SPECIAL TOPICS
AIMS
1. To introduce the existence of Special Topics in the curriculum of the medical profession.
2. To understand the science and it's practices of health ergonomics in the medical profession.
3. To understand the science and it's practices of travelers medicine in the medical profession.
4. To understand the science and it's practices of health care in elderly in the medical profession.
5. To understand the science and it's practices of the palliative medicine in the medical profession.
PLANERS
NO NAME DEPARTMENT PHONE
1 Prof.Dr.dr.I Nyoman Adiputra, MOH,PFK,Sp.Erg (Head) Fisiology 0811397971
2 dr. N.K. Putri Ariani, SpKJ Psychiatrist 082237817384
LECTURER
NO NAME DEPARTMENT PHONE
1 Prof.Dr.W.Suardana. Sp.THTKL (K) ENT 0811385299
2 dr.AA Ayu Srikandhyawati, Sp.KFR Rehabilitation Medic 08156041505 3 dr. Putu Anda Tusta Adiputra,
SpB(K)Onk
Surgery 08123826430
4 Dra. Retno Indaryati. S. Psi Rehabilitation Medic 08123831862 5 Dr. Tjokorda Gde Dharmayuda,
Sp.PD KHOM.
Internal Medicine 0811394108
6 Prof.Dr.dr.I Nyoman Adiputra, MOH,PFK,Sp.Erg
Fisiology 0811397971
7 dr. Made Jawi, M.Kes Pharmacology 08179787972
8 DR.dr.Cok Jaya Lesmana, SpKJ Psychiatrist 0816295779 9 Dr. Ida Bagus Putu Alit, SpF, DFM Forensic 081916613459
10 dr. Dudut Rustyadi, SpF Forensic 08123994234
11 dr. Henky, Sp.F., M.BEth, FACLM Forensic 08123988486
~ FACILITATORS ~
Regular Class
NO NAME GROUP DEPT PHONE ROOM
1 dr. Made Dharmadi , MPH A1 Public Health 08123804985 3rd floorR.3.01
2 dr. Made Widhi Asih, Sp.Rad A2 Radiology 081916442626 3rd floorR.3.02
3 dr. I Gede Sastra Winata, M.Biomed, Sp.OG A3 Obgyn 081338713951 3rd floorR.3.03
4 Dr. Luh Made Indah Sri Handari A, S.Psi, M.Erg A4 Fisiology 081337095870 3rd floorR.3.04
5 Ida Bagus Nyoman Putra Dwija, S.Si, M.Biotech A5 Microbiology 08179747502 3rd floorR.3.05
6 Desak Gde Diah Dharma Santhi, S.Si, Apt, M.Kes A6 Clinical Pathology 0817569021 3rd floorR.3.06
7 dr. Tjokorda Gde Dharmayuda, Sp.PD-KHOM A7 Interna 0811394108 3rd floorR.3.07
8 dr. Kadek Fajar Martha, M.Biomed,Sp.OG A8 Obgyn 081236297575 3rd floorR.3.08
9 dr. I Wayan Gede Sutadarma, M Gizi A9 Biochemistry 082144071268 3rd floorR.3.20
10 dr. I Putu Adiartha Griadhi, M.Fis, AIFO A10 Fisiology 081999636899 3rd floorR.3.21
11 Ni Wayan Tianing, S.Si, M.Kes A11 Biochemistry 08123982504 3rd floorR.3.22
12 dr. I Gusti Agung Gd Mahendra Wijaya, Sp.Onk,. Rad A12 Radiology 08990179750 3rd floorR.3.23
English Class
NO NAME GROUP DEPT PHONE ROOM
1 dr. Henky, Sp.F., M.BEth, FACLM B1 Forensic 08123988486 3rd floorR.3.01
2 Dr.dr. Cokorda Bagus Jaya Lesmana, Sp.KJ B2 Psychiatry 0816295779 3rd floorR.3.02
3 dr. I Gusti Lanang Ngurah Agung Artha Wiguna, Sp.OT (K) B3 Orthopaedi 0811388859 3rd floorR.3.03
4 dr. Putu Wardani, M.Biomed, Sp.An B4 DME 08113992784 3rd floorR.3.04
5 dr. I Made Susila Utama, Sp.PD-KPTI B5 Interna 08123815025 3rd floorR.3.05
6 dr. I Gusti Ngurah Wien Aryana ,Sp.OT B6 Orthopaedi 0811385263 3rd floorR.3.06
7 dr. Komang Andi Dwi Saputra, Sp.THT- KL B7 ENT 081338701878 3rd floorR.3.07
8 dr. I G A Dewi Ratnayanti , M.Biomed B8 Histology 085104550344 3rd floorR.3.08
9 Dr.dr. Susy Purnawati, MKK B9 Fisiology 08123989891 3rd floorR.3.20
10 dr. I Wayan Juli Sumadi, Sp.PA B10 PathologyAnatomy 082237407778 3rd floorR.3.21
11 Dr. Luh Seri Ani, S.KM,M.Kes B11 Public Health 08123924326 3rd floorR.3.22
CURRICULUM BLOCK :
Sub Topic Paliatif Medicine
Aims :
To understand Paliatif Medicine is Part of Medical Education.
Paliatif Medicine most important for patient with severe diseases, chronic illness, and in terminal stage
To assess common forms of symptoms and sign patient in severe disease, chronic illness, and patient in terminal stage.
To diagnose and manage common physical problem in severe disease, chronic illness, and patient in terminal stage.
To aplly the basic principles of Palliatif medicine.for patient in severe disease, chronic illness, and patient in terminal stage.
LEARNING OUTCOMES
1. Describe about Paliatif Medicine and its clinical implications 2. Describe the general principles of Paliatif medicine
3. Apply the general principles of Paliatif medicine for patient with severe diseases, chronic illnees, and in terminal stage.
4. Recognize or identify common forms of problem patient with severe diseases, chronic illnees, and in terminal stage.
TIME TABLE
PALIATIVEMEDICINE
No DATE/ Lecture L E C LECTURE TOPICCLASS B CLASS A
TIME ACTIVITIES TIME ACTIVITIES
1 Wednes day
Concept,
Philosophy
and
Principle of
Palliative
medicine
08.00-09.00 Lecture 09.00-10.00 Lecture
Des, 30 2015 09.00-10.30 Individual learning 10.00-11.30 Student Project Prof.Dr.W Suardana, SpTHTKL (K)
10.30-12.00 SGD 12.00-13.30
Independen t Learning 12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 1130-12.00 Break
14.00-15.00 Planary Session 15.00-16.00 Plenary Session 2 Thursday In patient Hospice and Palliatif care
08.00-09.00 Lecture 09.00-10.00 Lecture Des, 31 2015 09-00-10.00 Individual learning 10.00-11.30 Student Project
dr . AA Ayu Srikandhy awati, Sp.KFR
10.30-12.00 SGD 12.00-13.30
Independen t Learning 12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 11.30.12.00 Break
14.00-15.00 Pleanary Session 15.00-16.00 Pleanary Session 3 Monday Emergency in Paliatif
medicine
08.00-09.00 Lecture 09.00.10.00 Lecture Jan, 4 2016 09.00-10.30 Individual learning 10.00-11.30 Student Project dr. Putu Anda Tusta Adiputra, SpB(K)On k
10.30-12.00 SGD 12.00-13.30
Independen t Learning
12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 11.30-12.00 Break
14.00-15.00 Plenary Session 15.00-16.00 Plenary Session 4 Tuesday Communica tion in
Dra. Retno Indaryati, S.Psi
Palliatif Care 10.30-12.00 SGD 12.00-13.30 nt Learning 12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 11.30-12.00 Break
14.00-15.00
Pleanary
Session 15.00-16.00
Pleanary Session
5 Wednes day
Modern supportive
care in Onkologi
Holistic approach for
Cancer patient
08-00-09.00 Lecture 09.00-10.00 Lecture
Jan, 6
2016 09.00-10.30
Individual
Learning 10.00-11.30
Student Project
Dr. Tjok Darmayud a, Sp.PD. KHOM
10.30-12.00 SGD 12.00-13.30
Independen t Learning 12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 11.30-12.00 Break
14.00-15.00
Pleanary
Session 15.00-16.00
Pleanary Session
TIME TABLE
Complementary and Alternative Medicine (CAM)
English Class (Class B)
Day/date Time Activity Venue Conveyer
Thursday 7 Jan 2016
08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 Lecture 1 Indiv. Learning SGD Break Student Project Pleanary Class room Discussion Room Class room
Dr.Md Jawi.
