2nd day of DHO posting with school health team

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

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!

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.