DHO POSTING OF AIMST MBBS STUDENTS BATCH 7

MBBS EXAM QUESTIONS FOR SECOND THIRD AND FINAL YEARS: Community Medicine

2011-03-08T17:00:00.000+08:00

MBBS EXAM QUESTIONS FOR SECOND THIRD AND FINAL YEARS: Community Medicine: "COMMUNITY MEDICINE (Ref:Preventive and Social Medicine. K PARK. 19th Ed) Examination Pattern THEORY Written Exam 1 60 Marks Written Ex..."

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.

..................................................................................................................................................................

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...

Padang Terap Team Reporting....

2008-08-01T19:36:00.002+08:00

hi! everyone,
Sorry for late update of daily report of my group. It is due to some technical problem that cannot be avoided.

Day 3 report:

As normal we arrived at the health office at 8am awaiting for some field work. As scheduled, today we had be given briefing by Tuan Haji Yaakob regarding HIV/AIDS cases and tuberculosis cases managed.

He started his briefing with some statistic about the HIV/AIDS cases. There is 3 identified HIV -positive case in Padang Terap this year. And he is not able to reveal the total cases that already identified and being treated in Padang Terap District.

His briefing mainly focused on:

1. screening
2. diagnosis
3. what is the role of district health office when HIV/AIDS patient passed away.

Screening
-before marriage, it is compulsory for the Islam couples to get their HIV/AIDS screening done before they proceed with their marriage
-voluntary with details, whereby such person gives their full consent to get their blood tested for HIV/AIDS
-voluntary without name, gives full consent for report but there will be only identification number and the person just can call the office to know their result.

Diagnosis
According to Tn Haji Yaakob, the diagnosis of HIV/AIDS only confirmed after the person who is positive of screening test undergone two ELISA test and both shows positive.

After the confirmation of the diagnosis, the details of patient is will be inserted into CDCIS or E-NOTICE which will act as database for Health Ministry to monitor the cases with the help of DHO.

when the HIV/AIDS patient passed away..Close monitoring by the CDC unit
The patient will be wrapped into few layers of clothes and plastics before given to the their family. The patient will be cleaned with hypochloride solution then a layer of white cloth will be used followed by the plastic cover. Then will be wrapped again with the cloth. This procedure is mainly done in hospitals.

In case where the patient passed away in house and he/she not brought to hospital, the DHO will be providing the family with necessary things such as apron, mask and clothes.

Tuberculosis
Tuan Haji Yaakob explained very briefly about the procedures and the forms that used in process of treating tuberulosis and eradicating the contacts

There is 12 forms that used in case of Tubeculosis.

Form 10A1- case monitoring
Form 10A2- confirmation
form 10A3- investigation (hospital and field)
Form 10A4- record purpose

Form 10B1- hospital record
Form 10B2-hospital record summary

Form 10C1 and Form 10C2 - Contact form

Form 10E - defaulters

Form 10F - contuination of treatment

Form 10G- MDRT

Form 10J- Tuberculosis patient dies (*used only when the patient is still under medication)

He explained the procedures that to be followed when filling up the forms and also investigating the case.

In addition, he talled to us about DOTT (direct observation of tuberculosis treatment). It is normally done in chest clinic in hospital and the patient will be required to come there everyday to take anti-tuberculosis drugs under the observation of the nurses. It is normally done for at least 2 months and more for those who frequently defaulting the treatment course.

-------------------------------------------------------------------------------------------------
Then Tuan Haji Yaakob brought us to Pondok Inabah 1 which located approximately 7km from district health office. Pondok Inabah 1 is the private centre to treat the drug abusers and it is recognised by the Anti-Dadah Kebangsaan (ADH).

There we briefed by the Tok Guru about the drug-free method to treat the drug abusers. It is mainly through holistic methods whereby the principle that they're using is follows Quran.

It was new experience to us whereby until now we thought that only government centers are providing such services.

more info to come as special report.

___________________________________________________________________

In afternoon we had pleasant visit by Dr.Sawrirajan.We explained to him the activities had been done so far and he gave some suggestions and instructions that should be done before the end of this posting.

We would like to thank him for his suggestions.

Then we had short discussion with Distric Health Officer, Dr.Latifah. She talked to us about the services that available in Health Clinics in this distric and also states more about the organization chart of the Padang Terap Distric Health Office.

We also would like to thank you her for the guidance and advise given

last day in kota setar

2008-08-01T18:52:00.000+08:00

9.30- 11.30am
briefing by En.hassan(PPKPK) regarding occupational health

day 9 in kota setar district health office

2008-08-01T18:45:00.000+08:00

today's activities\

8.30am-10.00am
speech by Mr.zaidi regarding water and sanitation(BAKAS,bekalan air dan kesihatan alam sekitar)
2.00pm-4.00pm
briefing on food quality and sampling by Mr.Mohd Fauzi. folowings are topics discussed:

role and function of Food Quality and Sampling unit
hoiw sampling is being done
rating of premises that sell food items(school canteens,restaurants,factories)

8th day of dho posting(kota setar)

2008-08-01T18:40:00.000+08:00

as usual, the 1st session of briefing starts at 9am. Mr.Abdullah (PPKPK of vector unit) gave us talk on how to control an outbreak cause by vectors.in his talk,he stresed more on malaria and dengue outbreak.

ANSWERS TO DR. SAPNA'S QUESTIONS

2008-08-01T18:38:00.002+08:00

THE QUESTIONS ARE:

1.Why is a second fogging done around a case of Dengue?
2.Why on the 7th day after the first fogging?
3.What is the insecticide used for fogging?What is the mechanism of action and the quantity in which it is used?
4.What are the different type of sprays used for fogging?

THE ANSWERS
(taken from Park's Textbook of Preventive and Social Medicine 17th edP544-548)

Question 1: It is done to kill any missed infected adult mosquitoes and newly grown adult mosquitoes from an infected pupa.

2. If an infected female mosquitoe so happen to lay eggs on the first fogging, the 'infected eggs' are protected from the fogging effect as the fog only effective in killing adult mosquitoes. The eggs will reach larva stage at day 5-7 and pupa stage at 6-7 days. A second fogging is done on day 7 to kill the Culicine (Culex, Aedes, and Mansonia) larvae through their siphon tube that is attached to its 8th segment of its body that is exposed to the air. But the main idea of fogging on 7th day is to kill the pupa. The pupa represents the resting stage in the life history of the mosquito.It has 2 small respiratory tubes (trumpets) project from the upper surface of the thorax, therefore the fod or mist sprayed on 7th day will effectively kill them as well.

3. The insecticide used in Malaysia for fogging normally is Resigen (S-bioallethrin, permethrin (25/75) and piperonyl butoxide). S-bioallethrin and Permethrin belongs to the family of synthetic chemicals called pyrethroids and functions as a neurotoxin, affecting neuron membranes by prolonging sodium channel activation. Piperonyl butoxide (PBO) is a pesticide synergist and also a potent cytochrome P450 inhibitor. It does not, by itself have pesticidal properties.
The quantity used in oil-based will be 1L of Permethrin (100mL of Resigen :1L of Diesel). *note, the fogging machine can fit 5.5L but the staffs prepare 5L of mixtures.

4. Other types of spray used are:
Residual insecticide (Malathion and fenitrothion) using ULV fogging.

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

2008-08-01T18:37:00.006+08:00

KMDHO TEAM STARTED WITH HOPE BUT ENDED WITH DISAPPOINTMENT

As the title went, we really got disappointed when practical session for premise inspection and food sampling was cancelled as the person in charged could not make it to prepare us such activities. Besides that, it was Thursday and no food sampling will be taken as the Laboratory is off from friday till Sunday.

So, we continued with THEORY LECTURES again. We were briefed by PPKP Adam who is in charged of the Food Safety and Quality Control (FSQC).

PPKP Adam

The law used by this unit will be the Akta Makanan 1983 ( Food Act 1983), Peraturan makanan 1985 ( Food Regulations 1985), and Standard Peraturan Air Minuman berbungkus 1985 (Standard Regulation of Packed Water 1985). Practically, Peraturan-peraturan Hasil Tembakau 2004 (Tobacco Control Act 2004) comes under the Food Act and Food regulation.

He told us briefly about what the factory has to deal with DHO before setting up a food processing factory and surveillance done in school/food premise, factory, restaurant and static stalls.

When a new food related factory is established, the factory is required to apply license from State municipal. The municipal will then forward a letter to FSQC of KMDHO. FSQC unit will then conduct a food sampling on that premise besides assessing the cleanliness of the factory, machine, tools, and the staffs. Typhi IV card of the employees are assessed as well. Thyphi IV card is an identification card that is given when salmonella typhi vaccination is given to the food handler of the factory or food premise.

