Scenario B Blok 22 Batch

2018

“Indiscriminate Dumping”

Ceria Village is located near the river, where there is a slaughterhouse. Based
on the report of the environmental health officer at the Puskesmas, the slaughtering
waste is directly dumped into the river. Community bathing, washing and toilet
activities use river water. The livelihoods of the people in Ceria village are forest-
encroaching farmers, who clear land by burning trees.
Dr. Susi has only worked for one year at the Puskesmas Bahagia, where she
received a report from the Puskesmas surveillance staff that the incidence of
diarrhea cases had doubled from the previous month, while from data of the top ten
diseases, acute respiratory infection (ARI) was ranked first. Dr. Susi is going to
conduct an epidemiological investigation of diarrhea and provide counseling on
cases of infectious diseases.

I. Clarification of term
1. Epidemiological: Any deviation from or disturbance in the normal
structure or function of a body part, organ or system characterized by a
characteristic group of symptoms and signs (Dorland, 2015).
2. Incidence: The certain even such as, the number of new case of specific
disease occuring during given period in population risk (Dorland,
2015)
3. Surveillance: the process of collecting, processing, analyzing, and
interpreting data systemically and continuously and disseminating
information to units that need to be able to take action
4. Puskesmas health service facility that organizes public health efforts
and first-level individual health efforts, by prioritizing promotive and
preventive efforts, to achieve the highest level of public health in its
working area (Putri, 2017)
 5. Acute respiratory infection: Consists of upper respiratory tract
infections and lower respiratoryhanging from the affected respiratory
tract area (Zulaikhah et al., 2017).
6. Waste: caused by biological agents, among others, viruses, bacteria,
fungi and parasites (Lescano et al., 2010).
7. Diseases: Any deviation from or disturbance in the normal structure or
function of a body part, organ or system characterized by a
characteristic group of symptoms and signs (Dorland, 2015).
8. Diarrhea: Abnormal discharge of watery stools many times (Dorland,
2015)
9. Counseling: An activity or efforts to convey health messages to
community, group or individual with hope the presence of messages
can get knowledge about better health, ultimately the knowledge can
change his behavior (Notoatmodjo, 2012)
10. Infectious diseases: disease can be transmitted to humanity caused by
biological agents, among others, viruses, bacteria, fungi and parasites
(Lescano et al., 2010).
11. Investigation: investigation by recording or recording facts conducting
reviews, experiments, and so on, with the aim of obtaining answers to
questions (KBBI)
II. Identification of problem
1. Ceria Village is located near the river, where there is a
slaughterhouse. Based on the report of the environmental health
officer at the Puskesmas, the slaughtering waste is directly dumped
into the river. Community bathing, washing and toilet activities use
river water. The livelihoods of the people in Ceria village are forest-
encroaching farmers, who clear land by burning trees.
2. Dr. Susi has only worked for one year at the Puskesmas Bahagia,
where she received a report from the Puskesmas surveillance staff
that the incidence of diarrhea cases had doubled from the previous
month, while from data of the top ten diseases, acute respiratory
infection (ARI) was ranked first.
 3. Dr. Susi is going to conduct an epidemiological investigation of
diarrhea and provide counseling on cases of infectious diseases.

III. Prioritize of problem

Number 1, because is the main problem so that Dr. Susi will conduct an
epidemiological investigation of diarrhea and provide counseling about
infectious disease cases.
IV. Analysis of Problem
1. Ceria Village is located near the river, where there is a slaughterhouse.
Based on the report of the environmental health officer at the Puskesmas,
the slaughtering waste is directly dumped into the river. Community
bathing, washing and toilet activities use river water. The livelihoods of
the people in Ceria village are forest-encroaching farmers, who clear land
by burning trees.
a. What is the meaning Ceria Village is located near the river, where
there is a slaughterhouse. Based on the report of the environmental
health officer at the Puskesmas, the slaughtering waste is directly
dumped into the river?
b. What is the impact the slaughtering waste is dricetly dumped into the
river?

c. What is the meaning Community bathing, washing and toilet

activities use river water?
Community bathing, washing and toilet activities use river water is
one of the risk factor for complaints. Water pollution can be caused by
waste from domestic, industrial and agriculture. poor water sanitation
will cause disease. Some water-related diseases (Waterborne Deseases).
Drinking water contamination by wastewater and / or by human waste
(feces), which contains organisms that can causing disease, viruses,
pathogenic bacteria and so on, can spread rapidly throughout the drinking
water service network system, and can cause an outbreak or explosion in
the number of disease sufferers in an area in a short time (Herlambang,
2018).
Poor water sanitation can also be caused by the presence of chemical
substances due to activities such as bathing and washing. The risk or
danger to health can also be due to the presence of substances or chemical
compounds in drinking water, which exceed the allowable concentration
threshold. The presence of chemical substances / compounds in drinking
water can occur naturally and or as a result of human activities, for
example by household, industrial waste, etc. Several chemical
substances / compounds that are toxic to the human body, for example
heavy metals, pesticides, hydrocarbon micro-pollutants, natural or
artificial radioactive substances and so on (Herlambang, 2018).

