Tuesday, November 18, 2008

Family Medicine Posting in Klinik Kesihatan Merbok (Group A3) Part 2 [09/11/2008-12/11/2008]

Hello back....

So sorry for me to take some time to continue writing in this blog regarding our 2nd week experience in Klinik Kesihatan Merbok. We had a wonderful and fabulous time there.

Day 6 (09/11/2008)
We had a very short day wherewe just clerked elderly patient and did some assessment on them such as Elderly Cognitive Assessment Questionnaire (ECAQ), Mini Mental State Examination (MMSE), Psychiatry Depression Scale, Symptoms of Dementia Screener (SDS) and Modified Barthel Index. Those test are actually compulsory to be tested on every elderly patients. We then presented our patients to Dr. Jamilah. We were also told that there is something called as "Geriatric Giants" which includes Instability, Immobility and Incontinence.

Day 7 (10/11/2008)
First of all, we were being briefed on children with special needs programme. We were told that it is the most important to prevent handicap children here in Malaysia and that the MOH (Ministry of Health) had launch a pre-pregnancy clinic in year 2004 where these clinics are located in both Klinik Kesihatan and in the Hospital to have a pre-pregnancy care. In the pre-pregnancy care, a couple of things have been looked into such as:-
1) Early diagnosis of Diabetes Mellitus, Hypertension, and Thyrotoxicosis
2) Counselling for all patients <50>
3) Advise to pregnant mothers that:-

(a) If mother is diagnosis to have thyrotoxicosis, they can be pregnant after the treatment
(b) Thyrotoxicosis can cause abortion
(c) Mothers who are pregnant are advise to take folic acid to prevent teratogenicity
(d) Mothers who are pregnant with diabetes mellitus have to be taken good care of to prevent
anencephaly, spina bifida, etc
(e) Mothers who are pregnant with heart problem will eventually face more medical problems
compare to their child
(f) Mothers who are pregnant with diagnosis of epilepsy can have teratogenicity effects to the
child if the mother is on anti-epileptic drugs
(g) If the mother is pregnant and is diagnose to have rubella infection, 99% the fetus will get
teratogenisity effects and therefore abortion have to take place. In the first trimester if
the mother comes with fever and rash, must ask whether the mother concern has been
given immunisation towards rubella or not. Then a titer test must be done and if the test
turns out to be positive, then pregnancy must be terminated.

Normally after delivery, agross examination will be done during the follow-up. Any developmental milestone delay will be detected and a early stimulation programme or exercise is done during the infant period (in this category, different exercises are given based on the age of the patient). After the age of one, if there is still a gross delay, then the patient is referred to the Paediatric Department to confirm the diagnosis. Once the diagnosis is confirmed in the Hospital, the patients will then be follow-up in any Klinik Kesihatan nearby. The diagnosis is categorised into mild, moderate or severe and then the patient undergo the multidisciplinary approach (including Paediatricians, Health team, Teachers, Physiotherapists, Social welfare and Parents) in order to get optimal care.

For the mild disability, they are sent to the TASKA. The moderate disability children will still be trained by the occupational therapist on simple tasks like toilet train skills, self-care and basic occupational therapy. As for the sever disability, they will be sent to the Children Rehabilitation Centre (PDK) and will be taught basic living there.

For severe mental retardation (eg. imperforated anus, etc), it involves two care units which are:-
1) Health Care
(a) Nursing for nursing care
(b) Physiotherapist for physiotherapy care
(c) Specialist for medication treatment
(d) Medical Officer for medication treatment
(e) Paediatricians for further care
(f) Occupational therapy - refer to Hospital
(g) Speech therapy - refer to Hospital
2) Community Care
(a) Jabatan Kesihatan (Health Department)
(b) Jabatan Pelajaran (Education Department)
(c) Jabatan Kebajikan Masyarakat (Social Welfare Department)
(d) Jabatan NGOs (Non-Governement Organisation)

