content
TRANSCRIPT
TABLE OF CONTENTS
CONTENT PAGE
TABLE OF CONTENTS.............................................................................................................i
DECLARATION.......................................................................................................................iii
APPROVAL..............................................................................................................................iv
DEDICATION............................................................................................................................v
ACKNOWLEDGEMENT.........................................................................................................vi
LIST OF ABREVIATIONS...................................................................................................vii
CHAPTER ONE: BACKGROUND OF INTERNSHIP TRAINING.......................................1
1.0 Introduction.......................................................................................................................1
1.1 Specific Objectives of the Internship................................................................................1
1.2 Scope of the Internship.....................................................................................................1
1.3 Organizational Profile.......................................................................................................2
1.3.1 Background of the hospital........................................................................................2
1.3.2 Geographical location................................................................................................2
1.3.3 MRRH’s Mission statement, Vision, and goals.........................................................3
1. 3.4 Objectives of Mbale Regional Referral Hospital......................................................3
1.3.5 Activities of the organization..................................................................................3
1.3.6 Clientele.....................................................................................................................4
1.3.7 Mbale Regional Referral Hospital organogram.........................................................5
CHAPTER TWO: MANAGEMENT OF THE INTERNSHIP EXERCISE.............................6
2.0 Introduction.......................................................................................................................6
2.1 Reporting And Induction at the Organization...................................................................6
2.2 The Department to Which I Was Assigned......................................................................6
2.2.1 Category Of The Department.....................................................................................6
2.2.2 Services Offered At The Department........................................................................6
2.3 The Activities And Tasks I Participated In.....................................................................10
2.4 The Officers I Worked With And What They Do.........................................................12
2.5 Relationship With Other Officers In Executing My Duties And Responsibilities........13
2.6 Role Of The Work Supervisor........................................................................................13
CHAPTER THREE: METHODOLOGY.................................................................................14
3.0 The Social Work Functions That MRRH Adheres To....................................................14
3.1 Approaches To Health Care Delivery Used By The Agency.........................................15
3.2 Methods Of Social Work Used By The Student And Agency........................................15
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3.3 Different Skills Employed By The Internee During Fieldwork......................................17
3.4 Various Techniques Used When Handling Cases..........................................................19
3.5 Application Of Theories Of Social Work Used..............................................................19
3.6 The Different Principles And Values Adhered To During The Internship.....................21
3.7 Application Of Social Work Roles During The Placement............................................23
CHAPTER FOUR: FINDINGS AND OBSERVATIONS.......................................................25
4.0 Knowledge And Skills Gained During The Placement..................................................25
4.1 How I Intend To Utilize What I Have Learnt For My Professional Development.......25
4.2 Personal Contribution To The Organization (My Innovations)......................................26
4.3 Challenges Noticed During The Internship (Work Related) That Are Affecting...........26
4.3.1 The Organization.....................................................................................................26
4.3.2 The Workers.............................................................................................................27
4.3.3 The Internee.............................................................................................................27
CHAPTER FIVE: CONCLUSION AND RECOMMENDATION.........................................28
5.0 Assessment Of The Internship Exercise In The Organization........................................28
5.1 Recommendations For The Identified Problems............................................................28
5.2 Conclusion......................................................................................................................29
APPENDIX 1: WORKPLAN...................................................................................................30
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DECLARATION
I MABALA FLAVIA do hereby declare that this report is solely my own initiative and has
never been presented in any of the universities or institutions of learning for any award.
Signed ............................................. Date .................................................
MABALA FLAVIA
Reg No: EJ11/BSW/BUW/012
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APPROVAL
I do approve that this work was carried out by MABALA FLAVIA under Infectious
Disesases Clinic - Mbale Regional Referral Hospital. The fieldwork exercise was duly
supervised by me and the report herein ready for submission.
Name:……………………………..................
Signature:……………………………............
Date:…………………………………………
iv
DEDICATION
I dedicate this piece of work to my beloved mother miss Mugide Rose Mabala who has really
struggled to ensure that i reach where i am. May God bless her abundantly.
My only two brothers Mabala Robert and Mabala Ronald, my beloved niece Nguja Asadi and
nephew Namulolo Sophie, you have all been important mostly my brother Mabala Robert
who has opened up a way for my education.
Lastly, I thank my maternal family members for guiding me morally, spiritually and
academically. You have been role models for many of us.
God bless you all.
v
ACKNOWLEDGEMENT
I acknowledge the valuable assistance especially of my mother Miss Mugide Rose Mabala
who has been and still is more of a parent for the financial assistance and for being there for
me at all times. Mummy, you are my hero.
I also acknowledged with all respect all the staff of Infectious Diseases Clinic under the
providence of Mbale Regional Referral Hospital for accepting me to carryout my internship
training from their organization.
I thank the ART clinic In-charge Sister Mutenyo Beatrice and the ART clinic Co-ordinator
Doctor John Peter Masaba of Mbale Regional Referral Hospital for their dedication, patience,
guidance and parental encouragement rendered towards me during my internship
I would like to thank my Uncle, Aunties and Cousins for the care they showed me throughout
my education. I also thank the friends i worked with in the organization; Kissa Jenifer, Fred
Omiro, Sirikye Sowal and Dina Obra who shared with me what they knew since they were
from different institutions
Lastly, i thank my lecturers for ther efforts and guidance they provided to me. Speical thanks
to the Director UCU Mr. Omoda and the entire staff of UCU
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LIST OF ABREVIATIONS
AIC Aids Information Centre
AIDS Accquired Defficience Inmmuno Syndrom
ART Anti Retroviral Therapy
BSWSA Bachelor of Social Work and Social Administration
CBC Complete BloodCell Count
CDC Centre for Disease Control
CPD Continuing Professional Development
DR Doctor
EID Early Infant Diagnosis
HIV Human Immunodeffitience Virus
IDC Infectious Disease Clinic
MOH Mnistry Of Health
MRRH Mbale Regional Referral Hospital
MRS Medical Record System
OPD Out Patient Department
PHC Primary Health Care
PIDC Paediatric Infectious Disease Clinic
PMTCT Prevention of Mother to Child Transmission of HIV
PNO Principal Nursing Officer
STD Sexually Transmitted Disease
SPNO Senior Principal Nursing Officer
SR. Sister
TASO The Aids Support Organization
VCT Voluntary Counselling and Testing
UCU Uganda Christian University
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CHAPTER ONE: BACKGROUND OF INTERNSHIP TRAINING
1.0 Introduction
This chapter explains the importance of the internship exercise, background of the
organization, mission statement, goals of the organization, what the organization does and the
organizational structure.
The Department of Social Sciences, Uganda Christian University usually plans for her
students a period of institutional attachment where students are sent out to different
organizations and placed to work under senior officers, who play the role of trainers and / or
mentors in the field of specialization.
Internship is a career–related, professionally supervised programme, designed to provide the
students with an opportunity to receive a practical credit for a meaningful career – related,
real-world experience in a variety of organizational settings in preparation for the practical
work they will be required to do upon completing the course.