d. What kind of slaughtering waste?

e. What disease can causes by slaughtering waste?

f. What are the requirements for clean water?
According to Peraturan Menteri Kesehatan Republik Indonesia Nomor 32
Tahun 2017 Tentang Standar Baku Mutu Kesehatan Lingkungan dan
Persyaratan Kesehatan Air Untuk Keperluan Higiene Sanitasi, Kolam
Renang, Solus Per Aqua, dan Pemandian Umum, Environmental Health
Quality Standards for Water media for Sanitation Hygiene Purposes
include physical, biological and chemical parameters which can be
mandatory parameters and additional parameters. Mandatory parameters
are parameters that must be checked periodically in accordance with
statutory provisions, while additional parameters are only required to be
checked if geohydrological conditions indicate potential contamination
with respect to additional parameters. Water for Hygiene Purposes
Sanitation is used for personal hygiene maintenance such as bathing and
toothbrushes, as well as for washing foodstuffs, eating utensils and
clothes. In addition, water for sanitation purposes can be used as raw
water for drinking water.
Table 1. Physical Parameters in Health Quality Standards Environment
for Water Media for Sanitation Hygiene Purposes
No Mandatory Parameters Unit Quality Standards
. (maximum level)
1. Turbidity NTU 25
2. Colour TCU 50
3. Dissolved solid mg/l 1000
(Total Dissolved Solid)
4. Temperature ˚C Air temperature ± 3
5. Taste Tasteless
6. Smell Odorless
(Peraturan Menteri Kesehatan Republik Indonesia Nomor 32 Tahun 2017
Tentang Standar Baku Mutu Kesehatan Lingkungan dan Persyaratan
Kesehatan Air Untuk Keperluan Higiene Sanitasi, Kolam Renang, Solus
Per Aqua, dan Pemandian Umum).

Table 2 lists the mandatory parameters for biological parameters to be

checked for sanitary hygiene purposes which includes total coliform and
escherichia coli with colony forming units in 100 ml water samples.
Table 2. Biological Parameters in Health Quality Standards Environment
for Water Media for Sanitation Hygiene Purposes
No Mandatory Parameters Unit Quality Standards
. (maximum level)
1. Total coliform CFU/100ml 50
2. E. Coli CFU/100ml 0
(Peraturan Menteri Kesehatan Republik Indonesia Nomor 32 Tahun 2017
Tentang Standar Baku Mutu Kesehatan Lingkungan dan Persyaratan
Kesehatan Air Untuk Keperluan Higiene Sanitasi, Kolam Renang, Solus
Per Aqua, dan Pemandian Umum).
Table 3 lists the chemical parameters to be checked for sanitary hygiene
purposes which includes 10 mandatory parameters and 10 additional
parameters. Additional parameters are set by the district / city government
and the port / airport authority.
Table 3. Chemical Parameters in Health Quality Standards Environment
for Water Media for Sanitation Hygiene Purposes
No Mandatory Parameters Unit Quality Standards
. (maximum level)
Required
1. pH mg/l 6,5-8,5
2. Iron mg/l 1
3. Fluoride mg/l 1,5
4. Hardness (CaCO3) mg/l 500
5. Manganese mg/l 0,5
6. Nitrates, as N mg/l 10
7. Nitrites, as N mg/l 1
8. Cyanide mg/l 0,1
9. Detergent mg/l 0,05
10 Total pesticides mg/l 0,1
Additional
1. Mercury mg/l 0,001
2. Arsenic mg/l 0,05
3. Cadmium mg/l 0,005
4. Chromium (6 valence) mg/l 0,05
5. Selenium mg/l 0,01
6. Zinc mg/l 15
7. Sulfate mg/l 400
8. Lead mg/l 0,05
9. Benzene mg/l 0,01
10 Organic matter (KMNO4) mg/l 10
(Peraturan Menteri Kesehatan Republik Indonesia Nomor 32 Tahun 2017
Tentang Standar Baku Mutu Kesehatan Lingkungan dan Persyaratan
Kesehatan Air Untuk Keperluan Higiene Sanitasi, Kolam Renang, Solus
Per Aqua, dan Pemandian Umum).

