Kuala Muda DHO posting

Venue:  gym room (UPK department)

Time: 11.30am

Topic:  food unit and health education

Held by:  PZM En. Wan Nurusabah (nutritionist)

Objectives:

-          To ensure implementation of ‘baby friendly hospital initiative’ in health clinics.

-          Counseling In terms of overweight, obesity and nutritional education.

-          To curb malnutrition in lower socioeconomic living

-          To fully understand IDD  and its risks in community.

-          To promote weight management program  under a community scale

Seated in a fully equipped enormous gym, we started the session with greetings, Introductions, light candor and picture taking. En. Wan inquired about the difference between a nutritionist and dietician.  Answering that a nutritionist works at more community-based level, with patients being referred from health clinics.  The nutritionist collaborates with the public health department. On the contrary a dietician works under an established hospital environment.

 PZM En. Wan also briefed us about the counseling session he provides to various clinics in Kuala Muda district. There are basically two types i.e., individual and group discussion. Individual counseling is based upon person preference proves to be a more reliable approach, where as the group counseling consisting of more than 9-10 individuals call for certain demerits.

We continued talking about the different programs held in the district intended to promote healthy living in the community.

Undernourished Children Program

En. Wan being ever so jovial talked about the food basket program and the criterion implemented by MOH to follow

- Growth chart that falls below the normal percentile (yellow zone for 3 consecutive times or into the red zone for at least once)
- Per capita income of RM100 and below
- Congenital problems which may require financial aid.

We conferred that Malnutrition is not only based on socioeconomic factors but may involve aspects such as poor breastfeeding , recurrent infections, lack of nutritional education .Each of these factors is also impacted by political instability and war, lack of sanitation, poor food distribution, economic downturns, erratic health care provision, and by factors at the community/regional level.  

A particular Food Basket is worth around RM150, given monthly for a minimum of 6months to a maximum of 6years following review, evaluation and follow-up. The food basket contains different categories food yet balanced and proportionate.

Breast feeding and BFHI Program:

PZM En. Wan discussed

-the importance of  breastfeeding, proper techniques and benefits to both mother and child.

 -The instigation of (BFHI) baby friendly hospital initiative program certified by WHO and the criteria with which  it s rules are implemented

- Understanding the Ten steps outlined by WHO and INICEF in their joint statement in 1989

AIMS OF BFHI and THE TEN STEP POLICY:

-          To create conducive conditions in hospitals and thereafter for women who wish to breastfeed

-          To empower women to make the right choices in feeding their babies

1.        Train all health care staff in skills necessary to implement this policy.

2.        Inform all pregnant mothers about the benefits and management of breastfeeding

3.        Help mothers to initiate breastfeeding within half-hour of birth

4.        Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants

5.        Have a written breastfeeding policy that is routinely communicated to all health staff.

6.        Give newborn infants no food or drinks other than breast milk unless medically indicated.

7.        Practice rooming in  - allow mothers and infants to remain together 24 hours a day

8.        Encourage breast feeding on demand

9.        Give no artificial teats or pacifiers to breast feeding infants

10.     Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospitals or clinics.

The IDD Program –

·         Salt iodization is by far the most important population-based intervention for IDD control and has been shown to be efficacious in alleviating IDD assuming iodine concentrations in the salt are at appropriate levels at the time of consumption.

·          Efforts toward establishing and sustaining national salt iodization program have accelerated and revolutionized over recent years from pipelines distribution to commercial iodinated salt production. This has become a compulsory feature in Sabah and Sarawak.

Weight Management Program

  - Counsels about improving lifestyle, nutrition and physical activity

  -Helps provide usage of gym facilities

Before we proceeded to end this session En. Wan briefed a little about prevalent conditions related to pregnancy, that the community faces such as, anemia, hypertension etc. and ways to overcome them.

Day 8 - Communicable disease surveillance andNotification,CDCIS & HIV and TB Units Activities.

Communicable Disease Control Unit

It was in the evening of our 8th day of DHO posting......Phew....It was a long morning......Although it has been 8 days,the excitement never decreased.....Our evening activity was conducted by Communicable disease control Unit.We gathered in the unit around 2.30pm and briefing was given by Madam Rosmayati bte Yusuf(PPKP Kuala Muda).

