Thursday, July 8, 2010

Day 5 (8/7/10)-- Dirty work continues...

Today the Pejabat Kesihatan continues their dirty work but this time the victims are not the makan shop,but rather those small kedai runcit in Sik.Today they are going from shops to shops just to see if any of their food products have expired or without label and carry out the punishment according to their offence.


If the food products sold have exceeded their expiry date,then the officers will confiscate these products without any compound.If the seal of the products are broken,then they will seend one sample back to their lab for investigation,if the microbiology test turns out to be positive,then the health officers have the rights to bring the owner of the shop to court =_=


Apart from this offence,if the food products that they sell have incomplete labelling such as those without address of the factory,or those without stating the ingredients,then again the officers will also confiscate those products...however this time will have some mercy as it is so obvious this is not the shop's fault,the officers will write a special receipt which the shop owner can claim the money from the supplier,and also the supplier is required to see the officers to clear off their guild.


Today one of the shops was robbed(err..,i mean confiscated) of the tea and coffee powder due to the absence of address on their labels.At the same time we bump into the other group which claim that the officer which they are following also confiscated a lot of stuff from many shops.What a pity...



1st Shop to 'visit'.
Mr. Asri (PKPP) looked at the expired date of canned food.






Third Shop


Tea Flour without labelling - no nutrition Information, no Ingredients Information.

Tea Flour Without Expired date, nutritional information, ingredients information

" I have sealing... I have Sealing", edited from the song of "Sailing"
Sealed Tea Flour With Labelling

Form - List of the seized by court order under Food Act 1983 Section 4.1.f

A. Form - Agreement of the Food to be courted
B. Form - Notice of the food to be courted under Food Act 1983

Wednesday, July 7, 2010

7/7/10 (Operation By Food Hygiene control unit )

As mentioned by my colleagues, our group 9 people were separated into 3 subgroups to follow the trip of the spot check operation. My group, Dennis Hung and me followed Mr. Dzullkifri ,PPKP under the unit of KKM ( Keselamatan dan Kualiti Makanan OR Food Hygiene and Quality control ) to witness how they do the operation.

Before the operation started, we are warned not to approach too near to the spot and cannot communicate with the owner of the shop.

The first victim was school canteen of Sekolah Kebangsaan Sik Dalam. We had some discussion with 2 Pegawai Kesihatan. One of them was Mr. Hassan. We witnessed how they check the hygiene at the surrounding area. Mr. Hassan told us that all of us should not miss the things under the table because most of the thing is hiden right there, moreover, vector, especially mouse, they like to 'habit' such kind of 'comfortable' environment.


When we reach to the school canteen, Mr. Dzullkifri requested the owner to take her food premise licence and identity card. He filled in all the form required to write a assessment report and comment about the particular food premise. If the food or environmental hygiene within or at the surrounding area contains contamination that is suitable for the spreading of the vector born disease. They will close the food premise. (Details explained subsequently)


Mr. Dzullkifri opened his bag to take out the form to be filled in.
He was filling the form.

The school canteen hygiene was satisfactory. However, Mr. Hassan told us that the own keep the pet under the table. It should not to be done so because all animal are not allowed walk in and out in the food premise. They have warned the owner not to do so. Even though the food premise is not been punished under the food act, they will still give the health education to the owner, telling them the things should be aware of, what should be cleaned and so forth to improve the food hygiene. They also explained to the owner on how the communicable disease could be spread, especially the vector born disease that was brought by the mouse. After that, they will stick the Food Premise Visiting card.




In the Food Premise Visiting Card, name of the premise,name of the owner and date of the operation would be written down. According to Mr. Hassan, they will do the operation to that area at least 3 times per year. Operation to be done is more frequent in the town.

Once finishing hand over a copy of the report to the premise owner, Mr. Hassan asked me to take the notice board (below) - iodine salt added to the water pipe system . It is not under Food Hygiene Control Unit, but it is very essential to highlight here. Due to the geographical area of Sik District, the citizens, especially in the rural area are hardly to get the seafood(rich of iodine). Therefore, there is high prevalence of hypothyroidism cases among the citizens in the Sik. However, due to iodine salt intervention programme, the incidence of the hypothyroidism is reducing annually. (discussed yesterday) The water pipe system was added with the iodine salt, so that all the citizens would beneficial to get sufficient iodine.

Food Premise Visiting Card




Next, we went the Padang Cichak. "Cicak" , in malay, literally mean lizard. I thought it was a lizard field. Haha...Before reached the next premise in the Padang Cichak, Mr. Dzukifri told us we would go to visit the 'old customer' in that area.



Mr. Hassan check the surrounding area, looked at the cupboard. He asked us to come nearer the cupboard and smell what are the smell produced in the above picture. Guess what? What we answered were wrong. It was the smell produced by mouse. OMG! Mouse PU (pass urine) in the cupboard!!!!