According to the Kemenkes RI (2018), the requirements for drinking

water are as follows :
1. Not tasteless
2. Nothing
3. Colorless
4. Does not contain harmful microorganisms
5. Does not contain heavy metals

g. What is the indicator of water polution?

the indicator of water pollution are:
1. Changes in water temperature Water whose temperature rises will
disrupt the life of aquatic organisms because dissolved oxygen levels
in water will decrease along with the increase in temperature.
2. Changes in pH or hydrogen ion concentration Normal water that
meets the requirements for life has a pH range of 6.5-8.5. Wastewater
and wastewater from industrial activities discharged into rivers will
change the pH of the water which in turn can disrupt the life of
organisms in the water.
3. Change in color, smell and taste of water Waste materials in the form
of organic and inorganic materials can dissolve in water. If the waste
material dissolves in water, it will change color. Water in normal
circumstances will not be colored so that it looks clear and clear. The
odor that comes out of the water can come directly from sewage or
wastewater from industry, or it can come from the degradation of
waste materials by microbes that live in water. The appearance of an
odor in environmental water can absolutely be used as a sign of a high
level of water pollution. The color change in water is due to the
 minerals dissolved in the water. Changes in taste in general are also
followed by changes in pH.
4. Sedimentation, colloids, and dissolved materials. Deposits and
colloids as well as dissolved materials come from the presence of
solid industrial waste materials. Deposits and colloids floating in the
water will block the entry of sunlight into the water layer, as a result,
the photosynthesis process does not take place optimally. If the
sediment comes from organic material, the sediment will be degraded
into simpler materials. In this case the oxygen level will decrease
further. If the dissolved waste material is inorganic, the water will get
additional metal ions, of which many heavy metal ions are toxic.
5. Microorganisms play a very important role in the process of
degradation of organic waste materials. If there is enough waste
material to be degraded, it means that the proliferation of
microorganisms is also increasing, this does not rule out the
possibility of pathogenic microbes also developing as well.
6. Increase the radioactivity of environmental water. Radioactive
substances can cause various kinds of biological damage if handled
incorrectly. This substance already exists naturally on earth and its
existence could also increase due to the use of nuclear technology
which is not environmentally friendly in the fields of medicine and
agriculture, for example.
Clean water parameters for health
According to Riyanto (2009), Water parameters related to health can be
done with physical parameters, chemical parameters and biological
parameters. If these parameters exceed the standard, it will have an impact
on human health.
1. Physical Parameters
Physical parameters include:
a. Temperature The maximum temperature allowed is 30 ° C. The
waste water temperature is generally higher than normal water
 temperature. This is due to the condition of the water process in
industrial activities using a higher temperature.
b. Sedimentation substance The maximum permissible precipitate is
1.0 mg / L. Substances deposited in water are caused by the
deposition process due to the gravitational force of the substances
floating in the water. The purpose of settling is to purify the water
so as to reduce turbidity. Precipitation is only useful in separation
coarse particles that descend fast. Another result of deposition is
the separation of bacteria. The percentage of bacteria is
proportional to turbidity.
2. Chemical Parameters
Chemical parameters that can be measured include :
a. pH pH shows the concentration of H + ions and is an important
parameter in determining the quality of wastewater and deep
water. The pH limit obtained is 6.5 - 8.5.
b. Biological Oxygen Demand (BOD) Biological Oxygen Demand
(BOD) is the amount of oxygen needed for microbial growth. The
maximum permissible BOD is 30 mg / L as O2. if BOD exceeds
30 mg / L, will reduce the growth of certain microbes (good
microbes) and cause the growth of "bad" microbes.
The high growth of bad microbes can cause various diseases.
c. Chemical Oxygen Demand (COD) Chemical Oxygen Demand
(COD) is the amount of oxygen needed to oxidize chemical
substances in a water system. The maximum permissible COD is
80 mg / L as O2, if it exceeds it can cause various diseases.
d. Dissolved oxygen (DO) is one of the parameters regarding water
quality. The availability of dissolved oxygen in water determines
life in these waters. The quality standard for DO content in the
river is 6 Mg / L. The higher the Dissolved Oxygen (DO) content
the better the water quality.
3. Biological Parameters Healthy water is water that does not contain
microorganisms such as pathogenic microbes. Pathogenic microbes
 are the cause of various kinds of germs such as dysentery, typhoid,
cholera, protists, viruses and pathogenic bacteria that cause disease.
With these standards, the consumption water we use will be safe for
our health, therefore be selective human beings for our health and also
for our survival.

