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Category Archives: Kuala Muda

17/10/11 Methadone replacement therapy

Harm Reduction Program, including:
(a) Methadone Replacement Therapy
(b) Program of syringe exchange

Today we will be focusing more on Methadone Replacement Therapy. This program started since 2008 and it is run by one FMS, one MO one AMO and one staff nurse. It is a cooperative program with Agensi Anti Dadah Kebangsaan (ADK).The objective of this program is to prevent transmission of HIV to other people. It is not a program for rehabilitation.

Below is the carta alir pemilihan perserta metadon. First of all, patient will go to ADK to report themselves as drug addicts. The ADK will then refer them to Klinik Kesihatan for screening (Liver Function Test) to be done. Those with a normal LFT results will be reviewed by medical officer for the dosage of methadone required. New patient will be sent to intoxication room for 3 – 4 hours to observe if there is any side effects.

Total number of registered patient is 112 people, inclusing 78 active cases and 34 defaulted cases(patient enter prison or unable to contact patient). the youngest patient is only 16 years old while the oldest patient is 68 years old.

card given by ADK

 

Liver Function Test that must be done during patient selection

Urine test must be done everyday for the first 2 months. Those with 3 times urine positive will no longer be entertained by the clinic.
urine strips used to test patient's urine. 2 red lines indicates negative while one red line indicated positive.

to test the presence of methadone in patient's urine. a negative result indicates that patient is not using his own urine for the urine test.

On the other hand, the first 2 times of LFT should be done half year once. if the results are all normal, LFT should be done one year once. LFT should be done immediately if the patient complaints of any withdrawal symptoms.

Patients with unstable condition are required to come back to KKISP everyday for their methadone replacement. First of all, they have to write their names in one record book which will help the staff to ensure that all the patients go to the pharmacy to take the methadone.
record book in clinic

patients namelist in pharmacy. Pharmacist will tick the patient's name once the come to take their methadone.

Each patient will have their own cup to take the methadone.

In the pharmacy, the pharmacist will prepare the methadone according to dosage required by each patient.


Above is a video showing how the pharmacist prepare methadone.

For patients with stable condition, they are allowed to take the methadone back home and drink by themselves. The number of patient under DOT is 53 and the remainders are under stable condition.

The major problem face by this program is the difficulty to handle patients. Most of them are not cooperative and some of them even have aggresive behavior. As an example, some patients used other people’s urine for urine test in order to get a negative result. Some patients bring back methadone and sell it for RM30.

 
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Posted by on October 17, 2011 in Kuala Muda

 

Program Warga Emas in Klinik Kesihatan Bukit Selambau

Today’s trip was a very enjoyable one to all of us in group F1, though the trip to KK Bkt Selambau was far n tiring, it was worth the journey it took.

Today’s activity is to visit the Program Warga Emas in KK Bukit Selambau. We gathered at KK Bandar 8o’clock in the morning, then we followed En Yusof, who was today’s activity person in charge to KK Bkt Selambau.

Immediately after reaching at KK Bkt Selambau, we were introduced to a few of the Kelab Warga Tua members


 and the president for the club, Pn. Fauziah. At the mean time, another group was setting up PA system for some morning exercise. The atmosphere was so welcoming that we immediately felt like at home. We joined the club for some exercise, and we enjoyed the moves very much. The folks are creative bunch, as we can see from the moves they did for the morning exercise, which include the chicken dance song, Silat-tai chi style movements, movements assimilate ‘menuai padi, petik mangga’ and et cetera with songs of fast rhythm and they are real energizers.

After doing exercise, they welcomed us by playing Kompang, which is a type of Malay traditional musical instrument. Of note, the Kompang they use are all hand-made by themselves. It’s part of their activities in the Kelab Warga Tua.

Caption: Pn Fauziah the chairperson of the Kelab Warga Tua.

