Thursday, December 9, 2010

Environmental Medicine : Pollution around us

Environmental Medicine deals with environmental risk factors and human health. This is related to all of us since we are all exposed to air to breathe, water to drink, food and beverages. The risk factors can be of many different kinds like radioactivity, chemicals or ultra-violet radiation from the sun. Many of the risk factors could be avoided or reduced with the knowledge that they exist and what the risk situations are.

The emphasis is on dietary and lifestyle habits, chemicals, water, indoor and outdoor air quality at home, work and school. It considers each patient as a unique individual exposed to a unique set of circumstances and thus needing individualized therapy

Pollution around us

Type of Exposure
  • Biological : bacteria, viruses, molds, candida, parasites, foods, animal dander, dust and pollen from trees, grasses and weeds. 
  • Chemical : substances such as formaldehyde, phenol, solvents, petroleum products, pesticides, herbicides, PCBs, heavy metals, asbestos, chlorine, sulfur dioxide, alcohol, tobacco and medications. 
  • Physical : heat, cold, weather cycles, noise, positive and negative ions, electromagnetic radiation, X-rays, nuclear explosions, reactor accidents and radon gas. 
  • Psychosocial : prolonged psychological stress in personal relationships or at work, a death in the family, fire, bankruptcy or job loss.
Daily Exposure
Do you realize that our daily consumption and daily activity contain dangerous toxin that if accumulated in certain amount, can cause side effect to our health.

Chemicals are everywhere
  • bedroom - fabric softeners, flame reterdants,dry cleaning
  • bathroom - chlorine, cosmetics, shampoos, toothpaste, hair products, colognes
  • kitchen - pesticides, hormones, antibiotics, cookware, plastics, petroleum residue, trans fats, flavorings, sweeteners

Illness induced caused by chemicals
  • Plasticizers TMA - complex antigens
  • dry cleaning fluid - cardiovascular
  • solvents - panic disorders
  • hydrocarbons - glomerulonephritis
  • formaldehyde - fatigue, cancer
  • pesticides - brain fog ( loss concentration, poor memory, irritability, depression)
Adaptation (called tolerance, acclimatization or addiction) brings about what is called a "masking" phenomenon. This results in many patients and physicians missing the effect of a particular substance (be it food or toxin) on an individual’s health.

1. Lecture note week 3, Environmental Medicine and global health, by Prof dr Hari Kusnanto Josep

Wednesday, December 8, 2010

Environmental Medicine : Do you lose your concentration easily?

students sleep in lecture hall

There are many factors that can affect our concentration. When you're sleepy, difficult to focus in something, if you're sleepy in lecture hall, ofcourse you can't absorb what the lecturer said. If you lose your concentration easily, maybe there is something wrong in your cerebral hemispheres or the reticular activating system have been injured. An altered level of consciousness can result from a variety of factors, including alterations in the chemical environment of the brain (e.g. exposure to poisons), insufficient oxygen or blood flow in the brain, and excessive pressure within the skull. Do you know that if you expose to pesticide for a long time, you will develop a brain fog.

Pesticide in our lives
In 2002 1.1 billion pounds of pesticides were used by 90% of households in the United States. There are more than 1,055 active ingredients registered as pesticides, which are put together to produce over 16,000 pesticide products that are being marketed in the United States.
Pesticide is dangerous, but we still consume it as our daily meal

  • Pesticides are used to control organisms considered harmful. 
  • kill mosquitoes that can transmit potentially deadly diseases like west nile virus, yellow fever, and malaria.
  • kill bees, wasps or ants that can cause allergic reactions. Insecticides can protect animals from illnesses that can be caused by parasites such as fleas.
  • prevent sickness in humans that could be caused by mouldy food or diseased produce. 
  • Herbicides can be used to clear roadside weeds, trees and brush. They can also kill invasive weeds that may cause environmental damage. Herbicides are commonly applied in ponds and lakes to control algae and plants such as water grasses that can interfere with activities like swimming and fishing and cause the water to look or smell unpleasant.
  • Used in grocery stores and food storage facilities to manage rodents and insects that infest food such as grain. 