Facillitator
Dr.Md Jawi
Monday 11 Jan 2016
08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 Lecture 2 Indiv. Learning SGD Break Student Project Pleanary Class room Discussion Room Class room
Dr.Md Jawi.
Facillitator
Dr.Md Jawi
Tuesday 12 Jan 2016
08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 Lecture 3 Indiv. Learning SGD Break Student Project Pleanary Class room Discussion Room Class room DR.dr.Cok Jaya L, SpKJ
Facillitator
DR.dr.Cok Jaya L, SpKJ Wednesday
13 Jan 2016
08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 Lecture 4 Indiv. Learning SGD Break Student Project Pleanary Class room Discussion Room Class room Prof. Adiputra Facillitator Prof. Adiputra Thursday 14 Jan 2016
08.00-09.00 09.00-10.30 10.30-12.00 12.00-12.30 12.30-14.00 14.00-15.00 Lecture 5 Indiv. Learning SGD Break Student Project Pleanary Class room Discussion Room Class room Prof. Adiputra Facillitator Prof. Adiputra
Reguler Class (Class A)
Day/date Time Activity Venue Conveyer
Thursday 7 Jan 2016
09.00-10.00 10.00-11.30 11.30-12.00 12.00-13.30 13.30-15.00 15.00-16.00 Lecture 1 Student Project Break Indiv. Learning SGD Pleanary Class room Discussion Room Class room
Dr. Md Jawi
Facillitator
Dr. Md Jawi
Monday 11 Jan 2016
09.00-10.00 10.00-11.30 11.30-12.00 12.00-13.30 13.30-15.00 15.00-16.00 Lecture 2 Student Project Break Indiv. Learning SGD Pleanary Class room Discussion Room Class room
Dr. Md Jawi
Facillitator
Dr. Md Jawi
Tuesday 12 Jan 2016
09.00-10.00 10.00-11.30 11.30-12.00 12.00-13.30 13.30-15.00 15.00-16.00 Lecture 3 Student Project Break Indiv. Learning SGD Pleanary Class room Discussion Room Class room DR.dr.Cok Jaya L, SpKJ
Facillitator
DR.dr.Cok Jaya L, SpKJ Wednesday
13 Jan 2016
09.00-10.00 10.00-11.30 11.30-12.00 12.00-13.30 13.30-15.00 15.00-16.00 Lecture 4 Student Project Break Indiv. Learning SGD Pleanary Class room Discussion Room Class room Pof. Adiputra Facillitator Prof. Adiputra Thursday 14 Jan 2016
09.00-10.00 10.00-11.30 11.30-12.00 12.00-13.30 13.30-15.00 15.00-16.00 Lecture 5 Student Project Break Indiv. Learning SGD Pleanary Class room Discussion Room Class room Pof. Adiputra Facillitator Prof. Adiputra
TIME TABLE
FORENSIC
No DATE/ Lecture L E C LECTURE TOPICCLASS B CLASS A
TIME ACTIVITIES TIME ACTIVITIES
1 Friday Lecture 1 : Introduction to Forensic Medicine Lecture 2 : Ethics in Forensic Medicine
08.00-08.30 Lecture 1 09.00-09.30 Lecture 1 08.30-0900 Lecture 2 09.30-10.00 Lecture 2 Jan, 15 2016 09.00-10.30 Individual learning 10.00-11.30 Student Project dr. Henky, Sp.F., M.BEth, FACLM
10.30-12.00 SGD 12.00-13.30
Independent Learning 12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 1130-12.00 Break
14.00-15.00 Planary Session 15.00-16.00 Plenary Session 2 Monday Lecture : Aspek Medikolegal Kematian
08.00-09.00 Lecture 09.00-10.00 Lecture Jan, 18 2016 09-00-10.00 Individual learning 10.00-11.30 Student Project dr. Dudut Rustyadi, SpF
10.30-12.00 SGD 12.00-13.30
Independent Learning 12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 11.30.12.00 Break
14.00-15.00 Pleanary Session 15.00-16.00 Pleanary Session 3 Tuesday Lecture : Asfiksia dan Tenggelam
08.00-09.00 Lecture 09.00.10.00 Lecture Jan, 19 2016 09.00-10.30 Individual learning 10.00-11.30 Student Project dr. Kunthi Yulianti, SpKF
10.30-12.00 SGD 12.00-13.30
Independent Learning
12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 11.30-12.00 Break
14.00-15.00
Plenary
Session 15.00-16.00
Plenary Session 4 Wednesday Lecture :
Kekerasan Fisik (Penganiaya an) dan Kejahatan Seksual (Sexual Assault)
08.00-09.00 Lecture 09.00-10.00 Lecture Jan, 20 2016 09.00-10.30 Individual learning 10.00-11.30 Student Project Dr. Ida Bagus Putu Alit, spF, DFM
10.30-12.00 SGD 12.00-13.30
Indenpenden t Learning 12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 11.30-12.00 Break
14.00-15.00 Session 15.00-16.00 Session
5 Friday Lecture 1 :
Sudden Death
Lecture 2 : Forensic Toxicology
08.00-08.30 Lecture 1 09.00-09.30 Lecture 1 08.30-0900 Lecture 2 09.30-10.00 Lecture 2 Jan, 21
2016
09.00-10.30 Individual Learning
10.00-11.30 Student Project
dr. Henky, Sp.F., M.BEth, FACLM
10.30-12.00 SGD 12.00-13.30 Independent Learning 12.00-12.30 Break 13.30-15.00 SGD
12.30-14.00
Student
Project 11.30-12.00 Break 14.00-15.00 Pleanary
Session
15.00-16.00 Pleanary Session
PALIATIF MEDICINE
Abstract
Palliative care is any form of medical care or treatment that concentrates on reducing the severity of disease symptoms, rather than providing a cure, particularly for the disease which is treatment is not curable. Palliative care improves the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support to from diagnosis to the end of life and bereavement.
Concept and philosophy of Palliative care consist of provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until death; offers a support system to help the family cope during the patients illness and in their own bereavement; uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated; will enhance quality of life, and may also positively influence the course of illness; is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
The goal of palliative care is relief from suffering, treatment of pain and other distressing symptoms, psychological and spiritual care, a support system to help the individual live as actively as possible, and a support system to sustain the individual's family in other word is holistic approach of care (bio-psycho-socio-cultural and spiritual aspect).
Hospice care is other term for palliative medicine which focuses for terminal ill while palliative care services beginning from the diagnosis of the disease.
Learning task
1. What is palliative medicine?
2. What are the objectives of palliative care?
3. Did you know about holistic approach in the palliative medicine? 4. Who are the targets in the palliative care?
5. Describe the concept and principle of palliative medicine! 6. What is bereavement consultation? To who will be doing? 7. Describe of past model and modern model of palliative care! 8. Describe of hospice care and differentiation from palliative care!
Lecture 1 :
Concept, Philosophy and Principle of Palliative
medicine
Abstract
The World Health Organization defines palliative care as an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.
Patients receiving palliative care may deteriorate suddenly due to their illness or another acute medical or surgical problem. At the end of life acute exacerbations of medical symptoms (e.g. dyspnea) in palliative care patients often result in emergency medical services being alerted.
Major emergencies in palliative care :
Hypercalcaemia
Bleeding
Superior venal caval obstruction
Spinal cord compression
Bone fractures
Seizure
Emergencies in palliative care also include sudden severe exacerbation of symptoms. Therefore, onset of severe pain, exacerbation of breathlessness, and worsening of other symptoms are also discussed with their appropriate treatment. A small armamentarium of appropriate medications is thus shown to cover treatment of the various emergencies that may arise. As palliative care deals with patients who are suffering from progressive fatal conditions, death is the expected end.
Lecture 2 :
In Patient Hospice and Paliatif Care
dr.AA Ayu Srikandhyawati, Sp.KFR
Lecture 3 :
Emergency in Palliative Care
dr. Putu Anda Tusta Adiputra, SpB(K)Onk
Lecture 4 :
.
