Kalkaalinta iyo umulinta

Waxa guddiyadu raadiyaan

• Waad baadhaa ka hor intaadan ficil samayn: calaamadaha muhiimka ah si sax ah ayaad u qaaddaa, waad garanaysaa marka natiijadu caadi ka baxsan tahay, goor horena caawimaad ayaad u yeedhaa halkii aad sugi lahayd wareegga dhakhtarka.
• Badbaadada daawada oo caado kuu ah: qiyaas kasta waxaad ku hubisaa shuruudaha daawo-siinta saxda ah, xasaasiyadda ayaad weydiisaa, amar daawo oo khaldan u muuqdana waad su'aashaa.
• Ka hortagga caabuqa oo aad dhab ahaan u dhaqanto: gacmo-dhaqid waqtiyada saxda ah, PPE (qalabka ilaalinta jidhka) oo loo xidho loona furo tartiibka saxda ah, irbadaha la isticmaalayna isla markiiba sanduuqa ammaanka (safety box) la geliyo.
• Umulisooyinka, daryeel hooyo oo ammaan ah: waad taqaannaa calaamadaha khatarta ee uurka iyo foosha, waad sharxi kartaa sida partograph-ku go'aannada u hago, waqtigana waad u gudbisaa.
• Diiwaan iyo wareejin cad: qoraallo waqtigooda la qoray oo leh saacadda iyo saxiixaaga, iyo wareejin uu kalkaaliyaha xigaa ku shaqayn karo isagoon malayn.
• Ixtiraam iyo sir-hayn: bukaanka iyo qoyska si naxariis leh ayaad ula hadashaa, ogolaansho ayaad weydiisaa, macluumaadka bukaan kastana sir ayaad u haysaa.

Su'aalaha ay weydiiyaan

1. 1“Nooga sheeg sida aad u qaaddo una diiwaangeliso calaamadaha muhiimka ah ee bukaan cusub oo la jiifiyey.”

   Sababta ay u weydiiyaan: Guddigu wuxuu hubinayaa xirfadda caafimaad ee aasaasiga ah iyo inaad ficil ka qaaddo waxa aad hesho. Musharrixiin badan ayaa tiriya calaamadaha, laakiin weligood ma sheegaan waxa ay ku sameeyaan natiijo caadi ka baxsan.

   Sida looga jawaabo

   • Calaamad kasta tartiib u magacaw: heerkulka, garaaca wadnaha, xawaaraha neefsashada, cadaadiska dhiigga, heerka oksijiinta haddii pulse oximeter jiro, iyo heerka miyirka.
   • Muuji farsamo wanaagsan: bukaanka oo nasanaya, cuff cabbirkiisu sax yahay, neefsashada ilmahana daqiiqad buuxda ayaa la tiriyaa.
   • Sheeg waxa aad ku samayso qiime caadi ka baxsan: dib u qiyaas, u sheeg kalkaaliyaha masuulka ah ama dhakhtarka, qorna waqtiga aad u sheegtay.
   • Ku dhammee diiwaanka: qiime kasta, waqtiga iyo saxiixaaga oo lagu qoro kaarka la-socodka (observation chart).

   When a patient is admitted, I let them rest for a few minutes, then take temperature, pulse, breathing rate and blood pressure, and oxygen saturation when we have a working oximeter. I count breathing for a full minute, especially in children. I write each value with the time and sign the chart. Last month an elderly man came in with a low blood pressure and a fast pulse. I rechecked on the other arm, called the doctor on duty straight away and wrote down the time I called. He was started on treatment within minutes.

2. 2“Sidee u hubisaa inaad daawada saxda ah siiso bukaanka saxda ah?”

   Sababta ay u weydiiyaan: Khaladaadka daawadu waa mid ka mid ah sababaha ugu waaweyn ee dhibaatada laga hortagi karo ee daryeelka caafimaadka. Guddigu wuxuu rabaa hannaan aad mar kasta raacdo, ee ma aha ballan ah inaad taxaddari doonto.