In the district of Kuala Muda, Kedah, there are some Child Rehabilitation Centre (PDK). They can be found in:-
1) Merbok
2) Bedong
3) Bukit Selambau
4) Kota Kuala Muda

We then follow Dr. Jamilah to a Child Rehabilitation Centre (PDK) in Merbok. Over there, they are taught according to the ages. For the young ones, they are given some toys to play with. For those schooling-aged, they will be taught simple words and pronouncation. For adolescents, they will be given some tasks to do like sewing, bakery, etc and the things that they had done will be sold off so that the disabled children can received some money in the end. The parents of each children will be paid some money to encourage them to send their child to the centre. Currently they are paid RM 150 per month.

We were then being left in the Muzium Arkeology Bujang when the day ends.

Day 8 (11/11/2008)
We were being briefed by Staff Nurse Meriam on nutrition control on antenatal mothers. A normal diet containing carbohydrate, protein and vitamins were being advised to those pregnant mothers.

Day 9 (12/11/2008)
Today is our last day in Klinik Kesihatan Merbok. In the morning, we were assigned a few patients to be clerked and then we headed to the Physiotherapy Department to follow-up a patient. Over there in the department, a short briefing were being told to us by a new physiotherapist. Besides observing her teaching a stroke patient on how to move her right upper limbs, she also brief us on regarding the physiotherapy unit. In the whole of Malaysia, there are more than 200 Klinik Kesihatan but only 18 Klinik Kesihatan has a Physiotherapy unit with equipments by its own. In Kedah, there are 3 Klinik Kesihatan which has the facilities. They are:-
1) KK Merbok
2) KK Bandar Alor Setar
3) KK Pendang

However, in Sungai Petani, there are 5 Klinik Kesihatan which has physiotherapy unit of which only one had equipments. The 5 are:-
1) KK Merbok
2) KK Bedong
3) KK Selambau
4) KK Bandar Sungai Petani
5) KK Kuala Muda

Out of the 5 mentioned above, the physiotherapist from KK Merbok will visit the rest of the Klinik Kesihatan once in a month with portable equipments.
We then have a brief closing up session with Dr. Jamilah discussing about the whole entire programme of ours in the 2 weeks.

In the afternoon, we had a briefing on Tuberculosis and Adolescent by Staff Nurse Norizah. In the tuberculosis briefing, we learnt that there is 2 types of treatment given which are known as PR1 (Pusat Rawatan 1) and PR 2 (Pusat Rawatan 2). In PR1, they can start with anti-tuberculous medcations. The places are such as chest clinic (seen in any KK with Family Medicine Specialist (FMS) - KK Merbok and KK Bandar). For PR2, they are not allowed to start any medications but can only give DOTS to the patients. Screening for tuberculosis is open to:-
1) Walk-in patient with symptoms
2) Any diabetes patient with symptoms
3) Any HIV patients
The screening for tuberculosis regardless of any type of the patients will have to fill up the TBIS form and sent to the District Health Office Kuala Muda within 1 week. The 'Pegawai Persekitaran' will go to the patient's house to get any family members who may be in contact with the patient. A notification form is also been filled up. The patient's contact will be ask to take sputum and chest X-ray (for child, Mantoux test is taken and no CXR is taken). Patient is clerked by the doctor (an envelope and a file will be given to the patient). Baseline investigations (eg. LFT, AST, Sputum C&S, HIV status, RBS, etc) were done. Then, treatment (dosage) is given to the patient depending upon the body weight of the patient. A small book will be given to the patient; either yellow (for PTB +ve) or white (PTB -ve). For PTB negative, sputum culture is not require.
There are 2 different phase for treatment. In Phase 1, 52 doses are given. Then, the chest X-ray and sputum culture is being repeated before proceeding to Phase 2 where 32 doses are given (every fortnightly). After that, follow-up will be the first 3 months, follow by 6 months, 9 months and 2 years respectively. If patient's contact or family members were to be found positive, treat them accordingly too. If there is a defaulter, the 'Pegawai Persekitaran' will be informed and they will track the patients down and treatment is tobe started all over again. Then, they will be given a red card.
A template or brochure is given to patients to let them realise the importance of DOTS, the food and diet and also to educate the patient on tuberculosis. If a patient were to be transferred, a 'Borang 10K' must be filled up and the receiving place must make sure that the patient turn up for regular follow-ups. If the patient has passed away, a 'Borang 10J' have to be filled up. All together, there are about 25 forms just for tuberculosis.
In KK Merbok which covers areas like Bedong, Selambau and Merbok, there are about 10 new patients of tuberculosis yearly.
As for the adolescent briefing, we got to know that the range for adolescent is 10-18 years old. Any walk-in patient for screening or any refer cases (normally from the school) will then be given a form to be filled up. Then, any problems will be detected (eg drug abusers, smoking, depression, molest, etc) and they will be counselled. In KK Merbok, all female adolescent are counsel by S/N Norizah. Even for any male adolescent who smokes will be counsel by her too. For other male adolescent, they will be counsel by medical assisstant. Unless there is cases which are very severe, then those adolescent will be refer to the medical officer or the family medicine specialist.
And this ends our 2 weeks of posting in KK Merbok. We did had a splendid time there...
i hope you did enjoy reading the article...
Thank you...

