DAY 963-976

Apr 22 - May 5

1) As I type this, we have less than two weeks before our end-of-semester exams (Medicine & Public Health). It has been an unforgettable experience in Public Health rotation - exploring most of Penang and understanding more about health on a population scale. Group B (our group) has officially finished with our rotation last week, so it's just full steam ahead for our exam preparations.

2) Among the highlights of our two weeks was getting to use the thermal fogger (AgroFog AR35) - used in cases of isolated dengue cases. Dengue is endemic in Malaysia, therefore lots of preventive measures exist, not to mention active and passive surveillance to ensure outbreaks are prevented/curbed at the earliest.

3) We also had a food safety inspection visit to a school (SMK Sama Gagah). There is a whole checklist to go through which contains requirements to be met, and failure to do so carries demerit marks. At the end, the marks are tallied, and if less than a specific threshold (usually <70%) the canteen operators can be compounded for no more than 14 days, after which a re-inspection is carried out and allowed to reopen if it meets the requirements set by the Health Inspector. While they were not perfect, the canteen that we visited did well enough to pass, with a list of recommendations they need to follow up with for future inspection.

4) We also had the opportunity to see how rapid screening for HIV/AIDS and TB (Mantoux test) is carried out. For HIV/AIDS, the results come out in just 10-15 minutes - which is incredible! Of course, while it is for screening, further diagnostic tests i.e. Western Blot. For the TB test, if I can recall correctly (and I better too, as my exams will cover this XD) - 0.1cc tuberculin purified protein derivative (PPD) is injected intradermally into the forearm (three finger breadths distal to the antecubital fossa). Within 48-72 hrs (usually 72 hrs is used), the person returns for check-up, during which an induration (wheal) is expected around the forearm. If this measures <10mm in a normal (otherwise asymptomatic) person, this is a negative test. If it measures >10mm (or >15mm in HCW), this is considered positive, and further screening tests i.e. sputum for AFB culture, or even a CXR may be warranted.

5) The HIV/AIDS Rapid test is absurdly easy to carry out. After sterilising skin/wearing gloves etc, prick a finger, obtain a drop of blood, let it drop to the well of the test kit, and wait 10-15 min. One line at "control" is negative, while two lines at" control" and "test" is considered positive, and further testing is required to confirm the diagnosis. Keeping in mind that HIV/AIDS still carries a lot of stigma, one would do well to conduct pre- and post- test counselling for the patient, especially in case the test comes out positive.

6) The other highlights include a visit to the PBA PP (Perbadanan Bekalan Air - Penang Water Supply Corporation), where we learnt all about the importance of water quality control. We also learnt how to take a water sample and send it to the lab for chemical analysis. According to the health officers, Penang (as a state) has the highest water consumption, and yet the lowest tariff (RM0.30 per 1000 gallons water) out of all the other states in Malaysia. Therefore, the onus falls on us to save water as much as possible to ensure continuous quality water supply.

7) To cap off the week, we had a very enjoyable lunch cum meeting with Prof. Sam McConkey, who taught us Trop Med at RCSI just last year. He was back in our college to have a little chat with us on improving the quality of RCSI's education, especially for the pre-clinical years. We bounced opinions off each other over lunch. It was a very informal conversation, but I felt happy that I was able to voice out my opinions in general.

8) Weekend has been rather chill, with me mostly at home and trying hard not to procrastinate. As the saying goes, procrastination is the thief of time. And at this point, I don't have the luxury of time XD
Anyway, that's it for this edition of my blog - I expect to be fairly busy with exam prep in the coming weeks of my exams, but I will definitely try my best to continue blogging as much as possible. Thanks very much for visiting, and have a nice week ahead. Cheers!

With Prof. McConkey on his visit to RUMC

(he had previously visited Perdana University, KL the week before)

Group photo at the end of Public Health Rotation:

(l-r: Gary, Chloe, Su Wei, Sim, Esther, Shi Hui, Ray, Dr. Noraishah bt. Jaafar (Health Officer Seberang Perai Tengah), Dr. Tan, Myself, Mahitha, Gershon, Ruth, Helmi, Mr. Tan, Mr. Baha)

That's me holding an Agrofog AR35 thermal fogger

(note the lack of PPE - personal protective equipment)

(usually a face mask, goggles, gloves, and ear protection would be worn as a minimum)

And that's just another candid photo of us XD

"I Mum Mum" Pan Mee Specialty Restaurant - at All Seasons Place with Denise and Aly :)

SMK Sama Gagah canteen inspection visit - that's a grade "A" for cleanliness

HIV Rapid Test - one line at "control" (as shown here) indicates negative result

Mantoux Tuberculin skin test (TST) - three finger breadths intradermal injection :)

Visit to the PBA (Water Supply Corporation)

Here is where the process of flocculation occurs

I only found out later that this aquarium serves to monitor the water quality - if the fish start dying one by one, then something has happened to the treated water!

Chemical dosing of water - unfortunately maintenance works meant that we didn't get a chance to go in and have a look - but the processes in general include fluoridation, chlorination, addition of lime and calcium hydroxide (to counter the acidity due to PAC added earlier in the water treatment process)

The whole water treatment process (complete with clock tower which actually does tell the time XD)

Air Itam Service Reservoir

It was swelteringly hot as we watched the inspectors take a water sample to be sent for chemical analysis

Water source for testing purposes only

My friends still found the time to smile amidst the intense heat!

So first step is let the water run for 2 or 3 minutes (to clear off any impurities at the nozzle)

Testing kit consists of a turbidimeter, a conductivity meter, a pH meter, and a colorimeter (for free residual chlorine testing)

Burning the tap from bottom up with a blowtorch (to disinfect the external surface completely of microbes)

A heaping plate of lunch for only RM7 (that's a huge fried fish!)

Belachan fried rice at Sri York Cafeteria today :)

Spicy aglio olio spaghetti at Coffee Elements @ All Seasons

Could not resist their coffee walnut cake - it's huge!

Today we went to inspect the water supply and sanitation (BAKAS programme), mainly targeted towards rural ("kampung") residents

Pour flush latrines - built specifically to reduce transmission of infectious diseases via faecal oral route

Just turn right and keep going to Ipoh XD

Some tuna sandwiches for a change

This cake (durian fromage) at Secret Recipe is SERIOUSLY good - it really tastes like actual durian as opposed to durian flavouring etc.

Dry chilli pan mee at "I Mum Mum" was really worth the price - just RM6!