Tuesday, December 7, 2010

More Than Just A Talk

Communication is the creation or exchange of thoughts, ideas, emotions, and understanding between sender(s) and receiver(s). It is essential whether to build or to maintain bonding or relationship.

Effective communication skills are truly important, be it as simple as in a conversation between two people or complex as in a team, institutions, or even community. It is indeed a backbone for the basic functions many things, more significantly for management.

I've been wondering hard how would I discuss this, so instead of making a set of lecture or a long article, I chose to make one case to be discussed based on the specific skills as the importance of communication skills in the identification of problems, making analysis, and planning for required action depends on the function itself.

Now, hold my hand; let’s put ourselves as one team. (Yes, you n me and our few other imaginary team members..) We were given Rp 20millions by UGM Red Cross Organization to manage logistics aid to Desa XXX in conjunction to Merapi eruption.

The very main principle in this case is for each individual to bring themselves practicing "assertive" style of communication of which there are 4 types of communication style:

You win and everyone else loses
You lose and everyone else wins
You lose and you do everything you can to make others loses too
Everyone wins

Communication skill 1: Ability to make a good ice breaking and introduction

This may be the first time we met. Come on, introduce ourselves to one another~ Let say we already know each other, hence a warm greeting would be very nice:)

Then we can start to dip our toe into our main purpose. Everyone have to list down what's the necessities actually are. Give opportunity to each other to convey ideas and explanations based on individual's perspectives. Avoid misunderstandings or even debate on matters not in line to everyone's satisfaction. Everyone has to be open and ready to give and to accept comments: positive or negative.

Communication skill 2: Ability to convey the goals and objectives

Together we defining our goals and objectives or what we are trying to achieve. Everyone must cooperate and must not be too ignorance yet too persuasive for their opinions to be accepted by all. We must remember that goals and objectives should be specific, realistic and listed in order of importance.

Communication skill 3: Ability to be cooperative and responsive

1. To our team members. 2. To our UGM Red Cross Organization 3. To the community of Desa XXX. You see, to only acknowledged that the people of desa XXX is our target beneficiaries is not enough. We have to get to know them better: their condition, the people, the place so we can plan the best actions for them. In this case, everyone has the responsibility to do research about what will be provided in the logistics we are going to deliver. 

Communication skill 4: Ability to be understanding

There are many, but I take one very typical problem occurring when a team/ group/ institutions/ community held a meeting or something: TIME MANAGEMENT. You see, a good timing is somehow what makes a good discussion useful. Too short won't help much for people to digest the topics being brought on, but too long won't help to make people give full attention to. Everyone must know or at least attempt to know what the priorities actually are. Remember that everyone has their own thing- to do- list. Be tolerable:)

Communication skill 5: Ability to do essential evaluation

It's like a rolling procedure to end our discussion. We go thoroughly checking had we list out the correct problems? Had we make a good analysis? Had we provide a good plan? And we also evaluate ourselves. Everyone must ready to improve especially if there's any flaws in the midst of the conversations. Problems identifications are done. Analysis had been made. Plans are listed. Now we can work on the actions:)

The fundamental of these measurements are based on the key aspects of GOOD CLINICAL PERFORMANCE in accordance to the concept of "Systematic Working & Systematic Thinking":

"The right things are done (correct problems being identified) in the right way (correct analysis) at the right time for the right person (the organization, team members, community), by the right people with right behavior (good and effective communication skills)".


Well.. We're done with the teamwork imaginary role- playing. Thank you for reading my rigmarole till here, though:)  These are just a very few examples I can put here, and I'm sure there are many more good communication skills within those. All of all, I believe the values of good and effective communication skills explains well upon it importance. In any situation, good and effective communication skills are like a battery to a clock. That's what make it works~

  • "Communication in Working Place", Guest lecture: Panti Rapih Hospital
  • "Interpersonal Communication and Advocacy", Practical Session (Public Health)

Monday, December 6, 2010

MEDICAL DOCTOR: Up Close and Personal

When I was a little girl, I love having a role- play with my siblings and friends; as a doctor, nurse or patient. Little that I know at that time, doctor's responsibility is far beyond injecting patient or having nurse do whatever a doctor order them to or having a nurse to wipe the sweat using piles of tissue during the operation procedure..

Leadership and Role as a Member of Organization, Society, & Citizen.


The role of medical doctors as members of society, and citizen refer to the functions of a doctor as a leader in 4 main areas in health care:

1. Health Promotion 
Doctors advocate for public health policies and provide advice and care aimed to improve health and wellbeing.

2. Disease and injury prevention 
Counseling and screening for acute and chronic diseases are integral to the role of doctors. Well.. Prevention is better than cure:)
3. Chronic Disease Management
This include the diagnosis, treatment and prevention of complications (secondary prevention).

