Day 8 (13/7/10) -----talks on health programme

Early morning, we were given talks by Mr Md. Zahid Talib, officer from health promotion unit. First, we were told the organisation of the health promotion unit and who is responsible for the whole unit. Health promotion unit work closely with all other unit like school health unit, maternal child health unit, surely the purpose is for health education.

Health promotion campaign will often be conducted by the unit in the whole district. Sometimes, they are also invited by school to give talks on health education. In case of outbreak of disease, this unit will form a small body with the villager to spread news about the outbreak and how to prevent. Most of the time, talks on danger of smoking and prevention of denggi are given as these are two of the most common happening in the district.

A program for primary school student know as " kelab dr muda" was conducted in the district in which 20 schools are participating. A few schools refuse to participate due to unknown reasons. The purpose of this program is to give health education to primary school student. Only top student are chosen to be involved in this program as they are said to be able to handle bigger responsibilities. 2 teachers will be chosen to head the club so that all programs can be supervised by the teachers. Each year, exam on health knowledge will be given for the students to make sure that they gain from joining the club. Those that perform well in the exam will be given certificate.

Next, talk on non communicable diseases were taken by Mr Zainuddin. We were first briefted about the 4 mukim in Sik and how they cover the whole district. Stop smoking program and obesity are among the highlights of the talks. We were told the different act and law on the penalty on those caught smoking. Different amount of penalty are applicable depending on the type of severity of the offences. Not only that, we were told how the smoking sign inside buses, taxies and premises should be displayed and the dimension for each of them. The dimensions are standart for the whole district and thus any alteration will be fined. Each individual involved must ensure that the no smoking rules are enforced. There are also no smoking clinic in Klinik Kesihatan Jeniang conducted every thursday. The purpose of the clinic is to help those that willing to stop smoking to get ride of their addiction. Nicotine replacement therapy will be given so that they will not return to smoking.

Obesity program are also conducted by calculating the BMI for all the staff working under the district health office. The purpose of this program is to ensure that all the staff lead a good life that will make them more productive in their job.

This is then followed by talks given by Mr. Asri who will talk to us on the vision and mission of the health program. We were told on the different programs available on primary care interface. We were also provided with materials on how they deals with patients of hypertension asthma and diabetes. Other than that, we were explained in details on how they respond to patients turn up on the health clinics. A maximum waiting time for each patient is 30 minutes failling which they must write a report on why they are not able to respond fast in 30 minutes.

We were also told that in order to ensure that emergency cases are attended to immediately, upon arriving in the hospital in working hour, a maximum waiting time of 1 minute is applicable. Besides, we were also informed that rehabilitation cases for patients of tuberculosis and mental health are conducted in the clinics. Before finishing the talks, Mr Asri borrow us a few books on standard operating procedure, diabetes, hypertension, caring for old folks, etc........ for us to go thru.

Loji Pembersihan Air Batu 5 Sik

Upon reaching the area

Duty roster

'Bilik Pump' where treated water are being pumped to the various water tank around the district

Water Quality Control Laboratory

Flowmeter Setting

Day 7-12/7/10 Loji Air Batu 5 Sik

Today the journey continues as we are taken for a visit to the water treatment plant in Sik. We waited in the room for Mr. Izzudin until 12pm because he was busy with the legalization problem in the court for food quality control.

The people in charged, Mr. Hazri took us around the plan and show us how the process is carried out.Firstly, the water is being channeled from the mountain river ( Sungai Chepir) near by and then the water will enter a tank.

After that,water is allowed to add a chemical known as PAX-18, with its active ingredient polyaluminium chloride (9% of Al), is a coagulation agent that is used mainly to precipitate phosphates, to prevent surface water eutrophication and incidences of cyanobacteria.

Subsequently, the water will undergo sedimentation to remove the unsoluble dirt.These planks contain multiple slits to ensure more time for the aluminium to react completely in water. Every phase has its own sedimentation tank and the retention time for each tank is 2 hours. To ensure the sedimentation process is effective, this tank is cleaned at least once a month.After that the water is treated with PAC to convert soluble debris into unsoluble debris and followed by its removal by filtration.

The water is then treated with lime to remove the foul smell of the water.The water is then treated with fluorine which functions to strengthen the teeth and also chlorine is added to kill any water borne microorganism.The dosages of fluoride are as recommended by the Jabatan Pergigian Malaysia, 0.7mg/L..Calcium hydroxide (lime) is added into the filtered water to adjust its pH value to a safer pH range for consumption.

Water is stored in the storage tank,there is a "main-meter" includes any meter measuring water, all or part of which is subsequently measured by one or more sub-meters. The water is then pumped out under high pressure to supply the residents.

