Aimst University M.B.B.S Community Medicine and District Health Office Posting
MBBS Batch 5&6 District Health Office Posting in Baling, Kedah Darul Aman
Week 1(19/11/2007-22/11/2007)
Introduction
Hi everyone,
Let me first introduce my group members who were posted to Baling for our District Health Office posting from 19th November 2007 till 13th December 2007. Our group is headed by Chng Kay Ly and we had a fabulous and wonderful time there.
From left to right: Chng Kay Ly (leader), Charlotte Marie, Cheah Boon Eu, Jeevan, Deva Vinod and S. Dinesh
Hereby, I shall bring you to what we had done in our first week of our posting in Baling.
MONDAY 19TH NOVEMBER 2007
We reported to Pejabat Kesihatan Daerah Baling(District Health Office) to KJK Maznah Hussin and FMS Dr. Delima Kalsom binti Abdul Wahab.
We later left for Klinik Kesihatan Kupang and was introduced to FMS Dr Zamri Mansor and the medical officers.
Dr Azira, one of the medical officers, later briefed us on the various departments that are available in the clinic. Among those available are the pathology laboratory, pharmacy, computer room, library, dental clinic, psychosocial rehabilitation (PSR), immunization room and many more.
The above photos are taken when we were posted at the District Health Office and Klinik Kesihatan Kupang; respectively.
TUESDAY 20TH NOVEMBER 2007
We reported to Klinik Kesihatan Kupang. Our topic of study for the day was Maternal Child Health (MCH) and Family Planning.
We were separated into 3 pairs and were assigned cases pertaining child heath, maternal health and family planning. The cases clerked were later discussed with the Family Medical Specialist (FMS) Dr Zamri.
Jururawat Kesihatan Umum Haliza taught us the process of booking and we were allowed to perform booking for the patients under her close supervision.
We also discussed with him the advantages and disadvantages of family planning, the criterias available and he diligently taught us about the history taking of family planning.
In the afternoon, we had a brief class on psychosocial rehabilitation(PSR); again by Dr. Zamri.
The photos are taken in Klinik Kesihatan Kupang during our MCH posting where antenatal check-ups, child healthcare and family planning were taken place. The first photo was taken when one of our group member were given an opportunity to book a pregnant lady with the gestation of 15 weeks. The photo on the right is taken during a child (at age 1 month) follow-up and the mother of the child also came for postnatal check-up and family planning dine by the staff nurse present.
MCH
MCH or better known as Maternal and Child Health has its own objectives as:-
- To provide care and consultation to mothers during pregnancy
- To screen women at potential risk of complications and difficulties throughout the three trimesters
- To diagnose complications and plan treatment early
- To reduce maternal apprehension regarding delivery
- To reduce maternal and infant mortality and morbidity
- To educate mothers regarding the available opportunities of family planning and the advantages and disadvantages to adhering to such programmes
- To educate mothers about proper personal hygiene
- To help mothers understand the need of proper care and proper environment for optimal health of infant
Antenatal
Regarding "Booking" which is done for pregnant women who had their first check-up, it is normally done by the Community Nurse in Klinik Desa and Staff Nurse in Klinik Kesihatan. In Klinik Kesihatan, a red book and another card is being filled up simultaneously. The red book is later given for the pregnant lady to keep and they were informed to bring during their following follow-ups. There will also be another big record book which is meant to record all the patients who come for follow-up. From there, the nurses will be able to trace every patients for their compliance of follow-ups. As for the card, it will be kept as a copy in the Klinik Kesihatan. In both the books and the card, certain information are being recorded. The personal information, the height, weight and blood pressure were first taken as the vitals. Later, a blood test on Hb level, blood group and the Rhesus were taken. At the same time, a drop of blood will be use to test for the HIV status with the consent given by the patients. A urine test is also taken to confirm the pregnancy as well as to check for the albumin and sugar content in the urine. After that, the patients will be called into a room where a thorough medical examination is performed. During the thorough medical examination, the patient is also taught on how to do a "Breast Self Examination" . After that, the patient is being advised on their food diet as well as some supplements (eg. iron tablets, etc) were given. A date is being given to the patient to come back for the next follow-up. If the patient defaulted the follow-up, the Staff Nurses will go to their house during their "Home Visit" period to follow-up the patients.
Besides that, there is a tagging system during booking. There are 4 different colour tagging - White, Green, Yellow and Red.
White: Patient has no complication during the follow-up of the pregnancy.
Green: Patient has minor complications (eg. Rhesus -ve, history of recurrent miscarriage, Anaemia, etc) and need to see a Consultant with a follow-up date given.
