1. GULU UNIVERSITY
FACULTY OF MEDICINE
DEPARTMENT OF PUBLIC HEALTH
COMMUNITY CLERKSHIP REPORT
ACADEMIC YEAR 2012/2013 SEMESTER TWO
APRIL/MAY 2013
MADI OPEI HEALTH CENTRE IV
LAMWO DISTRICT
NORTHERN UGANDA
Student Name Reg No Signature
Mr. TURYASIIMA MUNANURA K
Email: tumiek@yahoo.com
09/U/041/GUM ….………………………
Site Supervisor Signature
Ms. ACAYO EDNA
……………………………………………….

2. ACKNOWLEDGEMENTS
We would like to extend my sincere thanks to Gulu University for the wonderful program
of community clerkship, Madi Opei Health Centre IV for hosting and giving us the
opportunity to learn more clinical skills.
Special thanks go to Ms. Edna Acayo (The In-charge), Mr. Okumu George (Assistant In-
charge), the Health Inspector Mr. Bongomin Richard and the entire staff of Madi Opei
HC IV.
Finally thank the Madi Opei community and community leaders at large for allowing us
work with them for the 5 weeks at Madi Opei HC IV.
God bless all of you.

3. ACRONYMS/ ABBREVIATIONS
ANC Antenatal Clinic
ARI Acute Respiratory Infection
ART Anti-Retroviral Therapy
BCG Bacillus Calmette Guerin
COBERS Community Based Education Research
and Service
DPT Diptheria Pertussis Tetanus
EID Early Infant Diagnosis
ETC And So On
F/P Family Planning
H/C Health Center
H/I Health Inspector
HSD Health Sub District
IPD In Patient Department
LC Local Council
MCH Maternal Child Health
NGO Non-Governmental Organisation
OPD Out Patient Department
ORS Oral Rehydration Salts
SCO Senior Clinical Officer
TBA Traditional Birth Attendants

4. OPERATIONAL DEFINITIONS
COBERS Community Based Education Research and Service
CTRR HIV Positive result
Depo Provera An injectable contraceptive
Environmental
surrounding
Circumference or influences
Immunization Rendering immunity
Malaria A tropical disease contracted from mosquito bites leading to
the presence of protozoal parasites in red blood cells
Nutrition The process by which food is ingested and assimilated in the
body.
Population Number of people living in an area at a particular time
Sanitation Use of measures designed to promote health and prevent
disease
VDRL An antigen test for syphilis

5. SUMMARY
Gulu University situated in Northern Uganda is spearheading community transformation
with its motto “for community transformation” and the mission of faculty of medicine
“to produce highly competent human resources for health, conduct high quality
health research and provide effective community services in order to contribute to a
healthy and productive population appropriate for community transformation”.
Also through the introduction of community based education research and service
(COBERS) sites, the Faculty of Medicine sends fourth year medical students to Health
Centre III/IV facilities within Northern Uganda to do community clerkship and have
experience with the rural Ugandan setting.
Two medical students were sent to each health facility and to Madi Opei Health Centre
IV in particular for community clerkship for a period of 5 weeks (April and May 2013).
The purpose of community clerkship is to equip the medical students with the clinical
skills and to nurture our desire and responsibility to “give back” to the people less
fortunate than themselves as they strive to improve population health and transform the
communities. The program also allows students to learn and practice community research
through the introduction of community based education research and service (COBERS).
We were able to attain clinical skills by clerking patients, administering treatment,
monitoring the patients, general management of common conditions, making outreaches
to communities as well as giving health talks. We also had time at the health facility to
carry out the research on “Determinants of First antenatal care visit by pregnant
mothers at COBERS sites in Northern Uganda”

