Friday, October 19, 2012

Day 12 (Oct 18, 2012) : KPAS Unit

KPAS Unit, which was also known as Unit Kesihatan Pekerjaan dan Alam Sekitar. This unit mainly targeted on the occupational health and environment health issues. We had a theory session with PPKP Azman, who in- charged of this unit in Pendang DHO. We were briefly being told about the aims of this unit and the different activities carried out by the unit to ensure the safety of the environment as well as the employers, employees and the consumers. After introduction of the unit was done, Mr. Azman showed us the Audit system, which was used to assess the safety and health of the premises, healthcare facilities and workplaces. 


Strategies:
1.Integration of the occupational health services at the primary healthcare level.
2.Strengthening the epidemiological monitoring of occupational diseases including the chemical and pesticide poisonings.
3.Promoting the occupational safety and health at the workplace
 
Two fields: Occupational health and Environment health  
(a) Occupational health and safety
1.   Investigate incidence of accidents, poisoning and occupational diseases
2.  Investigate the complaints which related to occupational and environment health
3.   Investigations are done together with Department of Occupational Safety and Health (DOSH).
 
(b) Inspection of premises & Environment Health Impact Assessment (EHIA)
1. Inspection of premises to identify hazards 
2. Inspection of TASKA, child-care centers 
3. Inspection of TADIKA/TABIKA  
4. Carry out Health and Safety Audit System 
5. Investigate the open burning and send the report to Department of Environment Malaysia 
6. Investigation of environmental pollution   7. Approval of application/renewal of various trading licenses (except food business licenses) 


Health and Safety Audit System  
Objectives of Health and Safety Audit System
1.  Raise the awareness of OSHA( Occupational safety and
     Health Administration )1994.
2.  Identify hazards that may not be identified .
3.  Determine whether the employer pays attention on
     occupational health and safety and whether the employees
     comply to it or not .
4.  Identify the level of implementation of safety and health 
     activities .
5.  Identify the level of awareness of health-related 
     occupational safety and health .
6.  Make recommendations for remedial measures for 
     deficiencies identified .
 

 

 

Day 11 ( Oct17, 2012) : BAKAS Unit

BAKAS Unit, This was a very important unit which they played an important role in maintaining health in the community by building a safe water supply system for daily usage and  construction of sewage system to dispose the wastes from the household. Today, we were given the chance to probe into the unit about its aims, duties and vision & challenges in construction of well in rural area, gravity feed system, SPAL (Sistem Pelupusan Air Limbah), SPSP ( Sistem Pelupusan Sisa Pepejal) etc.

Objective of BAKAS:
To improve the health status of the residents in the rural area by reducing the incidence of the communicable diseases, especially the water-borne/food-borne diseases and parasitic infections.

Aims:
  • To encourage and improve the awareness in the residents regarding the disposal of the feces properly through the use of "tandas curah" system.
  • To raise the awareness in the residents in usage of clean water from the pipe connection JKR (Jabatan Kerja Raya), pipe connection JKR/KKM(Kementeriaan Kesihatan Malaysia), Tube well, Tube well with pipe connection to the houses and gravity feed system.
  • To encourage the residents to keep the cleanliness of the house by using the trash pit (lubang sampah) and controlled sewage system.


Responsibilities/ Duties

  • To educate the rural population in building the toilet.
  • To provide subsidies for the construction of toilet to the residents in need that lived in rural area.
    To encourage the rural population to use pipe connection JKR or JKR/KKM, build tube well connections to the houses for those area without JKR pipeline.
  • To show the population the technique to make the trash pit.
  • To provide the health education to the residents in raising their awareness regarding the importance of environment cleanliness.

Building the pipe connections and the gravity feed system





 

Day 10: TB & Leprosy Unit/ NCD Unit

TB/ Leprosy Unit was come under the CDC Unit. On the day 3, we did not manage to meet PPKP Roshafizi who in-charged of the TB/Leprosy Unit in Pendang DHO. Likewise, TB & leprosy were communicable diseases that can be notified via the use of E-Notifikasi. TB must be notified within 1 week time so that immediate treatment can be started and prevent the spread of the bacilli from one to another. The main objective of establishment of this unit was to notify and control the TB cases in Pendang.

Notifications:



Written notification forms
 



















DOTS (Direct Observe Therapy, Short course)
The unit also carried out the disease control program to prevent the spread and early detection and treatment of the TB patients. The DOTS (Direct Observe Treatment) was the most effective strategy in controlling TB. Hence, in Pendnag DHO, DOTS service was available as well. We were brought to the treatment room and Mr. Roshafizi showed us the appointment card of the patient and the different drugs used in the Anti-tuberculous treatment. 


