Kazakhstan: IMCI at work
Malin Bring
Carefully following the nurse’s instructions, five-year old Ruslan breathes into the spacer made from a large plastic bottle. His mother stands beside him, listening closely to the advice from the nurse.
This is a good example of IMCI at work, if you ask paediatrician Polina Slugina.
Little Ruslan holds the spacer filled with aerosol medication Salbutamol in front of his face with both hands, breathing deeply into the open-ended bottom of the bottle. The nurse helps him to support it, and monitors the time and correctness of the procedure. It will help the cough-ridden Ruslan to breathe more freely, and reduce the necessity to come back to the hospital for treatment, explains the nurse, showing his mother how she can repeat the procedure once they get back home, using a simple plastic bottle.
The scene is an outpatient paediatric ambulatory of the regional hospital of Osakarov in the Karaganda region, the work place of district paediatrician and IMCI advocate Polina Slugina.
IMCI stands for Integrated Management of Childhood Illnesses, and is a strategy developed by WHO and UNICEF, now in use in over 100 countries over the world.
“One of the many assets of the strategy is that it teaches us how to reduce the distance between doctor and patient”, says Polina Slugina.
“When I was at Medical school, they only taught us how to identify and conquer a disease, whereas very much in fact depends on how we communicate with parents and patients.”
The strategy is directed towards children below five years of age, and focuses on reducing the most common causes of death, disability and illness among children. It includes both preventive and curative elements, and focuses on improving the skills of health care staff as well as improving the health practices carried out by families and communities. As opposed to the more common single diagnosis method, IMCI is an integrated strategy that takes into account the variety of factors which can threaten the health of children, the logic being that children in countries with limited resources are often suffering from more than one condition at a time.
Kazakhstan was the first ex-Soviet country to introduce IMCI in 1999. The Karaganda region began implementing the strategy the year after, as one of two pioneering regions. Today, it has been carried out in five of Kazakhstan’s 14 regions, and around 15 – 20 percent of the country’s health care workers have been trained in in-service training. In 2008, the Ministry of Health decided to adopt IMCI as an integrated, nationwide policy.
The ongoing project “Support for Maternal and Child Health in Kazakhstan”, funded by the EU and supported technically by WHO/Europe, is taking the strategy one step further in three pilot regions, with focus on strengthening health system support and continuum of quality care from pregnancy to birth and childhood.
By now Ruslan has finished his breathing exercise. Waving goodbye to the nurse and the paediatrician, he leaves the hospital with a proud expression on his face, holding his mother by the hand.
Not all patients have been as co-operative as Ruslan and his mother, comments Polina Slugina.
“Many of my patients were astonished when I began involving them in my counselling. Often they would agree to whatever I said, and then just go home and do things the way they had always done them.”
Her solution to the problem was to turn her attention to the older generation.
“I realized I had to convince the grandmothers first, because they have a huge influence over the families. Once I made friends with a grandmother I knew the rest of the family would listen to what I had to say.”
Polina Slugina has had to do some persuading to convince a few of her colleagues about the benefits of IMCI as well. There are doctors who have no interest in stepping down from their high horses to explain complicated matters in simple language to their patients, she feels.
“Because of the excellent trainers I had in IMCI, I came to understand that its apparent simplicity is only the exterior; inside there are hundreds of years of knowledge. A medical person needs to have proficient knowledge and a large soul to explain things simply.”
This is a good example of IMCI at work, if you ask paediatrician Polina Slugina.
Little Ruslan holds the spacer filled with aerosol medication Salbutamol in front of his face with both hands, breathing deeply into the open-ended bottom of the bottle. The nurse helps him to support it, and monitors the time and correctness of the procedure. It will help the cough-ridden Ruslan to breathe more freely, and reduce the necessity to come back to the hospital for treatment, explains the nurse, showing his mother how she can repeat the procedure once they get back home, using a simple plastic bottle.
The scene is an outpatient paediatric ambulatory of the regional hospital of Osakarov in the Karaganda region, the work place of district paediatrician and IMCI advocate Polina Slugina.
IMCI stands for Integrated Management of Childhood Illnesses, and is a strategy developed by WHO and UNICEF, now in use in over 100 countries over the world.
“One of the many assets of the strategy is that it teaches us how to reduce the distance between doctor and patient”, says Polina Slugina.
“When I was at Medical school, they only taught us how to identify and conquer a disease, whereas very much in fact depends on how we communicate with parents and patients.”
The strategy is directed towards children below five years of age, and focuses on reducing the most common causes of death, disability and illness among children. It includes both preventive and curative elements, and focuses on improving the skills of health care staff as well as improving the health practices carried out by families and communities. As opposed to the more common single diagnosis method, IMCI is an integrated strategy that takes into account the variety of factors which can threaten the health of children, the logic being that children in countries with limited resources are often suffering from more than one condition at a time.
Kazakhstan was the first ex-Soviet country to introduce IMCI in 1999. The Karaganda region began implementing the strategy the year after, as one of two pioneering regions. Today, it has been carried out in five of Kazakhstan’s 14 regions, and around 15 – 20 percent of the country’s health care workers have been trained in in-service training. In 2008, the Ministry of Health decided to adopt IMCI as an integrated, nationwide policy.
The ongoing project “Support for Maternal and Child Health in Kazakhstan”, funded by the EU and supported technically by WHO/Europe, is taking the strategy one step further in three pilot regions, with focus on strengthening health system support and continuum of quality care from pregnancy to birth and childhood.
By now Ruslan has finished his breathing exercise. Waving goodbye to the nurse and the paediatrician, he leaves the hospital with a proud expression on his face, holding his mother by the hand.
Not all patients have been as co-operative as Ruslan and his mother, comments Polina Slugina.
“Many of my patients were astonished when I began involving them in my counselling. Often they would agree to whatever I said, and then just go home and do things the way they had always done them.”
Her solution to the problem was to turn her attention to the older generation.
“I realized I had to convince the grandmothers first, because they have a huge influence over the families. Once I made friends with a grandmother I knew the rest of the family would listen to what I had to say.”
Polina Slugina has had to do some persuading to convince a few of her colleagues about the benefits of IMCI as well. There are doctors who have no interest in stepping down from their high horses to explain complicated matters in simple language to their patients, she feels.
“Because of the excellent trainers I had in IMCI, I came to understand that its apparent simplicity is only the exterior; inside there are hundreds of years of knowledge. A medical person needs to have proficient knowledge and a large soul to explain things simply.”