   Sida looga jawaabo

   • Magacaw shuruudaha: bukaanka saxda ah, daawada saxda ah, qiyaasta saxda ah, habka saxda ah ee la qaato (afka, irbad, xidid), waqtiga saxda ah iyo diiwaangelinta saxda ah. Isbitaallada qaar waxay ku daraan sababta saxda ah iyo la-socodka saameynta daawada.
   • Aqoonsiga ku hubi laba shay, sida magaca iyo lambarka faylka, xasaasiyaddana weydii ka hor qiyaasta ugu horreysa.
   • Sheeg inaad calaamadda daawada (label) iyo taariikhda dhacitaanka akhrido in ka badan hal mar, iyo inaad su'aasho amar kasta oo aan caddayn ama khaldan u muuqda.
   • Ku dar in daawooyinka khatarta sare leh, sida insulin ama oxytocin, mar labaad lala hubiyo kalkaaliye kale.

   I follow the rights of medication administration on every round: right patient, drug, dose, route, time and documentation. I check the patient's name and file number against the drug chart, and I ask about allergies before a first dose. I read the label when I take the medicine from the shelf, when I prepare it and again at the bedside. If a prescription is unclear, I call the prescriber before giving anything. Once I saw an antibiotic prescribed for a woman whose file said she was allergic to penicillin. I held the dose and called the doctor, and the order was changed.

3. 3“Waxaad ogaatay inaad khalad daawo samaysay. Maxaad samaynaysaa?”

   Sababta ay u weydiiyaan: Guddigu wuxuu hubinayaa daacadnimada iyo sida aad badbaadada bukaanka u aragto. Khalad la qariyo aad ayuu uga khatar badan yahay khaladka laftiisa, waxayna rabaan inay maqlaan inaad isla markiiba soo sheegi lahayd.

   Sida looga jawaabo

   • Marka hore bukaanka hubi: calaamadaha muhiimka ah, falcelin kasta oo jirta, oo la joog.
   • Isla markiiba u sheeg kalkaaliyaha masuulka ah iyo dhakhtarka, raacna tilmaamahooda.
   • Waxa dhacay si xaqiiqo ah ugu qor qoraallada bukaanka, buuxina warbixinta shilka (incident report) haddii xaruntu leedahay.
   • Sheeg waxa aad ka baratay iyo waxa aad hadda si kale u samayso, adigoon cid kale eedayn.

4. 4“Haweeney uur 34 toddobaad ah leh ayaa ANC timid, waxayna qabtaa madax-xanuun daran iyo arag cakiran. Maxaad samaynaysaa?”

   Sababta ay u weydiiyaan: Kuwani waa calaamadaha khatarta ee pre-eclampsia daran (dhiig-karka uurka), taas oo keeni karta eclampsia (gariir). Guddigu wuxuu hubinayaa inaad garato calaamadaha, inaad cabbirto waxyaabaha saxda ah, oo aad dib-u-dhac la'aan kor ugu gudbiso.

   Sida looga jawaabo

   • Magacaw dhibaatada: madax-xanuun daran iyo arag cakiran oo uurka dambe yimaada waa calaamadaha khatarta ee pre-eclampsia.
   • Sheeg waxa aad hubinayso: cadaadiska dhiigga, kaadida oo borotiin laga baadho, bararka wejiga iyo gacmaha, iyo garaaca wadnaha ilmaha.
   • Isla markiiba u gudbi dhakhtarka ama umulisada sare, una diyaargarow u-gudbinta. Daawada borotokoolka waxaa bixiya oo keliya shaqaale tababaran oo raacaya borotokoolka xarunta.
   • Deji, weligaa keligeed ha ka tagin, u sharax iyada iyo qoyskeeda, akhris kastana waqtigiisa ku qor.

   Severe headache and blurred vision at 34 weeks are danger signs of pre-eclampsia, so I would treat this as an emergency. I would take her blood pressure straight away, test her urine for protein, check for swelling and listen to the baby's heartbeat. While I do this, I would ask a colleague to call the doctor or senior midwife. If her blood pressure is high, we follow our severe pre-eclampsia protocol and arrange referral to the hospital, with a midwife travelling with her. I would stay with her, explain calmly to her and her husband what is happening, and write every reading with the time.