Then a random sampling of the food product will be done. The sample will be sent to Jabatan Kimia Penang (Penang Laboratory Dept.) and check the parameters such as chemical, physical and microbiological. Sample that require chemical and physical assessment must be sent to Laboratory by 3 days whereas sample must be sent within 24hours for microbiological parameters. Microbiological parameters include checking the presence of Salmonella spp, Staphylococcus Aureus, E. Coli, Coliform count and plate count.

After that, the label of the product will be assess according to Food regulation Act 1985 under Regulation 18 in which label with "Super, 100% Natural, King, Class 1, Brilliant, Quality Guaranteed, and High Quality are prohibited". Well, if someone were to ask me "How bout the brand Super Ring, Beras Super, and King ice cream?". I can only say, " sorry, I have no comment ladies and gentlemen".

When every assessment is passed, Health certificate will be issued by DHO of the state to the factory and the factory can now export to overseas as long as the requirements are met with the standard set by the importing country. For a better recognition, factory can apply Good Manufacturing Practice (GMP) and/or Hazard Analysis and Critical Control Point (HACCP). GMP is well recognised locally but not internationally. For HACCP, it is recognised both locally and internationally. If factory has HACCP recognition, food sampling is exempted. The municipal will then issue certificate to allow manufacturing in the last step of application process. For further information, JAKIM (the body that certify HALAL'ship') has no connection with DHO and they assess the food by themselves.

If the food sampling does not meet the requirement, the factory will not be closed but instead, the batch of the food produced will be disposed and a new batch of food is produced. Then the new sample is taken again until the batch of food produced meets the requirement.

For imported food such as the food brought in from Thailand, the product will be held at least 1-2 weeks for sampling. All the parameters are checked before the product are permitted to enter Malaysia. This topic is covered very briefly as we do not really have the facilities to appreciate the process. Hope the DHO team that is posted near to Thailand border will give us more coverage on this topic.

As for food surveillance, it will be done twice a year (especially in school canteen). If there is 1 outbreak of food poisoning, the surveillance will be done once every 4 months (3 times in a year). The premises are classified into Factory, Restaurant/Food Premise, School Canteen, Static Hawker, and Seasonal hawker (e.g. Lontong, festive cakes,and foods sold at a particular festive season). The process of surveillance and food sampling will be discussed in specific topic of day 4.

Then our activity is continued with lecture from KPAS unit at 2.30pm to 4.30pm by PPKP Tengku Baharudin. According to him, this unit is temporarily focusing on the health staffs only and will expand their scope on the other fields later in future. The main aspect that is taken cared by this unit is the Sharp Object Injury, Hepatitis B vaccination program, and Healthy Setting Program.

PPKP Tengku Baharudin

The law used in this unit will be Occupational Safety Health Act 1994 (OSHA ACT 1994). If someone is acting against this law, the guilty will be punished with a penalty of equal/less than RM50 000 or equal/less than 5 years of jail or both.

Any sharp injury must be notified within 24 hours to DHO office by phone and sent a notification form withing 7 days.

Healthy setting is then introduced to us. The definition of healthy setting is a place where everyone work together to achieve an agreed vision for the health and well being of worker and surrounding community. This program takes care of staff psychologically, socially and physically. A routine feedback is taken from staff on safe setting. This is to ensure health promotion and prevention are integrated into working environment.

This is all for today. Thanks for reading.

day 7 of DHO posting, at Kota Setar

2008-08-01T18:24:00.000+08:00

Mr.Hassan Abidin(PPKPK),the person incharge of CDC unit, brief us regarding role of CDC unit. we were mainly discussing about

actions taken during an outbreak
how do they curb or control an outbreak

the next session was suppose to be a practical session,but since the staffs were involved in medical auditing,thre were unable to do so. however we just attended a short briefing session by Mr.Ooi(PPKP). topics of discussion were 'Qality assurance programme' and 'communicable diseases'.

during lunch time Dr.K.Narayanan togather with Dr.Sopna came to visit us. we had a discussion with them mainly about our daily activies. several questions were directed to us by Dr.KN

1st ques: Why is there 2separate compartments within Ice Line Refrigerator(ILR)
2nd ques: why Dt is given at 7years old and not DPt?

day 6 in kota setar

2008-08-01T18:14:00.000+08:00

3/08/08

today our programme starts at 9am.we were given briefing by Tuan Hj Mansor (KPPKP),head of inspectorate unit regarding:

The function of Inspectorate unit, and
Activities conducted by NCD unit
Activities of investigation and prosecution unit

next session started after lunch break. it was also a short briefing session regarding:

Reinforcement of laws(peraturan-peraturan kawalan hasil tembakau)
E-notification

Last day in Padang Terap

2008-08-01T12:19:00.000+08:00

Day 9 [6.8.2008]

Today we were under the BAKAS unit. We are briefed by Mr.Hassan about the unit and what are their responsibilities. It was very short session and further explanation is given on out field visit to few places that comes under observation of BAKAS.

* First we were shown the water pump which was situated in the health office premises itself. The officers also briefed us on how samples were taken from this water pumps for testing.

Then we proceeded to a remote village to see how daily household waste materials were disposed.

* First we saw the steps that waste sink water goes through before it is channeled to a nearby drain. It is called "sistem pelupusan air limbah" all the materials to buld it is provided by BAKAS.

* After that we were shown the toilet used there. We were told that the government supplies all the materials required to build the toilet free of charge. Then the villagers will have to built it them self. The health officers will monitor the progress and approve it.

* Later we were shown how fruits and other wet waste products are disposed. This waste products are usually put in a hold dug in the earth and then a metal cap is provided by the health office. This cap is so that flies and other insects do not enter the dug hole. When the hole is nearly full the cap is removed and hole covered with sand. Normally villagers will plant fruit trees on top of the covered hole.

* Then we also saw the burning method which is used to dispose waste materials.

Monitoring is done frequently to villages with such waste disposal methods as it is important to prevent diseases and maintain a health lifestyle.

After that we went to Puncak Jeniang waterfalls. Here we saw a man made dam. This dam supplies water to a nearby village which has around 169 houses. The water collects in this dam and then there is a filter placed before the water goes to the houses through pipes. The pipes are fixed in a way that water will reach the villagers in high pressure. According to Mr.Hassan, 3 inch pipe is fixed at dam and when it reaches the village it is just half inch in diameter.

After that we came back to the health office and ended our 2 weeks DHO posting in Padang Terap District Health Office with lunch prepared by the office.

Here we also would like to thank you all the officers that spent some of their time with us briefing everything we need to know.

thank you

MCH- d' Padang Terap Team

2008-08-01T11:58:00.000+08:00

Day 7

Our 2^nd day on MCH clinic began with the short meeting with Family Medicine Specialist. He briefed shortly about the clinic which already briefed in detail by MNHO the previous day.

After the short meeting with FMS, we are explained by the staff nurse Aslizah about the antenatal check-up and we divided into 3 groups to observe the procedure that undertaken in routine antenatal check up.

The procedures are:

1. Walk-in into the clinic to get their number and also the antenatal card. (Normally follow-up cases because booking is done in “Klinik Desa”)

2. Then they’re required to have routine lab investigations such as Hb, RBS and urine examination. (HIV/VDRL test for new cases)

3. With the result of lab investigations, they will come to meet staff nurse for further check-up which will be done in two phase.

4. First phase – patient’s current height, weight and blood pressure measured (Pregnant ladies who had perceived quickening given ATT injection)

5. Second phase – patient will undergo routine abdominal examination and also will be counseled on pregnancy related problems such as anemia, spacing, diet and exercise.

During our visit, there are two patients receiving counseling on prevention of anemia and disadvantages for not having good spacing between pregnancies.

Besides counseling and routine abdominal examination, the staff nurse also in charge of dispensing hematinic medications and also iodine rich salt.

The hematinic drugs compromise of T.Vit B (Nicotinad 10mg; Riboflavin 1.5mg; Vitamin B1 1mg), T.Vit C 50mg, Folic Acid 5mg and Ferrous Fumerate 200mg.

Staff nurse in charge of the unit explained to us that, if the patients remain anemic in spite of consuming all the hematinics, they will be provided with softgel which having higher concentration of iron. They also will undergo serial counseling on food types that help in reducing anemia.

6. If any complications arise, then the patient will be referred to MO or FMS

Our expectation to follow JM to house visit for postnatal check-up is not fulfilled due to their busy day handling the antenatal check-ups.

