TUTORIAL REPORT

SCENARIO B BLOCK 22

Group 5
Mentor : dr. Putri Zalika Kesuma M.Pd.Ked
Members’s Name :
Muhammad Ismailsyah 702019004
Lutfiah Hafidzah 702019019
Amaliah Indah Putri 702019040
Asa Gemilang Puja Esha 702019049
Odyse Radtya H. Naibaho 702019056
Sylvia Salsalbilla Saputri 702019060
Marina Dwi Putri 702019075
Nur Azizah 702019078
Khofifah Alqiftiyah 70201908
Deska Fitriani 702019097
Wiwik Sulastri 702019104

FACULTY OF MEDICINE

UNIVERSITY MUHAMMADIYAH PALEMBANG

2021/2022
 FOREWORD

Praise our thanks to Allah SWT for all His mercy and grace. We were able
to complete the tutorial report entitled “Tutorial Report Scenario B Block 22” as a
group competency assignment. Shalawat along with greetings are always poured
out to our lord, the great prophet Muhammad SAW and his family, friends, and
followers until the end of time.

We recognize that this tutorial report is far from perfect. Therefore, we

expect constructive criticism and suggestions for improvement in the future. In
completing this tutorial report, the author received a lot of help, guidance and
advice. On this occasion, the author would like to respect and thank :

1. Allah SWT, who has given life with the coolness of faith.
2. Both parents who always provide material and spiritual support.
3. dr. Putri Zalika Kesuma M.Pd.Ked as the mentor for group 5.
4. Colleagues.
5. All those who help us. May Allah SWT reward all the charities given to
all those who have supported the author and I hope this tutorial report is
useful for us and the development of science. May we always be protected
by Allah SWT.

Palembang, November 2022

Writer

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 TABLE OF CONTENTS

FOREWORD.........................................................................................................ii

TABLE OF CONTENTS.....................................................................................iii

CHAPTER I PRELIMINARY.............................................................................1

1.1 Background....................................................................................................1

1.2 Purpose and Objectives..................................................................................1

CHAPTER II DISCUSSION.................................................................................3

2.1 Tutorial Data....................................................................................................3

2.2 Tutorial Rules.................................................................................................3

2.3 Scenario..........................................................................................................3

2.4 Clarification of Term......................................................................................4

2.5 Priority Problem.............................................................................................4

2.6 Problem Analysis...........................................................................................5

2.7 Conclusion....................................................................................................38

2.8 Conceptual of Framework............................................................................38

REFERENCES.....................................................................................................39

iii
 CHAPTER 1
PRELIMINARY

1.1 Background
Block of Community Medicine and Public Health is one of the blocks in
the seventh semester of the Medical Education Competency-Based Curriculum,
Faculty of Medicine, Muhammadiyah University of Palembang. As we know that
the learning program at FK UMP uses the KBK learning system and problem
based learning, so it is hoped that doctor graduates from FK UMP will become
doctors who are able to solve public health problems.
On this occasion, a scenario B case study tutorial was, “Mount Sinabung
Erupts”, Berastepu village is located near Mount Sinabung, is no longer habitable
ecause of the eruption of Mount Sinabung, Karo Regency. Due the eruption of
Mount Sinabung, people’s harvested vegetables cannot be transported to the city
because the roads are demages, The result, many of the community’s vegetables
became rotten which soiled the village. It is diffuclt for people to take clean water
for bathing, washing and dringking water because the water source is polluted
with rotting vagetables. The erupting volcanic lava ash hoarded people’s home.
Surveillance result from Puskesmas doctor there was an incrase the incidence of
ARI case reaching 3 times from the previous months. Puskesmas doctor plans to
conuct epidemiological investigations in several surrouning village and provide
public health counseling.

1.2 Purpose and Objectives

The aims and objectives of this case study tutorial report are:

1. As a tutorial group assignment report which is part of the CBC learning

system at the Faculty of Medicine, Muhammadiyah University of
Palembang.

2. Can solve the cases given in the scenario with the method of analysis and
group discussion learning.

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3. The achievement of the objectives of the tutorial learning method.

2
 CHAPTER II
DISCUSSION
2.1 Tutorial Data

Tutor : dr. Putri Zalika Kesuma M.Pd.Ked

Moderator : Asa Gemilang Puja Esha

Secretary Board : Wiwik Sulastri

Secretary Desk : Odyse Radtya H. Naibaho

Date and Time : 1. Monday, 7 November 2022

Time : 08.00 - Finished

2. Wednesday, 9 November 2022

Time : 08.00 – Finished

2.2 Tutorial Rules :

1. Tutorial members must have an opinion.
2. Prior permission if you want to give an opinion.
3. Speak polilety and full of manners.

