Tutor Sesi 1 Skenario C.docx

BAB I

PRELIMINARY 1.1.

Background The Community Medical and Community Health Block is the twenty-second block in the 7th semester of the Competency Based Curriculum (KBK) at the Faculty of Medicine, Muhammadiyah University of Palembang, which demands the mastery of the material, both knowledge and skills that will support to become a superior doctor, qualified, and islamic. On this occasion, C case scenario scenario C which presented cases related to Outbreak and Occupational Health.

1.2.

Purpose and Objective The purpose and objectives of the Case scenario tutorial C, namely:

1.

As a report task group tutorial that is part of the learning system Competency Based Curriculum (CBC) at the Faculty of Medicine, Muhammadiyah University of Palembang

2.

Can solve the case given in the scenario with the method of analysis and learning group discussion.

3.

Achieving the objectives of the tutorial learning method.

BAB II DISCUSSION 2.1

Data Tutorial Tutor

: dr. Iskandar

Moderator

: Meitria Nur Sabrina

Desk Secretary

: Soleha

Notulis

: Indah Ulfanov Pratiwi

Time

: Session 1: Tuesday, 07 November 2017 Time: 13.00-15.30 WIB Session 2: Thursday, 09 November 2017 Time: 13.00-15.30 WIB

Rule of tutorial :

1. Switch the phone off or in silence. 2. Raise your hand when going to argument. 3. Permission when going out of the room. 4. Prohibited activate the mobile phone when prosestutorial take place. 5. Prohibited from bringing food and drink during the tutorial process.

2.2

Tutorial Scenario Dr. Beny just worked for 6 months at the Puskesmas beringin Jaya. He got a report from his surveillance staff that this month there was an increase in cases of diarrhea, acute respiratory infections ( ARI) significantly. Beringin Jaya has been a village with endemic diarrhea and ARI. Puskesmas located is in Beringin Jaya village with population of 20.000. Beringin Jaya village is located on the river bank where the river is used by residents for bathing, washing and defecating. At the base of the river there is a rubber processing plant, where factory waste is directly flowed inti the river without prior treatment.

The work of general population is as a forest encroachment farmer, where to open their land to burn forest. Some of the population work as labor in rubber processing plant, generally they work not using personal protective equipment. Dr. Beny plan to investigate outbreaks to prevent transmission and to the seek the source of disease transmission. He will also provide education to prevent transmission of the disease. 2.3 Clarification of Problems 1. Surveillance staff

: The monitoring of behavior activities or other changing

information for purpose of influenzing, managing, directing or protecting people. 2. Endemic

: There is or usually a prevalence in the population at any

time. 3. Diarrhea

: The discharge of water stools is often abnormal.

4. Personal protective equipment : Protective equipment that must be used when working in accordance with the hazards of work to maintain the safety of the workers themselves and those around them. 5. Acute respiratory Infection : Classified as upper respiratory tract infection or lower respiratory infection. 6. Disease transmission

: Means by which contagious, pathogenic

microorganism are spread from one person to other. 7. Rubber processing plant

: Place of processing of raw rubber or natural

rubber which has undergone various technical development. 8. Provide public education

: Educating the public on environmental,

physical, social, emotional, intellectual, and spiritual health. 9. Prevent transmission

: Precautions for the spread of a disease.

10. Population

: The whole number of people or residents in an area.

11. To investigate

: Search out and examine the particular of in an attempt

to learn the facts of about something hidden. 12. Outbreaks particular time and place.

: A sudden increase in occurances of a disease in

Identification of problems

2.4

1. dr. Beny just worked for 6 months at the Puskesmas beringin Jaya. He got a report from his surveillance staff that this month there was an increase in cases of diarrhea, acute respiratory infections ( ARI) significantly. Beringin Jaya has been a village with endemic diarrhea and ARI. 2. Puskesmas located is in Beringin Jaya village with population of 20.000. Beringin Jaya village is located on the river bank where the river is used by residents for bathing, washing and defecati. At the base of the river there is a rubber processing plant, where factory waste is directly flowed inti the river without prior treatment. 3. The work of general population is as a forest encroachment farmer, where to open their land to burn forest. Some of the population work as labor in rubber processing plant, generally they work not using personal protective equipment. 4. Dr. Beny plan to investigate outbreaks to prevent transmission and to the seek the source of disease transmission. He will also provide education to prevent transmission of the disease.

