d' Padang Terap Team Reporting.....

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

1. To make sure the rate of eclampsia case less than 15/10,000 in Daerah Padang Terap.
2. To make sure there is no case pueperial sepsis happens in Daerah Padang Terap.
3. To make sure there is no maternal death.
4. To make sure 80% of pregnant mother checked by doctor at least 2times during pregnancy
5. To make sure the rate of SNNJ less than 100/100,000 life births
6. To make sure there is no case of Tetanus Neonatarum in Daerah Padang Terap.
7. To make sure 95% immunisation coverage given to babies.
8. 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.

d' Padang Terap Team reporting...

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....

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....

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.

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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.

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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 Padang Terap

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

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.

d' Padang Terap Team Reporting....

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.
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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.....