CHAPTER I

PHASE OF COPAR THE COMMUNITY HAS REACHED:

A. AS ENDORSED

During the endorsement, the said phase of the COPAR that the community has
reached is Organization building phase.

B. AS RE-EVALUATED

Since the activites conducted were; Courtesy Call to the Mayor, the Head of the
Rural Health Unit of Buguias and the Midwife, Barangay Captain and Barangay Health
Workers of Amgaleyguey; discussion of initial plans such as Sitio Classes,
administration of Tetanus Toxoid and aH1N1 vaccines, compost pit for the Barangay’s
garbage disposal, acculturation and home visitations the phase of the COPAR that the
community has reached is Entry Phase. After the initiation of the initial plans we were
able to collect and collate data for our basis of planning and organizing activities. Series
of community gatherings were planned and executed. An Action-Reflection-Action
Session was also conducted during the course of the exposure. Although there was an
activity done which falls under the Organization Phase; formation of informal training of
the school teacher including some of the community folks, most of the activities
accomplished falls under the Entry Phase that is why we considered this phase as the
current stage of COPAR.

1
 CHAPTER II

ROTATIONAL PLAN OF STUDENTS

STRATEGIES OR
NEEDS/PROBLEMS OBJECTIVES EVALUATION
ACTIONS

1. Rapport After 4 weeks of Conduct courtesy The objective was

Building community duty call with the partially met.
immersion rotation, barangay health
-We were able to
our group will be workers, barangay
conduct courtesy call
able to establish midwife, a kagawad
with the barangay
rapport and good and to the
health workers,
working relationship community folks.
barangay midwife, a
with the community
kagawad and to the
folks and residents.
community folks.
Attend meetings
with barangay
midwife.
- The group was
Participate with able to join and
school activities participate in
such as school different activities of
teachings. the barangay like
school teachings
Join socialization
and immunization.
activities with the
community
residents such as

2
 acculturation and
attending the mass
with the folks in
Jehovah’s
Witnesses.

After 4 weeks of Conduct home visits The objective was

community duty and surveys. fully met.
immersion rotation,
Communicate -The community
the community folks
therapeutically with people recognized
will be able to trust
the community the presence of
the student nurses
residents using the student nurses in
in their community.
community’s dialect their community and
of Ilokano and they accommodated
Kankana-ey as and welcomed us
much as possible. warmly.

Meet with the

barangay health
workers, barangay
midwife,and a
kagawad.

2. Data After 4 weeks of Conduct home visits The objectives were

Collection community duty and surveys. fully met.
and Case immersion rotation,
Case finding -the group was able
Findings the group will be
to conduct home
able to assess the Meet with the
visits and surveys to
past and present barangay health
the community
health status of the workers, barangay
residents of
community to midwife and a
Barangay Saclalan,

3
identify existing kagawad. Amgaleyguey ,
problems in the Buguias
Make family nursing
community of
care plan and
Barangay Saclalan,
implementation.
Amgaleyguey , - The group was
Buguias Coordinate with the able to meet with
health workers. the key persons
of the community
and the
community folks.

-the group was able

to make and
implement family
nursing care plans to
their respective family
client

After 4 weeks of Conduct home visit The objective was

community duty and surveys. fully met
immersion rotation,
Make family and -the group was able
the group will be
nursing care plan to identify measures
able to identify
to prevent and
measures to Coordinate with the
manage the
prevent and barangay health
assessed health
manage the workers and
problems through
assessed health midwife
home visit, home
needs and
Conduct health surveys, and in
problems.
teachings during coordination with the

4
 home visits. barangay health
workers and midwife.

Provision of quality
care to the
community folks.

3. Conduct After 4 weeks of Conduct home visit The objective was

practical and immersion, the and surveys partially met
feasible group will be able to
Meet with the -the group was able
activities that assess the past and
barangay officials, to conduct home
will promote present health
health workers, and visits and surveys to
independenc status of the
midwife the community
e and community to
residents of
empowermen identifying overt and Make family nursing
Barangay Saclalan,
t of the covert health needs care plan
Amgaleyguey,
community and problems in the
Coordinate with the Buguias
community of
barangay health
Barangay Saclalan, -the group was not
workers
Amgaleyguey, able to meet with the
Buguias like goiter, Case finding barangay officials,
urinary tract but is able to meet
infection, rhinitis, with the health
cough and colds, workers, midwife, and
scoliosis, stoke and community folks
wound care.
-the group was able
to make family
nursing care plans to
their respective family

5
 client

After 4 weeks of Conduct home visits The objective was

community duty and surveys fully met
immersion rotation,
Make family nursing -the group was able
the group will be
care plan to coordinate with the
able to identify
barangay health
measures to Coordinate with the
workers, and midwife
prevent and barangay health
regarding their needs
manage the workers
and concerns
assessed health
needs and
problems

4. Delivery of After 4 weeks of Respect and adjust The objective was

Health Care community duty to the community’s fully met
Services and immersion rotation, culture and way of
-The group was able
Health the groups will be living
to adjust with the
Teachings able to develop
Interact with the community’s way of
appropriate
community people living as well as to
knowledge, attitude,
using their own communicate with
and skills to be
dialects as much as them using Ilocano.
efficient student
possible
nurses offering
service to the
community

CHAPTER III

6
 SUMMARY OF ACCOMPLISHMENTS

During the community immersion, the group was able to employ vital responsibilities of
community nurses towards our committed pursuit of optimal health care.

Services rendered by what type of Health Worker

Nature of Services Services Rendered Who Provided the

Services

a. Promotive 1. Health teachings Clinical Instructor

regarding the Student Nurses
following:
 Proper Hygiene
including Hand
washing, Brushing
Teeth, Cleaning of
Ears and Combing of
hair with a fine
toothed comb.
 Proper Nutrition
 Breast Self
Examination
 Wound Care
 “Sangkap Pinoy Seal”
 Goiter
 Communicable
diseases such as
Tuberculosis,
Sexually Transmitted
Diseases, Diptheria,
Mumps,Measles,

7
 Chicken Pox,
Pertussis, Hepatitis A,
b. Preventive Cholera, Influenza Clinical Instructor
and Dysentery Student Nurses
2. Conduction of Brgy. Health Worker
Physical Assessment

1. Family Home Visits,

Case Finding and
Family health
teaching.
c. Rehabilitative 2. Operation Timbang Student Nurses
3. BP taking
4. Physical Assessment
5. Tetanus Toxoid and
aH1N1 Vaccination

1. Stroke rehabilitation

Case Attended

CASE NUMBER OF CASES

Arthritis 1
Cough and Colds 12
Ulcer 1
Hypertension 6
Poor Environmental Conditions 1
Poor Hygiene 9
Post Stroke 2
Pregnant 1
Breast Lumps 2
Malnutrition 8
Goiter 1

8
 Primary Complex 1

A. CAPABILITY BUILDING AND IGP COMPONENT

The target project that the group was to do a compost pit for the community
people. After the sitio class was conducted, the group proposed the construction of a
compost pit for sitio Tonglo. With the help of the community people present we
deliberated on the feasibility of the project. According to the community folks consulted
the proposed project was not appropriate with the wet season plus the type of soil that
was available was clay which allows minimal water absorption.

B. TRAINING AND EDUCATION

Specific Topics Types of Audiences Attendance Duration Method Used

Hygiene: 1 hour
Handwashing,
Question and
Brushing teeth,
Pupils of Tonglo Answer,
Cleaning of
Carino Primary 12 Actual
ears, Combing
School Demonstration
of Hair and
and Lecture.
Trimming of
Nails

Nutrition Parents, 22 Discussion

Teacher and with visual
Pupils of Tonglo aids
Carino Primary containing the

9
 definition of
School proper
nutrition

Teacher and
Management of 13
Pupils of Tonglo
Cough and Discussion
Carino Primary
Colds
School
Safety Teacher and
Discussion
measures Pupils of Tonglo
with Actual
during Carino Primary 13 Demonstration
incidence of fire School

1. Health
Teachings on
diseases like:

Management of
Community folks who 10 One-on-one
Hypertension 6
are hypertensive minutes discussion

One-on-one
Breast Self Female discussion
1 5
Examination community folk with actual
minutes
demonstration

Cough and One-on-one

Community folks who 10
colds 16 discussion
has cough and colds minutes

Painful Community folks who 1 10 One-on-one

Urination has been experiencing minutes discussion

10
 painful urination
urinary

Diabetes
Community folks via One-on-one
Mellitus type I 6
Home visits discussion
and II

Community folks via

Rabies 6 Discussion
Home visits

Community folks via

Influenza 6 Discussion
Home visits 1 hour
Community folks via and 30
Hepatitis A 6 Discussion
Home visits minutes
Community folks via
Dysentery 6 Discussion
Home visits

Sexually
Community folks via
Transmitted 6 Discussion
Home visits
Diseases

Community folks via

Dengue 6 Discussion
Home visits

Community folks via

Pneumonia 6 Discussion
Home visits

HEALTH SERVICES COMPONENT

PATIENT AGE ADDRESS CHIEF WHERE RESULT

REFERRED COMPLAINT REFERR OF
ED REFERRAL
/REMARKS
Mr. Ganado Saclalan, Hypertension Midwife

11
 Amgaleyguey
Mrs. Ganado Saclalan, Hypertension Midwife
Amgaleyguey

Desenia 51 Tonglo, Hypertension Midwife

Olantes Amgaleyguey
Lola kape Saclalan, New Born Care Midwife
Amgaleyguey
Filamy Minas 27 Tonglo, Pregnant Midwife
Amgaleyguey
Belen Minas 57 Tonglo, Hypertension Midwife
Amgaleyguey
Tonglo, Stroke Midwife
Amgaleyguey
Nena 57 Tonglo, Goiter, Midwife
Martinez Amgaleyguey Hypertension
Julio 49 Tonglo, Gout, Midwife
Martinez Amgaleyguey Hypertension
Vicente, 5 Tonglo, Bayang Midwife
Marliz Amgaleyguey
Vicente, 7 Tonglo, Bayang, Midwife
Jezler Amgaleyguey parasite
infestation
(lice),colds,
dental carries
Marlyn 34 Tonglo, Breast Lump Midwife
Balian Amgaleyguey
Judielyn 11 Tonglo, Dental carries, Midwife
Olantes Amgaleyguey colds
Jhaira Mae 7 Tonglo, Dental carries, Midwife
Baucas Amgaleyguey colds

Kezia Balian 7 Tonglo, Parasite Midwife

Amgaleyguey infestation
(lice),colds,
dental carries

12
 CHAPTER IV

PROBLEMS, ISSUES AND CONCERNS

The beauty of learning is that there is always a room to grow. Through the
imperfections and dilemmas that each society is facing they are given an endless
opportunity to be better. As student nurses we were challenged to deal with the different
problems, issues and concerns that arose during the four weeks of community
immersion using the nursing process.

These are the problems identified in Tonglo, Amgaleyguey, Buguias:

For the student nurses:

13
 • Lack of availability of jeepneys for transportation is a problem because the
jeepneys are primarily intended for delivering harvested vegetables,

• The group had difficulty in terms of the participants or audience for their sitio
class because they are only available during the evening and due to time
constraints because they spent more of their time at the farm in the morning and
would do house work when they arrive home

For the community:

• Various health deficits like hypertension, skin diseases, rabies, breast lumps,
cough and colds, goiter, arthritis and malnutrition

• Poor environmental sanitation- open canals, bottles, tires and other open water
containers was observed in the community which serves as a breeding place for
vectors of diseases, especially dengue. In addition, improper waste disposal was
also observed

• Poor hygiene- among the some school children was observed and was
manifested by presence of body odors, untrimmed nails, unkempt hair, and dirty
clothes and presence of skin diseases and parasitic infestations like lice

• Health workers are few that hinder the provision of care to the community folks.
In line with this is the distant location of the RHU

• Limited leaders present in the community that would serve as their guide in terms
of planning projects that will promote their health.

