Spesial Topic Tayang by Gextha 9 Jan 20151

8/9/2019 Spesial Topic Tayang by Gextha 9 Jan 20151

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Study GuideSpecial Topics

SPECIAL TOPICS

AIMS

1. To introduce the existence of Special Topics in the curriculum of the medicalprofession.

2. To understand the science and it's practices of health ergonomics in the medicalprofession.

3. To understand the science and it's practices of travelers medicine in the medicalprofession.

4. To understand the science and it's practices of health care in elderl in the medicalprofession.

!. To understand the science and it's practices of the palliative medicine in the medical

profession.". To understand the science and it's practices of the complementar and alternative

medicine in the medical profession.

#daana #niversit $acult of Medicine% M&# 1




PLANERS

NO NAME DEPARTMENT PHONE

1rof.(r.dr.I )oman Adiputra%M*+%$,%Sp.&rg -+ead

$isiolog/01131

2 dr. ).,. utri Ariani% Sp, schiatrist /022301304

LECTURER

NO NAME DEPARTMENT PHONE

1 rof.(r..Suardana. Sp.T+T,5 -, &)T /01130!2

2 dr.AA Au Sri6andha7ati% Sp.,$8 8eha9ilitation Medic /01!"/41!/!

3 dr. utu Anda Tusta Adiputra%Sp:-,*n6

Surger /012302"43/

4 (ra. 8etno Indarati. S. si 8eha9ilitation Medic /01230310"2

! (r. T;o6orda <de (harmauda%Sp.( ,+*M.

Internal Medicine /011341/0

" rof.(r.dr.I )oman Adiputra%M*+%$,%Sp.&rg

$isiolog /01131

dr. Made a7i% M.,es harmacolog /0102

0 (8.dr.=o6 aa 5esmana% Sp, schiatrist /01"2!

(r. Ida :agus utu Alit% sp$% ($M $orensic /011""134!

1/ dr. (udut 8ustadi% Sp$ $orensic /01234234

11 dr. +en6% Sp.$.% M.:&th% $A=5M $orensic /01230040"

12 dr. ,unthi >ulianti% Sp,$ $orensic /0133042//!





~ FACILITATORS ~

Regular Class

NO NAME GROUP DEPT PHONE ROOM

1dr. )i Made 8enn Anggreni8ena % Sp.( A1 Interna /010/3"!1"!"

2rd floor 8.2./

2(rs.I. ) Toa iartha% Apt

A2 harmac /011300"2rd floor 8.2.1/

3dr. I :. utra7an% Sp.(

A3 Interna /0123"14"22rd floor 8.2.11

4dr. Siann +era7ati% Sp.,

A4=linical

atholog/0123"1204/

2rd floor 8.2.12

!dr. <ede ,am9aana%Sp.(?,8

A! Interna /0124"0341"2rd floor 8.2.13

"dr. <ede &6a 8usdi Antara%Sp.:

A" Surger /013340/32rd floor 8.2.14

dr. <de Somaana% Sp.( A Interna /0134!13"13 2rd floor 8.2.1!

0dr. T;o6orda <de AgungSenapathi% Sp.An

A0 Anasthesi /01331122/2rd floor 8.2.1"

dr. &lsanti (7i Martadiani%Sp.8ad

A 8adiolog /010/!"3/2rd floor 8.2.22

1/dr. I aan 5osen Adnana%Sp (

A1/ Interna /0123!!3"2rd floor 8.2.23

English Class

NO NAME GROUP DEPT PHONE ROOM

1(r. dr. I aan Suranadi%Sp.An.,I= :1 Anasthesi /012304"!

2rd floor 8.2./

2(r. dr. I (e7a MadeSu6rama% MSi% Sp.M,-,

:2 Micro9iolog /0133021"!2rd floor 8.2.1/

3dr. (e7a Made Arti6a %Sp.

