it's always B!

Friday, 16 March 2012

Unit Bekalan Air & Kebersihan Alam Sekeliling (BAKAS)

we were brief by PKD of unit BAKAS about BAKAS. he made a presentation to give us a general view of how these unit run.

Objective:

1) improve health standard of citizen

2)decrease water borne disease

3)increase use of clean water

4)increase awareness of usage of clean water

Main activity run by BAKAS:

1)GFS( Gravity Feed System)

2)STAH- system tadahan air hujan( in Kelantan only)

3)SPAL-system pelupusan air limbah - sewerage drainage into earth

4)SPAP system pelupusan sisa pepejal- waste disposal system in rural area( in urban area- control by Majlis Perbandaran)

5) control and sampling of water innrural area

6)Iodine deficiency progromme- done in primary school, they test urine confirm.

7) Sanitation control of Tourism spot. for eg: Groupsol Resort, Camp PREK.

we also discuss on SPAL

-main function:draining of sewerage to earth.

this is build this system in the area lack for efficient sewerage drainage system. this is fully subsidize by government, eligible for income less than RM700.00. it's take 2 days to build. one sinki cost about RM600.00.but filter have change frequently ,so that it won't smells and cause infection.

-other than that we also well drilling.

1 well able to supply 4 houses. usually they will drill more than 50 feet deep, so that the surface earth water won't contaminate the water la. 1 well estimated cause RM5000.00.currently only 1 drilling machine in Kedah.

Excreta disposal were not much discuss.

we only told that in city or urban area is manage by Indah Water through septic tank. If is rural area- usually will use 'Gelung Cement'- and they cover and shift this well once is full.

after that we were bring to Jeniang Recreasi Centre to see the Gravity feeding System. Its able to supply 75 houses. The problem is there are leptospirosis cases the that damp. So the water have to cook before being drink or used.

Monday, 12 March 2012

PROSTAR = Program Sihat Tanpa AIDS untuk Remaja (Healthy Program without AIDS for Youth).
The programme was introduced by the Ministry of Health in 30Jun 1997 in its efforts towards tackling AIDS amongst our nation's youth. The programme, themed, ‘Action by Youth, for Youth and Through Youth’ makes use of peer education to disseminate messages.

The logo of the PROSTAR CLUB is the word ‘PROSTAR', which is short for ‘ Program Sihat Tanpa AIDS Untuk Remaja '.

The letter ‘S' symbolises people actively participating in this programme.
The dot above the ‘S' symbolises a man's head and reminds us of the dangers that can threaten our lives.
The use of the colour red in the words and in the dot symbolises PROSTAR's seriousness in its efforts to deal with the HIV/AIDS problem

Main objectives of PROSTAR are:
● To increase knowledge and awareness of the dangers of HIV infection among youths, as well as its prevention and control.
● To instill a positive attitude among the youths so that they are aware of the fact that HIV can be linked to other social ills.
● To encourage healthy lifestyle among youths and to hinder behaviour that is considered as high risks to HIV infection.
● To form a group of Peer Educators that are able to influence youths to practice healthy lifestyles and to mobilise them to participate in the effort of battling the AIDS threat
● To create a group of Peer Educators who can play the role as Social Service Volunteers in extending support service to youths.

PROSTAR has done a great job within this few years by introducing different services.

Since 2006, PKP (pusat perkhidmatan PROSTAR ) started 13 branches nationwide. It is a support center for teenagers where services such as outreach services, counselling, health promotion, training, communication, art, economy, recreation and socialty is introduced. It is a must for each PKP to have 6 training sessions and 60 programs within a year beside providing the services above. PKP receives financial support from the Club Prostar Malaysia and also unit HIV/AIDS KKM.

Training given:

Facilitator training

Pemimbing Rakan Sebaya (PRS) general training,

PRS school training,

Latihan Remaja Harapan,

Program Bersama Pelajar Sekolah, pelajar IPT, masyarakat, anak-anak yatim, orang tua, pemandu jarak jauh, penagih dadah dan golongan nyah.

The Objectives of the PKP:

a) To provide a youth friendly environment to help youths by providing health promotion, counselling and supportive services.

b) encourage the teenagers to utilize the facilities and services in PKP
training of PROSTAR, PRS volunteers
and also to train the volunteer to be a effective agent through outreach activities .

Different campaigns have been organized as well, for example Camp "THERE IS STILL HOPE", Progamme ONE DAY WITH PROSTAR , Symposium PERDANA REMAJA PROSTAR which at the PKP center. The target population of all these programs are the students who involved in gangsterism, vandalism, smoking, fighting, and disciplinary problems. They are chosen by the teachers from their respective schools.