Members of the club have to pay RM 2 per month as membership fee and the money will be collected by the treasurers to be deposited in the bank, and when the time comes, the money will be used to buy necessities like cooking ingredients for celebration purpose. The club celebrate Hari Raya, farewell party to fellow members who are moving to other places, a few other special occasions like today. The club is not a welfare group, it does not provide monetary support, however it does function as a social support group to support it’s member’s emotional, mental and physical health. For instance, it is a very good defaulter tracer for chronic diseases like hypertension and diabetes according to En. Yusof.

Caption: Hand-made Tudung Saji and Kompang by the club members.

The club usually gather on Sunday, Tuesday, and Thursday.  Sunday and Tuesday are exercise days. The folks will gather at Kelab Warga Tua, KK Bkt Selambau at 8am and then the exercise continue until 10am. Usually they will be exercising indoor, following the aerobic steps as shown in the television and only during certain occasion that they exercise outdoor, like today. Whereas on Thursday, it’s ‘other activities’ day, which include religious talks, handy-craft session, Kompang and Nasyid practice, cooking classes, and et cetera. Besides all the fixed activities on fixed days, the members can come on other days to use the exercise equipment. These equipment are sponsored by the government as a gift upon the establishment of Kelab Warga Tua. These equipment consists of treadmill, bicycle, pedals, and gymnasium ball. However, it is regret to report that currently they do not have any professional trainers or physiotherapist to guide them with those equipment, therefore they only uses the equipment as per their capability.

Caption: The exercise equipment sponsored by the government upon the establishment of Kelab Warga Tua.

In addition to the routine activities on fixed day, the club has other activities as well. For instance, it’s part of the club’s habit to constantly invite nutritionists, health officers, family medicine specialist to speak during health talks. Topics ranging from diet to information regarding chronic diseases. Besides that, just recently, they had went on an expedition to visit the Paddy Museum. Last year, 20 club members participated in the Hari Warga Emas which is a national event held in Rumah Seri Kenangan Cheras in KL.

After the talk and Q&A sessions with the folks, they invited us to have breakfast. All the food were cooked and prepared by the members of the club.

The feast began after the informative talks regarding Program Warga Emas in KK Bkt Selambau by En Yusof, Ms Ponnu, and Pn Fauziah.

It was not a coincident that Geetha’s birthday fall on that day, and so the feast was especial prepared for her. ^^

Happy Birthday Geetha !!!

Caption: A group picture to end the day… It was an enjoyable day, happy day!
-end-
thanks.

 
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Posted by on October 13, 2011 in Kuala Muda

 

HIV Programme at Klinik Kesihatan Kuala Muda

At 9am we were briefed by Mr Chong at KK Kuala Muda. He discussed with us the various programmes which have been implemented by Kementerian Kesihatan to increase awareness regarding the HIV situation in Malaysia and Kedah more specificly.

These are some of the programmes that were discussed:

  • PROSTAR
  • Premarital Screening
  • Anonymous HIV testing

PROSTAR is short for Program Sihat tanpa AIDS untuk Remaja(Health without AIDS for teenagers programme). It was inaugrated in 1996 in Kuala Lumpur. It uses various symbols to describe their goals.

+ add information

- divide responsibility

x double effort

- minus risks

= healthy life without AIDS

It largely involves teenagers and focuses on the many social problem among adolescents in the community. It uses teenagers as role models to spread the good word to those who are troubled and also receive insight from these tainted individuals.

Premarital screening is a newly developed HIV screening test for newlyweds. Mr Yusof is the health official who is in charge of this screening in KK Kuala Muda. It is compulsary for all Muslim couples and strongly recommended among non-Muslim couples. Both partners are registered into the HIV screening registration book and then they proceed to Room 1 where the screening test is carried out. The screening tool used is the rapid test.

Once the test result is positive, the health officials will hand them a statement and inform the marriage registry. The marriage registry will then counsel them. There is a pre and post test counselling session to inform the couple about the consequences of the test and what happens if they were to test positive or negative.

Individuals who test positive will then be referred to a family medicine specialist for a confirmatory test. If they were to test positive again, confirming HIV positive state, then a management plan will be discussed with the family medicine specialist.