6. BACKGROUND
Community clerkship is part of the academic requirement for a medical student to acquire
Bachelors of Medicine and Surgery at Gulu University. Its goal is to provide students
with the opportunity for practical training and learning in the real world situation while
providing the most needed health care services to communities in Northern Uganda.
Madi Opei HC IV is found in Central village, Kal Parish, Madi Opei Sub-county, Lamwo
County, East of Lamwo district in the Northern part of Uganda
It is about 28 miles from Kitgum town along Kitgum Lamwo district-Sudan Road.
The total Land area is about 16sq.km mostly covered by undulating plateaus and hills.
The vegetation type is savannah grassland.
The soil is of alluvial type and in some areas especially in the west, its tropical black soil
that is mixture of sand, silt and clay. It experiences tropical climate with moderate rainfall
ranging between 500mm-1000mm per annum and the rainfall is convectional in nature.
According to the 2002 population census, Madi Opei sub-county had an estimated
population of 14,722 people.
However the population projection for the year 2010 was 16,695 people.
The major social services and infrastructure existing in the sub-county include; 6
government aided primary schools, 1 missionary funded secondary school, 1 health
center IV and 1 health Centre II (non-functional) in Okol parish among others.

7. Economic Activities in the sub-county
The population is involved in various social economic activities including peasant
farming with a percentage of close to 96%. Women are mainly included in small scale
farming, domestic work and small scale agriculture related business. Agriculture receives
support from NAADs and NUSAF.
Other economic activities include; brick laying, seasonal hunting, firewood selling,
rearing domestic animals, small scale business, carpentry and joinery, fishing in river
Aringa, lumbering(on small scale), charcoal burning and sale, selling of liqor.
Water sources in Madi Opei Sub-county
TYPE NUMBER FUNCTIONAL NON-FUNCTIONAL
Borehole 58 50 8
Shallow Well 0 0 0
Dams 5 2 3
Springs 0 0 0
Hand-dug Well 0 0 0
Valley Dams 0 0 0
Some villages however don‟t have access to clean water for example Pama village, Okol
parish has no single borehole and they are at the moment depending on river Aringa.

8. MADI OPEI HEALTH CENTRE IV
It is the only public health Centre IV in the sub-county.
Staffing at the health unit:
Human Resource
Professional staff
Approved
staffing Norm
Position currently
filled
Gap(s)
Medical Officer 0
01 Senior Clinical officer 1
Senior Nursing officer
01 Public Health Nurse 1
01 Nursing officer(Nursing) 1
01 Nursing officer(Midwifery) 1
01 Nursing officer(psychiatry) 1
Enrolled psychiatric Nurse
01 Enrolled nurse 1
01 Enrolled Midwife 1
01 Nursing Assistant 1
01 Clinical officer 1
Ophthalmic clinical officer
01 Health inspector 1
Public Health Dental officer
01 Laboratory Technician 1

9. Assistant Entomological officer
Assistant Health Educator
Anesthetic officer
Anesthetic Assistant
02 Theatre Assistant 2
01 Laboratory Assistant 1
Cold chain Assistant
Health Assistant
Dispenser
Sub-total 14
Support staff
Account Assistant
Stores Assistant
01 Health information Assistant 1
Office typist
Driver
01 Askari 1
Porter
01 Cleaner 2
02 Vaccinators 2
Office Attendant
Sub-total 6
Total 20

10. Infrastructure
The health unit comprises of the following infrastructure:-
Premises
 A block which houses OPD, ANC clinic, pharmacy and clinicians‟ offices
 A block which houses the triage Centre.
 A block which houses in-patient department comprising of three wards, minor
theatre and Labour suit and Records room and vaccine and drug store and the
Young child Unit on the verandah.
 A block which houses the Laboratory.
 A block housing the ART clinic and TB clinic
 A block housing the theater
 A block housing the isolation ward.
 2 incinerators
 1 placenta pit
Others
 1 borehole
 Ambulance services for obstetrics cases (complications during labour) and other
emergencies.
Staff Quarters
 5 blocks, each has two units and each unit has two rooms for the nursing and
other support staffs
 one self-contained 2-bed roomed house for the resident doctor and
 Semi-permanent Grass-thatched houses (about 19 in number)