Thursday, November 6, 2008

Family Medicine Posting in Klinik Kesihatan Merbok (Group A3) Part 1 [02/11/2008-06/11/2008]

Welcome back to this blog...
But i would like to apologize that we do not have any photographs to show this time.

Currently my friends and i from Group A3 are in our final year of MBBS and we are posted in Klinik Kesihatan Merbok for 2 weeks for Family Medicine.

We consists of:-
1) Charlotte Marie d/o Ambrose Alexander (ID No: 0400387)
2) Chai Zsi Yuan (ID No: 0400414)
3) Chan Hui Ling (ID No: 0400420)
4) E'rlene Low Li Ern (ID No: 0400429)
5) Gan Yuen Keat (ID No: 0400435)
6) Cheah Boon Eu (ID No: 0400405)

Our posting in KK Merbok started on the 2nd of November 2008 and will end on the 13th of November 2008.

Hereby, what we have learnt it mostly a repetition of what we had done when we were in Year 4 (where we were posted in Baling and Sik for our District Health Office Posting). However, there are some activities and knowledges that we failed to collect during our previous postings in Year 4. Thus, i shall share it here with you.

Day 1 (02/11/2008)
A briefing about Family Medicine by Dr. Jamilah Abdullah and Staff Nurse Hasnah

Day 2 (03/11/2008)
We were being briefed on how Pap Smear is being done in KK Merbok. According to Staff Nurse Zakiah, every year, they have a target of 550 patients for Pap Smear examination. Sometimes, they will do health campaign to make the community aware about Pap Smear. Previously they used to send the Pap Smear samples to Hospital Sultan Abdul Halim, Sungai Petani for further investigations but since November 2008, the Pathlab representatives will come and collect the sample.

Besides Pap Smear, we were also told about Breast Self Examination (BSE).

After the two sessions mentioned, we were being briefed by Staff Nurse Meriam about Immunisation. Even though again this time we did not get a chance to go to the school to give the immunisation, we did learn some new things. First of all, all vaccines are being stored in the fridge at 2-8 degree Celcius. If at all there is no electricity, they will be inform early. However, most of the time, the fridge can maintain the temperature if left unopened for 48-72 hours depending on the different fridges used. The position of the fridge and the surrounding (eg. the wall) should be at least 30cm apart. And the fridge is normally placed in a room which is not exposed to the sunlight so that the temperature canbe maintained.

The temperature is maintain by cold chain which a minimec termometer is used to measure the temperature. The temperature is being taken twice a day (once in the morning at 8am and once in the evening at 4pm) and it is then being recorded in a book. Every time when the temperature is taken, a button is to be pressed on the minimec termometer to get the current temperature (suhu semasa). 3 colours will be used to draw the graph in the book to record the temperature. The red colour indicates the maximum temperature, the blue indicates the minimum temperature and the green indicates the current temperature. On weekends and public holidays (when the KK is not opened), there will still be someone resposible to come and check the temperature. If at all the fridge is not working or the vaccines has been exposed to a higher temperature, all the vaccines will be sent to the lab to be tested for its potency.