Yellow: Patient has complications (eg. GDM, HIV +ve, etc) and need to seek the Consultant within 48 hours
Red: Patient has complications (eg. Eclampsia, PIH, DKA, etc) and need to seek the Consultant immediately
Postnatal
Postnatal mothers also received follow-up in the Klinik Kesihatan or Klinik Desa respectively. However, those receiving follow-up in the two areas mentioned has to be confirmed by the doctors of any complications. This is also done by the Community Nurse in Klinik Desa and Staff Nurse in Klinik Kesihatan.
Child Health
After a delivery, the new infant is supposed to be follow-uped until the immunization status is completed. The mother of the child will be given a card with a growth chart and the immunization chart printed on it. She have to bring the child to either the Klinik Desa or Klinik Kesihatan for the follow-up. During the follow-up, the height, weight, and the head circumference were measured again either by the Community Nurse or Staff Nurse according to either Klinik Desa or Klinik Kesihatan respectively. Everytime a child is being measured, it is recorded in the card mentioned. Then, the growth chart is being plotted to see whether the child is growing well or not. If the child is coming for immunization, then the a thorough physical examination is done on the child to make sure that the child is healthy before the immunization is given.
PSR
PSR; Psychosocial Rehabilitation is a process to enable and to encourage those individuals with mental problems to achieve independency in the community, so that they are able to take care of their daily needs. In this programme in Klinik Kesihatan Kupang, the individuals are given chances to do sourvenirs, cooking, etc.
Among the objectives for the PSR are:-
- To enable the individual to adjust to attain his optimal level of independence, psychologically, socially, physically and economically.
- To enable the mentally patients to understand and able to control their own illness, achieve their optimal functions and to obtain independency.
The photos above are some of the sourvenirs done by the individuals when they spent their time in the psychosocial rehabilitation. They normally attend the rehabilitation on every Tuesday in the morning. Currently there are less than 10 patients as many of them has succeeded to be more independent and had found a better job.
WEDNESDAY 21ST NOVEMBER 2007
We reported to Klinik Kesihatan Kupang. Jururawat Kesihatan Norolasikhin and Jururawat Kesihatan Hamzah divided us into 2 groups and took us for home visit for postnatal mothers and neonatal jaundice in various villages. Among the villages that we visited were Taman Sri Landak (postnatal 8 days with G6PD deficiency male neonate) and Kampung Seberang Ketil (postnatal 9 days with G6PD deficiency female neonate).
Later, we visited Klinik Desa Kampung Pisang. We helped in the booking process.
Our final visit for the morning session was to Kampung Bendang where we visited a mother in her 20th postnatal day.
In the afternoon, we were given a brief lecture on geriatrics by Dr Zamri.
Home Visit
Home visit is done normally for those patients who are unable to seek medical treatment because transportation is not available in their places. However, home visit normally is done for postnatal mothers and infants with medical illness such as Jaundice, G6PD (Glucose-6-Phosphate Deficiency).
1st photo: Taken in Taman Sri Landak with S/N Norolasikhin checking on a 8 days old neonate who had G6PD. A thorough medical check-up with vital signs was taken for the mother of the child with the help of one of our group member.
2nd & 3rd photos: Taken in Kampung Seberand Ketil with S/N Norolasikhin weighing the baby followed by a thorough medical examination on the 9 days old neonate. The way of weighing the baby is done during Home Visit only as it is hard for them to carry around the weighing machine during the Home Visit.
4th photo: Taken in Klinik Desa (Community clinic) Kampung Pisang where one of our group member is seen taking blood pressure for a lady who came for follow-up of her pregnancy.
5th & 6th photos: Taken during a home visit in Kampung Bendang where S/N Norolasikhin and S/N Hamzah is seen doing a follow-up for both mother and 20 days old neonate.
THURSDAY 22ND NOVEMBER 2007
We introduced ourselves to a group of elderly people above 50 years of various background who are members of a society called "Warga Emas" .
We joined them in their morning activity of Tai Chi and Qi Gong. We later on joined them for a light refreshment prepared by the elderly folks themselves.
Warga Emas
"Warga Emas" better known as the Old Folks has formed a group of their own. They usually gather in Klinik Kesihatan Kupang on every Thursday from 8am till 10am. They will meet up; share their experiences and do some light exercises like "Tai Chi" and "Qi Gong" . Below are some photographs taken with their consents during their exercise activities. They normally exercise for about 45 minutes and then they will be served with some refreshment prepared by themselves.
