Kazakhstan: Stepping up the knowledge of IMCI hospital care
WHO/Malin Bring
A course on how to use the hospital-based Integrated Management of Childhood Illnesses (IMCI) approaches in her work at a children’s hospital has given paediatrician Sholpan Zhumativa improved skills and a new attitude towards her patients.
“Giving warmth and affection to sick children is one of the most valuable parts of IMCI to me”, she says.
The 37-year old paediatrician meets us over a cup of coffee at the IMCI-centre of the Regional Children’s Hospital in Chimkent, Kazakhstan. Next door a group of lively midwives and nurses are practicing the correct position for breastfeeding on a life size baby doll, and in an adjacent room a staff member is arranging brightly coloured plastic cups and plates on a shelf, demonstrating how simple kitchenware can serve as toys. Apart from giving courses on IMCI, the centre advices parents on how to care for and stimulate their children at home, for instance by using inexpensive household utensils as toys.
Taking a quick sip from her cup, Sholpan Zhumativa tells us she is in fact no newcomer to IMCI. Besides working as a paediatrician here at the hospital, she sometimes functions as a trainer at the centre, facilitating courses on IMCI at primary health care level. A few weeks ago, she intensified her knowledge by taking a five days’ training course on how to implement IMCI paediatric hospital care. The training was organized by WHO/Europe, as part of a joint two-year project with the EU, to improve maternal and child health in Kazakhstan.
“Even though I already knew the basics, I was impressed with how useful the information was,” she says.
The five days of training were packed with presentations, videos, clinical cases and practical sessions on how to provide proper assessment, timely and qualified help, and treat patients according to evidence based best practices. Throughout the course the participants discussed and compared their own practices with the IMCI guidelines, often recognizing cases of “over-classification” and excessive prescription of medicines in their respective hospitals. Changing one’s professional attitude towards a more child-friendly and considerate approach was another element of the course, tying in with the recommendations not to make any unnecessary medical interferences to one’s patients.
“I think this is one of the most important aspects of IMCI – to try to give the best conditions and affection to children.”
She appreciates the Pocket book of Hospital Care for Children that was handed out to the participants at the course, which presents up-to-date clinical guidelines adapted to the country’s needs. A pocket-sized manual published by WHO, it focuses on the major causes of childhood mortality and their treatments, in accordance with the guidelines of IMCI.
Learning that it was acceptable for her to consult this manual, or any other reference book, in front of a patient, was something of a revelation to her.
“One thing that was instilled in us during the Soviet times was that we must not lose face with a patient”, says Sholpan Zhumativa.
“Asking a colleague’s opinion or consulting a reference book about something we were not sure of was absolutely unacceptable. After this course, though, I feel free to check with the Pocketbook when I’m in doubt about a prescription or symptom. I’m comfortable with sharing both my knowledge and uncertainties with colleagues.”
Reducing the number of medical procedures and prescriptions is not always appreciated by her patients’ parents, however, Sholpan Zhumativa has found. After the many years of overmedicalization inherent to the Soviet system, some parents feel their children are not getting the right treatment if they are not given several tests and long lists of medicines.
“I’ve had cases where mothers have complained because all I gave them was advice on home care and no pills. Others have thought that I was trying to extort money from them when I refrained from giving their child an injection.”
At any rate, this kind of reaction is understandable and will phase out with time, she feels.
In 2008 the Ministry of Health adopted IMCI as an integrated national strategy, and the two-year project to improve child and maternal health in Kazakhstan, embarked upon by the EU and WHO/Europe, will most certainly contribute to the process of institutionalizing and integrating these approaches into primary and secondary care.
While Sholpan Zhumativa has been talking, her remaining coffee has grown cold. She pushes the cup aside and says it is time for her to go back to her ward.
“After the five days of training in IMCI, I was eager to get back to work and start practicing the new approach. It takes time, and we need to develop new skills to do it, but gradually we will get there”, she says.
“Giving warmth and affection to sick children is one of the most valuable parts of IMCI to me”, she says.
The 37-year old paediatrician meets us over a cup of coffee at the IMCI-centre of the Regional Children’s Hospital in Chimkent, Kazakhstan. Next door a group of lively midwives and nurses are practicing the correct position for breastfeeding on a life size baby doll, and in an adjacent room a staff member is arranging brightly coloured plastic cups and plates on a shelf, demonstrating how simple kitchenware can serve as toys. Apart from giving courses on IMCI, the centre advices parents on how to care for and stimulate their children at home, for instance by using inexpensive household utensils as toys.
Taking a quick sip from her cup, Sholpan Zhumativa tells us she is in fact no newcomer to IMCI. Besides working as a paediatrician here at the hospital, she sometimes functions as a trainer at the centre, facilitating courses on IMCI at primary health care level. A few weeks ago, she intensified her knowledge by taking a five days’ training course on how to implement IMCI paediatric hospital care. The training was organized by WHO/Europe, as part of a joint two-year project with the EU, to improve maternal and child health in Kazakhstan.
“Even though I already knew the basics, I was impressed with how useful the information was,” she says.
The five days of training were packed with presentations, videos, clinical cases and practical sessions on how to provide proper assessment, timely and qualified help, and treat patients according to evidence based best practices. Throughout the course the participants discussed and compared their own practices with the IMCI guidelines, often recognizing cases of “over-classification” and excessive prescription of medicines in their respective hospitals. Changing one’s professional attitude towards a more child-friendly and considerate approach was another element of the course, tying in with the recommendations not to make any unnecessary medical interferences to one’s patients.
“I think this is one of the most important aspects of IMCI – to try to give the best conditions and affection to children.”
She appreciates the Pocket book of Hospital Care for Children that was handed out to the participants at the course, which presents up-to-date clinical guidelines adapted to the country’s needs. A pocket-sized manual published by WHO, it focuses on the major causes of childhood mortality and their treatments, in accordance with the guidelines of IMCI.
Learning that it was acceptable for her to consult this manual, or any other reference book, in front of a patient, was something of a revelation to her.
“One thing that was instilled in us during the Soviet times was that we must not lose face with a patient”, says Sholpan Zhumativa.
“Asking a colleague’s opinion or consulting a reference book about something we were not sure of was absolutely unacceptable. After this course, though, I feel free to check with the Pocketbook when I’m in doubt about a prescription or symptom. I’m comfortable with sharing both my knowledge and uncertainties with colleagues.”
Reducing the number of medical procedures and prescriptions is not always appreciated by her patients’ parents, however, Sholpan Zhumativa has found. After the many years of overmedicalization inherent to the Soviet system, some parents feel their children are not getting the right treatment if they are not given several tests and long lists of medicines.
“I’ve had cases where mothers have complained because all I gave them was advice on home care and no pills. Others have thought that I was trying to extort money from them when I refrained from giving their child an injection.”
At any rate, this kind of reaction is understandable and will phase out with time, she feels.
In 2008 the Ministry of Health adopted IMCI as an integrated national strategy, and the two-year project to improve child and maternal health in Kazakhstan, embarked upon by the EU and WHO/Europe, will most certainly contribute to the process of institutionalizing and integrating these approaches into primary and secondary care.
While Sholpan Zhumativa has been talking, her remaining coffee has grown cold. She pushes the cup aside and says it is time for her to go back to her ward.
“After the five days of training in IMCI, I was eager to get back to work and start practicing the new approach. It takes time, and we need to develop new skills to do it, but gradually we will get there”, she says.