5. 5“Sidee u isticmaashaa partograph-ka, goormase wuxuu kuu sheegaa inaad ficil qaaddo?”

   Sababta ay u weydiiyaan: Partograph-ku waa qalabka ugu muhiimsan ee goor hore lagu ogaado foosha gaabisa ama xidhan. Guddigu wuxuu hubinayaa inaad go'aan ku gaadho, ee aanad u arkin foom aad buuxiso dhalmada ka dib.

   Sida looga jawaabo

   • Bilow marka foosha firfircooni bilaabato, oo buuxi inta ay socoto; weligaa xusuus ha kaga buuxin dhalmada ka dib.
   • Tiri waxa uu diiwaangeliyo: furfurnaanta afka ilmo-galeenka, hoos-u-degga madaxa ilmaha, xanuunka foosha (contractions), garaaca wadnaha ilmaha, biyaha (liquor), iyo garaaca wadnaha, cadaadiska dhiigga iyo heerkulka hooyada.
   • Sharax xariiqyada: marka la dhaafo xariiqda digniinta (alert line), foosha si ka gaabis ah sidii la filayey ayay u socotaa, markaa u sheeg qofka kaa sarreeya oo qorshee u-gudbinta haddii aad xarun caafimaad joogto; marka la gaadho xariiqda ficilka (action line), go'aan hadda ayaa la gaadhayaa.
   • Haddii aad taqaan, sheeg in xarumaha qaar hadda isticmaalaan WHO Labour Care Guide, oo ah qalab cusub oo isla fikraddaas ku dhisan.

6. 6“Sidee bukaannadaada ugu wareejisaa dhammaadka shift-ka?”

   Sababta ay u weydiiyaan: Khaladaad badan ayaa dhaca waqtiga wareejinta, marka macluumaad ku lumo inta u dhexeysa shift-yada. Guddigu wuxuu rabaa qaab cad, xaqiiqooyinka muhiimka ah ee bukaan kasta, iyo hawlaha weli harsan.

   Sida looga jawaabo

   • Isticmaal qaab sida SBAR: xaaladda, taariikhda, qiimeynta iyo talada.
   • Haddii ay suurtogal tahay, sariirta agteeda ku wareeji si kalkaaliyaha xigaa bukaanka ula arko.
   • Ka bilow bukaannada ugu xaaladda daran, kadib natiijooyinka la sugayo, daawooyinka waqtigoodu dhow yahay iyo qof kasta oo u-gudbin sugaya.
   • Hubi in qoraallada ay sheegaan wax la mid ah waxa aad afka ku wareejisay.

   I hand over at the bedside using SBAR. For each patient I give the situation, the background, my assessment and what needs doing next. I start with the sickest patients, then pending lab results and medicines due in the next hours. On a busy night in the maternity ward, I handed over a woman who had bled more than usual after delivery. I told the morning midwife the time of the last check, how the uterus felt, and that the doctor wanted her haemoglobin result before noon. She knew exactly what to watch, and the result was followed up on time.

7. 7“Walaalka bukaanad ayaa ku weydiiyey cudurka ay qabto, iyaduse waxay kaa codsatay inaad sir ka dhigto. Maxaad samaynaysaa?”

   Sababta ay u weydiiyaan: Bulshooyinka isku dhow, qoysasku badanaa waxay filaan in wax walba loo sheego. Guddigu wuxuu hubinayaa inaad ixtiraamto sir-haynta iyo doorashada bukaanka, adigoo haddana qoyska si naxariis leh ula dhaqmaya.

