ABSTRACT
The northeast region of Thailand is suffering from an early but rapidly growing HIV/AIDS epidemic, particularly among rural people. Policies and programmes have been implemented at national level to deal with the country wide problem. This case study examines the situation at district level, and considers how well prepared doctors and nurses in district hospitals and health centres are to deal with the burgeoning epidemic. It assesses the knowledge, attitudes and practices of these health workers, and also local management polices and the cost impact of implementing universal precautions. A self-administered questionnaire was given to all 120 nurses in the distrit, and formal observations, using a check-list, were made of the hospitals and health centres. Indepth interviews were held with the directors of nursing, supply officers, nurse counsellors, and doctors. The attitudes and feelings of nurses were explored in focus group discussions. Results showed that though general knowledge about transmission of HIV and universal precautions was reasonably good, practices did not always reflect that knowledge. For example, needles were frequently recapped, and the rate of needlestick injury was extremely high (64% in the previous two years). Other gaps in some areas included confusion about disinfectant solutions, an proper disposal of infectious waste. There was no proper reporting and follow-up system for needlestick injuries. Nurses had a great fear of becoming infected in the workplace, and of being themselves stigmatised. In general this not lead them to avoid caring for infected patients. Rather, they showed great compassion for them. However, some nurses and doctor placed great reliance on knowing their patients HIV status, in the belief that it would enable them to better protect themselves. This sometimes led to compromise in the area of confidentiality. There is a keenly felt lack of support systems for nurses. While inservice training has taken place, nurse counsellors trained, and some homecare services in operation, there appears to be a lack of forward planning for the inevitable increase in demand on services for chronically ill patients and treatment of opportunistic infections. A clear picture of the cost impact could not be gained, and this also reflects a lack of planning capacity. Nurses and doctors in general perform very creditably in difficult circumstances. However, as a mater of urgency, authorities need to address a number of issues such as improved inservice training, implementation of proper procedures for needlestick injuries and waste disposal, and forward planning.
ABSTRACT
An assessment of the use of traditional birth (TBAs) was undertaken in Phu Wiang District, Khon Kaen Province in Northeast Thailand form February to March 1992. The study was cross – sectional using a cluster random sampling scheme with probabiliry proportionate to size. According to official accounts, the utilization of TBA services by mothers has declined, particularly in their role as birth attendants and advisers on family planning. This study set out to substantiate this as well as find out what their new role is now. By questionnaire and in – depth interview it was ascertained that 31% of mothers with children under one had been delivered by TBAs. We found that overall, the utilization of TBAs by women before, during and after delivery were the following :- for anternatal care, 11.4% of mothers and pregnant women (n – 248) received either services or advice from TBAs. - for postpartum care, 35% of mothers (n = 183) were visited by TBAs.Overall , the proportion of all mothers in the sampled villages who received any advice or services from TBAs at any time last year, i.e. before, during, or after delivery was 49%.The fact that one – third of all deliveries were attended by TBAs in this study provides evidence that the TBA’s influence and acceptability continues to exist amingst people in remote rural areas even when formal health services are made available.
ABSTRACT
A cross sectional descriptive study to assess the health centre staff workload and associated factors in Nong Rua district, Khon Kaen Province, was researched from January to April 1991. Health centre yearly records, staff, patient and community interviews, and focus groups were the tools used to determine the health centre workload and community utilisation. The reuslts showed that in the district, health centres had a higher average promotive workload (64.1%) in relation to other activities followed by administrative (25.6%), curative (7.2%) and lastly preventive workload (3.1%) These results are comparable to the Ministry of Public Health’s guidelines regarding the distribution of services, which recommend 75% of time be spent in promotive and preventive activities with 25% for administrative and curative services. In this district 4 of the 13 health centres studied performed above their expected workload with 9 below. In relation to actual workload, 2 of the health centres were under staffed and 4 overstaffed. Distance from the health centre to the district hospital, and the cost of service, did not seemed to affect health centre utilisation and the existence of traditional healers, private clinics and the district hospital did not seemed to affect directly health centre workload. Although patients seemed to utilise the other health services in conjunction with the health centres. The choice of whether to use a health centre appears to be determined by perceived seriousness of the illness, the time the illness occurs, and the person’s perception as to who will give the best treatment. The finding showed a difference between the expected and actual work performed but although statistically significant in reality. If expected targets were to be reached there would need to be an overall increase of three staff in the district.