2.5

Problem analysis 1

a. What are the tasks of the surveillance staff? Answer: Based on the Decree of the Minister of Health No. 1479 / Menkes / SK / X / 2003 on Guidelines on the Implementation of Epidemiology Surveillance System for Infectious Diseases and Non Communicable Diseases, the role of surveillance of puskesmas is: 1. Data Collection and Processing The Puskesmas surveillance unit collects and processes STP Puskesmas data from the outpatient registers & inpatient registers at Puskesmas and Puskesmas Pembantu, excluding data from non-Puskesmas service units and health cadres. The collection and processing of data is utilized for analysis materials and recommendations for follow-up as well as data distribution.

2. Follow-up Analysis and Recommendation The Puskesmas surveillance unit conducts monthly analysis of potential outbreak diseases in its area in the form of a table according to the village / kelurahan and the weekly disease trend graph, then informs the results to the Puskesmas Head, as the implementation of local area monitoring (PWS) or early awareness system of potential outbreak diseases at the Puskesmas. If there is a tendency to increase the number of potential disease outbreaks, the Head of Puskesmas will conduct an epidemiological investigation and inform the District Health Office. The Puskesmas surveillance unit conducts an annual analysis of disease progression and links it to risk factors, environmental changes, and program planning and success. Puskesmas utilize the results as an annual profile material, Puskesmas planning materials, program and sector related information and District / Municipal Health Office.

3. Feedback Puskesmas surveillance unit sent monthly report attendance and data recovery request to Puskesmas Pembantu in its working area.

4. Reports Every week, Puskesmas send PWS data of potential disease of KLB PWS KLB (attached form 3). Every month, Puskesmas sends STP Puskesmas data to District / City Health Office with the type of disease and its variables as form STP. EFA (attached form 4). In the PWS data of potential outbreaks and STP data, this Puskesmas does not include data on non-health service units and health cadres data Each week, non-Puskesmas Service Units send PWS data of potential outbreaks to District Health Offices (KMK RI, 2003)

b. What is the meaning of dr.Beny receiving a report from sruveilans staff that this month there is an increase in cases of significant and endemic diarrhea and respiratory infection in Beringin Jaya village? Answer: The meaning has happened Extraordinary Occurrence (KLB) of ARI and diarrhea disease. Extraordinary Occurrence (KLB): the occurrence or increment of events. Significant epidemiological pain or death in an area over a period of time. (Regulation of the Minister of Health No. 949 / MENKES / SK / VII / 2004 Regulation of the Minister of Health No. 949 / MENKES / SK / VII / 2004).

c. What is the meaning surveillance staff? Answer: Based on the Decree of the Minister of Helath no. 45 / Menkes / 2014 on Guidelines on the Implementation of health surveillance. Health Surveillance is a systematic and observational activity continuous data and information about the incidence of the disease or health problems and conditions that affect the occurrence improvement and transmission of disease or health problems to obtain and provide information to guide action control and countermeasures effectively and efficiently.

d. How are surveillance measures? Answer: The decree of the minister of health of the republic of indonesia number 1116 / menkes / sk / viii / 2003 concerning guidelines for implementing epidemiology surveillance system. Health epidemiological surveillance activities are activities that are carried out continuously and systematically with the working mechanism as follows: 1. Identification of cases and health problems as well as other relevant information 2. Recording, reporting, and data processing 3. Analysis and interpretation of data 4. Epidemiological studies 5. Dissemination of information to units that need it

