DHO POSTING OF AIMST MBBS STUDENTS BATCH 7

A Dr Muda Video

2008-08-06T18:12:00.008+08:00

We got hold of his video

A trip to DXN

2008-08-06T18:12:00.004+08:00

After following on a BAKAS field trip to observe “tandas curah” and a 29 year old water pump, we left for another field trip with the Food Quality Control department to the DXN GanoDerma factory in Bukit Wang, about 11km from Jitra.
We arrived at 11.00pm and were ushered into the administrative lobby, we then went to the storage warehouse to meet Mr. Mohd Noor, the Environmental Health Assistant Officer from Food Quality Control Department.
He explained that when(in this case), the factory requests for a Health Certificate, the DHO will send its team to collect samples of the product. Usually 3 samples are collected for each batch of products:
1. The Accredited lab.
2. District Health Office.
3. Factory.
This is done for cross-referencing later on. Among the test done are:
1. pH.
2. Moisture.
3. Total Plate Count(TPC).
4. Heavy Metal( Lead, Mercury, Arsenic)
5. Microorganisms.
The lab results are obtained within 2 weeks and the Health Certificate is produced within a week if all conditions are met, so the entire process is done in 3 weeks. The cost is about RM 80 which is paid by the applicant.
The health certificate is necessary for exporting purposes.

After that we were invited for a ”Plant Tour”, Mr Lim Beng Tuan, the Senior Administrative Executive.
The company’s name is DXN Industries SDN. BHD. Started operations in 1995 as a plantation and was formally registered on the 20 November 1996. This site was opened in 1997. This plant has 730 workers and covers an area of 48 hectares. The company’s other plants are in Indonesia, China, and India.
DXN produces pharmaceutical, food, drinks, and cosmetic products which are exported to 22 countries around the world.

At the start of the tour we were brought to its plantation zone. This is where we first saw the preparation for seeding using sawdust and rice bran. Daily 5000 seeding bags are autoclaved for 2 hours at 125 °C and 11 PSI. It is then cooled down for a day before the spore is inserted in the polybag. The seeding room is kept clean, even unhealthy workers are not allowed in.
The mushrooms are then grown in cabins. There are 124 cabins of which only 4 are opened for tours. Each cabin has 21000 spores. The humidity and temperature are closely monitored. The mushrooms are harvested at about 3 months.
We were then taken to the pharmaceutical production line, where we were told that no photos were to be taken, as these were supposed to be company secrets. We saw how the different products were produced and packaged. At the end of the line we were given 4 sample tablets to try.
We then went to the food and beverage production line, followed by the cosmetic line where we were told about the company getting its “halal” certification by JAKIM.
At the end we were each given some free samples that are yet on the market.

PIC 1: at the autoclave

PIC 2: caffeine products

PIC 3: tablets given to us

PIC 4: production line

PIC 5: with Mr Lim

PIC 6: Tandas curah

PIC 7: Water pump

PIC 8: Culture cabin

PIC 9: Autoclave

JITRA: HIV/AIDS UNIT

2008-08-06T18:07:00.000+08:00

There HIV/AIDS unit is handled by only one person that is PPKP Mr.Osman bin Ali. He also analyses the data in Kubang Pasu district and the analysis is presented and discussed in epidemiology meeting..

OBJECTIVE

1) To give comprehensive medical treatment to the target group:-
a) Any high risk cases ( referred or voluntary )

b) Mother who conceive

c) Family members or any individual who takes care of HIV/AIDS patients.
2) To give medical information and support to those who in need.

ROLES AND RESPONSIBILITY AT DISTRICT LEVEL

The programmes in district level is lead by the district officer and helped by family medicine specialist, medical and health officer, assistant of environmental officer (PPKP) and the sisters and staff nurses.

Plan, implement and monitor programmes at district level.

Identification of problems and give feedback about PPHIV programme at district level.

Collect and insert registered cases from health clinic through on line at district level.

Plan and implement PPHIV activities at district level.

Receive all notifiable cases and confirm the contact cases.

HIGH RISK CASES

Drug addicts, who share the needles, having sex partner who have HIV, involve in unsafe sex, from mother who had HIV to the child and sexually transmitted illness (STI) patients are known as high risk cases.

The high risk cases will be counseled:

Pre test
- Given to those who wants to do the HIV screening

Post test
- Test results must be informed as fast as possible.

Home visit by PPKP for 3 reasons:
a) Contact Tracing
b) To give health education to the patient and also to the family members regarding nursing at home
c) To detect defaulters

FORM HIV/AIDS97 is a 3 in 1 form where we record information about HIV,AIDS and death of patient.

To register a patient as a case we need 2 positive results.

Sample verification or 2nd blood test must be obtained 1 week after 1st reactive ELISA test or just after informed by Lab which did the test.

Most cases are obtained from mothers who come for antenatal check-up and drug addicts.

NSP (National Strategy Plan) where by the MOH collaborates with other agencies or NGOs like AADK(Agency Anti-Dadah Kebangsaan,Schools,PLKN,Police) to provide talk and seminars related to HIV/AIDS.

In Kubang Pasu there is 2 PPHIV(Program Pengurusan HIV) that is in K.K Changloon and K.K Kepala Batas. All patients with HIV will be referred to PPHIV and all their contacts will be traced (Contact tracing).PPHIV does counseling,treatment and also lab test such as viral load and CD4.

After been diagnosed with HIV, their spouse and also their children < 6 years old should be informed and screened for HIV.

For year 2008 till 31 July, there has been 8 cases of HIV/AIDS been registered after 2 positive results.

The data from the forms are transferred to registration book and then into computer.

Corpse management

1) Notification received via telephone or verbally
2) Record into the record book
3) Patient record is checked in the communicable disease record book
4) Appropriate tools for corpse bathing (cleansing) procedure is prepared like rubber glove, mask and apron.
5) Visit the patients house and identify the person in charge of bathing the corpse.
6) Proper area for bathing the corpse has to designated.Proper disposal of bathing water has to be done that is into the drain or a hole that has been dug.
7) The dead person’s clothes has to be soaked in Clorox for 30 minutes before washed.
8) Explain to the person in charge the correct procedure to bath the corpse and ensure that’s they practice universal precautions.
9) Monitor the bathing procedure at all time
10) The corpse will be wrapped in 3 layers-
- first layer-white cloth
- second layer –plastic
-third layer – white cloth
Purpose is to eradicate microorganism
11)The equipments are soaked in Clorox for 30 minutes before washed and the floor is mopped with Clorox solution.

HARM REDUCTION
Sharing needles while injecting drugs cause 70% of reported HIV infection (2004)
The risk of practicing “unsafe sex” causes 20% of reported HIV infection (2004)
As a response to the 6th. Millennium Development Goal adopted during the Millennium Summit in 2000.
It is the fight against HIV/AIDS that remained to be achieved !

It is about making dangerous behavior less dangerous--It is less dangerous to inject drug with one’s own clean needle as opposed to sharing contaminated needle, and;
About improving Quality of Life--By providing the various supports to IDUs living with HIV/AIDS
And about saving lives--By not being infected or infecting others with HIV

Needle Exchange Program (NEP) is only one of many more harm reduction activities
NEP’s major role is to serve as a driving force towards a wide range of Harm Reduction related activities;
-Information, education and communication on risk reduction
-HIV Testing & counseling…. Condom use !!
-DST services, Half-way house…..
-T.B & STD screening and treatment,
-ARV treatment and;
-Psycho-social and moral care & support.

The Principles;
-First; to help the uninfected IDUs stay that way;
-Second; to help infected IDUs stay healthy, and;
-Third; to help infected IDUs initiate and sustain behaviors that will keep preventing HIV transmission to others.

