Industri fosfat di Indonesia menggunakan batuan fosfat dari Jordania, Maroko, Mesir dan Cina yang merupakan hasil tambang yang mengandung TENORM (Technologically Enhanced Naturally Occurring Radioactive Materials) yang umumnya terdiri atas 238U, 232Th, 228Th, 226Ra, 228Ra, 40K, 210Pb, 210Po, 222Rn dan 220Rn, yang mempunyai waktu paro sangat panjang. TENORM tersebut dapat memberikan kontribusi pajanan radiasi eksterna maupun interna kepada pekerja yang terlibat langsung dalam industri fosfat secara terus menerus. Penelitian ini bertujuan untuk memberikan rekomendasi kebijakan pengawasan terhadap TENORM pada industri fosfat. Penelitian menggunakan desain studi eksplorasi yang merupakan suatu penelitian dengan melakukan analisis kualitatif terhadap data yang dikumpulkan melalui wawancara maupun kajian literatur. Analisis data dilakukan melalui dua tahapan, yaitu melakukan perhitungan dengan menggunakan program RESRAD dan melakukan analisis literatur terhadap peraturan-peraturan yang terkait dengan TENORM, baik peraturan yang ada di Indonesia maupun di negara lain. Dari hasil penelitian diperoleh bahwa konsentrasi aktivitas radionuklida yang terkandung di dalam TENORM pada umumnya melebihi 1 Bq/g, dan perkiraan nilai total dosis efektif yang diterima pekerja di daerah kerja pada umumnya melebihi 1 mSv per tahun. Untuk itu, kebijakan pengawasan TENORM pada industri fosfat dapat diterapkan melalui koordinasi yang efektif dalam melindungi pekerja di industri fosfat antara BAPETEN (Badan Pengawas Tenaga Nuklir), selaku lembaga pengawas pemanfaatan tenaga nuklir, dengan badan pengawas terkait lainnya, seperti DEPPERIN, DEPNAKERTRANS, KLH, ESDM, PEMDA. Selain itu, kebijakan tersebut juga dapat diterapkan melalui pelaksanaan intervensi dengan tindakan remedial atau perizinan, yang baru dapat diterapkan setelah melaksanakan pengkajian dan analisis lebih lanjut.

The phosphate ores used in the phosphate industry in Indonesia are imported from Jordan, Marocco, Egypt, and China; ores that contain TENORM (Technologically Enhanced Naturally Occurring Radioactive Materials) generally consisting of 238U, 232Th, 228Th, 226Ra, 228Ra, 40K, 210Pb, 210Po, 222Rn and 220Rn, whose half lives are very long. The TENORM can contribute to the internal and external radiation exposures to the workers directly and continuously involved in the phosphate industry. The objective of the study is to provide recommendations on the regulatory policy of TENORM in the phosphate industry. The exploration study design is used in the study and is conducted by qualitatively analyzing the data gathered from interviews and references. Data analysis is carried out by using RESRAD software for the calculation and by studying relevant regulations concerning TENORM in Indonesia and in other countries. The results show that the activity concentrations of the radionuclides contained in the TENORM generally exceed 1 Bq/kg and the total estimated effective dose received by the workers in the working environment in general surpass 1 mSv/yr. Therefore, the regulatory policy of TENORM in the phosphate industry can be implemented through an effective coordination between BAPETEN (Nuclear Energy Regulatory Agency), as the competent regulatory authority in the utilization of nuclear energy, and other regulatory authorities, such as DEPPERIN (Department of Industry), DEPNAKERTRANS (Department of Labor and Transmigration), KLH (Ministry of Environment), ESDM (Department of Energy and Mineral Resources), and PEMDA (Provincial Government) with the aim to protect the workers in the phosphate industry. In addition, the policy can also be implemented through intervention by remedial action or through licensing, which can only be executed after further analysis and assessment.

