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).
- 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
- Peak flow meter
- Spirometer
- Asthma Bay
- Full Blood Count (if patient is fever)
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
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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.
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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
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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
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phone the patient or home visit
3. every half a year, patient data will be reviewed
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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.
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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
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meanwhile waiting to be called, patient can fill in their own
1. Height
2. Weight
3. Body Mass Index
4. Blood Pressure
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then they will be attended by Medical Attendant (2 rooms) in Treating Room
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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
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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
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the usual history taking will be taken and patient chief complain will be noted down
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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
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
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)
- January 2012 : 88 case (follow up)
- February 2012 : 90 case (follow up)
2. Hypertension
- Monthly (average) : 150 cases (follow up)
- 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-
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