Marirangwe Rural Health Centre

P.O. Box 99
Beatrice
22 April 2016
The Lecturer
Masvingo Polytechnic
P.O. Box 800
Masvingo
RE: Report for Mandeya Canisios Tendai, of how the attachment equipped in
knowledge, skills, and attitudes in Anatomy and Physiology at Marirangwe Rural
Health Centre.
Please find an attached copy of the above mentioned details.
I thank you in advance.
Yours faithfully
Mandeya Canisios Tendai

It has been the writers pleasure, (Mandeya Canisios Tendai), a trainee EHT to
provide a report on how the attachment equipped in the knowledge, skills, and
attitudes in Human Anatomy and Physiology. The trainee has been deployed at
Marirangwe Rural Health Centre in Seke district Mashonaland East province.
Family Planning and the hormone contained
The trainee observed the health care worker (nurse) administering depo provera to
woman and noticed that it is administered intravenously on the shoulder. The
injectable contains a single hormone, progesterone, like the one produced in the
womans body. It prevents pregnancy. The nurse clarified that the injectable
prevents the female egg from ripening (prevents ovulation). It causes a thick mucus
to form at the mouth of the uterus (cervix) making it difficult for the male seed to
enter the uterus. It also causes changes in the lining of the uterus making it
unsuitable for the fertilized seed (egg) to settle there. The nurse emphasized that
the injectable last for three months. For learning purpose the writer asked the nurse
for any side effects of the injectable. The nurse said that if affects the menstrual
cycle, some may have frequent bleeding, others do not menstruate at all, some
woman experience weight gain, while a few have dizziness, joint pains and
headaches.
The Voluntary Medical Male Circumcision (VMMC)
The writer (trainee EHT) observed the procedure of the VMMC being done to a
twenty year old boy. The nurse carried out the procedure using a non-surgical
method whereby the skin that covers the head of male sexual organ (the foreskin)
was removed without using surgical instruments. The nurse placed the non-surgical
device which is the ring on the foreskin and spread chemicals right round. After
seven days, the foreskin dries up and the nurse safely removed it together with the
device.
The writer got knowledge about the benefits of VMMC as the nurse explained to the
boy. She included penile hygiene which would be easily maintained, reduction of the
wifes risk of cervical cancer, reduction of chances of getting HIV by 60 percent and
reduction in the risk of other STIs. The writer talked to the boys experience after
device placement and at removal, he experienced some pain, the nurse gave him
painkillers (paracetamol tablets.)

Pregnant woman
The writer (trainee EHT) saw many pregnant mothers who came to the clinic for
their antenatal care visits (ANC.) What was observed was that a pregnant womans
heaps widens, the stomach grow bigger, breast grow bigger. The nurse gave them
health education on the importance of regular visits and early maternity booking
whenever they visit the clinic. She included various blood tests such as HIV,
Syphilis, Full Blood Count to be done and the imports of the tests, to see if the
embryo grows, and correction of abnormalities. After some days of observations, the
nurse asked the writer to do the health education on the presents of EHT, sister in
charge and all other staff at the clinic. After conducting the health education, all the
staff recommended the writer as he was skilled.
The writer observed three deliveries in the clinic labour ward on different days of
which two were boys and a girl. It was in the eyes of the writer that during delivery
the head of the baby comes first followed by the rest of the body, the baby
immediately cry to show that it is live and it is its first breath, the midwife cut the
cord, wipe the baby with cotton wool, weigh the baby, then massage the stomach of
the mother and the placenta come out. The midwife inject the mother with oxytocin
injection for vaginal muscle contraction, and the baby vaccinated with BCG to
prevent Tuberculosis.
Snakebite
A ten year old girl came to the clinic with her mother to seek treatment after being
bitten by a snake on the leg. It was noted that her mother had applied traditional
medicine on the bitten position and slight bleeding was noted. The health care
worker gave her tetanus toxoid injection, pain killers, then clean the area with
saline, she was dressed with betadine. All the procedures were in the eyes of the
writer and asked some questions in order to be equipped. The health care worker
educated the mother on the first aid at home pertaining snake bite before visiting
the health facility. The first aid included washing liberally with water for fifteen
minutes if the venom has been in the eyes, application of a pressure bandage firmly
around the limb starting from the bite site and moving upwards. This allows blood
flow to the limb but prevents lymph return and absorption of poison. Splint the limp
to prevent movement that would increase absorption of poison. It is not allowed to

