UJIAN AKHIR SEMESTER M.K.
PROMOSI KESEHATAN DI TEMPAT KERJA
MINAT K3 PRODI S-2 IKM FKM USU SEMESTER III T.A. 2021/2022
31 DESEMBER 2021, WAKTU UJIAN 14.15-15.45 WIB (90 MENIT)
Perhatian:
1. Baca dan pahamilah case history di bawah ini sesuai dengan nama sdr.
2. Jawaban dikirim ke akun google classroom.
3. Jawaban yang dikirim tidak boleh melewati waktu ujian (selesai pkl 15.45).
4. Jawaban diketik dengan rapi, huruf times new roman ukuran 12 dengan 1 spasi.
5. Tidak boleh ada jawaban yang sama antar teman. Bila terdapat jawaban
yang sama, maka jawabannya tidak akan dinilai.
Nama : ..............................................
NIM : ..............................................
Pertanyaan:
1. Jelaskan apa masalah dalam case history.
2. Jelaskan apa yang dapat dilakukan pekerja dan manajemen agar
kasus yang sama tidak terjadi.
3. Buatlah program promosi kesehatan terkait dengan case history
tersebut.
Case history 1 (NATASYA SANTA ELISABETH SIAHAAN)
A 25-year-old man presented for a pre-employment medical examination
prior to enrolling on a nursing degree course. His previous employment
had been in the drilling team on an oil rig. He was a fit looking, muscular
man but had to be turned down on the basis of recurrent back injury
which made him physically unsuitable for nurse training. The injury had
occurred on the oil rig, an environment notable for the machismo of
some of its workers. He had been told to haul 70 kg segments of metal
piping a height of some 10 metres. This he did with a rope, which his
mate tied round the objects while he leant over and pulled them up.
While doing this he developed acute lumbar pain and sciatica. After a
period off work he returned to the job and again injured his back while
undertaking another lifting task. Apparently, no consideration had been
given to the use of pulleys to lighten a task which required considerable
force in an anatomically inefficient posture.
Case history 2 (MARIA PUTRI REZEKI SIREGAR)
A 53-year-old librarian, who had been in the same job for about 19
years, began to complain that soon after the start of her working day her
eyes became watery and her nose started to itch. As the day
progressed, her chest felt tight as though she had a ‘chesty cold’. She
was symptom-free at weekends and her symptoms started to improve
within an hour of getting home on workdays. She attributed her
symptoms to the turning up of the ventilation in her library about a month
previously. She was asked to keep a record of peak expiratory flow at
approximately 2-hourly intervals for 4 weeks. This showed an
approximately 20 per cent variability between her maximum and
minimum peak flow readings and her values were slightly worse during
the working week when compared to the weekends. The
particulate pollution concentrations in the library were measured using a
continuous sampling infrared scattering device. This showed marked
rises in dust concentrations from approximately 10 micrograms per cubic
metre at baseline up to around six times higher values whenever the
ventilation was switched on. Attempts at identifying specific
aeroallergens were unsuccessful. The ventilation system was
overhauled and found to be heavily soiled, with contaminated filters,
evidence of fungal overgrowth and other debris. The system was
thoroughly cleaned and a regular service and maintenance schedule
instituted. She resumed work and became completely symptom free and
has remained well since.
Case history 3 (NUR AMRI SARI HARAHAP)
A 45-year-old man was employed as an operative on a production line in
a food factory. In a previous period of employment with the company he
had spent some time off sick with back pain. Nevertheless, his job
entailed collecting waste in plastic buckets from nine, often inaccessible,
points in the line. When the line was faulty, as many as 180 buckets
needed to be collected on a shift, whereas on a good day as few as 18
were required. When full the buckets weighed 67 kg and were dragged
to a main collection point where they were stacked three high on a pallet
for collection. In the course of this work the man (who was of short
stature) sustained a prolapsed intervertebral disc. Back and leg pain
were still present 2 years after the episode and had prevented his return
to work.
