INFORMATION ABOUT FOMEMA

FOMEMA -Foreign Workers Medical Examination Monitoring Agency FOMEMA strives and aims to ensure that identified communicable diseases are prevented from entering the country through our stringent monitoring and supervision of medical examinations on foreign workers.

Our vision is to be the premier agency responsible for the monitoring and supervision of such medical examinations in Malaysia. We are setting the standards for medical examinations so that your family, loved ones and fellow workers will be safe from these communicable diseases. This will also bring about tangible and intangible benefits to you and the country such as higher productivity, lower absenteeism and lower health care cost for everyone. In doing so, we also ensure that our public health facilities are not unduly burdened due to the large presence of unhealthy and unsuitable foreign workers crowding and utilizing these subsidized facilities or needing prolonged and extensive treatment.

FOMEMA will do its utmost to provide a fail-safe and secure monitoring and supervisory system for your protection. We hope you too, will play your part, and help us in Caring for Malaysia. OBJECTIVES OF THE FOREIGN WORKERS' HEALTH-SCREENING PROGRAM The Government's objectives for the mandatory health screening program of foreign workers are: To ensure that our country is free from identified communicable diseases; and To ensure that our national public health facilities are not overburdened by unhealthy foreign workers with conditions requiring prolonged and extensive treatment. OUR ROLE To monitor and supervise the medical examinations of foreign workers in Malaysia carried out by panel doctors', X-ray facilities and laboratories registered with Fomema. To ensure that the medical examinations carried out are of high quality and of such integrity as to be in compliance with approved standards, procedures and criteria. To establish a nationwide system of monitoring and supervision in the form of surveillance and inspectorate activities. To provide an IT infrastructure to enable secured transmission of results of by panel doctors, X-ray clinics and laboratories to the Immigration Department. To provide information and statistics enabling the health authorities to take immediate control measures to deal with communicable diseases detected among the foreign workers. To miminise likely abuses by irresponsible parties seeking to defraud the medical examination of foreign workers.

Adolescent Health - Sik district

Adolescent Health

Vision
- adolescent will enjoy peaceful and quality life with knowledge and skills for healthy behavior

Mission
- prepare whole and optima health services and enough support for adolescent, through increase in awareness, knowledge, skills and cooperation between agencies and societies and active involvement of adolescent in planning and implementation of health services.

Objective
- planning and preparing health services for all the adolescent include physical, mental, social and spiritual for healthy behaviors direction.

Specific objective
- support the spirit of formation of adolescent group with encouragement of healthy and responsible lifestyle.
- Prevent the social problems due to risky behaviors by promoting the healthy lifestyle and preparing appropriate care for health
- Encourage active participation of adolescent in activities with health promotion and prevention.

Definition

Adolescent can be categorized into
: early adolescent stage – 10 to 14 year old
: middle adolescent stage – 15 to 17 year old
: late adolescent stage – 18 to 19 year old


Adolescent health services:
- promotion and education about adolescent health
- screening for adolescent health
- treatment for adolescent
- Counseling
- Reference services

Other optional services :
- activities
- counseling for adolescent diet
- focus group counseling or family counseling
- promotion of adolescent health like exhibition, seminar, camp, etc
- adolescent club, health club, PROSTAR, etc

Services provided by the health clinics:
- Growth and development
- Diet
- Mental
- Sexual and reproductive
- Risky behaviour
- Physical



SKR form (Borang Saringan Kesihatan Remaja)

SKR-1 for male
SKR-2 for female

This form is used to identify the adolescent problems which related to diet, growth, mental, sexual and reproductive, accident risk, smoking, alcohol and drug usage among adolescent.

This screening is done at least 3 times according to the categories mentioned above due to each stage there will be different emotional and behavior problems which tend to change with time.

- Opportunistic screening in health clinics
- Periodically screening in school





Flow chart of the process of main job in adolescent health services

Child Health - Sik district

Child Health

There are various aspects of child health:

- Nutrition
- Growth & Development
- Immunization
- Maternal and Child Health Clinic
- School Health

Millennium Development Goals (for child health)

- Goal 4: Reduce child mortality
- Target 5: Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
Under-five mortality rate
Infant (under 1) mortality rate
Proportion of 1-year-old children immunised against measles

The National Breastfeeding Policy (2006) states:
“All mothers are encouraged to breastfeed their babies exclusively with breast milk from birth until 6 months of age and thereafter to continue until the child is 2 years old. Complementary foods should be introduced when the baby is 6 months old.”