JITRA: Preview of tommorow

2008-08-05T19:17:00.009+08:00

We found a 29 year old water pump, went on toilet-hunting adventure, visited a factory....were given a full tour and received RM 250 worth of free stuff..wait for it tommorow...

DAY 6 : JITRA

2008-08-05T19:17:00.004+08:00

CDC NOTIFICATION PROCESS

ORGANIZATION CHART

Pegawai kesihatan Daerah 1
Dr Nor Azian Bt AbdulWahab

Pegawai Kesihatan Daerah 2
Dr Azilan Abdullah

Ketua Unit PPKP Kanan
En Hussain B. Yusoff

PPKP Unit CDC
Pn Nor Diana Bt Nanyan

PPKP Unit CDC (HIV/AIDS & TIBI)
En Osman B.Ali

RESPONSIBILITIES OF CDC UNIT

1) Record all the communicable diseases in daily, weekly, monthly, and yearly basis.
2) Prepare reports on daily,weekly, 3 months, 6 months and yearly basis regarding communicable diseases as being instructed from time to time.
3) Conduct immediate investigations for any notified diseases to identify the source of the disease and control its spread.
4) Carry out ‘Disinfection’ and ‘Disinfestation’ procedures.
5) Analyse all the investigated cases besides recommending proper preventive and control measures to District Health Officer.
6) Give vaccination to the affected patients to avoid the spread of the disease.
7) Collect specimens such as blood,stool, vomitus, sputum, food particles and etc. for investigation purposes to detect the disease.
8) Working as a member of Health Team regarding communicable diseases.
9) Prepare and update all the dates, graphs and maps regarding communicable diseases.
10) Analyze all the collected data’s and submit its report to District Health Officer.
11) Identify and detect the patient in order to control the spread of the diseases.
12) File court orders against cases which related to communicable diseases.
13) Conduct epidemiological studies on communicable diseases control and its surveillance control.
14) Educate public regarding preventive and control measures of the communicable disease.

LIST OF NOTIFIABLE COMMUNICABLE DISEASE

Chancroid

Cholera

Dengue Fever and Dengue Haemorrhagic Fever

Diptheria

Dysentry

Food Poisoning

Gonococcal infections

HIV (all form)

Leprosy

Malaria

Measles

Plague

Poliomyelitis

Rabies

Relapsing Fever

Syphilis (all form)

Tetanus (All form)

Tuberculosis (all form)

Typhoid and Paratyphoid Fever

Typhus and other Rickettsioses

Viral Encephalitis

Viral Hepatitis

Whooping cough

Yellow Fever.

PROCESS OF NOTIFIATION(SUMMARY)

1. Disease is suspected.
2. Notification form by Medical Officers but Telephone notification is done for certain diseases immediately.
3. Completed form will be sent through (hand,post, online and fax)
4. Records are updated.
5. Investigations are done

PIC 1: An icelined cooler for vaccination storage.

PIC 2: Confusion during the AIMST team visit.

For the more personal day to day story visit: http://www.dhojitra.blogspot.com/

KUALA MUDA, 7.8.08, (FINAL DAY)

2008-08-05T02:04:00.003+08:00

Adolescent health (Kesihatan remaja)

According to the definition of WHO (1993), adolescents are categorized under the age group of 10 to 19 years of age.

Objectives

To create awareness among adolescents about the importance of leading a healthy life style.
Prevent bad habits which cause ill health by organizing health promoting activities.
Encourage adolescents for their active involvement in health promoting activities for prevention of bad habit and health promotion purpose.

Guidelines for implementation of adolescent health.

Four categories:
1) Adolescent clinic
2) Standard operating procedure (SOP)
3) Adolescents health screening
4) Guidelines to manage adolescent health

Part I

Adolescent clinic
1.1 Objectives: guidelines for health officers.
1.2 Implemented on year 1998.Revised back on year 2000.
1.3 Definition :
1.3.1 adolescent:10-19 years
1.3.2 adolescent health is under the National adolescent health policy
1.4 clinic concept used in all the clinics
1.4.1 services provided by a health clinic:
1.4.1.1 screening
1.4.1.2 management
1.4.1.3 counseling
1.4.1.4 referrals
1.4.2 optional services
1.4.2.1 physical activity in group
1.4.2.2 family counseling
1.4.2.3 health promotion
1.4.2.4 activity clubs
1.5 -services scope in adolescent clinics
-covers health promotion,prevention,management and referral

The service scopes covers
1.5.1 developmental assessments
1.5.2 diet
1.5.3 mental
1.5.4 sexual and reproductive
1.5.5 high risk attitudes
1.5.6 physical

Part II: SOP (Standard operating procedure)
-Management of adolescent health clinic
Introduction: i) Entry point through JPL
ii)’one stop’ service centers
iii) Daily clinic with centralized counters
Facilities in clinic
Medical registration card 96-pin 1/78
Registration book KKR/Fail KKR
Screening form SKR1 & SKR2
Height and weight scaling machines
BMI charts
Guidelines books
Adolescent health services
SOP book fir medical assistance (part 1 & part 2)
Standard laboratory tools
Checkup rooms and counseling
Human models
Flip charts

Part III
Screening Programmes
3.1-Introduction-To identify attitude or health problems
3.2 SKR forms (screening forms) SKR 1-males, SKR 2 –Females
3.3 implementation of SKR –regular check ups-#times (12, 13 and 17 years)
3.4 methods of health screening-guidelines for male adolescent (m/s 37), female perempuan(m/s 42)

Guidelines for sexual and reproductive system
4.1.1 Amenorrhea
4.1.2 Abdominal pain during menstruation
4.1.3 Abdominal Mass
4.1.4 Menstrual irregularity
4.1.5 Vaginal discharge
Dietary
4.2.1 Underweight problem
4.2.2. Overweight problem
4.2.3 Anemia

Psychological aspect:
4.3.1 Adjustment disorders
4.3.2 Anxiety disorders
4.3.3. Depressive disorders

Attitude problems
4.4.1 Smoking
4.4.2 Gum sniffing
4.4.3 Alcohol
4.4.4 Vandalism
4.4.5 Amphetamine
4.4.6 Acne
4.4.7 Headache
4.4.8 Intentional injury
4.4.9 Non intentional injury
4.4.10 abdominal pain

Part IV
Management of adolescent and flow chart (last page)

Reported by Shanky

KUALA MUDA, 6.8.08, (DAY 8): SPECIFIC REPORT

2008-08-05T02:03:00.004+08:00

We went to water treatment plant at 8.oo am.It was the Sungai Petani and Pinang Tunggal Water Treatment Plant. The activity was a surprise for us as Mr. Silva, the PPKP for KMAM told us that he had already take special permission for us to enter water treatment plant. We could see how the river water was processed and become the clean water that comes out from our house pipe.

Firstly the river water was passed through a screen to trap the branches and large objects. Then the deep seated water with sand are sucked up by a pipe and poured to a small drain-like-connections in order to protect the sucking pump that connects to the treatment pond. At the pond, the water undergone aeration in order to oxidized the ferum, magnesium, and other metals so that it will not dissolved into the water. Through this process, the carbon dioxide and hydrogen sulfate will be released into the air.

Then the water went into flocculation pond. Aluminium sulfate or Poly Aluminium Chloride (PAC) is used to coagulate the small suspension of solids and colloidal materials. This coagulated to form Floc.

Then the water that is free of floc will be channelled to sedimentation tank. The retention time is 2 hours. The water is then percolated through a bed of a fine sand to remove fine suspended solids and colloidal matter.

After filtration, the water is then neutralised with calcium hydroxide to increase the pH of the water as it was acidified before by the PAC. The water is then added with sodium silicoflouride for the purpose of producing healthy teeth among the drinker. Chlorination is the next step in which chlorine is added into the water to kill residual bacteria. The water then is stored in clear water tank and channelled out to the household and another pipe channeled back to them for their usage (mixing chemicals).

