Pneumonia is severe when a person is having

1: COMMON PULMONARY difficulty breathing and experiences respiratory

DISEASES distress.

Who is most at risk of COVID-19 pneumonia?

Pneumonia is a severe lung infection. In some people, People with conditions that weaken the lungs or
it can be fatal, especially among the elderly and those immune system may be more vulnerable to COVID-19
with respiratory disorders. COVID-19, the disease the pneumonia.
novel coronavirus causes, can spread to the lungs, Those conditions include:
causing pneumonia. • cancer
• diabetes
According to the Centers for Disease Control and • high blood pressure
Prevention (CDC), COVID-19 is a respiratory illness. A • severe heart disease
person may have a dry cough, fever, muscle aches, and • kidney or liver disease
fatigue. The virus can progress through the respiratory • asthma and other breathing disorders
tract and into a person’s lungs. This causes Additionally, people over 65 years of age have a much
inflammation and the air sacs, or alveoli, that can fill higher risk
with fluid and pus. This progression then limits a
person’s ability to take in oxygen. How do doctors diagnose pneumonia
To diagnose pneumonia, doctors typically perform
People with severe cases of pneumonia may have lungs imaging scans to look for swelling, inflammation, or
that are so inflamed they cannot take in enough oxygen fluid in the lungs. Although, sometimes, a diagnosis is
or expel enough carbon dioxide. Continuous oxygen possible without any imaging.
deprivation can damage many of the body’s organs, CT scans can diagnose pneumonia, though some
causing kidney failure, heart failure, and other life doctors may recommend an X-ray or another type of
threatening conditions. scan.
According to the World Health Organization (WHO), To test for COVID-19, doctors can take a swab from
the most common diagnosis for severe COVID-19 is the nose and the mouth.
severe pneumonia. For people who do develop
symptoms in the lungs, COVID-19 Treatment for COVID-19 pneumonia
may be life threatening. According to the CDC, inpatient care for those with
severe cases of COVID-19 typically focuses on
In China, doctors classified 81% of COVID-19 cases as managing the complications.
mild. These mild infections include mild cases of If a doctor suspects that a person is experiencing
pneumonia. The remaining 19% of cases were more pneumonia, they may prescribe antibiotics even though
severe. this will not treat COVID-19.
People with more severe pneumonia may need to stay
How does COVID-19 affect the lungs? in the hospital. While in the hospital, a person may
People with COVID-19 pneumonia experience changes receive intravenous (IV) fluids and monitoring. People
in their lungs, including: with breathing difficulties may need a ventilator or
• inflammation that may be so severe, it oxygen therapy.
damages the lungs’ alveoli
• fluid accumulation in the lungs Precautions to take
• gas exchange difficulties that make it hard to To avoid contracting the coronavirus or transmitting
get enough oxygen or expel enough carbon it to someone else, a person should:
dioxide • Avoid contact: They should avoid contact
• fluid leaking out of blood vessels in the lungs with people outside their own household, as
much as possible. When contact is
Symptoms of pneumonia unavoidable, they should maintain a safe 6-
The symptoms of pneumonia can vary from mild to foot distance from other people. They must
severe. However, typical symptoms include: also avoid physical contact with others,
• coughing including shaking hands.
• loss of appetite • Wash hands frequently: Do so by using soap
• nausea and warm water. Learn more about how to
• vomiting wash the hands properly here.
• shortness of breath • Not go outside: Remain at home and do not
• fever go out into public places if sick.
• difficulty breathing deeply
People who have or believe they have COVID-19 COVID-19 pneumonia, methylprednisolone treatment
should take the following additional precautions: may be beneficial for those who have developed ARDS
• Avoid other people, including those in the on disease progression.
same home.
• Wear a face covering when around other However, these results should be interpreted with
people. caution owing to potential bias and residual
• Isolate in a single room and when using the confounding in this observational study with a small
bathroom to avoid spreading germs. sample size. Double-blinded randomized clinical trials
• Do not share personal care products. should be conducted to validate these results.
• Practice good self-care by getting plenty of
rest, eating regularly, and drinking lots of The risk factors related to the development of ARDS
fluids. and progression from ARDS to death included older
• Call a doctor if symptoms are severe. age, neutrophilia, and organ and coagulation
dysfunction (eg, higher LDH and D-dimer). In addition,
we observed that several factors associated with the
JOURNAL: (from reference) development of ARDS were not associated with death
Risk Factors Associated With Acute Respiratory (eg, comorbidities, lymphocyte counts, CD3 and CD4 T-
Distress Syndrome and Death in Patients With cell counts, AST, prealbumin, creatinine, glucose, low-
Coronavirus Disease 2019 Pneumonia in Wuhan, density lipoprotein, serum ferritin, PT). Moreover, the
China difference in median D-dimer between the death and
survival groups was larger than that between the
Older age was associated with greater risk of ARDS and non-ARDS groups, which suggests that
development of ARDS and death likely owing to less disseminated intravascular coagulation was on the
rigorous immune response. Although high fever was pathway to death in some patients. Interestingly,
associated with the development of ARDS, it was also although high fever was positively associated with
associated with better outcomes among patients with development of ARDS, it was negatively related to
ARDS. Moreover, treatment with methylprednisolone death, which is consistent with results noted in a study
may be beneficial for patients who develop ARDS. by Schell-Chaple et al. However, the differences in
patient temperature between the groups were very
What clinical characteristics are associated with the small and self-reported before hospital admission, thus
development of acute respiratory distress syndrome the data regarding high fever should be cautiously
(ARDS) and progression from ARDS to death among interpreted.
patients with coronavirus disease 2019 (COVID-19)
pneumonia? The pathogenesis of highly pathogenic human
coronavirus is still not completely understood.
In this cohort study involving 201 patients with Cytokine storm and viral evasion of cellular immune
confirmed COVID-19 pneumonia, risk factors responses are thought to play important roles in
associated with the development of ARDS and disease severity.9 Neutrophilia was found in both the
progression from ARDS to death included older age, peripheral blood and lung of patients with SARSCoV.
neutrophilia, and organ and coagulation dysfunction.
Treatment with methylprednisolone may be beneficial The severity of lung damage correlated with extensive
for patients who develop ARDS. pulmonary infiltration of neutrophils and macrophages
and higher numbers of these cells in the peripheral
Risk for developing ARDS included factors consistent blood in patients with Middle East respiratory
with immune activation; older age was associated with syndrome. Neutrophils are the main source of
both ARDS development and death, likely owing to less chemokines and cytokines. The generation of cytokine
robust immune responses. storm can lead to ARDS, which is a leading cause of
death in patients with severe acute respiratory
In this cohort study, we reported the clinical syndrome and Middle East respiratory syndrome. In
characteristics and risk factors associated with clinical this study, patients with COVID-19 pneumonia who
outcomes in patients with COVID-19 pneumonia who had developed ARDS had significantly higher
developed ARDS after admission, neutrophil counts than did those without ARDS,
As well as those who progressed from ARDS to death. perhaps leading to the activation of neutrophils to
Patients who received methylprednisolone treatment execute an immune response against the virus, but also
were much more likely to develop ARDS likely owing to contributing to cytokine storm. This may partly explain
confounding by indication; specifically, sicker patients the positive association of high fever and ARDS found
were more likely to be given methylprednisolone. at the early stages of COVID- 19. In addition,
However, administration of methylprednisolone considering that older age is associated with declined
appeared to reduce the risk of death in patients with immune competence, the results of the present study
ARDS. These findings suggest that for patients with
showed that older age was associated with both ARDS • The fundamental basis of COPC is the
and death. Therefore, older age related to death may be community and the ethic of service to drive
due to less robust immune responses. The results of community health development
this study show that higher CD3 and CD4 T cell counts Gardner et al. 2000
might protect patients from developing ARDS, but • Community oriented Primary Care is a process
similar results were not observed when examined for of improving a community’s health by using
death, possibly because of limited sample size. CD8 principles of public health, epidemiology,
counts were significantly higher in those who were preventive medicine, and primary care that has
alive. These results indicate the important roles of CD4 been shown to have positive health benefits for
and CD8 T cells in COVID-19 pneumonia. Earlier communities worldwide.
July 21, 2017
studies have revealed that SARS-CoV, which was
• How is community oriented primary care
reported to share the same cell entry receptors with
different from primary care?
SARS-CoV-2, could infect immune cells, including T
o COPC does not believe in the link
lymphocytes, monocytes, andmacrophages.19 The
between primary and secondary
CD3, CD4, and CD8 T-cell counts decreased at the
prevention
onset of illness; this decrease persisted until the
o COPC adds a population-based
recovery period of SARS-CoV pneumonia. In addition,
approach to identifying and addressing
CD4 and CD8 T-cell counts decreased in the peripheral
community health problems
blood specimen of patients with fatal SARS-CoV
pneumonia, which was consistent with these results
THREE REQUIREMENTS FOR IMPLEMENTING
that patients with COVID-19 pneumonia and ARDS
A TRUE COPC PROGRAM:
presented with lymphocytopenia (CD3, CD4, andCD8T
1. a primary care practice providing
cells).
accessible, comprehensive, coordinated,
Studies demonstrated that T-cell responses can inhibit
continuous over time, and accountable health
the overactivation of innate immunity. T cells were
care services
reported to help clear SARS-CoV, and a suboptimal T-
2. a defined community for whose heath the
cell response was found to cause pathological changes
practice has assumed responsibility.
observed in mice with SARS-CoV. We hypothesized
In this context, community refers to geographic
that persistent and gradual increases in lymphocyte
or social communities; groups that form within
responses might be required for effective immunity
the workplace, church, or schools; or persons
against SARS-CoV-2 infection. Further studies are
enrolled in a common health plan
needed to characterize the role of the neutrophil and
Specifically excluded are communities
lymphocyte response or that of CD4 and CD8 T-cell
consisting of the active patients in a practice.
immune response in SARS-CoV-2 infection. Nutting PA, Wood M, Conner EM. Community oriented
Primary Care in the United States: A status report. JAMA
1985; 253: 1763-6.2

2: COMMUNITY 3. A process including the following steps:

a. Defining and characterizing the
ORIENTED PRIMARY community,
b. Describing community health
CARE problems,
c. Modifying the health care program to
COMMUNITY ORIENTED PRIMARY CARE address high-priority heath needs, and
DEFINED: d. Monitoring the effectiveness of
• A continuous process by which primary health program modifications
care is provided to a defined community on the
bases of its assessed health needs by the THE “COMMUNITY” IN COPC (in order of
planned integration of public health with preference)
primary care • A true community is a sociological sense
• “marriage of public health and primary care” • A defined neighborhood
Mullan F., Epstein L., Community Oriented Primary care: New • Workers in a defined factory or company,
Relevance in a changing world students in a defined school
• It unifies two forms of practice – the clinical • People registered as potential users of a
care of individuals in the community and physicians’ group practice, health maintenance
aspects of community medicine organization, neighborhood health center or
• A more integrated approach to healthcare base other defined service
upon principles defined from epidemiology, • Users of a defined service or repeated users of
primary care, preventive medicine, and health the service
promotion.
FIVE ESSENTIAL FEATURES OF COPC • Extension of community health programs
• The use of high standards of epidemiologic and beyond the framework of primary care, e.g.,
clinical activities as complementary functions o Promoting health education programs
• Definition of the population for which the in schools or community centers
service is/feels responsible o Participating in broad programs of
• Defined programs to deal with the health community development that deal with
problems of the community or its subgroups the root causes of health and disease in
within the framework of primary healthcare the community.
(health promotion, primary or secondary
prevention, curative, alleviative or FIVE COPC PRINCIPLES
rehabilitative care 1. Responsibility for the health and health care of
• Involvement of the community in the a defined population
promotion of its health. (prerequisite for 2. Heath care based on identified health needs at
satisfactory and continued functioning of the population level
COPC) 3. Prioritization
• Accessibility that is not limited to geographic 4. Intervention covering all stages of the health
accessibility illness continuum
5. Community participation
OTHER FEATURES OF COPC:
• The use of epidemiologic and clinical skills as WHY COPC?
complementary functions • COPC can help make what you are already
• Definition of the population for which the doing better
service is or feels responsible - Community definition
• Defined programs to deal with the health - Needs assessment
problems of the community or its subgroups, - Quality improvement
within the framework of primary care - Uniform data system reporting
• Involvement of the community in the - Meaningful use
promotion of its health • Address upstream factors and solve past
• Accessibility problems
• More comprehensive grants
• Equity: reach those that really need the
OTHER HIGHLY DESIRABLE FEATURES resources
ALTHOUGH NOT ESSENTIAL: PROCESSES IN THE DEVELOPMENT OF COPC
• Integration of at least the coordination of 1. PRELIMINARY STEPS
curative, rehabilitative, preventive and Traditional primary care practitioners of Western societies,
promotive health care family or village doctors, were renowned for their knowledge
about the people they doctored. It was wisdom born of the
• A comprehensive approach to health care
experience in day-to-day practice and participation in
encompassing social and mental, as well as activities of the social world of which they were a part.
physical aspects of health and extending to However, this does not meet the needs of present-day COPC.
behavioral, social environmental and other Helpful as it may be in providing a subjective picture of the
determinants of health. community and its main health problems, the systematic
• A multidisciplinary health team development of demographic, social, health, and other
• Mobility of the health team relevant data is essential for community medicine in primary
• Extension of community health programs care. The information needed concerns the primary care
beyond the framework of primary care practice itself, the community it serves, and the state of
health of the community.
Defining the community included in a particular practice is
ELEMENTS OF COPC an important step in the development of COPC in the
• The integration, or at least the coordination, of practice.
curative, rehabilitative, preventive, and 2. COMMUNITY HEALTH DIAGNOSIS AND
promotive health care HEALTH SURVEILLANCE
• A comprehensive approach to health care, • Epidemiologic study of the differential
encompassing social and mental as well as distribution of particular health conditions and
physical aspects of health, and extending to the factors that determine their distribution
behavioral, social, environmental, and other • Data gathered from patient records, household
determinants of health surveys, and other programs of practice –
• A multidisciplinary health team school health services, senior citizen clubs
• Mobility of the health teams – “outreach” • A continuing process – as the state of health of
activities the community changes, so do the
determinants of these changes
 • This requires ongoing health surveillance in 5. EVALUATION
the community. • Based on measures of outcome (desirable and
3. PLANNING OF INTERVENTION undersirable),
• Based on knowledge gathered through the • Changes in health status and factors that may
preliminary steps and community diagnosis affect it
• Questions to be answered: • Measures of the care provided (extent to which
o What is already being done about the planned activities were performed and quality
health condition/defined problem by of the performance
health and other services, by the • Measurement of community response, the
primary practice itself or by the community’s satisfaction
community itself? • Economic efficiency
o What are the resources of the health
team for initiating and carrying out a • Misconceptions about evaluation
community program? o Must be complex
• The planning process includes: o Requires complicated statistical
o Decisions on general and specific goals, methods
sub-goals, and their relative o Begins after the completion of the
practicability and priorities project
o Involves consideration of alternative
strategies, their feasibility and likely 6. DECISION MAKING FOR FUTURE
outcomes, decisions on procedure, ACTION
sequence, timing, allocation of • Following surveillance and evaluation of the
resources, roles of health team situation is reappraised and new decisions are
members and design of records made for continuation/modification of various
o Planning of systems to monitor elements of the program
progress of the program as well as • Modifications may be introduced at various
system for surveillance of changes in stages in the program
the community health and factors
determining its health and formulation
of criteria to evaluate the program

4. IMPLEMENTATION
• Treatment and counselling of individuals
• Community health education
• Community organization
*special emphasis on community involvement in the
promotion of its own health

• Various activities:
o Clinical and individual health care in
office practice and home calls
o Laboratory and other special
investigations
o Household visits and other group
situations for household surveys, BARRIERS TO INITIATING COPC ACTIVITIS
health education and stimulation of Lack of:
family and community interest and • Time
involvement • Expertise
o Initiating and maintaining inter- • Contacts
agency functioning and community • Financial incentives
interest and involvement
o Initiating and maintaining inter- SUMMARY:
agency functioning to promote • COPC is the marriage of public health and
community health programs primary care
o Use of health recording procedures
• The 6 steps of COPC are:
suitable for community analysis as well 1. Preliminary steps
as for individual care 2. Community health diagnosis and
health surveillance
 3. Planning of intervention
4. Implementation
5. Evaluation
6. Decision making for future action

3: UNIVERSAL HEALTH
CARE
WHAT IS UNIVERSAL HEALTH CARE?
Ensuring that all people have access to needed health
services (including prevention, promotion, treatment,
rehabilitation and palliation) of sufficient quality to be
effective while also ensuring that the use of these
services does not expose the user the financial
hardship. (WHO) Advantages Disadvantages
• Lowers overall health • Healthy people to pay
UNIVERSAL HEALTH CARE OBJECTIVES: care cost for economy for other people’s
• equity in access to health services - those • Lowers administrative medical care
who need the services should get them, not only costs for care (doctors • It may stop people from
those who can pay for them only deal with one gov’t being careful about their
• quality of health services is good enough to agency) health
improve the health of those receiving services • Standardized billing • Long wait time for
• financial-risk protection - ensuring that the procedures and elective procedures
cost of using care does not put people at risk of coverage rules • Doctors may cut care to
financial hardship
• Forces hospitals and lower costs if they aren't
doctors to provide well paid by cost-cutting
standard of service at a governments
low cost • Health care costs may
• Creates a healthier overwhelm government
workforce for budgets
healthcare providers • Government may limit
• Early childhood care payment amounts to
prevents future cost keep costs low
• Governments can
impose regulations and
taxes to guide the
population toward
healthier choices

UHC GUIDING PRINCIPLES

1. Leaving no one behind: a commitment to
equity, non-discrimination and a human
rights-based approach
- The 2030 Agenda for sustainable
development established the attainment of
UHC as part and parcel of the overarching
goal of equity, ensuring that no one is left
behind.
- UHC must account for the heterogeneity of
the population, for instance in relation to
differences in sex, age, geographical areas,
education, income, disability, migration
status and other factors relevant for the
national and subnational context
UHC Pros and Cons: 2. Transparency and accountability for
results
- Key attributes of governance and
determine the performance of a health
 system if they lead to adjustments in - Multi-stakeholder partnerships are
policies, strategies and resource allocation. important to facilitate the sharing of
- Transparency in decision-making, knowledge, experiences and lessons on
monitoring and review, as well as what works in HSS.
participation by populations, is pivotal for
accountability. UHC MONITORING BY WHO
- Transparency requires access and • Monitoring progress towards UHC should
availability for citizens to budget focus on 2 things:
information. o The proportion of a population that can
- Open and participative decision-making on access essential quality health services.
health policies and priorities can promote o The proportion of the population that
accountability. spends a large amount of household
3. Evidence-based national health strategies income on health.
and leadership as the foundations for • Achieving UHC is one of the targets the nations
Health Systems Strengthening (HSS) of the world set when adopting the
- Country-specific contexts require country- Sustainable Development Goal
specific solutions. National leadership is
the basis for identifying custom-fit
approaches and solutions.
- Using comprehensive quality data and
evidence in identifying actual health needs
and appropriate policy
- Data and evidence can contribute to ensure
that the five dimensions of health systems
performance are implemented, programs
are strengthened and no one is left behind.

