Study Guide Special Topics
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.
6. To understand the science and it's practices of the complementary and alternative
medicine in the medical profession.
Udayana University Faculty of Medicine, MEU
1
Study Guide Special Topics
PLANERS
NO
1
2
NAME
DEPARTMENT
Prof.Dr.dr.I Nyoman Adiputra,
MOH,PFK,Sp.Erg (Head)
dr. N.K. Putri Ariani, SpKJ
Fisiology
Psychiatrist
PHONE
0811397971
082237817384
LECTURER
NO
NAME
DEPARTMENT
PHONE
1
Prof.Dr.W.Suardana. Sp.THTKL (K)
ENT
0811385299
2
3
dr.AA Ayu Srikandhyawati, Sp.KFR
dr. Putu Anda Tusta Adiputra,
SpB(K)Onk
Dra. Retno Indaryati. S. Psi
Dr. Tjokorda Gde Dharmayuda,
Sp.PD KHOM.
Prof.Dr.dr.I Nyoman Adiputra,
MOH,PFK,Sp.Erg
dr. Made Jawi, M.Kes
DR.dr.Cok Jaya Lesmana, SpKJ
Rehabilitation Medic
Surgery
08156041505
08123826430
Rehabilitation Medic
Internal Medicine
08123831862
0811394108
Fisiology
0811397971
Pharmacology
Psychiatrist
08179787972
0816295779
4
5
6
7
8
Udayana University Faculty of Medicine, MEU
2
Study Guide Special Topics
~ FACILITATORS ~
Regular Class
NO
1
2
3
4
5
6
7
8
9
10
NAME
dr. Ni Made Renny Anggreni
Rena , Sp.PD
Drs.I. N Toya Wiartha, Apt
dr. I B. Putrawan, Sp.PD
dr. Sianny Herawati, Sp.PK
dr. Gede Kambayana,
Sp.PD-KR
dr. Gede Eka Rusdi Antara,
Sp.B
dr. Gde Somayana, Sp.PD
dr. Tjokorda Gde Agung
Senapathi, Sp.An
dr. Elysanti Dwi Martadiani,
Sp.Rad
dr. I Wayan Losen Adnyana,
Sp PD
GROUP
DEPT
PHONE
ROOM
A1
Interna
081803651656
A2
Pharmacy
0811399886
A3
Interna
081236194672
A4
Clinical
Pathology
081236172840
A5
Interna
08124683416
A6
Surgery
081337794803
A7
Interna
081345136913
A8
Anasthesi
081337711220
A9
Radiology
081805673099
A10
Interna
08123995536
GROUP
DEPT
PHONE
ROOM
B1
Anasthesi
08123847675
2rd floor
R.2.09
B2
Microbiology
081338291965
B3
Pulmonology
08123875875
B4
Biochemistry
081338776244
B5
Anasthesi
08175253037
B6
Obgyn
0817561966
B7
Interna
08123974128
B8
Opthalmology
08123846995
B9
Pharmacology
081936043700
B10
Neurology
08179782240
2rd floor
R.2.09
2rd floor
R.2.10
2rd floor
R.2.11
2rd floor
R.2.12
2rd floor
R.2.13
2rd floor
R.2.14
2rd floor
R.2.15
2rd floor
R.2.16
2rd floor
R.2.22
2rd floor
R.2.23
English Class
NO
1
2
3
4
5
6
7
8
9
10
NAME
Dr. dr. I Wayan Suranadi,
Sp.An.KIC
Dr. dr. I Dewa Made
Sukrama, MSi, Sp.MK(K)
dr. Dewa Made Artika ,
Sp.P
dr. Desak Made
Wihandani, M.Kes
dr. Cynthia Dewi Sinardja,
Sp.An
dr. Anom Suardika, Sp.OG
dr. Nyoman Astika, Sp.PDKger-FINASIM
dr. Anak Agung Mas
Putrawati Triningrat, Sp.M
dr. I Wayan Sucindra
Dewi, S.Ked
dr. A.A.Bagus Ngurah
Nuartha, Sp.S(K)
Udayana University Faculty of Medicine, MEU
2rd floor
R.2.10
2rd floor
R.2.11
2rd floor
R.2.12
2rd floor
R.2.13
2rd floor
R.2.14
2rd floor
R.2.15
2rd floor
R.2.16
2rd floor
R.2.22
2rd floor
R.2.23
3
Study Guide Special Topics
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.