h. What are the criteria of healthy environments?

i. How to proceed slaughtering waste before throw away?
j. What are the requirements for a healthy latrine?
According to the Peraturan Menteri Kesehatan No. 3 Tahun 2014 Tentang
Sanitasi Total Berbasis Masyarakat Jamban Sehat Efektif Untuk Memutus
Mata Rantai Penularan Penyakit in Depkes RI (2004), there are several
requirements for healthy latrines, including:
1. Do not pollute drinking water sources, the location of the collecting
holes is 10-15 meters from drinking water sources.
2. It is odorless and the feces cannot be touched by insects or mice.
3. It is wide enough and sloping towards the squatting hole so that it
does not contaminate the surrounding soil.
4. Easy to clean and safe to use.
5. Equipped with protective walls and roofs, waterproof and colored
walls.
6. Enough lighting.
7. Watertight floors.
8. Good ventilation.
9. Water and cleaning tools are available.

k. What is the relation between main problem and based on the report of
the environmental health officer?
l. What is the meaning The livelihoods of the people in Ceria village
are forest-encroaching farmers, who clear land by burning trees?
m. What the impact of clear land by burning trees?
 n. What is the indicator of air polution?
Based on Peraturan Pemerintah Republik Indonesia Nomor 41 Tahun
1999 tentang Pengendalian Pencemaran Udara, the levels of air pollution
are determined. The national standard air for carbon monoxide (CO) is
15,000 µg / Nm ', sulfur dioxide (SO2) is 632 µg / Nm³, and nirogen
dioxide (NO2) is 316 µg / Nm³. Air pollution can be obtained by several
factors, one of which is the climate factor. High air temperature
conditions will cause the airborne material in the form of particles to
become dry and light so that it lasts longer in the air. Air pollutants can
be in the form of gases, namely nitrogen oxides (NO, NO2), sulfur
oxides (SO, SO2), carbon monoxide (CO), oxidants (O3), lead (Pb),
volatile gases that are spread into the air and in the form of dust (TSP) or
particulates

According to the national Ambient Air Quality Standard (BMUA) in the

Government Regulation on Air Pollution Control (PP Number 41 of
1999) only mentions 9 (nine) types of common pollutants, namely Sulfur
Dioxide (SO2), Carbon Monoxide (CO), Nitrogen Dioxide (NO2),
Ozone (O3), Hydro Carbon (HC), PM10, PM2,5, TSP (dust), Pb (lead),
dustfall (dust falling). The best indicator in determining the degree of a
case of pollution is by measuring or checking the concentration of sulfur
dioxide gas, smoke index, and dust particles in the air

o. What are the impact of air polution?

p. What diseases can causes by air polution?

2. Dr. Susi has only worked for one year at the Puskesmas Bahagia, where
she received a report from the Puskesmas surveillance staff that the
incidence of diarrhea cases had doubled from the previous month, while
from data of the top ten diseases, acute respiratory infection (ARI) was
ranked first.
a. What is the meaning Dr. Susi has only worked for one year at the
Puskesmas Bahagia, where she received a report from the Puskesmas
surveillance staff that the incidence of diarrhea cases had doubled
from the previous month, while from data of the top ten diseases,
acute respiratory infection (ARI) was ranked first?
b. What is the definition of outbreaks?
c. What is the criteria of outbreaks?
According to Peraturan Menteri Kesehatan Republik Indonesia Nomor
1501/MENKES/PER/X/2010 Tentang Jenis Penyakit Menular Tertentu
yang dapat Menimbulkan Wabah dan Upaya Penanggulangan, There are 7
criteria for outbreaks, they are :
1. The emergence of a certain infectious disease that was not previously
available or unknown in an area
2. Increased incidence of pain continuously for 3 (three) periods in
hours, days or weeks consecutively according to the type of disease
3. An increase in the incidence of morbidity to be two or more times
compared to the previous period in hours, days, or weeks according
to the type of illness
4. The number of new sufferers in a period of 1 (one) month shows an
increase of two or more times compared to the average number per
month in the previous year
5. The average number of morbidity incidents per month for 1 (one)
year shows an increase of two or more times compared to the average
number of morbidity incidents per month in the previous year
6. The Case Fatality Rate in 1 (one) period of time shows an increase of
50% (fifty percent) or more compared to the case fatality rate of a
disease in the previous period within the same period.
7. The Proportional Rate of new sufferers in one period shows an
increase of two or more times compared to the previous period in the
same period
d. How to do prevention of outbreaks?
According to Undang-Undang Nomor 4 Tahun 1984 tentang Wabah
Penyakit Menular dan Peraturan Pemerintah Nomor 40 Tahun 1991,
concerning the prevention of infectious diseases regulates that any
outbreaks of infectious diseases or situations that can lead to outbreaks of
infectious diseases (extraordinary events) must be handled as early as
possible. Prevention efforts are carried out through improving risk factors,
overcoming disease from the source of transmission, breaking the chain of
disease transmission, increasing the vulnerability of a group of people
based on epidemiological characteristics and strengthening the
community service system.
Management of outbreaks / outbreaks includes epidemiological
investigations and surveillance; patient management; prevention and
immunization; elimination of disease causes; handling of bodies due to
the plague; outreach to the community; and other countermeasures
(Peraturan Menteri Kesehatan Republik Indonesia Nomor 45 Tahun 2014
Tentang Penyelenggaraan Surveilans Kesehatan Pasal 4 ayat 1).