4. Making health systems everybody’s

business - with engagement of citizens,
communities, civil society, and private
sector INDICATIORS OF THE LEVEL AND EQUITY OF
- Integrated multi- stakeholder policy HEALTH COVERAGE IN COUNTRIES:
dialogue with national stakeholders, 1. REPRODUCTIVE, MATERNAL,
communities and civil society, including NEWBORN and CHILD HEALTH
disease-affected or marginalized and o family planning
vulnerable groups, as well as the private o antenatal and delivery care
sector. o full child immunization
- Civil society participation has to be o health education
anchored systematically in HSS action to 2. INFECTIOUS DISEASES
enable people-centered health services. o tuberculosis treatment
- Interventions of private sector as providers o HIV antiretroviral treatment
of essential services and products must be o Hepatitis treatment
placed under the stewardship of national o use of insecticide-treated bed nets for
and local governments. malaria prevention
5. International cooperation based on o adequate sanitation
mutual learning across countries and 3. NON-COMMUNICABLE DISEASES
development effectiveness principles o prevention and treatment of raised
- The ambitious 2030 Agenda for sustainable blood pressure
development called for strengthening o prevention and treatment of raised
international cooperation through an blood glucose
enhanced and revitalized global o cervical cancer screening
partnership to support implementation o tobacco smoking
and drive progress. 4. SERVICE CAPACITY and ACCESS
- International cooperation is based on o basic hospital access
mutual learning across countries as a o health worker density
critical vehicle to contribute to better o access to essential medicines
design and operational capacity o health security
development on the path to UHC.
A. Reproductive, maternal, newborn and child 2. ANTI-RETROVIRAL TREATMENT
health: • Due to simplified HIV treatment, (e.g. one pill,
1. Family planning once daily), care became increasingly
• Family planning is part of the foundation of decentralized and delivered by non-physician
good health. clinicians, enabling integration with primary-
• Family planning is also a critical component of care health services in some settings.
economic health — for individuals, families, • Almost 21 million people are now on
and countries. treatment—one of the greatest public health
• Family planning is an important economic achievements in history
mechanism to enable countries to afford UHC • Integration of HIV and other key services at
in the long run. the clinic level is well established, more
2. Antenatal and delivery care responsive to an individual’s comprehensive
• Antenatal care (ANC) coverage is an indicator needs (that is, more patient-centred) and
of access and use of health care during strongly recommended by WHO.
pregnancy. 3. HEPATITIS TREATMENT
• Receiving antenatal car at least four times • Investing in hepatitis is a smart decision for
increases the likelihood of receiving effective broader health outcomes. Investments in
maternal health interventions during the hepatitis elimination would lead to a 1.5%
antenatal period. increase in the global health price tag, but such
• Defined basic maternity and newborn care, and investments would bring greater returns on
ensure underserved populations are aware of better general health outcomes.
this foundational health care right. • Hepatitis testing and treatment services as
• Recognize the need for more trained frontline part of UHC efforts can cut global deaths by 5%
health care workers with the capacity and and increase healthy life years by about 10% by
support to improve access to quality care. 2030.
3. Full child immunization 4. INSECTICIDE-TREATED BEDNETS FOR
• Access to immunization is tracked through the MALARIA PROTECTION
coverage of the third dose of DTP3, one of four • To achieve zero malaria, the goal of involving
maternal and child health tracer interventions. everyone must have a focus on achieving
• DTP3 coverage is evidence of the fact that universal health coverage (UHC) of all malaria
immunization is one of the most widely interventions ranging from insecticide treated
available and equitably distributed bednets (ITNs) to appropriate provision of
interventions worldwide, however, several malaria diagnostics and medicines.
other important vaccines lag behind the 85% • Studies to date have focused on ITNs, which
coverage of DTP3 worldwide in 2017. include long-lasting insecticide treated nets
• Routine and campaign-based immunization (LLINs) plus nationwide monitoring through
programs reach some children in remote or the Demographic and Health Surveys (DHS),
poverty stricken areas whose families have the Malaria Indicator Surveys (MIS) and the
little other connection to the health system Multi-Indicator Cluster Surveys (MICS).
4. Health seeking behavior for pneumonia 5. ADEQUATE SANITATION
• Health-seeking behavior for pneumonia is • Water, sanitation and hygiene (WASH) in
another essential health indicator as defined by health care facilities (HCFs) are essential
the WHO. for improving quality within the context of
• The WHO has articulated “full child universal health coverage (UHC).
immunization” as an essential health service • UHC is a global health priority and part of the
that is proven cost-effective and safe that could Sustainable Development Goals (SDGs) under
reduce the burden of common bacterial causes target 3.8. WASH in health care facilities is
of childhood pneumonia also implicitly and explicitly captured in the
B. INFECTIOUS DISEASES 2030 Agenda for Sustainable Development
1. TUBERCULOSIS TREATMENT with the terms “universal” and “for all” in SDG
• Efforts to end TB and achieve UHC go hand-in- Targets 6.1 and 6.2, which recognizes that
hand. Given that the people most vulnerable to access to water and sanitation is a basic human
TB are often those “left behind” by health right.
services more. C. NON-COMMUNICABLE DISEASES
• The global move towards achieving UHC, for 1. PREVENTION AND TREATMENT OF RAISED
example through making quality and BLOOD PRESSURE
accessible services affordable for everyone, is • The United Nations Sustainable Development
an important opportunity to reach all people Goal (SDG 3.4.1) is to reduce by one third
with TB. premature mortality from noncommunicable
 diseases through prevention and treatment by emergency room services, general and specialty
2030 surgical services, x ray/radiology services,
• There is synergy between UHC and laboratory services, blood services without the
improvement of hypertension control. financial risk.
Treatment of hypertension can save more lives 2. HEALTH WORKER DENSITY
than any other adult health care intervention. • Accelerate progress towards universal health
• Improving hypertension treatment will coverage and the SDGs by ensuring equitable
improve many aspects of primary care and access to health workers within strengthened
contribute to the goal for universal health healthy system
coverage (UHC). • Expansion and transformation of the health
2. PREVENTION AND TREATMENT OF RAISED and social workforce
BLOOD GLUCOSE • Encourages actions in support of the creation of
• Diabetes, as one of noncommunicable diseases some 40 million new jobs and social sector by
(NCDs) have already received global attention, 2030, paying specific attention to addressing
and are given high priority in the context of the the projected shortages of 18 million workers
UHC. by 2030.
• As one of the major NCDs, diabetes is projected 3. ACCESS TO ESSENTIAL MEDICINES
to be the seventh-leading cause of death by • Essential medicines satisfy the priority health-
2030. The prevalence of diabetes in 11 care needs of the population.
countries of the WHO South-East Asia Region • Essential medicines policies are crucial to
is predicted to increase significantly, from 46.9 promoting health and achieving sustainable
million patients in 2000 to 119.5 million in development.
2030. • Sustainable Development Goal 3.8 specifically
• It is anticipated that, in the context of UHC, mentions the importance of “access to safe,
the higher prevalence of diabetes and higher effective, quality and affordable essential
population coverage with health insurance will medicines and vaccines for all” as a central
lead to increasing use of health services by component of Universal Health Coverage
patients with diabetes. (UHC), and Sustainable Development Goal 3.b
3. CERVICAL CANCER SCREENING emphasizes the need to develop medicines to
• Through UHC, early detection and prevention address persistent treatment gaps.
are applied even in some low-to-middle-income 4. HEALTH SECURITY
countries which do not have access to services • Defined as the activities required is both
such as: proactive and reactive to minimise the danger
• Vaccination against human papillomavirus (2 and impact of acute public health events that
doses) of 9–13-year-old girls endanger people’s health across geographical
• Cervical cancer by screening women aged 30– regions and international boundaries
49, either through visual inspection with acetic World Health Organization continuously plans
acid linked with timely treatment of pre- strategies to become prepared and prevent public
cancerous lesions health threats such as pandemics and also plausible
• Pap smear (cervical cytology) every 3–5 years ways to overcome them to achieve UHC.
• Human papillomavirus tests every 5 years
4. TOBACCO (NON-) SMOKING TYPES OF UHC
• Increase excise taxes and prices on tobacco 1. BEVERIDGE MODEL
products in particular can support efforts o health care is provided and financed by
towards UHC . In the Philippines, new tobacco the government through tax payments
and alcohol taxes collected more than $750 2. BISMARCK MODEL
million in its first year, much of it set aside to o It uses an insurance system called
cover free health care for vulnerable “sickness funds”
populations. o usually financed jointly by
• Implement plain/standardised packaging employers and employees through
and/or large graphic health warnings on all payroll deduction.
tobacco packages 3. NATIONAL HEALTH INSURANCE
• Implement effective mass media campaigns MODEL
that educate the public about the harms of o It uses private-sector providers, but
smoking/tobacco use and second-hand smoke payment comes from a government-run
D. SERVICE CAPACITY AND ACCESS insurance program that every citizen
1. BASIC HOSPITAL ACCESS pays into
• UHC aims to provide equitable basic hospital 4. OUT-OF-POCKET MODEL
access to all which should cater hospitalization, o “market driven” health care
 o The basic rule in such countries is that
the rich get medical care; the poor stay
sick or die.
BEVERIDGE BISMARCK NATIONAL THE OUT-
MODEL MODEL HEALTH OF-
INSURANCE POCKET
MODEL MODEL
Provided and Financed Payment Patients pay
financed by jointly by comes from a for their
the employers government- expenses out-
government and run insurance of-pocket
through tax employees program that
payments via payroll every citizen
deduction pays into

Services and Services are Service and Most

service provided by service common
providers/ private providers are model in less
health staff doctors and private developed
are under the hospitals country
government
UHC ACT IN THE PHILIPPINES
Every citizen Taxes go into Every citizen Healthcare is • Ensure that all Filipinos are guaranteed
has the same a pays into the driven by equitable access to quality and affordable
access to care government, national income health care goods and services and protected
a health insurance
insurance plan against financial risk.
fund that • The UHC bill seeks to realize universal health
covers coverage through a systemic approach and
everyone clear delineation of the roles of key agencies
Potential risk Provision of Potential for Opt for
of care for those long waiting village and stakeholders
overutilization unable to lists and healers for
work delays in treatment
treatment

EXAMPLES OF SOME COUNTRIES WITH UHC

• Australia: mixed health plan “Medicare”
• Canada: national health insurance
system. The government pays for services
provided by a private delivery system.
• France: social health insurance system that
OVERVIEW: RA 11223 – UHC ACT
provides care to all legal residents
• A health care model that provides all Filipinos
• Germany: social health insurance program.
access to a comprehensive set of quality and
Everyone must have public health insurance,
cost-effective, promotive, preventive, curative,
but those above a certain income can choose
rehabilitative and palliative health services
private insurance instead.
without causing financial hardship and
• Switzerland: social health insurance system
prioritizes the needs of the population who
for all residents.
cannot afford such services
• United Kingdom: single-payer health care
that covers all residents
• Last February 20, 2019, pres. Duterte signed a
• United States has a mixture of government-
uhc bill into law (republic act no. 11223)
run and private insurance.
=> this law enrolls all filipino citizens in the national
health insurance program
• It is a consolidation of Senate bill no. 1896 and
house bill no 5784 and was passed on december
10, 2018
• Senator ejercito (chair of the health
committee); senator agara (chair of the ways
and means committee); senators binay and
villanueva (co-authors of the bill)
 • Employees with formal employment
characterized by the existence of an employer-
employee relationship
• Kasambahays
• All other workers who are not covered by
formal contracts or agreements and whose
premium contributions are self-paid, and with
capacity to pay premiums
• Professional practitioners;
• Overseas Filipino Workers
• Sea-based Filipino workers or
seafarers and land-based overseas
Filipino workers;
• Filipinos living abroad;
GENERAL OBJECTIVES: • Filipinos with dual citizenship;
• Progressively realize universal health care in • All Filipinos aged 21 years and above who have
the country through a systemic approach and the capacity to pay premiums.
clear delineation of roles of key agencies and INDIRECT CONTRIBUTORS
stakeholders towards better performance in • Indigents identified by the DSWD
the health system; and • Beneficiaries of Pantawid Pamilyang Filipino
• Ensure that all Filipinos are guaranteed Program Modified Conditional Cash Transfer
equitable access to quality and affordable (4Ps/MCCT);
health care goods and services and protected • Senior citizens who are not currently covered
against financial risk. by the program;
POPULATION COVERAGE: • Persons with disability,
• Every Filipino citizen shall be automatically • All Filipinos aged 21 years old and above
included into the National Health Insurance without the capacity to pay premiums;
Program • Sangguniang Kabataan officials
• All Filipinos deemed members of the national • Those previously identified at point-of-service
health insurance program either as direct (POS) or during registration, members
contributory members (with capacity to pay) previously sponsored by LGUs and those who
and indirect contributory members (all others). are not yet in the PhilHeaith database and are
By automatically enrolling our citizens into the financially incapable to pay premiums.
National Health Insurance Program and expanding Entitlement to Benefits
PhilHealth coverage to include free medical • Every member shall be granted immediate
consultations and laboratory tests, the Universal eligibility for health benefit packages
Health Care Law that I signed today will guarantee under the Program, provided: (a.) philhealth id
equitable access to quality and affordable health care shall not be required, (b.) no *co-payment shall
services for all Filipinos – Pres. Duterte (20 Feb 2019) be charged of services, (c.) co-payments and
*co-insurance for amenities in public hospitals
shall be regulated by the doh and philhealth,
and (d.) current philhealth package members
shall not be reduced.
*co-payment = flat fee or predetermined rate at point of
service
*co-insurance = % of a medical charge that is paid by
the insured, with the rest paid by the health insurance
plan

Program Membership
• Membership into the Program shall be
simplified into two (2) types, direct contributors
and indirect contributors, with their qualified
dependents, namely:
• Legal spouse/s who is/are not an active
member;
• Unmarried and unemployed legitimate,
PROGRAM MEMBERSHIP illegitimate children, and legally adopted or
DIRECT CONTRIBUTORS
 stepchildren below twenty-one (21) years of • PhilHealth shall implement a comprehensive
age; outpatient benefit, including outpatient drug
• Foster children as defined in RA 10165 (Foster benefit and emergency medical services in
Care Act of2012); and, accordance with the recommendation of Health
• Parents who are sixty (60) years old and above, Technology Assessment Council (HTAC)
not otherwise an enrolled member. • The benefits shall include, but are not limited
to:
HEALTH SERVICES DELIVERY • services of health care professionals;
• Population-based health services: (a.) primary • diagnostic, laboratory, dental and other
care provider network; (b.) epidemiologic medical services;
surveillance; (c.) health promotion programs or • personal preventive services
campaigns prescription drugs and biologicals
• Individual-based health service: philhealth • other services deemed appropriate
shall: (a.) endeavor to contract for the delivery • Provision of Primary Care Providers
of health services; (b.) endeavor to shift to • The DOH and local government units (LGUs)
paying providers, develop differential payment shall endeavor to provide a health care delivery
schemes, institute strong surveillance and system that shall afford every Filipino a
audit mechanisms. primary care provider
• The primary care provider shall act as the
HEALTH TECHNOLOGY ASSESSMENT (HTA) navigator, initial and continuing point of
• Systematic evaluation of properties, effects or contact in health care delivery system;
impact of health-related technologies, devices, Provided, That except in emergency or serious
medicines, vaccines, procedures, and all other cases and when proximity is a concern, access
health-related systems developed to help solve to higher levels of care shall be coordinated by
a problem and improve quality of lives and the primary care provider.
health outcomes. • Registration of Filipinos to Primary Care
• Htac = A group of health experts who will be Provider Networks
responsible for evaluating latest health • Every Filipino shall register with a public or
developments and recommending their use to private primary care provider of choice with
DOH and PhilHealth due consideration to proximity and ease of
travel of those seeking care, absorptive
APPROPRIATIONS capacity of the provider for quality care, and
• Total incremental Sin tax reform law provider capability to deliver the required
• Philippine Amusement and Gaming services, among others.
Corporation – 50% of national government’s • The LGUs, with the assistance from DOH and
share PhilHealth, shall register their respective
• Philippine Charity Sweepstakes Office constituents to a primary care provider within
(PCSO) – 40% of its charity fund, net of their territorial jurisdiction; Provided, That the
document stamp tax payments, and mandatory DOH, in coordination with PhilHealth, shall
PCSO contributions promulgate the guidelines on the registration
• Premium contributions of direct contributory of every Filipino to a primary care provider that
members stipulate the standard processes, procedures,
• Annual appropriations of the DOH in the GAA guidelines, form, and data management,
National government subsidy to PhilHealth among others.
included in the GAA • Population-based health services shall be
UHC: SERVICE COVERAGE financed by the national government through
• Immediate Eligibility to Benefits the DOH and provided free of charge at point of
• Every Filipino shall be granted immediate service for all Filipinos.
eligibility and access to preventive, • All Filipinos are guaranteed zero co-payments
promotive, curative, rehabilitative, and for basic / ward accommodations and fixed, co-
palliative care for medical, dental, mental and payment for non-basic admissions in
emergency health services, delivered as government hospitals
population-based or individual-based health
services
• The DOH and PhilHealth shall define specific
health service packages for population- based
and individual-based health services
• Comprehensive Outpatient Benefits
F1 PLUS FOR HEALTH
F1 PLUS FOR HEALTH: STRATEGIC PILLARS
• the DOH envisions Filipinos to be among the
• Through F1 Plus, the DOH is currently
healthiest people in Southeast Asia by 2022,
pursuing reforms and interventions toward
and in Asia by 2040.
UHC as espoused in five pillars:
• It aims to lead the country in the development
FINANCING
of a productive, resilient, equitable and people-
The financing pillar aims to secure sustainable
centered health system towards the
investments to improve health outcomes, and ensuring
attainment of UHC,
efficient and equitable use of health resources. This
• Guided by the values of professionalism,
entails rationalizing health spending, and focusing of
responsiveness, integrity, compassion and
financial resources on high-impact interventions.
excellence.
SERVICE DELIVERY
The service delivery pillar ensures the availability and
accessibility of essential quality health services at
appropriate levels of care, especially for the poor. This
involves strengthening of health care provider
networks and provision of comprehensive service
delivery packages to meet the needs of the population.
REGULATION
The regulation pillar focuses on guaranteeing high
quality and affordable health products, devices,
facilities, and services. Under this pillar, regulatory
systems and processes will be streamlined,
harmonizes, and innovated.
GOVERNANCE
The Governance pillar, on the other hand, is about
strengthening of sectoral leadership and management,
and strengthening of evidence generation from
research to guide policy development and program
implementation
PERFORMANCE ACCOUNTABILITY
• Aligned closely with the thrust of UHC, the F1 The Performance Accountability pillar incorporates the
Plus for Health is a comprehensive strategy for performance governance system across the first four
achieving the DOH’s strategic goals: pillars, to enable better public accountability and
transparency in all health programs, projects, and
activities.

4: TELEMEDICINE
WHAT IS TELEMEDICINE?
Telemedicine is a term coined in the 1970s, which
literally means “healing at a distance”
From the Greek prefix “tele” or working in another or
remote health facility, or real time “telo” or “tel” which
means “transmission over a distance.”
WHAT IS TELEHEALTH?
The delivery and facilitation of health and helth-
related services, medical care, provider and patient
education, health information serveices, and self-care
via telecommunications and digital communication
technologies.

SYNCHRONOUS ASYNCHRONOUS
• Fast transmission • Slower transmission,
• Needs a common clock due to extra bits and
signal or some way of gaps
sharing it • Cheap and easy to
• May have to wait briefly implement. No clock
until data can be sent sharing
• Can transmit when
ready
• Almost all parallel transmission is
synchronous
How did we deliver information before? • Asynchronous transmission is used when data
• Bubonic plague information was exchanged in is sent sporadically, e.g., via a mouse or
Europe using heliograph or bonfires keyboard
• Lists of casualties during the Civil War were
sent using telegraph along with orders of
medical supplies.

When was telemedicine first used?

