Dealing with unconscious victims

By

The Ministry of Health

An unconscious victim is defined as a person who is unresponsive to verbal commands and stimulus. An unconscious victim may or may not have breathing and signs of circulation (breathing, coughing and movements).

The first priority is to open the airway to get air into the lungs so that oxygen can reach the brain and other vital organs. Remember, brain damage begins within four to six minutes if nothing is done.

Some injuries and illnesses can result in a victim becoming confused or even unconscious. The individual may be wide awake and alert, completely unresponsive to outside stimulation or somewhere between these extremes.

Causes: May vary, that include: Severe bleeding, severe burns, epilepsy, heart attack, stroke, diabetes, hypertension and so on.

Initial assessment should be made thoroughly and quickly. The purposes are mainly to prioritise the victim, find the main causes of such condition and to determine the existence of life threatening conditions.

If the victim is not fully conscious, you need to monitor any changes in the level of response as the victim's condition can deteriorate and he may become unconscious at any time.

NOTE: In any case, if the victim is not responding to any means of stimuli, further assessment needs to be carried out. (Please refer to CPR procedures)

Safety measure should be made when handling an unconscious victim as you do not want the victim to suffer any wrongdoings being done on him.
Below are some steps that need to be taken into account when you attempt to rescue the victim.

DO:
- Activate Emergency Medical Ambulance Service (EMAS 991),
- Check any danger to you or the victim as you approach the scene,
- Look for clues such as special bracelet or necklace that may indicate the victim has any illnesses such as diabetes mellitus or epilepsy,
- Make sure that the victim's airway is opened; any loose dentures need to be removed;
- Check the victim for any obvious injuries eg bleeding, fracture or evidence of falling from a certain height and so on,
- Put the victim in the recovery position; if trauma is not suspected and victim is breathing or resumes breathing and signs of circulation,
- Observe the victim's condition every three to five minutes, while waiting for the ambulance to arrive,
- Loosen tight clothing especially around the neck, chest and waist,
- Move the victim (if there is no suspected head or neck injury) to open air if victim is in a crowded place,
- Raise and support the legs to improve the blood supply to the vital organs, unless there are obvious injuries to the victim's body,
- Cover the victim with a blanket or whatever else is available to conserve heat.

DON'T:
- Leave the victim alone unless you have to go for help,
- Delay the victim's removal to the hospital,
- Remove the victim if you suspect the victim has a head or spine injury,
- Let the victim eat, drink or smoke,
- Throw any water over the victim's face and/or body,
- Slap the victim's face,
- Shout, scream or shake the victim,
- Give any medications, hot drinks or any alcoholic beverages,
- Use smelling salts or ammonia inhalants.

PRECAUTION
- If you suspect the victim is having head or spinal injury, try to leave the victim in the position in which you found him/her.
- If you need to put the victim in the recovery position, keep the victim's - head and neck in alignment with the body.

Source: Weekend, 28 Feb 2009

Skin disease and your work

By

Ministry of Health

What is occupational skin disease or dermatosis?
Occupational skin disease or dermatosis is skin disease due to workplace exposures to physical, chemical or biological agents.

What is the most common type of occupational dermatosis?
The most common type is contact dermatitis. Dermatitis or eczema is inflammation of the skin which is characterised by redness, swelling, fluid-filled blisters and oozing in acute stages and thickening, broken skin and colour changes in the chronic stage of the disease.

What are the different types of contact dermatitis found in the workplace?
There are two major types of dermatitis: irritant contact dermatitis caused by irritants, and allergic contact dermatitis caused by allergens

A previous medical history of a skin diseas, such as eczema, the pre-existing disease may aggravate these irritants/allergens.

What are the high risk occupations which can cause contact dermatitis?

An example of such high risk jobs and the cause of the skin disease:


What are the other common types of occupational dermatosis?

- Heat rash due to excessive heat
- Sun-damaged skin due to prolonged exposure to ultraviolet light
- Fungal infection
- Parasites such as mites
- Acne-caused by oil and grease
- Skin cancer caused by ultraviolet light, pitch and tar


How can we prevent occupational dermatosis?
- Always follow proper and safe work practices
- Always practise good personal hygiene
- Ensure adequate environmental conditions, such as proper ventilation and temperature
- Do not use solvents or abrasive detergents to clean your skin. Use proper skin cleansers or a mild soap. If possible, take a shower before going home
- Use barrier creams if appropriate and regular moisturisers
- Dry your skin thoroughly after work. Ensure disposable towels are provided to dry your hands
- Use personal protective equipment such as masks, boots, gowns and hypoallergenic gloves if appropriate to avoid skin contamination.