ABSTRAK

Indonesia berada pada peringkat ke 5 dari 22 negara dengan beban TB tertinggi didunia. Sekitar 75% penderita TB adalah kelompok usia paling produktif secaraekonomis (15-50 tahun). Untuk menghindari pasien putus berobat karena lamanyapasien harus mengkonsumsi obat, maka diperlukan seorang Pengawas MenelanObat (PMO). Sebaiknya PMO adalah petugas kesehatan, bertugas untukmengingatkan pasien agar mau berobat secara teratur, mengingatkan pasien untukperiksa ulang dahak pada waktu yang ditentukan dan memberikan penyuluhankesehatan kepada pasien tentang penyakit TB.Kasus putus berobat pada pasien TB di BBKPM Bandung yang terus meningkatmelebihi target nasional yaitu <10% sedikit menunjukkan bahwa kepatuhanpasien menelan obat masih kurang. Lebih dari 90% pasien dewasa yang datangberobat di BBKPM Bandungmemiliki nomor telepon seluler, oleh karena itu studiini bertujuan untuk mengembangkan sistem Informasi PMO berbasis SMSGateway pada pasien TB BTA positif. Pengembangan sistem ini diharapkan dapatmengatasi permasalahan pengawasan terhadap pasien TB dengan mobilitas tinggiterutama di kota besar agar komunikasi antar pasien dan petugas kesehatan dapatberjalan efektif dan kegiatan PMO di BBKPM Bandung tetap dapat dilaksanakan.Gambaran sistem informasi PMO yang sedang berjalan diperoleh berdasarkanhasil studi kualitatif peneliti dengan metode telaah dokumen, observasi danwawancara mendalam terhadap 24 informan yang terdiri dari pejabat pengambilkebijakan di BBKPM Bandung, petugas kesehatan di ruang penyuluhan, petugaspencatatan dan pelaporan TB serta surveyor. Analisis sistem ini menggunakanpendekatan masukan (input), proses dan keluaran (output) untuk dapatmengidentifikasi permasalahan sistem yang ada. Hasil pengembangan sistemberupa prototype sistem informasi pengawasan menelan obat (PMO) denganmenggunakan SMS gateway. Petugas kesehatan di ruang penyuluhan bertindaksebagai PMO dan user pada aplikasi ini. Keluaran sistem informasi adalah pasienmenerima pesan pengingat harian menelan obat, pesan pengingat waktunyakontrol ulang dan pesan informasi kesehatan tentang penyakit TB serta laporanpelaksanaan kegiatan PMO berbasis SMS Gateway kepada Kepala Seksi PromosiKesehatan dan Kepala Seksi Pelayanan Kesehatan.

ABSTRAC

TIndonesia is ranked 5th out of 22 countries with the highest TB burden in theworld. Approximately 75% of TB patients are a group of the most economicallyproductive age (15-50 years). To avoid treatment of patients drop out due to thelong patients should take the drug, it would require a Supervisory. Supervisor isthe health officer should, served to remind the patient to treatment regularly,reminding patients to check the sputum at the appointed time and provide healtheducation to patients about TB disease.Withdrawing treatment in TB patients in Bandung Lung Clinic growing beyondnational target of <10% fewer patients showed that adherence to medicationingestion is still lacking. More than 90% of adult patients who come for treatmentin Bandung Lung Clinic have a cell phone number, therefore this study aims todevelop an information system of drug intake supervision based on gateway shortmessage system on smear positive TB patients. Development of this system isexpected to solve the problem of TB surveillance of patients with high mobility,especially in large cities so that communication between patients and health careworkers can be effective and activities of treatment supervision in Bandung LungClinic still be implemented.Overview of drug intake supervision information systems ongoing qualitativestudy based on the results obtained with the method researchers document review,observation and depth interviews with 24 informants consisting of officialsBandung Lung Clinic policy makers in Bandung, health officials in the healtheducation space, recording and reporting of TB officer and surveyor. This systemanalyzes input approach, process and output to be able to identify the problems ofthe existing system. The results of the development is a prototype system to drugintake supervision information system by using the gateway short messagesystem. Health workers in counseling space acts as a PMO and user in thisapplication. Patient information system output is received daily remindermessages ingesting the drug, the time control message repeated reminders andhealth information messages about TB disease and report on implementation ofsupervision-based Gateway short message system to Health Promotion SectionHead and Section Head of Health Services.