Physicians on Earth successfully monitored the health
of astronauts in space

CATEGORIES OF TELEMEDICINE
A. STORE AND FORWARD TELEMEDICINE
- Also known as asynchronous telemedicine
- Does not require the communicating sides
to be in contact at the same time of data
exchange TELEMEDICINE APPLICATIONS
- Data can be collected, organized, and Classified into FOUR basic types:
stored 1. According to the mode of communication
- When feasible, the data are sent to the 2. Timing of the information transmitted
intended destination for diagnosis or 3. The purpose of the consultation
analysis 4. The interaction between the involvement
B. REAL-TIME TELEMEDICINE
- Synchronous telemedicine ACCORDING TO THE MODE OF
- Differs in that it requires both the health COMMUNICATION
professional practitioner and the patient to Video: (telemedicine facility, apps, video on chat
be in contact at the same time platforms, skype/facetime etc.)
- Considered interactive and live Audio: (phone, VOIP, Apps etc.)
- Includes videoconference aided by tools for Text-based: Telemedicine chat based applications:
audio and visual examination (specialized telemedicine smartphone apps, websites,
- Devices for remote physical examination, other internet-based systems, etc.)
such as electronic stethoscopes General messaging/text/chat platforms
(WhatsApp, Google Hangouts, Facebook messenger)
Asynchronous (email, fax)
 • Health worker to registered medical
ACCORDING TO TIMING OF INFORMATION practitioner
TRANSMITTED • Caregiver to registered medical practitioner
Realtime Video/Audio/Text interaction
• Exchange of relevant information for diagnosis, WHAT IS THE BEST PLATFORM TO USE FOR
medication, and health education and COMMUNICATION?
counselling Technology used and mode of communications
Asynchronous Information 3 primary modes: VIDEO, AUDIO, TEXT
• Transmission of summary of patient VIDEO
complaints (telemedicine facility, apps, video on chat,
• Supplementary data including images, lab platforms, facetime)
reports or radiological investigations Strengths: Limitations:
• Data can be forwarded to different parties at • Closest to an in-person • Is dependent on high
any point of time and thereafter accessed per consult, real time quality internet
convenience/need interaction connection at both ends,
• Patient identification else will lead to
ACCORDING TO THE PURPOSE OF THE is easier suboptimal exchange of
CONSULTATION • RMP can see the information
For Non-Emergency consult: patient and discuss • Since there is a
A. First consult with any registered medical with the caregiver possibility of
practitioner • Visual cues can be abuse/misuse, ensuring
- Diagnosis perceived privacy of patients in
- Treatment • Inspection of patient video consults is
- Health education can be carried out extremely important
- Counselling AUDIO
(phone, VOIP, apps)
Strengths: Limitations:
• Convenient and fast • Non-verbal cues may be
• Unlimited reach missed
• Most suitable for • Not suitable for
urgent cases conditions that require
• No separate a visual inspection (e.g.
infrastructure skin, eye, or tongue)
required • Patient identification
• Privacy ensured needs to be clearer,
• Real-time interaction greater chance of
imposters representing
the real patient
TEXT
(text-based: specialized chat-based telemedicine,
smartphone apps, SMS, Websites, messaging
systems, FB messenger)
Strengths: Limitations:
B. Follow-up consult with the same RMP • Convenient and quick • Besides the visual and
• Documentation and physical touch, text-
EMERGENCY CONSULT FOR IMMEDIATE identification may be based interactions also
ASSISTANCE OR FIRST AID an integral feature of miss the verbal cues
• Should be avoided for emergency care when the platform • Difficult to establish
alternative in-person care is available • Suitable for urgent rapport with the
• Should be limited to first aid, life-saving cases, or follow-ups, patient
measure, counseling, and advise on referral second opinions • Cannot be sure of
• Patient must be advised for an in-person provided RMP has identity of the doctor or
interaction with a registered medical enough context from patient
practitioner the earliest other sources
• No separate
infrastructure
ACCORDING TO THE INDIVIDUALS INVOLVED required
• Patient to registered medical practitioner • Can be real time
• Registered medical practitioner to RMP
PATIENT MANAGEMENT • Medicines used for common conditions and are
First Consult means: often available ‘over the counter’
• Patient is consulting with the RMP for the first • Medicines that may be deemed necessary
time during public health emergencies
• The patient has consulted with the RMP LIST A:
earlier, but more than 6 months have lapsed • Medications which can be prescribed during
• Since the previous consultation the first consult which is a video consultation
• The patient has consulted with the RMP • Re-prescribed for refill, in case of follow-up
earlier, but for a different health condition • Relatively safe medicines with low potential for
• There are new symptoms that are not in the abuse
spectrum of the condition LIST B:
• RMP does not recall the context of previous • Medication prescribed in a patient who is
treatment and advice undergoing follow-up consultation in addition
Follow-up consult means: to those which have been prescribed during in-
• The patient is consulting with the same RMP person consult for the same medical condition.
within 6 months of his/her previous PROHIBITED LIST:
consultation • These medicines have a high potential of abuse
• for continuation of care of the same health and could harm the patient or society at large
condition if used improperly

PATIENT MANAGEMENT: HEALTH EDUCATION PRESCRIBING MEDICINES: Issue a Prescription and

Impart Health Promotion and Disease Prevention Transmit
A. related to diet, physical activity, cessation of • Photo, scan, digital copy of a signed
smoking, contagious infections and so on. prescription
B. Give advice on immunizations, exercise, • E-prescription
hygiene practices, mosquito control • Patient via email or any messaging platform
• Transmitting the prescription directly to a
PATIENT MANAGEMENT: COUNSELLING pharmacy
Specific advice given to patients:
- Include food restrictions
- Do’s and Don’ts for a patient on anticancer
drugs
- Proper use of a hearing aid
- Home physiotherapy

PATIENT MANAGEMENT: PRESCRIBING

MEDICINES
- Is the professional discretion of the RMP
- It entails the same professional
accountability as in the traditional in-
person consult.
- Same prevailing principle will be
applicable to a telemedicine consult.
- ONLY when the RMP is satisfied that
he/she has gathered adequate and relavant
information about the patient’s medical
condition and prescribed medicines are in
the best interest of the patient.
- Prescribing medicines without an
appropriate diagnosis/provisional
diagnosis will amount to a
professional misconduct.

PRESCRIBING MEDICINE: Specific Restrictions

LIST O: ESSENTIAL PRINCIPLE:
• It will comprise those medicines which are safe The Professional Judgement of a Medical
to be prescribed through any mode of tele- Practitioner should be the guiding Principle
consultation
 1. We are positioned to decide whether a
technology-based consultation is sufficient, or
in-person review is needed
2. Practitioner shall exercise proper discretion
and not compromise on the quality of care
3. Mode of communication depends on the type of
medical condition. If a case requires a video
consultation for examination, medical
practitioner should explicitly ask for it.
4. At any stage, the patient has the right to choose
to discontinue the teleconsultation

HOW TO DO A PHYSICAL EXAMINATION ON

TELEMEDICINE

HOW TO CONDUCT A HIGH QUALITY

TELECONSULTATION
1. Convey value with your welcome
- Brief behaviors such as smiling and
looking at the camera
- Acknowledge the virtual nature of the
interaction
- In addition to identifying oneself, ask
patients to introduce family members or
other companions in the room.
2. Introduce the technology for first time
users
- Normalize any discomfort with the new
First consult: Patient to Registered Medical modality
Practitioner - Demonstrate confidence in the technology
and reason for modality
- Include instructions on what to do in case
of disconnection
3. Collaboratively set the agenda
- Determine mutually agreeable agenda
items
- Explain how you will get the information
you need for diagnosis and treatment
- This helps set realistic expectations for
the patient
4. Express empathy
- Non-verbal: be aware of facial gestures,
voice quality and tone. Disable picture-in-
 picture function and look at the patient.
Fidgeting or posture of the doctor can
seem exaggerated on camera
- Verbal: give support or partnership
statements and validate the patient’s
experience. Inform the patient when you
are occupied such as writing notes or
looking at radiologic images or their lab
results
5. Reflective Listening
- Summarizing and clarifying questions in
case of delay or signal interference
- Have the patient repeat back what they
understand as well
6. Provide closure
- Give a clear sign to the patient that the
visit is coming to a close.

DUTIES and RESPONSIBILITIES

• Principles of medical ethics, including
professional norms for protecting patient
privacy and confidentiality must be upheld How much should you charge?
and practiced. FEE FOR TELEMEDICINE CONSULTATION:
• We are not held responsible for breach of • Telemedicine consultation should be treated
confidentiality if there is a reasonable the same way as in-person consultation from a
evidence to believe that patient’s privacy and fee perspective
confidentiality has been compromised by a • RMP may charge an appropriate fee for the
technology breach. telemedicine consultation provided
• RMP should also give a receipt/invoice for the
MAINTAIN DIGITAL TRAIL/DOCUMENTATION fee charged for providing telemedicine-based
OF CONSULTATION consultation
• Log or record of telemedicine interaction (e.g.
phone logs, email records, chat/text record, BENEFITS OF TELEMEDICINE
video interaction logs, etc.) • Shortens the distances and saves time
• Patient records, reports, documents, images through bringing healthcare services within
diagnostics, data, etc. (digital or non-digital) reach of patients
utilized in the telemedicine consultation • Physicians and health providers can reach
should be retained by the RMP. patients and colleagues in distant areas with
• In case a prescription is shared with the no time
patient, the RMP is required to maintain the • Reduces the cost and inconvenience of
prescription records are required for in-person travelling
consults. • Hospital’s length of stay patients is reduces
and chronic disease managements are
According to a Review and Analysis of improved.
Telephone-Related Malpractice Claims, the
following were the Most Common Allegations:
• Delay in the diagnosis
• Poor or no documentation
• Misdiagnosis because of an incomplete history
• Inadequate communication with family or
patient
• Improper medical management
• Untrained, unqualified staff fiving medical
advice
 isolates from nine inpatients, eight of whom
had visited the Huanan seafood market in
5: COVID-19 •
Wuhan.
Ten genome sequences of 2019-nCoV obtained
HISTORY from the nine patients were extremely similar,
• Coronaviruses are important human and exhibiting more than 99.98% sequence
animal pathogens. identity.
• December 2019, a novel coronavirus was • Phylogenetic analysis revealed that 2019-nCoV
identified as the cause of a cluster of fell within the subgenus Sarbecovirus of the
pneumonia cases in Wuhan, a city in the Hubei genus Betacoronavirus
Province of China. • Genetically distinct from SARS-CoV.
• WHO is working 24/7 to analyze data, provide • Homology modelling revealed that 2019-nCoV
advice, coordinate with partners, help had a similar receptor-binding domain
countries prepare, increase supplies and structure to that of SARS-CoV, despite
manage expert networks amino acid variation at some key residues.
• These data are consistent with a bat reservoir
for coronaviruses in general and for 2019-nCoV
in particular.
• However, despite the importance of bats,
several facts suggest that another animal
(maybe Pangolins) is acting as an intermediate
host between bats and humans.
1. First, the outbreak was first reported in
late December, 2019, when most bat
species in Wuhan are hibernating.
2. 2. Second, no bats were sold or found at the
Huanan seafood market, whereas various
non-aquatic animals (including mammals)
were available for purchase.
3. 3. Third, the sequence identity between
2019-nCoV and its close relatives bat-SL-
CoVZC45 and bat-SL-CoVZXC21 was less
than 90%, which is reflected in the
relatively long branch between
them.Hence, bat-SL-CoVZC45 and bat-SL-
CoVZXC21 are not direct ancestors of
2019nCoV.
4. 4. Fourth, in both SARS-CoV and MERS-
CoV, bats acted as the natural reservoir,
with another animal (masked palm civet
It rapidly spread, resulting in an epidemic throughout for SARS-CoV and dromedary camels for
China, followed by an increasing number of cases in MERSCoV) acting as an intermediate host,
other countries throughout the world. with humans as terminal hosts.
Conclusion:
In February 2020, the World Health Organization Therefore, on the basis of current data, it seems
designated the disease COVID-19, which stands for likely that the 2019-nCoV causing the Wuhan
Coronavirus disease 2019 outbreak might also be initially hosted by bats,
and might have been transmitted to humans
The virus that causes COVID-19 is designated Severe via currently unknown wild animal(s) sold at
Acute respiratory syndrome coronavirus 2 the Huanan seafood market.
(SARS-CoV-2); previously, it was referred to as 2019-
nCoV. VIROLOGY
• Coronaviruses are a family of RNA viruses,
GENOMIC CHARACTERISATION AND named for their crown-like appearance.
EPIDEMIOLOGY OF 2019 NOVEL • Human disease is caused by viruses belonging
CORONAVIRUS: IMPLICATIONS FOR VIRUS to the Orthocoronavirinae subfamily.
ORIGINS AND RECEPTOR BINDING
• Next-generation sequencing of samples from
bronchoalveolar lavage fluid, and cultured
Orthocoronavirinae Subfamily
This subfamily is further classified into four
Genera:
1) Alpha-coronavirus (alphaCoV)
2) Beta-coronavirus (betaCoV)
3) Gamma-coronavirus (gammaCoV)
4) Delta-coronavirus (deltaCoV)

In the past, zoonotic spread of other Beta-

coronaviruses led to :
*MERS-CoV (Coronavirus causing Middle
Eastern respiratory syndrome)
*SARS-CoV (Coronavirus causing severe acute
respiratory syndrome).
S Protein
The Novel coronavirus SARS-CoV-2 was found to be S or spike protein
genetically distinct but with some similarities to • This protein is responsible for allowing the
previously identified Beta-coronavirus. virus to attach to the membrane of the host cell.
• It contains a receptor binding domain which
SARS-CoV-2 has genomic sequences up to 96% recognizes a specific receptor the Angiotensin
identical to a beta-coronavirus RaTG13, isolated from converting enzyme receptor 2 which is
bats of the species Rhinolophus affinis. expressed in their lungs, heart, kidneys, and
intestines.
The receptor-binding domain (RBD) of the S protein of • It has been shown that this protein binds to the
SARS-CoV-2 is similar to a coronavirus isolated from ACE 2 receptor with at least the same affinity
Malayan pangolins (Manis javanica). and potentially as much as 20 times greater
affinity than the SARS virus this could be one
PATHOGENESIS of the explanations for the reasons why it's
The life cycle of the virus with the host consists of the spreading so easily.
following 5 steps: • Spike is composed of a transmembrane
1) Attachment trimetric glycoprotein protruding from the
2) Penetration viral surface, which determines the diversity of
3) Biosynthesis coronaviruses and host tropism.
4) Maturation • Spike comprises two functional subunits;
5) Release o S1 subunit is responsible for binding
to the host cell receptor
• Once viruses bind to host receptors o S2 subunit is for the fusion of the viral
(Attachment), they enter host cells through and cellular membranes.
endocytosis or membrane fusion • ACE2 expression was high in lung, heart,
(Penetration). ileum, kidney and bladder.
• Once viral contents are released inside the host • In lung, ACE2 was highly expressed on lung
cells, viral RNA enters the nucleus for epithelial cells.
replication. Viral mRNA is used to make viral • Angiotensin converting enzyme 2 (ACE2)
proteins (Biosynthesis). was identified as a functional receptor for
• Then, new viral particles are made SARS-CoV 2
(Maturation) and released. • Structural and functional analysis showed that
the Spike for SARS-CoV-2 also bound to ACE2
STRUCTURES
SARS-CoV-2 encodes four major structural proteins: M Protein
1) Spike (S) Protein Membrane protein
2) Membrane (M) Protein • Is the most abundant on the viral surface and
3) Envelope (E) Protein defines the shape of the viral envelope
4) Nucleocapsid (N) Protein • It can be thought of as the central organizer for
corona virus assembly, and interacts with the
other structural proteins
E Protein • SARS-CoV-2 has been detected in non-
Envelope protein respiratory specimens, including stool, blood,
• Is the smallest of the major structural proteins ocular secretions, and semen, but the role of
on the viable membrane which appears to have these sites in transmission is uncertain.
several roles. • Detection of SARS-CoV-2 RNA in blood has
• It is integral in the assembly and release of the also been reported in some but not all studies
virus from host cells that have tested for it.
• During viral replication, it is largely localized • However, the likelihood of bloodborne
at the site of intracellular trafficking more transmission (eg, through blood products or
specifically at the Endoplasmic reticulum and needlesticks) appears low; respiratory viruses
the Golgi apparatus are generally not transmitted through the
bloodborne route.
essentially the M and E proteins play a critical role in • Transfusion-transmitted infection has not been
turning the host cell apparatus into workshops where reported for SARS-CoV-2 or for the related
the virus and our own cells work together to make new MERS-CoV or SARS-CoV.
viral particles
Airborne Transmission
Viral Envelope. Airborne transmission may be possible in specific
• Located underneath the surface proteins circumstances and settings in which procedures or
• Is the viruses’ outer layer that is derived from support treatments that generate aerosols are
the host’s cell membrane. performed.
• A fatty layer and in contact with soap it will • Endotracheal intubation
break down killing the virus. • Bronchoscopy
• This is the reason why hand-washing with soap • Open suctioning
is so important to prevent the spread of this • Administration of nebulized treatment
virus. • Manual ventilation before intubation

Capsid • Disconnecting the patient from the ventilator

• Located underneath the Viral envelope. • Non-invasive positive-pressure ventilation
• Is a protein shell that encloses the genetic • Tracheostomy
material of the virus. • Cardiopulmonary resuscitation

N Protein Indirect Transmission

Nucleocapsid • Transmission may also occur through fomites
• Bound to the virus's single strand of RNA in the immediate environment around the
which is where all its genetic information is infected person.
held to allow itself to replicate. • Therefore, transmission of the COVID-19 virus
• Appears to be multifunctional, it essentially can occur by direct contact with infected people
inhibits a lot of the host cells’ defense and indirect contact with surfaces in the
mechanisms and assists the viral RNA in immediate environment or with objects used on
replicating itself and therefore in creating new the infected person (e.g., stethoscope or
viral particles. thermometer).

