FIRST SCHEDULE
CONSENT TO PRACTISE AS LOCUM
| | Medical Practitioners and Dentists Board |
| | P.O.Box 30016 |
| | NAIROBI |
| | ......................................... |
RE: APPLICATION FOR LOCUM
I acknowledge your letter dated ......................................................... Ref. No. ............... applying for a locumPermission is hereby granted for Dr .................................................................. Reg. No. ................ to work asa locum in your place of practice during your absence from............................ to ............................Yours faithfully,Registrar/ChairmanSECOND SCHEDULE
MINIMUM REQUIREMENTS
PART A—MINIMUM REQUIREMENTS FOR A GENERAL PRACTITIONER
1.PREMISES:(1)premises should contain the following accommodation—(b)A consulting room which should be reasonably sound-proofed so that conversations taking place therein are not easily audible outside the consulting room.(c)An examination room which should be either a separate room or a curtained-off part of a consulting room.(d)A treatment room in which such procedures as the giving of medications and the carrying out of minor surgical operations can be done.(e)Adequate toilet facilities.(1)The practitioner should attempt to keep in his premises a stock of those essential drugs which he considers should be administered to his patients in his premises and especially if his practice is not in a location where there may be a dispensing pharmacy. The range of drugs that he should have is wide, but he ought to have at least the following—Injections of analgesics (for example, pethidine, morphine, etc.); antibiotics, antihistamines, bronchodilators, antiemetics, antispamodics, local anaesthetics and corticosteroids. For the purpose of administering injections, he should have disposable syringes and needles and surgical spirit.(2)Further the doctor should provide himself with a bag which he can carry with him when visiting patients, when travelling or to be available for him to use whenever his services may be needed. This bag should contain as a minimum the following—Such drugs as injections of analgesics, antibiotics, brochodilators, tranquilisers, local anaesthetics, antispasmodics, antiemetics, oral preparations such as antipyretics, analgesics, gastrointestinal sedatives, antidiarrhoeais, antihistamines, brochodilators, antibiotics, muscle relaxants, etc.(3)For the purpose of the doctor's bag, it is now the practice to carry disposable syringes and needles rather than the old steel and glass syringes which require sterilization. The bag will be adequately furnished if it carries a supply of 2 ml disposable syringes and 25 g (1 in) and 21 g (l1/2 in) disposable needles. It is also convenient to carry strips of spirit swabs rather than carrying a supply of surgical spirit and pieces of cotton wool. Practitioners shall take steps to destroy all disposable equipment to avoid their possible use.4.APPROVED DESCRIPTION OF NAME"DR ................................... MBBS BDS"MEDICAL PRACTITIONER /DENTIST/CLINICAL LABORATORY/CLINICAL RADIOLOGICAL LABORATORY."DR./MR............................. MBBS, DCH,MRCP, FRCS, M.MED., FRCR* etc.SPECIALIST* PHYSICIAN, PAEDIATRICIAN , DERMATOLOGIST,ANAESTHETIST, RADIOLOGIST, PSYCHIATRIST,PATHOLOGIST, OBSTETRICIAN AND GYNAECOLOGIST,SURGEON (*ORTHOPAEDIC, UROLOGIST, NEUROSURGEON,THORACIC, PLASTIC, OPHTHALMOLOGY, ENT) etc.*Delete where not applicablePART B - MINIMUM REQUIREMENT FOR A DENTAL SURGERY
1.WAITING ROOM: With basic furniture, telephone. etc.2.LABORATORY /WORKSHOP:(a) Basic Laboratory Requirement4.Laboratory motor and hand piece,6.Pliers, wax knife, etc.,10.Polishing brushes, cone felt, etc.(b) Basic Requirements in filling Materials2.Dental cements;(ii)Zinc and copper phosphates(iv)Silicate and silioophosphate cements3.TOILET: —with wash basin and water borne sanitation.4.SURGERY: —composed of the following basic essentials—(i)dental unit with low and high speed drills which are water cooled.(ii)wash-basin with running water(iv)cabinet with basic dental instruments(v)basic drugs and medicaments used in dentistry including antimicrobials, corticosteroids, anelgesics, haemostatic and anaesthetic drugs, in addition to antiseptics and disinfectants;(vi)lockable cabinet, containing essential emergency drugs.(vii)emergency oxygen cylinder(viii)cabinet for patients' records and card system.5.INTRAORAL RADIOLOGICAL UNITTHIRD SCHEDULE
RETURN OF NOTIFIABLE INFECTIOUS DISEASES
The following diseases are notified on Med. 25 Forms. These forms are obtainable from Central Medical Stores or any government medical institution.2.Severe diarrhoeal diseases5.Smallpox (Variola major)6.Smallpox (Variola minor)10.Cerebro-spinal fever (meningococcal meningitis)15.Tuberculosis (all forms)16.Malaria S.T. (in high altitude areas)17.Sexually transmitted diseasesFOURTH SCHEDULE