Brain Fog
Brain fog can be simply defined as mental confusion or even lack of mental clarity. Brain fog affects all the age groups and may interfere in performance at work, school and relationships. The name 'brain fog' is related to the feeling the person has and features with
  • loss of mental acuity - forgetfulness, inability of one to think clearly and decreased attention span
  • detachment and discouragement
  • depression and anxiety may accompany the underlying condition
  • low-self-esteem, lead to accidents and be predisposing factor in crime and delinquency.
  • problems with concentration, lack of focus and confusion
  • face problems when it comes to learning new tasks and solving problems and finally, there is decreased mental stamina and obvious reduction in creativity.

what can cause brain fog? 
  • Physical imbalance and emotional causes are only some of them. The change in brain's function can be also caused by biochemical elements. 
  • Stress is most definitely the leading cause of brain fog. Stress also contributes to depression. Coping with stress and learning how to relax may be beneficial in overcoming the problem.
  • Another cause of brain fog is insufficient blood supply of the brain. Poor circulation can be enhanced by yoga or similar physical activity or with certain medications which can be only prescribed by the doctor. 
  • Exposure to certain metals, pesticides, carpet cleaners and carbon monoxide may also induce brain fog. The symptoms may additionally occur due to excessive exposure to electromagnetic fields. 

How to detoxify your body from Pesticide exposure?
More and more, people are discovering that they have environmental sensitivities. Many fruit and vegetable supplies that are non-organically produced contain residue, and pesticides are commonly used on lawns and gardens. Frequent complaints or symptoms are tiredness, brain fog, skin rashes, and overall sluggishness. It's not easy to eliminate all exposure, but you can help to detoxify your body and flush it out of your system.
  • Increase selenium dose. Selenium is a mineral that is important for the production of an enzyme that helps to detoxify your body. A suggested dosage is: 200-400 mcg taken as a supplement daily.
  • Eat certain foods such as lemons to help reduce certain pesticide levels in your body. Asparagus (organic is preferable, but not necessary), has been proven effective in reducing a widely used pesticide to very low levels in the body.
  • Eggs are another powerhouse, not only to increase energy levels but as a toxin remover.Try free-range omega eggs for added benefit.
  • Use your bath to detoxify your body. About one quarter of the toxins in your body are eliminated through the skin. Using epsom salt baths a couple times per week can help significantly to draw toxins out.
  • Try skin brushing for detoxification benefits. The simple act of skin brushing is stimulating, thereby reducing the fatigue induced by pesticide exposure. Moreover, it also helps the lymph drainage system to flushtoxins from your system. A daily skin brushing regimen is optimal, but even a few times a week can be helpful.
bath for detoxification

eggs increase energy and act as toxin remover

Lemons to reduce pesticides level in body


True Story
I have been dealing with phantom health issues for over 4 years. In August 2004 while working for a Pest Control company. I had a major pesticidespill occur. A backpack sprayer of termidor (fipronil) spilled all over the back and shoulders of my shirt, literally soaking my shirt. The coworker training me said don't report it, we would get fired. He just said change your shirt. I ended up quitting the job due to chemical sensitivity.

A little time passes and my drive slowly diminishes to nothing and motivation in general. In fact even waking up with dreams were gone. I was noticing my brain was becoming impaired. I started having a numbness to life. I was having weird burning sensations in my head and was always going to the doctor just not feeling right.

The doc did a brain MRI and it was normal. The doctor would pass it off as depression or anxiety and once sent to a neurologist who only gave me one visit and dismissed anything could be related to pesticides.

I also noticed I couldn't use cleaners anymore unless I had very good ventilation like outdoors. I would get brain fog that lasted for hours.