Before supply to residents, water sampling is taken to investigate the water content as mentioned (refer yesterday blog 11/7/2010). 3 samples will be taken: raw water, Storage Water in the tank, treated water that supply the residents.

Water Sampling

Each water storage tank is supplied by two pump which operate alternately. This is to ensure that in case one pump break down, the other pump can still function thus no water shortage will be faced by the residents

.

Summary of Water Treatment

Day 6 (11 July '10): Water Quality Control Unit

Water is a basic necessity when it comes to life. The importance of monitoring water quality is as important as drinking water everyday.

In this post we will be looking into the unit controlling the water quality and how it functions.

Although the importance of this unit is high but, the importance based on staff allocation is not proven to be one. There are only two officers in-charge of this unit.

The main will be: (substitute) Mr. Izzuddin and he has his assistant. Mr. Izz is just an acting chief of the unit as the chief is on leave.

He claims most of the job workload ends on the desk it self, end of the day, if they receive any complaints of water impurity then the field work starts.

Besides that, the unit itself run a routine check before the water source is released for public use.

The sampling of water is done twice a week. The samplings are done from various part of stations which he called as "points". They have one exactly in front of their Health office in Sik. Besides that, there are also number of them around in Sik.

The samplings are done to check on both Bio-Chemical and Microbiological aspects.

When are they done:

a) Samplings done prior to water treatment

b) Samplings done after water treatment

c) Samplings done before supply connected to public.

Now, we will look into the aspects that are monitored during the "point" checks.

a) Chloride level in water

b) pH of water

c) Conductivity of water

d) Turbidity of the water

e) Organisms in the water (mainly microbiology unit)

Above pic, from left to right: water pH, conductivity, turbidity, Chloride concentration.

The image on top shows the electronic gadgets used to evaluate different aspects of water as mentioned above.

The samples taken for microbiological assessment should reach the lab within 24 hours or else it is deemed as unfit for analysis.

There are cases reported positive of samples containing leptospirosis organism.

The source mainly from lake water. The officer claimed its mainly on the lower side closer to a canteen and not on the upper side. Rat habitation might be one of the cause. Observations are done routinely to monitor the situation.

How are samples taken:

a) Samples, as mentioned above are normally drawn from the "point".

This point is actually a small station with built in tap. As you can see from the image beside, its a inversed "J- shaped" tap. Its of chrome, the officer claimed.

b)Before sample of water are collected, water from the tap is let for a free flow in due to clear any stagnant water, then using a glass contained the water sample is taken.

c) to test for chloride, small amount of chloride particles are added to the water sample which turns into pink after a shake. Its then wiped of clean from any water drops outside the container. This is

so that the results will not contribute towards false positive.

d) using designated electronic measurement tool the concentration of chloride is then analysed.

e) same goes to other test except for the samples that will be sent for microbiological

assessment.

For samples being sent for microbiological assessment, the tap (inversed J shaped) will be heated thoroughly to kill any existing organism on the tap itself.

After which water is let for a free flow before samples drawn. Samples are labelled and sealed, within 24hours sent for analysis.

As mentioned above, samples are also taken from rivers too. The SIK health office is in-charge of 2 rivers, namely, Kuala Muda and Sik rivers respectively.

Samples are taken from all the point throughout the river. If there are contaminations, the points will help the officers to trace where it started.

Below are some photos that i took...have been uploaded for your view.

Chloride concentration in water reading meter

water pH reader

demonstrated pH value of 7.29

water turbidity reader having read 18.5 a/IU

So, Ladies and Gentlemen, we all understand how important water is in our daily life, drinking is not all our responsibility is, when it comes to taking care of its purity, it is a must for all of us. This will contribute towards a better health and if we save the water...then a better future too....

-adios-

Day 6 -- 11/7/10-- Water sampling

Every week water sampling will be done twice as informed by the officer, Mr Izzuddin. Every week they will check out one district.During the whole process they will assess the water quality before, during,and after processing.

For every water sampling they will have 2 parameter,one for unprocessed water and the other for processed water.Whenever4 the job is being carried out,they will bring 4 portable devices to the sampling site,which respectively testing for pH,TDS,conductivity and chlorine.

From left: Device to test for level of pH, Conductivity, Turbidity, Chlorine

Mr Izzuddin demonstrating how to test for turbidity.

For those chemicals parameter and microbiological profile which cannot be assessed on the spot,they will send a few samples of the water to the lab and the results will come out within 24 hours.To preserve the water sample,they will put the water in a tube filled with nitric acid.

After that, we were given a talk on how they prosecute those caught smoking under age, smoking in area not permitted and producing fake ingredients on pack food. Later we were taken to the court where the officer in charge told us how they normally prosecute those involved and how the charges are read to them, all the court proceeding were explained to us in detailed as no mistake should be made in court.

The main entrance of mahkamah majistret Sik

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

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.....