Saturday, October 9 2010
Last Tuesday (05-10-2010), I was suddenly summoned by the boss of the family health (a doctor, call it DRM). I am informed that last night (Monday night) a patient (called sajaj FZ) came to him with symptoms of flu, after he extract information on the FZ, it turns out there are some FZ chickens that died suddenly a few days ago. Because of suspicion and worry bird flu, then the DRM report (sorry, informed) told me about this incident because I'm was one of the staff which disease prevention programs that are charged to me was about a zoonotic bird flu included.
Long story short, armed with the knowledge I have (from college and some training), I went to the house of FZ to triangulate the beginning. Fortunately FZ house just a few hundred yards from the office, entered the hall. It turned out that this family is a religious family, FZ big scarf and wear veils. My husband accepted by the FZ, a udztas (say AH) is very friendly, he received me very well. AH has 8 children (so many, the AH so often forget how much the number of children, sometimes she calls her son as much as 9 persons, AH too often forget to order his son).
AH informed that on Sunday (03-10-2010), there is the chicken that died suddenly of 7 animals. Two days before death, the chickens began to suffer ill with symptoms of diarrhea, swollen eyes, cold, and purple comb. One was slaughtered sick chickens and consumed by this family.
The status of some family members are..
AH/L/51 onset of illness on the date of 30-09-2010. Date 29-09-2010 go mourn in remote areas (Mallawa, Maros) and came home on a motorcycle rain. Date 05-10-2010 fever began to fall. Dated 08-10-2010 has no fever but was still coughing.
FZ/P/41, wife of AH from fever on the date 02-10-2010, had a cough for a long time, there is a history of treat sick chickens at the date of 03-10-2010. Dated 08-10-2010 has no fever but was still coughing.
HD/P/11, son of AH-4 to the onset of illness on 04-10-2010, there is a history of contact with chickens that died suddenly (holding by entering into the cage and bury). Fever began to fall on 08-04-2010 but still coughing and weak body condition.
UK/L/5, son of the 8th AH onset of illness on 04-10-2010. Fever began to fall on 08-10-2010 but the cough is getting worse. There was no contact with sick and dead poultry.
YK/L/3, child-9 AH onset of illness on 03-10-2010. Fever began to fall on 08-10-2010 but coughs and colds worse. There was no contact with sick and dead poultry.
In addition to these 5 people, there is also a neighbor who is also the brother of AH AH ill with symptoms of fever, but no contact with sick chickens and sudden death.
Based on the information I as surveillance officers reported this to my direct supervisor who forwarded to the head of the Public Health Service Maros. And that same day (Tuesday, 05-10-2010) Maros stated Unusual (KLB) the suspect / suspect bird flu. 38 C), accompanied by a cough and sore throat and in the last 7 days had contact with sick birds and sudden death. " se="Kategori suspek flu burung untuk KLB ini adalah penderita demam (>38 C) dengan disertai batuk dan sakit tenggorokan dan dalam 7 hari terakhir pernah kontak dengan unggas yang sakit dan mati mendadak." closure_uid_slim20="77">Category suspected bird flu outbreaks are patients for fever (> 38 C), accompanied by a cough and sore throat and in the last 7 days had contact with sick birds and sudden death. " se="Laporan KLB W1 <24>" closure_uid_slim20="78">Report outbreaks W1 <24>
Almost all provincial surveillance officer is not in place. Currently no events Socialization of Avian Influenza in several districts and their local facilitators so. Incidentally Socialization of new bird flu will be held at Maros in the next week (12 and 13 October 2010). In the province there was only left a few administrative staff.
There is no inventory of equipment and materials to face bird flu outbreaks in Maros (oseltamivir / Tamiflu expired, personal protective equipment (PPE) is not adequate, the specimen retrieval instrument does not exist) so that waiting for the supply of equipment and materials from the province.
No outbreaks of operational costs in all health centers and district levels. All use the personal cost.
With all the limitations, I am as a surveillance officer continued to governance best possible case. In addition to reporting to the province, I also contacted the farm workers the same day (Tuesday) to do rapid test in birds. But the rapid test can not be done on chicken carcasses that have been buried more than 24 hours. The officer only gave disinfecting livestock corral and took blood samples of chicken that is still healthy, relatives chickens that died suddenly. That said, the new blood tests can be known of the fastest 5 days.