Ministry of Health Public Awareness Programme

Source: Weekend 14 Feb 2009

Self-management of Osteo-Arthritic knee

By

Mohammad Khairul Anuar Bin Pehin Haji Hasrin,

Physiotherapy Dept, RIPAS Hospital

Osteo-arthritis is a wear and tear process occurring in joints in the body that are under the most stress eg the knee, hip, lower back and neck. Many people are affected by this condition although it is mainly the middle-aged or elderly who is affected, younger people, as early as thirty can show mild arthritic symptoms.

ANATOMY
The knee joint is made up of two bones of the thigh and lower leg - the femur and tibia. They have a smooth polished surface at their end called cartilage. The cartilage allows free gliding movement between the two bones. It also acts as a shock absorber. A strong bag-like membrane called the capsule surrounds the whole joint. It is reinforced by ligaments, which bind the joint together. Inside the capsule is the joint fluid (synovium). The joint fluid is important in lubricating the joint and nourishing the cartilage. Each of these structures is involved in the wear and tear process of osteo-arthritis.

PATHOLOGY
In osteo-arthritis of the knee, the cartilage becomes roughened and begins to thin out in the part of the joint where usually more weight is borne or sometimes where no movement occurs - eventually patches of bone are exposed. The exact initiating factor is still uncertain, but the condition will be aggravated by a combination and variety of factors, which include the durability of cartilage, the natural ageing process, over use or lack of use, a previous injury and excess weight.

RESULTS
The surrounding capsule and ligaments respond to these changes by a stiffening process. The effects are felt after a period of inactivity. The stiffening loosens up with movement. As the joint surfaces become closer and less smooth, movement becomes less supple. Reduced shock absorption makes the knee more vulnerable to stress, so that aching follows any stress more readily.

ACTION NEEDED
Once the cartilage has worn away, it cannot be replaced, therefore you should aim to conserve your cartilage. This can be done by reducing stress to the cartilage and keeping the cartilage well nourished, which it receives from the joint fluid. These nutrients have to be squeezed into the cartilage by the pressure of movement, otherwise the cartilage starves. Thus the nutrients have to be pumped into the area by muscular movement and then squeezed into the cartilage.

DO's AND DON'Ts

Joint Mobility
Don't be immobile - Long periods of immobility should be avoided as it means there is no squeezing effect of the joint fluid into the cartilage.
Do be mobile - Keep your knee movement full. Allowing your knees to stiffen and lose some movement at extreme straight or bent positions will restrict your activities and reduce nourishment to the cartilage.

Compression Of The Joint
Don't compress your joints excessively - For example, long bouts of standing, walking or running; sudden impact on your joint (running on concrete, stepping awkwardly down steps); being overweight or carrying extra weight (shopping or carrying young children for too long) Also try to be and maintain your optimum weight.

Do ease off weight on joint regularly - Keep shifting from one foot to the other; sit down to take weight off your feet whenever possible; use a walking stick to help reduce the weight going through the joint.

Do compensate for the loss of shock - Step carefully down steps; wear correct footwear with good shock absorbing soles (eg crepe or sorbo-rubber); when kneeling, use a foam cushion.

Twisting The Joint
Don't twist the joint - This stressful movement eg. getting up from the floor, will grind the joint surfaces together and strain the ligaments and capsule.

Do avoid twisting the joint - Avoid having to get up from the floor or sitting back on your heels; wear low heel shoes; sit with your leg uncrossed.

Strength Of Surrounding Muscles
Don't let leg muscles weaken - If this happens, the support of the knee joint is reduced, and your knee will be more vulnerable to strain.

Do protect your joint by keeping muscles strong by exercising them.

