Kuala Muda District Office - Day 6

As for this day, on 23/11/11, we had our program in Klinik Kesihatan Bandar, Sungai Petani. We started the day at 9am, with a warm welcome by Mr.Yusof, the person in charge of us for the day. The program planned for the day was to learn the working system on how the outpatient clinic, x-ray department, pathological lab and pharmacy function in the Klinik Kesihatan Bandar Sungai Petani.

Firstly, Mr Yusof briefed us about the activities for the day. Briefing was held in the non communicable disease clinic’s counseling room. Mr Yusof explained to us about the non communicable disease clinic. The non communicable disease clinic covers patient with hypertension, diabetic and asthma. These patient doesn’t have to go through the outpatient clinic ( Unit Pesakit Luar). Patients have to make an appointment to meet the doctor in this clinic and not walk in. Patient that had registered with this clinic, will have their follow up here too. There are about 3 doctors in this clinic and each day there will be about 200-300 patients, more on a Sunday.

Despite that, in the clinic, there is a counseling room where health education and counseling will be given to the patients. Counseling usually done by the nurses, pharmacist and also the dietician (Pegawai zat makanan). The pharmacist will counsel the patient regarding the medication, doses and side effect of a medicine. The dietician do come occasionally and advise the patient about their food intake and importance of having a proper diet. Diabetic educator will educate the patient about diabetic, complication prevention and also diabetic care.

After that, we proceeded to the outpatient clinic. Initially it was known as Klinik Pesakit Luar, but now it is known as Unit Pesakit Luar. This unit consists of 8 medical officers, medical assistances and nurses. There are 8 examination rooms and 1 treatment room. There are about 400-500 patients per day on more on Sunday. The operating hour for this unit is 8am -5pm, extended hours 5.30pm to 9.30pm. This unit covers mostly all the medical illness except for hypertension, diabetic and asthma which is covered by the non communicable disease clinic.


Patients that need medical attention will walk in to the clinic. Upon that, they will have to register in counter 1 and number will be given. Criteria for treatment charges are as below:- Child below 1 year of age - free

- School going children - free
- Public - RM 1
- Pregnant mothers for outpatient treatment - RM 1
- Government servant/ retiree - free
- Disable or special people - free
- Specialist treatment for each visit - RM 5
- Non Malaysian/ migrant - RM 15

After registration, another number will be given and patients have to wait for their turn to meet the medical officers. They have a separate counter for those who want to do only medical examination. They will have to register and get their number to meet the medical officers. Charges for medical examination depend on the tests that are done.

We are then brought to the treatment room, where a medical officer, Dr Suresh briefed us about the common cases seen. The most common case seen is acute respiratory infection. Furthermore, if the medical officer suspects some severe disease, investigations will be ordered or patient will be referred to the hospital. Apart from diagnosing, the medical officers also will order investigations and write prescription slip for the patient. Medical certificate will not be given to patient after 5pm. Previously, when there is overcrowding of patient and lack of medical officers, the medical assistance are allow to examine the patient ( minor cases). Jabatan Kesihatan Negeri (JKN) has come out with a rule that 100% of the patient has to be seen by the medical officers and not the assistants. Flow chart of triaging outpatients are as below :

In the outpatient clinic, there is also procedure/ treatment room. This includes treating the emergency cases that comes to the clinic. Facilities and equipments available in the room are as follow : - emergency trolley - daily dressing - procedures ordered by medical officers such as suturing, blood withdrawal - nebulizer – foe AEBA patients - ECG – monitor the cardiac activity

As for emergency cases, treatment is given first, and then patient is asked to register.

Together with the unit pesakit luar, there is Pusat Rawatan 1, which is the TB room. Here the medical officer will diagnose and start the multidrug therapy immediately. Patients will present with symptoms of tibi in the outpatient clinic. When the medical officer suspects it, patient will be screened and if it’s positive, medication will be started. The TB room is actually a division of communicable disease control department (CDC). The head of the division is Dr. Umai which is placed in JKN ( Jabatan Kesihatan Negeri) . She is responsible of monitoring the program carried out by the department. Despite that, there is a team who goes home visit in case of default treatment. Patient can also get their medication from Klinik Desa.

X-Ray Department
Next, we were brought to the x-ray deparment. X-ray is one of the service of unit pesakit luar. We were briefed by an x-ray technician Pn Zainah. The organization chart of the department is as follow :

The head of the department is district health officer 1 and followed by district health officer 2. It is followed by x-ray technician. The department has 2 x-ray machine, and no CT/MRI facility. There are two type of x-ray machine, digital and conventional. Conventional type of machine is used in KK Bandar, Sungai Petani. After taking the x-ray, the film has to be process in dark room. It usually takes 5-10mins to process the film. For those whom are working in this department, they are exposed to radiation. To access the radiation level, a film card is given to each worker. The workers has to carry the card on them when they working. Every month, the card is sent for examination and the radiation let they will be doing office level is noted. If the radiation level of the technician is high, the technician wont be working in x-ray room, infact they will be given less job and office work.

If the patient is pregnant, they have to inform the x-ray technician as x-ray film won’t be taken. It is to prevent the radiation exposure on the baby.

Next, we went to pat hological lab. Briefing was done by Sister Cheah. In the pathological lab, simple test are done except for tissue culture and sensitivity.

Test available

· Urine analysis ( UFEME) · Urine micro albumin · Urine pregnancy test · Total serum bilirubin NNJ · Renal profile · Liver function test · Blood glucose · Plasma glucose · HbA1c · Fasting lipid profile · Serum uric acid · Serum calcium/ phosphate · Full biochemical screening · Full blood count · ESR · VDRL · Dengue test · Blood grouping · Rapid HIV test · Sputum AFB · Gram staining · BFMP · Wet smear for trichomonas · Stool FEME

This department consist of medical lab technician ( 3-5 of them) whom will be running all the test. Patient will come with the request form from the medical officers, and examination will be done. Some test’s result can be available immediately but some result will be available after few days. They have machines and analyzer machine to run the entire test.

Soon after that, we went to the pharmacy department. Briefing was done by Pn Natrah. The department is in charge of packaging and dispatching medication to the patients. The department includes per packing unit where the medication are prepared in various sizes,drug name,dosage,batch and expiry date. This pre packed drug later will be sent to the intergration and substor in the pharmacy department itself. The intergration stor is responsible for the drug supply/ medicine supply to the entire health clinic under Kuala Muda district. Nowadays the commonly used drug comes in a blister pack. Most common drug given to the patient are anti diabetic, anti hypertensive, paracetamol, cough mixture and antibiotics.

Patients whom want medication have to have a prescription slip issued by the doctor. With the slip, they can come and collect the medication. Patient with chronic diseases usually will be prescript for 3 month medication, but in the pharmacy they will give medicine enough for a month. After that, the patient has to come and collect medication again. Patients can inform the pharmacy earlier that they are coming and collecting the medicine via · Call & collect· My Sms· Email

If the patient is using any of these services, they will leave their prescription slip in the pharmacy and a card will be given to them. Date of the next medicine collection will be noted there.

The supply of medicine in the pharmacy stor is for a month. The wastage rate of the drug is low as 0.2%. if the supply is not enough, the drug can be taken from the intergration store which is situated in KK Bandar itself.

In a nutshell, we learned alot on how are the different working system of different departments in Klinik Kesihatan Bandar. Thanks to all those who gave us the briefing and explain each and everything.

-Karoshini-