1.1 Specific Objectives of the Internship
To give the internee an opportunity of balancing their appreciation of the Lecture
room theories practical application.
To prepare the internee for challenges likely to be encountered in the field of Social
work and social sciences.
To fulfill the requirement for the award of the BSWSA degree.
To expose the student to the work environment which allows room for interaction with various
offices and get acquainted with the requirements of executing his/her duties.
To acquire practical skills in social work.
To develop interpersonal communication skills and ability to work as a team
To create links for contacts for future job opportunities.
1.2 Scope of the Internship
The internship exercise was carried out in IDC- MRRH which is located in Mbale
Municipality and has a Catchment area of 11 districts namely; Mbale, Sironko, Bududa,
Manafwa, Tororo, Busia, Butaleja, Bukedea, Kumi and Namutumba.
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1.3 Organizational Profile
1.3.1 Background of the hospital
Mbale regional referral hospital is a Governmental owned public hospital, funded by the
Uganda Ministry of Health. It was started in 1924 as a small health centre and was later
developed into a district hospital and has been expanding since 1950s till it gained the
regional status. MBALE REGIONAL REFERRAL HOSPITAL serves districts of Mbale,
Sironko, Budaka, Kumi, Pallisa, Tororo, Busia, Katakwi, Kapchorwa and sometimes moroto
soroti and kotido.
Mbale regional hospital has become the fourth largest in the country after Mulago,Butabika
and Jinja hospitals. It was originally designed for a bed capacity of 370 but due to the
increasing demand of services . The number of patients has increased rising the number of
beds to 400. The hospital has grown through the decades by way of contribution of various
stakeholders and freinds.
The hospital was established with the basic aim of achieving the goals of primary health care
(PHC) through the promotion of health, treatment and prevention of disease infections among
the people.
In the hospital, both inpatient and outpatient care services are provided and they include
clinical, diagnostic and therapeutic services.
The hospital is divided into the following departments: Obstetrics and Gynaecology, Surgery,
Internal medicine, Paediatrics, Outpatient, Theatre, Masaba wing and Causality wing. It is run
by a total of 330 staff. 168 are nursing staff who carry out curative, promotive, preventive and
rehabilitative services among others. Masaba wing was constructed in the 1960s to cater for
those who could pay. In Lions Aid Norway (LAN) in conjuction with Ministry of Health
constructed and equipped the eye department. In the same year,Masaba wing and the clinic
complex were renovated. Currently the Japan International Co-operation Agency(J.I.C.A) has
constructed a new maternity ward.The other staffs include support staff, drivers and security
personnel.
1.3.2 Geographical location
Mbale Regional Referral Hospital is located within the Industrial division, Mbale
municipality on Pallisa road in Mbale district in the eastern region of Uganda.
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It is located 42 km north of Tororo town, 56 km South East of Kumi town, 57 km East of
Pallisa and 55 km South East of Kapchorwa town. Mbale district is 256 km east of Kampala
city and 52 km from the Western Kenya boarder
1.3.3 MRRH’s Mission statement, Vision, and goals.
Mission Statement
To provide general and specialized health services to the people in the catchment area for
improved quality of life
Vision
To become the leading Regional Referral Hospital in the provision of quality specialized
Health Services in the Region
Goal
Total satisfaction to patients across Uganda.
1. 3.4 Objectives of Mbale Regional Referral Hospital
Mbale Regional Referral Hospital objectives can be achieved through its functions that
include:
To ensure efficient and effective utilization of resource available in hospital.
To contribute to regional and national human resource development for the health
sector.
To contribute to the development and implementation of the health policy and
inspection work.
To provide wide improvements in the quality of parent care as per ministry of health
standards.
To technically supervise district health services.
To deliver an agreed range of additional specialist health care services like
orthopaedic workshop, surgery, eye and radiology.
To the highest health standard possible to the region.
1.3.5 Activities of the organization
The activities are categorzed in cases of Curative, Preventative, Rehabilitation, Palliative,
Family planning and Counseling services.
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The activities include;
General health care and treatment including specialised care.
Support services to lower health units.
Health education in schools and communities.
Immunization
Water and sanitation.programmes.
Technical and professional services through support supervision and guidance
1.3.6 Clientele
Clientele comprise patients of both sexes and both Adults and children. The services
Include;Medical Services, Surgical Services, Gynaecological and Obstetric conditions,
Opthalmology, Ear, Nose and Throat,Dental services,Radiological services,Rehabilitative
services, mental health services. Laboratory services, counseling and support services such as
those offered at IDC.
The most common presented conditions are;
Malaria,Diarrhoea,Anaemia,Pneumonia,Respiratory tract infections,HIV/AIDs with all
related complications,Typhoid fever.
Most of the Clients are general patients with simple treatable conditions seen and managed in
OPD but others are referral cases- Complicated in nature, for specialized services that need
admission and care as in –patient.
The Clients come from the catchment are already described above
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1.3.7 Mbale Regional Referral Hospital organogram.
HOSPITAL BOARD
MEDICAL SUPERINTENDENT
PAEDIATRIC
PATHOLOGY
ANAESTHESIA
CLINICAL SERVICES
OBS/GYNAECOLOGY
GENERAL SURGERY
E.N.T
ORTHOPAEDIC SURG
OPHTHALMOLOGY
DENTAL
MEDICINE
COMMUNITY HEALTY
DIAGNOSTIC THERAPEUTIC SE SERVICE NURSING SERVICES FINANCE & ADMINISTRATION
ADMINISTRATION
PROCUREMENT
HUMAN RESOURCE
REGISTRY
FINANCE
SUPPLIES
ENGINEERING
MEDICAL RECORDS
SECURITY
SPNO
PNO
AREA MANAGERS
SNO
NURSING OFFICERS
E/N/M
MED. SOC. WORKER
DOMESTIC ASSISTANT
RADIOLOGY
LABORATORY
PHYSIOTHERAPY
OCCUPATIONAL
PHARMACY
NUTRITION
INTERNAL AUDIT
SUPPORT STAFF
CHAPTER TWO: MANAGEMENT OF THE INTERNSHIP EXERCISE.
2.0 Introduction
The previous chapter, mainly focused on the background of the internship exercise and its
importance. This particular chapter will look into management of the internship exercise as a
key aspect and the activities that the internee participated in, how different departments
correspond with the work duties. This chapter also covers the activities which were carried out
by the student. It includes how activities were conducted, the skills and methods of Social
work put into practice, principles, roles and values.
2.1 Reporting And Induction at the Organization
I reported to the Organization (MRRH) and to the Principal Hospital Administrator’s office
in particular on the 2nd of September 2011. He allocated me to IDC unit and placed me under
the supervision of the sister In-charge IDC Mrs. Mutenyo Beatrice
The Sister In-charge briefed me about the Organization (MRRH)-background, mission,
vision, strategic objectives, services offered its clientele and Organization structure.
