Counceling for migrant worker by rkdhaugoda

1. j}b]lzs /f]huf/sfnfluhfg] sfdbfx?sf] nflu :jf:Yo k/fdz{ sIff • HEALTH COUNCELING FOR MIGRANT WORKERS • k/fdz{stf{ :- DR. RAJ KUMAR DHAUGODA MBBS, MD in FAMILY MEDICINE

2. Orientation class on health for migrant workers , our responsibility and Normal accident theory Dr. Raj Kumar Dhaugoda MBBS ,MD ( FAMILY MEDICINE ) SENIOR CONSULTANT FAMILY PHYSICIAN

3. small things cause great things LITTLE- FACT- THINGS • Heath is wealth- we should think • We are going for little wealth with risk of greater health • we are thinking of Wealth is health ( our situation) • Little education saves more wealth and health. • Normal accident theory- we should know it and how to prevent or manage it • SPEND FOR A BRICK AND GET FACILITIES OF A HOME.

4. Major stresses of migrant workers migrant workers have inevitable vulnerable of double stresses • 1. stresses from new working place • 2. stresses from missed family problems and economical related stresses. • MENTAL AND PHYSICAL STRESSES TOGETHER CAUSES– DISBALANCES OF HEALTH OF MIND AND BODY MUTUALLY.

5. What is normal accident theory ? Normal accident theory suggests that in complex, tightly coupled systems, accidents are inevitable. • सामान्य दुर्घटना सिद्धांतcg';f/ s'g} klg  जटिल, क8f lgod युQm प्रणाली मf, दुर्घटना अपरिहार्य x'G5 .

6. What is normal accident theory • Failure in one part (thought, material, human, or organization) may coincide with the failure of an entirely different part. This unforeseeable combination can cause cascading failures of other parts. • In complex systems these possible combinations are practically limitless. • System “unraveling” have an intelligence of their own: they expose hidden connections, neutralize redundancies, bypass firewalls, and exploit chance circumstances for which no engineer could reasonably plan. • Cascading failures can accelerate out of control, confounding human operators and denying them a chance for recovery. • Accidents are inevitable -- “normal.”

7. What should we do to protect against accidentsor mission failure? • Normal accident theory suggests that in complex, tightly coupled systems, accidents are inevitable. • Accidents can be prevented through good organizational design and management.

8. fFailure of mission is an inevitable event- in our life.What is the primary cause of this mission failure? • Human error • Mechanical failure • The environmental mal adjustment. • little understanding of Design of the system • lack of knowledge • Lack of access for helpline • Lack of systems for helping • Lack of alternative best management • Lack of knowledge of harm reducing management.

9. The answer • All of the above Life is a complex system.

10. What Characterizes a ComplexSystem? A complex system exhibits complex interactions when it has: • Unfamiliar, unplanned, or unexpected sequences which are not visible or not immediately comprehensible • Design features such as branching, feedback loops • Opportunities for failures to jump across subsystem boundaries.

11. What Characterizes a ComplexSystem? A complex system is tightly coupled when it has: • Time-dependent processes which cannot wait • Rigidly ordered processes (as in sequence A must follow B) • Only one path to a successful outcome • Very little slack (requiring precise quantities of specific resources for successful operation).

12. The Foundation of a Major Injury • 00.3% of all accidents produce major injuries • 08.8% of all accidents produce minor injuries • 90.9% of all accidents produce no injuries Out of 330 various accidents • 300 accidents= no injuries • 29 accidents= minor injuries • 1 accident= major injuries • Source: H. W. Heinrich, Industrial Accident Prevention, 1950, p. 24.

13. How to overcome from normal accidents To defend against normal accidents, we must understand the • complex interactions of our programs, • analyze close-calls बाल बाल बच]]sf] ca:yf(when you come extremely close to a dangerous or unpleasant situation or only just manage to avoid it) and mishaps ( unfortunate accidents) to determine root causes, and • USE this knowledge to improve programs and operations and modify organization according to our need.

14. Close-Call Initiative • Analysis of close-calls, incidents, and mishaps can be effective • in identifying unforeseen complex interactions if the proper attention is applied. • Root causes of potential major accidents can be uncovered through careful analysis. • Proper corrective actions for the prevention of future accidents can be then developed. It is essential to use incidents to gain insight into interactive complexity

15. 1357 migrant workers died in 3 and a half yearssurvey finds a significant number of deaths could have been avoided. • according to a survey done by foreign ministry in coordination with the foreign employment board. • Published in Kathmandu post-in Jan. 12-2012- • Shows Lack of pre-departure- orientation classes on- -work place safety -road safety or rules -climatic conditions and precaution - health education - crisisful mind management -regular health counseling and information body.