COMPLEMENTARY AND ALTERNATIVE MEDICINE ( CAM )
Abstract
Public awareness and use of complementary and alternative medicine (CAM) are complex phenomena that have grown extraordinarily in the past decade. One reason for this phenomenon no doubt is the enormous increase in public access to worldwide information through the world wide web and widespread newsmedia coverage. Commercial advertising and an endless exposure through the lay press, ranging from tabloid publications to magazines, medical journals, and books, have vigorously promoted the concepts of disease prevention and healing by unconventional means, striking a sensitive (and highly lucrative) chord in a truly global population.Another reason for the popularity of CAM is the upwardly spiraling cost of modern allopathic medical care. New technologies have been developed at a record pace, producing many medical, surgical and diagnostic innovations, most of which are unquestionably improvements but which also are very expensive. The expense and the resulting rationing of these new modalities by managed care programs in an attempt to reduce the costs of medical care have placed them out of reach of a large segment of the population. One consequence appears to be the creation of a strong public desire for a wide range of complementary and alternative modalities to prevent and treat the full gamut of human illness. The younger generation, in particular, seems to be developing distrust of the technological innovations of the medical profession and their potential for adverse effects, while becoming more interested in CAM and preventive medicine. The elderly population has also turned to CAM, but perhaps for different reasons.
Whatever the reasons, a veritable blitz of advertising and recommendations for CAM products has arrived and has received strong public interest and approval, with very little support or encouragement from the medical community. Many patients are more informed of alternative therapies than their physicians, a situation that, in itself, should encourage physicians to learn more about CAM. No matter how a physician feels about the usefulness of CAM, it is no longer adequate simply to brush off the patients' questions with an uninformed answer; doing so only serves to broaden the communication gap between the public and the medical profession.Therefore, as a medical student who will be leading the
Lecture 5 :
Holistic Approach for Cancer Patient
Dr. Tjokorda Gde Dharmayuda, Sp.PD KHOM
Lecture 1 :
medical staff should know to bridge information gaps or provide correct information to the CAM. In this lecture (the learning process) will be discussed in outline on CAM, so that, future integrated treatment system can be achieved.
References
1. The Journal of Alternative and Complementary Medicine 2. BMC Complementary and Alternative Medicine
3. Evidence-Based Complementary and Alternative Medicine
Abstract
Plants had been used for medicinal purposes long before recorded history.In the early 19th century, when chemical analysis first became available, scientists began to extract and modify the active ingredients from plants. Recently, the World Health Organization estimated that 80% of people worldwide rely on herbal medicines for some part of their primary health care. Herbal medicine , also called botanical medicine or phytomedicine, refers to using a plant's seeds, berries, roots, leaves, bark, or flowers for medicinal purposes. Herbalism has a long tradition of use outside of conventional medicine. It is becoming more mainstream as improvements in analysis and quality control along with advances in clinical research show the value of herbal medicine in the treating and preventing disease.
In many cases, scientists aren’t sure what specific ingredient in a particular herb works to treat a condition or illness. Whole herbs contain many ingredients, and they may work together to produce a beneficial effect. Many factors determine how effective an herb will be. For example, the type of environment (climate, bugs, soil quality) in which a plant grew will affect it, as will how and when it was harvested and processed.
The herbs available in most stores come in several different forms: teas, syrups, oils, liquid extracts, tinctures, and dry extracts (pills or capsules). Teas can be made from dried herbs left to soak for a few minutes in hot water, or by boiling herbs in water and then straining the liquid. Syrups, made from concentrated extracts and added to sweet tasting preparations, are often used for sore throats and coughs. Oils are extracted from plants and often used as rubs for massage, either by themselves or as part of an ointment or cream. Tinctures and liquid extracts are made of active herbal ingredients dissolved in a liquid (usually water, alcohol, or glycerol). Tinctures are typically a 1:5 or 1:10 concentration, meaning that one part of the herb is prepared with 5 - 10 parts (by weight) of the liquid. Liquid extracts are more concentrated than tinctures and are typically a 1:1 concentration. A dry extract form is the most concentrated form of an herbal product (typically 2:1 - 8:1) and is sold as a tablet, capsule, or lozenge.
Often, herbs may be used together because the combination is more effective and may have fewer side effects. Health care providers must take many factors into account when recommending herbs, including the species and variety of the plant, the plant's habitat, how it was stored and processed, and whether or not there are contaminants (including heavy metals and pesticides).
All medicinal agents have potentiallyunexpected effects including toxicity, andherbs are no different.As with otherdrugs, the risk of unexpected effects maybe influenced by a user’s age, gender,genetics, nutrition status, and concurrentdisease states and treatments.In clinicalpractice recognizing adverse effects of herbalmedicine is not routine and their reporting iseven less frequent.It is important to be aware of anysubstances that have the potential to causetoxicities and to interact with prescribedmedications. Most adverse reactions involvethe skin, liver, GI tract but can involve theheart (e.g.ephedra). Significant hepatotoxiceffects were reported with kava or Echinacea when taken concurrently with otherheptatoxic drugs. The use of a drug and aherb that are both associated with potentialhepatotoxic effects should be avoided.
Herbal medicine is used to treat many conditions, such as asthma, eczema, premenstrual syndrome, rheumatoid arthritis, migraine, menopausal symptoms, chronic fatigue, irritable bowel syndrome, and cancer, among others. Herbal supplements are best taken under the guidance of a trained health care provider. For example, one study found that 90% of arthritic patients use alternative therapies, such as herbal medicine.Be sure to consult with your doctor or pharmacist before taking any herbs. Some common herbs and their uses are discussed in this lecture.
References
Journal of Herbs, Spices & Medicinal Plants Journal of Herbal Medicine
Abstract
Hypnosis is a way to harness the imagination to therapeutic strategies designed to help people feel and live better, from reducing pain and anxiety to controlling habits and dissociation. Hypnosis has occupied an unusual position in relation to both mainstream and complementary or, as it is now more often referred to, integrative medicine. It has a long history of being used both within and outside of medicine. Hypnotic capacity can be identified and mobilized as a valuable adjunct to a variety of psychotherapeutic strategies.
The word hypnosis comes from the Greek root hypnos, which means sleep. This is misleading, because hypnosis, as a phenomenon, is not a form of sleep; rather, it is a complex process of attentive, receptive concentration. Although peripheral awareness is reduced in sleep and hypnosis, focal attention, which is diffuse in sleep, is heightened during the hypnotic trance. Since the days of Franz Anton Mesmer, techniques of trance induction and the use of trance phenomena for psychotherapeutic change have been confused. This has led to a lack of understanding of the differences between aspects of the hypnotic experience that are influenced by the therapist and those that are due to the individual's degree of hypnotizability, personality style, and motivation. The hypnotist does not project hypnosis onto the subject. The role of the hypnotist is rather to assess an individual's inherent biological capacity for trance and to teach the patient how to use it in a given psychotherapeutic program.
The therapist must reassure the subject that he or she will not be embarrassed or humiliated, will not be asked to do anything he or she would not want to do in the waking state, and that it will be a temporary procedure only. Some subjects may be concerned that if they can be hypnotized, it shows they are weak or stupid. On the contrary, therapists
Lecture 3 :
Hypnosis
explain that only subjects who can strongly focus their attention can be hypnotized. Hypnotherapy brings the patient to an awareness of the feelings and desires of their unconscious mind. It enables them to reframe an experience (e.g., with family, friends, coworkers) or proto-experience, laden with distressing feelings or conflict, into a positive one. The patient is brought to see and feel memories of the past, place them into their present, project them into their future life, and understand and reframe them. The patient actively expresses emotions from their unconscious mind, and develops a different understanding of these memories. The hypnotic state further enables them to modify past situations and feelings, and record these as newly changed in conscious memory.
Learning program
THE BALINESE TRADITIONAL MEDICINE
I Nyoman Adiputra
INTRODUCTION
In every nation or sub-nation there is a traditional way to remedy the aillment or illnesses or diseases. The intended knowledge is handed down generation to generation, informs of traditions and it's practices. The traditions might be written or spoken orally. In case the source of traditional healing knowledge is written, there is a factual thing that those information is written on a various of materials. For example in the Balinese the intended knowledge is written on a palm leaf (lontar). In other sub-ethnic may use skin of tree or other materials.
The Balinese traditional knowledges had been known since those day. It is generally known as usadha, which is means medicines.