4. Health Surveillance 
It's doctor's job to care for and report suspected or confirmed infectious diseases that threaten the health of people. Through screening, diagnosis and reporting, doctors play a major role in helping to reduce the severity of outbreaks.


The duties towards doctors' profession include working together with other physicians to create a healthier community, country, and world for everyone to live in. Any member of the organization is best treated as partners:)
Doctors are the usually a leader in the healthcare of which there are list of must- be - so in the pockets:
  • Have a strong commitment to excellent service and communicate it through words and deeds – clearly and consistently to those inside and outside the organization
  • Creating and sustaining the organizational culture and convincing their employees to believe in that culture as well
  • Motivate people develop their talents, provide them with proper resources,  and reward them when they succeed
Medical doctors also must know that they are the essential parts of organizations that profoundly influence people’s live. They will work hard on behalf of that team’s goal because they are so committed to the purpose of the organization. .

“ Act as a Leader, not a Manager,
  Stop Managing, Start Leading !”
(Robert Flater: “Jack Welch and GE Way”)
When it comes to teamwork, doctors must remember that they are part of the team. Members can be anybody; other doctors, specialists, nurses, paramedics, volunteers, NGOs, and many other. 

This is when the implementation of the concept of systematic working & systemic thinking plays a very major role for the sake of betterment in the role of a medical doctor.

"They should know that they can not work alone, with competence of others they will get synergism."
(Fattler MD, Ford RC, & Heaton CP; 2006)

Individuals within the organization are charged with the responsibility for the completion of each task (systematic) while maintaining a partnership with a deep understanding of the proportional rights in order to obtain synergy in the organization (systemic). Similarly, there should be cooperation among organizations in order to obtain synergies in one country.
  • "Leadership and Teamwork", lecture by Prof. dr. Budi Mulyono, Sp. PK (K)
  • "Communication in Working Place", Guest lecture: Panti Rapih Hospital
  • "Poor Team- Working in Health Care Personnel", GROUP 8 TUTORIAL SESSIONS (Week 4)
  • "Systemic Thinking", Practical Session guidelines in BLOCK 4.2 Lab. Manual Book: Health System & Disaster, UGM. Guided by Prof. dr. Laksono Trisnantoro, M. Sc., Ph. D

Sunday, December 5, 2010

Love Like This

For today's post, I won't be discussing about things theoretically. Notwithstanding, they surely do have certain theoretical concept I've been discussing in my previous posts as the fundamental values. Lots of programs held and done in relation to disaster during the prevention, mitigation, response, and yes during the recovery period. You can check on the topics at my INDEX and browse on any that you would like to read.

Here you have my listings of programs that put a smile and even laughter not only to the victims, but also to me :)

I chose programs held for Merapi eruption event as I, myself had the experience to feel and witness the whole plots of the disaster. *Err.. minus the part where we, the Malaysians were taken back by the embassy for the evacuation..*

1. Government

At any level; national, provincial, or district, it's obvious that government plays a very major role in the walk of program for the victims. Some may not be satisfying, but let's us take the positiveness of those:)
Indonesian President Susilo Bambang Yudhoyono (SBY) during his visit to a temporary shelter in Klaten of Indonesia's central Java province November 3, 2010. (Source: TotallyCoolPix)
Amongst all of SBY's statements, this one is my favourite:

"Saya akan berangkat, menunggu persiapan ke depan, karena saya harus berada dengan rakyat di sana. Untuk memastikan saya berada di sana bersama mereka."

2. Private authority
Click to know details about the program.

By 22 November 2010, Super deal 2 Milyar (2 Millions) hits the telly with different approach from its previous ones'. It comes with the concept of care, as a concern for the victims of the eruption of Mount Merapi. The shooting is done in "Gelanggang Olah Raga" (Sports Arena), of the University of Yogyakarta.

The program broadcasts on ANTV channel everyday at 7.30PM (1930 WIB).

3. Volunteers

Read more about Mr Kamen Rider visit at UMY News~
Familiar to the figure with the kids? That's Kamen Rider, the hero for the kids no matter the kids are any spoiled children with home dear family, living safe and sound at home, or the children at the refugee camp :)

This all- time superhero was brought especially to cheer the kids at the UMY refugee camp (Posko Pengungsi UMY) by IKOM Radio dan Divisi INFOKOM UMY.

I somehow believe Mr Kamen Rider had not only cheering the kids but the adults as well. He was one of our childhood hero either, isn't he? *Well.. Okay, may be not to you, but he is to me^^*

Well.. There are truly only a few out of lots, lots, lots more programs held. To put even a quarter of those would require hundreds posts in this humble blog of mine. It shows that bringing smile to others help putting a smile to ourselves, don't you think?


