Updates in Philippine Expanded Program on Immunization in Region 3

by Zero Mella MD, Sajorda River Park, Iba, Zambales — The  Expanded Program on  Immunization has been around since the 70′s when the WHO implemented it on our country. There is now a move to incorporate EPI for children and mothers with adult and elderly immunization. This will be managed by the National Immunization Committee of the DOH. This will be implemented in the future.

EPI, or the free vaccines given by the Philippines Department of Health (DOH), covers the following

• Tuberculosis;
• Diphtheria, tetanus and pertussis;
• Poliomyelitis;
• Measles;
• Mumps;
• Rubella or German measles;
• Hepatitis-B;
• H. Influenza type B (HIB)

Lailani Mangulabnan MD, Region III Director for EPI, states that since 2009, the DOH has been monitoring and supervising aggressively the barangay and provincial centers regarding implementation of the EPI. With the help of the CDC, the office of Dr. Mangulabnan have found major problems regarding implementation in some remote barangays including:

• improper training
• Injection issues
  • use of prefilled syringes
  • improper use of aspirating needles
• improper disposal
• improper temperature monitoring of cold storage

Despite these problems identified, EPI in region 3 has been able to provide 97.9% coverage in 2011 which is very satisfactory.

Recommendations

Dr. Mangulabnan was able to create recommendations for the provincial, regional, and city health offices for Region 3. These include:

1. Strengthen Stock Management

This would include proper inventory keeping and reporting to the EPI office; proper use and training for cold chain storage , and proper utilization and disposal techniques.

2. Eliminate Dropouts and Missed Opportunities

The office of Dr. Mangulabnan has found certain regional and provincial hospitals with provisional requirements for the EPI and have found a lot of missed opportunities for education and implementation of the EPI. Philhealth coverage may provide some incentive in private clinics as it covers first doses of the immunization. The suggestion is still to utilize every visit to update both maternal and child immunizations.

3. Target outreach and community mobilization to depressed areas

The EPI target coverage is still 100%. Doctors, Nurses, and Midwives are called to utilize the various barangay health workers to educate the unimmunized population. The vaccines are free and are life-saving.

4. Ensure all health facilities receive at least quarterly intensive supervisory visits and are trained in REB

Supervisory visits provide a way to create standardization of care in every barangay. REB is a program of the EPI to educate hard-to reach communities. The goal is to educate them to utilize the various free vaccines provided by the government.

5. Strengthen data management and surveillance

Reporting is crucial in managing the day to day decisions and budgeting of the EPI. To ensure continuous supply of vaccines, local municipal and city health offices must provide correct data flow regarding inventory, coordinator programs and activities.

The EPI Regional Office hopes to ensure that by 2012 we will be able to reach the targets and reconcile the deficiencies found in the present.

 

 

Book Review: Diablo 3 The Book of Cain

Olongapo City, Philippines —The much anticipated release of the sequel to the Diablo PC game series gave me quite an excitement. As an avid fan for more than 10 years, I have been enjoying much of the literature Blizzard has been putting up the internet. The game’s storyline is solid. It transports you to a world of demons and angels and their eternal struggle. And you play a character in the middle of it. It’s a beautiful saga and finally I was able to piece it all together with this book:

Diablo III: Book of Cain

 

This is a wonderful read. It starts with the will of Deckard Cain addressed to his niece. It narrates the events even before Diablo I. It soughts to explain the questions left by two preceding games. The book starts with a narrative about Anu and the Dragon; how they were both destroyed in the initial conflict creating the universe as we know it. Anu’s remains became the Worldstone and the Dragon’s, the seven evils as we now know it. The seven evils are Diablo, Baal, Mephisto, Andariel, Duriel (this 5 are the ones we met in the previous 2 games), Belial, and Azmodan. The mention of the latter 2 is a premonition of what we could be expecting at the 3rd installment of the game.

The story continues to tell of the story of King Leoric and his sons Prince Albrecht and Aidan. This narrative is about the initial story of the game as the heroes proceed to venture into the catacombs to seek and slay Diablo, the Lord of Terror. Aidan, the hero of the story is possessed and becomes the Dark Wanderer in Diablo II. The story tells of the slaying of Andariel and Duriel, the two big foes met in Diablo II’s first stages of the game.