It is a matter of culture; culture of people who believe on that. Generally the Balinese do believe on traditional healing due to the fact that there are three basic elements for the it's efficacy. The elements are: 1) the source of knowledge; 2) the provider; and 3) the consumer.
The source of knowledge informs written materials which called usadha. There are many kinds of usadha. Belong to the usadha group are: 1) general knowledge (tatwa), such as brahmanda tatwa (cosmology), atma tatwa (soul), wrehaspati tatwa (philosophy), aji sangkhya (philosophy), wariga (caleder), agama (religion), rwa bhineda (philosophy); 2) medical knowledge: such as panca maha bhuta (medical physic), saraswati (anatomy), sastra sanga (anatomy), buwana mahbah (pathology), pinarah pitu (patophysiology), kahilangan kawah (pathopa=hysiology), and pati urip (patho-physiology)' taru premana, sundari siksa, (the great pharmacopea), budha kecapi, kalimaha usadha-usadhi (the complete medical knowledge; 3) summary (kaputusan) such as kaputusan punggung tiwas. The naming system of usadha is based on: a) the subject to be treated; b) by using the name of color.
Based on subject to be treated there are classification of usadha as the followings: 1) usadha rare (paediatrics); 2) usadha dalem (internal medicine); 3) usadha buduh (mental illness); 4) usadha gondong (goitre disease); 5) usadha kecacar (smallpox); 6) usadha ila (leprozy), 6) usadha cukil daki (dermatology); 7) usadha manak (obstetrics), 8) usadha kamatus (venerology).
Lecture 4 :
Based on color name, there are usadha classification as the followings: 1) usadha kuning/yelow (paediatrics); 2) usadha putih/white (for adolescent); 3) usadha bang/red ( for adult); 4) usadha cemeng/black (geriatrics).
All of those subject must be studied by those who like to become a traditional healer or balian. Balian in this case is called Balian Usadha.
In fact in Bali there are many type of traditional healers, such as 1) Balian Usadha, who are equivalent to medical doctor; they become Balian after a long and hard study on the usadha. 2) Balian Ketakson, a traditional healer by incidently he (she) got a magical thing, by which he (she) has a power and capability to cure an illness person. This kind of Balian can not be duplicated. 3) Balian Manak, traditional healer who specializing in delivery as a midwife. 4) Balian elung, as a bone setter for patient suffering from a fracture. 5) Balian tenung, those who are offering the service as a fortune teller; 6) Balian engengan, those who are ...
Who will become a Balian?
Theoretically, every body and both sexes, who learn about the sources of traditional knowledges could become a Balian. But, as a preference there are a certain pre-requirements such as there is a gynealogy; it means that the candidate should has ancester as a Balian; the candicate also should pass by the general knowledge first, and the age should at the late of thirty. The candidate also shoul directly to approach a Balian who will become his (her) teacher during the learning process. The process of learning is very very informal. Eventhough, there is a process of evaluation of the learning processs, which can be done by both ways (candidate and the teacher). When a candidate is allowed to practice what he or she being studied is depend on evaluation process.
Consumer in this case are the Balinese who are believe on the traditional healing, without considering the educational level, economic class, rescidences (in the town or rural). Usually, the Balinese may come to Balian at the beginning of suffering, or at the late stage after getting some medical doctor helps, but, without any improvement. The consumer in this case are aksing the help of the traditional healer not only for the illnesses, but also for other thing such as consultation in conducting a ceremony, asking time to start any activity for a better result. Or might be also for asking as a mediator for a certain porpuse.
In offering the service a Balian may examining the patient. The procedure for that is equivalent to what the MD is doing. It consist of: 1) interviewing (anamnesis); 2) inspecting (by watching or seing; 3) palpating; 4) percussing, 5) auscultating. Another additional examination such as environmental condition is also done. Usually interview is done in a longer time.
After a diagnose had been done the Balian will give a treatment to the patient in hand. The treatment procedure consist of a) medication using herbals or other material such as minerals, oils, and part of animals' organ; it can be for causative therapy; symptomatic therapy and supportive therapy; b) religious ceremony such as purification. The drugs used is given by the traditional healer based on their prescriptions.
In doing their jobs the traditional healer has never seek for money. Therefore, there is no exact tariff; the patient usually offer the payment informs of in natural things.
Lecture 5 :
A Balian is morally conduct
Another hint that the traditional healer do their job in moral conduct is that whenever he (she) knows the cause of the sickness , he or she will not tell to any others or if it must be open just for the limited one. He or she always advice to be kept secretly for the better future relationship. The traditional healer always to offer his or her service in accordance to the ethic and moral guidances. In doing so, he or she should also know the calender and it's practice. He or she is mastering on some other topics for example as mediator to the evil or devil spirits, knows about the future (fortune teller), as a consultant for the villiger, as an artist, as a priest, as a village council, as a village administrator and as a informal leader in the village.
The traditional healer knows about the basic concept of health and illness. An individual is considered in a healthy condition if there is harmony or in a balance between physical and mental one; or between micro-cosmic and macro-cosmic. If due to a certain thing there is disharmony or imbalance it will cause a sickness. Therefore the treatment is by change the disharmony into a harmony; or imbalance into a balance
The cause of the diseases traditionally, could be divided into two parts, namely internally and externally. Internal cause, it is due to a dysharmony between the kanda Pat (the four siblings), panca maha bhuta (the five principle elements), sad ripu (the six enemies), and sapta timira (the sevent sins). The external cause of disease interms of supra natural power, demons, evil spirits, toxic agents (from the plants, animals, metals, minerals); environmental aspect such as mal-construction or mal-composition of house, wind or sin.
LEARNING TASKS
Case
• Aunt Tilly is diagnosed with breast cancer and is recommended to start chemotherapy and radiation treatments. Aunt Tilly knows that chemotherapy can make her feel horrible and radiation can be painful. She is referred to a palliative care program for symptom management and receives excellent treatment of her chemotherapy induced nausea, fatigue, and oral thrush (a yeast infection of the mouth common in chemotherapy patients). She is also visited by a Medical Social Worker who helps her complete her advance directives, just in case she loses the ability to speak for herself. She gets weekly visits from a chaplain who prays with her and discusses Aunt Tilly's theological questions.Well, Aunt Tilly endured three rounds of chemotherapy and a week of radiation but her breast cancer is aggressive and resistant to treatment. Aunt Tilly is told that she has six months to live and is referred to hospice care. Hospice comes to Aunt Tilly's home and continues with the expert symptom management that the palliative care team started. They address new symptoms as the arise and begin to talk to Aunt Tilly about her impending death and what her goals and priorities are. Hospice helps Aunt Tilly to fulfill her life-long dream of riding in a Porsche and helps her reconcile with her long estranged daughter Talula. Aunt Tilly dies peacefully surrounded by her family.
1. Describe the disease suffered aunt Telly!
2. What is recommended by doctor to treat aunt Telly?
3. Describe the effect of treatment which is recommended by doctor!
4. Aunt Tilly knows that chemotherapy can make her feel horrible and radiation can be painful. Discussed of this effect of treatment knows by aunt Tilly!
5. Discussed of yeast infection of the mouth very common in chemotherapy patients! 6. Describe what Palliative team will do to aunt Telly who’s suffered of late stage of
cancer disease! What objective of the strategies! 7. Discuss why aunt Telly need hospice care!
8. What will the Hospice team take care for aunt Telly condition?
9. Aunt Tilly dies peacefully surrounded by her family. Discussed of this statement!
Day
1
Case :
Mr. Ketut, 60 years old, hospitalized in Sanglah with Lung Cancer, stadium Paliative since one month ago.
He know about his diagnosis and no other treatment (surgery or chemotherapy) for him. He want to die at home among his family. The primary doctor consult him to Paliative team.
LEARNING TASK :
1. Definition of Paliative Medicine.
2. Taking and formulate a complete history of this case. 3. Make the plan for this patient.
4. What is your opinion when the patient feel short of breath at home.
SELF ASSESSMENT :
1. What do you know about Paliative Medicine? 2. Explain about Paliative Care.
3. Discribe 10 (ten) dimension of Quality of Life (Jennifer J . Clinich & Harvey Schipper).
Where is the place of Paliative care and give the explaination.
.
Vignette 1
A woman, 55 years old diagnosed with mestastastic breast cancer come to the emergency unit with chief complain of loss of consciousness.