Beside targeting the teenagers, sometimes there are other outreach projects organized by PROSTAR such as the PROJECT of INTERVENTION HEALTHY STYLE (sat away from HIV/AIDS) within the population of long distance vehicle drivers. this activity was carrying out at Klang, Selangor.

Booklet and buletin of Prostar was also distribute among the public to increase their awareness about the existence of the PROSTAR club and the services available.

-khor wan teng & karen tan-

Special Clinics

Information on special clinics were collected in 2 different Klinik Kesihatan on 2 different events. so here, i will include 2 set of data based on 2 different Klinik Kesihatan , hopefully it doesnt confused any of you guys. =)

1st on KK LUBUK MERBAU, visited on the beginning of 3rd week (6 March 2012)

here we reached KK Lubuk Merbau and were informed that in this clinics, apart from Alternate Birth Care, prenatal and antenatal clinics, they too do have Special clinics. After briefed by the medical officer on Alternate Birth Care, we dispersed ourselves into groups where some went for antenatal and prenatal and some for the primary health care.

as for me and ming zhi, we walked over to the special clinics. there we were assisted by a medical attendant in charge, Mr. Hassan.

According to Mr. Hassan, the clinic was established on the same day ABC was established which is at 1996. It initially served as an outpatient department for medical cases. Slowly as more and more patient were screened for the medical cases especially on Diabetes Melitus and Hypertension, the clinic gradually became special clinic

Monday : Hypertension Clinic for appointment date
Tuesday : Diabetes Clinic for appointment date
Wednesday : Specialist day where specialist will be in the clinic.

apart from Wednesday, the rest of the day, the patient will be examined by the Medical Attendant of the day. However, if there is emergency such as
1. uncontrolled complicated diabetes
2. Blood pressure of more than 200mmHg systolic
3. change of doses and types of drugs.

then the case will referred to the medical officer or by the specialist on wednesday. The distribution of the manpower in the clinics are as below (not including the antenatal and ABC clinic) :

1 Specialist (Family Medicine Specialist) who comes at Wednesday
1 Medical Officer responsible only when the case is referred to her. She basically in-charged of the antenatal clinic.
2 Medical Attendant who responsible on the campaign and examination of the patient
1 Nurse who helped in registration
1 Staffness who responsible in regulating the work of all nurses including the nurse in the antenatal and ABC.
1 lab assistant - keeping the blood sample that had yet to sent to Kuala Nerang and also basic simple test.
1 pharmacist
2 pharmacist assistant

Data as below :
Total Coverage in Lubuk Merbau : 10 000

1. Diabetes Melitus
since the operation of the KK : 506 cases
in 2011 : 46 cases
Jan 2012 : 3 cases

active patient (patients who are frequent visitor to the clinic -- 6 times per year) : 353 patients out of 506 (69.8%)
inactive patient (patients who has not visited the clinic for the past 6 months : 153 patients.

most of the patients are above 50 years old
more female than male

2. Hypertension.
since operation of the KK : 446
in 2011 : 37 cases
Jan 2012 : 0

most of the patients are above 50 years old
more male than female patient

3. Asthma.
since operation of the KK : 56
16 patients on metered dose inhalers.
40 patients on oral medication

4 out 56 (7.1%) are children
52 out of 56 patients (92.9) are adukts

more of male patient than female patient.

Facilities available for each special clinics :

1. Diabetic clinics :

Lab - Routine blood in the clinic, HBa1c, Fasting Blood Sugar
Pharmacy
Appointment date with medical officer on Tuesday
Electrocardiography
Physical examination
Dressing for leg ulcer (in 2012 : 1 patient and 2011 : 2 patient)
Visual assessment with Fundoscopy (will be referred to Alor Setar. only available for 1st week every month - mobile fundo camera).

2. Hypertension clinics :

Lab - Routine blood (will be sent to KK Kuala Nerang)
Appointment date with medical officer on Monday
Pharmacy
Oral Glucose Tolerance Test
Electrocardiography
Physical examination

3. Asthma Clinics :

Peak flow meter
Spirometer
Asthma Bay
Full Blood Count (if patient is fever)

Assessment of the patient (same for all 3 clinic) :

Registration at the clinic first - if is new patient (recording based on identity card) or follow up patient.