Actions or interventions made were:

• Contacting the drivers one day or few hours before the trip going to Saclalan.

• With regards to the limited audience, the student nurses were the one who went
to every houses to conduct their health teaching during the evening.

• Moreover, for the problem on waste disposal the group proposed a compost pit
for the whole community but then there were no available land because land

14
 owners rendered their land to other gardeners and the kind of soil they have is
not suitable for composting.

• Student nurses had event of sitio classed or family teaching in regards with the
queries that the community have

15
 CHAPTER V

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

SUMMARY:

Summarized activities that were conducted by the BSN IV-F2 batch 2011 student
nurses of Saint Louis University in Tonglo, Barangay Amgaleyguey, Buguias, Benguet
during our community exposure for the first semester of the school year 2010-2011 is
presented in this chapter.

Our group had our community exposure under Ms. Genevieve Pablito. During the
first week, the group had courtesy calls with Ireneo Calwag, vice mayor of Abatan, Dr.
Hilda Kimakim and Captain Nardo Bacyan of Amgaleyguey. We had our ocular survey
at sitio Saclalan and Tonglo conducted home visits for the initial intented family clients.

For the duration of the second week of our community exposure, we joined the
Agamang assembly held at the Barangay health clinic. After the assembly, we
administered free AH1N1 vaccination mostly to women. We also took the height
measurement of the students in Saclalan Elementary school with the coordination of Mr.
Geoffrey Limpayos, elementary teacher. As we finished our other activities, we also
administered tetanus toxoid immunization in Saclalan and Tonglo.

On the third week of our community experience, we transferred to our new staff
house at Tonglo, Primary School. After, we conducted our sitio class on communicable
diseases held at the Primary school in Tonglo with the help of Ma’am Marg Pangisban,
primary school teacher. We continued our health teachings per house on the next day
with regards the same topic, communicable diseases with Diabetes Mellitus. During our
second day of that week we conducted Physical Assessment on the pupils and got their
BMI. And on our last day during that week, we had our general cleaning in our staff
house.

On the fourth week of our community exposure, we continued home visitations

and at the same time conducted health teachings as well, not only to the family client

16
but also to the pupils. We also gave suyod for the kids and had our rotational exam.
During the evening, we had our party and ARAS.

CONCLUSIONS

Being in the community is somewhat experiencing their way of living and to be

one of them. As student nurses, it is one way for us to render our service and at the
same time to learn from them.

For the duration of the immersion, we were able to learn how to adapt with the
people and to be sensitive with their feelings. Also, we were able to hear their
complaints and problems with regards to their health.

We then conclude that the people need further health teachings and reinforce to
them the importance of hygiene and environmental sanitation.

RECOMMENDATIONS

• Improper waste disposal- Composting should be implemented during summer.

• Far distance of RHU- health workers should be the one to attend and visit the
people in the community especially the high risk or vulnerable groups (pregnant
and children)

• Skin diseases and parasitic infestations particularly lice- reinforce to them

hygiene and nutrition

• Limited participants during sitio class- we recommend that health care providers
may conduct the health teachings in every houses during home visits most
especially at around 5:00 in the evening when the owner of the houses are
available.

17
To the Primary Health Care Providers (Midwife and Barangay Health Workers)

We encourage the health care providers to coordinate with the other

health team in conducting programs and seminar in solving the problems of the
community.

To the Community Youth:

Encourage them to join in any organization that may develop their sense
of leadership and responsibility because they will soon be the next leader and
responsible adults of our society.

To the Community Folks:

The most important recommendation for them is the compliance. Even though
how much you would reinforce them about the teachings, health promotion will not be
successful if they would not cooperate and do their part.

To the Student Nurses:

Learn to adapt with the community and be sensitive enough because we have
different cultures and practices. We are there not to have vacation and to be recognized
but we are there to be one with them.

18
 CHAPTER VI

LEARNING INSIGHTS

BALTAZAR, ROHMEL OLYVER L.

At first I was so excited to have a community in Buguias because the place is

new to me and I want to explore and socialize with the community folks but during our
first day, I had a hard time in adapting in the place because there are many flies and the
water is very cold. And as time pass by I was able to cope in the place.

For me, this community exposure is more challenging that what we had in third
year because we walked farther, the weather are extremes, no electricity and some of
the community folks are ignoring us.

In this community, I also learned or tried something that I haven’t tried yet. That
is to harvest a Chinese cabbage and I enjoyed the experience and through that
experience, I felt what the farmers are feeling or experiencing every time they are
planting and harvesting.

This community exposure is exhausting but enjoyable, exciting and educational.

FAUSTINO, RAMIL Jr. S.

This community immersion is truly worthy, because I was able to experience the
real essence of community nursing. It made me realize that I’m still fortunate despite the
difficulties that I’m experiencing right now. If I am to compare the people in “this”
community to the people in the “city”, the people here are rightful to be called “the real
rich people” because they know how to value the things they work for. And it is really
amusing to know and of course to experience the hospitality and willingness of the
people to learn. When I was in the community, I saw the great difference between rural
and urban areas, not in terms of living but on how they deal with life. The most

19
important thing that I have learned in the community is on knowing how to put myself in
the shoes of others, in this way, we can see and experience the life of the people whom
we see as different from us, and from this, we can greatly appreciate the differences
and uniqueness of each individual.

BENITEZ, RAE ANN S.

Busy street, bright lights, white collar jobs, and soaring buildings all pertains to
the metropolitan where in fast pace of advancement come to pass. While a bumpy and
rocky road, hectares of field and a simple lifestyle is what the country side lives out. The
world is a yin yang that should be in balanced, the metropolitan and the country side
has their own pros and cons and that we have to look into. Many would I think prefer to
live in the city because of the easier life in hand with technology, a snap of a finger
brings what you need. But I tell you, the country side offers you more important things
than a technology could bring. Like the hardships of being a farmer and at the same
time a mother of four or five, how children could afford to walk for hours just to go to
school and the closeness of people in the place. But maybe at the end of the day
despite of life uncertainties, it still depends on us how we deal with it…and how we live
with it.

The small details of our lives are what really matter. It is not the mansion, the car,
property, the money in the bank. These create an environment conducive for happiness
but cannot give happiness in themselves. It’s the relationship you have with your family
and friends that matters most because after all, material things when gone can be
acquired easily but true friends when gone is hard to find. We may have a lot of friends
but only a few of them can we consider our true friend, those who really knows us inside
and out. A good relationship doesn’t only mean a glittering sun in the eyes and a happy
and fun relationship but good relationships also take account of the presence of
misunderstanding and challenges that helps strengthen the bond friends have.
learning content

20
JAVIER, JOMARIZ

For our four weeks stay at Buguias immersing and being with the community
members made me realize the essence of being selfless to your fellow being. It is the
inner sense of being that you dig deeper to be able to be aware and to know more
about the current situation of a certain community. Establishing rapport was never been
a problem for us due to the warm welcome that the community is giving us. What struck
me most were the smiles and a helping hand given by the community folks without
having hesitations and never expecting something in return from us. The simplicity of
life in Buguias challenges me that I am still lucky to be living in an urban area where
everything has all been prepared in an instant for our convenience and accessibility
purposes that not like in Buguias, in order for you to have that something, you have to
work hard for it to achieve it. Buguias made me realize that not everything can be
bought by money.. happiness is priceless.

Despite the hardships that we had from our tires being flat for several times,
walking kilometers in order to reach our destinations, carrying heavy loads, lack of
adequate sleep and alike, we were able to learn from these experiences.

As for my clinical group which we have considered as a family, as long as each

member will be cooperating and helping each other, we will be able to finish our tasks
completely in a shorter period of time. This community exposure in Buguias will never
be forgotten.

MANGAPOT, MARIBEL

Throughout the years I stayed in the college I used to be sitting in the four
corners of a room and listening to our instructors. Being also in the hospital made me
feel what profession I belong to. All the while I thought learning is better when we are
inside the classrooms and having our duties in the hospital but community immersion
proved me wrong.

21
 Being in the community taught me a lot of things that we can’t learn from the
school. I learned how to mingle with other people even if they are not even familiar to
me, how to share what I have even if I have less, how to adjust to the things that are
there even if I am not used to using it.

Also being in the community, I developed my self confidence talking to others,

and I also had difficulty talking in Ilocano but I understand Ilocano.

MARIANO, KARREN A.

The stage starts off dim and all I can hear are strange voices. A burst of light
then comes along, showing people of brown skin speaking in a different tongue (south
Asian perhaps?) planting one of everyday’s staple of all staples, rice. Now, I get the
picture. As I was watching the movie with a drink on my hand, I got this sharp nostalgic
feeling of knowing what it’s like to set your foot in that rich soil and feel as if everything
is calm and that everything is relaxed.

I consist one of society’s fast pace workers, I do things quick and straight to the
point. The term itself, “worker” sends a chill down my spine, as I realize I “work” my way
through life, and not “live” it. I live in a place where it seems as if progress pushes you
forward and leaves you no choice whether or not you choose to be left behind; I
therefore work each chore as if time has a limit. Without realizing it I had been tired all
this time. These I am guilty of.

I am born human, of flesh and blood not of bolts and oil. The whole experience
living and breathing community life made me realize these after such a long time.
Because we face the difficulties of reality head on daily, from finances to professional
struggles, we kind of forget the “other realities” in our lives that mold us to be human. I
learned to listen to my body and give in to its’ requests once in a while. I learned to be
grateful of what I have and what I shall be blessed with because these are gifts the
Father chose me not to devour but share. The experience is truly remarkable like
everyone says, each unique of its reasons of course, but nonetheless life-changing.

22
PAJO, PHYLLIS

Before there will be a country there would still be province, a city, a municipality,
a barangay, a sitio and a family which comprises the basic unit of a community. The
world is indeed a mystifying place and I finally realized why by merely looking at the
place of Amgaleyguey. The world is such because there a re people whose minds and
hearts are interloping with emotions, so difficult to interpret in their complexity and
because of families, people would continue to exist.

But nowadays, many Filipino families are destitute of quality health care services
due to the current socio-economic status that many families in our country remain
flaccid with regards to their health. Many families are unaware of such services due to
poor and utile delivery of health care services added by the lack of initiative of both the
government to muster health care workers and families to avail for cost effective Due to
poor and ineffective delivery of health care services, many families are unaware of such
services with the lack of initiative of both the government to muster heath care workers
and families to benefit for cheaper health care services putting at risk the welfare of all
which remains unanswered. The laxity of both parties only directs to a greater problem,
the augmented vulnerability of every Filipinos to obtain and develop a disease bringing
about a contagion. It is the responsibility of every Filipinos to seek and demand for
quality heath care services and it is the responsibility of every health worker to provide
such services despite the scarcity on resources. It is a basic right of every family to
have the privilege to maintain and promote the well-being of each member of the family;
hence they ought to benefit from quality health care services.

SALVADOR, FIONETTE ANCE R.

It’s not always about being the best, but rather, it is doing your best. We might
not be the best group who has been exposed in this particular area but surely, we have
done the best of our abilities in living with the community folks, adjusting to their way of

23
living, adapting every practice that was introduced and rendering health care services
and education to every people who need it. Too much learning has gone on our way
which have indeed widen our horizons and expanded our perspectives with regards to
the profession that we have chosen and to the life that we are not used to live with. All
of the difficulties that we’ve gone through were all worth it for every concept and
learning which we gained will never be taken away from us no matter how time would
take us to another journey and another experience.

SORIANO, ALIEVA VEA P.

