Perceptions of veterinarians regarding privatization of veterinary services delivery in Ghana and Jamaica

There are on-going reforms in the delivery of veterinary services in many developing countries, with privatization of certain veterinary activities as one of the approaches. In Jamaica, with the support of veterinarians, clinical aspects of veterinary services were privatized in 1992. In contrast, Ghanian veterinarians are generally wary of the government's on-going privatization process. The objective of this study is to find out if perceptions of the veterinarians from these two countries on certain issues of privatization were sufficiently different to explain the willingness or reluctance to go into private practice. The response proportions for predominantly self-administered questionnaires were 83 percent (121/145) and 92 percent (35/38) for Ghana and Jamaica, respectively. There was a very good (92 percent) agreement in the perceptions of veterinarians in Ghana and Jamaica on a battery of 24 responses pertaining to privatization of veterinary services. Generally, the perceptions of the veterinarians in Ghana and Jamaica were similar even though the predominant delivery systems for animal health services were different. Therefore, reasons other than those examined in this study may explain the differences in willingness.(Au)

Using focus groups to evaluate an education program

Two evaluation studies were carried out in 1995 and 1997. The first evaluation assessed tile effectiveness of the Psychiatric Nurse Practitioner's education program and its impact on mental health and psychiatry in Belize. The second study was done to determine if the mental health services were sustained in the country. Interviews and focus groups were used for data collection. In this paper the focus is on the findings from the focus groups. The findings show that the PNP's role performance was adequate, they have made an impact on the mental health services and the services are maintained (Au)

Users' perceptions of the quality of maternal and child health (MCH) services in Grenada

What do users think about the Maternal and Child Health (MCH) Services provided at government run community health facilities in Grenada? This study was done to analyse the quality of MCH services delivered, according to the perception of the users. Data were collected using a pre-tested structured questionnaire, focus group discussions and natural group interviews. 237 users of MCH services were interviewed at randomly selected community health facilities. Ninety-six percent of users were of the opinion that their health workers showed interest and understanding and were friendly and courteous. Ninety-six percent of users were comfortable with the health workers who attended to them. Ninety-two percent of users were questioned by health workers. However, 26 percent received no explanations and instructions. Forty-nine percent of users perceived consultations with health workers to be short. The hours of service delivery were inconvenient for employed persons using the service. Statistically significant differences existed in user satisfaction by location of facility and type of facility at which care was received. Areas identified for improvement include health workers' inter-personal relations and infrastructure, including the availability of sanitary facilities and supplies for users. 65 percent of users of MCH services were not gainfully employed (37 percent unemployed, 28 percent housewives). Occupational status and educational attainment levels of respondents reflected a disproportionaly higher number from lower socioeconomic groups among users of the MCH services. Rescheduling of hours for service delivery is recommended to encourage more employed persons to use the services.(AU)

Experience of parents of children with disabilities with health services in Jamaica

In order to determine the experiences with health services of caregivers of children with disabilities (CWDs), and the attitudes of health care workers (HCWs) towards CWDs and their caregivers, a survey was conducted of 26 caregivers of clients of 3D project, St. Mary, Jamaica, using a checklist, and of 113 HCWs in St. Mary and Kingston who completed a questionnaire. Half of the CWDs referred by the HCWs to hospital in Kingston because of the lack of facilities in St. Mary eventually defaulted because there was no apparent improvement. 10 caregivers said that the cause of the disability was not explained, three others did not understand the explanations given, and only 4 understood the instructions of HCWs. These problems led to unrealistic expectations about the outcome of rehabilitation. 13 caregivers attributed disabiltiy of their CWDs to negligence, carelessness or poor treatment by HCWs during pregnancy or the early neonatal period. 87 percent of the HCWs, particularly Community Health Aides (CHAs), acknowledged at least some responsibility for the care of CWDs; but 10 percent, notably some nurses and midwives, denied responsibility. 90 percent referred patients for further care and 90 percent thought that they had made an impact on caregivers' "belief"; but more than half the CHAs, and 25 to 30 percent of the other groups, expressed dissatisfaction with their management of CWDs. This study has highlighted inadequacies in the care of CWDs in St. Mary and indicates that more appropriate preparation of all health staff for this important aspect of their work is required.(AU)

Experiences of parents of children with disabilities with the health services in Jamaica - abstract

