Trauma + Stress = PTSD

[Assalamualaikum & salam sejahtera]


Seems to be one good equation but did you all know what’s that means?

Stress can define by everybody in the world. Believe it or not? Believe it! But how the professional explain about the stress that not everyone know about it. Today’s topic of my discussion is about stress and PTSD.

There are several definition of stress.

1. stress = tension: (psychology) a state of mental or emotional strain or suspense (wordnetweb.princeton)

2. Stress is a term in psychology and biology, refers to the consequence of the failure of an organism – human or animal – to respond appropriately to emotional or physical threats, whether actual or imagined. (The Stress of Life, Hans Selye, New York: McGraw-Hill, 1956 - wikipedia)

Thus, there are the definition of stress. There are many type of stress. In your mind, what stress means to you? Is it a bad thing? or Is it a good thing for you?211847_f260

Eustress is one of the helpful types of stress. What is the definition for eustress? It is the type of stress you experience right before you have the need to exert physical force. Eustress prepares the muscles, heart, and mind for the strength needed for whatever is about to occur.stress-main_full

Distress is one of the negative types of stress. This is one of the types of  stress that the mind and body undergoes when the normal routine is constantly adjusted and altered. The mind is not comfortable with this routine, and craves the familiarity of a common routine. There are actually two types of distress: acute stress and chronic stress.

Acute stress is the most common form of stress. It comes from demands and pressures of the recent past and anticipated demands and pressures of the near future. Acute stress is thrilling and exciting in small doses, but too much is exhausting.

While acute stress can be thrilling and exciting, chronic stress is not. This is the grinding stress that wears people away day after day, year after year. Chronic stress destroys bodies, minds and lives. It wreaks havoc through long-term attrition. It's the stress of poverty, of dysfunctional families, of being trapped in an unhappy marriage or in a despised job or career. It's the stress that the never-ending "troubles".

Quadrant One: Chronic Eustress

Quadrant One is known as Chronic Eustress or long lasting, recurrent good stress. This is by far, the very best of the types of stress out there.

Words like fun, happiness, peace, joy, laughter, spirit, and love exist in this quadrant. When we are in a state of chronic eustress, our bodies have very high levels of the feel good hormones like Dopamine and Oxytocin. These hormones make it possible for us to have high levels of self-esteem and to have really strong relationships in all areas of your life, whether they be romantic, parental or work-related.


Quadrant Two: Acute Eustress

Quadrant Two is known as Acute Eustress or rapid onset, short, intense good stress. On a 'types of stress' scale of 1-10, with 1 being bad and 10 being good, this quadrant sits at about 6-7.

When you get some really fantastic news or you are engaged in a feel great workout or when something really wonderful happens to you, you experience this kind of stress. The body is temporarily, intensely and quickly flooded with feel good hormones like Dopamine and Oxytocin. This type of stress is desirable and it does a body good to experience this type of stress often.


Quadrant Three: Acute Distress

Quadrant Three is known as Acute Distress or rapid onset, short, intense bad stress. As far as types of stress go, this one is no fun but is not terribly dangerous and in fact it can save your life.

This type of stress happens when we feel shocked or threatened and our fight or flight stress response system kicks into gear. Our bodies are flooded with emergency response hormones such as adrenaline and cortisol. These hormones allow us to be alert and have increased strength, endurance and energy, thereby allowing us to respond to imminent danger.

This type of stress comes from things like a car accident or if you are attacked or if you feel extreme fear. While this type of stress is classified as a bad stress, it is not dangerous because it does not last a long time and the body will wash away these extra hormones when the danger or threat has passed. This stress helps us to survive.

Quadrant Four: Chronic Distress

Quadrant Four is known as Chronic Distress or long lasting, recurrent bad stress. This is by far the worst of the types of stress in our lives.

Chronic distress is the cause of most peoples' problems. With this kind of stress, your body is constantly flooded with emergency response hormones like Cortisol and Adrenaline. When your Endocrine System is over-used to this extent, things begin to malfunction.

Staying here will kill you and long before this quadrant gets around to that, it will more than steal your quality of life. So get out now, while you still can and stay out.

Now, when all of us already clear about stress, we’ll move on the main objective of it which is PTSD. Why I suddenly emerge this topic. In disaster, there are many combination stress. It can be a acute distress (when Merapi erupt) and chronic distress (as long as they don’t have works to do, as they live in refugee camp). Plus, there is trauma on the Merapi eruption. Thus, this lead to PTSD. Post Traumatic Stress Disorder.


PTSD is defined as a delayed reaction to an exceptionally stressful situation or a life threatening event. The delay can be as long as 6 months or even more. This disorder has gained significant attention during the past few years as more and more researches have commented on the short and long term effects of post traumatic stress disorder.

Many psychopathological conditions affecting adults and adolescents which were initially thought to be results of internal conflicts are now found to be due to a past stressful trauma. More researches are being done in this field.


