UP Philippine General Hospital Department of Family and Community Medicine

AREA C CLUSTER 10 BARANGAY BARUALTE AND BARANGAY IMELDA

COMMUNITY UPDATES MAY 1 - JUNE 11, 2012

INTERNS: TINGAO, BANDAR ALI I. VENTIGAN, JONATHAN L.

INTRODUCTION Community Medicine is a six-week rotation in a Community-Based Health Program that will provide learning experience, opportunities and skills to UP-PGH interns to work as a community medical practitioner in effectively delivering comprehensive health care to communities utilizing the primary health care approach. At the end of the rotation, the intern must be able: to exercise the different roles of the 5-star physician. are required to do 5 activities while in the area: 1. Updating the Community Diagnosis 2. Community organizing and training activities 3. Immersion within the foster family and assigned barangays 4. Research work 5. Out-patient clinic

The Community-Based Health Program (CBHP) is a partnership among the University, the Government and the Community where planning, implementation and evaluation are done with the active and genuine participation of the community. is a means by which community-oriented medical education can be achieved. Objectives are aligned with the three functions of the University namely training, research and service The municipality of San Juan in the province of Batangas is the current CBHP site. Under the MOA, UP Manila will work as a partner of the municipality of San Juan in the implementation of a community based health program until 2012. Currently, there has been no formal meeting about the extension of the programs.

San Juan, Batangas lies in the easternmost portion of Batangas. located in the southwestern part of mainland Luzon. It has a total land area of 27,340 kilometers, approximately 120 kilometers south of Metro Manila. Most of the main roads are cemented, inner road networks are still unpaved. Most of the total land area is devoted to agriculture, fishing, and ecotourism. It is divided into three (3) areas: Area A, B and C. Subdivided further into twelve (12) clusters for ease of control, the medical interns (us) were assigned at cluster 10 under Area C.

Area C/Cluster 10 covers two(2) barangays: 1. Barualte and 2. Imelda.

Barangay Barualte with a total land area of 4,453,745 km2 and a population of 1,617. The barangay council is headed by the Hon. Ruben Dala as captain, with seven (7) councilors. The main health center is located in Sitio Centro, managed by Ms. Arlene Agudera (the cluster 10 midwife) and six (6) BHWs and one (1) BNS. divided into seven(7) sitios: 1. Centro 2. Cumba 1 3. Cumba 2 4. CYO 5. Silangan 6. Talaba and 7. Tanglaw

Barangay Imelda with a total land area 4,729, 967 km2 and a population of 912. The barangay council is headed by the Hon. Arsenio Canuel as captain, also with seven councilors. The main health center is also managed by Ms. Arlene Agudera (the cluster 10 midwife) and five (5) BHWs and one (1) BNS. divided into five (5) sitios: 1. Bagong Silang-Silangan 2. Bagong Silang-Kanluran 3. Bandera 4. Baluk-Baluk and 5. Pandayan

CLINICS expected to conduct clinics 1-2 days per week in the barangay, whenever possible, once a week in each of the other barangays within the cluster. An opportunity for interns to assess BHWs IMCI monitoring. CLINIC SCHEDULE BARUALTE IMELDA Tuesday and Wednesday Monday and Thursday 8:00 AM - 3:00 PM 8:00 AM - 1:00 PM 6 BHWs, & 1 BNS 5 BHWs The barangay health centers in both barangays are staffed by Arlene Agudera (midwife).

TOTAL NUMBER OF PATIENT SEEN PER WEEK PER BARANGAY (as of May 8- June 9, 2012)
6 6

5 4 4 3 3 2 2 0 1 WEEK 1 WEEK 2 WEEK 3 WEEK 4 WEEK 5 1 1 2 4 4 BARUALTE IMELDA

Relatively small number of consults among the cluster in Area C. BHWs perspectives are may be due to: self-care remedies for minor illnesses prefer traditional healers/medico prefer consulting private practitioners for chronic and/or severe illnesses Barualte had the most number of consults, while infrequent at Imelda. On Week 1 at Imelda, there had no consults.

DISTRIBUTION OF PATIENT PER AGE PER BARANGAY

7 7 6 5 4 3 2 1 0 0-2 2 MONTHS 6 - 10 Y/O MONTHS - 5 Y/O 11 - 18 Y/O 19 - 45 Y/O 46 -65 Y/O >65 Y/O 0 0 0 0 2 1 0 1 3 2 2 3 BARUALTE IMELDA 6

INTERPRETATION BARUALTE Most of the patients seen were within age of 2 months 5 years old. Tailed by the patient aged >65 years old. IMELDA Most of the patients seen were within age of >65 years old. Tailed by the patient aged 46 -65 years old.