A community nurse work in diverse community settings to provide primary

nursing and health care across life span. Health promotion and intervention consciously
center on the client who is viewed holistically.

In the community, I believe that adaptation to the community lifestyle is the very
important thing to do to put up strong trust or rapport. It is not that easy to become
accustomed with new practice when you are in different tribe but at least we should
respect and understand each everyone’s way of life. As student nurse, we’re there to
help them identify their problems and to help them in solving it. In addition to have a
better result, compliance of each member of the community should be carried out
because even though the nurses would conduct many health teachings but the
community would not comply or don’t cooperate, there would be an unsuccessful result
in solving problems

In general, I learned how important people empowerment in the area in which all
of them really help and support each other especially during workdays and lend a hand
when problem arises. Participation and coordination would be one way in solving their
problems.

24
 LEARNING CONTENT

I CHLAMYDIA

What is chlamydia?

Chlamydia is a common sexually transmitted disease (STD) caused by the

bacterium, Chlamydia trachomatis,

How do people get chlamydia?

Chlamydia can be transmitted during vaginal, anal, or oral sex. Chlamydia can
also be passed from an infected mother to her baby during vaginal childbirth. Any
sexually active person can be infected with chlamydia. The greater the number of sex
partners, the greater the risk of infection. Because the cervix (opening to the uterus) of
teenage girls and young women is not fully matured and is probably more susceptible to
infection, they are at particularly high risk for infection if sexually active. Since chlamydia
can be transmitted by oral or anal sex, men who have sex with men are also at risk for
chlamydial infection.

What are the symptoms of chlamydia?

Chlamydia is known as a “silent” disease because the majority of infected people

have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after
exposure. In women, the bacteria initially infect the cervix and the urethra (urine canal).
Women who have symptoms might have an abnormal vaginal discharge or a burning
sensation when urinating. If the infection spreads from the cervix to the fallopian tubes
(tubes that carry fertilized eggs from the ovaries to the uterus), some women still have
no signs or symptoms; others have lower abdominal pain low back pain, nausea, fever,
pain during intercourse, or bleeding between menstrual periods. Chlamydial infection of
the cervix can spread to the rectum. Men with signs or symptoms might have a
discharge from their penis or a burning sensation when urinating. Men might also have

25
burning and itching around the opening of the penis. Pain and swelling in the testicles
are uncommon. Men or women who have receptive anal intercourse may acquire
chlamydial infection in the rectum, which can cause rectal pain, discharge, or bleeding.
Chlamydia can also be found in the throats of women and men having oral sex with an
infected partner.

What is the treatment for chlamydia?

Chlamydia can be easily treated and cured with antibiotics. A single dose of
azithromycin or a week of doxycycline (twice daily) are the most commonly used
treatments. HIV-positive persons with Chlamydia should receive the same treatment as
those who are HIV negative.

How can chlamydia be prevented?

The surest way to avoid transmission of STDs is to abstain from sexual contact,
or to be in a long-term mutually monogamous relationship with a partner who has been
tested and is known to be uninfected. Latex male condoms, when used consistently and
correctly, can reduce the risk of transmission of chlamydia. CDC recommends yearly
chlamydia testing of all sexually active women age 25 or younger, older women with risk
factors for chlamydial infections (those who have a new sex partner or multiple sex
partners), and all pregnant women. An appropriate sexual risk assessment by a health
care provider should always be conducted and may indicate more frequent screening
for some women. Any genital symptoms such as an unusual sore, discharge with odor,
burning during urination, or bleeding between menstrual cycles could mean an STD
infection. If a woman has any of these symptoms, she should stop having sex and
consult a health care provider immediately. Women who are told they have an STD and
are treated for it should notify all of their recent sex partners (sex partners within the
preceding 60 days) so they can see a health care provider and be evaluated for STDs.

26
Sexual activity should not resume until all sex partners have been examined and, if
necessary, treated.

SOURCE: Division of STD Prevention (DSTDP)Centers for Disease Control and

Prevention http://www.cdc.gov/std/ (content updated: May 2010)

Chlymda-http://www.cdc.gov/std/Chlamydia/ChlamydiaFactSheet-lowres-
2010.pdf

II. GONORRHEA

Gonorrhea is a sexually transmitted disease (STD). Gonorrhea is caused by

Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm,
moist areas of the reproductive tract, including the cervix (opening to the womb), uterus
(womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in
women and men. The bacterium can also grow in the mouth, throat, eyes, and anus.

How do people get gonorrhea

Gonorrhea is spread through contact with the penis, vagina, mouth, or anus.
Ejaculation does not have to occur for gonorrhea to be transmitted or acquired.
Gonorrhea can also be spread from mother to baby during delivery.

People who have had gonorrhea and received treatment may get infected again
if they have sexual contact with a person infected with gonorrhea.

Signs and Symptoms

Some men with gonorrhea may have no symptoms at all. However, some men
have signs or symptoms that appear two to five days after infection; symptoms can take
as long as 30 days to appear. Symptoms and signs include a burning sensation when
urinating, or a white, yellow, or green discharge from the penis. Sometimes men with
gonorrhea get painful or swollen testicles.

27
 In women, the symptoms of gonorrhea are often mild, but most women who are
infected have no symptoms. Even when a woman has symptoms, they can be so non-
specific as to be mistaken for a bladder or vaginal infection. The initial symptoms and
signs in women include a painful or burning sensation when urinating, increased vaginal
discharge, or vaginal bleeding between periods. Women with gonorrhea are at risk of
developing serious complications from the infection, regardless of the presence or
severity of symptoms.

Symptoms of rectal infection in both men and women may include discharge,
anal itching, soreness, bleeding, or painful bowel movements. Rectal infection also may
cause no symptoms. Infections in the throat may cause a sore throat but usually causes
no symptoms.

Treatment

Several antibiotics can successfully cure gonorrhea in adolescents and adults.

However, drug-resistant strains of gonorrhea are increasing in many areas of the world,
including the United States, and successful treatment of gonorrhea is becoming more
difficult. Because many people with gonorrhea also have chlamydia, another STD,
antibiotics for both infections are usually given together. Persons with gonorrhea should
be tested for other STDs.

It is important to take all of the medication prescribed to cure gonorrhea.

Although medication will stop the infection, it will not repair any permanent damage
done by the disease. People who have had gonorrhea and have been treated can get
the disease again if they have sexual contact with persons infected with gonorrhea. If a
person’s symptoms continue even after receiving treatment, he or she should return to a
doctor to be reevaluated.

Prevention

The surest way to avoid transmission of STDs is to abstain from sexual

intercourse, or to be in a long-term mutually monogamous relationship with a partner
who has been tested and is known to be uninfected.

28
 Latex condoms, when used consistently and correctly, can reduce the risk of
transmission of gonorrhea.

Any genital symptoms such as discharge or burning during urination or unusual

sore or rash should be a signal to stop having sex and to see a doctor immediately. If a
person has been diagnosed and treated for gonorrhea, he or she should notify all recent
sex partners so they can see a health care provider and be treated. This will reduce the
risk that the sex partners will develop serious complications from gonorrhea and will
also reduce the person’s risk of becoming re-infected. The person and all of his or her
sex partners must avoid sex until they have completed their treatment for gonorrhea

III SYPHILIS

What is syphilis?

Syphilis is a sexually transmitted disease (STD) caused by the bacterium

Treponema pallidum. It has often been called “the great imitator” because so many of
the signs and symptoms are indistinguishable from those of other diseases.

How do people get syphilis?

Syphilis is passed from person to person through direct contact with syphilis
sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores
also can occur on the lips and in the mouth. Transmission of the organism occurs during
vaginal, anal, or oral sex. Pregnant women with the disease can pass it to the babies
they are carrying. Syphilis cannot be spread through contact with toilet seats,
doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils.

29
 What are the signs and symptoms?

Many people infected with syphilis do not have any symptoms for years, yet
remain at risk for late complications if they are not treated. Although transmission
occurs from persons with sores who are in the primary or secondary stage, many of
these sores are unrecognized. Thus, transmission may occur from persons who are
unaware of their infection.

Primary Stage: The primary stage of syphilis is usually marked by the

appearance of a single sore (called a chancre), but there may be multiple sores. The
time between infection with syphilis and the start of the first symptom can range from 10
to 90 days (average 21 days). The chancre is usually firm, round, small, and painless. It
appears at the spot where syphilis entered the body. The chancre lasts 3 to 6 weeks,
and it heals without treatment. However, if adequate treatment is not administered, the
infection progresses to the secondary stage.

Secondary Stage: Skin rash and mucous membrane lesions characterize the
secondary stage. This stage typically starts with the development of a rash on one or
more areas of the body. The rash usually does not cause itching. Rashes associated
with secondary syphilis can appear as the chancre is healing or several weeks after the
chancre has healed. The characteristic rash of secondary syphilis may appear as rough,
red, or reddish brown spots both on the palms of the hands and the bottoms of the feet.
In addition to rashes, symptoms of secondary syphilis may include fever, swollen lymph
glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and
fatigue. The signs and symptoms of secondary syphilis will resolve with or without
treatment, but without treatment, the infection will progress to the latent and possibly
late stages of disease.

Late and Latent Stages: The latent (hidden) stage of syphilis begins when
primary and secondary symptoms disappear. Without treatment, the infected person will
continue to have syphilis even though there are no signs or symptoms; infection
remains in the body. This latent stage can last for years. In the late stages of syphilis,

30
the disease may subsequently damage the internal organs, including the brain, nerves,
eyes, heart, blood vessels, liver, bones, and joints. Signs and symptoms of the late
stage of syphilis include difficulty coordinating muscle movements, paralysis,
numbness, gradual blindness, and dementia. This damage may be serious enough to
cause death.

What is the treatment for syphilis?

Syphilis is easy to cure in its early stages. A single intramuscularinjection of

penicillin, an antibiotic, will cure a person who has had syphilis for less than a yearThere
are no home remedies or over-the-counter drugs that will cure syphilis.

How can syphilis be prevented?

The surest way to avoid transmission of sexually transmitted diseases, including

syphilis, is to abstain from sexual contact or to be in a long-term mutually monogamous
relationship witha partner who has been tested and is known to be uninfected.

Avoiding alcohol and drug use may also help prevent transmission of syphilis
because these activities may lead to risky sexual behavior. It is important that sex
partners talk to each other about their HIV status and history of other STDs so that
preventive action can be taken. Genital ulcer diseases, like syphilis, can occur in both
male and female genital areas that are covered or protected by a latex condom, as well
as in areas that are not covered. Correct and consistent use of latex condoms can
reduce the risk of syphilis, as well as genital herpes and chancroid, only when the
infected area or site of potential exposure is protected.

Condoms lubricated with spermicides (especially Nonoxynol-9or N-9) are no

more effective than other lubricated condoms in protecting against the transmission of
STDs. Use of condoms lubricated with N-9 is not recommended for STD/HIV
prevention. Transmission of an STD, including syphilis cannot be prevented by washing
the genitals, urinating, and/or douching after sex. Any unusual discharge, sore, or rash,
particularly in the groin area, should be a signal to refrain from having sex and to see a
doctor immediately.

31
 Source: SOURCE: Division of STD Prevention (DSTDP)Centers for Disease
Control and Prevention http://www.cdc.gov/std/ (content updated: December 2007)

Syphillis-http://www.cdc.gov/std/Syphyllis/SyphyllisFactSheet-lowres-2007.pdf

IV BURNS

Definition:

Burns are injuries to tissues caused by heat, friction, electricity, radiation, or chemicals.
Burns may be caused by even a brief encounter with heat greater than 120°F (49°C).
The source of this heat may be the sun (causing a sunburn), hot liquids, steam, fire,
electricity, friction (causing rug burns and rope burns), and chemicals (causing a caustic
burn upon contact).