Saturday, December 4, 2010

Prevention is Better than Cure

A disaster not only brings suffering or injuries at the time it strikes  but afterward, too, in the form of psychological effects and infectious disease. The mental and emotional effects of natural disasters may not be apparent at first. This is because the first reaction is to take care of the physical damage while on the other hand, the agents of infectious disease find favorable conditions after a catastrophe and can easily spread if nothing is done to prevent them.


Typically, in a state of emergency, people need to be rescued and their physical safety is of first concern. Efforts are focused on cleaning up, rebuilding and providing shelter, etc. Because there are so many things that need to be taken care of, many people have to put their emotions on the back burner while they deal with the physical damage..
Mental health phases after disaster
There are two main things needed to be done on the victims:

1. Prompt treatment
Every single psychiatry symptoms finding should be considered as important signal as a psychopathology condition. Can be like people who appear to keep on being silent or hysterical cry or shouts.

2. Regular evaluation
Evaluation of the mental status of disaster- affected people should be done routinely. The procedures can be started right after the triage is done and continue thoroughly.

I've discussed about the clinical emergency response on physically and psychologically in my previous post. Welcome to read it back :)

Meanwhile, the prevention measurements should also being intervened towards the staff in charge for the psychological managements. They may be are already trained to do the job, nonetheless, they are also human with limitation of strength. Hence, it's recommended that these workers are placed in disaster affected area in less than 2 weeks. They have to avoid from experiencing psychiatric morbidity protecting them from any flaws on their emotion, energy, and even activities so they can be a truly good support group for the victims.


Lots of people are in close proximity during a time that challenges the ability practice normal hygiene, with strained bathroom facilities and diaper changes occurring in close quarters. Worst when they can't get clean water sources. It can also due to problems finding fresh clothes and laundry facilities and disposing of trash. It's not uncommon for people in the refugee camp to suffer diarrhea, nausea and respiratory illnesses, including colds.

The general safeguards which can be done and yes; can be explained to the refugees for them to really practice may include:
  • Water must be boiled or treated with iodine or chlorine before using it to clean, cook with or drink.
  • Fully cook food.
  • Wounds need to be cleaned as soon as possible and care should be taken to avoid new ones. Make sure they know who and where that they can get a treatment from.
  • Hygiene is one of the best infectious disease preventions. The victims notwithstanding, may not be able to care on this by themselves. There are so many of them and they have their own problems to deal with.. It's mostly (yes, not 100%) our responsible. Staff or volunteers to the the sanitary procedures are very important.
Here is the example of good management which support the prevention of infectious disease in the refugee camp on the Merapi eruption victims :)

Click to enlarge
That describes the condition of Posko SD Gambiranom, Manukan, Condongcatur, Depok (it's actually a school. Read the whole story for full details). One of the best statement to be highlighted is, 

"Secara umum, di posko ini, pengungsi dan relawan bekerjasama agar kondisi pengungsian tetap bersih dan rapi."

Translated: "In general, in this post, refugees and volunteers working for the refugee condition is kept clean and tidy."
Crystal clear, right?
The responsible for these preventions measurement goes to everyone involving in the circumstances :)

  • "Disaster Management in Mental health", lecture by dr. Bambang Hastha Yoga, Sp. KJ
  • "Disaster Surveillance", Guest lecture: Dinkes Propinsi DIY

Friday, December 3, 2010


I believe this is quite a big topic in disaster as most victims experiencing trauma; can be as little as they can easily and independently overcome it, or as complicated and tough as it becomes severe.

PTSD, stands for post-traumatic stress disorder, is an anxiety disorder that can develop to become a significant stress after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. According to MERCK, PTSD causes recurring, intrusive recollections of an overwhelming traumatic incident that persist more than 1 months, as well as emotional numbing and hyperarousal.

 "How PTSD occurs?"

It starts with trauma, where the initial normal reflections of a person are fear or worry represented by the characteristics of being anxious. The feelings collectively produce personal response which can be either realistic or unrealistic. The unrealistic responses are what is called PTSD.

"Time course and PTSD subtypes"

"Will everyone experience PTSD?"

No. It depends on the vulnerability of each individual, which is influenced by several factors:

1. Pre trauma factors

i. Ability to be independent
Individual inner protective skills enables some people to be "protected" from get carried away too much by his/ her own feelings or emotions as to be an I- don't- care person.. Ignorance is bliss, eh?

ii. Family
Family "trainings" affect a lot on one's characteristic and yes, one's life. Remember when we were little, and our parents (or love- to- bully big brothers or sisters..) threaten us with things like, "If you go out alone, you'll be kidnapped!" or "If you go to that place, ghost will catch you!"? This actually consciously or subconsciously influenced our capability to face things truly boldly.

