Wednesday, December 8, 2010

Exams~near the corner....

.......السلام عليكم ورحمة الله وبركاته

Dec 6 (Mon)
class start at 9am-3pm

Dec 8 (Wed)
class start at 7am-3pm

Dec 9 (Thurs)
class start at 1pm-3pm

Dec 10 (Fri)
class start at 9am-11pm

Dec 11 (Sat)
Block 4.2 exam at 10am

+ Anthropo (12 Qs)

Wow.... I have classes straight in this week
(except for Awal Muharram
, falls on 7th Dec) which is the exam week. Not to complain about these but as I said.. we are also the victim of Merapi eruption.
*haha, just joking*

Good luck fellow friends.. All the best in answering the questions. Hope we all pass with flying colors,okay?

Hope all our effort and contribution pay us a reward, Insya-Allah. :)

*Leadership vs Managership* ---> which one is our choice?

.......السلام عليكم ورحمة الله وبركاته

On which side you are more comfortable when you are in charge?

Side A

Side B





playing safe
















Doing things right

Doing right things

So, which one are you dominating? If you choose Side B, so congratulations! You are right on tract by choosing the criteria of a Leader . As you can see, doing the things listed in Side A are also ‘Okay’ but we are now in the era of transforming from Managership towards Leadership.

Most people talk as though leadership and management is the same thing. Fundamentally, they are very different. Unfortunately, a lot of people do not understand this.

"I don't like to be managed. But if you lead me, I'll follow you anywhere."

The difference between leadership and managership may be best described by James M. Kouzes and Barry Z. Posner in their book, The Leadership Challenge. "The difference between managers and leaders," say Kouzes and Posner, "is the difference between night and day. One of the ways to differentiate leadership from managership is by this adage — you lead people and manage projects.

pic: "manage vs lead"

So are managers leaders or are leaders managers? "Leader" is not an accepted job title in organizations. Companies don't hire leaders, they hire managers. But the most effective managers are effective leaders. To identify what leaders do, Kouzes and Posner asked people to describe their personal best leadership experiences. Their research revealed five leadership practices common to successful leaders. These leaders:

  1. Challenged the process
  2. Inspired a shared vision
  3. Enabled others to act
  4. Modeled the way
  5. Encouraged the heart

Kouzes and Posner describe effective leaders as "pioneers." They challenge the process. They want to build a better mouse trap. This is one of the things that separate them from managers. Managers manage a process.

Differences between What Leaders and Managers Do



Working in the system

Working on the system


Create opportunities

Control risks

Seek opportunities

Enforce organizational rules

Change organizational rules

Seek and then follow direction

Provide a vision to believe in and strategic alignment

Control people by pushing them in the right direction

Motivate people by satisfying basic human needs

Coordinate effort

Inspire achievement and energize people

Provide instructions

Coach followers, create self-leaders, and empower them

Are leaders in and managers out? Managership must still be practiced but should be related to tasks rather than people. For example, time management, inventory management or debt management are critical tasks within an organization. But people management is more a function of leadership than a task to be managed. Certain roles within an organization are best suited for people with a task orientation rather than a people orientation. Leaders are able to show how tasks tie into the bigger picture.

Management could be described as a function of leadership or leadership a function of management. Irwin Federman, president and chief executive officer of Monolithic Memories, puts it this way:

"Your job gives you authority. Your behavior earns you respect."

Leadership is a behavior — the behavior that will lead dynamic organizations in the twenty-first century.

1) Lecture note Leadership and Teamwork by Prof. dr. Budi Mulyono, Sp. PK(K)


Monday, December 6, 2010

Are you ready?

.......السلام عليكم ورحمة الله وبركاته

Some random fact about Medical Doctor:

A physician, or medical doctor, leads the medical team in caring for patients as the primary healthcare provider. A doctor diagnoses and treats diseases and conditions, as well as provides treatment in many forms including medication, procedures, surgery, or therapy.

The physician shoulders the highest degree of responsibility of coordinating the patient’s medical treatment from beginning to the end, analyzing the patient’s symptoms and conditions, and managing their care for the best results and recovery. Some physicians provide general, ongoing preventative care, or management of basic chronic issues such as hypertension or diabetes. Other doctors are more specialized, and treat only certain systems of the body on a more in-depth basis.

Skills Needed :

A physician is part investigator, part counselor, and part scientist. Doctors must have a very strong grasp of math, science, chemistry and biology, and be able to analyze information and solve problems. Additionally, most physicians should exhibit excellent interpersonal skills in order to communicate effectively with patients and their families.

Physicians must be able to think quickly on their feet, and make critical decisions accurately and efficiently. If a physician aims to go into private practice and own his or her own healthcare business, it would be helpful to have a basic understanding of business and accounting principles as well.