DAY 3 :JITRA

2008-08-01T01:00:00.004+08:00

Adolescent Health

Adolescent health specifically targets those between the age of 11 and 19 years old, with focus on sexual and reproductive health, growth and development, nutrition, mental and physical health.

Objective

1. Plan and provide health services to all adolescents which include the physical, mental and spiritual aspects to guide them towards a healthy life.
2. Prevent health problems due to risky behavior by promoting a healthy lifestyle.
3. Encourage adolescent involvement in healthy activities.

Standard Operating Procedure

1. Registration by Administrative Assistant.
2. New patients are given a screening form to fill up by Medical Assistant.
3. Antropometry(weight, height and BMI) measurements are done by Medical Assistant.
4. Screening form is assessed by Medical Assistant.
5. Further medical examination done by medical officer, if necessary.
6. Lab Test (hemoglobin and any specified test) done by Medical lab technician.
7. Referred to Family Medicine Specialist or other government agencies.
8. Given treatment, counseling and health education.
9. Next appointment given and asked to return home.

Activities

1. Identify, educate and treat adolescents with sexual and reproductive health problems( abnormal menstrual cycle, abdominal pain, mass, urogenital discharge, abnormal genitalia, sexual abuse, high risk behavior, and abnormal sexual orientation.)
2. Identify, educate and treat adolescents about nutrition.
3. Identify, educate and treat adolescents with mental health disorders( anxiety, stress, adjustment, behavioral, depressive and deviance)
4. Identify, educate and treat adolescents with high risk behavior( smoking, substance abuse, alcohol, vandalism, truancy, illegal racing)
5. Identify, educate and treat adolescent with physical health problems(acne, headache, non –intentional injury, and abdominal pain)

Records

Individual records are updated during visit along with screening form. Monthly records are prepared by MAs and biannual reports are sent to State Health Department on:
1. Number of new cases.
2. Number of old cases.
3. Types of morbidity.
4. Number of adolescents on treatment and counseling.
5. Number of referrals.
6. Number of screenings.

The team in front of the District Health Office in Jitra

DAY 2 : JITRA

2008-08-01T00:30:00.000+08:00

Geriatric Health

Objective

To plan, prepare and provide services to all geriatric age- group patients encompassing physical, mental, social, and spiritual as well to reduce disability and increase independence.

Improve cooperation between Ministry of Health, NGOs and government agencies regarding geriatric health.

Enhance public knowledge and involvement with geriatric health.

Geriatric Health District Committee

Chairman : District Health Officer

Vice Chairman : Hospital Director

Secretary : Medical & Health Officer

Committee members : Family Medicine Specialist

Dental Officer

Dietician
Health Nurse
Medical Assistant
Physiotherapist

Their roles include planning activities, promotions, prevention, treatment for geriatric residents.

They also provide training for Health professionals based on official modules by the MOH and place them at Geriatric Units.

They also plan and implement suitable activities for the public based on the Geriatric Care Module.

They also encourage the involvement of the public in Geriatric Health Care through Geriatric Clubs, Fund raisers, Health Club and so on.

Inspect and analyze the achievement of this program.

Geriatric Clinic

The clinic runs concurrently with the regular Out-Patient Department and all geriatric patients are advised to undergo regular health examination every year.

Standard Operating Procedure
1. Registration is done by Administrative assistant.
2. History taking done by Medical Assistant
3. Initial examination (blood pressure, pulse rate, weight, height, body mass index, vision and hearing test) done by Medical Assistant
4. If necessary patient is referred to medical officer for further examination
5. Lab test (hemoglobin levels, random blood sugar and urine FEME) done medical lab technician.
6. If normal, patient may return home, if necessary treatment is provided.
7. Referrals are made to dietician, psychologist, family medicine specialist, dental officer, and social & welfare officer and nearest hospital.

Activities

1. Health Education at the health clinic, schools and community centres. This includes health talks, giving out flyers / posters and audio video presentation.
2. Screening, like BMI , pap smear , diabetes , hypertension , oral hygiene , breast examination , assessment of daily living
3. Treatment like counseling , physiotherapy, occupational therapy , stress management and home care nursing.

Records

Individual records are updated during every visit and every month the MA produces a monthly report. Every six months the medical assistant in charge of each health clinic sends a report to the State health deaprtment on :
1. Number of new patients
2. Numbers of repeat patient
3. Number of patient who were completely assessed.
4. Number of referrals
5. Number of each diagnosis.

From the left: A diagram of the district of Kubang Pasu(the biggest district in Kedah), Briefing at the meeting room.

DAY 4: JITRA

2008-08-01T00:09:00.000+08:00

Role of Medical Assistants

Screening of patient
• History-taking.
• Vital signs examination.
• Physical examination.
• Lab investigation or X-ray

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.

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

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

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.

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.

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

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

What is Resigen?

2008-07-31T16:02:00.002+08:00

Product Details

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BAYER CROPSCIENCE (MALAYSIA) SDN BHD (7563M)
12th Floor, Wisma Damansara
Jalan Semantan
Kuala Lumpur
Malaysia
Tel: 603-2723 0888
Fax: 603-2094 4230
Website: www.bayercropscience.com

RESIGEN

COUNTRY ORIGIN
FRANCE

DESCRIPTION
Resigen is an emulsifiable concentrate used for space spray, either indoors or outdoors. Resigen contains a mixture of active ingredients that make it especially effective in the control of flying insects particularly mosquitoes and flies.

Resigen can be diluted with oil or water for thermal fogging, misting and Ultra-Low Volume application both indoors and outdoors. Thanks to the three active ingredients: S-bioallethrin (for rapid flush out, knockdown and kill), permethrin (25/75) (and piperonyl butoxide that make Resigen a Fast Kill and Quick knockdown insecticide.

FEATURES
Resigen Insecticide France

Space Spray

Quick knockdown

Fast kill

Visit this site.
http://www.asiabuilders.com/Asiabuilders/2007/ABprod_det.aspx?name=RESIGEN&ind_ctry_code=conMY&co_code=50014640&prod_code=50014640p7&display_ind=1

Question
What are the other types of insecticides used?

Group B - I had raised several other questions when I came there. Please put down those questions, find out the answers and post them.
Narayan

2nd day of DHO posting with school health team

2008-07-30T23:15:00.000+08:00

28/07/2008

on 2nd day of our posting, we followed the school health team to observe the immunization. our groups were divided into 2 teams,'team A' and 'team B'......

TEAM A

we team A followed the nurses to a chinese school(SEKOLAH JENIS KEBANGSAAN PEI SHIN) which is located at Kuala Kedah. we observed how MMR and OPV were given to standard one students.there were total of 27 students received OPV and MMR, whereas only one student of standard six who was absent during the 1st visit received rubella.

TEAM B
Team B went to Sek Haji Mohd Shariff, Kota Setar, to observe DT and OPV vaccination.there were 61 students received those vaccines and only 3 students (previously missed out cases) received rubella. apart from that , deworming were also carried out for pre school students. before the vaccines were given, the nurses did general physical examination and review the consent letter.

KUALA MUDA, 29.7.08, (DAY 3): SPECIFIC DAILY REPORT

2008-07-30T20:19:00.031+08:00

MISSION :

2nd Fogging due to positive Dengue case (done on 7th day after the 1st fogging)

OBJECTIVES:

To control Dengue outbreak at that particular area
To kill possible remaining adult mosquitoes carrying Dengue virus (1st fogging only killed adult infected mosquitoes but not the infected larvae)
Enable student to learn the process of fogging like us

LOCATION:

Bandar Baru Housing area, Sungai Petani, Kedah (HOT SPOT OF DENGUE OUTBREAK)

DATE&TIME:

29 JULY 2008, 1730-1930 HOUR

TEAM:

Pekerja Rendah Am PRA U1, 13 AIMST Medical Students, Municipal Workers

LAW USED:

Destruction of Disease-Bearing Insect Act 1975 (DDBIA) and Prevention & Control of Infectious Disease

TARGET:

All of the unfortunate flying mosquitoes (since we can't specifically kill Aedes)

TOOLS USED:

Thermal fogging machine (Please remember to fill either water-base or oil-base 'mosquitocites')
Goggle
Head-set like sound proof device
Mask
Gloves
Fogging Uniform

Termal Fogging Machine (Looks like machine-gun to us)

Goggle

Sound proof device

Really cool Mask

Old Style Uniform (No one can see him at nitght)

New look (He is such a good poser)

DESCRIPTION:

Fogging is normally done in the evening during sunsets for 3 reasons:

a)Mosquitoes are like us, we don't like hot sun

b) By evening, the sun sets and human heat easily sensed by their 'infrared eyes'

c) the active ingredient will evaporate like sweats into the air making it less effective in killing mosquitoes.