2.3 Scenario

“Mount Sinabung Erupts”

Berastepu village is located near Mount Sinabung, is no longer

habitable ecause of the eruption of Mount Sinabung, Karo Regency. Due
the eruption of Mount Sinabung, people’s harvested vegetables cannot be
transported to the city because the roads are demages, The result, many of
the community’s vegetables became rotten which soiled the village. It is
diffuclt for people to take clean water for bathing, washing and dringking
water because the water source is polluted with rotting vagetables. The
erupting volcanic lava ash hoarded people’s home.

3
 Surveillance result from Puskesmas doctor there was an incrase the
incidence of ARI case reaching 3 times from the previous months.
Puskesmas doctor plans to conuct epidemiological investigations in
several surrouning village and provide public health counseling.

2.4 Clarification of Term

No Clarification of Term
Data recording officer who do routine an
1. Survilance
epidemiology (KBBI, 2018).
The erupted of a mountain (KBBI, 2018).
2. Eruption
On education that given by public health malters to
3. Public health
the people that use psiology methode (KBBI,
counseling
2018).
Consists of upper respiratory tract infections and
4. ARI
lower respiratory trac diases, cause by infection of
microorganisme (Dorland, 2015).
Indentification image, infection and population
5. Epidemiological
discover the mecanism of tranfusion with the
eventnal goal being to develop infection for
prevention, detection, thereatment, and control of
infection (Dorlnad, 2015).
An air contains a gas that has no colour of toxicity
6. Polluted
(KBBI, 2018).
A change in conditions in a water reservoir such as
7. Water polluted
lakes, rivers, oceans and groundwater due to
human activities. Lakes, rivers, oceans and
groundwater are an important part of the human
life cycle and are
part of the hydrological cycle (KBBI, 2018)
Unused disposal materials that have a negative
8. Rotten
impact on society if not managed properly. Waste is

4
 the rest of production, both from nature and the
result of human activities (KBBI, 2018)

2.5 Identification of Problem

1. Berastepu village is located near Mount Sinabung, is no longer

habitable ecause of the eruption of Mount Sinabung, Karo Regency.
Due the eruption of Mount Sinabung, people’s harvested vegetables
cannot be transported to the city because the roads are demages, The
result, many of the community’s vegetables became rotten which
soiled the village. It is diffuclt for people to take clean water for
bathing, washing and dringking water because the water source is
polluted with rotting vagetables. The erupting volcanic lava ash
hoarded people’s home.

2. Surveillance result from Puskesmas doctor there was an incrase the

incidence of ARI case reaching 3 times from the previous months.
Puskesmas doctor plans to conuct epidemiological investigations in
several surrouning village and provide public health counseling.

2.6 Priority Problem

No 1

Because Berastepu village is located near Mount sinabung, because we

need to take care the polution.

2.7 Problem Analysis

1. Berastepu village is located near Mount Sinabung, is no longer

habitable ecause of the eruption of Mount Sinabung, Karo Regency.
Due the eruption of Mount Sinabung, people’s harvested vegetables
cannot be transported to the city because the roads are demages, The
result, many of the community’s vegetables became rotten which
soiled the village. It is diffuclt for people to take clean water for

5
bathing, washing and

6
dringking water because the water source is polluted with rotting
vagetables. The erupting volcanic lava ash hoarded people’s home.
a. What the meaning Berastepu village is located near Mount
Sinabung, is no longer habitable ecause of the eruption of
Mount Sinabung, Karo Regency. Due the eruption of Mount
Sinabung, people’s harvested vegetables cannot be transported
to the city because the roads are demages, The result, many of
the community’s vegetables became rotten which soiled the
village? Answer :

The meaning is Unhabitable berastepu village is the cause

of air pollution and water pollution. Water pollution contains
rotten vegetables which cause high organic matter loads that
can pollute the water and air pollution contains lava eruption
which cause spread of toxic gas which contains carbon
dioxide, sulphur dioxide, hydrogen sulfide, nitrogen that can
pollute the air.
That's why it's describing an AMDAL (an analysis of
environmental impacts), where in this case there is a volcanic
eruption (traditional hazards: natural phenomena) which causes
pollution in air, water, food and soil) which results in
disturbances both individually and in a population.

b. What are the criteria a place is habitable ?

Answer:
Criteria for habitable places are influenced by urban planning
and design (Weziak Bilowolska, 2016). Habitable places
aspects varies depending on the scale of the city with indicators
as follows:
1. Physical aspects, such as the size and location of the
city, road network, pedestrian paths, vegetation, and
building.
2. Accessibility aspect, in the form of ease of access to
public facilities.

