BLOCK 4.2 EXAMINATION

As the tittle goes, I'm sitting for this block's examination today..

I'm scared and worry.. God knows, I AM- Extremely, nonetheless, I'm quite excited.

Honestly, this blogging is not based on what I can memorize upon all the facts, concepts, details, but based on my understanding and personal views. But plus with my effort to indeed try my best to memorize those as my preparations to sit the for the paper, I hope those help me to do well in the examination.. Amin..

I have to apologize that I managed not to cover all the discussions to this point, especially the fact that some lectures were given quite late; during the examination week itself. I can't guarantee to continue pouring out the discussions (if you go to INDEX, you can see there are a few topics are still not being discussed). I will, if there are spaces in the midst of business; new block, examinations, thesis, assignments. In any way though, this blog is dedicated for a long- term benefits for me, and I wish I able to make it for everyone too.

Just go to INDEX, it's easier for you to choose which topic you want to read about. My whole reflections are there. That's what I manage to give, so far. Welcome yourself, anytime..

I would like pour my huge appreciation to all the respected professors (especially Prof dr. Laksono as the block coordinator), doctors, guests (from Ministry of Health, RS Sardjito, RS Panti Rapih, DinKes, etc), and every individuals responsibled in conducting our practical sessions, skill laboratories, and many other activities in this BLOCK 4.2 : Health System & Disaster. THANK YOU VERY MUCH.

Last but not least, my very best wishes to all my batchmates; INTERMED 07, including me either. May success and luck be with us. Amin..

Love,

Nur Taufiqah Idris.

Reference: My Heart..

It Never Sink.. YET

Infectious disease is one of the many health problem deserve much of our attention, since back to years and years ago till now. The spectrum of these diseases is expanding with the occurrence of new diseases which i. e. the new emerging diseases and the come- back of those once we thought to have been eliminated, the reemerging diseases.

If I ask you, what's the disease you know best which is highly infectious? Easily spread? The spreading affect not only family in house, not only community in one city, not only citizens in one country, but worldwide, GLOBAL. You may name a few, but I'm pretty sure that one of the answers would be INFLUENZA.

AVIAN FLU

It can be flu we all used to experience (at least once in a lifetime, but I'm sure more) since we were little, it can be avian flu, or even swine flu. I chose to discuss about Avian flu the fact that the trains of avian influenza A which causes avian flu is a highly pathogenic H5N1 virus and cause tremendously great effects, globally.
 

"The root of cause"

Click to enlarge

Avian influenza is an infection caused by avian (bird) influenza (flu) A viruses. These influenza A viruses occur naturally among birds. Wild birds worldwide get flu A infections in their intestines, but usually do not get sick from flu infections (non pathogenic influenza virus). However, avian influenza is very contagious among birds and some of these viruses can make certain domesticated bird species, including chickens, ducks, and turkeys, very sick and kill them.

"How we, human get it"

During an outbreak of avian influenza among poultry, there is a possible risk of infection for people who have contact with infected birds or surfaces that have been contaminated with secretions or excretions from infected birds.

You see, there are 2 main concerns very much highlighted of its effects toward human health:

1. H5N1 virus has caused by far the greatest number of human cases of very severe disease and the greatest number of deaths. It has crossed the species barrier to infect humans on at least three occasions in previous years: in Hong Kong in 1997 (18 cases with six deaths), in Hong Kong in 2003 (two cases with one death) and in the outbreaks that began in December 2003 and were first recognized in January 2004.

2. The risk that the H5N1 virus – if given enough opportunities – will develop the characteristics it needs to start another influenza pandemic.

"How influenza pandemic happens and can start another"

The virus has met all prerequisites for the start of a pandemic save one: an ability to spread efficiently and sustainably among humans. The virus can improve its transmissibility among humans via two principal mechanisms.

1. Reassortment

It's an event in which genetic material is exchanged between human and avian viruses during co-infection of a human or pig. Reassortment could result in a fully transmissible pandemic virus, announced by a sudden surge of cases with explosive spread.

2. Adaptive mutation

A more gradual process, whereby the capability of the virus to bind to human cells increases during subsequent infections of humans. Adaptive mutation, expressed initially as small clusters of human cases with some evidence of human-to-human transmission, would probably give the world some time to take defensive action, if detected sufficiently early.

