DHO Kuala Muda - water supply and primary health care

DHO Kuala Muda -Primary Health Unit

15/1/2009 9am-11am by PPP(K) Dr Yusof ( penolong pegawai perubatan kanan PKD kuala muda)

8 Goals of Primary Health

1.Wellness focus-supply life long health services
2.Personal focus
3.Informed person-promote knowledge through health education
4.Self-help-Improve individual's ability to assess own health status
5.Care provider-at home or close to home
6.Coordinated and continous seamless care
7.Services tailored to individual/group need-special services to fulfill the need for individual & group in certain situation.
8.Effecive, efficient & affordable service.

5 Concepts of Primary Health Care

1.penjagaan comprehensive
2.Universal access & coverage especially health promotion
3.Health equity as part of development related to justice
4.Community participation in defining & implementing health agenda
5.Intersectoral approaches to health

Health services 'asasi'

1.Health education
2.Food safety and nutrition
3.Safe water supply & environment sanitation
4.Maternal & Child's health
5.Immunisation
6.Prevention & Control of endemic disease
7.Treatment of minor ailment & injury
8.Essential drug supply

New Health services

1.Family medicine
2.Geriatic health, teenager, women
3.Home treatment
4.Rehabilitation
5.Mental & community health
6.CDC
7Worker's health

Briefing on KMAM ( Kuality Mutu Air Minum)
by: PPPK Mr Selva on 1130am

KMAM - undergo activities that control the water quality supply the state

Objective - ensure the water supply is safe and sufficient

Main programme
1.Quality control
2.Testing the cleanliness of water
3.Proccesing and evalutaing data
4.Restoration action
5.Institution investigation

There are 67 stations and 7 Logi in Kuala Muda.

Unit Kawalan Penyakit Bawaan Vektor DHO Kuala Muda

Group B

DHO Kuala Muda

Date: 13/01/2008

Our group, group D, met up in the bilik gerakan of the Unit Kawalan Penyakit Bawaan Vektor of Pejabat Kesihatan Daerah Kuala Muda at 9.00 a.m. We were addressed by Mr.Nordin bin Omar, the Penolong Pegawai Kesihatan Persekitaran Kanan of the unit. He is in-charge of the Control and Surveillance division of the unit as well. After that, Mr Burke Patrick Lumuria, who is one of the Penolong Pegawai Kesihtan Persekitaran of the unit, gave us a briefing on our surveillance trip of the day. It was an Aedes Surveillance to be done at locations where dengue cases were newly reported.

Surveillance team were sent to 4 locations: Jalan Sekerat, Kampung Sungai Jagung, Bandar Laguna Merbok and Gurun. Group D was divided to two teams, consisting of 6 members each, which followed the Bandar Laguna Merbok and Gurun teams. At 10.00 a.m., the teams followed the unit jeep to their respective locations.

At the location of each team, the house of the patient with dengue fever was identified and surveillance for Aedes mosquito breeding spots was done in houses within 200m radius from the patient's house. The group of six were again divided into 3 groups and each two members followed two unit officers for the survey. In each house, possible breeding spots (clear, stagnant water) were checked inside and outside the house e.g. decorative pots, fish ponds, bathroom pails,etc. ABATE 500 SG was put in possible breeding spots found. Announcement of fogging in the evening was made in each house and a pamphlet of the disease was given. The survey lasted for about two hours in both locations, and at the end of survey both teams reported of finding Aedes mosquito larvae in few of the houses surveyed. The unit officers explained that malarial virus is commonly found in estates while filiriasis virus in swamp areas.

After lunch break, at 2.30 p.m, Group D members met up again in the bilik gerakan of the Unit Kawalan Penyakit Bawaan Vektor of Pejabat Kesihatan Daerah Kuala Muda. Mr.Lumuria gave us a short talk about vector borne diseases and how the unit function in actively preventing the spread of vector borne disease in the district. He also briefed us about the various detection methods, investigations done, notification and summons charges as well as management of the disease spread (fogging). Some interesting facts given:

• An outbreak for dengue is described when 2 cases are detected within 2 weeks of detection of the first case.
• An outbreak for malaria, on the other hand, is described even with detection of one case in a location.
• He also told if both cases are not within 200m radius, then it is NOT considered as an outbreak.
• Compound charges start from RM100 for domestic household, RM150 for schools, RM300 - RM10,000 for factories, etc.
• In apartments, fogging done from top most floor to the ground floor because mosquitoes could travel through the lifts!