   Sida looga jawaabo

   • Si cad u sheeg in bukaanka qaangaadhka ahi go'aamiyo cidda loo sheegayo, marka laga reebo haddii sharciga ama siyaasadda xaruntu si kale dhahdo.
   • Walaalka si edeb leh ugu sharax inaadan sheegi karin, kuna talin inuu iyada si toos ah ula hadlo.
   • U bandhig inaad ka caawiso inay qoyskeeda la hadasho haddii ay rabto, weligaana ha kaga hadlin bukaannada waddooyinka ama qof kuu soo wacay oo aanad aqoon.

8. 8“Nooga warran mar aad la macaamishay qoys xanaaqsan ama cabsanaya.”

   Sababta ay u weydiiyaan: Qoysaska joogga qolalka jiifka iyo qolka dhalmada badanaa way cabsadaan. Guddigu wuxuu hubinayaa inaad dagganaato, dhegaysato, erayo fudud ku sharaxdo, daryeelka bukaankana sii wado.

   Sida looga jawaabo

   • Isticmaal hal xaalad oo dhab ah: waxa dhacay, waxa aad tidhi iyo waxa isbeddelay.
   • Muuji inaad marka hore dhegaysatay, kadibna Soomaali fudud ugu sharaxday waxa la samaynayo iyo sababta.
   • Haddii dhibaato dhab ah jirtay, sida sugitaan dheer, sheeg sida aad ugu gudbisay qofka masuulka ah.

   At an MCH in Hargeisa, a father became angry because his newborn had been moved to the newborn corner and nobody had told him why. I asked him to sit with me, listened, and apologised that no one had explained. I told him in simple Somali that the baby was breathing a little fast, so we were watching her closely and keeping her warm, and I took him to see her. He calmed down. Afterwards I suggested to the in-charge that one staff member always updates the family when a baby is moved, and we started doing that.

Tusaalooyinka jawaabaha waa English, luqadda guddiyada badankoodu isticmaalaan. Adigu erayadaada ku sheeg.