Schedule and Typical Workday :

Schedules vary according to the type of medicine a physician practices. Most doctors work 50-60+ hours per week at least. A typical day in the life of a doctor usually includes 6-8 hours seeing patients in an office-based setting, plus 1-2 hours rounding on patients in the hospital. Surgeons will typically work 2-3 full days in the hospital Operating Room performing surgeries. Additionally, a physician will also invest time completing administrative duties such as updating patient records, returning phone calls, or handling miscellaneous office issues.

Salary / Compensation :

Contrary to popular belief, most physicians are not actually employees of hospitals or clinics. Many doctors are in private practice, either owning their own solo practice or in a partnership business arrangement with other physicians. Therefore, how much a physician actually earns depends on many factors such as patient volume, insurance carriers of the patients seen, and many other issues.

Taking all of those factors into consideration, physicians can earn annual income of anywhere from about $18,000 - $25,000 for a Family Medicine physician, up to over $25o,000 annually for specialists or subspecialists.

The purpose of my entry this time is to give an idea about the medical physician. There are many other things to discover, but this only a rough of it. So I would like to ask you and also my self, are we sure we want to be a medical doctor? The task are so many while the payment is not that encouraging. Hmmm, what ever answer you have in your minds, just close your eyes and look at the bottom of your heart. I am sure He will guide us as long as our intention is good. Being a medical doctor is a noble job. Giving a helping hand is not always easy. The good deed is not to be rewarded now, but to be claimed later.. insya allah.

HIV/AIDS~a gLobaL HeaLth chaLLenge!!

.......السلام عليكم ورحمة الله وبركاته

Until 30 September 2010, the cumulative number of AIDS cases recorded 22, 726 cases in 32 provinces scattered in 300 district (kabupaten) / cities (kota). Out of that amount, still it is highly dominated by the productive age group (20-29) 47.8%, age group (30-39) 30.9%, and age group (40-49) as much as 9.1%. Most cases occurred in the 10 provinces namely Jakarta, West Java, Central Java, East Java, Papua, Bali, West Kalimantan, South Sulawesi, North Sumatra and Riau. While the modes of transmission occur through heterosexual contact (51.3 percent), injecting drug users (39.6 percent), male-male sex (3.1 percent) and mother to her baby carriers (2.6 percent).

Acquired Immune Deficiency Syndrome (or AIDS) is a collection of symptoms and syndrome arising due to damage to the human immune system due to HIV infection or infection by other viruses. From its name, Human Immunodeficiency Virus (or HIV) is a virus that weakens the immunity in the human body. People affected by this virus will become vulnerable to opportunistic infections or tumors susceptible. Although the existing handling can slow the rate of virus growth, but the disease is not completely curable.

Researchers generally believe that HIV originated in sub-Saharan Africa. It is estimated that AIDS has infected 38.6 million people around the world. In January 2006, UNAIDS in collaboration with the WHO estimate that AIDS has caused the deaths of more than 25 million people since it was first recognized on June 5, 1981. Thus, this disease is one of the deadliest diseases in history. AIDS claimed to cause death as much as 2.4 to 3.3 million people in 2005 alone, and more than 570,000 people of whom are children. One-third of these deaths occurs in Sub-Saharan Africa, retarding the growth of economy and destroys the power of human resources there.


HIV virus is a retrovirus that usually attacks the vital organs of the human immune system, such as CD4+ T cells (a type of T cells), macrophages, and dendritic cells. HIV damages the CD4+ T cells directly and indirectly, whereas CD4+ T cells needed for immune system to function properly. When HIV has killed CD4+ T cells to the number shrank to less than 200 per microliter (mL) of blood, then the immunity at the cellular level will be lost, and the result is a condition known as AIDS. Acute infection with HIV will progress to clinically latent infectionà early symptoms of HIV infectionà eventually AIDS, which are identified by examining the number of CD4+ T cells in the blood and the presence of certain infections.

Clinical Manifestations:

The various symptoms of AIDS usually will not occur in people who have good immune system. Most of these conditions occur due to infection by bacteria, viruses, fungi and parasites, which are usually, controlled by elements of the immune system that HIV damages. HIV affects nearly every organ system. People with AIDS are also at greater risk of suffering from cancers such as Kaposi's sarcoma, cervical cancer, and immune system cancers known as lymphomas.

More over, people with AIDS often have systemic symptoms of infection, such as fever, sweating (especially at night), swollen glands, chills, weakness, and weight loss.

However, the rate of development of this disease can be varies from 2 weeks to 20 years. Many factors influence it; (1) the strength of the body to defend against HIV (such as immune function) from an infected person. (2) Older people generally have a weaker immunity than younger people, so more at risk of rapid disease progression. (3) Less access to health care and other infections such as tuberculosis can also accelerate the development of this disease. (4) The genetic legacy of an infected person also plays an important role. Some people are naturally resistant to some HIV variants. HIV has some genetic variation and a variety of different forms, which will cause the rate of development of clinical disease are different also.