:3 ulmonolog /01230!0!2rd floor 8.2.11

4dr. (esa6 Madeihandani% M.,es

:4 :iochemistr /01330"2442rd floor 8.2.12

!dr. =nthia (e7i Sinard;a%Sp.An

:! Anasthesi /01!2!3/32rd floor 8.2.13

" dr. Anom Suardi6a% Sp.*< :" *9gn /01!"1""2rd floor 8.2.14

dr. )oman Asti6a% Sp.(?,ger?$I)ASIM

: Interna /012341202rd floor 8.2.1!

0dr. Ana6 Agung Masutra7ati Triningrat% Sp.M

:0 *pthalmolog /012304"!2rd floor 8.2.1"

dr. I aan Sucindra (e7i%S.,ed

: harmacolog /013"/43//2rd floor 8.2.22

1/dr. A.A.:agus )gurah)uartha% Sp.S-,

:1/ )eurolog /010224/2rd floor 8.2.23





CURRICULUM BLOCK

Su! T"#i$ Palia%i& Me'i$ine

Aims @

To understand aliatif Medicine is art of Medical &ducation.

aliatif Medicine most important for patient 7ith severe diseases% chronic illness% and in

terminal stage

To assess common forms of smptoms and sign patient in severe disease% chronic illness%

and patient in terminal stage.

To diagnose and manage common phsical pro9lem in severe disease% chronic illness% and

patient in terminal stage.

To apll the 9asic principles of alliatif medicine.for patient in severe disease% chronic

illness% and patient in terminal stage.

LEARNING OUTCOMES

1. (escri9e a9out aliatif Medicine and its clinical implications

2. (escri9e the general principles of aliatif medicine

3. Appl the general principles of aliatif medicine for patient 7ith severe diseases%

chronic illnees% and in terminal stage.

4. 8ecognie or identif common forms of pro9lem patient 7ith severe diseases%


!. Appl general principles the plan of aliatif care for patient 7ith severe diseases%


TIME TABLE





PALIATI(E MEDICINE

N" DATE)Le$%ure

LEC

LECTURETOPIC

CLASS B CLASS A

TIM& A=TIBITI&S TIM& A=TIBITI&S

1 $rida

=oncept%hilosoph

andrinciple of alliativemedicine

/0.//?/.// 5ecture /.//?1/.// 5ecture

an% 2/1! /.//?1/.3/

Individuallearning 1/.//?11.3/

Studentro;ect

rof.(r.Suardana%SpT+T,5-,

1/.3/?12.// S<( 12.//?13.3/Independent 5earning

12.//?12.3/ :rea6 13.3/?1!.// S<(

12.3/?14.//Studentro;ect 113/?12.// :rea6

14.//?1!.//lanarSession 1!.//?1".//

lenarSession

2 Monda

In patient+ospice andalliatif care

/0.//?/.// 5ecture /.//?1/.// 5ecture

an% 122/1! /?//?1/.//


Studentro;ect

dr . AA AuSri6andha7ati%Sp.,$8

1/.3/?12.// S<( 12.//?13.3/Independen

t5earning

12.//?12.3/ :rea6 13.3/?1!.// S<(

12.3/?14.//Studentro;ect 11.3/.12.// :rea6

14.//?1!.//leanarSession 1!.//?1".//

leanarSession

3 Tuesda&mergencin aliatif medicine

/0.//?/.// 5ecture /.//.1/.// 5ecture

an% 132/1! /.//?1/.3/


Studentro;ect

dr. utu AndaTusta

Adiputra%Sp:-,*n6


12.//?12.3/ :rea6 13.3/?1!.// S<(

12.3/?14.//Studentro;ect 11.3/?12.// :rea6

14.//?1!.//lenarSession 1!.//?1".//

lenarSession

4 ednesda

=ommunication in

alliatif =are

/0.//?/.// 5ecture /.//?1/.// 5ecture

an% 142/1! /.//?1/.3/


Studentro;ect

(ra.

1/.3/?12.// S<( 12.//?13.3/

Indenpende

nt 5earning12.//?12.3/ :rea6 13.3/?1!.// S<(

Student

#daana #niversit $acult of Medicine% M&# !