Indonesia berpotensi rawan terjadi bencana alam gempa bumi. Kerugian negara akibat bencana alam sejak  tsunami Aceh bulan desember tahun 2004 hingga gempa di sumatera barat mencapai 150 triliun lebih. Selain kerugian harta benda gempa mengakibatkan korban jiwa masif, korban luka, dan kerusakan infrastruktur. Dalam kurun waktu 5 tahun terakhir kerugian tersebut terus berulang terjadi hal tersebut diakibatkan oleh karena kegagalan tata kelola. Tata kelola bencana yang baik harus didukung Good Coorporate Governance dan Good Cinical Governance. Bencana gempa bumi di Lombok, Palu, Cianjur dan Turki telah menyebabkan kerusakan infrastruktur kesehatan, menelan korban jiwa massal dan mengakibatkan korban luka berat yang banyak. Korban umumnya adalah kasus patah tulang yang ditangani oleh dokter orthopedi. Pada saat tanggap darurat bencana gempa bumi pertolongan korban menjadi lambat disebabkan oleh beberapa hal antara lain : tenaga medis lokal turut menjadi korban, distribusi logistik terganggu, peran pemerintah dan lembaga non pemerintah dalam komando, koordinasi dan komunikasi antar lembaga kebencanaan belum sepenuhnya terintegrasi dengan regulasi yang ada, akses menuju layanan rujukan kesehatan dan fasilitas kesehatan yang terganggu. Hal tersebut menambah keparahan tata kelola bencana gempa bumi bahkan disertai tsunami, likuifaksi, longsor maupun wabah pandemi. Tujuan dari penelitian ini untuk menyusun model tata kelola darurat orthopedi pada fase tanggap darurat bencana gempa bumi berbasis sistem input proses dan output yang terjadi. Menggunakan multi case study methods di Lombok, Palu, Cianjur dan Turki rancangan penelitian ini disusun melalui lima tahapan penelitian dengan pendekatan kualitatif. Hasil penelitian yang didapat dari hasil analisis kesenjangan menunjukkan bahwa tata kelola pada dimensi karakteristik gempa, faktor eksternal dan resiliensi bangunan fasilitas kesehatan mempengaruhi faktor existing condition yang sudah ada pada tata kelola darurat orthopedi fase tanggap darurat bencana gempa bumi. Konstruksi model dihasilkan dari analisis pengembangan tata kelola lama melalui analisis kesenjangan dari dimensi existing condition dan precondition yang telah dilakukan prediksi acceptancenya berdasar governansi klinis, organisasi dan kebencanaan sebagai rancang bangun adaptive model dari tata kelola bencana yaitu model MELFASSER. Model MELFASSER merupakan penyempurnaan dari tata kelola lama yang disusun dengan memperhitungkan dimensi karakteristik gempa antara lain Magnitude, Epicentrum dan Locations, Fore and After Shock, Side Effect dan juga mempertimbangkan faktor eksternal dan Resiliensi bangunan layanan kesehatan. Hasil temuan ini dikembangkan menjadi ajuan rancangan borang MELFASSE untuk penilaian pemberdayaan local resources dan rekomendasi aktifasi existing condition dan borang RVAHBR untuk penilaian ketahanan gedung faskes sebagai preliminary assessment pada tata kelola darurat orthopedi fase tanggap darurat bencana gempa bumi. borang MELFASSE-R yang disusun diharapkan akan lebih luas pemanfaatannya dan dapat digunakan dengan mudah sesuai dengan kapasitas sumberdaya lokal dalam menyusun rekomendasi aksi selanjutnya pada saat fase tanggap darurat bencana gempa bumi.

Indonesia is prone to potential earthquake natural disasters. State losses due to disasters since the Aceh tsunami in December 2004  to West Sumatra earthquake reached more than 150 trillion rupiah. Apart from significant property lossess, the earthquake resulted in massive loss of life, injuries and infrastructure damages. Over the past 5 years, these losses have continued to occur repeatedly, this is due to failures in governance. Good disaster governance must be supported by Good Corporate Governance and Good Clinical Governance. Earthquake disasters in Lombok, Palu, Cianjur and Turkey lead to many health infrastructures damage, severe mass casualties, and resulted in many serious injuries. Victims of serious injuries most commonly suffer from bone fractures that require treatment by an orthopedic surgeon. During the earthquake response phase, humanitarian aid to victims was slow due to several things, including : local medical personnel became victims, logistics distribution was disrupted, the role of government and non-governmental institution in command, coordination and communication among disasters institution  was not fully integrated with existing regulations, access to health referral services and health facilities is disrupted. This increases to the severity of earthquake disaster governance, even accompanied by tsunamis, liquefaction, landslides and pandemic outbreaks. The aim of this research is to establish a model for orthopedic emergency governance in an earthquake disaster response phase based on the process input and output systems. Using multi case study methods in Lombok, Palu, Cianjur and Turkey, this research design was structured through five stages with a qualitative approach. The research results obtained from the gap analysis showed that governance in the dimensions of earthquake characteristics, external factors and resilience of health facility buildings influenced existing condition factors that already established in orthopedic emergency governance during the response phase earthquake disasters. The model generated from development analysis of existing disaster governance through gap analysis of existing conditions dimensions and preconditions whose acceptance predictions have been carried out based on clinical, organizational and disaster governance as a design for an adaptive model of disaster governance, namely the MELFASSER model. The MELFASSER model is an adaptive model from an established existing disaster governance systems in consideration of earthquake characteristics dimensions including Magnitude, Epicenter and Location, Fore and AfterShock, Side effects and also considering External factors and the Resilience of health service buildings. The results of these findings were developed into a proposal to design the MELFASSE form for assessing the empowerment of local resources and recommendations for activating existing conditions and the RVAHBR form for assessing the resilience of health facility buildings as a preliminary assessment in orthopedic emergency management during the earthquake emergency response phase.  The proposed MELFASSE-R forms is hopefully will have a broader use and to be easily adapted and carried out by existing local resources as a recommendation for further action in the response phase of an earthquake disaster.