Thursday, 07-10-2010 provincial officials as many as 2 people took to the location of the data and give oseltamivir and Communication, Information, Education and Communication (IEC) on the AH family. It is planned to be taken specimens of HD the next day. Still on the same day, I consulted the provinces and the province suggested that patients with suspected bird flu immediately referred to hospitals for Wahidin Sudirohusodo Makassar (referral hospitals Avian Influenza). It is appropriate technical procedures management of the AI, if not then all that happens within the AH becomes my responsibility as a surveillance officer. There is also suggested that I prepare a statement if AH is not willing to refer their children, which if AH is not willing to refer their children then the responsibility is switched to the AH.
Friday, 08-10-2010 I contact the clinic surveillance officers to make referrals of patients with suspected AI on behalf of the HD directly to RSWS (Note, this is my first experience doing governance AI, previously only practice in the training that was very much different from the reality on the ground .) Letters of reference has been made, thankfully AH willing to refer their children. I am amazed at the AH family, very patient and understanding, this family is very earthy. I explained that all the costs borne by the government.
Here, another problem emerged. There was no ambulance to bring HD to RSWS. Ambulance available in the clinic but the clinic's head were many reasons for this and would not lend her car. Fear of contaminated pamungkasnya reasons. Ambulances to transport suspect AI must have a bulkhead between driver and patient that is behind. Before and after delivering the patient, the car must be in disinfectant. Finally I merental car with my own money, rather than displaced patients, I thought. Not according to the procedure but what may make, HD should be immediately brought to RSWS.
With communication via telephone, provincial officials are willing to standby at RSWS wait we arrived. Anyway, we received something wrong, he said. But the only disappointment that I can. Arriving at RSWS at 11.00, I do not find sepotongpun provincial officer. We like a regular patient, and severity I do not know anything. But with convincing style, I am convinced AH and family to wait a while.
In RSWS no one to serve us, after showing a referral to the Triage, they also do not know anything (apparently they only doctor coas). My long standing in the triage of emergency room I finally came out into the ER registration, with a slightly higher tone registration officer told me to go straight (koq scolded people ask?). I patiently re-entered and asked the doctors one by one. Finally there is the show for me to report to the triage of children.
After seeing the suspect AI referral letter, some of which watch in the triage of a child panicked. Suddenly there who took the referral letter and took it to a room. Five minutes later the harpy letter out of the room and sent me directly to the Infection Centre (IC), a few buildings from the ER.
Patiently, we (me, chauffeur rental, AH, FZ, HD, UK, YK) exit from the ER to find a place that is without a clue. Two times we were around RSWS (with two times out of parking fees as well), we finally found the IC. But no one, no duty officer (probably because it was signed in recess Friday prayers, at 11:40). Finally I was desperate to the 2nd floor of IC, I met a cool pair of doctors told me. Just a short answer, try the question below (duh, if the doctor did not know I was from the bottom, around the room but no one? Or, he will not be bothered to tell by her partner?). Finally I decided to bring directly into the AH and family waiting on the 2nd floor of IC, as he sat and waited. Not too sat down, we reprimanded an officer who was carrying a patient. This is why? Children are forbidden to come in here! Emotions and I almost lost control. I immediately showed the referral letter, the clerk was shocked and gave sense to me to bring patients to the ER for the photo. I ran out of patience a little longer. With the sound a bit high, I explained that I had from the ER and was told directly to the IC. But with full conviction, the clerk assured me by making a note in the letter of referral to the ER. Finally, I yield, we also returned to the ER with a car, except AH who rushed to the mosque for Friday prayers. In the ER I met with a polite security guard who showed a thoracic images (in fact, security here is more polite and patient than the less coas doctor. Ask why?). No photo officer, Back security guard politely explained that all officers break Friday prayers.
With nervous, I ask permission to FZ Friday prayers. For while the FZ are after him.
After Friday prayers, suddenly all matters so smoothly. There has been a serving officer, until HD is placed in isolation rooms IC. HD will be accompanied by his father, AH should not be out of the room at least up to 5 days ahead, when the laboratory results are known. If negative AI, then the HD should come home.
Actually I am very sorry for this family. I felt guilty had been "thrown" HD and AH to the small prison conditions that may be more severe than the criminal prison, isolation rooms. Imagine, AH unable to make a living these days, whether anyone is keeping his family at home. Well, hopefully things get better soon, hopefully things do not happen we do not want shared. Very valuable experience.
But, by the way where the provincial officer yah?
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