Monday, January 19, 2009

Full report of DHO

23 January 2009
DHO Padang Terap
Group E

1) Unit NCD (4th January 2009)

We had a briefing session with the Head of Non-Communicable Disease Control Unit (Unit Kawalan Penyakit Tidak Berjangkit).In the session we were introduced to the unit's aims and objectives besides briefing us the various programmes targeted at the community to increase awareness about non communicable diseases.


AIM : To bring awareness about lifestyles which can lead to diseases

To restore health of the individual and community

OBJECTIVES : 1. Identify NCD among community and health workers at risk

2. Create awareness about lifestyles that increases the risk of NCD through education, support groups and law

3. Provide CME training on occupational health to health workers

Targets : 1. Diabetes

2. Cardiovascular Diseases

3. Hypertension

4. Smoking and smokers

5. Cancer

6. Substance abuse


CVD Screening – Screening is done to detect cardiovascular diseases in all patients who come to the chosen Klinik Kesihatan(example klinik Kesihatan Naka). This activity was first started in 2007 and the supply of equipments needed for this screening programme is taken from the Kedah's Jabatan Kesihatan Negeri

Stop Smoking Campaign – This programme which is also known s Kempen Tak Nak is divided into two sessions; first to the health workers and second to school children. Through this programme, the targeted groups are educated on ways to quit smoking.

Control of Tobacco Products Act 1993 – This act restricts or prohibits smoking at public areas, direct advertising, and tobacco sales to anyone under the age of 18 years old. This act also requires health warnings stated on cigarette packs. Enforcement of this act in Padang Terap is done by issuing compounds to individuals who have been found smoking in "no-smoking" zone

2) Unit Vector ( 5th January 2009)

The vector unit was one of the more interesting sub-postings we had during our visit to the Kuala Nerang Health Office.

Before setting foot to the field of work- we were briefed by Encik Muhd. Zain, the Head of the Vector Unit, on the outcomes of the vector unit.

He explained to us that he was in-charge of all cases concerning Malaria, Filiarisis and Dengue. Now with the existence of Chikungunya, it has been listed under his department.

He explained how that with the help of the Vector Unit, the cases of Filiarisis and Malaria has dropped drastically to a near zero at Kuala Nerang. The only problems they still faced were Dengue outbreaks. In 2008, 155 cases were reported and he showed us how Dengue had a cyclical pattern as far as annual cases were reported.

He explained the process of reporting from the time the MO makes a report to the time where fogging is done.

He gave us the outlook scenario from the time the MO reports a clinical diagnosis of Dengue within 24 hours, the hospital will key in into their new online system called VEKPRO. They will receive the reports on a daily basis and then investigate accordingly. If they receive one complaint from that area, they will investigate that area.

Upon investigation they will start the fogging activity. They use 2 main materials for fogging- a fogging machine for indoor purposes and another called ULV@ Ultra Low Volume.

We were explained on it further at the field site where we went to Kg Lubok at around 5.30 pm. We were given hands on experience on how fogging is done and the procedures. We were also told about the differences on fogging and ULV and how effective they are.

We were clearly shown the difference between the methods and also various ways of informing the people of the surrounding area.

We were also privileged enough to go on the Dengue checks at a near-by FELDA area. We were shown step by step how to approach the house-owner and do check and how to detect areas that could contain larvae. We were also educated by those experience officers on how to determine Aegypti and Albopictus larvae from Culex larvae. We were thought how they took samples for larvae testing and the procedures and forms to fill in stating that a collecting sample has been done and how a compound is issued.

Overall, it was an interesting unit posting that we all enjoyed. The unit vector offered us full co-operation and we were informative to all our questions posed

3) Unit BAKAS ( 6th January 2009)

We assembled in the Pejabat Kesihatan Daerah Padang Terap meeting room for a briefing session at 8.30am on 6th January 2009. We were introduced to the aims and objectives of the unit. After a short session, we were then brought to different kampung in Padang Terap to show us the various water and sewage system used.

All 12 of us were taken in two Land Rovers to the kampung. At the first kampung,w e were shown the ' system pelupusan air limbah (SPAL)' or also known as water sullage system. For this system, the materials and guidance will be provided to the community and then they would build the system for their respective houses.

We were also shown "tandas curah" system whereby the toilet is connected to a pit latrine for the disposal of waste products. The materials for the construction of 'tandas curah' are provided but the villagers would have to build it themselves.

We were then taken to view the 'sistem telaga air pam terkawal' which is aimed at supplying water to the areas that do not receive clean water supply from pipe.