16. The major causes of deaths • Road accidents • Work place accidents • Suicide • Natural cause • Heart attack • Respiratory problems • Murder • others

17. The number of deaths according to major causes • Natural cause-299 • Respiratory problem-292 • Suicide-120 • MURDERED-100 • Heart attack-76 • Work place accidents-102 • Road accident-185 • Others CAUSES-183

18. Country wise number of deaths • Malyasia-441 • Saudi arabia-305 • Quatar-306 • UAE-125 • Kuwait-21 • South korea-9 • Others-64

19. Number of death from sole health related cause=889( OUT OF 1357) • Natural causes-299 • Heart attack-76 • Respiratory problem-292 • Suicide-120 • Work place accidents related to poor concentration and mental stress-102 TOTAL=889

20. Death by age group • 20- 50 years • Productive age groups • Mostly – premature deaths • Huge- economical and family- loss.

21. The major causes of suicide • Extreme work place environment • Not finding things as expectation • More frustration • More mental stress- depression • Un-protective- sexual act- mental stress- because of STD / AIDS/ HIV

22. HOW TO MINIMISE DEATH FROM RTA, ACCIDENTS IN WORK PLACE, BEING MURDERED,ABNORMAL ENVIROMENTS • THERE SHOULD BE STRICT RULE AND REGULATION ABOUT THE PRE-DEPARTURE ORINTATION OR COUNSELING CLASS- TO THE MIGRANT WORKERS , FROM THE MIGRATION RESOURSE CENTER ( MRC) WHICH IS RUN UNDER THE FOREIGN EMPLOYMENT PROMOTION BOARD ( FEPB) • MRC( migration resource center)-record shows only-466 visited to acquire information on the destination country.

23. MUST TAKE INFORMATION FROM MRC ( migration resource centre ) • ABOUT-DESTATION COUNTRY-REGARDING -ENVITOMENT, WEATHER,TEMTERATURE. - CULTURE, RELEGION, TABOOS,ETHICS - TRAFIC RULES, AND OTHER RULES AND REGULATION - ABOUT PLACE OF WORKING COMPANY -epidemics of disease and life style and food habit affeting factors eg malaria ,dengue, mycoplasmainfectios , RO mineral water and indoor working habit. • ABOUT- NEPALI EMBASSY OR COUNSULAR OFFICE- PROPER –ADDRESS, CONTACT NUMBER, NAME OF CONTACT PERSON

24. To minimize the death from health related situations • There should be the strict rule and regulation of taking pre-departure health orientation and counseling class to migrant workers , from authorized health institution • Migrant workers should have knowledge on health safety measure on time. • There should be established such authorized health online health counseling center , especially for the migrant workers

25. To minimize the death from health related situations • Such authorized health counseling center should provide the easy and quality service to the migrant workers With least of cost- e.g.by qualified doctors- family physician for comprehensive online health assessment, counseling, providing with prescribed medicine to migrant workers via currier as soon as possible. And continuous keep in touch with mentally and physically sick migrant workers.

26. The major factors that effluence health of migrant workers 1. All kinds of stresses -new place, unfeasible accommodation -new environments -new cultures, law, language and food pattern problems -not meeting expectations - family- distraction, home sick 2. Low self esteem 3. Low understanding/ lower level of knowledge 4.Nutritinal – pattern- ( lack of balance diet)

27. The major factors that effluence health of migrant workers 5. Uses of elicit substances and risk behaviors 6. Lack of adequate rest due to over exertions 7. Lack of adequate health care facility 8. Lack of on time health service seeking behavior. 9. Language barrier and low quality health service 10. Lack of comprehensive health care and counseling body and its access. 11. Lack of quality drugs according to health problems . 12. Vulnerable to communicable diseases from friends- TB,RISK BEHAVIOUR HABITS, PNEUMONIA , AGE, TYPHOID etc.

28. INTRODUCTION OF FAMILY MEDICINE andfamily physician • Family medicine is the medical specialty which provides continuing, comprehensive health care for the individual and family. • It is a specialty in breadth that integrates the philosophical, biological, and clinical and behavioral sciences. • The scope of family medicine encompasses all ages, sexes, each organ system and every disease entity. • It has patient center approach rather than disease center.