Even if they test positive, the decision on whether or not to continue with the marriage is entirely in their hands.

Screening is done 4 times a week at the KK Kuala Muda in Room 1.

Anonymous screening test is usually conducted among high risk individuals.

High risk individuals include:

  • prisoners
  • individuals in rehabilitation centers
  • individuals indentified through PROSTAR

This test ensures that the identity of those who volunteer to get tested remain strictly confidential. A screening tool such as Rapid test is used to identify those reactive/non-reactive.If they are reactive then a confirmatory tool such as VDRL/TPHA will be carried out.

In conclusion, today was a very informative day. We would like to thank Mr Chong and Mr Yusof for sharing their knowledge regarding this topic. Remember:

HIV IS A NOTIFIABLE DISEASE WITHIN 24 HOURS:)

Thank you!

 
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Posted by on October 12, 2011 in Kuala Muda

 

DAY 9 –communicable diseases part 1 : Tuberculosis

We all arrived in KKSP at 9am and followed Mr. Cheong to Pusat Rawatan TB 1 which is located laterally to the main building.

Mr cheong introduced staff nurse Ms.Che Rose who is one of the 2 staff in charge of the pusat rawatan TB 1.

2 types of pusat rawatan TB

According to her, the total number of registered TB patients is 24 in Kuala Muda district. The disease is more common in elderly however the youngest patient is 10 years old. Directly observed therapy is mandatory for all patients which means that all of them must come back to the pusat rawatan TB 1 and take their medication under supervision of the staff nurse. So far, there are no defaulted cases. Patients are also advised regarding time of medication, diet, lifestyle and also side effects of the drugs.
However, there are still some patients that refuse to take drugs due to the following reasons:
• Side effects of the drugs
• Tiredness
• Lack of education.
Multiple drugs resistance might occur due to this.
Various steps have been taken in order to overcome this problem.
1. Compensation for TB patients
• 2 months holidays are given.
• Allowance TB in which RM 150 is given at the first 2 months of therapy followed by another RM150 for the next 4 months of therapy. (stopped at 2011)
• Bus tickets are given free to those that are staying far away from clinics.

2. Buku Rawatan (TBIS 16E), including:

• Patient’s basic information

• Name of supervisor and his or her information (patient’s family members, friends or whoever staying with patient)

• Treatment center information
• Treatment regime

• Treatment schedule for continuation phase

3. Retan Bulanan Rawatan TB

• Red tick – these patients are allowed to take medication at home but they are still under supervision. The criteria are:
 Elderly people
 OKU
 Very poor patients
 Working patients
 Patients staying far away .
• Blue tick – these patients are cured but they still have to go to the clinic for observation.
• Red crossed – these patients do not turn up.

Defaulted case –>1st day:Call the patient –> 2nd day:Inform PPP (penolong pegawai persekitaran)–>A red colour defaulted card will be stick on the Buku rawatan.

1st visit to the patient’s house –> 2nd visit to the patient’s house with sister.–> 3rd visit with sister and MO. –> Call police and arrest the patient under act 15.

Mr Choong and Ms. Che Rose then explained to us the treatment that should be given. According to them, oral treatment is not the first line therapy but it is preferable because most people are anxious about injection. The dosage of each drug is changed according to the phase of treatment and patient’s body weight.

drugs and dosage

 

streptomycin

 

akurit-4

 

checklist for treatment side effects that should be done every visit

Finally mr.Cheong showed us the room where all the patients’ files are kept before we dismissed at 11.00am.

 
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Posted by on October 11, 2011 in Kuala Muda

 

Day 8- asthmatic clinic in KK Bakar Arang

We all arrived at kk bakar arang at 9am and met Mr.Chong at 9.30am. KK bakar arang is a type 2 kk. a more developed kk compared to kk bandar.

Mr.Chong was very generous, he started off by distributing some reading materials for our presentations and also reference. our deepest gratitude to him.