After the talk, Mr. Lumuria took us to see the mosquito larvae collected by one of our team members: it was an Aedes albopictus mosquito larva. Also, he showed us the fogging machine AF-35, used in fogging within radius of 200m. There is also the Ultra Low Volume fogging which is done at 400m radius for the house where the case detected. He explained how they work and the various fogging agents:

Type 1 – dangerous, Type 2 – malathion (organophosphate). Type 3 – resigen, Type 4 – domestic insectitide (ridsect)

The agents may be water or oil based but, the interesting fact is that, oil-based is more used, though both are equally effective, because the public believes a smoky fogging method is more effective!

After the talk, at 5.30p.m., the group members were divided into two teams followed the fogging unit for fogging in two locations: Jalan Sekerat and Kampong Sungai Jagung.

At the locations, the fogging team head, Mr.Josli first announced about the fogging in each household and surrounding areas. Food items were told to kept closed and members of the family were told to be outside their homes for 30mins after fogging. After that the team members followed the unit officers for fogging. The ULV team did the fogging in the surrounding area first, and then fogging using the AF-35 was done inside the houses of the location. Man, was it smoking! With that, at 7.00p.m our team members called it a day.

Bekalan Air dan Kesihatan Alam Sekitar in DHO Kota Star

Date : 14 January 2009
DHO Kota Star
Group A

The Bekalan air dan Kesihatan Alam Sekitar(BAKAS) is led by PPKP Md Zaki. BAKAS mainly covers aspects, they are – water supply, solid waste disposal, sewage and toilet and waste water disposal. The function of BAKAS is to build the above necessities in the various villages. Their focus is mainly in the villages and not in urban areas. The programme was launched to reduce the spread of water and food borne diseases.

The objective of the unit is to is to increase the quality of the water in the rural areas and to reduce the number of food and water borne cases. Activities performed by the BAKAS unit include the following

• Reorganizing the data of villages at risk
• Providing qualified houses with Sistem pelupusan air limbahan(SPAL)
• Providing qualified houses with Sistem pelupusan sisa pepejal(SPSP)
• Providing qualified houses with Water supply JKR/KKM project
• Providing qualified houses with Tandas curah
• Choosing 1 village for an integrated SPAL system
• Joining all activities done by the inspectorate unit
• Attending courses to improve knowledge
• Participating in sports and other activities

The water supply project’s purpose is to provide enough clean water supply to the rural population. The project uses simple principles while focusing on a good design, and building and easy maintenance. Sanitary toilets aim at creating a system where by fecal matter can be disposed in a proper way to avoid the spread of disease. The materials needed to make these toilets are provided by BAKAS to those whom are unable to purchase them. Initially the waste water management system and solid waste disposal systems were not given much attention because the unit focused mainly on water supply but currently there is a lot of focus in this area due to its importance.

There are various types of water supplies available. The choice depends on the availability of JKR water supply, affordability and water source. If there is JKR water supply with good pressure then BAKAS merely provides pipes which are then used to connect the main pipes to the houses. This project is a collaboration between JKR and KKM. The cost for the resident is RM 500 which includes the deposit and the pay of the contractors. If there is a water source from the mountain then a gravity feed is created. If there is no other water source available then the underground water source will have to be used. This source is harnessed by a pump which can either be manual or electrical.
Plan for the JKR KKM project

The SPAL system is a system where the water used for washing is removed and channeled to a filter before being release. Before the introduction of this system the water would stagnate and flies and other vectors would breed. This new system can reduce the incidence of food and water borne disease while making the village look better. The system starts at the sink where the water is channeled to a filter near the house. The water from here is then channeled to another collectiopn point where water from three houses meet. This water then passes through another series of filters before being release into a river. upon inspection the system revealed a small problem - if the filter near the house was not cleaned then the whole SPAL would be clogged leading to breeding of vectors. Thus co-operation form the villagers is also needed for the project.

Sistem pelupusan air limbahan(SPAL) which is being constructed

Filtering system in SPAL

The SPSP system waste designed to avoid vectors from breeding in the garbage produced by the village. It is a simple system where the garbage is stored in a large concrete cylinder which is kept closed. When the container is full then rubbish inside is burnt. The problem arises when people are ignorant and still continue with their old ways. There is also a problem where the concrete will start to crack is things like wood are burnt.

Sistem pelupusan sisa pepjal(SPSP)

The ‘Tandas curah’ system was developed for sanitation of the people. It avoids the spread of disease by avoiding contamination of water sources by fecal matter.

Tandas curah
Plan of a tandas curah

The allocation of material for the BAKAS unit per year is around

• Tandas curah – 30-40 units
• Sistem pelupusan air limbahan(SPAL) - 100 units
• Sistem pelupusan sisa pepejal(SPSP) – 90-100 units
• Water supply – 100 units

BAKAS aims at

• Reaching 100% water supply in rural areas
• Preparing utilities which aer suitable for the use of the villagers
• Making sure that all utilities provided work efficiently
• Improving all aspects of hygiene in rural areas