--> Short course chemotherapy which is used for 6 to 8 months for newly infected sputum positive patients.
-->  Direct observation on TB patient by the observer by seeing and ensuring the patient has swallowed the TB medications.
-->  The observer is usually from the district health office (health personnel) and staff nurses which are well-trained. They ensure that the patient takes the right medication with the right dosage in the correct  time. 
 --> Each dose of medication taken by the patient under supervision should be recorded. 

  

It recorded the date when the DOTS was started, and also the following dates when the patient came for DOTS in Pendang DHO. If there is any "miss-out" session in the appointment book, DHO officer will phone the patient to find out the reason they missed their medications and if the patient did not pick up the phone, health officers will pay a visit to their houses and advised them come back to DHO for the continuation of the DOTS to prevent any emergence of the drug-resistance strain due to breakdown of the treatment. 
As we knew that, TB treatment consists of multiple drugs to be taken by the patient in one shot at one time. The first line drugs used are Isioniazid (150mg), Ethambutol(400mg), Pyrazinamide (250mg), Rifampicin (300mg), Ethambutol (400mg), Pyridoxine (10mg), Second line treatment: Fluoroquinolones, Kanamycin, Amikacin. Akurit 3 and 4: This drug regime is combination of 3 to 4 different types of first line anti-TB drug. (not available in Pendang)



 


Day 9 (Oct 15,2012) : UIP Unit

This was the first day of the third week of DHO posting. We were having a session on duties and responsibilities of UIP (Unit Inspektorat dan Penguatkuasaan, Investigation & Prosecution Unit), which was also known as the Enforcement Unit in the DHO. The main objective of the establishment of this unit is to carry out the enforcement of the Health Law against those breached the law.

Introduction:
  Establishment is based on the Public Health Circular No. 1/2004 
dated 11 February 2004, signed by the Deputy Director of Health
at that time, namely  Dato 'Dr. Shafie Ooyub.
•  UPP in DHO Pendang was staffed by an Assistant 
Environmental Health officer (En. Hassim) and an Assistant Public 
Health.
 
AIMS: 
To carry out the duties of enforcement and prosecution of public health law with more professional as well as enhance the quality and effectiveness of enforcement of Public Health Law. 

Objectives: To enforce public health laws that provide protection and equal justice to all parties, in particular in the Health District Pendang.


LIST OF LAWS / REGULATIONS THE ADOPTION 
•  Food Act 1983 and Food Regulations 1985.
  Destruction of Disease-Bearing Insects Act 1975 and
    amendments (2000) 
  The Prevention and Control of Infectious Diseases 1988
•  Regulations of Tobacco Control 2004
  Guidelines under the Food Act 1983.
•  Enforcement Guidelines under the Destruction of Disease-
    Bearing Insects (APSPP 1975)











       

    







 

Wednesday, October 17, 2012

Day 7 & 8 (Oct 10&11, 2012) : Food Quality Control (Theory & Field Trip)

Food Quality Control Unit (KMM)

It was the day 7, we had come across to a quite interesting topic today, i.e the food quality control. Food quality is very important in maintaining good health in the community. PPKP in the unit, Mr. Chiang gave us a little talk on how the unit control the food quality in the market, vaccination program of the food handlers and premise inspection.


 KMM is responsible for the followings:

1.To protect the public from being cheated and from health danger 

with regards to preparation, sales and usage of food and other 

related stuff


2. In order to achieve the above mentioned goals, inspections are 

done at food premises in the district, such as school canteen, 

cafeteria, food stalls, restaurants and food factories.

3. Inspections carried out following the guidelines as stated in the 

Food Act 1983 (Act 281) and Law.




Form that used for inspection of food premises:
 
-- Based on the demerit system
-- They inspected the premises for their food quality, methods of their food handling, hand-washing, kitchenwares, water supply, floor etc.


 Law Enforcement 

based on AKTA 

MAKANAN 1983 

(AKTA 281) & 

Peraturan-Peraturan

















Day 8: Field Trip


The restaurant we went for our field trip was called d'Kafe Pokok 

Pisang. We went into the kitchen where the kafe workers were 

preparing the food for their customer for inspection. We observed 

the floor, the kitchenwares, the food and their storage etc.