TRANSMISSION
• Via respiratory droplets from coughing, and
sneezing.
• Virus released in respiratory secretions can
infect other individuals via direct contact with
mucous membranes.
• Droplets usually cannot travel more than 6
feet.
• Reproduction number (R0 - R naught) = 2.2
Estimated that an infected individual is likely to spread
the disease to an average of 2.2 people

Route of person-to-person transmission

• Infection can also occur if a person touches an
infected surface and then touches his or her
eyes, nose, or mouth.
VIRAL SHEDDING AND 3. The viral genome begins to replicate
PERIOD OF INFECTIVITY 4. The newly formed envelope glycoproteins
• The precise interval during which an are inserted into the membrane of the
individual with COVID-19 is infectious is endoplasmic reticulum or Golgi, and the
uncertain. nucleocapsid is formed by the combination
• It appears that SARS-CoV-2 can be of genomic RNA, and nucleocapsid protein.
transmitted prior to the development of 5. Then, viral particles germinate into the
symptoms and throughout the course of illness, endoplasmic reticulum-Golgi intermediate
particularly early in the course. compartment (ERGIC).
6. Lastly, the vesicles containing the virus
INCUBATION PERIOD particles then fuse with the plasma
• Symptoms develop 2 days to 2 weeks membrane to release the virus
following exposure to the virus. • Limited innate immune response.
• In a study, mean incubation period was 5.1 • At this stage the virus can be detected by nasal swabs.
days and that 97.5% of individuals who
developed symptoms did so within 11.5 days STAGE 2: UPPER AIRWAY AND CONDUCTING
of infection. AIRWAY RESPONSE (NEXT FEW DAYS)
• Transmission of SARS-CoV-2 from • The virus propagates and migrates down the
asymptomatic individuals (or individuals respiratory tract along the conducting airways
within the incubation period) has been well- • More robust innate immune response is
documented triggered
• Nasal swabs or sputum should yield the virus
RISK FACTORS (SARS-CoV-2)
Include (but are not limited to): • Disease is clinically manifested
• Advanced age • 80% of patients will present with a mild
• Immunocompromised state (Diabetes, disease
Cardiovascular disease, Hypertension, Chronic
pulmonary disease, Chronic renal disease, STAGE 3: HYPOXIA, GROUND GLASS
Liver disease) INFILTRATES, AND PROGRESSION TO ARDS
• Malignancy • About 20% of the infected patients will progress
• Severe obesity to stage 3 disease and develop pulmonary
Occupational Risk: infiltrates
• Employees of seafood and wet animal • The virus now reaches the gas exchange
wholesale markets in Wuhan units of the lung and infects alveolar type II
• Healthcare workers cells
• Frontliners • SARS-CoV propagates within type II cells
• Large number of viral particles are released
Groups at Higher Risk for Severe Illness • Cells undergo apoptosis and die
COVID-19 is a new disease and there is limited • Released viral particles infect adjacent type II
information regarding risk factors for severe illness. pneumocytes
Based on currently available information and clinical • Damaged cells induce innate inflammation
expertise, older adults and people of any age who in the lungs that is largely mediated by pro-
have serious underlying medical conditions inflammatory macrophages and
might be at higher risk for severe illness from granulocytes.
COVID-19. • Lung inflammation is the main cause of life-
threatening respiratory disorders at the severe
PATHOPHYSIOLOGY stage
STAGE 1: ASYMPTOMATIC STATE (INITIAL 1–2
DAYS OF INFECTION)
The inhaled virus SARS-CoV-2 likely binds its
spike (S) protein to angiotensin-converting
enzyme 2 (ACE2) receptor of the epithelial cells
in the nasal cavity.
Local replication, and propagation of the virus
1. After the virus enters the cells, the viral
RNA genome is released into the
cytoplasm
2. Viral genome is translated into two
polyproteins, and structural proteins
CLINICAL MANIFESTATIONS • Exposure to an individual with laboratory-
To discuss the protocol/algorithm on how to clinically confirmed COVID19 within 14 days
assess and manage patients with COVID-19 • A complete or partial loss of the sense of smell
(anosmia) has been reported as a potential
history finding in patients eventually
diagnosed with COVID-19

APPROACH TO A PATIENT
• Physical examination should be done in a
enclosed area
• An airborne infection isolation room is
ideal
• Patients should wear surgical mask
• Standard contact and airborne
precautions should be observed, and treating
healthcare personnel should wear eye
protection

PERTINENT HISTORY
• Travel history to an area with active local
transmission within 14 days
• Exposure to an individual who recently
returned from a country or area experiencing
active local transmission (Example: from
Wuhan City, China) within 14 days
• Exposure to an individual under investigation
(with signs and symptoms, or travel history)
within 14 days
Contact tracing 5. A negative IgM test DOES NOT rule out
Contact as defined by the WHO Global Surveillance for COVID-19 and the symptomatic patient should
COVID-19 disease interim guidance (as of March 20, REMAIN ISOLATED and swabbed using RT-
2020) is a person who experienced any one of the PCR for confirmation.
following exposures during the 2 days before and the 6. IgG-only positive individuals without RT-PCR
14 days after the onset of symptoms of a probable or should be labeled as presumptive past
confirmed case COVID-19 and not be officially counted as
• Face-to-face contact with a probable or confirmed unless there is a further validation
confirmed case within 1 meter and for more test in the future, or if validated with a PRNT
than 15 minute (Plaque reduction neutralization test) or viral
• Direct physical contact with a probable or culture by a third party.
confirmed case q If a patient is symptomatic, an RT-PCR
• Direct care for a patient with probable or should be done, and the patient should
confirmed COVID-19 disease without using be quarantined. If a patient is
proper PPE asymptomatic, there is no need to test
• Other situations as indicated by local risk using an RT-PCR.
assessments 7. The IgG antibody can be used as an adjunct
test to clear quarantined patients who remain
rRT-PCR asymptomatic at 14 days post discharge. The
• Real-time reverse transcription-polymerase presence of antibodies typically indicates viral
chain reaction (rRT-PCR) assay – the currently clearance. If IgG is positive, the patient can
recommended test to confirm COVID-19 be released from self-quarantine. If IgG is
infection is an rRT-PCR assay, which can be negative, a repeat RT-PCR should be
used to detect the virus. performed
• Using this assay, SARS CoV-2 can be detected 8. ONLY medical doctors can prescribe and
in nasal or pharyngeal samples, sputum, interpret the use of the antibody-based test
bronchoalveolar lavage fluid, and other bodily kits. These kits will not be available over the
fluids, including feces and blood counter.

Covid-19 IgM and IgG Rapid Diagnostic Test (RDT) Other tests
kits • Complete Blood Count (CBC)
• FDA approved RDT kits for SARS-CoV2 testing • Blood tests for creatinine, LFTs, sodium,
on March 30, 2020 potassium, magnesium, calcium, albumin and
• 88.86% sensitivity, 90.63% specificity inflammatory markers such as lactate
• True accuracy of immunoassays have not been dehydrogenase (LDH), Ferritin, C-reactive
established protein (CRP), and procalcitonin
• Likelihood of false negatives from • Prothrombin and D-Dimer
immunoassays should be considered • Arterial blood gas (ABG) measurement
• Cross reactivity with other coronavirus and flu • Blood cultures if concomitant bacterial
viruses as well as its detection rate have not infection is suspected
been determined • Respiratory tract specimen for influenza
• Insufficient evidence to be used as stand-alone testing
kits, not suitable for mass testing • Sputum, endotracheal aspirate (ETA), or
bronchoalveolar lavage fluid culture and
RDT Kits can be used under these conditions sensitivity
1. Only Food and Drug Administration (FDA) • Chest x-ray
approved kits should be used. • High resolution chest CT scan plain
2. A COVID-19 antibody test CANNOT be used as • ECG
a stand-alone test to definitively diagnose
COVID-19 and CANNOT be used for mass
testing.
3. The COVID-19 RDT can only be used in people
who had onset of symptoms for at least 5 days
(i.e. for IgM) and 21 days (i.e. for IgG). Most
kits include both IgM and IgG, so they can be
used by day 5.
4. Anyone who tests positive for IgM should be
tested with an RT-PCR to confirm the positive
test.
WAYS TO PREVENT THE SPREAD OF THE
VIRUS
How it spreads?
COVID-19 is transmitted from person to person via
droplets, contact, and fomites.
• Between people who are in close contact with
one another (within about 6 feet).
• Through respiratory droplets produced when
an infected person coughs, sneezes or talks.
These droplets can land in the mouths or noses of 4. Adults with Acute Respiratory Distress
people who are nearby or possibly be inhaled into the Syndrome (ARDS)
lungs.
Supportive therapy and Monitoring for COVID-19
Protective measures patients with Pneumonia
• Practice frequent and proper handwashing. • Give supplemental oxygen therapy
• Practice proper cough etiquette. • Regularly assess the need for intubation and
• When outside your home, practice social mechanical ventilation.
distancing or physical distancing. • Use conservative fluid management
• Give appropriate empiric antimicrobials.
DESIGNATE A HOT ZONE. • Give oseltamivir
• this is where you wash/disinfect before • Do NOT routinely give systemic corticosteroids
entering your houses. (foot bath & • Closely monitor patients with pneumonia
alcohol/sanitizer) • Identify and properly manage other co-
• a separate basket for used clothes and mask. morbidities adequately.
• storage or container where you can
temporarily place unclean items. Management of Severe Sepsis or Septic Shock
• Avoid unprotected contact with farm or wild • Admit the patient to the ICU.
animals (alive or dead), animal markets, and • Give appropriate antimicrobials
products that come from animals (such as • Determine if infection was acquired in the
uncooked meat). community or in the hospital
• Clean and disinfect frequently touched • Early effective fluid resuscitation
surfaces regularly. • Apply vasopressors when shock persists
• Vasopressors can be given through a peripheral
IV access.
• Consider an inotrope such as dobutamine

Management of ARDS
• Admit the patient to the ICU.
• Recognize severe hypoxemic respiratory failure
• Hypoxemic patients without ARDS should be
monitored closely in an ICU setting for clinical
deterioration and need for invasive mechanical
ventilation.
• Referral to the appropriate specialists
• Endotracheal intubation should be performed
• Implement lung protection strategy
• Patient should be immediately placed prone for
no less than 12 hours with the goal of lung
recruitment
• Use a conservative fluid management strategy
Management for ARDS patients without tissue
A. Surveillance Definitions hypoperfusion
1. Suspect case • neuromuscular blockade by continuous
2. Probable case infusion should not be routinely used.
3. Confirmed case • Extracorporeal life support (ECLS) should be
B. Clinical Classification of patients with considered
Probable or Confirmed COVID-19 infection • Avoid disconnecting the patient from the
1. Adults (agee<60) with stable or no ventilator
comorbid diseases and uncomplicated
• Minimize nebulization
upper respiratory tract infection
2. Adults (age >60) with stable or
Investigational Drugs for Treatment of COVID
unstable co morbid diseases and
Pneumonia
pneumonia
Remdesivir - inhibits viral RNA polymerases
3. Adults with severe pneumonia, severe
Chloroquine or hydroxychloroquine - was found to
sepsis or septic shock (manage as
block COVID-19 infection at low-micromolar
Community Acquired Pneumonia-High concentration
Risk (CAP-HR) based on 2020
Philippine CAP Guideline)
Lopinavir-ritonavir - patients under the combined • lethargy,
therapy had a lower risk of acute respiratory distress • edema, loss of appetite,
syndrome (ARDS) and death • apathy,
Tocilizumab - It is currently used mainly for • irritability,
rheumatoid arthritis, a single infusion of Tocilizumab • change in hair color
given to severely or critically ill COVID-19 patients • dermatoses.
resulted in prompt improvement in clinical,
inflammatory and radiologic markers. 2. Secondary Undernutrition
• Due to secondary causes that limit an adequate
6: MALNUTRITION supply of nutrients to the body.
• These include disorders that affects GI
• a state of disease caused by sustained function, wasting disorders and conditions that
deficiency, excess or imbalance of the supplies increase metabolic demands such as infections,
of calories, nutrients, or both that are available hyperthyroidism, and other critical illnesses
for use in the body and conditions.

4 types of malnutrition: 3. Specific nutrient deficiency

• Undernutrition • A nutritional deficiency occurs when the body
• Specific nutrient deficiency doesn’t absorb or get from food the necessary
• Overnutrition amount of a specific nutrient.
• Nutrient imbalance • pathological state resulting from a relative or
absolute lack of individual nutrient
1. Primary undernutrition
• The outcome of insufficient food caused XEROPTHALMIA
primarily by an inadequate intake of dietary or • caused by severe vitamin A deficiency and refer
food energy whether or not any specific to impairment of night vision and or pathologic
nutrient deficiency is present changes in the eyes.
• Also referred to as protein-energy malnutrition KERATOMALACIA
(PEM), increases vulnerability to infectious • Softening of the entire thickness of part or the
diseases since energy, protein and certain whole of the Cornea.
vitamins and minerals play crucial roles in
immune functions VITAMIN A DEFICIENCY
CONJUCTIVAL XEROSIS
Protein Energy Malnutrition(PEM) • Dryness, thickening, pigmentation and luck of
Marasmus luster and transparency of the bulbar
• Severe loss of subcutaneous fat and muscle due conjunctiva of the exposed part of the eyeball
to low calories and protein intake CORNEAL ULCER
• Seen in nutritional emergencies, conflict, and • The cornea looks dull and has a small crater,
calamities which called a Corneal “Ulcer”
• Primary cause of very poor quality diets that BITOT’S SPOT
result to loss appetite, growth cessation and • These are abnormalities of the conjunctiva of
low immunity the eye. The conjunctiva has a white to
• The body tries to conserve energy by reducing silver/gray foamy area on it, very similar to
activity, appetite and growth soap bubbles
• Lead to death if not treated properly
• Features: VITAMIN D DEFICIENCY
• skin and bone appearance, Rickets
• old man facie • characterized by soft and fragile bones,
• prominent rib cage and shoulders enlarged joints, bowed legs and deformities of
• loose skin on the upper arm and thighs the chest, spine and pelvis. This condition
• loose buttocks with absent muscle usually occurs in children.
mass RICKETY ROSARY OR BEADING OF THE RIBS
• but appears alert. • Symmetrical modular enlargement of the
Kwashiorkor costochondral junction
• results from a diet grossly deficient in protein. Tetany - characterized by low serum calcium level of 7.5
• means sickness of the older child when the next mg/100 ml or less, muscle twitching, cramps and
baby is born convulsion
• occurs after breastfeeding stops and child is Osteomalacia or adult rickets - bone softening; results
weaned into a starchy diet when vitamin D and calcium are inadequate.
• Features:
VITAMIN E DEFICIENCY FOLATE DEFICIENCY
• Deficiency symptoms include low blood • Glossitis and other oral lesions
tocopherol level and red blood cell hemolysis • GIT disturbances
(destruction) • Megaloblastic anemia
VITAMIN K DEFICIENCY • Congenital Neural Tube Defects (NTD) in
• Hypoprothrombinemia manifested as delayed infants of mothers with severely depleted folate
blood clotting time stores

BERI-BERI – Due to thiamine (B1) deficiency GOITER

• Wet beriberi affects the heart and circulatory enlargement of the thyroid gland, caused by iodine
system. In extreme cases, wet beriberi can deficiency, either due to dietary deficiency or factors
cause heart failure. other than diet
• Dry beriberi damages the nerves and can lead
to decreased muscle strength and IODINE DEFICIENCY DISORDER
eventually, muscle paralysis. preferred term for a group of diseases/conditions due to
iodine deficiency: includes goiter, cretinism, impaired
ARIBOFLAVINOSIS mental & physical development etc.
Due to deficiency in riboflavin or vitamin B2
Dermatologic manifestations of riboflavin deficiency 4. Nutrient imbalance
include
• Cheilosis • Ability of the body to absorb certain nutrients
• chapping and fissuring of the lips or result from a poor diet
• Sore, red tongue • pathological state resulting from a
• oily, scaly skin rashes on the scrotum, vulva, disproportion among essential nutrients with
and philtrum. or without absolute deficiency of any nutrient,
e.g.
PELLAGRA • amino acid imbalance
niacin deficiency or vitamin b3 deficiency • calcium deficiency syndrome when
• Glossitis and stomatitis, followed by Vitamin D is lacking
ulcerations in the mouth, increased salivation,
and edema of the tongue. 5. Overnutrition
• Dermatitis a state of physical health resulting from long
• Diarrhea standing dietary practices that is excessive of the
• psychosis, encephalopathy (characterized by normal needs of the family
impaired consciousness), and cognitive decline
(dementia). Psychosis COMMON PROBLEMS
1. Obesity
COBALAMIN (VITAMIN B12) DEFICIENCY 2. Coronary artery disease
• Symptoms are: sore tongue, anorexia, 3. Hypertension
abdominal discomfort, coldness of extremities, 4. Diabetes Mellitus
general weakness and neurologic changes 5. Some Cancers
• Pernicious anemia is basically due to the
absence of the intrinsic factor in gastric juice. FACTORS CONTRIBUTING TO OVERNUTRITION
Thus, cobalamin, even if present in the diet in 1. Lifestyle factors
adequate amounts, is not absorbed. 2. Increasing affluence of certain sectors which
facilitates the change in lifestyles.
SCURVY 3. Change in demographic structure
vitamin C deficiency. 4. Genetics
It can lead to:
• Anemia PUBLIC HEALTH NUTRITION
• Debility CAUSES OF MALNUTRITION IN THE
• Exhaustion PHILIPPINES
• spontaneous bleeding A review of the literature in the Philippines (Corpus,
• pain in the limbs, and especially the legs 1989) as well as the national surveys of FNRI reveal
• swelling in some parts of the body the following causes of malnutrition:
• sometimes ulceration of the gums and loss of 1. Direct or primary causes
teeth. a. Inadequate and/or unbalanced food
intake. (low protein low caloric intake)
 The surveys have shown low intakes of o Natural sseasonal variations in
such foods as vegetables and fruits, availability of food
milk, eggs, dried beans, fats and oils,
Resulting in low per capita intakes of Underlying all these factors are government policies
most essential nutrients (agriculture, land use, pricing, wages etc.), political
b. Poor biological utilization of food structure and the peace and order situation or socio-
DOH statistics as well as several political unrest.
surveys have shown A high prevalence
of infectious diseases and parasitism Other causes are:
which interfere with the biological - economic disorder, national/international
utilization of food. - inappropriate development strategies
2. Indirect or secondary causes resulting in poverty
a. Economic Factor (poverty) - modernization, westernization
- income is low - actions of multinational corporations
- expenditure for food is limited and - corruption in government
food prices are high
- occupation of HH head is EFFECTS OF MALNUTRITION
characterized by unsteady or irregular On Mental Development and performance
income 1. When nutritional deprivation is severe and
b. Socio-cultural factors prolonged and occurs during the first year of
o Parental education is low life, the retardation of brain development and
o Lack of nutrition knowledge among function may not be cured by nutritional
mothers (faulty food habits, beliefs, rehabilitation (Joint FAO/WHO Expert
and practices) Committee)
o Infant feeding practices are poor 2. Abnormal behavior due to malnutrition such as
o Intra-household food distribution listlessness, apathy, inattention and poor
or sharing visual acuity and judgement impair the
o Mothers lack time for child learning process.
c. Demographic factiors 3. Malnutrition leads to sub-optimal performance
o malnutrition is more likely to occur at school age and subsequent school drop-outs
in large families, particularly On Physical Development, Fitness and Productivity
where there is more than one 1. Inadequate dietary intake impairs growth and
preschooler or four or more physical development.
children. 2. Parameters of growth physical development
o mother’s age and fertility behavior and fitness have been found to be associated
incidence of PEM has been found with physical performance measured by work
higher among children of teenage output and length of working time (Loyola and
mothers Corpus, 1992 and Herrin 1994)
o where birth interval is less than 17 3. Productivity is also affected by mental ability
months. which in turn is affected by nutritional status.(
o Rural to urban migration has given Herrin 1994)
rise to overcrowded slum areas, On National Development
breeding places for infectious 1. Slow economic growth due to low productivity
diseases which predispose to and shorter span of productive years of the
malnutrition population.
d. Health factors 2. Slow social development of a large sector of the
Risk of malnutrition is higher when: population.
o Mother’s nutritional status is poor 3. Increase expenditure for basic services.
o Child has low birthweight 4. Social unrest, high criminality rates
o Infectious disease and parasitism
co-exist with poor dietary intake Other Nutrition-Related problems of Public Health
e. Environmental/Ecologic factors Significance
o Exposure to drastic weather 1. Dental caries
condition such as typhoon and - an overall poor diet, excessive consumption
drought of sugar-rich foods, poor personal hygiene
o Geographic location and and genetics are important etiological
topography (physical features of factors
the place) which affect access to 2. Osteoporosis, postmenopausal and senile
basic services (among elderly)
STATISTICS Nutrition program
Malnutrition, in all its forms, includes undernutrition • Malnutrition continues to be a public health
(wasting, stunting, underweight), inadequate vitamins concern in the country. The common
or minerals, overweight, obesity, and resulting diet- nutritional deficiencies are vitamin a, Iron and
related noncommunicable diseases Iodine.
• adults • GOAL: to improve quality of life of Filipinos
• Overweight or obese - 1.9 billion through better nutrition, improved health and
• Underweight – 462 million increased productivity.
• children • Programs and projects are: micronutrient
• Wasted – 52 million supplementation, food fortification, nutrition
• Severeley wasted – 17 million information, communication and education,
• Stunted – 155 million home, school and community food production,
• Overweight or obese – 41 million and food assistance

