DHO KOTA STAR BATCH 12 MBBS AIMST UNIVERSITY

VECTOR BORNE DISEASE CONTROL UNIT

9:00am

Set off from Pejabat Kesihatan Daerah (though we reached there earlier…)

More than 6 of staff members of the Vector unit departed in their vans, while we pursued them in cars.

10:00pm

Reached site at Kg Nelayan, Kuala Kedah.

Here we were split into two groups ,one of 5 and the other of 4 members respectively.

The two groups took samples from different houses in Kuala Kedah.

One of the staff sprayed Abate (liquid) in drains. Within housing area where water samples were taken for larvae, packets with Abate were dissolved. Abate is a liquid based insecticide(composition-1ml Abate in 8L water).

Permission is first obtained from the house owner before sample is taken. There were some houses without people in which case a notice is stuck in front of their house, informing them that their house will be surveyed the following day.

A sample may be taken from a house just for indexing purposes, in the event the larvae turn out to be Aedes larvae.

Water samples are taken from a house with stagnant water collections from the outside of house-flower pots and other places.

Water is sampled by a pipette to obtain a sample of at least 5 larvae.

The sample can be concentrated by draining off excess liquid in order to collect more larvae.

Sampling either done in areas where Aedes is endemic or from where dengue cases have been reported in the past or where there has been a report of a case of dengue. Even a single case of dengue reported warrants a sampling from that site.

Fogging is done later in the evening.

We came to know how to differentiate Culex larvae from Aedes larvae -Culex larvae swim at the top while Aedes swim at the bottom in the water sample taken.(it was interesting to peer at the water sample seeing a majority of them swimming at the top).

Also, only houses, stalls, other premise owners with Aedes larvae alone are fined, those found with culex larvae aren’t subject to it.

Also sampled was a nearby lake area which had sacks of cans left for disposal and lots of larvae were found swimming on top of sample.

Hence our morning passed by…

2.30pm-5.00pm

Our day resumed after staff and we had lunch. We assembled in the vector unit which had fascinating models of the different mosquito vectors and their distinct features such as the stripes on their body.

We were briefed by a busy female member of Vector unit about Vekpro.

Each case’s particulars were entered in detail in this data base including:

Details of time –year, week and what time, Person who registered it-Medical assistant, doctor or nurse.

Details of person-Patient details-address, IC

Details of place- the registration no. of district are taken

Also present are details of the hospital where the patient registered- hosp. registration no., ward name. There are three hospital codes-

HK-Hosp. Kerajaaan-govt. hosp

HS-Hospital Swasta- private hosp

KS-Klinik Swasta- private clinic

The lab result of patient’s blood profile such as PC, Prothrombin time, Platelet count bleeding and Clotting time present

Each patient is assigned to be treated by his district. Investigation is done about the recent movements of the patient- if he traveled to an Aedes endemic area and acquired the case there then he is treated as an imported case-kes import while if he caught dengue from his own place of stay where dengue is /is not prevalent-he is classified as a local case-kes tempatan.

Dengue cases are classified into three- dengue fever, dengue hemorrhagic fever, death due to dengue.

Based on patient details 3 places in Kedah were identified to have dengue outbreaks-data for which is being compiled.

We were given information leaflets on dengue.

Next we were briefed by a member of fogging unit.

He told us about the water based and oil base mixtures used for fogging

Aqua Resijen=0.16 L Aqua + 8L water

Acettellic= 0.32LAcetellic + 8L diesel

Abate500E = 0.001L Abate + 8L water

Acetellic= 0.16L in 1 case

Aqua res=0.08L in 1 case.

These are in 1 case used for foggers who fog manually. This is practiced usually and covers a perimeter of 200m.

If the workers aren’t enough then ULV is used this mans that the vehicle does the fogging. This spans a perimeter of 400m. This has a composition of 10L acetellic+15 L diesel.

FOGGING

We set off for fogging and reached College cum hostel of trainee medical assistants (female), Alor setar- Kolej Asrama Penolong Pegawai perubatan at 6.20pm.

A female candidate was reported to have dengue here hence the fogging.

The officers garbed themselves with the protective equipment- orange overalls, yellow caps, face masks, ear muffs and protective boots

The fogging tanks are known as Agrofogs. These agrofogs had gone through several startup trials at the PKD itself. They were unloaded from the trucks and some of them were filed with water base formulae while others were filled with oil based formulae after filtering the formulae. The former were for spray within the hostel premises while the latter for the area surrounding it. 4 areas were targeted for fogging.

The staff kindly demonstrated how to carry these heavy Agrofogs upon seeing our interest. Some of our heroes and heroines posed for pics with the machines as you may see(pictures to be uploaded later).