Finally, we were taken to Puncak Janing. We were shown 'sistem tadahan air' which catches rain water to supply rural areas around with clean water .



To reduce the incidence of communicable and vector-borne diseases associated with poor sanitation in the rural and urban areas through improvement & upgrading of environmental sanitation and wholesome water supply system.


§ To promote the construction and use of sanitary water supply and excreta disposal systems through the provision of technical assistance for the design of such systems using technology which is appropriate and acceptable to the community.

§ To supply of equipment and materials for the construction of these systems and facilities by the communities on a community participation basis to ensure acceptance, utilization and maintenance by the communities.

§ To give priority to areas and communities identified to be at risk.

§ Collaborate with relevant Federal/ State/ Local Government/ Voluntary organisations in providing safe drinking water and adequate sanitation facilities/services to all.

§ To carry out health education to promote adoption of sanitary/hygiene practices by the public.

§ To establish and maintain a proper surveillance system to :

§ ensure that sanitation facilities in use are properly maintained.

§ ensure sanitary water supplies through periodic inspection, water sampling and monitoring of follow up remedial action

§ monitor progress of programme.

Component :

1.Proper water system - paip connection system by KKM/JKR
- Gravity Feed System or GFS (sistem bekalan air gravity)
- sistem tadahan air hujan

- system telaga air pam terkawal

2. Proper sanitation system

- sistem Tandas curah

- SPAL, system pelupusan air limpah (water waste disposal)
- SPSP, system pelupusan sisa pepejal (solid waste disposal)

4) Unit CDC ( 7th January 2009)

Communicable Diseases including:-

  • Dengue
  • Malaria
  • Tuberculosis
  • Leprosy (Kusta)


Ø Padang Terap had a few cases of Dengue and Chingkunya. Padang Terap District Office was notified about these cases and DHO people were took further steps to go for forging in that area.

Ø We went together with them for forging at evening.

Ø We also went to few places like Lubok Merbau for inspection of Dengue larva. We experienced on how to collect larva.


Ø For Malaria, we didn't have any cases. The DHO people briefed us on Malaria.


Ø DHO will receive form 10A1 from hospital regarding a new case and DHO will record in a book about the details for register and reference purposes.

Ø In TB cases, its compulsory to do HIV test especially young adults.

Ø They will refer to the ward 1-2 weeks (intensive treatment). (DOTS)

Ø Reasons for default of treatment in Padang Terap:

Ø Clinic is far away from house

Ø No transport

Ø Side effects of medication

Ø Chores to do

Ø Change of address

Ø Most of cases here are aged between 30 and above.

Ø Last year got 33 news cases.

Ø If TB patient under treatment die or patient die in the house form 10J will be filled by these people.


Ø Give education and counseling to patients

Ø Goes to their house whenever gets call and continuous to go until the patient stop defaulting.


Ø Screening

Ø Increase rate of default due to stigma

Ø 7 cases were identified

Ø Pusat Pengurusan HIV in Naka

Ø Pra- perkhawinan – HIV test before marriage

Ø More cases of HIV due to drugs, sexual transmission and also through vertical transmission

Ø Every months fill up complication form

5) Unit UPK (8th January 2009)

Well UPK or unit promosi kesihatan basically focuses on educating the community. This unit plays a role on giving information about new diseases that's affecting them. However this unit does not work by itself but works in combination with various other units in promoting health. The main focus of UPK in Padang Terap is based on PROSTAR. So what's prostar and how it works we'l see now.


Prostar was first established in 1996 and it's clubbed under the health ministry. This unit focuses on the problems faced by the teenagers in the district. Some of the topics that they've focused so far are like

Ø Drugs

Ø Hiv/Aids

Ø Gangsterism

Ø "ponteng sekolah"

Ø "memberanteras budaya melapak"

Ø "mat-rempit"

Some of the programs held are like trip to langkawi for selected school students from Padang Terap. This students are those with problems that are selected by the school teachers and handed to the prostar. During the trip there are various activities conducted . some of them are,

* Seminars on how to have a healthy and productive life.

* Talks on how to overcome problems in life and focus on studies.