Case history 4 (VIVI PRETTY LUMBANTORUAN)
An occupational physician was inspecting a light engineering department
spread over a couple of rooms, as part of an investigation of possible
occupational dermatitis. The physician noticed that some of the
machinery was very noisy and wearing of personal protective equipment
was inconsistent. He made some interim recommendations. These
included the replacement of the oldest equipment by quieter and more
modern tools, relocation of the less noisy jobs so that they were all
together in a relatively quieter area (segregation) and strict enforcement
of the wearing of personal protection in the residual noisy area. In the
longer term, after consultation with workers and managers, a programme
of education, health surveillance for noise-induced hearing loss,
professional occupational hygiene assessments of noise, and further
steps to reduce exposure was instituted.
Case history 5 (SRI YUSNANI)
A firm manufacturing fine tools embarked on, and publicized, a health
promotion exercise. This included offering a wide range of high fibre, low
fat meals in the staff canteen, providing exercise facilities, and classes to
help in stopping smoking. Many executives and some other office staff
but few manual workers took advantage of this. Most employees still
brought in their own lunches or went out for chips and beer at lunchtime.
Few employees who did not previously engage in physical exercise
started to do so as a result of this programme. In the meantime, some
employees in parts of the firm continued to suffer from noise-induced
hearing loss and tinnitus. Others had occupational diseases of the skin
from exposure to cutting oils and other agents. One developed features
of ‘hard metal’ lung disease. These were often first evident during their
attendances at the Occupational Health Department or when referred by
their general practitioner (GP) to hospital out-patient specialists. A clear
strategy and mechanism for preventing many of these cases or
managing their consequences was lacking. Most workers viewed health
promotion as implemented by the firm with considerable scepticism and
even resentment at what some perceived as rank hypocrisy.
Case history 6 (INDRI HARDIYANTI)
An award scheme was established for firms based in a large area in
order to afford recognition to those that had fulfilled certain criteria for
‘health at work’. The criteria were heavily based on evidence of lifestyle
interventions, such as dietary measures, exercise facilities, smoking
cessation and stresshealth management classes. A few large, high
profile companies pursued the scheme but the majority of, usually
smaller, companies (which employ the majority of the working
population) were indifferent to the scheme. A large company employing
thousands and with a turnover of hundreds of millions of pounds was
assessed by a body which had developed the award scheme and
qualified for a prestigious trophy on the basis of having fulfilled a number
of the criteria. The company then experienced a work-related fatality. It
was later prosecuted, found guilty of negligence, and felt compelled to
return the award.
Case history 7 (INDRA MASJID)
A well-intentioned manager in a large National Health Service hospital
decided to introduce a programme of health promotion. A detailed policy
was worked out, based on his concept of what the workforce needed,
and included action on smoking, healthy eating, exercise and stress
management. A committee was then established to set the wheels in
motion and implement the policy. This included union representatives.
Many members of the committee not only smoked but also considered
themselves experts on stress management. The meetings of the
committee, taking part against a background of management–union
dispute with respect to NHS reorganization and redundancies,
became a stage for argument about provision of recreational facilities,
time off work for counselling and places for smokers to smoke!
Resentment was then expressed that workers had neither been
informed nor consulted on fundamental issues such as musculoskeletal
ill-health and stress. The project came to an unsatisfactory end when the
manager was himself declared redundant.
Case history 8 (A. FATHURRAHMAN AZWIN NASUTION)
A trained occupational physician was appointed in a part-time capacity
for a chemical firm that had previously employed the services of a GP. In
the first few sessions many employees walked in quietly, waited to be
weighed and then rolled up their shirt sleeves for their yearly blood
pressure measurement and blood test. The new physician then
discovered that it had been the practice for production workers to have
a ‘full medical’ with a yearly estimation of liver function tests and full
blood count. On an initial site visit by the occupational physician, many
respiratory and cutaneous hazards were evident but none for which
blood tests would have been required as a form of health surveillance.
