guidelines for the operationalization of mobile medical ... · nutrition counselling, anc/pnc...
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Guidelines for the Operationalization of Mobile Medical Services (MMS)
October 2014 Background Access to health care and equitable distribution of health services in Iraq is a priority for the Federal Ministry of Health, Ministry of Health – KRI and health cluster partners. The Iraqi Standards for provision of health services are listed in the “Basic Package of Health Services for Iraq” Federal Ministry of Health in 2010. However, provision of health care in a mobile unit (mobile team or mobile clinic) was neither mentioned nor discussed as part of the modalities for provision of medical care for Iraqi people in 2010.
With the deteriorating humanitarian situation and the influx of more than 1.8 million IDPs and around 250,000 Syrian refugees to many Governorates in Iraq especially in the Kurdistan Region, health care provision faced challenging situation to reach those in need including IDPs, Refugees and impacted communities living in camps and out of camps across Iraq. Affected population settled in any locations and added burden on the available health services in locations where they settled. In hard-to-reach areas and in areas without health facilities, Ministry of Health (MoH), Directorates of Health (DoH) and heath partners had to use the modality of mobile medical services in the form of mobile medical teams and mobile clinics to reach as many people as possible with health services. However, the lack of standards for operating the mobile medical services was a challenge for the DoHs and health partners to identify the essential health services to provide through the mobile medical service units and to have standardized services to ensure equality among the affected population.
Taking health care to the doorsteps of the IDPs, Refugees and impacted communities in different parts of Iraq including Kurdistan Region is the principle behind this initiative and is intended to reach" the population in need of basic health services.
Health and Nutrition cluster in coordination with the MoH and DoHs took the initiative and established a working group to set standards for operating Mobile Medical Services to ensure equitable access to basic health services to the affected population in Iraq. The purpose of mobile medical service is to provide medical preventive and curative services in order to ensure the availability of quality health care services for people in need in remote and underserved areas and for patients who need various types of medical care provided in a cost-effective way. The working group met several times in September – October 2014 with many communications among the members of the working group using different means to reach a consensus on the standards for the MMS.
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These guidelines outline basic Standard Operating Procedures that should be in put place to ensure the best performance of MMS and maximum benefit for the people in need of medical services
Acknowledgement
Health and Nutrition Cluster thanks the Federal Ministry of Health in Iraq, Ministry of Health in Kurdistan Region for their guidance and input into this document. We also thanks the cluster partners from NGOs and UN who participated in preparation of this document including MSF – France (Moderator of the working group), MDM – France, UIMS – Iraq, Malteser, IMC, WVI and WHO. We also thank all cluster partners for their perusal and input into this document.
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Objectives • To harmonize the operationalization of Mobile Medical Services (mobile medical teams and mobile
clinics) in locations of Internally Displaced People in camps and out of camps besides impacted communities.
• Maximize the utilization of health care services for the best interest of the affected communities including IDPs.
Every Mobile Medical Service Unit shall ensure: a) MINIMUM/MAXIMUM OUTREACH: based on the population of individuals:
• 500 = 2.5 hours (not more than 2 sites per day), once a week • 1000 = half day, 9:30 to 13:30 (one site per day), 1-2 a week depending on factors to assess • 2000 = 2-3 times a week (at least) • 3000 or greater = 5 times a week (at least).
b) SITE ASSESSMENT, considering the following:
i) Nearest hospital or PHC to know availability of HR and services provided).
ii) Security: ! Security situation on the settlement site (presence of soldiers/rebels, mines,) ! Any protection from the authority or international agency? ! To what extent does the lack of security affects survival (access to food, water, firewood) ! Number of reports of violent events (rape, beatings, robbery, gunshots ! Proportion of consultations due to violent events
iii) Hygiene and sanitation: ! Current facilities for excreta disposal, type and number ! General hygiene on the site ! Availability and use of soap ! Presence of vector transmitting communicable diseases
iv) Water ! Sources of water (river, well,...) ! Is access to water for free ? (In some places people have to pay to take water from a well for
instance) ! Quantity (litres/person/day) and quality ! Proportion of families having sufficient and adequate water transportation and storage means ! Number, type and location of water points
v) Shelters ! Types of shelter in use, proportion of household with protective shelter ! Shelter surface available per refugee + Number of people per shelter ! Proportion of households with cooking utensils, blanket, clothes,... ! Availability of energy/fuel.