"Treatment"

Actually, many resources stated that there is no effective treatment for avian influenza. Nevertheless, in general, treatment with the antiviral medication oseltamivir (Tamiflu) or zanamivir (Relenza) may make the disease less severe -- if the patient start taking the medicine within 48 hours after the symptoms start

Back to INDEX

References:

• "New Emerging Diseases: Avian Influenza, Swine Influenza, SARS", lecture by dr. Titik Nuryastuti, M. Si., PhD.
  
• WHO | Avian Influenza ("bird flu")

I Can Do Your Job, You Can Do Mine

What's the problem?

One of the main constraints in many of health care problems is a serious shortage of health workers. The shortage of well-trained health workers is global but low- and middle income countries feel the crisis most acutely.

Click to enlarge

The workforce crisis has no single cause. Public health care systems are not training and recruiting enough people. Well, some may say that “Hey, there are so many of them are produced”, or “Come on. There are thousands of students given a scholarship by the government to study things related to health care”. Yes, that’s true. But the truth then, when they enter the working life for good, no one can really have full control of where they are going to pour their service to.

Be it in Malaysia, or Indonesia, the pool of skilled workers is unevenly distributed, with high concentrations in urban areas and many working in the private sector rather than in public health care. Many resign due to the pressure of poor working conditions and low pay. Others migrate to better jobs abroad or with the private sector and nongovernmental organizations.

To be frank, this is a typical phenomenon in Malaysia. Many of us are rich enough to pay the government the whole bucks of money and work abroad, instead of the actual regulation where we have to pay the scholarship given to us by giving our service to the government i.e working in the government hospital for certain period of time.

What's the solution? 

Task shifting refers to a process of delegation whereby tasks are moved, where appropriate, to less specialized health workers. Through this workforce reorganization, task shifting helps making a better use of the human resources currently available.

Let me give some example. When doctors are in short supply, a qualified nurse could often prescribe and dispense the medication. Just like the scenario I gave in my previous post: "That's Ours". I hope anyone out there who used to scold a nurse because of the same reason will read my blog and learn something^^

And that doesn't stop there.The community workers can potentially deliver a wide range of services, thus freeing the time of qualified nurses. Training a new community health worker takes between one week and one year depending on the competencies required. Compare to about 3 years of training required for a nurse to fully qualify. For countries that depend on highly specialized professionals and are therefore highly concentrated and very costly, this task shifting thingy can help to cut the cost (if not much, but still a little, right?)

Save time, save energy, save cost:)

Any proof showing the benefits of  it?

WHO, in collaboration with the Office of the United States Global AIDS Coordinator (OGAC), had launched the WHO/OGAC Task Shifting Project as a key contribution to the “Train” element of the “Treat, Train, Retain” plan.

Below is shown how task shifting help in expanding the pool of human resources for health:)

During our group tutorial, some of my friends who went to certain Europe countries for the student exchange program shared their experience about this matter (Thank you William and Hema^^). Even the high-income countries like United Kingdom have also had practical experience with task shifting. How? By empowering nurses to prescribe medication (the routine's) has been successful especially in expanding services.

Same goes to United States  and Australia. They are even more daring though. Task shifting is adapted from professionals to non-professional community members. Many people with chronic conditions, such as asthma, diabetes and HIV infection, are trained to manage their own diseases on a daily basis. Two direct benefits: They need less health care, and have better health outcomes. Beyond that, people living with diseases are also trained becoming somewhat the tutors for other patients in expert patient programs.

What are the important measurements for its implementation?

There are several things very much required to be highlighted. First is that, task shifting must be implemented within systems that contain checks and balances that are sufficient to protect both health workers and the people receiving health care. It’s best to decide things by doing a good checking on its pros and cons. Just like when we are doing a research for a drug: Benefits must outweigh the risks.

Secondly, task shifting must be implemented such that it improves the overall quality of care. It should not and must not be associated with second-rate services. That’s why the appropriate and accurate training are required.

To my conclusion, task shifting can rapidly expand the number of health service providers by better using the available human resources, but no matter what and how it’s done, it still is: NO COMPROMISE ON QUALITY.

Back to INDEX

References:

•  WHO: Treat, Train, Retrain."Task Shifting Global Recommendations and Guidelines", provided by Prof. dr. Laksono Trisnantoro, M. Sc., PhD
• Human Resources for Health: "Task shifting- the answer to the human resources crisis in Africa?" 
• "Poor Team- Working in Health Care Personnel", GROUP 8 TUTORIAL SESSIONS (Week 4)

That's OURS

Miss Nur is a nurse on ward Bougainvillea that morning. Then one patient ring a bell.