The occupational physician spoke to workers individually, found out
about their jobs, their lifestyles, their general health and their attitudes to
it. Most employees welcomed the opportunity to sit down and be
listened to. A minority complained to their union representatives and
hence to the factory manager that ‘the new doctor had stopped the blood
tests’. The physician explained the reasoning for abandoning the tests to
the factory manager, and asked for the opportunity of participating in
safety committee meetings, where he explained the reasons for taking
detailed occupational histories, and the limited value of blood tests in
that particular context. This was paralleled by regular workplace visits by
the physician and by occupational hygiene advice on reducing risks at
source. The workforce and management accepted that the more
important work-related risks were now being assessed and accorded the
priority that they deserved. The spontaneous consultation rate
increased, concerns about health in relation to work or other factors
were more openly addressed, both within the clinic and the safety
committee, which became better attended by safety representatives and
senior managers. On average one new health-related issue was placed
on the agenda for each meeting and discussed following a short
presentation by the physician. Discussion thereafter was generally
fruitful, resulting in an agreed plan of action on both occupational health
and lifestyle issues.
Case history 9 (RAHMADINA KHAIRANI)
An employer in a large service organization sought the advice of an
occupational physician for the purpose of launching a healthy workplace
strategy. The personnel officer tabled various suggestions including
changing the balance of food available in the canteen together with
appropriate labelling, weight reduction and ‘stop smoking’ classes,
exercise facilities, mammography, cholesterol and cervical screening.
The physician reviewed various sources of information and found that
the employer was doing very little to facilitate employment of disabled
employees or to rehabilitate its own employees when off sick, even when
disabled by their work. In fact managers were tending to press
for premature ill-health retirement in many cases without attempting to
alter the work to rehabilitate the workers. Health surveillance in relation
to skin and respiratory hazards of occupation was scanty,
while a disproportionately large resource was devoted to initial health
assessment of job applicants. Many employees and some managers
were very ignorant of the health risks arising from their work or
on the means of reducing these risks. First aid provision was less than
that required by law. The physician pointed out the contradictions
between the professed aim to promote health and the plethora
of ideas to modify lifestyle on the one hand, and the many shortcomings
that he had found regarding health protection in relation to work.
Case history 10 (RAHMI WARDANI)
An accounts clerk presented to the occupational physician complaining
of sore feet and wondering whether he had athlete’s foot. The physician
explained that such complaints would not normally be dealt with in the
occupational health department but agreed to examine the feet on the
understanding that further management would be undertaken by the GP.
The feet were slightly swollen and the webs between the toes
macerated. The employee jokingly conceded that he had slept in his
shoes and socks. Further enquiry and examination revealed a
substantial alcohol intake (of the order of 5 units per day), heavy
smoking, symptoms consistent with chronic bronchitis, poor dietary
habits, unsatisfactory oral hygiene and moderate obesity. The physician
enquired in detail about the patient’s habits but in a non-judgemental
way and providedanswers to the patient’s questions that followed the
detailed clinical assessment. The patient then asked for the physician’s
advice on diet, smoking and rational alcohol consumption. This was
provided verbally, backed up by health education literature, target setting
and a review appointment with the occupational health nurse. The GP
was consulted and agreed to this plan. Over a period of a few
months the patient’s alcohol consumption fell to about 14 units per week,
his weight was restored to normal, he stopped smoking, and resumed
attending the dentist. His feet improved with basic personal
hygiene and without specific treatment.
Case history 11 (SARAH ADINDA)
A bus driver had been employed for several years by a company that
permitted smoking on board, long after the epidemiological evidence of
the harmful effects of inhaling tobacco smoke was available. He had
never smoked and yet he developed cancer of the bronchus. He sued
his employer, arguing that his cancer was, more likely than not, caused
by his passive inhalation of side-stream tobacco smoke at work. The
case was settled out of court by the bus company paying a substantial
sum to the driver.