Sorry for the simplicity because the blogger of this post is busy like an ant. (If any questions please do ask in the communication box. thanks.)

KUALA MUDA, 6.8.08, (DAY 8): DAILY REPORT

2008-08-05T02:02:00.005+08:00

At 8.00 am, we departed for water treatment plan. Further detail will be listed in specific report.

At 11.45 am, a briefing regarding primary health care including expended and extended scope( mental health, geriatric health and stop smoking) delivered by Mr.Yusof Hashim, penolong pegawai perubatan kanan. The briefing extended up to 1.30pm.

After explaining the vision and mission of Ministry of Health, he introduced all the 8 goals of primary health care. He also talked about the organization chart of this unit. We were informed that government has allocated 0.6billion for primary health care. Besides that, according to 9th Malaysian Plan, for the Management of Crisis and Disasters, our government has become a member of an international network called Government Integrated Regulation Network (GIRN). It comprises a system of signaling sign of danger if there is any natural disasters in any country, among the members of GIRN.

There are additional services in primary health care which includes 4 expanded scopes namely, geriatric health( programme warga emas), adolescent health ( programme remaja), mental health and stop smoking( klinik berhenti merokok).

At 1.30 we dispersed for lunch break. Then, at 2.30 , we reassemble again for briefing on non communicable diseases and Methadon replacement therapy.

Non-communicable disease (NCD) Unit
(Surveillance for diabetes mellitus and cardiovascular disorders cases)
This session suppose to be carry out in the morning from 11.30am to 1.00pm but have to postpone to afternoon from 2.30pm to 4.00pm due to Mr.Selva suddenly called in the early morning say want to bring us visit to the loji pembersih air Sungai Petani & Pinang Tunggal.
Sharp at 2.30pm, all of my group members are gather in the clinic waiting for Mr.chong (PPP)k but unfortunately he is not around here . Even he is not around but he got order the staff nurses to bring us visit around the clinic to see what activities and how the activities carry out. We start our activities around 3.00pm. According to the staff nurses this clinic working hours is start from 7.30am to 5.00pm and they only having break for 1 hour from 1.00pm to 2.00pm. Timetable will be attached later.
Today they going to have funduscopy and do screening for diabetes patients. Staff nurses also explained to us how the records of the patient stored according to the last 4 digit number of identity card, gender and race. All the patient records are stored in one room. Staff nurses also got shows us the small record book for diabetes and cardiovascular disorders patients. Green color one is for diabetes patient whereby blue color one is for cardiovascular disorders. Normally patients will come every 3-4 months for follow up but for those the disease is not well controlled need to come more frequently for follow up. In the clinic there is a register counter specifically prepared for DM and hypertension patients. There is also a corner prepared for them to check their blood pressure, blood glucose, weight and also height to ensure that the disease is well controlled or not.

(Methadone maintenance therapy )
Another unit we went during this session is the Methadone maintenance therapy (MMT) program which is conducted by Mr.khairul (MA). According to Mr.khairul, there are 48 clients in Kuala Muda district list who received the therapy. Anyway according to the research there are actually around 500 cases but only 48 come and get the free therapy from government. The objective of this program is to prevent increase HIV cases in the Kuala Muda district. Mr.khairul also informed us that there is a specialist name Dr. Nor Azah in this unit. He also got explained to us how the client get register for the free therapy. First they must get a letter from ADK (Anti Dadah Kebangsaan), after that they need to do blood test and urine test before they get registered. For blood test they need to repeat after 6months whereby urine test for the first 2 months they need to do urine test every weeks then once in a month after that. One step test (urine test) used to detect the abuse of morphine, cannabis and amphetamine. However there is a special urine stick used to detect morphine and amphetamine separately. Once morphine are detected they will stop the therapy for that particular day and they will ask the client come only on the next day, but if amphetamine and cannabis are detected the therapy still given because morphine won’t cause overdose. According to Mr.khairul methadone usually started provided from 5mg and slowly increased to maximum 70mg in this DHO Kuala Muda.

At 4pm, we went to family planning unit (LPPKN) which is situated just beside the KMDHO. All of us were welcomed by Sister Zuriana who also briefed us about LPPKN. During the briefing, all of us were eager to know about LPPKN as it was unfamiliar to us.

To our surprise, LPPKN is neither government agency nor a private company. We were informed that LPPKN is a semi-government organisation which is an agency of Ministry of Woman, Family, and Community Development. Currently, there are 4 functioning LPPKN clinics in several districts in Kedah, namely Baling, Kulim, Kota Star, and Kuala Muda. The core services provided by LPPKN clinic include: papsmear, breast examination, psychosexual counselling, women and men wellness, family counselling, and marriage counselling.

However, there are no identified clinic and menopausal clinic available in LPPKN Kuala Muda at the moment. These services are only provided in LPPKN kota Star.

After the briefing, we were brought by the sister to visit the counseling room. In the counseling room, we had the opportunity to have a look on several contraceptive devices such as Implanon, IUD, OCP. we were also taught on the function, effectiveness and some disadvantages of various method of contraception. By 5.30pm we were dismissed and each of us were given some pamplets.

Reported by Thana, Yew Chai, and Chia Leong

KUALA MUDA, 5.8.08, (DAY 7): SPECIFIC REPORT

2008-08-05T01:59:00.016+08:00

Mission: Active case finding (Aedes Survey) in Taman Ria Jaya

Objective:

To find active case of Aedes (Positive breeding of mosquito larvae)
To take preventive measures by adding ABATE into water tank
To give awareness to public regarding Dengue fever and Aedes via pamplet

Date/Time: 5.8.08, 10.30am-12.30pm

Team: 3 teams, each team consist of PKA and 4 AIMST medical students (+1 in a team)

Law Used: Destruction of Disease Bearing Insect 1975

Tools Used: Empty sterile bottle, seal, pipet (small and large), forms, notice, ID card, Vest

Description:

Total of 88 houses were in for checking by the officers. We were divided in 3 groups and each group followed 2 officers to the specific locations.
The officers went house by house. They always introduced themselves and showed their identity to the house owners before beginning with the surveillance. The house owners followed the officers during the surveillance, as required. They checked the flower pots at the veranda, and any other containers that may contain water. Inside the house, they checked the washrooms and the toilets. They also flushed the toilets in order to check its efficacy as the spoiled flushes can be place for the mosquito breeding. If there were no larvae found, the officers add about 10g of Abate in powder form to the water in the toilet flushes and in any water containing pots or containers as a precaution.
In total of 88 houses only 3 houses were found to have larvae. In these houses, after the breeding place of the larvae found, the officers will it to house owners. They then show the empty bottles to house owners before collecting the samples as evidence that there were no foul play present. Then the samples were collected by using pipette. In both the houses 5 bottles of samples were collected each. Then the bottles were sealed and labeled with information like the date of the sample taken, the location of the sample collected and who collected it. The house owners were needed to write their identification card number and sign the label. The Pembantu Kesihatan Awam and/or the Pekerja Am witnessed these procedures. The house owners were given compound under the Act of Destruction of Disease Bearing Insect 1975, section 13. They will be required to pay RM100 each in the District Health Office by 14 days. The offenders are also given extra 7 days notice if they are not able to pay the compound within 14 days.
While in the empty houses where the owners were not present at the time, one notice was sticked in the front door to notify that the surveillance will be done the next day

Procedure:

Introduce ownself and show ID. Then explain the motive of survey.

Enter the house only if allowed, if not allowed (or no one is at home), a notice is sticked to the wall telling that survey will be doen the next day. If resident still insist not to allow health officer to enter for checking, then the act plays an important part this time. DDBIA 1975 will be used for lawsuit
Surrounding of the house is surveyed for potential breeding site for larvae
If found, a sample of AT LEAST 5 LARVAEs ARE TAKEN.

