Belajar Global Health di UNSW melalui Twitter dan Blog

Sungguh pengalaman baru buat saya ketika mengikuti kuliah International health semester lalu. Istilah International Health saat ini menjadi rancu dengan istilah Gobal Health. Saat ini dengan akan berakhirnya MDG di 2015, public health praktisi lebih sering menggunakan istilah global health. Haampir sama tapi tak serupa. Ini akan saya bahas dicerita saya berikutnya.

Yang unik dengan kuliah ini adalah salah satu penilaiannya dengan diskusi online melalui twitter setiap hari senin jam 7 malam. Ternyata tidak hanya saya yang masih tergolong gaptek, banyak juga yang belum familiar dengan social media ini. Kami disarankan follow masing-masing teman di kelas dan beberapa akun twitter terkait global health seperti WHO, UNICEF, Billgates Rollback Malaria, dll tergantung interest masing-masing. Alasan utamanya adalah sebagai mahasiswa postgrad kita diharapkan mengikuti perkembangan global health berikut pro dan kontra karena ilmu ini terus berkembang. Kita juga diharapkan berkontribusi dengan menyumbangkan ide dan pikiran dalam 500 kata dalam blog global health UNSW.

Dengan mengikuti komunitas global health di UNSW, saya mendapat kesempatan mengikuti dialog langsung Q&A ABC dengan sang philantropis terkenal Bill Gates uang diadakan di UNSW. Bill Gates memberikan dana yang sangat besar untuk penelitian TB dan HIV di UNSW. Bill Gates memiliki keyakinan jika kita bisa menemukan vaccine baru dan obat baru untuk TB, penyakit yang sampai sekarang belum juga bisa dieliminasi ini, akan menyelamatkan banyak nyawa. Walaupun jalan menuju kesana masih panjang dan memerlukan dana yang tidak sedikit, dia tetap optimis. Dia juga mensupport funding gap untuk program bebas polio agar anak-anak terselamatkan dari penyakit mematikan ini. Selain kesehatan, ternyata Bill Gates juga mensupport dana untuk edukasi. Menurutnya meningkatkan kualitas guru dan proses pembelajaran anak akan meningkatkan taraf hidup dan kesehatan. Betapa mulia hati Bill Gates dan Melinda. Semoga B&MG yang lainnya akan muncul dan bersama memerangi masalah kemiskinan dan kesehatan dunia.

Menurut saya social media memiliki banyak keuntungan. Selain kita bisa mengupdate informasi, berdiskusi online dan mengenal teman sekelas lebih baik, kita ternyata telah membentuk jaringan global health yang pasti akan sangat berguna bagi karir dan penelitian di masa datang. Bahkan di twitter kami bisa berdiskusi dengan external student yang berada di afrika dan di London. Sungguh pengalaman yang menarik. Yang menjadi tantangan saya saat ini adalah melanjutkan update informasi melalui twitter di semester ini disela-sela tugas saya yang berjibum. Well I like learning Global Health in UNSW :)

Pentingnya Memahami Proses (Kuliah Clinical Governance)

Kuliah minggu lalu adalah tentang menghubungkan proses dan hasil didalam sebuah sistem kesehatan. Menariknya Julie, dosen favorit saya, memberi contoh pembuka mengenai anak kita. Kita sebagai orang tua berharap anak kita bisa menghasilkan sesuatu sedangkan kita sibuk dengan urusan kita. Tiba ketika anak kita datang ke kita dengan membawa hasil karyanya, kita sangat terkejut dan memujinya. Namun kita tidak tahu proses pada anak kita untuk menghasilkan karyanya itu. Bagaimana dia harus gagal, mencoba dan mencobanya. Moral of the story adalah sebagai orangtua kita sebaiknya mengikuti proses, betapa sulitnya memperbaiki proses itu dan menghargai proses  hingga anak kita mendapat hasil. Don't expect good outcomes if you don't understand the process behind that.