Case history 12 (DIAN ARDIKA SITANGGANG)
A health authority had decided that it wished to set an example in
relation to health promotion in the workplace. It decreed that as from a
specific date, all smoking by staff was prohibited on its premises,
and disciplinary proceedings (which could lead to dismissal) would be
instituted against any staff member caught flouting the rule. A female
domestic assistant who had smoked all her life found that all of a sudden
she could not do so. Even most of her official breaks were not long
enough for her to change into her outdoor clothing and go and smoke
outside the premises. She resigned her job butpromptly instituted
proceedings alleging constructive dismissal.
Case history 13 (USAHA SATRIA PRATAMA TARIGAN)
A 55-year-old supervisor was referred for the first time to the
occupational physician because she had been abusing alcohol, had
become intolerable to work with, and was performing very poorly. Her
manager said that her colleagues would no longer carry her and that
they had got to the end of the line. He requested that she be retired on
the grounds of ill-health or that her employment be terminated on the
grounds of incapacity; as far as he and her workmates were concerned
they were not ready to accept her back at work. The occupational
physician made further enquiries and found that the worker’s alcohol
problem had been known, and had caused some difficulties at her work,
for at least 5 years. Mean red cell corpuscular volume and serum
gamma glutamyl transaminase level were both elevated to a level
consistent with significant chronic alcohol abuse.
Case history 14 (MUHAMMAD NIDAL NASUTION)
A 47-year-old porter was formally referred to the occupational physician
because of his alcohol problem. He had been noted to be late for work
and hung over on some mornings, usually after payday or after a
weekend off. Sometimes he came back late and smelling of alcohol after
lunch breaks. His manager had given him a formal warning but said that
he would support him provided he followed professional advice and
showed reasonable goodwill and signs of improvement. The physician
found that the worker lived alone, his only close relative being his
mother; he socialized with a group of friends who drank heavily; he had
no understanding of the relative alcohol content of different drinks
and measures. Until the formal warning by his manager he had not
realized how noticeably poor his performance had become, and he was
particularly shaken by the prospect of losing his job. The
physician reviewed the alcohol history in detail, at the same time taking
the opportunity to explain the alcohol content of various drinks. The
porter was given a diary in which to record his alcohol consumption
every day and was reviewed at frequent intervals by the physician or
nurse. During the counselling he acknowledged the role of peer pressure
in fostering his drinking habits and followed the physician’s advice to
change his circle of friends. This took some time but was eventually
achieved. About 9 months after the original referral, the worker, his
manager and the physician were in agreement that he no longer had an
alcohol-related problem, that he was a valued member of the
workforce and that no further follow-up was needed, although, like other
workers on that site, he was aware of the availability of the OHS for
advice and support at any time should he need it.
Case history 15 (CORRY CLARA JUNILA)
A 26-year-old nurse was referred to the occupational physician because
of doubts about her fitness for work. No specific details were identified in
the referral letter, although, on enquiry, the physician was told that she
concentrated poorly, seemed to forget instructions that she had been
given, and was slow in her work. On history taking and physical
examination no cause for concern could be found and the physician
reassured the nurse and her manager accordingly, but expressed
a readiness to review her on request if necessary at a later date. About
9 months later the nurse was suspended from duty having been caught
stealing benzodiazepines and other drugs from the ward. During
disciplinary hearings it was claimed that she had become dependent on
drugs after having been given anxiolytics when she was younger
following the death of a parent. Extenuating circumstances were
accepted and she did not lose her job. She was eventually rehabilitated
in collaboration with a psychiatrist.
Case history 16 (LIZAHRA IZZATI)
An occupational physician was appointed to a firm that manufactured
controlled drugs. The firm had a policy, stipulated in the contract of
employment of each worker, that possession of one of those
drugs would result in instant dismissal without notice. In order to enforce
this, workers could besearched without warning and some white-collar
employees were constituted into search teams for either gender. The
physician discovered that the nurse had been assigned to a search team
although had never been called to participate in one – indeed no search
had been carried out within recent memory. The physician advised the
factory manager that it was inappropriate for occupational health staff to
participate in what was a purely disciplinary and enforcement role, while
at the same time attempting to engage in health-promoting activities,
including availability for confidential counselling. The manager accepted
this and the nurse was removed from the roll of search team members.