I made calls to various experts. I even did my own research and found this pesticide along with others are hormone disruptors and cause other effect which would explain why I am on hormone replacement therapy.

All I know is something is not right. Not only do I have hormone probolems but a 3cm lesion on my liver, sensitivity to any cleaners where I can getbrain fog and other issues.

I found a place in Texas that deals specifically with what I was exposed to from testing to treatment.

If you have battled any of this let me know.


Monday, December 6, 2010

What Actually Are We Looking For???

I still remember when I'm doing my foundation at Kolej Teknologi Timur(KTT) in Sepang, my lecturer asked everyone, a simple question " Why you want to be a doctor?", but yet it is a difficult  question for me.

Sample answers :
  • help others who in difficulties
  • i have experience with one of my family who have cancer, so I wanna help him
  • family order
  • its run in my blood
  • my bestfriends choose it
  • money, money, money
  • popular and be respected by the tittle "doctor"
  • no need to find work, for sure there is job for a doctor after grad
  • prove that i can overcome my fear toward blood
  • straight A's student always choose medicine, so do I
  • i've been doctrine
  • i just apply scholarship for it, i get it, so just try it

Actually there are a lot of answers for that simple question. So, what you or me set in our mind at the beginning... the beginning of our pathway to become a doctor? Have you heard about this " you are what you're thinking". What you think, will control your action, your deed and make what you are now. So, think about it again.

which type of doctor you wannabe?

Brain Drain

Is a migration of trained and talented individuals from one institution, or from one country or part of a country to another in search of better working conditions, a higher uality of life and/ or a less hostile environment. 
  • external - when trained and skilled human resources leave their country to go and work in developed countries or to work in developing countyies
  • internal - when trained and skilled human resources are not employed in the fields of their experties or when human resources move from the public sector to the private sector or within a sector of a particular country. 
so, why we bother bout this brain drain? because brain drain is a phenomenon prevalent in all industries in every nation, especially IT and healthcare. Migration of trained professionals from these fields has created an acute shortage of professionals in countries.

Reasons for brain drain 
1. WHO report, 2006
  • developed countries - A growing aging population and increasingly high-tech health care are exacerbating the demand for health care workers. In addition, poor planning and underinvestment in health worker education has left developed nations with too few domestic health workers to meet the demand, according to the WHO report.
  • developing countries -  economic policies limit investment in public-sector health care and reduce funds for health worker education. At the same time, according to the WHO, the AIDS epidemic has placed unprecedented burdens, including high rates of HIV-related illness and death among health workers, on these already stressed health systems. Faced with poor working conditions and limited economic prospects in their home countries, many health workers choose to migrate to fill the demand in wealthier nations.
2. Aljunid, WP Sh Ezat, Ismail A. (2004)
  • Better remuneration in private sector 
  • Less favorable working environment in public sector 
  • Location of private facilities in towns and cities 
  • Bureaucracy in public sector 
  • Heavy workload in public sector

shortage of healthcare provider (NEJM, 2007)

In Malaysia, 25% of all doctors are specialist. From this, 75 % work in private hospital, ironically, 70% of complex cases treated in public hospital. As a result, the good people just keep leaving government posts for other jobs. 

As Aid Thoughts puts it, “When the top of that ladder ends at the UN, not the government, ambitious civil servants will feel less motivated to excel…Even when the few bright stars do bother to overachieve, they’re quickly snapped-up into the development sector.”

Medical tourism

Medical tourism is like having a vaccation while having a medical treatment in other countries which offer more cheapers treatment for your own countries. For example, Mr John Smith, from US need to pay 23.938 US dollar for by pass surgery. If he use that same amount of money and get treatment in Malaysia, he only need to pay for 6.315 USD and the remain he can use it to go vacation in Malaysia (exclude payment for room).