In the fridge, the vaccines are arranged in such a way that the live vaccines are placed at the most top. Live vaccines such as BCG, PV, Measles, etc; when given, it must not be cleaned with a spirit swab. BCG vaccination is given at birth and if there is no scar at the age of 3 months, it is given again and to be check again at the age of 7 years old, 12 years old and in secondary school. BCG is use to protect tuberculosis and the vaccination can only protect a person for 15 years.

A type of vaccination which is called as Triantrix is currently given. It contains of DPT, Influenza or HiB and Hep B. Baby who are HIV positive or those who are under chemotherapy, OPV is not given to them due to low immune system.

Complication for mumps in a male is impotence and complications for measles are meningitis, pneumonia and etc.

For a pregnant lady, vaccinations such as Tetanus and Rubella are those commonly asked to them. If an antenatal lady is Gravida 1, then she will be given 2 doses of Tetanus and if the mother is more than Gravida 1, then she will only be given 1 dose of Tetanus. In Gravida 1, the first dose is normally given at the 18/52 POG. And the second dose is given after 1 month of the first dose. If mothers who are more than Gravida 1, the dose is given one month after quickening. Rubella on the other hand is given to mothers after one week of postnatal to those mothers who had never had Rubella vaccination before.

For ATT, Hep B, DPT and DA (Double Antigen), they are usually whitish grey in colour. If it get spoiled, the colour will changed to yellowish brown. Another way of knowing whether the vaccination is still potent is by looking at the sediment. If there is sediment present, try to shake the bottle. If the sediment is still there, this means that the vaccine is no longer potent. As for MMR, the normal colour is light pink.

Day 3 (04/11/2008)
We had a more concise discussion about Cardiovascular Diseases and Diabetes Mellitus with Dr. Jamilah in Klinik Kesihatan Bedong.

For Cardiovascular Diseases, the cut-off point for a screening is 45 years old for males and 55 years old for females. For hypertension, the most important investigations done is urine analysis. For lipid profile, the most important ones that they will look into are LDL follow by HDL and TGL.

As for the Diabetes Mellitus, the current prevalence in Malaysia is 12%.

Day 4 (05/11/2008)
For the morning sessions, we follow the clinic on NCDC (eg DM and HPT, mostly). We each clerk a case from the OPD in KK Merbok and presented them to Dr. Jamilah Abdullah.

In the afternoon, we had a briefing on CDC (eg. HIV). We were told that the prevalence of HIV in the world is about 80,000 and the incidence for HIV daily is 16 patients worldwide. In Kuala Muda, there are about 50 patients with HIV and in the whole of Kedah, there are about 500 patients diagnosed with HIV.

All tuberculosis and high-risk patients are subjected to HIV test. In a high-risk patients, ELISA is done and the samples are sent to the Hospital and it takes about 3-4 days for the results to be returned. If a low-risk patients (eg, pregnant mothers, marriage couples, etc) a rapid test is to be done in the KK.

HIV virus will die once expose to the air. HIV can be transmitted through a lot of ways. As for needle-prick injury, the chances of getting HIV is 0.14% and HIV can be spread through sexual intercourse by 0.9%.

In a pregnant lady with HIV positive, she will be started on STAT (short-term antiretroviral therapy). With the treatment, there is only 8% chances of the fetus developing HIV, but without the therapy the fetus is at a 30% rate of getting HIV. The therapy will be stopped after delivery. The objective of this therapy is to prevent the fetus from getting HIV from the mother. For all the HIV positive pregnant lady, the mode of delivery will be Caesarean Section as baby will have a higher chance (which is 60%) of getting HIV is the mother deliver through spontaneous vaginal delivery.