29. Modes of comprehensive online health assessment and counseling • Adequate numbers of hot-line – telephone- direct access service • Adequate numbers of- net phone with audio visual –access- via web cam chat, yahoo messenger of face book with direct instant service provider. • Via direct – mobile-phone – conversation-facilities. • Via- e- mailing- with rapid response reply system-

30. Possible solutions from comprehensive online health assessment and counseling • Regarding legal problems about- passport. Other documentation, legal cases against- migrant workers. • To provide knowledge regarding travel document. • To provide medical documents for leave in company-for emergency conditions. • To help humanly to migrant workers via information technology for various expected and unexpected problems in the extreme situations. • To provide pre- departure and post departure comprehensive health orientation class and telemedicine health assessment and counseling – to migrant workers.

31. Possible solutions from comprehensive online health assessment and counseling • easy and quality service to the migrant workers With least of cost- e.g.by qualified doctors- family physician for comprehensive online health assessment, counseling, providing with prescribed medicine to migrant workers via currier as soon as possible. And continuous keep in touch with mentally and physically sick migrant workers. • Designing useful web site on comprehensive online health assessment and counseling- which can be helpful to the migrant workers.

32. :jf:Yosf] j}1flgs kl/efiff • æ:jf:Yo eg]s]f s'g} klgJolQmdf a9L cfTdansf] ;fy} cWofTdsjfbL ;f]r / cEof;sf] t'ngfdfåGåfTdsef}ltsjfbL ;f]r / cEof; ;fk]lIfs ?kdfclwstdx'g' , tyfpQmJolQmsf] sf]ifLotgfjsf/s tTjx? (TNF -α / ;lqmoNFkB) sf] ;fk]lIfst'ngfdfsf]ifLoleqLtgfj/f]wstTjx? (IkBα/ X-factor) ;+t'lntcj:yfdf /xg' xf] Æ. - BY DR. RAJ KUMAR DHAUGODA

33. :jf:Yosf] åGåfTds j}1flgs kl/efiff åGåfTdsef}ltsjfbL ;f]r / Jojxf/ ePsf] jl9 cfTdalnoJolQmsf] z/L/df ;fk]lIfs jl9 tgfj/f]wstTjx? (IkBa tyfX factor) :jf:Yo(Health) /f]u (Disease) cWofTdLs ;f]r / Jojxf/ ePsf] sdcfTdjlnoJolQmsf] z/L/dftgfjsf/s tTjx? ;lqmoTNF- œ tyfNFkBsf] cj:yf . - BY DR. RAJ KUMAR DHAUGODA

34. /f]u sf] åGåfTds j}1flgs kl/efiff • /f]u sf] åGåfTds j}1flgs kl/efiff • æ /f]u eg]sf] s'g}klgJolQmdfsdcfTdansf] ;fy} cWofTdjfbL ;f]r / cEof;sf] t'ngfdfåGåfTdsef}ltsjfbL ;f]r / cEof; ;fk]lIfs ?kdfsdx'g] , tyfpQmJolQmsf] sf]lifotgfjsf/s tTjx? (TNF-α / ;s[o NFkB)sf] t'ngfdfsf]lifoleqLtgfj/f]wstTjx? (IKBα/ x-factor)sf] dfqf ;fk]lIfs ?kdfsd /xg' xf] . Æ - BY DR. RAJ KUMAR DHAUGODA

35. /f]u k|lt/f]wstf(Immunity) eg]sf] • æs'g}klgJolQmdfal9 cfTdansf] ;fy} p;dfåGåfTdsef}ltsjfbL ;f]r / cEof; M tyfsf]lifoleqLtgfj/f]wstTjx? ( IkBα/ x-factor) sf] ;fk]lIfsdfqfdf ;+t'lnt ?kdf /xg' xf] . Æ - BY DR. RAJ KUMAR DHAUGODA

36. :j:Yo /xgsf] nflu • Dffgl;stgfa af6 aRgal9 cfTdansf] cfaZostf kb{5 . • afXotgfjsf/s tTjx? af6 aRg ,cWofTdjfbL ;f]r / cEof;sf] t'ngfdfåGåfTdsef}ltsjfbL ;f]r / cEof; ;fk]lIfs ?kdfclwstdx'g' kb{5 . • sf]ifLotgfjsf/s tTjx? (TNF -α / ;lqmoNFkB) sf] ;fk]lIfst'ngfdfsf]ifLoleqLtgfj/f]wstTjx? (IkBα/ X-factor) ;+t'lntcj:yfdf/xg' kb{5 . • X-factor- ePsf] ;+t'NlL TF ef]hg cfaZos kb{5 .