Resident will be explained that the bucket contains larvae and show the larvae to him/her

Explain to the resident that he or she has againt the law of DDBIA 1975 and a compound will be given.

Before sample is taken, the new sterile bottle is shown to the resident first to prove that there is no foul-play

At least 5 larvaes are taken by pipet

The bottle contain these larvaes are shown to the resident again and then the bottle is sealed

Bottle is labeled and compound is written.

ABATE (larvicides) are put in water tank or potential space of water collection (both positive and negative findings of larvae)

Education is given to the resident both verbally and through written materials.

Sample is sent to DHO lab to analyst the breed of mosquito

Discussion:

Have you ever wonder that if any larvae is found in a drain outside of a particular house, will that particular resident be compounded? If yes, how to prove that the larvae did not swim from the drain of the other house further up to that particular resident's drain?

The answer is that there no need for us to crack head. This mission is to detect any aedes larvae in a household. Aedes only breed in water holding container and not normally in the dirty stagnant drain like those of Culex.

Do you know that Dengue fever (DF) and Dengue Haemorrhagic fever (DHF) are beaten by different Aedes?

Aedes main species are Aedes Aegypti and Aedes Albopictus (Asian Tiger Mosquito). Aedes Aegypti cause DHF whereas Aedes Albopictus cause DF. Aedes Aegypti likes to breed in dark area and Aedes Albopictus can breed in clear and open space stagnant clean water. Thus, if a larvae is found in the pail just like the picture shown below, it is most likely to be Aedes Albopictus.

How to know whether it is Culcine (Aedes, Culex, Mansonia) and Anopheles by looking at the larvae sampled?

To differentiate the which is the most likely type of mosquito, there is a great explaination given in K.Park 17th ed. page 545. In this contex, we will just consider on larvae. The sampled larvae is closely observed for siphon tube. It will be whitish pale in colour which is quite similar to the colour of cartilage. The siphon is located at 8th segment of the larvae. If there is appearance of siphon, the species will be Culcine.

Besides, the way how the larvae rest just below the meniscus of water can also distinguish which type of mosquitoes. The larvae that rest inclined at an angle to water surface will be the Culcine but not anopheles. Anopheles rest parallel to the water surface.

Thumbs:

Introduction before entering the house.

Consent given. We entered the house.

Surrounding of the house is looked for potential breeding site.

Gan was hoping to see one larvae but none was found.

The 'Abate guy' entered the house.

Toilet was checked.

Water collection for bathing was checked.

Collecting plate under the refrigerator was checked.

Abate in powder form is put into water straight. The chemical effect can last for 3 months.

Health education is given via written form to make the public aware about Dengue and Aedes.

Potential breeding site.

Larvaes spotted! Many of them!

Larvae spotted by health officer.

Resident is shown the breeding site and explained the characteristic of the larvae and how to identify it in layman's term.

Sample is taken with pipet

Sample is put into sterile empty bottle.

Bigger pipet for easy sampling

At least 5 samples of larvae taken

The larvae of Aedes look like this and it is the same as those in the sample bottle.

Bottle is sealed.

Compound is written by PKA.

Video:

Reported by Gaaitheri and Gan

KUALA MUDA, 5.8.08, (DAY 7): DAILY REPORT

2008-08-05T01:58:00.009+08:00

KMDHO starts with field work

The day started at 8am where we started to gather in the Vector Borne Diseases Unit. Our field work for this morning is Aedes Surveillance in Taman Ria Jaya. After the Officers of the Unit finished their meeting,we were told to follow them to the surveillance area. The meeting was told to be about internal auditing and also about the surveillance that was going to take place. We were not allowed to participate in the meeting.
The meeting finished about 10am and we started to drive to the initial location of the surveillance, that is the Sekolah Menengah Kebangsaan Taman Ria Jaya. About 10.30am in the morning, we entered the school. 3 officers were there to do the surveillance. All the places where Aedes mosquitos can breed were checked. Those places are like the small pond, nursery, back of the canteen, and the surroundings of the school.
The larvae were found in the school nursery. The samples were collected in 5 small bottles using pipette. The bottles were then sealed and labeled with information like the date of the sample taken, the location of the sample collected and who collected it. The headmaster signed the label. The Pembantu Kesihatan Awam and/or the Pekerja Am witnessed these procedures. The school will be compounded RM 150, under the Act of Destruction of Disease Bearing Insect 1975, section 13.
After finishing the surveillance in the school, we then proceeded to the housing area, Taman Serampang that was opposite the school. The detail will be described in specific report.

Aedes Survey at Taman Ria Jaya

The entire surveillance session extended up to 12pm. We then dispersed for lunch. At 1.30pm we meet again at the Meeting room in the main building as Dr. Sawari Rajan, Dr.Kay, Dr.Sapna, and Dr. Lily came to meet us. In this 30 minute session, they questioned us about the things we learned over the last and this week and gave us some feedback on topics that should be covered in detail. Thanks to their suggestion that lead us to apply family planning topic from LPPKN which was governed by different ministry.

Visits from the honourable lectures, from left to right: Dr. Sawri Rajan, Dr. Sapna, Dr. Kay, and Dr. Lily.

PPP(K) Mr.Berhan

The next session was at 2.30pm PPP(K) Mr.Berhan. He is in charge of HIV anonymous and HIV testing pre-marriage proceedings. The session started off with a slide show. The first few slides were about the history of HIV that covered the first cases in the world and also in Malaysia. The first case in Malaysia was found in the year 1986. He also covered the mode of spread of the virus, and characteristics of the virus. It is found that blood, semen and vaginal fluids have very high content of the virus compared to the least containing tears, saliva and milk. There were also slides about the opportunistic infections that are common in HIV/Aids patients, e.g like Genital Candidiasis, Oral hairy leukoplakia, Pneumocyctic carinii pneumonia and TB.
The up coming slides contained graphs that contained needed statistics about the disease. There were slides about the prevalence and incidence of HIV patients in the world (1998). Africa has the highest number of both the prevalence and incidence globally, that is about 22.5 million prevalence cases. Global estimation of AIDS patient in the year1998 is 33.4 million and number of death is 2.4 million.
While in Malaysia from the year 1989-1998 the amount of HIV patients were 28,541 and amount of AIDS patients were 2354. The most common age groups that are affected in Malaysia are from the age 30-39 and 20-29. In Kedah from 1989-1998 the most commonly affected race were Malays with 74%, next are Chinese with 14%, then Indian 6% and other races who are Malaysian contribute about 3% and foreigners are bout 3% also. Besides that another graph showed sharing IV drug needles as the highest mode of transmission (82%) in Kedah, next is the heterosexual intercourse(11%) and third largest is the homosexual intercourse(3%). The fishermen are the most affected people with HIV in Kedah, next are factory workers. While in females most of the affected ones were housewives.
Besides that, measures to prevent HIV/AIDS were also discussed. Preventive measures for HIV/AIDS are very important as there is no cure or vaccines for it. Everybody is advised to live a healthy, straight lifestyle. The public are advised not to share needles if they are IV drug users, and do not practice random or unprotected sex with multiple partners. Besides that mothers are advised to have early detection test.
After that, we also discussed the programmes that run for Muslims. These programmes involve those who are intent to tie the knot. It is compulsory for them to fill up the Borang Pemohonan Pemeriksaan Kesihatan which is from the National Islamic Department. They need to involve in Programme Ujian Saringan HIV Pra-perkahwinan. If one of the partner’s test is reactive, that person will be referred to Family Medical Specialist, however the positive result of the individual will not be told to the other partner. If the test is positive after referring to the Family Medicine Specialist, treatment will be started and these individuals will be referred to the Islamic Department for decisions to be made about the marriage.
Other forms that are needed to be filled in are Reten Bulanan saringan HIV Pra-perkahwinan, Reten Modified Syndromic approach. While for the non-muslim they have Programme Pengurusan HIV but this is not compulsory.