All the treatment for infectious diseases are free of charge in Malaysia. As for HIV, a 6 monthly CD4+ check-up is done to see whether the patient needs the treatment for HIV (HAART). HAART is also known as highly active antiretroviral therapy which is given to those HIV patients with CD4+ count less than 250. The first dose is normally given to the patients but the subsequent doses is not free of charge. Currently, Malaysia is importing the HAART medications (Cipla) from India.

If a HIV positive patient were to be diagnose with tuberculosis, the HAART therapy will be stopped for one month when they start with their anti-tuberculosis medications. In HIV positive patients, IV streptomycin will not be given as they are trying to reduce the risk of getting needle-prick injury. Unless the HIV positive patient has been on HAART therapy for a long time, then it is not stop as by stopping it can cause resistance.

Day 5 (06/11/2008)
We follow Sister Che Bunga and a Community Nurse for Home Visit programme. Before a home visit is done, the nurses in-charge must have a worksheet on the objectives of the "Rumah Lawat" programme and they must submit a report after that. A home visit is normally done to those who are postnatal, antenatal, child follow-up and HOSPICE follow-up.

For the postnatal, a home visit is done on day 1, 2, 3, 4, 5, 6, 7, 8, 9, 10 and 20. The first 10 days is important to detect for any Jaundice. The infant is then being measured for his or her weight at the 10th and 20th day. For antenatal home visit, it is done in a routine schedule which is once in first trimester, once in second trimester and once in third trimester. Unless, the mother has other complications, then the home visit would be more frequent. In a antenatal follow-up, first a urine dipstick is used to detect any abnormalities like sugar or protein in the urine. Then, a thorough medical check-up will be done (eg. measuring the blood pressure, checking for the fundal height and other general examinations). For child follow-up, it is meant for disable child or child with inadequate nutrition.

The things which are being brought during a home visit are:-
1) Delivery set
2) Swabbing set
3) Sterile gloves
4) Swabs and swabs
5) Top and Tail set
6) Urine dipstick
7) IV line
8) Catheters
9) Hibitane cream
10) Hibitane spirit
11) Fetal scope
12) Needles and Syringe
13) IV saline
14) Disposable sucker
15) Chinese paper
16) Mask and drape
17) Filter paper (to detect for G6PD)
18) Blood pressure set (Sphingomanometer)
19) Termometer
20) Measuring tape
21) etc......

This conclude our first week of our Family Medicine posting in Klinik Kesihatan Merbok.
Hope you enjoy reading our experience.
i will be posting our second week soon.
Till then, thank you very much.

Friday, April 18, 2008

Role of Medical Assisstants

Some background information regarding medical assistants (MA)
1) Multi skilled, multifunctional healthcare providers for more than 100 years.
2) Initially known as ‘dressers’.
3) Often called the ‘backbone’ of rural health services and ‘jack of all trades’ in hospitals.
4) Male nurse profession introduced in mid-50s
5) In 1977, Hospital Assistants (Registration) Board established under ‘Act 180’.
6) In 1992, nomenclature of ‘hospital assistants’ changed to ‘medical assistants’. Training upgraded to diploma level.
7) The Board functions under Medical Practices Division. DG of Health is the Chairman. Chief Medical Assistant is the Secretary of the Board.

Role of PPP (Medical Assistants):
• Responsible in the promotion, prevention, curative and rehabilitation of community under the inspection of medical officer in the primary health care set-up.
• Assisting family medicine specialist and medical officer in term of clinical settings, documentation, medical training, management of health care and research.
• Head a primary health care clinic during the absence of medical officer.

Their works includes:

A.) Screening of patient
• History-taking.
• Vital signs examination.
• Physical examination.
• Lab investigation or X-ray ( whenever necessary)

B.) Examination, diagnosis and treatment
• Carrying out certain diagnostic and therapeutic procedures, such as ECG, nebulization, IV infusion.
• Carrying out certain minor procedure, namely application of POP, I&D and so on.
• Giving injection.
• Taking IV blood sample.