Orientation/induction was done during the course of the first week to expose the internee to
various sub-departments under IDC like reception, Counseling, Laboratory, Data, and the Post
test Club among others. This process gave the ad open mind to draw her work plan for the
internship and also get familiar with the different departments directly working with IDC. She
further briefed the internee about the duties and responsibilities of the Department and the
operation of the entire Hospital-giving me first hand practical experience of the Organization.
2.2 The Department to Which I Was Assigned
2.2.1 Category Of The Department
I was assigned to carry out my Internship under counselling which falls under specialised care
in IDC. IDC is a Unit that offers general and speciallised care for HIV/AIDS patients with a
total of over 3500 active patients in HIV care. IDC falls under the Medical departmet of the
hospital.
2.2.2 Services Offered At The Department.
The department provides general and specialised care to HIV and AIDS patients. These
services or activities can be categorised as below;
Orientation
Reception
Counselling services
Nutritional support
Health Education
Laboratory services which include CD4 tests, etcetra
PMTCT
Palliative care
Care and Treatment (for both ART and Pre-ART clients)
Early Infant Diagnosis for HIV exposed infants including follow-up.
Community support and follow-up.
Community outreaches.
THE COUNSELLING DEPARTMENT
The counselling department was the main department in IDC in which i carried out my
internship exercise and is headed by Miss Nandala Constance with the assistance of other
members like.
The counselling department at IDC provides psycho-social support and care to clients living
with HIV and AIDS.
The Counselling department provides counseeling to all clients that pass through the clinic
and these services can be discussed as below;
a) Pre- test counselling. Pre-test counselling is offered to clients before testing to make
client be firm or ready with the results he/she is going to receive. It is mainly about the
reasons for testing, marital history, confidentiality, Information about IDC, previously
tested for HIV, couple testing, behaviours of the client, among others.
b) Post-test counselling. It is done after a counsellor has given out results to the client. Post-
test counselling is offered to clients according to the results that the client has got, for
example, clients found HIV positive are counselled on how to maintain a positive life and
stay longer and healthy with the virus like doing light physical exercises, feeding on the
balanced diet, seeking social support, spiritual care adherence to drugs among others.
Whereas negative clients are counselled on how to maintain that negative life by being
faithful to one partner, ensure correct condom use or abstain from sex.
c) Adherence Counselling/ART prepartion. Here clients are educated on the why
complete adherence to drugs are needed. Information about what the client should expect
or feel after starting ARVs is dissimeted. The clients is also furnished with information
about how to take the pills, when, and what to do if one forgets a dose. They are also
encouraged to get a treatment supporter. This sessions are mainly for preparing clients
who are naive to ARVs for lifetime treatment taking ARVs. However, clients who are
already on ARVs and are non-adherent are also counselled or reminded about the
importance of taking ARVs. These sessions are very important for the clients.
d) On going/supportive counselling. for clients already enrolled in care or taking ARVS.
social problems may arise affecting their adherence and affecting their health. Hence the
need for supportive or on going counselling. Here issues discussed include how to contact
the clinic, symptom management/palliative care at home, prevention of opportunistic
infections, shared confidentiallity. clients are advised to attend this sessions with their
caregivers or encouraged to get one for those who dont have.
e) Couple Counselling. Clients are advised on positive prevention especially the discordant,
safe living, the never party is also encouraged to taste and support the positive one.
f) Nutritional Counselling. This is aimed at equipping clients with information about good
dietry, good feeding practices. The severely moulnourished clients are reffered for
nutritional supplements as the counselling on good feeding habits goes on.
LABORATORY DEPARTMENT.
The laboratory department has a significant role in the centre as its where the tests that inform
decision are done.
It is headed by Mr. David Baliruno and boasts of a rich number of staff each performing
different duties.
The laboratory offers both free and paid tests. Most of HIV and AIDS clients enrolled at IDC
are eligible for free laboratory services. However, some of the services are paid for.
The tests done in the laboratory include;- CD4 tests, Viral Load, CBC, pregnancy tests,
among other tests all vital for proper monitoring of HIV and AIDS cleints.
Phlebotomy/Bleeding of patients.
This is where the sample of blood is drawn from clients by use of cotton wool with spirit,
injection that sucks blood in the test tube and there after they attach the numbers to the client’s
sample and the form for tracking purposes.
Laboratory room.
After getting the sample from client, it is taken in the lab for testing. They first put the sample
in centrifuge machine to separate the cells. In those cells formed, there are white blood cells,
red blood cells and plasma where by they use plasma for testing.
In testing the sample they have three testing procedures i.e. Determine, Dipstick for
Confirmatory (start perk), Un- gold (tie-breaker).
The sample is first put on a determine, if it reacts, you go to another procedure which is
dipstick/ start park for confirmatory. If it also reacts, then the client is HIV positive you end
there but when it does not react, you go to another step that is uni-gold, if it reacts the client is
positive at least the procedures should show the same result,CD4 count and other tests are
carried out.
DATA DEPARTMENT
This is the bank for all the patients records and information. The data department plays one of
the biggest roles in IDC since data in used to measure the performance of the clinic in terms
of services delivery to its clients.
This department is Headed by Mr. Aleu Philip the Data Manager with two data assistants.
The Data department at IDC represents the Monitoring and Evaluation system of the centre
and uses both Paper based and electronic systems for monitoring patients.
The Data department plays a supervisory roles as far as data capture into the MOH standard
Data collection tools concerned.
It also ensures that data is entered into the computers and saved securely for future references
and research.
It is this same department that compiles reports both periodically and adhoc. These progress
reports are then subbmitted to different funding organization and MOH for planning purposes
and decision making.
PHARMACY
Here drugs are supplied to the clients. Both ARVs and Septrins. This department is headed by
a pharmacy technician one Mr. Titus Watoya.
Some drugs other than ARVs and Septrin for treating opportunistic infections are also present
in the pharmacy and clients can access these drugs at no cost.
RECEPTION
This is the starting point for everybody including the clients. Its also the inquiries point. The
reception is responsible for registering all clients which involves filling of background
information and giving of file numbers to clients serially. Here information like, name, place
of residence, and other demorgraphics about clients are recorded into the Pre-ART book. New
files are then opened up for the new clients baring their client numbers.
This sub-department is also under the counselling department and occupied by a counsellor at
any one time.
2.3 The Activities And Tasks I Participated In
Orientation.
This was the first activity in the reporting week. There was listening, noting down and asking
where neccessary. Answers were provided by the other counsellors and nurse in-charge,
counsellor volunteers also where of great help. I learnt lessons about the centre, its principles,
values, methods and activities.
Reception and Recording.
The reception signifies the starting point for clients. Directions including other relevant
information is given to clients here. forexample those who need a transfer in and refered to the
enrollment room in order to record and enter the client’s records into the files with the
guidance of the clinicians.
HIV Counselling and Testing/Guidance
The student/internee participated in the counselling of clients and guiding them with the help
of the information on the ART card. This was done in the counselling room and it also helped
the student know the preferences of the different clients.