Details about the Zakarum, the Vizjerei Mages, the Horadrim and Tal Rasha explain the details behind the main storyline. The archangels, of whom we have only met Tyrael, were also discussed. He happens to be a part of the Council of Angiris at the High Heavens. He was instrumental in saving the human race when a vote came to the council as to the eradication of humans.

The book ends in the last parts of the Diablo II Exapansion storyline. This is where Tyrael destroys the corrupted Worldstone. It explodes and lays waste to the Deadlands of Mount Arreat. New civilizations were mentioned in the last part of the book which could be instrumental in Diablo 3′s storyline like Westmarch, Skovos Isles, Kehjistan and the Torajan Jungles. A new brand of mercenary was also mentioned and they were called demon hunters. Repetition of Azmodan and Belial’s important parts in the future were signs that they will be minor antagonist in the story. Diablo was told to have been banished in the abyss but since he is the main antagonist, we will expect the game to shift a deus ex machina to summon Diablo back into the mortal realm.

The book is available in hardcover by Insight Editions. The interior is filled with monochrome yellow images and penciled artwork from great artists. It looks like an oversize tome that came straight from the game. It’s a great add to fans of the Diablo game out there. Most of whom are already in the working class like me who would also like to pay for kick-ass items like these!

Buy it now from Amazon!

Zero MD Recommends Elisha Collections!

Since its inception, I’ve been a part of Elisha Collections. Now, I am partly responsible fro spreading the word. I have only a basic understanding of IT but so far it pays to know even a little. It’s a fast paced world. Not keeping up is almost the same as financial suicide. Now I take helm as Elisha Collections’ social media manager. This is one of the hardest task ever. I’m a full-time rural health doctor, sidelining as an ER physician, a husband, father, and now this?? I must be crazy. But hey I am taking steps not to bury myself in work. Every now and then, I have 5 minutes of silence while I’m awake. Just kidding.

The idea is to find a way to work less and earn more. To be able to make that even a tiny bit feasible, you have to work hard. Stocks and Money market are not good for me right now because the market is full of greedy people overpricing the market. The best is to go into business. My wife and I started Elisha Collections actually out of curiosity. We couldn’t get products we like in the net to the Philippine market. We started to find out that the same raw materials in Quiapo, Marikina, and Pandacan are being sold in major Philippine branded clothing stores. They are just marketed differently and priced ridiculously. So we opted to find our own niche. And we found it by importing.

Elisha Collections is now the best distributor of China-made fashion jewelry in Olongapo City. We are now constantly supplying budding retail fashion stores. It’s one of the best things that the global recession taught most of us. It taught us to endure and have an optimistic entrepreneurial spirit. Most of those affected by this paradigm shift are women, including my wife of course. They feel empowered and that is what we provide as a vision for our company. To empower women entreprenuers by giving them a source of income, and a support system to maintain that income. With only 2 employees, my wife and I have to settle to sacrifice a lot with this goal in mind.

Our product line includes bags; fashion jewelry (cheap but of good quality and design) such as necklaces, bracelets, earrings and rings; clothing; belt, watches, and shoes! We have them all listed in www.elishacollections.com! It features 10,000 items that are up for grabs. However due to increase demand, our suppliers find it hard to stock most of them. So you can expect a delay as we negotiate your orders with our suppliers.

As social media manager, I’ve started a new blog which will be our online fashion magazine. Aptly named: elishamagazine.blogspot.com 

This will feature detail product previews of our products. Bloggers who like surfing picture blogs will definitely love them. We are currently processing articles regarding women’s health, exercise and nutrition to add to the blog. Nowadays, it’s very easy to be labeled a plagiarist. So I am trying to avoid that pitall. I’m currently editing and giving it second and third looks before giving it a thumbs up. I am also talking to a few local actors if they can give their views. We are doing a major upgrade of Elisha Collections in terms of social media marketing. And it is very hard with limited resources and time. Someday, I’ll be delegating all this to some department but since that department hasn’t existed yet… Well, I’m it.

We got Youtube, Facebook, Google Plus, Tumblr, Multiply, and Twitter. I don’t use as much exposure on myself though. Not yet anyway… wink wink. Elisha Collections will be my masterpiece, my soon to be crowning glory of  basic IT-ness. Amidst the polyphasic sleep patterns and a lot of carpal tunnel spasms from too much typing is probably glory on the other side. This company will define us one day. And I’m glad I’m in it from the beginning.