* Talks on the danger of drugs and HIV/AIDS

* Sports and games

The objectives of the PROSTAR is to shape the students towards better life. As student today are the leader of tomorrow PROSTAR is doing a very good job.


v Health carnival

v Quiz kesihatan

v "senaman pagi" morning exercise.

v KOMBI (dengue)

v Screening programs and more


6) Unit KMAM ( 8th January 2009)

The Kawalan Mutu Air Minum (KMAM) seminar was conducted by Encik Mohd Ali at Jabatan Kesihatan Padang Terap. He touched on various topics like :

1. Duties in KMAM

a) to conduct water sampling for microorganisms, short and long chemistry tests and pesticides.

eg: microorganisms - E. coli

physical testing - pH, turbidity

short chemistry test - Al, Fe, Cl, Fl

long chemistry test - arsenic, Cu, Zn, Mg

These tests are done on treated and untreated water. Treated water samples (eg: from the loji) are packed with a sodium disulphate tablet to neutralize the chlorine, while untreated water samples (eg: from the river) does not need any preservatives

Sampling is done at kawasan tadahan air, loji-loji and fields and estates

Labeling of the samples need - Date, Time, Place, pH, residual chlorine

b) to report and conduct investigations in any deviation of water quality control

c) to help in educating people about the importance of good water quality

2. The water flow network of Padang Terap (pic)

Basically :

River ----> treatment plant outlet-----> service resevoir outlet -----> sampling station -----> building (eg: hospital)

We also saw the various equipment for testing the water samples like the turbidity sensor (if the reading is >5, the turbidity is bad) and the chlorine sensor

7) Unit Kesihatan Primer ( 11th January 2009)

In the morning, we were briefed by Encik Haji Roshidi regarding primary healthcare. There is 1 Hospital, 3 Klinik Kesihatan and 12 Klinik Desa in the Padang Terap district. He also explained the aspect of healthcare offered in these clinics which mainly includes maternal and child care as well as an outpatient department. The Klinik Kesihatan consists of a doctor, a head nurse and a number of nurses and medical assistants according to its need. However in the Klinik Desa, usually only 2 nurses (jururawat masyarakat) are present, sometimes more are needed if the clinic is busy. There are 2 type of Klinik Desa, a regular one and one with quarters for the staffs which is otherwise known as Klinik Desa 2G. Of the 3 Klinik Kesihatan, one of it (Klinik Kesihatan Kuala Nerang) does not have an OPD.

In the afternoon, we were taken to Klinik Kesihatan Naka. We were briefed by Dr. Low about the set up of the clinic, which consists of an Outpatient Department as well as a maternal and child care clinic. In the OPD, we were able to see the various equipment used, although not up to date, was sufficient to treat patients. Dr. Low claimed that there are not many patients that attend the clinic and it leaves him with ample time to study. Emergency cases that arrive are immediately stabilized and sent to the nearby hospital as soon as possible. Although certain resuscitative equipments may not be available, the doctor has to improvise and try his best to stabilize the patient's condition. There is also a dispensary together with the OPD.

The maternal and child care clinic is another building by itself. There are various services provided which is mainly booking, antenatal visits, family planning and many more. The clinic is also equipped with an ultrasound machine. There are various pamphlets available to educate mothers regarding motherhood. The clinic also organizes various campaigns for mothers, which include safe motherhood, education on gestational diabetes, breastfeeding, awareness of cancer, family planning and many more.

8) Unit KKM (14th January 2009)

The objectives are:

1) To determine the food produce and process from any sort of food institution is

safe for the public to consume.

2) To detect any false information in terms of quality of food to prevent any dishonesty

among the food handlers and the customers.

3) To evaluate the preparation of food (demerit system)

Demerit system.

- If less than 60% of the total marks than, the food handlers got 2 options;

· To do the necessary things or suggested ideas to upgrade the deficient facilities within 14 days.

· To close the shop if do not agree with the terms and condition.

- If the changes are done within 14 days, than re-evaluation will be done to re- asses the

food handlers.

- In case of school canteen, the canteen owner which received less than 70% of the total

marks, will have to close the canteen.

- Sometimes, even if the marks are high, if the water is untreated then the canteen owner

still have to close the canteen.

Care of the food.

- Educate the food handlers on the nessacity to separate cooked food from raw food.

- Wash the raw food before cooking

-Use clean kitchen utensils

-Store food in a clean containers.

Food poisoning.

- If there is cases of food poisoning, that particular food institution have to be closed

down and investigation will be conducted.

- To prevent food poising, the food handlers have to undergone a short course for 1

week & besides that, they also have to receive an anti- typhoid injection (TY2) which

should be renewed every 3 years.

Hazard Critical Control Point (HACCP).

- Normally it is conducted in the factory but critical control point will be evaluated in the

food premise.

- This is important in terms of assessing the food quality.

- Plays an important role in determining which steps of preparing the food that

went wrong in cases of food poisoning.


- The food premise is check at random.