Classification of Burns:

Classification Of Burns

First-Degree The burned area is painful. The outer skin is reddened. Slight swelling
(Minor) is present.

The burned area is painful. The underskin is affected. Blisters may

Second-Degree
form. The area may have a wet, shiny appearance because of exposed
(Moderate)
tissue.

The burned area is insensitive due to the destruction of nerve endings.

Third-Degree
Skin is destroyed.Muscle tissues and bone underneath may be
(Critical)
damaged. The area may be charred, white, or grayish in color.

Signs of a burn are localized redness, swelling, and pain. A severe burn will also blister.
The skin may also peel, appear white or charred, and feel numb. A burn may trigger a
headache and fever. Extensive burns may induce shock, the symptoms of which are
faintness, weakness, rapid pulse and breathing, pale and clammy skin, and bluish lips
and fingernails.

32
Burn treatment consists of relieving pain, preventing infection, and maintaining body
fluids, electrolytes, and calorie intake while the body heals. Treatment of chemical or
electrical burns is slightly different from the treatment of thermal burns but the objectives
are the same.

Thermal burn treatment

The first act of thermal burn treatment is to stop the burning process. This may be
accomplished by letting cool water run over the burned area or by soaking it in cool (not
cold) water. Ice should never be applied to the burn. Cool (not cold) wet compresses
may provide some pain relief when applied to small areas of first- and second-degree
burns. Butter, shortening, or similar salve should never be applied to the burn since it
prevents heat from escaping and drives the burning process deeper into the skin.

If the burn is minor, it may be cleaned gently with soap and water. Blisters should not be
broken. If the skin of the burned area is unbroken and it is not likely to be further irritated
by pressure or friction, the burn should be left exposed to the air to promote healing. If
the skin is broken or apt to be disturbed, the burned area should be coated lightly with
an antibacterial ointment and covered with a sterile bandage. Aspirin, acetaminophen
(Tylenol), or ibuprofen (Advil) may be taken to ease pain and relieve inflammation. A
doctor should be consulted if these signs of infection appear: increased warmth,
redness, pain, or swelling; pus or similar drainage from the wound; swollen lymph
nodes; or red streaks spreading away from the burn.

In situations where a person has received moderate or critical burns, lifesaving

measures take precedence over burn treatment and emergency medical assistance
must be called. A person with serious burns may stop breathing, and artificial respiration
(also called mouth-to-mouth resuscitation or rescue breathing) should be administered
immediately. Also, a person with burns covering more than 12% BSA is likely to go into
shock; this condition may be prevented by laying the person flat and elevating the feet
about 12 in (30 cm). Burned arms and hands should also be raised higher than the
person's heart.

33
In rescues, a blanket may be used to smother any flames as the person is removed
from danger. The person whose clothing is on fire should "stop, drop, and roll" or be
assisted in lying flat on the ground and rolling to put out the fire. Afterwards, only burnt
clothing that comes off easily should be removed; any clothing embedded in the burn
should not be disturbed. Removing any smoldering apparel and covering the person
with a light, cool, wet cloth, such as a sheet but not a blanket or towel, will stop the
burning process.

At the hospital, the staff will provide further medical treatment. A tube to aid breathing
may be inserted if the patient's airways or lungs have been damaged, as can happen
during an explosion or a fire in a enclosed space. Also, because burns dramatically
deplete the body of fluids, replacement fluids are administered intravenously. The
patient is also given antibiotics intravenously to prevent infection, and he or she may
also receive a tetanus shot, depending on his or her immunization history. Once the
burned area is cleaned and treated with antibiotic cream or ointment, it is covered in
sterile bandages, which are changed two to three times a day. Surgical removal of dead
tissue (debridement) also takes place. As the burns heal, thick, taut scabs (eschar)
form, which the doctor may have to cut to improve blood flow to the more elastic healthy
tissue beneath. The patient will also undergo physical and occupational therapy to keep
the burned areas from becoming inflexible and to minimize scarring.

In cases where the skin has been so damaged that it cannot properly heal, a skin graft
is usually performed. A skin graft involves taking a piece of skin from an unburned
portion of the patient's body (autograft) and transplanting it to the burned area. When
doctors cannot immediately use the patient's own skin, a temporary graft is performed
using the skin of a human donor (allograft), either alive or dead, or the skin of an animal
(xenograft), usually that of a pig.

The burn victim also may be placed in a hyperbaric chamber, if one is available. In a
hyperbaric chamber (which can be a specialized room or enclosed space), the patient is
exposed to pure oxygen under high pressure, which can aid in healing. However, for
this therapy to be effective, the patient must be placed in a chamber within 24 hours of
being burned.

34
Chemical burn treatment

Burns from liquid chemicals must be rinsed with cool water for at least 15 minutes to
stop the burning process. Any burn to the eye must be similarly flushed with water. In
cases of burns from dry chemicals such as lime, the powder should be completely
brushed away before the area is washed. Any clothing which may have absorbed the
chemical should be removed. The burn should then be loosely covered with a sterile
gauze pad and the person taken to the hospital for further treatment. A physician may
be able to neutralize the offending chemical with another before treating the burn like a
thermal burn of similar severity.

Electrical burn treatment

Before electrical burns are treated at the site of the accident, the power source must be
disconnected if possible and the victim moved away from it to keep the person giving
aid from being electrocuted. Lifesaving measures again take priority over burn
treatment, so breathing must be checked and assisted if necessary. Electrical burns
should be loosely covered with sterile gauze pads and the person taken to the hospital
for further treatment.

Burns are commonly received in residential fires. Properly placed and working smoke
detectors in combination with rapid evacuation plans will minimize a person's exposure
to smoke and flames in the event of a fire. Children must be taught never to play with
matches, lighters, fireworks, gasoline, and cleaning fluids.

Burns by scalding with hot water or other liquids may be prevented by setting the water
heater thermostat no higher than 120°F (49°C), checking the temperature of bath water
before getting into the tub, and turning pot handles on the stove out of the reach of
children. Care should be used when removing covers from pans of steaming foods and
when uncovering or opening foods heated in a microwave oven.

Thermal burns are often received from electrical appliances. Care should be exercised
around stoves, space heaters, irons, and curling irons.

35
Sunburns may be avoided by the liberal use of a sunscreen containing either an opaque
active ingredient such as zinc oxide or titanium dioxide or a nonopaque active ingredient
such as PABA (para-aminobenzoic acid) or benzophenone. Hats, loose clothing, and
umbrellas also provide protection, especially between 10 A.M. and 3 P.M. when the
most damaging ultraviolet rays are present in direct sunlight.

Electrical burns may be prevented by covering unused electrical outlets with safety
plugs and keeping electrical cords away from infants and toddlers who might chew on
them. Persons should also seek shelter indoors during a thunderstorm to avoid being
struck by lightning.

Chemical burns may be prevented by wearing protective clothing, including gloves and
eyeshields. Chemical agents should always be used according to the manufacturer's
instructions and properly stored when not in use.

Common Causes

1. Carelessness with match and cigarette smoking.

2. Scald from hot liquid.

3. Defective heating, cooking and electrical equipment.

4. Immersion in overheated bath water.

5. Use of such chemicals as lye, strong acids and strong detergent

Home Remedy for Burns

Honey. When applied to a burn, honey draws out fluids from the tissues, effectively
cleaning the wound. You may also apply the honey to a gauze bandage, which is less
sticky than direct application. On a piece of sterile gauze, place a dollop of honey and
put the bandage directly on the burn, honey-side down. Change the dressing three to
four times a day.

Oatmeal. A good way to relieve the itch is by putting this breakfast cereal into the tub.

36
Crumble 1 cup uncooked oatmeal into a bath of lukewarm water as the tub is filling.
Soak 15 to 20 minutes and then air dry so that a thin coating of oatmeal remains on
your skin. Use caution getting in and out of the tub since the oatmeal makes surfaces
slippery.

Salt. Mouth burns can be relieved by rinsing with salt water every hour or so. Mix 1/2
teaspoon salt in 8 ounces warm water.

Tea bags. The tannic acid found in black tea helps draw heat from a burn. Put 2 to 3
tea bags under a spout of cool water and collect the tea in a small bowl. Gently dab the
liquid on the burn site.

Another method is to make a concoction using 3 or 4 tea bags, 2 cups fresh mint
leaves, and 4 cups boiling water. Strain liquid into a jar and allow to cool. To use, dab
the mixture on burned skin with a cotton ball or washcloth.

If you're on the go, you can also make a stay-in-place poultice out of 2 or 3 wet tea
bags. Simply place cool, wet tea bags directly on the burn and wrap them with a piece
of gauze to hold them in place.

Vinegar. Vinegar works as an astringent and antiseptic on minor burns and helps
prevent infection. Dilute the vinegar with equal parts water, and rinse the burned area
with the solution.

Toothpaste is awesome on a burn. It helps relieve the burning feeling, and it's like an
instant cool. Do not use on open blisters or really bad burns.

Ice cube. A tongue burn is best treated with ice rather than cool water. Often, in great
anticipation, children (and adults, for that matter) sip their soup or hot chocolate before it

37
cools down and get a tongue burn. Since it's tricky to stick a burned tongue under the
faucet, try sucking on an ice cube. First rinse the cube under water so it doesn't stick to
the tongue or lips.

Milk. For a minor burn, soak the burned area in milk for 15 minutes or so. You may also
apply a cloth soaked in milk to the area. Repeat every few hours to relieve pain. Be sure
to wash out the cloth after use, as it will sour quickly.

Cool water. can restrict blood flow to the burn site and further damage delicate tissues.
Instead, gently run cool water or place cool compresses over the burn site for ten
minutes. Do this as quickly as possible, preferably within seconds of getting a burn.
Cool water not only feels good but will help stop the burn from spreading, and the
sooner you run cool water on the burn, the greater the effect will be to reduce it.

V DIABETES MELLITUS

- metabolic disorder characterized by hyperglycemia( increase blood sugar)

that results to defective insulin production, secretion or utilization

Insulin- essential for the utilization of glucose

CAUSES/ predisposing factors:

1. hereditary factors
2. faulty diet
3. obesity
4. age
5. emotionally stressed
6. faulty life style- smoking, alcohol intake, lack of exercise
SIGNS and SYMPTOMS
1. weight loss
2. fatigue

38
 3. Polyuria- frequent urination
4. polyphagia- increased hunger
5. polydipsia- excessive thirst
6. blurred vision

COMPLICATIONS

1. Kidney disease
2. heart disease
3. eye problems
4. amputation

MANAGEMENT:

1. Dietary control, limit Carbohydrates and saturated fats

2. Control Blood glucose and lipid levels
3. weight reduction
4. exercise
5. prevent breaks in the skin
6. ampalaya

VI TUBERCULOSIS

DEFINITION
Tuberculosis (TB) is a potentially fatal contagious disease that can affect almost any
part of the body but is mainly an infection of the lungs. It is caused by a bacterial
microorganism, the tubercle bacillus or Mycobacterium tuberculosis. Although TB can
be treated, cured, and can be prevented if persons at risk take certain drugs, scientists
have never come close to wiping it out. Few diseases have caused so much distressing
illness for centuries and claimed so many lives.

LATENT VS. ACTIVE TB

Not everyone infected with TB bacteria becomes sick. As a result, two TB-related
conditions exist: latent TB infection and active TB disease.

39
 • Latent TB Infection
TB bacteria can live in your body without making you sick. This is called latent TB
infection (LTBI). In most people who breathe in TB bacteria and become
infected, the body is able to fight the bacteria to stop them from growing. People
with latent TB infection do not feel sick and do not have any symptoms. The only
sign of TB infection is a positive reaction to the tuberculin skin test or special TB
blood test. People with latent TB infection are not infectious and cannot spread TB
bacteria to others. However, if TB bacteria become active in the body and multiply,
the person will get sick with TB disease.

