Environmental Health and Hazards

People always mention and talk about environmental health. But what is it actually?

Environmental health 

It addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted towards preventing disease and creating health-supportive environments. 

However, this definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics.

The following are some of the environment related health problems that needs careful tacking through incorporation of various cross-cutting efforts which quite often goes beyond the influence of ministry of health:

• Living conditions with poor housing and overcrowding, inadequate sanitary facilities, and challenging communicable and vector-borne diseases
• Unhealthy lifestyles and nutrition transition that needs massive behavior change campaigns
• Growing urbanization, unhealthy work environment, and air pollution
• Complexities with food safety and security, food habits and healthy diet
• Climate change and its adverse impacts with extreme climatic behaviors, and need for preparedness to its mitigation and adaptation.

In accordance with the Global Health Agenda, WHO’s priorities in Eleventh General Programme of Work 2006-2015, has equally focused for Environmental Health, and has elaborated it under one of its priorities namely:  

“Providing support to countries in moving to universal coverage with effective public health interventions”

This is designed to include clusters such as communicable and non-communicable disease prevention and control; sexual and reproductive health; infant, child, adolescent and maternal health and the health of older persons; environment-related health problems, and effective response in terms of crisis; and research.

The following are some of the environmental hazards that have caused numerous medical and health problems to the community at risk and susceptible to it:

Indoor air pollution

Exposure to indoor air pollution from solid fuels has been linked to many diseases, in particular pneumonia among children and chronic respiratory diseases among adults.

Outdoor air pollution

Air pollution continues to pose a significant threat to health worldwide. Many countries around the world do not have regulations on air pollution.

Chemical safety

Chemical Safety is achieved by undertaking all activities involving chemicals in such a way as to ensure the safety of human health and the environment. It covers all chemicals, natural and manufactured, and the full range of exposure situations from the natural presence of chemicals in the environment to their extraction or synthesis, industrial production, transport use and disposal.

Children's environmental health

Child survival and development hinge on basic needs to support life; among these, a safe, healthy and clean environment is fundamental.

Electromagnetic fields

Electric and magnetic fields are part of the spectrum of electromagnetic radiation which extends from static electric and magnetic fields, through radiofrequency and infrared radiation, to X-rays.

Environmental health in Emergencies

Death and disease burden from emergencies, disasters and disease outbreaks associated with environmental risk factors can be significantly reduced by effective prevention, preparedness and response capacities.

Global environmental change

Large-scale and global environmental hazards to human health include climate change, ozone depletion, loss of biodiversity and much more.

Ionizing radiation

The aim of the Radiation and Environmental Health Program is to look for solutions to protect human health from ionizing radiation hazards by raising people's awareness of the potential health risks

Occupational Health

Workplace fatalities, injuries and illnesses remain at unacceptably high levels and involve an enormous and unnecessary health burden, suffering, and economic loss.

Ultraviolet radiation

Ultraviolet (UV) rays are a part of sunlight that is an invisible form of radiation. UV rays can penetrate and change the structure of skin cells. There are three types of UV rays: ultraviolet A (UVA), ultraviolet B (UVB), and ultraviolet C (UVC). UVA is the most abundant source of solar radiation at the earth's surface and penetrates beyond the top layer of human skin. Small amounts of UV are essential for the production of vitamin D in people, yet overexposure may result in acute and chronic health effects on the skin, eye and immune system.

Water, sanitation and health

Water pollution is a major problem in the global context. It has been suggested that it is the leading worldwide cause of deaths and diseases. As aspects of water, sanitation and hygiene oppose a very high health burden, where interventions could make a major difference and where the present state of knowledge is poor. However, many countries are challenged to provide these basic necessities to their populations, leaving people at risk for water, sanitation, and hygiene (WASH)-related diseases.

References:

1. WHO, Environmental health
2. www.cdc.gov, search on environmental health
3. Environmental medicine and global health lecture

Crackhead

I was browsing through the internet for some "blogging" ideas when i came across an interesting website about illegal drugs which ironically have amazing medical benefits.

don't believe me? click!

illegally beneficial?

Don't use it as an excuse to take them though. Hehe :p 

Phases of Disaster

Sudden ecological phenomenon of sufficient magnitude to require external assistance

World Health Organization

The whole world cries for help. Soothing anthems sung and donations overflow. Quite naturally the voices of the unfortunate flood the ear of the generous and words are often put in action. Disasters are not over-rated. Lives lost unbearably regardless of race and social standards. One may ask, how possible is it to cheat death in a situation like this. Let us not play god as the unknown rest in the Almighty.