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 3. Health aspects, in the form of access, personal health,
and environmental health and safety.
4. Communication aspect, in the form of communication
technology and transportation.
5. Aspects of character, reflected in a sense of comfort,
place and time, stability, and aesthetics.
6. Aspects of personal freedom, such as freedom
expression, privacy and affordability.
A healthy house is a house that meets healthy criteria,
which are at least a house component and sanitation facilities
as well as behavior in one area at a certain time. The minimum
criteria that meet according to the Department of Health (2007)
for each parameter are as follows:
1. The group of house components must at a minimum
have a ceiling, wall, floor, bedroom window, living
room window, ventilation, means kitchen exhaust, and
lighting.
2. The group of sanitation facilities must at a minimum
have clean water facilities, latrines (dung disposal
facilities), waste water disposal facilities (SPAL), and
waste disposal facilities.
3. Home sanitation behavior is a public health effort that
focuses on focus on controlling the physical structure
used (Forstinus et al., 2016)

c. What is the impact of eruption to our health ?

Answer:
Health impacts due to the eruption of Mount Merapi:
a) Burns of varying degrees of severity.
b) Direct injury and disease from rock, gravel, larvae
and other eruptive particles.

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 c) Exposure to volcanic ash containing a number of
hazardous substances orparticulate material
contained in volcanic ashsuch as Sulfur Dioxide
(SO2), Hydrogen Sulfide gas (H2S), Nitrogen
Dioxide NO2), and dust in the form of dust particles
(Total Suspended Particulate or Particulate Matter)
which can causemajor diseases such as acute
respiratory infections (ARI).
d) Exacerbating long-standing illnesses.
e) Traffic accidents due to dusty or slippery roads,
falling due to panic, and contaminated
food(Manurung and Trilaksono, 2016)
In general, the impacts of volcanic eruptions that need to be
watched out for are divided into two, namely the effects of
solids/dust and gases that have the potential to be hazardous to
public health. The Ministry of Health of the Republic of
Indonesia stated that volcanic ash can cause respiratory
problems and eye irritation. This can be more serious if the dust
contains some metallic elements. Metal elements that need to
be watched out for are silica, physically in the form of small
and rather sharp grains, if inhaled it can cause coughing and
even irritation of the respiratory tract.
Other metal elements that are usually present are sodium,
calcium, and potassium which are irritating when inhaled.
Other metal elements such as lead, zinc, cadmium, and copper
have low concentrations.
Volcanic eruptions contain gases that can endanger public
health, the content of which is feared is SO2, because natural
reactions can form sulfate elements which are very irritating to
the skin, eyes and respiratory tract. In addition, CO2 gas is
oxygen binding which if inhaled a person can die from lack of
oxygen (Kemenekes RI, 2018).

9
d. What is the legal goverment rules about environment ?
Answer:
Legal grounds, such as :
1. UU Number 32 in 2009 about protection and
management of the environment.
2. UU Number 36 in 2009 about health in Pasal 163 about
environmental health.
3. UU Number 18 in 2008 about waste management
tentang in pasal 22.
4. Peraturan Pemerintah Number 82 in 2001 about
management of water quality and water pollution.
5. Peraturan Presiden Number 16 in 2015 about ministry
of environment and forestry.
6. Peraturan Menteri Lingkungan Hidup and Kehutanan
Number P.18/MenLHK-II/
Undang-Undang RI Nomor 32 tahun 2009 about
perlindungan dan pengelolaan lingkungan hidup which is The
environment is a unitary space with all things, forces, states,
and living things,
including humans and their behavior, which affect
nature itself, survival livelihoods, and human well-
being as well as other living things. Protection and
management of the environment include:
1. Planning
2. Utilization
3. Control
4. Maintenance
5. Supervision
6. And law enforcement.

1
e. How to procces organic wastes or vegetables became rotten ?
Answer:
Organic waste can be processed into compost which is used in
plant. How to:
1. Dig the soil as deep as 30/40 cm or can useuse a special
place (zinc bucket or drum).
2. After that, enter the organic waste into the soil hole or
where it will be used. After that close the hole
containing organic waste.
3. Flush the soil containing organic waste with water
every afternoon, do a reversal of the fertilizer material it
every 12 days.
4. Composting is carried out for 40 days (if routine),
Composting is carried out for 3 months (if not routine).
After open it and lift the compost, compost ready to use.
The waste has been composted and is ready to be used
for plant.

f. What kind of disease that come from polluted air ?