The manifestations of the disorder are seen after a couple of months. The impact of the event is so much that the person who is affected, tries to avoid any stimuli reminding him of that past stressful event. In spite of it, if the person experiences the stimuli, the manifestations become more severe, with more anxiety and more arousal.

An affected person gets repeated recollection of the stressful event as Flashbacks or dreams. The person re-experiences the original trauma and gets affected both physiologically and psychologically and tries to avoid such stimuli. Repeated Re-experiences cause a behavioral change in the person.

Thus, when there is disaster especially deadly disaster like tsunami, earthquake or volcano eruption, psychological management cannot be left out at the first hand. Psychologist or psychiatrist has to collaborate to enhance the services to the victims. They are must one of the member of rapid response team during disaster management. The impact of PTSD is so huge till they can be suicide attempt. 

Wasior-Sassu Psychology Team of Palang Merah Indonesia in Wasior



1. American Psychological Association

2. stressfocus

3. Strictly Stress Management

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Health Education Professional

[Assalamualaikum & salam sejahtera]

Code of Ethics for the Health Education Profession

The Health Education profession is dedicated to excellence in the practice of promoting individual, patient, family, organizational, and community health. Health Education Officer are responsible for upholding the integrity and ethics of the profession as they face the daily challenges of making decisions.

By acknowledging the value of diversity in society and embracing a cross-cultural approach, Health Education Officer support the worth, dignity, potential, and uniqueness of all people. The Code of Ethics provides a framework of shared values within which Health Education is practice. The Code of Ethics is grounded in fundamental ethical principles that underlie all health care services: respect for autonomy, promotion of social justice, evidence based intervention and avoidance of harm. The responsibility of each Health Education Officer is to aspire to the highest possible standards of conduct and to encourage the ethical behavior of all those with whom they work. Regardless of job title, professional affiliation, work setting, or population served, Health Education Officer abides by these guidelines when making professional decisions.


Article I: Responsibility to the Public
A Health Education Officer's ultimate responsibility is to educate people for the purpose of promoting, maintaining, and improving individual, patient, family, and community health. When a conflict of issues arises among individuals, groups, organizations, agencies, or institutions, Health Education Officer must consider all issues and give priority to those that promote wellness and quality of living through principles of self-determination and freedom of choice for the individual.

Section 1: Health Education Officer support the right of individuals to make informed decisions regarding health, as long as such decisions pose no threat to the health of others.
Section 2: Health Education Officer encourages actions, health and social policies that support and facilitate the best balance of benefits over harm for all affected parties.
Section 3: Health Education Officer accurately communicate the potential benefits and consequences of the services and programs with which they are associated.
Section 4: Health Education Officer accepts the responsibility to act on issues that can adversely affect the health of individuals, patient, families, and communities.
Section 5: Health Education Officer is truthful about their qualifications and the limitations of their expertise and provides services consistent with their competencies.
Section 6: Health Education Officer respect and protects the privacy and dignity of individuals.
Section 7: Health Education Officer actively involves individuals, patients, families, and communities in the entire educational process so that all aspects of the process are clearly conveyed and understood by those who may be affected.
Section 8: Health Education Officer respect and acknowledge the rights of others to hold diverse norms, religious, ethnics, belief, cultural values, attitudes, and opinions.
Section 9: Health Education Officer provides services equitably to all people.

Article II: Responsibility to the Profession
Health Education Officer is responsible for their professional behavior, for the reputation of their profession, and for promoting ethical conduct among their colleagues

Section 1: Health Education Officer maintain, improve, and expand their professional competence through continue professional development (CPD) issues related to the health of the public.
Section 2: Health Education Officer model and encourage nondiscriminatory standards of behavior in their interactions with others.
Section 3: Health Education Officer encourages and accepts responsible critical discussion to protect and enhance the profession.
Section 4: Health Education Officer contributes to the development of the profession by sharing the processes and outcomes of their work.
Section 5: Health Education Officer is aware of possible professional conflicts of interest, exercise integrity in conflict situations, and do not manipulate or violate the rights of others.
Section 6: Health Education Officer gives appropriate recognition to others for their professional contributions and achievements



Article III: Responsibility to Employers
Health Education Officer recognizes the boundaries of their professional competence and are accountable for their professional activities and actions.

Section 1: Health Education Officer maintains competence in their areas of professional practice.
Section 2: Health Education Officer accurately represents their qualifications and the qualifications of others whom they work with.
Section 3: Health Education Officer use appropriate standards, theories, and guidelines as criteria when carrying out their professional responsibilities.
Section 4: Health Education Officer anticipates and discloses competing commitments, conflicts of interest, and endorsement of products.
Section 5: Health Education Officer openly communicates to employers, expectations of job-related assignments that conflict with their professional ethics.



Article IV: Responsibility in the Delivery of Health Education
Health Education Officer promotes integrity in the delivery of health education. They respect the rights, dignity, confidentiality, and worth of all people by adapting strategies and methods to the needs of diverse communities and populations.