6. Make recommendations and follow-up alternatives 7. Feedback

e. Anyone who becomes surveillance? Answer: Human resources of health epidemiology surveillance system include: 1. Epidemiologists (S1, S2, S3) 2. Epidemiological surveillance officers trained field epidemiologic assistants, and trained puskesmas officers epidemiologic surveillance 3. Health unit managers who have an epidemiological orientation 4. Position of epidemiological function 5. Entomology functional position 6. Functional position of sanitarian 7. Functional position statistisi 8. Laboratory human resources 9. Other related human resources

f. What an indicator of an area is said to be endemic? Answer: It is evenly distributed, occurs continuously in every season and comes from the region concerned. g. Anything related to endemic and for example? Answer: 1. Endemic: persistent disease in a particular place, population and community (minimum 3 years in a row). For example: DHF 2. Epidemic (epidemic): an increase of disease beyond normal (2 x fold before) in the community. Example: filariasis 3. Pandemic: epidemics that exist in a very large area (worldwide) Example: H1N1 2009 (Swine flu)

4. Sporadic: the ongoing incident is in short time and at the time of each observation the events are not interconnected in the manufacturing process. For example: NE disease.

h. How does disease travel naturally and transmisinya? (diarrhea and ARI) Answer: Diarrhea: Transmission of infectious germs that cause diarrhea is transmitted through Face-Oral germs can be transmitted when entered into the mouth through food, drink or contaminated objects with feces, such as fingers, food containers or drinking places to be washed with contaminated water. People who are covered by clean water supply have a lower risk of diarrhea than people who do not get clean water. Communities can reduce the risk of diarrhea by using clean water and protecting the water from contamination from the source to storage at home (Soepardi, 2011).

ARI: Transmission of infectious agents through airborne is disease transmission caused by spreading droplet nuclei that remain infectious when flying in the air in long distances and long periods of time. Transmission through the air can be further categorized into "obligate" or "preferential" transmission (Soepardi, 2011).

2

a. What is the relationship of Beringin Jaya village located on the river bank with the condition of river use for bathing, washing and defecation purposes? Answer:

Rubber factory by the river Pollution of the river water The village of Beringin Jaya (located on the edge of the river)

Community behavior habits use river water for bathing, washing, defecation (water washed diseases) Endemis Diarrhea

diarrhea

There is no influence from outside the village

b. What is the impact on the health of residents who use river water for bathing, washing and defecation? Answer: According to (Workie, Amare, Melake Demena et al. 2003) which includes wateborne disease are:

Categories

of Diseases

agents Bacterial

Shigellosis

Causes

Caused Transmission

organisms

route of disease

Shigella. Sp

Man-Feces-waterfood and drinkhuman

Thyphoid

Salmonella dan

Cholera

thypi Man-Feces-water-

salmonella food and drink-

parathypi

human

Vibrio Cholera

Man-Feces-waterfood and drinkhuman

Acute Gastroenteritis

E. coli

Man-feces-waterhuman

Infectious hepatitis

Viral

Hepatitis A virus

Man-feces-water-

Hepatitis E Virus

food and drinkhuman

Poliomyelitis

Polio virus

Man-feces-waterhuman

Acute Gastroentritis

Rota Virus

Man-feces-waterhuman

Amebiasis

Protozoal

Entamoeba

Man-feces-water-

Hystolitica

food and drinkhuman

Giardiasis

Giardia lamblia

Man-feces-waterfood and drinkhuman

Helminths

Dracunculiasis

Drancunculus

(Guinea Worm)

medinesis

Man-water-human

c. What are the types of diseases associated with water as transmissions? Answer: According to the way of spreading, there are four kinds of diseases that contagion involves water: 1) Water Borne Disease That is a disease transmitted directly through drinking water, where the drinking water contains pathogenic germs causing the concerned to become sick. Included in this category are cholera, typhoid, dysentery etc.

