Background
This report is to explain what I did and learned during my internship period in the 23 July policlinic. The report is also a requirement for the Master Study Program Health and Society: International Gender Studies at the Charite Universitätsmedizin Berlin; in which the participants had to undertake 4 weeks long internship to fulfil the Master Program requirement. The following report was prepared for an internship carried out at the primary health care department with in the 23 July policlinic at Benghazi-Libya.
The 23 July Policlinic
The policlinics in Libya perform a key role in maintaining health in Libya's population. Anyone in Libya can use the policlinics. It serves the Libyan people free of charge. There are 39 policlinics in Libya, with the capacity of handling approximately 50.000 to 60.000 patients. They are out-patient clinic for all medical specialties staffed by specialty physicians in most areas of medicine.
The 23 July policlinic is located at Benghazi Al Jadeda area at Benghazi-Libya, located between 2 ring Streets (3rd and 4th ring Streets) and service relatively a new district in southern Benghazi. Opening hours are from 8 am to 3:30 pm, six days a week. This polyclinic has a variety of different healthcare services staffed by specialized physicians and excellent nursing staff. It comprises different departments, namely, primary health care department which includes (gynecology, pediatrics), dental department, internal medicine department, ophthalmology department, first aid department (open 24 hours), surgical department and pharmacy. The dental department provides diagnosis, extraction, scaling and radiological services. The medicine department provides chronic disease management like hypertension and diabetes, ophthalmology department provides ophthalmological disorders management, surgical department provides minor surgeries held under local anesthesia and also follow-up of patients discharged from the surgical words in hospitals. Primary health care department which undertakes a major part of the polyclinic services and provides counseling, family planning to prevent unwanted pregnancies, contraceptive prescription, management of gynecological disorders, antenatal and postnatal care, immunization, management of common childhood illnesses and growth monitoring for the babies. First aid department provides first aid services, treatment of wounds and simple trauma, referral to the hospitals in case of acute illnesses and major trauma. Outpatient pharmacy provides the medication for the Libyan people free of charge. The typical patient visit flow is started by registering at the demand department and take a number by turn, see the doctor, go to laboratory or X-ray (if required), see doctor then drop prescription at the pharmacy and take the medication or refer for the hospital.
The Objective of the Internship
This internship period was basically designed to get familiar with field work aspect of public health focusing on reproductive, maternal, natal, postnatal health and immunization as a part of Libyan primary health care program.
Libyan Primary Health Care Strategy.
The national health strategy aims at providing health for all and the achievement of high quality and uniform distribution of health services among the people. Basic health care has been given a high priority by creating the Department of Primary Health Care at the central level as well as at the provincial levels among the 31 municipalities (mainly in the Policlinics). The national health plan is formulated in steps. Before the changes of March, 2000, health plans were studied by the Health Secretariat as well as by the Popular Health Committees in the municipalities.
The main pillars which support primary health care are:
Health Decree No. 24 in 1994 was formulated to restructure primary health care within the redesigned national health strategy that endorsed again the global elements of primary health care but also included mental health, school health, occupational health and social and health care of the elderly. Moreover, the decree promised to integrate health development with overall socioeconomic development and to streamline the entry to health care through family practice. The Libyan Arab Red Crescent Society collaborates by providing health care and diagnostic centres. Community health services and endemic disease control departments generally deliver primary health care in the Libyan Jamahiriya. The running and funding of health care services has been mainly from the public sector. Health expenditure on primary health care is estimated to be 40% of the total health budget allocated to the municipalities.
Description of Activities during the Internship
My internship in The 23 July policlinic started at 02.04.2009 after arrangement with the clinic director and that was not difficult actually as I am still employed as dentist in ministry of health and environment in Benghazi-Libya, at my first day I went in a visit with the clinic director in almost all of the departments and then to the primary health care department where I was introduced to the medical and nursing staff, whom easily accepted me as an intern even for all the internship period . And thanks to this friendly acceptance.
During the opening hours which are from 8 am to 3:30 pm 6 days a week (Friday is a holiday), the department of primary health care is managed through one gynecologist which is usually a female doctor, one pediatrician and four nurses, one of the nurses is responsible for patients registering and office work. Patients are pregnant women, mothers with children, women suffering a gynecological problems, baby and child immunization and women seeking counseling and family planning. The number of the patients daily allowance is between 25 to 30 patients include appointments.
I found myself interesting in immunization program as a part of national plan under supervision of WHO and also in family planning and counseling.
The immunization program started in most of the cases in the hospital at the day of birth which is B.C.G, O.P.V and Hep. B.V, after that are the rest of the vaccination done in the primary health care units in the policlinics from age of 2 months to age of 15 years as follows: At age of 2 months ( Hep. B V, D.P.T, Hib, O.P.V) and the same vaccinations at the age of 4 months and 6 months. At age of 12 months (M.M.R). At age of 18 months (D.P.T, M.M.R, O.P.V). At age of 6 years (D.T, O.P.V, A.C.Y.W135). At age of 12 years (O.P.V), At age 15 (T.d).
The internship was an amazing chance to discoverer people awareness toward immunization and the reason for that maybe the free of charge services or immunization campaign includes media, posters and flyers. I asked personally many mothers about the immunization and I found that many of them do not know any information about the vaccination and their types but they knew that was a good thing for their children must do.
When a mother with a baby visited the department for a first time (at age of 2 months) will get a immunization card which approved from WHO and after general medical examination and measurement of child weight and height to be sure if the child healthy and grows normally then he or she will prepared to get the vaccine doses and the mother will be instructed to observe her baby closely for any complication like fever and allergies and to bring her baby back if his situation get worse. By simple fever the mother was instructed to give Paracetamol suppository. Which is available free of charge in the Policlinic pharmacy. After completion of the vaccination procedure the pediatrician will fill down the immunization card and he will inform the mother about the next appointment.
During my presence in the Primary health care department and especially with the gynecologist (mother and child care) I got more practical experience beside my theoretical knowledge about the different family planning methods which are possible in our Libyan culture. All of the women attending the mother and child care unit were married women and I noticed that the desire to control conception is arising out of the recognition of the increasing "costs" in terms of time and energy which children demand for their overall optimum development and upbringing. Currently, women are working outside their homes and finding it more and more difficult to handle the domestic responsibilities of a large number of children.
The majority of the women use oral contraceptives (OCs) as it's the most simple method but without any awareness of their side effects, some women use Intrauterine devices (IUD) and as the gynecologist told me the rate of IUD acceptance has been increasing with time, it was difficult for me to ask some of the women if their husbands use male condom or not and the answer was no in the most of the cases and that was not a surprise for me as there was no promotion for condom use and that may be because of the cultural and traditional restrictions.
Beside family planning and counseling many pregnant women attend the mother and child care unit to have regular check ups like clinical and Ultrasonic examinations, measurement of blood pressure, weight and blood investigations. Some of pregnant women which have serious problems were referred to the hospital (Al-Jamahiriya Maternity Hospital, Benghazi).
One of the activities of the primary health care department is school health services among the neighbour schools as we visited 2 schools ( primary and secondary schools) and our team was a mixture of 2 general practitioners, 2 nurses and our Bus driver, and we were supplied with sterile syringes, vaccination and some medications, our duty was to give all students at age of 6 and 12 years the required vaccination also to do a general inspection for the general health condition and registering of any suspected cases of endemic diseases.