8etnoIndarati%S.si

12.3/?14.// ro;ect 11.3/?12.// :rea6

14.//?1!.//leanarSession 1!.//?1".//

leanarSession

! Thursda Modernsupportivecare in

*n6ologi

+olisticapproach for

=ancer patient

/0?//?/.// 5ecture /.//?1/.// 5ecturean% 1!2/1! /.//?1/.3/

Individual5earning 1/.//?11.3/

Studentro;ect

(r. T;o6(armauda% Sp.(.,+*M


12.//?12.3/ :rea6 13.3/?1!.// S<(


14.//?1!.//leanarSession 1!.//?1".//

leanarSession

$e9% /3% 2/1! &xamination Team

TIME TABLE

#daana #niversit $acult of Medicine% M&# "




C"*#le*en%ar+ an' Al%erna%i,e Me'i$ine -CAM.

English Class -Class B.

Da+)'a%e Ti*e A$%i,i%+ (enue C"n,e+er

$rida1" an 2/1!

/0.//?/.///.//?1/.3/1/.3/?12.//12.//?12.3/12.3/?14.//14.//?1!.//

5ecture 1Indiv. 5earningS<(:rea6Student Project leanar

=lass room

(iscussion8oom

=lass room

(r.Md a7i.

$acillitator

(r.Md a7i

ednesda21 an 2/1!

/0.//?/.///.//?1/.3/1/.3/?12.//

12.//?12.3/12.3/?14.//14.//?1!.//

5ecture 2Indiv. 5earningS<(

:rea6Student Project leanar

=lass room

(iscussion

8oom

=lass room

(r.Md a7i.

$acillitator

(r.Md a7i

Thursda22 an 2/1!

/0.//?/.///.//?1/.3/1/.3/?12.//12.//?12.3/12.3/?14.//14.//?1!.//


=lass room

(iscussion8oom

=lass room

(8.dr.=o6aa 5% Sp,

$acillitator

(8.dr.=o6aa 5% Sp,

$rida23 an 2/1!

/0.//?/.///.//?1/.3/1/.3/?12.//12.//?12.3/12.3/?14.//14.//?1!.//


=lass room

(iscussion8oom

=lass room

rof. Adiputra

$acillitator

rof. Adiputra

Monda2" an 2/1!

/0.//?/.///.//?1/.3/1/.3/?12.//12.//?12.3/

12.3/?14.//14.//?1!.//

5ecture !Indiv. 5earningS<(:rea6

Student Project leanar

=lass room

(iscussion8oom

=lass room

rof. Adiputra

$acillitator

rof. Adiputra


Reguler Class -Class A.

#daana #niversit $acult of Medicine% M&#




Da+)'a%e Ti*e A$%i,i%+ (enue C"n,e+er

$rida1" an 2/1!

/.//?1/.//1/.//?11.3/11.3/?12.//12.//?13.3/13.3/?1!.//1!.//?1".//

5ecture 1Student Project :rea6Indiv. 5earningS<(leanar

=lass room

(iscussion8oom

=lass room

(r. Md a7i

$acillitator

(r. Md a7i

ednesda21 an 2/1!

/.//?1/.//1/.//?11.3/11.3/?12.//12.//?13.3/13.3/?1!.//1!.//?1".//

5ecture 2Student Project :rea6Indiv. 5earningS<(leanar

=lass room

(iscussion8oom

=lass room

(r. Md a7i

$acillitator

(r. Md a7i

Thursda22 an 2/1!

/.//?1/.//

1/.//?11.3/11.3/?12.//12.//?13.3/13.3/?1!.//1!.//?1".//

5ecture 3

Student Project :rea6Indiv. 5earningS<(leanar

=lass room

(iscussion8oom

=lass room

(8.dr.=o6

aa 5% Sp,

$acillitator

(8.dr.=o6aa 5% Sp,

$rida23 an 2/1!

/.//?1/.//1/.//?11.3/11.3/?12.//12.//?13.3/13.3/?1!.//

1!.//?1".//

5ecture 4Student Project :rea6Indiv. 5earningS<(

leanar

=lass room

(iscussion8oom

=lass room

of. Adiputra

$acillitator

rof. Adiputra

Monda2" an 2/1!

