Accidents can happen anywhere, anytime. Medical assistance is not always readily available on the spot.  It takes time for a doctor and/or nurse to get to the location, while in most emergencies, time is of the essence. This is why the more people that know how to do first aid, the better.  One of BIMC Hospital’s key objectives is to teach basic first aid training to as many people as possible. One resort that has directly benefitted from basic first aid training is AYANA.

Knowing the importance of first aid, AYANA holds regular first aid training for their staff, provided by BIMC Hospital. The training program is a half day class providing information on how to respond in accident and emergency situations. There are certain ways to effectively call for help, to check and help someone who just had an accident, and also not least important, how to safely help people without giving the patient further injuries or injuring one self.

On 21 January 2010, I Made Suriadi, a member of AYANA’s pool deck team, was one of the trainees to recently attend the half day first aid training class. In the course, he learnt first aid tecniques for common accidents and emergencies.  In the resuscitation practical lesson, techniques included how to open the airway, check breathing, giving rescue breaths, perform chest compressions, etc. Never would he imagine he would need to put his new skills to use so soon.

Just one day after Suriadi earned his basic first aid certificate, on 22 January 2010, he found one of the hotel guests nearly drowning in the hotel’s main pool. The resort’s pool is deeper in the middle  than on the sides, and the guest swam to the middle and panicked. Suriadi and his fellow worker, Nadia, quickly reacted to prevent the guest from drowning.  With the help of some of the hotel’s gardening staff who were working nearby, they took the guest out of the water.  Suriadi promptly implemented his training, checking the guest’s airway, breathing and circulation. Luckily, the quick response saved the guest from any submersion injury and he totally recuperated without any complications after recovering from the shock.

This is a great example of how important basic first aid training is.

]]> http://bimcbali.com/news-update/saved-one-soul.html/feed http://bimcbali.com/news-update/dr-dianwaty-sppd.html http://bimcbali.com/news-update/dr-dianwaty-sppd.html#comments Mon, 25 Jan 2010 09:21:36 +0000 BIMC-Doctor http://bimcbali.com/?p=142
read more ...]]> “Patient comes first”. This is one of BIMC doctors’ motto in practice. Our doctors use all available resources to identify the diagnosis and give proper treatment. In some special cases, BIMC doctors need to consult other doctors, specialists in their field, for definitive treatment. One of them is Dr. Dianwaty, internal medicine specialist.

The term “Internal Medicine” originally comes from the German term Innere Medizin, a discipline popularized in Germany in the late 1800s to describe physicians who combined the science of the laboratory with the care of patients. Many early 20th century American doctors studied medicine in Germany and brought this medical field to the United States. Thus, the name “internal medicine” was adopted. Like many words adopted from other languages, it unfortunately doesn’t exactly fit an English meaning. So, an internal medicine specialist, or also known as internists, does not mean they only deal with the “internal body organs”.

To make it simple, internal medicine doctors are specialists focusing in prevention, diagnosis and treatment in non-surgical adult diseases. Internists, such as Dr. Dianwaty,  are equipped to deal with whatever problem a patient brings — no matter how common or rare, or how simple or complex. They are specially trained to solve puzzling diagnostic problems and can handle severe chronic illnesses and situations where several different illnesses may strike at the same time.

The newest member of the BIMC doctors’ team, Dr. Dianwaty, had her internal medicine education at Makati Medical Center, Phillipines. In addition to her education abroad, this Atma Jaya Universtiy graduate, also attended a one year adaptation program at Universitas Indonesia, Jakarta, One of the finest universities in Indonesia.

Dr. Dian, will be available to discuss the best treatment for diseases such as hypertension, cholesterol problems, thyroid function disorders, diabetes, etc, with you. Do not hesistate to call for an appointment.

When an emergency call is made to an emergency hotline, time is of the essence as a life may be at risk.  Knowing where the caller is telephoning from is of utmost importance. With the new GPS installed in their ambulances, BIMC aims to get to an emergency in the fastest possible time, not waste valuable time looking for a hotel, house or villa.