• low- and middle-income countries - 45% of DOH Nutrition Program

deaths among children under 5 years of age are General Objective:
linked to undernutrition.. At the same time, in • The overall objective is to improve the survival
these same countries, rates of childhood of infants and young children by improving
overweight and obesity are rising their nutritional status, growth and
• The developmental, economic, social and development through optimal feeding.
medical impacts of the global burden of Specific Objectives:
malnutrition are serious and lasting, for • To raise awareness of the main problems
individuals and their families , for communities affecting infant and young child feeding,
and for countries. identify approaches to their solution, and
provide a framework of essential interventions;
Philippines • To create an environment that will enable
• leading nutritional problems in the mothers, families and other caregivers in all
Philippines: Protein-energy malnutrition circumstances to make and implement
(PEM) and micronutrient deficiencies informed choices about optimal feeding
• NCR practices for infants and young children.
• Prevalence rate • To increase commitment of the local chief
• 15.1% - Underweight children executives and other partners.
ages 5 y/o & below PROGRAM COMPONENTS
• 24.9% - stunting Breastfeeding practices
• 6.4% - wasting • 1st 6 months – exclusive breastfeeding
• 6% - underweight according to • To achieve growth & development
height (2015) • no other food or drinks, even water
• other nutrition problems include iron • Vitamins and medicines are permitted
deficiency anemia and vitamin a deficiency and by physicians.
poor nutritional condition of mothers who are Complementary feeding program
about to give birth • Appropriate complementary feeding
• immediate causes: o Infants shall be given appropriate
• indeed inadequate food intake complementary foods at age six
• as the percentage of food secure months in order to meet their evolving
households decreased nutritional requirements. This means
• 51.3% in 2013 to 36.1% in 2015 that it should be given timely,
• and percentage of food insecure adequate, safe, and properly fed.
households increased Micronutrient Supplementation
• from 9.5% in 2013 to 29.2% in • to address the health and nutritional need of
2015 infants and children
• Poor health status - upper respiratory • improve their growth and survival
infection, pneumonia, bronchitis and diarrhea • twice a year distribution
also among the immediate causes • vitamin A capsules through “araw ng
• However the underlying causes - inaccessibility Sangkap Pinoy” (ASAP), known as
to food and inadequate care or improper food garantisadong pambata or child health
intake week
• provide micronutrient
supplements to 6-71 months
 old preschoolers on a
nationwide scale. 7: COUNSELLING
As stated in the video, Professionals who work
intimately with others have a personal responsibility
to the awareness of their own life issues. A counselor
should be self-aware. Without a high level of self-
awareness, the counselor will hinder the progress of
their clients since in their session, what tends to
happen is that the focus is shifted from the client to the
therapist, thus making it harder to meet the needs of
the client. A counselor must be aware of their needs,
areas of unfinished business, personal conflicts,
UNIVERSAL SALT IODIZATION
defenses, and vulnerabilities.
Encourage and educate on the use of iodized salt in
As a person, a counselor may have the thought
the preparation of foods for older infants, young
that to be one, working to be appreciated instead of
children, and even adults to prevent iodine deficiency
working towards the best interest of their clients could
disorders
motivate them. These could make it possible that a
• Asin law, republic act 8172, “an act
counselor to give more advise than what is necessary,
promoting salt iodization nationwide and for
which then makes the client dependent, and
other purposes. “signed into law on dec. 20,
perpetuate the tendency to look outside of themselves
1995
for answers.
• Yr 2013 ra 10611 food safety act
These interfering motivations can make the
strenghthening the food safety regulatory
goals of therapy suffer because when counselors with a
system to protect consumer health and
need for approval focus on trying to win the acceptance,
facilitate market access of local foods and food
admiration and even awe of their clients.
products
With regards to unresolved personal conflicts,
Food Fortification
counselors should be aware of their biases, areas of
• mandatory food fortification of staple foods –
denial, and unresolved issues. Their biases should not,
rice, flour edible oil, sugar and voluntary food
in any way, hinder the treatment of their client. These
fortification of processed food and products.
should be put away and an open mind be at the ready
(Vitamin A, Iron, Iodine)
to be able to accommodate the patient’s needs. Areas of
• Fortification
denial should also be, at the least, disregarded, since
• addition of any or more essential
these as well could affect the treatment of the client.
nutrients to food, whether or not it is
Lastly, unresolved issues must then be met. The
normally contained in the food, for the
counselor himself should be able to put this aside for a
purpose of preventing or correcting a
time, and come back to it, but only to be able to resolve
demonstrated deficiency of one or
these issues.
more nutrients in the population or
Doing personal therapy during training as a
specific population groups
counselor helps to know what the experience of being a
• Republic act 8976, “an act establishingthe
client is like. Most of us have blind spots and
Philippine food fortification program”
unfinished businesses that may interfere with our
mandating fortification of flour, oil and sugar
effectiveness as a counselor. During training, there
with vitamin a and flour and rice with iron
may be some issues that may surface, so there is
• food fortification day theme 2010: eo 382
possibility that the counselor in training may get the
declares November 7 as the national food
need to tell people what to do, or have all the answers
fortification day
and be perfect, as well as be recognized and
• Sangkap pinoy seal program encourages
appreciated.
manufacturers to fortify their food products
As a professional, it sometimes happens that a
with 1/3 of recommended daily allowance of
client may develop strong feelings toward their
Iron, Vitamin A, and Iodine.
counselor. This is called Transference, which is the
Pinggang Pinoy
process whereby clients projects onto their counselor’s
past feelings or attitudes they had toward significant
people in their lives. It is said in several codes of ethics,
laws and their amendments, as well as the oath a
counselor takes that it is of highly unprofessional
behavior to engage with the feelings that the patient
may otherwise only feel toward them by means of
transference. It is important to keep themselves on the
right track, focused on being able to help their clients,
and not be a part in their further demise.
 that perception back to the individual to clarify what
Clients are more likely to achieve their goals when they have said. The main skills involved in
there is a healthy and trusting relationship that exists communicating empathy are non-verbal and verbal
between the client and the therapist. Naturally, the attending, paraphrasing what the patient has
way in which the counselor engages the client can be a communicated, reflecting on how the patient feels, and
very effective tool in the helping relationship. These also on implied messages.
skills are qualities that a counselor should be able to
possess to be effective in their work, not only to improve Nonverbal and Verbal attending: this involves the
the lives of their clients, but also themselves as well. counselor’s conduct which communicates to the patient
that the counselor is paying full attention to what the
1. Listening patient is saying in a caring and helpful way.
Attending: It is when a counselor positions himself in
front of a patient in a way that lets the patient know Paraphrasing: the counselor may want to focus on
that he is aware of them, that he has their full and keywords and main ideas that the client has
undivided attention, and that they care about what communicated and communicate them back to the
they are going to say, and in general, who they are as a patient in a rephrased, shortened form. The four tools
person. This can be done by maintaining eye contact, used to help in paraphrasing are listening and recalling
removing anything in the room that may distract from everything that the client expressed to make sure that
focusing on the patient, by nodding in affirmation to the counselor has recalled everything and did not miss
what the patient says, by trying to not move around so any significant details. The second tool is identifying
much because moving around may make it seem that content and aspect of the information the patient has
the counselor is antsy and ready for the patient to stop shared by deciding what event, situation, idea, or
talking. Doing this may make it seem to the patient person the client is talking about. The content refers to
that the counselor is not willing to hear them or that what is actually being said through words, expressions,
he has better things to do. Another is through and patterns, oftentimes even through what they omit.
encouraging verbalizations in which the counselor tells Rephrasing the entirety of what they communicated
the patient to dive further or move on with the story. yet as briefly as possible by using keywords and main
Through reflecting the patient’s posture and language, ideas the patient has used to repeat back to them in
this can make the client feel more comfortable and that fresh way. The fourth tool is perception check. This
the counselor seems to be more engaged. Eighty allows for the patient to confirm or deny the precision
percent of communication takes place non-verbally. of the counselor’s paraphrase. A counselor may do this
Attending is an important way to communicate to the in form of a question.
patient that the counselor cares about them.
Reflecting on the patient’s feelings: the counselor may
Observing: It is imperative to be able to retain both the want to go back over with what the patient has
verbal and the non-verbal information conveyed by the communicated directly though words as well as
patient through observation. Through observation, we through non-verbal behaviors in a respectful and open
obtain what the patient is actually saying, as well as ended approach. A fair deduction may be made about
process all the non-verbal communication. In content, what the patient may feel emotionally. It is imperative
the counselor must be mindful of the words being said, for the counselor to choose cautiously the words to
the expressions, as well as the patterns, as these may communicated back to the client. This is why it is
provide further insight. It is also important to important to say the same or similar word that the
recognize what is not being said. A counselor must patient has used. A counselor must also remember that
develop the ability to remember what was said, and to what the patient is feeling is very real, and oftentimes
clarify with the patient what he was saying. In process, very deep. Wrong word choice can oftentimes be
it pertains to all non-verbal communication, so it is harmful to process.
helpful to recognize how the content was presented. A
counselor must not only be mindful of how his non- 3. Genuineness:
verbal communication, an important part of listening A counselor must be honest, himself, and comfortable.
is being conscious of his patient’s non-verbal A counselor’s actions need to reflect the words he is
communication as well. Recognizing recurring themes, saying. Oftentimes, a person can say the right things
body language, interactions, and more. but his heart and mind are far off. A counselor must be
genuine with what he is saying. What he says should
2. Empathy be paired with his behavior. For example, when a
It doesn’t mean that the counselor must be able to counselor has expressed that he is comfortable with
identify with the patient, nor does he need to share his helping a patient navigate through all issues and yet
own experiences. A counselor may not actually know he acts surprised or uncomfortable when they talk
how a patient feels, but it is important to be able to about a more private and intimate issue, it could
discern another’s experience and then communicate become a stumbling block in the growth process.
 4. Unconditional Positive Regard: 9. Information giving and removing obstacles to
Regardless of what is said, there needs to be an endless change:
amount of kindness and expression of caring. Flaws A counselor would want to give facts, data, and
may be seen but it is not a counselor’s job to argue, but answers. Together with the patient, they both could
it is to be able to help the patient to see things through identify problems that could hinder with the growth
the scope of reality. Everybody needs encouragement process and think through possible solutions and
and guidance to help us see things through the scope of alternatives.
reality. Affirming the patient in their hurt, happiness,
or confusion is a good way to convey to the patient that
it is okay to be experiencing these emotions. 8: ACTIVE LISTENING
5. Concreteness:
SKILLS
It is important to stay focused on specific and relevant
facts and feelings and to avoid getting off topic, making there are three steps in counselling, not that I’m
sweeping statements or talking about the counselor planning to be a therapist or anything, I just found it
and not the client. Helping the client to recognize and rather interesting… so there are three steps: there’s
pursue growth in one specific area of the several exploring, understanding, and action. For exploring,
presented can reiterate to the client the goal and also there is beginning, in which we begin by helping the
the intended structure of that specific session. patient settle in. there’s also contracting, wherein we
Presenting questions and propositions can help the set the terms; there’s also attending, of course the
patient to clarify facts, terms, feelings, and goals. By patient needs to my complete and undivided attention.
adapting a here and now focus, addressing the material Silence is important so the patient can make himself
that comes up in the room becomes the focus. heard, interruptions may be unappreciated. Reflecting
feelings, wherein I pick up the emotions. Paraphrasing
6. Open questions: in which I repeat to the patient what he has said based
This is a helpful questioning method to clarify or on my understanding. Focusing, this is where we
explore thoughts and feelings. When asking open determine which among his issues are the most
ended questions, a counselor wouldn’t want to request pressing, and we then determine how fixing that issue
a specific bit of information, or limit the question to a would help in dealing with the other troubles.
brief answer. The goal is to drive deep and explorative
thought. If the patient is already doing these, it is no After we are finished with exploring, we then go
longer necessary for a counselor to perform these. Ask through with the phase of Understanding. There are
intentional and purposeful questions. The goal is not to elements which are essential in this phase. The first is
drill the patient. A counselor should not make the immediacy, this is the immediate feeling that the
patient feel as if they are interrogated but it is to help therapist feels when reacting to the client. The second
them through an issue. A counselor may want to follow- is self-disclosure, in which the counselor shares
up with a paraphrase which may encourage the patient experiences which can be helpful for the client to
to share more. realize from where the therapist comes from.
Confronting discrepancies, where we both gently
7. Counselor self-disclosure. challenge the discrepancies that are being felt by the
This is when the counselor shares personal feelings, life client. Recognizing patters and Identifying themes are
experiences, or certain reactions to the client. It is safer the last elements.
not to self-disclose unless there is no other way to meet
a clinical need in which case, it should only include With the last phase, the End, the therapist
relevant content intended to build the patient up. summarizes, evaluates the clients, and have the client
set his goals
8. Interpretation:
This is any statement outside of what the patient has ACTIVE LISTENING
actually said, or may be aware of. When interpreting, • What makes a good doctor? According to a poll
the counselor is able to provide a new perspective, conducted by the speaker, it is the ability to
provoke thoughts or feelings, or present an explanation listen which garnered a 72% response among
for behaviors. Interpretations may help patients the choices beating medical knowledge,
connect things that they have compartmentalized, diagnostic skills, and technical or procedural
reveal patterns or themes, or it could offer a fresh way skills.
of thinking. It is important for a counselor to not • Clinical listening is the “essentia” of good
overuse this since it may come across as accusing or doctoring. It is a priority requirement among
accusatory. medical practitioners.
• For patients, clinical listening is important
because it provides the patient information for
 diagnosis. To the patients, listening is 7. Attentive listening is not a neutral act – it can
therapeutic, because in some way, listening to have positive or negative impact on the patient,
a person will cure half of one’s problems. caregiver, and their relationship
Clinical listening is also important in the 8. Attentive listening necessitates the formation
doctor-patient relationship. To the patients, if of new habits
the doctor listens, the doctor gives the patient
respect. Also, to the doctor, listening takes How do we do it?
time. • Turn-waiting – pseudo listening
• Defensive listening
Listening paradox • Critical listening
70% of waking time in communication • Judgmental listening
• 11% writing • Skeptical listening
• 15% reading • Rhetorical listening
• 32% talking • Record keeping listening
• 42% listening • Attentive or deep or relational or affiliative
Listening is “the type of communication we engage in listening
the most and learn first, yet it requires a skill we are There are several methods on how to do listening: turn
taught the least. waiting – pseudo listening which is not really listening,
but rather listening so you know when to talk,
defensive listening which is learned by lawyers, critical
Paradox: Socio-Cultural Context listening which is essential for a music critic,
Listening is second to seeing – eyes are better witness judgmental listening is for teachers, skeptical listening
Listening is second to speaking for academic philosophers, rhetorical listening which is
- Courses on rhetoric, public speaking used by politicians, and record keeping listening for
- Speaking is macho: leadership, attention beaurocrats, all these however, are not suitable for
Listening is misunderstood caregivers or healthcare workers. For caregivers, it
- Not seen as a challenge is essential that they utilize attentive or deep or
- Seen as passive relational or affiliative listening. It is important
Listening is difficult clinically.
- Requires maturity
- Shift of relationships

WHY DO WE LISTEN?
Informational: flight info, medical history
- I will know what to think
Transactional: broker, surgical history
- I will know what to do
Relational: teacher, physician
- I will know who you are (and what I must
be)

CLINICAL LISTENING: How do we describe it?

1. Attentive listening is a perceptual, cognitive
and social act There is a spectrum in which a clinician must be
2. Attentive listening is an active process present. It encompasses the two spheres of doubt and
3. Attentive listening is triadic: the speaker, the belief. A clinician must be open but not gullible, since
utterance, and the listener patients will sense quickly if the clinician does believe
4. Listening attentively involves focusing on word in what the patient is saying.
choice, paralanguage and non-verbal cues
and signs ATTENTIVE LISTENING
5. Listening attentively requires: receptiveness, Deep/relational/affiliative
an understanding of how spoken language COMPASSIONATE LISTENING
works; and an ability to move between open- “people are dying in spirit for lack of it”
mindedness and an awareness of inference “what do I need to be for you?”
6. Attentive listening can accomplish the “accompaniment or partnership”
following: reveal the personhood and concerns There are two ways to look at listening. There is
of the patient, produce diagnostically relevant attentive listening, which tends to be deep, rational, or
data, and assist in healing affiliative, and there is compassionate listening which
was, in the video, put best in quotes such as “people are
dying in spirit for lack of it,” “what do I need to be for RATIONAL LISTENING: Special Features:
you?” and accompaniment or partnership. “ Seldom is there a deep, open-hearted, unjudging
reception of the other. And so we all talk louder and
LISTENING TO THE NON-VERBAL more stridently and with a terrible desperation. By
• Listening for pauses, cadence, timbre, register contrast, if someone truly listens to me, my spirit
• Sensitivity to non-verbal communication begins to expand.” Mary O’Reilley: Radical Presence
• Mindful of our own non-verbal communication
• Non-verbal communication to signal that we Requires education in process
are listening One of the biggest challenges for physicians is listening
o Distance to people who aren’t talking. Past experiences of not
o Acknowledgement being heard or even perceptions that someone doesn’t
o Demeanor/orientation care or won’t understand can shut a person down.
o Eye contact Rational listening requires education in process.
o Immediacy/rapport
o Bespoke Requires education in content
It is needed for a clinician to be mindful of the non- “is this a story of shame and they need you to listen? Is
verbal. These can be done by listening for pauses, this a story of fear and they need you to be there with
cadences, the timbre, as well as the register. Doing this them? Is this a story of blame… or self-blame and they
can then improve the sensitivity to non-verbal need to hear that it wasn’t their fault? I mean, what is
communication. In addition to that, a clinician must the story? So what role do they need you to be in?”
also be mindful of his own non-verbal communication.
To show to the patient that we are indeed listening, WHAT DOES CLINICAL LISTENING
maintaining distance, acknowledging what the ACCOMPLISH?
patient’s statements, fixing our demeanor or • Creates the dyadic relationship for care
orientation, maintaining eye contact, as well as our • Enacts recognition of the other and respect for
immediacy or rapport. It is important to make it as the person
unique and bespoke as possible. • Listening is maieutic
• Enables understanding across broad horizons
• Leads to co-construction of meaning
• Creates a conduit for healing

Relational Outcomes
TRUST
Willingness to be vulnerable, feeling cared for, knowing
promises will be kept
HOPE
Belief that some positive future beyond present suffering
is possible
BEING KNOWN
Accumulates sense that the physician knows the patient
as a person.

WHAT ARE THE CHALLENGES?

Voice of Experience
• Paternalism: “Father knows best”
o Power and class
• When did empathic become emphatic?
Our own comfort in silence
Role confusion: Who are we in the moment?
Goal confusion: What is our purpose?