A survey was conducted in the parish of St Mary, Jamaica, in 1996, to gain a better understanding of experiences of parents of children with disabilities (CWDs) with health services, and to determine the attitudes of health care workers (HCWs) towards CWDs and their parents. Twenty-six personal interviews were conducted with the caregivers of clients (CWDs) of 3D Projects using a predefined checklist as a guideline, and 113 HCWs completed a questionnaire with closed and open-ended questions. The health services in St Mary do not offer much special help to CWDs, so doctors referred CWDs to hospitals in Kingston. After a while parents stopped going there because they did not see any improvement. Parents claimed the information given by medical personnel was too vague or too difficult to understand. They therefore have unrealistic ideas about the rehabilitaton possibilities for their children. It seemed that parents with a positive attitude towards their child and the disability had better experiences with health services. The majority of problems parents experience have to do with communication. HCWs are not adequately trained to manage all aspects of disability. Therefore they only feel responsible for medical care and treatment. There is also an educational barrier between doctors and parents. This, together with inadequate training, results in doctors not explaining at the parents' level of understanding. The findings have a wider implication than just the childhood disability field as it was found that many parents blame medical personnel for their children's disabilities, believing that unexplained procedures, treatment or neglect damaged their children. Clearly there is a need for more appropriate preparation of all health staff so that parents get full and clear information from the start. It is incumbent on medical staff to find ways to communicate more effectively so that parents can understand, use, follow through and get information even when no medical treatment is necessary. (AU)

Knowledge attitudes and practices of breastfeeding among health care workers in selected hospitals in Jamaica

The decline in breastfeeding has contributed significantly to infant morbidity and mortality worldwide. This has captured the attention of the United Nation's Children's Fund (UNICEF) and the World Health Organization (WHO) who have identified corrective strategies. Jamaica, like many other developing countries has experienced the effects of this decline and has adopted strategies to protect, promote and support breastfeeding. These include implementing the "Ten Steps to Successful Breastfeeding" and adopting the Baby Friendly Hospital Initiative. As an initial step, the Ministry of Health has embarked on an agressive training programme in lactation management for health care workers. The aim of this project was to determine the knowledge, attitudes and practices of the health care workers in selected hospitals being prepared for the initaitive and those which are not being prepared, 112 health care workers involved in the care of patients in the maternity ward were interviewed. Mean scores of knowledge, attitudes and practices were relatively high. Health workers in the hospitals being prepared for the initiative had higher scores in all three areas than those not being prepared. Althought the association between knowledge and attitudes and knowledge and practices did not appear to be significant, there was a strong positive relationship between attitudes and practices. There is the indication for continued training to increase the knowledge base and practices to complement their positive attitudes. (AU)

Attitudes of medical students toward the acquired immune deficiency syndrome (AIDS)

Several studies have reported negative attitudes toward AIDS patients, homosexuals and drug abusers among physicians, nurses, and health workers in training. To examine attitudes towards AIDS of a group who in the near future would be practising physicians in the Caribbean, medical students at the Cave Hill Campus of the University of the West Indies were surveyed regarding their attitudes towards AIDS. This paper analyses responses to 21 attitude items with reference to five primary areas related to AIDS: testing for HIV, homosexuality, fear of contagion, comfort in interacting with AIDS patients, and intention to care for persons with AIDS. The analysis indicates that these students were not all comfortable with issues related to homosexuality, and there was wide variation and some inconsistency in opinions regarding controversial and contentious issues. Most of these students, regardless of their choice of speciality after graduation will eventually come into contact with an HIV-positive individual or an AIDS patient. There is a distinct possibility that biases and misperceptions held during the period of training are at great risk of being carried over into clinical practice, resulting in unwillingness, or even refusal, to treat certain types of patients. What has also become evident is that emphasis should be placed on ethical and attitudinal training within the Faculty of Medical Sciences. Our future doctors have to be trained to effectively manage the many psycho-social, ethical, and legal problems that will be generated by the AIDS epidemic. What is urgently needed, therefore, is relevant curriculum design and development in the area of AIDS education directed at the region's future physicians (AU)

An evaluation of the status of leprosy in Jamaica

The incidence and prevalence rates of leprosy in Jamaica during the period 1982-1992 were compared and the levels of the knowledge, attitudes and practices of both health workers and leprosy patients towards leprosy and the leprosy programme were determined. Statistical data were collected through the examination of records and the administration of questionnaires. A sample of 188 health workers and 30 leprosy patients were chosen from the South East Health Region. The incidence and prevalence rates have remained relatively low, averaging 0.029/10,000 and 0.69/10,000 respectively. Since the beginning of the period (1982), Jamaica has, by WHO standards, attained the status of elimination of leprosy (prevalence of less than 1 case per 10,000 population). The knowledge, attitudes and practices of both health workers and patients have improved when compared with previous studies (Raglan, 1976; Ministry of Health, 1985-1988).(AU)