2) Water Washed Disease It is a disease caused by poor water hygiene. Mode of transmission may be: a) GI infection, such as diarrhea in children, b) Infection of the skin and eyes, such as scabies and trachoma. c) Diseases through rodent urinary fluid, such as leptospirosis. 3) Water Based Disease Is a disease caused by seeds of disease that most of the life cycle associated with water. An example of this disease is Schistosomiasis. 4) Water Related Vectors It is a disease caused by a disease vector that partially or all of its longings is in the water. Included in this category are dengue fever, malaria, filariasis, etc. (Priyanto, 2011).

d. What are the types of latrines? Answer: 1) Cemplung toilet, latrine (pit latrine) Inside the pit latrine ranged between 1.53 meters. In accordance with the rural areas, the latrine can be made from bamboo, bamboo walls, and the roof of coconut leaves or rice leaves. The distance from drinking water sources is at least 15 meters away. 2) Ventilated cistern (ventilated improved pit latrine = VIP latrine) This toilet is almost the same as the cemplung latrine, the difference is more complete, that is using the pipe vent. For rural areas, these ventilation pipes can be made with bamboo. 3) Toast pond (fishpond latrine) These latrines are built on fish ponds. 4) Fertilizer toilet (the compost privy) In principle, these latrines are like a cemplung latrine, only more shallow excavations. In addition, the latrine is also to dispose of animal waste and waste, and leaves. 5) Septic tank This type of septic tank latrine is the most eligible way, therefore, the recommended disposal of these stools. Septic tanks consist of a watertight sedimentary tank, in which faeces and waste water enter and decompose. In this tank, the stool will be for several days. During this time, the stool will have 2 processes:

a) Chemical process b) Biological processes (Notoadmodjo, 2011).

e. How to waste factory treatment? Answer: Wastewater treatment methods: Wastewater treatment is intended to protect the environment against waste water pollution. Some simple ways of waste water treatment include: a) Dilution The wastewater is diluted until it reaches a sufficiently low concentration, then is discharged into water bodies. b) Oxidation ponds (oxidation ponds) In principle, this way of processing is the utilization of sunlight, algae, batteries and oxygen in the process of natural cleansing. Wastewater is flowed into a large rectangular pool with a depth of between 1-2 meters. The walls and bottom of the pond need not be lined with anything. The location of the pond should be far from residential areas, and in open areas, thus allowing good wind circulation. c) Irrigation Wastewater is poured into open trenches dug, and water will seep into the ground through the base of the trench walls (Notoatmodjo, 2011)

f. What are the criteria for making good latrines? Answer: According Notoadmojo (2011) A toilet called healthy for rural areas must meet the following requirements: 1. Does not pollute the surface of the soil around the latrine 2. Do not contaminate surface water around it 3. Not pollute the surrounding groundwater 4. Unaffordable by insects especially flies and cockroaches and other animals 5. Does not cause odor 6. Easy to use and maintain (maintenance)

7. Simple design 8. Cheap 9. Can be accepted by the wearer.

3. a. What diseases are likely to be experienced by farmers encroaching forests and laborers factory? Answer: - Diseases of the forest planters Respiratory diseases: ARI, Pneumonia.

- Disease on factory workers: Chemical trauma, ARI.

b. What good tools are used by rubber farmers and workers processing rubber processing? Answer: Forest encroachers: 1. Head protector (hat, head hood) 2. Eye and face protection devices (safety goggles, masks) 3. Earplugs (ear plugs, earplugs) 4. Respiratory protective equipment (mask) 5. Hand protective device (gloves) 6. Foot protector (boots)

Rubber Factory Workers: 1. Head protector (safety helmet) 2. Eye and face protection devices (safety goggles, masks) 3. Earplugs (ear plugs, earplugs) 4. Respiratory protective equipment (mask) 5. Hand protective device (gloves) 6. Foot protector (safety shoes).