The challenges of clinical listening include, but are not

limited to, paternalism in which the clinician tends to
know what is best even if that best is not the best with
regards to the care of the patient, also the loss of
empathy which can be stemmed for being too emphatic.
Another is that the clinician may find too much comfort
in silence. Lastly, there tends to be a confusion within
roles. A clinician should know who they are in the
moment, what the purpose is and the goals that should purchases an ultrasound machine as a substitute.
be accomplished. It could be added that bad practice in Another classification is receptive or neurological
medicine can also be a challenge, as well as the deafness in which the clinician can hear but cannot
devaluation of actually talking to the patient. interpret the signals due to a processing problem.
Under this, and the clinician misses patient word
Reward Systems usage, misses patient context. The third classification
Med student: “ You can get away with being brusque… is reflexive clinical deafness in which the clinician
you can’t get away with bad medicine.” hears his own words, but does not see the impact on the
“there was nothing I could do – so I just talked to the patient. This is an example which exhibits a lack of
patient” self-awareness. The last classification is complete
communication failure. The clinician neither speaks
HOW CAN WE TEACH CLINICAL LISTENING? nor listens. This is a rare phenomenon but is seen
Small Group Learning amongst dermatologists.
1. Read transcript: others listen
Compare: reading, role-play and voice CAN IT MAKE A DIFFERENCE?
of patient “Certain aspects of doctor-patient communication seem
2. Written descriptions of audio of patients to have an influence on patients’ behavior and well-
With and without video being:
3. Figurative language and metaphors - Satisfaction with care
4. Logic of stories - Adherence to treatment
5. Prosody, tempo, pitch - Recall and understanding of medical
6. Affective states information
7. Word choice - Coping with disease
8. Distancing from disease - Quality of life
- State of health”
CLINICAL DEAFNESS: IMPAIRED Clinical listening can make a difference. Certain
CAREGIVERS aspects of doctor-patient communication seem to have
A. Simple Clinical Deafness an influence on patients’ behavior and well-being. Good
1. Passive: clinician who does not listen listening and communication increases satisfaction of
2. Active: hears but interrupts – 18 sec care, their adherence to treatment plan, the patient’s
syndrome ability to recall and understand medical information,
3. One-word trigger: drop down menu sign and cope with the disease, thus improving the patient’s
4. Acquired specialty variants – e.g. quality of life and state of health.
stethoscope tubal scarring – purchase of
ultrasound machine • The patient has two needs: the first is the need
B. Receptive of Neurological Deafness: can to know and understand, and the second is the
hear but cannot interpret signals – a processing need to feel known and understood.
problem
1. Misses patient word usage STUDIES OF BEHAVIOR
2. Misses patient context Affiliation Control
C. Reflexive Clinical Deafness: caregiver hears • Extremely attentive • Tends to come on strong
own words, but not their impact on patient – a • Listens very carefully • Dominates
lack of self-awareness • Deliberately acts… I conversations
D. Complete Communication Failure: know… is listening • Verbally exaggerates to
Clinician neither speaks nor listens • Very encouraging emphasize
• Very relaxed • Dramatizes a lot
Impaired caregivers are not patients who cannot hear, • Eyes reflect what s/he is • Very argumentative
but rather doctors who can’t hear. There are feeling • Constantly gestures
classifications, which include simple clinical deafness.
Under this are passive in which a clinician who does CLINICAL HYPOCOMPETENCE
not listen, another is active in which the clinician hears Interview of Low Therapeutic Content
but interrupts, the so-called “18 second syndrome.” • “it is news to many of our house staff that a
Another is one word trigger in which when a clinician diagnostic interview should be therapeutic to
hears a specific word, it is as if he gets a dropdown the patient”
menu that essentially provides ancillaries that he • “the use of the familiar rituals of meeting is
thinks may be helpful but does not listen about why therapeutic in itself, for it affirms that the
and when the condition happened. Another is called patient has not strayed beyond the bounds of
acquired, in the webinar the example was a cardiologist civilization into the hands of the technicians.”
whose stethoscope has tubal scarring and for that he • “I am with you”
Inappropriately High control style
• “the patient’s job is to tell his story and the
physician’s job is to listen and hear.”
• “…the patient’s voice should be heard and little
of the interviewer’s”

Clinical hypocompetence can be characterized in two

ways: interview of low therapeutic content, and
inappropriately high control style. In the former, the
webinar speaker emphasized that with those that
exhibit this type of hypocompetence, it may seem to be
news that a diagnostic interview should be therapeutic
to the patient. It is further emphasized that the use of
the familiar rituals of meeting is therapeutic in itself,
for it affirms that the patient has not strayed beyond
the bounds of civilization into the hands of the
technicians. Furthermore, the speaker emphasized the
importance of transmission of the sense that the
clinician is with the patient. In the latter example. The
speaker emphasized that it is the patient’s job to tell
his story and the physician’s job to listen and hear. The
patient’s voice should be heard and little of the
interviewer’s.
Listening is active, it is work. The joy of listening is
quite substantial and one of the privileges of being a
clinician or a caregiver is that of listening to the people
of whom care is given to.
With regards to time constraints, it is imperative that
the clinician should make use of the time allotted to be
with the patient as much as he could. To most, the lack
of time is the most common excuse. Listening carefully
to the patient can become an investment.
Family Medicine & Community Health 3
Family Oriented Medical Record
Arnel Herrera, MD | 11 September 2018
Family roles with regards to health
OUTLINE: Family wellness plan
I. MEDICAL RECORD Records should be simple, complete, clear, and efficient
II. CONCEPT OF FOMR
A. Basic parts o FOMR A. BASIC PARTS OF FOMR
1. Summary of socio demographic data of Summary of socio-demographic data of nuclear family
nuclear family members members
2. Family assessment tool and family wellness
Family assessment tools and family wellness plan
plan
a. Genogram Consultation records of each family members
b. Family APGAR
c. Family Map 1. Summary of socio – demographic data of nuclear family
d. Family health beliefs interview members
st
e. Family wellness plan Front page of the FOMR (Advantage: 1 glance will give
3. Consultation records of each family the family physician an idea who among the family
members members will have a ff up or has a disease like
III. KEEPING TRACK OF QUALITY MEDICAL RECORDS hypertension, DM)
IV. ELECTRONIC RECORDS AND PRIVACY
Includes information about the nuclear family of the
CONFIDENTIALITY ISSUES SURROUNDING FOMR
patient and/or others sharing the household with the
patient for a long period of time
I. MEDICAL RECORD
The composition of the family, health problem they
The cornerstone of a good clinical practice and accurate encounter, reasons for visits, and follow-up care plan
documentation is a good medical record Updates done on an annual basis
It includes the account of patients signs and symptoms,
assessment and diagnostics, and treatments received 2. Family assessment tool and family wellness plan
Ensures the continuity of quality medical care and These are two integral parts of the FOMR
effective communication with other health care providers Unique feature of a family physician practice because the
Used also for medico-legal purposes (for our protection) family physician is able to see the interrelatedness of
Bases for 3rd party payers health and illness
HMO: Health Maintenance Organization The problem is: the completion can take more than one
Used for effective teaching and research tools (Chart and visit (usually 3-4 visits before completion)
records are used to teach interns, clerks and residents Family assessment tool Genogram, APGAR, Family map,
especially for data in research) Family health beliefs
Can provide evidence of care that patient has received
Documentation increases the effectivity for follow through 2.1 Genogram
care and data for assessment of practice Provides graphical representation of illnesses
Included in medical records is the pharmacologic and non Identify the different health care roles of the family members
pharmacologic management of the patient assume once a family member got sick
Important roles to be identified
Before, POMR (Problem Oriented Medical Record) is utilized but o Breadwinner/financer
family physicians improved a more comprehensive record, the FOMR o Caregiver/alternate caregiver - Important if the illness
because in POMR, the data incudes only the individual / patient. In
is chronic or if the patient is bedridden
care giving, the mother usually takes care of the sick but if the
mother is not around, any significant others will take care of the o Index patient
pa ien ha s h famil is considered as an all for he rea men of o Decision maker - Identify If the breadwinner /
the patient, therefore, making the family oriented medical record. caregiver is not the breadwinner
o Family doctor
II. CONCEPT OF FAMILY ORIENTED MEDICAL RECORD (FOMR) Genogram Example
Should extend beyond filing of the individual records of o Should be 3 generations
nuclear family members and include o There is a legend.
Common tools of family assessment Do not include legends of male/female as
■ Genogram well as the bonds, and ‘living together
■ APGAR (these legends are universal and are
Health beliefs of the family

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Family Medicine & Community Health 3
Family Oriented Medical Record
understood by the physician). Also do not 2.3 Family map
include the ‘dead legend. Determines stability of family relationship
Important are for diseases. No universal What s the meaning of those lines?
legends for these. Family APGAR and Family Map usually Aids the family
o Index patient, breadwinner or caregiver are missing in physician to gauge how family members will take care of
the example the sick member of the family who ll take care of the sick
If the APGAR score is dysfunctional and if the Family map
shows Problematic relationship, then doctor is warned
that there will be problem in care-giving
Example
a. Child: APGAR is 2, family map is problematic
relationship - refer to DSWD
b. Adult/Geriatric - refer to other sectors of society,
because there will be problems

2.2 Family APGAR

Adaptation, partnership, growth, affect, resolve
Assess degree of family planning
o Important if you want to evaluate how the family
members will take care of the sick family
2.4 Family health beliefs interview
member
Cultural beliefs or biases that affect health seeking and
o Can have as many family members as you want,
health maintenance behaviour
just take the average
Help address the family s desired treatment goals
o Scoring
Responses in the questions below should be included in
0-3 severely dysfunctional
the FOMR
4-6 moderately dysfunctional
a. Do they belong to an ethnic or religious group
7-10 highly functional
with distinct health practices?
o No blood transfusion - Jehovah s
b. What is the patients and family s explanation for
the illness?
c. Will they be open to non-conventional
therapies?
d. What are the treatment goals and preferences
for therapeutic approaches?

2.5 Family wellness plan

Important things that should be included:
a. What screening tests should be requested?
b. If there were any immunizations done?
c. Any lifestyle changes/counselling?
Family physician practice because they see
interrelatedness between health and illness
Problem is completion can take more than one visit

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 Family Medicine & Community Health 3
Family Oriented Medical Record
Anything that is checked or included in the Review of
Systems should not be included in the history of present
illness and anything that is included or related to the
history of present illness should not be included here in
the ROS
Past Medical History should not be part of History of
Present Illness
Example of common mistake:
a. The problem is HTN and DM, and yet still
included in PMH; should not be included
because it is an on-going problem even if
3. Consultation records of each family members
diagnosed 10 years ago. From the start in
1. Front sheet containing summarized problem list and
management History, label the patient Hypertensive or
2. Record of initial consult Diabetic and indicate if controlled or not.
3. Record of subsequent consult in a SOAP (subjective,
objective, assessment, plan) format

3.1. Front sheet containing summarized problems list and

management
Gives physician birds eye view of family health problems
Saves time on going through the individual records

3.3. Record of a subsequent consult in SOAP format – Follow up

patient record
S - Subjective
o Chief Complaint
o History of Present Illness
C - Psychosocial Context of the disease
3.2. Record of initial consult o Example: Child complaining of abdominal pain; in
Date of Consult and History history, mother has anxiety disorder because she
Should be included: is in the midst of trial separation from her
a. History of Present Illness husband.
b. Review of Systems o Psychosocial Context: Child is using the illness to
c. Past Medical History gain attention from the parents. Pag may sakit
d. Personal/Social History siya, laging magkasama yung parents niya hoping
e. Obstetric/Menstrual History (females only) that they will patch-up things.
f. Birth/Maternal History, Developmental O - Objective
Milestones, and Immunization History (pediatric o Vital Signs
patients) o Clinical Exam
g. Physical Examination o Laboratory Results - requested during the initial
h. Assessment Plan consult
o Diagnostic and therapeutic test for A - Assessment
treatment o Should be current
o Follow-up o Based on history and physical examination
o Referral findings, not previous diagnosis of previous
Should not be included: consultation
a. Family History - included in the genogram

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Family Medicine & Community Health 3
Family Oriented Medical Record
o Example: Patient is already diagnosed as
hypertensive 3 years ago; you still need to put it III. KEEPING TRACK OF QUALITY MEDICAL RECORDS
in the present assessment. State the present Are the records easy to retrieve?
situation of HTN: controlled or uncontrolled. Individual patient files should be identifiable
Uncontrolled indicate stage JNC 7/8 within the family record.
Controlled by medications or lifestyle Illness and treatments should be easily accessed
changes same with the lab results.
P Plan of Management Are the records legible?
o Diagnostics (any lab work-ups) Write legibly.
o Therapeutics (any medicines prescribed) Are the records arranged chronologically?
o Supportive treatment (non-pharmacologic) How? Arrange from the most recent to the
o Any Advice oldest. Most recent should be on top.
o Referrals Do the records also keep track not only of curative but also
o Date of follow-up preventive services for the patient and the family?
Health teachings should be also included.
FOOLLOW-UP PATIENT RECORD (FPR) Advice and health education given to the
patient.
* At present, we are currently using papers, but in some
institutions, they are already using electronic records
(other countries).

IV. ELECTRONIC RECORDS AND PRIVACY CONFIDENTIALITY ISSUES

SURROUNDING FOMR
Cost effective for it eliminates the need for paper based
system and helps facilitate communication among staff
members.
Initial investment
■ Software for electronic records very
expensive
Staff training
■ Efficient implementation
RA 10173 (DATA PRIVACY ACT) entitled an ac pro ec ing
individual personal information in the information and
communication systems in the government and the private
sector, crating for this purpose a national privacy
commission and for o her p rposes classified health
records as sensitive personal information
Most important is the privacy and confidentiality of the
patient and the family.

REFERENCES
1. Lecture recording and ppt or Dr Hererra

Again, the FOMR can be modified based on the demand of

practice. It can be fit to purpose.

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UNIVERSAL HEALTH CARE
Anabelle Pabilona-Tiu MD | 25 August 2018 | Topic 4
Outline o Leadership Reforms - aims to make health care
I. Universal Health Care providers more reliable & responsible
A. Time of UHC –
B. Why aim for UHC?
C. Objectives of UHC
D. Reforms of UHC WHY AIM FOR UNIVERSAL HEALTH CARE?
E. Advantage and Disadvantages of UHC
F. 4 Categories of UHC - All individuals and communities must receive the health services
II. Kalusugan Pangkalahatan
they need without suffering any great financial loss.
A. Beneficiaries of PhilHealth Achieving UHC is one of the targets the nations of the world set when
B. Philheatlh Categories adopting the Sustainable Development Goal

3 critical Dimensions:
1. Who is covered?
2. What services should be covered?
UNIVERSAL HEALTH CARE 3. How much of the cost is covered?
– Also Known as:
o Universal Health Coverage - Based on a research conducted in on December 31, 2017
o Universal Coverage the following findings have been surmised:
o Universal Care • At least half of the world’s population do not
o Socialized Health Care have a full coverage of essential health services
o Hallmark of a government to improve the well- • About 100 million people are still pushed into
being of its citizens extreme poverty
• Over 800 million people (about 12%) of their
budget was provided for health care
Timeline of Universal Health Care (UHC)
• All member nations/states aims to provide UHC
– 1948 – demand for Universal Health Care (UHC) started
by 2030
this year; the World Health Organization declared UHC as
a basic human right
– 1978 – WHO conference in Alma Ata – Primary Health
Care; population-based; aims for essential, affordable,
attainable, accessible, acceptable, and participating health
care; provision of 1st contact care which is person-focused
and ongoing health care
– 1990 – Call for integrating public health with community
medicine
– 1995 – 2015 – Millennium Development Goals (MDG) – Objectives of UHC
centered in promotion of people-centered care; aims to 1. Equity in access to health services
provide in-service delivery reforms & healthy communities - Those who need the services should get them, not
in terms of policy reforms for primary health care by 2008. only those who can pay for them
– 1998 – WHO declared that health is a fundamental human 2. Quality of health care services
right - Is good enough to improve the health of those
– 2009 – World Health Organization Assembly Resolution; receiving services
Family physicians will be part of the primary health care 3. Financial Risk Protection
team; focuses in the following core values: person-
centeredness, comprehensiveness of care, continuity of
care, regular & trusted provider at entry points; in line with
this the PHC aims to provide better health outcomes,
greater patient satisfaction, less hospitalization, and greater
equity in health
– 2010 – the WHO launched their program, Health Systems
Financing The Path to Universal Coverage

Reforms of PHC based on UHC Guidelines

o Universal Coverage Reforms – aims to improve
health equity (equal ang treatment sa mga tao, if
you can’t pay equal pa din ang services sa mga
tao)
o Service Delivery Reforms – aims to make health
systems people-centered
o Policy Reforms - aims to promote and protect
health of the community

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FMC201 UNIVERSAL HEALTH CARE T4

Advantages of UHC
1. Lowers health care cost for economy (the government will Examples of Countries with UHC
now control the price of the medicine)
1. Australia – Uses the two tier system; UHC is known as
2. Eliminates administrative costs of dealing with different
Medicare
private health insurers
2. Canada – uses the single payer system
3. Standardized billing procedures and coverage rules
3. France – uses the two tier system with 75% of healthcare
4. Forces hospitals and doctors to provide standard of service
bills payed by the government
at a low cost
4. Germany
5. Creates a healthier workplace for healthcare providers
5. Singapore – uses the two tier system
6. Cuba – model of UHC for developing countries;
Disadvantages of UHC a. Accessibility family physicians
1. Forces healthy people to pay for other people’s medical b. Universality of health insurance
care c. Community oriented primary care
2. With free UHC, people may not be as careful with their d. Epidemiological surveillance
health e. Inclusion of complementary and integrative medicine
3. Long wait time for elective procedures f. Family doctors paid by salaries provided by the
4. Government may limit payment amounts to keep costs low government
5. Health care costs may overwhelm government budgets 7. Thailand – mixed private and public insurance since 2001.
a. Primary use of health care providers
- The Philippines aims to have UHC by the year 2030 b. Quality of health care accreditation
- UHC monitoring focuses on 2 things: c. Use of standard benefit package and payment method
1. Proportion of the population that can access essential d. Decentralization of fund management to the to the
quality health services provinces
2. Proportion of the population that can spend a large 8. Taiwan – National Health Insurance since March 1995;
amount of their household budget for their health covers 99% of healthcare services with only a small
amount of co-payment and some registration
9. US – government and private sector pays for healthcare (ex.
4 Categories of UHC
OBAMACARE & MEDICAID)
1. Reproductive, Maternal, Newborn & Child health 10. Philippines – aims for UHC by the year 2030; aims to be a
(all life stages dapat covered ng UHC. it includes family healthcare leader in the ASEAN region by 2022
planning, delivery care, post partum care, immunization of
children and health education)
2. Infectious diseases (poor environmental sanitation) Kalusugan Pangkalahatan
3. Non-communicable diseases
4. Service Capacity & access (hospital access, clinic access,
health worker availability, provision of medicine)

- Who is supporting countries to develop their health systems

to move towards and sustain UHC to monitor progress

Factors for compliance to achieve UHC

1. Strong, efficient& well-run health system that meets priority
health needs through people-centred care
2. Affordability – providing a system for financing health
services.
3. Access to essential medicines and technologies to diagnose
and treat medical problems
4. A sufficient capacity of well –trained and motivated health
care workers to provide the best available services - UHC program in the Philippines
- 3 Goals:
1. Financial Risk Protection
Types of UHC
2. Improved access to quality hospitals
1. Single Payer System a. The Health Facility Enhancement Program
- Healthcare is paid by the government using taxes but (HFEP) shall provide funds to improve
health care is provided by the private sector facility preparedness for trauma and
3. Attainment of health related MDGs
2. Two Tier Payer System a. Community Health teams (CHTs) – volunteer
- Government pays about 2/3 of hospital bills and the groups
remaining 1/3 is paid by the private sector b. Rural Nurses- will be trained to become
trainers
3. Mandatory Health Insurance c. Provision of services using the life cycle
- Funding for healthcare is subtracted from a private sector approach
employee’s payroll taxes
- The government pays for healthcare

4. Socialized funding
- Insurance and healthcare provided by the government

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FMC201 UNIVERSAL HEALTH CARE T4

Types of UHC

created in 1995

- Primary Goal: to ensure a sustainable national health

insurance program for all

- Republic Act 7875 – National Health Insurance Act of 1995

§
- House Bill 5784 – Health Technology Assessment and
Health Technology Assessment Council

- Beneficiaries of PhilHealth
a. Legitimate spouse who is not member of PhilHealth
b. Children below 21 yrs (unmarried & unemployed)
c. Children 21 & above with disabilities
d. Members 60 years and above who already paid their
premium insurance fees (ex. pensioners)
e. Philhealth members whose parents have disabilities

- Philhealth Member Categories

a. Formal- employed members of government and
private sector
b. Indigents – all members who have no visible means of
income or with insufficient income; subsidized by
DSWD; also known as “ PhilHealth sa Masa”
c. Sponsored Members – members whose contribution
are paid by another individual
d. Lifetime members – retired members who have paid
the 120 months’ premium contributions
e. Informal economy – self-earning individuals
f. Overseas Filipinos – OFWs and dual citizens
g. Senior citizens – for members 60 years old and above
and are not currently covered by any existing REFERENCES
membership categories by PhilHealth
1. Dr. Tiu’s PPT and Discussions
- Over 12 yrs, countries will be in a race to end all forms of 2. Recordings
powerty by halting inequities and ensuring that no one is 3. Previous Transes
left behind

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Sustainable Development Goals
Maria Theresa Chua, MD, FPAFP | 03 November 2018 | Topic 12
Outline • The goals cover the three dimensions of sustainable
I. MILLENIUM DEVELOPMENT GOALS development: economic growth, social inclusion and
II. SUSTAINABLE DEVELOPMENT GOALS
III. RESULT OF SUSTAINABLE DEVELOPMENT GOALS environmental protection

