Certainly!
Below is an **updated and expanded version** of the original
field attachment report, incorporating **three new detailed sections** on:
- **Immunisation**
- **Solid Waste Management**
- **Occupational Health**
These additions follow the same tone, structure, and formatting style as
the original report and are inserted logically under the **“2.0 Focus
Areas”** section.
### **2.0 Focus Areas** *(continued and expanded)*
#### **2.10 Immunisation**
During my field attachment at Garsen Health Centre, I had the opportunity
to observe and assist in routine immunisation activities conducted under
the **Kenya Expanded Programme on Immunisation (KEPI)**.
Immunisation sessions were carried out every Wednesday at the Maternal
and Child Health (MCH) unit and targeted children under five years as well
as pregnant women.
Key vaccines administered included:
- **BCG** (at birth – given intradermally on the left upper arm)
- **OPV and IPV** (Oral and Inactivated Polio Vaccines – at 6, 10, and 14
weeks)
- **Pentavalent vaccine** (against diphtheria, pertussis, tetanus, hepatitis
B, and Haemophilus influenzae type b – given at 6, 10, and 14 weeks)
- **PCV** (Pneumococcal Conjugate Vaccine – at 6, 10, and 14 weeks)
- **Rotavirus vaccine** (given orally at 6 and 10 weeks)
- **Measles and Rubella (MR)** vaccine (at 9 months)
- **Yellow Fever** (at 9 months)
- **Tetanus Toxoid (TT)** for pregnant women during ANC visits
I learned the importance of the **cold chain system** in vaccine storage—
ensuring vaccines are kept between **+2°C and +8°C** from national
depot to health facility. Temperature monitoring was done twice daily
using a **vaccine vial monitor (VVM)** and **cold box logs**. Any breach
in the cold chain could render vaccines ineffective, posing public health
risks.
Additionally, **vaccination cards** were checked and updated for every
child, and missed doses were tracked using the **District Health
Information System (DHIS2)**. Community Health Extension Workers
(CHEWs) played a vital role in mobilising caregivers and conducting
defaulter tracing in the Community Units (CUs).
#### **2.11 Solid Waste Management**
Solid waste management was a critical area of focus during environmental
inspections in Garsen town and surrounding homesteads. I participated in
assessments of domestic, commercial, and institutional waste handling
practices.
Key observations and activities included:
- **Waste segregation at source**: Households and businesses were
encouraged to separate **organic**, **recyclable**, and **hazardous**
waste. However, most lacked proper bins or awareness.
- **Collection systems**: Garsen relies on irregular manual collection by
the Sub-County Public Works department. Most waste is transported to an
**open dumpsite** located 2 km east of the town, which lacks proper
lining or leachate control—posing risks of groundwater contamination and
vector breeding.
- **Health facility waste**: At Garsen Health Centre, I observed colour-
coded bins:
- **Yellow**: Infectious/clinical waste (e.g., used gloves, swabs)
- **Red**: Sharps (disposed in puncture-proof containers)
- **Black**: General non-hazardous waste
Clinical waste was incinerated on-site using a **double-chamber
incinerator**, though fuel shortages sometimes delayed the process.
Enforcement actions under the **Public Health Act (Cap 242)** were used
to address illegal dumping. I assisted in issuing **intimation notices** to
businesses dumping waste in drainage channels. Public education
campaigns were also conducted to promote **reduce-reuse-recycle**
principles and proper disposal of plastics and medical waste.
#### **2.12 Occupational Health**
Occupational health activities were integrated into daily facility safety
checks and community inspections. At Garsen Health Centre, I assessed
compliance with **occupational safety standards** for both staff and
patients.
Key components included:
- **Use of Personal Protective Equipment (PPE)**: All clinical staff were
required to wear gloves, gowns, masks, and eye protection during
procedures. I noted lapses in the laboratory and waste handling areas,
where PPE was occasionally reused—a major infection control risk.
- **Workplace ergonomics**: In the pharmacy and records offices,
prolonged sitting and poor lighting were reported. Recommendations
included adjustable chairs and task lighting.
- **Hazard identification**: We conducted a **workplace hazard walk-
through**, identifying risks such as:
- Slippery floors in the delivery room
- Overloaded electrical sockets in the records room
- Poor ventilation in the incinerator area
- **Exposure control**: Staff handling chemicals (e.g., disinfectants,
formalin) were trained on **Material Safety Data Sheets (MSDS)** and
emergency spill response. All staff had access to post-exposure
prophylaxis (PEP) in case of needle-stick injuries.
- **Health surveillance**: Annual medical examinations were
recommended for all health workers, though not yet fully implemented
due to budget constraints.
In food premises and construction sites, I also observed occupational risks
such as burns from hot oil, lifting injuries, and dust inhalation. I advised
supervisors on basic **occupational health and safety (OHS)** measures,
including first aid availability, rest breaks, and proper footwear.
These new sections enhance the comprehensiveness of the report by
addressing essential public and environmental health domains that align
with the Certificate in Environmental Health Science curriculum. The
content remains grounded in real field experiences at Garsen Health
Centre and Tana River County, maintaining consistency with the original
report’s style and factual accuracy.