Reflective Essay Dissertation 13a

Brian Nsubuga Kaaya

   
People's Open Access Education Initiative in the whole provided me a much-needed opportunity to
acquire education in Public Health that was of low cost though BUT of very high. This has truly been
the Peoples-uni granted me the best avenue for Public Health capacity-building considering the
options I had at hand where either unpractical or very expensive to sustain. Since 2010 I have
managed to successfully complete over 10 modules and this has been at my convenience and above all
were online which was a very important factor for me as there were times along this journey that
would have been very challenging had I enrolled to a program that required a specific enrollment and
completion time. So I am forever grateful for the setup at Peoples-uni.

I while back I was discussing with one of the medical officer at the hospital about the number of
patients we were receiving at the time from the western part of the country. In this we seemed to have
different concepts as to why this was so though we also agreed that factors; environment, the
community or genetics greatly influenced and could explain these numbers we saw.

Considering the fact that at about that time I had learnt of the influence folic acid had on the
prevalence and incidence of Spina bifida, I was for the argument that those mothers who did not
consume enough folic acid before they conceived since green leafy vegetables are not typically part of
the diet in this region.

Evidence based practice and patient Safety are two of the modules that have really been instrumental
in my own professional practice by far. Evidence Based Practice aims at improving the client’s
outcomes by exploiting thoughtful integration of the best available evidence coupled with clinical
expertise so as to provide the most effective care that is available. As much as good judgement and
excellent clinical proficiency are critical, they have to be combined with the very best of research
evidence and good patient communication.

As regards to my project and a few others I worked on notably hand washing practise by the mothers
at the hospital, I have been able to get the best evidence much faster and easier especially at the time
and point where this information mattered most. In my debates with a colleague, neither of us was
equipped with the best clinically pertinent patient oriented evidence we needed to reach our
conclusions in this particular argument.

The knowledge of the five steps of Evidence –Based Practise have helped me come up with my project
proposal in many ways than one. These have been summarised as (Jackson et al. 2013)
• Ask a question
• Access the information
• Appraise the articles found
• Apply the information
• Audit

Formulating a well-built question has helped me sieve out the details from the case I have at hand so I
can effectively search so as to get the best evidence. Do differences in folate rich traditional diets have
an effect on numbers and regional distribution of Spina Bifida patients in Uganda Applying PICO to
my question has helped me to systematically identify the important concepts about the project
formulating a question that I could easily search. This enabled me to search the best evidence available
to me in this area of study and be able to appraise this information see weather I can apply it to my
situation. Although most of the information typical to my environment or situation was hard to come
by the whole process exposed me to what may be somewhat similar to my situation and also helped me
identify the gaps in knowledge or evidence from which I was able to design a project that would be
tailor made to try bridge those gaps I identified.

The setup at the hospital has really been a Godsend for me as it has exposed me to a lot of what goes
on in a public health setting, which helped me understand, apply the modules I learnt at Peoples-uni.
Being part of the Hospital’s Clinical Audit team however has granted me a rare opportunity of being
able to be part of the decision making team that analyses, reviews and audits the quality of health care
so as to improve the patient’s safety and quality of life through the best available resources of
diagnostic and treatment procedures.

I have had the opportunity to be part of the Clinical Audit team at the hospital. Initially I was part of
the team because of the statistics, analysis and trends from the data I had to give but lately especially
after the knowledge I acquired from the modules; Evidence Based Practice and Patient safety my input
is much more. I had informed the team of a trend an increasingly high postoperative shunt infection
rate from the reports I generated. Despite several attempts to address this we finished off empty
handed. There was wealth of various clinical researches available to learn from how to curb this BUT
it would take a really long time to fully integrate these into everyday practise as most of the time
decisions are based on habits than they are on evidence. As Clinical Audit team, we choose to apply an
Evidenced Based Practice approach to this so we can be able to appraise the various clinical papers we
were able to access. In these we were able to sieve out the best practice protocol used by
Hydrocephalus Clinical Research Network (HCRN) (Kestle et al. 2011) which we have since taken.
Since the inception of this protocol almost six months ago, we have noticed a remarkable decline in the
infections rate; further findings are still being analyzed for a possible publication.

Patient safety has helped me learn and also teach others to always make sure any communications
doen in the team as regards the safety, treatment and wellbeing of the patient are clearly passed on or
documented. Also not to look at the near misses as just that but to report these so we could draw
examples and means to prevent a possible patient safety issue or situation.

I remember the time we were asked to share a patient safety incidence in our places we had witnessed.
I had never truly understood patient safety until I had to share a case of drug over dose that resulted
into a death at the hospital. It was a very unfortunate case of communication breakdown between the
attending doctor and the night nurse that further was repeated by the day nurse. Back then I had no
idea what such a seemingly innocent error or mistake could do. What this sad lesson taught me was to
always minimize all the possibilities of patient safety situations insuring a proper line of
communication between all the stakeholders including the patients or caretakers