c. What are the types of occupational diseases? Answer: According to the International Labor Organization (ILO), occupational accidents are classified by 4 kinds: 1) Classification by accident type a) Fall b) Wrapped objects c) Pounded or exposed to objects d) Squashed by objects e) Movements beyond ability f) High temperature effect g) Exposed to electric current h) Contact of hazardous materials or radiation 2) Classification by cause a) Machines, such as power generation machines, sawmills, and so on. b) conveyance, land transport, air and water transport equipment. c) Other equipment, such as burner and heating kitchens, refrigeration installations, electrical appliances, and so on. d) Materials, substances, and radiation, such as explosives, gases, chemicals, and so on. e) Work environment (outside buildings, inside buildings, and below ground) f) Other causes 3) Classification by nature of injury or abnormality a) Fracture b) Dislocation c) Strain muscles d) Bruises and other deep wounds e) Amputation f) Wounds on the surface g) Concussion and crumbling h) Burns i) Sudden poisoning

j) Influence of radiation k) And others 4) Classification according to location of abnormalities or injuries in the body a) Head b) Neck c) Agency d) Top member e) Lower member f) Plenty of places g) Other location (Notoadmojo, 2011)

d. What is K3 and its system at the factory? Answer: K3 are all conditions and factors that can impact on occupational safety and health for workers and others in the workplace. OHSAS stands for Occupational Health and Safety Assessment Series (OHSAS 18001) is an international standard for implementing Occupational Safety and Health Management Systems in the workplace / company. Compulsory procedures of OHS are contained in OHSAS 18001 in 2007 which are: a. Hazard Identification, Risk Assessment and Control Procedures b. Conformity Evaluation Procedure Against Legal Requirements, Regulations, And Legislation on Occupational Safety and Health c. Competency, Training and Awareness Procedures d. Communication Procedures, Participation and Consultation e. Document Control Procedures f. Operational Control Procedures g. Emergency Preparedness and Response Procedures h. Performance Measurement and Monitoring Procedures i. Procedures for Investigation and Incident Analysis j. Non-Conformity, Corrective Action and Precautions

k. Record / Record Control l. Internal Audit Procedures.

e.

How is the law that controlled of K3? Answer: a.

Laws governing the OSH implementation system: a. In the Law of the Republic of Indonesia Number 13 Year 2003 on Employment Article 87. 1) Every company must implement a safety and health management system integrated with the company's management system. 2) Provisions concerning the application of occupational safety and health management systems as referred to in paragraph (1) shall be regulated by a Government Regulation.

b.

In Government Regulation No. 50 of 2012 on the implementation of occupational safety and health management system of article 10-13.

f. How to prevent occupational diseases? Answer: To prevent occupational diseases can be made between various efforts other: 1) Periodic Medical Examination. 2) Special Health Checkup. 3) Health Services. 4) Provision of Facilities and Infrastructure and more convenient workplace improvements.

4. a. What are the criteria of an area that is said to be an outbreak? Answer: An area may be specified in an outbreak, if it falls incorrectly one criterion as follows: a. The emergence of a particular infectious disease as referred to in Article 4 which was previously absent or unknown in an area.

b. Increased incidence of continuous pain for 3 (three) periods in hours, days or weeks consecutively according to the type of illness. c. Increased incidence of pain twice or more compared to previous period within hours, days or weeks by type of illness. d. The number of new patients within a period of 1 (one) month shows an increase of two or more times compared with the average number per month in the previous year. e. The average number of incidences of morbidity per month for 1 (one) year showed an increase of two or more times compared with the average number of incidences of morbidity per month in the previous year. f. Case Fatality Rate (Case Fatality Rate) in 1 (one) period of time indicates an increase of 50% (fifty percent) or more compared to the mortality rate of a disease case of the previous period in the same period. g. Proportional rate of new patient in one period shows increase twice or more compared to one previous period in the same period. (Permenkes, 2010)

b. What are the steps to conduct an outbreak investigation? Answer: According to Regulation of the Minister of Health of the Republic of Indonesia No 949 / MENKES / SK / VIII / 2004, Investigation of alleged outbreaks by: 1) In the Health Service Unit, the health worker asks every visitor of the Health Service Unit about the possibility of an increase in the number of people suspected of the outbreak at a particular location. 2) In the Health Services Unit, the health worker checks the inpatient and outpatient registers of any possible increase in suspected cases at a particular location based on the patient's address, age, and gender or other characteristics. 3) The health worker interviewed the village head, the head of the dormitory and everyone who knows the state of the community about the increase of the suspected disease of the outbreak.

