A Dr Muda Video

We got hold of his video

A trip to DXN

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

DAY 3 :JITRA

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

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

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.

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

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.