Tuesday, May 26, 2009

Pemberantasan Penyakit (disease wipe)

KATA PENGANTAR

Syuku Alhamdulillah penyusun panjatkan kehadirat Allah SWT yang telah melimpahkan rahmat dan karunia-Nya sehingga makalah tentang pemberantasan penyakit malaria ini rampung sudah.

Dalam kesempatan ini penyusun mengucapkan terima kasih yang sebersar-besarnya kepada para guru penyusun yang telah memberikan ilmunya kepada penyusun.

Penyusun menyadari bahwa masih banyak kekurangan yang terdapat didalam penulisan dan isi makalah ini. Oleh karena itu, atas masukan saran dan kritikan yang positif bagi perbaikan makalah ini penyusun ucapkan terima kasih. Dan akhirnya penyusun berharap semoga makalah ini bermanfaat bagi penyusun pribadi dan bagi semua pihak yang membaca dan membutuhkannya.

Banda Aceh, 18 April 2009

Penyusun


BAB I

PENDAHULUAN

A. Latar Belakang

Malaria masih merupakan masalah kesehatan masyarakat yang penting di Indonesia, khususnya diluar Jawa dan Bali, di Indonesia transmigrasi dan daerah lain yang didatangi penduduk baru di daerah non endemik sering terjadi lotusan atau wabah yang menimbulkan kematian. Lebih dari setengah penduduk Indonesia masih hidup di daerah dimana terjadi penularan malaria, sehingga beresiko tertular malaria.

Akibat dari perpindahan penduduk dan arus transportasi yang cepat penderita malaria bisa dijumpai di daerah yang tidak ada penularan. Seperti di Jakarta, walaupun tidak ada penularan malaria, tidak jarang ditemukan penderita malaria dan bahkan sampai ada penderita yang meninggal dunia karena tidak pasti diagnosisnya dan terlambat atau salah pengobatan.

Kemudian juga penyakit malaria di provinsi Nanggroe Aceh Darussalam merupakan penyakit yang bersifat endemis dan terutama menyerang masyarakat di daerah pedesaan, dan terutama sekali penduduk yang tinggal di Pulau Weh, Sabang, dan Pulo Aceh, sehingga penyakit ini masih menjadi masalah kesehatan masyarakat di daerah ini. Dari hasil penelitian terhadap PR ( Parasite Rate ) malaria, ternyata provinsi NAD merupakan daerah peringkat ketiga tertinggi di Indonesia setelah Irian dan Maluku. Itulah sebabnya, maka penyakit malaria itu termasuk salah satu masalah kesehatan yang perlu segera di tandai secara bersama-sama dengan melibatkan seluruh lapisan masyarakat.

Apabila dilihat dari angka klinis malaria di Nanggroe Aceh Darussalam pada tahun 1984 terdapat delapan penderita perseribu penduduk dengan Slide Parasite Rat (SPR) 7,60 % dan pada tahun 1985 terjadi penurunan angka klinis menjadi tiga orang perseribu penduduk, akan tetapi terjadi peningkatan SPR menjadi 16,74%.

Sedangkan dari hasil malario metric survey evaluasi yang dilakukan di daerah operasi penyemprotan pada tahun 1984 ditemukan Parasite Rate (PR) sebesar 2,94% dan pada tahun 1985 terjadi sedikit penurunan menjadi 2,31 % tetapi naik lagi pada tahun 1986 menjadi 3,29 %, sedangkan pada daerah yang sudah dilakukan operasi penyemprotan dilakukan kegiatan malario metric survey evaluasi, dimana pada tahun 2002 ditemukan Parasite Rate berkisar antara 2,79 % hingga 5,14 % dengan plasmodium fakipanin dan plasmodium viva x yang lebih dominan.