• Active TB Disease
TB bacteria become active if the immune system can't stop them from growing.
When TB bacteria are active (multiplying in your body), this is called TB disease.
TB disease will make you sick. People with TB disease may spread the bacteria to
people they spend time with every day. Many people who have latent TB infection
never develop TB disease. Some people develop TB disease soon after becoming
infected (within weeks) before their immune system can fight the TB bacteria.
Other people may get sick years later, when their immune system becomes weak
for another reason.
For persons whose immune systems are weak, especially those with HIV
infection, the risk of developing TB disease is much higher than for persons with
normal immune systems.

A Person with Latent TB Infection A Person with Active TB Disease

- a bad cough that lasts 3 weeks or
longer
- pain in the chest
- coughing up blood or sputum
- weakness or fatigue
• Has no symptoms
- weight loss
- no appetite
- chills
- fever
- sweating at night
• Does not feel sick • Usually feels sick
• Cannot spread TB bacteria to others • May spread TB bacteria to others
• Usually has a skin test or blood test result • Usually has a skin test or blood test
indicating TB infection result indicating TB infection
• Has a normal chest x-ray and a negative • May have an abnormal chest x-ray, or

40
sputum smear positive sputum smear or culture
• Needs treatment for latent TB infection to • Needs treatment to treat active TB
prevent active TB disease disease

SIGNS AND SYMPTOMS

1. Respiratory Signs and Symptoms

Miliary TB always starts in the lungs. As the Myobacterium tuberculosis bacteria
infiltrate the lungs, the body forms warty growths, called "tubercles," around the pockets
of bacteria in the lung tissue. The tubercles irritate and damage the lung tissue, causing
coughing and bloody sputum. The tubercles also affect lung function and capacity,
resulting in difficulty breathing and shortness of breath . In addition to the cough and
difficulty breathing, the patient may also experience chest pain.

2. Fever, Chills and Night Sweats

The patient may develop a fever as the body tries to rid itself of the infection. Chills and
night sweats are a common occurrence as the patient overheats from the fever, sweats
to cool down, then becomes chilled.

3. Loss of Appetite, Weight Loss and Anemia

The patient may stop eating, because of the fever, the general malaise and fatigue
associated with the disease or a combination of factors. During the active phase of the
illness, the body is also expending a lot of energy fighting the disease. This, combined
with the loss of appetite, can result in rapid weight loss and anemia.

4. Swelling of the Lymph Nodes, Liver and Spleen

The lymph nodes act as jail cells for bacteria, holding them in place until white blood
cells can kill them off. During a systemic infection, the lymph nodes will swell as they fill
with bacteria. The liver and spleen serve similar blood-cleaning functions and may
become swollen as well.

5. Joint Pain
If the bacteria spread to bone, there may be pain in the affected bone or the associated
joint. The patient may also feel joint pain as a consequence of the fever and general
malaise.

6. Other Symptoms
TB can spread to any area of the body and the symptoms vary greatly, depending on
the organ or system affected. In the kidneys, it may cause kidney/lower back pain and

41
blood in the urine. In the skin, it may cause rashes. In addition, once the disease
spreads, it could lie dormant and show no symptoms for years.

TRANSMISSION
When people suffering from active pulmonary TB cough, sneeze, speak, or spit,
they expel infectious aerosol droplets 0.5 to 5 µm in diameter. A single sneeze can
release up to 40,000 droplets.[37] Each one of these droplets may transmit the disease,
since the infectious dose of tuberculosis is very low and inhaling less than ten bacteria
may cause an infection.[38][39]
People with prolonged, frequent, or intense contact are at particularly high risk of
becoming infected, with an estimated 22% infection rate. A person with active but
untreated tuberculosis can infect 10–15 other people per year.[4] Others at risk include
people in areas where TB is common, people who inject drugs using unsanitary
needles, residents and employees of high-risk congregate settings, medically under-
served and low-income populations, high-risk racial or ethnic minority populations,
children exposed to adults in high-risk categories, patientsimmunocompromised by
conditions such as HIV/AIDS, people who take immunosuppressant drugs, and health
care workers serving these high-risk clients.[40]
Transmission can only occur from people with active — not latent — TB [1]. The
probability of transmission from one person to another depends upon the number of
infectious droplets expelled by a carrier, the effectiveness of ventilation, the duration of
exposure, and thevirulence of the M. tuberculosis strain.[9] The chain of transmission
can, therefore, be broken by isolating patients with active disease and starting effective
anti-tuberculous therapy. After two weeks of such treatment, people with non-
resistant active TB generally cease to be contagious. If someone does become infected,
then it will take at least 21 days, or three to four weeks, before the newly infected
person can transmit the disease to others.[41] TB can also be transmitted by eating meat
infected with TB. Mycobacterium bovis causes TB in cattle.

VACCINES
Many countries use Bacillus Calmette-Guérin (BCG) vaccine as part of their TB control
programmes, especially for infants. According to the WHO, this is the most often used
vaccine worldwide, with 85% of infants in 172 countries immunized in 1993. This was
the first vaccine for TB and developed at the Pasteur Institute in France between 1905
and 1921. The protective efficacy of BCG for preventing serious forms of TB
(e.g. meningitis) in children is greater than 80%; its protective efficacy for preventing
pulmonary TB in adolescents and adults is variable, ranging from 0 to 80%.[64]

42
  Infants or children with negative skin test results who are continually exposed to
untreated or ineffectively treated patients or will be continually exposed to multidrug-
resistant TB.
 Healthcare workers considered on an individual basis in settings in which a high
percentage of MDR-TB patients has been found, transmission of MDR-TB is likely,
and TB control precautions have been implemented and were not successful.

BCG provides some protection against severe forms of pediatric TB, but has been
shown to be unreliable against adult pulmonary TB, which accounts for most of the
disease burden worldwide. Currently, there are more cases of TB on the planet than at
any other time in history and most agree there is an urgent need for a newer, more
effective vaccine that would prevent all forms of TB—including drug resistant strains—in
all age groups and among people with HIV.[66]
Several new vaccines to prevent TB infection are being developed. The
first recombinant tuberculosis vaccine rBCG30, entered clinical trialsin the United States
in 2004, sponsored by the National Institute of Allergy and Infectious Diseases (NIAID).
[67]
A 2005 study showed that aDNA TB vaccine given with
conventional chemotherapy can accelerate the disappearance of bacteria as well as
protect against re-infection in mice; it may take four to five years to be available in
humans.[68] A very promising TB vaccine, MVA85A, is currently in phase II trials in South
Africa by a group led by Oxford University,[69] and is based on a genetically
modified vaccinia virus. Many other strategies are also being used to develop novel
vaccines,[70] including both subunit vaccines (fusion molecules composed of
two recombinant proteins delivered in an adjuvant) such as Hybrid-1, HyVac4 or M72,
and recombinant adenoviruses such as Ad35.[71][72][73][74] Some of these vaccines can be
effectively administered without needles, making them preferable for areas where HIV is
very common.[75] All of these vaccines have been successfully tested in humans and are
now in extended testing in TB-endemic regions. To encourage further discovery,
researchers and policymakers are promoting new economic models of vaccine
development including prizes, tax incentives and advance market commitments.[76][77]

TREATMENT
Treatment for TB uses antibiotics to kill the bacteria. Effective TB treatment is
difficult, due to the unusual structure and chemical composition of the mycobacterial cell
wall, which makes many antibiotics ineffective and hinders the entry of drugs.[79][80][81]
[82]
The two antibiotics most commonly used are rifampicin and isoniazid. However,
instead of the short course of antibiotics typically used to cure other bacterial infections,
TB requires much longer periods of treatment (around 6 to 24 months) to entirely

43
eliminate mycobacteria from the body.[9] Latent TB treatment usually uses a single
antibiotic, while active TB disease is best treated with combinations of several
antibiotics, to reduce the risk of the bacteria developing antibiotic resistance.[83] People
with latent infections are treated to prevent them from progressing to active TB disease
later in life. Drug resistant tuberculosis is transmitted in the same way as regular TB.
Primary resistance occurs in persons who are infected with a resistant strain of TB. A
patient with fully susceptible TB develops secondary resistance (acquired resistance)
during TB therapy because of inadequate treatment, not taking the prescribed regimen
appropriately, or using low quality medication.[83]
Drug-resistant TB is a public health issue in many developing countries, as
treatment is longer and requires more expensive drugs. Multi-drug-resistant
tuberculosis (MDR-TB) is defined as resistance to the two most effective first-line TB
drugs: rifampicin and isoniazid. Extensively drug-resistant TB (XDR-TB) is also resistant
to three or more of the six classes of second-line drugs.[84] The DOTS (Directly
Observed Treatment Short-course) strategy of tuberculosis treatment recommended by
WHO was based on clinical trials done in the 1970s by Tuberculosis Research Centre,
Chennai, India. The country in which a person with TB lives can determine what
treatment they receive. This is because multidrug-resistant tuberculosis is resistant to
most first-line medications, the use second-line antituberculosis medications is
necessary to cure the patient. However, the price of these medications is high; thus
poor people in the developing world have no or limited access to these treatments.

Treating TB infection (latent TB)

If tests show that you have TB infection but not active disease, your doctor may
recommend preventive drug therapy to destroy bacteria that might become active in the
future. You're likely to receive a daily or twice-a-week dose of the TB medication
isoniazid. For treatment to be effective, you usually take isoniazid for nine months.
Long-term use of isoniazid can cause side effects, including the life-threatening liver
disease hepatitis. For this reason, your doctor will monitor you closely while you're
taking isoniazid. During treatment, avoid using acetaminophen (Tylenol, others) and
avoid or limit alcohol use. Both increase your risk of liver damage.

Treating active TB disease

If you're diagnosed with active TB, you're likely to begin taking four medications —
isoniazid, rifampin (Rifadin), ethambutol (Myambutol) and pyrazinamide. This regimen
may change if tests later show some of these drugs to be ineffective. Even so, you'll
continue to take several medications. Depending on the severity of your disease and

44
whether the bacteria are drug-resistant, one or two of the four drugs may be stopped
after a few months. You may be hospitalized for the first two weeks of therapy or until
tests show that you're no longer contagious.

PREVENTION

In general, TB is preventable. From a public health standpoint, the best way to control
TB is to diagnose and treat people with TB infection before they develop active disease
and to take careful precautions with people hospitalized with TB. But there also are
measures you can take on your own to help protect yourself and others:

 Keep your immune system healthy. Eat plenty of healthy foods including fruits
and vegetables, get enough sleep, and exercise at least 30 minutes a day most days
of the week to keep your immune system in top form.

 Get tested regularly. Experts advise people who have a high risk of TB to get a
skin test once a year. This includes people with HIV or other conditions that weaken
the immune system, people who live or work in a prison or nursing home, health
care workers, people from countries with high rates of TB, and others in high-risk
groups.

 Consider preventive therapy. If you test positive for latent TB infection, your
doctor will likely advise you to take medications to reduce your risk of developing
active TB. Vaccination with BCG isn't recommended for general use in the United
States, because it isn't very effective in adults and it causes a false-positive result on
a Mantoux skin test. But the vaccine is often given to infants in countries where TB is
more common. Vaccination can prevent severe TB in children. Researchers are
working on developing a more effective TB vaccine.

 Finish your entire course of medication. This is the most important step you
can take to protect yourself and others from TB. When you stop treatment early or
skip doses, TB bacteria have a chance to develop mutations that allow them to
survive the most potent TB drugs. The resulting drug-resistant strains are much
more deadly and difficult to treat.