Reported by Gaaitheri

KUALA MUDA, 4.8.08, (DAY 6): SPECIFIC REPORT

2008-08-05T01:56:00.005+08:00

Drinking Water Qualitity Control Unit (KMAM)

In the afternoon 2.30pm, we were briefed by PPKP Silva on water supply and drinking water control. After that, we followed him to a nearby auxilliary for water sampling.

Mission: Water sampling in District Kuala Muda

Objective: Monitoring of water supply in District Kuala Muda.

Description:
- Water flowed from its main source the river or lake to treatment plant outlet (TPO) and finally to services reservoir outlet (SRO) and auxiliary.
- Various treatments have done in TRO include the flocculation, oxidation,
sendimentation, filtration and chlorination.
- Water sampling usually done in SRO and auxiliary.
- There are 67 SRO (station) in District Kuala Muda.
- 7 treatment plants are available in District Kuala Muda.
- There are 4 parameter have to be measured in water sampling:
1. Parameter 1 includes the physical and microbiology test. It is done in weekly basis. For the physical test: PH (6.5-9), NTU (nephelometric turbidity units) < color="#33ffff">Location: Auxilliary nearby the old hospital (A012)

Date: 04.08.2008 4.15pm

Team: PPKP Silva together with a PKA and Group B members. (Water sampling is usually done by a PPKP and a PKA.)

Tool Used: water container, Whirl Pack, PH meter, Colorimeter, NTU meter, Soudogaz etc.

Procedure:
- Water from SRO or auxilliary was allowed to flow for 2-3 minutes.
- Water has been filled in three water containers. First water container for PH testing. A probe inserted in the 1st container and PH meter show the value in a short while.
- Second water container placed in NTU meter and it showed up the turbidity value.
- Third water container mixed with DPD (white powder reagent). The water changed its color into pink after the mixture occurred. It is then placed in the colorimeter and chlorine value shown on the monitor.
- Before the sample for bacteriology test was taken, tap water was heated by soudogaz in order to get ride of bacterial along the tap and pipe.
- Whirl pack has been used to collect bacteriology water sample. Technique of sterile opening and enclose the pack was applied. Water around 100ml has been filled in the Whirl pack.
- Detail of water sampling such as the date, time and location of water sampling was stated clearly on the whirl pack.
- Whirl pack has been kept in cool ice box with temperature of 4 to 10 Celsius in order to prevent microorganism from multiplication.
- Forms were filled and samples were sent to labs within 24 hours.

Reported by Helly Chai

THUMBS: (coming up)

KUALA MUDA, 4.8.08, (DAY 6): DAILY REPORT

2008-08-05T01:55:00.009+08:00

Nutrition Unit

PZM En. Wan Mohd Nurussabah bin Hj Abd. Karim of KMDHO

The briefing about nutrition unit started at 9.00am provided by PZM En. Wan Mohd Nurussabah bin Hj Abd. Karim. (PZM- pegawai zat makanan). En Wan is a graduate of UKM after his 3 years studies in food science. We have been told that every district has only one nutritionist and he is the nutritionist in District Kuala Muda. Basically nutrition unit is covering all the matter which related to food.

The job scope of a nutritionist is the following:
- Give counseling to the patient who are malnutrition in the nutrition clinic.
- Received cases which are referred from Doctor in hospital or clinic especially like cases of diabetes mellitus or hypertension.
- Give advise to the antenatal mother who have gestational diabetes mellitus
- Give counseling to the antenatal mother whose body weight did not increased correspondent to her period of pregnancy and so on.

We have been told by En Wan that there are difference between nutritionist and dietitian. Dietitian is the one who usually worked in hospital. They treat uncontrolled cases while the patient is in the hospital. There is no followed up done by the dietitian. Meanwhile, Nutritionist worked in the district health office. They serve more on community, prevent people from getting sick and treat those who were discharged from hospital.

The patient will come to visit nutritionist every month. Details such as diet recall for 24 hours, the main meal time, quantity, quality and way of food processing have been asked by nutritionist. This has done in order to calculate the daily calorie of patient and make sure their food is good and suitable for them. Daily calorie for a healthy adult is 2000 to 2500 calorie while 1500 to 1800 calorie for child. According to their diet habit, advice and diet modification have been given to patient.

The main activities held by nutrition unit include:
- Survey IDD (iodine deficiency disorder)
- Program kekurangan zat makanan (KZM)
- Program Penyusuan susu ibu (PSI)

Survey IDD
It has been started for more than 20 years. This is a randomized survey which concentrated on school student. Sample of urine is taken to measure the value of iodine within the body. There was found in the survey that IDD was serious not only in the rural area which is far away from the sea such as Sabah and Sarawak, many cases of low iodine found in the student of Kuala Muda. Some steps have been taken by the government to control this problem such as provide the iodinated salt in the market and setting up the iodinator in the main pipe. Iodinator has been settled up in a few places which are far away from the sea such as Sik and Padang Serai.

Program Kekurangan Zat Makanan (KZM)
The program cover for children aged 6 months to 7 years old. It has been categorized into yellow and red color where yellow are child who lack of nutrition and red are the serious cases. Under the program, the family income per capita less than RM87 can apply for aid in the form of food basket.

Food basket contains:
- Carbohydrate: rice, noodle, biscuit, flour etc.
- Protein : Ikan bilis, bean
- Fat : full cream milk(1kg)
- Multivitamins
Each food basket contains of 180% of calorie. Food basket provided for a child at least 6 months dependent on their health condition. If it is necessary, the child will be received the aids until the age of 7 years old. So far, we have been told by En Wan that district Kuala Muda has 14 of such cases in year 2008. Staff from district will make the monthly visit to the house of those received food basket. Recipient is also obligate to join all the activities which are held by nutrition unit. Besides that, child with congenital problem can apply for the food basket.

Program Penyusuan Susu Ibu (PSI)
It is a program promoted by WHO and held in worldwide. It concentrates on exclusive breast feeding where only breast milk is feed to child until the age of 6 months. In order to enforce the program, baby friendly hospital initiative (BFHI) has been settled up. Under this policy:
- 80% of staff include the doctor and specialist are obligate to attend breast feeding
courses for 18 hours.
- No milk bottle or artificial nipple should be placed in the hospital.
- Staff should encourage and support postnatal mother to feed their child with breast milk.
- Postal and pamphlet related to breast feeding should provide to the mother.
- Talk about breast milk feeding is provided to antenatal mother.
- Staff nurse who made the 1st postnatal visit should educate and give practical to the mother about breast feeding.
- No advertisement for formulated milk is allowed in the hospital.

Besides this entire program, nutrition also held some program for obesity in adolescent and body weight management program. Activities such as jungle tracking, hiking were organized by them in order to promote healthy lifestyle among younger generation.

Reported by Helly Chai

KUALA MUDA, 3.8.08, (DAY 5): SPECIFIC REPORT

2008-08-05T01:55:00.007+08:00

After delivery, home visit are done from the 1st to 10th day and on the 20th day. This is visit is for both maternal and child.