Section 1: Health Education Officer is sensitive to social and cultural diversity and is in accord with the laws, when planning and implementing programs.
Section 2: Health Education Officer are informed of the latest advances in theory, research, and practice, and use strategies and methods that are grounded in and contribute to development of professional standards, theories, guidelines, statistics, and experience.
Section 3: Health Education Officer is committed to rigorous evaluation of both program effectiveness and the methods used to achieve results.
Section 4: Health Education Officer empowers individuals to adopt and practice healthy lifestyles through informed choice rather than by coercion or intimidation.
Section 5: Health Education Officer communicates the potential outcomes of proposed services, strategies, and pending decisions to all individuals who will be affected.



Article V: Responsibility in Research and Evaluation
Health Education Officer contributes to the health of the population and to the profession through research and evaluation activities. When planning and conducting research or evaluation, Health Education Officer do so in accordance with federal and state laws and regulations, organizational and institutional policies, and professional standards.

Section 1: Health Education Officer support principles and practices of research and evaluation that do no harm to individuals, groups, society, or the environment.
Section 2: Health Education Officer ensures that participation in research is voluntary and is based upon the informed consent of the participants.
Section 3: Health Education Officer respects the privacy, rights, and dignity of research participants, and honor commitments made to those participants.
Section 4: Health Education Officer treats all information obtained from participants as confidential unless otherwise required by law.
Section 5: Health Education Officer takes credit, including authorship, only for work they have actually performed and give credit to the contributions of others.
Section 6: Health Education Officer who serves as research or evaluation consultants discuss their results only with those to whom they are providing service, unless maintaining such confidentiality would jeopardize the health or safety of others.
Section 7: Health Education Officer reports the results of their research and evaluation objectively, accurately, and in a timely fashion.



Article VI: Responsibility in Professional Preparation
Those involved in the preparation and training of Health Education Officer have an obligation to accord learners the same respect and treatment given other groups by providing quality education that benefits the profession and the public.

Section 1: Health Education Officer select students for professional preparation programs based upon equal opportunity for all, and the individuals academic performance, abilities, and potential contribution to the profession and the public's health.
Section 2: Health Education Officer strives to make the educational environment and culture conducive to the health of all involved, and all forms of discrimination.
Section 3: Health Education Officer involved in professional preparation and professional development engage in careful preparation; present material that is accurate, up-to-date, and timely; provide reasonable and timely feedback; state clear and reasonable expectations; and conduct fair assessments and evaluations of learners.
Section 4: Health Education Officer provides objective and accurate counseling to learners about career opportunities, development, and advancement.
Section 5: Health Education Officer provides adequate supervision and meaningful opportunities for the professional development of learners.


Reference :


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World AIDS Day-Where were we?

[Assalamualaikum & salam sejahtera]

aids-world-dayToday’s is 1st December 2010. When it comes to December, there are many  events that we are really remember. Since 1995, the President of the United States has made an official proclamation on World AIDS Day on 1st December every year. Governments of other nations have followed suit and issued similar announcements.

Why HIV and AIDS so special till there is a day for it?

First, we need to understand the term. HIV can be explained as:

HHuman – This particular virus can only infect human beings.

IImmunodeficiency – HIV weakens your immune system by destroying important cells that fight disease and infection. A "deficient" immune system can't protect you.

VVirus – A virus can only reproduce itself by taking over a cell in the body of its host.

While AIDS is:

AAcquired – AIDS is not something you inherit from your parents. You acquire AIDS after birth.

IImmuno – Your body's immune system includes all the organs and cells that work to fight off infection or disease.

DDeficiency – You get AIDS when your immune system is "deficient," or isn't working the way it should.

SSyndrome – A syndrome is a collection of symptoms and signs of disease. AIDS is a syndrome, rather than a single disease, because it is a complex illness with a wide range of complications and symptoms.

The continuous statistical analysis of HIV and AIDS is perform by many independent bodies and also World Health Organization (WHO). The U.S. Centers for Disease Control & Prevention (CDC) operate the largest and most comprehensive HIV/AIDS surveillance system in America. They suggest from the data 2006:

1.   An estimated 56,300 Americans are newly infected with HIV each year. 2. There are approximately 1.1 million Americans who are living with HIV/AIDS.

3.  The CDC estimates that 21% of HIV-positive people don’t know they are infected-meaning they may be transmitting HIV without knowing it.

WHO perform surveillance system for integrated data of AIDS and HIV infected patients around the world. Here are the data from 2008 and 2009.

2010 Global Report Core En 2009 Global Report Core En

From the both data, we can imagine that the burden of the disease is very huge to the world health. Thus, World AIDS Day 2010 is design to increase awareness of people around the world that we have a high risk to get infected with HIV and lead to AIDS if not manage carefully. Currently, the Antiretroviral drug is supply by WHO and other NGO’s to the world. They required a lot of money to keep ample delivery and production of the drug. Thus, World AIDS Day also used as a platform to increase human right awareness to contribute to reduce the burden of disease.