BIMC Hospital has loaded participating BIMC members’ addresses into the GPS unit’s database along with a photo of the front of the house/villa as an identification icon.  There are currently over 200 members participating in the program.  In addition, the GPS is also loaded with coordinates of hotels, restaurants and other tourist attractions spots which may be useful in an emergency.

It’s good to know that GPS can not only help us save time in our daily lives, but can also help save lives … daily.

BIMC HOSPITAL
24 Hour Medical & Emergency Centre
T. (+62-361) 761263
www.bimcbali.com

The official medical term is tinea pedis.  Tinea means infection from dermatophyte fungi and pedis means foot, so it clearly is a fungus infection of the foot.  Although this infection is actually not an exclusive of the foot, it can also spread or infect the nails, groin, or armpits.  Practically, almost any skin area can get this fungus infection, anywhere that has a keratin layer.

It is the most common fungus infection and is found in around 70% of the world’s population.

Transmission

Most commonly from moist environments where people walk barefoot such as showers, bath houses, locker rooms or sharing footware from an infected person.  Rarely, it can be transmitted from sharing towels with an infected person.

Keep in mind the fungus still needs the right environment, which is the warm and humid skin, to grow and cause the infection.

Symptoms

The infection shows as a skin rash and itchiness.  Some conditions may be flaky skin, small bumps, cracked, blistered, peeling area, or “cheesy” appearance with bad odor.

Another important fact is that it is not an infection exclusively on the foot, it can also spread or infect the nails, groin, or armpits.  Practically, almost any skin area can get this fungus infection.

What you can do?

Most over-the-counter antifungal medications works to kill the fungus, however other measures are necessary for the complete treatment:

• Keep your feet as clean and dry as possible.
• Carefully dry your feet after bathing and showering. Remove flaky skin each day with dry tissue paper or gauze.
• After drying your feet, apply the antifungal treatment.
• Follow the instruction on how long you should apply the medication. Most of the time it takes weeks to complete the treatment.

Whenever in any doubt, ask your doctor. Your doctor might perform a test by scraping the affected area.  Don’t worry this procedure is painless.  A special laboratorium process can see objectively under the microscope which type of fungus is the cause.

Prevention

• Keep your feet clean and dry, especially after showering. Make sure you dry your feet thoroughly, especially between the toes.
• Avoid tight or synthetic closed footware. If possible, wear open sandals or shoes with porous soles and uppers.
• Wear light socks made of natural absorbent fibres, cotton would be the fabric of choice in Bali.
• Change your socks daily.
• Dry your sneakers under the sun to make them dry. You may add some shoe disinfectant.
• Go barefoot at home occassionally.
• Wear sandals around pool areas, public showers and gyms to steer clear of the fungus.
• Don’t share towels or footwear.

Swine flu is a highly contagious acute respiratory disease of pigs caused by influenza A virus.  It causes high levels of illness and low death rates in pigs. Swine influenza viruses may circulate amongst pigs throughout the year. Studies show 30-50% of commercial US swine have been infected with swine flu.  The mortality rate is 1-4%.

Swine flu viruses do not normally infect humans. However, they do sometimes cross the species barrier to cause disease in humans. The current human swine flu outbreak is caused by the H1N1 subtype.

What  are symptoms in human?

The symptoms are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have also reported diarrhea and vomiting. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people.

How do people get infected?

Humans can get infected from direct contact or close proximity to infected pigs, so people working in the pig industry are most susceptible. Human-to-human transmission can also occur.  It spreads mainly through coughing or sneezing. Sometimes people may become infected by touching something with the flu viruses on it, e.g. surfaces contaminated by droplets from a cough or sneeze and then touching their mouth or nose before washing their hands. The virus is thought to be able to live approximately 2 hours on surfaces.