1. Palliative care is necessarily multidisciplinary. What does the principles of palliative care?
2. Hypercalcaemia is the commonest life threatening metabolic disorder encountered in patients with cancer. What is the presenting features of hypercalcaemia?
3. What is the etiology of hypercalcaemia in patient with cancer? Explain about it! 4. Explain the management of hypercalcaemia in the palliative care?
Day
3
Mrs. Ann is a 43-year-old woman with metastatic melanoma. She has completed two cycles of treatment with a combination therapy that she has tolerated not-quite well. Her major complaints had been fatigue, loss her weight and insomnia. Before starting a third cycle of treatment, she experienced some visual hallucination, and emotional disturbances. The doctor presumed there are another metastatic site of disease in the brain. The drug responses occur many disturbances in her metabolism, make her nausea, and sometime vomiting.
According to the family, all of information about the symptoms made her very anxious. That is the reason, her family meet and ask to the doctor to keep all the bad news about her disease. The doctor must let only the family know the reality, and the patient only know the good ones, so she will get better improve and recovery.
Learning Task
1. Please describe what must the doctor said and explain to the family
2. Please give the best explanation to the patient, while you know she is in depressed condition.
3. Why Palliative care serves as a bridge between the therapist, the patient, and the family?
4. Depression and other mental disorders often complicate the treatment of medical illness, and deviant illness behavior such as suicide is a common problem in patients who are organically ill. What will you suggest to the patient who suffered the disorders?
5. When the best time you give the worsening of symptoms to the patients?
6. Is that necessary to report all the side effects of the medication, so the patient can be prepared before?
7. Why must we give much attention to the palliative staff and care-giver?
Soon will be added
Learning Task
Cancer patients using or considering complementary or alternative therapy. The patients discuss this decision with their doctor or nurse, as they would any therapeutic approach. Some complementary and alternative therapies may interfere with standard treatment or may be harmful when used with conventional treatment. It is also a good idea to become informed about the therapy, including whether the results of scientific studies support the claims that are made for it. As a doctor you could explain this problem.
A.
What benefits can be expected from this therapy? What are the risks associated with this therapy? Do the known benefits outweigh the risks? What side effects can be expected?
Will the therapy interfere with conventional treatment? Is this therapy part of a clinical trial?
If so, who is sponsoring the trial?
Will the therapy be covered by health insurance?
B.
What the role of complementary therapies bellow for Cancer patients? Acupuncture
Exercise
Expressive arts (art and writing) yoga
Humor therapy Massage therapy Music therapy Qigong Reflexology
Learning task
Many patients use herbal medicine with conventional drugs in treating diseases, or use of herbal products and medications together. For example, diabetic patients might benefit from taking Korean red ginseng or Panax ginseng because this herb can lower blood sugar levels and might allow patients to rely on less medication.
However, interactions between herbal products and medication can sometimes result in adverse clinical outcomes.
A. If you to be a medical doctor, what are your opinion about that case ? B.
1. What is herbal medicine? 2. How do herbal medicinework?
3. How is herbal medicine sold in stores? 4. What is the future of herbal medicine?
Day
6
Case I
Mrs. K. was a 44-year-old well-trained psychiatrist with 4 years of psychoanalytic training who had failed her board examinations 2 years in a row. This was especially disturbing because she was well informed and her colleagues knew her as a competent psychiatrist. Yet something happened in the examination process that led to blocking and intellectual paralysis.
Question:
1. Explain treatment option for her condition 2. Explain the role of therapist
3. Explain how to assess her hypnotic capacity 4. Explain the restructuring of the problems
5. Explain how hypnotherapy can help her problems
Case II
Andy, 38 years old was a world-class athlete who collapsed suddenly in an alley. He was brought to a hospital emergency room, where he nearly died of internal bleeding from a lymphoma the size of a grapefruit in his abdomen. He was hospitalized and placed on chemotherapy. He was extremely anxious, and increasing doses of opiates had little effect on his pain. He was literally “climbing the walls” and alienating the nursing staff charged with his care. His parents were afraid that he was becoming a drug addict.
Question:
1. Explain treatment option for her condition 2. Explain the role of therapist
3. Explain how to assess her hypnotic capacity 4. Explain the restructuring of the problems
5. Explain how hypnotherapy can help her problems
Self-assessment:
1. Explain principles of psychotherapy with hypnosis 2. Explain the use of hypnosis in forensic psychiatry 3. Explain about hypnotic dissociation
4. Explain some indication for hypnosis use 5. Explain about hypnotic induction profile
1. How does the traditional medicine still function in Bali? 2. Mention the basic elements which make it function!
3. Discuss the traditional knowledges of the Balinese traditional medicine you know, and it’s correspondences to the modern medicine.
4. Discuss how the classification of usadha is done, and give some example accordingly!
5. Classify the traditional healer in Bali you know and discuss what is (are) the advantages & disadvantages of those types.
6. Before some one become a traditional healer (Balian) could you summarize how the process he or she did?
7What do you thing, whether a Balian is a professional one or not? 8 Elaborate how the diagnosis is made by a Balian Usadha?
9 According to the traditional knowledges, could you summarize the cause of disease?
10 Try to compare the modern aspect and the traditional aspect of disease aetiology?
11Try to explain the pathogenesis of disease traditionally?
12. How many roles or functions of Balian Usadha do you know?
13. Try to find out that the Balian Usadha is morally conduct. Supports your opinion!
14. Is there any fixed-tariff for Baliaj Usadha in offering his or her services?
1. How the process of healing is done by Balian Usadha in Bali?
2. What kind of materials for medication used by a Balian Usadha that you know?
3. Is there any source of traditional knowledge for medicinal plants in Bali? 4. Discuss the role of the medicinal plants you know!
5. Discuss how the patient shall use the herbal medicine as you know! 6. Discuss the dosage of drug used in the source of knowledges
traditionally!
7. How the medicinal plants’ effect could be estimated? Is there any hint practically?
8. Try to compare the traditional medicine and modern medicine!.
Day
9
Abstra ct
Forensic medicine is a branch of medicine specialising in the application of medical knowledge for the purposes of administration of the law and judicial proceeding. In order to solve criminal cases related to human body, investigators usually seek medical advice from physicians since the doctors have a thorough knowledge of human body. Therefore, only medical officers are authorised to examine the human body because of their competency.
The relationship between medicine and law has been noted since 3000 BC in Egypt, Babylon, Greece, Rome, and the Middle East. At that time, medicine was strongly influenced by religion, superstition, and magic. The priest, as the intermediary between God and man, had a dual function as the physician and the jurist. Thus, at that moment, scientific method has not yet been adapted for medico-legal investigation.
The pioneer of scientific medico-legal death investigation was begun in China in 1236, which was followed by a tremendous development of forensic medicine in Europe. In the US, history recorded that the application of scientific forensic evidence in the court was less developed because of political interest.
In Indonesia, forensic medicine was first introduced in the Dutch Colonial Era around 1920 by H.J.F.Roll in STOVIA. Later, this field of study was continuously growing which produced many forensic medicine specialists. Subsequently, they established Perhimpunan Dokter Forensik Indonesia (PDFI) in 1990. In order to fulfil the need of forensic services in society, PDFI has founded five divisions, namely forensic pathology, clinical forensic medicine, forensic serology and bio-molecular, forensic toxicology, ethics and medico-legal.
In general, there are two roles of medical officers: as an assessing physician and as a certifying physician. If medical doctors are requested to assist the judicial proceedings, they must collect every scientific evidence by documenting and analysing any information, facts, and findings. Finally, every step of these processes is concluded in medical certificate or medico-legal report.
References:
1. Sampurna B, Samsu Z. Peranan Ilmu Forensik Dalam Penegakan Hukum. Jakarta: Bagian Kedokteran Forensik Fakultas Kedokteran Universitas Indonesia; 2003.
2. Knight B. Forensic pathology. Second Edition. Great Britain: Arnold; 2004.
3. Smith S. The History and Development of Forensic Medicine. British Medical Journal. Mar 24, 1951; 1(4707): 599–607.
4. Buchanan D. Forensic Medicine: A Clinician’s View. In: Legal and Forensic Medicine. Beran RG, editor. Berlin: Springer-Verlag; 2013.