During the counselling sessions, the internee educated the clients following well laid out
guidelines on how to take drugs/pills that is to say pre-ART counselling. A lot of information
was shared here between the internee and clients with the help of a counsellor in some
instances.
The internee also prepared clients who were to be tested for HIV and also those already tested
for HIV. Hence the internee participated in both Pre-Test and Post-Test Counselling.
Clients who tested HIV positive would be sent to the internee to prepare them for lifetime
treatment of HIV and AIDS. This sessions demanded high levels of communication skills and
sometimes clients would become emotional and break down. This demanded emotional
strength on the side of the internee.
Ongoing Counselling.
This involves the continuation of counselling following poor adherence, client initiated or as
instructed by the clinicians. This called for high levels of communication skills and sharing of
information between clients and the internee showing confidentiality. This internnee
participated in this sessions daily some of which where group sessions.
Health Education
The internee educated the clients on how to live positively for example on dietry, prevention
of other infections or diseases, sharing confidentiality. Stigma and its disadvantages. These
health education sessions were usually carried out in the morining in the clients waiting area
before the clients receive any other services. The Health Education sessions provided both the
clients and the internee with more knowledge since the communication was two way and the
clients were actively participating. This sessions usually lasted 20 minutes and were
interactive sometimes in all languages so that all clients would understand.
Early Infant Diagnosis/PMTCT
This involved counselling both pregnant mothers and those who have delivered about HIV.
The internee participated in PMTCT counselling on how to prevent HIVfrom reaching the
newly born or unborn baby, Safe Infant Feeding or Breast Feeding practices etc. Taking
prescriptions under the doctor’s instructions, educating them on family planning methods
among others.
Pre-ART Counselling
The Internee also participated in educating the clients to be started on ARVs on good practices
about taking drugs. This often involved discussions with the clients about when to take drugs,
in most cases the clients who decide and the internee would advise or inform basing on the
decision of the clients.
These sessions where highly interactive. Sometimes the clients would inform the internee that
they were not ready to start taking the drugs. Several Counselling sessions would be done
before the final decision is made. This built strong relationships between the internee and
clients based on mutual trust.
Data Related tasks/Sorting and Retrieval of files
The internee participated in sorting of clients files for the next day together with volunteers.
The task involved picking files out from the file cabinets according to the appointment lists
and arranging them to await the next day.
The internee also helped in putting back clients results from the laboratory into their
respective files so that by the time they are due for their next scheduled visit, their results
would be in their respective files.
These tasks were carried out in the data room or files room.
Meetings
The internee attended and participated in the monthly meetings of the units. Each department
under the unit was to report on its progress, challeges and a wayforward would be developed.
In one of meetings the internee was put to task to present a report on the challenges faced by
the counsellors in the counselling department. This helped to build good communication skills
the internee greatly benefited from.
2.4 The Officers I Worked With And What They Do
The Nurses.
The three Nursing officers i worked with headed by the sister in-charge where all helpful in
guidance and in mentoring me during my internship exercise.
The sister in-charge played the supervisory role for all nurses and counsellors in the unit. The
other nurses helped in the day to day tasks like weigting of patients, traiging, etcetra.
Counsellors.
The counsellors provide couselling services to the clients thoughout the week. The internee
spent most of her time with the counsellors sometimes counselling clients together or
mentoring the internee.
Data Manager.
Was very helpful when it came to informing the internee about the client load in the unit. The
date manager provided the internee with details about the numbers of clients attending. This
enabled the internee plan her activities basing on the workload.
The internee also helped the data manager sort files to be entered into the electronic database.
Phlembotomist.
The phlebotomist was responsible for drawing blood for testing from the clients. Some of
clients were sent directly to the phlembotomist from the internee after undergoing pre-test
counselling.
Clinicians.
This included doctors and clinical offiers who sometimes sent clients to the internee for
adherence and ongoing counselling/support. The clinicians treat the different clients, diagnise
different infections and prescribe drugs for the clients.
2.5 Relationship With Other Officers In Executing My Duties And Responsibilities
Generally the relationship with all officers,those identified above and many others was good.
They were all very helpful to me executing my duties and responsibilities.
They were co-operative and accorded me the necessary assistance.Most duties and
responsibilities were carried out under instruction/supervision of the sister in-charge who was
my work supervisor
2.6 Role Of The Work Supervisor
She ensured that I was orientated into the Organization and in Particular the different sub-
departments in the department to which i was assigned.
She ensured that I arrived intime and involved me in the daily work in the unit as much as
possible.
She assigned me duties and responsibilities and aided me in execution of these duties.
She endeavoured to explain the relevant policies and norms of the Organization to the
internee.
She played a motherly and supervisory role to me mentoring me and critising me where
necessary.
CHAPTER THREE: METHODOLOGY
3.0 The Social Work Functions That MRRH Adheres To
Mbale Regional Referral Hospital like any other health care agency has a setting for providing
health care services to the society. It has become a social instrument which faces the
community and, if functioning properly, should be able to reflect the communities wants and
needs.
Broadly, Mbale Regional Referral Hospital’s activities or services focus on curative,
preventive and/or educational, and rehabilitative functions of social work.
Curative:
Its primary function is curative and this is concerned with providing patient care and treatment
with the goal of eliminating factors that have caused breakdown of functioning. This care can
be categorised into short-term, intermediate term, and long-term care. The treatment of
patients is done by way of inward, OPD and as clinic patients for example the its HIV clients
at IDC are managed as clinic patients. This is generally the care given to the patients by the
staff e.g. physicians diagnising diabetes, surgical operations, treatment of malaria, ART care.
etcetra.
Preventive and/or Educational functions:
Mbale Regional Referral Hospital recognizes the importance of the preventive, promotive
and/or educational components of health care, and provides all the required services through
its infrastructure to the fullest extent possible. Through its community health department and
by use of its periodic reports, the hospital has been able to track and monitor the incidence and
prevalance of all communicable diseases consequently taking the neccessary preventive
action. Various programmes have been designed to inform and educate the people so that they
share a responsibility in preserving good health by adopting healthy life-styles. These
programmes are focused mainly on the high risk groups such as pregnant mothers and
children. One of such programmes is the HCT programme in the hospital. HIV counselling
and Testing is done in all units with the aim of reducing its spread among people, especially
the vulnerable groups. All mothers attending Antenatal are tested for HIV in its PMTCT
programme. Health Education on HIV prevention is done every morning in most of the units,
emphasis is made abstainence, condoms are distributed freely and all clients encouraged to
test for HIV. This programmes also extends out to the community through the community
outreach campaigns. Like the Immunization and VCT campaigns.
Rehabilitative functions:
This falls under specialised care in the hospital. The hospital has specialised staff that are
resposible for the provision of these services. These include, Physiotherapists, counsellors,
nutritionists, occupational therapists. etcetra.
3.1 Approaches To Health Care Delivery Used By The Agency
MRRH uses a Primary Health Care (PHC) approach to health service delivery where by its
services are universally accessible to individuals of all ages, income brackets, and families in
its catchment area at a cost that the community and the country can afford. Most of the
services in the hospital for example malaria drugs are free while a client might be asked to
buy a special drug if not available in the hospital. PHC is an approach to health that focuses
on health equity – producing social policy.
