Introduction and Background Information

The Community Health Department (CHD) is located in the third floor of the hospital main building. The department activities are based on the three pillars of KCMC which are Services, Teaching and Research. The CHD has the vision “to see a working whole system that actively facilitates learning, research, as well as provision of community services that fulfill the KCMC vision” and the mission “to send for mighty hope, and work together to heal the world.”

Thousands of former students of KCMC are working all over Tanzania. Specialists from KCMC visit hospitals in many parts of the country by road or by air, with over 250 service days per year. Nearly 10,000 patients are seen and over 500 operations performed. KCMC is connected to more than 25 hospitals around its network allowing for knowledge and experience sharing both direct and indirect. This gives staff in the field an opportunity to obtain expert advice and assistance whenever needed and intime.

Among outreach activities are home visits by the Social Welfare Department, Mother and Child Health, Occupational therapy and Cancer care (palliative care). Community Health Department experts including Public Health Doctors and Nurses collaborate with others within KCMC and throughout the surrounding area in providing health education, health promotion services, research and teaching.

Activities

A. Services

CHD is known for its efficiency in conducting health education for both in and out patients. The Health education given varies and depends on the local need but also according to the national and world health days (to commemorate). HE is provided to our clients live on site or via radio sessions and in addition through TV screens available at the OPD/clinics.

Last year (2020) we had opportunity to use available Radio stations in Moshi that includes Moshi FM, Kitcheko FM and Radio Sauti ya Injili to educate communities about various health issues such as Non Communicable Diseases like Cancer, Diabetes, Hypertension and heart problems, infections including outbreaks such as HIV, Cholera and Covid-19. Throughout these educative sessions we have constantly reminded individuals/clients on importance of staying health through eating healthy meals (balanced diet) which contains appropriate amount of nutrients and calories i.e. carbohydrates, protein, fats, vitamins, minerals as well as regular exercises and drinking enough water.

Specifically to mention a few, we offer health education at the following departments on regular basis: - Obstetrics & Gynecology Department. Health education to pregnant and non-pregnant women includes those who have given birth and are admitted in OG1 and OG2 wards. Topic covered ranges from importance of early health care seeking mainly early booking for pregnant women with their partners, educate on danger signs awareness, anemia in pregnancy, importance of breast milk and how to hold/position the baby during breast feeding, how to express breast milk and safe storage for the babies for working mothers. Also postnatal mothers are educated on the importance immunization including the different types of vaccine for their babies and schedule. Otherwise, additional topic of family planning is offered throughout ante and postnatal for women and their partners to choose their preferred method.

Health education and counseling to postnatal mothers are provided regularly, focusing on both mother’s and the new baby’s health. The issues includes postnatal care, nutrition including young infant feeding and importance of breast milk, how to position the baby during breastfeeding, good attachment, as well as child immunization. Additionally, also family planning issues for mothers.

As described above, for out-patients health education and promotion activities focusing on infectious diseases and outbreak are emphasized [Dengue, Cholera, Covid-19, etc.], Non Communicable Diseases like Hypertension, diabetes, cancer are covered and related lifestyle predisposing factors such as Obesity are taught.

Environmental Health including Infection Control at various facilities in and surrounding the hospital i.e. inspection of hostels, kitchen and nearby restaurants: our team facilitates hygiene practices to all staff and students in the area. We carry out health status assessment to ensure they are free of any infection that may be transmitted to others i.e. during handling of food etc. Routine medical examination is been done as per KCMC infection prevention and control guidelines (three times per year) to ensure food security.

They perform urine and stool investigations amongst other tests, (a detailed report is available in the department and the Matrons’ office). For the nearby hotels, we have conducted environmental hygiene and sanitation assessments and all challenges encountered are feed back to the team and hotel owners for solving; Example, problem maintaining clean hand washing facilities. Additionally, we conduct and supervise pest control and management program (done by housekeeping department) at the hospital.

Community Outreach and Engagement Activities

1. COVID-19 Advocacy through media (radio) in Moshi - to raise awareness and understanding as well as public health measures to be taken as precautions.
2. Screening for Non Communicable Diseases (NCD) and associated risk factors - Hypertension among community members in Hai District. About 600 members were screened.
3. Cervical cancer screening and health education.
4. Blood donation sensitization among staff and students KCMC/KCMUCo - 492 units of blood collected.

In collaboration with our college (KCMUCo), we do conduct outreach services training the” tomorrows” doctor on how to engage and work with communities. Students visits their assigned villages and identify respective health facilities i.e. dispensaries or health centre to learn the role of health management team committees in relation to communities they are serving.

They get opportunities to visit households, assess health issues of importance as reported by household members and later feedback to the health team and together discuss possible solutions and way forward. Additionally, students visit people with disability, CCBRT, sewage system and schools. The aim for all this community activities is to make the students aware of the community needs so that they can from their early career development, plan to work in rural areas.

B. Training and Students’ Supervision

Training is one of the major activities the department is involved in both to health care workers and to students. We provide in-service health education sessions to health care workers at different departments based on the need i.e. trained nurses and doctors including internists on infection prevention and control (IPC) including environmental health including waste management but importantly case management for covid-19 and contact tracing. In addition, we do prepare and conduct on job training to health care workers in relation to maternal and child health.

For students KCMUCo, we offer training in various topics including Health Promotion, Research Methodology, Epidemiology, Biostatistics and Nutrition to both undergraduates and Post graduates as per annual timetable. Teaching methodologies includes class lectures, discussions, Team Based learning-TBL, and Problem Based Learning-PBL, to allow students to acquire the theoretical and practical skills of the subject course contents.

C. Research

1. Quality improvement research such as Client Satisfaction Kamanda, Simon, Majaliwa, John, Shehe, Rashid, Muro, Florida & Njau, Bernard. (2020). Pregnant Women Level of Satisfaction on Quality of Care in Reproductive and Child Health clinic at Huruma Designated District Hospital in Rombo District, Kilimanjaro Region, Tanzania. East African Health Research Journal. 4. 10.24248/eahrj.v4i1.621.
2. Interventional and AMR Research funded by Northumbria – Understanding Antibiotic use, Antibiotic Resistance and Antibiotic dispensing Practices in Kilimanjaro region Tanzania,″ (Principal Investigators: Dr Sarah Urasa, Co-PI: Dr Florida Muro).
3. Nutritional related Research funded by MEPI - Medical Education Partnership Initiative an independent organization that works in partnership with the KCMUCo:-
4. Assessment of school policies and environment in promoting physical activity and nutrition toward prevention of non-communicable diseases among school age children in Moshi Municipality, Tanzania.

D. Cross-Cutting Activities - Uzima Garden

Uzima is a place to seek refuge, inspiration and healing. It is a space dedicated to exploring that fact that living well is about dwelling well with others. Uzima is about relationships -- biological and social; people can come in, walk, sit, wonder, learn and teach. Questions of nourishment in the 21st century require attending to humans and the earth simultaneously. They require understanding the ways that the health of the soil, air, water, and plants are critical to the health of people.

The profound forms of healing required sustaining people and communities today require innovating the spaces in which teaching and healing foster strengths, capacities and vitality of humans and ecologies together. Uzima is a space where medicine and medical care might be reshaped through the knowledge of older healing systems in Tanzania that have long thought about the health of the environment and the health of humans together and agricultural traditions have long worked with and cultivated lush biodiverse spaces to support the vitality of individuals and communities.