E-DRUG: PRDU and Case Management Protocols
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Dear E-drug Users,
The purpose of this communication is to present some
thoughts on drawing case management protocols.
As far as developing practical guidelines for health
workers is concerned, the Integrated Management of
Childhood Illness (IMCI); Sexually Transmitted
Infections / Diseases (STIs/STDs); Tuberculosis
Control; Reproductive Health; and now HIV/AIDS
Programmes, have registered excellent progress.
Most of these guidelines, however, are tailored for
clinicians working at lower level clinics. In
addition, the guidelines leave out a major category of
healthcare providers, who are probably seeing more
patients than the health workers at hospital / clinic
level. The healthcare providers left out are the drug
shop operators, as well as trained pharmacy personnel
in the private sector for profit. Although these
providers need the clinical skills, the approach must
not be the same as that for health professionals in a
hospital/clinic setting. It must be different because
the environment in which they work differs from that
of a typical hospital or clinic, on many fronts�
The other issue I want to raise is about the practical
relevance of clinical guidelines for diseases other
than those covered in the IMCI; STI/STD; HIV/AIDS
programmes�such as: Typhoid fever; brucellosis;
urinary tract infections, especially in adults. These
problems make a number of health workers to perform
what we call, �blind treatment.�� This kind of
empirical treatment is expensive both in terms of time
and money�as well as in terms of unnecessary exposure
to chemicals, and is one of the irrefutable reasons
for justifying use of several medications for treating
a syndrome.
Most guidelines I have come across in my country that
seek to address management of conditions for which a
number of health workers administer blind treatment,
especially in adults, follow the typical format:
Disease; signs, and symptoms; differentials;
investigations; and management (Traditional Approach).
Yet the reality is that patients present with
specific problems�signaling a range of
disorders�through which health workers work, with or
without equitable facilities for investigations. And
some times, like in the private sector, clients may be
willing to pay for relevant investigations.
Although the approach I have dubbed Traditional
Approach is good for students in their initial stages
of study, it isn�t at a latter stage�and also as
apparent, for a practitioner.
Before concluding, here is a second last remark. The
text, Medicine in the Tropics, Diagnostic Pathways in
Clinical Medicine, 2nd Edition, 1980; Author:
B.J.Essex, MBBS, MRCP, M.Sc, MRCGP; Primary Care
Physician Consultant; World Health Organization;
Publisher: Churchill Livingstone, Edinburgh London and
New York 1980; ISBN: 0-443-02059-0; Library of
Congress Catalog Card Number 79-41473, is worth
upgrading. A good goal for this would be to
incorporate current aspects of both absence and
presence of capacity to perform basic investigations.
Finally, in developing settings drug shop operators /
pharmacy staff see many children and men and women
before the disorders/infections advance. And there
seems to be no reason to object to the wonderful work
they do. So with other factors that influence
behavior aside, are we adequately equipping this level
of care?
George Kibumba, MPS.,
Teaching Assistant; Clinical Pharmacy; Dept of Pharmacy,
Makerere University, Kampala, Uganda
kibumba@yahoo.com
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