As health care providers, there are certain things that falls into our responsibility. Let us start by understanding the phases of disaster first:

HAZARD: It simply means a chance to be injured or hurt. In this context of discussion, we will focus of natural disaster hazards that may cause harm once the event or disaster strikes. They are called “Geohazards”. “

Quoting from www.yearofplanetearth.org,

Geohazard is a term that includes geological hazards like landslides and volcanoes, hydrometeorological hazards like floods and freak tides, and geophysical hazards like earthquakes. Any Earth process that poses risk to human life can be said to be a geohazard, ranging in scope from local events (such as small rockfalls) to global geophysical events that can threaten the existence of our entire species, like major asteroid impacts and supervolcanic eruptions.

EVENT: It is the occurrence of natural event, due to the hazards and risk present at that area.

IMPACT: Disasters, whether natural or human-made, often leave people affected to face difficult times due to loss of lives, property and also emotional stability. For example, due to catastrophic events such as floods, volcano eruptions, fires, droughts and blizzards. It is how the event caused the effect to the people involved.

DAMAGE: It means harm or injury to property or a person, resulting in loss of value or the impairment of usefulness. The damage can often be reduced when the community have the resilient to absorb the impact.

MITIGATION: Mitigation efforts attempt to prevent hazards from developing into disasters altogether, or to reduce the effects of disasters when they occur. The mitigation phase differs from the other phases because it focuses on long-term measures for reducing or eliminating risk.

PREPAREDNESS: Preparedness is a continuous cycle of planning, organizing, training, equipping, exercising, evaluation and improvement activities to ensure effective coordination and the enhancement of capabilities to prevent, protect against, respond to, recover from, and mitigate the effects of natural disasters, acts of terrorism, and other man-made disasters.

RESPONSE: The response phase includes the mobilization of the necessary emergency services and first responders in the disaster area.

RECOVERY: The aim of the recovery phase is to restore the affected area to its previous state. It differs from the response phase in its focus; recovery efforts are concerned with issues and decisions that must be made after immediate needs are addressed. Recovery efforts are primarily concerned with actions that involve rebuilding destroyed property, re-employment, and the repair of other essential infrastructure.

In the future, when we became general practitioners, we have to bear in mind that our roles is not limited to only during the response phase when there is an overflow of victims to the hospital, but indeed from mitigation and preparedness up until recovery and social mobilization of the community. 

For example, experiences indeed are our best teachers. When a certain disaster strikes an area, the next time the hazards occur we should prepare all the equipments and materials necessary to deal with the event that might arise from the increasing risks. By abiding and realizing our roles, disaster management can be practised to its highest objective and potential.

References:

1. Conceptual framework of disaster and disaster management: Dr. Hendro's lecture
2. World Health Organization
3. www.yearofplanetearth.com

Community Involvement for Health: A Personal Experience

I can still remember the closeness of the group. All discussing one matter towards achieving one goal, and that is taking active actions for the betterment of the community. 

I was involved in an LSM called SHEEP Indonesia and the experiences I got were beyond priceless. I learned that the community has a unique way of getting together when it comes to issues of health. Each month a group of Kader from the women’s association of the community of Sapen will join hands and efforts to organize a gathering called Posyandu.

There are two types of Posyandu or pos perlayanan terpadu held monthly, and those are Posyandu Lansia and Posyandu Balita. Here they will do all sorts of activities such as blood pressure measurement, health talks and also story sharing in Posyandu Lansia. In Posyandu Balita which caters for the children below the age of 5, the activities held are weight and height measurements as well as nutritional counselling. 

Quite often, when I have the time, I will join in such activities. At the back of my mind, I can’t help but to think, who else that is more fitted to ensure that you are always healthy if not the people who know you, your background and also your stories. The idea of community involvement in health promotion and education is an astoundingly fantastic idea in my point of view. Despite the fact of having been there for a rather short time, truthfully, I already felt like I was a part of the community.

That’s my story and it is very closely related to the topic of “Doctor and Community Participation and Mobilization” that we learn in this block. 