Route of transmission:

Three main routes of entry of HIV virus into the body is through sexual contact, contiguity (exposure) with a fluid (include blood) or tissue of infected, as well as from mother to fetus or infant during the period around birth (perinatal period) and also through breastfeeding. Although HIV can be found in saliva, tears and urine of infected people, but there is no record of cases of infection caused by these fluids, thus the risk of infection can generally be ignored.


“Knowing your epidemic in a particular region or country is the first, essential step in identifying, selecting and funding the most appropriate and effective HIV prevention measures for that country or region." - UNAIDS guidelines for HIV prevention.

1) Sexual transmission:

Someone can eliminate or reduce their risk of becoming infected with HIV during sex by choosing to:

  • Abstain from sex or delay first sex
  • Be faithful to one partner or have fewer partners
  • Condomise, which means using male or female condoms consistently and correctly (pic: condom machine)

There is now very strong evidence that male circumcision reduces the risk of HIV transmission from women to men by around 50%, which is enough to justify its promotion as an HIV prevention measure in some high-prevalence areas. However, studies of circumcision and HIV suggest that the procedure does not reduce the likelihood of male-to-female transmission, and the effect on male-to-male transmission is unknown.

2) Blood transmission:

People who share equipment to inject recreational drugs are high risk becoming infected with HIV from other drug users who have HIV. Methadone maintenance and other drug treatment programs are effective ways to help people eliminate this but, there will always be some injecting drug users who are unwilling or unable to end their habit, and these people should be encouraged to minimize the risk of infection by not sharing equipment.

  • Needle exchange programs have been shown to reduce the number of new HIV infections These programs distribute clean needles and safely dispose of used ones, and also offer related services such as referrals to drug treatment centres and HIV counseling and testing. Needle exchanges are a necessary part of HIV prevention in any community that contains injecting drug users.
  • Small group counseling, community outreach and other activities are also important for injecting drug users to encourage safer behaviour and access to available prevention options.
  • Transfusion of infected blood or blood products is the most efficient of all ways to transmit HIV. However, the chances of this happening can be greatly reduced by screening all blood supplies for the virus, and by heat-treating blood products where possible. In addition, because screening is not quite 100% accurate, it is sensible to place some restrictions on who is eligible to donate, provided that these are justified by epidemiological evidence, and don’t unnecessarily limit supply or fuel prejudice. Reducing the number of unnecessary transfusions also helps to minimize risk.
  • Health care workers run a risk of HIV infection through contact with infected blood. The most effective way for staff to limit this risk is to practise universal precautions, which means acting as though every patient is potentially infected. Universal precautions include washing hands and using protective barriers for direct contact with blood and other body fluids.

3) From mother-to-child transmission:

The first step towards reducing the number of babies infected in this way is to prevent HIV infection in women, and to prevent unwanted pregnancies.

  • A course of antiretroviral drugs given to her during pregnancy and labour as well as to her newborn baby can greatly reduce the chances of the child becoming infected. Although the most effective treatment involves a combination of drugs taken over a long period, even a single dose of treatment can cut the transmission rate by half.
  • A caesarean section is an operation to deliver a baby through its mother’s abdominal wall, which reduces the baby’s exposure to its mother’s body fluids. This procedure lowers the risk of HIV transmission, but is likely to be recommended only if the mother has a high level of HIV in her blood, and if the benefit to her baby outweighs the risk of the intervention.

Antiretroviral drug treatment:

This is the main type of treatment for HIV and AIDS. It is not a cure, but it can stop people from becoming ill for many years. The treatment consists of drugs that have to be taken every day for the rest of a person’s life.

The aim of antiretroviral treatment is to keep the amount of HIV in the body at a low level. This stops any weakening of the immune system and allows it to recover from any damage that HIV might have caused already.

Taking two or more antiretroviral drugs at a time is called combination therapy. Taking a combination of three or more anti-HIV drugs is sometimes referred to as Highly Active Antiretroviral Therapy (HAART).

Antiretroviral drug class


First approved to treat HIV

How they attack HIV

Nucleoside/ Nucleotide Reverse Transcriptase Inhibitors

nucleoside analogues,


NRTIs interfere with the action of an HIV protein called reverse transcriptase, which the virus needs to make new copies of itself..

Non-Nucleoside Reverse Transcriptase Inhibitors



NNRTIs also stop HIV from replicating within cells by inhibiting the reverse transcriptase protein.

Protease Inhibitors



PIs inhibit protease, which is another protein involved in the HIV replication process.