Without mercy, they immediately released the notice to close the food premise. In addition, the owner store the cooked bihun in the refrigerator. OMG! Suprisingly, there is still one person had teh O ice right there. Haha. According to Mr. Hassan, the Notice Food Premise Closing Order will be sticked in the food premise.(green color Form as shown in below) The owner should not tear it out. In order to re-open their shop, they have to clean all the shop within 14days. Within these 14 days, they cannot open their shop and do the business until second visit is done to confirm their premise is hygiene. However, if they clean it withn 3 days, they can call PPKP to re-check and permit them to open the shop. At the second visit, if they fulfil the requirement of cleaniness, the Notice would be tored. Business could be continued. , IF, the owner continues to open the shop within these 14days without taking action to clean the house and call PPKP for second visit , they would be courted under Food Act 1983. 'Compound' charged on them is around RM 3000-4000.



Even though the food premise are caught several times, according to Mr. Hassan, they will not stop their licence in running the business. In personal opinion, I think it is the weakness of the Food Act because people will not scare of the Act. As long as you clean it, you can re-open your shop no matter how many times you get caught!






Notice Food Premise Closing Order


Then, we continue our journey, we went to a village, there is a Siam Temper at the road side where there are lots of turtle statures along the temper. Mr. Dzullkifri told us that it is a turtle village. Dennis and Me thought he was joking with us. After a while, I saw the sightboard. It is written - Kampung Kura (Turtle Village). Here they released another Notice to close a Siamese shop because the food is contaminated.





Next, several shops were 'visited', no 'compound' was being done. Around 1230pm, we went back to Sik DHO. During the journey, Mr. Hassan told us that for each of the food premise owner, every 3 years, they should go to the Health Center to get vaccinated with antityphoid-vaccine. It will cost RM5.oo on them. The main idea is to prevent the spreading of salmonella typhi to the community if the food premise owner carries the disease. Besides that, all the food premise owner should not wear slipper in their shop. All of them who not yet attend the Food Campaign are advised to go. This campaign is mainly conveying the messenge to food premise owner in importance of self hygiene and environmental hygiene so that they could be educated to prepare more hygiene environment in their premise.


In the afternoon, again, we have our class with Mr. Dzullkifri. He gave us the lecture on Food Hygiene and Quality Control .




To be updated ....... tomorrow.....

Day 4 (7/7/10) Operation by the Vector control unit, Sik DHO.

Its not always common nor its entirely dependent on when and how public places will be checked by the vector control unit. But, when it was planned to be conducted, we were there to witness it and that we consider it to be a fortunate opportunity.

Our group were divided into three and the two other groups followed the Food Hygiene control unit and my group, (S.Pala, Sujes and Ram), got the chance to follow with the vector control unit.

Today's task given to the vector control unit is to check the premises around Sik for insects breeding. The places were limited to car workshops, tyre repairing centres and steel selling shops.

Mr. Bun Chun, vector control unit officer, from Alor Setar, was the supervisor for today's operation.
We stopped at almost 8 shops, mostly car repairing centres.

The officers in-charge started looking for potential insect breeding spots like in unused rubber tyre were rain water has accumulated, left over metal barrels and not to leave, in the wash room too.


There were almost 3 different samples taken from three different shop lots and compounds were
issued to them. For the shop lots where no occupants resided, notice were pasted on the entrance door. According to one of the officer, a recheck will be carried out after a week to check for the changes.

There were also notices issued to certain shops to direct them to clean their work place as most of them were of a big mess.

The procedure before issuing a compound for larva breeding:
a)Basic pipette and a glass container were used to take sample from water in which
larva were seen. After the sample collection, small amount of alcohol is added to it mainly to preserve the sample.
b)Then photos were taken when officers are explaining to the witness (on behalf of land lord or shop owner), as a proof to show that the procedure was done in the presence of someone on behalf
of the shop owner.
c) Compounds were then issued.


Photos were not only taken by the officers but also by me to furnish this blog as an update on Day 4's activity.

More photos will be uploaded as soon as possible.

The operation came to a halt just before lunch, at around 1pm, and was to be continued after 2pm.

Tuesday, July 6, 2010

Day 3 (6/7/10)

The 3rd day of our posting didn't start well.

We were there waiting until 10am but no one came for us. When i decided to go looking for the person in charge, Dr Ishak passed by and helped us to shift the afternoon slot to 10am.

So, we were taken by Sister Aminah to KKIA Sik and she showed us the growth chart. Besides, she also showed us the 'booking' book of pregnancy. Before labelling the color of the 'booking' book of pregnancy, we need to assess several things so that they would deliver at the certain hospital.


Here are the indication for color labelling:
1. White Code 1 - deliver in hospital
2. White Code 11 - could be delivered at home
3. Green Code - refer to Medical Officer or House Officer
4. Red Code - Immediately admit to ward
5. Yellow Code - Refer to nearest O&G specialist

CodingCoding


According to Sister Aminah, if the patient with green label is found to qualify to label as other code,eg. PIH so coding change to red code, the red code will be sticked just above the green label, but not cover the green label.