/.//?1/.//1/.//?11.3/11.3/?12.//12.//?13.3/13.3/?1!.//1!.//?1".//

5ecture !Student Project :rea6Indiv. 5earningS<(leanar

=lass room

(iscussion8oom

=lass room

of. Adiputra

$acillitator

rof. Adiputra


PALIATIF MEDICINE


Le$%ure / =oncept% hilosoph and rinciple of alliative

medicinerof.dr..Suardana Sp.T+T?,5-,

0




A9stract

alliative care is an form of medical care or treatment that concentrates on reducingthe severit of disease smptoms% rather than providing a cure% particularl for thedisease 7hich is treatment is not cura9le. alliative care improves the Cualit of life of patients and families 7ho face life?threatening illness% 9 providing pain and smptomrelief% spiritual and pschosocial support to from diagnosis to the end of life and9ereavement.=oncept and philosoph of alliative care consist of provides relief from pain and other

distressing smptomsD affirms life and regards ding as a normal processD intendsneither to hasten or postpone deathD integrates the pschological and spiritual aspectsof patient careD offers a support sstem to help patients live as activel as possi9le untildeathD offers a support sstem to help the famil cope during the patients illness and intheir o7n 9ereavementD uses a team approach to address the needs of patients andtheir families% including 9ereavement counseling% if indicatedD 7ill enhance Cualit of life%and ma also positivel influence the course of illnessD is applica9le earl in the courseof illness% in con;unction 7ith other therapies that are intended to prolong life% such aschemotherap or radiation therap% and includes those investigations needed to 9etter understand and manage distressing clinical complications.The goal of palliative care is relief from suffering% treatment of pain and other distressingsmptoms% pschological and spiritual care% a support sstem to help the individual live

as activel as possi9le% and a support sstem to sustain the individual's famil in other 7ord is holistic approach of care -9io?pscho?socio?cultural and spiritual aspect.+ospice care is other term for palliative medicine 7hich focuses for terminal ill 7hilepalliative care services 9eginning from the diagnosis of the disease.

5earning tas61. hat is palliative medicineE2. hat are the o9;ectives of palliative careE3. (id ou 6no7 a9out holistic approach in the palliative medicineE4. ho are the targets in the palliative careE!. (escri9e the concept and principle of palliative medicineF". hat is 9ereavement consultationE To 7ho 7ill 9e doingE. (escri9e of past model and modern model of palliative careF0. (escri9e of hospice care and differentiation from palliative careF


Le$%ure 0 In Pa%ien% H"s#i$e an' Palia%i& Care

'r1AA A+u Sri2an'h+a3a%i4 S#1KFR




A!s%ra$%

The orld +ealth *rganiation defines palliative care as an approach that improves theCualit of life of patients and their families facing the pro9lem associated 7ith life?

threatening illness% through the prevention and relief of suffering 9 means of earlidentification and impecca9le assessment and treatment of pain and other pro9lems%phsical% pschosocial and spiritual.atients receiving palliative care ma deteriorate suddenl due to their illness or another acute medical or surgical pro9lem. At the end of life acute exacer9ations of medicalsmptoms -e.g. dspnea in palliative care patients often result in emergenc medicalservices 9eing alerted.

Ma;or emergencies in palliative care @

• +percalcaemia

• :leeding

• Superior venal caval o9struction

• Spinal cord compression

• :one fractures

• Seiure

&mergencies in palliative care also include sudden severe exacer9ation of smptoms.Therefore% onset of severe pain% exacer9ation of 9reathlessness% and 7orsening of other smptoms are also discussed 7ith their appropriate treatment. A small armamentarium of appropriate medications is thus sho7n to cover treatment of the various emergencies thatma arise. As palliative care deals 7ith patients 7ho are suffering from progressive fatalconditions% death is the expected end.


