Day 9 (24.2.11) - Adios Alor Setar

by S.J.Poobalan

The last day started at 9am at the main meeting room of Kota Setar DHO. At 9am we had a briefing from Mr.Fitri, officer from the (Keselamatan Pekerjaan  dan Alam Sekitar/ Occuptional Safety and Environmental Health) KPAS. He explained to us regarding various aspects of occupational safety and environmental health. He also shared with us various statistics regarding the topic.

After that, Staff Nurse Rozaini took over the session to explain more specifically about needle-prick injury. She also shared with us her experience of dealing with needle-prick injury cases.

Around 11am, we were quite bored with continuous talks without a break, but not after the beginning of the next session by officer from the Kawalan Mutu Air Minuman (KMAM) unit.  He explained to us the various water sources, the differences between them, water treatment and storage system. He also gave lots of info regarding the inter-departmental co-operation between Jabatan Kerja Raya and Jabatan Kesihatan. He also provided handout regarding the topic. 

After that, he brought us to the chemical laboratory to demonstrate the drinking water quality analysis method. He brought us to a specific water sampling tab which is located around few meters away from the laboratory. He brought along all the essential tools and chemicals for the demonstration. He thought all of us how to perform a systematic physical and chemical analysis of drinking water. After that he provided a collecting bag to all of us and gave us chance to try in our own.

After lunch the next session started as scheduled with the BAKAS unit. Talk was given by Mr. Ridzuan, officer from the BAKAS unit. In his talk, he covered most of the important aspects of BAKAS and also he answered all our queries at the end of the session. The talk was extremely useful.

Around 4pm everything came to an end. We were done with all the scheduled activities. It was time for farewell from the DHO. We thanked all the officers who helped us during the posting. And left the DHO with a heavy heart filled with lots of fun and sweet memories.

Adolescent Health

The two main programs on adolescent health organized by the Ministry of Health are:

• PROSTAR
• Program Doktor Muda

PROSTAR 

This is a program which educates teenagers about HIV/AIDS as an effort to prevent its incidence among youngsters.

Kota Setar district is very active in PROSTAR.

PROSTAR stands for Program Sihat untuk Remaja. It was formerly known as Program Sihat Tanpa AIDS untuk Remaja.

The program was established by Ministry of Health, Malaysia with the support from various agencies.

The concept of PROSTAR is " From Youth, Through Youth, For Youth". Peer educators will promote healthy lifestyles among youth.

Objectives of PROSTAR

a) To increase awareness & knowledge on healthy lifestyles

b) To inculcate positive attitudes on healthy lifestyles practices

c) To encourage youth to adopt healthy lifestyles & avoid health

     risk behaviours

c) To train peer educators that can influence other youth to practice healthy lifestyles

d) To encourage volunteerism among youth that can eventually

     provide social support for other youth

Target Groups

Aged between 13 to 25 years old including:

• School students
• School leavers
• High risk group or troubled youth who have disciplinary problems, substance abusers, runaways & other high risk behaviours
• Marginalized group such as sex workers, homosexual & transsexual

Target Behaviors

• Smoking
• Using drugs
• Having multiple partners & unprotected sexual relationship
• Anti social behaviours

Recommended Behaviors


Healthy lifestyles practices such as:

• No smoking
• No alcohol
• Healthy minds
• Engage in physical activities
• Healthy eating

~ Pamphlets on PROSTAR ~

~ Logbook for Students participating in PROSTAR ~

Program Doktor Muda (Young Doctors Program)

Young doctors are a group of students; especially primary school students that have been trained in relevant aspects of health so that they can be an agent to promote good health knowledge and practices to their peers and family members

General Objective

To empower the student with health knowledge and skills in order to improve their own health and their peer’s health.

Specific Objectives

1. To facilitate the students, their peers and family members towards the adoption of healthy lifestyle
2. To develop the student as a role model and guide towards the adoption of healthy lifestyle
3. To encourage the student to help the health staff and teachers in organizing health activities in their school
4. To strengthen the school’s effort in improving the health of the students
5. Encourage parents/ guardian to give proper attention to the student’s health
6. Strengthening the collaboration between the Education and MOH Department in an effort to encourage good health practices among the students

Activities

• Promoting the adoption of healthy lifestyle
• Helping the school to promote a clean, healthy and safe environment
• Helping health staff and teachers in organizing health activities in their school
• Inform the school authorities of the occurrence of any disease / health problems
• Treat simple injury

~ Constitution book for members of Young Doctors Program ~

For further details, log on to:
http://www.drmuda.gov.my/drmuda.*

by Tineshwary Tannimalai

Day 8 (23.2.11) - H20 around us

by S.J.Poobalan

"Water an elemental,

Water a fundamental, 

Building block of life..."