c) MMU ACTIVITIES:
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The following activities should be taken to consideration; Triage, stabilization, general consultation, Baby nutrition counselling, ANC/PNC services, EPI, ORS point, drugs dispenser and if needed arranging referrals to the d) MOBILE CLINIC ORGANIZATION AND PATIENT FLOW:
An illustration of patient in mobile medical unit
STRUCTURE (this can be one or more tents in emergency settings or a big area with folding privacy screen)
1 Waiting area and triage should have: • Large space with bench or chairs • Adequate temperature (ventilated and shade if hot, close and warm if cold) • Tables + chair for registration and triage nurse • Drinking water + hand washing
i) HUMAN RESOURCE:
• 1 crowd controller • 1 register clerk (according to workload) • 1 nurse
ii) MEDICAL EQUIPMENT:
• Scale • Thermometers • BP cuff • Stethoscope • Oximeter
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• MUAC (children and pregnant women) • Hand sanitizer, cup (to clean thermometers) • Health cards (Annex I), tally sheet for MUAC (Annex II) and dressing registration book, pens • Medical protocols which includes: triage criteria
iii) ACTIVITIES AND TEAM:
a) Crowd controller and health promoters
• Welcomes and informs patient and the families about the patient flow from triage to consultation,
• Orients the patients to the triage per the order of arrival (in general women and children first, then elderlies and men the last),
• Does crowd control if necessary. • Health promotion • If emergency case, the patient is sent directly to the stabilization room, according to triage
criteria
Triage (usually in the waiting area): b) Clerk register:
• Documents contact data in the registration book: date, site, identification number,
name/surname, age, town of origin, current residency • Fill in the health card with contact data (only if new patient or for the patient has lost the
health card); c) Nurse
• Measures and fills in the health card with vital signs: body temperature, pulse rate,
respiratory rate, oxygenation, and, if adult, blood pressure. If the patient has already the health card, new vital signs, MUAC (if needed) and weight are taken and registered with the current date.
• If there are any signs or symptoms of emergency, the patient is sent to the emergency room • Performs and records anthropomorphic measurements as weight (pediatric and adult scale)
and brachial perimeter-MUAC (from 6 month age to 5 years old of age). • Checks EPI status (EPI package of BCG, DTP, oral polio and measles vaccine for children
and TT for women of childbearing age) and if needed refers to the nearest immunization center (or MC EPI once a week)
• Orients then patients to consultations, according to their medical priority (red, yellow or green) based on triage protocols
• Data collection (to be given to the mobile clinic supervisor).
2 Stabilization room for emergency cases and dressing/injections should have: • Separate room
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• Tables + chairs for medical team • Examination bed or Mattress (That can be asked to the community. To keep it clean it has to
be wrapped with cellophane) • Drinking water + hand washing • EPI room, however this is optional
i) HUMAN RESOURCE:
• Medical Doctor • nurse
ii) MEDICAL EQUIPMENT:
• Thermometer • BP cuff • Stethoscope • Otoscope • Pulse oximeter • Suction foot operated (twin pump) • Hanger for infusion • Ambubag and emergency bag • Abscess suture set • Hemo Q (Hemoglobin) (optional) • Glucometer • Urine dip stick • Pregnancy test • Dressings • If EPI, vaccine carrier and icepacks • safety box • Hand sanitizer • Referral Forms (Annex III), pens • Medical protocols include: a) Management of tachypnea, dyspnoea; hyper/ hypothermia; hypo / hypertension; tachy /
bradycardia; unconscious patients; signs of dehydration; convulsions; severe vomiting; severe diarrhoea, anaphylaxis, snake /scorpion bites etc…
b) Dressing and suture c) Hygiene d) If EPI, immunization protocols
iii) ACTIVITIES AND TEAMS:
Nurse and a Medical Doctor will ensure that first aid treatment, stabilization or resuscitation and if needed refers to the nearest Hospital To treat or refer maternal/neonatal complications as appropriate. Data collection (to be given to the mobile clinic supervisor) Dressing / Injection room: a nurse (the same for stabilization/observation and emergency)
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" Rapid tests (urine strip, glucometer) are performed, per the doctor’s request. The result is noted in the health card.