AIDS and HIV infection used to be prevented at many level of transmission. There are only 3 ways of transmission:

  1. Sexual Intercourse – the most common transmission. Thus, many activist and volunteer promote the used of condom to reduce the transmission especially to multiple partner and free sex.
  2. Blood exchange – in this group, the target population is injection drug user who are commonly share syringe. The transmission of HIV virus through blood transfusion is very minimal.
  3. Vertical transmission – it means that mother to child transmission. The mother get infected, the child has very high risk to get HIV infection.

There are many ways to prevent us from the HIV transmission. But the awareness of prevention among people is minimal. Thus, World AIDS Day is used to be the medium of prevention of HIV transmission promotion.

On the other hands, there are also many of them get infected with HIV has problem with the community. There are not treated well in the community because most probably they are afraid of transmission which are only a myth. By this awareness day, we hope the community understand about the HIV and AIDS and they will change their perception towards HIV infected people.

Every year, WORLD AIDS DAY has a theme as their target. 2010 is the continuotion of the theme in 2009 which is Universal Access and Human Right.

Universal Access is the think that very important to reduce the number of HIV infected patients. Where were we? We should there for them.. otherwise, who else?

On World AIDS Day 2010, the global community is focusing attention on protecting human rights of all people affected by HIV.

Today, I call on all sectors to protect human rights, including the right to health, and to combat discrimination. Working with people living with HIV is critical for an effective HIV response and Member States need to be mindful of the commitments made in the 2006 Political Declaration on HIV/AIDS to promote better legal and dgsocial environments for people to access HIV testing, prevention and  treatment.

WHO is firmly committed to the goal of achieving universal access to key HIV services. However, this will not be possible unless we make sure that the human rights of everyone, everywhere, are protected and promoted.

Dr Margaret Chan, WHO Director-General

There are many sector already support the AIDS Day. Where we we now?

Eighty monuments around the world will turn red in support of the (RED) campaign's 2015 goal to have zero children born infected with HIV.

As evening sets in Sydney, Australia, the iconic Opera House will be illuminated in red with U2's Bono kicking off the campaign. Time zone by time zone, similarly significant attractions will turn red for just one night. From Table Mountain in South Africa and the London Eye in London to the Empire State Building in New York and LAX in LA, on Wednesday the world will see red as a symbol of hope that an end to the fight against AIDS is near.


1. World Health Organization website


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Poll of the Week Result…

[Assalamualaikum & salam sejahtera]

Today’s, I wanna share the result of the second Poll of the Week.


Out 13 people vote to the aspect in which government need to improve, most are vote for healthcare management. Healthcare management required a large no of human resources who are dealing the management without practice as medicine. It is hard to practice both in one time.

Healthcare management is referring to the system of patient management. Patient flow in the health center or hospital is very important to reduce the burden of the patient in the hospital. If possible, try to make them feel as their home while queuing to meet healthcare provider.

However, surprisingly, healthcare finance is the least of the vote. That should be indicate that healthcare finance so far, lesser problem to the citizen of patient. Healthcare finance involve area of payment by the patient to the doctor. If they are covered with insurance, thus, they might face no problem but when they are using pay-for-service or out-of-pocket method, they might have problem with this.

Other problems are quite evenly distributed. With some improvement in the public health services, they might be increase the trustworthiness of public to the  health department.

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Disaster –view of professional perspective

[Assalamualaikum & salam sejahtera]

Disaster Risk Reduction or known as DRR is always develop from one to another. They learn from the previous experience of disaster. What the professional define it.  Disaster Risk Reduction (DRR) measures are designed to protect livelihoods and the assets of communities and individuals from the impact of hazards.

Disaster only happen when all this terminology has occur. What it is?

39. Conceptual Framework of Disaster and Disaster Management

A) Hazard - Hazards are potentially damaging physical events, phenomena or human activities which cause any or all of the following: the loss of life, injury, physical damage, environmental degradation, and social and economic disruption. Examples include both natural hazards such as floods, landslides, cyclones, earthquakes and volcanoes and man-made hazards such as inappropriate policies, accidents, war and conflict. These two classes of hazard are not mutually exclusive and often interact with each other.

B) Risk – Risk is probability and magnitude of the size of impact when there is event of hazard occur. The risk are proportional to hazard and vulnerability and disproportional to capacity.

C) Event – When the hazard already occur.

D) Impact – The impact of the event is when the event has contact to the community or people surround it.

E) Damage – When the impact are too large to handle, the impact caused damage.

F) Disaster – When the damage cannot be handle in that area, which required external sources, then we call it as disaster. If there is no need external resources, we just call it as event.

…we must shift from a culture of reaction to a culture of prevention…it is more humane… also much cheaper…

Kofi Annan, 1999

G) Prevention – any action taken to reduce the hazard by avoiding the hazard or safety precaution

H) Mitigation - reducing the frequency, scale, intensity and impact of hazards

I) Preparedness - strengthening the capacity of communities to withstand, respond to and recover from hazards, and of government, implementing partners.