• 2030, The 17 SDGS with 169 targets are broader in

I. MILLENIUM DEVELOPMENT GOALS
scope and go further that the MDGs by addressing the
• UN millennium declaration root causes of poverty and the universal need for
• September 6-8 2000 development
• 8 goals are roadmap to development towards HFA • Over the next 15 yrs., with these new goals that
• TARGET TO BE ACHIEVED BY YEAR 2015; BASELINE universally apply to all, countries will be mobilize
1990 efforts to end all forms of poverty, fight for inequalities
THE 8 MDGs and tackle climate change, while ensuring no one is left
1. Eradicate extreme poverty and hunger behind
o 1.25 dollar per day
2. Achieve universal primary education 1. END OF POVERTY
3. Promote gender equality and empower women a) Poverty is more than lack of income and resources
4. Reduce child mortality b) Its manifestation includes hunger and malnutrition,
5. Improve maternal health limited access to education and other basic services,
6. Combat HIV/AIDS, Malaria and other Disease social discrimination and exclusion as well as lack of
7. Ensure environmental sustainability participation in decision making
8. Develop a global partnership for development c) About one in five persons in developing regions live
Notes: Report from 2015 (MDGs) on less than US $1.25 per day
Which have been achieved? d) High poverty rates are often found in small, fragile
and conflict-affected countries
• Poverty rate (reduced)
e) Once in four children under five has inadequate
• Equality in primary education
height for age
• Access to improved sources of water
• Malaria and tuberculosis 2. ZERO HUNGER
Which goals lag behind?
a. Hunger and malnutrition mean less productive
• Many children still denied right to primary individual, who are more prone to disease and thus
education often unable to earn more and improve their
• Mortality rate fro children under five dropped by livelihoods
53% b. Poor nutrition causes nearly half of deaths in
• MMR declined by 45% children under five-3.1 million children each year
• Despite many successes, the poorest and most c. The food and agriculture sector is central for
vulnerable people are being left behind hunger any poverty eradication
• Gender inequality persist
• Big gap exist between the poorest and richest 3. GOOD HEALTH AND WELL BEING
households, and between rural and urban areas a. By 2030, reduce global MMR to less than 75
• Children from poorer household >2x likely to be per 100,000 LB
stunted and 4x likely to be out of school b. Reduce neonatal mortality to at least as low as
• 56% BIRTHS IN RURAL AREAS ATTENDED BY SBA 12 per 1000 live birth and under 5 mortality to
VS 87% IN URBAN at least as low as 25 per 1000 live births
• 50% of people in rural areas lack improved c. End epidemics of AIDS, TB, malaria, tropical
sanitation facilities diseases, combat hepatitis, water-borne
• climate change and environmental degradation diseases
undermine progress achieved and poor people d. Reduce by 1/3 premature mortality from NCDs
suffer the most e. Strengthen the prevention and treatment of
• conflicts remain the biggest threat to human substance abuse
development f. By 2020, halve the number of global deaths
• millions of poor people still live in poverty and and injuries from road traffic accidents
hunger, without access to basic service g. By 2030, ensure universal access to sexual and
reproductive health care services
II. SUSTAINABLE DEVELOPMENT GOALS h. Achieve universal health coverage, including
• Development that meets the needs of the present financial risk and protection access to quality
without compromising the ability of future generation essential health care services and access to
to meet their own hands

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FMC201 SUSTAINABLE DEVELOPMENT GOALs T12

safe, effective, quality and affordable essential

medicines and vaccines for all
i. By 2030, substantially reduce the number of
deaths and illnesses from hazardous chemical
and air, water and soil pollution and
contamination
j. Strengthen implementation of the WHO
framework convention on tobacco control
k. Support research and development of
vaccines and medicines
l. Substantially increase health financing and the
recruitment, development, training and
retention of the health workforce
m. Strengthen the capacity of all countries, in
particular developing countries, for early
warning, risk reduction and management of
national and global health risk

4. QUALITY EDUCATION 6. CLEAN WATER AND SANITATION

a. By 2030, ensure the all grits and boys complete free, a. Around 1.8 billion people globally use a source of
equitable and quality primary and secondary drinking water that will fecally contaminated
education, ensure equal access for all women and men b. 2.4 billion lack access to basic sanitation services
to affordable and quality technical; vocational and c. water scarcity affects more than 40 percent of the
tertiary education global population
b. Build and upgrade education facilities d. more than 80% of wastewater is discharged into rivers
c. By 2020, substantially expand globally the number of and seas without any treatment
scholarship available to developing countries e. worldwide, more than 2 million people die every year
d. By 2030, substantially increase the supply of qualified from diarrheal diseases
teachers f. by 2030, achieve universal and equitable access to
e. Ensure inclusive and equitable quality education and safe and affordable drinking water
promote lifelong learning g. by 2030, achieve access to adequate and equitable
sanitation and hygiene
h. by 2030, improve water quality by reducing pollution,
5. GENDER EQUALITY halving the proportion of untreated wastewater and
a. End all forms of discrimination against all women and increasing recycling and safe reuse globally
girls everywhere
7. AFFORDABLE AND CLEN ENERGY
b. Eliminate all forms of violence against all women and
girls a) ensure access to affordable reliable, sustainable and
c. Eliminate all harmful practices, such as child, early modern energy for all
and forced marriage and female genital mutilation b) over 1.2 billion people- one in five people of the
d. Ensure women’s full and effective participation and world’s population – do not have access to electricity
equal opportunities for leadership
8. DECENT WORK AND ECONOMIC GROWTH
e. Ensure universal access to sexual and reproductive
rights a. promote sustained, inclusive and sustainable
economic growth.
b. Full and productive employment and decent work
for all
c. nearly 2.2 billion people live below the US dollar 2
poverty line
d. poverty eradication is only possible through stable
and well paid jobs
e. providing the youth with the best opportunity to
transition to a decent job calls for investing in
education and training of the highest possible
quality

9. INDUSTRY, INNOVATION AND INFRASTRUCTURE

a. inadequate infrastructure leads to a lack of access
to markets, jobs, information and training, creating
a major barrier to doing business

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FMC201 SUSTAINABLE DEVELOPMENT GOALs T12
10. REDUCE INEQUALITITES 14. LIFE BELOW WATER
a. inequalities still persists and large disparities a) over three billion people depends on marine and
remain in access to health and education services coastal biodiversity for their livelihood
and other assets b) oceans absorb about 30 percent of carbon dioxide
b. Children in the poorest 20% of the population are produced by human, buffering the impact of global
still up to 3x more likely to die before reaching their warming
th
5 birthday c) oceans serve as the world’s largest source of protein,
c. Woman in rural areas are still up to 3x more likely with more than 3 billion people depending on the
to die while giving birth oceans as their primary source of protein
d. To reduce inequality, policies should be universal d) as much as 40 percent of the world oceans are heavily
in principle paying attention to the needs of affected by human activities, including pollution,
disadvantaged and marginalized populations depleted fisheries, and loss of coastal habitats

11. SUSTAINABLE CITIES AND COMMUNITIES 15. LIFE ON LAND

a. make cities and human settlement inclusive, safe, a) in addition to providing foods security and shelter,
resilient and sustainable forest is key to combating climate change, protecting
b. half of humanity – 3.5 billion people – live in cities biodiversity and the homes of the indigenous
today population
c. 828 million people live in slums b) deforestation
d. rapid urbanization is exerting pressure on fresh c) desertification – conversion of land into desert
water supplies, sewage, the living environment and
public health 16. PEACE, JUSTICE AND STRONG INSTITUTIONS
e. common urban challenges include congestion, a. promote peaceful and inclusive societies for
lack of funds to provide basic services, a shortage sustainable development, provide access to justice for
of adequate housing and declining infrastructure all and build effective, accountable and inclusive
f. to make cities sustainable, we can create good, institution in all levels
affordable public housing, upgrade slum
settlement, invest in public transport, create green 17. PARTNERSHIP FOR THE GOAL
spaces and get a broader range of people involved a. strengthen the means of implementation and
in urban planning decisions revitalize the global partnership for sustainable
development
12. RESPONSIBLE CONSUMPTION AND PRODUCTION b. a successful sustainable development agenda
a. Water
i. Less than 3% of world’s water is fresh II. RESULTS OF SDGs
ii. Man is polluting water faster than
nature can recycle and purify water 1. NO POVERTY
iii. More than 1 billion people do not
• Only 45% of the world’s population are covered by at
have access to fresh water
least one social protection cash benefit
iv. Need for infrastructure
• Economic losses attributed to disasters were over $300
b. Energy
billion in 2017
v. Households consume 29 per cent of
global energy and consequently 2. ZERO HUNGER
contribute to 21 percent of resultants
• World hunger is on the rise again: 815 million people
CO2 emissions
were undernourished in 2016, up from 777 million in
c. Food
2015
vi. 3 billion tons of food is wasted per
• Stunting, Wasting and overweight still affected millions
year
of children under 5 in 2017
vii. overconsumption of food
viii. land/ marine environment 3. GOOD HEALTH AND WELL BEING
degradation, overfishing
• Births attended by skilled health personnel increased
ix. food sector accounts for 30% of total
globally
energy consumption and 22% of total
• Under +5 deaths fell between 2000 and 2016
greenhouse gas emissions
• HIV incidence rate for women of reproductive age in
13. CLIMATE ACTION sub-Saharan Africa is 10 times higher than global
average
a. people are experiencing the significant impacts of
• The world is not on track to end malaria by 2030
climate change, which include changing weather
• 216 million cases of malaria in 2016
patterns, rising sea level, and more extreme weather
• 210 million cases of malaria in 2013
events
b. climate change is a global challenge that requires
solutions that need to be coordinated at the
international level

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FMC201 SUSTAINABLE DEVELOPMENT GOALs T12
4. QUALITY EDUCATION • The majority of countries have ratified the Paris
• More than half of children and adolescents are not Agreement and provided nationally determined
achieving minimum proficiency in reading and contributions (NDCs)
mathematics
• More trained teachers are needed for quality education 14. LIFE BELOW WATER
• Mean coverage of marine KBAs increased between
5. GENDER EQUALITY 2000 and 2018
• Child marriage in Southern Asia decreased by over 40 • Open ocean sites show current levels of acidity have
percent between 2000 and 2017 increased by 26 percent since the start of the Industrial
• Women spend about three times as many hours in Revolution
unpaid domestic and care work as men
15. LIFE ON LAND
6. CLEAN WATER AND SANITATION • The Red List Index shows alarming trend in the decline
• 3 in 10 people lack access to safely managed drinking of mammals, birds, amphibians, corals and cycads.
water services
• 6 in 10 people lack access to safely managed sanitation 16. PEACE, JUSTICE AND STRONG INSTITUTIONS
facilities • More than 570 different trafficking in persons flows
• Data from 79 countries show 59 percent of all were detected between 2012 and 2014
wastewater is safely treated • Proportion of prisoners held in detention without
sentencing has remained almost constant in the last
7. AFFORDABLE AND CLEAN ENERGY decade
• 55 percent of renewable energy was derived from • Globally, 73 percent of children under 5 have had their
modern forms in 2015 births registered
• 4 in 10 people still lack access to clean cooking fuels and
technologies 17. PARTNERSHIP FOR THE GOALS
• ODA for capacity-building and national planning was
8. DECENT WORK AND ECONOMIC GROWTH S20.4 billion in 2016, which has been stable since 2010
• Earning inequalities are still persuasive: men earned • LDCs’ share of world merchandise exports feel between
12.5 percent more than women in 40 out of 45 countries 2013 and 2016 after a long period of increase
with data • In 2015, developing countries received only 0.3 percent
• Youth were three times more likely to be unemployed of total ODA to support all areas of statistics.
than adults in 2017

9. INDUSTRY, INNOVATION AND INFRASTRUCTURE

• Global carbon intensity decreased by 19 percent
between 2000 and 2015
• Proportion of population covered by a 3G mobile
broadband network was lower in the LDCs in 2016

10. REDUCE INEQUALITIES

• Products exported by SIDS facing zero tarrifs increased
by 20 percent between 2010 and 2016
• Remittances to low and middle-income countries
represented over 75 percent of total global remittances
in 2017

11. SUSTAINABLE CITIES AND COMMUNITIES

• In 2016, 4.2 million people died from ambient air
pollution
• Damage to housing due to natural disasters showed a
statistically significant rise between 1990 and 2013

12. RESPONSIBLE CONSUMPTION AND PRODUCTION

• Globally by 2018, 108 countries had national policies
REFERENCES
on sustainable consumption and production
• 93 percent of the world’s 250 largest companies are 1. Dr. Chua's Power point and Discussion
now reporting in sustainability 2. Recording

13. CLIMATE ACTION

• 2017 was the most costly North Atlantic hurricane
season on record

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 Family Medicine & Community Health 2
Sustainable Development Goals
Maria Theresa Chua, MD, FPAFP | 03 November 2018 | Topic 12
Outline • The goals cover the three dimensions of sustainable
I. MILLENIUM DEVELOPMENT GOALS development: economic growth, social inclusion and
II. SUSTAINABLE DEVELOPMENT GOALS
III. RESULT OF SUSTAINABLE DEVELOPMENT GOALS environmental protection

• 2030, The 17 SDGS with 169 targets are broader in

I. MILLENIUM DEVELOPMENT GOALS
scope and go further that the MDGs by addressing the
• UN millennium declaration root causes of poverty and the universal need for
• September 6-8 2000 development
• 8 goals are roadmap to development towards HFA • Over the next 15 yrs., with these new goals that
• TARGET TO BE ACHIEVED BY YEAR 2015; BASELINE universally apply to all, countries will be mobilize
1990 efforts to end all forms of poverty, fight for inequalities
THE 8 MDGs and tackle climate change, while ensuring no one is left
1. Eradicate extreme poverty and hunger behind
o 1.25 dollar per day
2. Achieve universal primary education 1. END OF POVERTY
3. Promote gender equality and empower women a) Poverty is more than lack of income and resources
4. Reduce child mortality b) Its manifestation includes hunger and malnutrition,
5. Improve maternal health limited access to education and other basic services,
6. Combat HIV/AIDS, Malaria and other Disease social discrimination and exclusion as well as lack of
7. Ensure environmental sustainability participation in decision making
8. Develop a global partnership for development c) About one in five persons in developing regions live
Notes: Report from 2015 (MDGs) on less than US $1.25 per day
Which have been achieved? d) High poverty rates are often found in small, fragile
and conflict-affected countries
• Poverty rate (reduced)
e) Once in four children under five has inadequate
• Equality in primary education
height for age
• Access to improved sources of water
• Malaria and tuberculosis 2. ZERO HUNGER
Which goals lag behind?
a. Hunger and malnutrition mean less productive
• Many children still denied right to primary individual, who are more prone to disease and thus
education often unable to earn more and improve their
• Mortality rate fro children under five dropped by livelihoods
53% b. Poor nutrition causes nearly half of deaths in
• MMR declined by 45% children under five-3.1 million children each year
• Despite many successes, the poorest and most c. The food and agriculture sector is central for
vulnerable people are being left behind hunger any poverty eradication
• Gender inequality persist
• Big gap exist between the poorest and richest 3. GOOD HEALTH AND WELL BEING
households, and between rural and urban areas a. By 2030, reduce global MMR to less than 75
• Children from poorer household >2x likely to be per 100,000 LB
stunted and 4x likely to be out of school b. Reduce neonatal mortality to at least as low as
• 56% BIRTHS IN RURAL AREAS ATTENDED BY SBA 12 per 1000 live birth and under 5 mortality to
VS 87% IN URBAN at least as low as 25 per 1000 live births
• 50% of people in rural areas lack improved c. End epidemics of AIDS, TB, malaria, tropical
sanitation facilities diseases, combat hepatitis, water-borne
• climate change and environmental degradation diseases
undermine progress achieved and poor people d. Reduce by 1/3 premature mortality from NCDs
suffer the most e. Strengthen the prevention and treatment of
• conflicts remain the biggest threat to human substance abuse
development f. By 2020, halve the number of global deaths
• millions of poor people still live in poverty and and injuries from road traffic accidents
hunger, without access to basic service g. By 2030, ensure universal access to sexual and
reproductive health care services
II. SUSTAINABLE DEVELOPMENT GOALS h. Achieve universal health coverage, including
• Development that meets the needs of the present financial risk and protection access to quality
without compromising the ability of future generation essential health care services and access to
to meet their own hands

Transcribed by: Marmar, Naceno, Tabjan, Velasco Page 1 of 4

FMC201 SUSTAINABLE DEVELOPMENT GOALs T12

safe, effective, quality and affordable essential

medicines and vaccines for all
i. By 2030, substantially reduce the number of
deaths and illnesses from hazardous chemical
and air, water and soil pollution and
contamination
j. Strengthen implementation of the WHO
framework convention on tobacco control
k. Support research and development of
vaccines and medicines
l. Substantially increase health financing and the
recruitment, development, training and
retention of the health workforce
m. Strengthen the capacity of all countries, in
particular developing countries, for early
warning, risk reduction and management of
national and global health risk

4. QUALITY EDUCATION 6. CLEAN WATER AND SANITATION

a. By 2030, ensure the all grits and boys complete free, a. Around 1.8 billion people globally use a source of
equitable and quality primary and secondary drinking water that will fecally contaminated
education, ensure equal access for all women and men b. 2.4 billion lack access to basic sanitation services
to affordable and quality technical; vocational and c. water scarcity affects more than 40 percent of the
tertiary education global population
b. Build and upgrade education facilities d. more than 80% of wastewater is discharged into rivers
c. By 2020, substantially expand globally the number of and seas without any treatment
scholarship available to developing countries e. worldwide, more than 2 million people die every year
d. By 2030, substantially increase the supply of qualified from diarrheal diseases
teachers f. by 2030, achieve universal and equitable access to
e. Ensure inclusive and equitable quality education and safe and affordable drinking water
promote lifelong learning g. by 2030, achieve access to adequate and equitable
sanitation and hygiene
h. by 2030, improve water quality by reducing pollution,
5. GENDER EQUALITY halving the proportion of untreated wastewater and
a. End all forms of discrimination against all women and increasing recycling and safe reuse globally
girls everywhere
7. AFFORDABLE AND CLEN ENERGY
b. Eliminate all forms of violence against all women and
girls a) ensure access to affordable reliable, sustainable and
c. Eliminate all harmful practices, such as child, early modern energy for all
and forced marriage and female genital mutilation b) over 1.2 billion people- one in five people of the
d. Ensure women’s full and effective participation and world’s population – do not have access to electricity
equal opportunities for leadership
8. DECENT WORK AND ECONOMIC GROWTH
e. Ensure universal access to sexual and reproductive
rights a. promote sustained, inclusive and sustainable
economic growth.
b. Full and productive employment and decent work
for all
c. nearly 2.2 billion people live below the US dollar 2
poverty line
d. poverty eradication is only possible through stable
and well paid jobs
e. providing the youth with the best opportunity to
transition to a decent job calls for investing in
education and training of the highest possible
quality

9. INDUSTRY, INNOVATION AND INFRASTRUCTURE

a. inadequate infrastructure leads to a lack of access
to markets, jobs, information and training, creating
a major barrier to doing business

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FMC201 SUSTAINABLE DEVELOPMENT GOALs T12
10. REDUCE INEQUALITITES 14. LIFE BELOW WATER
a. inequalities still persists and large disparities a) over three billion people depends on marine and
remain in access to health and education services coastal biodiversity for their livelihood
and other assets b) oceans absorb about 30 percent of carbon dioxide
b. Children in the poorest 20% of the population are produced by human, buffering the impact of global
still up to 3x more likely to die before reaching their warming
th
5 birthday c) oceans serve as the world’s largest source of protein,
c. Woman in rural areas are still up to 3x more likely with more than 3 billion people depending on the
to die while giving birth oceans as their primary source of protein
d. To reduce inequality, policies should be universal d) as much as 40 percent of the world oceans are heavily
in principle paying attention to the needs of affected by human activities, including pollution,
disadvantaged and marginalized populations depleted fisheries, and loss of coastal habitats