" Injections are performed per the doctor’s prescription. " Dressings are performed according to patients’ needs, respecting hygiene rules. " Data collection (to be given to the mobile clinic supervisor)
3 Medical consultation room should have:
• Separate room • Tables + chairs for medical team. Chair for patient • Examination bed or Mattress (can be requested from host the community). To keep it clean
it should be wrapped with cellophane) • Drinking water + hand washing
i) HUMAN RESOURCE:
1 Medical Doctor ii) MEDICAL EQUIPMENT:
• BP cuff • Stethoscope • Hand sanitizer • Otoscope • Referral papers, pens, chronic patient’s card (Annex IV), tally sheet (Annex V) (one for
each Medical Doctor), • Medical protocols include: clinical guidelines and essential drug list
iii) ACTIVITIES AND TEAMS
Medical Doctor for each patient will: " Collect a complete past medical history and ongoing complain " Assess and performs comprehensive clinical examination of the patient using diagnosis test
available in an appropriate way " Assess mental health status with particular attention to anxiety and depression; behavioural
disorders; somatic disorders; functional complaints; psychotic disorders. Refer to mental health clinician if considered necessary (see human resources options)
" Refers suspected SGBV cases " Provide ANC and PNC minimum services " Prescribes appropriate treatment and plan a proper follow up (if the date of the next mobile
clinic is known) " Data collection/tally sheet (to be given to the mobile clinic supervisor) " Ensure a proper hand over written for transfer of patient. Advise patients how to give the
feedback referral (by phone or coming the next scheduled mobile clinic date " Open file for chronic diseases " Supervise the respect of the code of medical ethics
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4 Drugs dispenser room (Pharmacy) should have: • Separate room with adequate temperature • Tables + chairs for medical team. Chair for patient • Drinking water + hand washing
i) HUMAN RESOURCE:
1 nurse as drug dispenser. A nurse could be replaced by a medical assistant for specific activities. ii) MEDICAL EQUIPMENT:
• Tablet counter • Tablet cutter • Plastic boxes for drugs/equipment • Water for ORS • Pens • Medical protocols include: - essential drug list
iii) ACTIVITIES AND TEAMS:
• Drugs are provided to the patient according to doctors’ prescription. • Drug dispenser checks right patient, right drug, right dose, right route and right time. In case of
unclear prescription the drug dispenser has to cross check with the doctor. • Responsible for preparing ORS solution and checking the patient taking the first dose. • Explanation and education are provided to the patient about his/her treatment and disease. • Provision of drugs for the patient with chronic diseases on regular bases (Hypertension,
Diabetes, ischemic heart disease, psychotic disorders etc.) • Fill in drugs daily consumption (to be given to the mobile clinic supervisor) • Is responsible for the good maintenance of the drugs and bio equipment
In camp setting: ambulance on stand-by for critical cases only
OPTIONAL:
5 Reproductive Health (RH) room should have:
• Separate room • Tables + chairs for medical team. Chair for patient • Examination bed • Hand washing + Drinking water
i) HUMAN RESOURCE:
1 midwife ii) MEDICAL EQUIPMENT:
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• Thermometer • BP cuff • Stethoscope • Fetal movements cup • safety box • Hand sanitizer • Referral papers, pens • Medical protocols include: - clinical guidelines reproductive health
iii) ACTIVITIES AND TEAMS: a) ANC: • Questioning and carrying out examinations (check for hypertension, oedema, abdominal
palpation of fundus) of patients during consultations • Referring to the nearest EPI in case of need of anti-tetanus vaccinations in accordance with the
vaccination calendar • Providing necessary information to future mothers, for example on:
" the importance of vaccination and following prophylactic treatment " the importance of pregnancy follow up and early detection of signs of delivery " the detection of all anomalies during the pregnancy (signs of infection, blood loss, etc.)