4) Opening of service post at the location of suspected outbreak and analyzing patient data of treatment to know the possibility of existence of increase of suspected disease. 5) Visiting suspected persons home or home-to-house visits to all residents depending on the choice of investigation team.

c. How to prevent disease transmission and provide health education in the community? Answer: 1. Primary prevention. Primary prevention is the effort to modify risk factors or prevent the development of risk factors, before the start of pathological changes, performed at the stage of suseptibel and disease induction, with the aim of preventing or delaying the occurrence of new cases of disease. 2. Secondary prevention. Secondary prevention is a preventive effort in the asymptomatic disease phase, precisely at the preclinical stage, on the incidence of clinical disease symptoms through early detection (early detection). 3.Terertial prevention. Tertiary prevention is the prevention of disease progression in the direction of the consequences of worse disease, with the aim of improving the quality of life of patients. Tertiary prevention is usually done by doctors and a number of other health professions (eg, physiotherapists) (Depkes RI, 1994).

5. How is Islam's view related to this case? Answer: The Word of Allah SWT in Q.S. Ar-Ruum, 30: 41:

Meaning: "It has been seen that the damage on land and at sea is due to the deeds of human hands; God wants them to feel some of the (result) of their deeds due to) their deeds, in order that they return to the right path. "

Conclusion Residents around the river Beringin Jaya Village pollute the river by bathing, washing, and defecating and clearing land by burning the forest, thus increasing the incidence of diarrhea and ISPA.

Conceptual Framework Burn Forest

Smoke Pollution

ARI

Factory wasted flowed into river without prior treatment

Polluted water

Water used by residents for vathing, washing, and defecating Polluted water Diarrhea

BIBLIOGRAPHY

Kemenkes RI. 2014. Situasi dan Analisis Hepatitis. Infodatin Pusat Data dan Informasi Kementerian Kesehatan RI, Jakarta, Indonesia. Menteri Kesehatan Republik Indonesia. 2003. Keputusan Menteri Kesehatan RI Nomor 1116 tahun 2003 Pedoman Penyelenggaraan Sistem Survelilans Epidemiologi Kesehatan. Jakarta: Departemen Kesehatan Noor, N. 2008. Epidemiologi. Jakarta: Rineka Cipta Notoatmodjo, Soekidjo. 2011. Kesehatan Masyarakat: Ilmu dan Seni. Rineka Cipta, Jakarta, Indonesia. Pedoman Surveilans Epidemiologi Penyakit Menular. Departemen Kesehatan Republik Indonesia Direktorat Jendral PPM-PLP Direktorat Epidemiologi dan Imunisasi. 1994. Jakarta Permenkes RI nomor 1501 Tahun 2010 tentang Jenis Penyakit Menular Tertentu yang dapat menimbulkan Wabah dan Upaya Penanggulangan. Priyanto, Dwi. 2011. Peran Air dalam Penyebaran Penyakit. BALABA, 7 (1), pp 27-28. Putra, Maha A. A Ngr. 2012. Analisis Sistem Informasi Geografis Kepadatan Penduduk kota Denpasar dengan mengunakan ARC view 3,3. Dapat diakses di ojs.unud.ac.id. [Diakses pada 9 November 2016] Soepardi, Jane. 2011. Situasi Diare di Indonesia. Buletin Data Kementerian Kesehatan RI, Jakarta, Indonesia. Tarwaka. Keselamatan dan Kesehatan Kerja. Manajemen dan implementasi K3 di tempat kerja. Surakarta: Harapan Press. 2008