B. Tujuan

1. Tujuan umum

Menurunkan angka kematian dan mencegah terjadi Kejadian Luar Biasa (KBL) serta sedapat mungkin menurunkan dan mempersempit daerah penularan

2. Tujuan khusus

Ø Menurunkan kematian akibat malaria

Ø Untuk menjaga agar manusia tidak akan dihinggapi suatu penyakit


BAB II

PEMBAHASAN

A. Pengertian

Penyakit malaria adalah penyakit infeksi massal didaerah tertentu yang mempunyai Nyamuk Anopheles sebagai vektornya (penularnya), Agent penyebab malaria adalah plasmodium,

B. Penyebab

1. Penyebab dari Individu

a. Kurangnya kesadaran akan kebersihan diri

b. Banyak penumpukan barang-barang di kamar dan rumah

c. Kebisaan berada diluar rumah sampai larut malam

2. Penyebab dari lingkungan

a. Kurangnya pelayanan kesehatan di daerah pedesaan

b. Kurangnya penyediaan obat-obatan anti malaria di daerah pedesaan/lingkungan

c. Tidaknya perubahan prilaku dilingkungan seperti sistem penanggulangan air yang jelek

d. Tidak atau kurangnya kebersihan lingkungan seperti banyaknya penumpukan sampah dan genangan air

C. Gejala Klinis

Gejala-gejala klinis malaria yaitu :

1. Demam

Demam ini berhubungan dengan proses skizogoni (pecahnya merozoit/skiton) dan berhubungan dengan pengaruh terbentuknya sitokin dan atau toksin lainnya.

2. Pembesaran Limpa

Pembesaran limpa mengalami kongesti, menghitam, dan menjadi keras karena timbunan pigma entrosit parasit dan jaringan ikat yang bertambah, limpa penderita akan menjadi bengkak, nyeri, dan penderita akan mengalami hiperemesis

3. Anemia

Disebabkan oleh penghancuran entrosit yang berlebihan. Ganguan pembentukan entrosit karena depresi.

4. Ikterus

Disebabkan karena hemolisis dan gangguan hepar.

5. Gejala Umum

Kelesuan, malaise, sakit kepala, sakit belakang, nyeri pada tulang/otot, anorexia, perut tak enak, diare ringan dan kadang-kadang merasa dingin di punggung.

D. Penularan malaria

Penularan malaria dapat berlangsung dengan 3 cara yaitu :

1. Penularan secara alami, melalui gigitan nyamuk anopheles betina yang terinfeksi ke tubuh manusia (Natural Infection)

2. Induksi, jika stadium aseksual dalam entrosit masuk kedalam darah manusia melalui transpusi darah suntikan.

3. Ataupun seperti pada bayi baru lahir, yang masuk melalui plasenta ibu yang terinfeksi (Congunital Infection)

E. Upaya Pencegahan

Dalam melakukan pencegahan penyakit malaria, terdapat beberapa langkah pencegahan yang harus dilakukan.

Beberapa tindakan tersebut adalah sebagai berikut :

1. Meningkatkan sanitasi pribadi dan sanitasi lingkungan

2. Menggunakan insektisida untuk membasmi vektor anopheles ataupun dengan menggunakan pembunuh nyamuk elektrik.

3. Memasang kawat kasa pada rumah-rumah di daerah endemic malaria

4. Menggunakan kelambu pada waktu tidur di malam hari.

5. Menggunakan “ Insect Repellants “ pada bagian tubuh terbuka di saat tidur, terutama di malam hari

6. Pengambilan donor darah diperiksa terlebih dahulu kesehatannya, dimana orang tersebut ataupun donor tersebut harus di pastikan bebas dari malaria.

7. Kepada penderita melaria dan gametecarriers harus dipastikan bebas dari malaria

8. Mengunakan obat supressive anti malaria secara teratur bagi penduduk di daerah endemic malaria

9. Pengawasan reguler terhadap ex penderita/excarriers oleh petugas-petugas medis di unit-unit penyelenggaraan pelayanan kesehatan setempat

10. Melakukan desinseksi terhadap kapal-kapal, pesawat, dan kendaraan yang datang dari daerah endemis malaria, oleh petugas-petugas kantor kesehatan pelabuhan setempat.