• Identify potentially complicated deliveries for early referral (previous scar in uterus, multiple gestation, severe pre-eclampsia, abnormal lie at term, poor obstetric history etc.) the nearest gynecologist (referral letter)
• Updating the patients’ register and follow up forms • Provide Ferrous Sulphate + Folic acid (Medical Doctor prescription)
b) PNC: Maternal review
• Vital signs • Uterine involution • Secondary postpartum haemorrhage (lochia) • Anaemia, sepsis or breast complications • Any concurrent illness, e.g. urinary incontinence • Contraception options • Assessment of psychological well-being
c) Neonatal review:
• Maternal history (fever, treatments, prolonged rupture of membranes etc.) • Head to toe check including eyes, palate, genitalia/anus and reflexes • Temperature • Weight and head circumference • Cord care (keep clean and allow to dry) • Feeding
# Signs of danger/illness, e.g. infection, convulsion, birth injury
6 Mental Health room should have:
• Separate room
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• Tables + chairs for medical team. Chair for patient • Drinking water
i) HUMAN RESOURCE:
a) Mental Health Clinician. In addition the following should be considered: b) LOGISTIC TEAM:
• 1 logistician (can be the driver or team member) who is also clerk • 1 (minimum) crowd controller (better if from the host community)
Functions of the Logistician:
" Arranges movements to reach the site " Is responsible of the team and patients security " Provides material needed to perform medical activities: tents, tables, chairs, water, soap,
coolers for drugs (needed if high temperature, to store drugs), towels, plastic boxes etc. " Being responsible for the chain of medical waste treatment (collection, sorting,
destruction, dumping)
c) Medical Doctor: at least one trained on identification of reactions to a traumatic event, Medically Unexplained Physical Symptoms – MUPS and minimum package on RH)
d) Other medical team members should include: 1-2 health/hygiene promoter (Consider a
trained staff member to train community worker(s)) plus:
Option 1 (less than 50 consultations/MMU site or 100 consultations/day – goal is less than this, however need to consider possibility of high demand))
" 1 medical doctor " 2 nurses: one for triage, one for stabilization room, dressing/injections and as drugs
dispenser.
Option 2 (more than 50 consultations/MMU site) " 2 (or more) medical doctors " 3 (minimum) nurses: one for triage, one for stabilization room and dressing/injections
and one as drugs dispenser. A nurse could be replaced by a medical assistant for specific activities.
Optional: (at least once a week if mobile PHC. Midwife for comprehensive RH package)
" 1 midwife " 1 mental health clinician – (social worker or psychologist)
ii) Medical protocols: - mental state assessment and risk screen
iii) ACTIVITIES AND TEAMS: The mental health clinician will:
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• conduct a mental state assessment and risk screen • Initiate basic assessment and Psychological First Aid • Assessment and treatment with brief (very limited and boundaried) psychological
interventions as appropriate to context, for instance: " Motivational interviewing " Structured Problem Solving " Short term Cognitive Behavioral interventions (if clinic will be repeated and client
will be available) " Brief supportive psychotherapy
• Consider referral to secondary level service if available/ appropriate
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Annex I Front view of the health card
Back view of the health card
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Annex II Tally sheet for MUAC Tally sheet: outpatient department of Erbil, Kurdistan
Week
Residents
Refugees
consultations < 5 y.o. ≥ 5 y.o.
< 5 y.o. ≥ 5 y.o. Dressing/injection room
injection
Dressing (new cases)
Dressing (follow-up cases)
Referrals to
Electiv referrals
Emergency referrals
Structure3
Structure4
Structure5
Other structures
Rape Number of cases
Malaria rapid diagnostic test (to be filled only if no specific labortory data collection) Number of tests done
Number of positive tests
patient's follow-up (old cases)
Hypertention
Diabetes Mellitus
Epilesy
Chronic asthma
Other old cases
MUAC at OPD 6-23 m 24-59 m
6-23 m 24-59 m
Number of screened children
Red
Orange
Oedema
Population figurres
Refugees
< 5 y.o. ≥ 5 y.o.
< 5 y.o. ≥ 5 y.o.
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Annex III Referral!Form!
REFERRED!TO:!_____________________________________________!!!!!!!!!!!Date:!________________________!
PATIENT!NAME:!___________________________________________!!!Age:!_______________!Sex:!__________!
Address!of!Patient:!______________________________________________!!
BRIEF!CLINICAL!HISPTORY!AND!P.E!(Including!past!and!present!history):_________________________________!
____________________________________________________________________________________________!
KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK
KKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKKK!
WORKING!/PROVISIONAL!Disgnosis:______________________________________________________________!
ACTION!UNDERTAKEN!(to!include!medication!given,!laboratory!if!any):__________________________________!
_____________________________________________________________________________________________!
REASON!FOR!REFFERAL:_________________________________________________________________________!!!!
Waiting!for!your!feedback,!thanks!for!the!care!you!will!provide!to!this!patient.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
REFERRED!BY:_______________________!
