5th DaY Maternal and Child Health, Family Planning

So basically today was the 5th day of our posting, and for the first time we were not posted in District Health Office in Kubang Pasu but we had to travel further up north to Klinik Kesihatan Changlun. On our arrival we were greeted by the warm welcome of Sister Shaebah, the sister in charge of the clinic. As usual, in the mornings the clinics will be quite busy but still Sister Shaebah managed to find some time to explain us the organization and the services provided in the Changlun Health Clinic.

                This Kliinik Kesihatan Changlun is actually one of the 8 Klinik Kesihatan under the Kubang Pasu District Health Office. And it also supervises 6 other Klinik Desa which are located aroud the area. This clinic is basically run by  1 specialist doctor, 1 medical officer, 1 sister which is Sister Shaebah, 2 Jururawat Kerja Am (JKA), 5 Jururawat Kesihatan, and 6 Jururawat Masyarakat. Basically, this clinic caters for pregnant and post natal ladies, children and also outpatient department

Antenatal Care

   Booking - Before 12 weeks by the staff nurse or community nurse 

Flow chart of antenatal mothers

Booking

                 - Recorded in Kad (a) (given to mother) , Kad (b) is kept for records
                 - UPT done to confirm pregnancy
                 - Vital Signs, Weight, height, blood pressure, and general examination is done
                 - Rubella status, Tetanus toxoid dose status determined
                 - Routine Lab Investigations: Blood typing and rhesus, VDRL, HIV Rapid Test,
                   Blood glucose and Hb levels, Urine glucose and protein

Mothers ‘red book’ are separated based on  risk (colour tags) and area (colour string)
Based on risk,
a. White I (Option to deliver at hospital)
b. White II (Option to deliver at home or alternative birth centre)
c. Green: Refer to medical officer
d. Yellow: Refer to Family Medicine Specialist
e. Red: Refer for immediate hospital admission (Consultant Obstetrician)

Based on residence,


Colour string based on location



Routine Visits
a. General examination - Weight Gain, Blood Pressure,
b. Lab investigation - Urine Tests (protein and sugar) and Hb levels
c. Obstetrics examination- Gestational weeks , SFH , Presentation and lie of fetus
d. Fetal Kick Chart (At quickening/28 weeks)

e. Ultrasound monitoring
f. Anti- Tetanus toxoid : usually given after quickening (20th week and 1 month later)
• For primigravida
i. 1st and 2nd dose.
• For multi
i. 1 dose only
ii. Gap > 5 years after previous pregnancy (2 doses)

Frequency of visit:
1 to 28 weeks - monthy
28- 36 weeks - monthly
36 weeks onwards- weekly
Frequency increases based on severity


After 12 weeks of gestation, mothers are started on hematinics. Hematinics given include:
- Folic acid
- Ferrous Fumarate
- Vitamin B Complex
- Vitamin C

Management of HIV positive mother

Besides, we were told that health seminars were held for antenatal mothers such as  Healthy Eating during pregnancy, Growth of fetus in Womb, Birthing Process, and Diabetic in Pregnancy. Mothers coming for routine check up are made to attend the seminar.

Intranatal Care

Alternative Birth Centre- only for white tagging with no complications
Preffered by some patients as it is closer to their home and is husband friendly

Currently, ABC  isn’t active as they are shifting to another location.

Postnatal Care

The community nurses will do home visits on day 1 till 4, followed by day 6, 8 10 and 20.
Attention will be given particularly at mother’s episiotomy wound, cesarean section wound, and baby’s jaundice if any.

After one month post delivery, the mother will bring her baby to the clinic for assessment. For the mother:
- weight
- urine analysis
- haemoglobin
- palpation to assess uterine involution
- advice on family planning methods

For the child,           



Child visit schedule



                                    
- Anthropometrics measurement
o Weight
o Length
o Head circumference
o Chest circumference
- Full physical examination

Immunization

 

               

      As for Family Planning Department , it is basically run by all the staffs in this clinics, but most of it is handled by the the Jururawat Masyarakat. Only certain high risk cases such as congenital problems or other health problems such as HIV patients will be handled by the specialist. Majority of the patients at Family Planning are post natal women, who wish to space out their pregnancies. Pap smear services are also provided by this department. However, there is no fixed budget for this department, and according to Sister, the budget provided by District Health Office is usually very low, resulting in inability to carry out any activities. Thus, most of the activities regarding family planning such as ‘ceramah’ and campaigns are done by NGO’s and private personals with the help of clinic staffs.

Flow chart in family planning clinic

                As for the type of contraceptives, only pills , condoms and injection is provided here. The main reason why only these contraceptives are given out here is because due to State Health policy. Any individual wishing to have other type of contraceptive such as IUD will have do it in the private hospitals or clinics. Among these three, pill method is the most commonly used.

 

                Counseling services are also provided for high risk pregnancies, pre marriage pregnancies and also for pre pregnancy period for married women. Among the challenges here are most of the patients do not adhere to the TCA dates, making the process of contraception less effective.

                From Klinik Kesihatan Changlun, we went further up north to another Klinik Kesihatan which was located adjacent to the border if Malaysia-Thailand, Klinik Kesihatan Laka Temin. Even here, their family planning department runs on the same system as in Changlun with the same type of drugs and services.