5. Beran RG. Analysis - What Is Legal Medicine? Journal of Forensic and Legal Medicine. 2008; 15(3): 158-62.
6. Wecht CH. The History of Legal Medicine. J Am Acad Psychiatry Law. 2005; 33:245–51.
Lecture: Introduction to Forensic Medicine
dr. Henky, Sp.F., M,BEth., FACLM.
Learning Outcomes
Able to understand the definition, concept, and scope of forensic medicine.
Able to understand the role of physician to assist law enforcement and legal proceeding
Learning Task Vignette
A-28-year-old man’s dead body with a gunshot wound in his left chest has been transferred to the department of forensic medicine. The investigator asks you as a medical officer to issue a medico-legal report (Visum et Repertum).
Assignments:
1. What is the definition of forensic medicine?
2. Why does the investigator ask for a medico-legal report (Visum et Repertum)? What is the legal basis?
3. In relation to this case, please mention and explain any scientific evidence which must be documented in the medico-legal report (Visum et Repertum)!
Self Assessment
1. Explain the history of forensic medicine! 2. Explain the legal proofing system in Indonesia!
3. Mention and explain the divisions of forensic medicine!
4. Mention and explain the scope, role, and duty of forensic medicine!
Abstra ct
Aristotle has argued that everything in this life has an end or a goal (telos). According to him, the ultimate goal of human life is to achieve human flourishing (eudaimonia). This goal could be achieved if one can fulfill his/her role to be functioning well as a human being in accordance with his/her specific specialties. For instances, the function of a good knife is to cut well, and the function of a good doctor is to treat the patient well.
The main purpose of forensic medicine is to assist the administration of the law and judicial proceeding. Hence, a good forensic medicine specialist is a doctor who is useful to assist law enforcement. This goal can be accomplished by applying ethical principle when conducting forensic medical service which leads to good forensic medical practice. In daily practice, ethics in forensic medicine has specific and unique characteristics because of the interaction between forensic practitioners and investigators, and dualism role between patient and victim/perpetrator. This uniqueness is formed as a consequence of the specific role of forensic physician that is as a certifying doctor. Therefore, the principles of professionalism, objectivity, impartiality, as well as intra- and inter- professional teamwork are the core substances of the code of ethics of forensic medicine.
Forensic medicine physicians, either clinical forensic medicine practitioners or forensic pathologists, frequently encounter many ethical dilemmas. The four principles of biomedical ethics, introduced by Beauchamp and Childress could be applied to resolve these moral disputes while performing clinical forensic medicine practice since these principles, historically, were formulated to protect living research subjects. The four principles could also be utilized by forensic pathologists to respect the dead. These basic moral principles combined with the code of conduct for forensic mortuary personnel can be applied to make
decisions when dealing with ethical quandaries which arise while dealing with the dead body as well as interacting with the grieving families.
References:
1. Aristotle. excerpt from Nichomachean Ethics. In: Cahn SM, editor. Classics of Political and Moral Philosophy. New York: Oxford University Press; 2002. p. 182-221.
2. Beauchamp TL, Childress JF. The Principles of Biomedical Ethics 7th ed. New York: Oxford University Press; 2013.
3. El-Nageh M, Linehan B, Cordner S, Wells D, McKelvie H. Ethical Practice in Laboratory Medicine and Forensic Pathology. WHO Regional Publications; 1999.
4. Kode Etik Kedokteran Forensik Indonesia; 2004.
Learning Outcomes
Able to act and behave in accordance with the highest ethical standards of forensic medicine.
Able to act and behave in line with the basic principle of medical ethics and Indonesian ethical guidelines for forensic medicine practitioners.
Able to resolve ethical issues faced while conducting forensic medicine practice.
Learning Task Vignette 1
A 38-year-old-woman has been taken by a police to the hospital with an allegation of adultery. The investigator asks the doctor to issue a medico-legal report (Visum et Repertum). Unfortunately, the woman refutes genitalia examination planned by physician, including collecting samples and taking photographs for evidence.
Assignments:
1. What is the ethical issue in this case?
2. What is the conflict between ethical principles in this case? 3. What is your decision in this situation? Explain your justification! Vignette 2
A-28-year-old man’s dead body with a gunshot wound in his left chest has been transferred to the department of forensic medicine. The investigator asks you as a medical officer to perform an autopsy. However, his relatives do not give their permission to conduct the autopsy.
Assignments:
1. What is the ethical issue in this case?
2. What is the conflict between ethical principles in this case? 3. What is your decision in this situation? Explain your justification!
Self Assessment
1. Mention the basic moral principles contained in several articles of Indonesian ethical guidelines for forensic medicine practitioners below!
2. Dokter forensik harus tetap objektif dan menggunakan kemampuannya sebaik-baiknya sehingga keadilan dapat dilayani dengan fakta kedokteran forensik yang akurat.
4. Sebagai saksi ahli, dokter forensik harus memberikan bantuan yang independen kepada pengadilan dengan pendapatnya yang objektif dan tidak bias, serta tidak sekali-kali berperan sebagai advokat.
5. Sebagai saksi ahli, dokter forensik harus menyajikan fakta yang objektif dan menyeluruh serta dasar pemikiran dan sumber dari mana pendapatnya dikemukakan. 6. Sebagai saksi ahli, dokter forensik harus dapat menjelaskan sedemikian rupa dengan
tidak menjawab pertanyaan atau menerangkan masalah yang berada di luar keahliannya.
7. Sebagai saksi ahli, dokter forensik harus memastikan bahwa keterangannya adalah benar, seluruhnya benar dan tiada lain selain benar.
8. Dokter forensik harus mendukung sejawatnya yang telah melakukan profesinya sesuai dengan standar tetapi memperoleh penekanan oleh pihak lain sehingga kebebasan profesinya terganggu.
Abstrak
Di Indonesia, menurut Pasal 117 Undang-Undang No. 36 tahun 2009 tentang Kesehatan, seseorang dinyatakan telah meninggal apabila fungsi jantung-sirkulasi dan sistem pernapasan terbukti telah berhenti secara permanen, atau apabila kematian batang otak telah dapat dibuktikan. Thanatologi adalah ilmu yang mempelajari tentang kematian dan perubahan yang terjadi setelah kematian dan faktor-faktor yang mempengaruhi perubahan tersebut. Ada beberapa jenis kematian yaitu Mati Somatis / Mati Klinis, Mati Seluler / Mati Molekuler, Mati Serebral / Mati Otak, Mati Batang Otak . Mati Suri / Mati Semu. Terdapat aspek medikolegal dari peristiwa kematian dan isu-isu terkait kematian yaitu Cara Kematian, Penyebab Kematian, Mekanisme Kematian, Lokasi Kematian dan Konsekuensi Kematian. Untuk menjawab isu-isu tersebut langkah yang sangat penting pada investigasi kematian adalah pemeriksaan jenazah. Pemeriksaan jenazah lengkap (otopsi) meliputi pemeriksaan luar, pemeriksaan dalam dan pemeriksaan laboratorium penunjang. Masing-masing pemeriksaan tidak dapat berdiri sendiri, merupakan satu kesatuan sehingga didapatkan kesimpulan sebab, mekanisme dan perkiraan cara kematian. Dokter sering dimintai bantuan untuk melakukan pemeriksaan jenazah karena dianggap yang paling mengetahui mengenai seluk beluk tubuh manusia. Penyidik bila ingin meminta bantuan dokter dalam memeriksa jenazah harus sesuai dengan prosedur medikolegal yang berlaku.
Pada kondisi bencana massal atau jenazah tidak dikenal peran pemeriksaan identifikasi sangatlah penting. Identifikasi forensik merupakan upaya yang dilakukan dengan tujuan untuk menentukan identitas seseorang, karena identitas adalah hak asasi manusia, hak dan kewajiban hukum negara, menentukan status keluarga ( anak, istri / suami ), status social, dan penentuan langkah dalam penyidikan. Tujuan utama dalam proses identifikasi adalah pada kasus yang bukan pidana agar korban dapat diserahkan kepada pihak keluarga untuk ditindak lanjuti seperti dilakukan penguburan, kremasi, penyelesaian klaim asuransi atau masalah waris, dan lain-lain. Sedangkan pada kasus pidana, identifikasi korban merupakan hal pertama yang perlu dilakukan sebelum menemukan tersangka (sebagai langkah awal dalam proses penyidikan).