Our day started at 8am with the Bekalan Air & Kebersihan Alam Sekitar (BAKAS) unit. After a short briefing by Mr.Rafidy, who is an officer in the BAKAS unit, we started our journey to the site to visit various types of water drainage, sanitary and water management system. Our first destination was Kampung Sg. Mati which is located in a small town called Langgar which is at around 30minutes drive from the DHO. The village was surrounded by vast paddy field which gave us a warm welcome. We visited house by house to invigilate the sewage and sanitation system. We were given sufficient information regarding SPAL and SUMP sewage water disposal system.

Then our journey continued to Kampung Tok Kun which is located 1 hour away from the previous village. In this village, we managed to gain knowledge on water pump and sewage water disposal system. We could appreciate the difference in the system with the previous kampong.

Our third destination was a rubber estate around 10km from the Pokok Sena town. Here we were so lucky to observe the well drilling process for a family who do not have proper water supply as their previous well dried off. During surveillance, the health officers found out this problem so to provide good quality drinking water for the family of five, BAKAS unit of Kota Setar DHO and engineering unit of State Health Department together came out with this well-drilling plan. This house was situated in the middle of a vast rubber estate but government never fails to look after their basic needs. The government officers also were so dedicated and enthusiastic to carry out this 

program in midst of all the problems such as poor infrastructure in that area.

In the evening some of the students were in the health promotion unit to gather more information about health promotion in the DHO settting under the guidance of Mr. Mohamad and another group of students went to restaurants to check for food quality and cleanliness of premises with the officers from the food quality control unit.

They went to the stalls with Mr.Musa bin Hasan (PPKP) and another health officer around 3 pm. Food premise inspection was done at 5 stalls. It was a routine inspection that has been done. Each year there will be one inspection for each food premises. Criteria that are taken into account are as following:

·         Cleanliness of the stall

·         Cleanliness of cooking equipments

·         Cleanliness of surrounding area

·         Appearance of the hawker (apron, cleanliness, neat)

·         Typhoid vaccination taken by all food-handlers

·         Cleanliness and quality of food which is served

·         Presence of proper dustbin

 All food handlers are required to get typhoid vaccination. Food handlers who did not get themselves vaccinated are usually given a letter to ask them to do so. Second inspection will be done after 1 month to know whether they already get themselves vaccinated. As such, during the inspection session today, only one lady was given that letter.

PPKP follows the checklist while inspecting the stalls. Marks were given, if less than 76, the shop need to be closed for 14 days. Thus, in order to be safe, marks shall be more than 76. However, the drainage system for all the stalls was poor. It seems Kota Setar City Council (Majlis Perbandaran Kota Setar-MPKS) does not clear this problem although after several complaints from the food handlers. Also, most of the stalls do not have a proper dustbin or disposal system. The inspection session ended around 5.30 pm.

After a long day, we return back to campus. It was a fruitful day indeed as we learned many things which I doubt whether we would get another opportunity like today to learn.

Health Management Information System (HMIS)

q  Health Management Information System (HMIS) is use in assisting for the effective planning, development, coordination and evaluation of the individual program. It is a decision support system for health management and a system that links information to managerial concern.

q Public health informatics is the application of information on science & technology to public health practice & research.

ü  Data:- attributes, variables, events or discrete observations

ü  Information:- reduced, tabulated & summarized

ü  Intelligence:- information with social & political value

WHO defines Health Care System as including all the activities where primary purpose is to promote, restore or maintain health.

Benefits of Health Management Information Systems (HMIS) as stated by World Health Organization (WHO):

Ø  

Helping decision makers to detect and control emerging and endemic health problems, monitor progress towards health goals, and promote equity.

Ø  Empowering individuals and communities with timely and understandable health-related information, and drive improvements in quality of services.

Ø  Strengthening the evidence base for effective health policies and enabling innovation through research.

Ø  Improving governance, mobilizing new resources, and ensuring accountability in the way they are used. 