-If patient is Malaysian, the charges will be RM 1.00 while for foreigner it will be RM 15.00

↓

if emergency cases will be referred immediately to the Medical Officer in charge

if non-emergency cases, then patient will wait for the turn to be called up. unless on special day such as MONDAY for hypertension appointment date and TUESDAY for diabetic cases, the rest of the day will be seen by the Medical Attendant.

↓

if there is no complication and patient is stable, continuation of medication

if there is UNCONTROLLED DIABETES or BLOOD PRESSURE MORE THAN 200mmHG or COMPLICATION OF THE SYSTEMIC DISEASE, then referral to medical officer

↓

referral to Hospital Kuala Nerang or Hospital Sultan Bahiyah.

Monitoring of the patient :

1. Follow up of patient by the date given.

for Hypertension patient - if severe : follow up every 1-2 months

if stable : follow up every 2 - 3 months.

2. if there is problem with the lab test

↓

phone the patient or home visit

3. every half a year, patient data will be reviewed

↓

reason for defaulting the treatment or failure to come for treatment

↓

dead
fine - become inactive
defaulter due to transport problem or seasonal problem.

Steps taken to raised the awareness of the public about the 3 systemic illness :

1. Campaign : twice a year in the selected village.

- during the campaign : routine physical examination will be done such as blood pressure, weight, and for female (pap smear).

- screening of the patient is done for all 3 systemic disease.

2. Education

- importance of food intake and healthy daily lifestyle.

- the complication that the disease could lead to

- importance of follow up and get treated.

3. Screening forms dispersed to all villagers and they were asked to fill in the form, if there is any problem, immediately come to the clinic for medical attention.

Budget is determined by the District Health Office.

Medication available in each clinics :
1. Diabetic Clinic :
1. oral hypoglycaemic agent :
    - metformin 500mg (obese)

    - Glibenclamide 5mg
    - Glicazide 80mg
2. Combination medication
- metformin 500mg + Glibenclamide 5mg → Glucovance
3. List A (only by Specialist)
    - acarbose 50mg
4. Insulin pump
    - Humuli N (only night)
    - Humuli R (3times per day)
    - Mixard
    - Humuli 30/70

2. Hypertensive clinics :
1. oral medication
    - captopril 25mg
    - metoprolol 100mg
    - hydrochorothiazide 25mg
    - hydrochorothiazide 50mg
    - lovastatin 20mg

2. List A
    - Felodipine 10mg
    - Lozatane 80mg
    - Telmisartan 80mg

3. Asthma clinics :
1. oral medication
    - teophylline 125mg (normal)
    - teophylline 250mg
    - terbutaline 25mg
    - prednisolone 5mg

2. Inhalers
    - Bentoline
    - Budesomide
    - Duolin
    - Beclomethasone

2nd on Klinik Kesihatan Naka, visited on the the last day of 3rd week (8th of March) :

Similar to Klinik Kesihatan Lubuk Merbau, this clinic too has an antenatal clinic, however it has additional of Methadone clinic as well as Mental Health Clinic (which will be updated as a post itself). In this KK Naka, it is however, bigger and far more well organized compare to KK Lubuk Merbau.

in all outpatient including the outpatient in maternal child health, the average of walk-in patient add up in average of 100 patients per day.

The facilities available in the clinic is :
1. outpatient department
2. screening for cardiovascular disorder
3. investigation of blood sugar level
4. investigation of cholesterol level
5. investigation of blood pressure
6. stop smoking program
7. body weight measurement
8. investigation of urine
9. health advice service
10. height measurement
11. methadone clinic
12. nutrition advice
13. Pre-marriage screening

The distribution of manpower in the clinic are as follow :
1 specialist (different from KK Lubuk Merbau who is there only on wednesday, the Family Medicine Specialist is here everyday)
1 Medical officer
4 Medical Attendant
1 Dietician
7 Nurses where 1 is in outpatient department
3 Pharmacist
2 Lab Assistant

The Registration of the patient is as follow :

Patient register himself/herself in the Registration Counter (Kaunter Pendaftaran)

if is new patient then recording will be according to patient identity card number

if is a follow up patient, patient;s medical progress note will be searched according to the identity card of the patient.

↓

Like mentioned above, the coding of patient medical progress card is according to the identity card of the patient.

