Re: Indonesia BF - 5/17/06
Re: Indonesia BF - 5/17/06
<TABLE class=contentpaneopen><TBODY><TR><TD class=contentheading width="100%">Bird flu in North Sumatra: the Failure of the Application of Health Epidemiology </TD><TD class=buttonheading align=right width="100%">
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</TD></TR></TBODY></TABLE><TABLE class=contentpaneopen><TBODY><TR><TD vAlign=top align=left width="70%" colSpan=2>Written by editorial staff </TD></TR><TR><TD class=createdate vAlign=top colSpan=2>On Wednesday, on May 17 2006 </TD></TR><TR><TD vAlign=top colSpan=2>By Fotarisman Zaluchu
With the most startled feeling, we read the news how bird flu happened in
North Sumatra. The discovery of the case of positive bird flu to humankind in North Sumatra happened in the Karo Regency. What meaning that? That meant North Sumatra will face a big homework. Bird flu was a serious problem where his mortality rate achieved almost 75 percent of the case that was found in Indonesia. In the other country, the mortality rate resulting from bird flu that was measured was based on Case Fatality Rate (CFR) in fact could reach 100 percent.
Then was not abundant if bird flu becomes a big threat for the world now. The world was threatened by the pandemic that spread, as happening in the HIV/AIDS. the Level of the death resulting from bird flu that very high made the problem of this illness become the horror illness. Almost all the countries made use of the supervision system that very tight to prevent the attendance of this bird flu virus in his country.
This dikarenakan the cost that emerged as a result of the problem, very much was present, very high. For his patient, every time the case happened, was needed by the handling that very especially to prevent the spread to that other that still was healthy. That no longer for fees has looked for the source of the spread, as well as the extermination of the source of the spread.
Epidemiology
Epidemiology was knowledge that studied concerning the problem of the illness, the spreading and factors that affected him. With epidemiology, was built the monitoring system, the detection and the control of the problem of the health easily. That dikarenakan in epidemiology, was known that his name of an amount of equipment that will help prevented or controlled the illness.
One of the applications of epidemiology was that each illness was present not very, but with the certain pattern. This pattern in connection with time, the place and the person. Meaning that, the illness had the certain pattern, places that enabled, as well as people that in an epidemiological manner very susceptible or was easy tertular or suffered the certain illness.
If made use of exact epidemiology, then bird flu in fact could have been guessed will happen where. Take the example of the matter of the place. In view of the fact that bird flu spread through the poultry, then they that was close to this region really will be easy tertular. Strangely indeed, the case that happened in North Sumatra apparently must be researched more far, because of cases of the spread that happened in Indonesia only around Java and South Sumatra. Why happened in the Karo Regency, this needed the research and epidemiology investigation.
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Was related to the person, they who are affected by bird flu usually did not know the age and gender.However had the matter that could be done in an epidemiological manner, that is that is gotten by risky groups higher to get this illness.This risk was because of having the certain characteristics that increased the possibility of receiving the illness.They were the breeders, the birds breeder, the user of poultry fertiliser, as well as that was in the livestock breeding region.The problem is, indeed controlled this in our place really was difficult.Most locations of poultry livestock breeding very much close to humankind so as to facilitate the spread of the illness.Only with used the data concerning time, the place and the person above, then epidemiology could have guessed what will happen to an area.Then necessarily, policy makers have in this area applied one of the main weapons epidemiological, that is the mechanism surveilans.Surveilans essentially was efforts that were carried out continually to monitor and pay attention to the running of the illness.There is now the view, especially from the health senior figure in this area, that stated that North Sumatra did not experience the case of bird flu.This was the way of thinking that very much the incorrect usage.Not the discovery of the case of bird flu was uptil now caused at least by several matters.Firstly, each illness had that his name the natural story of the illness.Meaning that, without the intervention, each illness will follow a trip beginning with the stage where not yet emerging the sign up to the stage where the illness has been increasingly serious.The lack of the discovery of the case of bird flu could because the period that was passed was still not known, because was in the zone that was acknowledged as sub-clinical.Supposing that having the discovery of the case then, then this case has been slow in being handled because the case trip usually is long enough.