J) Resilience - the ability of a system to absorb perturbations or stresses without changes in its fundamental structure or function that would drive the system into a different state (or extinction).

     i) Absorbing Capacity – anything that has ability to absorb the impact of event

    ii) Buffering Capacity – anything that being kept as support during the event/disaster

K) Response – any action after the event to reduce the damage when there is an event

L) Recovery Development – action taken to recover or restore better or at least to normal life of the damage after disaster.

Here are the example:


10.14 MerapiA) In Yogyakarta, there is Mount Merapi which is one of the most active  volcano in the world.

B) There are thousands of people live within 3km from the summit of volcano.

Bali-News-Merapi-Eruption-2010-10-27-3 C) On 26 October 2010, the Merapi erupt with such a great scale. Second eruption taken on 5th November 2010 with a greater scale.

D) The eruption produce volcanic ash and hot wave which has been flow to the residential area.foto-setelah-merapi-meletus-jogja-17

E) The hot wave can reach 600-1000°C with speed of 200-300  KM/hour   where living thing cannot withstand to the extreme heat. Volcanic ash rain to the nearby town and went to as far as 400KM from Merapi. There many  village totally damage with 250 people died due to Merapi eruption 2010. 0204pengungsi

F) In that case, there are 40 000-50 000 refugee required many essential living things to continue their life in the refugee camp. External sources required. There are many NGO’s from all over the country bring the donations and services for the refugee. 39. Conceptual Framework of Disaster and Disaster Management

G) Merapi are going to be there forever. Some of them given an option to relocation to the safer place for example to the Kalimantan where there is no volcano there. 

H) Badan Nasional Penangunglangan Bencana (BNBP) has create mitigation p20p1-lgplan. Mitigation Plans form the foundation for a community's  long-term strategy to reduce disaster losses and break the cycle of disaster damage, reconstruction, and repeated damage. The planning process is as important as the plan itself. It creates a framework for risk-based decision making to reduce damages to lives, property, and the economy from future disasters. Hazard mitigation is sustained action taken to reduce or eliminate long-term risk to people and their property from hazards. There is also called hazard mapping that can be consider as mitigation process.INDONESIA-VOLCANO

I) National Volcanologist Agency has authority to determine the danger  zone of vocano. On the 24th October 2010, Dr Surono increase the level of volcano to “alert level 4” which mean that all people surround the Merapi should evacuate to out of 10KM danger zone. All hospital, government agencies and NGO are told to be ready for anytime of eruption.

DSC05042 J) i) Few years ago, in 2006, the eruption is not as such in 2010. Fortunately, the government already build a dam to facilitate the flow of lava in to the river and not to the residential area. The dam can stand till 75million cubic of lava.inventory020

J ii) Since Merapi eruption happen once in 3-5 years, the hospital already  prepared 10% extra of drugs to any related diseases due to Merapi eruption. This is as emergency buffer drug that might be required for the disaster.

K) Since the eruption happen, the disaster plan taken with many doctors are ready to deliver care to the victim in hospital. Refugee camp built as fast as they could for the refugee, All of these known as response.

L) After Merapi stop erupting, people are recover by develop the area again.


1. Approach to Disaster Risk Reduction, September 2005

2. Kasperson, et al. (2002)


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Express yourself here...

[Assalamualaikum & salam sejahtera]

Poll of the Week:

In which aspect should the government improve of health system?
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Poll-of-the-Week Result

[Assalamualaikum & salam sejahtera]

It is not easy to attract people to fill the poll in such way that there are no rewards to them. However, there is still some of them has an effort to express their opinion through poll.

Last week (14-21 November 2010) poll is “Is today's health system of Indonesia met the expectation of citizen?”

The result is:


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Here, I’m alone as doctor? Nurse:we are here!!

[Assalamualaikum & salam sejahtera]

In contrast to the previous post which there are many healthcare professional in one area. Now, I want to express my opinion on the problem shortage of doctor in primary health care or primary health center.


The current shortage of healthcare professionals has become a global problems. The major factor contributor to this is brain drain from the rural to urban area, from poorer country to richer countries. World Health Report 2006 suggest that several wealthy countries of the world rely heavily on physicians from other countries.

The report describes the situation of New Zealand and Great Britain, where one third of the active physicians are from abroad, as well as the USA and Canada, whose physician workforces consist of nearly one quarter foreign physicians.  On the other side, some African countries, such as South Africa, Ghana and Angola have lost 20 to 35 % of their physicians to emigration.This situation leaves some of the poorest countries of the world with nearly no physicians. While many wealthy countries have a physician to population ratio of 1 to 500, in Malawi, for instance, this ratio is 1 to 50.000. According to the WHO, a total of 57 countries, mostly in sub-Saharan Africa, but also including Bangladesh, India and Indonesia, face serious health workforce shortages.


That's only one part of the problem, then it comes to second part of the problem which is the demand. At the same time, the demand for health care is rising. In high- and middle-income countries, large populations of ageing people and changing patterns of disease mean a steady growth in the demands on health services. Low-income countries continue to deal with an unfinished agenda of infectious diseases and emerging chronic illness 1. Meeting the commitments to combat disease, reduce child mortality and improve maternal health, as enshrined in the Millennium Development Goals, will involve strengthening health systems so that they are capable of delivering a wide range of health services on a scale much larger than at present.