Infected people may be able to infect others beginning 1 day before symptoms develop and up to 7 or more days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

Swine influenza viruses are not transmitted by food. You can not get swine influenza from eating pork or pork products. Eating properly handled and cooked pork and pork products are safe. Cooking pork to an internal temperature of 70˚C kills the swine flu virus.

What is the major concern?

Although the current swine flu does not have a high mortality rate, it is known to be highly contagious. Like all influenza viruses, swine flu viruses change constantly. When influenza viruses from different species infect a single subject, the viruses can reassort (i.e. swap genes) and new viruses that are a mix of swine, human and/or avian influenza viruses can emerge.

The concern is if the new virus has a high morbidity and mortality rate, i.e. spread easily person-to-person and have a high death rate, then a pandemic can occur.  The disease can cause a global outbreak and can sweep across the country and around the world in very short time.

How does it affect Bali?

Currently, Bali is free from swine flu, either in pigs or human. However, special precautions are already performed since Bali has a high traffic of international travelers.

To get up to date information about this topic, visit our website www.bimcbali.com

Tips to Prevent Flu Transmission

Influenza can spread mainly from person to person through coughing or sneezing. Sometimes people may become infected by touching something with flu viruses on it, e.g. surfaces contaminated by droplets from a cough or sneeze and then touching their mouth or nose before washing their hands.

What can I do to protect myself from getting flu?

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth.
• Try to avoid close contact with sick people.

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick, limit your contact with other people as much as possible. Do not go to work or school if ill. Cover your mouth and nose with a tissue when coughing or sneezing. It may prevent those around you from getting sick. Put your used tissue in the waste basket. Cover your cough or sneeze if you do not have a tissue. Then, clean your hands and do so every time you cough or sneeze.

What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner. We recommend that when you wash your hands — with soap and warm water — that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn’t need water to work; the alcohol in it kills the germs on your hands.

Education and training is still a major focus for BIMC Hospital. Besides routine continuing medical staff training to update their knowledge and skills, the MEDT department also take social responsibility to educate non-medical people in first aid training. To mark the 11 years celebration BIMC Hospital conducted two classes of First Aid Training specifically for  Taxi drivers and Non Profil Organisation. Blue Bird taxi drivers, staffs from Yayasan Kemanusiaan Indonesia, IDEP Foundation, Bali Orphan Foundation, Yayasan Bali Hati, Bali Nurani Foundation, Yayasan Bumi Sehat, ROLE Foundation and SLBN PTN Bali were among the participants.

The main celebration event was held on July 26th with a staff gathering.

The anniversary was sponsored by: Bali Hai Cruises, Hard Rock Hotel, Waterbom Bali, Kopi Bali House, Natural Spa & Reflexology, Peneeda View Beach Hotel, Sobek, Bounty Cruises, Billabong, Bali Discovery Tours, Bali Dynasty Resort, New Kuta Golf, Bali Garden Beach Resort, Telkomsel, 100 Sunset Boutique Hotel, Villa Air Bali, Disini Villas, Harris Resort Kuta, The Gangsa, Sentosa Private Villas And Spa, St. Regis, Be Wish Tour & Travel, Ochanoma Cafe, Galang Production, Softsign Panelneon, The Jakarta Post and L’ Ultimo Paradiso.

BIMC is proud of its 11 year of service and certainly will continue giving its best in medical assistance in Bali.

Snoring happens when the muscles in the roof of your mouth (soft palate), tongue and throat vibrates in a relaxed condition during sleep.

Some conditions which may precipitate snoring are inflammation of the respiratory tract such as hay fever, influenza or sinusitis, alcohol, obesity and smoking.  Children can also snore due to enlarged tonsils.

Habitual snoring may just be annoying and cause daytime sleepiness, but in some conditions it may cause serious health problems, that is when it is sleep apnea.

When you snore and notice some of these symptoms you might have sleeping apnea.