Watch out for many exciting changes in Elisha Collections! Even if you don’t purchase, spreading the word can help us a lot. I love you guys.

Serving Champions – Milo Marathon Qualifiers in Olongapo City

City Health Office, Olongapo City – The recently concluded Olongapo City Milo Marathon qualifier round featured a lot of runners probably in the thousands. Most of the competitors are mainly in it for the  fun to jog or run along with peers from school or work. Some are more than enthusiasts and are vying for a slot in the Nationals to be held on December 11 at SM Mall of Asia.

Volunteers from the City Health Office, led by Dr. Zero Mella and Dra. Elizabeth Carillo, served on the first aid station. They were  accompanied by Jaime Elcaño, Maricor Bernardo, Ariel Acayan, and Perla Canya.

Since the run was conducted in the early hours of the morning, there were no reported heat strokes or any heat related problems. Most of the patients they saw were due to exhaustion. Patients presented with palpitations, hypertension, shortness of breath; and some had minor abrasions which were easily treated.

Medical supplies were rummaged from the city health office. Tournament organizers failed to supply the team with bandages, antiseptics, pain medications and even a supply of water. We noted that the drinking water supply for the runners was empty even before the 21K runners hit the finish line. There was a massive number of runners with an age range of 4 years to 70 years old on the contest grounds. This probably contributed to the shortage of drinks. But despite this limitations, no runners were seriously injured.

The qualifier was a success. You can see in each competitor’s face that they do not regret joining the competition. Each one is a champion in their own right as each one contributed a big favor to their health. Running is a cardio exercise that, done in a regular fashion, can prevent major ailments as arthritis, obesity, hyperlipidemia, diabetes, hypertension and other cardiovascular diseases. Awareness to the sport’s benefits was positively brought out to the crowd.

A cheerdancing competition concluded the event. Proceeds of the event will fund Milo’s initiative to provide 10,000 shoes to needy children. Runners in the 21K and 10K category that finished the time limit will get a chance to compete in the 35th Milo Marathon Nationals.

Zero Mella MD on the Independence Day Run, Subic Bay

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Subic Bay, Philippines – Starting as a small joke between me and my wife turned out to be a reality as we signed up on the last minute of the preregistration. Getting up by 5:15 am on race day, we panicked as we were supposed to be there 15 minutes before as the race starts at 5:30. We were out of the house by 5 minutes and on the starting line for the 3K on the dot.

We were amazed at the number of kids on the 3k starting line that we felt embarassed joining the Kids race. Albeit that, we were able to finish our first marathon and we are planning to do it again. We loved the experience and we even took pictures with a few acquaintances. The independence day run was a charity event for the School of Aetas and for other charity events by the Franciscan Sister Order.

New Treatment for Ebola found!

In May 2010, a group of scientists from the National Emerging Infectious Diseases Laboratories at Boston University announced they had developed a drug containing small interfering RNAs that prevented reproduction of the virus in monkeys.^[33][34] The group’s leader Thomas Geisbert claimed the results of the group’s study showed their experimental treatment resulted in “complete protection” of monkeys from the virus. Virologist Heinz Feldmann hailed the findings of the study as a “milestone” that could be used to combat similar viruses.^[35] Geisbert claimed a lack of market interest could impair the development of the treatment for humans, given the comparatively low number of Ebola cases worldwide.^[36] The trial on monkeys had been funded by the United States Department of Defense.^[34]

The preceeding article is from wikipedia. This dreaded disease which kills within 48 hours after exposure may have met its match. Human trials should be undertaken.

200% Custom’s Tax Part 2

Sorry, I wasn’t able to follow up on the previous post. I honestly forgot and got busy.

We went all the way to the DHL office in Pasay. We were so exhausted in the ride. We were greeted courteously and we made our inquiries politely (my dad suggested we do it this way, he use to be high up in DTI). We might not be able to get our package if we tried to scream at them and choke their necks with a sleeper hold. So we waited patiently for a representative from DHL to assist us. The following conversation took place:

“Kayo po si …,ung package galing hongkong?” (Are you …[my friend's name], the one with the package from Hongkong?)