We were told the usage of colour tagging for each category of pregnancy. Some modification like tying a red thread at the corner of the book for patient with PIH was practised in Sik.Other thread for example green, yellow indicate specific kampung of Sik so that it would be more faster to find the record book KKK1/93A during searching the record book.

Eg. of Labelling as KZM
Once the baby is born, corresponding family will be given Child Health and Developmental Growth Record. There are 2 colors, blue is for boys, red is for girls. If they found the baby is inappropriate for weight, They will be labelled as KZM (Kurang Zat Makanan) or Malnutrition.




If the Child is found to have KZM and parents have the financial problem. They will be supported by government under a programme known as Programme Keluarga Kekurangan Zat Makanan. It provides the Basket service in which a balanced diet food would be presented to that family monthly, Each Basket Food costs about RM 100. The contents of Basket Service are: Carbohydrate(rice, bee hun, maraconi, flour), protein (green bean, sardine, fishes, anchovies), Fat (Cooking oil, Full Cream milk, margarine), Vitamins (cod liver oil, chewing tablets).


Another programme under child with KZM is Programme Dapur Sihat. The objectives are :
1. how to prepare proper food for weaning
2. provide information about food nutrients
3. how to cook healthy meals for the family
4. to expand the menu of healthy meals
Staff Nurses will demonstrate how to cook the food. In order to get their attention, food are prepared prior to the demonstration because audiance will get distracted and feel hungry easily, so that they will not pay attention on what they demonstrate. The programme will show preparation of 4 types of meals - breakfast, lunch, snack and dinner.







Rigevidon , Regulon, Marvelon



Injected Form of Medroxyprogesterone


IUD


After that we were taken around the KKIA to know the facilities provided. Each type of family planning method were told to us. Sister Aminah also went to the extend of taking out every contraceptive pills and devices available inside the clinic to show us.

'Bilik Penyusuan' was available in the clinic as breast feeding is encouraged. Besides, we were told that Sik provide VIA service, or visual inspection acetic acid which is another method to detect cervical cancer other than pap smear. Sister Aminah proudly told us that the VIA(Visual Inspection Acetic Acid) service is only available in Sik and not in other part of Malaysia.According to Sister Aminah, VIA is far more cheaper than pap smear, the cost is about RM2. Moreover, results are immediate, whereas pap smear result requires 2weeks to 1month. She wanted all of us in the group to know the VIA and wants all of us to have a look at the VIA if possible.


Later on, we were briefed about how to keep the vaccine in a cold chain. there are few ice boxes to keep the vaccine when they need to use. BCG vaccine should not mix with other vaccine in the ice box because it is a live vaccine. Other than that, Sister taught us how to read the Min Max Thermometer. The lower end of meniscus point of blue level point indicate the minumum and maximum temperature, the 2 upper meniscus level of mercuries indicate the current temperature. The vaccine should be kept between 2-8 degree celcius. And the temperature should be monitor hourly.





Vaccine storage in Ice box


MinMax




Cold Chain System


The round ended at 12pm. After the round, Sister Aminah passed us to Sister Azizah, which will be telling us about food and nutrient. She taught us how to use Z-score (Malaysia Version) to assess the nutritional status of a children. (as below)




The formula are: (application for the age 0-6years old)


1. Weight Z-score For Age: {Current weight - mean} / SD
- refer weight z-score for age in the table.


2.Weight Z-score For Height: [Current weight - mean]/ SD
- refer weight z-score for height in the table.

3. Height Z-score For AgeL [current height - mean]/ SD
-refer height z-score for age in the table.
Plot it in growth chart to assess the nutritional status of the child.



We were told about food basket and the category of patient eligible to be given food basket. Food basket will be given monthly to those needed and among the items are cooking oil, eggs, sardin, beans, vitamins, bihun, iodine salt for those needed, ikan bilis 1kg and 5kg of rice. Those eligible to receive food basket are those who are very poor and recommended bythe medical officer or specialist in charge.
The talks ended at 1.05pm. We were allowed to go back so our day ended early for 6/7/10. We were provided with many extra knowledge which we are not able to get in other text books today.

The Vigorous Crew members of batch 12 posted to Sik District Health Office.


From clock-wise: S.Pala, Fidelia, Tharshinii, Chuan way, Ram, Jun Sian, Sujes, Dennis Hung, Zheng Hao


Students attentive during a presentation by Dr Ishak (DHO)


Mr. Dennis Hung and the partly visible fogging machine


Another picture snapper and our blog administator, Mr.Jun Sian

Day 3 (July 6, 2010), Snaps revealing vector control unit in Sik, Kedah


Appropriate uniform that should be worn before fogging


Vector control unit office


Map showing the Dengue prone area in Sik, Kedah



Part of vector control unit, the Information Unit



The fogging machine and photos taken prior to fogging