Lastly before we left for the restaurant, Mr Chiang gave some 

advices to the restaurant owner.
Label the food (ingredients used for cooking)
—All the workers should wear apron and cover shoes
—Keep vegetables and poultry(chicken,fish) separately
—Cover the food that were kept in container




















 

The same form that brought along with Mr. Chiang during the inspection: 




Day 6 (Oct 9, 2012): Vector Control Field Trip


In the day 5, we had done the theory part with PPKP Yusof Eating on the notification, vector control, law enforcement in the vector control etc.  Since the fogging (Aedes control) can only be done during evening, we couldn't follow the health officers around to see how the fogging was done. PPKP Yusof Eating knew that we couldn't join them for fogging due to our afternoon classes in the campus, he asked an health officer in the DHO to demonstrate the fogging equipments used in the vector control activities, such as the thermal fogger and show us the pesticides used for killing the Aedes & Anopheles mosquitoes.

Thermal Fogger














Store room (Fogging equipments)



Demonstration the use of thermal fogger:


















After the demonstration, we was brought to the nearby villages for inspection of the houses for the larvae. The inspection was done from one house to another. The health officers told that the village they went for inspection was Kampung Suka Mari, which was recently flooded and it had become a potential place for the Aedes mosquitoes to breed. Hence, they inspected the houses for any flower pots, tyres, garbage bin etc which will hold the clear stagnant water in them for the breeding of the Aedes mosquitoes.


House to House inspection






Larva collection:







Almost every houses that kept flower pots, empty pails that were containing the clear stagnant water will carry the larvae. Hence, the officers collected the larvae and brought back to the DHO to identify the mosquito species.





Day 5: (Oct 8, 2012) : Vector Control Unit

We had done our theory session on the Vector control program with PPKP Yusof Eating. The main objective of vector control unit is to control the spread of the diseases by eliminating the vectors.

Functions of this unit:
1. Prevent the occurrence of dengue cases
2.To control dengue outbreaks
3. Prevent re-occurrence of Dengue Fever in priority localities
4. Improve Malaria prevention and control activities, especially foreigners
5. Prevent the spread of Malaria to the local population


Organization Chart of VBDCP 













 


In 2012, the dengue cases in Pendang was quite high. The dengue cases were the highest in week 22 and week 25, it was mainly due to the rainy season that creating many potential sites for the Aedes mosquitoes to breed, hence the incidence of dengue increased.


Similarly, Vector-borne diseases can be notified via computerized system, the E-notifikasi. Other methods of notification are as follow:
 





 

Vector control program is very crucial in reducing the number of dengue cases in Pendang. There were a few activities were carried out by the unit to control the number of vectors. Aedes survey was a field trip/operation carried out by the health officers to find out any houses that had breeding sites for Aedes larva (determined by index such as Aedes index....). If an house area was having a high Aedes index, the unit will consider and plan a fogging in that particular area in near future because it was a potential place that was having impending risk of dengue outbreak. Fogging is the adulticiding program which targeted only the adult mosquitoes. Abating & larvaciding are the control of the number of mosquitoes by killing their larvae, it can be done by using chemicals,i.e. the ABATE or biological method such as the use of Bacillus thuringiensis. Law enforcement played an important role in reducing the number of vectors as well. For those who found breaking the law (e.g. there were lots of pots, bins....that contains clear stagnant water which act as the breeding site for mosquitoes) will be compounded with an amount of money not more than RM500. They can make an appeal to the District Health Office to get a reduction in the compound. They were given two weeks time i.e. 14 days to make the payment, if not they will be sued in the court. 


Day 3 & 4 ( Oct 3&4, 2012): CDC Unit ; HIV/AIDS Unit


This was the third day in Pendang DHO, we were having our session with PPKP Wan Nur Aishah and PPKP Izham. They are both from the CDC unit, while that PPKP Wan Nur Aishah in-charged of most of the communicable diseases other than the HIV/AIDS and TB/Leprosy. PPKP Izham was taking the HIV/AIDS control program with us.

 The procedures for all the communicable diseases are same:



For the notification, there was a computerized notification system, called "E-Notifikasi"




 
This system is used by hospitals and district health office to ensure 

rapid spread of information regarding any communicable disease / 

outbreak. All the cases must be confirmed and registered by a 

medical practitioner.






























 

Books used for guidance in outbreak investigation and 

notification:






















HIV/AIDS Unit: 

Similar system used for notifications. The forms used for the  

HIV/AIDS notification were different from the other 

communicable diseases.


Functions of this unit:


  1. To verify cases that are notified.
  2. —To investigate cases notified.
  3. —To supervise burial of patient with HIV and AIDS for both muslim and non-muslim.
  4. —To Plan programmes for awarness this is also known as “National Stratergy Plan”
  5. —Methadone Programme
  6. —NSEP (Needle Syringe Exchange Project)