Case history 17 (ZSA ZSA DWITA SARI BATUBARA)
A 53-year-old computing officer came to consult the occupational
physician after her manager had informally suggested that some form of
counselling or stress management advice might help her. The
employee was tense, anxious and distressed because she had found
progressive difficulty in keeping up with increased work demands. The
unit was scheduled to merge with another and she was uncertain of the
consequences that this might have on her employment. She had some
slight difficulties with vision because of severe myopia and a retinal
detachment which had been treated, but this in itself was not a major
problem provided she could work at her own pace. Her manager later
said that she had become increasingly withdrawn into simple repetitive
tasks while allowing a backlog of important requests to accumulate.
The physician expressed the opinion that an adequate and sustained
improvement in her well-being would best be achieved by a change in
her work plan and responsibilities. This was difficult to arrange
but she was eventually given responsibility for the induction training in
keyboard skills and basic computer training for new members of staff.
This was a fairly circumscribed job with a steady and relatively
predictable load, well within her skills, and resulted in continuing useful
employment and well-being. A few years later her duties were changed
again because of a reorganization and she developed an anxiety
neurosis. This, together with some worsening of her vision, prompted
premature retirement on grounds of ill-health.
Case history 18 (ARIES MUNANDAR)
A senior manager telephoned the occupational physician and sought a
consultation away from their usual workplace. He complained of
headache, heartburn, anxiety and tiredness, and of difficulty in
falling asleep. He said that he had noticed increased irritability with close
colleagues and family, and that his libido had decreased. He had
reached the conclusion that his symptoms were stress related.
There had been many changes in the organization, including the
introduction of productivity targets expected of his unit, and he had to
transmit these stresses and expectations to his juniors. This placed
him in internal conflict. Together with a number of his peers he was
uncertain about the consequences of reorganization, in which it was
rumoured that one or more of them would be made redundant.
Physical examination was normal. Further discussion permitted him to
identify various occupational stressors, over which unfortunately neither
he nor the physician could exercise significant influence, especially as
he did not wish any other people to become involved. The physician’s
reassurance that the symptoms were not an indication of some other
underlying pathology provided some relief. The value of coping
strategies such as allocating specific time and place for work and
domestic activities was discussed and the physician provided him with
further written information relating to other sources of advice.
Case history 19 (ANGGI PRATAMA SAGALA)
A 50-year-old security officer presented himself to the occupational
health department asking whether a ‘cholesterol test’ might be on offer.
He did not have any cardiac or vascular symptoms, although he
complained of ‘heartburn’ which was relieved by antacid tablets. His
father had died at the age of 64 years from pneumonia against a
background of chronic lung disease, while his 75-year-old mother
was alive and well with no history of cardiac disease. He had smoked at
least 15 cigarettes a day since his early twenties and drank an average
of 10 pints of beer per week. He was normotensive and not
overweight, and the rest of his physical examination was normal. The
relevance of various lifestyle risk factors in general and particularly with
regard to his lifestyle was explained by the occupational
physician. He accepted that his smoking history presented a higher risk
than that which might be related to blood cholesterol level alone.
Cholesterol measurement was not pursued as a first line but
he resolved to attempt to stop smoking, to ensure his alcohol drinking
remained under control, and to engage in regular exercise. He
succeeded in reducing his smoking considerably, although not in
stopping altogether. Having done so he was encouraged to see his GP
for further review.
Case history 20 (ANGGI DIAH LESTARI)
A 32-year-old executive was found to have positive dipstick screening
test for haemoglobin in his urine in the course of a routine medical
examination in industry. A repeat test was also positive and he was
referred back to his GP with a letter indicating the results of this. A
further urine test carried out by the GP was followed by a referral to a
urologist, intravenous nephropyelography and cystoscopy. He was told
very little about the purpose and the results of these tests. Besides the
physical discomfort, he and his wife were very anxious about the
proceedings and the implications. Eventually he was told that no
abnormality had been found and he remained physically well although
with the anxiety that he might have had something that had been
missed.
