Pentingnya IPAL Rumah Sakit

link dari republika :
http://www.republika.co.id/online_detail.asp?id=188968&kat_id=23

Dari 26 Rumah Sakit (RS) yang berada di Kotamadya Jakarta Timur, baru 20 RS yang memiliki Instalasi Pengolahan Air Limbah (IPAL). "Ini artinya, enam rumah sakit lainnya beresiko untuk mencemari lingkungan, akibat limbah mereka," Selain itu, ungkap Utomo, baru 14 RS yang memiliki dokumen. "Dan yang telah mengimplementasikan dokumen tersebut hanya sembilan rumah sakit saja," jelasnya. Ia juga menambahkan 18 RS telah memiliki insenerator. Namun, katanya, insenerator tersebut belum ada yang kerjanya benar-benar baik.

More about IPAL :
http://www.depkes.go.id/index.php?option=news&task=viewarticle&sid=60&Itemid=2
Kendati Departemen Kesehatan telah menyusun Standar Pelayanan Minimal (SPM) untuk mengukur kualitas pelayanan kesehatan dasar yang salah satunya adalah kewajiban rumah sakit dan Puskesmas untuk mengolah limbahnya. Namun Menkes mengakui bahwa penerapannya masih belum baik. Berdasarkan hasil assesment tahun 2002, diketahui bahwa baru 49 % dari 1.176 rumah sakit (526 rumah sakit pemerintah dan 652 rumah sakit milik swasta) di 30 provinsi, baru 648 RS yang memiliki incinerator dan 36% memiliki IPAL (Instalasi Pengolah Air Limbah) dengan kondisi sebagian diantaranya tidak berfungsi

How IPAL works ?
http://www.pdpersi.co.id/pdpersi/news/kesling.php3?id=180
case : RS St.Carolus


Ket:
Incinerator: Tempat Pembakaran.
JP III: Jasa Pihak ke-3.

limbah non medis ini terbagi menjadi dua bagian, yaitu limbah basah dan limbah kering. Limbah basah bisa berupa sisa-sisa sayuran, makanan, sisa nasi, dan sebagainya. Limbah ini kemudian bisa dimanfaatkan untuk makanan ternak. Sementara untuk limbah kering, jika masih bisa dimanfaatkan atau dijual, maka akan dijual, seperti kardus-kardus bekas dan sebagainya. Tapi untuk yang tidak bisa dijual, maka sebaiknya langsung dibakar.

Sementara limbah medis terdiri dari infeksius dan non infeksius. Limbah infeksius non cair biasanya langsung dibakar. Misalnya jarum suntik, pisau bekas operasi, bekas perban, infus dan sebagainya. Sementara yang cair akan masuk pada IPAL. Limbah non infeksius sendiri akan dipilah secara selektif. Yang cair tentu saja masuk IPAL. Yang non cair, jika bisa didaur ulang, maka akan di daur ulang. Untuk yang tidak bisa di daur ulang akan langsung dibakar.

untuk membangun IPAL di RS Carolus dibutuhkan biaya sekitar 1,5 milyar!!. Biaya besar ini terhitung cost saja, tanpa keuntungan secara materiil. Tetapi jika tidak membangun IPAL, maka kesehatan lingkungan hidup terancam

Limbah berbahaya ini bukan semata yang cair saja, melainkan juga yang padat. “Misalnya jarum suntik, pisau bekas operasi, botol-botol bekas, sisa bahan makanan penderita infeksius, perban dan lain-lain itu harus secara jelas dibedakan, lalu segera dimusnahkan atau dibakar,” “Sebab jika diambil alih pemulung, atau orang-orang yang tidak bertanggung jawab, bisa runyam..

Sementara mengenai limbah cair “Limbah laundry bisa infeksius karena mengandung cairan darah, atau sisa urine. Begitu juga dengan bahan-bahan spesimen lainnya yang berbentuk cair. Bisa infeksius, terutama dari orang-orang yang menderita penyakit menular.”

ada beberapa jenis pengelolaan IPAL. Yaitu Sistem Aerob/Bioreaktor, Sistem UnAerob, dan Sistem Founding.

Sistem Aerob adalah sistem yang membutuhkan banyak oksigen, dan dilakukan di lahan terbuka sehingga mempermudah pengontrolan. Keuntungannya antara lain, lahan yang digunakan sempit, lumpur yang dihasilkan sedikit, bahan kimia yang dipergunakan juga sedikit, dan pemakaian listrik minimal. Proses pengolahan waktu pada sistem aerob adalah empat hingga enam jam.

Sistem Unaerob adalah sistem yang tidak membutuhkan oksiogen. Oleh karenanya dilakukan di ruangan tertutup. Lahan yang dibutuhkan Unaerob cukup luas. Sayangnya, jika ada kebocoran sulit dikontrol (pengawasan lebih sulit). Selain itu, jika terjadi kebocoran, bau sulit dicegah dan jumlah lumpur yang harus dibuang cukup banyak. Keuntungannya, dari segi estetika unaerob lebih unggul, karena limbah tak terlihat dan disimpan di bawah tanah (semacam septic tank).

