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 and 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.

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

References:

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.

 

-tHaNk yOu-

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.

References:

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 the 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.

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:

Protein
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.

Mineral
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.

Vitamin
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.

Fat
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 also 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.

References:

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, articlebased.com

 

-tHaNk yOu-

Disaster-A way to educate the community

[Assalamualaikum & salam sejahtera]

Referring to my previous, i’m too early for the disaster. However, i’m very interested to share information on how the government educate the people who are in the risk area. In the few weeks, there are many disaster happen in Indonesia. It starts with the flood disaster in Wasior, West Papua.

(10th October 2010)

“At around 4 am East Indonesian Time on Monday, October 4, 2010, a ferocious flash floods hit Wasior the capital city of Wondama Bay regency. Within minutes the city inundated with a raging stream of water. The flood destroys houses, cars and whatever else was on its path. 65 people were reported dead and 76 were seriously injured with dozens are still missing. Local residents describe the event as a small tsunami. “

Jakarta Updates

Then, after the disaster management still in the process, volcanic activity of Mount Merapi increasing significantly. Thus, evacuation of the people living in the Merapi Mount area is started and this is officially that disaster management has begun.

"Officials have predicted that if it erupts, magma would flow to the southern side," said Sri Purnomo, the head of Sleman regency, where Mount Merapi is located. He said officials were warning some 11,400 villagers living on the mountain's southern slope to prepare for "urgent evacuation." About 40,000 people live close to the mountain.

Sri Purnomo, the head of Sleman regency

The Jakarta Post

It is not an easy task to evacuate 40 000 people out of danger area. Not all the people there want to evacuate as they believe that the Merapi is still not dangerous. Not so long after that, there are earthquake and tsunami in the Mentawai Islands, Sumatera. When its comes to earthquake and tsunami, it is totally disaster.

Indonesia is an archipelago in Southeast Asia consisting of 17,000 islands (6,000 inhabited) and straddling the equator. The largest islands are Sumatra, Java (the most populous), Bali, Kalimantan (Indonesia's part of Borneo), Sulawesi (Celebes), the Nusa Tenggara islands, the Moluccas Islands, and Irian Jaya (also called West Papua), the western part of New Guinea. Its neighbor to the north is Malaysia and to the east is Papua New Guinea.

Indonesia, part of the “ring of fire,” has the largest number of active volcanoes in the world. Earthquakes are frequent. Wallace's line, a zoological demarcation between Asian and Australian flora and fauna, divides Indonesia.

Read more: Indonesia: History, Geography, Government, and Culture

Since, Indonesia are very risky to the natural disaster and man-made disaster, what are the promotion has been made by the government in order to deliver this message to the community?

While I’m browsing for the information, I have found one interesting fact that the Indonesia government has made it in a comics form and the comic is suitable for everyone and has for almost all disaster that might takes place in Indonesia.

Here are some examples related to the disaster comic made by Yayasan IDEP, Comunity Based Disaster Management.

Volcanic Eruption

Tsunami

Earthquake

Terrorism

Hopefully, by this information will be useful to the community in order to enhance the effectiveness in disaster management. This program and method I can consider as one of the best method to apply because it encourage all ages to read that.

CBDM Comic Books

Each of the following A5 sized comic books include fictional stories about what a community did when its village was struck by a disaster. Each comic book also includes a fact sheet about the specific disaster covered in the comic’s storyline and appropriate responses. These comics are appropriate for distribution to all members of communities, schools, NGOs etc.

Tsunami Comic - Download in Indonesian (2.9 mb) or English (3.1 mb)
Earthquake Comic - Download in Indonesian (4.9 mb) or English (4.6 mb)
Flood Comic - Download in Indonesian (3.3 mb) or English (3.4 mb)
Landslide Comic - Download in Indonesian (2.8 mb) or English (3.5 mb)
Volcano Comic - Download in Indonesian (3.7 mb) or English (3.9 mb)
Storm Comic - Download in Indonesian (3.9 mb) or English (3.9 mb)
Building Peace Comic - Download in Indonesian (3.6 mb) or English (3.8 mb)
Terrorist Attack Comic - Download in Indonesian (1.7 KB) or English (2.7 mb)

-tHaNk yOu-

Poll of the Week

[Assalamualaikum & salam sejahtera]

Is today's health system of Indonesia met the expectation of citizen?

Strongly Agree

Agree

Disagree

Strongly Disagree

or View Results

Create your own poll at Flisti.com

-tHaNk yOu-