However there is another tagging system in the clinic which is specially for the emergency cases and it is according to color coding :

1. red : severe cases

2. yellow : moderate

3. green : mild and this will normally seen as outpatient

↓

meanwhile waiting to be called, patient can fill in their own

1. Height

2. Weight

3. Body Mass Index

4. Blood Pressure

↓

then they will be attended by Medical Attendant (2 rooms) in Treating Room

↓

1. if patients is stable and under control → continuation of the medication

2. in uncontrolled diabetes melitus, blood pressure more than 200mmHg or complication of the systemic disease → referral to Medical Officer or Specialist

↓

referral to Hospital Kuala Nerang or Hospital Sultan Bahiyah

In the Treating Room , the following were measured and noted :

1. Vital signs

2. Blood pressure

3. Pulse rate

4. Temperature

↓

the usual history taking will be taken and patient chief complain will be noted down

↓

if patient is stable : continuation of medication

if there is additional symptoms then patient will be treated symptomatically.
Defaulter will be informed to the Health Inspector

In Diabetic Clinic, additional assessment will be taken which is visual acuity. the instrument used is Fundocamera. It was a mobile fundocamera used nowadays. this is because it could increase the number of case screened as not all patient could be reached. patient who stayed far from KK NAKA normally will visit the nearby clinics, notably KK LUBUK MERBAU. by using a mobile fundocamera, patient who gets their treatment in KK LUBUK MERBAU could actually had their visual screened. It is also easier for patient to get screened instead of asking the patient to travel all the way to KK NAKA for a visual acuity. This also becomes the main reason for the defaulted treatment. As the data showed only 455 cases were screened on 2011 instead of the target 1000 cases, thus, mobile fundocamera is used.

The facilities available in KK NAKA :

1. Pharmacy

2. Lab - Routine Blood Examination, Random Blood Sugar, HBA1C level, Fasting Blood Sugar.

3. Emergency and procedure room - for dressing

4. Toilet and suture of diabetic foot

5. Asthma Bay

6. Observation room - for Directly Observation Therapy in Tuberculosis.

average of 5 patient per day in the emergency or procedure room (this includes the observation room and asthma bay).

The screening usually done in Village or the outpatient department, where the screening forms (the same as the screening form shown above), are distributed and it is self-filled form. The target is 10 cases per day or 50 per month.

If the target not reached, then campaigns will be carried out which are named as Hari Hypertension and Hari Diabetes Melitus . Both were done simultaneously on same day twice a week. A group of 5 people consists of 1 medical attendant, 1 nurse, 1 driver and 1 pemandu perawatan kesihatan. They will give out the forms and some of high risk patients will be examined (routine physical examination). this too could trace down the defaulter.

Besides this, there is also Kem Kesihatan (Health Camp) or better known as Program Kesihatan (Health Program) where is done in felda or rural village. 10 to 15 people from the village (mostly of the high risk patient) , were invited and brought to the community hall for a talk about Hypertension and Diabetes Melitus. this done 3 times per month.

Data as below :
Total Population as in 2011 : 20,977
Total Patient who seeks treatment : 1,662

1. Diabetes Melitus

Total case since operation day : 357

monthly (average) : 200 case (follow up)

10 case (new)

January 2012 : 88 case (follow up)
February 2012 : 90 case (follow up)

2. Hypertension

Monthly (average) : 150 cases (follow up)

20 cases (new)

January 2012 : 226 cases (follow up)
February 2012 : 201 cases (follow up)

3. Asthma

Monthly (average) : 30 case (follow up)
January 2012 : 55 cases
February 2012 : 44 cases

The charge is as follow:

Malaysian RM 1.00
Foreigner RM 15.00

The budget determined by the District Health Office. Medication as above.

- by Jolyn Ch'ng and Koh Ming Zhi-

Sunday, 11 March 2012

Food sampling Activity

Venue: Grocery shop
Today our group had the privilege to come along with En Elan and Pak Lang to just have an idea about what they do during food sampling.

The food samples are required to be at least 250g each, from the same batch (serial number), same packaging. 3 packs are chosen for each type of food item. 1 for the owner, 1 for the chemistry labs, and 1 for the Food sampling Unit.
The ones sampled are usually from lesser known brands because the better established brands usually comply with the requirements set.

For today, their initial plan was to obtain samples of coffee (foreign matter, percentage of coffee), tea (colouring), oyster sauce and dry food.
Some points to be taken note of include the label, ingredients, expiry date and in canned food, dents.

The items chosen so far

The owner calculating and preparing the receipt for the sold products.

Filling in the form required

A copy of the form for each product. Details filled in include the designated sample serial number (by the food sampling unit), name of the food product and date.
The serial number of the form as well as the sample is essential for reference if the case is brought to the court.
Analyzing the sample serial number:
PT means Padang Terap, 12 means 2012, and 045 is the 45th sample taken by the unit for that year.