11. Activities carried out at Madi Opei HC IV
On arrival at the facility, we were warmly welcomed and escorted to our place of
residence formerly occupied by Medicins Sans Frontiers (MSF), which seemed
comfortable. We got acquainted with one senior midwife, an enrolled nurse and a nursing
assistant with whom we saw the patients over the first few days.
During this time, we also got acquainted with our residence and the trading Centre. We
underwent orientation in the second week about the general health unit system/activities.
We made our duty Rota which we started using from the 2nd
week up to the last week,
after consultation with the in-charge and the various departmental heads.
We rotated in the major departments of Out-patient, In-patient, laboratory, immunization,
Maternity and the HIV/AIDS Clinic following a rota we had designed.
We generally participated in all the facility programmes but key to note here include:
OPD, IPD clerkship/ treatment, family health days, PMTCT follow up for pregnant and
lactating mothers and immunization outreach activities.
Our outreaches targeted the Villages of Guda in Pobura Parish, Lubiri-wigweng in Pobura
parish, Malech in Kal Parish, Central in Kal parish and Kalala in Kal parish. Out-reaches
done on Sabbath days were done in collaboration with UNICEF and are named Family
Health Days (targeting people from churches and mosques).

12. Generally the health Centre carries out the following;
o General in-patient and out-patient care
o Voluntary counseling and testing for HIV
o HIV/AIDS care and treatment for children, adolescents, and Adults including
ART, septrine prophylaxis, Post Exposure Prophylaxis, etc.
o Prevention of mother to child transmission of HIV.
o Maternal child health services (ANC deliveries, PNC family planning services)
o Immunization
o Laboratory services
o Therapeutic and supplementary feeding services
o Minor surgical procedures including safe male circumcision
o Health education
o Participated in generating, recording and updating data in appropriate HMIS
registers in the health facility
Some of the out-reach activities done include.
o Immunization
o School health programs
o Home visits including follow-up of TB patients
o VCT, HIV/AIDS and support including ART
o Supplementary feeding
o Support supervision of lower level health facilities and supervision of VHTs.
o Measuring of MUAC to access for malnutrition

13. Common conditions (According to the hospital records and observation)
The top ten disease conditions in the HSD are:-
1- RTI (Upper)
2- Acute diarrhea
3- Skin conditions
4- Pneumonia
5- Intestinal worms
6- Malaria
7- Dysentery
8- Oral conditions
9- Epilepsy
10- Trauma and other miscellaneous conditions
Rare conditions
1. Tetanus.
2. Nodding syndrome.
3. Snake bites etc.

14. ACHIEVEMENTS (OUTPUT)
Out-patient department
MONTH MALE FEMALE BELOW 5
YEARS
TOTAL
April 281 544 297 1122
May 211 328 235 774
 Conducted health talks on the management of common conditions like use of
ORS in treatment of acute diarrhea, use of mosquito nets.
 Educated pregnant mothers on the benefits of early enrolment for antenatal care
and problems of late attendances
 Clerking of patients, carrying out minor surgical procedures like STS, I&D,
injections, wound dressing
In- patient Department:
April 2013
ITEM NUMBER
ADMISSIONS 99
REFERRALS 10
DEATHS 0

15. May 2013
ITEM NUMBER
ADMISSIONS 80
REFERRALS 07
DEATHS 0
HIV/AIDS CLINIC report (2012)
Number of clients newly enrolled on ART 30
Number of clients who come for septrine refill 640
Number of clients who come for ART refill 261
Number of infants attending EID 57
Number of infants newly enrolled for EID 12
Number of infants transferred from EID to chronic care 3
The HIV/AIDS clinic works separately from the health facility but under the same
management.
Patients tested and proven to be HIV positive are counseled and eligibility for HAART
treatment done by the staff. Some of the measures used are CD4+ counting with machine
provided by the government.
We were each on the A-clinic for about 5 days and did HIV/AIDS counseling and testing
plus administration of drugs.

