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.

SUNDAY 9TH DECEMBER 2007
- 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.

MONDAY 10TH DECEMBER 2007
- 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.

TUESDAY 11TH DECEMBER 2007
- 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.

WEDNESDAY 12TH DECEMBER 2007
- 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.

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

Hi,

Sorry for the delay...

Let us continue...

SUNDAY 2ND DECEMBER 2007
- 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.

MONDAY 3RD DECEMBER 2007
- 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.

TUESDAY 4TH DECEMBER 2007
- 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.

WEDNESDAY 5TH DECEMBER 2007
- 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.

THURSDAY 6TH DECEMBER 2007
- 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.