AUDIOMTERIC TESTING IN HOUSE TRAINING

Today, Kuching Specialist Hospital organised an in-house training on audiometric testing, conducted by Mr Derrick Chan of Top Hearing Care Centre KL. We bought our audiometric machine and static silent booth from this company many years ago. 13 staff attended the training, majority are our nurses who conduct the audiometric testing.

Mr Derrick Chan divided his teaching into theory and practical. He covered the following topics:

1. Ear 2. How we hear? 3. Pure Tone 4. Audiogram 5. Results Interpretation. During the hand on audiometric testing, each of the participants was taught on how to conduct the pure tone air conduction testing as required under FMA 1967 (Noise Exposure 1989). Beside that the participants were also taught on how to operate the audiometric machine as well as how to 'trouble shooting' in case the machine has some technical problems.

A copy of Noise Exposure regulation 1989 was also given to each of the participants. The salient features in the regulation were also highlighted.

The training started from 1 pm until 5:45 pm. Each participants will receive a certificate of attendance.

Workplace Accident: Amputation of Right Thumb

2 weeks ago, a worker came with Amputation of his Right Thumb at the base, alleged accidentally cut by a machine saw. This is a workplace accident and needs further investigation to find out the root cause as well as needs to be notified to DOSH by the employer.

For the worker, it will be the worst experience, he will grieve for the loss of his right thumb, worst still he is the right handed person. He appealed to the ortho. surgeon to rejoin his right thumb back. Yes, the surgeon tried but the difficult thing is- it occured at the joint line of his right thumb, the outcome would not be that successful in term of function and might be failed.

The impact of this loss incident is a trauma and a crisis experience in his life. He will in grief for a certain duration of time. While his thumb is badly injured, his mind is traumatised by the incident. What will his employer do to help him?

EMERGENCY RESPONSE EXERCISE @ IOT Management II

EMERGENCY RESPONSE EXERCISE @ IOT Management

Today, at 2:30 pm I attended 2nd Fire Drill exercise conducted by Independent Oil Terminal Management (IOTM) at their LPG Terminal at Senari Port. The exercise took 1 hour with participation from Jabatan Bomba Dan Penyelamat and Kuching Port Authority. As a whole, the exercise has improved compare with last year exercise. Congratulation to IOTM!

HEALTH TALK AT PMB, JKR Kuching

Today (15 December,2009) I was invited by SHECOM of Pusat Makmal Bahan-Bahan (PMB), JKR at Tabuan Jaya Kuching to give a talk on Stress Management at 9:30 a.m.

My talk was entitled Occupational & Psychological Stress. My presentation is divided into two part : 1) Understand Stress 2) Basic Management of Stress.

I focused on 2 components of stress situation which is vital to understand in order to manage STRESS effectively. First component is the STRESSOR or source of stress. The first step in stress management is to identify the STRESSOR and decide whether it can be eliminate, modify or cannot at all. If the source can be eliminated and modified, it will make it easy to manage the stress. In some situation, the source cannot be changed at all for example loss event (death).So we have to be rational to accept it as a FACT in life. In this case, the strategy is to concentrate on the way you cope (response) with the situation. The approach will be individual and organizational.

Although the talk has a small crowd but during Q&A session, there were a lot of questions asked by the participants.

NIOSH : Best OSH Practice Seminar

On 14 December, 2009 I presented one topic entitled : Hazards & Risk @ Workplace : Identification, Prevention and Rectification at Merdeka Palace, Kuching. I shared the concept of HRA (Health Risk Assessment) that was practiced by SHELL as one good practice in handling health hazards at workplace. According to NIOSH Kuching, the total number of participants were 70 with many registered at last minute.

HEALTH TALK AT BROOKE DOCKYARD

On the 8 December, 2009 I have a privilege to give a health talk on occupational hazard to the workers of Brooke DockYard, Kuching. The topic of my health talk is on Noise at workplace. Around 20 workers were attending the talk. Few questions were asked by the participants.

ASSAR SENARI: Healthy workforce Health Screening Program

The first batch of ASSARSENARI GROUP's workforce participated in 'Healthy Workforce Healthg Screening Program' on 4 November, 2009. 20 staff including CEO, COO, Legal Adviser, Human Resource executives etc. attended the program.

The objectives of this program are:

1.To identify the baseline health status of the workforce

2.To identify the workforce who has risk factors for NCD occurrence

3.To identify the workers who has established NCD and also CD

4.To design a future plan for monitoring schedule of the workers health status

5.To assess the needs of health promotion to maintain the healthy life status of the worker

The program use WHO STEPS questionnaire to achieve the above objectives. The program will check each of the worker on the 8 modifiable risk factors for the Non Communicable Diseases.

