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OCCUPATIONAL HEALTH IN INDONESIA
AN OVERVIEW
Astrid Sulistomo
Dep. Of Community Medicine
FMUI
Name : DR. Dr. Astrid Widajati Sulistomo, MPH, SpOk
Staff of Community Medicine Dep FMUI
EDUCATION:Medical Doctor – University of Indonesia, 1976
MPH (Occupational Medicine – , University of Michigan, 1994
Occupational Medicine Specialist – MKKI, 2003
Doktor (PhD) – University of Indonesia , 2008
CURRENT POSITION :Director of University Clinic UI
Secretary of Occupational Medicine Specialist Program
Chair of CME Division Indonesian Associatio and College of Occupational Medicine
Specialist
Curriculum Vitae
8/23/2017 OH in INDONESIA AS 2
SCOPE OF PRESENTATION
• Background
• Worker population
• Problem statement
• Occupational Health
• Laws and Regulation
• Competencies in Occupational Medicine
8/23/2017 OH in INDONESIA AS 3
BACKGROUND
• Indonesia as the largest archipelago in the world, is also known as a country with plenty of natural resources.
• In the last decades industry has developed rapidly - in all sectors (mining, manufacture, agriculture, transportation)
• Remote areas that are underdeveloped also are affected by industrial development
8/23/2017 OH in INDONESIA AS 4
8/23/2017 OH in INDONESIA AS 5
CURRENT SITUATION IN INDONESIA
Population : 237,556 million
Unemployment Rate 5.92% (7.17 million)
BPS , data Febr 2013 :
2.569.400 Formal industries
160 Industrial estates in 13 provinces
CHARACTERISTICS OF WORKERS:
• 50% of the Indonesian workforce had only elementary school education
• Only 8% of the Indonesian Workforce have an Academic/University degree
• www.fiskal.depkeu.go.id
• Prevalence of common diseases: Infection and undernutrition is still high
50% work in agriculture, forestry and fishing – sectors with highest risk
8/23/2017 OH in INDONESIA AS 6
PROBLEM STATEMENT
• Based on reports by PT Jamsostek, in 2012: 103.000 work related accidents occurred - an increase from previous years
• 9 work related deaths occur daily
• 25 disabilitis per day
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Problem Statement (2)
• Those figures are based on reported cases –underreporting is still high
• Occupational Disease (?)
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PROBLEM STATEMENT (3)
• No representative national data exist on Occupational Diseases
• Studies on Occupational Health problems in Indonesia are still limited
• Human Resources in Occupational Health are still limited
8/23/2017 OH in INDONESIA AS 9
23/08/2017Prepared by Dewi Soemarko, modified
Dina D (Juli 2015)10
23/08/2017Prepared by Dewi Soemarko, modified
Dina D (Juli 2015)11
OHS PROGRAM
• Since 1970, implementation of OHSprogram by industries is mandatory by Law no 1/1970 on Safety at work
• Regulates about safety at work
• Regulates to have an OHS team at the workplace
• Primary Prevention at the workplace
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OCCUPATIONAL HEALTH • Occupational Health is the promotion and
maintenance of the highest degree of physical, mental and social well-being of workers in all occupations by preventing departures from health, controlling risks and the adaptation of work to people, and people to their jobs. (ILO / WHO 1950)
• OH deals with all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards. (WHO)
OH in INDONESIA AS 138/23/2017
OTHER OH DEFINITION