Changing attitudes of nurses - abstract

It is believed that the attitudes of nurses have changed over the years from the orientation of 'ideal service to the public' (altruism) to self interest as a primary goal. The study aimed at investigating if there is in fact a change of attitude and the reasons for change. The convenient sample included Registered Nurses, other health care workers and members of the public. The findings revealed that there is a change in the attitude of nurses towards patients and that dissatisfaction with salary and inadequacy factors contributed to this change. The demands imposed by society influence to some extent the change in the orientation of the nurses. Members of the public are concerned and express some degree of sympathy with the nurses in view of their adverse working condition and economic deprivation. The information gained from this study can serve at least two purposes: 1. To sensitize nurses to the importance of examining our attitudes towards clients and seek to bring some improvement. 2. To provide information to make recommendation for improvement in the social and economic welfare of nurses. (AU)

Anaesthesia: the medical students' perspective - abstract

Traditionally the number of doctors specialising in anaesthesia is low, an occurrence even more marked in the Caribbean. This study presents an analysis of the attitude of 219 medical students to anaesthesia at the University Hospital of the West Indies. Three groups of medical students - the preclinical group, the first clinical year group and the final year group were surveyed, using a questionnaire containing 10 knowledge and 15 attitude questions. The mean knowledge scores (out of ten) were 7.29 ñ 1.56 for the preclinical group, 8.52 ñ 1.33 for the first clinical year group and 9.28 ñ 0.86 for the final year group. The score of the final year group was significantly higher (p<0.001) than that of both other groups, this group having completed a five-week mandatory rotation in anaesthesia. Significant differences were found between the responses of the different groups in 3 of the attitude questions, but the overall response in all groups generally indicated a positive attitude to anaesthesia; 25.5 percent of the preclinical group, 32 percent of the first clinical year group and 40.5 percent of the final year group indicated an interest in anaesthesia as a post-graduate speciality (p = 0.13). However, the number of residents entering the anaesthetic postgraduate programme does not reflect such a high level of interest. This may indicate a change in attitude during the internship period resulting in a decreasing level of interest in the specialty. Measures need to be instituted so that this level of interest may be sustained throughout internship and encourage admission into the specialty (AU)

An assessment of the need for the dietitian in the management of patients with chronic noncommunicable diseases in primary health care in Cornwall County, Jamaica

Nutrition-related chronic noncommunicable diseases have emerged as one of the leading public health concerns of the last five decades. This problem is common in both developed and serveral developing countries with Jamaica as no exception. The aetiology and nature of these diseases render the level primary health care best suited for their management. Nutrition and dietary intervention is implicated if control in adult disability, morbidity and premature mortality from these diseases is to be realized. The report examines the nutritional assessment, information and counselling given to patients with common nutrition-related chronic noncommunicable disease at the level of primary care inthe country of Cornwall in Jamaica. The attitude of primary health care professional to the introduction of dietitian and their potential contribution. Seventy-seven health care recipients with chronic noncommunicable disease and 48 health care providers from four health centres were provided with questionnaires. The results which have been tabulated indicate hat although nutrition intervention is relatively frequent and done by individuals from a variety of health professions, it is deficient in the fundamental concepts and principles of nutrition and dietetics. However, a fair understanding of the nutritional care process seems to exist. The primary care health professional indicated a positive attitude towards the introduction of the dietitian. Seventy percent did not agree that nutrition education was primarily the duty of the dietitian. A number of conclusions were drawn from the study which formed the basis for the recommendations. (AU)

Educating nurses to change their attitudes about caring for patients with HIV/AIDS

Changing nurses' attitude about caring for HIV/AIDS patients is a challenge for nursing leaders, who have no choice but to promote an attractive and acceptable environment in which nurses can practice safely, compassionately and knowledgeably. Below, how nursing administrators and educators can develop strategies to meet nursing needs (AU)

Perceptions of the elderly among nursing home aides of three Black cultural groups

The Perceptions of the Elderly State (PES) was administered to a sample of 246 aides working in nursing homes in the New York Metropolitan Area. The aides represented three Black American cultural groups; African Americans, English-speaking Caribbean Blacks (including Jamaicans, Trinidadians, and Barbadians) and Haitians. Members of these groups make up the overwhelming majority of nursing homes aides in New York City. The results indicate that aides from all three groups had generally favorable attitudes towards the elderly, but the English-speaking Caribbean groups expressed significantly more favorable attitudes than aides in either of the two other groups. The observed differences were attributed to the traditional role of the older individual within West Indian value culture as disciplinarian and authority figure. Implications for in-service education are discussed.(AU)

The attitudes, experiences and needs of private practioners in the Kingston Metropolitan area in relation to HIV-infected patients - abstract