5. Apply general principles the plan of Paliatif care for patient with severe diseases,
chronic illnees, and in terminal stage.
Udayana University Faculty of Medicine, MEU
4
Study Guide Special Topics
TIME TABLE
PALIATIVE MEDICINE
No
1
DATE/
Lecture
Friday
Jan, 9
2015
Prof.Dr.W
Suardana,
SpTHTKL
(K)
L
E
C
LECTURE
TOPIC
Concept,
Philosophy
and
Principle of
Palliative
medicine
CLASS B
TIME
ACTIVITIES
TIME
ACTIVITIES
08.00-09.00
Lecture
Individual
learning
09.00-10.00
SGD
Break
Student
Project
Planary
Session
12.00-13.30
13.30-15.00
Lecture
Student
Project
Independent
Learning
SGD
Lecture
Individual
learning
09.00-10.00
12.00-13.30
13.30-15.00
12.30-14.00
SGD
Break
Student
Project
Lecture
Student
Project
Independent
Learning
SGD
11.30.12.00
Break
14.00-15.00
Pleanary
Session
15.00-16.00
Pleanary
Session
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
2
Monday
Jan, 12
2015
dr . AA
Ayu
Srikandhy
awati,
Sp.KFR
3
Tuesday
Jan, 13
2015
08.00-09.00
09-00-10.00
In patient
Hospice and
Palliatif care
dr. Putu
Anda
Tusta
Adiputra,
SpB(K)On
k
4
Wednes
day
Jan, 14
2015
10.30-12.00
12.00-12.30
08.00-09.00
Emergency
in Paliatif
medicine
Communica
tion in
Palliatif Care
Udayana University Faculty of Medicine, MEU
CLASS A
10.00-11.30
1130-12.00
15.00-16.00
10.00-11.30
09.00.10.00
Break
Plenary
Session
09.00-10.30
Lecture
Individual
learning
10.00-11.30
10.30-12.00
SGD
12.00-13.30
Lecture
Student
Project
Independent
Learning
12.00-12.30
13.30-15.00
SGD
12.30-14.00
Break
Student
Project
11.30-12.00
Break
14.00-15.00
Plenary
Session
15.00-16.00
Plenary
Session
08.00-09.00
Lecture
09.00-10.00
Lecture
09.00-10.30
Individual
learning
10.00-11.30
10.30-12.00
SGD
12.00-13.30
Student
Project
Indenpende
nt Learning
5
Study Guide Special Topics
12.00-12.30
Dra.
Retno
Indaryati,
S.Psi
5
Thursday
Jan, 15
2015
Dr. Tjok
Darmayud
a, Sp.PD.
KHOM
Modern
supportive
care in
Onkologi
Holistic
approach for
Cancer
patient
12.30-14.00
Break
Student
Project
14.00-15.00
Pleanary
Session
08-00-09.00
13.30-15.00
SGD
11.30-12.00
Break
15.00-16.00
Pleanary
Session
Lecture
Individual
Learning
09.00-10.00
12.00-13.30
13.30-15.00
12.30-14.00
SGD
Break
Student
Project
Lecture
Student
Project
Independent
Learning
SGD
11.30-12.00
Break
14.00-15.00
Pleanary
Session
15.00-16.00
Pleanary
Session
09.00-10.30
10.30-12.00
12.00-12.30
10.00-11.30
Feb, 03, 2015  Examination Team
Udayana University Faculty of Medicine, MEU
6
Study Guide Special Topics
TIME TABLE
Complementary and Alternative Medicine (CAM)
English Class (Class B)
Day/date
Friday
16 Jan 2015
Wednesday
21 Jan 2015
Thursday
22 Jan 2015
Time
Activity
Venue
Conveyer
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
Dr.Md Jawi.
