Day 11: Official Closing of the Blog

I’ve finally made it to Day 11! Yay! [give a pat to myself =P]

This post will be the official closure of my blog, mymedicaldiary.blogspot.com, dedicated to Block 4.2: Health System and Disaster.

There’s many events happened during this blog, which is a once-in-a-lifetime experience to (I guess) most of us… From the Merapi eruption to the evacuation, and then our first time even experience, fly back to Malaysia with Charlie. 

[Charlie's kinda give me a comfortable feeling, although it really cold during the flight! =P]

Anyway, 2day post will be a little informal cause there’s no facts in here. But just as an official ‘declaration’ that it will be my last post here.

I would like to thank everyone who has given their parts in making this blog a success; either directly or indirectly.

Firstly, thank God for giving me the time and passion to continue this blog until the end. Sometimes, I almost gave up doing it because it takes some of my precious time to do other things. 

[originally, I did it to get an 'A' for Block 4.2, but in the end, I feel like it helps me improve my passion to read more] 

Then, I would like to thank my sister, Anne and my brothers, Dorod and Alvin for helping me to start up a blog. Thanx sis! Thanx bro!

[its been awhile since I last did a blog and I needed some guidance on doing it ;)]

I would like to thank the professors and doctors and the guest lecturers for giving the lecture, which I’ve used for some of my blog posts information.  

And I would like to thank my parents for supporting me in doing this blog, especially my mom cause I’ve been using the internet for most of my stay in Malaysia (during evacuation period) and seldom help her much with housework [sooo sorry mum!].  And thanx dad for the financial support of paying the internet bills! ^_^

Not forgetting my friends, you know who you are. You give inputs, comments and encouragement to make my blog as it now. Thank you very much!

I hope this blog is beneficial not only for myself, but to the readers as well. I do find it useful to do a blog because it makes me read more on the topic, and search more of outside information (other than lecturer’s notes) from the internet and e-books. How about you? =)

And I apologize if anything in this blog contradicts your beliefs or opinion.

Now, I announce this blog CLOSED… 

Yours sincerely,

Adeline

(^^,)

Day 10: Disaster Victim Identification

Still on the topic of Disaster, but now I'm going to discuss about the management of dead victims in disaster. As I have mention in my earlier post, Day 7: More About Disaster: Disaster and its Effect to Mental Health; victims of disaster can be classified into 3 groups: (primary, secondary and tertiary victims). 

However, victims can also be group as:

• Non-injured
• Injured
• Dead

I will not discuss the management of non-injured victims and injured victims here. But I will focus more on dead victims. 

How do we identified dead victims?
Here I will elaborate more on dead victims identification. [Please read on... (^^,)]

Day 9: Nosocomial Infections

What is nosocomial infection? And why is it important for us to know?

Let’s start with familiarising ourselves with the meaning of nosocomial infection.

Nosocomial infection (NI) or also known as hospital-acquired infection is an infection acquired in the hospital by a patient who was admitted for a reason other than that infection. This infection is not present in the patient at the time of admission to the hospital but it developed during the course of stay in the hospital. This infection includes the occupational infections among staff in the hospital.

There are 2 main forms on NI; endogenous infection and exogenous infection.

1. Endogenous infection, or also known as self-infection or auto-infection is the infection developed during the stay in the hospital. The causative agent comes from the patient (normal flora or colonisers of skin and other epithelial surfaces) and it infected the patient due to their decrease immunity.

2. Exogenous infection can be further divided into 2 type; cross-infection and environmental infection. It can come from another person or an environmental source.

• Cross-infection – the patient comes into contact with new infective agents and develops infection

• Environmental infection – the organism acquired depends on the nature of the source. For example; moist areas tend to be colonized with Gram-negative rods (eg: Escherichis coli, Klebsiella, Psedomonas) whereas air and dust-borne organisms are those that can withstand drying (eg: streptococci, staphylococci, mycobacteria, acinetobacter). Other sources can come from food, in fluids catheters, endoscope, ventilator and respiratory equipment, and etc.

Day 8: Triage in Disaster

Triage in French means: to sort. Triage is the sorting of patients into categories of priority to rationally allocate limited resources; it is proverbially, to do “the greatest good for the greatest number”.

In normal circumstances, triage uses all available manpower and supplies. The resources are used to focus on saving one’s life. However, in mass casualty situation, in which the number of injured exceeds the ability to treat in normal manner; the resources are used to focus on saving as many lives as possible. Patients are prioritized based on ‘survivability’.

