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

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 ;)

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:

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

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..

ATTENTION

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.....

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.

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