For example in IDC, ARVs and other HIV services such as counselling and test are accessible
freely by anyone irrespective of age, social status (income level) or background.
The principles of Primacy health care are relavant today not just for the organization of health
care systems, but also for how health care systems should act as an engine for promoting
health and development more generally, and as an instrument for promoting equity and
empowering the poor.
3.2 Methods Of Social Work Used By The Student And Agency
MRRH employs casework, groupwork and community work, social welfare administration
and social research methods in the execution of its social work activities. Some of the
methods are used more frequently than the others depending on resource availability like time,
or space. The decision to use one of the methods in preferance of another depended on the
type of case.
Casework Method
This was the method that was most commonly used by the organization and hence the internee
in carrying out tasks. This method tries to help the client, find a solution of their problem of
social adjustment which they are unable to handle in a satisfactory way by their own effort.
At IDC this method was mainly used to prepare an HIV infected client to join the HIV
support group for meaningful living with HIV. The internee was able to go deep into the pains
of an HIV infected person and enable the client to face up to the problem. Interviewing and
assesement were major tools of casework.
The internee also used casework dealing with clients during pre-test HIV counselling. For
example the internee encountered a 17-year old unmarried student who had sex with only one
partner fealt “safe” because she was not sleeping around. She reported that her and partner
were not using condoms, as she is very sure that she and her partner are mutually
monogamous. She was willing to take an HIV test and saw the need for her partner to get
tested, but was reluctant to discuss it with her partner because she felt she didn’t want to get
into that kind of discussion with partner stating that it would have a negative reaction from
him since it had happened in the past.
The internee was able to assess that the client was conteplative about getting her partner tested
for HIV because she saw the need to know her partner’s status, though she considered the
action to be risky for her relationship.
The strategy the internee used was to invite the client to compare the benefits of getting her
partner tested (knowing that she was not at risk for acquiring HIV) versus the negative
consequences (her partner getting angry at her because of questioning his sexual history). The
internee then offered a substitute by suggesting that the client can tell her partner that the
hospital is recommending HIV testing to all clients and their partners. The client can then
suggest that the partner be tested as part of a routine medical recommendation, without the
need to disclose or mention past sexual history. The client agreed to try the approach.
Group work
This was applied in conditions were resources were scarce yet information was to be reached
to big number of clients. In otherwords, the HIV infected individuals are much in need of
group help. The group work focused the HIV infected individual in the group. The group
Itself was a platform where the HIV clients were able to freely express themselves and share
their problems and help one another. This group work The internee was instrumental in
organizing the group, guiding the group work process. Mutual acceptance was the basis for
the group work.
The internee found that it was easier to help an HIV infected person to change his/her attitude
to the rest of one’s life in a group setting than to change one through case work.
Community organizaiton work.
This was mainly steered by the community linkages coordiantor who is stationed at IDC. Here
people of a particular community would be called for a meeting at IDC or even at the
community and discuss necessary action to prevent and control the spread of HIV. However
the internee did not participate much in these activities.
Social Welfare Administration
In providing services to the HIV/AIDS patients the hospital uses a few professionally trained
social workers to man the service delivery towards this pandemic. This is evidenced by the
existance of a hospital health worker.
Social Work Research.
For the effective implementation of any HIV related programme in the hospital, the role of the
social work research has not be neglected. The hospital has a centre for Epidermiology and
research. The issues surrouding HIV/AIDS are very sensitive to individuals, groups and
communities. The hospital social worker is the most ideal person and therefore works hand in
hand with the epidermiologist to assess these social issues and the type of gender dimensions
of HIV/AIDS.
3.3 Different Skills Employed By The Internee During Fieldwork
Since counseling is a conversation or dialogue between the counselor and client, the counselor
needs certain communication skills in order to facilitate change. The internee used the
following communication skills in executing the tasks.
1. Attending
Attending refers to the ways in which counselors can be “with” their clients, both physically
and psychologically. The Internee used effective attending to inform clients that she was with
them and that they can share their world with the internee. Effective attending also put the
internee in a position to listen carefully to what the clients were saying.
Effective attending demanded eye contact with the client, being natural to the client, leaning
forward toward the client (when applicable), maintaining an open posture, and being relaxed
as much as possible. Effective attending puts counselors in a position to listen carefully to
what their clients are saying or not saying.
2. Listening
Listening refers to the ability of counselors to capture and understand the messages clients
communicate as they tell their stories, whether those messages are transmitted verbally or
non-verbally. When a client tells you his or her story, it usually comprises a mixture of
experiences (what happened to him or her), behaviours (what the client did or failed to do),
and affect (the feelings or emotions associated with the experiences and behaviour). The
internee has to listen to the mix of experiences, behaviour and feelings the clients used to
describe their problem situations. It was also important to “hear” what the client is not saying.
so as to make correct judgements.
3. Basic empathy
The Internee employed basic empathy when couselling clients. This involved listening to
clients, understanding them and their concerns as best as she could, and communicating this
understanding to them in such a way that they might understand themselves more fully and act
on their understanding. To listen with empathy meant that the counsellor must temporarily
forget about his or her own frame of reference and try to see the client's world and the way the
client sees him or herself as though he or she were seeing it through the eyes of the client. The
internee was then able to share this understanding of the client's world with the client in either
a verbal or non-verbal way.
4. Probing or questioning
Probing involves statements and questions from the counselor that enable clients to explore
more fully any relevant issue of their lives. Probes can take the form of statements, questions,
requests, single word or phrases and non-verbal prompts. The internee used probing mainly to
encourage non-assertive or reluctant clients to tell their stories, to help clients to remain
focussed on relevant and important issues, to help clients to identify experiences, behaviours
and feelings that give a fuller picture to their story, in other words, to fill in missing pieces of
the picture, to help clients to move forward in the helping process and to help clients
understand themselves and their problem situations more fully
5. Summarizing
The internee found it sometimes useful to summaries what was said in a session so as to
provide a focus to what was previously discussed, and so as to challenge the client to move
forward. Summaries were particularly helpful at the beginning of a new session. A summary
of this point can give direction to clients who do not know where to start; it can prevent
clients from merely repeating what they have already said, and it can pressure a client to move
forwards.
6. Observation
It was necessary to observe the client wholly. This required a lot of attention especially when
the client is telling their story. Observation is especially important to be able to listen to the
non-verbal communication from the client.
3.4 Various Techniques Used When Handling Cases.
Social Skills Training
Social skills training is a type of psychotherapy that works to help people improve their social
skills so they can become socially competent. It is predominantly a behavioral therapy and can
be done one-on-one or in a group situation. For example the internee in one or two cases dealt
with situations where an HIV client had to be given skills on how to stop excessive
consumption of alcohol yet the client lives in an area where there is excessive consumption of
alcohol.