! ! ! ! ! ! ! ! Tel!No:_____________________________!!
! ! ! RESPONSE!of!REFERRAL!HOSPITAL/!HEALTH!FACILITY!NAME!OF!HOSPITAL/!HEALTH!FACILITY:________________________________________!PATIENT!NAME:___________________________!DATE!OF!DISCHARGE:!_______________________!!FINAL!DIAGNOSIS:!! MANAGEMENT/!TREATMENT!GIVEN:!______________________________________________________________! ________________________________________________________________________________________________________ MEDICATIONS!AND!ADVICES!GIVEN:__________________________________________________________________________!!________________________________________________________________________________________________________!!NEXT!FOLLOWKUP:!________________________________________________________________________________________________________!!!!!!!!!!!!!!!!!Thanks!a!lot!for!referring!the!said!patient.! DR.. ___________________________________________
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Annex IV Chronic Patient Card
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Annex V Tally sheet for weekly reports
CAMP: لمخ"م& DATE: لتا#"خ' WEEKLY HEALTH DATA ب(انا- 'لصح(ة 'السبوعي Acute Conditions (RECORD NEW CASES)
0-4 5 - 14 15 - 49 50 +
"لظر!) "لحال$ة "! /Female #كر /Male &المر&' &لحال"ة
\Female #كر \Male $نثى \Female #كر \Male $نثى
\Female #كر \Male $نثى $نثى
Upper Respiratory Infection (URTI)
)لت%ا# في &لج#ا! 'لتنفسي &لعلو!
00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000 00000 00000
Lower Respiratory Infection (LRTI)
)لت%ا# في &لج#ا! 'لتنفسي &لسفلي
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Watery Diarrhea* !س#ا% مائي
00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000
00000 00000 00000 00000 00000 00000
Bloody Diarrhea* !س#ا% $مو!
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Malaria (suspected) 00000 مال#"ا 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
17#
#
Skin Infection (including Scabies)
"مر"! %لجلد متضمنا %لجر!
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Total Number of Scabies Only (example III): لرقم .لن,ائي للجر$ فقط.
Eye Infection !لت#ا& %لع"ن
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Ear Infection !لت#ا& $ال"!
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Dental Condition !"مر" &السنا!
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Intestinal Worms !"لد$د" 'لمعو"ة
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Acute Jaundice Syndrome*
متال#مة 'ل%رقا! %لحا!
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Measles* 00000 &لحصبة 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Meningitis* (suspected)
&شتبا! &لت#ا! &لسحا"ا
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Acute Flaccid Paralysis*
شلل #خو حا!
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Tuberculosis (suspected)
&شتبا! بمر! $لسل
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Fever of unknown origin
حمى مج$ولة %لسبب
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Sexually Transmitted Infection (STI)
'لت$ابا! منقولة جنس"ا
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
18#
#
Urinary Tract Infection (UTI)
)لت%ا# في &لمسالك &لبول"ة
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Chicken Pox - Varicella-zoster
00000 &لجد"!00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Acute Malnutrition سوء'لتغذ"ة %لحا!
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Leishmaniasis 00000 )لل"شمان"ا 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Gynaecological Conditions
"مر"! نسائ"ة
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Anaemia !00000 فقر $لد 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Musculo-Skeletic Pain/Generalized Body Pain
"مر"! \عضل"ة)آل& جسد"ة عامة
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Other !00000 غ#ر 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
MMENTS/NOTES تعل$قا!
Chronic Conditions (RECORD NEW CASES)
0-4 5 - 14 15 - 49 50 +
تسج"ل \&مر&% مزمنة /Female #كر /Male حاال% جد#د!
/Female #كر /Male $نثى /Female #كر /Male $نثى
/Female #كر /Male $نثى $نثى
19#
#
Diabetes !00000 &لسكر 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Hypertension !تفا%& ضغط $لد!
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Asthma 00000 %لربو 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Ischaemic Heart Disease
مر! %لقلب 'القفا"!
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Cardiovascular Disease (other)
"مر"! %لقلب $&ال$ع"ة \'لدمو"ة غ#ر!
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Chronic Obstructive Pulmonary Disease
مر! "النسد"! &لرئو! &لمزمن
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Liver Disease !"مر" %لكبد
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Thyroid Problems في مشاكل %لغد!
