Community Medicine Batch 9

Thursday, February 26, 2009

Our Last Day in Sik

Hi everybody! As all of us know, today is our last day of DHO posting in Sik. Although we are here just for two weeks, we can feel the “farewell day feeling” on our last day..

Actually, today our programme is outdoor activity. According to our schedule, we will be having short briefing on Bekalan Air dan Keselamatan Alam Sekitar(BAKAS). First we went to Pejabat Kesihatan Daerah Sik. The PPKP unit was in charge to guide us to Kampung Sungai Senam.

Then, to proceed further to top of the hill, we get into one jeep. This is definitely a different experience for all of us. We travel through the jeep along the way to hill. The jeep stopped halfway, and we experienced hiking to continue our journey to the place where water is stored.

The place is called Gravity Feed System (GFT). The GFT is built in 1987, but just functioned for 2 years and has not been used after that until now. Currently, the village people are planning to reconstruct the GFT. The source is from the hill water and supplying to village people.

Together with us and the PPKP, many village men followed us to the hill. After reached the hill, the Tok Imam of the village gave us a short briefing on the GFT, how it is managed and the reconstruction planning. Then, the PPKP showed us the method of checking water conductivity, oxygen content, pH and turbidity. The range of normal values for conductivity is <100, for oxygen content (by oxygen meter) is 1-1000, for pH is 5-7 and for turbidity is 1-1000. This is to ensure that the water is safe to drink by the village people.

After that, we had breakfast and drink prepared by the village people, which is not new thing for us in Sik. The village people are very friendly and humble as well.

This is our beloved captain, Mr.Nitiyanantham.

All of a sudden, one guy jumped into the water to open the pipe, and to allow the flow of the water. Photos below showing the chain of reaction of that incident.

After that, we came down the hill by the same jeep, and then by car back to Kampung Sungai Senam. Then, we went to Pejabat Kesihatan Daerah (PKD) Sik. We said goodbye to the people in PKD and left to Sungai Petani.

At the end of the day, we planned a get-together, so that we can share our memories in this past two weeks in Sik. So, we went for dinner together in Wandly Siang. Eventhough we were tired, we spent a lot of time tonight chit-chating with each other. We were very happy that we could work together. Through this posting, we learnt a lot about team work and hope we will get a chance to team up again in future. Goodbye and meet again next time!

Group A:Day 10 Kuala Muda

The day started with a lecture on the scope of services provided by the Primary Healthcare unit by Encik Yusof, who is a long- serving Medical Asisstant with 27 years of experience. He was very passionate about the significance of Primary Healthcare and emphasized much on the definition and impact of Primary healthcare on the community.

Primary Healthcare is essential health care which is based on practical, scientifically sound and socially acceptable methods and technology and should be made universally accessible to individuals and families in the community. It forms an integral part of the country’s health system and has a central function in the social and economic development of the community.

Primary health care becomes the first level of contact for individuals, the family and the community with the national health system, bringing health care as close as possible to where people live and work and constitutes the first element of a continuing health care process.

Another unexpected incident that happen that day was Encik Yusof became the 1st person in the district to give us a treat in the hospital canteen. Everyone had some light moment after the lecture.

Thus, in Kuala Muda District alone, there are 6 Klinik Kesihatan, 1 Klinik Kesihatan Bandar in Sungai Petani. Specific clinics such as Chronic Diseases Clinic which cater for patients with diabetes mellitus, hypertension etc. and Mental Health Clinic are also available within the Klinik Kesihatan. Another branch in Primary Healthcare which is rising in importance is the “Expanded Scope of Healthcare”, which includes Adolescent health, Geriatric health and a Quit Smoking Clinic.

Later in the day, we visited a secondary school (SM Sg. Layar). A group of staff nurses and Jururawat Masyarakat were already there to organize an Tetanus immunization session for Form 3 students. When we went there, we were asked to help out in physical examination of the students. It was quite overwhelming to see never- ending batches of students streaming into the room. Nevertheless, we were able to start organizing ourselves to perform physical examination and giving the ATT injections in an orderly manner.

In the afternoon, after a very late lunch at 3pm, we went to the out- patient department at Klinik Kesihatan Bandar Sg. Petani to collect some health clinic cards, forms and to observe the running of the OPD.


Today morning at 7.30,we start our journey again to Sik.Thick mist along the way make us as tough we are entering Genting Highland.We reach PKD at 8.30am.At 9AM,PPKP Mohd.Dzullkifli Che Mit and PPKP Mohd.AsriHarun,from the food quality control unit,gave us briefing about food quality control and sampling of food.During the 2 hour talk,we learnt in detail about the process of food quality control and also about the Food Act 1983.

HACCP-Hazard Analysis Critical Control Point is identification of critical point(cp) or critical control point(ccp)in the process of making food which begin from the process raw food until to the end product.Identification of CP and CCP help in preventing occurance of food poisoning and besides that we can take preventive measurements at the point of the food production.

Then,we had a visit to Sek.Men.Kebangsaan Agama Sik to observe the management of canteen (DAPUR ASRAMA)in the context of cleanliness,preparation of food and also about the anti-thyphoid vaccination status among the food handlers.

First we visited the cold storage where raw foods such as chicken,fish,prawns are stored for daily uses.

There was another store room to keep dry foods such as rice,eggs,oil and other cooking things.

En.Ridzuan,the head of the "dapur asrama" ,gave us briefing about food handling safety and also the cleanliness of the canteen.

En.Ridzuan showed us the immunization cards of his workers.Each vaccination is RM20 for Malaysian citizen and RM40 for immigrants.

He also showed us the list of daily menu of the food to be prepared for the students.