Assertive Training
Assertiveness training is a form of behavior therapy designed to help people stand up for
themselves—to empower themselves, in more contemporary terms. It is a response that seeks
to maintain an appropriate balance between passivity and aggression. Assertive responses
promote fairness and equality in human interactions, based on a positive sense of respect for
self and others. The internee used this technique when dealing with HIV positive adolescents
who had lost a lot of self esteem because of stigmatization. Group sessions where organized
with role-plays.
Rational emotive therapy
The internee used this technique to encourage the HIV clients to focus on their emotional
problems in order to understand, challenges and change the irrational beliefs that underpin
these problems. For example some clients believed that they would not live for more than 10
years. These irrational beliefs greatly caused a lot of emotional problems. The internee here
had to explain the truth and help to eliminate those beliefs.
3.5 Application Of Theories Of Social Work Used
Every social worker wants to do good and make the world around him a better place to live.
How exactly one goes about solving a particular social problem depends on its nature as each
one is unique in itself. Sound social work theory provides the path to analyze the root cause of
the problem and identifies the way to choose the best course of action. Of course there are
more than one better solutions to any problem and many levels at which a problem can be
dealt with. It draws on sociology, psychological theory, economics and even political science
to analyze the various aspects of a social problem. It provides ways in which people can be
helped on a personal and social level, to overcome their hardships.
Social Cognitive Theory
Social cognitive theory attempts to understand social problems through the lens of individual
psychology. An individual and his behavior affects and is affected by society. Antisocial
behavior, which is the cause of many social problems occurs due to psychological problems
and imbalances on an individual level. Social cognitive theory aims at solving social problems
through counseling of people at an individual level. It relies on the individual efficacy to
power the change that one wants to see in a society.
The social cognitive theory explains how people acquire and maintain certain behavioral
patterns, while also providing the basis for intervention strategies (Bandura, 1997). Evaluating
behavioral change depends on the factors environment, people and behavior.
It views the adoption of behaviors as a social process influenced by interactions with a person
and others in their environment. Two primary components of this theory are: 1) modeling of
behaviors we see others performing, and 2) self-efficacy, a person’s belief that s/he is capable
of performing the new behavior in the proposed situation.
If people lack awareness of how their lifestyle habits affect their health, they have little reason
to put themselves through the misery of changing the bad habits they enjoy. They are lectured
more than they want to hear about their unhealthy practices. Applications of theories of health
behavior have tended to assume adequate knowledge of health risks. It is usually high.
Knowledge creates the precondition for change. But additional self-influences are needed to
overcome the impediments to adopting new lifestyle habits and maintaining them.
Beliefs of personal efficacy occupy a pivotal regulative role in the causal structure of social
cognitive theory (Bandura, 1997). Perceived self-efficacy refers to beliefs in one's capabilities
to organize and execute the courses of action required to produce given levels of attainments.
Although a sense of personal efficacy is concerned with perceived capabilities to produce
effects, the events over which personal influence is exercised varies widely. It may entail
regulating of one's own motivation, thought processes, affective states and behavior patterns,
or changing environmental conditions, depending on which aspects of life one seeks to
manage. Efficacy belief is a major basis of action. Unless people believe they can produce
desired effects by their actions, they have little incentive to act or to persevere in the face of
difficulties and setbacks. Whatever else may serve as motivators, they must be founded on the
belief that one has the power to produce desired changes by one’s actions. Exercise of control
requires not only skills, but a strong sense of efficacy to use them effectively and consistently
under difficult circumstances. Efficacy beliefs not only operate in their own right. They act on
other determinants in the regulation of behavior (Bandura, 1997).
Beliefs in one's learning efficacy and efficient deployment of effort enhance acquisition of
knowledge and skills for managing the demands of everyday life. Efficacy beliefs also
regulate motivation by determining the goals people set for themselves, the strength of
commitment to them and the outcomes they expect for their efforts. Belief in the power to
produce effects determines how long people will persevere in the face of obstacles and failure
experiences, their resilience to adversity, whether their thought patterns are self-hindering or
self-aiding, and how much stress and depression they experience in coping with taxing
environmental demands. The beliefs that people hold about their capabilities, therefore, affect
whether they make good or poor use of the skills they possess.
This theory is greatly employed in Behavioral interventions to reduce the transmission of HIV
infection among sex workers and their clients through the promotion of condom use among
the sex workers.
3.6 The Different Principles And Values Adhered To During The Internship
The principles and values adhered to by the internee during the internship exercise are based
on social work’s core values of service, social justice, dignity and worth of the person,
importance of human relationships, integrity, and competence. These principles set forth
ideals to which the internee aspired to.
Value: Service
Ethical Principle: Social workers’ primary goal is to help people in need and to address
social problems.
The internee elevated service to others above self-interest. The internee drew on her
knowledge and skills to help people in need and to address social problems with no
expectation of significant financial return (pro bono service).
Value: Social Justice
Ethical Principle: Social workers challenge social injustice.
The internee pursued social change, particularly with and on behalf of vulnerable and HIV
oppressed individuals and groups of people. The internee’s social change efforts were focused
primarily on issues of poverty, unemployment, discrimination, and other forms of social
injustice. These activities sought to promote sensitivity to and knowledge about oppression
and cultural and ethnic diversity. The internee strived to ensure access to needed information,
services, and resources; equality of opportunity; and meaningful participation in decision
making for all people.
Value: Dignity and Worth of the Person
Ethical Principle: Social workers respect the inherent dignity and worth of the person.
The internee treated each client in a caring and respectful fashion, mindful of individual
differences and cultural and ethnic diversity. The internee promoted clients’ socially
responsible self-determination. The internee sought to resolve conflicts between clients’
interests and the broader society’s interests in a socially responsible manner consistent with
the values, ethical principles, and ethical standards of the profession.
Value: Importance of Human Relationships
Ethical Principle: Social workers recognize the central importance of human relationships.
The internee as a social worker understood that relationships between and among people are
an important vehicle for change. She engaged people as partners in the helping process to
strengthen relationships among people in a purposeful effort to promote, restore, maintain,
and enhance the wellbeing of individuals, families, social groups, organizations, and
communities.
Value: Integrity
Ethical Principle: Social workers behave in a trustworthy manner.
The internee acted honestly and responsibly and promoted ethical practices on the part of the
organizations with which they were working. The internee was continually aware of
profession’s mission, values, ethical principles, and ethical standards and practiced in a
manner that was consistent with them
Value: Competence
Ethical Principle: Social workers practice within their areas of competence and develop and
enhance their professional expertise.
The internee only provided services and represented herself as competent only within the
boundaries of their education, training, license and supervised experience. She continually
strived to increase her professional knowledge and skills and to apply them in practice. Social
workers should aspire to contribute to the knowledge base of the profession.
Value: Privacy and Confidentiality
Ethical Principle: Social workers should respect clients’ right to privacy.
The internee respected the clients right to privacy and did not solicit private information from
clients uncless it was essential to providing services or conducting social work evaluation.
And once private information was shared, standards of confidentiality applied.