• Occupational health and safety is a cross-disciplinary area concerned with protecting the safety, health and welfare of people engaged in work or employment. The goal of all occupational health and safety programs is to foster a safe work environment
• Components of Occupational Health:
– Occupational Medicine, Industrial Hygiene, Occupational Health Nursing, Ergonomi, Industrial Toxicology, Industrial Psychology
OH in INDONESIA AS 148/23/2017
Relationship of OHS Professionals
8/23/2017 OH in INDONESIA AS 15
Sources
INDUSTRIAL HYGIENIST
OH – DOCTOR & NURSESAFETY OFFICER
DOKTER DI BIDANG KESEHATAN KERJA DI INDONESIA
• Dokter + pelatihan Hiperkes ( 2 minggu ) dan pelatihan di bidang kedokteran okupasi lain
• Dokter + Magister Kedokteran Kerja (+ 460 orang)
• Dokter + Magister Kesehatan dan Keselamatan Kerja (manajemen program K3)
• Dokter Spesialis Kedokteran Okupasi (+180 orang)
• Kebutuhan akan dokter yang dapat memberikan pelayanan Kesehatan Kerja masih sangat tinggi
8/23/2017O
H in IN
DO
NE
SIA
AS
16
BIDANG ILMU KEDOKTERAN (AIPI)
Kedokteran
Biomedik
Kimia fisika, biologi, biokimia,
dll
Klinik
Medik Bedah
Interna, anak, bedah, obgyn, rehab medis, dll
Komunitas
Kedok keluarga, kedok okupasi, kedok Olahraga,
dll
8/23/2017 OH in INDONESIA AS 17
RELATED REGULATION
Basic Law 1945: Every Indonesian citizen has the right to a decent
work
Law nr 13/2003 on workers: Each worker has a right to be protected
Law nr 36/2009 on Health Regulates scope, responsibility and duties od government, employer and workers to protect workers health
8/23/2017 OH in INDONESIA AS 18
OTHER RELATED REGULATION
• Presidential Letter of Decree RI 22.1993: – 31 Diseases caused by work that are
compensable
• Regulation of Minister of Manpower 2/1980– Required to do pre-employment, periodic and
special health examination
• Regulation o Minister of Manpower 01/1980– Manadatory to report occupational accidents
and diseases
8/23/2017 OH in INDONESIA AS 19
• Regulation of Minister of Manpower 03/82– Regulates about OH services
• Regulation of Minister of Mining and Energy 555 K/26/M/PE/1995– OHS Team in each oil and gas industry
– OHS Training or all supervisors
• Distribution letter and Regulation of Minister of Manpower 01/1997 and 51/1999 – TLV of Physical and Chemical Hazards
8/23/2017 OH in INDONESIA AS 20
8/23/2017 OH in INDONESIA AS 21
8/23/2017 OH in INDONESIA AS 22
8/23/2017 OH in INDONESIA AS 23
23/08/2017Prepared by Dewi Soemarko,
modified Dina D (Juli 2015)24
ICD 10 - OH
Penyakit Akibat Kerja• ILO Convention No. 121 di Geneva pada December 1991 Penyakit karena agen,
penyakit sesuai target organ dan keganasan
• ICD 10 – OH , secara umum dibagi menjadi:1. Diseases caused by agents
1.1 Diseases caused by chemical agents1.2 Diseases caused by physical agents1.3 Diseases caused by biological agents
2. Diseases by target organ2.1 Occupational respiratory diseases2.2 Occupational skin diseases2.3 Occupational musculoskeletal diseases
3. Occupational cancer4. Others
23/08/2017Prepared by Dewi Soemarko,
modified Dina D (Juli 2015)25
OCCUPATIONAL HEALTH SERVICES
8/23/2017 OH in INDONESIA AS 26
SASARAN PROGRAM KESEHATAN KERJA :
1. Komunitas dan individu pekerja
2. Komunitas di sekitar lingkungan tempat kerja.
8/23/2017 Pelayanan Kedokteran Okupasi - A.S27
PELAYANAN KESEHATAN KERJA
• Fokus :– pengaruh pekerjaan terhadap kesehatan :
• Penilaian risiko potensi bahaya
• Pencegahan Penyakit Akibat Kerja
• Diagnosis Penyakit Akibat Kerja
– pengaruh kesehatan terhadap pekerjaan:• penilaian apakah pekerja masih laik kerja
• upaya rehabilitasi agar pekerja dapat kembali bekerja.