The 8 Modifiable risk factors are:

1. Smoking

2. Alcohol Consumption

3.Unhealthy Diet

4. Physical Inactivity

5. Obesity

6. High Blood Pressure

7. High Sugar Level

8. High lipid levels

Second batch of the participants will attend their health screening session on 7 December 2009

SHELL TIMUR Sdn Bhd Kuching HSSE WEEK

SHELL TIMUR SDN BHD, Kuching Installation, launched their HSSE Week 2009 from 3 to 6 November, 2009 recently. The HSSE week was officially opened by SHELL Malaysia Chairman, Dato' Saw Choo Boon. The Theme for this year HSSE Week was "Do The Right Things : Life Saving Rules". I was invited to give health talk on ' FATIGUE MANAGEMENT'. Jabatan Keselamatan Jalan Raya (JKJR) Sarawak also provided exhibition on Road Safety Awareness and Pengangkutan Mekar Tiasa (PMT), one of SHELL's haulier exhibited their activities and new vehicle for petrol transportation.

Preparing Workplace for Pandemic H1N1

Although Pandemic H1N1 is in its cool phase atleast in the news, but we need to prepare for the 2nd wave of infection which is much expected.

ILO has produce a Guidance and Action Manual that can be adopted by any organisation for the above purpose.

AOEMM SEMINAR : Influenza A H1N1 Pandemic

Just back from KL via Flight AK 5218 landed at 9:50 pm, delayed almost 20 minutes due to some technical problem. Impressed with safety measures done in the flight with the pilot went out discussed the technical problem with the engineer. After clearance and given green light to fly by the engineer, the pilot announced the good news to the passenger.

I went to KL on Sunday night to attend today Seminar on Influenza A H1n1 Pandemic: Pragmatic Approaches for the workplace organised by Academy of Occupational & Envrionmental Medicine, Malaysia (AOEMM) at Grand Dorsett Subang Hotel.

The seminar started with the Keynote address on Situation Report on Influenza A H1N1/09 in Malaysia - What to expect in time to come by Dr Sirajuddin Hashim, Sr. Principal Assistant Director Diseases Control Division, Ministry of Health.

7 Lectures were delivered by expert as follows:

1. Mitigation Phase : Actions taken by MOH and Role of Private Medical Services Provider by Dr Priya Ragunath from MOH.

2. Clinical Presentation and Management of Influenza A H1n1 : The Malaysian Experience by Dr Suresh Kumar, Consultant Infectioius Disease Physician, Sungai Buloh Hospital

3. Health Care Wokers - The Appropriate Protective Measures in the Healthcare Facility by Ms Josephine Xavier, Sime Darby Medical Centre

4. Influenza Pandemic: ILO Training Material on Workplace Action by Dr Zalina from DOSH

5. Recommended Preventive Actions to be taken in the workplace - the Role of Employers & Employees by Dr Abed onn, Medical Director GE

6. Business Continutiy Plan : What Works by Dr Khatijah Jumangat from Infineon Technologies

7. Risk Perception and Risk Communication during the Current H1N1 Pandemic by Prof. Dr KG Rampal of UKM

I will post some new informations from each of the lectures later....

MEDICAL SURVEILLANCE - Noise

This past few weeks I am really busy analysing audiometric results of employees from 2 of our corporate clients. Analysing the audiometric results is very time consuming and painful especially if you dont have the previous result in hand. Lucky for me as I have created the audiometry surveillance database for me to keep the data of my clients so that I can compare their current audiometric results with the previous one. This is important especially if we want to determine the occurence of standard threshold shift (STS).

After the analysis done, the reports need to be revealed to the workers as well as their employer. Advising the employer on the important of implementing the Hearing Conservation Program is very important. Nonetheless, educating the employee on the risk of noise to their hearing and the important of wearing Hearing Protective devices is very challenging.

Generally, the findings will be classified into 3 categories:

1. Normal Hearing

2. Hearing Impairment

3. Noise Induced Hearing loss (hearing loss at high frequency 3 Khz - 6 Khz or typical 4 Khz notching).

The category 2 & 3, need to be notified to DOSH. Here is the problem start to emerge, some employers look scary and try to argue about the findings.

My advice to them will be:

Implement the Comprehensive Hearing Conservation Program and DOSH will be pleased with your effort.

