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 3 (02/12/2007-06/12/2007)

SUNDAY 2ND DECEMBER 2007

The topic of the day was outbreak investigation. The team reported to Pusat Pengawalan Vektor at 9 am. We then followed a team of health officers to Kampung Tanjung Luas to prepare slides for detection of malaria based on the recent reporting of new cases in the area.

We visited 2 houses where each one of us were taught and given the opportunity to prepare slides under the supervision of the health officers. As the road leading to the houses were small and unsuitable for vehicles, we reached the houses on feet to collect the samples.

The pictures besides show how the malaria sample is being taken. First, the amount of people and their details were recorded in a piece of paper.

From there, the numbering system is being used as the first person in the list will have their blood sample stored in the first column in the box. The person involved is to be pricked in the finger (after a alcohol swab-to prevent infection) and blood is taken. The blood is smeared into thick and thin film before storing into the box.



We being given a chance to perform the procedure.

The next programme planned for the day was fogging. We gathered in front of Pejabat Kesihatan Daerah Baling at 6pm.

We were separated into 2 groups whereby 3 students followed one health officer who conducted the fogging. We were then given a chance each to fog a certain area ourselves. Fogging began around 6.15pm and ended around 7pm. The health officer explained to us that fogging is usually done during dusk and dawn. This is because it is the nature of the Aedes mosquitoes to come out during that time.

The first photo showing the "agrofog" which was used during the fogging session done on that day. After being shown the way of fogging, we were each being given a chance to fog a particular area.

MONDAY 3RD DECEMBER 2007

We reported to PPKP Rozaidi Shamsudin in the morning. He taught us on data entry and analysis regarding the outbreak investigations such as dengue, malaria, filariasis and Japanese Encephalitis.

We were introduced to the data system used by the Baling district vector control department ( Pusat Pengawalan Vektor daerah Baling). It is a unique and sophisticated system called VEKPRO, which is in short for Vector Programme.

The system consists of data registration of new cases and statistics management of all cases according to the respective years.

We also learn how cases are prioritized. For example, one reparted malaria case is considered an outbreak whereas for dengue, it is considered an outbreak only when at least 2 dengue cases have been reported within the same area within 14 days.

TUESDAY 4TH DECEMBER 2007

The programme for the day was environmental health and sanitation. However, as there was a leprosy patient that was going to be transported to Hospital Kulim from Baling district, we were allowed to follow this team. We learnt the procedure of referring a defaulted patient from Klinik Kesihatan to a nearby hospital.

We followed a health department vehicle into Kampung Seratus to pick the patient and then transport the patient to Hospital Kulim. We had the opportunity to elicit history from the patient and to conduct a short physical examination on him.

Later in the afternoon, we proceeded with the programme for the day under the guidance of PPKP Hamzah Ahmad. We were briefed regarding environmental health and sanitation for this district, their activities, contributions and achievements throughout the recent years.

We were then brought by the health officers to Kampung Rebong where we were introduced and exposed to the house connection system. We saw water sysem of each house which communicated with other surrounding houses. This system then drained into two water tanks which finally released the water into a nearby river. This ensures the cleanliness and sanitation of the area is maintained. It also helps prevent the spread of diseases among villagers.

We also had an opportunity to watch several villagers "gotong royong" to build a squatting toilet or rather known as "tandas curah" . This project is subsidized by the government.

The pictures above show how the drainage system of the "kampung" works. From the sink of the house, it is drained into a a pipe with a filter at the end of it.

Then this pipe drains from every houses to a particular tank. From the first tank it is drain into the second tank where the water is filtered again to prevent the oily water from entering the river later on.

picture above shows the villagers doing "gotong-royong" in order to build a "tandas curah" for themselves. The boys will spent their time helping out during the school holiday.

picture shows how the villagers store their equipments.


The pictures show the "Gravity-Feet System" which use to supply water to 111 villagers in the total of 26 houses. Over here, the water is being filtered before supplying to the villagers.

THURSDAY 6TH DECEMBER 2007

The topic for the day was health promotion and health quality control. The nutritionist or rather known as Pegawai Zat Makanan, Puan Juliani Faridza Alias briefed us on the health promotion and quality control programmes run by the Pejabat Kesihatan Daerah Baling.

She mentioned that the department’s duty is divided into three main parts which consists of monitoring, rehabilitation and promotion. Monitoring includes ethics regarding breast feeding whereby factories are given restrictions regarding promoting and encouraging the sales of their milk formulas to mothers. Among the examples of restrictions drawn up by this ethics include the restriction of promotion of such formulas in hospitals that are baby friendly and the restriction of giving out samples of milk formulas in clinics that promote breastfeeding. Rehabilitation and promotion include providing financial aid to families according to their income margin, arranging cooking demonstrations to mothers with under nourished children, promoting breast feeding, counselling for individuals with diabetes and hypertension, providing iodine salt to individuals with iodine deficiency disorder ( IDD ) and iodinators to schools, providing food baskets ( bakul makanan ) which consists of rice for carbohydrate, eggs and sardine for protein, Scott’s emulsion or Champs supplements for vitamins and milk for calcium to undernourished children from families of the lower income group, providing hematinics and softgel for individuals with anemia and many other activites such as breast feeding campaigns.

After the briefing, we were brought to Klinik Kesihatan Kampung Lalang where we observed how the nurses conducted cooking demonstrations to mothers with under nourished children. We were then taught how to enquire thoroughly regarding a child’s diet from the mother and were each given a chance to elicit history and counsel these mothers under the supervision and guidance of the nutritionist.

After that, we were brought to Klinik Desa Tanjung Pari where we were shown the breast feeding room of the clinic that won the best room among all other clinics in the district of Baling.