In response to the worldwide health workforce shortage, the WHO  has developed Global Recommendations and Guidelines on Task Shifting.

There the problems. The solution is task-shifting. What is task shifting?


Task shifting is the name now given to a process whereby specific tasks are moved, where appropriate, to health workers with shorter training andds fewer qualifications. By reorganizing the workforce in this way, task shifting  can make more efficient use of existing human resources and ease bottlenecks in service delivery. Where further additional human resources are needed, task shifting may also involve the delegation of some clearly delineated tasks to newly created cadres of health workers who receive specific, competency-based training.  Task shifting alone will not put an end to the shortage of health workers but it may offer the only realistic possibility of expanding health workforce capacity fast enough to meet the urgent need for health care services.

Transfer of tasks and skills in Health,Dr AKA Kroo Florent,Medical Association of Ivory Coast presented to the SEMINAR OF THE WORLD MEDICAL ASSOCIATION, Human resources for health & the future of health care Reykjavík, Iceland, 8 & 9 March 2009 that in Ivory Coast, the shortage of health personnel has made the country try to apply the task shifting system. The Ivory Coast suffers from a shortage of health‐care structures in rural areas of the country; under‐equipped and unequally distributed structures with insufficient RHS. The difficulties in accessing care are compounded by precarious and laborious means of evacuation in an emergency. Nurses and midwives are authorized to prescribe a certain number of drugs, for which they are fully accountable (list).


Why it is very important to take action on the shortage of health care management?


It is very important to provide sufficient access of health to the citizens. Access of health is affect by many factors. One of them is the availability of health care providers.  it is already proven that to the area with high density of health care provider has higher chances of survival as compare to the area with low density of health workers.

The concept has been spreading rapidly and with intense urgency among providers of HIV prevention, care, and treatment services in many regions of Africa. Studies consistently show that task shifting in the provision of HIV services (such as distributing antiretroviral therapy) and other areas of healthcare can increase access, improve the coverage and quality of health services, and reduce the costs of providing services.

Slide1 (2) Slide2

According to the WHO, Indonesia as well as many other countries in Africa has high number of nurses and midwives as compare to the doctor. Thus, this suggests an important opportunity to train nurses and other mid-level providers to offer clinical methods of contraception such as IUDs, implants, and female sterilization. Decades of evidence show that nurses and other mid-level providers can safely deliver these long-acting and permanent methods (LAPMs), although the practice is not yet widespread.

Here are one story of the impact of shortage of doctor in Africa:

On a busy weekday at a rural family planning clinic in Senegal, a young woman enters the newly built facility. She announces that she is interested in birth control and would like to meet with a healthcare provider. The clinic is staffed by two registered nurses, a community nurse, and a doctor. But the doctor splits his time between this clinic and another one in a more urban area. Today he is at the urban centre.

After a short wait, the woman meets with one of the nurses. Upon learning about all the contraceptive methods for which she is eligible, the woman decides to try an intrauterine device (IUD), because she wants to prevent pregnancy for at least a few years and prefers a nonhormonal method that requires no daily or monthly upkeep. Unfortunately, the nurse says that she is not allowed to insert IUDs. She also tells the woman that the doctor who inserts them will not be back until next week. Discouraged and unwilling to try another method, the woman leaves for her long journey home--unprotected from an unintended pregnancy. Maybe she will be able to return to the clinic next week. Maybe she won't.”

Africa Health, November 2009:
Task shifting is expanding the roles of family planning providers


1.  Africa Health, November 2009: Task shifting is expanding the roles of family planning providers

2. World Health Organization.The world health report 2006: working together for health.

3. SEMINAR OF THE WORLD MEDICAL ASSOCIATION, Human resources for health & the future of health care Reykjavík, Iceland, 8 & 9 March 2009

4.  Task shifting : rational redistribution of tasks among health workforce teams : global recommendations and guidelines.


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Am I working alone here???

[Assalamualaikum & salam sejahtera]

Health care system is of the important element in health system beside health finances. Health care system consists more than one profession or known as multiprofession. When there are more than one profession, it is impossible that we are dealing with intraprofession but also interprofession. Today’s, there are many university already start with interprofessionalism course in the learning period.

As such in Faculty of Medicine, Gadjah Mada University, there is a week in the block that teach and share the knowledge of the interprofessionalism. This topic looks like simple process but it is actually harder that medicine. It needs several skill to fulfill the needs of interprofessionalism.

Before I describe the interprofessionalism, let me introduce what are the healthcare professional there in the clinical setting (hospital). Basically, according to British Medical Association (BMA), there are 3 broad healthcare professional in the healthcare system.

  1. Doctors – General practitioner,  GP specialty registrar, lecturer, medical student, researcher, specialist, consultant,  junior doctor, senior doctor

  2. Nerve & Midwives – Health advisor specialist, clinical nurse specialist, nursery nurse, nurse consultant, nursing auxiliary, staff nurse, specialist nurse

  3. Allied Health Professionals – Dietician, Assistant practitioner, optometrist, audiologist, orthontist, counseling psychologist, radiographer ‘diagnostic

* to read for full list of health professional, click here.