The strong (Ahem…) boys were selected to help the foggers with their equipment while we girls stood aside to watch. Unfortunately the staff didn’t have any spare protective equipment for us so even the boys found themselves running off the smoke…

So ended a tiring, informative but fun day

Morning 8.30am

we had a WARM welcome by Mr.Tengku Yusuf, Mr.Willam’s boss, head of Enforcement Unit and Food Quality Control Unit. We wee rthen introduced to Mr.Wan Qaiyim who is in-charge of food sampling and food premise inspection.

9am

We had a short introduction about food sampling method and food premise inspection. Our group was then split into two:

Group A: Went to a stall and a grocery store for food inspection

Coordinator: Mr.Lai

Group B: Was sent to Tesco for food sampling (to check for pesticide concentration level) in green vegetables, local and imported fruits, nuts and tubers.

Coordinator: Mr Wan

9.30am:

Field trip to Tesco by 6 of our group members and 5 of their team members.

Procedures include:

1) Samples obtained (potato, short beans, senkuang) [minimum 1 kg for sampling]

2) Sealed in a special paper bag with pores for ventilation purposes

3) Cover sealed using a sticker provided with the KKM logo

10 am:

Went to a ice cream stall and checked for the level of cleanliness, and license for the shop keeper including their anti typhoid vaccination (kad pelalian pengendali makanan). They follow a list of guidelines to be followed by every shop with an overall scoring system. Every shop should obtain a score of above 70% for their continuity of their shop. Those shop that has obtained a score less than 70% according to the law, the shop will be closed for a maximum of 2weeks.

10.30am:

Went to KFC outlet and learned something special about that change the oil which is done once in every 10 days.

11.00am:

We had a short lecture topic about food acts, methods of food sampling, confiscation of food products, reporting of complains received about the particular food, and food poisoning control program.

3.00pm:

Mr.Lim, in-charge of the Unit Penyiasatan dan Pendakwaan showed us a few case files of which he was the officer in-charge. He also said that the Food Act 1983 includes Food Regulation, Peraturan Kawalan Hasil Tembakau and Peraturan Kebersihan Makanan 2009 which is to be enforced in 2014.

4.30pm:

---END---

We were welcomed by Mr.Cheang, Health Inspectorate, at 9.30pm. He gave a brief talk on the enforcement of tobacco usage, He further explained on the smoking issue among the community of Kota Setar. He also provided us with a list of prohibited areas to smoking and shared some personal experiences of his own while he was carrying out his duties. The job sounded cool..:)...but dangerous!.....He then reffered us to Mr.Yong who is currently incharge of the non-CDC department......

Mr.Nazri, another Health Inspectorate then took over where he spoke on Tuberculosis and Leprosy. He provided us with a copy of the epidemiology and the statistical data for the prevalence of tuberculosis in the district of Kota Setar. The referral system for a patient with sputum positive results is as follows:

Some of the criteria in this TBIS system are:

a. DHO will become the centre for data collection, and the reports are given to the district

b. Main reports are from the DHO which start from the treatment centre

c. State level report is sent to the ministry 3 months once

d. All cases even from the private sector are registered at DHO according to residence address

e. Patients data and the lab results are important according to DOTS

The main 5 components of DOTS:

a. Leadership commitments

b. Case detection through sputum evaluation

c. Standardized regime treatment usage and DOTS

d. Continuous medical supply

e. Uniform Information Management System

Mr.Nazri then continued on a briefing about leprosy. He told us that there was only 2 reported cases in Kota Setar. There are 2 types of mycobacterium leprae namely multibacillary( contagious) and paucibacillary (non-contagious). This desease is spread by bodily contact.

The day was further prolonged by another talk by Mr.Hasrul who is incharge of the HIV unit of the Kota Setar district. He showed us slide presentations on the disease prevalence in this district. He was happy that the prevalence rate has dropped over these years due to the effectiveness of programs conducted by various levels of the community such as PROSTAR, NSEP, and Health Carnivals.

Nurse Rozaini and Mr. Fitri of the KPAS unit had a discussion with us shortly after Mr.Nazri's. They briefed us on occupational hazards such as accidents at work place, acquired skin and lung diseases, and noise induced hearing loss. There are separate forms that are filled up according to each hazard eg: WEHU A1, WEHU S1 S2, and WEHU L1....:)

Finally we left for lunch and returned for the last session of the day at 2.30pm with Mr. Yong. We had a discussion on non-CDC such as Diabetic Programme, Hypertension Programme, Asthma, Obesity Programme and Quit Smoking Clinic. He told us that in future the Mental Programme will be included as one of the non-CDC aswell. In Kota Setar district there is a 25% of successfull rate of the counselling session for the Quit Smoking Clinic and there are about 19000 reported of diabetes till this year at the Diabetic Clinic.

Our day finally ended with Mr.Yong showing us around the Diabetic Health Clinic and also to the record storage room.......

It was a hectic day, but however we enjoyed ourselves!

**Ranjeeta**