Mawduucyada dib u eeg

• Vital signs and early warning scoresHeerkulka, garaaca wadnaha, xawaaraha neefsashada, cadaadiska dhiigga, heerka oksijiinta iyo heerka miyirka (AVPU: miyir leh, codka ka jawaaba, xanuunka ka jawaaba, aan waxba ka jawaabin). Isbitaallo badan waxay isticmaalaan early warning score, oo dhibco u daraya qiime kasta oo caadi ka baxsan kuna tusaya goorta aad dhakhtarka wacayso. Waxaa laga yaabaa inay ku weydiiyaan waxa aad samayso marka dhibcuhu kor u kacaan.
• Triage (ETAT for children)Triage waxay bukaannada u kala horraysiisaa sida ay xaaladdoodu u degdeg tahay, ee ma aha sida ay u yimaadeen. ETAT-ka carruurtu wuxuu isticmaalaa saddex kooxood: calaamadaha degdegga (hawo-mareenka oo xidhan ama neefsasho dhib ah, shoog, miyir-beel, gariir, fuuq-bax daran) oo isla markiiba la daweeyo, calaamadaha mudnaanta leh oo marka xigta la arko, iyo kiisaska aan degdegga ahayn oo safka sugaya. Filo su'aal ah: “Saddex bukaan ayaa wada yimid. Kee baad marka hore arkaysaa?”
• Rights of medication administrationHubinta ka horreysa qiyaas kasta: bukaanka, daawada, qiyaasta, habka la qaato, waqtiga iyo diiwaangelinta oo dhammaantood sax ah; isbitaallo badan waxay ku daraan sababta saxda ah iyo la-socodka saameynta. Xifdi, una diyaar garow inaad sheegto sida aad mid kasta sariirta agteeda ugu hubiso, iyo in daawooyinka khatarta sare leh mar labaad la hubiyo.
• Hand hygiene: WHO 5 MomentsGacmaha nadiifi ka hor intaadan bukaan taabin, ka hor hawl nadiif ah ama jeermis-la'aan ah, kadib khatar ah inaad taabatay dareerayaasha jidhka, kadib markaad bukaan taabato, iyo kadib markaad taabato waxyaabaha bukaanka ku xeeran. Isticmaal alcohol hand rub marka gacmuhu nadiif u muuqdaan, saabuun iyo biyona marka wasakh lagu arkayo.
• PPE donning and doffingXidhashada (donning): goonka, maaskarada, ilaaliyaha indhaha, kadibna galoofyada. Furidda (doffing): galoofyada, ilaaliyaha indhaha, goonka, maaskarada, kadibna gacmaha nadiifi. Haddii tartiibka la khalda, gacmahaaga iyo wejigaaga ayaa wasakhoobaya. Goobta xirfadaha badanaa waxay kaa codsataa inaad tan muujiso.
• Sharps and healthcare wasteWeligaa ha u celin daboolka irbad la isticmaalay; si toos ah u geli sanduuqa ammaanka (safety box), xidhna sanduuqa marka uu buuxsamo afar meelood saddex meel (three-quarters).Qashinka u kala saar weelasha midabbada leh ee xaruntaadu isticmaasho (irbadaha, qashinka caabuqa leh, qashinka caadiga ah). Waxaa laga yaabaa inay ku weydiiyaan waxa aad samayso haddii irbad ku mudo: nabarka dhaq, isla markiiba soo sheeg, raacna borotokoolka xarunta.
• Antenatal care (ANC)Kulanno la qorsheeyey inta uurku socdo si loo hubiyo cadaadiska dhiigga, miisaanka, koritaanka iyo garaaca wadnaha ilmaha, iyo dhiig-yaraanta, loona bixiyo tallaalka teetanada, iron iyo folic acid, iyo talo ku saabsan u diyaargarowga dhalmada iyo calaamadaha khatarta. Habka WHO ee hadda wuxuu ku talinayaa ugu yaraan siddeed kulan. U diyaar garow inaad tiriso waxa aad samayso booqashada koowaad.
• Danger signs in pregnancyDhiig ka yimaada siilka, gariir, madax-xanuun daran oo arag cakiran la socdo, qandho, calool-xanuun daran, neefsasho degdeg ah ama dhib leh, bararka wejiga iyo gacmaha, dhaqdhaqaaqa ilmaha oo yaraaday, iyo biyaha oo dillaaca ka hor foosha. Mid kasta oo ka mid ah wuxuu u baahan yahay baadhis degdeg ah, badanaana u-gudbin. Guddiyada umulisooyinku badanaa waxay kaa codsadaan inaad tiriso oo aad sheegto waxa aad marka hore samayso.
• Partograph (alert and action lines)Jaantus hal bog ah oo muujiya horumarka foosha, xaaladda ilmaha iyo xaaladda hooyada. Haddii furfurnaanta afka ilmo-galeenku dhaafto xariiqda digniinta (alert line), foosha way ka gaabis tahay sidii la filayey: u sheeg qofka kaa sarreeya oo qorshee u-gudbin haddii aad xarun caafimaad joogto. Xariiqda ficilka (action line) marka la gaadho, go'aan waa in la gaadhaa. Xarumaha qaar hadda waxay beddelkeeda isticmaalaan WHO Labour Care Guide.
• AMTSL (third stage of labour)Maareynta firfircoon ee marxaladda saddexaad ee foosha waxay ka hortagtaa dhiig-bax culus dhalmada ka dib: daawo ilmo-galeenka ciriiriya, badanaa oxytocin, wax yar kadib marka ilmaha dhasho; jiidis xakameysan oo xudunta ah oo uu sameeyo qof tababaran; iyo hubinta in ilmo-galeenku adag yahay kadib marka mandheertu soo baxdo. Dhiig-baxa dhalmada ka dib waa sabab weyn oo dhimashada hooyooyinka, sidaas darteed guddiyada umulisooyinku badanaa way weydiiyaan.
• SBAR and documentationSBAR (xaaladda, taariikhda, qiimeynta, talada) waa qaab gaaban oo loo isticmaalo marka dhakhtar la wacayo ama bukaan la wareejinayo. Qoraallada wanaagsan waxaa la qoraa isla waqtiga, waxay leeyihiin taariikh, saacad iyo saxiix, waana xaqiiqo; weligood lagama qoro xusuus goor dambe. Waxaa laga yaabaa in lagaa codsado inaad cod dheer ku samayso wicitaan SBAR ah.
• Consent and confidentialityKa hor hawl caafimaad, u sharax bukaanka waxa aad samaynayso iyo sababta, kana hel ogolaanshihiisa; ilmaha waxaa ogolaada waalidka ama masuulka. Waxa bukaanku kuu sheego waxay ku koobnaanayaan kooxda daryeelka, marka laga reebo haddii sharciga ama siyaasadda xaruntu si kale u dalbato. Guddiyadu waxay tan ku tijaabiyaan qaraabo, qof taleefan ku soo wacay ama shaqaale kale oo faahfaahin weydiinaya.