Discussion
Room
Facillitator
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
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
Lecture 3
Indiv. Learning
SGD
Break
Student Project
Pleanary
Dr.Md Jawi
Class room
Class room
Discussion
Room
Monday
26 Jan 2015
08.00-09.00
09.00-10.30
10.30-12.00
12.00-12.30
12.30-14.00
14.00-15.00
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
Lecture 5
Indiv. Learning
SGD
Break
Student Project
Pleanary
Facillitator
Dr.Md Jawi
Class room
Class room
Discussion
Room
Class room
Friday
23 Jan 2015
Dr.Md Jawi.
Class room
Discussion
Room
DR.dr.Cok
Jaya L, SpKJ
Facillitator
DR.dr.Cok
Jaya L, SpKJ
Prof. Adiputra
Facillitator
Prof. Adiputra
Class room
Class room
Discussion
Room
Prof. Adiputra
Facillitator
Prof. Adiputra
Class room
Feb, 03, 2015  Examination Team
Udayana University Faculty of Medicine, MEU
7
Study Guide Special Topics
Reguler Class (Class A)
Day/date
Friday
16 Jan 2015
Wednesday
21 Jan 2015
Thursday
22 Jan 2015
Time
Activity
Venue
Conveyer
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
Dr. Md Jawi
Discussion
Room
Facillitator
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
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
Lecture 3
Student Project
Break
Indiv. Learning
SGD
Pleanary
Dr. Md Jawi
Class room
Class room
Discussion
Room
Monday
26 Jan 2015
09.00-10.00
10.00-11.30
11.30-12.00
12.00-13.30
13.30-15.00
15.00-16.00
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
Lecture 5
Student Project
Break
Indiv. Learning
SGD
Pleanary
Facillitator
Dr. Md Jawi
Class room
Class room
Discussion
Room
Class room
Friday
23 Jan 2015
Dr. Md Jawi
Class room
Discussion
Room
DR.dr.Cok
Jaya L, SpKJ
Facillitator
DR.dr.Cok
Jaya L, SpKJ
Pof. Adiputra
Facillitator
Prof. Adiputra
Class room
Class room
Discussion
Room
Pof. Adiputra
Facillitator
Prof. Adiputra
Class room
Feb, 03, 2015  Examination Team
Udayana University Faculty of Medicine, MEU
8
Study Guide Special Topics
PALIATIF MEDICINE
Lecture 1 :
Concept, Philosophy and Principle of Palliative
medicine
Prof.dr.W.Suardana Sp.THT-KL(K)
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!
Udayana University Faculty of Medicine, MEU
9
Study Guide Special Topics
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
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 lifethreatening 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 4 :
Communication in Palliative care
Retno Indaryati Kusuma, Dra, Psikolog
Udayana University Faculty of Medicine, MEU
10
Study Guide Special Topics
.
Lecture 5 :
Holistic Approach for Cancer Patient
Dr. Tjokorda Gde Dharmayuda, Sp.PD KHOM
COMPLEMENTARY AND ALTERNATIVE MEDICINE ( CAM )
Lecture 1 :
Complimentary and Alternative Medicine (CAM)
Dr. Made Jawi, M Kes
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
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.
Udayana University Faculty of Medicine, MEU
11
Study Guide Special Topics
References
1. The Journal of Alternative and Complementary Medicine
2. BMC Complementary and Alternative Medicine
3. Evidence-Based Complementary and Alternative Medicine
Lecture 2 :
Herbal Medicine
Dr. Made Jawi, M Kes
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
Udayana University Faculty of Medicine, MEU
12
Study Guide Special Topics
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
Lecture 3 :
Hypnosis
Dr. dr. Cokorda Bagus Jaya Lesmana, SpKJ
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
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
Udayana University Faculty of Medicine, MEU
13
Study Guide Special Topics
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.
Treatment using hypnosis involves not merely abreaction of trauma, but also working
through it by assisting with the management of uncomfortable affect, enhancing patients'
control over it, and enabling them to cognitively restructure its meaning. Catharsis is a
beginning but not an end in itself, and it can lead to retraumatization if it is not accompanied
by support in managing affective response, control over the accessing of traumatic
memories, and help in working through them.