World Breastfeeding Week 2009 is 1-7 August 2009

Baby Friendly Hospital Initiative
Ten steps to successful breastfeeding [A joint WHO/UNICEF statement (1989)]
Every facility providing maternity services and care for newborn infants should :
1. Have a written breastfeeding policy that is routinely communicated to all health care staff.
2. Train all health care staff in skills necessary to implement this policy.
3. Inform all pregnant women about the benefits and management of breastfeeding.
4. Help mothers initiate breastfeeding within half-hour of birth
5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
6. Give newborn infants no food or drink other than breast milk unless medically indicated.
7. Practise rooming-in allows mothers and infants to remain together-24 hours a day.
8. Encourage breastfeeding on demand.
9. Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
10. Foster the establishment of breastfeeding support group and refer to them on discharge.

Breastfeeding and Child Survival
1. Follow the breastfeeding policy
- exclusive breastfeeding from birth to first 4-6 months
- no pacifier
- additional food only be given after the baby 4-6 months old

2. Advantages of breast milk compare to formulated milk
- prevent infection(bacteria, virus), respiratory infection and diarrhea
- prevent the baby from allergic
- sudden infant rate decreases

3. Colostrums
- high proteins, fat soluble vitamins (Vit A, D, E, K), zinc and sodium
- Low lactose(4%), fats and water soluble vitamins (Vit B complex, C)
- High vitamin K (prevent Haemorrhagic Disease of Newborn)
- High sIgA
- Passive immunization
- Stimulate passing out of meconium – to prevent neonatal jaundice
- Contain “Bifidus factors” which encourage the growth of Lactobacillus Bifidus – to prevent the growth of pathogenic E.coli.
- Active enzymes like lipase, lactase, lysozyme
- Antioxidant, Beta kerotene

4. Advantages for the mother
- oxytocin produced during breastfeeding will help the involution of uterus and prevent postpartum hemorrhage.
- Natural contraception
- Decrease the risk of breast cancer
- Decreases post partum psychosis


To overcome nutritional diseases and deficiencies, especially prevalent in rural areas, the Government initiated the multi-agency “Applied Food and Nutrition” programme in the 1970s and the “School Supplementary Feeding Programme” to provide children from low income families with food supplements including milk.
As a result, acute malnutrition is no longer a problem in our country.
Trends between 1990 and 2001 in under-five weight for age show that not more than 1% are severely underweight. On the other hand, Malaysia has begun to see the emergence of overweight and obesity in both children and adults.

School Supplementary Feeding Program (SSFP)[Rancangan Makanan Tambahan(RMT)]

• The main objective of SSFP is to improve the health and nutritional status of children, especially those from the rural areas, through a provision of a wholesome and balanced meal.


• To improve health and food habits and to prevent the occurrence of malnutrition among school children


• To educate children on food selection


• To encourage the participation of parents, teachers and public in the welfare of the school


• To strengthen health and nutrition programs in schools

Other informations will be posted soon. .. .

Family planning in Sik

Family planning.

Date: 7/7/09
By: Ketua Jururawat Masyarakat- Nur Aziah Ismail
Blogged by: Mark Paul

Aim of family planning is to space out pregnancies.

Benefits to mother: prevent maternal depletion syndrome, provide sufficient time for mother’s body to replenish stores; able to provide sufficient attention and care to each child.some mothers have heart disease or autoimmune diseases such as SLE, which require longer spacing as pregnancy worsens the disease and can lead to maternal death.
Will not be a burden to mothers if pregnancies are spaced out.

Benefit to child: able to get sufficient attention and care from mother. Prevents IUGR and small for gestational age (SGA).

Main age group of users in Sik: women/mothers of 20-35 years old.

How: staff nurses and the community nurses ( jururawat masyarakat) give the mothers counseling about family planning and contraception during antenatal period and also postnatal period.The counseling is given to the mothers and their husbands.They even hold small talks to the couples, to educate them about family planning. It is done from time to time. The ultimate choice of to use contraception or types of contraception used lies on the couple’s decision.

Methods: male condoms- are commonly used method. Couple comes to KKIA twice a month, each visit they get 12 condoms, that is 24 condoms per month.
oral contraceptive pills- combined and progesterone only pills- COCP, POP. In terms on medication, COCP is the most common among pills, depo-provera IM injectios and Multiload copper IUCD.

COCP used in Sik are Regivedon, Marvelon. Starts 42 days after delivery or when menstrual cycle starts. Not used if candidate have risk factors or history of heart disease, thromboembolism, breast and ovarian cancer.

POP used is Noriday- commonly used if mother is still breastfeeding. Starts by 0-6 months after delivery; COCP causes non-lactation..

Both COCP & POP are available in all KK and KD is Sik. Can be started by staff nurses, community nurses, MOs, FMS. Before starting them on pills, an extensive history is taken regarding the heart diseases, breast problems, thromboembolism.

Depo provera injections via IM lasts for 3 months, also available in all KK & KD in Sik. Can be administered by staff nurses, community nurses, MOs, FMS.