Triage fails in one of two ways:

Undertriage – undertriage represents a failure to identify the casualties who could benefit from scarce medical resources such as the serious casualty whose life would be saved decisively with rapid evacuation and prompt emergency surgery. In terms of test characteristics, undertriage means poor sensitivity to those who would get the most benefit from the medical resources available.

Overtriage – overtriage occurs when casualties who, do not benefit from a scarce resource nonetheless receive that resource. Overtriage signifies a sorting system with low specificity. Noncritical patients who receive immediate care even though they could safely wait (at the expense of more serious, saveable casualties) constitute one form of overtriage. It can also occur when expectant, sick patients, so sick with little chance of treatment success are provided with precious medical resources.

Triage following disaster is not a single processing step; rather triage underlies all aspects of the response, including on-site rescue, evacuation, receiving hospital activities, decontamination, and so on. Because all these steps evolve throughout the time-course of the response, response priorities are important. Triage is what we can call, a dynamic process.

Day 7: More About Disaster: Disaster and its Effects to Mental Health

Due to the fact that there’s so many things related to disaster, I’ve separate them into 2 posts.

Natural and Man-made disaster may cause:

• Death
• Injury
• Financial loss
• Mental disorder, etc.

The psychological impact of disaster is often immeasurable. Whereas the physical injuries caused by disaster can be visualized, it is much more difficult to identify the psychological trauma that many experience as a result of a disaster event.

Mental health issues stemming from disasters are becoming increasingly integrated into post-disaster assessment, with more emphasis on mental health being an urgent aspect of public health relief. The mental health community stresses that providers and disaster relief personnel need to have a meaningful understanding of the psychological and social needs of victims in a disaster.

Victims of disaster can be classified into 3 groups:

1. Primary casualties suffer physical injury and acute psychological sequel as a consequence or may experience psychological harm alone.

2. Secondary casualties include affected relatives and friends of primary casualties and witnesses of the event who were not directly affected.

3. Tertiary victims are rescue workers and healthcare providers.

Day 7: It's All About Disaster

As I’ve promised, I’ve made a post especially about Disaster.

First thing should be mention is the definition of ‘Disaster’. What is disaster?

Disaster can be defined as:

“Sudden ecological phenomenon of sufficient magnitude to require external assistance”

[WHO]

“Destructive effect of natural and manmade force overwhelm the ability of given area or community to meet the demand for health care”

[American College of Emergency Physicians]

 “A serious disruption of the functioning of a society, causing widespread human, material or environmental loses which exceeded the ability of the affected society to cope using its own resources”

[United Nations Disaster Management Training Programme (UNDMTP)]

Those are the various definition of Disaster, yet they carry similar understanding to us. It’s an unexpected turn of event (natural or manmade) that causes damage and requires external aid. These are the 3 main points that I want to stress on about the definition of Disaster.

Disaster can be classified as: Natural Disaster and Man-made Disaster.

Natural disaster:

• Earthquake
• Volcanic eruption
• Tsunami, Flood
• Hurricanes, Cyclones, Typhoons
• Famine
• Winter Storm

Man-made disaster:

• Airplane crash
• Terrorist attack
• Nuclear-Radiologic

From the examples given, there are many casualties involved. In order to reduce or minimized the possible damage to people, their properties and the environment; Disaster Medicine is introduced.

Day 6: Primary Health Care in Indonesia

Alright… Before this, I’ve mention about Primary Health Care (PHC) in general and about Declaration of Alma-Ata. So, I’ve decided that we should recognize the PHC around ourselves, in this case Indonesia.

Actually, prior to Declaration of Alma-Ata in 1978 regarding PHC, Indonesia has already developed various forms of PHC in some regions. Based on research in 1976, it is noted that 200 community-based health activities (CBHA) have been implemented and carried out within the community. Along that time, PHC has developed rapidly in various forms of CBHA and one of it as Posyandu (Integrated Service Post), which activities covers 5 major programs: family planning, maternal and child health, nutrition improvement, immunization and diarrhea prevention. Besides Posyandu, there is village maternity home (VMH) which is managed by village midwife as a way to make maternal and child health services close to the community. However, in 1997, the CBHA went into a decline during monetary crisis which resulted in multi-dimension crises.

Various services provided by Posyandu

Indonesia experienced a political reform following the 1997 monetary crisis. One form of the change in health sector was the issuance of Health Minister Decree number 128/Menkes/SK/II/2004 regarding the basic policy of health care.

There are 3 functions of PHC:

• Center for health development
• Center of community empowerment
• Center of health service at primary level which divided into:
• Individual health service
• Public health service