- Food samples that have been taken depends on the food alert.

- The food samples which have been taken in a sterile bag and sent to the lab for


- A warning and compound will be given to the food handlers which have broken certain

laws based on a form KMM 3P2 which asses:

· The food process

· The food handlers

· Kitchen utensils

· Water supply

· Washing hand facilities

· The floor, wall and ceiling

· Garbage disposal facilities

· Pest


- Must be visible.

- Must be in a common language

- Must include:

v The real food content

v List of ingredients

v Address of the distributor

v Statement on the additives added into the food.

v Origin of the food (Product of which country)

v Date process and due date.

Export and Import.

-Check for the physical sample before distributing the food to the public.

- Check for the food source.

- Laws are based on the Food Act 1983.

Sunday, January 18, 2009

Primary health care in DHO Kota Star

DHO Kota Star
Group A
14January 2009

A small lecture was taken by Senior Medical Assistant Chong regarding primary health care. He started by showing us the mission and vision of the KKM. He then went on to discuss the 8 goals of primary health care.
  1. Wellness focus - treatment which is focused on provide lifelong health
  2. Individual focus - individual focus treatment which should be on time and in the right place
  3. Informed person - providing information through health education to allow a person to make decisions regarding one's health
  4. Self help - increasing the ability of the individual to take care of his own health
  5. Care provided at home or close to home - using a multimedia service to allow virtual service at home or community centres
  6. Coordinated, conscious and seamless care - providing a complete health service which caters for all levels of life
  7. Service tailored to individual or group needs - provide proper service needed by particular individuals or groups
  8. Effective efficient and affordable servicee - Effective efficient and affordable service for the whole community
Thus one can describe the primary health care as

  • Essential health care
  • Based on practical, scientifically sound and socially acceptable methods and technology.
  • Made Universally  accessible to individuals and families in the community by means acceptable to them
  • It forms an integral part of the country’s health system
  • It is a central function and the main focus of the overall social and economic development of the community.
  • At a cost that the community and the country can afford to maintain at every stage of their development in a spirit of self reliance and self determination.
  • It is the first level of contact of 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 constitute the first element of a continuing health care process.
The elements in primary health care service are
  • Health education,
  • Food supply and proper nutrition, safe water and basic sanitation,
  • Maternal and child care, immunisation
  • Family planning,
  • Mental health
  • Prevention and control of endemic diseases,
  • Basic treatment of health problems
  • Provisions of essential drugs.
The role of a health personal in the primary health care is

  • Health advocator
  • Counselor
  • Team Player
  • Call-Center Manager
  • Clinic Practitioner
Subsequently we discussed regarding the change which the primary health care service has underwent. The 1st change is from a 3 level to a 2 level system - which has Klinik Desa and Klinik Kesihatan. The changes are a result of the addition of supporting goals in the 9th Malaysia Plan

Primary Goals

  • Prevent and Reduce Disease Burden
  • Enhance Health Care Delivery

Supporting Goals

  • Optimisation of Resources
  • Enhance Research
  • Manage Crisis and Disasters
  • Strengthen Health Information MS
Description about these goals

Prevent and Reduce Disease Burden

  • Treat the ill
  • Manage those with risk
  • Prevent the onset of preventable risks

The aim of reducing the disease burden.The primary health care now has to pay more attention to the 'with risk' and 'potential risk' groups.

Enhance Health Care Delivery

  • Fast Access
  • Safe and high quality
  • Hassle-free and better comfort

Optimisation of Resources

  • Multi-skilling
  • Sharing
  • Remote management

Enhance Research

  • Participate towards evidence based planning and intervention

Manage Crisis and Disasters

  • Increase HR capacity and capability
  • Adequate and appropriate facilities
  • ‘Current’ protocols for management

Strengthen Health Information MS

  • Reduce repetitive request
  • Increase safety through reducing error
  • Enhance sharing of data and info facilitate continuity of care

The following are the services which should be provided by the primary health services. The bolded entries have been added after the 7th Malaysian plan.


  • Maternal
  • Child
  • Adolescent
  • Adult
  • Geriatric


  • Acute
  • Chronic
  • Infectious

Emergency - Support

  • Pre-hospital
  • Call centre
  • Rapid Response

Support Services

  • Pharmacy
  • Pathology
  • Radiology
  • Rehabilitative

An intergrated system of clinics

A proposal for the way patients are treated in the primary healthcare setting

The powerpoint sildes given Mr.Choong- phc Kota star

activity group B 12/1/2009

Immunization in a school by Group B attached in DHO Kuala Muda