus justifying its choice. The second mobile clinic shall be located on the western part of Namibia, nearer to Arandison.
Finally, a third mobile clinic shall be set at Uhlenhorst, south of Windhoek. In itself the mobile clinic shall consist of three units, all resembling the inside area of for example, a well equipped ambulance. In terms of size, the mobile clinic shall be 30 ft. long and 8 ft. wide.
For each new of these mobile clinics 2 nurses shall be on duty around the clock, 24 hours every day of the week. This way, the mobile clinic concept seeks to ensure that the rural communities have access to medical services and supplies whenever they are in need of it.
Furthermore, those patients examined and found to be in need of specialized medical attention shall also benefit from transportation services of the mobile clinic program. These shall hence be transported to the nearby hospital for further medical care.
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The mobile clinic concept is an ongoing project in Namibia, thanks to the support to funds from an American organization. The idea is to facilitate emergency medical aid to rural patients. There is a need to have skilled medical professionals, such a trained doctors and nurses to ensure the success of this program. The staff will be charged with the responsibility of improving health care delivery to the rural population.
It is also a chance for the staff to provide first aid to the rural patients, and also in the treatment of minor ailments. For those patients that manifest symptoms of disease requiring specialized attention, transport shall be arranged by the mobile clinic staff to get these to the closest hospital for further treatment. By operating on a 24/7 basis, it means that the rural population have a chance of accessing health care services around the clock.
Training of local nurses
It is the intention of this medical program to offer medical training to those Namibians who are committed to be part of the medical staff for the three mobile clinics. Basically, the form of training shall be on-the job in nature. Those local volunteers for the program shall be trained on the basic skills on health and hygiene issues.
This is an opportunity for the willing members of the population, especially the youths who have no formal employment, to volunteer and serve the community. Additionally, such members of the community shall also get paid for services provided.
The students chosen for training will be required to observe and assist nurses at each of the three mobile clinics, in order to learn basic medical skills. Through practice, the volunteers will not only gain medical experience, but shall also have been trained to assume duty in these same clinics in the future.
In terms of training, it is projected that such trainees will work on the threes mobile clinics on a rotational basis, to gain experience form diverse backgrounds. It is also the expectation of this training program that such trainees will be involved in a number of activities that will augment their training program.
The idea of incorporating the locals into the mobile clinic program is ideal for sustainability of this project. Besides, these volunteers are allocated incentives for their participation, and this acts a motivation for them to join the program. This is besides the certificates that they are going to obtain once the training program is over.
Basically, the trainees will be required to show a lot of attention during the entire training period. At the observation station, trainees will be expected to learn how to carry out such practices as pregnancy tests, urine tests, and glucose tests. They will also be trained on how to interpret the result obtained.
At the nursing station, the trainees shall be required to spend three hours each day assisting the nurse with his/her activities. During this time, they will closely watch and observe how the nurses approaches a patients and administer for example, injections, distribute medication, and offer medical advise such as in proper nutrition.
Furthermore, trainees will also attend some of the consultation session with the doctor, and see how they usually listen to a patient’s ailments, make a diagnosis, and prescribe medication. Tips on first aid shall also be offered to the trainees by the nurses. Training on the use of equipments and tools of an emergency case shall also be explained and demonstrated to the trainees.
This will ensure that in the absence of either a doctor or nurse, a trainee will be better able to handle emergency situations without panicking. At the pharmacy station, the trainees shall be trained on the proper methods of dispensing various forms of drugs, as per the prescription of a doctor or authorized clinical officer.
The initial training shall consist of three months training at the mobile clinic. At the end of this period, the participant will undertake an evaluation test, consisting of both a written paper and two practical demonstration tests on the area of training. The doctors and nurses will be charged with the responsibility of administering this test.
Upon a satisfactory performance, the successful candidates shall then be incorporated as staff members of the mobile clinic. They will also be put of the payroll of the program, as part of the nursing staff members. The local members shall be charged with a number of responsibilities. These include the provision of primary health care t patients.
This will be in the form of medical examinations of patients, offering treatment, emergency referrals, and reassuring patients who have been diagnosed with or are awaiting results of a serious condition. In addition, these trained nursing staff shall also be expected to assist in carrying out pregnancy and urine tests, as well as in the recording of findings.
Blood and glucose testing and recording is yet another responsibility that this nursing staffs are expected to carry out. Other responsibilities includes carrying out X-rays and ultra sound services, testing for malaria and HIV, cleaning and dressing wounds, counseling of patients undergoing a HIV/AIDS test, family planning services and counseling of substance abuse victims.
