JITRA: Preview of tommorow

We found a 29 year old water pump, went on toilet-hunting adventure, visited a factory....were given a full tour and received RM 250 worth of free stuff..wait for it tommorow...

DAY 6 : JITRA

CDC NOTIFICATION PROCESS

• ORGANIZATION CHART
  
  Pegawai kesihatan Daerah 1
  Dr Nor Azian Bt AbdulWahab
  
  Pegawai Kesihatan Daerah 2
  Dr Azilan Abdullah
  
  Ketua Unit PPKP Kanan
  En Hussain B. Yusoff
  
  PPKP Unit CDC
  Pn Nor Diana Bt Nanyan
  
  PPKP Unit CDC (HIV/AIDS & TIBI)
  En Osman B.Ali
  
  
  RESPONSIBILITIES OF CDC UNIT
  
  1) Record all the communicable diseases in daily, weekly, monthly, and yearly basis.
  2) Prepare reports on daily,weekly, 3 months, 6 months and yearly basis regarding communicable diseases as being instructed from time to time.
  3) Conduct immediate investigations for any notified diseases to identify the source of the disease and control its spread.
  4) Carry out ‘Disinfection’ and ‘Disinfestation’ procedures.
  5) Analyse all the investigated cases besides recommending proper preventive and control measures to District Health Officer.
  6) Give vaccination to the affected patients to avoid the spread of the disease.
  7) Collect specimens such as blood,stool, vomitus, sputum, food particles and etc. for investigation purposes to detect the disease.
  8) Working as a member of Health Team regarding communicable diseases.
  9) Prepare and update all the dates, graphs and maps regarding communicable diseases.
  10) Analyze all the collected data’s and submit its report to District Health Officer.
  11) Identify and detect the patient in order to control the spread of the diseases.
  12) File court orders against cases which related to communicable diseases.
  13) Conduct epidemiological studies on communicable diseases control and its surveillance control.
  14) Educate public regarding preventive and control measures of the communicable disease.
  
  
  
  
  
  
  LIST OF NOTIFIABLE COMMUNICABLE DISEASE


• Chancroid


• Cholera


• Dengue Fever and Dengue Haemorrhagic Fever


• Diptheria


• Dysentry


• Food Poisoning


• Gonococcal infections


• HIV (all form)


• Leprosy


• Malaria


• Measles


• Plague


• Poliomyelitis


• Rabies


• Relapsing Fever


• Syphilis (all form)


• Tetanus (All form)


• Tuberculosis (all form)


• Typhoid and Paratyphoid Fever


• Typhus and other Rickettsioses


• Viral Encephalitis


• Viral Hepatitis


• Whooping cough


• Yellow Fever.

PROCESS OF NOTIFIATION(SUMMARY)



1. Disease is suspected.
2. Notification form by Medical Officers but Telephone notification is done for certain diseases immediately.
3. Completed form will be sent through (hand,post, online and fax)
4. Records are updated.
5. Investigations are done










PIC 1: An icelined cooler for vaccination storage.

PIC 2: Confusion during the AIMST team visit.

For the more personal day to day story visit: http://www.dhojitra.blogspot.com/

KUALA MUDA, 7.8.08, (FINAL DAY)

Adolescent health (Kesihatan remaja)

According to the definition of WHO (1993), adolescents are categorized under the age group of 10 to 19 years of age.


Objectives

To create awareness among adolescents about the importance of leading a healthy life style.
Prevent bad habits which cause ill health by organizing health promoting activities.
Encourage adolescents for their active involvement in health promoting activities for prevention of bad habit and health promotion purpose.

Guidelines for implementation of adolescent health.

