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

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

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)

1. Rhesus negative.
2. Body weight of mother before pregnancy or at booking weight is <>
3. Current health problem ( including psychiatry and handicapped) except Diabetes and Hypertension.
4. Past Gynecological operation.
5. Drug/cigarette/alcohol addiction.
6. Unsure Last Normal Menstrual Period ( LMNP).
7. Past History of continuous miscarriages ( > 3 times).
8. 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

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

day 4

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

DAY 3 of DHO posting

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

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

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

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

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

KMAM- Kawalan Mutu Air Minuman (PPKP Noor Hazimah)

PPKP KMAM SIK DISTRICT- quality maintainance of drinking water

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

(indicator) . They include:

1. programme for safe drinking water
2. budgeting the programme in the district level
3. 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)..>

4. 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)

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

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

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

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

10. maintenance of water quality system

11. 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...

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...