Family Medicine Lecture 2 PDF

LECTURE (2) Working with the community  Community is complex and most importantly meets the shared needs of a group of people.  Each residency ’ s community will have different needs and will change over time.  In some instances, community may be defined by geographic location, particularly i...

LECTURE (2) Working with the community  Community is complex and most importantly meets the shared needs of a group of people.  Each residency ’ s community will have different needs and will change over time.  In some instances, community may be defined by geographic location, particularly in a rural setting. In urban and suburban areas, a community may be defined by location, but also may be defined by specific characteristics such as patients living at less than 200% of the poverty level within certain zip codes, or immigrant persons living in a specific geographic area.  At times, the population and community may overlap, though they are not the same.  In medicine, we often discuss population health with panel medicine, but this is not always the community truly served by the residency program.  Drawing sketch maps for the catchments area including the mother village and the satellites  Enumeration of the houses, which is the first step for creation of the family folders  The family folders will identify every member in the community, the socio-economic and the housing conditions; thus providing baseline information for the community served.  The initial comprehensive medical check will define the health profile and identify main health problems in the community   Within the identified community you should know the following: ① Demographic features and population characteristics (the family folders will provide this information). ② Economic activities. ③ Social stratification and power relations (the leading families, and community leaders). ④ Organizations and their functions and activities  Community committees and community development organizations. ① Existing health or community development projects and activities and the involved organizations. ② Leadership pattern (formal and informal) and its influence. ③ Culture and traditions. ④ Education levels. ⑤ Environmental sanitation situation and problems. ⑥ Critical issues and problems.  There are several mechanisms through which the FHU could work with community. ① The FHU should build partnership with the community, ② Conduct needs assessment ③ Participatory planning to address specific health issues through concerted efforts that could be mainstreamed in the District/FHU plans.  The existing mechanism is the community representation in the Board of FHU.  A potential mechanism is the Community Health Committee. In addition to specially arranged public meetings to discuss specific issues.  The FHU Board include two members from the community.  Criteria for selection of these members should be: ① They should be genuine members from the community, living in the community for at least 10 years. ② Have good relations and communication with different groups in the community. ③ Enthusiastic, dedicated and willing to actively participate in board activities. ④ Have an acceptable standard of education to be able to contribute.  May be existing, or needs to be created.  The creation of an CHC will help to: ① Add authority to community work which often lacks a constituency; ② Serve as a link between the community and the health facility, and between the community and the district ③ Capture the synergism possible through concerted government and community group action ④ Build broad commitment and support for the overall health issues in the community ⑤ Ensures continuity of work ⑥ Provide a mechanism to facilitate development of new and innovative solutions to identified needs and problems, as well as create partnerships within the community ① The chief executive of the local village council ② The chairman of the local elected council ③ Two representatives from active NGOs (rotated every year to secure wide representation) ④ Two natural community leaders (rotated every year to secure wide representation) ⑤ FHU director, physicians, head nurse, and a representative for Raedat (rotated every year to secure wide representation) ⑥ The social worker ⑦ A representative for women (rotated every year to secure wide representation) ⑧ A representative from the youth club (rotated every year to secure wide representation)  This is an initial step in implementing the Family Health Model and bringing the community and the FHU in close contact.  In rural areas:  Enumerate the houses in the mother village and satellites. A folder is then created for each family.  The comprehensive initial examination for all family members will bring all individuals in the community in close contact with the FHU team.  In urban areas:  Creation of family folders can follow almost the same lines in small towns with clear catchments areas, and in new housing compounds having a clear design, and the houses are well identified.  In big cities and over crowded areas:  It will be practically impossible to cover all houses/families in the surrounding.  Self selection may be appropriate approach.  This can be done through community mobilization efforts, working with other organizations who could provide family health care as NGOs, or who would market services of the FHU.  A practical approach would be that every client, from the catchments area, entering the unit for any reason (almost all would come for child vaccination) is identified as a candidate for the roster.  She is asked to consult with the family head and bring all family members to be registered and subjected to the initial clinical examination.  The nurse, or any other health care service representative entering the household is directed to the following basic principles: ① Greet the first person to see and every one else you meet in the household ② Introduce yourself by name and affiliation ③ Take sometime to be acquainted with the people in the room, notice how they relate to each other, who seems to be the leader? ④ always be friendly and polite, and establish rapport ⑤ Explain the purpose of your visit ⑥ Assure them that any information they give will be kept confidential ⑦ Apply good communication skills, specially if the purpose of the visit is health education