Sedangkan sistem founding adalah sistem yang membutuhkan lahan luas. Pross pengendapan dan penguraian biologis membutuhkan waktu yang lama, karena dilakukan secara alami. Dalam founding, proses pengolahan antara empat hari hingga seminggu.

Application Specialist Training 15-18 Feb 05 -- SiemensLife

Siemens LIFE
So.. What is this animal ? and what an application specialist do with that ?
Siemens said : Life provides exactly what customers need to get the most out of their investment throughout its lifecycle. With seven key programs that support the continuous development of customer skills and customer products. Enabling them to take technology further. Profitability higher. And patient care to the next level. It´s the framework for helping our customers meet their clinical and business objectives.

I said : with Life they just integrated customer care division.. all for one, before 2003, each BU has their own CC division and their own programs (SomatomLife, MagnetomWorld, USBridge).. with this Life they want to integrate all of it..so nothing new here.. as Costumer Care solution it still consist of common thing in CC division : consists of programs and after sales services...

so , of course one part of the programs is the EDUCATE.

Applications training is one way for transfering what clinician should know in order to optimize using those expensive instruments in daily clinical application. Its not make sense to give a sophisticated - modern toy to a boy, without telling him what he can do with it.. right ? ;p thus,clinician and doctors will be thoroughly trained in the use of new CT scanner to make sure that they gain maximum benefits from investment they made.

And thats what an application specialist exactly do !
They meet the costumer and travel around as well as the sales marketing guys do.. they understand how basically the instrument works as well as the physic-application guys do.. they concern about how the instrument's doing in the clinic/hospital as the clinician do.. and one thing: they care about the patient, as the doctor do !
well,.. actually that's too much.. :p

but to become an application specialist means, possibility to learn a lot of thing, get in touch with latest improvement in the instrument and get sympathy from clinician and doctor.. well, u teach them how to get the most from the instrument.. (they loves application specialist more than sales guys.. :p)

like we always said.. learn it, apply it and share it.. thats what a knowledge stands for ! :)

GE MEdical System and SixSIGMA

Hari gini blm pernah denger Six SIgma ? sama.. :p

image src:http://www.smallpeice.co.uk
but think about it.. how does it looks like.. when SIx sigma meets a huge great medical company like GE Medical System ? we know they are already have their own 'Work Out' system .--- as 'Proven Outcomes' for Siemen'.. why must they adopt this six sigma ?

read this : http://savelives.gecareers.com/abtus_cf6sigma.html
Imagine a quality initiative so ambitious, its goal is to achieve perfection -- to be 99.9996% defect-free in every product, service, process and technology throughout a company. Through Six Sigma, that company is GE. And through Six Sigma, GE Medical Systems continues to set itself apart from the competition by maintaining an unparalleled dedication to absolute customer satisfaction.

What is Six Sigma?
Six Sigma is a rigorous quality initiative -- a highly disciplined process designed to reduce defects and drive improvements throughout our business. To meet our goal of near perfection, we employ many Six Sigma tools -- gathering "voice of the customers," SIPOC process mapping, Analysis of Variance (ANOVA), and Design of Experiment (DOE) -- which all GE Medical Systems employees become equipped with through intensive training.

Six Sigma quality is more than a goal. It's a commitment woven deeply into the fabric of everything we do. We embrace change and welcome every opportunity to better serve our customers in ways they can see, feel and measure. We strive to achieve Six Sigma quality by making sure our products are exactly what our customers want. And by making sure we deliver the highest standards of performance against any and all measurements.

Six Sigma involves an intense sharing of ideas, and thus builds upon an earlier GE initiative known as "Work-Out™." Beyond identifying and implementing "best practices," however, Six Sigma creates a culture with unlimited capacity to improve every GE Medical Systems product, service and technology.

A Six Sigma breakthrough in GE
The introduction of Six Sigma sparked an incredible energy in our people at GE Medical Systems, and its effects were tangible from the outset.

image src:http://news.bbc.co.uk/
GE Medical Systems led the way among GE businesses in seeing that our customers benefit from Six Sigma. Our 1998 introduction of LightSpeed™, our revolutionary Computed Tomography system, was GE's first product completely "Designed For Six Sigma" (DFSS).

Clearly, our customer focused Six Sigma efforts are achieving their goals -- customer reaction to LightSpeed has been unprecedented, with new orders for the system coming in at a rate six times faster than any product we have ever introduced.

"There is an infinite capacity to improve everything " -- Jack Welch GE Chairman.

the ECG signal

just for fun...need to remember all these things again for my thesis report.. :)

The electrocardiogram (ECG) consists of recording the bio-electrical signal of the heart muscles. The heart’s electrical activity is recorded from electrodes on the body surface. ECG is a powerful clinical tool for diagnosing cardiac abnormalities.