Answer:
In general, the health effects of polluted air (PM10
concentration) are disorders of the cardiovascular system,
respiratory problems, and death. WHO (2014), according to
WHO (2011) the health effects of exposure to polluted air
(especially PM10 substances) in a short time can affect the
reaction of lung inflammation, ARI (upper respiratory tract
infection), disorders of the cardiovascular system, increased
emergency care, increased drug use, even death. While the
long- term impact can increase symptoms of lower respiratory
tract disorders, asthma exacerbations, decreased lung function
in children, increased chronic obstructive pulmonary disease,

1
 decreased lung function in adults, decreased average life
expectancy, especially death caused by by cardiopulmonary
disease and the probability of lung cancer incidence (Nurjanah,
2014).
Diseases that can be transmitted and spread directly or
indirectly through respiratory air are known as air borne
disease. Types of transmitted diseases include (Chandra, 2009)
:
1. pulmonary tuberculosis
2. Varicella
3. Diphtheria
4. Influenza
5. Variola
6. Morbili
7. Meningitis
8. Scarlet fever
9. Mumps
10.Rubella
11.Pertussis

g. what is the impact of organic waste to our health and

environtment?
Answer:
In addition, 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

1
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).
Other impacts such as :
1. Producing Methane Gas
The first thing that makes a pile of organic waste can be
threatening is methane gas. Organic waste that
accumulates can cause an explosion, because it does
not get enough oxygen exposure. As a result,
methagonis continue to accumulate in large quantities
and are trapped in the soil. When on the verge, the
garbage explodes with power like a big bomb. Even
that does not include the flammable nature of methane
gas. No wonder there are often fires in the landfill area
suddenly.
2. Various Dangerous Diseases
The threat of organic waste does not stop at methane
gas. Due to the fact, piles of organic waste are the most
preferred habitat by animals such as rats, flies,
cockroaches and mosquitoes. A row of animals that can
carry various infectious diseases through various
bacteria and viruses. In addition, there are still many
diseases that have the potential to be transmitted
through organic waste. For example, tetanus disease
that can infect, when there is metal waste that injures
the skin and is contaminated by various bacteria. Other
diseases also
1
 have a higher risk with the accumulation of organic
waste, such as skin infections, food poisoning, hepatitis
A, salmonella infections and so on.
3. Triggering Global Warming
Organic waste is indeed safe if it opens and blends back
into nature. The problem is that more organic waste
only accumulates in landfills without oxygen
circulation and does not decompose. In the end, the
molecule releases into the air into methane gas which is
21 times more harmful to the ozone layer than carbon
dioxide because it absorbs more heat. Where next has a
more serious effect on climate change for human life on
earth (Nurdin dkk, 2020)

h. What is the parameter or criteria of water poluted an air

polution?
Answer:
Air quality is generally assessed from the concentration of
air pollution parameters that are measured to be higher or lower
than the value of the National Ambient Air Quality Standard.
The national ambient air quality standard is set as the
maximum limit for ambient air quality to prevent air pollution
as attached in PP No 41 of 1999.
ISPU (Air Pollution Standards Index) based on the Decree
of the Head of the Environmental Impact Management Agency
No. 107 of 1997 concerning Calculation and Reporting and
Information on Air Pollution Standard Index.
The results of the calculation of the ISPU value are used to
categorize the air quality conditions in a place. The
qualification is based on the ISPU value of the main pollutant
parameters (Kurniawan, 2018).

1
i. How is the mecanism of water bone disease transmision ?
Answer:
Air Pollutant Standard Index (ISPU)Currently the air
quality standard index used officially in Indonesia is the Air
Pollutant Standard Index (ISPU), this is in accordance with the
Decree of the State Minister of the Environment Number: KEP
45 / MENLH / 1997 concerning the Air Pollutant Standard
Index. In the decision, the considerations used include: that in
order to provide convenience of uniformity of ambient air
quality information to the public at a certain location and time
and as a material consideration in carrying out air pollution
control efforts, it is necessary to develop an Air Pollutant
Standard Index. The Air Pollutant Standard Index is a number
that does not have units that describe the condition of ambient
air quality at a certain location and time based on the impact on
human health, aesthetic value and other living things. The Air
Pollutant Standard Index is determined by changing the
measured air pollutant level into a dimensionless number. The
Air Pollutant Standard Index data is obtained from the
operation of the Automatic Ambient Air Quality Monitoring
Station. Meanwhile, the Air Pollutant Standard Index
Parameters include:
1) Particulate (PM10).
2) Carbon dioxide (CO).
3) Sulfur dioxide (SO2).
4) Nitrogen dioxide (NO2).
5) Ozone (O3)

The calculation and reporting as well as information on the

Air Pollution Standard Index is determined by the Head of the
Environmental Impact Controlling Agency, namely the Decree
of the Head of the Environmental Impact Controlling Agency
no. 107 of 1997 dated November 21, 1997.

1
 j. How to prevent water and air polution in the case ?

Answer:
No Paramete Uni Class 1 Clas Clas Clas Descriptio
. r t s2 s3 s4 n

1. Temperat ℃ Dev 3 Dev Dev Dev Difference

with
ur 3 3 3
temperatur
e
air above
water level
2. Dissolved solid Mg/ 1.00 1.00 1.000 2.000 Not applicable
total (TDS) L 0 0
for the estuary

3.