Dalam 'improvement of the health system', kita harus memandang kompleksitas sebuah sistem yang didalam terdapat 6 pilars yang terdiri dari delivery of health services, information, workforce, commodities, financing dan leadership. Health system tidak akan mebaik hanya dengan training dan dana saja. Semua bagian/pilar dalam proses tersebut harus di tingkatkan. Harus diingat pula, melalui PDSA (Plan Do Study Act) cycle dalam CQI (continuous Quality Improvement) harus diterapkan secara berkala untuk menjamin hasil yang diharapkan dapat tecapai.

My wishes

Sometimes I don’t understand why God give me this opportunity while I am not really expecting it. I never imagine that I will live in Bali for more than a month after 32 years of my life. When I was kid, I spent no more than 2 weeks for my school holiday in Bali. Now, I have an opportunity to stay in Bali for 6 months continuously. I hope I can learn lot of things out of my study purposes.

First, I hope I can build more strong relationship with my family as well as the extended family after almost 10 years married. Lucky me, I have the best parents in law in the world who make everything easier for me. I have no difficulty in communication with them especially for settling my accommodation and time arrangements.

Second, I am expecting to speak Balinese fluently within six months. However people sometimes laugh when I speak Balinese with a Javanese accent. I don’t mind, they laugh in positive perspective. I believe that I can learn more quick from elderly and kids who can’t speak bahasa well. This is a good challenge for forcing me to speak Balinese, otherwise we could not have the conversations.  

Third, I wish I have time to explore more about Bali particularly Denpasar city. Once again, my parents in law have a big role in this process. They provide me a new motorbike as my main vehicle for making everything goes smoothly and for exploring Denpasar city.

Last but not least, I hope I can meet my old friends in Denpasar like mb Wulan, Yanti, Mb Oka, Ayu, Anik, Mb Alit, Luh Nik, etc. Having them will be a good chance for me to rebuild our memories and relationship.

Apart from all those wishes, the most important wish is I can reach the 4 big purposes of IALF course: increase the language skills, knowledge in cross cultural, academic skills and higher IELTS score test. Om Avighnam Astu, I will.

New journey in 2012

It has been long time I have stopped to write this blog... nearly 2 years I guess. Not because I didn't have enough stories to write, but I didn't have time and willingness to start writing. Since now, I have to... I have to start practicing to write, to read, to speak and to listen in English. Why? Ok... I will tell you the story.

While working part time in TB research, I applied for ADS scholarship and clinical microbiology specialist Program at the same time. Honestly, I wasn't sure I will get the scholarship after applying for the third times... So, thanks to God, I accepted as resident of Clinical Microbiology program UGM period of July 2011. Studying while working is not easy for me... but I believe this is a good step for my carrier. When I almost forgot at all about ADS and busy with my study, I received a surprising email mentioned that I was sellected as one of 700 people choosen to be interviewed for ADS scholarship. This is not easy but Andi has convinced me that I have to do this step and he gave me his fully support to through this hard part. I do believe that God loves me... He always give the very best things for me even I doubt to my self. Doing my best for what God gave me is what I have to do. A month later I received news that I got the ADS scholarship and have to attend the Pre Departure Training in Bali for 6 months. As the consequence of this, I will leave Lita in Jogja with mbah and kakung. I understand this is unconfortable not only for Lita, for me as well. But lucky me, Lita is a great daughter and she will survive physically without me... for sure my heart will always be with her.... PDT is start of my new journey and I will write all my experiences down and share it in this blog....