Four categories:
1) Adolescent clinic
2) Standard operating procedure (SOP)
3) Adolescents health screening
4) Guidelines to manage adolescent health

Part I

Adolescent clinic
1.1 Objectives: guidelines for health officers.
1.2 Implemented on year 1998.Revised back on year 2000.
1.3 Definition :
1.3.1 adolescent:10-19 years
1.3.2 adolescent health is under the National adolescent health policy
1.4 clinic concept used in all the clinics
1.4.1 services provided by a health clinic:
1.4.1.1 screening
1.4.1.2 management
1.4.1.3 counseling
1.4.1.4 referrals
1.4.2 optional services
1.4.2.1 physical activity in group
1.4.2.2 family counseling
1.4.2.3 health promotion
1.4.2.4 activity clubs
1.5 -services scope in adolescent clinics
-covers health promotion,prevention,management and referral


The service scopes covers
1.5.1 developmental assessments
1.5.2 diet
1.5.3 mental
1.5.4 sexual and reproductive
1.5.5 high risk attitudes
1.5.6 physical

Part II: SOP (Standard operating procedure)
-Management of adolescent health clinic
Introduction: i) Entry point through JPL
ii)’one stop’ service centers
iii) Daily clinic with centralized counters
Facilities in clinic
Medical registration card 96-pin 1/78
Registration book KKR/Fail KKR
Screening form SKR1 & SKR2
Height and weight scaling machines
BMI charts
Guidelines books
Adolescent health services
SOP book fir medical assistance (part 1 & part 2)
Standard laboratory tools
Checkup rooms and counseling
Human models
Flip charts

Part III
Screening Programmes
3.1-Introduction-To identify attitude or health problems
3.2 SKR forms (screening forms) SKR 1-males, SKR 2 –Females
3.3 implementation of SKR –regular check ups-#times (12, 13 and 17 years)
3.4 methods of health screening-guidelines for male adolescent (m/s 37), female perempuan(m/s 42)

Guidelines for sexual and reproductive system
4.1.1 Amenorrhea
4.1.2 Abdominal pain during menstruation
4.1.3 Abdominal Mass
4.1.4 Menstrual irregularity
4.1.5 Vaginal discharge
Dietary
4.2.1 Underweight problem
4.2.2. Overweight problem
4.2.3 Anemia



Psychological aspect:
4.3.1 Adjustment disorders
4.3.2 Anxiety disorders
4.3.3. Depressive disorders

Attitude problems
4.4.1 Smoking
4.4.2 Gum sniffing
4.4.3 Alcohol
4.4.4 Vandalism
4.4.5 Amphetamine
4.4.6 Acne
4.4.7 Headache
4.4.8 Intentional injury
4.4.9 Non intentional injury
4.4.10 abdominal pain

Part IV
Management of adolescent and flow chart (last page)

Reported by Shanky

KUALA MUDA, 6.8.08, (DAY 8): SPECIFIC REPORT

We went to water treatment plant at 8.oo am.It was the Sungai Petani and Pinang Tunggal Water Treatment Plant. The activity was a surprise for us as Mr. Silva, the PPKP for KMAM told us that he had already take special permission for us to enter water treatment plant. We could see how the river water was processed and become the clean water that comes out from our house pipe.

Firstly the river water was passed through a screen to trap the branches and large objects. Then the deep seated water with sand are sucked up by a pipe and poured to a small drain-like-connections in order to protect the sucking pump that connects to the treatment pond. At the pond, the water undergone aeration in order to oxidized the ferum, magnesium, and other metals so that it will not dissolved into the water. Through this process, the carbon dioxide and hydrogen sulfate will be released into the air.

Then the water went into flocculation pond. Aluminium sulfate or Poly Aluminium Chloride (PAC) is used to coagulate the small suspension of solids and colloidal materials. This coagulated to form Floc.

Then the water that is free of floc will be channelled to sedimentation tank. The retention time is 2 hours. The water is then percolated through a bed of a fine sand to remove fine suspended solids and colloidal matter.

After filtration, the water is then neutralised with calcium hydroxide to increase the pH of the water as it was acidified before by the PAC. The water is then added with sodium silicoflouride for the purpose of producing healthy teeth among the drinker. Chlorination is the next step in which chlorine is added into the water to kill residual bacteria. The water then is stored in clear water tank and channelled out to the household and another pipe channeled back to them for their usage (mixing chemicals).