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Cancer !00000 'لسر#ا 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Gastritis or Peptic Ulcer Disease
&لت#ا! "لمعد# "! &لقرحة 'ل%ضم"ة
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Other !00000 غ#ر 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
20#
#
Mental Health (RECORD NEW CASES)
0-4 5 - 14 15 - 49 50 +
تسج"ل \'لصحة 'لنفس"ة حاال% جد#د!
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Epilepsy/Seizures !لصر%\ نوبة مرض"ة
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Alcohol and Other Substance Abuse Disorder
تعا"ي \&لكحو! \"لمخد#"! &ال$ما!
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Psychotic Disorder !ضر$با$ عقل"ة
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Mental Retardation/Intellectual Disability
&لتخلف \&لعقلي&العاقة 'لذ$ن"ة
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Severe Emotional Disorder
"ضطر"! عا#في شد"د
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Medically Unexplained Somatic Complaint
"عر"! جسد"ة غ&ر مبر"! $ب"ا
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Other !00000 غ#ر 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Injuries (RECORD NEW CASES)
0-4 5 - 14 15 - 49 50 +
تسج&ل حاال! \&لجر"! جد#د!
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Injury (Intentional) ضربة متعمد!
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Injury (Unintentional)
%صابة عرض"ة
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Burns !"00000 00000 00000 00000 00000 00000 00000 00000 حر
21#
#
00000 00000 00000 00000 00000 00000 00000 00000
Accident !"00000 حا 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Bites 00000 لسعة 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Other !00000 غ#ر 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
00000 00000
Referrals (RECORD NEW CASES)
0-4 5 - 14 15 - 49 50 +
تسج&ل حاال! \)لتحو#ال! جد#د!
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Male/ كر# Female/ $نثى
Emergency 00000 &سعافي 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
Elective غ"ر \&سعافي 'خت$ا"!
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
00000 00000 00000 00000
22"
"
Annex VI List of essential medicines for mobile medical service
Medicine
Acetylsalisylic acid 100 mg Tab Albendazole, 400 mg or mebendazole 100 mg Tab Aluminium hydroxide 400mg Tab Amlodipine 5 mg Tab Amoxycillin 250 mg cap Caps Amoxycillin 250 mg susp Susp. Amoxycillin 500 mg Tab Amoxicillin 500 mg / clavulanic acid 125 mg Tab Amoxicillin / clavulanic acid powder 125/31.25 mg Susp. Atenolol 50 mg Tab Azithromycin 250 mg Tab Cephalexin 250 caps Tab Cephalexine 250 mg susp Susp. Chlorpheniramine 4 mg Tab Ciprofloxacin hydrochloride, 500 mg Tab Cloxacillin sodium, eq. 250 mg base Caps Co- trimoxazole ( trimidar ) 40mg Susp. Diclofenac potassium 50 mg or ibuprofen 400 mg Tab Doxycyclin 100 mg Tab Enalapril 10 mg Tab Ferrous fumarate 185 mg (60mg ir.) / folic acid 0.4 mg Tab Furosemide 40 mg Tab Glibenclamide 5 mg Tab Glimepride 2 mg Tab Hyoscine butylbromide Tab Isordil dinitrate 5 mg Tab Metformin hcl 1000 mg Tab Metformin hcl 500 mg Tab
23"
"
Metoclopramide 10 mg Tab Metronidazole 250 mg Tab Metronidazole, 125mg/5ml, dry powd.fr 100ml Susp. Omeprazole 20 mg Tab Oral rehydration salts (ors) low osmol Sachet Paracetamol (acetaminophen), 100 mg Tab
Paracetamol (acetaminophen), 500 mg Tab Paracetamol (acetaminophen), 120 mg/5 ml Prednisolone, 5 mg Tab Progestrone 100 mg Tab
Salbutamol 0.1 mg / dose inh Inhaler External drugs