Fusion or Entry Inhibitors


Fusion or entry inhibitors prevent HIV from binding to or entering human immune cells

Integrase Inhibitors


Integrase inhibitors interfere with the integrase enzyme, which HIV needs to insert its genetic material into human cells.

Until now, it is very limited data used for understanding the local epidemic, for planning the response and also its quality still remain crucial issues. I believe, by strengthening the strategic information in Indonesia will also promoting the right response for controlling the diverse HIV epidemic in Indonesia.


Sunday, December 5, 2010

NosocomiaL infection~ is it our fault?

.......السلام عليكم ورحمة الله وبركاته

"My 9-year-old daughter was recently released from the hospital after what was supposedly an uneventful tonsillectomy. Three days after her release, she had to be rushed back to the hospital from complications from a staph infection that I am sure she picked up from the hospital. Can I bring a medical malpractice suit against the hospital for the ensuing costs to treat this infection?"

I found this question from a medical malpractice website. Maybe many question like this has been rose before. When a patient is admitted to the hospital, he or she expects to receive treatment and emerge healthier than when they entered. However, oftentimes patients are exposed to certain conditions in which they can be subject to acquisition of an infection.

What the patient described may be a NOSOCOMIAL INFECTION, which is also known as a hospital-acquired infection. This type of hospital-acquired infection is typically absent during time of admission but diagnosed within the first 48 hours of course of stay in the hospital, or 30 days after their release.

The infection may be developed from the hospital admission, but we have to make things clear. There are 2 forms of nosocomial infections:

i) Endogenous /auto infection- the causative agents comes from the patients and the infection develop during the stay in the hospital as a result of patient’s decrease resistance. ii) Cross infection – the patients comes into contact with new infective agents and soon develops infection.

some classified it to be 3forms




Contact transmission

The most important and frequent mode of transmission of nosocomial infections.

Droplet transmission

Occurs when droplets are generated from the source person mainly during coughing, sneezing, and talking, and during the performance of certain procedures such as bronchoscopy.

Airborne transmission

Occurs by dissemination of either airborne droplet nuclei (small-particle residue {5 µm or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms transmitted by airborne transmission include Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses.

Common vehicle transmission

Applies to microorganisms transmitted to the host by contaminated items such as food, water, medications, devices, and equipment.

Vector borne transmission

Occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.

Contact transmission is further divided into two subgroups: direct-contact transmission and indirect-contact transmission.

Routes of contact transmission



Direct-contact transmission

Involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as occurs when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host.

Indirect-contact transmission

Involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients. In addition, the improper use of saline flush syringes, vials, and bags has been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes.

Factors predisposing a patient to infection can broadly be divided into three areas
  • People in hospitals are usually already in a poor state of health, impairing their defense against bacteria – advanced age or premature birth along with immunodeficiency (due to drugs, illness, or irradiation) present a general risk, while other diseases can present specific risks - for instance, chronic obstructive pulmonary disease can increase chances of respiratory tract infection.
  • Invasive devices, for instance intubation tubes, catheters, surgical drains, and tracheostomy tubes all bypass the body’s natural lines of defence against pathogens and provide an easy route for infection. Patients already colonised on admission are instantly put at greater risk when they undergo an invasive procedure.
  • A patient’s treatment itself can leave them vulnerable to infectionimmunosuppression and antacid treatment undermine the body’s defences, while antimicrobial therapy (removing competitive flora and only leaving resistant organisms) and recurrent blood transfusions have also been identified as risk factors

What I want to emphasis here, the infection is not solely arise from the hospital fault. However, the following steps taken by hospital personnel and guests can help in preventing the spread of infection and maintain a sanitary environment:

  1. Proper sterilization of medical tools, dressings, and uniforms
  2. Isolate patients with especially contagious illnesses
  3. Frequent and proper hand washing
  4. Use aprons and gloves at all times
  5. Proper sterilization of all surfaces
  6. Make sure to use alcohol rubs and antimicrobial agents when possible

Despite the best safety precautions, patients still may be infected when staying at a hospital. The thing is, if the infection is due to the negligent behavior of others, they may be entitled to financial compensation following a civil lawsuit. The hospital administration, staff and maintenance crews have a responsibility to provide optimal care to patients. If this does not happen and reckless behavior occurs, they should be held accountable for their actions. A medical malpractice lawyer can offer advice to patients injured by hospital acquired infection, regarding their rights to pursue a lawsuit against the hospital for all damages.

Therefore, it is critical that hospital staff take all appropriate measures to minimize the chance of an infection being allowed to spread amongst patients. Additionally, doctors and other hospital staff must be cognizant of symptoms occurring in patients in order to provide proper treatment early enough to prevent injury to the patient.

pic: infection at the surgical site

1) Lecture note “Nosocomial Infection” by dr. Hera Nirwati, M. Kes
3) Nosocomial-Infections