To help keep your family and friends from getting sick if you have active TB:

 Stay home. Don't go to work or school or sleep in a room with other people
during the first few weeks of treatment for active TB.

45
  Ensure adequate ventilation. Open the windows whenever possible to let in
fresh air.

 Cover your mouth. It takes two to three weeks of treatment before you're no
longer contagious. During that time, be sure to cover your mouth with a tissue
anytime you laugh, sneeze or cough. Put the dirty tissue in a bag, seal it and throw it
away. Also, wearing a mask when you're around other people during the first three
weeks of treatment may help lessen the risk of transmission.

VII DENGUE

Dengue is a mosquito-borne infection that causes a severe flu-like illness, and

sometimes a potentially lethal complication called dengue haemorrhagic fever. Global
incidence of dengue has grown dramatically in recent decades.About two fifths of the
world's population are now at risk.

• Dengue is found in tropical and sub-tropical climates worldwide,

mostly in urban and semi-urban areas.
• Dengue haemorrhagic fever is a leading cause of serious illness
and death among children in some Asian countries.
• There is no specific treatment for dengue, but appropriate medical
care frequently saves the lives of patients with the more serious dengue
haemorrhagic fever.
• The only way to prevent dengue virus transmission is to combat the
disease-carrying mosquitoes.

46
Dengue is a mosquito-borne infection that in recent decades has become a major
international public health concern. Dengue is found in tropical and sub-tropical regions
around the world, predominantly in urban and semi-urban areas. Dengue haemorrhagic
fever (DHF), a potentially lethal complication, was first recognized in the 1950s during
dengue epidemics in the Philippines and Thailand. Today DHF affects most Asian
countries and has become a leading cause of hospitalization and death among children
in the region. There are four distinct, but closely related, viruses that cause dengue.
Recovery from infection by one provides lifelong immunity against that virus but confers
only partial and transient protection against subsequent infection by the other three
viruses. There is good evidence that sequential infection increases the risk of
developing DHF.

TRANSMISSION

Dengue viruses are transmitted to humans through the bites of infective

female Aedes mosquitoes. Mosquitoes generally acquire the virus while feeding on the
blood of an infected person. After virus incubation for eight to 10 days, an infected
mosquito is capable, during probing and blood feeding, of transmitting the virus for the
rest of its life. Infected female mosquitoes may also transmit the virus to their offspring
by transovarial (via the eggs) transmission, but the role of this in sustaining transmission
of the virus to humans has not yet been defined.
Infected humans are the main carriers and multipliers of the virus, serving as a source
of the virus for uninfected mosquitoes. The virus circulates in the blood of infected
humans for two to seven days, at approximately the same time that they have a
fever; Aedes mosquitoes may acquire the virus when they feed on an individual during
this period. Some studies have shown that monkeys in some parts of the world play a
similar role in transmission.

THE VIRUS

Human dengue can be caused by four distinct, but closely related viruses of the family
Flaviviridae. Because the viruses are defined based on serologic responses, they are
referred to as dengue "serotypes" (DEN-1, DEN-2, DEN-3, and DEN-4). The four
dengue serotypes are sufficiently different that infection with one type does not provide
immunity to infection with the others, so individuals can be infected multiple times (the
first infection is referred to as primary, subsequent ones as secondary). There is some
evidence that secondary infections are more likely to develop into the more severe
manifestation of the disease known as dengue hemorrhagic fever (DHF) through a

47
mechanism known as antibody dependent enhancement (ADE) that allows increased
uptake and virus replication during a secondary infection (Cummings et al. 2005).
Humans and other primates are the only known natural vertebrate hosts for dengue
infection. Although the forest dengue strain that usually infects wild primates is
genetically distinct from the endemic/epidemic strains usually infecting humans, both
groups can be infected with either strain.

THE VECTORS

The main vector of dengue is the yellow fever mosquito Aedes aegypti, but the Asian
tiger mosquito, Aedes albopictus is also a competent vector and can function as an
interhabitat bridge vector for the arboviruses (Lourenço-de-Oliveira et al. 2004).
Ae. aegypti is a medium-sized dark mosquito with black and white striped legs and a
silvery white lyre shaped pattern of scales on the dorsal side of the thorax (Figure 1).
With origins in Africa, Ae. aegypti now has a cosmopolitan range that extends from 30
degrees N to 35 degrees S latitude. Prior to the arrival of Ae. albopictus in North
America in the 1980s, Ae. aegypti was a common mosquito throughout the
southeastern United States. Now it occurs primarily in urban areas in south Florida,
southern Louisiana and southeastern Texas, and is occasionally found in neighboring
states and also in Arizona where conditions are usually too dry for the establishment
of Ae. albopictuspopulations.

Adults are found within or near human environments, often biting indoors or in sheltered
areas near houses. This mosquito is predominantly a day biter, but may rarely bite early
in the night. Containers of water, both natural and artificial, serve as larval habitats for
this species. Examples include discarded cans, tires, roof gutters, water barrels, flower
pots, phytotelmata (plant held water bodies such as those occurring in bromeliad axils
and tree holes), miscellaneous water holding debris, and many others.

Ae. albopictus is characterized by its small, black and white body. It also has black and
white striped legs but instead of a lyre pattern, it has a single silvery white scale stripe
along the dorsal side of the thorax (Figure 1). The original range of this species was
throughout the oriental region from the tropics of Southeast Asia, the Pacific and Indian
Ocean islands, north through China and Japan and west to Madagascar. During the
19th century, its range expanded to include the Hawaiian Islands. It was introduced into
Texas in 1985, and since then has expanded to include close to 30 States in the United
States and 866 countries worldwide (CDC 2007). It is found throughout Florida with the
possible exception of the Florida Keys. In many places, the arrival of Ae. albopictus has
been associated with the decline in the abundance and distribution of Ae.
aegypti (O'Meara et al. 1995). Ae. albopictus occurs in the same types of habitats

48
as Ae. aegypt,however, it occurs in non-urban locations more frequently than Ae.
aegypti, and in general, tends to prefer less urbanized areas than the former species
(Rey et al. 2006).

THE DISEASE

Infection starts when the virus is injected via the bite of an infected mosquito. Viral
replication is relatively quick, and within about a day the virus can be found in regional
lymph nodes; from there, the virus quickly spreads throughout the body. During this
infectious phase, the virus can be passed on to uninfected mosquitoes that bite the
infected person, and these can spread the disease to other persons.

Symptoms of dengue usually start within 4 to 6 days after infection and include high
fever, severe headache, pain behind the eyes, severe joint and muscle pain (hence the
name “break-bone fever”, often used to describe the disease) , nausea, vomiting, and
skin rash. Some cases develop much milder symptoms, which can be mistaken for a flu
or other viral infection.
Symptoms of the disease last 6-8 days. Fever usually manifests itself about four days
after infection, but the virus can be detected in the body a day or two before that (Figure
2). During the early stages of the disease, diagnosis is made by detection of viremia
because antibody loads are not high enough at those times for diagnosis.

Dengue hemorrhagic fever is a potentially fatal complication characterized by high

fever, damage to lymph and blood vessels, bleeding from the nose, gums, and from
under the skin, enlargement of the liver, and circulatory failure. The symptoms may
progress to massive bleeding, shock and death (dengue shock syndrome - DSS). DHF
Symptoms usually manifest themselves 6-10 days after infection.

SIGNS AND SYMPTOMS

A symptom is something the patient feels or reports, while a sign is something that other
people, including the doctor detects. A headache may be an example of a symptom,
while a rash may be an example of a sign.

As there are different severities of dengue fever, the symptoms can vary.

49
Mild Dengue Fever - symptoms can appear up to seven days after the mosquito
carrying the virus bites, and usually disappear after a week. This form of the disease
hardly ever results in serious or fatal complications. The symptoms of mild dengue fever
are:

• Aching muscles and joints

• Body rash that can disappear and then reappear
• High fever
• Intense headache
• Pain behind the eyes
• Vomiting and feeling nauseous

Dengue hemorrhagic fever (DHF) - symptoms during onset may be mild, but gradually
worsen after a number of days. DHF can result in death if not treated in time. Mild
dengue fever symptoms may occur in DHF, as well as the ones listed below:

• Bleeding from your mouth/gums

• Nosebleeds
• Clammy skin
• Considerably damaged lymph and blood vessels
• Internal bleeding, which can result in black vomit and feces (stools)
• Lower number of platelets in blood - these are the cells that help clot your blood
• Sensitive stomach
• Small blood spots under your skin
• Weak pulse

Dengue shock syndrome - This is the worst form of dengue which can also result in
death, again mild dengue fever symptoms may appear, but others likely to appear are:

• Intense stomach pain

• Disorientation
• Sudden hypotension (fast drop in blood pressure)
• Heavy bleeding
• Regular vomiting
• Blood vessels leaking fluid
• Death

COMPLICATIONS OF DENGUE

50
The majority of people suffering from dengue fever get better within 2 weeks. However,
some individuals can suffer fatigue and depression for months after the infection.
Dengue fever can develop to harsher forms of the disease i.e. Dengue hemorrhagic
fever and Dengue shock syndrome.

TREATMENT OPTIONS

Because dengue is a virus there is no specific treatment or cure, however there are
things the patient or the doctor can do to help, depending on the severity of the
disease.

For milder forms of dengue the treatment methods are:

• Prevent dehydration - high fever and vomiting can dehydrate the body. Make sure
you drink clean (ideally bottled) water rather than tap water. Rehydration salts can
also help replace fluids and minerals.
• Painkillers - this can help lower fever and ease pain. As some NSAIDs (non-steroidal
anti-inflammatory drugs), such as aspirin or ibuprofen can increase the risk of
internal bleeding, patients are advised to use Tylenol (paracetamol) instead.

The following treatment options are designed for the more severe forms of dengue
fever:

• Intravenous fluid supplementation (IV drip) - in some harsher cases of dengue the
patient is unable to take fluids orally (via the mouth) and will need to receive an IV
drip.
• Bloood transfusion - a blood transfusion may be recommended for patients with
severe dehydration.
• Hospital care - it is important that you be treated by medical professionals, this way
you can be properly monitored (e.g. fluid levels, blood pressure) in case your
symptoms worsen. If the patient is cared for by physicians and nurses experienced
with the effects and complications of hemorrhagic fever, lives can be saved.

PREVENTION

At present there is no dengue vaccine; one is currently in development. Even so,

developing a vaccine to protect against four closely related viruses that can cause the
disease will not be easy. The best method of prevention is to avoid being bitten by

51
mosquitoes. If you live or travel to an area where dengue exists, there a number of
ways to avoid being bitten:

• Clothing - your chances of being bitten are significantly reduced if you expose as
little skin as possible. When in an area with mosquitoes, be sure to wear long
trousers/pants, long sleeved shirts, and socks. For further protection, tuck your pant
legs into your shoes or socks. Wear a hat.

• Mosquito repellants - be sure to use one with at least 10% concentration of

DEET, you will need a higher concentration the longer you need the protection,
avoid using DEET on young children.

• Use mosquito traps and nets - studies have shown that the risk of being bitten by
mosquitoes is considerably reduced if you use a mosquito net when you go to sleep.
Untreated nets are significantly less effective because the mosquito can bite the host
through the net if the person is standing next to it. Also, even tiny holes in the netting
are usually enough for the mosquito to find a way in. Nets that have been treated
with insecticide are much more protective. Not only does the insecticide kill the
mosquito and other insects, it is also a repellent - fewer mosquitoes are likely to
enter the room(s).

• Smell - Avoid wearing heavily scented soaps and perfumes.

• Windows - use structural barriers, such as window screens or netting.