Hawlaha la sameeyo ee laga yaabo in lagu siiyo

1. 1Goob xirfadeed oo calaamadaha muhiimka ah: waxaad qof tabarruc ah ama qaab-tusaale ka qaaddaa dhammaan calaamadaha, waadna diiwaangelisaa. Maalinta ka horreysa saaxiib kula celceli, tallaabo kasta cod dheer ku sheeg, sheegna waxa aad samayn lahayd haddii qiime caadi ka baxsan yahay.
2. 2Muujinta gacmo-dhaqidda iyo PPE: waxaa laga yaabaa in lagaa codsado inaad gacmaha ku dhaqdo tallaabooyinka WHO, oo aad xidho kadibna furto PPE. Tartiibka ku celceli ilaa uu caado kuu noqdo; qiimeeyuhu wuxuu eegayaa inaad wejigaaga ama dusha galoofyada taabato.
3. 3Kiis qoraal ah, 30 ilaa 60 daqiiqo: saddex bukaan oo mar wada yimaada, ama haweeney foolanaysa oo partograph-keedu dhaafayo xariiqda digniinta. Tartiibkan ku jawaab: baadh, ficil ku samee heerkaaga, kor u gudbi, qoyska la hadal, diiwaangeli.
4. 4Hubinta kaarka daawada: waxaa lagu siinayaa kaar daawo oo khaladaad qarsoon leh, sida waqti qiyaas oo maqan, hab qaadasho oo khaldan, ama daawo uu bukaanku xasaasiyad ku leeyahay. Si tartiib ah u akhri, shuruudaha mid mid u dabaq, sheegna inaad wici lahayd qofka qoray halkii aad malayn lahayd.
5. 5Hadal caafimaad oo gaaban: shan daqiiqo oo aad la hadlayso hooyo tusaale ah oo ku saabsan calaamadaha khatarta ee ilmaha dhasha ama naas-nuujin keliya. Isticmaal Soomaali fudud, hal fikrad mar kasta, kana codso inay kuu soo celiso qodobbada muhiimka ah si aad u hubiso inay fahantay.

Khaladaadka ka fogow

• Inaad borotokoollo magacawdo adigoon ka sheegin hal tallaabo oo dhab ah, taas oo guddigu uusan ku garan karin inaad isticmaashay iyo in kale.
• Inaad sharaxdo daaweyn ka baxsan heerkaaga ama shatigaaga, sida inaad keligaa go'aamiso daawo, si aad karti ugu muuqato.
• Inaad tidhaahdo waxaad sugi lahayd wareegga dhakhtarka iyadoo bukaanku horeba calaamado khatar ah muujinayo.
• Inaad ilowdo qoyska iyo diiwaanka marka aad kiis ka jawaabayso; guddiyadu isgaarsiinta iyo diiwaangelinta waxay u xisaabiyaan qayb ka mid ah daryeelka.
• Inaad sheegato tababar ama xirfad aadan lahayn; goobta xirfadaha ama wicitaan loo diro tababaraha ayaa muujin doona.
• Inaad sheegto magaca bukaan dhab ah ama faahfaahin lagu garan karo marka aad sheeko ka sheegayso wareysiga.

Hubin degdeg ah

5 su'aalood. Mid kasta ka jawaab si aad u aragto sharaxaadda.