River Water Quality Standards And The Like

1
1
k. What is the clasification of air polution ?
Answer:
1. Pollution caused by motor vehicle fumes.
2. power plant.
3. Volcanic eruption pollutant ash.
4. industrial or factory smoke waste.

1
 5. agricultural waste.
6. Mining activities cause air pollution.
7. household activities.
8. forest fires air pollution pollutants.
9. the effect of landfills on air pollution.
10. Illegaloging or Logging of Wild Forests (Putera, 2019).

l. What is the meaning the erupted volcanic lava ash hoarded

people’s home ?
Answer:
The meaning is air pollution may happen as a result of
volcanic dust. Volcanic dust released by volcanoes contain
many chemical gas elements, such as hydrogen sulfide (H2S),
carbon monoxide (CO), nitrogen dioxide (NO2), ammonia gas
(NH3), and sulfur dioxide (SO2). These elements are very toxic
on the human body in general. Volcanic ash is formed during
volcanic eruptions. Volcanic dust composed of fine rock
fragments, minerals and glass, hard, coarse dust, Slightly
corrosive and insoluble in water. the content and content of
volcanic ash, especially about the minerals quartz, cristobalite
or tridymite. It is crystalline silica free. In an eruption the dust
particles can be so fine that the dust can enter deep into the
lungs. With high exposure, healthy individuals. People will
experience chest discomfort with increased coughing and
irritation (Yuarsa, 2019)

m. What are the criteria of clean air ?

Answer:
Criteria clean air that is :
1. Colorless
2. Odorless
3. Tasteless

1
 4. Not mixied with foreign objects
5. Feels fresh when we inhale
6. Feel cool
7. Can be used as a body health therapy
According to Keputusan Menteri Kesehatan Republik
Indonesia Nomor 1405/MENKES/SK/XI/2002 Tentang
Persyaratan Kesehatan Lingkungan Kerja Perkantoran dan
Industri, the requirements for clean air are :
1. Temperature and humidity - Temperature: 18 - 28 0 C -
Humidity: 40% - 60%.
2. Air exchange: 0.283 M3 / minute / person with
ventilation rate: 0.15 - 0.25 m / sec. For work spaces that
do not use cooling, they must have ventilation holes at
least 15% of the floor area by applying a cross
ventilation system.
3. Pollutant gas The content of pollutant gases in the work
space, in an average measurement of 8 hours.
4. Microbiology - the number of germs is less than 700
colonies/m3 of air.

n. What is the parameter or criteria of clean water ?

Answer:

No. Parameter Unit Class Class Class Class Description

1 2 3 4

1. Temperatur ℃ Dev 3 Dev 3 Dev 3 Dev 3 Difference

with
temperature
air above
water level
2. Dissolved Mg/L 1.000 1.000 1.000 2.000 Not
solid applicable
total (TDS) for the
estuary
3.

2
River Water Quality Standards And The Like

2
2
Lake Water Quality Standards And The Like

2
Information:

1. First class is water whose designation can be used for drinking

water raw water, and/or other designations that require water
quality the same as that use.
2. Second class is water whose designation can be used for
infrastructure/facilities. water recreation, freshwater fish

2
 cultivation, animal husbandry, water to irrigate crops, and/or
other uses that require the same water quality as those uses.
3. The third class is water whose designation can be used for
freshwater fish cultivation, animal husbandry, water for
irrigating plants, and/or other uses that require the same water
quality as that use.
4. Fourth class is water whose designation can be used to irrigate
crops and/or other uses that require the same water quality as
that use (Peraturan Perundang-undangan RI)

o. What is the mecanism of airbone dieseas transmision ?

Answer:
Transmission of disease through the air is intended to be a
mode of transmission that occurs without contact with patients
or with contaminated objects. Most of the transmission through
the air can also be transmitted through direct contact, but it is
not uncommon for diseases that are mostly transmitted by
sucking in air containing
causative elements/micro-organisms. Transmission of
disease through the air can occur in the form of droplets or
nuclei or in the form of dust.
1. Droplet nuclei that come out through the mouth or nose
either when coughing or sneezing or when talking or
breathing, have different sizes. Droplet nuclei are very
small particles as remnants of dried droplets. Its
formation can be done in various ways, including by
evaporating droplets that are coughed up or sneezed into
the air. Droplet nuclei can also form from aerolization of
infectious materials. Due to its very small size, this form
can remain in the air for quite a long time and can be
sucked in when breathing and into the respiratory
apparatus.