The boom in medical tourism has already brought about fierce competition in the private sector. Late prime minister of Thailand, Thaksin Shinawatra in 2003, aims to attract foreign patients to high-end medical services and facilities on offer at private hospitals, and to support these hospitals in competing with medical services in other countries in the region like Malaysia and Singapore.

Of course the foreigner will go to the private sector because they're not the citizen of that country. This cause internal brain drain, with high payment, less workload, more comfortable working place and mingle with high-income patient.

medical tourism

So, as a doctor to be, where we gonna work, rural or city area, private or public hospital? Let us sit down, forget about big things, about pathophysio, about mechanism and what so ever. Lets think about small things but yet it count for a big move, about ourself. Which type of doctor will we be?

refferences :

3. Lecture note, Malaysian health Care System : Current Issues and Future Challenges, by Dr. Sharifa Ezzat Wan Puteh

Saturday, December 4, 2010

What's Gonna Work?? ---> Teamwork

 “ Act as a Leader, not a Manager,
Stop Managing, Start Leading !”

In a Health Care environment a patient may encounter dozens of professionals, from a whole range of varied disciplines, in a short space of time. In theory they should all combine together to provide the best outcome but all too often confusions and problems arise.

What is Interprofessional Health?The IHC uses the terms interdisciplinary and interprofessionalinterchangeably. Most current professional education involves students, all from the same discipline or profession, mastering a specific body of knowledge, types of skills and modes of conduct.

Multiprofessional education occurs when students from the health-related occupations with different educational backgrounds are brought together to understand a particular problem or experience.

Interprofessional education occurs when students from various professions learn from and about each other to improve collaboration and the quality of care. Their interactions are characterized by integration and modification reflecting participants understanding of the core principles and concepts of each contributing discipline and familiarity with the basic language and mindsets of the various disciplines (Clark, P.G. (1993), Journal of Interprofessional Care, 7(3), p. 219-220.

Barrett et al (2005) suggest the prefix ‘multi' tends to imply the involvement of personnel from different professions, disciplines or agencies, whilst the prefix ‘inter' tends to imply collaboration, particularly in areas such as decision making.

Rationale for Interprofessional Health Care Teams
I. Interprofessional health care team work can facilitate:
  1. More effective and efficient patient care, patients benefit from receiving care from the health care health professional with the expertise specific to the patient's individual problem, team work can provide coordination which can prevent any aspect of the patient's care from being overlooked or shortchanged
  2. Professional growth and job satisfaction, which results from doing the work you have studied and trained for
  3. Understanding of how the health professions can work together to enhance health promotion, public health, prevention, interdisciplinary research, community based participatory research and many other health related but not specifically patient care oriented activities
  4. Economy in health care costs, e.g., eliminating duplication, and delays in care provision
  5. Enhanced breadth of knowledge and appreciation for the skills and knowledge of other health professionals, above and beyond roles in team work
II. Interprofessional initiatives can benefit:
  1. Health sciences students
  2. Health sciences educators
  3. Health care practitioners and clinicians working in teams
  4. Patients and families
III. Positive attitudes about health care team work can be promoted and enhanced by increased knowledge and skill in professional communication and cultural effectiveness.

This short video introduces a programme thats used to train all health and social care professionals in the University of Leicesters local region. The focus of this programme is on helping trainees to work alongside one another in multidisciplinary teams its not enough simply to know what each type of specialist does, they need to be able to work together in allsorts of combinations and in allsorts of environments and situations.


How we want to collaborate with each other? even within the same profession also sometimes there is also a problem. How we want to put away the EGO especially when we think that we are higher than the others. Doctors feel challenged when nurses correct them. Actually it is not about what degree you have, or about you CGPA, it is all about manner, politeness, and experience that make you knowledgable, make you become respected. 

Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice.