Functions of HMIS

1.      Determination of information requirement

2.      Information gathering, processing and monitoring

3.      Production of report.

4.      Dissemination of report to users.

5.      Documentation

6.      Training of generators and users of HMIS 

Quality of Good HIS

•  Should be population-based data
• Data should have a sensible correlation
• Should use operational terms & functional terms
• Data presentations by diagrams, figures & charts
• Data feedback should be possible

Components of HIS

•  Vital events
•  Demographic characters
•  Health data(morbidity, mortality, disability & quality of life)
• Health resources(money, material, manpower)
• Health service(bed occupancy)Health service outcome

Uses of HIS

• Health status of community is measured
• Health care need is assessed
• Health problems are identified
• Health status comparison is possible
• Planning, organizing, executing &  evaluation are possible
• Impact of health services is assessed
• A tool for research activity

Sources of HIS

• Registration of vital events
• Notification of diseases
• Census
• Sample registration system
• Hospital records
• National registry of diseases
• Survey report
• Screening report
• Surveillance report 

HMIS in Kedah

Formed in June 2003 and started off with 4 staff members.

This unit monitors and updates all the information systems in Kedah.

Information Systems include:

• 1.      Human Resource Information System (HRMIS)
• 2.      CDCIS System & TBIS System
• 3.      Tele-health System
• 4.      Universal Service Provision
• 5.      Diabetic Registry of Malaysia
• 6.      National AIDS Registry

This unit is responsible also in buying computers and computer software besides giving training to hospital staff on how to use the information system.

Communicable Disease Control Information System (CDCIS)

• An online program/website to register the new cases of communicable diseases.
• Once the cases are registered, the cases can be reviewed by the higher health centers.
• This way the number of cases in the whole of Malaysia which has been reported can be traced and precautions taken before the communicable diseases spread.
• CDCIS is also useful in keeping records of such cases.
• The cases will be notified by the doctors either in the general or private hospitals. Doctors will call up the Health Office to notify them and provide them with necessary information.
• CDCIS is now known as E-Notifikasi, which can be assessed by anyone with a registered username and password.
• It can be accessed via the following link:

                                          http://enotifikasi.moh.gov.my 

~ CDCIS Screenshot ~

E-Dengue

• It is a new online system specific for Dengue cases. 
• It is a branch of CDCIS, started in January 2011.

HMIS-Tuberculosis (HMIS-TB)

• HMIS-TB is a system of collection of data based on clinic or treatment centre. At the same time, notification of communicable diseases including tuberculosis is sent and registered at the district health office.
• This leads to a lot of contradiction in terms of data between the treatment centers and district health office. 
• It also indirectly causes the failure of the Epidemiology Unit and State Health Office to obtain accurate information about tuberculosis cases in their own district although they are supposed to be responsible in the coordination of control and preventive measures. 

TUBERCULOUS INFORMATION SYSTEM (TBIS)

• TBIS is a new system which is used to overcome problems with HMIS-TB. This is neither software nor a website. It is merely a system which uses paper forms to record information about Tuberculosis.
• Various forms are available for different purposes:

Form 10A1 – details of the patient
Form 10A2 – details of the treatment
Form 10C – for contact tracing
Form 10D – to inform defaulter
Form 10K – for transfer of patients to other district
Form 10J – for patients who die while receiving treatment, or those who die within 6 months after 

cessation of treatment 

VEKPRO

• This is software which is installed on selected computers in the DHO.
• Unlike e-notifikasi, whatever data being entered into the software is available only to that particular computer user.
• It covers various vector-borne diseases such as Dengue, Malaria, Filariasis, Japanese Encephalitis etc.
• The data is compiled and sent to the State Health Office ideally on a daily basis.
• The difference between VEKPRO and e-notifikasi is that the keying in of data into VEKPRO requires the fulfillment of a few criteria whereas for e-notifikasi, such conditions are not necessary.
• For example, a dengue case can only be recorded into VEKPRO if the patient is having certain criteria such as fever more than 38^oC, joint pain and so on. As for e-notifikasi, the case has to be keyed in even though the patient is suspected for dengue but is not having the symptoms as stated in the VEKPRO system. 

~ VEKPRO screenshot ~

WATER QUALITY SYSTEM (WQS)

• Software used by Kawalan Mutu Air Minuman (KMAM).
• Functions like VEKPRO, enables the officer to record all the readings obtained from every trip for water sampling.
• Each data sheet belongs to a sampling station, in that sheet are various columns for the readings, such as turbidity, conductivity, chlorine level etc. Again, the report has to be saved and emailed to higher level for reporting.
• Only installed on one computer per DHO, and the officer in charge has to bring the computer to the State Health Office for the installation process. 