MINIMUM STANDARDS FOR A CLINICAL LABORATORY
1.CATEGORIES AND RESPONSIBILITIES OF PATHOLOGISTS:(a) General Pathologist:(i)This is a specialist whose basic training has covered all the disciplines of clinical laboratory medicine and who ultimately has attained a recognisable higher qualification in any one or all other disciplines.(ii)General pathologists shall run laboratories that carry out the following investigations—1.Morbid anatomy, histopathology and cytology2.Haematology and blood transfusion4.Medical microbiology and parasitology7.Other allied laboratory investigations.(b) Single Discipline Pathologist:This shall be a medically qualified person whose training shall not have covered all the disciplines of clinical laboratory medicine but who shall be a holder of a postgraduate qualification in only one discipline. He shall practise only in his particular discipline of specialization.(c) Categories of Pathology Laboratories:For purposes of the practice of clinical laboratory medicine, the following categories of laboratories shall be recognized—(i)Government hospitals and local authority laboratories;(ii)Non-profit making missionary hospital laboratories;(iii)Non-government or private hospital laboratories which which charge economical fees;(iv)Private clinical laboratories not attached to hospitals;(v)Nursing home laboratories;(vi)Other non-profit making laboratories.2.MINIMUM FACILITIES FOR A PRIVATE CLINICAL LABORATORY (r. 29)(i)A minimum of any three of the following disciplines should be offered—1.Haematology and Blood Transfusion2.Medical Microbiology and Parasitology4.Morbid anatomy, Histopathology and Cytology1.At least one pathologist.2.At least one qualified technologist for each of the disciplines.(iii)PHYSICAL FACILITIES:2.Specimen collection room with a couch.4.Adequate laboratory space dictated by activities.1.Autoclave for sterilization of specimens before disposal.2.Fire fighting equipment.3.Sinks with both cold and hot water.1.At least one microscope.8.Disposable syringes and needles.14.Necessary laboratory glassware.15.Chemical balance.(iv)REAGENTS AND CHEMICALS:There should he minimum reagents and chemicals to enable a confirmatory diagnosis to be reached in each of the disciplines offered.All specimens must be recorded in a register. Such registration should show the following: Date, Patient's name, attending doctor's name, nature of the specimen and tests requested.FIFTH SCHEDULE
REQUIREMENTS FOR A CLINICAL RADIOLOGICAL LABORATORY
1.MINIMUM REQUIREMENTS FOR A CLINICAL RADIOLOGICAL LABORATORYFor the purpose of considering radiological protection facilities the following should be adopted as a general guide—LEVEL 0—Clinics and health stations operated by a nurse or medical assistant without any direct medical supervision—No radiological facility required.LEVEL 1—Small clinics, health stations or general practices under supervision of a general practitioner who can undertake emergency work and refer patients to other levels—radiography only for chest, fractures (mainly extremities), and in exceptional cases plain abdomen necessary. No fluoroscopy should be undertaken.LEVEL 2—District Hospitals or rural hospitals staffed by a small number of doctors and undertaking general medical care and minor surgery, some private hospitals, clinics and non-profit making hospitals may be included in this group—radiographic examinations required include chest, simple abdomen, fractures, and possibly some fluoroscopic examinations.LEVEL 3—Medium sized regional provincial hospital that undertakes routine hospital work such as general medical care and routine surgery including abdominal surgery. The medical staff should include specialists in main fields as defined in these Rules.All general radiographic work is needed which would include some special examinations e.g. tomography, angiography, urography, etc.LEVEL 4 & 5-Large central and general hospitals including teaching hospitals where all types of radiological procedures are required.2.FOR A PROPERLY ORGANIZED RADIATION PROTECTION PROGRAMME TO SUCCEED, it is strongly recommended that—(1)In hospitals at levels 3, 4 and 5, all x-ray diagnostic examinations should be carried out by the diagnostic radiology department.(2)Even when an x-ray equipment is installed in other departments the head of the radiology department should have responsibility for radiological aspects of any examination performed.