Next, he showed us the clinic book for asthmatic patient, that book was a district specific approach (DSA) programme, which means the book is not a standard procedure by our government. It is locally prepared by a group consisting FMS and MOs.

This the first two page of the book.

We were told about the quality assurance programme consisting client friendly clinic, appropriate management of asthma and appropriate management of DM.

Thereafter, we were brought for a quick tour of the KK. We had an insight of the record room, dressing and TB treatment room, outpatient department, resuscitation/ treatment room, x-ray room and finally Mr.Chong was kind enough to show us the equipments inside an ambulance. In each of these rooms we were briefed about the daily routine carried out and how it is managed and also we discussed the problems faced by each department.

We saw a patient with diabetic foot ulcer whom supposed to come for dressing daily. the number of times patient should come for dressing depends on the severity of their condition.

The session came to an end after discussing each page of the asthma clinic book in the meeting room, the flow of how  asthma patients are registered until they received treatment and follow ups were as per what explained in the diabetic clinic.

We adjourned at 11.15am.

 
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Posted by on October 10, 2011 in Kuala Muda

 

Day 7: Primary CAre

Today we were briefed by Mr.Chong Koy Seng on Primary Care. The topics of discussion were:

  • The concept of primary care & how it will help to protect the health of community
  • The common health problems affecting various age group.
  • Demography and service coverage

We were also taken to the Diabetic Clinic and learnt about its management.

Details of today’s topic will be presented at the end of our KK posting.. :)

 
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Posted by on October 9, 2011 in Kuala Muda

 

Day 5 : Laboratory and X-ray Department KK Kuala Muda

Today our posting was in laboratory and X-ray department in Klinik Kesihatan Kuala Muda.

We started the day with a brief introduction to laboratory and the x-ray department in KK Kuala Muda by En.Chong Koy Seng. There he introduced us to the person in charge of the departments.

First we went to laboratory department. Pn.Noranti who was the medical laboratory technologist explained everything regarding the management and maintainance of the department.

The Lab gives service to walk-in patients and also receives samples from the other department such as Outpatient department.The main function of the lab is for screening. If any pathological finding has been noted, it will be sent to Hospital Alor Setar and Sg.Petani for further investigation.The test which are done in the lab includes:

  • Urine analysis
  • Full blood count
  • Liver function test
  • Renal function test
  • ESR
  • Blood glucose test
  • VDRL

Normally, the test results will be given to the patient after 3 days. If in cases of urgency , the results will be prepared within 30 minutes and sent to the doctor. There are also rapid tests available such as Dengue test and HIV test.

Pn.Noranti also explained about the equipments used and their function. These are some the equipments. 

Urine analyser

Urine analyserHematology analyser

Pn.Noranti also explained about the precaution techniques used by the MLT ( medical lab technologist).

Pn.Noranti explaining

Pn.Noranti explaining

The analysed samples are disposed after 24hours. Most of the samples are disposed into a Yellow bin . There are also coloured plastic bags for other clinical waste. These clinical waste are then collected everyday by the clinical waste management company which also known as FIBER.

After collecting data from the laboratory we proceeded to the X-ray department. There we were guided by Pn.Ros, who is a X-ray technician. She brought us around the X-ray department.

Firstly, we were brought to the X-ray room, where she explained the procedure involved in taking a X-ray. She also showed us some protection materials used such as the lead gown and gonad shield used during the procedure.

After that, we were brought to the dark room, where they process the films.

Pn.Ros explaining the procedure

Pn.Ros explaining the procedure

That was the activities that we did today. It was indeed a pleasant day and we gained a lot of knowledge regarding the lab and x-ray department.

 
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Posted by on October 5, 2011 in Kuala Muda

 

Day 3 – School health Unit

School health Unit

The team and Dr Chi reached Kuala Muda Health Centre at 8am. We met Sister in charge of School Unit

Health (Sister Busroh). She gave us a rough idea on today’s activity. We are planned to follow the School Unit to a primary school in Jeniang district. Sister and her staffs are performing visual defect examination on the students. We will be given opportunity to do the test.