Benzyl benzoate, 25%, lotion, 1 l, bot. Bot Betamethasone n 0.1% or hydrocortisone acetate Oint. Calamine, 15%, lotion, 500 ml, bot. Bot Gentamycin 5mg oint E.oint. Miconazol nitrate, 2%, cream, 30 g, tube Tetracycline hydrochloride, 1%, eye ointment, ster, 5g, Tube Zinc oxide, 10%, ointment, 100 g, tube Tube
Injectable medicines
Adrenalin 1mg/ml Amp. Atropine amp Amp. Dexamethazone 4 mg / ml Amp. Diclofenac sodium 75 mg / 2ml or 75mg / 3 ml Amp. Furosemide 10 mg / 1 ml or 20 mg / 2 ml Amp. Lidocaine 1%, without preservatives, 10 ml ampoule Amp. Metoclopramide hydrochloride, 5 mg/ml, 2 ml, amp Amp. Ringer lactate 500 ml
24"
"
Annex VII List of medical supplies for mobile medical service
MEDICAL SUPPLIES Blood lancet Box Compress, non woven, 7.5 cm, 4 plies, non sterile Compress, gauze, paraffin, 10 cm x 10 cm, sterile Compress, gauze, 10 cm, 12 plies,sterile Cotton pack 100mg Pack Cotton roll 500 g Roll Crep bandage 5 cm Roll Crep bandge 10 cm Roll Crep bandge 3 cm Roll Draw sheets / big fine roll Piece Elastic bandge medium Roll Gauze roll Roll Gauze swap 4*4 Piece Idoine galon 5l Gallon Polyvidone iodine, 10%, solution, 200 ml Bot Sodium chloride, 0.9%, 500 ml Bot Latex gloues l Box Latex gloues m Box Latex gloues s Box Napkin Box Nylon disposable gloves Box Plaster roll paper Boll Plaster roll zinc oxide Piece Pregnancy test Piece Test, urine, ph,dens,prot,gluc,ket,blood,nit,leuc, 1 strip Protective mask Box Sealed sterelization pouches or bags 30cm*40cm Piece Sharp containers (large) Piece Sharp containers small Piece Syringe 3 cc Box Syringe 5 cc Box Thermometer Piece Tongue depressor Box Needle, s.u., luer, 21 g (0.8 x 40 mm) green, im Box Needle, s.u., luer, 23 g (0.6 x 30mm) blue, sc, im child Box Set, infusion 'y', luer lock, air inlet, sterile, s.u. Piece
25"
"
Set, infusion, paediatric, precision, sterile, s.u. Piece Iv catheter, injection port, s.u. 16 g (1.7 x 55 mm), grey Box Iv catheter, injection port, s.u. 18 g (1.2 x 45 mm), green Box Iv catheter, injection port, s.u. 20 g (1.0 x 32 mm), pink Box Iv catheter, injection port, s.u. 22 g ( 0,8 x 25 mm), blue Box Iv catheter, injection port, s.u. 24 g (0.7 x 19 mm) yellow Box Syringe, s.u., luer, 2 ml Box Syringe, s.u., luer, 5 ml Box Syringe, s.u., luer, insulin, 100 iu/1 ml + fixed needle Box Card, health, arabic/english a5 recto/verso Piece Bag, plastic, for drugs, 6 x 8 cm Box Bag, plastic, for health card, 16 x 22 cm Box Blanket, survival, 220 x 140 cm, thickness 12 microns Piece Gloves, surgical, latex, s.u., n.p., sterile, pair, 7.5 Piece Razor, disposable Piece Sut. Non abs. Mono. (3/0) needle 1/2 18mm round Box Scalpel n 3 and 7 blade, s.u., sterile, n 11, 01-22-11 Piece Container, sample, plast., 60ml, no sterile, urine Box Glucometer, blood glucose monitor (nova statstrip) Piece Glucometer nova statstrip, 1 strip Piece Oxymeter masimo sensor adult, reus. Lncs-dci ref1863 Piece Bracelet, brachial perimeter (muac), ped , pp, 115 mm Piece Hemoq and stripes Piece Scale, electronic, mother/child, 200 kg x 50 g Piece Otoscope speculums reusable Box Sphygmomanometer, one-hand manometer, velcro, adult Piece Stethoscopes Piece Tablet counter, triangular, metal, 17 cm Piece Tablet cutter, stainless steel blade Piece Dressing set, 3 instruments, w/o box Piece Abscess suture set, 7 instruments, w/o box Piece Battery, dry cell, alkaline, 1.5 v, r6 (aaa) Piece Othoscope Piece Clinical guidelines book Piece Essential drugs book Piece Who z-score chart Piece Pens Box List of drugs Piece Forms Piece
26"
"
Alcohol swab ( square pad, 2.5 x 2.5 cm) for injection purposes Alcohol gel hand sanitizer for medical teams 500 ml Megaphone for the health/hygiene education IEC materials for health/hygiene education