Le$%ure 5

E*ergen$+ in Pallia%i,e Care

'r1 Pu%u An'a Tus%a A'i#u%ra4 S#B-K.On2

Le$%ure 6

C"**uni$a%i"n in Pallia%i,e $are

Re%n" In'ar+a%i Kusu*a4 Dra4 Psi2"l"g

1/




.

COMPLEMENTAR7 AND ALTERNATI(E MEDICINE - CAM .

A!s%ra$%

u9lic a7areness and use of complementar and alternative medicine -=AM are complexphenomena that have gro7n extraordinaril in the past decade. *ne reason for thisphenomenon no dou9t is the enormous increase in pu9lic access to 7orld7ide informationthrough the 7orld 7ide 7e9 and 7idespread ne7smedia coverage. =ommercial advertisingand an endless exposure through the la press% ranging from ta9loid pu9lications tomagaines% medical ;ournals% and 9oo6s% have vigorousl promoted the concepts of disease

prevention and healing 9 unconventional means% stri6ing a sensitive -and highl lucrativechord in a trul glo9al population.Another reason for the popularit of =AM is the up7ardlspiraling cost of modern allopathic medical care. )e7 technologies have 9een developed ata record pace% producing man medical% surgical and diagnostic innovations% most of 7hichare unCuestiona9l improvements 9ut 7hich also are ver expensive. The expense and theresulting rationing of these ne7 modalities 9 managed care programs in an attempt toreduce the costs of medical care have placed them out of reach of a large segment of thepopulation. *ne conseCuence appears to 9e the creation of a strong pu9lic desire for a 7iderange of complementar and alternative modalities to prevent and treat the full gamut of human illness. The ounger generation% in particular% seems to 9e developing distrust of thetechnological innovations of the medical profession and their potential for adverse effects%7hile 9ecoming more interested in =AM and preventive medicine. The elderl populationhas also turned to =AM% 9ut perhaps for different reasons.hatever the reasons% a verita9le 9lit of advertising and recommendations for =AMproducts has arrived and has received strong pu9lic interest and approval% 7ith ver littlesupport or encouragement from the medical communit. Man patients are more informed of alternative therapies than their phsicians% a situation that% in itself% should encouragephsicians to learn more a9out =AM. )o matter ho7 a phsician feels a9out the usefulnessof =AM% it is no longer adeCuate simpl to 9rush off the patients' Cuestions 7ith anuninformed ans7erD doing so onl serves to 9roaden the communication gap 9et7een thepu9lic and the medical profession.Therefore% as a medical student 7ho 7ill 9e leading themedical staff should 6no7 to 9ridge information gaps or provide correct information to the=AM. In this lecture -the learning process 7ill 9e discussed in outline on =AM% so that%

future integrated treatment sstem can 9e achieved.


Le$%ure 8

H"lis%i$ A##r"a$h &"r Can$er Pa%ien%

Dr1 T9"2"r'a G'e Dhar*a+u'a4 S#1PD KHOM

Le$%ure /

C"*#li*en%ar+ an' Al%erna%i,e Me'i$ine -CAM.

Dr1 Ma'e :a3i4 M Kes

11




8eferences1. The ournal of Alternative and =omplementar Medicine2. :M= =omplementar and Alternative Medicine3. &vidence?:ased =omplementar and Alternative Medicine

A!s%ra$%

lants had 9een used for medicinal purposes long 9efore recorded histor.In the earl 1thcentur% 7hen chemical analsis first 9ecame availa9le% scientists 9egan to extract and