• Excessive daytime sleepiness
• Loud snoring
• Episodes of “not breathing” during sleep
• Abrupt awakenings accompanied by shortness of breath
• Waking up with a dry mouth or sore throat
• Morning headache
• Difficulty staying asleep (insomnia)

Apnea is a Greek word for “without breath”.  When sleep apnea is related to the topic above, it is called obstructive sleep apnea.  There is also another type, called central sleep apnea, when the brain doesn’t send proper signals to the muscles that control breathing.

In obstructive sleep apnea, the relaxing muscles of throat and tongue with the narrowing airways causes a transient stop of breathing.  This may lower the level of oxygen in the blood.  When the brain senses this condition, it rouses you from sleep so you wake up and open your airway.  This “wake up call” is usually brief and most people do not remember it.  This pattern may repeat 20 - 30 times each hour.  This disruption may cause the symptoms of sleep apnea.

Before you consult your doctor, you can folow these tips to avoid snoring:

• Sleep on your side. Lying on the back allows the tongue to fall backward into the throat
• Reduce yor body weight if you are overweight. People who are overweight have more loose throat tissue which are more likely to vibrate when they breathe and extra bulkiness in the throat would make the airway more narrow.
• Reduce your alcohol intake and avoid drinking alcohol 4-5 hours before sleep, since alcohol acts as a sedative, relaxing the throat muscles.
• Stop smoking. Smoking may increase the amount of inflammation and fluid retention in the upper airway.
• Don’t take sleeping pills or sedative medicines. These medicines will relax the throat muscles.

When all of the above doesn’t help, you should consult your doctor.  A long term of apnea epsidose may cause serious complications, such as:

• Cardiovascular problems. The sudden drop of oxygen level may increase blood pressure and strain the cardiovascular system.
• Fatigue. Without a good night sleep, people with sleep apnea often experience severe daytime drowsiness, fatigue and irritability. They may also experience difficulty concentrating.
• Others : morning headaches,mood swings, depression, need to urinate frequently at night, etc.

There are several treatments available, either to reduce snoring or correct the sleep apnea condition.  From simple oral appliances to advance surgery of the throat.  Managing something seemingly simple and common as snoring can actually increase your quality of health and give your partner a restful night of sleep.

Further studies have developed the conventional X-ray to the more advanced diagnostic equipments, such as the CT-Scan, Ultrasound, etc. But the famous black and white x-ray is still widely used as one of the first line diagnosis, because it is a simple, fast,  and a relatively inexpensive procedure.

If you ever had an x-ray before you will know that after the radiology technician takes the “shot”, they will process the image in a machine that will print it to a special film. Then the doctor will show you the X-ray film on a lamp box. Some disadvantage of this conventional technology is:

• It takes spaces Just 1 or 2 films won’t be much a problem, but imagine if you needed serial
  X-rays and have to bring each one at every follow up. Not to mention the need to store it for months or years to show your doctor next time.
• It causes chemical waste. The x-ray film contains certain chemicals that are shed during the printing process, therefore showing the image we see on the film. These chemicals need special processing before it can be dispossed of or if possible, recycled.
• It’s impractical. Besides taking space. Some x-rays are also large and since they shouldn’t be folded, it can be difficult to transport these films.

Now with the advancement of digital technology, X-rays become simpler and environmentally friendly. With the digital technology, after the “shot”, the technician will input the image into a computer and process it digitally. The digital image can be processed, as you edit your photo in a graphic program. So, the doctors can zoom in a certain area they think is abnormal, they can sharpen the image, they can try to get a better picture of what’s in your body. Storage also becomes much more easier because it can be saved in a CD. The doctor will have the file saved in his database, or when you go to another hospital you can simply give the CD and they just need to pop it in their computer.

SPF
The sun protection factor (SPF) or filtering power of a sunscreen product determines what percentage of the ultraviolet rays get through to the skin. An SPF of 15 allows only 1/15 (7%) of the sun’s rays to get through and thereby extends safe sun exposure from 20 minutes to 5 hours without the skin burning. A SPF higher than 15 protects against sunburn for more than 5 hours.