This is the dining hall of the school.Wah,big,clean,filled with antique and attractive items.
And again the hospitality of people of Sik is truly touching.We were served with mee goreng,nutritious fruits and tea.

At night,8.30pm we had a golden opportunity to follow the officers fromthe FQC unit to three food premises in Sik.

At each premises,the officers invigilate about the cleanliness of the premises,the antityphoid vaccination status among food handlers and also the safety of the preparation of foods.

The is a specific scoring system used to evaluate the safety of the premises.If the scoring is less than 70%,the premise will be closed.We visited 3 premises and the second premise was closed due to two main reasons:none of the food handlers have been vaccinated against typhoid and raw foods were not kept properly which can lead to cross contamination.

Wednesday, February 25, 2009

Padang Terap D10: FINALE

‘Wei... cun we are going back! Getting up early not as usual would be a scene to be cherished. The finale… had come. Lured into the excitement of heading back to a place where we esteem.’ That was the entire discussion the night before.

But the scene varied the day next. Getting up late and quite interestingly a slight dullness was painted on everyone’s face. DHO had Typhoid vaccination that morning and had invited us to join the program. The nurse guided us on methods of vaccination and even gave an opportunity for us to vaccinate some locals. They were mainly food handlers and our experience with needles earlier proved to be helpful.

A short Q&A session with En. Ali to fill up the missing bits on our assignments was the day’s start off. Soon after, we marched to the vaccination place. Some left halfway to get forms that were not available earlier on.
After the session, we were guided downstairs for a farewell party. And as expected, we had a treat that put a smile on our lips. A short photography session concluded our posting.

We were grateful to all members of Padang Terap District Health Office. They've guided us with ease and the entire posting was a fete to our hearts. We’ve learned a lot. Having said so, we do admit that there’s more to go however, our stay in padang Terap perhaps had fruited with experiences of a lifetime. We learned that despite the extensive roles of hospital is indisputable; the community approach of public health has its undeterred function and reputation.

Padang Terap D9: Day Before Finale

Our second last day in Padang Terap was all about sampling. We began our day in a market where food inspectors from KKM bought two extra large chickens not for meal but for testing. Our officer in charge Mr. Pergas was kind enough to explain us all about food sampling and their role in monitoring. Our morning session ends in the office where we were briefed about food safety and control.

The evening was devoted to KMAM or the water team as we call them. These people took us to a pump station in Kuala Nerang to teach us on water sampling and testing. Again (now not by car but by van) we set out on that 5 minutes journey to a well maintained station. The oficer taught us on all procedures and tests that are routinely performed. It was a great to see sampling and testing being done in that small van.

Well, the day was supposed to end there but our doctor (which is us actually) had their chance to write their first referral letter to the hospital on the kids that we diagnosed during our visit with the school team. That would surely be ‘a dream come’ true for them.

That night we had a special time with our ‘favorite’ Vector Unit’ in seafood shop. Except for the vegans, we enjoyed our food. But the whole lot of us had a great time. We can’t believe that tomorrow would be our last day. Well, every beginning has an end.

Group A: Day 9 Kuala Muda

On the 9th day, we gathered early to complete our task of gathering additional information from the hospital staff. Then, we marched towards the TB Unit for another essential briefing session by MR Rosli about his core duty in investigating the contact person of TB patient by visiting their respective houses after notification. According to him, it is vital to fill in various forms such as BORANG 10A-1 ( Maklumat Penukaran Rawatan Pesakit TB ), BORANG 10C-2 ( Pemeriksaan Saringan TB ) , BORANG 10C-1 ( NOtis Menjalani pemeriksaan pengesahan ), 'Slip no. daftar TB' and 'maklumat penyiasatan kes TB'.

In addition, the recent format they are practicing now is the ‘e-notis’ system that started in 2008, which it is updated daily by reporting TB cases. As such, any TB cases will be notified in a very short period of time.

There are 3 main treatment centre in Kuala Muda, namely HSAH, KK SP, KK Merbok also known as PR1 while 5 others are in KK Bukit Selambau, Bedong, Bandar Baru Sungai Lalang,, Kota Kuala Muda, and Bakar Arang. These 5 centres are named PR2, where only drug therapy (DOTS) is available. While in PR1, the centre provides extra services such as diagnosing or detecting and treating TB patient in addition to the DOTS programme. These many centres provided by our beloved government are for the conveniences of the public to continue their daily treatment nearby their residence.

The DOTS programme is usually under the supervision of the staff nurses in the TB control unit room. The usual regimes for TB drugs are rifampicin, isoniazide, pyrizinamide, ethambutol, streptomycin. These drugs are packed according to the patients' daily dosage and kept in a white container with the patient;s name written. We also managed to observe, a walk-in patient receiving his daily treatment at the centre.

The evening session started with a breezy rain. MR ZAMANI (PPKP) from the CDC Unit took another two hours of briefing. This unit usually deals with diseases such as TB (MR. Rosli), HIV infection (MR. Hasani) , and communicable diseases which are divided into water and food borne diseases under the management of Pn. Ros and non-water and food borne diseases by Mr. Zamani himself. Being an experienced health officer, he explained about how the notifications of the notifiable diseases were done, common cases that were usually reported such as measles, hand,food and mouth disease, dengue fever, TB, Chikugunya and food poisoning. He showed us various types of forms that must be filled. He also taught us on how to carry out an investigations if an outbreak should occur like, food poisoning. We then learnt about CDC surveillance system such as measles using ‘e-notis’ (SM2) by reporting the cases to the federal health office from the district. Mr. Zamani also shared with us about his job responsibilities in handling HIV patients in which all of us found very interesting. Last but not least, we went to his work place to have an overview idea about notification via ‘e-notis’ using his computer.