(3)Level 1 refers to a rural or remote area where no other radiological service is available and the supervision is that of a general practitioner with limited skill in radiology. A fully qualified radiographer may not be available at this level and the x-ray equipment may be operated by a nurse or laboratory technician. Such a nurse or technician should have had additional training in radiography.(4)In areas where a more comprehensive radiological service is available, no attempt should be made to provide a level 1 radiological service.(1)The x-ray room should provide adequate radiation protection for people outside the room, who may have no knowledge of radiation or radiation requirements.(2)The basic x-ray room for general purposes should be about 6 x 4 x 3 metres in size, with wall thickness in all directions of 2 mm. lead equivalent.(3)The doors, the darkroom hatch, and covers for services and other instructions through the wall should have the same lead equivalent protection.(4)Windows should be at least 2 metres from the ground outside the x-ray room and 1.6 metres from the floor level of the room.(5)If the control panel is within the x-ray room, the protective shield should be positioned such that neither "once scattered" radiation nor direct radiation can pass round the edge of the shield from any part of the room where x-ray procedures are carried out.(6)The darkroom should be at least 6 sq. meters in area.(7)There should be at least two protected changing cubicles of 1.5 sq. metres minimum size, preferably outside the x-ray room.(8)If ordinary building material are used, they should be thick enough e.g. in the range 70.25 KV, 15 cm of concrete or 2 brick with plaster is sufficient.(9)However, if a prefabricated wood or metal building is being planned, it will need lead lining, preferably supported by plywood to prevent sagging. (2mm. lead sheet is adequate).(10)Converting an old bulding for an x-ray room will need a review by a radiation protection expert.4.CHOICE OF X-RAY EQUIPMENT:(1)The x-ray equipment should be adequate for its purposes e.g. at level 1 of radiological care, a good stationary x-ray tube and generator should be employed. Improvisation of a mobile machine in an old room used for other purposes should not be tolerated under any circumstances.(2)For routine general radiography, necessary ancillary apparatus should be provided e.g. chest stand and a stationary couch with grid and film x-ray.(3)To avoid mains voltage drops, the power supply to an x-ray unit should be separated from, say that for lifts, etc.(4)Where power supplies are particularly unreliable, battery operated or condenser discharge equipment should be used.(5)An x-ray tube head of lower rating than that of generator should be installed.(6)For exposure controls, meters giving clear indication of voltage, current, and milliampere-seconds at all times are required.(7)The timing device must be capable of making sufficiently short exposures (say down to 0.04 sec.) must terminate a present exposure, and must be "dead man" type.(8)All x-ray, fluoroscopic and dental equipment must further meet the protection standards as laid down by the International Commission on Radiation Protection.(9)The normal output for radiographic units should lie from 60 KV and above with preferably not less than 50mA. For flouroscopic units without image intensifiers, 75 KV and 2-3mA is the normal order. 3mA should not be exceeded at 100 KV.5.SAFETY PROCEDURES:RADIOGRAPHY(1)Staff positions should be behind protective shields preferably outside the ex-ray room providing there is adequate view through a lead glass and communication device for speaking to the patient during exposure.(2)During special techniques, where staff need be in the x- room, protective aprons and gloves should be worn.(3)Films should be supported mechanically. Beam size shou be reduced to cover by means of light beam diaphrams or variab cones only areas under investigation.FLUOROSCOPY(1)Only essential persons who must wear protective aprons should be present in the room during fluoroscopy.(2)The fluoroscopy switch should be spring loaded so that is not left on unnecessarily or accidentally.(3)A cumulative timing device that gives an audible warning and finally switches off after a few minutes to restrict the total switch-on time of the equipment.(4)A properly darkened room.(5)A fluoroscopy switch coupled with the rooms red light.(6)If sufficient information can be obtained from radiography alone (e.g. as in chest examinations) then fluoroscopy should not be done.(7)There should be effective coning devices.(8)With conventional equipment, adequate dark adaptation of at least 15 minutes prior to screening is necessary.ROOM LAYOUT(1)Primary x-ray beam should not fall on the darkroom wall and should not routinely point towards doors or windows.