A few studies suggest that interprofessional educational experiences can enhance participants’ understanding of teamwork, although participants have mostly been professionals already working in the clinical setting. For example, Nash & Hoy (1993) reported that GPS and nurses believed that a three-day residential workshop on the interprofessional delivery of terminal care had enhanced their capacity to work collaboratively. A study of final year students of occupational therapy, physiotherapy and other allied health professions found that two-day interprofessional workshops had a positive influence on participants’ understanding of teamwork (Parsell et al, 1998).

Refferences :

Friday, December 3, 2010

Disaster Management

In Indonesia, there is 220 millions people live in 1.9 million hectares of land, consist of  17.583 islands, which has 120 active volcanoes and 5860 rivers. Because of Indonesia is a meeting place of two tectonic plates, Australia and Asia, it is a Supermarket of Disaster. This year, there are huge disaster happened in Indonesia, flood wasior, Tsunami in Mentawai and also Merapi eruption in Yogyakarta. 

So, because of those thing, we need an organization to set up plan to face those problems. 

·         Geo- reference unit/ accuracy : District/Municipality
·         usage : Coordinatio, formulating Guidance and policy in the national level and international cooperation
·         type of data : secondary

·         Geo-reference unit/accuracy : Subdistrict (Kecamatan)
·         Usage : Coordination, formulating Guidance and policy and cooperation at provincial level
·         type of data : secondary

·         Geo-reference unit/accuracy : Village (Desa/Kelurahan)
·         Usage : Emergency Response, operation purposes, Dm Plan & policy at local levels
·         type of data : primary

Cycle of Disaster Management

Prevention: Activities to provide outright avoidance of the adverse impact of hazards and related environmental, technological and biological disasters.

Mitigation: Ongoing structural and non-structural measures undertaken to limit the adverse impact of natural hazards, environmental degradation and technological hazards. Such as build houses far away from hazard, build houses that is flexible when earthquake happens, build dam to prevent flood, with good infrastucture

Preparedness: Activities and measures to ensure effective response in an emergency and its impacts, including timely and effective early warnings and the temporary removal of people and property from a threatening location.

Relief/response: The provision of assistance and/or intervention during or immediately after a disaster to meet the life preservation and basic subsistence needs of those affected.

Recovery: Decisions and actions taken after a disaster with a view to restoring living conditions of the stricken community, while encouraging and facilitating adjustments to reduce disaster risk.

include under response

In the late 1990s, increasing disaster losses worldwide highlighted the need to move beyond ‘managing disaster events’ and to better address the risk processes that drive them in the first place. It was in this context that greater concerted emphasis was placed on ‘disaster risk reduction’ rather than ‘disaster management’. Unlike the disaster management cycle, effective disaster risk reduction roots itself in careful risk identification and analysis—before implementing prevention or mitigation actions.

Requiring for Space Information
Indonesia is a disaster prone country, both natural and human induce disaster. Disaster management in Indonesia needs support form space technology in terms of hazard and risk mapping, early warning, damage assessment and rehabilitation.Asia-Pacific Regional Space Agency Forum, APRSAF play an inportant role to assisst Indonesia in the disaster management.

��Satellite Data for Risk Assessment
  • Hazard mapping
  • Vulnerabiliy and risk mapping
Risk Mapping of Mount Merapi --- to aware people

��Satellite Data for Early Warning
  • Monitoring and prediction weather
  • Transmitting data for warning (tsunami)
��Satellite Data for Estimating Damage

��Satellite Data for Rehabilitation

Refferences :

Thursday, December 2, 2010

dead bodies are everywhere ~

burning body cause by hot material (500 - 1000 degree celcius) -->

 how we want to determined dead body?

Steps in Disaster Victim Identification (DVI)
To make something go smoother, we must have plan. "he who fails to plan, plan to fails"...
Same goes in disaster victim management. We must have guideline to follow. From my lecture, the lecturer said that most country follow this except America, and it cause chaotic when disaster happen there.

so, disaster victim management has 5 steps,
  • the scence of accident -
As a rule, the search for the bodies of victims of a disaster cannot begin until all survivors have been rescued. In order to overcome this initial chaos to the extent possible, a structured search and discovery phase should be prepared in cooperation with the Evidence Collection Team, the Disaster Investigation Team and the Access Control and Security Team. This phase includes the search for bodies, property and evidence.