“Yup, inquire lng nmin bkit ang mahal nung value na bngay ng customs e may resibo kami na 100 dollars lng yan” (Yup, we were just inquiring why customs overvalued the product when we had a receipt?)

“Mam, kasi po, madaming 18 karat gold” (Mam, you have a lot of  items with 18 karat gold)

Oh we were laughing! We bought spinoffs and cheap fashion jewelry! And get this, the appraising was done by a well-experienced customs official! Oh that was so funny. All our anger vanished, customs officials actually admitted that they were “well experienced” and that they valued spinoffs as 18 karat gold. The DHL official gave us no names as to who appraised it and how.

My friend insisted for a custom’s official. I wasn’t there at the room but she told me something I’ve seen hundreds of times at a government office and even in government hospitals. It’s what I call a TELENOVELA scene. A superior comes up to the erring party and consoles the complainant. She reprimanded the erring official (no names, they are very strict with names!) and starts to offer the complainant a deal. My friend, convinced that that was all there was to it and consoled by the superior, immediately accepts the deal. No legal matters were discussed, no complaints filed, its a lot of BS going on there! It sucked that I wasn’t in the room. The deal was 100 dollars off the damn overvalued price. I asked why my friend accepted such a deal? Para matapos na ( So I can get on with it). We were waiting for hours. The customs entertained us at about 6 pm. She was glad to have the items but overpaid for them. She got duped into the telenovela scene.

We were able to gather our losses when all the items were sold. However, BOC still got 200 dollars of our money. Oh we got a receipt. And we weren’t the only ones who had experienced it this way. Apparently from what I gather the BOC stations themselves on large shipping carriers and waits for packages that are labeled purchases. If you declare them as gifts or personal effects, they wouldn’t care. Purchases are another matter to them. I don’t know how they re-value the items but their ‘experienced’ appraisers are doubtful at best.

We had 2 other complainants there at the DHL office in Pasay. They had the same problem with the BOC!

And just to prove all the statements I have placed here: We made two more international purchases and we told our suppliers the problem. They both shipped the items as gifts/personal effects and sent them without using the major carriers FedEx or DHL. They used DepEx (a singapore company) and LBC. The more unknown to the BOC, the better. Also they used euros and yen as values to hide the US dollar conversion.

Guess what? The two other shipments were BASICALLY IGNORED! And this time we shipped to the tune of 200 dollars per package. NO TAX was imposed! “Only in the Philippines,” this was the statement from both suppliers.

Olongapo Hits 40°C, No Alarms raised

Olongapo Hits 40 degrees midday in Olongapo City today. Nobody was alarmed and thank God, so far I heard of nobody hurt. The  election was just over and people flock the streets of Olongapo anyway, thinking this was just another hot day. PAGASA was right a month ago when they forecasted a much hotter May season. I would suggest patients to have sunblock on at least twice a day depnding on the SPF they are using if they plan to be directly under the sun. Also, always bring water and keep cool. 2 more notches in the temp and I’ll be complaining to the city health office why there was no warning. 40C can already excacerbate many fevers and can cause cardiac arrest or stroke in susceptible individuals.

Internet Nostalgia

I had the advantage of seeing the internet and computing from two different eras because I had chosen a different path in life and that is to be a doctor. I took up the stethoscope and chose a career that is far from all this. I never thought that the past will catch up on me.

I destroyed the first PC I ever touched by being ignorant of the word “format.” I picked up a dictionary, and I was about nine then and I learned that format means to arrange things in a pretty manner. The geekish computer term has never been printed in a Webster’s before. I saw this machine, a big hunk of plastic compared to what I’m using now, and it had a screen and lots of text. One of the words or choices that came up on screen was FORMAT. “Are you sure you want to format Disk drive C:?” I clicked YES. And everything was history, including my friends files!

I had to learn all about the computer since then and its parts and everything. I eventually had my own and I tinkered with it. And I learned about LAN, WAN, and the wonderful internet. I learned BASIC and COBOL until my nose bled. And I was scripting HTML all way back 20 years ago! I was using mockup internet sites using Wordperfect and linking my documents and making it look like I had a supercomputer. Internet then was very costly. You can surf the net for 1 hour with 50 pesos. Factored to inflation (average of 5% per year) and converted to today’s Philippine peso, that’s about 132 pesos per hour. Back in those days I had a total of 1-2 hours of internet PER WEEK! Because that’s all I can afford.

