Front line health workers (3)
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Source: ahila-net@who.ch
Meeting the information needs of front line health workers - or what
kind of information, and how much is it used?
I'm very glad Robert Kakembo has produced such an expansive response
to my query some weeks ago about 'front line health workers' and
their information needs and that he has aired it on AHILANet. The
problem of information under-and non-use has perhaps far greater sig-
nificance than we have realised so far.
It's a problem which we have avoided facing up to for too long. The
use of appropriate information and of scientific evidence is at the
heart of good medical and clinical practice. We hope that by airing
here what is a strange and unexpected difficulty in information de-
livery for front line health professionals in particular, we may get
some open and positive input that could show the way to some solu-
tions.
UNDER-USE OF INFORMATION
Like Robert, we've had feedback in recent years from a range of
health professionals of different ages and backgrounds here, about
the lack of uptake of information by health professionals, doctors in
particular, at district level and above. Our own experience is that
the number of requests coming from the provincial and district cen-
tres to our library, never very high, has declined somewhat in recent
years. Is the need for information less or are there other factors
to consider? We have heard that young inexperienced personnel have
as much or even greater need for direct contact with visiting con-
sultants and/or other committed experts if information is to be ef-
fectively communicated and taken up.
OBSTACLES TO INFORMATION USE?
The reasons suggested to us by a range of doctors here for the under-
use of information are surprisingly consistent. They relate to:
1. a lack of time and energy to find the right information - owing to
overwork and excessive commitments;
2. a lack of motivation attributable to non-availability of appropri-
ate information sources;
3. a lack of motivation attributable to poor working conditions and
poor financial rewards (as evidenced by recent lengthy strikes
here and in other countries of the region);
4. the unwillingness of some young doctors to be perceived by pa-
tients (and perhaps even colleagues?) to need information for pa-
tient care: on the assumption that patients expect qualified doc-
tors to know all they need to know, and/or that they will lose
face/prestige by looking up information in front of patients;
5. the nature of the medical curriculum, which overwhelms students
with the whole huge and ever-growing range of medical knowledge,
and yet does not train them how, selectively, to find, evaluate
and apply it (except perhaps in problem based learning curricula);
6. the failure of some teachers to instil in their students not only
the spirit of curiosity necessary for learning, but also a sense
of their obligation as clinicians to continue throughout their
working lives to inform and update themselves as far as possible,
in the interests of best practice.
CONTINUING MEDICAL EDUCATION (CME)
Most countries now recognise that continuing medical education is es-
sential; facilities for CME are increasingly available in the North,
as are the means of ensuring, on an annual basis, that practitioners
take advantage of them.
We hope to look into some of these issues here, together with members
of our teaching staff, to see how we can help promote CME.
PUBLICATIONS FROM THE CME PROGRAMME AT MAKERERE'S DEPT OF SURGERY
To refer briefly to Robert Kakembo's remarks on the material provided
by the Continuing Medical Education programme of the Dept of Surgery
in Makerere's Faculty of Medicine:- I referred in my request for in-
put for GK97 to some examples we have here of the CME papers and
leaflets given as handouts to accompany skills updating workshops at
district hospitals in Uganda. These consist mainly of very basic "how
do I do it" therapeutic guidelines, using plain language and very
simple diagrams, on such common problems as management of snake bite,
of hand sepsis, of pain in AIDS, or on the use of antibiotics, provi-
sion of safe water to hospitals etc. These are not at all academic or
research-oriented, but are practical primers for clinical workers who
are unable to access this specific and practical information from
books or manuals.
PERSONAL FILES
Our hope is that if this type and level of information were readily
available in the form of sheets, papers, leaflets or posters etc,
health workers could maintain and update their **own personal files**
of simple instructional material, protocols, clincial or management
guidelines, updates on drug regimens, essential drugs etc.
THE PURPOSE OF MEDLINE ABSTRACTS
On the free digest of abstracts from MEDLINE which we produce quar-
terly for Zimbabwe's health professionals (Current health information
Zimbabwe - CHIZ) - this is not intended at all as "how to do it" ma-
terial. CHIZ is intended only to enable distant health workers who
don't see current medical journals to know what developments are tak-
ing place, both in local health issues, and in the fields of main-
stream international medicine as well.
Over the years we've received dozens of letters of appreciation for
this updating service, and we receive a steady trickle of requests
from nurses, doctors, pharmacists, environmental health technicians
and others to be put on our mailing list. We realise that summaries
of more directly and locally relevant unpublished material would also
be greatly valued, but we lack the staff - the manpower with the
skills and the time to identify, select and summarise such local
sources. We do have a database of that material in the library, with
full text documents available.
We very much need and would greatly value any comments, experiences,
advice from information or health professionals on the problems of
information uptake, distribution, and sustainability; and on the
kinds of material that would be good for 'frontline health workers'
personal files.
Helga Patrikios
Deputy University Librarian, Medical Librarian
University of Zimbabwe
P.O. Box M.P. 45, Mount Pleasant
Harare, Zimbabwe
Tel: +263-4-791631
Fax: +263-4-795019
mailto:patrikios@healthnet.zw
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