11. Kepada pendatang-pendatang baru ke daerah endemis malaria, diharuskan sebelumnya menggunakan obat-obat profilaxsis anti malaria dengan chloroguin ataupun fansidar

12. Pemberian imunisasi terhadap contact case jika memungkinkan ataupun jika vaksin anti malaria telah tersedia.

F. Upaya Pemberatasan Malaria

Pada tahun 1968, sergiev dan kawan-kawannya menganjurkan bahwa untuk pemberantasan malaria perlu dilakukan empat tindakan utama, yaitu :

1. Tindakan terhadap sumber infeksi : terdiri dari 3 bagian yaitu :

a. Screening terhadap penduduk

b. Pengobatan terhadap penderita dan carries (chemothe rapia), baik dengan jalan pengobatan reguler ataupun pegobatan anti relape

c. Chemoprophylaxis, baik secara umum, perorangan, musiman ataupun waktu terjadi transmisi atau pre epidemic

2. Tindakan pemberantasan vector : terdiri dari 4 bagian yaitu :

a. Pencegahan dan pengawasan terhadap rencana pembangunan hydroprojects

b. Melikuidasi tempat-tempat berkembang biak vector

c. Membasmi larva-larva didalam air (dengan cara anti malaria hydrotechnical system biological ataupun chemical measures)

d. Membasmi nyamuk-nyamuk yang berterbangan, baik dengan cara penyomprotan DDT, pengabutan, bom aerosols ataupun dengan menggunakan alat perangkap nyamuk.

3. Tindakan pencegahan terhadap gigitan nyamuk

Merupakan tindakan yang dilakukan dengan cara zooprophy laxis ataupun dengan cara mekanik dimana manusia harus tidur di dalam kelambu dan jendela-jendela pintu rumah harus diberi kawat kasa.

4. Tindakan pendidikan kesehatan

Merupakan tindakan dengan cara memberi penyuluhan kesehatan kepada masyarakat. Dengan adanya penyuluhan kesehatan kepada masyarakat maka kita akan dapat merubah prilaku mereka dari tidak tahu menjadi tahu.

G. Prinsip dasar pengobatan malaria

Sebelum mengobati malaria terlebih dahulu kita harus mengetahui prinsip-prinsip dasar untuk pengobatan malaria, yaitu :

1. Pengobatan haruslah diberikan sedini mungkin setelah diagnosa penyakit ditegakkan

2. Pengobatan haruslah teratur dan systemis

3. Selain penderita yang harus diobati secara edeguate, juga pasien caniers atau gameto carriess harus dilikudasi

4. Pengawasan rutin oleh petugas medis harus dilaksanakan terhadap reconvalessent selama 1,5 tahun untuk malaria tropica, dan 2 tahun untuk malaria demam 3 hari (Malaria Rertina)

5. Untuk melaksanakan tugas tersebut, selain dengan mengunakan chemiopreparat sintesis anti malaria dan obat-obatan golongan anti biotika, juga harus dibarengi dengan obat-obatan suplemen lainnya seperti haemotherapi makanan yang bergizi tinggi yang lengkap dengan vitamin dan mineral serta garam calsium, zat besi, fosfat, dll.

6. Dalam mengobati sesuatu penyakit maka menetapkan diagnosis yang benar adalah salah satu faktor yang sangat penting untuk diketahui terlebih dahulu. Karena : “Bene diagnostic bene curat” yang artinya apabila baik/benar diagnosisnya maka baik pula pengobatannya (Hypoctates)

H. Jenis-jenis obat anti malaria

1. Bigumal (Paludrine, Balusil, Chorguanid, Diguamil, Guanol, Palusil, Plasin, Proguanide, Chloriguane)

2. Acrichine (Atebrine, Atabrine, Methoguine, Chemiochine, Chinacrine, Haffkine, Hepacrine, Italchine)

3. Plasmocide adalah krital powder berwarna kekuning-kuningan agak jingga dan sedikit berasa pahit

4. Chingamine (Choroguine, Diphospat, Nivaguine, Resohin)

5. Hydroxychloroguine (Plaguenil, Ercoguin, Ox Cyhlorochinum, Oxychlo Roguine, Plaguinol, Quensyl, Reumoide)

6. Chloridine (Pyrimethamine, Malocide, Daraprine, Darachior, Tindurin) kristal powder berwarna putih berbau dan tanpa rasa

7. Primachine (Primaguine, Avon, Neo Quipenyl) obat yang larut dalam air

8. Chinoade (Guinocide)

9. Chinene (Ethytcarbonas Chinin / Euchinin)

10. Fansidar (Melidar Atau Suldox)


BAB III

PENUTUP

A. kesimpulan

1. Penyakit malaria adalah salah satu penyakit mular pada manusia dan nyamuk anopheles betina adalah sebagai vektor utamanya.