37. causes of increased level of cellular stress factors ( tnf-alpha and NfkB) • Abnormal physical stress , hot temperature,etreme cold, extreme exertion, sleep depriviation • Infections and infestation, inflammations • Hormones enzyme imbalances • Psychological stress • Deficiency of vitamins and minerals • Any trauma • Tumors • Metabolic disorders

38. स्वस्थ हुने सरल उपायहरु • १. दिन्को १ घन्टा घाम ताप्ने२.दिन्को १ घन्टा हिड्ने वा परिश्रम गर्ने३.पानी उमालेर खाने ( तर जार को पानी नखाने RO processing पानी खानु हुदैन)४.चिल्लो गुलियो कम खाने, स्वस्थ खानेकुरा खाने।।सरुवा रोग हरु र दुर्घटना हरु बाट बच्ने उपाय अबलम्बन गर्ने /normal accident theory को बारेमा जान्कारी रहने ।५.चुरोट नखादा राम्रो ; खायेपनी दिन्मा एउटा मात्र खाने६.मासु हप्ता मा एक पटक मात्र खाने।७.महिनामा एक पटक जुका को औसधि खाने।८.अरुलाइ पिडा हुने काम नगर्ने।९.बिज्ञान मा रुचि अर्थात् द्वन्द्वात्मक भौतिक वाद मा बढी बिश्वास राख्ने तर अन्धबिश्वास र अतिवाद मा कम रुचि राख्ने।

39. स्वस्थ हुने सरल उपायहरु • १०.आफुले गर्नुपर्ने काम आत्मबिस्वास का साथ गर्ने। राम्रो को लागि आशाबादी हुने।अपरधिक बिचार र कार्य बाट टाढा रहने।११.नियमित बचत गर्ने तथा अनावश्यक खर्च नगर्ने। र अनिवार्य स्वास्थ्य तथा जीवन बिमा गर्ने।छोरा छोरी र नाति नातिना को लागि सम्पत्ति नथुपार्ने। स्वस्थ्य मनोरञ्जन र आबस्यक आरम गर्ने , परिवार लाई उचित समय दिने।१२. बिबाद लाई समाधान गर्न द्वन्द ब्यबस्थापन को नीति अप्नाउने। एक कदम पछाडी र दुई कदम अगादी को तरिका अपनाउने।१३.स्वास्थ्य मा केही समस्या भयमा सुरुको अबस्थामा नै चिकित्सक को सल्ल्लाह लिने (फेमिली फिजिसिअन सङग सल्लाह लिनु राम्रो )१४. बेरोजगारी नरहने।काम को सम्मान गर्ने।कुनै पनि आयमुलक पेसा वा ब्यबसाय गर्ने। कुलत मा नफस्ने।१५. नेपाल को राज्नैतिक अवस्था , सम्बिधान, र विभिन्न कानुन हरु जस्तै मुलिकी ऐन , फौज्दरी कानुन आदि को अनिबार्य जानी राख्ने। मुलुक को प्रत्येक नागरिक ले कानुन अनिवार्य जानेको हुनै पर्दछ।

40. { x]/fO{ / a'em\fO{ dfkl/at{g WAY OF LOOKING X]/fO{ CONCEPT UNDERSTANDING a'em\fO{

41. OUR GREAT WISHING • BEST OF LUCK • GOOD JOURNEY • TAKE CARE • IF ANY PROBLEME SHARE WITH US • WE ARE WORKING FOR YOU. • WE WISH YOU ALL THE BEST .

42. AT THE END • IF YOU HAVE ANY QUERRES ? • FREELY YOU CAN ASK .

43. LAST BUT NOT THE LEAST TIPS, • ALWAYS EQUIPED WITH COMMUNICATION • YOUR last FRIEND IS INFORMATION TECHNOLOGY- informed with FRIENDS, MOBILE , E-MAIL. FACEBOOK, OTHER NEWS WEB SITES, LIKE www.ekantipure.com other important phone numbers( like our office, embassy, MRC ,FOREIGN MINISRY ) • SHARE YOUR PROBLEMS AND EXPERIENCE TO FRIENDS THEY CAN TAKE LESSON FROM YOUR TRAUBLES.