PRACTICAL TIPS AT HOME TO HELP EASE YOUR ACHES AND PAINS
Wear knee supports or bandages - Their warmth and gentle pressure may help to ease your symptoms.
Massage around your knee - Gentle but firm circular kneading movements with the pads of your fingers may help ease the symptoms of stiffness around your joint.
Heat applied to the joint - This can help reduce the sensation of pain experienced. Use a quarter filled hot water bottle, filled with 'bath hot' water. Apply to your knee and leave for 15-20 minutes, this should feel very comfortable.
Cold may be more effective for some people, especially if heat tends to make no difference. Crush ice cubes in a dampened face flannel and apply to your knee. Allow approximately 10-15 minutes. Your knee should be slightly pink at the end.

Ministry of Health Public Awareness Programme

(Ref: A Practical Guide To The Care And Protection Of The Osteo-Arthritic Knee - Written By Chartered Physiotherapists, United Kingdom)

Source: Weekend 7 Feb 2009

Suffer from asthma? Exercise

By

Ministry of Health

Being active is an essential part of healthy living.




Paula Radcliff, Professional Marathon Runner, (World Record Holder).





Asthma should not be a reason not to exercise, play sport or keep fit.

In the past it was believed that asthmatics should not take part in team sports and vigorous activities. We know now this is not true as there are many top athletes in various sports who have asthma.

Regular exercise increases fitness and if done appropriately it can help reduce the frequency of asthma attacks.

Exercise is important to asthmatics because it can increase/improve:
- Exercise tolerance
- Self esteem
- Confidence
- Psychological and physical well being

If you are asthmatic and would like to take part in regular activity the following steps can be used to ensure that it is done as safely and as comfortable as possible.

Visit the doctor
It is important to visit your doctor before taking part in any form of exercise to make sure that it is safe. Your doctor should give you some advice on how to manage your asthma and on the suitability of the activities that you are interested in.

Recognise the symptoms
If your asthma is not under control or if you are experiencing any of the following do not exercise, as it can be hazardous:
- Wheezing
- Coughing
- Feeling tightness in the chest
- Breathlessness
- Cold or Flu

Plan your activities
Make sure your asthma is managed properly
Bring your asthma medication with you
Use your asthma medication about five to 10 minutes before you warm up. (Your doctor will advise you on the most suitable medication)
Always warm up by lightly moving and stretching for 10 to 15 minutes before you play sport or exercise
Always cool down

If you have an asthma attack:
- Stop what you are doing if you experience any early signs of an asthma attack
- Take four puffs of your reliever / inhaler (Ventolin or Bricanyl)
- Wait four minutes
- Wait until you are symptom free before you restart exercising
- If symptoms do not go away use your reliever again as directed

Benefits of regular exercise
- Better weight control
- More energy
- Brighter mental outlook
- Increased self-esteem
- Reduced risk of heart disease high blood pressure, diabetes and colon cancer
- Reduced risk of colon cancer
- Less chance of cold and flu
- Health and strong bones, joints and muscles
- Fitness and flexibility
- Better quality of life

Always remember
Being active is an essential part of healthy living and that asthma should not be a reason not to exercise, instead regular exercise should be a part of any asthma management plan.

- Ministry of Health Public Awareness Programme

Source: Weekend 17 January 2009

Do-It-Yourself Depression Remedies

By

Howard Levy, M.D.

Treatment of depression often involves multiple and different strategies. For some patients, a few simple home remedies are all that's needed. But even those who need counseling and/or medications will benefit from these do-it-yourself techniques:

Exercise.

The fatigue and poor motivation brought on by depression can make it very hard to get up and get moving, so resuming or increasing your former exercise program—or beginning a new one—may be difficult at first. However, the rewards should come quickly. The increased blood flow, breathing rate, and muscle use associated with exercise will improve energy levels during the day and result in more restful sleep overnight.

Even more importantly, exercise causes the release of chemicals called endorphins in the brain. Endorphins elevate the mood and increase energy levels. They are the source of the "runner's high"—a state of euphoria that endurance athletes experience after a sustained period of exertion. Think of endorphins as your own natural antidepressants.

And, of course, exercise has additional benefits beyond treating depression. High on the list is reducing the risks of diabetes, high blood pressure, and coronary artery disease. Burning calories while exercising can also help you combat the tendency towards weight gain that's associated with both depression itself and with several prescription antidepressant medications.

One trick for overcoming inertia and beginning an exercise regimen is to simply make a schedule of exercise time, and commit to doing a specific activity during that time. Start with 20 to 30 minutes 3 times per week, and then try to build towards 45 to 60 minutes every day. If it helps you, try thinking of exercise as a prescription from your doctor to treat depression. It also helps if you can find one or more types of physical activity that you enjoy, or at least don't dislike too much.