Our team had to follow the Clinic’s van to Jeniang district, we used four cars for the journey. The journey took about 40 minutes to reach the school. As we reach,the pupils were having their tea time so we took the opportunity to ask sister on how to do the test and also help to set the temporary medical room.

We set up the Snellen’s chart, weighing machine and also other equipment.Once the set up was done,12 pupil were chosen and made them queue. We brief them on the examination that will be done and made sure they had they “Rekod Buku Kesihatan”.Each of us got a chance to do the test,we did the recording as well in the book. Majority of them had normal vision.

After the examination,we thank the school teachers and the pupils for the co operation. We also were grateful to the school unit team for bring us all the way just to give a chance on the field. The school unit invited us to join immunization programme which will be held at 2pm,we could not follow the activity due to our lectures at the campus starts at 2pm. We thank all the party and the left Jeniang full of satisfaction. =)

 
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Posted by on October 4, 2011 in Kuala Muda

 

Day 2 in Klinik Kesihatan Bakar Arang…

 

 

 

 

 

 

 

Klinik Kesihatan Bakar Arang is one of the health clinic centre in the district of Kuala Muda.. Today we are posted to this health clinic to learn mainly on the topic of family planning services that is currently practiced in the health centre.. Before the sister come and guide us, we gather at the waiting hall and and some discussion on what are the main questions we need to ask the sister..

 

 

 

Sister Marhaini is the one who guided us for the day and she told us that Klinik kesihatan Bakar Arang (KKBA) is a busy clinic, especially today(Sunday) as they can see around 500 patients per day and at the peak it can comes to about 1000 during festives!! Klinik Kesihatan Bakar Arang covers around 450,000 of the population..

She told us that as for the family planning services, the target population is mainly for the high risk mother, such as the advanced age group and the mother with underlying medical illness (DM, HT).. The most commonly used family planning method that the clinic provides is the combined oral contraceptive pills and the only barrier method, which is the condom.. This is due to the financial budget of the clinic.. All of the permanent contraception, such as vasectomy and emergency cases (rape) are not done in the KKBA.. They are usually referred to the hospital..

Types of contraceptive method provided in KKBA:

 

 

 

 

 

 

 

 

Sister Marhaini told us that counseling on the family planning is done when the mother is still pregnant and they are told to report to the clinic once they had undergone the delivery so that the nurses can do the home visit.. The counseling is usually done earlier so that the father and mother aware of the importance of family planning and they can have ample time for discussions and choose for the best method of contraception..

 

 

 

 

 

 

 

 

After the mother is registered to health clinic, the health status of them had to be checked (height and weight, blood pressure, past history on any medical illnesses) and they had to be categorized into class 1-4 according to the Purple Book protocol or the pink coloured modified WHO medical Eligibility Criteria Wheel for Contraceptive Use.. As for Class 1 and 2, the mother can use the contraceptive method as prescribed and for the class 3 and 4 mothers, it is not advisable and not allowed.. For all the mothers, they are requested to visit the clinics once in 6 month to do the regular check-ups (blood pressure, weight, paps smear and also breast lump).

After the discussions, Sister brought us to visit the clinic and make some brief explanation on the services provided in it, such as antenatal and child health services.. Later on we went to the meeting hall and Sister wanted to show us the file that records the statistic on the mothers that had come for the family planning service..

 

 

 

 

 

 

 

The fade yellow document is the old Kad Perancang Keluarga and the bright pink ones is the new one.. In it the nurses have to fill up the biodata of the mother and classify the mother health status as in the protocol.. Each time of the follow-up, mother’s health status are recorded in it.. The purple colored card is the newly introduced Kad Perancang Keluarga Sementara and the big book recorded all the stocks of drugs and condoms in the clinic.. The drug provided in the clinic are bought by the kementerian kesihatan daerah through pharmacy in bulk to ensure lower price and it is done monthly..