A questionnaire survey of 83 private practioners in the Kingston Metropolitan area (representing 20 percent of practioners in the area) showed that, in the past 5 years, 51(61 percent) had established 185 doctor-patient relationships with suspected and confirmed HIV/AIDS patients. Only 77 percent of the 108 confirmed cases were reported to the Ministry of Health, suggesting a need to better integrate the private practitioners into the notification system. There was a disparity between the number of practitioners who were willing to do HIV testing (50; 60 percent) and those willing to do the necessary counselling (30; 36 percent). Deep reservations were felt, such that only 24 percent were willing to maintain a therapeutic relationship with an HIV-infected patient. Three of the 4 reservations expressed could be partially alleviated by an educational programme aimed at the private practitioners and their support staff; 75 percent of the practitioners were desirous of a consistent referral system for further care. The establishment of an HIV/AIDS research/treatment centre may answer this need through a supporting role to co-ordinate an islandwide programme for the medical, social and legal management of HIV-infected patients. (AU)

Do relatives of terminally ill patients also benefit from hospice care?

An analysis was carried out on the extent to which staff responded to the relatives of cancer patients who had been admitted to the Consie Walters Hospice Care Centre, and the Pain Centre, both located in Kingston, Jamaica. Although no relationship was found between frequency of intervention and relatives' (caregivers') health, grief reactions were found to be related to a need for staff interaction. The more caregivers reported that they needed staff emotional support and practical assistance, the more intensely the reported grief, and the greater were their reports of anxiety and insomnia. Age was found to influence the relationship between adjustment and receiving intervention (AU)

Attitudes towards leprosy (Hansen's disease) among physicians and nurses in a general hospital - abstract

This study was designed to determine some of the attitudes to leprosy among physicians and nurses working in a general hospital in Trinidad. Twenty-two physicians and 31 nurses of varying grades were administered a brief questionnaire which sought to reveal personal attitudes to, and any superficial knowledge of leprosy. It was found that while most respondents had heard about leprosy before entering medical or nursing school, they were ignorant of important facts about the disease. Many gave subjective responses to the diagnosis that were not based on fact, but rather on personal fears. While doctors were slightly more informed than nurses regarding the need for isolation and were less hesitant in caring for leprosy patients, overall there appeared to be no solid knowledge of leprosy. It is concluded that there should be more effective teaching about leprosy in our medical and nursing schools so that the disease can be diagnosed and treated early, and thus prevent the stigma associated with the patient with untreated, destructive late leprosy (AU)

Feasibility of integrating community psychiatric services into primary health care facilities in Belize: a preliminary report

Paper states that the inception of a new Psychiatric Nurse Practitioner's Programme at the Belize School of Nursing in 1990 signalled the phasing out of the existing outreach program to rural districts. In its place would be a community-based psychiatric service headed by Psychiatric Nurse Practitioners deployed to district work stations. This study aimed at exploring the readiness of members of the health services previously involved to accept the impending change in psychiatric service delivery and to assess the extent of integration of community mental health at this time. In August of 1991, a self-administered questionnaire was issued to psychiatric service delivery personnel, both form primary and secondary care, and structured interviews were carried out with senior administrators in Belize. The results indicate a high level of basic training and a notable degree of integration already existing within the system. The vast majority of primary and secondary care respondents appeared willing to accept the new category of worker into the system, and both groups were also willing to participate in routine care of the mentally ill, especially if trained to do so. The administrators' responses hinted at a lack of cohesiveness among this group regarding achievement of policy objectives. In view of these findings, a forum for review of and forward planning for the psychiatric services in Belize would be welcome at this time(AU)

Student learning experiences with Jamaican practitioners

Due to the destruction of teaching facilities in primary care by a recent hurricane, first clinical year medical students were placed with general practitioners, in order to fulfil the requirements of a community medicine clerkship. Student feedback indicated a very high level of interest, with a varity of learning experiences - the attitudinal attributes of general practitioners ranking highest. This experience has provided a useful opportunity to enhance the training of medical students and to develop collaborative links with non - university physicians. This paper summarizes the experiences of the first 39 students involved in the clerkship. (AU)

Knowledge and understanding of AIDS among health-care workers in Jamaica

Six hundred and fifty questionnaires were sent to Health-care Workers (HCW) in four hospitals to assess the knowledge and understanding on HIV transmission and isolation precautions to be instituted for control and also to ascertain whether any differences in knowledge existed between HCW of teaching and non-teaching hospitals. Five hundred and nine questionaires were returned, a response rate of 79 percent . Questions on HIV transmission via blood transfusion and sexual intercourse and proper disposal of sharp instruments received the highest scores (85-100), embracing all groups of teaching and non-teaching hospitals. The greatest area of misconception and misunderstanding was reflected in responses obtained on isolation precautions (<30) for both teaching and non-teaching hospitals. Our study emphasizes an urgent need for comprehensive, continuous education of HCW on prevention and control of HIV infections in Jamaica (AU)