Operations of the mobile clinic
In terms of operation, there shall be a total of three clinics, with the main one operating from the most highly populated rural area in Namibia. The other two clinics shall hence be located in areas that are less condensed population-wise. All the people in the surrounding community shall have access to health care. The mobile clinic shall be restocked fortnightly, with the supplies being acquired from the main station. This of course shall be dependent on the needs of the patients for medical supplies.
Two nurses shall take charge of the individual clinic every hour of the day. The nurses shall also be assisted to local volunteers who will be admitted into the program as trainees. Once training is over, these trained locals can then be trusted to take charge of health care provision at the mobile clinic, on a shift basis.
They will be expected to assist the nurses in order that they may not be overwhelmed by the demand for health care services. In any case, the locals will be expected to sustain the mobile clinic once the donors have left. Moreover, this is also an opportunity for these trained nurses to give back to the community, while at the same time also earning an income.
For purposes of containing emergency cases, each of the two nurses at a local mobile clinic will be equipped with a pager. This is meant to call for back-up from the main station in the event that an emergency situation has occurred. Patients attending the mobile clinic shall have access to such basic health care services as dental, prenatal, and optometry, among others.
The nature of the individual mobile clinic stations is that they can easily be towed away as the need arise, and hence the mobile clinic concept. As such, the actual clinic shall be in the form of a truck equipped with the necessary medical facilities. This is a both a cost-effective and flexible method of getting health services to people in remote areas.
Consultations and minor procedures shall be taken care of outside the truck mobile clinic. Here, a makeshift table and a nurse shall be stationed to receive patients and book an appointment with the doctor. Inside the truck, an examination table with another nurse will be present, along with the needed medical equipment and supplies. These would include a stethoscope and a blood pressure kit.
Each one of these clinics shall be 30ft long and 8ft wide. The main government hospital in Windhoek, the capital city of Namibia, shall act as the central supply point of medical supplies fro these mobile clinics, once the supplies have run out. Besides, this could act as a good chance for the program to liaise with the government in strengthening the provision of health care to the rural areas.
Significance of the program
The idea of training local Namibians to work in the mobile clinics is important for a number of reasons. First, it acts as a method of knowledge transfer to the local community; in that they are better able to take charge of their health care needs by way of receiving medical attention and education.
There is also the issue of building confidence and trust, by involving members of the community in such a program. Besides, this is one way through which the program can be able to establish capacity building within the remote areas of Namibia, in terms of health care provision.
Through training and absorbing the locals, this is another way of assisting in the creation of jobs for the local community. As such, those members of the community employed by the mobile clinic program will have improved economic conditions. This then enable them to meet the basic needs of their families, include access to health care.
Besides, the locals are able to acquire a lot of knowledge as regards the nature of a wide range of diseases, how to handle first aid cases, emergency situations, while at the same time assisting the larger community with advice regarding health and wellness.
Such a program is also bound to help increase levels of hygiene at the household levels. The trained members of the community happen to belong to a larger community, and it is only natural that they would impart the same knowledge they received on to others.
In this way, the overall health status of the community may be seen to improve, thus relieving the pressure of disease burden among the rural poor.
Furthermore, it has often been reveled that the success of community projects especially in the third world countries depends on the level to which they are involved in its implementation (MHHS 2003).
When a program seeks to train the locals to become active participants of its activities, this tends to motivate them. As such, the progress and sustainability of a program of this nature is made much easier (Stratton 2005).
This is because the local community tends to feel as if they own the program. By training the local members of thee community as health care givers in the mobile clinics, this is also a form of empowering the local community to take control of their health care.
According to previous research findings, it had been revealed that a lot of the rural population continues being marginalized in as far as the provision of health care is concerned.
On the other hand, the provision of health care program in the urban areas nearer to major cities seems to be better, perhaps due to accessibility by the members of public, and the fact that a lot more of the medical professionals are also likely to be concentrated around the city.
By training the local members of the community, this program hopes to attain tremendous accomplishments in the prevention and control of infectious diseases. Furthermore, the disease burden of especially tuberculosis, HIV/AIDS and malaria seems to be more concentrated in Africa, with the rural population having a higher prevalence rate among this group, as opposed to urban dwellers (Hourihan 2003).