During the post natal visit, the neonate is assessed as below:

weight
head circumference
length
general well being
-weak
-irritable
-anemic
-cyanosis
-jaundice
-alter bowel habit
-problems related to micturation
-feeding problem
-skin problem
5. Vital signs
-respiratory rate (normal 40-60/min)
-heart rate (normal 120-160/min)
-temperature

6. Examination of the head
-shape
-fontanelle
-swelling
-caput
7. Examination of neck
-swelling
8. Examination of eye
-abnormal e.g. congenital ptosis, squint
-cataract
-abnormal conjunctiva
-discharge
9. Examination of mouth
-cleft palate
-cleft lip
-oral thrush
10. Examination of ears
-abnormalities
-discharge
11. Respiratory system
-abnormalities in the nose
-sub/intercoastal recessation
-shape of chest wall
-breath sound
12. Cardiovascular system
-murmur
-femoral pulse
13. Gastrointestinal system
-distension
-umbilicus
-mass
-patency of anus
14. Genitalia
-male: testis, penis, scrotum
-female: imperforated hymen, discharge
15. Musculoskeletal system
-spine
-fingers and toes
-clubfoot / CTEV
-hip dislocation
16. Neurological system
-fits
-reflex ( moro / grasp / rooting)
-tone

The mother is assessed for:
a) general well being
b) temperature
c) blood pressure
d) pulse rate
e) breast examination
f) SFH
g) Perineum
h) Lokia
i) Urine albumin/sugar
j) BO/PU
k) Signs and symptoms of pulmonary thromboembolism

We were also briefed about the colour coding system which includes:
White 1: Deliver in hospital
a) primigravida
b) age <18>40
c) gravida 6 and above
d) height <145>145
f) age >18 or <40>37 and <41>2 kg and <3.5kg>3)
g) unsure of LMp
h) Past obstetric history e.g caesarean, DM, eclampsia, hypertension, prenatal death, perineum tear of grade 3, postpartum hemorrhage, instrumental delivery, baby weight <2.5kg>4.0kg
i) High blood pressure (140/90 mmHg) with urine albumin negative
j) Hb <>2kg in a week)
n) Weight >80kg
o) SFH more or less than 4 cm compared to POA
p) Malposition with no signs of delivery in >34 week
q) Head not engaged
Yellow: Refer to family health specialist or O&G specialist clinic
a) HIV +ve
b) Hepatitis B+ve
c) DM
d) Reduce fetal movement when >32 weeks
e) Gestation more than 7 days than given EDD
f) More than 1 fetus

Red: Immediate admission to hospital
a) eclampsia
b) pre eclampsia or BP >160/110mmHg
c) chest pain with symptoms such as palpitation, shortness of breath
d) Shortness of breath noted while performing simple task e.g. Sweeping, washing dishes
e) Uncontrolled DM
f) Abnormal fetal heart rate
g) Anemia
h) Premature contraction
i) Leaking liquor without contraction
j) Sudden exacerbation of asthma
k) Antepartum hemorrhage

Reported by Rathna

KUALA MUDA, 3.8.08, (DAY 5): DAILY REPORT

2008-08-05T01:31:00.005+08:00

Today was a rather exciting day for us as a field work was arranged for by the BAKAS unit. Firstly, we gather in the meeting room at 9 am for a short briefing before we left to the site. Mr. Kammarudin who is the head of BAKAS unit gave a short briefing about the activities carried out by the BAKAS unit.

PPKP Mr. Kammarudin (BAKAS unit)

BAKAS activity is the continuation of the activity done since early 1960s - it emphasis on preventing the spread of communicable disease in terms to improve the health status of the suburban community by providing hygienic environment.

Main BAKAS Component:

1. Water supply project: Piping system (sistem sambungan paip JKR/KKM

Gravity Water Supply system (sistem Bekalan Air Graviti : water sampling in this system is done twice yearly, if any outbreak sampling is done more frequently).

Controlled well system (Sistem Telaga Terkawal) - not done anymore

Rain water reservoir System (sistem tadahan air hujan) - not done anymore

2. Sanitation Project

Building of flush toilet

Sewerage system

Solid waste disposal system

3. Maintenance, upgrading and replacing the above system

According to Mr. Kamarudin, a budget of RM 114000 is allocated annually to this unit to carry out their activities.

When a request is made by villager is for subsidised their sanitation system. BAKAS unit first registers the request and will decide whether or not to give the subsidy. It is given based on three criterion:

family below poverty line (PPRT)
disable people
single mother

After the briefing, we went to a village in Bedong where BAKAS unit had built a sullage system and pit latrine for the village houses there. This visit was to survey and to make sure that the project has been completed.

Water sullage system.

Water sullage cok.

In the sullage system, a sink is built outside the house and the sullage is connected outside into a hole called 'cok'. The 'cok' is the comes in various size but normally is 3 feet x 3 feet cylinder. The bottom end of the cylinder cok is open but the top is covered with a cement cover which has a hole in the centre of the circle for future suction. This cok is burried into the water-absorbedable-earth up to the level just before the cover. A pipe from sink is attached on feet below to the cover onto the body of the cylinder. Water with small wasteis release out from the sink and enter into the cok and in turn it is absorbed into the soil while for the pit latrine, the human waste is collected into a similar cok. Once the pit latrine is full, a new set of pit latrine will be done but for the water sullage cok, the waste will be sucked out through the small 2 inches in diameter hole in the center of the cover. New water sullage system is made if frequent spills occur.

Pit latrine at the back of toilet.

After the field work, we had a small photo taking session before taking off.

Photo session.

About 2.30p.m. we gathered at the maternal and child health unit and we were greeted by Sister Zainab. She then introduced us to her other staffs. Sister Ponnu then took over the session to brief us on antenatal and postnatal checkup.

The maternal and child health clinic in the Kuala Muda district is open from Sunday to Wednesday. Some of the services provided in this clinic include:
- antenatal and postnatal checkups
- pap smear
- vaccination

Other than this the nurses in the clinic also goes for home visits. Normally 4 visits are done if there are no any complications during the pregnancy. In case of any complications then more number of home visits is done. The pregnant mother also requires coming for her antenatal checkup in the health clinic. During her first 28 weeks of pregnancy she has to visit the clinic once a month while from the 28-36 week she has to come once in 2 weeks and after the 36 week of pregnancy she has to come weekly for follow up.

Reported by Rathna

KUALA MUDA, 31.7.08, (DAY 4): SPECIFIC REPORT

2008-08-05T00:10:00.003+08:00

SAMPLING OF FOOD FOR CHEMICAL AND PHYSICAL ANALYSIS

Early preparation starts in DHO on the matter of which premise to check; number, type of sample and type of food to be taken; tools for sampling; and who will be the witness (normally will be one of the staffs). Identification card and money must be prepared for the food (The sample of the food is bought for investigation and it is not 'donated' by the premise).

When we reach at that particular premise, introduction is given and identification card is shown. Then explain about the motive of the visiting.

Then randomly choose the food for sampling and payment is made. For retailer, a receipt is asked. If the sample is taken from a factory or import agent, no payment is made but a letter stating that DHO has taken the particular sample. Each time of sampling, 3 samples are taken randomly (but the same batch of food product). The samples are labelled. 1 sample is for the owner to keep, 1 is for analysis and the other 1 is for keeping in DHO store. This is important in the sense that when the analysed sample failed to meet the standard requirement (parameters), the same will goes to the other 2 samples. In this way, the owner will not be able to accuse DHO of making false or biased analysis. Then sample is then registered in HMIS and sent to Laboratory within 3 days.Once the food is proved to meet the criteria, the 3 samples can be disposed properly.

For microbiological analysis, the steps are the same as above. The only difference is that the sample required is just 1 in number. No sample is given to the owner or to be stored in DHO for reference.

DAY 6 - Sik District Clinic ;)

2008-08-04T22:04:00.010+08:00

hi friends... how is the 2nd week of DHO posting getting on? hope everything is going smooth in each district..

At 9 am today , we had a talk on an IP preparation or Investigation Paper preparation by the Officer in charge of the enforcement unit.

An IP or Investigation Paper is an official paper prepared by the Investigation Oficer based on a case file which is to be submitted to the Higher Officer in case of a Court Trial.
It is also to collect the necessary evidence or speciments for the concerned trial in Court.

Q : When is an IP opened?