Sorry for the simplicity because the blogger of this post is busy like an ant. (If any questions please do ask in the communication box. thanks.)

KUALA MUDA, 6.8.08, (DAY 8): DAILY REPORT

At 8.00 am, we departed for water treatment plan. Further detail will be listed in specific report.

At 11.45 am, a briefing regarding primary health care including expended and extended scope( mental health, geriatric health and stop smoking) delivered by Mr.Yusof Hashim, penolong pegawai perubatan kanan. The briefing extended up to 1.30pm.

After explaining the vision and mission of Ministry of Health, he introduced all the 8 goals of primary health care. He also talked about the organization chart of this unit. We were informed that government has allocated 0.6billion for primary health care. Besides that, according to 9th Malaysian Plan, for the Management of Crisis and Disasters, our government has become a member of an international network called Government Integrated Regulation Network (GIRN). It comprises a system of signaling sign of danger if there is any natural disasters in any country, among the members of GIRN.

There are additional services in primary health care which includes 4 expanded scopes namely, geriatric health( programme warga emas), adolescent health ( programme remaja), mental health and stop smoking( klinik berhenti merokok).

At 1.30 we dispersed for lunch break. Then, at 2.30 , we reassemble again for briefing on non communicable diseases and Methadon replacement therapy.

Non-communicable disease (NCD) Unit
(Surveillance for diabetes mellitus and cardiovascular disorders cases)
This session suppose to be carry out in the morning from 11.30am to 1.00pm but have to postpone to afternoon from 2.30pm to 4.00pm due to Mr.Selva suddenly called in the early morning say want to bring us visit to the loji pembersih air Sungai Petani & Pinang Tunggal.
Sharp at 2.30pm, all of my group members are gather in the clinic waiting for Mr.chong (PPP)k but unfortunately he is not around here . Even he is not around but he got order the staff nurses to bring us visit around the clinic to see what activities and how the activities carry out. We start our activities around 3.00pm. According to the staff nurses this clinic working hours is start from 7.30am to 5.00pm and they only having break for 1 hour from 1.00pm to 2.00pm. Timetable will be attached later.
Today they going to have funduscopy and do screening for diabetes patients. Staff nurses also explained to us how the records of the patient stored according to the last 4 digit number of identity card, gender and race. All the patient records are stored in one room. Staff nurses also got shows us the small record book for diabetes and cardiovascular disorders patients. Green color one is for diabetes patient whereby blue color one is for cardiovascular disorders. Normally patients will come every 3-4 months for follow up but for those the disease is not well controlled need to come more frequently for follow up. In the clinic there is a register counter specifically prepared for DM and hypertension patients. There is also a corner prepared for them to check their blood pressure, blood glucose, weight and also height to ensure that the disease is well controlled or not.


(Methadone maintenance therapy )
Another unit we went during this session is the Methadone maintenance therapy (MMT) program which is conducted by Mr.khairul (MA). According to Mr.khairul, there are 48 clients in Kuala Muda district list who received the therapy. Anyway according to the research there are actually around 500 cases but only 48 come and get the free therapy from government. The objective of this program is to prevent increase HIV cases in the Kuala Muda district. Mr.khairul also informed us that there is a specialist name Dr. Nor Azah in this unit. He also got explained to us how the client get register for the free therapy. First they must get a letter from ADK (Anti Dadah Kebangsaan), after that they need to do blood test and urine test before they get registered. For blood test they need to repeat after 6months whereby urine test for the first 2 months they need to do urine test every weeks then once in a month after that. One step test (urine test) used to detect the abuse of morphine, cannabis and amphetamine. However there is a special urine stick used to detect morphine and amphetamine separately. Once morphine are detected they will stop the therapy for that particular day and they will ask the client come only on the next day, but if amphetamine and cannabis are detected the therapy still given because morphine won’t cause overdose. According to Mr.khairul methadone usually started provided from 5mg and slowly increased to maximum 70mg in this DHO Kuala Muda.