Note: The above picture was captured from my humble database created using Filemaker Pro

HAZARDS DURING HARI RAYA

During my hariraya visit to my grand uncle's house yesterday, from his neighbour's house suddenly blasted a long chain of fire crackers with a very loud unwanted sound. Of course it causes NOISE - one form of physical hazards. In my experience, the intensity of that noise must be between 90 to 105 dB (based on this field study).
The firecrackers' noise lasted for more than 5 minutes. I managed to record it at its last part(about 24 seconds duration). My ears feel discomfort although I was sitting in my granduncle's house about 20 feet away and it also annoyed our conversation.
I supposed, it not only can cause 'temporary standard shift (TTS)' to my hearing but also can cause physical injury. I hope this 'hariraya' celebration will not end up with tragic otherwise

it will loss its meaning.

.

SELAMAT MENYAMBUT EIDUL FITRI 1430H

Alhamdulillah, hari ini kita menyambut kedatangan syawal, hari kita kembali semula kepada fitrah setelah menjalani tarbiyah terhadap nafsu sepanjang bulan Ramadhan al-Mubarak. Pemergian Ramadhan tentu menyedihkan kita setelah tekun menjalani ibadah puasa selama sebulan, semuga ibadah puasa kita mendapat keberkatan dan diterima Allah Taala. Ketibaan Syawal tentu disambut dengan penuh kesyukuran, berbekal dengan tarbiyah madrasah Ramadhan diharap kita dapat meningkat nafsu kita ke tingkat mutmainnah.

Begitulah sunnah kehidupan ini, kita perlu sentiasa memperbaiki diri dan prestasi agar ilmu dan amal kita meningkat.

Prevention is Better Than Cure

Medical adage, "Prevention is Better Than Cure", is one of the health principle we should practice in our daily life. Health Prevention refers to any activity we do that prevent the health from harm. The fact is Prevention is cheaper than Treatment cannot be disputed.

Prevention Mode of Action can be classified into 3 stages:

1. Primary Prevention

2. Secondary Prevention

3. Tertiary Prevention

Primary Prevention:

In primary prevention stage, the main activities are to prevent disease or injury from occuring. Primary Prevention can be done at individual and community level. The focus of activity in primary prevention stage can be directed at host in order to increase his resistance to the agent, for instance by giving immunisations, stop smoking et cetera. Primary prevention activity also can be directed on the environment such as reduce the condition favorable to the vector of the agent such as in biological hazards (example:Fogging to destroy aedes mosquito inorder to prevent Dengue disease). The acitivities in primary prevention do not depend on the doctors alone. Health Protection and Health Promotion are the two tools widely used in primary prevention.

In Health Protection, the main aim is to eliminate the agent and also any predisposing factors that can cause the disease. Hierarchy of Control is included in this Health Protection tool. Health Promotion is another tool that not only give the health education to the individu but also empower them to take care and responsible of their own health.

Secondary Prevention:

In Secondary Prevention the main aims is to detect the disease early and manage it as early as possible to prevent its complication. Detection of disease can be made through health screening, health and medical surveillance. In our current contact of handling influenza A H1N1 infection both home quarantine and mitigation phase are belong to this stage of prevention.

Tertiary Prevention:

Tertiary Prevention are activities which promote rehabilitation, restoration and maintenance of maximum function after the disease and its complications have stabilised. The activities are directed at host and also environment.

Host-Agent-Environment Paradigm

Before we explore 'Health Prevention Concept' further, it is important at this juncture to understand another paradigm called 'Host-Agent-Environment' which contributes to ill health condition. In this paradigm, the Host, Agent and Environment interact with each other to form a condition that favors ill health or disease to occur. The Host is the person who has or at risk of specific disease. The Agent is the organism or direct cause of the disease. In occupational health we called its health hazards categorised as Biological, Chemical, Ergonomics, Physical and Psychological (BCEPP). The Environment includes the external factors which influence the host or his susceptibility to the agent and also the vector which transmits or carries the agent from the environment to the host. This paradigm explains the causation and transmission of many diseases. The combination of factors in these 3 premises in effects form a contagion of theories of disease causation.

The factors in the host which contributes to his susceptibility to the disease are age, gender, genetic, occupation, lifestyle, education etc. The agent's factors which contribute in disease susceptibility in the host are biological, type, characteristics etc. The factors in the environment are the economic, social condition,climate etc. This 'Host-Agent-Environment' complex interaction only can cause disease with Allah Willing.

Occupational Health explored

In my last posting, I concluded that WHO's definition of health can be accepted as an ideal goals that everybody should achieve. The state of complete physical, mental, spiritual and social well being is the state of being in equalibrium. But in reality, health is a continuous responding process of adjustment of the four mentioned human dimensions to the demands of everyday life. These demands arise as a result of the interaction between ourselves with others and our environment. In simple word, we live in the interactive ecology system. So, to preserve our health in the state of complete well being, we cannot act alone. We need a balance interactive of this ecosystem so that it is always in equilibrium states or state of well being. So the responsiblilty to preserve health is beyond individual; it also involves the active role of the family, society and environment. In the nutshell,we need a maintenance of health preservation effort at individual level and also a health protective and promoting system at the family, society and environment level.