The briefing was conducted first on objectives of the unit. The main objective of the unit is to prevent and control communicable disease around Kuala Muda district. The unit is also involved in notification of communicable diseases and investigation of an outbreak. 

Briefing by Madam Rosmayati bte Yusuf PPKP of the Unit.

Following briefing on objectives she introduced us to the notification system in Kuala Muda district. There were 2 types of notification according to the duration. There are :

1) Notification via telephone followed by written (within 24hrs)
2) Written notification within a week

Notification via telephone is done for following diseases :

1.  Dengue fever and Dengue hemorrhagic fever
2.  Yellow fever
3.  Diphtheria
4.  Ebola
5.  Food poisoning
6.  Cholera
7.  Plague
8.  Poliomyelitis
9.  Rabies
10.  Measles 

  
Written notification within one week after diagnosis

1. - Whooping cough
2. - Measles
3. - Dysenteries (all forms)
4. - Gonococcal infection (all forms)
5. - Leprosy
6. - Malaria
7. - Myocarditis
8. - Relapsing fever
9. - Syphilis (all forms)
10. - Tetanus (all forms)
11. - Typhoid and parathyphoid fevers
12. - Typhus and other ricketsioses
13. - Tuberculosis
14. - Viral encephalitis
15. - Viral hepatitis
16. - Any other life-threatening microbial infection
17. - HIV

Out of all these infection the common notifiable disease in Kuala Muda district are :

 1) Dengue
 2) TB
 3) Food Poisoning
 4) Gonorrhea

Census of notifiable disease in 2008

Census of notifiable disease in 2009

Census of notifiable disease in 2010

 

 

 

We were further explained about the notification sysytem in Kuala Muda district.They use E.Notification where it involve notificaton through internet were it gives a wider access especially by the health ministry.

And she continued with explanation on how an outbreak is detected and investigated. Usually occurence of 2 or more cases in a particular time is considered as an outbreak and investigation of an outbreak follows a systemic procedures where some of the procedures are done according to the situation and clinical settings.

Investigation of an outbreak differs for each disease. So there are certain protocols enforced to be followed in approaching an outbreak.

Protocols for Investigation of an Outbreak.

Protocols for Cholera outbreak

Protocols for Typhoid outbreak

Protocols for Food Poisoning

Most of the time CDC unit joins with other units in district health office in investigating and management of an outbreak especially with Food Quality and Health promotion team. 

We had the briefing for almost an hour and she explained as much as she could. The session was ended with questions from our group members and brief discussion on the questions. We were given a tiny break before we continued with the next session.
 


HIV and TB Units

After a short break our day continued with briefing on HIV unit in Kuala Muda District Health Office. It is a branch of CDC Unit. The briefing was conducted by Mr. Johari. He started the briefing with introduction and statistics of HIV cases in 2011 according to epidemiological weeks.

He explained that there are few roles of HIV Unit where they are involved in death caused by AIDS. HIV Unit are responsible sterilising the deceased,gaining permit for burial, and recording through E.Notification which is called as National AIDS Registry (NAR).

Briefing by HIV Unit went on for almost an hour and ended with Q&A session with Mr.Johari.

Around 4.15pm we starte dwith briefing by Mr Rosli b. Abdul Halim on TB Unit. 

Briefing by Mr Rosli b. Abdul Halim

Briefing was starte dwith introduction of group members and quickly we went into notification system which is done through E.Notification. TB Unit has its own written notification system which is called as TBIS. 

Briefing on TB Unit went on for almost an hour. We gathered adequate information through Mr. Rosli. He was kind enough to provide us some of the documents which is used in recording and notifying TB. The session ended around 5.00pm....And of course we learned alot......

By,

Povaneswaran @ Vanesh

Day 7, Tuesday, February 22, 2011, Kuala Muda DHO

Today at 9.00 am ,we were brought in to Unit Keselamatan and Kualiti Makanan by PPKP En.Firdaus. We were briefed about the function of this unit and its role. The Food Act 1983 gives them power to inspect, check any food premise at random. They will also check label, expiry date, manufacturers address on the food product that is been sold at the shop. Mr.Firdaus explained that they will buy 3 food sample from the shop. One of the sample will be sent to Penang Chemical Lab for sampling, while another sample will stored by the unit. Another sample will be given to shop owner if in case the shop owner is not satisfied with test result and decided test at any private chemical lab. 