2. Penyakit malaria tidak hanya menjadi masalah kesehatan di Daerah Istimewa Aceh saja, tetapi masih merupakan masalah kesehatan masyarakat secara Nasional dan Internasional

3. Pemberantasan malaria tidak akan berhasil tanpa adanya kerja sama yang baik dalam masyarakat, terutama sekali pada waktu dilakukan penyemprotan rumah ke rumah

4. Bagi penderita malaria tanpa mendapatkan pengobatan sama sekali, maka kemungkinan untuk hidup bagi penderita tersebut tidak melebihi dua tahun sejak mulai pertama masuknya plasmodium malaria ke dalam tubuh. Dan meninggal dunia karna komplikasi seperti splenitis chirrhosis hepatitis dan anemi

5. Penyakit anemia adalah penyakit yang dapat di sembuhkan dengan sempurna, asal pengobatannya cukup memenuhi syarat yang sempurna pula.

B. Saran

1. Pendekatan lintas sektoral dan penyuluhan-penyuluhan kesehatan kepada masyarakat sebelum melakukan tindakan-tindakan pemberantasan malaria adalah sangat penting dan perlu ditingkatkan

2. Untuk mencegah terhadap gigitan nyamuk, maka diharuskan bagi setiap orang yang tinggal di daerah malaria untuk tidur didalam kelambu.

3. apabila seseorang merasa sudah tidak enak badan, lemah, demam, menggigil, mulut pahit dan muntah-muntah, maka dia harus segera menghubungi dokter ataupun unit pelayanan kesehatan yang terdekat untuk mendapatkan pengobatan yang baik.


DAFTAR PUSTAKA

Pemberantasan penyakit malaria, Chairuddin Meuraxa, 2004.

Penerbit CV. Wahana, Banda Aceh

Malaria : epidimiologi, patogenesis, menifestasi klinis dan penanganan, 1999, penerbit EGC, Jakarta

Behavior


Nicholas Wade, in Scientists find beginnings of Morality in Primate Behavior (NYTimes), produces a definition of sociality.

Sociality is comprised of four behaviors:

  1. empathy
  2. the ability to learn and follow social rules
  3. reciprocity
  4. peacemaking

So this would answer the question: What does social mean? That’s a core part of what we’re talking about here at Bokardo. If an animal exhibits these four behaviors, then we can say that it is a social animal. This is a good foundational to start with, or at least a quick overview that addresses concrete behavior.

Wade goes on to add to Frans de Waal’s research (which is the basis of the article) that two more behaviors are exhibited by humans that aren’t seen in other primates: “People enforce their society’s moral codes much more rigorously with rewards, punishments and reputation building (than other primates do). They also apply a degree of judgment and reason, for which there are no parallels in animals.”

When talking about sociality in terms of behaviors, we get into interesting questions quickly. What does empathy look like on the Web? Reciprocity? What does Identity have to do with this? (Certainly in the physical world there is much less need to worry about the is-this-person-who-they-claim-to-be? type of Identity) It would seem that online Identity only obfuscates the issue further, and possibly adds more behaviors to the mix as well…and focuses us more on things like trust. But I believe that even though it is more difficult to clarify relationships on the Web they still rely on the same factors as offline, and this list seems like a good place to start.

Another interesting part of this article is the debate between philosophers and biologists on the origin of morality. Philosophers generally think it begins with conscious reasoning while biologists lean toward emotions.

Who Am I

Who Am I?

“Who am I?” is the central question in life. What is your answer to this question, and how is your understanding helping you in life?