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Secondly, not the discovery of the case of bird flu could also be significant that the detection system that was done did not satisfy to find the case.Meaning that the official of the health did not work maximal or detection equipment did not satisfy for that.On the other hand the discovery of the case also not weigh down that the case increased, but possibly because the official of the health just worked hard by making use of the sophisticated implement.So, who might not with too much hurried guaranteed that North Sumatra free from bird flu.This statement did not have a basis and completely lead astray even disturbed the community.Came back to the monitoring had a name surveilans, the problem of the health in fact could be controlled as early as possible if this equipment went well.The system surveilans gathered the data continually monitored.The monitoring was based on the graph that was made for that, as well as mengeksekusi the decision was linked with the jump of the illness.Escape him knowledge concerning the monitoring of bird flu in North Sumatra apparently because of the sector of the health and the sector passage, ignored surveilans.If this earlier could be applied, then as early as possible, will be done by the intervention in the area with the case of bird flu to the poultry, or the potential area experienced bird flu.The intervention quickly, epidemiology also used prangkat especially to do the intervention in the illness.That was followed by making use of three important questions, that is whether the program that has been done uptil now, then whether results that was reached with the program, following, moreover that could be done.Secara epidemiology, the first step to do the control of the problem of bird flu in this territory was to compile a team that was led by an epidemiology, that will move into two main territories, that is that was linked with the problem of the health, and that was linked with the sector apart from the health.The territory must be apart from the health involved definitely with got suport the data from the sector of the health.In this movement, the sector of the health as immediately as possible to do epidemiological investigation knew the location, the risk factor, the potential group and the spread stain of bird flu in this territory.Knowledge about this pattern as quickly as possible must be done, sembari treated his sufferer.</PRE>Menyangkut orang, mereka yang terkena flu burung biasanya tidak mengenal umur dan jenis kelamin. Namun ada hal yang bisa dikerjakan secara epidemiologis, yaitu bahwa terdapat kelompok-kelompok berisiko lebih tinggi untuk mendapatkan penyakit ini. Risiko ini ada karena memiliki karakteristik tertentu yang meningkatkan kemungkinan memperoleh penyakit. Mereka adalah para peternak, pemelihara burung, pengguna pupuk ternak unggas, serta yang berada di kawasan peternakan. Masalahnya, memang mengendalikan hal ini di tempat kita sangat sulit. Kebanyakan lokasi peternakan unggas amat dekat dengan manusia sehingga memudahkan penularan penyakit.
Hanya dengan menggunakan data-data mengenai waktu, tempat dan orang di atas, maka epidemiologi sudah bisa menebak apa yang akan terjadi pada sebuah daerah. Maka seharusnya, penentu kebijakan di daerah ini sudah menerapkan salah satu “senjata” utama epidemiologis, yaitu mekanisme surveilans. Surveilans pada hakekatnya adalah upaya yang dilakukan secara terus menerus untuk memantau dan memperhatikan jalannya penyakit.
Ada sementara pandangan, terutama dari petinggi kesehatan di daerah ini, yang menyatakan bahwa Sumatera Utara tidak mengalami kasus flu burung. Ini merupakan cara berpikir yang amat salah kaprah.
Tidak ditemukannya kasus flu burung selama ini disebabkan setidaknya oleh beberapa hal. Pertama, setiap penyakit memiliki yang namanya riwayat alamiah penyakit. Artinya, tanpa intervensi, setiap penyakit akan menempuh sebuah perjalanan mulai dari tahap dimana belum muncul gejala sampai dengan tahap dimana penyakit sudah semakin parah. Tiadanya penemuan kasus flu burung bisa karena masa yang dilewati masih belum diketahui, karena berada dalam zone yang disebut sub-klinis. Andainya ada penemuan kasus pun, maka kasus tersebut sudah terlambat ditangani karena perjalanan kasus biasanya sudah cukup panjang.
Kedua, tidak ditemukannya kasus flu burung juga bisa berarti bahwa sistem deteksi yang dikerjakan tidak memadai untuk menemukan kasus. Artinya petugas kesehatan tidak bekerja maksimal atau perangkat deteksi tidak memadai untuk itu. Sebaliknya penemuan kasus juga bukan berati bahwa kasus meningkat, namun mungkin karena petugas kesehatan baru bekerja keras dengan menggunakan alat yang canggih.