Fogging will be done within 1-2 hours for 2 reasons: a) to prevent staff from tripping steps or falling into a drain due to fogging effect and pitch black night b) the resident could not start their dinner
Fogging shall never be done in 3 situations: a) when there is funeral or marriage in that particular place b)when it is raining c) when there is a kenduri (Feast/party)
Fogging is normally done from 6.30-7.30pm but also depends on the sunset mainly.
If a person do not allow fogging to proceed in the house, a notice is given and if the person still ignore the notice, DDBIA 1975 can be used in lawsuit.
There are 2 types of fogging methog namely Ultra Low Volume (ULV), whereby a car is used to spray the insecticide and thermal fogging machine which was shown above.
ULV can only fog outside of the residency and a slow moving vehicle with 5-8km/hr speed is required.
Thermal fogging machine can be used to fog outside and inside the house but require more apparatus.
A radius of 200m must be 'fogged' simultaneously (why so?it's because the mosquitoes can't fly beyond 200m radius thus they will have to die within 200, exception applied to mosquitoes with good stamina)
The active substance used as insecticide is Permethrin.
It can be prepared as water based (water + Permethrine) or oil based (20mL of Permethrine/1L of diesel).

Water based perparation

The fogging tank can fit around 5.5 L thus a total of 5L preparations can be prepared. Let's test you math! If 5L is to be prepared, how much liter(s) of Permethrin needed?

METHOD:

Notify the residents about the fogging so that they can take appropriate measures to cover their food and keep their clothes.
Fog areas including drain, bushes, houses and surrounding area.
Bath straight away after conducting such activities.

THUMBNAILS:

Reaching the "HOT SPOT"

When we reached the destination, the 13 of the AIMST medical students of Batch 7 went to notify the residents and guess what happened to the individual of them?

1. THE RESIDENTS THOUGHT THAT WE WERE SALESMAN AND SALESGIRL .... (==,")

2. DINESHI AND THANA WERE GREETED BY SOMETHING BEFORE THE GATE...

A CUTE SHORTY DOG BARKING TO SAY 'DON'T FOG ME...'

3. GAN WAS FOLLOWED SILENTLY BY A GUEST BEFORE HE NOTICED IT

YEA.... A TAME-LOOKING SIBERIAN HUSK! THANK GOD HE'S BEFORE THE GATE

4. RATHNA, HELLY, AND PARI CALLED THE OWNER BUT THEY WE'RE HIDING IN THE HOUSE NOT COMING OUT

5. THANA FELT WIERD WHEN THE DOOR IS WIDELY OPEN BUT NO PEOPLE IN THE HOUSE AT THAT PARTICULAR TIME

6. KAVITHA AND PRAVENA GOT A GOOD RESIDENT WHO LISTENS TO THEM

After the notification to the residents, we waited the staffs to fog but they were sitting at corridoor as if they were waiting for someone. However we discovered our own activities while waiting for the so-called 'someone'.

We were contesting 'who is holding the thermal fogging machine correctly'. In you opinion, which of the following are the correct method of holding a 'fogging machine'?

Dineshi's 'salesgirl's' style?

Yew Chai's 'soldier-of-fortune' style?

Rathna's 'i-am-going-to-school' style?

Shankri's 'Anopheles-resting-position' style?

Pravena's 'Aedes-resting-position' style?

Gan's 'holding-a-guitar' style?

Kavitha's 'Selamba' syle?

Helly's 'stewardess' style?

Chia Leong's single-handed style?

Pari's 'holding-a-handbag' style?

Gaaitheri's 'Terkangkang' style?

BESIDES THAT, GAN FOUND OTHER USAGE OF THE FOGGING APPARATUS.

Ever wonder why the DJ's not deaf? Because they used sound-proof device in Disco

The goggle is sealed so tight that it can also be used for swimming.

After 20 minutes of waiting, we arranged the fogging machines on the floor and we stood around waiting what the staffs were waiting for.

Finally after 30 minutes of waiting we got to know what were the staff actually waiting for.

They were waiting the Municipal 'Fogger' Team

The operation then began:

He looks like a SWAT rather than a 'fogger'

They started that noisy buzzing sound of the fogging machine. Maybe it is the loud buzzing sound that frightened those mosquitoes away rather than that Permethrine.

LOCk & LOAD!!~~ (He actually waited 15s for me to snap him in that position)

ERm.. Mr. Fogger, where is the smoke?Is your machine working?

Have you ever wonder why the smoke is not as white as you seen before? That's because they used water based preparations.

This is what we call oil-based preparations (hmn.. he's not wearing Gan's DJ head-set and not even a swimming goggle)

Water-based fogging is suitable for inner house fogging.

Hope you guys and girls enjoy this session!

KUALA MUDA, 29.7.08, (DAY 3): DAILY REPORT: CDC HIV, TB AND LEPROSY + FOGGING!

2008-07-30T01:20:00.016+08:00

We assembled at the Communicable Disease Control (CDC) Unit meeting room at 8am with Mr. Mohd Fendi Ibrahim, Ass. Env. Health Officer PPKP of CDC unit in charged of Tuberculosis and Leprosy.

Mr. Fendi, Ass. Env. Health Officer PPKP of CDC unit

Mr. Fendi briefed us regarding the procedures undertaken to register patients diagnosed with TB and Leprosy. There are 120 patients diagnosed with TB in KMDHO. When a patient has been diagnosed with TB, the notification form together with several other forms such as that mentioned below are filled:

1) TBIS 10A1: Regarding the details of commencement of treatment
2) TBIS 10A4: To be filled by investigator and sent to Pusat Rawatan 1 regarding registration details.
3) TBIS 10C1: Concerning the investigation carried out to confirm diagnosis

4) TBIS 10A3: Regarding socioeconomic status, drug treatment, detail regarding conditions of the surrounding environment, and to identify risk factors.

These forms are filled up by the medical and health officer (M&HO) and sent to the DHO, where it is registered in a registration book for TB patients. Details regarding treatment, whether the patient is dead or alive is also entered in the registration book . If the patient is dead, it is important to mention if the patient passed on within 2 months of commencement of treatment or after (signify that the patient is in severe TB infection). The death of a TB patient should also be documented in Borang Siasatan Kematian Kes Tibi Dalam Rawatan. The case is then entered into the e-notifikasi database and separately MyTB database system.

Mesyuarat Audit Kematian Tinggi is held once in 6 months among doctors who treated TB patients and PPKP of TB & Leprosy unit to discuss the cases and certify deaths due to TB. If the patient diagnosed with TB is a foreigner, a letter is sent to the immigration department to facilitate the sending off of the patient to native country.

Defaulter who is present with TB symptoms 2 months after commencement of treatment will be registered as new case.

Then, we were told about the registration of Lepers.

There are only 2 cases of leprosy to date in KUALA MUDA district, one of them being a Nepalise who has been sent back to Nepal. The protocols to be followed in dealing with a leper is according to Manual Pengurusan Kusta. When a patient is diagnosed with leprosy, Borang Appendix 2A is filled up and submitted to KMDHO.

Mr. Hasani, PPKP of HIV/AIDS division

At 10am we were joined by Mr. Hasani, PPKP of HIV/AIDS division. he first explained the objectives of this division, which is to decrease the incidence of HIV patients in the community by health promotion, curt transmission of HIV infection and to prevent HIV infection among teenagers via PROSTAR (Program Sihat Tanpa AIDS untunk Remaja).
He continued to explain to us regarding the procedures undertaken to register a HIV/AIDS patient. Notification form is filled in by the doctor who diagnosed the patient with HIV infection or AIDS. The notification form is submitted to the DHO and registered by the PPKP in charge. Investigation will be carried out on all reported cases by the PPKP in charged. All persons who are in contact with the patient will be given retroviral therapy and counselling.

Kavitha, are you yawning? GOtCha~~~~!

Death of a HIV/AIDS patient will have to be documented and submitted to the Ministry of health. The HIV/AIDS division will have to send representative to the late patient's house to observe the rituals that are performed to the remains, are performed as required. This division conducts course annually to educate the community on how to manage the remains of a HIV/AIDS patient following death according to HIV/AIDS Standard Precaution. We dispersed for lunch at 11am.