C.) Emergency treatment
• Involve in preliminary management during emergency.
• Conduct First Aids and CPR.
• Referral of cases to medical officer / nearest health centre.

D.) Referral
o Refer cases which are not within their limit to hospital.
o Handling referral cases from paramedics.
o Receiving follow-up of stable cases from the hospital.
o In time of emergency, a medical assistant is allowed to drive the ambulance, provided that there was a written order from medical officer.

E.) Ambulance service
• Head the ambulance team.
• Responsible to ensure that all the equipments in the ambulance are in good condition.

F.) Health education and counseling
Ø Responsible for counseling the patients and community.
Ø Involve in health campaign.

G.) Treatment of communicable diseases
• Case tracing.
• Case notification.
• Contact tracing.
• Provide treatment.
• Give immunization injections when needed.
• Home visits to defaulters and to give health education.

H.) Treatment of non-communicable diseases
– Screening and detection.
– Initiate treatment.
– Follow-up for stable cases.
– Give counseling and health education.

I.) Immunization
• Examination and injection of Anti-Typhoid jab to food handler.
• ATT injection.
• Meningococcal injection to those going to perform Hajj.
• Japanese encephalitis vaccination
• Cholera injection.

J.) After working hours
• Attend to emergency cases after working hours.

K.) As assistant pharmacists
• Medication dispensing.
• Packing medicine.
• Recording medicine usage.

By [Michelle] Huang Mooi Sia
FMHS Batch 5/6
p/s: any suggestion, please feel free to contact me at michellehms82@yahoo.com

Sunday, March 30, 2008

District Health Office Posting in Baling, Kedah Darul Aman [Part IV - Week 4 (09/12/2007-12/12/2007)]

Hi everyone once again,

Hereby, i shall bring you to the final week of our DHO posting in Baling, Kedah.

- The topic for the day was primary care. PPKP Danial met the team in Klinik Kesihatan Kupang. We were briefed regarding the various primary care services available. Among the services available include Diabetic clinic, Antismoking clinic, Geriatric clinic, Hypertension clinic, HIV screening clinic and many more.
- PPKP Danial also briefed us regarding the emergency set up and basic life support. We were also taught regarding the functions of each item on the emergency trolley. We were also briefed about how an emergency call is directed to the call centre in Hospital Sultanah Bahiyah, Alor Star from Telekom Malaysia.
- Later in the evening, we attended the antismoking clinic in hospital Baling. Encik Mohd Rusli briefed us on how the clinic is run according to protocols set up by the Health Ministry. Later, we observed him counseling a new patient.

- We met PPKP Nizam who is in-charge of Kawalan Mutu Makanan. We were briefed regarding the various forms available, the procedure of collecting food samples and transporting it to Butterworth, and also procedures regarding the closure of food premises.
- Later, PPKP Mazran explained to us about KPAS, that is the abbreviation of Kesihatan Pekerja dan Alam Sekitar. He explained to us regarding the duties and programmes of KPAS.
Among the activities carried out are:
(a) surveillance of cases of injuries and skin diseases among factory workers
(b) investigation and management of needle stick injuries
(c) education of workers regarding safety equipments
(d) monitoring of the school environment
(e) monitoring the cleanliness and sanitation of the Pusat Latihan Khidmat Negara before and during the programme
(f) supporting ‘healthy setting’
(g) early detection of cardiovascular diseases among workers
(h) investigation of public complains such as complains of cleanliness of animal farms
- Later at noon, one of our AIMST Community Medicine lecturer; Dr. Sawri Rajan met us in the District Health Office of Baling to discuss about the activities we are suppose to be carrying out during our posting here. He also discussed with us regarding the write-up of the log book of Community Medicine.