For shop which serves food, there are few criteria that PPKP checks such as cleanliness, Anti-Typhoid vaccination for workers who serve food. If the workers are not vaccinated, they are given 1 week notice to get vaccination. During the inspection of the shop, the shop will be graded by demerit marks. If the premise scores below 70 marks,  the shop will be ordered to close for 2 weeks. 2 weeks time is given for the food premise owner to correct their mistake. Failure of the shop to close will result in law suit by the court. After 2 weeks, PPKP will come again to inspect where the shop will allowed to open if the fulfill all the criteria.

          For one year, the Unit must take 700 sample from new product, product with  history, and international product.  But PPKP emphasize more on international product for sampling.      

          After the briefing, we followed 2 PPKP members for health inspection in Makbul Restaurant. Cleanliness in the kitchen and store are satisfactory. But the food servers are advised some small adjustment they have to do. The PPKP also checked whether all food handlers are immunized with the Anti-Typhoid injection, and to be issued this card by the DHO. This vaccine will last for 3 years once given, so if after 3 years the employee is still handling food, he/she has to receive another shot of Anti-Typhoid. The Makbul Restaurant was given 78 marks and the demerit marks are given based on this form, Borang KKM-PPKM-2/09.

Time: 2.30pm

Venue: G-mart (Taman Petain Jaya)

Topic: food sampling

Personnel in charge: PPKP En. Firdaous and his colleague

Objectives:

1.  - ensure that food sampling should be conducted under food act 1983 and food rules and regulations 1985.
2.  -Basis and method of product inspection and confiscation
3. -Methods of sample collection

Food sampling protocol includes:

Ø  Field visitation with PPKP personnel, the PPKP uses his/her identity and certification card to make clear the account of visit.

Ø  Inspection and choice of the food product needed to be sampled follows the below mentioned criterion.

Ø  Payment is to be made to the owner of the store in accordance a receipt is also made

Ø  Collection of three samples from each product for analysis

Ø  Products are labeled and sealed

 

Criteria involved for inspection of food products:

-           

Pre  Previous history of  any suspicious product sold in market

-          International products

-          New products in the market

About 700 products are inspected in a year using per product based system where goods are picked and chosen by the food quality and safety department. Sites where inspections are carried out pertain frequently to sundry shops, schools and supermarkets. 

  

 sample that was confiscated

Three samples of the same product confiscated are initially purchased and labeled using MOH formal tag. Of which, one sample is to be sent to the Jabatan Kimia Penang (chemical plant) for analysis, the second remains within the site and given to the store owner, the third is taken back to the office of PPKP. All three are relabeled and given identification number. The public is not informed about the confiscation of the marketed product to avoid discrepancy.

The sample sent for chemical analysis checks to see the addition of substances such as aflatosin, PTZ, benzoik/ sorbit, okratosin, proximate, preservatives /additives, level of contamination etc.  However a microbiological analysis evaluates bacterial contamination commonly from sources such as E.coli, Bacillus, and Staph. aureus. 

    PPKP Personnel adjusting proper identity tag and label

  A product labeled and sealed to be sent for chemical, physical and microbiological analysis

Our exhilarating session came to an end at about 5pm in the evening. Even as the scorching heat and the excruciating Sungai Petani weather made us tired, our spirits were rather heightened. A truly fun filled experience!!

DAY 6 - School Health Programme and Antenatal/Postnatal Care!

Good morning…our day started of at 9.00am at Klinik Kesihatan Bandar where we all gathered before heading off to Sek Keb Saraswathy.

the Pejabat Kesihatan Van which carried all  the vaccines and the nurses...

When arrived we headed to the Bilik Sains where the nurses were already performing the physical examination on year 6 students which consist of :

Looking for lice in their hair

Measuring their BMI( where if BMI>3O, they will be referred to PZM for diet counseling)

Visual test

Look for previous BCG scar( whereby if it is absent the student will be re vaccinated again) –absent BCG scars are most commonly seen among the immigrants.

Their cleanliness observed and lastly systemic review is conducted noting for patients with Bronchial Asthma ( ask if they are using inhalers), heart diseases and ect.