The meaning of ECG waves and intervals are here explained.
P-wave: It represents the sequential activation (depolarisation) of the right and left atriums. For normal ECG, the P-wave duration is inferior to 120 ms.
QRS complex: It represents the right and left ventricular depolarisation.
ST - T-wave: This wave represents the ventricular repolarisation.
U-wave: This wave is not always observable and its origin is not clear, but it may represent “afterddepolarisations” in the ventricles.
PR-interval: This is the time interval from onset of atrial depolarisation (P-wave) to onset of ventricular depolarisation (QRS complex).
QRS duration: This is the duration of ventricular muscle depolarisation. It is normally inferior to 100 ms.
QT-interval: It represents the duration of ventricular depolarisation and repolarisation.
RR-interval: It represents the duration of ventricular cardiac cycle. This is an indicator of ventricular rate. For a normal ECG, the heart rate is about 60 - 90 bpm .
PP-interval: It represents the duration of atrial cycle.

I first learn it on my third semester at BME ITB. Thanks to Mrs. Yoke, my favoúrite lecturer..:)

Sensation 64

Just imagine if in one second, 64 slices of each 0,75 mm scan your body 3 times !
means : 64x0,75x3 mm/s..depend on the table feed, it could reach more than 15cm per second, and with fine detail..!

not a fan of math ? just see image below : it is from real instrument already installed in several clinics.. (not from the lab lika some company claimed ;) )

"Now we can see small detail"
(Professor Willi A. Kalender, PhD;Clinical expert )

Aspaki : kurangi impor belanja alat kesehatan !!

Pemerintah perlu meningkatkan pembelian produk peralatan kesehatan sebesar Rp. 3 triliun selama lima tahun ke depan, serta mengurangi produk impor yang kini mencapai 60% dari belanja. Ketua Umum Asosiasi Produsen Peralatan Kesehatan Indonesia (Aspaki), Buntoro mengatakan saat ini pemerintah belum menganggap industri peralatan kesehatan sebagai sektor unggulan di dalam negeri, sehingga daya serap di pasar belum maksimal. Seharusnya pemerintah membuat road map bagi sektor peralatan kesehatan, sehingga produk lokal akan bersaing di pasar dalam negeri. Deperindag dan Depkes perlu melakukan kerjasama lintas departemen dan menetapkan kebijakan bersama.

just wondering 3T itu bs dibeliin berapa CT ya .. :D

Product Sales And Consumer Training, Siemens Erlangen 1- 4 February 2005

how does it look like, when marketing team from around the world gathering in a training... discussing how to sell as much as they can, and beat the competitors as hard as they can ?
IT IS FUN ! hehehe...

Thanks to Mr. Bruder, finally they allowed me to join the PSC Training in Erlangen for CT part. The trainer is Mr. Mathieson -International merketing for CT.



The training divided into 2 parts :

Fisrt part......
theoretical and latest development in CT done by simenes -- They call it THE BULLETS.. :D
interesting part, of course : UFC and Z-sharp technology. 2 sensationl innovative technique sinde the slip rings and the multi slice era.. doing this Z-sharp gives you 0.3 mm detail resolution with dose characteristic as low as 0.6 mm ! amazing.. and also the UFC detector which enables this super velocity scanning happen.. the results ? Rotation time to 0.33, resolution to 0.4 mm and dose ? 66,67% less than ever !!

Second parts...
the real war began... huehehehe.. here explained how to compete with others competitor,.. key selling factors,..the minimum 4 bullets for each products.. competitor's weakness,.. siemens strength.. how to beat them.. how to show costumer: SIemens is.. faster, better, better,faster,better,... cheaper ? wait a sec !.. if only u sell Somatom Spirit u can compete with price,... or perhaps get one from refurbished system with SIEMENS PROVEN OUTCOMES 5 years warranty.. the price then so nice.. :)

after all.. itsnice to join the training.. it is a lot of fun.. and give me clear ideas how is the market for this Biomedical instrument worldwide..

YPKKIndonesia - dan Jamsosnas

iseng lihat berita : http://berita.kafedago.com/lihatkomentar.asp?beritaid=13735
" Yang sekarang terjadi, begitu pasien masuk, langsung dilakukan pemeriksaan lengkap, memakai peralatan canggih seperti magnetic resonance imaging (MRI), USG (Ultrasonograf) tiga dimensi, computerized tomographic scanner (CT Scanner) dan lain-lain, meski tidak diperlukan. Benarkah rumor seperti itu? Oh iya, hal-hal seperti itu memang terjadi, kata Dr. Marius Widjajarta SE, Ketua Yayasan Pemberdayaan Konsumen Kesehatan Indonesia (YPKKI)...." ---truncated

YPKKI (Yayasan Pemberdayaan Konsumen Kesehatan Indonesia) adalah organisasi non pemerintah, mandiri dan nirlaba yang bercita-cita memberdayakan konsumen kesehatan sehingga mereka dapat memperoleh jasa layanan kesehatan sesuai dengan hak dan kewajibannya.Email: ypkki@yahoo.com

comments :
btw, bagaimanakah perkembangan Sistem Jaminan Sosial Nasional (Jamsosnas) ??
RUU Sistem Jaminan Sosial Nasional telah disahkan oleh Dewan Perwakilan Rakyat Republik Indonesia (DPR RI) pada tanggal 28 September, 2004.

Sebuah analisis menarik bisa dibaca di sini : http://www.smeru.or.id/report/workpaper/jamsosnas/Jamsosnasind.pdf