Jadi, siapapun tidak boleh dengan terlalu terburu-buru menjamin bahwa Sumatera Utara bebas dari flu burung. Pernyataan tersebut tidak berdasar dan sama sekali menyesatkan bahkan meresahkan masyarakat.
Kembali kepada pemantauan bernama surveilans, masalah kesehatan sebenarnya bisa dikendalikan sedini mungkin jika perangkat ini berjalan dengan baik. Sistem surveilans mengumpulkan data terus menerus memantau. Pemantauan berdasarkan grafik yang dibuat untuk itu, serta mengeksekusi keputusan berkaitan dengan melonjaknya penyakit.
Luputnya pengetahuan mengenai pemantauan flu burung di Sumatera Utara kelihatannya karena sektor kesehatan dan lintas sektor, mengabaikan surveilans. Jika saja ini tadinya bisa diterapkan, maka sedini mungkin, akan dilakukan intervensi di daerah dengan kasus flu burung pada unggas, atau daerah yang potensial mengalami flu burung.
Intervensi
Secara cepat, epidemiologi juga menggunakan prangkat khusus untuk melakukan intervensi terhadap penyakit. Hal itu ditempuh dengan menggunakan tiga pertanyaan penting, yaitu apakah program yang sudah dikerjakan selama ini, lalu apakah hasil yang dicapai dengan program itu, berikutnya, apalagi yang bisa dikerjakan.
Secara epidemiologi, langkah pertama untuk melakukan penanggulangan masalah flu burung di wilayah ini adalah menyusun sebuah tim yang dipimpin oleh seorang epidemiologi, yang akan bergerak ke dalam dua wilayah utama, yaitu yang berkaitan dengan masalah kesehatan, dan yang berkaitan dengan sektor di luar kesehatan. Wilayah di luar kesehatan perlu dilibatkan tentunya dengan mendapatkan suport data dari sektor kesehatan. Dalam gerakan ini, sektor kesehatan sesegera mungkin untuk melakukan penyelidikan epidemiologis mengetahui lokasi, faktor risiko, kelompok potensial dan noda penularan flu burung di wilayah ini. Pengetahuan mengenai pola ini harus secepat mungkin dikerjakan, sembari mengobati penderitanya. Masyarakat di kawasan tersebut juga difokuskan perhatiannya pada pengenalan gejala, sehingga kasus flu burung bisa diminimalisir ledakannya.
Berdasarkan data-data yang dikumpulkan itu, maka sektor di luar kesehatan bisa mengerjakan pekerjaan pemusnahan unggas (jika diperlukan), pembagian desinfektan serta penerangan kepada masyarakat, bahkan isolasi transportasi lokasi yang terserang. Apa boleh buat, untuk mencegah penularan ini ke wilayah yang lebih luas, maka hal-hal tersebut harus dikerjakan untuk sementara waktu.
Berikutnya, seluruh perangkat kesehatan di daerah ini diminta siaga. Hadirnya flu burung di satu daerah yang berdekatan akan meningkatkan risiko penularan pada daerah lain, mengingat mobilitas penduduk yang sangat tinggi. Pendistribusian data dan perangkat yang berhubungan dengan informasi ini harus dikerjakan dan dilakukan. Semua daerah harus mengawasi perubahan-perubahan yang muncul di daerahnya. Petugas kesehatan harus segera melakukan pemeriksaan secara random pada lokasi yang rawan flu burung, serta melaporkan setiap kasus diduga (suspect) pada tahap yang paling dini.
Tidak ada salahnya menyiagakan masyarakat. Seluruh upaya yang mungkin bisa dikerjakan oleh masyarakat harus dilakukan. Promosi kesehatan juga harus dikerjakan di seluruh daerah.
Inilah kejadian flu burung pertama pada manusia di Sumatera Utara. Semoga saja ini bukan awal, namun segera bisa diakhiri dan memutuskan mata rantai penularan flu burung yang semakin mengglobal ini. Kita mungkin terlambat dalam mendeteksinya, namun jangan sampai terlambat dalam menanganinya. Aplikasi epidemiologi adalah kata kunci terhadap seluruh upaya pengendalian masalah kesehatan, termasuk flu burung. (Penulis bekerja di Badan Litbang Propsu/m)
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