Tips:
• When going to the beach use a sun block with a SPF 25 or higher.
• For every day use, apply sunscreen with SPF 15 or higher.
• Children generally should avoid direct sunlight, use protective clothing such as a hat, long sleeved shirt, sunglasses etc. If needed, apply a creamy non-fragrant sun block with SPF 25-30.
• Babies under 6 months must avoid direct sunlight.

Type
There are several kinds of sunscreen available. Lotion and cream are the favorites, and give good protection. Oil is easy to apply because it spreads more easily, but it only provides a thin layer of protection and needs more frequent application and in addition, it causes a greasy sensation on the skin. Gel is also easy to apply but it also tends to wash or sweat off more easily and there’s usually a stinging sensation caused by the alcohol content contained in it. Sun block sticks are good, but problematic to apply on larger areas. Nowadays the dry spray on lotion is also popular and provides good protection. However, sprays aren’t recommended. It’s wasteful and most of the effective content is lost to the air and it usually forms an uneven layer on the skin.

Tips:
• Use the type of sunscreen of your preference. Make sure you read the recommendation when to reapply the sunscreen (usually every 3 or 4 hours).
• Apply sunscreen 30 minutes before exposure to the sun to give it time to penetrate the skin.
• Give special attention to the areas most likely to become sunburned, such as your nose, ears, cheeks and shoulders.

Waterproof
Sunscreens will wash away with sweat and water, especially after swimming. Some sunscreens proclaim to be waterproof or water resistant. Research shows that the “water resistant” sunscreen can maintain their SPF after 40 minutes of water immersion, and the “waterproof” after 80 minutes. Saltwater reduces the SPF faster than freshwater. This brings out a new production of “surf shop sunscreens” that proclaims to maintain effective SPF for seawater activities, however, there are no significant studies to show that these are more resistant.

Tips:
• Apply the sunscreen at least twice more frequently than recommended (about every 2 hours) for water activities, especially for sea water activities.
• Re-apply immediately after swimming or profuse sweating.

Sunscreen and Others
Besides sunscreen, you might consider to use insect repellent when you visit Bali. In some areas, mosquitoes can be quite a problem. Concomitant use of sunscreen with DEET, the active component in most insect repellents, lowers the effective SPF by 34%!

Tips:
• Use a sunscreen with SPF 30+.
• Some sunscreens are safe to apply on the face and lips, just make sure the type of sunscreen applied is appropriate for these areas.

More
• Use a sunscreen every day even when it’s a cloudy day.
• Wear UV close-fitting protecting sunglasses to protect against eye damage. (read our article about sunglasses)
• Wear sun protective clothing. Dark, tightly woven clothes are best.
• Use shade and limit your exposure to the sun, especially between 10 am and 4 pm, when radiation is at its strongest.
• Don’t forget to keep hydrated, drink a lot of water.
• Wear a hat that protects your face, neck and ears.

Source:
• MdConsult
• National Safety Council: Sun Safety Program
• Auerbach: Wilderness Medicine 4th ed., Mosby, 2001

What is it?
Our bodies have wonderful mechanisms for sensing and making sense out of motion. There are several important motion sensing parts of the body. The semicircular canals of the inner ear are like miniature levels that orient the head in space. The eyes also constantly update the brain with information about motion. In addition, the nerves in our joints, especially the ankles, knees and spine, are motion detectors. Even the light touch sensors of the skin can detect our movement in the air.

Normally, these different sensors provide our brains with a coordinated, immediate sense of how our body is moving and how the brain should respond.