A: 1. when there is a breach in POSITIVE SAMPLING
2. any wrong doings by the accused during an Investigation
3. refusal of closure of the premise after an order has been handed out

Below is a speciment taken from an IP for your knowledge ..

Other than that, pictures of the premise concerned with speciments should be taken as a close up mode such as the ones below:

Slide 6

at 11 am we had a talk by the CDC Unit PPKP Mr.Jamil Osman

As you know the mission of a CDC Unit is to prevent and control the Communicable Disease Spread. The Unit works under the Slide 2

Akta Pencegahan Dan Pengawalan Penyakit Berjangkit 1988

Below is a flowchart of how the UNIT works:

We were visited by Dr.Sawri and Dr.Kay at 12.30 noon where there was a wrap up session till today with them regarding our activities in Sik District Clinic soo far.

We dispersed at 1pm after the discussion...

That's all for today then.. take care everyone..

Slide 6

ATTENTION

2008-08-04T13:38:00.002+08:00

TO ALL GROUPS,

For next weeks presentation, we need details for each presentation from all districts.....

My group A is doing Child Health and Health Infrastructure, to all other groups, pls send your WORD 2003 documents to....
windowcleaner09@yahoo.com by wednesday.

Pls write:
1. grp name
2. person incharge
3. contact no.

d' Padang Terap Team Reporting.....

2008-08-04T00:05:00.001+08:00

On day 6, Padang Terap Team have visited Klinik Kesihatan Naka Padang Terap.It is situated approximately 25 km away from Kuala Nerang.Today our schedule focused on Maternal and child health care(MCH).Immunisation procedure was observed by our team. When we were there, our group was briefed by staff nurse Azliza.

She explained work loads done by staff there and procedures followed in Klinik Kesihatan Naka.There are few objectives in unit kualiti Kesihatan dan kanak kanak.They are as follows

To make sure the rate of eclampsia case less than 15/10,000 in Daerah Padang Terap.
To make sure there is no case pueperial sepsis happens in Daerah Padang Terap.
To make sure there is no maternal death.
To make sure 80% of pregnant mother checked by doctor at least 2times during pregnancy
To make sure the rate of SNNJ less than 100/100,000 life births
To make sure there is no case of Tetanus Neonatarum in Daerah Padang Terap.
To make sure 95% immunisation coverage given to babies.
To make sure 80% of new receiptionist family planning to undergo pap smear and breast examination.

Besides that she also mentioned that children (0 days to 6Yeas) and mothers (Antenatal, natal and Postnatal) are to be the main priority of the Klinik Kesihatan Naka.

Then our team went to outpatient department, Mr.Anuar Mustapha, Medical Assistant U29 briefs us on the procedures and the management of that clinic. There is one staff nurse, two medical attendants, dispenser, and one attendant working under that clinic. Sunday is the day for hypertension clinic and Wednesday would be for diabetic clinic. The other days are for combined clinic. They also provide geriatric, adolescent health care and also quit smoking clinic. Today he just briefed us about the hypertension and diabetic clinic and promised to explain about the other health services tomorrow.

Generally services provided in this clinic are

Ø Out patient treatment

Ø Checking of Glucose level in blood

Ø Checking of cholesterol level

Ø Blood pressure checking

Ø Quit smoking program

Ø Weight and height of patient is taken

Ø Urine checkup

Ø Lab

Ø Medications

Ø Counseling to mental patients

Ø Advice on health

5 strategy of health promotion in Klinik Kesihatan Naka

Ø “Smart Partnership” with government agency, private and NGO to healthy environment

Ø To enhance involvement of community in this program

Ø Knowledge and skills of community and care providers enhanced in health promotion

Ø Health policy is revised

Ø Current health service is improved according to latest technology

Hypertension Clinic

As mentioned earlier, it is held on every Sunday and there is approximately 250 patients in this area and every Sunday there will be around 30-40 patients will come for hypertension clinic. The routine check-ups done and if there is any complications the patient is referred to medical officer and further treatment is done at Hospital Kuala Nerang.

Diabetes Clinic

Normally each time patient comes; staff nurses will be taking BMI, blood pressure and blood glucose. Normal patients will be handled by Medical Assistants and complicated patients will be sent to Medical officer. Investigations such s Full blood count, ECG, Uric acid level done routinely and fundoscopy done once in a year.

He added that there is a project called Project Diabetic Educator begun last September aiming in educating medical attendants and staff nurses on the basis of Diabetic Education which should be given to each diabetic patient. The Kedah state has become the pioneer for the project and participants are chosen according to 1 year test. The requirements needed for being participants in this program is to finish a log book composing of 200 diabetic session in 1 year time. For example, 50 patients those given 4 counseling sessions on different aspects considered 200 sessions. The aspects concentrated in this program are counseling on treatment, diet, exercise and foot examination. End of the year there will be an osce examination in this element for the participants to access the level of their ability to counsel the patients.

Pondok Remaja Inabah 1,Malaysia- d' Padang Terap team

2008-08-03T23:49:00.002+08:00

On day three of our posting in Padang Terap Health Office. We were briefed on the workings of the communicable disease control unit PPKP Tn.Haji Yaakob who is in charge of the HIV & TB unit. After a comprehensive briefing we were brought to visit a drug rehabilitation centre called Pondok Inabah 1 Malaysia. It is located in a remote place deep in the rubber estate in Pokok Sena district. It is a drug rehabilitation centre especially for Islam’s.

The centre focuses on religious upbringing and enhances the religious beliefs in the drug abuse victims and thus able to eradicate the addiction on the substance. It was said to originate from East Jawa, Indonesia in 1905, pioneered by a religious teacher named Tok Guru Abah Anom. Who set up a religious based drug rehabilitation centre there after concerning for many youngsters who were drawn into the social degradation. The methods of rehabilitation was then was learned by the Tok Guru from Malaysia who thus set up the Pondok Remaja Inabah 1 in Malaysia 28 years ago in Kedah.

Now there are 3 such centers in Malaysia and various counselors through out the country to help the Islamic youngsters to cope and free from such substance abuse behaviors. The methodology or “method” as they call it is fundamentally based on constant religious teaching and prayers. Its concept is to control and cleanse ones thoughts, lust and the heart or emotions. With that they are able to control their desires and thus refrain from such addictive behaviors able to channel their thoughts and desire in a positive channel.

Their main method of therapy is to bath in fresh water at 3am in the morning called “mandi taubat”, and then they pray and constantly chant religious scriptures. Despite that they also do various activities such as reading and group based discussions. They also undergo various vocational training in order to self sustain them in the future. The methodology used here is of a holistic approach as to refrain oneself from indulging in socially ill behaviors through inner self control and to be able to accept the community in a new perspective. Thus far their track record incredibly excellent with more than 4000 victims or “anak bina” have been successfully rehabilitated and have attained a very successful life.

JITRA :Antenatal COLOR Coding

2008-08-03T17:48:00.002+08:00

An update of our earlier posting on maternal health....today was our Inspectorate general briefing.

MANAGING THE PREGNANT LADIES ACCORDING TO THE COLOUR CODING SYSTEM

RED COLOR –IMMEDIATE ADMITTANCE TO HOSPITAL

1. Eclampsia
Preeclampsia-high blood pressure with albumin content in the urine 1+ or having such symptom or BP >160/110 mmHg.
2. Chest pain during pregnancy with sign symptoms like shortness of breath and palpitation
3. Breathing difficulty during doing mild work like swiping the floor, washing dishes
4. Uncontrolled diabetes during pregnancy ( presence of ketone bodies)
5. Bleeding per vagina during pregnancy
6. Abnormal heart beat of the fetus
· FHR < 110/min at and after 26 weeks
· FHR > 160/min after 34 weeks( heart rate is raised in premature)
7. Presence of anemic symptoms regardless the gestation week
8. Premature contraction of the uterus
9. Leaking liquor without uterine contraction
10. Severe Asthmatic attack

YELLOW COLOR-REFERAL TO FAMILY MEDICINE SPECILIST /O& G CLINIC NEARBY

1. HIV positive mother

2. Hepatitis B positive mother

3. High blood pressure > 140/90 and <160/110>

4. Diabetic mother.

5. Reduced foetal movement at > 32 weeks of gestation.

6. Gestation is more than 7 days from the Estimation Date of Delivery

7. Multiple pregnancy

GREEN CODE-REFERRED TO MEDICAL OFFICER (M& HO)

Rhesus negative.
Body weight of mother before pregnancy or at booking weight is <>
Current health problem ( including psychiatry and handicapped) except Diabetes and Hypertension.
Past Gynecological operation.
Drug/cigarette/alcohol addiction.
Unsure Last Normal Menstrual Period ( LMNP).
Past History of continuous miscarriages ( > 3 times).
Past history of obstetrics.

