Today was the third and the last day of our Disease Control posting! We had an amazing time at the Vector Unit for the past two days and today, we focused on Communicable Disease Control (CDC). The day started off with a brief introduction of En. Tengku Yusoff, Penolong Pegawai Kesihatan Persekitaran Kanan (KPPKP). He is the coordinator for our group.
The CDC Unit is actually subdivided into CDC Unit itself, TB and Leprosy Unit and HIV/AIDS Unit.
CDC Unit
According to him, the CDC Unit is further divided into:
1) Immunization Diseases – TB, Polio, Measles, Hepatitis
2) Food and Water Borne Diseases – Cholera, Typhoid, Dysentry
3) Zoonosis – Leptospirosis, H1N1
The function of this unit is to investigate, control and prevent communicable diseases occurring in the district and their objective is to reduce the morbidity, mortality and incidence of cases of communicable disease in the Kota Star district.
In order for them to conduct any sort of investigation, proper notification by the medical practitioners to the unit is required. Mandatory notification is required for 27 diseases and it has to be done verbally and/or written to the nearest DHO within 24 hours/ 1 week depending on the disease. Mr. Lai stressed on the importance of details needed for notification such as the address, telephone number and occupation.
(I'm really sorry the pictures are rotated as such. I tried multiple times to correct it but it keeps rotating itself :( I'll upload them on gmail too. )
At the DHO CDC Unit, upon receiving the notification which is usually done via phone, the case is registered in the system and the notification is verified. The officers from the unit will then proceed by going to the hospital to investigate by taking history and obtaining samples. Other than that, contact tracing is also done along with disinfection or quarantining if necessary. The control and prevention program varies for different diseases.
TB/LEPROSY UNIT
The briefing was conducted by En. Zahidi who is also a PPKP. He showed us the various forms used in cases of TB. They are mainly 3 forms, which are the notification form, investigation form and also a form to report the death of a TB patient.
(I couldn't rotate this either)
The objective of this unit and how they function is similar to the CDC unit, in which after notification, they conduct investigation followed by control and prevention.
There are 3 TB treatment clinics in Kota Star; Klinik Dada, Klinik Kesihatan Pokok Sena and Klinik Kesihatan Bandar.
HIV/AIDS UNIT
The briefing was conducted by Staff Nurse Rosida.
The function is this unit is to monitor notifications and carrying out control and prevention programs. They also conduct investigations that include contact tracing.
As for HIV and AIDS, they require separate notifications. A patient who is tested positive for HIV (1st notification) who later on develops AIDS (2nd notification) and eventually passes away (3rd notification) will require 3 notifications.
There are various control programs that carried out;
1) Harm Reduction – consists of : NSEP (Needle Syringe Exchange Program),
Methadone Replacement Therapy, and also handing out condoms for free.
2) Premaritial Program
3) HIV Testing without name (Saringan Tanpa Nama)
4) Voluntary HIV Testing (with or without name)
5) HIV Testing for pregnant mothers (compulsory)
6) HIV Testing for blood and organ donors
7) HIV Testing for prisoners or drug addicts at rehabilitation centre.
HIV Testing is done by first performing a rapid test – Rapid Anti-HIV(1&2). A reactive test will then require a blood test to be done and the necessary form needs to be filled up. A positive blood test will then require a second blood test – confirmatory test. If the confirmatory test is also positive, a notification form will be required to be sent to the DHO.
(negative result)
Apart from that, En.Tengku Yusoff briefed us about the disposal of clinical wastes and the importance of proper disposal.
The day then ended at 12 p.m.
In the evening, Sawin and I participated in the fogging activity. We were first briefed by Mr. Faiz who is also a PPKP at the Vector Unit.
Fogging activities are carried out almost everyday by the Vector Unit. Different groups are assigned to different areas which include housing areas and also schools. Priority is given to areas with cases of dengue and also high incidence areas. It is usually carried out late in the evening or early morning. Fogging activities cannot be carried out in the rain or when there are strong winds or when it' A team consists of the driver, a PKA and a PA who is usually the fogger who is required to don the protective gear. The staff are exposed to the fogging chemicals which is an occupational hazard. However, yearly examinations and protective measures are taken to ensure the level of harm is reduced to minimum.
There are two types of fogging methods; thermal fogging which is commonly done and also Ultra Light Volume (ULV). The fogging chemical used can be either oil based or water based. Usually both are used, one after another. The area covered should be 50 meters radius with a buffer covering 200 meters radius where else in outbreak areas, the area covered should be 200 meters radius with a buffer covering 400 meters radius.
A team consists of the driver, a PKA and a PA who is usually the fogger who is required to don the protective gear. The PKA usually goes to obtain permission from every household. If no permission is given to enter the house, fogging is done only outside the house.
We went to Taman Aman with Mr. Faiz and the other teams as there was a dengue case reported form that area. We witnessed the preparation of the equipments and how the fogging activity is carried out. Although it appears to be simple, it requires systematic coverage and coordination among the staff.
That marks the end of the Disease Control posting which was really exciting to be honest :) All the officers have been nothing but extremely helpful and wonderful.
Prepared by,
Deepashankari Suppiah
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