Pekerja Kereta Api AS 2812/12/2012
PELAYANAN KESEHATAN KERJA
• PELAYANAN MEDIS:
– Pelayanan yang diberikan dokter, dibantu oleh tenaga kesehatan lain
• PELAYANAN NON-MEDIS:
– Promosi Kesehatan
– Pengendalian Lingkungan Kerja
Pelayanan Kedokteran Okupasi -
A.S298/23/2017
PELAYANAN MEDIS :
• Pemeriksaan Pra kerja
• Pemeriksaan Berkala
• Diagnosis Dini Penyakit Akibat Kerja
• Diagnosis dan Penanganan PAK/KAK
• Fit to Work
• Return to Work Evaluation
• Penentuan Kecacadan & Perhitungan Kompensasi
12/12/2012Pekerja Kereta Api AS 30
8/23/2017Pelayanan Kedokteran Okupasi - A.S31
RESULT
IMMEDIATE CAUSES
UNSAFE CONDITIONS
UNSAFE ACTS
CONTRIBUTING CAUSES
HUBUNGAN KESEHATAN PEKERJA
DENGAN RISIKO KECELAKAAN
SAFETY
MANAGEMENT
PROGRAM
MENTAL
CONDITION
OF WORKERS
PHYSICAL
CONDITION
OF WORKERS
A
C
C
I
D
E
N
T
STEPWISE DEVELOPMENT OF OHS (ILO/WHO 2005)
8/23/2017Pelayanan Kedokteran Okupasi -
A.S32
STANDAR KOMPETENSI DOKTER INDONESIA 2012
• Melakukan diagnosis penyakit akibat kerja dengan 7 langkah diagnosis okupasi – level 4
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KOMPETENSI SPESIALIS KEDOKTERAN OKUPASI
8/23/2017 OH in INDONESIA AS 34
Prepared by Dewi S
Soemarko ( 29 Aug 2014)
35
A Kompetensi Umum1 Aspek medikolegal, etika, dan perundang-undangan dalam
kedokteran okupasi
2 Komunikasi dalam bidang Kedokteran Okupasi
3 Keselamatan Pasien dalam Kedokteran Okupasi (Patient
Safety)
4 Kerjasama Tim dalam bidang Kedokteran Okupasi
STANDAR KOMPETENSI DOKTER SPESIALIS
KEDOKTERAN OKUPASI
B Kompetensi Dasar B.1. Kompetensi Utama
1 Mampu melakukan surveilens medis pada komunitas
pekerja (Occupational Medical Surveilance)
2 Mampu melakukan penatalaksanaan dan penanganan
Penyakit akibat Kerja secara komprehensif termasuk
penentuan Diagnosis Okupasi
3 Mampu membuat penilaian laik kerja (Fit to work)
pekerja
4 Mampu melakukan evaluasi dan mengembangkan
program kembali kerja (Return to work)
5 Mampu melakukan penilaian kecacatan dan
perhitungan persentase kecacatan akibat kecelakaan
kerja atau penyakit akibat kerja
B.2. Kompetensi Penunjang
1 Mampu merancang dan melakukan pemeriksaan Kesehatan
sebelum kerja dan berkala serta khusus pada pekerja dan komunitas
pekerja sesuai dengan karakteristik pekerja, jenis pekerjaan dan
pajanannya
2 Mampu melakukan analisis dan menyimpulkan hasil pemeriksaan
kesehatan kerja secara individu dan kelompok serta membuat
rekomendasi yang mampu laksana
3 Mampu merancang dan melaksanakan program promotif dan
preventif dalam bidang kedokteran okupasi dan kesehatan kerja
4 Mampu melakukan pendidikan dan komunikasi efektif dalam
bidang kedokteran okupasi
5 Mampu mengembangkan dan mengelola program K3 dan
kedokteran okupasi di tempat kerja yang sesuai dengan tingkat risiko
6 Mampu mengidentifikasi faktor risiko dan bahaya potensial di
tempat kerja maupun lingkungan di tempat kerja yang dapat
mempengaruhi kesehatan individu pekerja dan komunitas
(masyarakat dan komunitas sekitarnya )
7 Mampu melakukan identifikasi pajanan di tempat kerja dan penilaian
serta pengendalian pajanan di tempat kerja (manajemen risiko)
8 Mampu melakukan analisis tugas kerja di perusahaan (Job analysis
pekerja).
9 Mampu mengimplementasi prinsip-prinsip
toksikologi industri pada pekerja dan komunitas
yang terpajan.
10 Mampu mengaplikasikan aspek psikologi kerja
dalam menunjang keputusan penatalaksanaan
masalah kesehatan kerja
1
1
Mampu melakukan analisis dampak bahaya
lingkungan kerja bagi pekerja dan masyarakat
sekitar
1
2
Mampu melakukan penelitian sesuai kaidah ilmiah
dalam bidang kedokteran okupasi
1
3
Mampu menganalisis kebutuhan gizi komunitas
pekerja
1
4
Mampu melakukan analisis dan pencegahan
kecelakaan kerja secara komprehensif
1
5
Mampu melakukan dan atau menilai uji latih
kapasitas paru dan kardivaskuler untuk penentuan
laik kerja (fit to work).