We assembled at Unit Kawalan Penyakit Bawaan Vektor (Vector Control Unit) at 2.30pm. We were given a talk by Mr. Burke A/K Patrick Lummuria regarding the notification and investigations of a dengue case. Once the Notification form of a dengue case is submitted to the DHO, a Health Inspector from the Klinik Kesihatan will be dispersed to investigate the case. The Health inspector will be required to fill up an investigation form for dengue case which will encompass details concerning the patiend and his/her surrounding environment. The inspector will be required to elicit details about the patient's activities for 14 days prior to the notification , as the incubation period for the virus before signs and symptoms manifest is 14 days. The details collected are also registered in Record Book and Vekpro (a database that is used but it is not online database system like e-notifikasi)

Mr. Burke A/K Patrick Lummuria PPKP of Vector (Control Unit)

24 hours following the notification, activities such as investigate the hospitalised patient,fogging, larvaciding and 'search and destroy' are performed within 24 hours following the notification. Aedes Survey is conducted within 48 hours of notification, whereby this unit will dispatch it's members to survey houses in the vicinity of the patient's house for larvae in bredding places such as stagnant water. The results of this survey will be converted into Aedes Index (BRETEAU INDEX) which is the number of house with positive larvae divided with number of houses surveyed times 100. If the index is more than 1 % control measures should be taken. The Aedes Index limit varied according to time.

Hen larvae is identified, the owner of the followint house or premises will be issued compund as follows:

a) House = RM100

b) Shop = RM150

c) Schoo = RM150

d) Factory = RM500

The container consist of the larvae will be preserved with 70% + hot water. It will be used for investigation for the type of mosquitoe and act as exhibit if lawsuit should be approached.

At 5.30pm till 7.30pm, we followed members of this team for fogging activity at Pekan Baru housing area. we arrived at teh housing area around 6pm. we individually went and notified occupants of teh houses that the fogging activity will comnece at 7pm and approprate measures should be taken to prevent contamination of the food during the fogging activity. The fogging activity began at 7pm and we called it a day at 7.30pm after snapping pictures and observed the activities.

Reported by Praveena.

Sik District Clinic Day 3 activities

2008-07-29T23:12:00.010+08:00

Day 3

We visited Klinik Kesihatan Jeniang at 8.30am. We had a briefing by the Klinik MO Dr.Noor and the Penolong Pegawai Kesihatan Encik Jurid regarding the organizational structure of the Klinik. The FMS (Family Medicine Specialist) Dr.Habshah was away , therefore we were briefed by the MO.

Dr.Noor then briefed us further on the Procedures done in Klinik Kesihatan Sik

and Klinik Kesihatan Jeniang which is the VIA or Visual Inspection with Acetic Acid for Cervical cancer screening.

Encik Jurid brought us around the whole Klinik Kesihatan and led us to ABC(Alternative Bedding Centre) for phototherapy and labour, Geriatric Cli

nic which comprises of Diabetic Clinic and Hypertension Clinic and also lastly to the MCH. We had lunch break from 11am to 12noon.

At 12noon we had a pleasant visit by Prof Narayan, Dr.Sapna and Dr.Lely. We reported to them about the activities done for the past 2 days.

Prof Narayan gave us a few suggestions on the research methods of Dengue and Malaria.

At 2pm, Jururawat Kesihatan Zainab gave us a talk on School Health Service. Ser

vices provided like Doktor Muda, Vaccination and Immunization, Counselling for Teenagers etc. We were done for the day, and we went back to SP because TOMORROW IS A PUBLIC HOLIDAY IN KEDAH :)

………………………………………………………………………………………

As I mentioned in the blog yesterday, the fogging session attended on Sunday was at 7pm.

Before the fogging session started , a briefing was given regarding the content of the fogging

liquid.

4 litres of diesel mixed with 80ml of Resigen per equipment which lasts

about 20 minutes with a radius of 200 m.

KUALA MUDA, 28.7.08 (DAY 2) : SPECIFIC DAILY REPORT

2008-07-29T02:46:00.015+08:00

MISSION :

OPERASI PPKHT 2004 (OPERATION TOBACCO CONTROL 2004)

OBJECTIVES:

1. TO CREATE AWARENESS AMONG SMOKER THAT THEY HAVE TO RESPECT THE NON-SMOKER IN PUBLIC PLACE.

2. TO GIVE COMPOUND TO THE OFFENDER IN PUBLIC PREMISES AS A WAY TO MAKE THEM AWARE.

LOCATION:
CENTRAL SQUARE, SUNGAI PETANI, KEDAH DARUL AMAN

DATE & TIME:

3PM - 6PM, 28 JULY 2008

TEAM:
3 TEAMS IN THAT OPERATION. THE TEAM CONSIST OF ASS. ENV. HEALTH OFFICERS, 8 TRAINEE ASS. ENV. HEALTH OFFICES, AND 13 KMDHO TEAM OF AIMST STUDENTS. EACH TEAM IN CHARGE 2 FLOORS (I.E. G&1, 2&3, 4&5).

LAW USED:
PERATURAN-PERATURAN KAWALAN HASIL TEMBAKAU 2004

(TOBACCO CONTROL ACT 2004)

TARGET:

THE SMOKER WITH HIS/HER CIGARETTE STILL BURNING WITHIN THE CONFINED AREA OF RESTRICTED SMOKING ZONE

EXHIBIT:

CIGARETTE OF THE OFFENDER

DESCRIPTION:

Smoking operation is done twice in a month in premises where smoking is prohibited.
Police force accompany the team to handle difficult case (uncooperative offender) and to search the pocket of offender (in a case whereby the offender refuse to give the cigarette).
The cigarette is collected in a sealed bottle as exhibit for the prosecution
A notice is given to offender during the operation.
Offender is given 4 weeks time to pay the summon at Finance Dept. Of the KMDHO Administrative Department.
Maximum of 2 weeks are required for DHO to get consent from Deputy Public Prosecutor (Alor Star)
Meaning that, if consent is not gained from Public Prosecutor, offender can't pay the compound yet. Thus he/she has maximum of 2 weeks duration to pay (4weeks - 2 weeks)

Each compound cost RM250/stick of cigarette.
If the offender pay the compound, the case is closed.
If the offender doesn't want to pay or never pay within 2 weeks, the case will be taken to civil court.
Offender who wants to pay may appeal to less the amount of compound. The extent of reduction depends on the negotiation between 2 parties (Offender and PPKPK).

The Maximum Charge by the court is RM 10 000 or 2 years jail or both.

METHODOLOGY:

Offender is noticed and approached.
The Ass. Env. Health Officer has to show the offender their ID or Badge and introduce themselves briefly.
Offender is explained that there is a rule that smoker must not smoke in public premises (Peraturan 2/Regulation 2) of Non-smoking area.
Offender is made clear that he/she has offended the law.
Offender is asked to put his/her lighted cigarette into a clean new bottle so that the cigarette contain only his finger print and not contaminated or for DNA analysis if offender challenge the case.
The bottle is sealed off around the cover of the bottle by a special template so that the exhibit will not be disturb or changed by any interested party
Offender is asked to show ID of his/hers
The notice sheet is written with correct details of the offender. There are 3 sheets with 3 different colours. White is original copy, Yellow is for the offender, and Green is for Audit.

THE THUMBS OF THE PROCESS:

* The blogger of this page has tried to censored the details of the pictures shown below in order to protect the offender's rights an confidentiality.

* The blogger intend to put the pictures below for educational purposes only and will not be responsible for any malicious act by others who misuse the pictures below for any other purposes.

* If it is against the law, the blogger is cooperative to delete the pictures immediately when contacted.

KMDHO team of AIMST medical students get ready for action!

Plans briefed in Operation Room

AIMST Med. Students are honored to be part of the team!

Arrival of the teams. ~LOCK AND LOAD!~

Suspected offender spotted...

Cigarette in his left hand

Cigarette detected. Target confirmed!~

Target approached, introduced, and explained.

The red circle is the badge of the Health Officer shown to the offender.

The cool Badge~~~

Offender is asked to show his ID and notice is written.

The seal...

Cigarette put into a bottle and sealed.

Cigarette act as evidence.

Sik District Clinic Day 2 activities.... continued

2008-07-29T01:22:00.011+08:00

Hello Batch7 mates..

As mentioned in our earlier blog, here are some pictures that we took during our visit to the Mother and Child clinic

1)Activities conducted for mothers by staff nurses to educate about a well balanced diet for their children.

2) At the Family Planning Clinic, when a mother of 3 children came in for an injectible contraception

3) At the Vaccination and Immunization Clinic, when we observed how the OPV and Tritantrix was Administered

Thats all for now.. more updates to be given soon.. till then.. take care and enjoy the posting friends :)

2008-07-28T22:52:00.003+08:00

Dear Students of Batch 7,

Kindly post the daily reports of the activity according to your groups, but for specific components,e.g.Maternal Health/ Child health/Environmental health etc..(discussed as seminars and those required as a part of your observations in the field) please make a single consolidated report by discussing amongst yourselves and then post it on the blog.