IUCD is only available in KK Jeniang (because FMS is stationed there) and KKIA Sik (by MO or FMS only). Can’t be administered by nurses.
The IUCD used here is Multiload copper IUCD, its market value is rm 250. Mirena is RM500, therefore it is not used. Suitable for women who tend to forget.
IUCD lasts for 3 years. It is inserted 42 days after delivery or 5 days after mensus begin. First, US scan is done to measure the cervix length, based on that measurement, the applicator length is adjusted too. Upon insertion, US scan is done again to determine if it is correctly placed. A review is done 6 weeks later using US scan. After that, annual review is done. It is only removed when 3 years period expired or when mother plan to get pregnant.

All methods are provided free by KK & KKIA & KD.

For women who is having heart disease, renal failure, SLE and others, which pregnancy worsens the disorders, they will require Norplant or Implanon, lasts for 5 years, to be done in LPPKN clinic in Sungai Petani and Baling. The couple bear the costs.

JM Suraya says family planning is very well accepted by the people of Sik and she says it is working well.

The financial allocation is provided by finance unit of PKD, the Sister buys the stocks from either the supplier, or via government tender. From KKIA Sik, she distribute them to the other KK and KD.

Unfortunately, there is no NGO operating in this field in Sik.

INFRASTRUCTURE IN SIK.

INFRASTRUCTURE IN SIK.
By Mark Paul.




Area: 1635 km-persegi (biggest district in Sik)
Population: 74400 people.
Density: 46 per km persegi
Main economy: rubber plantation.
Health facilities: 1 district hospital, 2 klinik kesihatan (KK), 1 klinik kesihatan ibu anak (KKIA), 19 klinik desa (KD), 1 health office complex, 2 dental clinics.

KK: in Jeniang (have 1 FMS, 2 MO, 4 MA AND nurses), and Sik (have 1 MO, and nurses; FMS visits Sik KKIA every Tuesday from Jeniang.)

KD: attended by nurses.

Within the health district office complex: there are:
- KKIA SIK
- Laboratory
- 2 meeting rooms
- Staff quarters
- Office blocks for all the units.
- Dental clinic.

SAFE MOTHERHOOD INITIATIVE 2 - SIK

Color Strings System on antenatal booklet for high risk pregnancy. (only in klinik kesihatan SIK)

It is one of the innovation project done by the Maternal and Child health clinic in Sik, under the program of Safe Motherhood Initiative. Strings with different color are tie on the right upper corner of both the antenatal booklets (Antenatal record KIK/1(a)/96 and KIK/1(b)/96) , according to the problem the antenatal mother is having. However, only
Antenatal Record KIK/1(a)/96 is kept in the clinic while the KIK/1(b)/96 is another copy for the mother. There are five colors of strings represent different antenatal problems:

1. red – hypertension in pregnancy
2. black – history of birth before arrival
3. yellow – anemia in pregnancy
4. blue – heart diseases in pregnancy
5. green – diabetes in pregnancy

If there are two or more strings of different color are tied on the antenatal booklet, that means the mother has more than one antenatal problem, for example black and red strings are tied on the booklet means the mother is having hypertension and she had history of birth before arrival (BBA).

All antenatal booklets will be kept in the shelf, those color strings tie on the booklet will be easily notice and so as the antenatal problems. The clinic staffs can find the case with different antenatal problem according the string’s color faster and easier. Management of the antenatal mother can focus more on the high risk cases with strings tied, especially those tied with more than one strings will be given priority first.

The color string system strengthens the original Color Coding System (stickers of different color on the front page of antenatal booklet) because the strings system makes the searching of booklets easier and faster on the shelf.

Benefits gain after this innovation:

1. management of antenatal cases become more effective and faster.
2. priority is given accurately for high risk mother
3. antenatal case with problem can be search from the shelf easier and faster
4. more attention is given for those with multiple problem (i.e multiple strings)
5. antenatal mother will be more alert as they know what problem they are facing
6. substandard maternal care is decreased

by Teoh Jia Qing 0500038

Reference:

1. Inovasi Keibua Selamat 1998 “Sistem tali berwarna pada kad antenatal kes berisiko”, pejabat kesihatan Sik Kedah Darulaman.

SAFE MOTHERHOOD INITIATIVE- SIK

TITLE: REDUCE INCIDENCE OF UNSAFE DELIVERY

The Safe Motherhood Initiative is a global effort that aims to reduce deaths and illnesses among women and infants, especially in developing countries. Partners in the Initiative support and implement safe motherhood interventions, in the context of broader reproductive health programmes.

Definition of safe delivery is any delivery that is conducted by a trained person.

Unsafe delivery is defined as all delivery that are not conducted by formally trained personnel. Classification:

1. Birth before arrival of any trained person such as nurse or doctor (mother delivers the baby alone).
2. delivery by TBA
3. delivery by untrained people or non-medical staff such as husband or mother-in-law.

