Penyakit Dalam Century

8/7/2019 Penyakit Dalam Century

1/42

Womens Health CurriculumWomens Health Curriculum

in Internal Medicinein Internal Medicine

Postgraduate TrainingPostgraduate Training


2/42

Prof. Dr. dr. Zubairi Djoerban, SpPD-KHOM

Dr. dr. Siti Setiati, SpPD-KGer, Mepid

dr. Purwita W. Laksmi, SpPD Dra. Sumarjanti

dr. Stephanie Dewi

Kanu Eltrantri


3/42

Background InformationBackground Information

Kolegium Perhimpunan Ahli Penyakit Dalam Indonesia

(Colegium of Indonesian Internal Medicine Specialist)

>1.900 Specialist in Internal Medicine

FKUI / Cipto Mangunkusumo: AIDS, Lupus, Breast Ca etc Unit Pelayanan Terpadu HIV RSCM

5.273 patients treated with Anti Retro Viral

110 ambulatory patients per day

287 pregnant women with HIV (2008-2011)

People Living with HIV/AIDS problems: Medical, Social, Economy


4/42

ClinicalCompetenceORGAN/SYSTEM COMPETENCIES

Hematology, Medical Oncology, Allergy

Hepatology, Pulmonology, Endocrinology

Cardiology, Nephrology, Psychosamtic

Geriatry, Gastroenterology, Rheumatology

SITE SPECIFIC

Consultative, Critical Care

Emergency Medicine

POPULATION SPECIFIC

Womens Health, Substance abuse

Geriatrics, Adolescent

Humanism

Profesionalism

Medical EthicsSocial Protection

Lifelong study

Clinical method

Clinical reasoning

Diagn.Process

Home care Rehabilitation

Management of Practice

Medical Informatics

IntegrativeCompetence


5/42

Womens health is one measure of a country health

and development

The scope of womens health is wide and complex, that

related with gender differences

Terima kasihTerima kasih

Background


6/42

The figures are largely due a very sharp increase in cases

in China, Indonesia and Vietnam which alone make up 50%

of the continents population.

http://indonesia.unfpa.org/hivaids.htm

http://www.guide4living.com/hiv-aids/asia.htm

http://data.unaids.org/Publications/Fact-Sheets04/fs_icaap_ap_01july05_en.pdf

Terima kasihTerima kasih

The HIV/AIDS epidemic in Indonesia is one of

the fastest growing in Asia


7/42

Five countries account

for the majority of PLHIV in

the Region

Four of these countries are

among the countries with

the highest burden of TB

HIV Prevalence in the South-East Asia Region: 2008

India:

2,300,000

Myanmar

42,000

Thailand

610,000

Nepal

70,000

Indonesia

293,000


8/42

735

744

755

759

907696

Thn 2004 Thn 2005 Thn 2006 Thn 2007 Thn 2008 Thn 2009

JUMLAH PASIEN BARU PERTAHUN

Number of people treated with ARV

until 31 Jan 2010: 4.590

7 Maret 2011: 5.273

Number of New Cases on 2004 - 2009


9/42

Tunai91%

jankesmas

4%

gakin2%

SKTM3% askes

PNS0%


10/42

215

370

10 13 14

0

50

100

150

200

250

300

350

400

BELUM KAWIN KAWIN DUDA JANDA TIDAK JELAS

Number of New Cases according to Marital Status JAN-NOV 2010

Single Married Divorced (M) Divorced (F) N/A


11/42

12181178

1491

1065

13501378

1440 1461

1351

1665

14091,460

418 403

503461 454

494 492 511446

499 514551

0

200

400

600

800

1000

1200

1400

1600

1800

Jan Feb Mrt Arp Mei Juni Juli Agst Sept Okt Nop Des

Number of Patient with ARV according to Gender

at POKDI HIV Clinic 2010

F

M


12/42

14591421

1777

16401608

16761740

1772

16201669

1711

1,796

177 160221

180 196 196 192 200 177 191218 215

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Jan Feb Mrt Arp Mei Juni Juli Agst Sept Okt Nop Des

Number of Patient with ARV according to Age

at POKDI HIV Clinic 2010

CHILDREN

ADULT


13/42

Female sex workersFemale sex workers

95,000- 157,000 Direct FSWs and 85,000- 107,000 Indirect

FSWs in Indonesia in 2006

6-16% of Direct FSWs and 2-9% of Indirect FSWs wereinfected with HIV

Chlamydia trachomatis 43.5% Jakarta, Bali 29.9%

Nesseiria gonorrhea 44.2 Jakarta, Bali 28.6% Active syphilis 9.2% Jakarta, Bali 4.8%

HIV: 6.25% Jakarta

Integrated Biological-Behavioral Surveillance among most-at-risk group in Indonesia 2007


14/42

Drug UsersDrug Users

190,000 - 248,000 IDU in Indonesia in 2006

IDU continue to have the highest prevalence of HIV among most-

at-risk-groups in Indonesia. The prevalence of HIV was 55-56% in

the three of the four cities in which biological data were collected,

but somewhat lower in Bandung (43%)

Prevalence of HIV 55.02% Jakarta, 56% Surabaya

Syphilis 0.1% Jakarta, Surabaya 1.6%

Gonorrhea 1.3% Jakarta, Surabaya 1.2%


15/42


16/42

The main objectives are to provide information on

multidisciplinary approach and treatment in managing

certain disease related toWomens Health including

social well being, which in turn raising the social

protection issues as more attentions are drawn into

the womens health subject, including HIV/AIDS in

women

Terima kasihTerima kasihObjectives


17/42

Gender is the social construction of the biological differences

between men and women

Gender is not Sex

Gender is not Women

Gender is a focus on the unequal

relations between men and women

Gender is learned, socially determined

behaviour


18/42

To consolidate the inclusion of womens health (24 meetings)

To develop modules on womens health issues in the curriculum form

postgraduate training of Internal Medicine in Faculty of Medicine

University of Indonesia

To increase capacity building: 10 lectures trained

To implement pilot on the curriculum for postgraduate training of internal

Medicine in Faculty of Medicine University of Indonesia:

Lectures

Observation

Evalution.