16. MATERNITY
ANC and Maternity Reports as for march 2013
a) HIV counseling and testing:
HIV counseling and testing of new
clients
160
Number of pregnant women
counseled, tested and received HIV
test
Total: 150
CTRR: 07
Number of women who knew their
HIV serostatus before 1st
ANC visit. WHO: 05
b) HAART administration during pregnancy:
Number of mothers given AZT +
sdNVP for PMTCT in ANC
05
Number of mothers given AZT/3TC +
sdNVP in PMTCT in ANC
00
Number of mothers receiving full
HAART
02

17. c) Labour and Intensive care:
Total number of deliveries Total: 22
CTRR: 5
Number of women( new clients ) tested during
labour and delivery
00
Number of clients who received AZT/3TC and
swallowed NEV during labour.
04
Number of clients who swallowed NVP only
during labour
03
Number of clients who initiated EBF within 1hr
of delivery
07
Number of given NVP suspension at birth 05
d) Post natal care for mothers:
Number of women tested and received results
during PNC( new clients)
00
Number of women tested HIV positive during ANC 00
Total number of women who received any method
of Family planning post-partum
26
Number of HIV positive women who received
Family Planning post-partum.
04

18. Family planning for the month of March;
METHOD NUMBER
COCs 07
Depo provera 50
Copper T 04
Condoms 11
Implanol 08
Total 80
We conducted normal deliveries in the supervision of nursing officers/mid wife, managed
common cases like abortions, Malaria in pregnancy, neonatal septicemia, Anemia in
pregnancy, carried out immunization of neonates.
Family planning techniques like implants, IUD‟s, Depo provera injection, contraceptive
pills and male condoms.
We delivered health talks on PMTCT, feeding, malaria prevention. We also vaccinated
the mothers against tetanus, examined the mothers. Also distributed folic acid, malaria
prophylaxis
NB: The above data results are estimates from observation and patient records, and
should not be used as references.

19. IMMUNISATION
BCG 28
OPV 60
DPT+HepB+Hib 50
Measles 23
Tetanus 27
Vitamin A 37
Deworming 23
NUTRITION
In-patients Therapeutic Care
New admission from 19th
April to 15th
May 2013……………………………….….3
Outpatient therapeutic care
Clients under care of OTC from 29th
April to 15th
May 2013 .......………………….10
THEATRE
Major procedures: None
Minor procedures:
o Debridement and wound care …..……………………… 03
o Incision and Drainage ………………………………..… 04
o Medical male circumcision …………………………..… 00
o Total ……………………………………………………. 07
NB: The above data results are estimates from observation and patient records, and
should not be used as references.

20. ROTATION AT THE HEALTH UNIT
We rotated in the different departments for easy work and maximum achievements and
switched after two weeks as follows:
Weeks 1 and 2 OPD, IPD and ANC Clinic Maternity
Weeks 3 and 4 AIDS Clinic, IN-PATIENT and Theatre
Other activities for example emergencies, ward-rounds, out-reaches, maternity care and
environmental activities were randomly done.
Note: We could however freely rotate in any department at any time.

21. Organization of clinical work at the facility
Duration
(weeks)
Activities Objectives Achievements Hindrances Supervisors
1 Briefing and
orientation at the unit.
Starting clerkship at
the unit.
Integration into
the system
Managing and
monitoring of
patients
Well oriented,
and integrated
into the unit
None Ms. Acayo
Edinah
(In-Charge)
2 Collect data on social
demographic issues.
Give health education
to mothers about care
for children on ward
and at OPD on how to
prevent common
diseases
Clerkship and start
community out
reaches
Data was
attained Health
talks at OPD,
ANC, and on
ward were
given.
Well done No outreach
due to fuel
Site supervisors

22. 3 Make community
visits
Active participation
in ANC
Determine
utilization of
F/P and MCH
services at the
unit
We had an
outreach to
Lawiye Dul
P/S
Family Health
days with
UNICEF
Walking
6Km to and
fro to give
services
Mr. Bongomin
Ms. Sharlon
and Ms. Miriam
4 Immunisation,
HIV/AIDS
Counselling and
Testing
To acquire
necessary
skills.
Well done None Ms. Pasca
Note:
Any free time was used to collect research done on “Determinants of ANC utilisation
by pregnant mothers at COBERS sites Northern Uganda”
„Family Health Days‟ every Sunday were done at churches targeting people who have
come to attend Sunday services. This is a program going on all health centres under
support from UNICEF.
Services offered include: Immunisation, vaccination, health talks, family planning and
deworming and assessment for malnutrition. Three of these out-reaches were done under
supervision.