Community participation by definition is an active involvement in planning, implementation and evaluation of health programme which ultimately is for their well being. What would be the ultimate goal is to empower the community so that they can identify and prioritize their needs and objectives (suitable with their community and their needs).

When we talk about needs, there are 4 types of needs that we need to consider:

1. Normative Needs
• It is based on experience and opinions of experts according to current research or findings
2. Felt Needs
• When groups or individuals say what they want or the problem they felt needs addressing. This is important because the planned changes are not always reflecting the community of concern.
3. Expressed Needs
• Expressed needs are shown in reality and reflects a problem. For example, the waiting list for childcare may express a need for more childcare centres.
4. Comparative Needs
• It is shown by comparing what is available to one group of people with what is available to another group.

Social mobilization capitalizes on people’s energies and commitments, on available resources, and on situations that can help move a group of people to achieve a common goal and understand why it matters to them. This organization’s governance also enables the community to make independent decisions about how it wants to manage its natural resources. This concept can be put in various aspects of healthcare and thus, makes it also the community's responsibility to enhance health care assessment and delivery to the people living under its wing.

References:

1. Lecture Note: Doctor and Community Participation and Mobilization by Dr. Supriyati, S.Sos.

Chronic Disease Management in Primary Care

Most people with major chronic illnesses such as diabetes, asthma, and depression receive care from primary care health providers. Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients and practicing within the context of family and community. 

In practice, these defining features of primary care, that is, continuity, comprehensiveness, and coordination match the care needs of chronically ill persons. The complexity of chronic illness and the frequent involvement of more than one caregiver and institution make coordination a cornerstone of high-quality medical care.

Chronic disease management refers to discrete programs directed at reducing costs, which would be increased due to the terms of treatment, and improving outcomes for patients with particular conditions. The components of chronic disease management consists of:

• Features of general community
• The health care system
• The performance of the institution (organizational systems, division of labor, team work and communication)

Why Primary Health Care should manage chronic diseases?

1.     Chronic diseases may have a range of severity from less severe to very severe. For example, Diabetes Mellitus and arthritis. PHC(s) will have a role in managing the less severe ones as well as the symptomatic managements.

2.     Pharmacological regiments used in treating chronic diseases are widely used. It is mostly common and non-toxis, thus PHC(s) can definitely play a part in distributing these drugs and managing these patients.

3.     Usually the patients with chronic illness have more than one condition. PHC doctors can play a part in catering the service for patients with their general training. This will also ensure a hollistic approach in managing patients can be brought to the table.

4.     The PHC(s) have more training in community behavioral change and attitude management support. This is seen rather fit with the community's need and demands.

*** 

There is a common misconception that primary health providers to provide acute care and remain that way despite the increase of major chronic diseases. Since then it has fallen short on performance and also at the perspective of the patients. Lack of physicians and also the long time of interaction may be some of the factors that influenced the drawbacks of chronic care management in primary health care centers.

 

Uniform perception among the team members of the primary health care centers regarding the role and function of the center to provide care for chronic diseases will help in omitting the misconception. This is because according to Eccles et al. (2009), perception of health care workers about chronic disease management is one of the most important parameter in primary care to serve patients with chronic diseases.

References:

1.   Tutorial week 4 discussion

2.   Lecture 15: Regulating Physicians and Services.

3.   Chronic Illness Management: What Is the Role of Primary Care? by Arlyss Anderson Rothman (Ph.D)

Going Mental

Help me :(

During disasters, no one can anticipate the level of stress and burden that comes with it. Sure, the logistic team can handle everything that the victims may need, but at times what should really be a matter of concern is the mental state of the victims. There are a few mental problems that may accompany different stages or phases after disaster:

• Critical Phase
• Acute stress disorders: this usually occur less than one month after an extreme stressor.
• After critical phase
• Post-Traumatic Stress disorder (PTSD): This can occur more than one month after an extreme stressor. It can also occur immediately for those who has had some sort of traumatic experiences previously.
• Prolonged Stressors
• After a catastrophic experience, the patient can endure unwanted personality change which is caused by his/her way of dealing with the disaster.