This article first examines various levels of self identity. Then it goes deeper to explore what “we are spiritual beings” really means.

Will the true YOU please step forward?

We define ourselves in various ways:

§ I am (my name).

§ I am (my work position, social status, etc.)

§ I am (my life experiences).

§ I am (my thoughts, or the thinking mind).

§ I am (my soul or spirit).

#1 is just a label. #2, like “I am a sales manager.” or “I am a mother.” is just the role you are playing at this time. It’s pretty easy to see these are not the real YOU.

Some people are invested in their experiences and believe they are the sum or the result of their life experiences. “I was abused as a child and so I am incapable of building a healthy relationship. This is me.” or “I am an American and so I live this way.” But I don’t think human life is like a physics experiment. We have free will that allows us to go outside what our experiences define.

#4 is big. Someone said, “I think therefore I am.” If you don’t embrace the idea of the soul, I guess this is how you define yourself. Pretty obviously, you know you are not just the body you can see and touch. There is something within that does the thinking – your mind. So you are the mind, or the combination of your body and mind. (If you think the mind is just a function of the brain, then the mind is part of the body – still, you define yourself as the body / mind.)

Then there are those who believe in #5. I use to think this way, too. Our essence is the soul, or the spirit, that currently resides in the physical body. The thinking mind is only a tool. And when we die, the soul moves on, to eventually have another incarnation.

The idea seemed to work until I experienced Ascension soul shift myself.

Soul shifts and the Self

As Akashic Record Reading specialist, I read people’s soul records. Most people live with one soul for the entirety of his or her life. Or, rather, the soul lives its whole incarnation.

However, there are those who go through soul shifts. When this is the case, I can count exactly how many souls have been involved, the characteristics of each soul, and when the shift happened. And as I wrote in that article, soul shifting itself is nothing new. All varieties of soul shifts except the Ascension soul shift have been known for some time.

  1. Ongoing soul shifts
  2. One-time soul shifts, or walk-ins, including:

Reinstatement soul shifts

§ Complete possessions

§ Placeholder soul shifts

§ Special cases such as Pleadings soul shifts

§ Ascension soul shifts

In each case, we can take one of the two perspectives to the question “Who am I?”

  1. I am the originally intended soul that was meant for me at birth.
  2. I am the soul I have now.

With ongoing soul shifts, there is one soul that was the originally intended soul. So although it was in the body only part of the time, we can say this is who he or she was meant to be. Alternatively, we can also interpret this situation that whichever soul that is in the body at the given moment is the self – at the time.

Similarly, in reinstatement soul shifts, we can say the originally intended soul that gets “reinstated” is the real you even though another soul was residing in the body for a while. It’s also valid to say that, when the other soul was residing in the body, that was you.

Complete possessions are sad cases. The originally intended soul gets kicked out by a negative soul. When this happens, I have to say the new soul is the you because there is no way to reverse the process.

Placeholder soul shifts are like reinstatement soul shifts but the first soul is a positive soul. So again, you are the originally intended soul. Or you can say the soul you had at the time is the real you.

How Ascension soul shifts differ from other soul shifts

However, Ascension soul shifts are different. With Ascension soul shift, the first soul is the originally intended soul. And the second soul is also intended – the shift is orchestrated somehow.

The repeatedly asked question about Ascension soul shift is “Why does this have to happen? What happens to the first soul? What happens to my spiritual development that I have accomplished as my first soul through many lifetimes?”

I sensed there was something bigger or higher than the soul that is still an individual, the ME, that was orchestrating these soul shifts. These soul shifts were not some random take over. At least the second soul knew the first soul and what was going on. But what is this “bigger or higher” something?

Here is my current understanding as I figured by communicating with my Akashic Record Guides.

The Source, the energy, and the soul

First there was the Source, the Source of all energy. The whole, therefore perfect, energy. Then it split part of it to create individualized forms of itself. Basically, it wanted to play. It was hard to play as a single existence ever, so it split itself to be many existences.

For now, let’s call these split energies “X’s”.

Some X’s became stars and planets. Most other X’s became residents of these star systems. Then they travelled around. Eventually some came to Earth, which is just another creation.