Please share information with your friends posted in other districts to understand various activities being carried out in different districts.

d' Padang Terap Team Reporting....

2008-07-28T22:38:00.004+08:00

Day 1(27 July 2008)

Reported at the district health office at 9am and we were welcomed by Mr. Musarrahad the Assistant Health and Environment Officer of the Food Safety and Quality Control Unit and subsequently briefed us on the general workings of the district health office. We had a general overview of the demographic details of the locality and the structural unit of the office and their respective responsibilities.
Padang Terap is the one of the biggest district in state of Kedah with total size of 1300 km2 with total population of about 68,768 peoples. The health office of the district situated at Kuala Nerang approximately 35km from North Alor Setar toll exit.

There is 1070 staffs of various ranks working in the District Health Office, headed by its respectable district health officer Dr.Latifah. There is
1)HOSPITAL KUALA NERANG
2)4 health clinic KLINIK KESIHATAN LUBUK MERBAU
 KLINIK KESIHATAN KUALA NERANG
 KLINIK KESIHATAN NAKA
 KINIK KESIHATAN BANDAR KUALA NERANG aka. HOSP K.NERANG,
3)16 “KLINIK DESA” under the administrative umbrella of Padang Terap District health office.

The ratio of health clinic to the population is, 1:22,922 while the ratio of “KLINIK DESA” to the population is 1:4298.

Soon after the general briefing, Mr.Pregas Rathnam the Assistant Health and Environment Officer of the Food Safety and Quality Control Unit (Unit Keselamatan & Kualiti Makanan) commenced briefing on the workings and organization of the unit. He explained to us the responsibilities and protocols undertaken by the unit to control the safety and quality of food in this district.
Their responsibilities governed are:

 Food safety and toxicology control
 food contamination control program, eradication and control of Aflatoxin in
food
 Food sampling
 Food premises inspection
 Closure of food premises
 Food seizing and to destroy if necessary
 Food poisoning investigation and control
 Issuance of license to bottled water manufacturer
 Imported food control
 Exported food control  issuance of “Health Certificate”
 Prosecutions and legal proceedings
 Industry and consumer education
 Laboratory services support

We were assured that we will be called to join a field work soon………. We thank them a lot for their kind and considerate cooperation.
___________________________________________________________________

Day 2 (28 July 2008)

Today at 8.45am, we met with Mr.Azlan Hussain the PKA of HIV/AIDS division of CDC unit. He talk to us about the unit workings and also the AIDS/HIV eradication and education program especially to teens from 13-30 years old. He told us real time stories and the challenges they face in preventing and educating the people on AIDS/HIV.

He also told about the programs and the counselling sessions which they conduct at district level.

Then after the short tea break, we met Mr.Faizul, one of the PPKP of CDC unit about notification of diseases, the procedure involved and also the process of dealing diseases like dengue, thypoid, HMFD and food poisoning. He also chat with us some realtime experiences.

Tomorrow we're joining the CDC unit again and expecting a fulfilled field work.
Till then, chiow.....

KUALA MUDA, 28.7.08, (DAY 2) : Daily Report : Started with lectures like those in class again but ended with interesting field work

2008-07-28T20:45:00.017+08:00

KMDHO TEAM LOADED WITH FACTS AGAIN AND AGAIN BUT ENDS THE DAY WITH THEIR 1ST FIELD WORK!

KMDHO team gathered in meeting room by 8.30am. We were loaded once again with facts on the organisation chart and the function of each units but this time more specifically on the job functions of Environmental Health. The lecture was given by the Chief Ass. Environmental Health Officer (K) PPKP Tn Hj. Samad. Though it was lengthy but we felt that the core messages he conveyed were indeed important and useful. The only difference of the information given is that each topic is explained with his experience in handling the local environmental health problems.

Chief Ass. Environmental Health Officer (K) PPKP Tn Hj. Samad

In his seminar, he explained to us that the organisation chart of the KMDHO differ from what was told. There are 3 MOH (PKD) rather than 2 previously. They has also added new units in Environmental Health Dept. namely Investigation and Prosecution Unit, & Control of Non Infectious Disease Unit (total of 9 subunits in Env. Health). There are 2 new main units formed, namely Nutrition Unit and Food Technology Unit.

Full attention from Students

'Enapa' Helly, are you looking at the cam? Concentrate k..?

We will only highlight the information in the context of our local settings during the discussion of Environmental Health. Firstly, Mr. Tn Hj. Samad introduce what is vector borne disease and explained that the vectors can be classified into Mosquitoes, Cockroach, Rodent, vetenerian and etc. The diseases monitored under this unit are Dengue, Japanese Encephalitis, Malaria, Filariasis, yellow fever, and Thypus. Specifically he told that if Aedes index is >= 5% (e.g. if 100 household is to be surveyed, 5 houses have Aedes larvae is considered to have Aedes index of 5%).

On the water quality control issue, we were informed that most of the Malaysian water supply is from surface water. The parameters follow by Malaysia is Malaysia Standard of Drinking Water.
According to him, our Malaysian Sandard of Drinking Water has higher level of standard than what is given in WHO standard as WHO set in such a way that it suites all country. We must be really thankful that Malaysian has fully treated clean water. We must take the suggestion like what Prof. Dr. Narayan said, "You don't have to boil the water for drinking" and by Adrian, "We boil water for making coffee or beverages only".

He also explain briefly on how water surveillance is done. Water are taken from river and channeled to treatment plant, to reservoir, and then distribute to household by reticulation technique (i.e. it is just like how carotid artery branches out to become external art., facial art., maxillary art., nasal art. and so on). The surveillance is done by taking water sample from each braching of the pipe line and this point is called sampling points. Normally, when there is an outbreak of water borne disease the pipeline proximal to the contaminated water is closed. Like wise if the pipe is broken or leaking, the proximal point of the leakage is closed for repair. He gave an example of cases happed in Perak whereby a foreigner transmitted Hepatitis A via water pipeline.

We asked a question to him in which most student always confused. It was the role of BAKAS and Water Quality Control Unit (WQC). He explained that the WQC is handled by private sector whereas BAKAS is by government. WQC produce the water taken from government,and then the processed water is sold back to the government to supply for the 'Rakyat'. In the other hand, BAKAS produce water in small scale. Why small scale?Why produce since the WQC is producing merely the total water supply to the Nation? Well, BAKAS initiate to find water source if there is no such services like those in rural area. They will find the source of water from underground. They will dig and fix a pipe connected to underground. Besides, BAKAS also incharge of setting Sanitary Latrine, Sulage Water, and 'Lubang sampah' (Rubbish Hole).

He taught us with full commitment.

We were also explained on Food Safety & Quality Control. The license is obtained from 2 authorities before a food is allowed to be sold locally or internationally. For local permit, Good Manufacturing Process (GMP) must be practiced before the license is granted. Under this rule, there must be a proper way of preparing food and proper way of handling it. In order to export food to international market, internationally trusted body or authority in Malaysia will be the Hazard Analysis Critical Control Point (HACCP). The law implemented in this unit is Food Act 1983 and Food Regulation 1985. During an outbreak of food poisoning, the problem they faced locally is that the food sample is not easy to obtain due to:

1. The particular causative food was totally sold off (delicious food are always unhealthy food)

2. The chemical effect decrease with time, thus, the chemical count (in ppm) decrease up to the

level the it can't be detected by the time of invetigation.

3. The side effect of the poisonous food emerge late

Under General Health he discussed briefly that Env. Health Unit will assess Housing Plan in which they will assess the future building will be overcrowded or not. Like wise, they will also assess premises.

Environmental Health Unit

After around 1 and half an hour seminar, we went to Infectious Disease Control Unit. We were briefed by Mr Zamani, Ass. Env Health Officer PPKP U29, on Notification and How the surveillance referral systems. Malaysia is following CDCIS (Communicable Diseases Control Information System) for notification. As we know, there are 2 types of notifications. One is within 24 hours, the other is within a week. For the 24 hour notification, a phone call must be made to CDC unit of the DHO. At the same time, notification form must be summited also. The call is made for fast preventive action by CDC unit of that particular DHO. Notification can be done by Private doctors or Hospital. The notification system started this year in Malaysia is E-Notice which is a web based notification system. The information can only be keyed-in only by CDC unit of the DHO or directly from Hospital. E-notice data collection is based on state only i.e. when all the total cases are sum up, it will be the total cases that reported in say Kedah state only but not from other state.