2
 2. Dust is the form of particles of various sizes as a result of
particle resuspension which is located on the floor, on the
bed and which is blown by the wind with the dust on the
floor/soil. It is the size of the droplet nuclei and dust that
will determine the possibility of transmission or not. In
droplet nuclei with large size, they will be stuck in the
airway and can be expelled out by mechanisms that
occur in the airway (Regulation of the Minister of Health
of the Republic of Indonesia Number
1077/Menkes/Per/V/2011).

2. Surveillance result from Puskesmas doctor there was an incrase the

incidence of ARI case reaching 3 times from the previous months.
Puskesmas doctor plans to conuct epidemiological investigations in
several surrouning village and provide public health counseling.
a. What the meaning Surveillance result from Puskesmas doctor
there was an incrase the incidence of ARI case reaching 3 times
from the previous months ?
Answer:
It means that there has been an outbreak of ARI. The acute
respiratory manifesttions seen after heavy ashfalls include
irritation of the chest and nose and throat discomfort
(Gudmundsson, 2011).
Based on Regulation of The Minister Of Health Of The
Republic Of Indonesia Number 1501/MENKES/PER/X/2010
About Certain Types Of Transmitted Disease That San Create
Outbreak. And Control Effort, an outbreak of an infectious
disease, hereinafter referred to as an epidemic, is an outbreak of
an infectious disease in the community whose number of
sufferers has significantly increased beyond the usual situation
at a certain time and area and can cause havoc. Extraordinary

2
 Events are the occurrence or increase in the incidence of illness
and/or death that is significantly significant epidemiology in an
area over a certain period of time, and is a condition that can
lead to an outbreak. An outbreak is defined as more cases of a
disease than expected in a specific location over a specific time
period. Suspicion often arises when health care workers report
an unusual cluster or a single, unexpected presentation
(Houlihan et al, 2019).

b. What is the defination of the

outbreaks? Answer:
According to Lescano et al. (2010), An outbreak is an
increase beyond expectation in the number of cases of a disease
or condition occurring among a specified population, in a well-
defined geographic location and period of time. Cases are
epidemiologically related, although this linkage is often not
initially evident and may only be discovered after thorough
investigation. For example, in the 1981 multistate outbreak of
Salmonella muenchen, the epidemiologic link was discovered
only when case patients reported smoking marijuana more
frequently than controls, and this rare Salmonella species was
isolated from marijuana samples from the homes of cases.
Outbreaks very often have an infectious origin, although some
can be due to noninfectious agents, such as food intoxication or
even hysteria. It is often difficult to define how many cases
beyond expectation constitutes an outbreak, but even one case
can indicate an outbreak if the disease has been eradicated
(smallpox) or eliminated (poliomyelitis in Europe), or is novel
to humans (highly pathogenic [H5N1] avian influenza in the
Americas) An outbreak is defined as more cases of a disease
than expected in a specific location over a specific time period.
Suspicion often arises when health care workers report an

2
 unusual cluster or a single, unexpected presentation (Houlihan
& Whitworth, 2019).

c. What is the criteria of the outbreaks?

Answer:
Based on the Regulation of the Minister of Health of the
Republic of Indonesia Number 1501/MENKES/PER/X/2010
Concerning Certain Types of Infectious Diseases That Can
Carry Out Outbreaks, an area can be designated as outbreak
status, if it meets one of the following criteria:
1) The emergence of certain infectious diseases that
previously did not exist or were not known in an area.
2) An increase in the incidence of pain continuously for 3
consecutive time periods in hours, days or weeks
according to the type of disease.
3) An increase in the incidence of pain two or more times
compared to the previous period in hours, days or
weeks according to the type of disease.
4) The number of new patients within 1 month showed an
increase of two or more times the monthly average in
the previous year.
5) The average number of pain cases per month for 1 year
shows an increase of two or more times compared to the
average number of pain cases per month in the previous
year.
6) The case fatality rate of a disease in a certain period of
time shows an increase of 50% or more compared to the
case fatality rate of a disease in the previous period in
the same period.
7) The proportion of new patients' disease in one period
shows an increase of two or more times compared to the
previous period in the same time period.

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d. How to prevent outbreaks in this case ?
Answer:

1. Health Promotion
Edukasi kesehatan, penggunaan leaflet/brosur kesehatan,
materi: gizi baik dan seimbang, kebiasaan hidup sehat.
2. Specific Protection
Perlindungan khusus (vaksinasi, penggunaan APD).
3. Early Diagnosis and Prompt Treatment
Diagnosis Dini dan Pengobatan yang Cepat dan Tepat (Eg:
screening penyakit).
4. Disability Limitation (Pembatasan Kecacatan)
5. Rehabilitation (Rehabilitasi)

e. What are type of surveillance ?