When the patient comes, there might be a referring system that almost delay in diagnosis and therapy. A complex interaction that has gaps and overlaps/redundancies. Gaps can impact the patient safety because there is no professional attend to them and thus indirectly worsen the quality of care. Where as, overlaps and redundancies has impact on access, efficient used of resources, and consistencies among healthcare professional. Thus, it is very important today’s learning process to include interprofesionalism course.


source: N. Posel, S. Faremo & D. Fleiszer; Moving toward the development of Interprofessional e-Cases;presented in Slice of Life, 18th International Meeting for medical Multimedia Developers and Educators, University of Lausanne, Switzerlnd, 4-8 July 2006

How these healthcare professional are working together?


source: N. Posel, S. Faremo & D. Fleiszer; Moving toward the development of Interprofessional e-Cases;presented in Slice of Life, 18th International Meeting for medical Multimedia Developers and Educators, University of Lausanne, Switzerlnd, 4-8 July 2006

Uniprofessional plan of care comparison is one the method to understand the role of each professional in the healthcare system. When a patient comes, they will know who are going to deliver the care and when each of the health professional needs the other healthcare professional. Working as a team has many advantages. Thus, interprofessional is very important to avoid the misunderstanding. 


Cross-sectoral interprofessional collaboration during health crises

“In 2005, northern Pakistan experienced a severe earthquake resulting in thousands of injuries. Relief efforts were particularly challenging in isolated mountain communities. A wound clinic was eventually opened within a partially constructed hotel, but had no source of water, making infection control extremely difficult. One of the volunteer health workers took the initiative to locate a trained plumber who was able to provide the clinic with a constant source of clean water within 48 hours. In this situation, seeking expertise outside of the conventional health-care team ensured earthquake victims were able to receive quality health-services in spite of the difficult circumstances (52). This is a common occurrence in emergency situations where collaboration across sectors can be essential to improving health outcomes (48).”

Framework for Action on Interprofessional Education & Collaborative Practice(WHO/HRH/HPN/10.3)

Here is the examples the needs of interprofessionalism. It is very important especially in emergency case and disaster management. It is very important that each one of the healthcare professional can not work alone.

To capture current interprofessional activities at a global level, the WHO Study Group on Interprofessional Education and Collaborative Practice conducted an international environmental scan between February and May 2008. The aim of this scan was to:

Determine the current status of interprofessional

  • *   Determine the current status of interprofessional education globally
    *   Identify best practices
    *  Illuminate examples of successes, barriers and enabling factors in interprofessional education.

A total of 396 respondents, representing 42 countries from each of the six WHO regions, provided insight about their respective interprofessional education programmes. These individuals represent various fields including practice (14.1 per cent), administration (10.6 per cent), education (50.4 per cent) and research (11.6 per cent).

sources: Framework for Action on Interprofessional Education & Collaborative Practice(WHO/HRH/HPN/10.3)

Results indicate that interprofessional education takes place in countries and healthcare settings across a range of income categories.* It involves students from a broad range of disciplines including allied health, medicine, midwifery, nursing and social work.


1. N. Posel, S. Faremo & D. Fleiszer; Moving toward the development of Interprofessional e-Cases;presented in Slice of Life, 18th International Meeting for medical Multimedia Developers and Educators, University of Lausanne, Switzerlnd, 4-8 July 2006

2. Framework for Action on Interprofessional Education & Collaborative Practice(WHO/HRH/HPN/10.3)

-tHaNk yOu-

[happy Eid-uL-Adha]

[Assalamualaikum & salam sejahtera]

Almighty Allah says in the Holy Quran, Chapter 22 Verse 34 :

"And to every nation we have appointed acts of devotion (sacrifice) that they may mention the name of Allah on what He has given them of the cattle quadrupeds; and your God is one God, therefore to Him should you submit, and give good news to the humble whose hearts tremble when Allah is mentioned, and those who are patient under that which afflicts them"


Today’s is one of the big celebration for Muslim in the world.  Eid- Ul- Adha is one of the special festivals of Muslim. Eid- Ul –Adha is also known as Bakr- Eid and festival of sacrifice. On this festival Muslims sacrifice their domestic animals like goat (Bakr- Eid), sheep, camel etc. This sacrifice made by Muslims is a symbol of sacrifice made by prophet Abraham.

The Festival of the Sacrifice is one of two major Islamic celebrations and takes place on 125808,xcitefun-109400the Islamic month Dhul-Hijjah, in which millions of Muslims from around the world make an annual pilgrimage to Makkah in order to worship Allah and to commemorate the willingness of the Prophet Abraham (PBUH) to sacrifice his son Ishmael in response to a command from God. Satisfied with Abraham’s devotion, God replaced Ishmael with a sheep at the last second, and the sheep was slaughtered instead. While pilgrims in Makkah re-enact this scene by slaughtering sheep of their own, Muslims who can afford it in the rest of the world also participate in this rite by slaughtering sheep, camels and cows.