For both Barangays, there were no patient seen within the age of 0-2 months old and 6 10 years old.

DISTRIBUTION OF PATIENT PER GENDER PER BARANGAY

100% 80% 60% 40% 20% 4 0% BARUALTE IMELDA 2 15 6 FEMALE MALE

Females are dominating the consult for both barangays. Males maybe work-demanding or doesnt consult at all.

DISTRIBUTION OF PATIENT PER ASSESSMENT PER BARANGAY

6 5 4 3 2 1 0 BARUALTE IMELDA 1 1 1 1 0 0 0 0 0 0 1 4 5 4 3 KERATO-CONJUNCTIVITIS SICCA PNCU/PREGNANCY BRONCHIAL ASTHMA HYPERTENSION PNEUMONIA SVI URTI

INTERPRETATION BARUALTE PNCU/PREGNANCY, is 3rd basis for consult. There were 1 cases appreciated for the following: keratoconjunctivitis sicca, bronchial astma, pneumonia and SVI. IMELDA There was 1 case of UTI seen.

For both Barangays, most of the patients seen were Hypertensive. Tailed by the patient consulting with URTI.

IMCI MONITORING each BHW should be monitored at least once regarding the proper acquisition and interpretation of vital signs and use of IMCI forms. regarded as venues for training and upgrading of the clinical skills of the BHWs and midfe in the diagnosis and appropriate management of patients, and the systematic maintenance and filing of patient records.

IMCI Competency- BARUALTE BHWs

9 8 7 6 5 4 3 2 1 0 8 8 8 8 8 6 8 8 8 8 8 8 8 8 8 8 8 8 8 6

Weve waited at least 3 weeks before IMCI patients breached into the health center. There were 8 IMCI patients seen. 3 BHws were monitored. The 2 BHW were quite competent, while the other 1 (new BHW) needs to supervised further. The counting of respiratory rate is unfavourably taken. There were patients <2 years old, the BHWs used the height scale instead length scale. The length scale was used instead as a surface of their water dispenser. Giving advices to the mother is essential, However, 2/8 did not. Same BHW (new) involved, but can be amended by supplementing appropriate instructional training.

IMCI Competency- IMELDA BHWs

2 1 1 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 1

There were supposed to be 2 patients for IMCI, However, the BHWs did not used the IMCI form to a 5 years old and 4 months child. The interns gave the new revised IMCI forms & insisted to the BHWs to use it but they declined. Thus, only 1 BHW had been on IMCI monitoring. Unfortunately, it had poor competency. The following were poorly noted by the BHWs: Respiratory rate, Assessing for malnutrion/anemia, feeding, child rearing, other problems and more importantly no advice was given.

ACTORS IN THE BARANGAY HEALTH CENTERS OF CLUSTER 10

MRS. ARLENE AGUDERA Cluster 10 Midwife BARANGAY BARUALTE BHWs BARANGAY IMELDA BHWs MAGDALENA GABIA PACENCIA AGUILA 62 years old 48 years old 27 years in service 12 years in service

EMILY VILLANUEVA 46 years old 11 years in service

ROSENDA REYES 66 years old 15 years in service

MINA CUERDO 55 years old 10 years in service

PRISCILA CANUEL 57 years old 15 years in service

ANNALIZA LUISTRO 38 years old 7 years in service

REGINA ABANILLA 56 years old 7 years in service

FELINA MANALO New BHW

DOLORES GUNO 39 years old 7 years in service

GRACIA PEREZ New BHW

ROSSEVEL BRITANIA BNS

DENGUE PREVENTION AND CONTROL PROGRAM BARANGAY BARUALTE OVITRAP CURRENT RESULTS 1ST CYCLE 2ND CYCLE 20.8% 0% 15% 10% 10% 15% 28% 13.1% 0% 10% 10% 10% 15% 10% 0% 7.6%

SITIO Silangan Tanglaw Cumba I Cumba II Centro CYO Talaba TOTAL

3RD CYCLE 0% 0% 10% 20% 25% 15% 10% 11.4%

Currently, there were 4 cycles of ovitrap harvested. The 4th cycle results have to be retrieved at the midwife.