Lecture : Aspek Medikolegal Kematian
Oleh : Dr. Dudut Rustyadi, Spf
Prinsip-prinsip dalam proses identifikasi adalah ; Pengumpulan Data Post Mortem
Merupakan data berupa hasil dari pemeriksaan mayat, bagian mayat atau kerangka yang meliputi data tentang keadaan umum dan keadaan khusus
Pengumpulan Data Ante Mortem
Merupakan data berupa informasi dari pihak keluarga yang merasa kehilangan anggota keluarganya tentang data keluarga, data pekerjaan, data polisi, data medis/gigi baik termasuk Foto rontgen, Laboratorium dan data benda – benda milik korban dan sebagainya.
Perbandingan Data Ante Mortem dan Data Post Mortem ( Rekonsiliasi )
References:
1. Budiyanto A, Widiatmaka W, Sudiono S, Winardi T, Mun’im A, Sidhi, Hertian S, et al. Ilmu kedokteran forensik. First Edition. Jakarta: Bagian Kedokteran Forensik Fakultas Kedokteran Universitas Indonesia; 1997.
2. Sampurna B, Samsu Z. Peranan Ilmu Forensik Dalam Penegakan Hukum. Jakarta: Bagian Kedokteran Forensik Fakultas Kedokteran Universitas Indonesia; 2003
3. Shepherd R. Simpson’s forensic medicine. Twelfth Edition. Great Britain: Arnold; 2003. 4. Knight B. Forensic pathology. Second Edition. Great Britain: Arnold; 2004.
5. Di Maio VJ, Di Maio D. Forensic pathology. Second Edition. USA: CRC Press; 2001
Learning Objective :
1. Mampu menjelaskan aspek medikolegal dari peristiwa kematian 2. Mampu menjelaskan cara penentuan kematian
3. Mampu menjelaskan jenis-jenis kematian
4. Mampu menjelaskan perkiraaan waktu kematian (Post Mortem Interval)
5. Mampu menjelaskan membedakan cara kematian, sebab kematian dan mekanisme kematian
6. Mampu menjelaskan proses identifikasi
7. Mampu menjelaskan peran dokter dalam proses identifikasi 8. Mampu menjelaskan jenis-jenis identifier
9. Mampu menjelaskan manfaat identifikasi
Skenario 1 :
Dokter Ahmad bekerja disebuah RSUD. Pada suatu hari saat jaga di IGD datang pasien dalam keadaan tidak sadar, diantar keluarganya dengan keterangan megalami kecelakaan lalu lintas sekitar 1 jam yang lalu. Pada saat diperiksa ternyata pasien sudah dalam keadaan meninggal atau Death On Arrival (DOA).
Assignments :
1. Bagaimanakah caranya dokter Ahmad menentukan bahwa telah terjadi kematian klinis pada pasien tersebut?
2. Jelaskan perubahan-perubahan yang terjadi apabila seseorang telah meninggal dunia dan cara memastikan telah terjadi kematian!
3. Bila keluarga meminta Surat Keterangan Kematian, apakah boleh langsung diterbitkan? Jelaskan!
4. Pada pemeriksaan luar ditemukan berupa lebam mayat berwarna merah keungguan pada tubuh bagian belakang yang hilangpada penekanan dan kaku mayat yang mudah dilawan, tentukan perkiraan waktu kematian pasien tersebut!
Skenario 2 :
Jenazah laki-laki ditemukan disebuah tanah kosong. Petugas kepolisian setempat kesulitan menentukan identitas laki-laki tersebut karena pada diperiksa tidak membawa dokumen identitas ataupun tanda pengenal. Jenazah kemudian dievakuasi ke RSUD untuk dilakukan pemeriksaan forensik.
Assignments :
1. Pada pemeriksaan luar jenazah, sebutkan dan jelaskan hal-hal yang menjadi petunjuk identifier agar identitas jenazah dapat diketahui!
2. Data Ante Mortem apa sajakah yang diperlukan agar dapat diketahui identitas jenazah tersebut?
3. Dapatkah diterbitkan Surat Keterangan Kematian pada jenazah yang belum dikenal? Jelaskan alasannya!
4. Bagaimanakah caranya menentukan identitas jenazah yang belum dikenal tersebut?
Abstrak
Asfiksia adalah suatu keadaan yang menimbulkan halangan dalam pertukaran gas di saluran nafas atau di paru-paru. Keadaan tersebut menimbulkan peningkatan kadar CO2
disertai penurunan kadar O2 dalam darah. Penyebab asfiksia dapat berbagai macam
diantaranya adalah mekanik, berbagai penyakit, obat-obatan dan trauma listrik. Disebut asfiksia mekanik bila penyebabnya adalah sumbatan mekanik pada saluran nafas. Menurut letak sumbatannya asfiksia mekanik dibedakan menjadi : gagging, choking, smothering (bekap), throttling or manual strangulation (cekik), strangulation by ligature (jerat), hanging (gantung), traumatik asfiksia (fiksasi otot pernafasan dada dan perut) serta sufokasi.
Tenggelam (drowning) adalah masuknya cairan yang cukup banyak ke dalam saluran nafas hingga ke paru-paru. Keadaan dimana tubuh seluruhnya masuk ke dalam air belum tentu menunjukkan orang tersebut tenggelam, sebaliknya tubuh yang tidak sepenuhnya masuk ke dalam air dapat merupakan peristiwa tenggelam. Masuknya air ke dalam saluran nafas hingga ke paru-paru menimbulkan mekanisme yang tidak serupa dengan
asfiksia mekanik, karenanya tenggelam tidak dimasukan ke dalam penyebab yang menimbulkan asfiksia.
References:
1. Budiyanto A, Widiatmaka W, Sudiono S, Winardi T, Mun’im A, Sidhi, Hertian S, et al. Ilmu kedokteran forensik. First Edition. Jakarta: Bagian Kedokteran Forensik Fakultas Kedokteran Universitas Indonesia; 1997.
2. Sampurna B, Samsu Z. Peranan Ilmu Forensik Dalam Penegakan Hukum. Jakarta: Bagian Kedokteran Forensik Fakultas Kedokteran Universitas Indonesia; 2003
3. Idries AM, Tjiptomartono AL, editors. Penerapan Ilmu Kedokteran Forensik dalam Proses Penyidikan. Jakarta: CV Sagung Seto; 2008
4. Shepherd R. Simpson’s forensic medicine. Twelfth Edition. Great Britain: Arnold; 2003. 5. Knight B. Forensic pathology. Second Edition. Great Britain: Arnold; 2004.
6. Di Maio VJ, Di Maio D. Forensic pathology. Second Edition. USA: CRC Press; 2001.
LECTURE : Asfiksia Dan Tenggelam
Oleh : dr. Kunthi Yulianti, SpKF
Learning Objective :
1. Memahami pengertian dan klasifikasi asfiksia mekanik
2. Mampu menjelaskan perbedaan masing-masing jenis asfiksia mekanik 3. Memahami pengertian dan klasifikasi tenggelam
4. Mampu menjelaskan mekanisme kematian pada tenggelam di air tawar dan di air asin. 5. Mampu menyebutkan temuan postmortem pada korban tenggelam
6. Mampu menjelaskan pemeriksaan getah paru dan diatom pada kasus tenggelam
Skenario 1 :
Jenazah Tn. IMD datang diantar oleh penyidik dari kepolisan ke Instalasi Kedokteran Forensik RSUD dengan membawa Surat Permintaan Visum et Repertum Jenazah. Dari keterangan polisi yang mengantar, jenazah ditemukan dalam posisi setengah duduk di bawah pohon mangga pada kebun yang jauh dari pemukiman dengan tali melilit dilehernya yang diikatkan pada dahan terendah dari pohon mangga tersebut. Dari pemeriksaan didapatkan :
Lebam mayat pada pinggang, bokong, kedua lengan bawah sampai ujung jari dan kedua tungkai, warna merah keunguan yang tidak hilang pada penekanan. Lebam mayat tidak tampak pada kedua telapak kaki
Kaku mayat pada seluruh tubuh Pembusukan tidak ada
Sebuah luka lecet tekan yang melingkari leher secara tidak penuh dari arah depan bawah ke belakang atas.
Tidak ditemukan luka-luka lain.