Laughter.

The simple act of laughing also releases endorphins, thus treating depression. Of course, being depressed can make it very hard to laugh, so this may not be practical advice in the early stages of treating severe depression. But as soon as you're able to, going out of your way to find funny things and experience some good, hearty laughter is seriously helpful!

Light.

It is well known that the shorter days of winter are associated with seasonal affective disorder (SAD) in many people, and worsen symptoms in those with chronic depression. Increasing your exposure to natural sunlight will help elevate your mood right away, and regular light therapy can be very beneficial for treating depression. If you've made the commitment to exercise as part of a depression management program, try to schedule at least some of your activity outdoors in the daytime. The winter months can be a challenge, but creative scheduling and some really warm clothes will help a lot. If getting outdoors isn't practical, the next best thing is to spend as much time as possible in front of a big window that lets in a lot of light.

Another option is artificial sunlight. There are several companies that market lamps specifically for treating depression, SAD, and low mood. These special lights can be ordered directly on the Internet, and are available in just about every price range. I suggest placing the light next to your bed and plugging it into a timer. Have it turn on about 10 minutes before you plan to wake up, and lie in bed under the light for about half an hour or so every day. Artificial sunlight is a great idea even if you already get time outdoors and/or window exposure during the day.

Attitude.

For many people, depression is caused or worsened by a variety of stressful or sad thoughts and situations. Resisting or denying a diagnosis of depression can become yet another source of stress, and actually worsen your symptoms. Failing to accomplish desired or necessary tasks, a common problem in depressed people, often makes things worse, too.

Try to take stock of your current abilities and limitations—what you can do now, not what you used to be able to do—and then set out some specific, modest goals. Just getting a few things accomplished can help to reduce stress, and that will help improve the depression.

Also, consider whether worrying about things beyond your control is productive or helpful to you. Perhaps the best way to summarize the importance of attitude is with the serenity prayer:

God, Grant me the serenity to accept the things I cannot change, Courage to change the things I can, and Wisdom to know the difference.

Source: Health.Yahoo.com - Posted on Thu, Jan 15, 2009

Obesity: Growing epidemic

By

Dr PS Sugathan

Specialist Paediatrician and Head of the Department of Paediatrics and Neonatology

RIPAS Hospital

Ministry of Health

Obesity is spreading worldwide like an epidemic. So what? Why should anyone be so concerned about obesity "epidemic"?

It is a fact that obesity causes diseases and eventually deaths on a large scale. Are you surprised? Shocked? If you are, half the purpose of this article is fulfilled. Awareness of a problem is half the solution, isn't it?

Yes, rising incidence of obesity is thought to be a significant factor for bringing down life expectancy in the affluent countries today; its overall impact on health is comparable to that of smoking. And less developed countries are catching up fast in this field.

How does obesity influence health and disease?

Obesity makes one prone to or aggravates a variety of chronic (i.e. long- lingering) illnesses like diabetes, high blood pressure, lung diseases and bone and joint problems. This list is not complete. It can shorten life span and even contribute to the development of some forms of cancer. A pretty depressing scenario, isn't it?

Okay. These are diseases affecting the grown-ups, so why are you bothering children with all these depressing information?

Well, obesity and all the related diseases have their foundation laid in childhood. Childhood obesity tends to stay with you, often grows with you, into adulthood and beyond, until it silently nudges you into the grave.

Enough of the scare-mongering.. Give us some hope. Aren't there any solutions?

There are solutions. And they constitute the remaining half of the purpose of this article. But be reminded. There are no shortcuts! No magic pills. No special diets - not suitable for children anyway. The key words are life style changes, consistency and community involvement.

But first the basics: Obesity is body weight, particularly body fat, in excess of the norm for one's age, sex and height. It results from an imbalance between supply and demand, input and expenditure, of (food) energy. When you take in more energy than your body spends on growth, repair and physical work (including daily chores, play and exercise), the positive balance, the excess energy, is stored in the body as fat. And it is the stored fat, not the muscle or bone mass that plays the havoc.

So what do we do?

Step 1: Increase the expenditure i.e. exercise
Say goodbye to sedentary (shall we call it lazy) habits.

