Scenario B Blok 22 Batch

2018

“Indiscriminate Dumping”

Ceria Village is located near the river, where there is a slaughterhouse. Based
on the report of the environmental health officer at the Puskesmas, the slaughtering
waste is directly dumped into the river. Community bathing, washing and toilet
activities use river water. The livelihoods of the people in Ceria village are forest-
encroaching farmers, who clear land by burning trees.
Dr. Susi has only worked for one year at the Puskesmas Bahagia, where she
received a report from the Puskesmas surveillance staff that the incidence of
diarrhea cases had doubled from the previous month, while from data of the top ten
diseases, acute respiratory infection (ARI) was ranked first. Dr. Susi is going to
conduct an epidemiological investigation of diarrhea and provide counseling on
cases of infectious diseases.

I. Clarification of term
1. Epidemiological: Any deviation from or disturbance in the normal
structure or function of a body part, organ or system characterized by a
characteristic group of symptoms and signs (Dorland, 2015).
2. Incidence: The certain even such as, the number of new case of specific
disease occuring during given period in population risk (Dorland,
2015)
3. Surveillance: the process of collecting, processing, analyzing, and
interpreting data systemically and continuously and disseminating
information to units that need to be able to take action
4. Puskesmas health service facility that organizes public health efforts
and first-level individual health efforts, by prioritizing promotive and
preventive efforts, to achieve the highest level of public health in its
working area (Putri, 2017)
 5. Acute respiratory infection: Consists of upper respiratory tract
infections and lower respiratoryhanging from the affected respiratory
tract area (Zulaikhah et al., 2017).
6. Waste: caused by biological agents, among others, viruses, bacteria,
fungi and parasites (Lescano et al., 2010).
7. Diseases: Any deviation from or disturbance in the normal structure or
function of a body part, organ or system characterized by a
characteristic group of symptoms and signs (Dorland, 2015).
8. Diarrhea: Abnormal discharge of watery stools many times (Dorland,
2015)
9. Counseling: An activity or efforts to convey health messages to
community, group or individual with hope the presence of messages
can get knowledge about better health, ultimately the knowledge can
change his behavior (Notoatmodjo, 2012)
10. Infectious diseases: disease can be transmitted to humanity caused by
biological agents, among others, viruses, bacteria, fungi and parasites
(Lescano et al., 2010).
11. Investigation: investigation by recording or recording facts conducting
reviews, experiments, and so on, with the aim of obtaining answers to
questions (KBBI)
II. Identification of problem
1. Ceria Village is located near the river, where there is a
slaughterhouse. Based on the report of the environmental health
officer at the Puskesmas, the slaughtering waste is directly dumped
into the river. Community bathing, washing and toilet activities use
river water. The livelihoods of the people in Ceria village are forest-
encroaching farmers, who clear land by burning trees.
2. Dr. Susi has only worked for one year at the Puskesmas Bahagia,
where she received a report from the Puskesmas surveillance staff
that the incidence of diarrhea cases had doubled from the previous
month, while from data of the top ten diseases, acute respiratory
infection (ARI) was ranked first.
 3. Dr. Susi is going to conduct an epidemiological investigation of
diarrhea and provide counseling on cases of infectious diseases.

III. Prioritize of problem

Number 1, because is the main problem so that Dr. Susi will conduct an
epidemiological investigation of diarrhea and provide counseling about
infectious disease cases.
IV. Analysis of Problem
1. Ceria Village is located near the river, where there is a slaughterhouse.
Based on the report of the environmental health officer at the Puskesmas,
the slaughtering waste is directly dumped into the river. Community
bathing, washing and toilet activities use river water. The livelihoods of
the people in Ceria village are forest-encroaching farmers, who clear land
by burning trees.
a. What is the meaning Ceria Village is located near the river, where
there is a slaughterhouse. Based on the report of the environmental
health officer at the Puskesmas, the slaughtering waste is directly
dumped into the river?
b. What is the impact the slaughtering waste is dricetly dumped into the
river?