~ National AIDS Registry screenshot ~

~ Diabetic Registry of Malaysia screenshot ~

Day 7 (22.2.11) - Glorious Food

by Navanitha Chandrasekaran

I woke up from my nice cozy bed at about six in the morning with a tingly feeling of excitement passing through my veins. It will be another lovely day to begin with my wonderful friends.

As the daily routine goes, we left our campus at 7.00 AM, heading towards Kota Star District Health Office. I looked outside the car window, astounded at the colour of the sunrise sending rays of light bouncing of my gleaming boat and hitting me in the eyes, knocking me back almost blinding me. The eye-catching scenery and greenery came to an end as the exhaust notes rumbling from the engine stopped. We have reached our welcoming Health Office.

After having a breathtaking journey, we assembled in the Food Quality Control Unit according to the schedule which has been given by our coordinator, Mr. Zaki on the very first day. There was a great excitement among us as we were eventually going to be assigned with a division involving food today.  Food...food...glorious food... Well, who would not be anticipated when they hear the word food. As our mouths were flooded with salivation, we were greeted by Mr. Musa bin Hasan, Assistant Health Inspector (Penolong Pegawai Kesihatan Persekitaran- PPKP) of the Food Quality Control Unit.

             Mr. Musa gave us a warm welcome to his division. He introduced the division to us by explaining the activities and responsibilities of the unit. Then, the discussion went on where we were told about the Premise Inspection. But, unfortunately we were unable to go to the food premises for Premise Inspection as Mr. Musa had an errand that needs to be done which was the e-blast operation (Ops Basuh).  In fact, he could not be very long with us. The entire unit were involved with this operation. Ops Basuh was an operation done in entire Malaysia under the umbrella of Ministry of Health in order to inspect the cigarette selling processes in 
shop outlets and food premises.

~ Mr.Musa bin Hasan briefed us on the roles & responsibilities of Food Quality Control Unit ~

Therefore, Mr. Musa handed us over to Mr. Wan Qaiyim bin Wan Izaham, Assistant Health Inspector (Penolong Pegawai Kesihatan Persekitaran- PPKP). Mr. Wan brought us to a market around 9.00 AM in order to expose us to the food sampling procedures. Green leafy vegetables weighing one kilogram were collected and sampled to test for the presence of pesticide. The sellers were given money for each sample which has been collected. Sampling was done in the morning in order to obtain a fresh sample. It was a routine activity of this unit. According to Mr. Wan, these food samples would be then send to the Laboratory of Food Analysis, Kangar in order to analyze contents or presence of pesticide in the vegetables. Each sample was sealed completely and labelled by means of record maintenance. After going to the field, we headed back to the Health Office where Mr. Wan explained the procedures and protocols of food sampling. All the doubts and the questions were cleared with the help of Mr. Wan.

~ Food sampling of vegetables in a market ~

~ Labeling of food sample ~

 

~ Paper bags used for collecting sample ~

              ~ Health Officers sealing the paper bags ~

Very soon after that, which was around 11 AM, we followed the teams involved in e-blast Operation (Ops Basuh). We were divided into three small groups consisting of four persons each where each group followed a team in a different location.

v  First group consists of Kishean, Poobalan, Kogil and Leong Chi Mun.

v  Second Group consists of Nelson, Tan Chia Hong, Ong Han Yi and Navanitha.

v  Third group consists of Gomalaa, Mohanajothi, Punitha, and Tineshwary

Inspection was conducted on shop outlets and food premises where the sales of cigarette were present. Two crucial criteria were taken into account which were:

v  Signboard showing, “No smoking below the age of 18”.

v  Notice showing minimum price of cigarette.

~ Sign board showing ' No smoking below age 18years & notice of minimum price of cigarettes ~

Premises who failed to follow these rules or regulations were fined by the Health Inspectors where else to those who did not have a proper signboard or notice was given a warning. The operation went on until 1.00 PM. Soon after that, we were dismissed by the Food Quality Control Unit and we had our lunch in a vegetarian restaurant. After having our delicious lunch, we headed back to the district health office.