(2)Where there is more than one equipment in the same room—(a)Only one generator per room should be installed.(b)A warning device should be mounted on each x-ray tube and control panel of the generator.(c)Adequate protective screen should be provided between each x-ray tube area.(3)For special technique such as tomography, angiography, etc. a special room should be provided.(4)Record room, offices and waiting room should be provided outside the main x-ray room at all levels.(5)Protective screens should be provided for all the positions in which staff are required to be during exposure in the x-ray room.(6)Persons required to assist during fluoroscopic procedures should wear a protective apron of at least 0.25 mm lead equivalent.(7)The physician performing the fluoroscopic procedures should wear a protective apron of at least 0.25 mm lead equivalent.(8)When a new x-ray facility goes into operation, all staff members who at any time may enter the department should be issued with radation monitoring badges.(9)Site monitoring during the radiation surveys should be done before commissioning the unit.(10)Persons likely to receive three tenths (3/10) of the annual maximum permissible dose should be monitored regularly.(11)Radiation personnel should be medically examined on initial appointment and at any time when the exposure levels as indicated personnel monitoring are sufficietly high.PROTECTION OF THE GENERAL PUBLIC(1)Careful attention must be paid to be protection of all areas around, above and below x-ray rooms.(2)Apart from adequate protective thickness of walls, floors, ceilings and doors, unprotected windows should not allow the pub outside to be irradiated.(3)Stray radiation should not reach the waiting rooms or other occupied areas.(4)One patient must not use a curtained corner of an x-ray room to change clothing while another is being radiographed in the same room.(5)Separate protected cubicles should be provided preferably outside x-ray room.(6)Lead-protected doors must always be closed during x-ray examinations.(7)Particular care should be taken to avoid irradiating patients in adjacent beds during mobile radiography.(8)Protective clothing should be sworn by parents holding children undergoing x-ray examinations. They should not stand in the path of a primary beam.SIXTH SCHEDULE
LIST OF APPROVED SPECIALIST POSTGRADUATE QUALIFICATION
| Speciality | Kenya | Foreign Equivalents |
| 1. Anaesthesia ............... | M. Med. (Anaesthesia) | F.F.A.R.C.S., F.F.A.A.R.C.S., M.D. (Anathesia), Dip. Am. Board of Anaesthesiology, etc. |
| 2.Internal Medicine | M.Med. (Medicine) | M.R.C.P. (U.K.), M.R.A.C.P., F.R.C.P. (C), Dip. Am. Board of Int. Medicine, M.D. (Medicine) New Delhi, etc. |
| 3.Obstetrics and Gynaecology | M.Med. (Obs./Gyn.) .. | M.R.C.O.G., F.R.C.S. (o.B.s./ GYN.) M.D. (O.B.S./GYN.), M.R.A.C.O.G., Dip. Am. Board of Obst. and Gynae., etc. |
| 4. Paediatrics | M.Med. (Paediatrics) | M.R.C.P. (U.K.), M.R.A.C., F.R.C.P., (C), Dip. Am. Board of Paediatrics, M.D. (PAED.) New Delhi, etc. |
| 5. Pathology | | M.R.C. (Path.), M.D. (Path.) New Delhi, Dip. Am. Board of Pathology, etc. |
| 6. Psychiatry .. .. .. | | M.R.C. (Psyc.), M.D. (Psych.) Dip. Am. Board of Psychiatry, etc. |
| 7. Radiology .. . . .. | M.Med. (Radiology) .. | F.R.C.R., M.D. (Radiology), Dip. Am. Board of Radiology, etc. |
| 8. (i) Surgery—General .. | M.Med. (Surgery) .. | F.R.C.S., F.R.A.C.S., F.R.C.S. (Canada), Dip. Am. Board of Surgeons, M.S. (New Delhi), etc. |
| (ii) Cardiothoracic Surgery | M.Med. (Surgery)* .. | F.R.C.S., F.R.A.C.S., F.R.C.S.(C), Dip. Am. Board of Surgeons, m.s.* (New Delhi), etc. |
| (iii) Neurosurgery | M.Med. (Surgery)* .. | F.R.C.S., F.R.A.C.S., F.R.C.S. (C), M.S. (New Delhi), Dip. Am. Board of Surgeons, etc.* |
| (iv) Ophthalmology .. | M.Med. (Ophthalmology) . . | F.R.C.S., F.R.A.C.S., F.R.C.S. (C), M.S. (New Delhi), Dip. Am. Board of Surgeons.* |
| (v) Orthopaedics and Trauma | M.Med. (Surgery)* .. | F.R.C.S., F.R.A.C.S., F.R.C.S. (C), M.S. (New Delhi), Dip. Am. Board of Surgeons, etc.* |
| (vi) Otorhinolaryngology | M.Med. (Surgery)* .. | F.R.C.S., F.R.A.C.S., F.R.C.S. (C), M.S. (New Delhi), Dip. Am. Board of Surgeons, etc.* |
| (vii) Plastic Surgery .. | M.Med. (Surgery)* .. | F.R.C.S., F.R.A.C.S., F.R.C.S (C), M.S. (New Delhi), Dip. Am. Board of Surgeons etc.* |
| 9. Dentistry .. | | F.D.S.R.C.S., M.D.S. (New Delhi). Cert. Am. Board of Orthodontics, Cert. Am. Board of Endodontics, Cert. Am. Board of Prosthetics, Cert. Am. Board of Periodontology, Cert. Am. Board of Oral and Maxillary facial Surgery, Cert. Am Board of Conservative Dentistry, etc. |