In order to ensure thorough search and photographic documentation, recovery and victim identification teams require accurate maps of the disaster area. As far as possible, the disaster site should be overlaid with a grid in order to facilitate search operations. This method has proven particularly effective for relatively large disaster areas. The grid consists of a base line which proceeds from or runs between identifiable fixed points on the ground as well as parallel lines drawn at intervals for instance of 10 m (but depending of the situation), thus forming square sections in which methodical searches can be conducted. To the extent possible, the grid should cover the entire disaster area.

  • collecting postmortem(PM) data
The PM Team collects all relevant dental medical and forensic data obtained from the bodies of deceased victims for the purpose of identifying said victims. The team consists of experts in the fields of fingerprint analysis, forensic pathology, forensic odontology and DNA analysis. All postmortem data are compiled in Pink document dor each victims.

  • collecting antemortem(AM) data
The goal of this approach is twofold: to ensure that actual cases of missing persons are not overlooked and to list all actual missing persons in order to facilitate the collection of AM data from relatives on the basis of the corresponding victim lists.

Personnel collecting ante mortem data should be experienced in obtaining detailed reports and must have a thorough knowledge of the layout and purpose of the appropriate forms. Wherever possible, personal (face‐to‐face) interviews are to be conducted. However, exceptional circumstances may require telephone interviews. The location and timing of the inter‐view will be dependent upon the location of the families of the missing persons/potential victims, as well as the facilities available. interviews are documented in Yellow document

A summary of examples of reference samples for AM DNA profiles 

  • reconcillation
The Reconciliation Team compares the AM and PM findings submitted by the AM and PM Teams, respectively. For practical reasons, the Reconciliation Team should be set up as near as possible to the Operations Command Centre. Considerable time can be saved in comparing data if a data processing and evaluation software is used. However, no computer program, no matter how effective it may be, can be more than a helpful tool. Final decisions must be made on the basis of all relevant criteria. If there is no possibility to use an evaluation software you find enclosed also the methods for evaluation.
  • returning to family/burial 
After all this process finish and bodies can be identified, it will be return to the family, or if still can't be identified, in a case of disaster, dead bodies must be burried within 3 days. If not in a disaster case, it should be kept until their relatives claim for certain period of time. 

Conducting DVI operations in CBRN environments, takes an immense amount of pre‐planning and training. The appropriate equipment must be available before starting any DVI. It takes a considerable amount of teamwork and TIME. DVI practitioners will need to work with other response agencies such as military, fire, scientific officers and radiological experts to accomplish the task safely and effectively.

Refferences :
2. Lecture note Week 5, Management of Dead Victim in Mass Disaster, by dr. Yudha Nurhantari

Wednesday, December 1, 2010

World Aids Day - 1 December

Started on 1st December 1988, World AIDS Day is about raising money, increasing awareness, fighting prejudice and improving education. The World AIDS Day theme for 2010 is 'Universal Access and Human Rights'. World AIDS Day is important for reminding people that HIV has not gone away, and that there are many things still to be done.

According to UNAIDS estimates, there are now 33.3 million people living with HIV, including 2.5 million children. During 2009 some 2.6 million people became newly infected with the virus and an estimated 1.8 million people died from AIDS.

The vast majority of people with HIV and AIDS live in lower- and middle-income countries. But HIV today is a threat to men, women and children on all continents around the world.

Stephen Fry and Martin Clunes discuss spanking the botty of the injustice that is HIV discrimination

UNICEF is launching Children and AIDS: Third stocktaking report. In Indonesia, UNICEF supports many HIV/AIDS awareness programs from remote villages in Papua all the way to Madrassah schools in East Java.