16 Melakukan dan atau menilai pemeriksaan untuk menilai
pajanan, menunjang penegakkan Diagnosis Okupasi
/PAK dan evaluasi pajanan serta penentuan laik kerja,
yaitu pemeriksaan
- biomonitoring
- spirometri Okupasi
- audiometri Okupasi
- ILO RAdiografi
- Uji Latih Kapasitas Paru dan Kardiovaskuler
- Pemeriksaan lainnya yang sesuai (lakasidaya reaction
time, Lantonine test,dll)17 Mampu melakukan pelatihan Pertolongan Pertama
pada Kecelakaan kerja dan penyakit darurat di
tempat kerja
18 Mampu mengembangkan dan mengimplementasikan
disaster plan yang sesuai dengan tempat kerja
CONCLUSION
• Occupational health has become more important in the last years
• Many national health programs now include workers as their target group
• Recognition of OH professionals, including Occupational Medicine Specialists by government and other sectors has increased in the last years
8/23/2017 OH in INDONESIA AS 40
RECOMMENDATION
• Effective occupational helath programs need:
– Improved coordination between ministries and other stakeholders
– Enforcement of existing laws and regulation
– Improved competencies of OH professionals
– Increase participation of the workers community
8/23/2017 OH in INDONESIA AS 41
Occupational Medicine Services for ALL
8/23/2017 Pelayanan Kedokteran Okupasi - A.S42
THANK YOU !
Performing Arts
MedicineJOGYA, AUGUST 2017
Sick of passion / sick from
passionINTRODUCTION TO DANCE AND MUSIC MEDICINE IN
RELATION TO OCCUPATIONAL MEDICINE
LAILANA PURVIS, MD, MSC, OHS, MBA, BA
SEMARANG, AUGUST 18, 2017
Dance and Music Medicine focuses on scientific
research of the healthy functions and disorders,
somatic or psychological,
which play a role in making music or dancing, as
well as the
prevention,
diagnosis and
treatment of diseases which dancers and
musicians can encounter.
Nederlandse Vereniging voor Dans-
en Muziekgeneeskunde
Founded in 2005
Broadens and deepens the interest and knowledge
in the field of medicine and medicine for dancers
and musicians
Promoting contact between physicians,
psychologists, physiotherapists, medical students
etc. with interest and passion for this form of
medicine
Providing scientific framework for dance and music
medicine
the Medical Centre for Dancers and Musicians is
located In the Medical Center Haaglanden
Unique in Europe; orthopedist, Boni Rietveld, works
fulltime as a consultant for dance and music
medicine
Various specialists as a consultant, specializing in
specific medical problems in dance and music
Recently, a psychiatric outpatient and a
neuropsychological clinic has been founded
Rehabilitation Friesland has a rehabilitation ward
for musicians
Beatrixoord Groningen also has a clinic for
musicians
Stats
In the Netherlands: 2500 - 3000 professional
dancers (including teachers and students.)
About 300,000 amateur dancers (incl. ballroom
en latin dancing)
Additionally 20000-25000 professional musicians
70000 popgroups
1-2 million amateur musicians
In every OH practice: about 40 amateur
dancers and 400-800 amateur musicians
Always ask about work, sports , hobbys…
Also if they play an instrument, dance, sing
Each “instrument” has its own injury repertoire
Dancers: especially orthopedic injuries: back, hip,
knee, ankle and foot
Musicians notably problems of the upper extremity:
back and neck, shoulder, elbow, wrist and hand
Singers: particularly vocal cord problems
All performing artists have to deal or have had to deal
with stage fright
Dancing is a professional sport on the square meter;
a dancer without pain does not exist.
Making music is top sport on the square centimeter;
a musician with pain has a potentially big
problem
Arabesque Attitude
Dancers: specific back
problems A unilateral painful arabesque is a stress fracture
until the contrary is proved.
Always refer with this type of complaints.
Diagnosis: X-ray / technetiumscan
Treatment is only useful if recent onset (active bone
scan).
Longer existent: treatment as with lumbago
NEVER advise to stop dancing
Demi plié
Result: torque on the knees with a rotatoir
malalignment of the patellofemoral joint andstress on the medial structures, “screwing your
knees“
Consequences: patellofemoral symptoms and risk
(lateral) patellar dislocation
Therapy: Careful turnout technique: lessons !!
Well treated patellar dislocation is
no reason to stop dancing!
Dancers: ankle problems
Ankle Injuries: 27% of all injuries
Consistency with extreme plantar flexion
(dancing a pointe)
Common problems:
Dancers Heel (posterior impingement syndrome)
Dancers Tendinitis
Dancing a pointe
Dancersheel
MusiciansGeneral treatment principles
In general, conservative principles:
Therapeutic consultation with explanations and
advice
Posture and exercise, usually based on
specialized physiotherapy
Other conservative therapies: injections,
immobilization, splinting, adapted instruments
Because the motor skills of the hands is very
delicate, and the actual tools of the musician
forms , one is very cautious towards surgical
therapy
Attitude violinplayer
Back and neck pain
Almost always due to attitude
Myalgia of the trapezius muscle and thoracic
outlet syndrome:
Tendency to hyperlordosing of the neck using
reading glasses to look at the lectern, often
accompanied by protraction of the shoulders,
causing the m. pectoralis minor pinching the
brachial plexus.