Value: Informed Consent
Ethical Principle: Social workers should provide services to clients only in the context of a
professional relationship based, when appropriate, on valid informed consent.
The internee used clear and understanding language to inform clients of the purpose of the
services, risks related to the service, relavant costs, reasonalble alternatives, clients’ right to
refuse or withdraw consent, and the time frame covered by the consent.
3.7 Application Of Social Work Roles During The Placement
Enabler:
In the enabler role, the internee helped the clients become capable of coping with situations related to HIV or
transitional stress. for example coping with the fact that they had to take ARVs for life The internee as a social
worker conveyed hope, reducing resistance and ambivalence, recognizing and managing feelings, identifying
and supporting personal strengths and social assets, breaking down problems into parts that can be solved more
readily, and maintained a focus on goals and the means of achieving them.
Advocate:
Advocacy involved directly representing a course of action on behalf on one or more clients, groups, or
communities, with the goal of securing or retaining social justice. The advocate role involved stepping forward
and speaking on behalf of the clients. Sometimes clients felt shy to open up to doctors and felt secure with the
internee. The internee would then be an advocate to the clients. The advocate role was one of the most
important roles assumed by the internee despite its potential difficulties since it involved speaking for the the
depressed HIV clients.
Negotiator:
As a negotiator the internee helped the different clients by effectively representing them and
helping them get services from the organization. A majority of clients needed some basic or
extra services for example mosquito nets and it was difficult for them to burgain and receive
these services. Here the Internee came in as a negotiator helping the clients get what they
needed.
Mediator:
The internee used the mediator role in resolving arguments or conflicts clients had with their communities or
the organization. Such cases involved divorce due to HIV discordancy and child custody cases. The internnee
observed that many children who lost their parents due to AIDS and were themselves infected had been
neglected in communities they lived in. As the mediator the internee helped the different families and
communities work out such differences while maintaining neutrality.
Integrator/Coordinator:
Integration is the process of bringing together various parts to form a unified whole.Coordination involves
bringing components together in some kind of organized manner. The internee as a social worker functioned as
an integrator/coordinator in may ways, ranging from advocacy and identification of coordination
opportunities, to provision of technical assistance, to direct involvement in the development and
implementations of service linkages for example identifying and linking mulnourished HIV clients to
nutritional services.
Manager:
Management in social work involves having some level of administrative responsibility for a social agency or
other unit to determine organizational goals. As a manager the internee was involved in activities like
acquisition of resources and allocating them to carry out programs; coordinating activities towards the
achievement of selected goals; and monitoring the process and structure to improve , assess, and make
necessary changes in processes and structure to improve effectiveness and efficiency. For example the internee
was involved in the procurement of Airtime to call lost-to-follow up HIV clients.
Educator:
The educator role played by the internee involved giving information and teaching skills to clients and other
systems within the organization. for example educating clients on male safe-circumssion, positive prevention,
adherence to ARVs etc.
Broker:
As a broker the internee helped link clients with community and organizational resources and services. The
internee as a broker also helped put fallen families together and differnt communities in touch with one another
to enhance their mutual interests, this required that the internnee be familiar with community services, have
general knowledge about eligibility requirements, and be sensitive to client needs. For example the internee
helped clients obtain HIV starter kits and other needed resources.
Facilitator:
A facilitator is one who serves as a leader for some group experience . As a facilitator the internee served as a
leader in family therapy groups, task groups, sensitivity groups, educational groups, a self-help groups, or a
group with some other focus. This involved moderating discussion and setting topics for discussion.
CHAPTER FOUR: FINDINGS AND OBSERVATIONS
4.0 Knowledge And Skills Gained During The Placement
The internee gained alot of knowledge on how to conduct oneself in a multi-disciplinary work
environment. for example the dress code, protocol of reporting and supervision. etc
The internee also learnt alot about time management, how to manage time and plan for
activities. Beating deadlines etc.
The internee learnt a great deal of communication skills. How to handle difficult situations,
the role of communication and its importance. This was gained mainly through talking to
different people in different languages in the organization..
The internee also gained skills in HIV pre-test and post-test counselling, ART preparation
counselling and ongoing and supportive counselling.
The internee was also equiped with skills and knowledge of conselling different categories of
people including marriage couple, youth, adolescents and children.
The Internship exercise also helped me acquire conflict resolution skills. I was exposed to alot
of conflicts that need my input to have them resolved, this helped me gain knowledge and
skills on how to resolve conflicts.
4.1 How I Intend To Utilize What I Have Learnt For My Professional Development
The internee dealt basically with people (clients) both internal and external, concepts of
human behavior, growth and development, social psychology, HIV/AIDS and
communication skills came into play, I couldn’t have managed without the knowledge of
these subjects. For instance, social psychology helped me to deal with persons
individually when it comes to situations where a client cannot express his/herself in
public, I was able to understand when they use physical expressions that occurs as a result
of emotions for example failure to utter a word, body language and change of the voice
tone.
During the internship, the internee realized that it takes many steps (even in a smaller organization)to
achieve a vision. This was ascertained by a number of observations
The Internee observes that teamwork played quite a huge role in attaining most of MRRH mandates. It
was equally important as the ability to work independent.But the goal must be to find a way to combine it
in the right way.
The Internee also learnt how to operate in a multi-disciplinary environment were different
cadres operate in a team for the achievement of a common goal or objective. Team spirit is
very important for the success of any organization and the internee plans to build on her
team involvement skills
The internee also learnt that for any Organization to succeed there is need for a good
administrative body for proper planning, budgeting, directing, Co-coordinating and
Monitoring and Evaluation thus intend to put my administrative knowledge and skills into
use to succeed as a manager one of the roles of social work.
The internee also learnt that for the Organization to thrive there is need for Inter-
departmental Collaboration.
To always delegate some duties and responsibilities in order to ensure efficiency.
Delegation of duties is necessary in order to achieve efficiency and effectiveness since it
reduces work load and occupies as well as motivating those delegated. There were cases
were the internee had to delegate some of the work to other colleagues.
The internee also learnt how to Relate with both superiors (High ranking) Officers and
Subordinates (lower ranking/lower cadre officers) a necessary for any organization to
succeed.
4.2 Personal Contribution To The Organization (My Innovations)
Accomplishing duties and responsibilities assigned to me relieved the Department of
workload to some extent.
Health Education to patients and caretakers is likely to improve on the hygiene of Hospital
Voluntary services provided by the internee that helped the organization achieve its
objectives.
4.3 Challenges Noticed During The Internship (Work Related) That Are Affecting
4.3.1 The Organization
- Lack of enough counselling rooms. Sometimes clients had to be counselled under trees.
- Furniture was not enough.
- The Department i worked with lacked a child friendly environment or other social
amenities like TV etc.
- Lack of adequate education material.
- The organization had only one social worker who was not sufficient to serve in the whole
hospital.
- Working/Operating on Meager budget
- Lack of transport for follow up of clients in the community.
4.3.2 The Workers
- Workload due to understaffing in most units
- Staff welfare is relatively poor given that most staffs are renting out and relatively far
hence making time management.