All too often, health care givers are not always able to reach the remotest parts of the rural communities. This means that such members are cut-off from receiving health care and advice on the ways and means through which hey can take control of their health (MHHS 2000).
In light of this, it is anticipated that the local nursing assistants shall help in reversing this trend, by facilitating a higher rate of penetration into the interior parts of the rural areas. In any case, they are more acquainted with the culture of the local community, and this is a big boost to a program of this nature.
Literacy levels in a majority of the rural communities in Namibia are exceedingly high (MHHS 2003) and there is therefore a need to have one of their own involved in the mobile clinic program to act as a facilitator between the members of staff of the program on the one hand, and the locals on the other.
Consequently, it is expected that the program will be a good opportunity to help the community improve their livelihood both economically (by providing jobs) and health-wise.
Shortcomings of the program
In as much as this program may be of benefit to the rural community, there are also some disadvantages that could accompany a nature of this nature. In the remote parts of Namibia, the success of such a program is also faced by a number of obstacles. First, getting the local to show interest as nursing staff trainees is rather difficult.
It becomes hard for the organizers of such an initiative to convince the locals owing to resistance on heir part. This from of resistance may be related to the fact that such an initiate is a foreign concept, and some community members have been known to frown on foreign-based programs regardless of the ensuing benefits.
Resistance on the part of the would-be trainees could also be on the basis of cultural differences. Besides, levels of educations are quite low in a majority of the rural areas in Namibia. For this reason, the prospective trainees may be educationally challenges to assume this kind of responsibility.
In addition, the idea of a mobile clinic program may face challenges with regard to sustainability from the local context. Although foreign aid may be there, still there is a need to have the blessings of the local community to avoid a rejection of such a program. For this reason, it becomes necessary to train the local members of the community so that the entire community may feel as if they ‘owned’ the program.
There is still the issue of trainees dropping out mid-way through the course, meaning that more will have to be trained. This adds onto the operation cost of a program of this nature. Already, two nurses may be enough for a single mobile clinic, and the absorbing of extra staff members could eat onto the budget of the program. Such funds could be put to better use by restocking the supplies for enhanced provision of medical care.
There is also a need to have more clinics in other remote areas; if at all a large portion of the population is to be reached. Three mobile clinics may not fully meet the needs of the rural population in Namibia, as the disease burden is pretty high. Nevertheless, this is a good start, and there are projection to expand in the near future depending on the availability f funds, and the initial reception of the program by the locals.
The future of the program
The program means more to the people of Namibia besides merely the training of volunteer nurses. Upon the successful completion of the training course, the successful members of the staff who gets absorbed into the program stands a chance of furthering their careers in the field of health care provision.
This would be based on the existing talents and acquired skills by these trained nursing staff. Should this happen, then it would mean that Namibia would have more health care profession in the future. Such professions would thus be faced with a challenge of replication similar health care projects in the rural areas and among other vulnerable groups. Consequently, the number of mobile clinics in Namibia could rise significantly, in tandem with an increased in health care professionals. Alternatively, they might opt to expand the existing program.
The future of mobile health care programs depends to a large extent on local health care providers. It is they who clearly understand the magnitude of the health condition in the population. As such, local voluntary nurses could in future assist a program of this nature in improving penetration and improved accuracy in the identification of the vulnerable members of the community.
The difficulties that the rural population faces in as far as the accessing of health care is concerned depend to a large extent on the ability of a health care provider to reach such members of the population. For this reason, a lot of health care givers are often hampered by poor road infrastructure, a common sight in a majority of the rural regions in Africa, including Namibia.
There is also the issue of deficient health care assistants, such as trained nurses, and Namibia seems to be in a dire need for these. The idea of a mobile clinic initiative ensures that these people have access to nurses, doctors, volunteer health workers, as well as optometrist.
Consequently, such programs tend to uplift the health and social status of rural communities. Extreme poverty cases among the rural poor means that getting medical attention becomes a luxury for them. Consequently, they continue suffering silently. Their economic activities get affected due to the immense disease burden that often accompanies the vicious poverty cycle.
Their financial situations do not get any better and they are also not capable of taking care of their families as they would wish. Mobile health clinics of this kind are free, as they already have been funded by international organizations. This means that people of all walks of life gets medical attention for free, and therefore there is no reason why anybody may not benefit from it.
The challenge then is how to bring such services to the people. Mobile clinics come in handy, by offering members of the rural areas convenience and accessibility in terms of health care, at no cost. By training local members as part of the nursing staff, the access of this kind of program is also enhanced.
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