SITIO Bandera Pandayan Silangan Baluk-baluk Kanluran TOTAL

BARANGAY IMELDA CURRENT OVITRAP RESULTS 1ST CYCLE 45% 30% 20% 15% 30% 28%

2ND CYCLE 5% 30% 20% 13.6% 10% 13.1%

Currently, there were 3 cycles of ovitrap harvested. The 3rd cycle results have to be retrieved at the midwife.

HERBAL GARDEN HALAMANG GAMOT Ampalaya Sambong Niyug-niyugan Lagundi Bawang Tsaang gubat Yerba Buena Bayabas Pansit-pansitan Acapulco INTERPRETATION BARUALTE There were no planted niyug-niyugan, bawang, and pansit-pansitan. IMELDA There was no planted pansit-pansitan.

For both barangays, their Herbal Garden was both left unattended and not sustained.

EXPANDED PROGRAM ON IMMUNIZATION BARANGAY DATE ADMINISTERED BARUALTE MAY 15, 2012 1 DPT1/OPV1 3 DPT2/OPV2 3 DPT3/OPV3 7 IMELDA MAY 7, 2012 2 DPT1/OPV1

TOTAL SCHEDULE

Every 2nd week of the month, Every 1st week of the month, preferably Wednesday preferably Monday There are expected lists of children for EPI. For both Barangays, there were no Hepa-B and measles available.

SOLID WASTE MANAGEMENT For both Barangays, there were no dynamic actions regarding the clearance of their solid waste. Burning is still rampant. Some sell recycled materials to junk shops. However, a considered ordinance will soon be implemented with fractions of penalty if not followed.

INTERDISCIPLINARY APPROACH (IDA) Currently, there were no patients enrolled in the IDA. However, Norma Javier, a retired BHW, and is diagnosed Type 2 Diabetes Mellitus, S/P Below the knee amputation (July 2010) was registered in previous years. For the incoming medical interns, please be diligent on finding candidates for IDA.

FOR THE INCOMING INTERNS: ENDORSEMENT Two-week Plan for the Incoming Interns (Pls. see separate page) Every Monday at ERC 215 or FAMMED room. Block preceptorial / learning sessions with the faculty in charge. Report of Outgoing Block of Interns Journal and Research reports Community Update report

RRCG BUS The bus will wait at UP-Pharmacy Bldg. until 6:30 AM bounding for San, Juan Batangas. A journal report will be required for every hour (or a fraction thereof) of tardiness.

Attendance Clinics Outpatient clinics Barualte, during Tuesdays and Wednesdays (8AM-3PM) Imelda, during Mondays and Thursdays (9AM-1PM) Bring your own paraphernalia (BP apparatus, sphygmomanometer, and Diagnostic set) Walk, bike or take a tricycle when going to health centers, dont be late and bring umbrella with you. Dont expect volumes of patient, consults are relatively small. As much as possible, observe the activities of midwife/BHWs (IMCI monitoring). Encourage the BHWs to use the length scale especially for children <2 years old. Encourage the BHWs to use IMCI forms for children < 5 years old. Ask for available list of medicines in each barangay health center for prescription convenience. You may bring and eat your food for lunch at the health centers. Share if you have more. Signing-IN is every Tuesday at 9:00 AM in the staff house at Poblacion, San Juan. Signing-OUT is on Saturdays after the End-of-the-week .

Immersion within the Foster Family and Assigned Barangays Consider yourself as a member of the community for the duration of COMMED rotation. You are expected to participate in community activities and know and interact with as many people in the community as possible, foremost with your foster family. Always inform your foster parents regarding your plans and whereabouts. required to give P300/week to the foster family as a compensation for the use of electricity, water and LPG. will be responsible for your own food for the duration of stay in the foster home. Greet every people you passed by: Magandang umaga/hapo/gabi po. Makikiraan po. Etc. Some community members will invite you for pagbabarik (drinking alcohol), have self-control. Refrain from barangay-hopping. Unless, you want to extend your COMMED.

End-of-the-week Report held every Saturday, 8:00 AM in the staff house. will present weekly mortality/morbidity reports of all the patients seen in the barangay. submit a soft copy of the patient census each week prior to your COMMED block liaison. discuss the patients medical history and physical examination, differential diagnoses, management, clinical course and case discussion.

CAPTURED ACTIVITIES