The understanding of this concept of health is very important especially when we want to explore occupational health (and also public health). Occupational health is the specific subset of the public health which focus its prevention activity by protecting and promoting health at workplace. The 'workplace' is the domain of occupational heath function. In the 'worker-workplace' ecosystem, workplace is the society and environment components. Since the worker is part of the population, the population as whole and a family as a specific origin of the worker also play a vital role in maintenance the state of well being of the worker.

Workers who come from families of the society in the population, brought with them their health state, belief and behavior to their workplace. At workplace they form an interactive mini ecosystem with the workplace and its environment. This mini ecosystem is a subset of a big ecosystem in the family, society and the population.

In preserving the workers' health, all the components of this mini ecosystem as well as the entire ecocystem have their roles to play. These roles must be integrated.

So the health prevention is an integrated functions which involved the worker, the workplace (the management,peer workers) and the environment (organisation, job task, building ec cetera.).

Health Prevention can be simply defined as stopping or eliminating the factors that can disturb the equilibrium of health. It involved protection and promotion of health at workplace. This is the main 2Ps activities of occupational health.

Health Prevention can be divided into three stages or phases.

1. Primary Prevention 2. Secondary Prevention 3. Tertiary Prevention

to be continued.....

Understand Health & Occupational Health

The soul of occupational health is prevention; its functions are to protect and promote the health of people at workplace. The key words here are Prevention, Health and Workforce(people at workplace). Let us understand the definition so that we don't have confused understanding.

According to WHO, HEALTH is defined as a state of complete physical, mental and social well being AND not merely the absence of disease or infirmity. Health is multidimensional. In this definition, WHO focuses on 3 specific dimensions of health namely Physical, Mental and Social.

However, in this posting I would like to add another dimension called spiritual to this definition. So now, our definition of health is " a state of complete Physical, Mental, Spiritual and Social well being". In this new definition, it is better to differentiate between mental health and spiritual health.

Mental health is a state of emotional and psychological well being in which an individual is able to use his or her cognitive and emotional capabilities to function in the society and meet ordinary demands of everyday life.

Spiritual health on the other hand is individual ability to differentiate between Right or Wrong and resolve to lead a more righteous life, free of stratagems, deception, dishonesty and selfishness.

To perceive health as a state at all is too idealistic. However, it is the ideal goal that everyone should achieve. In real fact, health is a process of continous adjustment to the changing demands of life.

.......next posting : Understand Prevention...stay tune

Self-Compliance

Last week, I asked my ordinary grass cutter came to do his job at my house compound. He knows the hazards of his job and he voluntarily used all the necessary Personal Protective Devices(PPD/PPE) according to his own standard. (Cover his face&head, using google, using long sleeve and using PCK safety boot). His self-compliance without even knowing the existence of OSHA 1994 is very much appreciated.

When come to safety, our inner self is fully aware to protect ourself from dangers. However, a lot of the time we see people totally ignorance about their safety especially on the road and at their workplace. They do unsafe acts and create unsafe conditions (the two culprits of accident) and it becomes their routine or behavior. Their mindset already corrupted by false satisfaction they get from the non accident consequences they get from their actions and conditions. This false satisfaction is like 'atomic bomb waiting to explode'. The vital question is : Can we change their practices or behaviour?

Definitely........ we need to change their mindset first....changing their mindset means changing their perception or to be accurate change their 'world view'. We only can change their 'world view' by giving them 'knowledge' (ilmu) using simple language that they can understand. By changing their mindset, only then they will change their behavior. In another word, we are talking about 'Behavior Based safety'. We have to use a lot of approaches including religion approach. In religion there are a lot of safety values we can practice.

BUERGER'S DISEASE

Tonite, one gentleman in his late twenties, came to our A&E Dept. with the above problem. He is suffering from this problem more than one year. He was previously treated in government hospital. On further questions, he claimed that he was a heavy chronic smoker and just quit recently. He came to A&E because he could not stand the pain on his fingers and toes. Some of his fingers and toes were already lost. At a glance, I diagnosed him as having Buerger's Disease. Detail about Buerger's Disease you can read here and also here.

When I asked him what is his occupation, he replied, "I was working at the Chemical Production Company. Now I already quit". I dont know whether his occupation has some relationship with his illness or not. I need to do some literature review on this subject. However, as far as my clinical knowledge on Buerger's Disease,I am sure it is related to heavy tobacco smoking. With this posting, I urge all of my fellow visitors of this blog who are smokers, please QUIT SMOKING. It is better now than later.