Answer :
There are several types of surveillance:
1) Individual surveillance;
Individual surveillance detects and monitors individuals
who are in contact with serious diseases, such as bubonic
plague, smallpox, tuberculosis, typhoid, yellow fever,
syphilis.
2) Disease surveillance
Disease surveillance carries out continuous monitoring
of the distribution and trend of disease incidence,
through systematic collection, consolidation, evaluation
of disease and death reports, as well as other relevant
data.

2
 3) Syndromic surveillance
Syndromic surveillance (multiple disease surveillance)
conducts continuous monitoring of disease syndromes (a
collection of symptoms), not individual diseases.
Syndromic surveillance relies on the detection of
observable individual and population health indicators
prior to confirmation of the diagnosis.
4) Laboratory-Based Surveillance
Laboratory-based surveillance is used to detect and
monitor infectious diseases. For example, in food-borne
diseases such as salmonellosis, the use of a central
laboratory to detect certain bacterial strains allows
detection of outbreaks.
5) Integrated surveillance
Integrated surveillance organizes and integrates all
surveillance activities in a jurisdiction
(state/province/district/city) as a shared public service.
Integrated surveillance uses the same structure,
processes and personnel, performing the function of
gathering the necessary information health surveillance
(amruddin, 2013).

f. What are the benefits of surveillance ?

Answer:
Benefits of surveillance, such as :
1. Can explain an ongoing pattern of disease that could be
linked to public health measures / interventions.
2. Can monitor the trend of endemic diseases .
3. To study the natural history of the disease and the
epidemiology of the disease, particularly for detecting the
outbreaks.

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 4. Provide basic information and data to project health care
needs in the future.
5. Can assist the implementation and effectiveness of special
control programs by comparing the magnitude of the
problem before and after program implementation.
6. Help determine health problems and priority program
targets at the program planning stage.
7. Identify high risk groups according to age, occupation,
place of residence where health problems often occur and
variations in occurrence over time (seasonality, from year
to year), and the way and the dynamics of disease
transmission contagious. (Amiruddin, 2019).

g. How to conduct investigation of epiemiology in a village ?

Answer:
1. Preparation
2. Establish an outbreak in a village
3. Establish case definition and specimen management
4. Identification and count all cases
5. Descriptive Analyze
6. Formulating Hypothesis
7. Testing hypothesis
8. Countermeasures
9. Making report and dissemination

h. What kind of epidemiology and what we use in this case ?

Answer:
1. Descriptive Epidemiology
Is the study of the frequency and spread of a health
problem regardless of the need to find answers to the
factors that cause these health problems. In descriptive
epidemiology, information is collected to "flag" or
summarize health

3
 events or problems. Descriptive epidemiology evaluates
all circumstances surrounding a person that may affect a
health event. The focus in this descriptive epidemiology is
frequency and pattern (Ellis Christensen, 2012), frequency
is used to assess the rate of occurrence, while patterns can
be used to help analytical epidemiology indicate risk
factors. This descriptive study also focuses on
thequestions who (who is affected), when (when they are
affected), and where (where they are affected).
2. Analytic Edemiology
Is an epidemiologist that emphasizes the search for
answers to the causes of the frequency, spread and
emergence of a health problem. In analytical epidemiology
is sought to find answers why (why), then analyzed the
relationship with the result caused. the causative factors
are directed to the factors that affect, while the
consequences point to the frequency, skpread, and
presence of a health problem. Therefore, it is necessary to
summarize hypotheses related to problems that arise, then
continued by testing the hypothesis through a study which
is then drawn a conclusion about the cause and effect of
the onset of a disease.
3. Experimental Epidemiology
The study was conducted by conducting experiments
(experiments) to the subject group, then compared to the
control group (which was not subject to the experiment).
Another experimental form that is often done is related to
the influence of counseling interventions on changes in
knowledge about a problem (Notoatmodjo, 2012).

3
i. How to do publich health counseling ?
Answer:
1. Assess community health needs.
2. Determine public health problems.
3. Prioritize the problems to be addressed first through public
health.
4. education.
5. Developing an extension plan
a) Make purpose.
b) Goals setting.
c) Compiling extension material / content.
d) Choose the right method.
e) Determine the type of props to be used.
f) Determination of evaluation criteria.
g) Implementation of education.
h) Assessment of outreach results.
i) Follow-up from instructors stages of post-counseling
services disaster includes activities as follows:
 Identify variations and the intensity of the
problems that (can) cause trauma and cause
interference with Effective Daily Living. thus
making Effective Life daily experienced by
students, educators, education staff, parents, and
the general public.
 Provide counseling services for overcome the
trauma and the Effective Life daily condition in
number 1 according to the conditions the
problems of the respective parties involved.
 Conditioning the re-occurrence learning process
and life conducive to involving students,
educators and education personnel with parental