e. How to conduct investigation of suspected outbreaks?

f. What is the relation between acute respiratory infection (ARI) with
the case?
g. What is the relation between the increase of diarrhea incidence with
the case?

h. How is the transmission of diarrhea in this case?

Waterborne disease is water that does not meet the requirements and is a
good transmission medium for disease. So in the case of transmission
through polluted water due to waste from the factory being discharged
into the river, causing the virus to develop rapidly, residents use the river
water to carry out activities such as bathing, washing, BAK and
defecating (waterborne mechanism).
Mode of Transmission. Diarhae is transmitted from person to person
through oral faecal, bacteria contaminates food and drink and the
causative agent is found in the faeces. (Azwar, 2005).

i. What are the duties and responsibilities of the puskesmas towards the
environment?

j. What causes the increased incidence of disease?

For Diarhae, Source of transmission namely drinking water or
contaminated food human feces containing bacteri Campylobacter,
Salmonella, Shigella, dan E. Coli. Some water-related diseases
(Waterborne Deseases). Drinking water contamination by wastewater
and / or by human waste (feces), which contains organisms that can
causing disease, viruses, pathogenic bacteria and so on, can spread rapidly
throughout the drinking water service network system, and can cause an
outbreak or explosion in the number of disease sufferers in an area in a
short time. Some of the special features of deployment these diseases,
among others, namely transmission process generally by mouth; occur in
service areas where the water is polluted; sufferers are generally
concentrated on a region temporarily; the sufferer is not limited to
ethnicity, age, or gender certain (Herlambang, 2018)

k. What are the goals and benefits of the surveillance staff?

l. How to make surveillance report in puskesmas?
m. What is the basic principal of surveillance?
According to Peraturan Menteri Kesehatan Republik Indonesia Nomor 45
Tahun 2014 Tentang Penyelenggaraan Surveilans Kesehatan, Operation
Surveillance Health done through data collection, data processing, data
analysis, and dissemination as an inseparable unit to produce information
that is objective, measurable, comparable over time, between regions, and
between community groups as material decision-making
3. Dr. Susi is going to conduct an epidemiological investigation of diarrhea
and provide counseling on cases of infectious diseases.
a. What is the meaning Dr. Susi is going to conduct an epidemiological
investigation of diarrhea and provide counseling on cases of
infectious diseases?
b. How is the process on the epidemiological investigation?
c. What kind of epidemiological investigation?
d. What are the methods of measuring epidemiology?
e. How to do good and correct counseling method?
1. Assess community health needs.
2. Determine public health problems.
3. Prioritize the problems to be addressed first through public health
education.
4. Developing an extension plan
1) Make purpose
2) Goals setting
3) Compiling extension material / content
4) Choose the right method
5) Determine the type of props to be used
6) Determination of evaluation criteria.
5. Implementation of education
6. Assessment of outreach results
7. Follow-up from instructors

f. What are the triangle of epidemiology in this case?

 4. What are the islamic value in this case? (QS 10 Yunus : 101, QS 59 Al-
Hasyr : 18, QS 49 Al-Hujarat: 6)

O you who have believed, if there comes to you a disobedient one with
information, investigate, lest you harm a people out of ignorance and
become, over what you have done, regretful.

V. Hypothesis
dr. Susi plans to conduct an epidemiological investigation of diarrhea and
provide counseling on infectious diseases because the increasing cases of
diarrhea and acute respiratory infections (ARI) may be caused by polluted
air and water.
VI. Conceptual Framework

Slaughtering waste Bathing, washing, Burn Trees

and toilet activities
on the river
Airbone disease

Waterbone disease Acute Respiratory

Infection increase to
rank first on
Diarrhea Outbreaks surveillance report

Conduct epidemiologocial
investigantion and Provide
Counseling