All these will be recorded in the blue book ( Rekod Kesihatan Murid).

the Rekod Kesihatan Murid book

 

in the Bilik Sains listening to the briefing  by sister Busroh

The components of the examination

The consent signed by the parents

with Sister Busroh (lady in blue)

in front of the Bilik Sains

Year 6 children will not be vaccinated excluding the children with absent scar. They will be briefed on the HPV vaccination which will be given to them next year ( form 1). After  the briefing,  a consent form will be handed to them  to get the permission  from their parents allowing them to receive the vaccination.

The HPV vaccine was introduce in Kuala Muda early this year for form 1 students where it is divided into 3 doses which is at 0,1 and 6 months.

Students being examined by the nurses

The lice medication which was given to the students with lice..

The lice medicine!!

Furthermore, all the girls and boys who was having lice were given the lice medication and the children were advice not to eat the medicine, to store it in a safe place which is away from their younger siblings and to put it on their head without applying oil and to leave it on their head for only 4 minutes as longer than that will cause their hair to fall. 

After examination, we all took a break as the next session will be for the afternoon session students where we will be giving vaccination to the standard 1 students.

During our break time after the morning session at Sek Keb Saraswathy, all of us went back to MCH clinic at KKBandar for the antenatal and postnatal session.

Here we met with sister Mariam who was a real jovial person thou she was upset with us for interrupting her break time ( haha). While joking with us she advised us on all the important things for us to know during this session and its significance. She really stressed on the significance of each antenatal assessment stating that as a future doctor it is very important for us to really understand it.

Entrance to the MCH clinic...

Sister Mariam

She basically recapped on all the antenatal assessment which we studied during our Obs and Gyne posting in 3^rd year,including the history taking and obstetric examination for the mothers..

She said that  the history taking would be more reliable if it was taken from the patient's parents itself…as careful assessment of the previos history and family history of the patient would help to exclude inherited diseases like Diabetic mellitus,bronchial asthma,cardiac disorders and hypertension. After the briefing we were asked to observe the clinic. 

The registration counter

The antenatal record books..

A mother being examined during one of her antenatal visit...

The Obstetric calender used to determine the Expected Date of Delivery of the mother..

In the lab where the urine and blood sample is being investigated  by Encik Mazuki (the lab assistant)

The HbA1c level is measured using this device

The hemoglobin level is detected using this device..

Outside the lab where mothers put their urine sample into the basket  out there!

We left the MCH clinic around 12pm to have our lunch break....
After having a break in Old Town Kopitiam, we gathered back in the school at sharp 2pm. We were all very exited to meet these young kiddos who are extremely afraid of needles.

The nurses have just arrived at the Pusat Sumber in the school where the vaccine will be given to the students!

Preparation of the vaccines!

Getting the needles ready..

The yellow  bins where the needles will be disposed..

The children just arrived and they were given their RKM books..

The class teacher was explaining to the students about the vaccination and they were told to  swallow the oral polio vaccines and not to spit it out!!

These children will be given 3 types of vaccination on the same day:

DT( Diptheria Toxoid and Tetanus Toxoid ) ( 0.5ml i/m)

Measles vaccine( 0.5ml s/c)

Oral Polio vaccine (2 drops)

we were giving them 2 drops of polio vaccines each

The oral polio vaccine ( 1 bottle can be used for 10 students only)

The subcutaneous vaccine which is being given by the nurse!

ALL THE CRYING STUDENTS THAT WE HAD:

Consulting the crying students...

We were  holding the students so that they would not push the needles away!!

 ALL OF US WERE GIVEN THE CHANCE TO HELP VACCINATE THE STUDENTS!

Most of us were anxious to give the injection- as it was our 1st time!

giving the intramuscular injection..

1 of our grp member giving the i.m injection also...

The children were also given 1 tablet of panadol-to be taken at home!

Children without the rekod kesihatan book and without parents consent will not be given the vaccine on that day…all these children including the ones absent will be given the vaccines later on.

With the presence of the old BCG scar, the BCG vaccine will not be given...

The BCG vaccines are stored in a cold chain box 

DT vaccine- given i/m ( on the left hand as it is painful)

The Measles vaccine given s/c ( on the right hand as it was less painful)

Our day ended with great satisfaction at about 5.30pm. We gave vaccines to 5 classes of standard 1 students. Therefore it was extremely tiring yet we enjoyed it...!!!

by J.R.Ranjaylina and R.Karthiga....