• Camping - if you are camping, treat clothes, shoes and camping gear with
permethrin. There are clothes which have been treated with permethrin.

• Certain times of day - try to avoid being outside at dawn, dusk and early evening.

• Stagnant water - the Aedes mosquito prefers to breed in clean, stagnant water. It
is important to frequently check and remove stagnant water in your home/premises.

• Turn pails (buckets) and watering cans over; store them under shelter so water
cannot accumulate in them.

52
 • Remove the water from plant pot plates. To remove mosquito eggs, clean and
scrub them thoroughly. Ideally, do not use plant pot plates.

• Loosen soil from potted plants. This will prevent puddles from developing on the
surface of hard soil.

• Make sure scupper drains are not blocked; do not place potted plants and other
objects over the scupper drains.

• Gully traps that are rarely used should be covered; replace gully traps with non-
perforated ones, and install anti-mosquito valves.

• Do not place receptacles under or on top of any air-conditioning unit.

• Flower vases - change the water every other day. When you do so, scrub the
inside of the vase thoroughly and rinse it out.

• Leaves - make sure leaves are not blocking anything which may result in the
accumulation of puddles or stagnant water.

VIII MEASLES

What is Measles?

Measles, also called rubeola, is a highly contagious respiratory infection that's caused
by a virus. It causes a total-body skin rash and flu-like symptoms, including a fever,
cough, and runny nose. Though rare in the United States, 20 million cases occur
worldwide every year.

Since measles is caused by a virus, there is no specific medical treatment and the virus
has to run its course. But a child who is sick should be sure to receive plenty of fluids
and rest, and be kept from spreading the infection to others.

53
Signs and Symptoms

While measles is probably best known for the full-body rash it causes, the first
symptoms of the infection are usually a hacking cough, runny nose, high fever, and red
eyes. A characteristic marker of measles are Koplik's spots, small red spots with blue-
white centers that appear inside the mouth.

The measles rash typically has a red or reddish brown blotchy appearance, and first
usually shows up on the forehead, then spreads downward over the face, neck, and
body, then down to the arms and feet.

Is Measles Contagious?

Measles is highly contagious — 90% of people who haven't been vaccinated for
measles will get it if they live in the same household as an infected person. Measles is
spread when someone comes in direct contact with infected droplets or when someone
with measles sneezes or coughs and spreads virus droplets through the air. A person
with measles is contagious from 1 to 2 days before symptoms start until about 4 days
after the rash appears.

Measles is very rare in the United States. Due to widespread immunizations, the
number of U.S. measles cases has declined in the last 50 years. Before measles
vaccination became available in the 1960s, more than 500,000 cases of measles were
reported every year. From 2000 to 2007, just an average of 63 cases per year was
reported.

However, in 2008 the United States saw an increase in measles cases and outbreaks
(more than three or more linked cases), with 131 cases reported between January and
July. More than 90% of those infected were not immunized or immunization status was
unknown.

The most important thing you can do to protect kids from measles is to have them
vaccinated according to the schedule prescribed by your doctor.

Prevention

Infants are generally protected from measles for 6 months after birth due to immunity
passed on from their mothers. Older kids are usually immunized against measles
according to state and school health regulations.

54
For most kids, the measles vaccine is part of the measles-mumps-rubella
immunizations (MMR) or measles-mumps-rubella-varicella immunization (MMRV) given
at 12 to 15 months of age and again at 4 to 6 years of age.

Measles vaccine is not usually given to infants younger than 12 months old. But if
there's a measles outbreak, the vaccine may be given when a child is 6-11 months old,
followed by the usual MMR immunization at 12-15 months and 4-6 years.

As with all immunization schedules, there are important exceptions and special
circumstances. Your child's doctor should have the most current information regarding
recommendations about the measles immunization. Measles vaccine should not be
given to pregnant women or to kids with untreated tuberculosis, leukemia or other
cancers, or people whose immune systems are suppressed for any reason.

Also, the vaccine shouldn't be given to kids who have a history of severe allergic
reaction to gelatin or to the antibiotic neomycin, as they are at risk for serious reactions
to the vaccine.

During a measles outbreak, people who have not been immunized (especially those at
risk of serious infection, such as pregnant women, infants, or kids with weakened
immune systems) can be protected from measles infection with an injection of measles
antibodies called immune globulin if it's given within 6 days of exposure. These
antibodies can either prevent measles or make symptoms less severe. The measles
vaccine also may offer some protection if given within 72 hours of measles exposure.

Vaccine Side Effects

Measles vaccine occasionally causes side effects in kids who don't have underlying
health problems. The most common reactions are fever between 6-12 days after
vaccination (in about 5%-15% of kids getting the vaccine) and a measles-like rash,
which isn't contagious and fades on its own (in about about 5% of vaccinated kids).

Treatment

There is no specific medical treatment for measles. To help manage symptoms,

which usually last for about 2 weeks, give your child plenty of fluids and encourage
extra rest. If fever is making your child uncomfortable, you may want to give a non-
aspirin fever medication such as acetaminophen or ibuprofen. Remember, you should
never give aspirin to a child who has a viral illness since the use of aspirin in such
cases has been associated with the development of Reye syndrome.

55
Kids with measles should be closely monitored. In some cases, measles can lead to
other complications, such as otitis media, croup, diarrhea, pneumonia, and encephalitis
(a serious brain infection), which may require antibiotics or hospitalization.

In developing countries, vitamin A has been found to decrease complications and death
associated with measles infections. In the U.S., vitamin A supplementation should be
considered for children between 6 months and 2 years who are hospitalized with
measles and its complications. Also, all kids older than 6 months with risk factors, such
as vitamin A deficiency, weakened immune system, or malnutrition may benefit from
vitamin A supplementation.

When to Call the Doctor

Call the doctor immediately if you suspect that your child has measles. Also, it's
important to get medical care following measles exposure, especially if your child:

• is an infant
• is taking medicines that suppress the immune system
• has tuberculosis, cancer, or a disease that affects the immune system

Remember that measles, a once common childhood disease, is preventable through

routine childhood immunization.

http://kidshealth.org/parent/infections/lung/measles.html#

IX CHICKEN POX

Chicken pox is a generalized infection caused by the varicella zoster virus, a member of
the herpes virus family . It is characterized by a blistery rash, poetically described as a
“dew drop on a rose petal base.” It occurs most frequently in children, between the ages
of five and eight. Less than 20 percent of all cases in the U.S. affect people over the
age of 15. Chicken pox is highly contagious to non-immune individuals (up to 90%),
although the disease severity can range from asymptomatic to serious illness with
complications. Having the disease usually creates life-long immunity, although it is
possible to get chicken pox again, particularly when the first case happened at less than
one year old or if the person becomes immunocompromised. Anyone who has had

56
chicken pox may later develop Shingles, which is a local recurrence of the rash, often
quite painful. Shingles comes from the initial infection and not from being exposed
again.

Certain children are at risk for more severe disease. These include newborns, any
children with an underlying immunodeficiency, such as children undergoing treatment
for cancer, and children on steroids. Additionally, because the virus can be spread to a
developing fetus, non-immune pregnant women who have been exposed and any
pregnant woman who develops the rash should seek medical care.

Description of Chicken Pox (Varicella)

Chicken pox is contracted by touching an infected person's blisters or anything that has
been contaminated by contact with them. The virus is also airborne since it may be
spread by an infected person by coughing and sneezing even before the rash develops.
Another way to get chicken pox is by direct contact to shingles, a localized rash caused
by the same virus. People with shingles are not infectious by the respiratory route.

The incubation period (time between exposure to the illness and the appearance of
symptoms) of chicken pox is 10 to 21 days. It is contagious from one to two days prior
to the rash until all of the blisters have crusted, typically about a week.

Typically, the younger the patient, the less severe the disease, and some people get
infected without ever showing any signs of illness. Variations of the disease course,
although rare, can be very severe, particularly in at risk patients, and can include
disseminated disease, hemorrhagic disease, and secondary bacterial infection.

Because of the current efforts to vaccinate children and prevent the disease, as well as
the potential risks from the disease, the old practice of having “Chicken Pox parties” to
ensure that children did get the disease while young is discouraged.

Symptoms of Chicken Pox (Varicella)

There are usually no symptoms before the rash occurs but occasionally there is fatigue
and some fever in the 24 hours before the rash is noticed. The typical rash goes
through a number of stages:

1. First it appears as flat red splotches

2. They become raised and may resemble small pimples
3. They develop into small blisters, called vesicles, which are very fragile
4. They may look like drops of water on a red base

57
5. As the vesicles break, the sores become pustular and form a crust - the crust is made
of dried serum, and not true pus. Itching is severe in the pustular stage.

The vesicles tend to appear in crops within two to six days. (This is an important
difference from small pox, where the lesions can look similar to chicken pox, but they
are all in the same stage.) All stages may be present in the same area. They often
appear on the scalp and in the mouth, and then spread to the rest of the body, but they
may begin anywhere. They are most numerous over shoulders, chest and back. There
may be only a few sores, or there may be hundreds. In patients with pre-existing
eczema, the lesions may first appear in the eczema patches.

The doctor should be called if the rash involves an eye, if fever is higher than 103, if
there is much vomiting, or if there are signs of bacterial infection (such as a green or
yellow discharge from the blisters, or any blisters with red streaks radiating outwards).
Go to the emergency room if there is difficulty breathing, indicating a possible
pneumonia, or if the person is confused, disoriented, ataxic (unsteady), has seizures, or
shows any other neurologic signs. When seeking medical attention, remember to let
health care providers know that the child might have chicken pox so that proper
isolation policies can be instituted to prevent additional exposures.

Treatment of Chicken Pox (Varicella)

The major problem in dealing with chicken pox is control of the intense itching and
reduction of the fever. Warm baths containing baking soda or oatmeal can help;
sometimes cool compresses or cool baths will calm itching. Anti-itching medication such
as diphenhydramine (Benadryl) and hydroxyzine (Atarax) can also be helpful. Topical
lotions may also help, but care should be exercised that children are not overdosed with
diphenhydramine by accidentally giving it by mouth and lotion. Steroid containing anti-
itch creams should never be used.

Aspirin should not be used for children or adolescents with chicken pox because of the
associated risk of Reye's syndrome, a rare but life-threatening condition. Fever can be
treated with acetaminophen. Ibuprofen should be avoided because of the association of
its use and more severe disease.

Cut the fingernails or use gloves to prevent skin damage from intense scratching. When
lesions occur in the mouth, gargling with salt water may provide comfort. Drink cold
fluids, and avoid hot, spicy, and acidic foods (e.g., orange juice).

Hands should be washed frequently and all of the skin should be kept clean in order to
prevent a complicating bacterial infection. If a bacterial infection is suspected or

58
becomes severe and results in the return of a fever, see a physician. Again, please
remember to announce that the child has chicken pox so that others may be
appropriately protected.

Scratching and infection can result in permanent scars. A visit to the physician may not
be necessary, unless a complication seems possible.

Acyclovir (Zovirax), an antiviral drug, can be used if started in the first day of the rash. It
is usually not necessary in previously well children, but is recommended for
immunocompromised patients.

Because chickenpox is extremely contagious, keep children home from daycare or

school until the blisters are all crusted over.

Prevention of Chicken Pox (Varicella)

Chicken pox can be prevented through vaccination (now recommended by almost all
major national health and public health groups). Recommendations are:

• Children and Adolescents: Healthy children can be vaccinated, optimally at

age 12 to 18 months or anytime through age 12, if they have no history of
chicken pox. Adolescents 13 years and older who have no history of chicken pox,
should receive two doses of vaccine four to eight weeks apart. Duration of
immunity after vaccination is not completely known. Re-vaccination with a
booster dose to sustain immunity through adulthood is currently being
considered.
• Adults: Two doses of varicella vaccine four to eight weeks apart are
recommended for healthy adults with no history of chicken pox or previous
vaccination. Health care workers, daycare workers, employees of colleges or
residential facilities, family members of immunocompromised individuals, and
others who live or work in environments in which transmission may be easy are
particularly encouraged to receive vaccination.