At 4pm, we went to family planning unit (LPPKN) which is situated just beside the KMDHO. All of us were welcomed by Sister Zuriana who also briefed us about LPPKN. During the briefing, all of us were eager to know about LPPKN as it was unfamiliar to us.

To our surprise, LPPKN is neither government agency nor a private company. We were informed that LPPKN is a semi-government organisation which is an agency of Ministry of Woman, Family, and Community Development. Currently, there are 4 functioning LPPKN clinics in several districts in Kedah, namely Baling, Kulim, Kota Star, and Kuala Muda. The core services provided by LPPKN clinic include: papsmear, breast examination, psychosexual counselling, women and men wellness, family counselling, and marriage counselling.

However, there are no identified clinic and menopausal clinic available in LPPKN Kuala Muda at the moment. These services are only provided in LPPKN kota Star.

After the briefing, we were brought by the sister to visit the counseling room. In the counseling room, we had the opportunity to have a look on several contraceptive devices such as Implanon, IUD, OCP. we were also taught on the function, effectiveness and some disadvantages of various method of contraception. By 5.30pm we were dismissed and each of us were given some pamplets.

Reported by Thana, Yew Chai, and Chia Leong

KUALA MUDA, 5.8.08, (DAY 7): SPECIFIC REPORT

Mission: Active case finding (Aedes Survey) in Taman Ria Jaya

Objective:

• To find active case of Aedes (Positive breeding of mosquito larvae)
• To take preventive measures by adding ABATE into water tank
• To give awareness to public regarding Dengue fever and Aedes via pamplet

Date/Time: 5.8.08, 10.30am-12.30pm

Team: 3 teams, each team consist of PKA and 4 AIMST medical students (+1 in a team)

Law Used: Destruction of Disease Bearing Insect 1975

Tools Used: Empty sterile bottle, seal, pipet (small and large), forms, notice, ID card, Vest

Description:

Total of 88 houses were in for checking by the officers. We were divided in 3 groups and each group followed 2 officers to the specific locations.
The officers went house by house. They always introduced themselves and showed their identity to the house owners before beginning with the surveillance. The house owners followed the officers during the surveillance, as required. They checked the flower pots at the veranda, and any other containers that may contain water. Inside the house, they checked the washrooms and the toilets. They also flushed the toilets in order to check its efficacy as the spoiled flushes can be place for the mosquito breeding. If there were no larvae found, the officers add about 10g of Abate in powder form to the water in the toilet flushes and in any water containing pots or containers as a precaution.
In total of 88 houses only 3 houses were found to have larvae. In these houses, after the breeding place of the larvae found, the officers will it to house owners. They then show the empty bottles to house owners before collecting the samples as evidence that there were no foul play present. Then the samples were collected by using pipette. In both the houses 5 bottles of samples were collected each. Then the bottles were sealed and labeled with information like the date of the sample taken, the location of the sample collected and who collected it. The house owners were needed to write their identification card number and sign the label. The Pembantu Kesihatan Awam and/or the Pekerja Am witnessed these procedures. The house owners were given compound under the Act of Destruction of Disease Bearing Insect 1975, section 13. They will be required to pay RM100 each in the District Health Office by 14 days. The offenders are also given extra 7 days notice if they are not able to pay the compound within 14 days.
While in the empty houses where the owners were not present at the time, one notice was sticked in the front door to notify that the surveillance will be done the next day

Procedure:

• Introduce ownself and show ID. Then explain the motive of survey.


• Enter the house only if allowed, if not allowed (or no one is at home), a notice is sticked to the wall telling that survey will be doen the next day. If resident still insist not to allow health officer to enter for checking, then the act plays an important part this time. DDBIA 1975 will be used for lawsuit
• Surrounding of the house is surveyed for potential breeding site for larvae
  
• If found, a sample of AT LEAST 5 LARVAEs ARE TAKEN.


