CBL 2 - Case 1

1. Beside the clinical management of the case, what other consideration should you have in the
management of the above case?
2. What is the relevant environmental issue that is related to the above case?

PROBLEMS/ISSUES

MEDICAL

Her 5-year-old boy

History
 frequent watery stool for the last three days.
 the last six months the boy has been having loose stools on and off lasting for a few days
which went off on its own.
 itchiness around the web of his fingers especially during the nights.
 NKMI
 Hx of her other five children also have loose stools on and off during the same period.

Physical examination:
 have stunted growth and the weight to be less than two standard deviations of the normal
weight for his age
 signs of mild dehydration.
 Afebrile
 the webs of the fingers, you found small red elevated lesions and blisters around the web of
the fingers; multiple healed lesions measuring between 0.5 and 2.0 cm all over the lower and
upper extremities
 otherwise normal.

SOCIAL

 5 kids.
 Refusal of admission.

OTHER

 The Orang Asli Village where they stayed was near the confluent of Tembeling and Dohong
rivers which is around six kilometers upriver from the clinic. (problem with distance and
transportation)

CLINICAL MANAGEMENT

 investigation for diarrhea.

 provided the child with medication for diarrhoea and scabies infection, and managed
malnutrition.
 home visits.
 Consideration:

SOCIAL
 Where is father? Single parent?
 Mother mental health status?
 neglect?
 Kids’ domestic abuse from mom

SOCIAL MANAGEMENT
 Food and water handling
 Nutrition
 Hygiene

ECONOMIC/ENVIRONMENTAL
 Financial?
 No good food? Malnutrition? Imbalanced diet
 Food choice, do they hunt animals to eat? Poor food handling.
 Clean water? Need to investigate the water supply.
 Poor waste management?
 Lack of access to medical care?
 Cultural belief & ignorance
 Lack of awareness
 Ineffective communication: Healthcare providers fail to deliver information
 Politics: lack of or under development
 Isolation of geographical factor.

Factor of infection:

 Water-borned disease!
 Hygienic problem
 Contaminated water source
 Toilet problem – the waste

3. What are the public health issues that you need to consider?

 Access to medical care (due to distance and transportation).

 Geographical isolation.
 No formal education.
 They maybe cannot speak/communicate with people other than their community.
 Lack of trust to outsider.

4. What are the other public health issues that you need to consider based on Figure 2?

 Small house.
  Roof? Poorly maintained house.
 We cannot see a toilet.
 Lack of electricity.
 Food storage, and no fridge.

5. What is the public health issue that you need to consider with regards to the water from Gravity
Feed System?

 Maintenance issue
 Education about waste management
 Cleaning the Gravity Feed System
 Difficulty to treat the water
 Need to boil the water before drinking/using

6. What public health issue you need to consider based on the scenario above?

Water-sealed latrines

 Cultural belief – natural

 Preference

7. What public health issue do you need to consider based on Figure 3?

 Food preparation – poor

 Safety issues – cooking in the house, kids are not safe.
 Air pollution (smoke – COPD)
 Fire hazard.
 Poor ventilation
 Fungal infection with the clothes
 Overcrowding.
 Cultural belief
 Preference to stay in old house
 Different from neighbor house
CBL 2 - Case 2
PROBLEMS/ISSUES

Raju a 55-year-old man of Indian descent

History
 last couple of days he has been experiencing difficulty in breathing after a short walk
 otherwise no other problem
 Underlying CCF, HTN, T2DM, obese BMI 32
 has been under follow-up from Klinik Kesihatan Kelana Jaya since the last three years.
 His CCF, hypertension and NIDDM were well managed with the medication provided by the
clinic.
 compliant to his medication and advice provided by the doctor at the clinic.
 works as a line supervisor at a nearby publishing company
 prints books, boxes, and brochures for local book publishing companies and food producers
 ensure that all the materials are properly printed according to the clients’ specification
 works five days a week from 8 am to 5 pm, with no overtime
 area where he works is ventilated by a fans and natural ventilation.
 married to Devi
 two girls and a boy
 All the three of his children are now working, but are still staying with the family

 What are the public health issues that you need to consider?

 Sedentary lifestyle – metabolic syndrome, complication, never use staircase (15 floors).
 Smoker? Passive smoker (from his children)
 Fluid restriction?
 Stress from boss.
 Not enough income. Stay in low cost house. High living cost.
 Break down of lift in PPR Flats.
 Food – outside, not healthy.
 Lack of physical activity.
 Chemical – metals. At work.

2. What is the environmental issue that you need to consider?

 Stay in PJ.
 Air pollution.

Trigger 2:
1. What is API? Air pollution index.
 What is the value of knowing API in the management of Raju?
 To determine whether he should avoid outdoor exertion or using protection.

 What component of API is the most important in Raju’s case?

 Carbon monoxide

4. Besides clinical management, what other health advice will you provide for Raju?
 Exercise
 Diet

 Limit outdoor activity

 Wear mask
 Buy air filter in house
 Wash face post-exposure to polluted air
 Use car aircond, instead of open window
 Drink more water
 Don’t smoke
CBL 1

2. What do you think the health impact of this project in the community?

The person itself – increase knowledge about the benefits of good lifestyle, increase physical activity
among the communities, reduce comorbidities such as obesity & cardiovascular disease, and reduce
cases of hospital admission for complication of comorbidities.

3. What are the future challenges of this project?

Social: urbanization, causing less participation among the community. Population size increases and they
don’t want to maintain the project. Need proper long term plan.
Financial: financial constraints, such as less funding.
Political: disinformation, lack of effective policy, and failure of implementation of policy, (manpower)
bureaucratic mishandling.
CBL 3

1. Outline your steps to conduct a worksite investigation?

https://www.slideshare.net/daliaelshafei/walk-through-survey

 Make appointment to save times.

 Form a team (walkthrough survey).
 Identify number of workers involves in the unit.
 Review health complaints of other workers.
 Speak to someone who can explain the process
 Observe the work process
 Look at the documentation
 Look for those who is responsible to safety measures.
 Start to do the research and identify the source of hazard
 Discuss with the complainant
 Risk assessment
 Use of control measure
 Priority work accesses and things that needed to be improved.

2. As part of your investigation plan, you want to perform ergonomic assessment. What would be the
most suitable ergonomic tools? Explain on the parameters required / measured to enable you to use
these tools.

Ergonomic assessment tool & parameters

 Rodgers Muscle Fatigue Analysis
o Effort required for each muscle groups
o Frequency and duration for each cycle

 OCRA – occupational repetitive actions index

o Frequency
o Force
o Posture
o Recovering Multiplier
o Duration Multiplier

3. What would be your probable diagnosis?

Osteoarthritis.
De Quervain’s tenosynovitis.
Trigger thumb.

4. List your possible control measures to prevent further occurrence of this condition.

 Elimination
o Chemical
 Substitution
o Usage of latest machine with less latch friction
 Engineering
o Lubricants
 Administrative
o Job rotation
o Job practice – use of palm instead of thumb to push latch
o Ergo exercise video
o Department ergonomic briefing
o Avoid forward bending
o Reduce gripping and frequency of repetitive job
o PPE – use of glove which is electrostatic discharge, and back support (lumbar
support corset).

5. Upon investigation, you found that there were several cases of low back pain among other co-
workers in that company. You decided to plan a health promotion programme to prevent
musculoskeletal disorder or injuries. Describe the content and implementation of your programme.