To live in the physical bodies on Earth, X’s split part of themselves to form souls in much the same manner the Source split itself to be X’s. Perhaps most X’s split out just one soul and watched over how it goes.

The soul lived in one body. When the body was done, the soul crossed over to the other side for a temporary rest, and eventually came back to live another lifetime. This went on and on for millenniums of time. All the while the X of the soul was watching over its progress.

Ascension is the new game

Recently planet Earth and its residents decided to work out a new game plan. We have gone through plenty of lifetimes and saw the various different sides of life. We have done enough of the “learning by contrast” game. More and more of us are reaching the point that we can possibly reach as the existing soul. So we are going to change the matrix itself. We are going to do this Ascension.
Ascension is about increasing the vibration rate. For many of us, the souls we’ve had were good souls that were intended for each of us at birth, but they can go up only to a certain level of vibration rate. So our X’s decided to upgrade. Each X created another soul from itself and sent it to us. This is Ascension soul shift.

Because the new soul originates from the same X, it is the same type, same background group and training. It just vibrates higher and has no physical past life.

Meet X, your Higher Self

Now the issue of terminology. This is where things get sticky because it’s quite possible that person A uses the term to mean something different from what person B means with the same term.

For me, X is my Higher Self. My Higher Self came directly from the Source, and it infuses part of it to form my soul in much the same way the Source infused part of it to form my Higher Self. My Higher Self can create many souls if it wants.

It’s like making photocopies. Any number of souls can come from the Higher Self. Once the soul is created and incarnates in the physical body, it gets its own experiences. Like you can write memos on one of the photocopies. We’ve got too many scribbles on our copies (souls) that we decided to start anew with a fresh copy.

Who am I really?

So there are higher levels of answers to the first question, “Who am I?”

I am (my Higher Self).

I am God, the Source, or – just, I am.

Does this make sense to you? It does to me, so I concluded my communication with my guides.

A note in communication with spirit guides

If you are interested in trying this yourself, here is a brief cautionary note. Spirits use your existing frame of reference to give you ideas. So the analogy you get may well be different from mine.

Plus they are quite practical in their teaching. They know there are levels of understanding. Say, Newton’s law of gravity may or may not work in Einstein’s world, but if your understanding of physics is high school level (like most of us), they are not going to mention Einstein. They know that would just complicate things unnecessarily. So they tell you the law of gravity as Newton figured it out. If you work for NASA, on the other hand, you may get a different response. Both are, in a sense, “right” answers.

The answers I received make sense to me and so it’s good for me. For now. When my spirituality evolves further, I might get a new answer that may seem to contradict to what I know now. Just a possibility.

Ascension is a process to be one with God, or to be God

So the Ascension process promotes higher awareness of who we really are. We are not just our souls that goes through many lifetimes. We are our Higher Selves that are looking over all these experiences.

Further, we are the Source. We are God, the Creator. The split part is essentially the same in quality with the original. It’s a smaller individualized version, but like a piece of holograph, it has all the power and information of the original.

It gets really hard to “know” who I am at this level. It’s like trying to see my own nose. Not by the reflection on the mirror, but trying to see my nose itself. We are not quite capable of doing this. Likewise, after rigorous examination of who I am, seemingly ironically, I reach a point where I say, “I just am.” Everything and everyone are part of me, appearing to be different for the fun of it.

How do you identify yourself? Are you using the power that comes from realizing you are the Source?

I do Not Know

I recognise thin white bones
stretching into darkness.
I tick the box marked M.
Words are the worry
that never grows old.
To look within myself
I turn on the light.
I consume space
because it corners me.
When I call on my heart
it rings like an excuse.
Too much force
keeps me alive
but secretly I am
afraid of spiders.
I mark my offspring
but I wish they would
talk to me.
At work I employ people
to laugh at my jokes.
I can easily ignore
the consequences
of what I implement.
I deliberately hold grudges:
they help me
meet the challenge.
Indecision collapses me.
If you question my methods
I shit in the woods.
Tonight I let you
change the channel
but I cannot be sure