use traditional medication, to cut the wound, give electric shock to the wound and
to rub or massage the wound site.
HIV/AIDS
Marirangwe Rural Health Centre has HIV testing and ART services. The writer got
skilled after observing the health care worker doing, asking questions, reading
national guidelines, books, and charts. The writer got knowledge about HIV
progression which initially begin from the initial infection, window period, sero
conversion, HIV related illness then finally death to a person not at any drugs or
prophylaxis. Every client who test HIV positive at the clinic is staged according to
World Health Organization due to his/her present or past conditions. There are four
stages which are 1, 2, 3, and 4. Stage 1 is for those who are asymptomatic and they
may experience persistent generalized lymphadenopathy. Stage 2 is for those who
have skin conditions such as herpes zoster, angular chelitis, seborrheic dermatitis,
and fungal nail infections. Some may experience recurrent upper respiratory tract
infections (sinusitis, bronchitis otitis media, pharyngitis.) Those in stage 3 may
experience pulmonary tuberculosis, persistent oral candidiasis, borne or joint
infections, persistent fever, unexplained chronic diarrhea, unexplained anaemia,
severe presumed bacterial infections such as pneumonia, pyomyositis. Those in
stage 4 may experience kaposiss sarcoma (cancer), extra pulmonary tuberculosis,
criptococal meningitis, invasive cervical cancer, oesophageal thrush (candida in
trachea, bronchi or lungs.) The writer noticed some of these opportunistic infections
to some clients who came to clinic for the supply of their medication. The health
care worker said some clients experienced those infections and were treated and
healed.
Care of the skin of inpatients
A daily blanket bath should be carried out, and if the patient is incontinent of urine,
or perspires a lot, the bed linen must be changed, and the skin washed and dried
frequently, to prevent excoriation of the skin. Frequent turning of the patient, use of
sorbo pads, and careful positioning of limbs, should prevent pressure sores from
occurring. The use of an alternating pressure point mattress may be of value. When
attending to the patients needs, it is important to prevent abrasions or scratches of
his/her skin; thus watches and rings must not be worn by the health care worker.

Nails must be short and smoothly filled. Some days the nurse asked the writer for
assistant and was very interested in doing such practical work. The nurse presented
with some critical feedback in the areas to be corrected and the writers attitude
was good and accepted. The writer observed that acceptance of feedbacks improve
quality of work and learning as a trainee EHT thereby improving self awareness.
Care of the limbs
The health care workers avoid deformity of limbs and joints by massage of muscles,
careful positioning of limbs, and daily passive movements of all joints, through a full
range of movement. A bed cradle is very useful for preventing the pressure of
bedclothes upon the patients limbs. The writer observed the procedures thus
getting skills.
Blood Pressure
Everyone who visit the clinic aged sixteen years and above is tested for blood
pressure using an instrument called sphygmomanometer and the units are written
as mmHg. Blood pressure is the pressure exerted by the blood upon the walls of the
blood vessels. It is usually recorded in the arteries, where it is greater during the
contraction of the ventricles (systolic pressure) than during the period in which the
heart is relaxed (diastolic pressure). The patients blood pressure are either normal,
high or low, and high blood pressure is known as hypertension and low blood
pressure is known as hypotension. Hypertension is caused by prolonged
constrictions of arterioles, loss of elasticity of the arteriole walls, renal diseases, and
prolonged increase in the quantity of certain hormones which rise blood pressure
such as adrenaline and noradrenaline in phaeochromocytoma. Hypotension may be
associated with haemorrhage, burns, severe dehydration, vagal inhibition resulting
in a reduction in cardiac output, and severe infective states and anaphylactic shock.
The writer observed that most old aged patients blood pressure is high and are on
lifelong blood pressure treatment.
Body temperature
It was noted by the writer that every patient is taken temperature before treatment
iregardless of age. It was the writers pleasure to learn the procedure and
understood easily. The nurse defined temperature of the body as a measure of its

warmth or coldness compared with a standard, such as boiling or freezing water.

The instrument which is used to take temperature is called clinical thermometer.
Normal body temperature ranges from 35,5 to 37,5 degrees celcius. Hypothermia is
a term used for a state where the body temperature is below the normal range.
Pyrexia is a term denoting a body temperature raised above the normal range, and
this may occur either if the metabolic rate is increased or if the hypothalamic centre
is affected by pyrogens from micro-organisms or broken down tissue cells. Those
patients found with such conditions are given treatment.
Fracture
A thirty-five year old man reported to the clinic just one day after the independence
day after falling into a pit because of drunkness. He complained of painfull arm. The
arm was swollen and no bleeding was notted. The nurse gave him paracetamol to
relieve pain and refered him to Beatrice hospital for an X-ray. The following day he
came back with his X-ray, the doctor had documented that he has fracture on his
radius borne and needed a plaster. The nurse applied the plaster observed by the
writer. The patient was instructed to continue taking pain killers then to come back
for the removal of the plaster after six weeks. In order to be equipped the writer
asked the nurse about other bornes on the skeletal system, she mentioned their
types which are long, short and flat bones. Examples are scull, humerus, radius,
ulnar, shoulder blade, ribs, pelvis, heap girdle, thigh, tibia, fibular and showed some
of them on the picture displayed on wall in the dressing room at outpatient
department.
Burns
A certain mother came to clinic with her eight year old daughter after she was burnt
by hot water on the leg. The mother has broken the blisters and applied cooking oil
then applied a crap bandage. The epidermis and the upper dermis were affected
and the skin appeared red. The child showed that she was in pain and was crying.
The nurse removed the bandage then clean the area, applied the burn cream, then
applied a bandage. The baby was injected with a tetanus toxoid injection. The nurse
educated the mother about the management of burns at home before visiting the
health facility. She emphasized on running the skin under cool water for 15 minutes.

She told the mother not to apply cooking oil as it increase the burning effect, not to
break the blisters. The trainee EHT was taking note of the management.
The attachment was very important to the trainee EHT as he was equipped with
skills and technics of the e practical work at the health centre. The trainee was
pleased because the staff at the clinic work as a team and the community have no
complains. The staff members gave the trainee information as he was keen to learn,
and were able to answer the question asked.