Kuala Muda District Office- Day 5

As for this day, we had programs planned for us at Klinik Desa Sungai Layar and Klinik Desa Bujang. We went to Klinik Desa Sungai Layar first at 8a.m and we were welcomed by Matron Hasnah Wong. She was very helpful and gave us a very good idea on what exactly are the functions of a Klinik Desa.

Klinik Desa Sungai Layar is under Klinik Ibu dan Anak Kuala Muda. It is a new clinic which was completed in the year 2009 and started operating on August 2009. It is mainly run by one

Matron and her nurses. They also have one staff and one Jururawat Masyarakat on-call everyday. There is no doctor in the clinic on a daily basis but either a Medical-officer or House-officer comes once a week, which is on Tuesdays, for all the referred cases. Klinik Desa Sungai layar has the third highest workload.

The services offered by these clinics are:

1) antenatal and postnatal care

2) immunisation for children since birth up to 7 years old.

3) Family planning- only a few methods of family planning are offered in this clinic, such as Noriday, Rogevidon and Condoms.

Both of these clinics offer the same services and the admnistration and functions are all similar except that Klinik Desa Bujang comes under Klinik Kesihatan Merbok.

The antenatal and postnatal care offered are similar to the MCH Kuala Muda. Since these have been well explained and elaborated under the post by my fellow group mate Sheela on day 2, i'll just explain briefly. Antenatal visits mainly consist of height, weight and BMI measurement, blood test, Blood sugar profile, blood pressure, Physical examination (mainly measuring the symphyseal fundal height), and follow up. As for booking, most of them are expected to come for booking before 12weeks of gestation. It is important to do booking before 12 weeks of gestation to detect baseline blood pressure which is an essential part of pregnancy. Those who do not make it before 12 weeks must give a valid reason as to why they did not come early and this has to be reported by the nurses to the higher authority. The target is to achieve at least 85% of booking before 12 weeks of gestation. They also have a monthly target to be achieved, which includes both new and repeated cases. If this target is also not achieved, reasoning must be given. An important part of antenatal visit is detecting diabetes in pregnancy. There are almost more than 40% of mothers who come with Gestational Diabetes Mellitus to these clinics. These cases are labelled as high risk based on the appropriate color codes and serious cases will be referred to the hospitals. Mothers are also given Tetanus toxoid(ATT) during their antenatal visits. 2 doses for primi and 1 dose for those who have been pregnant before. ATT coverage in 100% in these clinics. For those who are detected to be anemic, low hemoglobin(Hb) they will be given Hematinics and a proper advise on how it has be taken along with an appropriate diet. They will be followed up and if still no changes, they will be referred to Klinik Kesihatan, and finally the hospital.

Besides just providing care for Malaysians, these clinics also take care of immigrants, including the illegals ones. Immigrants are charged RM15 for the services, but medications are free of charge. RM200 for home deliveries. Illegal immigrant cases must be reported to the immigration first before any action is taken.

Postnatal cases are seen both in the clinics and at homes (for high risk cases). Home visits are mainly for pregnancies with complications that require extra care and supervision. There will be one nurse who travels by her motorbike to the respective homes and keeps a check on these patients. They will be followed up until they have fully recovered from their problem. Sometimes, the number of homes visited may be more than the number of patients that were actually seen, this is because some of them may not be at home during the visit. So, when this is recorded, it will show higher number of homes than the number of patients attended.

Immunisation for new born babies till 7 years old are available. These will be given according to the immunisation schedule. There is a separate room for immunisation which is air-conditioned for the safety of the vaccines. This will be done by an experienced nurse and so far there has been no any problems or side effects reported.

Both the clinics consist of the main hall which is where the registration is done and the waiting room is. There is a room for the doctor, an examination room where pap smear and other examinations are done, an immunisation room, and a small lab where blood is drawn to check the hemoglobin level, glucose level and to carry out other simple investigations.

Attached below are some pictures taken during the posting here:

Organisational Chart of Klinik Desa Bujang

The Timetable for Klinik Desa Bujang

Map showing areas covered by Klinik Desa Bujang

In a nutshell, these clinics play a vital role in the care and safety of mother and child. We had a wonderful experience throughout our posting in these 2 clinics. Further more, with the cheerful Matron Hasnah Wong, our visit was indeed informative and educational.

- Sai Priyalatha Mariapan -