Terima kasihTerima kasihMethods


19/42

Terima kasihTerima kasihResults and Achievements


20/42

Topic: Gender Inequities in Health

Men and women have different needs

Different needs must be understood so as to respond in an

equitable and efficient manner to them

Terima kasihTerima kasihGuest Lecturer: Assoc Prof Dr Rosalia

Sciortino, Mahidol University


21/42


22/42

HEALTH

a state of completephysical, mental, and social

well-being and not merely the

absence of disease orinfirmity


23/42

SOCIAL DETERMINANTS OF HEALTH

The economic, political and social conditions

under which people live which determine

their health. Virtually all major diseases are

primarily determined by a network of

interacting exposures that increase or

decrease the risk for the disease.


24/42

Prof. DR. dr Zubairi Djoerban, SpPD-KHOM

Prof.DR.dr Sjamsuridjal Djauzi, SpPD-KAI

DR. dr Siti Setiati, SpPD-KGer, Mepid

dr. Aida Lydia, SpPD-KGH

DR dr. Noorwaty Sutandyo, SpPD-KHOM

dr. Purwita Widjaya Laksmi, SpPD

Terima kasihTerima kasihModule Development Team


25/42

From 25 meetings, the module is compiled in a

handbook

Includes topic of womens health module and related

health department incharge

Terima kasihTerima kasihHandbook


26/42

10 topics

Social Protection and Gender Issue

Infertility Issue

Healthy Lifestyle for

Women

Adolescence Health

HIV/AIDS

Pregnancy and Lactation

Menopause and Menstruation Issue Substance Abuse

Contraception Issue

Infection Prevention and STDs

Terima kasihTerima kasihImplementation


27/42

The inclusion of womens health in the curricula (25 meetingsheld and attended by 20 lecturers)

Module is compiled

To increase capacity building: 24 lectures trained

Lectures : Total 16 x 2 semester , with National Simposia

Observations for 3 semester : Includes interactive discussionson problem with patient with HIV/AIDS, includes their socialand psychiatric problem

Evaluation: Evaluation for the module

Evaluation for the activites and knowledge learnt

Evaluation for the topic discussed


28/42


29/42


30/42


31/42


32/42


33/42

Womens Health needs a holistic and multi

disiplinary approach , managing empathicly

including social and economic problem, that wasundermanaged previously

Recommendation given is implementation of the

modul in the curricula of postgraduate training in

internal medicine in other Indonesia educational

university centers.

Terima kasihTerima kasihLessons Learned


34/42

Thank youThank you


35/42

Topic: Gender Inequities in Health

Men and women have different needs

Different needs must be understood so as to respond in an

equitable and efficient manner to them

Terima kasihTerima kasihAssoc Prof Dr Rosalia Sciortino

Mahidol University


36/42

The difference between Sex and Gender

SEX: biological and physiological characteristics of males and

females (reproductive organs, chromosomes, hormones, etc)

GENDER: expected behaviour, roles, activities and attitudes

that have been learnt or imposed on us according to our sex.

This includes

economic, social and cultural attributes and opportunities

socially constructed roles, rights, responsibilities,

possibilities, and limitations assigned to women and men.

These roles are (a) hierarchical, (b) privilege one group

(often men) over another, (c) leads to unequal power

relations


37/42

GenderGender-- sensitive healthcare. Why bother?sensitive healthcare. Why bother?

Biological differences alone cannot explain different disease

patterns between females & males

Health conditions often affect women and men differently

Men and women who suffer from the same condition often:

exhibit different health seeking behaviours

present with different symptoms

are often misdiagnosed(especially women) - leads to

delays in adequate treatment


38/42

Can we afford gender-blind health care!

High maternal mortality ratio women attending antenatal

care but not coming for delivery

High use of ineffective alternative care for some acute illnesses

and also many chronic health conditions

Flight of health workforce from rural to urban

High burden of health care on women at the home level

Millions impoverished from health care costs, and there is

feminization of poverty


39/42

Why is social protection needed?Why is social protection needed?

Economic growth has been the driving force in reducing

poverty in the region. To reduce poverty, this requires that

more people become economically productive citizens

Without additional measures, the advantages of the market

economy may be limited to a part of society, those who are

educated, own productive assets, n have participated in

successful economic activities


40/42

Why is social protection needed?Why is social protection needed?

Social protection benefits the poor and non-poor

since both are exposed to risks such as crop failures,

illnesses, accidents, disability or death of thebreadwinner, or simply getting old and not able to

work


41/42

What are the benefits of social protection?What are the benefits of social protection?

Social protection prevents poverty Social protection improves quality of human capital

Investments in education and skills development increase the

competitiveness of the labor force

Social protection generates growth by raising domestic

demand, contributes to a stable demand and helps achieve

stable economic growth

Social protection increases social cohesion Social protection programs can help countries achieve their

MDGs related to poverty reduction and improving the

provision of health care and education


42/42

K

Terima kasihTerima kasihThe

Documents

Penyakit Dalam Century