Sputum Contamination and Centrifugation

This is the very first step in Culture specimen for diagnosis and identification Tuberculosis. Sputum decontamination is the process of removing contamination, particularly the cleaning off of dangerous materials (sputum). Sputum specimen was collected in falcon 50 ml in 2 collection times ie morning an in place/health provider (labeled with P and S). In this study, we examine sputum smear negatives sent by 3 BP4 (Balai Pengobatan Penyakit Paru-Paru) in Yogyakarta.
The decontamination is processed in the Basic Safety Containment level 2 (BSC 2) to protect the laboratory workers from the infection risks, since the transmission of TB can be through aerosol. The lab workers should wear the protection equipments: lab jacket, gloves and mask. The steps are described below:
1. Mix NaOH 3% and Na Citrat with the same volume (25+25 ml)
2. Add NALC 0.25 gr (after mix with NaOH-Na Citrat should be used within 24 hours)
this is known as decontamination solution.
3. Add the solution into specimen with volume 1:1
4. mix in vortex mixer
5. Add PBS (Phosphate Buffer Saline) until volume is 45 ml
6. centrifuge in 4 degree, 3500 RPM for 15 minutes.
7. Throw the all of the supernatant and add with PBS 2ml
8. Mix with vortex mixer
The sputum has been decontaminated and centrifuged and ready to be inoculated in the medium. In this study the decontaminated specimen is inoculated in Thin Layer Agar (with and without Para Nitro Benzene/PNB), Lowenstein Jensen (with and without PNB) Mycobacteria Growth Indicator Tube (MGIT) and object glass for direct microscopic examination. The rest of the specimen is kept in the pellet and freeze in -20 degree to be used for other purposes examination.

Firs day in Laboratory

After a week I've been busy with settling everything in Jogja, finally I can breath freely and start my journey. I visited Medical Faculty GMU to meet Bu Ning, my supervisor who has given me this opportunity. Nine o'clock in the morning sharply I stepped in to laboratory's door. Unfortunately, she has'nt come yet. I tried to enter the door after waiting for 15 minutes outside. I knocked one of the doors and meet Ibu Sunyi. She was smiling and trying to recognize me. She still remembered me and in a short time we had a long chat. She is the only one assistant of Bu Ning who works for TB research. She gave me some references and explained to me the progress of the on going research that I will involve in.
Let me give you an overview about the research. This research is about " Thin Layer Agar as a new rapid diagnosis of TB in smear negative patients in Jogjakarta", conducted by Department of Tropical Medicine GMU in collaboration with Institute of Tropical Medicine, Antwerp, Belgium. Since I will attend a TB course in Lausanne in October, they ask me to visit Antwerp for gaining some knowledge and skills in Thin Layer Agar. This is a good opportunity for me to start a new journey in TB Lab. I will assist Bu Ning in lab working for the on going study. The objective of the study is determine the sensitivity and specificity of TLA compare with other methods (Lwenstein Jensen/LJ and Mycobacterium Growth Indicator Tube/MGIT) in smear negative patients. The target samples is around 1400 negative smears patients taken from 3 BLKs in Jogjakarta. 161 has been successfully collected and examined.
After waiting for 3 hours, finally Bu Ning came in to her room. She looked happy and of course busy. She told me about the research and asked to observe the lab works for this 2 weeks and do it by myself after. Having half an hour effective discussion with her made me conclude that I should work hard with this.
Fortunately soon after the discussion was ended, I had an opportunity to observe directly the preparation of media (TLA), sputum decontamination and inoculation process in to TLA, MGIT, LJ and object glass for BTA examination. I will explain latter on the steps of each method. Basically, I really enjoy it and excited to involve in this study.
As I always say to Lita: I will never stop learning. Thanks for opening my way God, I will try more harder.

Smart Risk

I watched a kid's program accidentally in abckids this morning. His program has made me realize what happen in my life in this short time. Many value things that I need to share here.

The host asked the audience: do you feel bored if everyday you do the same things in your life? eat, sleep, watch, eat, sleep and watch again. We called this as a comfort zone. If you want to do something new, we called it take a risk. It is not always as dangerous risk but a smart risk. Sometime get out of the comfort zone make us feel uncomfortable. Therefore, before you decide to take the smart risk you should assess the positive and negative things that will be affected to the risk. From this assessment you should determine what is your goal and what are you afraid of? How you can cope this feeling and take the first step?

This is really useful for me to be applied in my recent new decision. I am assuming it as my smart risk. My goal is to get a new experience in TB area and enhance my capability and knowledge. The positive thing that might be happen if I take this risk is I can start my new carrier that is related to my background. The negative thing that might be happen is they don't satisfy with the result of the course. Thus, that is one thing that I am afraid of: failure.

For reducing the negative thing to be happened, I should more reading, learning and keep practicing as much as I can. Do my best and let God taking care of the rest.