3
 support at number 1 and number 2, as well as
public institutions and related social units (Ifdil,
2012).

j. What is puskesmas doctor contribution to the environtment

health ?
Answer:
According to the Minister of Health of the Republic of
Indonesia No. 13 of 2015 concerning the Implementation of
Environmental Health Services at Puskesmas, it is stated that
environmental health services are activities or a series of
activities that are shown to realize healthy environmental
quality, both from physical, chemical, biological, and social
aspects to prevent diseases and / or health disorders caused by
environmental risk factors (Permenkes, 2015)

k. What is the correlation between volcanic eruption with ARI

incidence ?
Answer:
The relationship between volcanic eruptions is in the form
ofExposure to volcanic ash containing a number of hazardous
substances orparticulate material contained in volcanic ashsuch
as Sulfur Dioxide (SO2), Hydrogen Sulfide gas (H2S),
Nitrogen Dioxide NO2), as well as dust in the form of dust
particles (Total Suspended Particulate or Particulate Matter) so
that the content of these hazardous substances can cause
respiratory tract disorders.the main disease such as in the case
of acute respiratory infection (ARI) (Manurung and Trilaksono,
2016).

l. How is the mecanism the eruption lava eruption causing

outbreaks of ARI ?
Answer:

3
 The number of ARI cases appears to be higher after
exposure to volcanic ash than before. Poor air quality when
aneruption occurs can cause ciliary, whereby the fine hairs
in the nasal cavity move more slowly. This can cause coarse
dust particles to not filter properly. Production of mucus in
the nasal cavity will also increase due to the slow movement of
the cilia, which can result in narrowing of the respiratory
tract. Narrowing of the respiratory tract will result in
individuals having difficulty breathing and make it difficult
to excrete inhaled dust particlesand bacteria from the
respiratory tract. In general, volcanic eruptions will produce
very fine volcanic ash particles. Exposure to volcanic ash with
high frequency can cause tightness in the chest, coughing,and
irritation. The severity dependson the size of the volcanic ash
that isinhaled and enters the respiratory tract. Volcanic ash
with a size of more than 10–100 micrometreswill settle inthe
upper respiratory tract. In volcanic ash with a size of 4–10
micrometresit will settle inthe trachea and bronchialtubes.
Volcanic ash with a diameter of less than four micrometreswill
enter the alveola. Exposure to volcanic ash containing
crystallin silica can worsen a person’scondition with
opportunistic infections (Tyas and Indawati, 2019)

m. What is the duty and functions of surveillance in the case ?

Answer:
1. Predicting and early detection of epidemics (outbreaks).
2. Monitor, evaluate, and improve disease prevention and
control programs.
3. Provide information for prioritization, policy making,
planning, implementation and allocation of health resources.
4. Monitoring the tendency of endemic diseases and estimating
the future impact of the disease.
5. Identify high-risk groups.

3
 6. Identify further investigations.
7. Know the epidemiological picture of a health problem or
disease based on time, place, and person.
8. Setting priorities for health problems, there are 3
requirements, namely the magnitude of the problem, the
existence of methods to solve the problem, and the
availability of costs to overcome the problem.
9. Knowing the scope of services, based on data on visits to
puskesmas, it can be estimated that the coverage of
puskesmas services is based on certain characteristics of
sufferers.
10. For early vigilance of the occurrence of extraordinar (KLB).
11. To Monitor and Assess the Program (Arwanti, 2018).

3. What is the Islamic Point of View (NNI) for this

case? Answer:
Al-qur’an Surah Yunus (101)

Say, "Observe what is in the heavens and earth." But of

no availwill be signs or warners to a people who do not believe

Al-qur’an Surah Al-Hujarat (6)

Meaning “O you who have believed, if there comes to you

a disobedient onewith information, investigate, lest you harm
a people out of ignorance and become, over what you have
3
 done, regretful.”

HR Bukhori
Meaning: "Death due to plague is a paradise for every Muslim
(who dies from it)".
Interpretation : That Allah SWT has given a calamity or disaster in the
form of an ARI epidemic is a necessary thing that must be faced. Any
disaster should actually be interpreted as a form of God's love for his
servants. Events that befall humans are essentially tests and trials of
faith and behavior that have been carried out by humans themselves.

2.8 Conclusion

Puskesmas Doctor order surveillance to analitycal do epidemiologycal

investigation about ARI and provide public health caunseling because of
outbreaks in Barestepu village by air pollution and water pollution.

3
2.9 Conceptual of Framework

Risk factor
(Eruption of mounth

Orgabic waste Valcanic

lava ash

Water pollution Air pollution

Airbone disease
Waterbo
ne

Outbreakas ARI
Analitic Epidemiological
Investigations and
Counseling of Public
Health

3
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