Mr Zamani, Ass. Env Health Officer PPKP U29

Out of so many diseases that must be notified, 4 cases in Malaysia can be notified based on symptoms and signs namely Food poisoning, HFMD, Tetanus and Measles. Meaning that, these 4 diseases are in confirm status, no laboratory investigation is required. After keying into e-notice, a separate notification of Measle cases are notified in SN2 (System Notifikasi 2). In SN2, confirmatory laboratory test is required. The problem face locally is that the doctor notify disease by filling inappropriate laboratory tests. (e.g. A measle is confirm by serology test but the doctor confirm it by Full Blood Count).

The highlight of the discussion is that , if a patient came from other state but is notified under KMDHO, how is the notification is to be done since the disease might occur from other place?

E.g. of the senario is:

If a patient who is from Melaka and got one of the notifiable disease from Melaka but he was diagnosed in Hospital Sultan Abdul Halim (HSAH) because he was studying in Kuala Muda District. HSAH will report to KMDHO. KMDHO then will report back to State Health Office SHO of Kedah. SHO of Kedah will register the case as Kedah case per se but will notify SHO of Melaka. The data collected will be transfered to SHO of Melaka later on and case will be deleted in SHO of Kedah. This is important in statistical studies in the sense that the data will not cross over to other states. Back to the flow now, when SHO of Melaka receive the notification, DHO of Melaka will be notified by SHO of Melaka. However, practically DHO of Kuala Muda will give a call to DHO of Melaka informally. Reason is the same, to take immediate action in prevention.

Second senario is that, if a person is from Yan district and was diagnosed in Kuala Muda district. How is the notification goes about in the same State? HSAH --> KMDHO --> Yan DHO. Here, no SHO of Kedah is involved.

Then we continued our day with another seminar which is given by Mr. Tan Siok Kong Senior Ass. Env. Health Officer (U32) on Investigation and Prosecution. There are 4 main acts practiced:

1. Food Act 1983

2. Food Regulation 1985

3. Tobacco Control Regulation Act 2004

4. Infectious Disease Act 1998

He gave example briefly for each act. In Food Act 2004, Benzoic acid must be less than 750 ppm only allowed food product such as Chilli sauce. For Infectious Disease Act, only some is practiced in real life such as Dengue case. This unit can't prosecute doctor who never initiate to notify the notifiable diseases. He explained to us more on Tobacco control act 2004. The stress the point that non-smoking area include worship place, government dept., shopping comlex, clinics, bus station, and air-cont. restaurant. Ministry of Health also minimised the number of cigarette in a pack to 20 sticks per pack only. MOH also enforced that no loose pack of cigarette can be sold as this will encourage adolescent buy it due to cheaper price. About how investigation and prosecution is done, we will discuss it in detail in next section under daily specific report. He explained what was told above via what he remembered because he couldn't find his power point. Thus, we were also tought about FORENSIC PHOTOGRAPHY.

Mr. Tan Siok Kong Senior Ass. Env. Health Officer (U32)

The core concept of forensic photography is that a picture must be taken clearly with full details that can be use as exhibit for prosecution. It include overview picture of the place, focus part of the place, and zoom image of the evidence. It is like before you want to operate a patient for CABG, before you are able to see a patient's heart, you must first see the patient as a whole (Let's say we capture a picture of the whole body, Image 1). then we will focus on the chest area (image 2), then focus on incised sternum (image 3), then focus to the heart (image 4), then to the major coronary artery (image 5), then to the brach of blocked artery (image 6). In these 6 images, we must take a point for reference and the point can be object that is not moveable or changed. E.g in this case, we include the patient's face into each picture. The main idea of taking a point specific to the patient is that when any lawsuit is taken, the picture could not be falcified by using other patient's picture.

If not clear with what we said, we will give another senario. Let's say a mosquito larvae is seen in a pot located in a hotel. First image will be overview of the hotel. We take the hotel's name as point of reference in that pic. Then we focus the door and include the hotel's name taken in first image. 3rd image will be the focus picture of the door and this time take a pole in the hotel as reference point (say there is a big unumovable pole in that hotel). Then Image of the way leading to the toilet is taken WITH THE POLE STILL SEEN IN THAT PIC. Then the picture will lead us to the toilet with the pot visible located in the toilet. We again zoom the image pot the pot including the items that can be found surrounding the toilet. Then we take another picture of a sample taken from the pot. By this method the owner of the hotel could not deny that the pot containing mosquito larvae is not his!

After lunch break, we rushed back to the meeting room in order to meet Dr. Shawirajan at 1.30pm. He briefed us on what to do and what information to get from KMDHO. He was the Medical Officer of Health PKD (U52) of KMDHOonce before joining AIMST.

He's the man! Our respected Dr. Shawirajan.

Mdm. Norejan, Health Promotion Officer PP(PK) S41

Then from 2pm to 3pm we we briefed quickly by Mdm. Norejan, Health Promotion Officer PP(PK) S41 on the activities done and 'Doktor Muda' program (YOUNG DOCTOR PROGRAM). We will not talk about this in detail because:

1. We lack of time (3pm has got anti-smoking operation prepared especially for us by Investigation and prosecution unit)

2. The verbal information was explain too fast and we could not digest it fuly.

3. The person sitting before this computer is sleepy as the time now is 2.16am and yet specific report has to be 'blogged'.

Somehow we managed to ask meaning of the grade designation.

U = Heath unit (e.g. U41)

R = Driver (e.g. R1)

S = Social (e.g. S41)

N = Admin (e.g. N17)

M = Management (e.g. Not identified yet

W = Finance (W17)

For those with number 41 and above are degree holder and below 41 is diploma holder. For those with 17 and below can apply with SPM result.

Thanks for the patience by reading such a 'long essay answers' and we hope the reader can benefit from these information. Thanks and see you in specific daily report and then the-person-before-the-computer can retire to bed.

Day 1 and 2 in Sik District Clnic

2008-07-28T15:07:00.002+08:00

Hello again from Sik District ....

Our Day 1 began with a briefing regarding our 8 day posting in this district by the District Health Officer Dr.Ishak and further briefed by the Penolong Pegawai Kesihatan or Assistant Health Officer Mr.Chin from 10am til 11 am.

We were served food and briefing was continued by Mr.Chin. After lunch , we had a talk by the Jururawat Kesihatan Suraya regarding the duties of nurses, primer health, home nursing, family health and school health.

We dispersed at`4.30 pm and there was a fogging session which was attended at 7pm.

...........................

Our Day 2 began with a visit to the Mother and Child Clinic and we observed a nutritious cooking demonstration by the staff nurses there . It was an educational programme for under nourished children. We also collected data from the Family Planning Clinic, Immunization and Vaccination information and also on breastfeeding etc.

Photos were taken and i will be updating it tomorrow.-

Till then , cheers!!!!

1st day of district posting at Kota Setar District health Officer

2008-07-28T11:34:00.004+08:00

27/07/2008

since 2day was our first day, we reach the district health office at 9am,but unfortunately the Pengarah was attending a conferance which only finished at 2.45pm. so we were told to come at 2.30pm to attend a briefing. the briefing was on Maternal Child Health(MCH), which was given by head of community nurse. the briefing ends at around 4.20pm. apart from that we also visited other departments within the district health office,for instance food and qality dept, and environmental dept.

KUALA MUDA, 27.7.08, (DAY 1) : STARTING EARLIER THAN IT IS THOUGHT AND FINISHED EARLIER THAN IT IS THOUGHT

2008-07-27T19:02:00.027+08:00

KMDHO team here to greet you all with the morale of "it is good being earlier to work place"......

Thirteen of us reached around 7.45am rather than 8.30am as scheduled. We gathered at the lobby, a place which was so familiar to us (as we were here once this building was still functioning as SP General Hospital) by 8 am.

Gearing up with our coats and apparatus.

Doesn't this building looks familiar to you?

Boards directing the location of the Units.

Sharp at 8am while we were sitting at the waiting area in front of the X-ray department, suddenly a man around early thirties approached us with a sweet cheerful smile. He is Mr. Berhanudin (Berhan) a Health Promotion Officer a.k.a. Penolong Pegawai Promosi Kesihatan PP(PK) of Kuala Muda DHO (KMDHO). He invited us humbly to a meeting room and asked if we have taken our breakfast. He will be the coordinator for us throughout this 2 weeks DHO posting.

Mr. Berhan PP(PK)

Everyone was so eager to start the day.