• Resident will be explained that the bucket contains larvae and show the larvae to him/her


• Explain to the resident that he or she has againt the law of DDBIA 1975 and a compound will be given.


• Before sample is taken, the new sterile bottle is shown to the resident first to prove that there is no foul-play


• At least 5 larvaes are taken by pipet


• The bottle contain these larvaes are shown to the resident again and then the bottle is sealed


• Bottle is labeled and compound is written.


• ABATE (larvicides) are put in water tank or potential space of water collection (both positive and negative findings of larvae)


• Education is given to the resident both verbally and through written materials.


• Sample is sent to DHO lab to analyst the breed of mosquito

Discussion:

Have you ever wonder that if any larvae is found in a drain outside of a particular house, will that particular resident be compounded? If yes, how to prove that the larvae did not swim from the drain of the other house further up to that particular resident's drain?

The answer is that there no need for us to crack head. This mission is to detect any aedes larvae in a household. Aedes only breed in water holding container and not normally in the dirty stagnant drain like those of Culex.

Do you know that Dengue fever (DF) and Dengue Haemorrhagic fever (DHF) are beaten by different Aedes?

Aedes main species are Aedes Aegypti and Aedes Albopictus (Asian Tiger Mosquito). Aedes Aegypti cause DHF whereas Aedes Albopictus cause DF. Aedes Aegypti likes to breed in dark area and Aedes Albopictus can breed in clear and open space stagnant clean water. Thus, if a larvae is found in the pail just like the picture shown below, it is most likely to be Aedes Albopictus.

How to know whether it is Culcine (Aedes, Culex, Mansonia) and Anopheles by looking at the larvae sampled?

To differentiate the which is the most likely type of mosquito, there is a great explaination given in K.Park 17th ed. page 545. In this contex, we will just consider on larvae. The sampled larvae is closely observed for siphon tube. It will be whitish pale in colour which is quite similar to the colour of cartilage. The siphon is located at 8th segment of the larvae. If there is appearance of siphon, the species will be Culcine.

Besides, the way how the larvae rest just below the meniscus of water can also distinguish which type of mosquitoes. The larvae that rest inclined at an angle to water surface will be the Culcine but not anopheles. Anopheles rest parallel to the water surface.

Thumbs:






Introduction before entering the house.






Consent given. We entered the house.






Surrounding of the house is looked for potential breeding site.






Gan was hoping to see one larvae but none was found.






The 'Abate guy' entered the house.






Toilet was checked.






Water collection for bathing was checked.






Collecting plate under the refrigerator was checked.






Abate in powder form is put into water straight. The chemical effect can last for 3 months.






Health education is given via written form to make the public aware about Dengue and Aedes.






Potential breeding site.






Larvaes spotted! Many of them!






Larvae spotted by health officer.



Resident is shown the breeding site and explained the characteristic of the larvae and how to identify it in layman's term.





Sample is taken with pipet





Sample is put into sterile empty bottle.


Bigger pipet for easy sampling





At least 5 samples of larvae taken




The larvae of Aedes look like this and it is the same as those in the sample bottle.


Bottle is sealed.





Compound is written by PKA.







Video:






Reported by Gaaitheri and Gan

KUALA MUDA, 5.8.08, (DAY 7): DAILY REPORT

KMDHO starts with field work

The day started at 8am where we started to gather in the Vector Borne Diseases Unit. Our field work for this morning is Aedes Surveillance in Taman Ria Jaya. After the Officers of the Unit finished their meeting,we were told to follow them to the surveillance area. The meeting was told to be about internal auditing and also about the surveillance that was going to take place. We were not allowed to participate in the meeting.
The meeting finished about 10am and we started to drive to the initial location of the surveillance, that is the Sekolah Menengah Kebangsaan Taman Ria Jaya. About 10.30am in the morning, we entered the school. 3 officers were there to do the surveillance. All the places where Aedes mosquitos can breed were checked. Those places are like the small pond, nursery, back of the canteen, and the surroundings of the school.
The larvae were found in the school nursery. The samples were collected in 5 small bottles using pipette. The bottles were then sealed and labeled with information like the date of the sample taken, the location of the sample collected and who collected it. The headmaster signed the label. The Pembantu Kesihatan Awam and/or the Pekerja Am witnessed these procedures. The school will be compounded RM 150, under the Act of Destruction of Disease Bearing Insect 1975, section 13.
After finishing the surveillance in the school, we then proceeded to the housing area, Taman Serampang that was opposite the school. The detail will be described in specific report.