23. OUTREACH PROGRAM
School Health
We carried out an outreach to Lawiye-Dul Primary School and Kwon-Choc P/S where we
offer free HIV/AIDS counseling and deworming
We conducted a health talk on relevance of Tetanus Toxoid (TT) vaccination to a group of
about 30 girls from this school after seeking permission from the school authorities.
Common diseases found among the students (from health Centre records) were Malaria,
Upper Respiratory Tract Infections, skin fungal infections (ring worms) diarrheal diseases
etc.
According to our findings, students at Lawiye-Dul school have access to safe drinking
water from a borehole but poor sanitation around the school compound.
Health promoting activities in the Community
We delivered health talks in Malec, Guda and Lubiri villages in Kal parish on
environmental health, After doing a survey together with the VHT‟s and community
leaders in the villages with special interest in the number of households with pit latrines,
number of households with mosquito nets, bushes around homes, hand washing practices
.In the event, we briefed them on the findings of the survey.
Thereafter we went on to sensitize them on the importance of using mosquito nets,
drinking safe and clean water, and use of pit latrines. The session was interactive as we
got their views, of which some were right and others we had to correct.

24. In summary the following activities were conducted;
 Sensitization on diarrheal diseases
 Demonstration on appropriate hand washing, making tippy taps and latrine covers
using cheap and locally available materials.
 Finding out and sensitization on prevention of common diseases
 Latrine coverage
Results of the survey in Guda and Lubiri villages
Village Popula
tion
No of
Households
Latrine
use
Latrines
under
constructions
Bathing
shelter
Drying
rack
Refuse
pit
Hand
washing
Safe
water
source
Lubiri 250 57 23 9 20 25 08 12 02
Guda 165 36 27 5 07 10 04 09 01
Community Diagnosis
From the results of the survey in the table above, Lubiri had poor latrine coverage (57
households having 23 latrines). Refuse pits were also few implying that there is poor
disposal of wastes. All the above were attributed to overcrowding hence shortage of
space. The level of hand washing was low for both Lubiri and Guda possibly because of
lack of a safe water source as indicated in the table above.
The common conditions found were diarrheal diseases in children, respiratory tract
infections, fungal skin infections and reproductive tract infections in women like Vaginal
Candidiasis.

25. RECOMMENDATIONS
o It was suggested that the sub county should allocate some land for construction of
pit latrines and digging pits for proper waste disposal in Lubiri.
o There was need to repair broken down boreholes and construction of protected
wells and bore holes.
o There was also need to sensitize the community on routine hand washing
practices.
o In order to curb the common conditions, the community was advised to take every
disease condition experienced to the health centre in time and adhere to the
treatment.
CHALLENGES MET DURING THIS COMMUNITY CLERKSHIP
University
 Lack of funding and inadequate supervision by the Lecturers.
 Poor accommodation at the Centre.
Health Centre
 Untimely request for drugs and delay in delivery of drugs.
 Understaffing leading to work overload.
 Inability to conduct outreaches in distant communities due to shortage of means
and fuel.
 Language barrier that necessitated an assistant to translate most times

26. WAY FORWARD
The health Centre management should consider timely request for drugs and more
staffing from the Government.
CONCLUSION
Community clerkship/ placement provide a great opportunity for medical students to
discover what happens beyond the class and town life. We had a wonderful time and
interaction with the patients at Madi Opei HC IV which helped us see other determinants
of ill-health other than the biology (that is poverty or the socio-economic life of a
patient).
Reviewed and corrected by: Mr. Bongomin Richard (Health Inspector Madi Opei HC
IV)
“FOR COMUNITY TRANSFORMATION”
Cc. Own copy
Cc. Department of Public health Gulu University
Cc. Madi Opei Health Centre
Cc. Sub-County Chief Madi Opei