11. SUSTAINABLE CITIES AND COMMUNITIES 15. LIFE ON LAND

a. make cities and human settlement inclusive, safe, a) in addition to providing foods security and shelter,
resilient and sustainable forest is key to combating climate change, protecting
b. half of humanity – 3.5 billion people – live in cities biodiversity and the homes of the indigenous
today population
c. 828 million people live in slums b) deforestation
d. rapid urbanization is exerting pressure on fresh c) desertification – conversion of land into desert
water supplies, sewage, the living environment and
public health 16. PEACE, JUSTICE AND STRONG INSTITUTIONS
e. common urban challenges include congestion, a. promote peaceful and inclusive societies for
lack of funds to provide basic services, a shortage sustainable development, provide access to justice for
of adequate housing and declining infrastructure all and build effective, accountable and inclusive
f. to make cities sustainable, we can create good, institution in all levels
affordable public housing, upgrade slum
settlement, invest in public transport, create green 17. PARTNERSHIP FOR THE GOAL
spaces and get a broader range of people involved a. strengthen the means of implementation and
in urban planning decisions revitalize the global partnership for sustainable
development
12. RESPONSIBLE CONSUMPTION AND PRODUCTION b. a successful sustainable development agenda
a. Water
i. Less than 3% of world’s water is fresh II. RESULTS OF SDGs
ii. Man is polluting water faster than
nature can recycle and purify water 1. NO POVERTY
iii. More than 1 billion people do not
• Only 45% of the world’s population are covered by at
have access to fresh water
least one social protection cash benefit
iv. Need for infrastructure
• Economic losses attributed to disasters were over $300
b. Energy
billion in 2017
v. Households consume 29 per cent of
global energy and consequently 2. ZERO HUNGER
contribute to 21 percent of resultants
• World hunger is on the rise again: 815 million people
CO2 emissions
were undernourished in 2016, up from 777 million in
c. Food
2015
vi. 3 billion tons of food is wasted per
• Stunting, Wasting and overweight still affected millions
year
of children under 5 in 2017
vii. overconsumption of food
viii. land/ marine environment 3. GOOD HEALTH AND WELL BEING
degradation, overfishing
• Births attended by skilled health personnel increased
ix. food sector accounts for 30% of total
globally
energy consumption and 22% of total
• Under +5 deaths fell between 2000 and 2016
greenhouse gas emissions
• HIV incidence rate for women of reproductive age in
13. CLIMATE ACTION sub-Saharan Africa is 10 times higher than global
average
a. people are experiencing the significant impacts of
• The world is not on track to end malaria by 2030
climate change, which include changing weather
• 216 million cases of malaria in 2016
patterns, rising sea level, and more extreme weather
• 210 million cases of malaria in 2013
events
b. climate change is a global challenge that requires
solutions that need to be coordinated at the
international level

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FMC201 SUSTAINABLE DEVELOPMENT GOALs T12
4. QUALITY EDUCATION • The majority of countries have ratified the Paris
• More than half of children and adolescents are not Agreement and provided nationally determined
achieving minimum proficiency in reading and contributions (NDCs)
mathematics
• More trained teachers are needed for quality education 14. LIFE BELOW WATER
• Mean coverage of marine KBAs increased between
5. GENDER EQUALITY 2000 and 2018
• Child marriage in Southern Asia decreased by over 40 • Open ocean sites show current levels of acidity have
percent between 2000 and 2017 increased by 26 percent since the start of the Industrial
• Women spend about three times as many hours in Revolution
unpaid domestic and care work as men
15. LIFE ON LAND
6. CLEAN WATER AND SANITATION • The Red List Index shows alarming trend in the decline
• 3 in 10 people lack access to safely managed drinking of mammals, birds, amphibians, corals and cycads.
water services
• 6 in 10 people lack access to safely managed sanitation 16. PEACE, JUSTICE AND STRONG INSTITUTIONS
facilities • More than 570 different trafficking in persons flows
• Data from 79 countries show 59 percent of all were detected between 2012 and 2014
wastewater is safely treated • Proportion of prisoners held in detention without
sentencing has remained almost constant in the last
7. AFFORDABLE AND CLEAN ENERGY decade
• 55 percent of renewable energy was derived from • Globally, 73 percent of children under 5 have had their
modern forms in 2015 births registered
• 4 in 10 people still lack access to clean cooking fuels and
technologies 17. PARTNERSHIP FOR THE GOALS
• ODA for capacity-building and national planning was
8. DECENT WORK AND ECONOMIC GROWTH S20.4 billion in 2016, which has been stable since 2010
• Earning inequalities are still persuasive: men earned • LDCs’ share of world merchandise exports feel between
12.5 percent more than women in 40 out of 45 countries 2013 and 2016 after a long period of increase
with data • In 2015, developing countries received only 0.3 percent
• Youth were three times more likely to be unemployed of total ODA to support all areas of statistics.
than adults in 2017

9. INDUSTRY, INNOVATION AND INFRASTRUCTURE

• Global carbon intensity decreased by 19 percent
between 2000 and 2015
• Proportion of population covered by a 3G mobile
broadband network was lower in the LDCs in 2016

10. REDUCE INEQUALITIES

• Products exported by SIDS facing zero tarrifs increased
by 20 percent between 2010 and 2016
• Remittances to low and middle-income countries
represented over 75 percent of total global remittances
in 2017

11. SUSTAINABLE CITIES AND COMMUNITIES

• In 2016, 4.2 million people died from ambient air
pollution
• Damage to housing due to natural disasters showed a
statistically significant rise between 1990 and 2013

12. RESPONSIBLE CONSUMPTION AND PRODUCTION

• Globally by 2018, 108 countries had national policies
REFERENCES
on sustainable consumption and production
• 93 percent of the world’s 250 largest companies are 1. Dr. Chua's Power point and Discussion
now reporting in sustainability 2. Recording

13. CLIMATE ACTION

• 2017 was the most costly North Atlantic hurricane
season on record

Transcribed by: Marmar, Naceno, Tabjan, Velasco Page 4 of 4

 adiuvante Dei gratia doctorum factionis 2014-2015
FMCH III: Dr. Arnel Herrera

COMMUNITY MENTAL HEALTH

MENTAL HEALTH IS A CALL TO ACTION. 3. Spirituality are part of us that deals with relationships, values and
addresses questions of purpose and meaning in life
When dealing with people, remember you are not dealing with Spirituality here may or may not be religion. You can have a
creatures of logic but with creatures of emotion. - Dale Carnegie religion and, with the same time, you can have relationship
ih c ea Y can al ha e a eligi n b d n
MENTAL HEALTH have any relationship with your creator. Why? Because your
parents are born in this religion, and so are you. Wala ka ng
A state of well-being in which the individual realizes her own abilities, magawa.
can cope with the normal stresses of life, can work productively and Spirituality is renewing our minds and spirits, and must be
fruitfully, and is able to give a contribution to his or her community seen in our actions and words.
(WHO).
MENTAL ILLNESS
So, what do you mean with state of well-being? Person is mentally,
emotionally and physically healthy. A person who is in a state of well- Clinical definition:
being usually lives a fulfilling life. Clinically significant behavioural problems
Associated with distress (painful symptoms)
ASPECTS OF MENTAL HEALTH Maladaptive responses to stressors from the internal or
external environment.
Causes disability (impairment in functioning)
1. Emotional Intelligence It interferes with the individual s social, occupational, or
Feels comfortable about oneself. physical functioning.
Have emotional self-control. Biological illness that responds to treatment.
- How do you know if you have emotional self-control? Illness of your brain.
You know how to delay gratification in life. You can say Not to be confused with weakness of character.
no to good things in order to say yes to greater things
in life. For example, as a student, you can say no to Disease of the brain
parties, internet games, boyfriends and girlfriends to Due to advances in technology, we are more able to see the
achieve greater things in life. disorder in the brain through neuroimaging techniques such as
Recognize emotions in others. PET scan or MRI.
- Empathy is merging of the selves. You feel the other
e le ffe ing
Can handle relationships.
Accepting people for what they are.

2. Resiliency
Emerge and grow from negative life events
- An hing ha d e n kill you makes you stronger.
Enjoys life and contented with simple everyday pleasures.
Ambitious but sets realistic goals.
- When you set goals, it should be SMART. But what is
better, SMART or SMARTER? SMARTER. The yellow areas are the neural circuits. It means that the brain
Specific is working properly.
Measurable
Attainable MENTAL ILLNESS WHO STATISTICS
Realistic
Time-bounded More than 450 million across the globe suffer from mental illness.
Exciting - At present, our population is 7 billion worldwide. 6.4 % of
Rewarding the population suffer from mental illness.
nd
Accepts new challenges, new experiences and new ideas. By 2030, depression will be the 2 highest cause of disease burden
rd
- So we must grow to the full capacity of our humanity. in middle income countries and the 3 highest in low income
We must never be the same person. We must change countries.
for the better. And when we do bad things to people, In the last 45 years, we sub-rate the increase by 60% worldwide.
we should ask for apology. Asking for apology, it Mental and psychosocial disabilities are also associated with rates
should start with (1) acknowledgment of sin. You of unemployment as high as 90%.
acknowledge first that you have wronged the person. - So, there is an associated stigma on people with mental
And then, we (2) apologize sincerely and (3) ask for illness. Usually, it accompanies unemployed people with
forgiveness. mental and psychosocial disabilities. Kaya nga ang
unemployment rate is as high as 90%.

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ROMELYN
 WHERE DOES MENTAL ILLNESS COME FROM? Feel sad, worthless Feel angry, irritable
Feel anxious and scared Feel suspicious and guarded
Heredity (genes) Avoid conflicts Create conflicts
- Especially depression. One parent is diagnosed with a major Have trouble setting Need to feel in control at all
depressive disorder. Chances are 50% of the children will also boundaries costs
have the disease. Use food, friends and love to Use alcohol, TV, sports and sex
Stress/traumatic life events self-medicate to self-medicate
- Your unmanaged stress is highly influential in triggering
symptoms of mental illness. - Now, who is more emotional, male or female? Female.
Parenting style Why? Because female has a larger deep limbic system than
- Especially schizophrenic parenting style. Usually in the family, male. That is why male takes advantage. Women love
who is the authority? Father. Bakit siya schizophrenic? Kasi in from flattery because of their being emotional. Men give
their home, yung mother ang authority. So the child is love to get sex while women give sex in order to get love.
confused kasi pagdating sa school, children are being taught For women, your Creator designed your body as a dessert
that ang authority in the family is the father. This could also rather than as appetizer. Dapat dessert kayo at di appetizer
lead to mental disability. Iba yung natututunan sa school at sa kasi if you keep offering your body as an appetizer, nobody
bahay nila Tha h e call i chi h enic a en ing will come in for the main course. Bakit? Binusog mo na sila
Psychological, environmental and socio-cultural factors. e. Ano ba dapat ang appetizer? Courtship. Main course?
- All of these can lead to mental illness. Marriage. Ano yung dessert? Intimacy. So never confuse
sex for love. Always keep it for marriage.
FACTS ABOUT MENTAL ILLNESS b. Anxiety = FEAR
When someone is in a state of anxiety, it usually means that
Has nothing to do with intelligence their mind and emotion are dominated by fear. Your FEAR is
Can happen to anyone also an acronym for False Emotions Appearing Real. They
Chronic but not contagious perpetually worry that something horrible will happen
Difficult to diagnose and treat because these people are dominated by fear. And meron ding
Treated but not cured fear if you are facing a night-yielding person or a gun is
- Pwedeng magkaroon ng lapses especially kung laging pointing at you. What will you do? Forget Everything And Run.
naeexpose dun sa triggering event. Acronym din yun.
Mentally ill are not all dangerous How real are our fears?
Should not be confused with terms psychopath and sociopath - The truth is..
- Those people who are dangerous are those who are 40% what we fear about never happens
psychopath and sociopath. 30% has already happened
- Psychopath is a person with long standing anti-social 12% has nothing to do with us
behaviour, a diminished capacity for empathy and remorse 10% relates to imagined illness
with poor behavioural control. In short, a person with a 8% legitimate
criminal mind or a criminal behaviour. So, 92% is not based on reality. Fear is a product of our
imagination. M f he ime i d e n e i Fea i a ch ice
SIGNS AND SYMPTOMS Kung gusto mo matakot every now and then, that is your
choice.
a. Change in behaviour, restlessness, irritability, talkativeness, c. Alcohol abuse
depression and suspicion Pa e n f d inking ha e l in ha m ne health,
If you have the signs and symptoms or persistence of the signs interpersonal relationships, ability to work and linked with
and symptoms for more than 2 weeks, it could lead to mental suicide
illnesss So the risk of suicide is high among older men who have
Depressive mind set history of drinking. And it increases if the person is suffering
- Persons in the midst of depression often describe a from depression. Around 75% of the time, this person will
negative and hopeless mindset about themselves, their commit suicide. So, 3 out of 4.
future and the world in general. d. Impaired sleep (insomnia) or sleeplessness for a prolonged period
- Self I can d i I m ele Imn g d Insomnia is chronic if you have sleeplessness for more than
- F e Thing ill ne e change There is no hope. one month. So ano pang causes ng insomnia niyo? Substance
- W ld Thi i a h ile lace What a horrible place to live abuse, mood and anxiety disorder. So all of these are
in Pag gan an ang mind e m he e n hing li e f associated with insomnia or sleeplessness.
So what will you do? You rather die. Sooner or later, you e. Fatigue
will kill yourself. You will commit suicide. Ano ung triad ng Lack of energy that does not go away even when you rest
depression that could lead to suicide? (1) Worthlessness, (2) A feeling of weariness and tiredness.
hopelessness, and (3) helplessness. Usually associated with depression, grieve and lack of
Difference of female and male depression motivation in life. People with severe depression, you always
stay in bed. Pwedeng 24 hours kang nakahiga if you are
Female Male severely depressed.You are unable to managed the most basic
motivation to life
Blame themselves Blame others (Projection)
(Introjection)

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ROMELYN
f. Memory loss (amnesia) of certain time periods, events and people - INDISPUTABLE NEED FOR ALTERNATIVE S ha he
Usually, people forget events that deeply disturbed him. For alternative? Sa community sila.
example, a car accident, totally forget about things that cause In Communities, nakakadena pa rin sila sa puno.
anxiety on your part. - Experience for majority of these people:
Neglect
FACTS ABOUT SUICIDE Rejection
No access to treatment
Prior attempts increase risk by 33% Poverty
Mental illness increase risk Stressed families
- 61% of major depression. Depression is the strongest risk factor Ridicule, Taunts
for suicide. Destitution These people are living in complete
- 48% personality disorder poverty and are abandoned. Sa urban area, sila yung
- 40% alcohol use tinatawag nating taong grasa.
- 10% anxiety disorder
- 6% schizophrenia Anong hallucination? Auditory. Anong klaseng COMMUNITY AS AN ALTERNATIVE IS IT POSSIBLE
delusion? Persecutory.
Understanding suicide behaviour increases prevention because WHO states that community mental health services are more
suicide is preventable. It can be prevented through education and accessible and effective. They lessen social exclusion and likely to
public awareness have less possibilities of neglect and violations of human right rather
than being institutionalized.
WHY DO PEOPLE DIE BY SUICIDE?
Community is a better alternative than institution.
Criteria:
Impulsiveness The decision to attempt suicide and the actual ACTION PLAN ON MENTAL HEALTH
attempt is, kaya impulsive, the time frame is only about 5 minutes
to 1 hour. Focus more on promotion, prevention & early intervention We
Depressed Depression is a major risk factor. 60%. have to catch the disease early on its stage.
Escape from suffering They want to end their mental and Improve access to services
physical pain. Di lang naman ung mga mentally ill ung nagcocommit Build workforce capacity Workforce capacity here is community
ng suicide, pati ung mga may cancer because they want to end participation. It is in the community that we train the health
their physical pain, physical suffering workers.
Communication 50-70% of patient who subsequently kill Better coordinate care & enable greater collaboration
themselves, nakikipagcommunicate muna na they will commit Provide a seamless and connected care systems What do you
icide Once he c mm nica e i i n n m c f mean by seamless? Continuous care or no interruption.
hel Nag a abi ila ng in en i n nila na he ill c mmi icide
Loss of a loved one If your pinakamamahal died, you follow also Two Key Concepts:
because there is nothing to live for. Un ung usual premise. That is 1. Institutionalize to place a person in a special location/house,
why they follow. Usually spouse yun. Bihira sa children. lonely isolated but cannot live independently, lose
individuality & ability to cope with life
Now, who attempt more suicide? Women or men? Sino mas marami? 2. Community group of people, socially interdependent,
Women because they attempt 3x more than men but men kill participate together, relationships, share practices, with
themselves 3x more than women. Age 18-24. collective action
So experiencially, they are almost opposite. The person is being
When male commit suicide, they usually use guns or firearms or they institutionalized compared to being put in the community.
jump in a building or tatalon sa train, MRT or LRT. It is usually violent
in nature. TREATMENT PROCESS

Ano ba ang gagawin ng babae? Maglalaslas ng konti (sa wrist), isa 1. Capacity Building
lang. Hahaha. Magpapapansin lang. - Breaking the silence of mental illness in communities You
must do community diagnosis. You will address the problems
COMMUNITY MENTAL HEALTH and needs of the people within the community. You immerse
yourself, talk to the leaders and try to gain their cooperation.
Refers to all activities undertaken in the community in the name of And as a health care provider, you must use active listening
mental health skills. You must listen twice as much as you speak.
In the context of Human Rights and Disability, the current situation 2. Treatment
is: - Ensuring treatment for mentally ill people with the active
In Institutions, nakakadena sila tapos poor sanitation. involvement of their families and communities, and using local
- Experience of these people: resources, government facilities
Degrading treatment
Neglect & lack of care
Inhuman conditions
Stripped of dignity

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ROMELYN
3. Sustainable Livelihoods (Rehabilitation) How it will work?
- Supporting practical projects that help mentally ill people to - Talk to Community (Capacity Building) Treatment Self-
realise their potentials and contribute to their communities Help Groups Livelihoods Acceptance Community
Rehabilitation is keeping them busy because this is
therapeutic for these people. It also removes the stigma they
are experiencing because they are productive. While being
treated, we have to rehabilitate them.
4. Community Support
- Services that support necessary to assist individuals in
achieving rehabilitative resiliency and recovery goals. These
services facilitate in illness self-management where you
identify specific mental illness barriers and work-related
coping strategies regarding this barriers.
5. Skill building
- Developing skills to endure hardships and to adapt to
adversity
6. Identification and Use of Natural Support
- Social recreational activities and use of community natural
resources Recreational facilities, barangay health centers,
schools, religious groups
7. Management & Administration
- To ensure work that is efficient and professional and satisfies
the needs of mentally ill people and their families
Management and admin must fulfilled the goals and
objectives of the program.

PROGRAM OUTCOMES PREVENTION OF MENTAL ILLNESS

Increased access to appropriate support services at the right time Power of positive attitude Focus more on the positive outlook
No delay of services rather than negative. Remember GIGO (Garbage in, garbage out),
Increased personal capacity & self-reliance Patient will manage pag good things ipapasok mo sa mind mo, ilalabas mo ay good
their own mental health and prevent any triggering factor or things din. We should discipline our minds to avoid degrading
stimulus that will provoke their mental illness. mental power.
Increased community participation Restrained feelings and emotions Choose our emotions and deal
with the consequences. Our emotions are responsible for many of
CAREGIVERS AND MENTORS the man s finest and greatest achievement. But it is also
responsible for greatest tragedy because these people cannot
The major objective of the caregivers and mentors is to treat, control their emotions.
rehabilitate and make them productive to reduce the stigma of their Take time-out from anxiety with confidence Rest is a necessity
mental illness. for mental rejuvenation.
Healing power of the world Humours, smiles and laughter are
Coordination and integration of care very best stress response. Ano nirerelease pag natatawa tayo?
- Multidisciplinary Morphine.
Referrals and links to appropriate services
- Intrasectoral From one health care provider to another MAJOR OBSTACLES IN DEVELOPING COUNTRIES
health care provider
- Intersectoral From one health care provider to another Mental health is less priority than physical health.
sector of the society like the social workers. Government budget is very low in physical health, more so in
Individual recovery plans All plan interventions are mental illness.
individualized depending on the needs of the person. Cultural concepts about mental stigma.
- Stigma is societal prejudice that prevents you from seeking
CARE COORDINATION health or speaking out.
Absence of organized social welfare network
Provides for a clinical provider and a community coordinator Little resources for preventive or positive mental health
Clinical providers Political instability and corruption
- psychiatrist, GP, mental health nurse Gender inequality and absence of basic human rights
Community coordinator
- caregivers, barangay health workers, midwife Stigmas are negative attitudes and behaviours based on fear, midst
- first line and misconception.
- will make the referrals to the clinical providers

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ROMELYN