Assignments
1. Informasi apa lagi yang perlu digali pada kasus ini!
2. Sebelum melakukan pemeriksaan jenazah apa yang perlu diperhatikan dokter!
3. Berdasarkan gambaran dan pola lukanya termasuk dalam asfiksia mekanik yang mana kasus ini, berikan alasannya!
4. Berdasarkan pemeriksaan jenazah, tentukan dan jelaskan perkiaraan cara kematian pada kasus ini!
Self assessment
1. Sebutkan klasifikasi asfiksia mekanik!
2. Jelaskan pengertian masing-masing klasifikasi asfiksia mekanik! 3. Jelaskan perbedaan antara gaging dan choking!
4. Jelaskan perbedaan cekik, gantung dan jerat!
5. Berdasarkan letak simpul dan posisi jenazah, jelaskan pembagian tipe gantung (hanging)!
6. Sebutkan temuan postmortem pada jenazah yang meninggal akibat asfiksia!
Skenario 2 :
Assignments:
1. Jelaskan apa yang perlu diperhatikan oleh seorang dokter, saat melakukan pemeriksaan luar jenazah pada kasus ini!
2. Bagaimana cara menenentukan penyebab kematian pada kasus ini!
3. Mengapa tubuh yang ditemukan di dalam air belum tentu meninggal karena tenggelam!
Self assessment
1. Jelaskan perbedaan mekanisme kematian pada tenggelam di air tawar dan air asin ! 2. Jelaskan perbedaan mekanisme kematian pada asfiksia mekanik dan tenggelam ! 3. Sebutkan temuan postmortem pada jenazah yang ditemukan di air!
4. Sebutkan temuan postmortem pada jenazah yang meninggal karena tenggelam! 5. Jelaskan cara pemeriksaan getah paru!
6. Jelaskan cara pemeriksaan diatom !
7. Jelaskan perbedaan kecepatan pembusukan di dalam tanah, di atas permukaan tanah (suhu lingkungan) dan di dalam air!
Kekerasan fisik dapat terjadi dimana-mana, baik dalam bentuk penganiayaan atau kekerasan fisik di dalam rumah tangga (domestic violence). Kekerasan fisik yang sengaja dilakukan untuk menimbulkan penderitaan pada korban disebut penganiayaan (torture). Penganiayaan menimbulkan luka-luka diluar tubuh dan juga bisa mengenai organ dalam (organ visceral) dan bahkan kematian.
Berdasarkan penyebab luka, luka dibedakan menjadi Luka Mekanis, Luka Fisik dan Luka Kimia. Luka Mekanis dapat disebabkan oleh kekerasan tumpul (blunt force trauma). Kekerasan tajam (sharp force trauma) dan luka tembak. Luka Fisik dapat disebabkab oleh suhu, elektrik dan barotrauma. Sedangkan luka kimia dapat disebabkan zat asam kuat dan Basa kuat.
Luka adalah salah satu bukti medis dari kasus tindak pidana penganiayaan disamping akibat yang ditimbulkannya.Sehubungan dengan bukti medis, Luka memiliki berbagai sifat yaitu sebagai bukti transient, bukti pola, bukti kontak dan bukti kondisional. Luka sebagai bukti transient karena luka cepat mengalami perubahan yaitu menyembuh atau mengalami komplikasi pada korban hidup atau berubah karena proses pembusukan pada korban meninggal. Bukti pola menunjukkan terjadinya luka mengikuti pola-pola tertentu baik bentuk maupun distribusinya. Pola benda penyebab,pola luka penaniayaan,pola luka akibat usaha bunuh diri atau akibat kecelakaan dapat ditentukan dari gambarannya. Luka juga sebagai bukti kondisional yaitu bukti yang dipengaruhi oleh berbagai factor. Usia dan status kesehatan korban merupakan salah satu factor yang mempengaruhi gambaran luka.
Kasus penganiayaan adalah tindak pidana dengan delik material dimana pertangungjawaban pelaku karena akibat dari perbuatannya. Pemeriksaan terhadap korban
LECTURE : KEKERASAN FISIK (PENGANIAYAAN) DAN KEJAHATAN SEKSUAL (SEXUAL ASSAULT)
Oleh : dr. Ida Bagus Putu Alit,SpF.DFM
tindak pidana penganiayaan adalah kewajiban hukum bagi dokter, maka seorang dokter harus (obligasi) bertanggung jawab untuk memeriksa, mendokumentasikan dan menginterpretasikan luka untuk kepentingan penegakan hukum. Interpretasi akibat dari luka yang menjadi bukti hukum (legal evidence) adalah derajat luka atau kualifikasi luka yang akan memberikan keyakinan Hakim di Pengadilan.
Setelah ditetapkan Undang-undang Perlindungan Anak (UU PA) dan Penghapusan Kekerasan dalam Rumah Tangga (UU PKDRT), maka kekerasan dibedakan menjadi beberapa bentuk kekerasan yaitu : Kekerasan Fisik, Kekerasan Psikologis,Kekerasan seksual dan penelantaran (negligence) serta perampasan kemerdekaan. Selain kekerasan fisik, kekerasan seksual memiliki angka kejadian yang tinggi terutama pada korban anak-anak. Komnas Perlindungan Anak menyatakan tahun 2014, Indonesia sudah mengalami kedaruratan kekerasan seksual anak.
Secara hukum, kejahatan seksual adalah kejahatan yang menentang kehendak (crime against will) dan kejahatan terhadap kepemilikan (crime against property). Kejahatan yang menentang kehendak apabila hubungan seksual dilakukan tanpa persetujuan (without consent) atau diperoleh dari persetujuan yang tidak sah. Persetujuan yang sah harus memenuhi syarat Alamiah (natural), spontan, tidak ada keraguan (unequivocal) dan atas keinginan sendiri (volunteer). Persetujuan tidak sah bila diperoleh dengan kekerasan (force), ancaman kekerasan (fear) dan tipu daya (fraud).
Kejahatan seksual sebagai kejahatan terhadap kepemilikan (crime against property) apabila hubungan seksual dilakukan terhadap pasangan yang sudah dalam ikatan perkawinan yang sah, termasuk dalam hal ini adalah perselingkuhan (overspel). Overspel bersifat Delik aduan yang hanya bisa dipidanakan bila salah satu pasangan merasa dirugikan.
Perkosaan (rape) adalah salah satu bentuk dari kejahatan seksual yang menentang kehendak. Hukum di Indonesia memandang perkosaan dari persepsi tertentu yang mungkin berbeda dengan pandangan hukum di Negara-negara lain. Perkosaan di Indonesia adalah pelakunya laki-laki (male crime),diluar perkawinan (extra marital crime),hanya lewat genito-genital (intra-vaginal crime) dan tanpa persetujuan (without consent).
Secara mengkhusus (lex spesialis), UU perlindungan Anak dan UU PKDRT menyatakan kekerasan seksual juga termasuk memaksa wanita berhubungan seksual dengan orang lain untuk tujuan tertentu termasuk penjualan orang (human traficing)
Peran dokter dalam kasus kejahatan seksual adalah membantu proses pembuktian hukum terhadap kasus tersebut. Pembuktian hukum adalah membuktikan memang benar tindak pidana (kejahatan seksual) itu terjadi dan memang benar tersangka adalah pelakunya. Dalam membuktikan terjadinya kejahat seksual, seorang dokter harus memberikan bukti-bukti medis berupa tanda kedewasaan korban, ada tidaknya tanda-tanda kekerasan,ada tidaknya tanda persetubuhan,waktu terjadinya persetubuhan dan akibat persetubuhan bila ditemukan. Tanda kedewasaan untuk membuktikan konpeten atau tidaknya korban dalam memberikan persetujuan dilakukannya hubungan seksual. Tanda kekerasan adalah bukti medis yang menunjukkan korban tidak setuju (without consent) yang dapat berupa luka-luka terutama pada daerah extra-aerogen atau tanda keracunan yang menurunkan kesadaran korban. Bukti persetubuhan dapat berupa tanda penetrasi dan atau tanda ejakulasi.Waktu persetubuhan dapat dibuktikan dengan proses penyembuhan pada genetalia atau karakteristik dari komponen mani yang diperiksa di laboratorium.
References:
1. Budiyanto A, Widiatmaka W, Sudiono S, Winardi T, Mun’im A, Sidhi, Hertian S, et al. Ilmu kedokteran forensik. 1st ed. Jakarta: Bagian Kedokteran Forensik Fakultas Kedokteran Universitas Indonesia; 1997.