~ Improper placing of the signboards ~


 ~ Health inspector issuing fine on a shop owner ~

We reached the District Health Office around 2.30 PM. Since Food Quality Control Unit was busy with e-blast Operation, we took this opportunity and time available to go to the Health Promotion Department. The office was filled with pamphlets and posters regarding health. We were allowed to take the pamphlets available. After spending our time in this department, we headed back to our campus at 4.30 PM with valuable information and precious knowledge which will enhance the moulding of a good doctor.

“Try not to become a man of success but rather to become a man of value”

-Albert Einstein-

Day 6 (21.2.11) - Fresh Day

by Punitha Kanasan

Let us start with a short lovely poem:

‘Night has ended for another day,

 Morning has come in a special way,

 May we smile like the sunny rays and leave our worries at the blue blue bay….’

As the quote sounds, our day also started so fresh even though yesterday was tiring. After five days of posting to Kota Setar, today is the first day we woke up after the sun rises around 7.10am. After we had our breakfast we left AIMST around 8.15am and reached DHO by 9.30am.

By 9.45am our briefing for communicable disease control regarding tuberculosis started. The briefing was given by Mohd Zahidi Abdul Ghani (PPKP).He briefed us again about the notification system which was already explained by Mr.Ooi yesterday, but in greater details on Tuberculosis (TB).According to him, only TB is notified manually by using paper forms out of all the communicable diseases. Notification is done by doctor in Borang Notifikasi 10A-1. Then, further investigations are done such as sputum smear examination, sputum culture and radiological test. Investigations done have to be recorded in Borang Siasatan 10A-3. Contact tracing is usually done and recorded in Borang Notifikasi 10C-1, 10C-2 and 10C-3. If the investigation result is positive the patients have to start their treatment called DOTS (Directly Observed Treatment, Short-course).

~ with Mr.Zahidi ~

After TB briefing was over, Dr.Sawri guided us regarding some exam-based questions and information that we have to find from each unit. He stressed more on the method of collecting food and water sample which was one of the most famous question asked in our continuous assessment. Besides that, he also asked us to find more information on immunization for children. The short briefing ended around 11am.

~ Dr.Sawri briefing us ~

~ with Dr.Sawri & Mr.Nasrul ~

Then we went to diabetic clinic around 11.30am to find more information on non-communicable diseases. All 12 of us were divided into six pairs. Then we were told to enter each sub-clinic as a pair. At one of the clinics, we had an opportunity to observe how the dietician Miss Nurul Hidayah and the pharmacist Miss Nina Fareha took a complete diet history from the patients and advice them regarding balanced diet. They also guide the patients regarding the dosage, frequency and the side effects of the drug. Random blood sugar test was done on every visit to find out patient compliance on drug. If the reading is above 15mmol/L this shows patient non-compliance on the drugs given.

~ at Diabetic clinic ~

~ pharmacist, Ms.Nina giving counselling to a patient ~ 

~ food pyramid model used at the clinic for educating patients ~

According to Miss Nina the clinic is open from Sunday to Thursday and fundoscopy is usually done only on Thursday. After spending about half an hour at the clinic we realized that most of the patients visited the clinic are having Diabetes Mellitus, Hypertension and Hyperlipidemia.

We had a short lunch break, but as usual it was enough for us to enjoy our meal at Menara Alor Setar Park. Only four of us went there including me, Gomalaa, Mohanajothi and Tineshwary.Rest of my group members enjoyed their lunch at Star Parade. After lunch, they also visited the Buddhist Temple nearby the DHO.

~ visit to Buddhist Temple ~

We were back at DHO around 2.30pm.All of us gathered at meeting room for the next briefing on non-communicable diseases (NCD) by Mr.Yong Phooi Wah (KPPP). He briefed us using the power point slides regarding the organization structure of NCD unit and the seriousness of NCD in our country. For year 2000 alone, the total NCD cases recorded in Malaysia was about 55,694,000. Besides that, he also told us about some of the NCD control programme such as Diabetic screening programme and Hypertension screening programme. NCD screening is done when the patient came to clinic with complains or else in medical camps and ‘Program Warga Emas’. The patients are screened for blood pressure, height, weight, BMI, urea level and RBC count. He also told us that recently new strategies had been implemented in DHO to reduce the NCD cases such as staff training and quality assurance programme (QAP). At the end of the session, we took pictures of the meeting room and the patient record books.

At last we came to the end of day 6. It’s time to pack up. We left the meeting room around 5pm and reached AIMST around 6pm after the heavy traffic jam in Alor Setar. As usual it was a tiring day but we enjoyed it!!!!!!