Keeping obesity under control is a life long process, and should start very early. It is common everywhere nowadays to see even toddlers being pushed around in prams and push chairs. (That is if ever they get an opportunity to get out of the house or the car). They are being denied the opportunity of enjoying and be enriched by the many - faceted sensory inputs associated with running around. In the process, the chance to burn a few calories of energy is lost. And we are laying the seeds of obesity here.

Inside the house the ever present television and computer games get children (and grown- ups) glued to them with minimal opportunity for physical activity. Television viewing also encourages binge eating while kids are bombarded with advertisements of obesity - enhancing junk food. Its influence on obesity is varied and vast indeed. Lesson: restrict TV viewing (to perhaps an hour a day on weekdays and a little longer during weekends).

Encourage energy expenditure by progressive physical activity. Incorporate some habits into your life's pattern rather than depend on bouts of activity which are well laid out, but practised intermittently or liable to be postponed indefinitely. In general, push the children out into the courtyard, into the playground or on to the bicycle and so on. If you can climb (stairs) don't use lifts, if you can run don't walk, if you can walk don't stand, if you can stand don't sit, if you can sit don't lie down etc.

But while many of these may appear to be matters of individual or family decision and determination, others need the thoughtful action of the community and society. Can you let your toddler accompany you on foot on an evening stroll if roads are not paved or shopping areas are not pedestrianised? What about bicycle lanes on the road? Can children go out to play if there are no suitable compounds/ grounds?

Step 2: Decrease the (food energy) input (intake) i.e. eat wisely
Here again, to be effective we have to catch them young, literally starting from the cradle, to postpone (the approach to) the grave. Exclusive breast feeding till six months of age has been shown to reduce obesity (in the mother as well as in the baby). Conversely, bottle-feeding may encourage it.
The type of food we eat and the type of eating habits we pick up from early on is of crucial importance. Everyone nowadays seems to know the value of eating a lot of vegetables and fruits. They know that energy - rich foods like oils and fats, sugars and sugary foods, refined and canned foods, cookies, biscuits and the like, and fizzy drinks should be cut down. But the wedge between knowledge and practice is alarmingly wide.

Whose responsibility is it to bridge the wedge? Who should be involved and targeted? Is it the individual child or adult? The housewife who should steer the shopping trolley away from the processed and ready-to-eat food section to isles between stacks of (healthy) raw food? Is it the amah (maid) who may be cooking the food using her own (unhealthy) recipes? The uncles, aunts and grandparents; who often out of a mistaken sense of love and caring, feed their loved ones additional junk food? Is it he supermarkets and restaurants including school cafeterias which serve trendy, tasty foods which may be nevertheless helping obesity? The health professionals who spend their scarce time on detecting and treating diseases while finding little time and inclination to look for and offer preventive counselling against advancing over-weightedness? Whose responsibility is it to prevent obesity in the individual and its epidemic in the community?

Who is responsible for preventing obesity (and promoting a generally healthy life-style) in a society?

The answer is obvious. In the ongoing war against an expanding waistline (and the havoc it plays on people's health) every one of us is a soldier on active duty. Students, children, who are moulded by as well as mould the society, certainly occupy the front line. And you and I have to act today. For, when it comes to obesity, prevention is the only real option; reversal by treatment is so frustratingly difficult. And it should start from infancy and continue as a life- long habit of regular physical activity and moderate food intake.

- Ministry of Health Public Awareness Programme

Source: Weekend 10 Jan 2009

Injury prevention in children

By

Dr P S Sugathan,

Specialist Paediatrician,

RIPAS Hospital

Worldwide, pedestrian injuries are a leading cause of death among children. This form of injury is relatively less frequent in Brunei. AFP

Injury is a major cause of death in children. Death is only part of the problem.

For every child who dies, another 30 or more are admitted in the hospital. Of these, many are discharged with lifelong disabilities.

The role of injury prevention is even more important in countries like Brunei where other causes of death like infection get effectively prevented and treated.

Injury is preventable
Many people believe that injuries result from "accidents" and therefore are not preventable.

About 200 years ago, infections were similarly considered to be beyond our powers to prevent and treat. It's not the case anymore. Yes, injuries also are preventable using current knowledge.

We now have much better understanding of the risk factors for injuries.
Consequently, we are better able to develop programmes for prevention and control of injuries.

