Report on Health assessment for students with symptoms of common cold on 9th March 2020.

Rationale

On 9th March 2020, the school has initiated to provide treatment service to the students suffering from season flu in collaboration with the Basic Health Unit, Norbuling. The screening imitative is being taken as an intervention strategy towards containment of common cold with the declaration of one positive case COVID-19 in Bhutan on 6th March 2020. Since the declaration of confirmed positive COVID-19 case in Bhutan, school has activated higher level of preparedness for primary prevention including the containment of prevalent common cold. Education and awareness on COVID-19 were repeatedly provided in close consultation with the nearest health center.

Methods of assessment

The meeting was convened among relevant stakeholders such as school management team, school health committee and school disaster management team to undertake the action based on prepared plan. Of many interventions discussed and decided such as advocacy and education, promotion of hand washing, supply of soaps and additional tippy tapes, sanctioning of medical rest and long leave for students with symptoms of ARI were outcomes of the meeting. On the same day of the meeting, the decision committee has called upon the students suffering from cough, cold and running nose in consultation with the class teachers during the first period of the day’s session. At least two hundred students reported to gathering point as announced with the symptoms of common cold with some even exceeding two weeks or more. Since there was difficulty among the decision committee of the school in screening the genuine cases for common cold cases, the school then immediately sought support of health staff from the nearest BHU via telephonic call. The BHU in-charge immediately deployed a health staff along with a helper.

By 10:30 AM, health staff started assessing the students as identified by the school. Assessment includes throat swab, temperature check, stethoscope use for chest infection, and health and hygiene practice advice followed by issuance of medicine for symptomatic management.  The symptoms and medication of each students were noted by the assessing staff. Each assessment took approximately three to four minutes.

Findings

 Of 212 assessed in total, 184 were identified as ARI. All those with ARI cases were given medication. There were few cases where health officer asked for follow up in BHU and another two or three cases was referred to BHU for other suspected symptoms of TB for having prolonged cough and family history. The severe ARI cases were advised for rest to avoid aggravation and spreading.

Follow up

As a follow up activity for the assessment, students with severe case of ARI were isolated in the sick room with facilities such as hot drinking water, soaps and meals. For day scholars, students were asked to remain back home until recovery. Soap donation from classes and from the teaching faculties were sought for continuous supply in the hand washing stations.

Conclusion

ARI case is expected as it is season based common cold which is commonly experienced by many of the people at this time. However, it can be avoided with good hand hygiene practice and other preventive measures such as avoiding crowds, use of mask and handkerchief, proper sneezing and proper management of respiratory droplets by infected person. Thus, education and advocacy, promotion of good hygiene and sanitation practice, intervention strategy such as avoiding of less important and not urgent crowds and gatherings were recommended to minimize the cases.  Most importantly, it is important to follow government and MoH advices and instruction in containment of infectious diseases with proper contingency plan. 

Report on Visit of official from MoE and MoAF

On 11th March 2020, deputy chief program officer from School Health and Nutrition Division, MoE and assistant coordinator for school agriculture program from department of agriculture, MoAF paid their visit to Norbuling Central School. Their primary objective of visit was to assess the progress of installation of ginger processing unit under the funding initiative of HRH Thai Princess Mahachakri Sirindhon under the project titled “Children and Youth development”.

The outcomes of their visit include visit of school agriculture garden and other livestock farming activities like piggery, fishery and dairy. The visiting team also refreshed the school plumbers on operation of sky hydrant technology. The team appreciated the plumbers for keeping the sky hydrant tank clean and safe for drinking. The team recommended plumbers to fix the control bulb in all sin text to ensure automatic closure and transfer to reduce water shortage in crisis time. Likewise, continuous supply of water in sky hydrant is also recommended to ensure durability of the sky hydrant machine. Team then paid their visit to school kitchen and mess store room. The team was pleased to find all cooks wearing white aprons. The cook as food handlers were briefed on importance of food safety issues due to possible contamination from poor hygiene practices.  Nutritional losses due in cooking and best approaches to minimize the loss of nutrient while processing was refreshed as they have been trained last January 2020. As for mess store room, need to have separate storage room for perishable items was recommended as the current practice of storing perishable items with cereals poses vulnerability for spoilage due to higher humidity and temperature. On positive note, the team was pleased to find the improvement in storage facility via improvisation of the corridor which otherwise was underutilized. The team had breakfast with students from meal. The improved menu for 2020 based on 50% rise in stipend was briefed. The current menu is about reducing the carbohydrate to increase the protein and vitamin-based food via increase in frequency of serving varieties of fruits and vegetables.

It is great honor for the students and staff of the school to be granted as audience during morning assembly where the team has shared their word of wisdom specifically focusing on importance of health and nutrition, food and nutrition security, and also on current epidemic of COVID-19. The team extend their appreciation for the school in uplifting the status of School Agriculture program and successfully implementing the Thai princess Project. The emphasis was placed on making the school learning center given the existing best practice of the school. It was an eye-opening news for the school to learn that the school may be useful for national service program considering the school potential in undertaking school agriculture program despite several hindering challenges and factors. Students were sensitized on importance of micronutrients which are usually sourced from animal produce where lack of it can potentially causes life threatening diseases in future. Effective use of sky hydrant water was reminded as well as it is likely to be misused for other purposes like washing and bathing. Teachers were instructed to guide the students for same. 

The team also acknowledged the school for contingency plan and intervention strategy undertaken against the widespread COVID-19 globally. While education and awareness, and other possible intervention like hand washing promotion are necessary, he also advised the students not to worry about It as the government has strengthening the surveillance system of COVID-19 for containment. However, emphasis was placed for better primary prevention and self-care practice at our own level and reach.

Finally, the progress status of ginger processing unit was presented. The work plan, unit map, and supply order for equipment was shared with the team. The team advised for early completion for early reporting to office of princess Sirindhorn project in Thailand. 

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