· Caesarean

· History of Pregnancy Induced Hypertension / Eclampsia / Diabetes

· Premature Death

· History of Low birth weight of the new born -

· Third degree perineal tear.

· Sticked placenta.

· Post partum hemorrhage.

· Instrumental delivery.

· High blood pressure with urine albumin.

· Anemia.

· SFH difference of 4cm compared to gestation period.

· Head did not engage.

. Weight more than 80kg.

· Elongated labor.

· Abnormal lie.

WHITE CODE 1 – HOSPITAL DELIVERY

1.Primigravida.

2.Young or old mother.

3.Grand multi Para( 6 or more).

4.Height of less than 145cm.

5.Single mother.

6.Unsuitable home environment.

WHITE CODE 2 – ALLOWED FOR HOME DELIVERY/ ALTERNATIVE BIRTHING CENTRE

Gravida 2-5
No past obstetrics problem.
No medical problem.
No past antenatal complications.
Height of more than 145cm.
Child-bearing age.
Appropriate fetal size and weight.
POA is between 37 and 41 weeks.
Proper family and social support.

day 4

2008-08-02T23:34:00.001+08:00

it was a public holiday...and resting day for all of us

DAY 3 of DHO posting

2008-08-02T23:24:00.002+08:00

29/07/2008

today's programme was on geriatrics health, adolescent health, as well as malnutrients. To this we have to go to Klinik Kesihatan Kuala Kedah, to meet Mr. Romli(medical assistant). he brought us around the health clinic to give us insight of health care services available in the clinic. then the person incharge of each department brief us on activities conducted in their respective departments. at noon one of our aimst lecturer, Dr. saurirajan join us for the discussion, and gave us more information regarding the activities conducted by the departments. thats all.....good bye

DAY 4 and DAY 5 from SIK District Clinic

2008-08-02T11:27:00.009+08:00

hello friends... sorry for the delay in report for Day 4 as we had some problem accesing to the internet..

Day 4 (31.07.2008) - we had a talk by the PPKP Mr Asri regarding Food Quality and Safety

details regarding day 4 will be added as soon as possible as we attended a field work with the PPKP to a restaurant for an assessment of the food quality and safety.

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Day 5 (3.08.2008) - at 9am, we had a talk by the

KMAM- Kawalan Mutu Air Minuman (PPKP Noor Hazimah)

PPKP KMAM SIK DISTRICT- quality maintainance of drinking water

Functions to increase QOL thru safe drinking water … free of E.Coli in general

(indicator) . They include:

programme for safe drinking water
budgeting the programme in the district level
interpret results of sample tested by Jabatan Kimia Pg … if not available, then sample will be sent to Jabatan Kimia Ipoh.

(clarity of water must be NTU<5)..>

sample collected once a week for one year in a Thio bag which contains thiosulfate.

5.check on the chlorine level in the treatment plant and give suggestions to the water
supplier (>0.2)

investigate based on the reports given by the community regarding dirty drinking water.

samples taken from sampling point of a blue box which is labelled as JBA

other than the Thio bag, samples are also taken in universal bottles

hache meter is used which tests for turbidity,ph,total dissolved solids,chlorine.

maintenance of water quality system

water also assessed for temperature in a reference bottle where the temperature

should be between 4 to 10 C.

PPKP NOOR showing how the sample collection is done..

at 11 am .. we had a talk by the KPAS or Occupational HEalth and Environmental Health PPKP Mr.Zaki on the functions and activities they do.

Functions of the KPAS unit:

1. inspection of hospitals
2. farm and garbage disposal area inspection
3.licensing of kindergarten, poultry and rubber industries
4. harzard analysis
5. inspection of quaries
6. healthy setting of a workplace and so forth

other than that, they also participate in the enforcement of tobacco production control and from time to time, they do check on the NAtional Service Camp site to keep track of the facilities provided for the National Service candidates.

we called it a day at 1pm ... more to come tomorrow..

d' Padang Terap Team reporting...

2008-08-01T23:03:00.000+08:00

Day 8(05/08/08)

Today we had briefing on Occupational and Environmental Health unit or KPAS (Kesihatan Pekerjaan dan Alam Sekitar) by Mr. Muhammad Fadzil(PPKP). We had short briefing on how the unit is works and as a field work, we followed him for an auditing work in a “Klinik Desa” nearby.

On his briefing, he explained to us that this unit only responsible for the occupational health of individuals working under the health ministry. The unit is responsible in providing all the safety equipments needed by other units and also health care providers. For example they provide safety vest for JM’s in “Klinik Desa” used when they go for house visit.

Then he explained to us about the forms that used to record the cases in health care units. The diseases are noise induced hearing loss, skin diseases, poisoning and lung diseases. Accident and sharps injury also will be notified and investigated.

Besides that, KPAS also responsible in making sure that certain group of health care providers get their Hepatis B vaccination. They are doctors, pharmacists, nurses and laboratory workers. Everyone who falls into this category will require having their vaccination and a card will be given to them stating the date of injection, anti-HBs test and HBsAg test result for further reference.

End of the session, he explained to us about the auditing process required to access the safety of workplace and also the safety precautions taken by the workers. This requires us to fill up two forms and there will be a calculation to get their demerit point. The demerit point will be reference when they should have the next auditing. If the point is more than 75%, the next auditing will 3years once, followed by 2 years once if the point is 50-75% and less than 50% indicates auditing of 6 months once. The form that used is OHU/Audit H&S-1 and Sheet 1.

Then we visited “Klinik Desa” Nako Nambua for auditing. Upon reaching and greeted by the JM, we start our auditing with the help of PPKP and his assistant. It takes about 1 hour to finish our auditing. Our attachment with KPAS unit is over with the field work in “Klinik Desa”.

In evening, we joined Vector unit for fogging activity at Kg.Hulu. Before heading to the village, we’re given short briefing on Vector unit and how the fogging is is done.

d" Padang Terap Team Reporting....

2008-08-01T20:33:00.002+08:00

Day 4-holiday

Day 5 (1/8/08)

As normal we reached the office at 8am and we scheduled to have briefing about the non-communicable disease and also the about the enforcement unit.

The officer, Mr.Zuraidi greet us with warm welcome to the meeting with him. He is responsible for two units and he is the only PPKP for that two units which comes under the PPKPK, Mr.Ali.

The two unit that under him is non-communicable disease unit and also enforcement unit. First of all, he started with the details of enforcement unit which responsible in charging those people who caught for health related offense.

He explained to us the flow of the process involved from the point of someone is get caught until the point his/her case goes to the court. He used the example of smoking in area which labeled as non-smoking area.

Unfortunately we can't join him on the enforcement activity even we're just 4 in number because he wanted to avoid the consequences that we will be facing if someone is get caught. We are quite disappointed for not able to join him on his activity.

Before leaving, he briefly told us about the non-communicable diseases and will be telling us in detail next week.

That's all for week 1 of DHO posting...