The total number of unsafe deliveries in Sik in 1994,1995 and 1996 are 8.0%,5% and 11.8% respectively, which is consider very high.

Health indicator

1. % of unsafe deliveries

Number of unsafe deliveries among home deliveries x 100

Total of home deliveries

2. % of perineal tears (2^nd and 3^rd degree)

3. % of puerperal sepsis

Number ofpueperal sepsis among unsafe deliveries x 100

Total of unsafe deliveries

4. % of neonatal tetanus

Service indicator

1. % of Antenatal mother given advice on safe delivery

Number of antenatal mother given advice on safe delivery x 100

Total antenatal mother

2. % of antenatal mother at term who defaulted and were traced within 24 hours

Number of antenatal mother at term who defaulted and were traced within 24 hours x 100

Total antenatal mother at term

3. % of clinic staff given training on service of safe delivery

Number of clinic staff given training on service of safe delivery x 100

Total number of clinic staffs

4. % of staff who attended motivation courses

Number of staff who attended motivation courses x 100

Total number of staff

5. % of TBA who attended dialog session on safe delivery at least once a year.

Number of TBA who attended dialog session on safe delivery at least once a year

Total number of TBA

6. % of unsafe delivery among high risk mothers.

Number of unsafe deliveries among high risk mother x 100

Total number of deliveries among high risk mother

Difficulty indicator

1. % of unsafe deliveries due to non-availability of district nurses.

Number of unsafe deliveries due to non-availability of district nurses x 100

Total number of unsafe deliveries

Solution description

Issue of concern problem area	Interventions
1. Non-compliance of the mother	1. Health education about safe delivery - for mothers during every antenatal visit. - to mother at inaccessible area during home visit - give printed text about safe delivery for Iman to read during Friday prayers -Focal group discussion who had experience of unsafe deliveries and complications. - activate Panel Penasihat and community leaders to advice/ assist in social problem of the mothers -distribution of pamphlets to all mothers. orientation and visit to maternity ward in hospital. Defaulted tracing system between health clinics and hospital. Dialogue session for traditional birth attendants.
2. Inadequate knowledge of staff about complication of unsafe delivery.	1. organize talks by visiting specialist 2. increase frequency and quality of supervision/visit by supervisory 3. training programmes.
3. lack of motivation in hospital/ health clinics staff.	1. organize motivation talks 2. Islamic value by public service learn motivation counseling skill from counselor.
4. Unavailability of district nurses	1. Advertise date of leaves 2.cooperation from TBA
5. Ineffective supervision	1. increase frequency of supervison. 2. Appoint Staff with problems 3. give more attention to staff’s concern.

Implementations:

1. Hospital labor rooms visit by groups of antenatal mother who had no experience of delivering in hospital.
2. special marking and black string tie on the antenatal check up booklet for those who had experience of unsafe delivery.
3. nurses who have no experience of conducting a labor is sent to hospital for courses on conducting a labor.
4. those antenatal mother who have risk of unsafe delivery are invited to a focal group discussion on the importance of safe delivery in health clinic.
5. special arrangement is made for unwed mothers, they can have their antenatal check up at the day other than the antenatal day and if required, can be sent to other clinic to avoid public attention on them.
6. talks is given in villages which are located far from health clinic about the problems of unsafe delivery.
7. make sure all the antenatal mothers who are high risk for unsafe delivery have the chance to visit the hospital labor room.
8. increase number of Alternative birth centers especially in inaccessible villages for away from the hospital. Eg. Health clinics in Both Jeniang and Bulau have their ABCs operated at year 2001.

Beneficial experiences in Daerah Sik

Birth	1996	1997	1998	1999	2000
Total birth in District	1302	1232	1243	1275	1266
Total Home Delivery (safe)	427	289	196	165	115
Total unsafe delivery	45	48	33	19	16
% unsafe delivery of home deliveries	10.5	16.6	16.8	11.5	12.2
% general unsafe delivery	3.46	3.9	2.65	1.49	1.3

Result of antenatal visit to hospital Sik (year 2000)

Clinic	Total antenatal mother visit to hospital	Total visiting sessions to hospital	Total antenatal mother visit to hospital with partners	Total number of hospital delivery	Total number of delivery conducted by community nurses	Total number of unsafe delivery
Maternal and Child Health Clinic Sik	80	12	24	74	6	-
Health Clinic Jeniang	58	12	5	56	2	-
Health clinic Gulau	48	12	9	38	10	-
Total	186	36	38	168	18	-

By Teoh Jia Qing 0500038

REFERENCES

1. Yearly report of Safe motherhood initiative, district team problem solving, 1997.
2. Projek Kumpulan Meningkat Mutu Kerja KKM