Being very costly, most of the information was free then. RTFM was the code I learned from hackers! It’s all about getting information and saving most of it. mIRC was the dominant P2P platform. FTP sites abound where you can download pirated programs! I wasn’t able to access the BB’s but then it was haven to everybody involved in the world of computing. I would have been a programmer and I could have used my early gift to create websites and other cool stuff but the expense was way too much burden for a Filipino poor. I quit and hit the books instead even though most of the information from printed media is 2 years outdated from the time it hits the bookstands.

I caught a few glimpse of the internet’s rise and not of its fall. Even the dot com bubble escaped me and that was about a few years back already! I saw Napster, I saw Friendster’s birth, I saw eBay and Amazon’s meteoric rise but I just didn’t give a damn much about them. And then it slowly came back, Flash evolved from its 5.0 version to a now fully programmable platform. I got  hooked to it a little and then Facebook. The big geek who quit came back too and started making iMacs and now iPods!

What was once a text only free information network is now a bustling commerce driven engine and oh, all the colors of the internet got me on a high like I had a hallucinogen inserted up my spine. I missed it. It moved ahead without me as all things do. And now I feel like I just missed my bus. The ship has sailed and I only have a canoe to rush to it and get on it. Rough seas ahead. I almost got scammed once on the net but that’s another story.

Even though I am a general practitioner, I am also on the e-commerce bandwagon. I am relearning how to ride a bike again so to speak. All the sites I used to get information on are still there except for one. What ever happened to Hackers.com? Jolly Roger’s book of terrorism is now a classic on the internet. Most of the methods can still work but are now considered low tech. But I’ll choose to be an internet pacifist instead and try to earn an honest job on the net.

What sucks is that I got back the habit of spending more than 20 hours a day in front of a computer screen! I think DSM IV will have to call a name for that syndrome.

Banner Trouble, Google Site Problem

The Loader Class is one of the most used class for me since its inception in 2.0 as MovieClipLoader Class. It can make great sites like 2Advanced.com which would hardly need a preloader at all even if it runs on 14.4 kbps. I make presentations using flash and the Loader Class. I got paid on one CD project about the hypothalamus using Flash and they were awed at its functionality. Recently I got commissioned to do a website but the banner had trouble loading on site! The banner had no trouble when you view it directly at the folder but when it’s embedded it just froze! This could be a problem with Google Sites, I don’t know. Single swf files with animation loads perfectly. But when I link them using the Loader Class and embed them, I probably get an error. Is there any way to know what error I could get while on site? I’ve pretty much given up. So I’ll  be loading a single SWF instead which could get really large and long to load. The following is a prototype version of the Banner.as that I wrote. I know it sucks but I’m going to improve it.

package{

import flash.display.Loader;

import flash.net.URLRequest;

import flash.display.MovieClip;

import flash.events.*;

import flash.utils.Timer;

public class Banner extends MovieClip{

private var url:String = “items_1.swf”;

private var myTimer:Timer = new Timer(10000, 3)

private var myLoader:Loader = new Loader;

private var slideNumber:Number = 1;

public function Banner(){

myLoader.load(new URLRequest(url));

trace (url);

trace (“loader works”);

addChild (myLoader);

configureListeners(myLoader.contentLoaderInfo);

myTimer.start();

}

private function configureListeners(dispatcher:IEventDispatcher):void{

dispatcher.addEventListener(Event.COMPLETE, startTimer);

}

public function startTimer(event:Event):void {

trace (“completed swf1″);

myTimer.addEventListener(TimerEvent.TIMER, switchMovie);

}

public function switchMovie(event:TimerEvent):void {

if (slideNumber < 3){

slideNumber ++;

trace (slideNumber);

url = “items_”+ slideNumber +”.swf”;

trace (url);

myLoader.load(new URLRequest(url));

addChild (myLoader);

} else if (slideNumber == 3) {

slideNumber = 0;

myTimer.reset();

trace (“Timer is reset”)

trace (slideNumber)

myTimer.start();

}

}

}

}