Motion sickness can result when there is a mismatch between these different systems. If the brain gets conflicting information from the ears and eyes or joints, the histamine receptors in the vomiting centres of the brain may be stimulated to slow down the movement of the GI tract. Even the sight of food can be unpleasant. The brain wants the body to take a break until it can figure things out.
When does it happen?
The word nausea is derived from the Greek word for ship – naus. Perhaps linguists connected the movement of the ship with sea sick. Actually many different types of motion can cause sickness including travel by sea, air, train, car, swing, space, camel, elephant, in fact virtually anything that moves. Other environmental stimuli that can cause motion sickness include exposure to artificial environments such as flight stimulators, amusement park rides and planetarium or IMAX theatres.
Who gets it?
Under the right circumstances, anyone can experience motion sickness. Some people are more susceptible to it than others. It tends to be worst on first boat trips or plane rides or space voyages, before the brain has a chance to get used to the new sensations. Sometimes a previous bad experience will trigger a new bout of motion sickness on an even gentler trip. Even anticipation of a ride can trigger symptoms. Either way, motion sickness tends to improve with age and eventually with experience.

Children in the back seat of the car are more susceptible when their height limits their view to seemingly stationary objects in the car. Reading also makes car sickness worse by focusing the attention on something that does not appear to be moving. The inner ears sense motion, but the rest of the body does not.

Some people get vertigo when standing over great heights because the visual cues of normal body swaying are lost over the great distances.

Some people get queasy, or at least a funny feeling in the stomach, when watching intense motion on a movie screen. The eyes suggest movement; the ears and joints and skin do not.

The most common places for motion sickness are cars, planes, boats, playground equipment and amusement park rides.
Many times the previous 24 hours are the reason for motion sickness not the journey itself. Hangovers, over tiredness, anxiety, minor illnesses all contribute to motion sickness. A heavy meal, full of fat and possibly over spiced, does not help either. Too many carbonated and or alcoholic drinks can unsettle your stomach, which will make you more sensitive to motion sickness during the journey. Therefore if you are not fit, rested and healthy you will probably suffer more motion sickness than you usually do.
What are the symptoms?
Mild motion sickness usually begins with a funny feeling in the stomach. If the mismatch in motion signals is not resolved to the brain’s satisfaction, the symptoms may progress to include sweating, yawning, crying (in babies), increased saliva, pallor, nausea and vomiting. Some people also breathe more quickly. Some have a headache. Some even faint.
Is it contagious?
Somewhat. The nausea centres of the brain are more sensitive when others are vomiting.
How long does it last?
The motion sickness lasts until soon after the motion has stopped, or until the brain has become comfortable with the motion.
How is it treated?
Either stop the motion, or do what you can to help the motion make sense to the brain.

Sometimes fresh air and focusing attention outside of the vehicle can provide enough additional information to the brain to break the cycle of motion sickness.

Sometimes, it is best to stop the car or merry-go-round and take a break. Frequent stops can make a big difference. Distraction (perhaps from a song) can also help.

Height vertigo can often be treated by sitting down and by focusing on a nearby object. Queasiness when watching a movie can be lessened by moving with the image.
Treatment for the nauseated children. Have your child lie down and keep a vomiting pan handy. Give him only sips of clear fluids until his/her stomach settles down. If your child goes to sleep, let him sleep. Usually, children don’t vomit more than once and all symptoms disappear in about 4 hours.
How can it be prevented?
Some antihistamines can block the chemical signals of motion sickness. If this is a frequent problem for your child, talk with your health care provider about how and when to use these medications.

Try arranging trips to reduce conflicting cues and take breaks early when symptoms do develop.

Other tips
• Avoid exposure to the causative situation as much as possible
• Stay in a central location on a boat or ship or in an aeroplane
• Sit in front seat of a car or central position in the rear seat, or drive rather than be a passenger
• Focus on a stable horizon or external object
• Avoid jerky, sudden movements when driving
• Eat a light meal then avoid food for three hours before departure
• Avoid heavy meals, dairy products and foods high in protein, calories or salt
• Avoid alcohol, smoking and strong smells
• Have access to cool, fresh air
• Avoid visual stimuli (e.g. reading, watching videos)
• Limit head movements (e.g. press head into the headrest)
• Lie in a supine position with eyes closed
• Have cognitive behavioural therapy with a psychologist
• Take medications for prevention and treatment
• Note that habituation or adaptation will occur with increasing length of exposure to the causative situation

Source:
• Dr. Greene’s webpage
• Medical Progress Journal