Treatment: explanation, physiotherapy and
possibly music spectacles
Shoulder problems
Impingement of m. supraspinatus
Prolonged statical posture of the forearm
(violinplayers, flutists)
Right abduction and left adduction:
“wringing out” of the rotatorcuff
Minimal bloodflow(critical zone of rotatorcuff)
subacromial impingement
Shoulder: treatment
Wringing out arises particularly with adduction of the arm:
Extra attention to strengthening the lateral rotators to prevent wringing out.
Scapular stabilization (exercise) to limit forward tilt of the shoulder
Sometimes ergonomic instrument adjustment: extra curvature, extended flaps etc. : custom made
Also operative treatment of impingement syndrome is possible, but is avoided as much as possible
flutist
Elbow
Guitar players: pinching of the nerve against the
soundboard
Complaint: pain on the medial side of the elbow
and paresthesias ulnar side of the hand
Treatment: night splint to prevent far-flexion; less
flexion of the elbow during play: learning from a
skilled physiotherapist
Sometimes neurolysis.
m. Flexor carpi ulnaris
Wrist
Many complaints of the wrist:
Carpal tunnel syndrome
Quervain’s Disease (adductor pollicis longus
and extensor pollicis brevis)
Finkelstein test
Anatomie
The hand
Triggerfingers and Dupuytren’s Disease
Malletfinger : carreer threathening
Polyartrosis DIP-joints: silver ring splint
Silver ring splint
Singers
Instrument: the larynx
Most common problem: vocal cord problems
Often overload due to inadequate technique
Vocal cords work as harmonica
Tightened by arytenoids
Air lets the vocal cords vibrate
Length of the vocal cord determines the height
Mouth, oral cavity and skull (soundboard) define
timbre
Anatomy
Vocal cord problems
Most common: vocal cord nodule or polyp
Due to overload: bad singing technique, shout
Complaint: hoarse, quickly lost voice
Therapy: surgical, then rest 2-3 months and then
build good singing voice use under guidance.
Symphonic Orchestra
Symphonic orchestra
Deafness
Deafness is a common problem among
musicians
A variety of preventive measures possible
Wearing otoplastics is recommended but leads
to difficulties hearing small differences, which are
especially important in classical music
Violinists have more hearing problems than
trumpet players: they sit in front of the copper
instruments in the orchestra, and always in loud
noise
“the nerves”:
psychological problems
Stage fright occurs in 70% of stage artists (British
Association for Performing Arts Medicine 1997)
Orchestra Musicians: 39% psychological problems,
of which stage fright 24.7% (Middlesbrough Town
& Fishbein 1988)
No more psychiatric disorders than in general
population but more ADHD and addictions (van
Eekeren 1999)
Profession specific stressors More soli - more stress
Hierarchical phenomena (conductor -
concertmaster)
Adverse playing conditions
Out of touch with the music
Poor organization of a music tour
Still have to prove through continuous auditing
Uncertainty about finances
The show must go on, even in illness
Janine Jansen: exploiting
a violin player
Ending / take home
messages
The main problem with passionate performing
artists is the fact that they are usually much too
late to see a doctor, for fear that his or her
playing, dancing, singing is prohibited.
Therefore, even minor complaints must be taken
seriously by performers and doctors
The advice to quit or "take it easy" causes the
patient to no longer visit the practice
Thank you for your attention
Biannual meeting followed by scientific and artistic
symposium "Art and Healing";
Active participation in the international journal
"Medical Problems of Performing Artists“
Participation in international research and
international associations such as IADMS:
International Association for Dance Medicine and
Science ( founded in 1990)
Annual Symposium on Medical Problems of
Performing Artists
Elbow
Ulnar neuropathy in the cubital tunnel
Common in musicians (9%), more often than CTS
Causes: prolonged far flexion of the elbow
(violinplayers) with simultaneous compression by
the two heads of flexor carpi ulnaris (FCU), which
stabilizes the os pisiforme in the abduction of the
little finger.
Also with spreading the fifth finger at forceful
touch with pianists, bass players
Anatomy in vivo
Anatomy