Most adults who do not know their immune status are, in fact, immune. However,
whenever there is a need to know, blood tests are available to check a person’s
immune status.

The vaccine is designed to prevent serious disease and it is highly effective for this
purpose. It is still possible to get a mild form of chicken pox, even after receiving the
vaccine. Sometimes, the vaccine itself can produce a few chicken pox lesions.

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The vaccine may also be used as part of post-exposure prophylaxis to prevent disease
in someone who has had a known exposure. It should be given within three days of the
exposure and would count the same as routine immunization. Additionally, within the
first four days, exposed individuals may get VZIG, a special anti-varicella
immunoglobulin that protects against infection, but does give any lasting protection, so
that the person should be immunized at a later time.

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 PICTURES

Chlamydia

Syphilis Cough

61
Classification of burns

62
Diabetes Mellitus

63
64
Dengue

65
PROTECT YOUR
FAMILY FROM
Tuberculosis
DENGUE

66
Measles

67
68
Chicken pox

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 ACTIVITY SHEET

ACTIVITIES NAME OF HOUSEHOLD NUMBER OF MEMBERS TOTAL

INFORMED

1. Sangkap Pinoy Seal Desenia Olantes 2

Information Marilyn Balian 1
Filamy Minas 4
Nena Martinez 1 8
2. Iodized Salt Desenia Olantes 2
Utilization Marilyn Balian 1
Filamy Minas 4 8
Nena Martinez 1
3. Breast Examination Desenia Olantes 2
Marilyn Balian 1
Filamy Minas 4 8
Nena Martinez 1

4. Communicable Desenia Olantes 2

Diseases Marilyn Balian 1
Filamy Minas 4 8
Nena Martinez 1

5. Operation Blood Caroline Dawagi 3

Pressure Jona Bao-idan 1
Nieves Libag 1 7
Roda Pallay 1
Desiree Alones 1

Prepared by:______________________

FAMILY PLANNING

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 NAME OF AGE DATE VISITED BP FAMILY PLANNING NUMBER OF REMARKS
ACCEPTOR METHOD USED FAMILY
PLANNING
SUPPLIES
Joyce Abag July16, 2010 100/70 Ligated

PRENATAL VISIT

NAME OF LMP GP AGE DATE TT DATE REMARKS

MOTHER RECEIVED FERROUS
SULFATE
GIVEN
Filamy Minas February 23, G1P0 27 years old TT1-July 5th month With regular
2010 check up

OPERATION TIMBANG

6-12 years old

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 NAME OF CHILD DATE WEIGHED AGE IN YEARS WEIGHT REMARKS

GRADE 1

Atting, Glenton July 1, 2010 6 17

Macasling, Swenson July 1, 2010 6 25

Pulsingay, Auston Jones July 1, 2010 5 17

Rivera, Jheric July 1, 2010 7 14

Andizo, Remgiel July 1, 2010 6 20

Bayangan, Lyzza July 1, 2010 6 13

Bayangan, Rose July 1, 2010 5 15

Caga, Francine July 1, 2010 6 18

Gisinguino, Kathy July 1, 2010 5 18

Sabado, Ritchelle July 1, 2010 5 14

Tenias, Yvonne July 1, 2010 5 17

GRADE 2

Agagen, Kyle July 1, 2010 7 20

Bao-idan, Brent July 1, 2010 7 17

Bao-idan, Flynn Jay July 1, 2010 7 20

Dat-ay, Graem Wayne July 1, 2010 7 19

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Eleno, Jomar July 1, 2010 7 20

Manuel, Alimark July 1, 2010 7 21

Sebio, Eric July 1, 2010 A A

Alen-an, Sky-lyn July 1, 2010 6 16

Lesino, Jade Nicole July 1, 2010 7 20

Tam-ing, Ziarelle July 1, 2010 7 18

Tenias, Sheryll July 1, 2010 7 19

GRADE 3

Caga, Ydrienne July 1, 2010 7 17

Wakat, Dennis July 1, 2010 10 30

Langpa, Jerwin July 1, 2010 9 25

Liwan, Denzel July 1, 2010 7 18

Ruiz, Mikey July 1, 2010 7 21

Baoeiden, Jinky July 1, 2010 7 18

Bayangan, Willsrah July 1, 2010 7 19

Dumapi, Kenjie July 1, 2010 9 25

Alones, Clint July 1, 2010 8 20

GRADE 4

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Carino, Mark July 1, 2010 8 25

Bao-idan, Jick July 1, 2010 8 20

Argabis, Verneil July 1, 2010 9 22

Oracion, Jazz Mark July 1, 2010 8 20

Palonan, Justin July 1, 2010 9 30

Abag, Jezer July 1, 2010 10 22

Balian, Keren July 1, 2010 9 22

Minas, Crisler July 1, 2010 8 20

Alones, Jeslyn July 1, 2010 9 24

Tenias, Supranee July 1, 2010 9 25

Olanles, Jodelyn July 1, 2010 11 30

Dopingay, Dan Kurt July 1, 2010 10 21

Agyapas, Cherry July 1, 2010 9 23

Alones, Mariel July 1, 2010 11 24

Bonoy. Keith July 1, 2010 8 30

GRADE 5

Bayangan, Shane July 1, 2010 11 27

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Wayan, Pandy July 1, 2010 10 26

Oracion, Jeriel July 1, 2010 11 26

Bao-idan, Jenard July 1, 2010 13 33

Talio, Rolly July 1, 2010 10 34

Incio, Jonel July 1, 2010 10 28

Tenias, Aiza July 1, 2010 10 28

Manuel, Eleonor July 1, 2010 11 34

Satur, Jela July 1, 2010 9 31

Libag, Rey July 1, 2010 11 30

Bao-idan, Edric July 1, 2010 10 31

Andizo, Raygic July 1, 2010 10 26

Billao, Norriel July 1, 2010 11 32

Bao-idan, Gabriella July 1, 2010 11 24

GRADE 6

Argabis, Jezred July 1, 2010 11 25

Abag, Joshua July 1, 2010 12 31

Vicente, Jerelyn July 1, 2010 10 31

Bonog, Keziah May July 1, 2010 11 28

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Dao-agey, Renelyn July 1, 2010 11 47

Osting, Letty July 1, 2010 11 45

Baguilat, Chariz July 1, 2010 11 30

Atting, Xyra Mae July 1, 2010 11 38

Atting, Jessa Mae July 1, 2010 10 34

Minas, Justine Joy July 1, 2010 11 27

Bao-idan, Edralin July 1, 2010 11 34

Sabado, Unimarie July 1, 2010 11 26

EXECUTIVE SUMMARY REPORT

COMMUNITY EXPOSURE

MUNICIPALITY: Buguias, Benguet

76
BARANGAY: Tonglo
REVISED: FIRST SEMESTER
SECOND SEMESTER

OBJECTIVE: to render quality and health related services based on community needs and guided by the principles of
COPAR

TABLE I: HEALTH PROMOTIVE AND PREVENTIVE ACTIVITIES

NATURE OF SERVICES NUMBER OF CLIENTS

1) Blood Pressure Monitoring/Taking 17
2) Annual Physical Examination -
3) Weight Monitoring 17
4) Breast Examination -
5) Herbal Garden -
6) Environmental Sanitation 6
7) Immunization 12 A(H1N1) vaccine and Tetanus Toxoid

TABLE II: SERVICE IN SUPPORT OF THE NUTRITION PROGRAM OF THE DOH

WEIGHT MONITORING

OPT CLIENTS NUMBER OF CLIENTS

1) Total Population 0-71 months 6
2) With Normal Weight
3) Above normal weight
4) Below Normal Weight
5) Very Low Weight
TABLE III: MATERNAL AND CHILD HEALTH SERVICES

SERVICES NUMBER OF CLIENTS

1) Ante-Natal care -

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2) Post-Partum Care -
3) Newborn Care 1
4) Discussion of the Family Planning method 1
5) Decided to Use the Method -
TOTAL

TABLE IV: CASES ATTENDED DURING THE PERIOD

SITIO HEALTH PROBLEM or MEDICAL NUMBER OF CLIENTS/CASE

CASE
Saclalan Hypertension 2

Tonglo Hypertension 2
Goiter 1
Gout 1
Stroke 1
Bayang 4

TABLE V: REFERRALS

PATIENT AGE ADDRESS CHIEF COMPLAINT WHERE RESULT OF

REFERRED REFERRE REFERRAL/R

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 D EMARKS
Mr. Ganado Saclalan, Hypertension Midwife
Amgaleyguey
Mrs. Ganado Saclalan, Hypertension Midwife
Amgaleyguey

Desenia 51 Tonglo, Hypertension Midwife

Olantes Amgaleyguey
Lola kape Saclalan, New Born Care Midwife
Amgaleyguey
Filamy Minas 27 Tonglo, Pregnant Midwife
Amgaleyguey
Belen Minas 57 Tonglo, Hypertension Midwife
Amgaleyguey
Tonglo, Stroke Midwife
Amgaleyguey
Nena Martinez 57 Tonglo, Goiter, Hypertension Midwife
Amgaleyguey
Julio Martinez 49 Tonglo, Gout, Hypertension Midwife
Amgaleyguey
Vicente, Marliz 5 Tonglo, Bayang Midwife
Amgaleyguey
Vicente, Jezler 7 Tonglo, Bayang, parasite Midwife
Amgaleyguey infestation (lice),colds,
dental carries
Marlyn Balian 34 Tonglo, Breast Lump Midwife
Amgaleyguey
Judielyn 11 Tonglo, Dental carries, colds Midwife
Olantes Amgaleyguey
Jhaira Mae 7 Tonglo, Dental carries, colds Midwife
Baucas Amgaleyguey

Kezia Balian 7 Tonglo, Parasite infestation Midwife

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 Amgaleyguey (lice),colds, dental
carries

TABLE VI: HEALH TRAINING AND EDUCATION

A. HEALTH TRAINING ACTIVITIES

TOPICS PARTICIPANTS/ DATE

NUMBER OF CLIENTS
Dengue, Measles, 9 July 29, 2010
Chicken Pox, Nutrition,
Tetanus, TB, Diptheria,
Mumps, Pertusis,

B. INFORMATION DISSEMINATION

HEALTH FOCUS NUMBER OF CLIENTS/FAMILY RECIPIENTS

Dengue 4 families
Pneumonia, Influenza, Cholera, Typhoid, 2 families
Shigella, Type 1 DM, Hepatitis, Helminthiasis
Scabies, Rabies, Leptos Pyrosis 2 families

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TABLE VII: LINKAGES AND NETWORKING

1) WITH GOVERNMENT AGENCIES

GOVERNMENT AGENCY PURPOSE OF RESULT

COORDINATION/LINKAGE

2) WITH PRIVATE AGENCIES

PRIVATE AGENCY PURPOSE OF COORDINATION/LINKAGE

3) WITH PEOPLE’S ORGANIZATION

PEOPLE’S ORGANIZATION PURPOSE OF COORDINATION/LINKAGE

AGAMANG

4) OTHER DEVELOPMENTAL PROGRAMS/PROJECTS IMPLEMENTED

NATURE OF THE PROGRAM BRIEF DESCRIPTION

TABLE VIII: ACCOMPLISHMENT REPORTS SUBMITTED

REPORTS DATE OF SUBMISSION SUBMITTED TO

1) CDX

81
2) CDPR
3) OTHERS specify

82