During the celebration of Eid al-Adha, Muslims commemorate and remember Abraham’s trials, by themselves slaughtering an animal Allah has given us power over animals and allowed us to eat meat. That is why Muslims slaughter animals by saying the name of Allah at the time of slaughtering. And give charity to the poor and impoverished by making contributions and distributing meat for Allah.

beef-organic-FD-lg These acts certainly spread happiness and good cheer amongst so many individuals and their families, especially during the festival of Eid-ul-Adha where Muslims are in the spirit of celebrations.

The meat from the sacrifice of Eid al-Adha is mostly given away to others. One-third is eaten by immediate family and relatives, one-third is given away to friends, and one-third is donated to the poor.

“It is not their meat nor their blood that reaches Allah; it is your piety that reaches Him.” (Qur’an 22:37)

Here are some benefits of eating meat for health, according to Buzzle:

Meat is a rich source of protein, which is needed by the body in very high quantities. Proteins play an important role for various body functions, including development, tissue repair and formation of antibodies that fight infections.

Meat contains a number of minerals, especially rich in iron, zinc and selenium. The body needs iron to form hemoglobin necessary for transporting oxygen from the lungs to other body parts.

Vitamins which are most prominent in meat are vitamin A, B complex (B1, B2, B3, B5, B6 and B12) and D. Vitamin A promotes good vision, support the development of bones and teeth and maintaining healthy skin. Vitamin B supports the central nervous system and improving mental health. And vitamin D to increase calcium and phosphorus, which in turn maintain healthy bones and teeth.

Fatty acids in meat are linoleic acid and palmiotelik. These fats can prevent the body from cancer and harmful viruses. The body also needs fat for brain development.

But, besides the benefits above, eating meat without balancing could be harmful for health.

Over eating Meat not only affects our health; it also has an effect on the environment, the morals, and the economies.

Just remember that eating meat “regularly is good for our health” because it supplies some of the essential nutrients that our body needs, but if you eat too much of it, of course there are some disadvantages which I will enumerate some of them below.

Here are some disfavors of eating a lot of meat:

Meat contains no fiber

Fiber helps the digestive system in the body. Without fiber, the body is at high risk of certain diseases such as cancer and heart problems. That’s why the people, who eat meat without balanced incessantly during Eid with other healthy lifestyle, are at high risk of cancer.

High saturated fat
Saturated fat, of course is not good for health. This is the main enemy for the blood vessels and heart. Over eating meat impairs the heart’s ability to do its job. Meat and dairy products are high in cholesterol and saturated fat. As these fatty substances, or “plaques,” build up inside the walls of arteries, blood flow to all areas of the body is impeded. This artery damage is called atherosclerosis. The result, many people have cardiovascular disease because of the habit of eating meat. Avoiding over eating meat is one of the best and simplest ways to cut down your fat consumption. Those who still eat beef are, in my view, foolishly exposing themselves to the risk of contracting the horrifying human version of Mad Cow Disease.

High in nitrate and salt
Processed meats such as bacon, hot dogs, ham and others are very bad for health. Meat can bring long-term negative effects because is contain many nitrates and salt as a preservative. High content of nitrate and salt can cause high blood pressure and trigger cardio vascular diseases like heart disease and stroke.

Moreover, Anaemia, appendicitis, arthritis, breast cancer, cancer of the colon, cancer of the prostate, constipation, diabetes, gall stones, gout, high blood pressure, indigestion, obesity, piles, strokes and varicose veins are just some of the well known disorders which are more likely to affect big-meat-eaters.

If you really want to eat meat, keep in mind not to eat meat every day, give your body a break because meat is food that is hard to digest. But meat is still needed for health, especially for children who are in its growth age.

Here’s the good news: Now that we know the disadvantages of over eating meat during Eid-ul-Adha, we can prevent them. Studies have shown that using of vegetable with meat.


The moral of whole text is that meat has always stayed as a rich source of food in terms of taste, nutrients and Balance_platealso medicinally at times. The advantages of having meat are helpful to younger people in the process of growth and they reach the elder ones as well. The invaluable source of food, the meat has been serving the people from times immemorial. But the overness of every thing cause malady and in diet cause harmful health.

Eating meat should also be balanced with healthy foods like vegetables and fruits, and do not forget to exercise regularly.

I am just painting a picture for you; if you will empathize it, it will be good for you and if you will not so good luck to you.


1. Ali Zhoraiz Jaffri, Eid-uL-Adha towards meat’s overness, 14-Nov-2010, The financial Daily

2. Dr. Ashiq Hussain, Eid-uL-Adha, 25-Nov-2009,



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Mohammad Fazrul bin Mohammad Basir, 4th year medical student of Faculty of Medicine, Gadjah Mada University, City of Student & Tourism, Yogyakarta, Indonesia. Being a medical student with an ambition to be director of government hospital later in my career, this blog is a good start. Enjoy yourself here!!

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