c. What is the meaning Community bathing, washing and toilet

activities use river water?
Community bathing, washing and toilet activities use river water is
one of the risk factor for complaints. Water pollution can be caused by
waste from domestic, industrial and agriculture. poor water sanitation
will cause disease. Some water-related diseases (Waterborne Deseases).
Drinking water contamination by wastewater and / or by human waste
(feces), which contains organisms that can causing disease, viruses,
pathogenic bacteria and so on, can spread rapidly throughout the drinking
water service network system, and can cause an outbreak or explosion in
 the number of disease sufferers in an area in a short time (Herlambang,
2018).
Poor water sanitation can also be caused by the presence of chemical
substances due to activities such as bathing and washing. The risk or
danger to health can also be due to the presence of substances or chemical
compounds in drinking water, which exceed the allowable concentration
threshold. The presence of chemical substances / compounds in drinking
water can occur naturally and or as a result of human activities, for
example by household, industrial waste, etc. Several chemical
substances / compounds that are toxic to the human body, for example
heavy metals, pesticides, hydrocarbon micro-pollutants, natural or
artificial radioactive substances and so on (Herlambang, 2018).
Herlambang, A. 2018. Pencemaran Air Dan Strategi Penggulangannya. Jurnal
Air Indonesia, 2(1). https://doi.org/10.29122/jai.v2i1.2280

d. What kind of slaughtering waste?

e. What disease can causes by slaughtering waste?

f. What are the requirements for clean water?

g. What is the indicator of water polution?

h. What are the criteria of healthy environments?

i. How to proceed slaughtering waste before throw away?
j. What are the requirements for a healthy latrine?
According to the Peraturan Menteri Kesehatan No. 3 Tahun 2014 Tentang
Sanitasi Total Berbasis Masyarakat Jamban Sehat Efektif Untuk Memutus
Mata Rantai Penularan Penyakit in Depkes RI (2004), there are several
requirements for healthy latrines, including:
1. Do not pollute drinking water sources, the location of the collecting
holes is 10-15 meters from drinking water sources.
 2. It is odorless and the feces cannot be touched by insects or mice.
3. It is wide enough and sloping towards the squatting hole so that it
does not contaminate the surrounding soil.
4. Easy to clean and safe to use.
5. Equipped with protective walls and roofs, waterproof and colored
walls.
6. Enough lighting.
7. Watertight floors.
8. Good ventilation.
9. Water and cleaning tools are available.
Depkes RI. 2014. Syarat-syarat Jamban Sehat. Jakarta: Departemen
Kesehatan RI.

k. What is the relation between main problem and based on the report of
the environmental health officer?
l. What is the meaning The livelihoods of the people in Ceria village
are forest-encroaching farmers, who clear land by burning trees?
m. What the impact of clear land by burning trees?

n. What is the indicator of air polution?

According to the national Ambient Air Quality Standard (BMUA) in the
Government Regulation on Air Pollution Control (PP Number 41 of
1999) only mentions 9 (nine) types of common pollutants, namely Sulfur
Dioxide (SO2), Carbon Monoxide (CO), Nitrogen Dioxide (NO2),
Ozone (O3), Hydro Carbon (HC), PM10, PM2,5, TSP (dust), Pb (lead),
dustfall (dust falling). The best indicator in determining the degree of a
case of pollution is by measuring or checking the concentration of sulfur
dioxide gas, smoke index, and dust particles in the air
Peraturan Pemerintah Republik Indonesia Nomor 41 Tahun 1999 :
Pengendalian Pencemaran Udara
 o. What are the impact of air polution?
p. What diseases can causes by air polution?

2. Dr. Susi has only worked for one year at the Puskesmas Bahagia, where
she received a report from the Puskesmas surveillance staff that the
incidence of diarrhea cases had doubled from the previous month, while
from data of the top ten diseases, acute respiratory infection (ARI) was
ranked first.
a. What is the meaning Dr. Susi has only worked for one year at the
Puskesmas Bahagia, where she received a report from the Puskesmas
surveillance staff that the incidence of diarrhea cases had doubled
from the previous month, while from data of the top ten diseases,
acute respiratory infection (ARI) was ranked first?
b. What is the definition of outbreaks?
c. What is the criteria of outbreaks?

d. How to do prevention of outbreaks?