Lets us look into detail what PTSD is all about

Based on experience, i have encountered a few cases where some of my friends and family members are traumatized by a gruesome incident they ever encountered in their lives. For example, when one is involved in an accident, it will take them a very long time to actually get in another car ride ever again. The following are the main symptoms of PTSD:

• "Flashbacks" about the traumatic event
• feelings of estrangement or detachment
• nightmares
• sleep disturbances 
• impaired functioning
• occupational instability
• memory disturbances
• parenting or marital difficulties

The patients may withdraw themselves from doing some activities that they think may cause them to have the same experience and are terrified for everything. When things like these happen, there are two possible route on how one can individually deal with their problem. 

They can either have healthy coping mechanisms or maladaptive coping strategies. Its these maladaptive coping strategies that we have to be very careful and clever to detect. 

Examples of maladaptive coping strategies are like:

• An increased use or abuse of alcohol, coffee, drugs, gambling, tobacco, etc.
• A compulsion to work more than usual
• A temptation to make hasty major life-decisions (e.g., a job change, a divorce)
• A tendency to completely avoid any feelings or thoughts about the event.

When an event of disaster happens, it can certainly cause very complicated mental health and psychosocial problems. The effect of the disaster varies from people, country and also economic backgrounds. For example, in developing countries, life problems and secondary disaster following the disaster is even prominent than the trauma primarily faced.

Therefore, prompt evaluation of the mental status of the people who deals with disaster should be done regularly and no "simple" sign should be taken lightly. Regular support groups in which survivors can discuss their feelings and experiences are also very important so that all their negativity can be transformed into effective and positive communication.

References:

1.     Lecture Note: Disaster Management in Mental Health (by Dr. Bambang Hastha Yoga, Sp.KJ)

2.     Medicine.net. Search on Post-Traumatic Stress Disorder

Blood Banking in Disaster

In a disaster, some or all of the following scenarios may materialize:

• Damage to health facilities at a time of increased demand for their services
• Disruption of social networks and the operations of health care and support entities.
• Environmental degradation leading to the proliferation of vectors and other sanitation problems.
• Human displacement leading to radically increased or decreased population density, affecting food supply and hygiene and precipitating the outbreak of communicable diseases.
• Damage and partial or total loss of basic services (transport, communications, water, electricity).

Only a comprehensive strategy comprising vulnerability assessment, mitigation, and closely-knit organization at the local, regional and national level will ensure an adequate response in disaster situations and guarantee the timely and cost-effective recovery and reconstruction of the affected facilities. A national blood bank system, including a central reference facility should be established for the handling of emergencies. The system should take into account the capacity and vulnerability of each centre, both from the point of view of infrastructure and the services it should provide in an emergency.

The organization and hierarchy of the blood bank network should be established in advance as part of the overall development and management of the system. An inventory of human and physical resources should be carried out, including the precise definition of roles and responsibilities.

The vulnerability assessment of laboratories and blood banks should uncover at

least the following information:

• Expected structural and non-structural behavior of the laboratory or blood bank facilities.
• Expected characteristics of the damage: location, causes, magnitude and consequences.
• Likely operational capacity after each type of disaster.
• Recovery time for full operational capacity.

Immediately after a disaster has struck, damage to each facility and to the system as a whole should be assessed from the point of view of both security and operational capacity. Then an assessment must be made of the need for blood, supplies, and other physical and human resources. If donations are required, one should ideally accept first of all people who have previously donated blood, and process the units of blood in accordance with national safety standards.

Emergency communications should be carefully planned and tested in advance. This includes redundant channels and alternative modes. Transportation of blood and other supplies and equipment to the affected areas should also be planned with care, including alternative routes in case roads have been blocked by landslides, debris or flooding. Simulations and drills should be carried out in normal times to test the efficacy of the system.

References:

1. www.unisdr.org
2. Disaster Bloodbanking lecture by Dr Teguh Triyono

World AIDS Day 2010 Slideshow Project

World AIDS Day 2010 falls on the 1^st of December 2010. Where is it celebrated and remembered? All over the world. HIV/AIDS has become a global crisis and an old friend to the human race. Who else will care, if not us and who else will act, if not us.

For this memorable day is no joking matter, we should always understand the role that we need to play and the mindsets about AIDS that we need to change. For every prejudice destroyed, comes with it the ultimate benefit. And that moment starts now.

Especially for this day, I’ve put together some photos easily accessible from Google and did some research on our national AIDS organizations (both Malaysia and Indonesia) before arranging it into a slideshow via windows moviemaker. Hopefully some of the info and words shared in the slideshow will spark a little bit (if not much) of understanding among us to combat this global enemy.

Enjoy.