Types of injuries
There are numerous ways by which children get injured. But we need to focus on injuries that are frequent and severe and for which proven prevention strategies are available.

The most important of such injuries in Brunei are: motor vehicle passenger injuries, pedestrian injuries, bicycle injuries, submersion, burns, and accidental ingestion of drugs and poisons.

Motor vehicle passenger injuries
Motor vehicle injuries are the leading cause of serious and fatal injuries at all ages. Therefore lot of efforts is to be made in this area.

Specific preventive steps include the following:
a. Child restraint devices: Proper use of appropriate child restraint devices can reduce serious injuries and fatalities by about two-third in children under four years; and by half in older children.

Observation in the United States have indicated that about 90 per cent of child restraint devices are improperly installed; and about 20 per cent of them are seriously misused. Brunei lags far behind developed countries in the use of child restraint devices.

Often as a direct consequence, we see a lot of children getting seriously injured during road traffic accidents. The proper use of child restraints has to be popularised on a priority basis in Brunei.

b. Adolescent drivers are responsible for a disproportionate number of motor vehicle injuries. This is due to their inexperience and is worsened by alcohol or drug abuse.

Perhaps our adolescents need to wait till a bit older before they start driving around unsupervised.

Pedestrian injuries
Worldwide, pedestrian injuries are a leading cause of death among children. This form of injury is relatively less frequent in Brunei.

Injuries typically occur when children run out into the street and are struck by oncoming vehicles. Educational programmes aimed at improving street related behaviour of children can achieve prevention.

This should be supplemented by roadway interventions like proper lighting; provision of sidewalks and speed barriers.

Bicycle injuries
Bicycle related trauma is the leading cause of childhood head injuries in many countries. Bicycle is probably less popular in Brunei.

Use of bicycle helmets can prevent about 85 per cent of head injuries and 88 per cent of associated brain damage.

Parents should be made aware of the need for bicycle helmets. The reluctance of children to use helmets should be reduced by ongoing education about the need and effectiveness of helmets.

Submersion
Drowning is a significant cause of death and disability in children. For every death due to submersion six children are hospitalised. Approximately one-fifth of hospitalised survivors suffer severe brain damage.

Brunei is endowed with tropical climate, long coastline, rivers and lakes, abundance of swimming pools and a sprawling water village. All these make the country particularly prone to occurrence of submersion injuries.

Specific preventive measures should include the following:
a. Parents should be constantly aware of the dangers to children from any body of water.

b. Young children should never be left alone in bathtubs or near swimming pools, ponds, rivers or beaches.

c. Swimming pools should be completely surrounded by a 5-foot fence with self-closing, self-latching gate.

d. Older children and adults, especially in water village, should learn CPR (life support training).

e. Children over five years should know how to swim.

f. No one should ever swim alone.

g. Even when supervised children should wear floatation devices when playing in rivers, streams, lakes or beaches.

h. Use of intoxicating drinks and drugs should be avoided.

Burns and scalds
Approximately 80 per cent of burn related deaths occur from house fires.
Risk factors include age less than four years, overcrowding, single parents, poverty, inadequate supervision, and distance from fire department.

Smoke detectors, when used correctly can reduce death and severe injuries from burns by nearly 90 per cent.

Parents should be aware of these devices, which should be installed and properly maintained in every kitchen.

Children's clothes should be made of fire resistant fabric. Furniture, bedding and home building materials should conform to flammability standards.

Scalds occur from hot liquids. Young children should never be left alone in kitchen or bath.

Whenever a liquid is being warmed or boiled, beware of young children around. Always check tap water temperature when washing / bathing children.

Ingestion of drugs and poisons / choking:
Accidental ingestion of drugs and other harmful materials like detergents and medicated oils meant for external use, is common in Brunei.

Medicines and poisons should always be kept out of reach of children. Food items, like peanuts and roasted seeds, which could be potential foreign bodies, should not be offered to young children.

Toys with pointed edges or small detachable parts should be avoided.

Please remember:
Injuries are a major public health problem causing death and disability in perfectly healthy children (and adults).

They are NOT inevitable "accidents" but tragedies preventable by thoughtful action. Some specifics steps in this direction are described in this article.

Do try to implement them today; tomorrow may be too late for someone you love.


Ministry of Health Public Awareness Programme

Source: Weekend, 20 December 2008