 

 

 

 

 

 

The table shows the number of cases of family programme for the district of Kuala Muda in August and a thing to be glad is KKBA had reach the target of 85% in the population :)

 

 

 

 

 

 

 

In the discussion, Sister Marhaini had also told us a lot of her own experience as a nurse.. She told us about the difficulties to handle the big group of patients in the health clinic and all sorts of difficulties in promoting a health programme.. For example, for the campaign in promoting the paps smear.. She told us that even though the nurses sacrifices a lot each time but sometimes the result of making awareness in the population are not as fruitful as the plan.. She said that every month there will be a meeting in district levels, where they have to present all the activities that they had done to promote each campaign.. Every 3 months once, they need to do presentations on the achievements in the state level..

Sister shared her experiences to us in a very interesting way where we all are very happy and really gain a lot from it.. Around lunch time, we all finished with discussions and are packed back to go home with more knowledge on family programme in us..:))

 

Prepared by Chong Chiew Wei and Geetha.:)

 
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Posted by on October 2, 2011 in Kuala Muda

 

DAy 1 at KK Kuala Muda

We were briefed by Matron Rashadah and Staff Nurse Zam. We were introduced to the  services provided by Klinik Ibu dan Anak KK Kuala Muda. Among them were antenatal and postnatal.

Some of topic of discussion were :

Maternal care services:

  • To provide care and consultation to pregnant mothers
  • To screen women at risk of complications and difficulties throughout the period of pregnancy
  • To educate mothers regarding breast-feeding & available methods of family planning

We were also briefed about the duties of community nurses, staff nurses, sisters & matron

  • Community nurses help in MCH clinic, home visits & on-call to Klinik Desa
  • Staff nurses supervises clinic. They refer complicated cases to the doctor
  • Sisters and matron work directly under District Health Officer, supervises the staff under them. Statistically, data collected frm health clinic is sent to the Matron. She watches MCH activities in the home district

Record Maintenance:

  • They are 2 books; one for the mother whc in KIK/ 1(a) / 96 / Home-based card & other for the clinic KIK / 1(b) / 96
  •  Filing and colour coding system à Color coding system is based upon areas of the district and medical condition of the pregnant women for example orange code indicated GDM. Pregnant mothers were categorized into colours such as white 1 ,white 2 , green and red. (Red = hypertension in pregnancy, black = history of birth before arrival, yellow = anaemia in pregnancy, blue = heart disease in pregnancy)

At the Ante-natal clinic

  • The clinic visits; first 28weeks = monthly, 28-36weeks = every 2weeks once, above 36weeks = every week. Frequent visits for problematic cases
  • Some of the routine lab investigations and physical examination done are; weight gain, BP, urine tests, Hb levels. Gestational weeks & symphysis fundal height (SFH) are also assessed
  • ATT is given when once fetal movement is felt & 1 month after for primi, first & 2nd dose given and for multi booster dose is given (1 dose only)
  • MO and HO does the examination on booking and at 36th week
  • Ultrasound monitoring on first visit around 12thweek & to check for viability and fetal growth and monitoring
  • medications prescribed to the pregnant mothers such as hematenics, folic acid, vitamin c and b complex

Child care services

  • Increase health status of children and complete immunization before school enrolment
  • Increase health status and provide immunization for pre-school, primary school and secondary school children.
  • Recording body weight since birth till 72months. There are 2 cards; blue for male and pink for female
  • There are 4 indicator levels; obesity, normal, Kurang zat makanan (KZM), KZM teruk

Family Planning

  • Comes under maternal & child health care
  • Mainly carried out by community nurses & staff nurses
  • We were briefed on types of contraceptives available in KK Kuala Muda

Activities

  • Management of problems related to contraception methods
  • Pap smear
  • Involves all mothers following childbirth
  • Programmes conducted by the districts are pre-pregnancy programme and Quality Assurance programme . Folic acid supplements are given to patients 6 months prior to getting married for all women of reproductive age. QA programme were aimed at school children (Std 1) with visual defect and newborn with severe neonatal jaundice.

 
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Posted by on October 2, 2011 in Kuala Muda

 
 
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