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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.
Lecture 4 :
Why traditional healing still used in Bali?
Prof. Dr. dr. I Nyoman Adiputra, MOH,PFK,SpErg
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).
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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 prerequirements 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.
Lecture 5 :
A Balian is morally conduct
Prof. Dr. dr. I Nyoman Adiputra, MOH,PFK,SpErg
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.
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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.
One thing should keep in mind is that in the usadha as a reference for the traditional
healer is not always the dose of drug written completely; how many leaves how many gram
of roots and how many time given in a day.. That is as one disadvantage of the traditional
healing process.
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LEARNING TASKS
Day
1
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!
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Day
2
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.
2.
3.
4.
Definition of Paliative Medicine.
Taking and formulate a complete history of this case.
Make the plan for this patient.
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.
Day
3
.
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?
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Day
4
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?
Day
5
Soon will be added
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Day
6
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
Day
7
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?
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Day
8
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 oldwas a world-class athlete who collapsed suddenly inan alley. He was
brought to a hospital emergency room,where he nearly died of internal bleeding from a
lymphomathe size of a grapefruit in his abdomen. He was hospitalizedand placed on
chemotherapy. He was extremely anxious,and increasing doses of opiates had little effect
on hispain. He was literally “climbing the walls” and alienatingthe nursing staff charged with
his care. His parents wereafraid 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
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Day
9
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?
Day
10
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!.
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~ CURRICULUM MAP ~
Smstr
Program or curriculum blocks
10
Senior Clerkship
9
Senior Clerkship
8
Senior clerkship
7
Medical
Emergency
(3 weeks)
Special Topic:
-Travel medicine
(2 weeks)
Elective Study III
(6 weeks)
Clinic Orientation
(Clerkship)
(6 weeks)
6
BCS (1 weeks)
The Respiratory
System and
Disorders
(4 weeks)
The
Cardiovascular
System and
Disorders
(4 weeks)
The Urinary
System and
Disorders
(3 weeks)
The Reproductive
System and
Disorders
(3 weeks)
BCS (1 weeks)
Alimentary
& hepatobiliary systems
& disorders
(4 Weeks)
BCS (1 weeks)
The Endocrine
System,
Metabolism and
Disorders
(4 weeks)
BCS (1 weeks)
Clinical Nutrition
and Disorders
(2 weeks)
BCS (1 weeks)
BCS (1 weeks)
Musculoskeletal
system &
connective
tissue disorders
(4 weeks)
Neuroscience
and
neurological
disorders
(4 weeks)
Behavior Change
and disorders
(4 weeks)
BCS (1 weeks)
Hematologic
system & disorders & clinical
oncology
(4 weeks)
BCS (1 weeks)
Immune
system &
disorders
(2 weeks)
BCS(1 weeks)
Infection
& infectious
diseases
(5 weeks)
BCS
(1 weeks)
The skin & hearing
system
& disorders
(3 weeks)
BCS (1 weeks)
Medical
Professionalism
(2 weeks)
BCS(1 weeks)
Evidence-based
Medical Practice
(2 weeks)
BCS (1 weeks)
Health Systembased Practice
(3 weeks)
BCS(1 weeks)
Community-based
practice
(4 weeks)
-
BCS (1 weeks)
Studium
Generale and
Humaniora
(3 weeks)
Medical
communication
(3 weeks)
BCS (1 weeks)
The cell
as biochemical machinery
(3 weeks)
Growth
&
development
(4 weeks)
BCS (1 weeks)
BCS(1 weeks)
BCS: (1 weeks)
BCS (1 weeks)
Elective Study
II
(1 weeks)
5
4
3
2
1
BCS (1 weeks)
Special Topic :
- Palliative
medicine
-Compleme
ntary &
Alternative
Medicine
- Forensic
(3 weeks)
Elective
Study II
(1 weeks)
Special Topic
- Ergonomi
- Geriatri
(2 weeks)
Elective
Study I
(2 weeks)
The Visual
system &
disorders
(2 weeks)
Pendidikan Pancasila & Kewarganegaraan (3 weeks)
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