According to Undang-Undang Nomor 4 Tahun 1984 tentang Wabah
Penyakit Menular dan Peraturan Pemerintah Nomor 40 Tahun 1991,
concerning the prevention of infectious diseases regulates that any
outbreaks of infectious diseases or situations that can lead to outbreaks of
infectious diseases (extraordinary events) must be handled as early as
possible. Prevention efforts are carried out through improving risk factors,
overcoming disease from the source of transmission, breaking the chain of
disease transmission, increasing the vulnerability of a group of people
based on epidemiological characteristics and strengthening the
community service system.
Management of outbreaks / outbreaks includes epidemiological
investigations and surveillance; patient management; prevention and
immunization; elimination of disease causes; handling of bodies due to
the plague; outreach to the community; and other countermeasures
 (Peraturan Menteri Kesehatan Republik Indonesia Nomor 45 Tahun 2014
Tentang Penyelenggaraan Surveilans Kesehatan Pasal 4 ayat 1).
Peraturan Menteri Kesehatan RI No 45 Tahun 2014 Tentang Penyelenggaraan
Surveilans Kesehatan.

e. How to conduct investigation of suspected outbreaks?

f. What is the relation between acute respiratory infection (ARI) with
the case?
g. What is the relation between the increase of diarrhea incidence with
the case?

h. How is the transmission of diarrhea in this case?

Waterborne disease is water that does not meet the requirements and is a
good transmission medium for disease. So in the case of transmission
through polluted water due to waste from the slaughterhouse being
discharged into the river, causing the virus, bacteria to develop rapidly,
residents use the river water to carry out activities such as bathing,
washing, BAK and defecating (waterborne mechanism).
Mode of Transmission. Diarhae is transmitted from person to person
through oral faecal, bacteria contaminates food and drink and the
causative agent is found in the faeces. (Azwar, 2005).
Azwar A. 2005. Pengantar Ilmu Kesehatan Lingkungan. Jakarta : Penerbit
Mutiara Sumber Widya Press.

i. What are the duties and responsibilities of the puskesmas towards the
environment?

j. What causes the increased incidence of disease?

For Diarhae, Source of transmission namely drinking water or
contaminated food human feces containing bacteri Campylobacter,
Salmonella, Shigella, dan E. Coli. Some water-related diseases
 (Waterborne Deseases). Drinking water contamination by wastewater
and / or by human waste (feces), which contains organisms that can
causing disease, viruses, pathogenic bacteria and so on, can spread rapidly
throughout the drinking water service network system, and can cause an
outbreak or explosion in the number of disease sufferers in an area in a
short time (Barret, et al., 2014).
Barrett, K. E., Barman, S. M., Boitano, S. , and Brooks, H. L. 2014. Ganong’s
Review of Medical Physiology. 23rd ed. New York: The McGraw-Hill
Companies, Inc.

k. What are the goals and benefits of the surveillance staff?

l. How to make surveillance report in puskesmas?
m. What is the basic principal of surveillance?

3. Dr. Susi is going to conduct an epidemiological investigation of diarrhea

and provide counseling on cases of infectious diseases.
a. What is the meaning Dr. Susi is going to conduct an epidemiological
investigation of diarrhea and provide counseling on cases of
infectious diseases?
b. How is the process on the epidemiological investigation?
c. What kind of epidemiological investigation?
d. What are the methods of measuring epidemiology?
e. How to do good and correct counseling method?

SEMANGATTTT EEE NYAIIII MONALISA

SUSILO ASTUTI KUSUMA
DININGRATTTTTTT
BESOK LIBURRR BTW
HAHHHAHAHAHHA :*
 4. What are the islamic value in this case? (QS 10 Yunus : 101, QS 59 Al-
Hasyr : 18, QS 49 Al-Hujarat: 6)

O you who have believed, if there comes to you a disobedient one with
information, investigate, lest you harm a people out of ignorance and
become, over what you have done, regretful.

V. Hypothesis
dr. Susi plans to conduct an epidemiological investigation of diarrhea and
provide counseling on infectious diseases because the increasing cases of
diarrhea and acute respiratory infections (ARI) may be caused by polluted
air and water.
VI. Conceptual Framework

Slaughtering waste Bathing, washing, Burn Trees

and toilet activities
on the river
Airbone disease

Waterbone disease Acute Respiratory

Infection increase to
rank first on
Diarrhea Outbreaks surveillance report