- The Department of Food Quality Control arranged to take us to observe the process of food sampling. We first gathered at Pejabat Kesihatan Baling at 8 am and then left for Petronas with the Food Quality Control team at 9am. Upon arrival, we observed the team collect 5 samples of food from the Petronas Mesra convenient store. The 5 samples collected were Dutch Lady Full Cream milk, Tiger brand milk cookies, Silverbird fruit cake, DRINHO soya bean and OOZI peanut butter. We then learned the methods of packaging the food items, labeling them and sealing it with the seal labeled ‘ LAK Rasmi”.
- Then, we followed the team to Butterworth where we observed how the items were received and registered for microbiology investigation by Makmal Keselamatan dan Kualiti Makanan, Negeri Pulau Pinang.

- We attended the Blindness Detection Programme or rather known as ‘Program Kebutaan’ in Klinik Kesihatan Tawar. This is an activity arranged under Non-communicable Diseases Control (NCDC) unit.
- We were briefed by Penolong Pegawai Perubatan Encik Amir regarding this programme. This Blindness Detection Programme is the pioneer programme in the country. Its center is based in Klinik Kesihatan Tawar. Therefore, all referrals from any health centers in the district of Baling would be sent here for evaluation before being referred to Sungai Petani for consultation by the opthalmologist.
- According to statistics, Perak is the state affected with the highest amount of blindness. Kedah currently ranks as the state with the sixth highest amount of blind cases in the country.
In 1950, it was recorded that 38 million people in the world were affected by blindness according to statistics prepared by WHO. Later on, a study was carried out in Malaysia from year 1996 to 1998. It was discovered that 2.71% (518680 people) out of 19 million people were affected with blindness.
- We learnt on how the screening process for blindness was done, the various methods of investigations and the different types of treatment provided.
- The Blindness Detection Programme unit is very active as they not only provide this service every Thursdays in Klinik Kesihatan Tawar, but also participate continuously in many of the health campaigns arranged by the district health office with the hope of creating awareness in the community pertaining the importance of healthy vision.

This is a photo of some of us bidding 'goodbye' to some of the stuffs in the Pejabat Kesihatan Daerah Baling.

Sunday, March 23, 2008

District Health Office Posting in Baling, Kedah Darul Aman [Part III - Week 3 (02/12/2007-06/12/2007)]

Sorry for the delay...
Let us continue...

- The topic of the day was outbreak investigation. The team reported to Pusat Pengawalan Vektor at 9 am. We then followed a team of health officers to Kampung Tanjung Luas to prepare slides for detection of malaria based on the recent reporting of new cases in the area.
- We visited 2 houses where each one of us were taught and given the opportunity to prepare slides under the supervision of the health officers. As the road leading to the houses were small and unsuitable for vehicles, we reached the houses on feet to collect the samples.
The pictures besides show how the malaria sample is being taken. First, the amount of people and their details were recorded in a piece of paper. From there, the numbering system is being used as the first person in the list will have their blood sample stored in the first column in the box (shown
in the third photo). The person involved is to be pricked in the finger (after a alcohol swab-to prevent infection) and blood is taken. The blood is smeared into thick and thin film before storing into the box. Below are photos of us being given a chance to perform the procedure.

- The next programme planned for the day was fogging. We gathered in front of Pejabat Kesihatan Daerah Baling at 6pm.
- We were separated into 2 groups whereby 3 students followed one health officer who conducted the fogging. We were then given a chance each to fog a certain area ourselves. Fogging began around 6.15pm and ended around 7pm. The health officer explained to us that fogging is usually done during dusk and dawn. This is because it is the nature of the Aedes mosquitoes to come out during that time.

The first photo showing the 'agrofog' which was used during the fogging session done on that day. After being shown the way of fogging, we were each being given a chance to fog a particular area.

- We reported to PPKP Rozaidi Shamsudin in the morning. He taught us on data entry and analysis regarding the outbreak investigations such as dengue, malaria, filariasis and Japanese Encephalitis.
- We were introduced to the data system used by the Baling district vector control department ( Pusat Pengawalan Vektor daerah Baling). It is a unique and sophisticated system called VEKPRO, which is in short for Vector Programme.
- The system consists of data registration of new cases and statistics management of all cases according to the respective years.
- We also learn how cases are prioritized. For example, one reparted malaria case is considered an outbreak whereas for dengue, it is considered an outbreak only when at least 2 dengue cases have been reported within the same area within 14 days.