- The workers salary payments are some times delayed which affects the performance of
their tasks.
- Some staff not adequately trained yet handling difficult cases. In the organization some
counselors are un experienced among them have limited knowledge and skills in what is
expected from their performance.
4.3.3 The Internee
- At the Commencement of the exercise, I met a number of challenges because it was my
first exposure to work given that I have never been involved in practical counselling
before and Health work.
- Practical application of the Lecture theories was at first a bit difficult
- Language barrier was a major problem that the internee faced when in the field most
especially when I was at the reception, other clients knew one language where by we were
not able to understand each other there for a challenge.
- Limited time frame for the Internship exercise makes it difficult to get adequate exposure
to all areas and activities of the Department and organization. The internee had to leave pre-
maturely before the complete products of her effort were finalised.
- Some staff were not willing to cooperative with the internee. Such were not willing to
reveal skills and knowledge to the internee.
- The internee was also financially handicaped during the exercise and this caused serious
financial difficulties since she had to facilitate her transport to and fro the agency, lunch
and breakfast.
CHAPTER FIVE: CONCLUSION AND RECOMMENDATION
5.0 Assessment Of The Internship Exercise In The Organization.
My period of placement in Mbale Regional Referral Hospital good, productive and interesting
because the whole staff of Mbale Regional Referral Hospital and particularly IDC were very
friendly and expressed a high degree of professionalism, hospitality and customer care.
Internship is a very important exercise in the Organization because
- The Internees boost the staffing level by accomplishing tasks
- The Internees bring in new inventions and innovations
- The Internees help the management to identify some problems unknown to them
- The internees help in suggesting solution/recommendation for the Organization to
overcome challenges.
5.1 Recommendations For The Identified Problems.
The following are some of the recommendations the internee was able to draw from her
observation to the problems of both the organization, workers and other parties concerned
and also to help in better service delivery.
The organization should try to motivate their employees/staff in order to improve on their
performance. Fore example paying of their salaries in time and allowances. This is
because it was found out that the staff’s salaries and allowances are some times delayed.
The internee also recommends that once in a while the agency should organize a team
building exercises outside MRRH Complex to its staff in order to bring them closer. This
would give staff time to re-examine what they have achieved so far, share personal
experiences and ideas, learn to be together and appreciate the importance of team work at
work.
There is need to train staff to enable them handle tasks more efficiently, especially those
involved in counselling.
There is need to provide more infrastructure in the form of more conselling rooms since it
was observed that there are very few counselling rooms in the facility.
The agency also need to recruit more staff, especially social workers/cousnellors to handle
the ever increasing number of clients who have social problems and hence need
5.2 Conclusion
From my experience I can wholeheartedly recommend Mbale Regional Referral Hospital’s
internship programme to any social worker who would like to experience an organization that
has in my opinion realized their vision to find the balance between being progressive, able to
balance human concerns and needs, technical considerations and nevertheless being highly
successful in its service delivery and professionalism. What you have to bring with you is the
willingness to improve knowledge about the environment,your work experience and you have
to be able to work independently, self motivated and you must solve smaller problems on your
own.
APPENDIX 1: WORKPLANDate Schedule Activity Venue Objectives/goals Skills Methods Person responsible
1st – 5th
September 2011
Orientation Agency - Visit and learn differnet department and thier
locations
- learning how the activities are carried out and
procedures in the agency
- questioning
- listening
- Sister Incharge
8th – 12th
September 2011
Orientation &
introduction to
the clinic/Unit
Agency - To be guided by the agency supervisor on how
to carryout activities.
- To draw out an internship plan with my work
based supervisor
- to learn how the agency works
- questioning
- observation
- Counsellor francis
15th – 19th
September 2011
Reception Agency - To learn how to welcome clients
- To learn how to use the ART books/registering
clients into the ART books.
- To learn how to direct clients and deliver
services to them
- Questioning
- Listening
- Recording
Casework - Counsellor Fred
22nd – 26th
September 2011
Training in
Counseling
Counselling
department
- To get familiar with counselling practices in the
agency.
- To learn how to enroll new clients into HIV
care
- Questioning
- Observation
Casework Counsellor fred.
Date Schedule Activity Venue Objectives/goals Skills Methods Person responsible
1st – 5th
October 2011
Training in
Counselling &
guidance
Counselling
department
- To know how the activity is done e.g
enrolling new clients into HIV care
- Questioning
- Observation
Casework Counsellor Francis
8th – 12th
October 2011
Enrolling the new
clients
Enrolment
department
- To record the given information by the
client onto the ART cards
- To know the environment in which the
client live i.e asking the place and the
people the clients stay with.
- Questioning
- Assesement.
Casework Counsellor Francis
15th – 19th
October 2011
Counselling and
guidance
Counselling
department
- To maintain the clients’s
confidentiallity and respect.
- To know how to respect the clients
dignity and be trustworthy to the client
- Interviewing
- communication,
listening intensively
Casework Cousnellor Constance
22nd – 26th
October 2011
On going
counselling
Counselling
department
- Learn the counselling procedure
- To learn the observation of
confidentiallity.
- to learn how to help the client make righ
decisions & involve hime or her
actively.
- Advocacy Casework Counsellor Frances &
Consellor Constance
29th – 31st
October 2011
Counselling Counselling
department
- To know to record and report on teh
helping process
- Assesement skills Casework Counsellor frances &
counsellor fred.
Date Schedule Activity Venue Objectives/goals Skills Methods Person responsible
3rd – 7th
November 2011
Health Education Agency - To learn how to educate the clients
on how to live a postive life
- To learn the importance of health
education to the clients
- To learn how to share information
from different clients and their view
about HIV/AIDS
- Communication
- Intervention
Groupwork
method
- Consellor Constance
& Counsellor Fred
10th – 14th
November 2011
Data Recording Data room
in the
agency
- To learn how to transfer the clients’
information into the ART books.
- To access the recorded file numbers
incase of the next appointment by
the doctors
- To know the population of the
clietns in the ART clinic
- Recording
- Observation
- Philip
17th – 21st
November 2011
Prevention of
Mother to Child
Transmission of
HIV
EID
point/room
at the
clinic
- To learn how to teach mothers on
how to feed their babies safely
- To learn how to educate the mothers
about the transmission of the virus
- Communication
skills
Groupwork
method
- Nakate Janet
Date Schedule Activity Venue Objectives/goals Skills Methods Person responsible
24th – 28th
November 2011
HIV cousnelling
and testing (HCT)
Counselling
room at the
clinic
- To learn how to offer the HCT
service
- To learn how to discuss the
importance of knowing one’s HIV
status.
- To learn how to give postive and
negative results to clients.
- Questioning
- Intervention
Casework
method
Counsellor Fred
1st – 4th
December 2011
Counselling Counselling
room at the
clinic
- To deal with a helping
relationship between internee and
the clients.
- To maintain the respect for the
client
- Questioning
- Interviewing
- Assessing
Casework Counsellor Constance