Then sharp at 9 am, the respected lady incharged of the DHO, Dr. Umai Kalsom, Medical Officer of Health (MOH) or in local designation, (PKD) of KM DHO gave us a talk on the background, objectives, vision & mission, organisation chart, unit services, and highlights of the District Health Office. She was very enthusiastic in explaining to us. Every bits of her efforts was not wasted as she gave us concise information on what is the exact role of preventive and promotive medicine carrried out by DHO.

Dr. Umai Kalsom, Medical Officer of Health PKD of KM DHO

We will only highlight what is the organisation in DHO and the unit services available in this blog apart from the many more informative lectures because this will be the core knowledge for us in this DHO posting (of course we will highlight their job responsibilities in detail when we reached r

espetive department).

KMDHO consists of 4 core services:

DHO is lead by 2 persons in charged namely Medical Officer of Health a.k.a. Pegawai Kesihatan Daerah PKD (U52) and 2nd MOH PKD (U48). Under both of them is a Family Medicine Specialist (FMS) a.k.a. PPK (U48). FMS is the only special features available in Malaysia.

Under PKD and FMS, there are 4 main units:

1. Family Health Development Unit (Curative Unit)

A) Primary Health Care (Handle by PP U29, PKB R3, Attenden U1)

B) Maternal & Child Health ( JK U29, JD/PJ U17, Bidan U11, Attendan U1)

C) Lab (JTMP U29, PTMP U11)

D) Pharmacy (PF U29)

E) Nutrition (will update this fact soon)

This unit is lead by Medical Officer PP U41, Matron PJ U36, Sister KJ U32, Pharmacist PF U41, Senior Assistnat Pharmacist PFK U32.

2. Environmental Health (Preventive Unit)

A) Infectious Disease Control

B) Infectious Disease Control (Vector Borne)

C) General Health

D) Food & Quality

E) BAKAS

F) Occupational Safety & Environmental Health

G) Water Quality Control

This Unit is lead by Chief Assistant Environmental Health Officer a.k.a. Ketua Penolong Pegawai Kesihatan Persekitaran, KPPKP U36 and Senior Assistant Environmental Health Officer PPKPK U32. Each of the subdivisions (From A to G) consist of PPKP U29, PKAK U14, PKA U11, PKB R3, and PRA U1.

3. Health Promotion (Promotive Unit)

This unit is lead by Health Promotion Officer PP(PK) U41. The team consists of several Health

Promotion Unit JAV N17

4. Administration

A) Services

B) Finance

C) Admin

This unit is lead by Assistant Executive Officer PTK N32. Each subdivisions consist of PT (N17).

After Dr. Umai Kalsom's lecture, we had a short break and we were briefed on Primary Health Care in KMDHO by Dr. Othman Hj. Siru who is the 2nd Medical Officer of Health PKD U48. He is a very experienced doctor in which he shared with us his experience in his Preventive and Promotive Health care.

Dr. Othman Hj. Siru who is the 2nd Medical Officer of Health

After his lecture we went back at 12.30pm as our evening lectures are posponed to tommorow.

That's why i put the title as 'STARTING EARLIER THAN IT IS THOUGHT AND FINISHED EARLIER THAN IT IS THOUGHT'.

The morale of "it is good being earlier to work place" took place when Mr. Berhan suddenly approached us sharp at 8am. Imagine if he has to wait us for another 30 minutes (perhaps > 30 minutes with 'MALAYSIAN TIMING') and I am sure he will have bad impression on us. Anyhow, there is no harm in going to work earlier but being late will bring death (in the context of our job responsiblity).

Guys and girls, what i wanted to keen on is "second does matter!"

That's all for today folks. We continue our journey to KMDHO tomorrow. Have a good day!

KUBANG PASU(DAY 1): We hit the ground running.

2008-07-27T17:35:00.005+08:00

Our morning has resulted with this bit.....

Antenatal clinic

The Kubang Pasu District Health Clinic in Jitra runs its antenatal clinic from Sunday to Wednesday every week from 9.00am to 12.15pm and from 2.45pm to 4.30pm. The team runs the antenatal clinic in four examination rooms.

The objective of this clinic is to inform the expectant mother of their present health, to identify problems, provide treatment and advice about their health.

Antenatal Clinic Staff
1. Family Health Specialist.(PPK)
2. Health Medical Officer.(PP&K)
3. Health Nurse.(JK)
4. Community Nurse.(JN)
5. Trained Midwife.(BT)
6. Nursing Assistant.(PJ)
7. Lab Technician.(JTMP)
8. Assistant Lab Technician.(PTMP)
9. Health Attendant.(AK)

General Procedure in Antenatal Clinic
1. Perform Lab Test.
2. Perform Physical and Abdominal Examination.
3. If there is a Problem, Refer to Medical Officer.
4. Counseling and Treatment.
5. Give Appointment Date.
6. Record.
7. End.

Antenatal Clinic Examination Procedure Sequence
1. Check the antenatal card.

2. Count the gestational period.

3. Interview expectant mother regarding her past and present health as well as her
nutrition and diet.

4. Preparation for examination.

5. Examine the patient from head to toe:

6. Abdominal Inspection:

7. Abdominal Palpation:

8. Inform and discuss findings with the mother.

helluuwsss from SIK DISTRICT :)

2008-07-26T19:37:00.015+08:00

HELLO THERE BATCH7 MATES !!! :)

Hope everyone is well and good for the posting which is commencing tomorrow.

Below are the names of the groupC members posted to the SIK DISTRICT CLINIC from the 27thof July2008 till the 8th of August2008.

1. Tai Ket Yan
2. Sarah Vinothini
3. Petrina
4. Abiramee
5 .Rathiga
6. Shamala
7. Lionel
8. Adrian
9. Yugaseelan
10. Lee Chung Bee
11. Choo yin Peng
12. Nimala

Just to refresh your memory, i am putting in their pictures as well :)

From Left: Petrina,Lionel and Nimala

From Left : Sarah(Group Leader), Choo Yin Peng and Lee Chung Bee

From Left: Tai Ket Yan (Group Leader) , Adrian, Yugaseelan

From Left : Shamala, Abi and Rathiga :)

We are required to learn the inner workings of the SIK District Health Office which includes areas like CDC Surveillance,
primary health, family health, disease control, food quality control, occupational safety, BAKAS (water quality and sanitation), vector control and KPAS.

We will be constantly updating you on our activities. Till then, its abi signing off!!

Take care and have fun at the posting everyone!!

ALOHA FROM KUBANG PASU

2008-07-26T17:12:00.009+08:00

Here is the group posted in the Kubang Pasu District Health Office in Jitra for 9 days from the 27th of July 2008 until the 8th of August 2008....

1. Assvin
2. Bernardine
3. Doreen
4. K.J. Linggeswary
5. Kuvaneswari
6. Lalithaambigai
7. Mohan
8. Mohana
9. Pravin Rajakumar
10. Sivasangaran
11. Stella
12. Valliamah

We are required to learn the inner workings of the Kubang Pasu District Health Office in Jitra which includes areas like CDC Surveillance, primary health, family health, disease control, food quality control, occupational safety, BAKAS (water quality and sanitaion), vector control and KPAS.

This is our team leader

We will be constantly updating you on our activities. We also have our team blog linked to this blog

The Team Posted to Kuala Muda District Health Office

2008-07-26T14:43:00.035+08:00

We are a team consist of 13 elegant medical students who will be undergoing our 4th year training in Kuala Muda DHO from 27 July 2008 - 8 August 2008 (The end of DHO is the starting of the 2008 Olympic!).

We are required to learn their training, job responsibility, methods of interacting with the community, planning and scheduling, record maintainance, reports generated and dispatched, response to feed back from higher authorities, and prepareness for contingencies and emergiencies including outbreaks in Kuala Muda DHO itself. The scope includes family health, disease control, food quality control, BAKAS (water quality and sanitaion), vector borne disease and KPAS.

Below are the team members:

From left to right: Gan Chye Chung (Leader/Gan), Rathna Ramayaj (Rathna), Chai Huei Xian (Helly), K.Gaaitheri (Gaaitheri)

From left to right: Govind Parimalahr (Pari), Hong Chia Leong (Chia Leong), S. Kavitha (Kavitha), Leiw Yew Chai (Yew Chai)

From left to right: M. Dineshi Dias (Dineshi), S. Mogana (Mogana), P. Praveena (Praveena), B. Sivasangkari (Sangkari)

C. Thanalectchumy (Thana)

Hope that we could bring you lively and informative experiences in DHO posting!

Experiences during DHO Posting.

2008-07-25T15:34:00.000+08:00

Dear Students of Batch 7, This blog has been created to share the experiences during the DHO posting. Post the information gathered on each activity of the DHO separately.