Aedes Survey at Taman Ria Jaya

The entire surveillance session extended up to 12pm. We then dispersed for lunch. At 1.30pm we meet again at the Meeting room in the main building as Dr. Sawari Rajan, Dr.Kay, Dr.Sapna, and Dr. Lily came to meet us. In this 30 minute session, they questioned us about the things we learned over the last and this week and gave us some feedback on topics that should be covered in detail. Thanks to their suggestion that lead us to apply family planning topic from LPPKN which was governed by different ministry.

Visits from the honourable lectures, from left to right: Dr. Sawri Rajan, Dr. Sapna, Dr. Kay, and Dr. Lily.

PPP(K) Mr.Berhan

The next session was at 2.30pm PPP(K) Mr.Berhan. He is in charge of HIV anonymous and HIV testing pre-marriage proceedings. The session started off with a slide show. The first few slides were about the history of HIV that covered the first cases in the world and also in Malaysia. The first case in Malaysia was found in the year 1986. He also covered the mode of spread of the virus, and characteristics of the virus. It is found that blood, semen and vaginal fluids have very high content of the virus compared to the least containing tears, saliva and milk. There were also slides about the opportunistic infections that are common in HIV/Aids patients, e.g like Genital Candidiasis, Oral hairy leukoplakia, Pneumocyctic carinii pneumonia and TB.
The up coming slides contained graphs that contained needed statistics about the disease. There were slides about the prevalence and incidence of HIV patients in the world (1998). Africa has the highest number of both the prevalence and incidence globally, that is about 22.5 million prevalence cases. Global estimation of AIDS patient in the year1998 is 33.4 million and number of death is 2.4 million.
While in Malaysia from the year 1989-1998 the amount of HIV patients were 28,541 and amount of AIDS patients were 2354. The most common age groups that are affected in Malaysia are from the age 30-39 and 20-29. In Kedah from 1989-1998 the most commonly affected race were Malays with 74%, next are Chinese with 14%, then Indian 6% and other races who are Malaysian contribute about 3% and foreigners are bout 3% also. Besides that another graph showed sharing IV drug needles as the highest mode of transmission (82%) in Kedah, next is the heterosexual intercourse(11%) and third largest is the homosexual intercourse(3%). The fishermen are the most affected people with HIV in Kedah, next are factory workers. While in females most of the affected ones were housewives.
Besides that, measures to prevent HIV/AIDS were also discussed. Preventive measures for HIV/AIDS are very important as there is no cure or vaccines for it. Everybody is advised to live a healthy, straight lifestyle. The public are advised not to share needles if they are IV drug users, and do not practice random or unprotected sex with multiple partners. Besides that mothers are advised to have early detection test.
After that, we also discussed the programmes that run for Muslims. These programmes involve those who are intent to tie the knot. It is compulsory for them to fill up the Borang Pemohonan Pemeriksaan Kesihatan which is from the National Islamic Department. They need to involve in Programme Ujian Saringan HIV Pra-perkahwinan. If one of the partner’s test is reactive, that person will be referred to Family Medical Specialist, however the positive result of the individual will not be told to the other partner. If the test is positive after referring to the Family Medicine Specialist, treatment will be started and these individuals will be referred to the Islamic Department for decisions to be made about the marriage.
Other forms that are needed to be filled in are Reten Bulanan saringan HIV Pra-perkahwinan, Reten Modified Syndromic approach. While for the non-muslim they have Programme Pengurusan HIV but this is not compulsory.

Reported by Gaaitheri