Miss Nur: Yes, what can I help you?

Patient: I have a headache.. I need my doctor, Dr Taufiqah.

Miss Nur read through the medical record of the patient. The patient had been hospitalized for 3 days due to Dengue Fever.

Miss Nur: Your doctor is having an urgent meeting. She used to explain me about your conditions. There's no need for her to come anyway. Here, this will help. (She passed the patient 500mg Paracetamol). You can ring a bell if your headache still persist:)

Patient: Who do think you are? You are just a nurse. How comes you let yourself giving a medication to me? I said I need my doctor! X(

***

That's somewhat typical, right? To the public, more often than not, they have a stigmatization on this. Yes, not all, but they have their own limited perspective on what's the specific list of jobs to specific profession. To us, people in health care of medical field would say that's part of the multiprofessional doings, or task shifting. Nonetheless, even some us are also not clear about it..

Multiprofessions 

Multi-professional working requires people from different professions and agencies to work together towards meeting the goals or needs. The term ‘Multi-Agency working' or ‘Integrated Working' mean different services, agencies, teams of professionals and other staff working together to provide services that meet the needs the beneficiaries.

Other terms are also used that would seem to imply similar meaning, including inter-professional, multidisciplinary, interdisciplinary, interagency. Barrett et al (2005) suggest the prefix ‘multi' tends to imply the involvement of personnel from different professions, disciplines or agencies, whilst the prefix ‘inter' tends to imply collaboration, particularly in areas such as decision making.

In this post, I'll try my best to bring us altogether to go deeper into this topic as it's one the very important learning especially for us, the health system members which is part of our leadership and managerial skills in order to handle health problems be it within our matters and definitely in the community. Remember, leadership and managerial skills are not only about giving out orders and health problems are not only patient's disease.

Professional learning in health system can generally be divided into two:

INTERPROFESSIONAL LEARNING	MULTIPROFESSIONAL LEARNING
2 groups: Physiotherapist/ social worker GP/ Nurse GP/ Health Service manager	3 or more professional groups: GP, nurses, physiotherapists, pharmacists
PRINCIPLES
Works to improve quality of care Involves service users and carers Promotes interprofessional collaboration	Professions learn with, from and about one another Enhance practice within the professions Respects integrity and contribution of others Increase professional satisfaction

As you can see, in general, we can conclude that the main goals of the learnings include to enhance understanding of each others professional role and responsibilities and to help develop team skills, and also to increase knowledge.

Multi Agency professionals must try to work successfully and be clear about ones role and to be aware of, and respectful of, the roles of other workers and agencies. We should actively seek and respect other people's knowledge and input to deliver the best outcomes for everyone. These behaviors should apply across the public, private and voluntary sectors.

The skills and knowledge of each individual are the source of betterment. One of the most important skills are the communication and teamwork. An effective communication between the personnel are very important to fruit a very well- done collaboration. The openness to share is also one of the main contributor for the improvement and learning. Knowledge are something goes beyond infinity. Imagine a bunch of intelligent people in one round of table:) Everyone knows or at least learn to know each others role and remit, and open to provide quires or opinions.

Well.. As I like to quote:

"EFFECTIVE HEALTH CARE DELIVERY DEPENDS ON HEALTH PROFESSIONALS WORKING TOGETHER TO ACHIEVE THE BEST POSSIBLE PATIENT OUTCOMES."

(Peter Brooks: Multiprofessional Health Education)

Next post would be about "Task Shifting", which also part of the art and science of leadership and managerial skills in order to handle health problems. Welcome to come visit here again:)

Back to INDEX 

Reference:

• "Coordinating Multiprofessions and Stakeholders", lecture by Prof. dr. Laksono Trisnantoro, M. Sc., PhD
• WHO: Framework for action on interprofessional education and collaborative practice

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:

AGGRESSIVE	You win and everyone else loses
PASSIVE	You lose and everyone else wins
PASSIVE- AGGRESSIVE	You lose and you do everything you can to make others loses too
ASSERTIVE	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~

Back to INDEX

References:

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

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..

"MEDICAL DOCTOR"

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

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.

ORGANIZATION

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.

Back to INDEX

References:

• "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
  

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."

(Source: Merapi Makin Tak Pasti, Ini Instruksi SBY)

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).

Say CHEESE :D

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?

PRAY FOR INDONESIA~