Other pre- trauma factors can be the presence of prior traumatization(s), pessimistic thoughts, hereditary, recent life stressors, and initial distress at the time of trauma.

2. Post trauma factors

i. Secondary victimization
This is very common to happen. Such as for the people to be the victim of the Merapi eruption disaster is their primary victimization, then there come another plight at the refugee camp.. Can be like, the staffs scold or even insult them when they don't queue properly in a line to take their foods or as the refugees sleep together in a very large number of people of variety background causing the high occurrence of sexual harassment or even abuse:(

ii. Ineffective coping
There are two types of refugees. One is grateful- type, they accept and appreciate with what they are given. Another type is the opposite's: Ungrateful and even keep complaining.. They should actually learn to adapt with the situations..

Other post- trauma factors can be the recovery environments and the lacking or ineffective treatments.

"Can PTSD be treated?"

Yes:) There are 2 types of management for PTSD: Pharmaceutical approach and Healing approach.

1. Pharmaceutical

Symptomatic drugs.
  • Benzodiazepines for anxiety or insomnia
  • TCAs (Tricyclic antidepressants) for depression
  • SSRIs (Selective serotonin reuptake inhibitors) for PTSD itself

2. Healing

These 7 principles of healing will indeed help the healing process of PTSD:

1. Starts by applying skills to manage PTSD symptoms
This includes skills to reduce distressing arousal and manage anger or intrusions. It's not curative, but reduce the troubling symptoms.

2. Healing occurs when traumatic memory is processed or integrated
The traumatic memory is connected to adaptive material be it the thoughts or emotions. Those can be released or expressed so the memory is connected to calmer, more supportive emotions as verbalizing helps to the memory together and be viewed more logical and realistic:)

3. Healing occurs when confronting replaces avoidance
Avoidance is the hallmark of anxiety disorder. Face it, don't run from it..

4. Healing occur in the climate of safety and pacing
Traumatized is a state of feeling unsafe. Progression is steadily yet slowly to remain in control.

5. Healing occurs when boundaries are intact 
Set up a firm, positive and realistic boundaries, then stay in the "safe zone":)

6. Kind awareness and acceptance of feeling aid the healing journey
Realizing that things happened for reason, and it's in the past though. Be optimistic. 

7. Balance in our lives is necessary
Not too much, not too least. Being too emotional or even too much of being an "I don't care anything" are not a good idea.


Thursday, December 2, 2010

Disaster Surveillance

Disaster, be it the natural or man made ones are mostly preventable or at least predictable. Merapi eruption for example, where the geological expertise able to provide expected data on its condition. Disaster preparedness (and mitigation) is hence should be established as such a system will be very useful at all stages of disaster (go to my previous post on Preparedness, Response, and Recovery.

Disaster surveillance therefore is needed so any actions are in a good hand of management making sure that how, who, when, and what are involved are all in the correct lines.

Why disaster surveillance is important? You see, effects of disasters are too wide; death, mild to severe injuries, psychosocial and economic effect, famine, and population movement. The potential indirect effects of disaster cause the increase of possible transmission of communicable disease because of the movement of the people into adjacent areas due to destruction dwelling. Overcrowding, lack of water supply, food shortage, and lack of sanitation facilities will lead to disease outbreaks because of the increase of the sensitivity to disease.

 Under normal circumstances, the existing National disease surveillance system serves the following purpose: early warning, situation and trend assessment, and evaluation of the effectiveness of health promotion and disease prevention programs.

Keys in Disaster Surveillance: 
Governance & Coordination 

The target is to integrate all resource and activities to become synergistic power, to tackle health problems in emergencies and disaster efficiently and effectively.

Simply put, "governance" means: the process of decision-making and the process by which decisions are implemented or not implemented (source: UNESCAP). To this, coordination plays a major role throughout this process.
Coordination are the backbone of the health programs integration in handling disaster which branches into 8 main scopes: basic and specialist health care, nutrition, immunization, reproductive care, vector control, sanitation and environment, health promotion, and logistic aids.

The management requires effective organization, proactive leadership, and critical mindset. Collaboration with government is also important besides having a good human relation. Obviously, interdisciplinary collaborative efforts is indeed very important in the design of disaster surveillance.

In many of my other posts, I'm sure you notice that I've been talking a lot about the importance of coordination. Indeed, I believe that in any action or plan which involves more than a single party truly requires a good coordination to work on.

United we stand, divided we fall!
Reference: "Disaster Surveillance", Guest lecture: Dinkes Propinsi DIY