- The programme for the day was environmental health and sanitation. However, as there was a leprosy patient that was going to be transported to Hospital Kulim from Baling district, we were allowed to follow this team. We learnt the procedure of referring a defaulted patient from Klinik Kesihatan to a nearby hospital.
- We followed a health department vehicle into Kampung Seratus to pick the patient and then transport the patient to Hospital Kulim. We had the opportunity to elicit history from the patient and to conduct a short physical examination on him.
- Later in the afternoon, we proceeded with the programme for the day under the guidance of PPKP Hamzah Ahmad. We were briefed regarding environmental health and sanitation for this district, their activities, contributions and achievements throughout the recent years.
- We were then brought by the health officers to Kampung Rebong where we were introduced and exposed to the house connection system. We saw water sysem of each house which communicated with other surrounding houses. This system then drained into two water tanks which finally released the water into a nearby river. This ensures the cleanliness and sanitation of the area is maintained. It also helps prevent the spread of diseases among villagers.
- We also had an opportunity to watch several villagers “gotong royong” to build a squatting toilet or rather known as ‘tandas curah’. This project is subsidized by the government.

The pictures above show how the drainage system of the 'kampung' works. From the sink of the house, it is drained into a a pipe with a filter at the end of it. Then this pipe drains from every houses to a particular tank. From the first tank it is drain into the second tank where the water is filtered again to prevent the oily water from entering the river later on.
The 7th picture above shows the villagers doing 'gotong-royong' in order to build a 'tandas curah' for themselves. The boys will spent their time helping out during the school holiday.

The last picture shows how the villagers store their equipments.

- The topic for the day was environmental health and sanitation or rather known as BAKAS. We were first taken to Lata Sungai Sedim where we were able to appreciate the gravity feet system.
- We then proceeded to Kuala Cahaya where we were shown the village water system that consists of a large well that supplies water to 111 people in a total of 26 houses. We spent some time with the villagers before we proceeded back to Baling.

The pictures show the 'Gravity-Feet System' which use to supply water to 111 villagers in the total of 26 houses. Over here, the water is being filtered before supplying to the villagers.

- The topic for the day was health promotion and health quality control. The nutritionist or rather known as Pegawai Zat Makanan, Puan Juliani Faridza Alias briefed us on the health promotion and quality control programmes run by the Pejabat Kesihatan Daerah Baling.
- She mentioned that the department’s duty is divided into three main parts which consists of monitoring, rehabilitation and promotion. Monitoring includes ethics regarding breast feeding whereby factories are given restrictions regarding promoting and encouraging the sales of their milk formulas to mothers. Among the examples of restrictions drawn up by this ethics include the restriction of promotion of such formulas in hospitals that are baby friendly and the restriction of giving out samples of milk formulas in clinics that promote breastfeeding. Rehabilitation and promotion include providing financial aid to families according to their income margin, arranging cooking demonstrations to mothers with under nourished children, promoting breast feeding, counselling for individuals with diabetes and hypertension, providing iodine salt to individuals with iodine deficiency disorder ( IDD ) and iodinators to schools, providing food baskets ( bakul makanan ) which consists of rice for carbohydrate, eggs and sardine for protein, Scott’s emulsion or Champs supplements for vitamins and milk for calcium to undernourished children from families of the lower income group, providing hematinics and softgel for individuals with anemia and many other activites such as breast feeding campaigns.
- After the briefing, we were brought to Klinik Kesihatan Kampung Lalang where we observed how the nurses conducted cooking demonstrations to mothers with under nourished children. We were then taught how to enquire thoroughly regarding a child’s diet from the mother and were each given a chance to elicit history and counsel these mothers under the supervision and guidance of the nutritionist.
- After that, we were brought to Klinik Desa Tanjung Pari where we were shown the breast feeding room of the clinic that won the best room among all other clinics in the district of Baling.