modif the active ingredients from plants. 8ecentl% the orld +ealth *rganiationestimated that 0/G of people 7orld7ide rel on her9al medicines for some part of their primar health care. +er9al medicine % also called 9otanical medicine or phtomedicine%refers to using a plant's seeds% 9erries% roots% leaves% 9ar6% or flo7ers for medicinalpurposes. +er9alism has a long tradition of use outside of conventional medicine. It is9ecoming more mainstream as improvements in analsis and Cualit control along 7ithadvances in clinical research sho7 the value of her9al medicine in the treating andpreventing disease.In man cases% scientists arenHt sure 7hat specific ingredient in a particular her9 7or6s totreat a condition or illness. hole her9s contain man ingredients% and the ma 7or6together to produce a 9eneficial effect. Man factors determine ho7 effective an her9 7ill9e. $or example% the tpe of environment -climate% 9ugs% soil Cualit in 7hich a plant gre77ill affect it% as 7ill ho7 and 7hen it 7as harvested and processed.The her9s availa9le in most stores come in several different forms@ teas% srups% oils% liCuidextracts% tinctures% and dr extracts -pills or capsules. Teas can 9e made from dried her9sleft to soa6 for a fe7 minutes in hot 7ater% or 9 9oiling her9s in 7ater and then straining theliCuid. Srups% made from concentrated extracts and added to s7eet tasting preparations%are often used for sore throats and coughs. *ils are extracted from plants and often used asru9s for massage% either 9 themselves or as part of an ointment or cream. Tinctures andliCuid extracts are made of active her9al ingredients dissolved in a liCuid -usuall 7ater%alcohol% or glcerol. Tinctures are tpicall a 1@! or 1@1/ concentration% meaning that onepart of the her9 is prepared 7ith ! ? 1/ parts -9 7eight of the liCuid. 5iCuid extracts aremore concentrated than tinctures and are tpicall a 1@1 concentration. A dr extract form is

the most concentrated form of an her9al product -tpicall 2@1 ? 0@1 and is sold as a ta9let%capsule% or loenge.*ften% her9s ma 9e used together 9ecause the com9ination is more effective and mahave fe7er side effects. +ealth care providers must ta6e man factors into account 7henrecommending her9s% including the species and variet of the plant% the plant's ha9itat% ho7it 7as stored and processed% and 7hether or not there are contaminants -including heavmetals and pesticides.

All medicinal agents have potentiallunexpected effects including toxicit% andher9s are nodifferent.As 7ith otherdrugs% the ris6 of unexpected effects ma9e influenced 9 a userHsage% gender%genetics% nutrition status% and concurrentdisease states and treatments.Inclinicalpractice recogniing adverse effects of her9almedicine is not routine and their

reporting iseven less freCuent.It is important to 9e a7are of ansu9stances that have thepotential to causetoxicities and to interact 7ith prescri9edmedications. Most adverse


Le$%ure 0

Her!al Me'i$ine

Dr1 Ma'e :a3i4 M Kes

12




reactions involvethe s6in% liver% <I tract 9ut can involve theheart -e.g.ephedra. Significanthepatotoxiceffects 7ere reported 7ith 6ava or &chinacea 7hen ta6en concurrentl 7ithotherheptatoxic drugs. The use of a drug and aher9 that are 9oth associated 7ithpotentialhepatotoxic effects should 9e avoided.+er9al medicine is used to treat man conditions% such as asthma% ecema% premenstrualsndrome% rheumatoid arthritis% migraine% menopausal smptoms% chronic fatigue% irrita9le9o7el sndrome% and cancer% among others. +er9al supplements are 9est ta6en under theguidance of a trained health care provider. $or example% one stud found that /G of arthritic patients use alternative therapies% such as her9al medicine.:e sure to consult 7ithour doctor or pharmacist 9efore ta6ing an her9s. Some common her9s and their uses arediscussed in this lecture.

8eferencesournal of +er9s% Spices Medicinal lantsournal of +er9al Medicine

A!s%ra$%

+pnosis is a 7a to harness the imagination to therapeutic strategies designed to helppeople feel and live 9etter% from reducing pain and anxiet to controlling ha9its and

dissociation. +pnosis has occupied an unusual position in relation to 9oth mainstream andcomplementar or% as it is no7 more often referred to% integrative medicine. It has a longhistor of 9eing used 9oth 7ithin and outside of medicine. +pnotic capacit can 9eidentified and mo9ilied as a valua9le ad;unct to a variet of pschotherapeutic strategies.

The 7ord hpnosis comes from the <ree6 root hpnos% 7hich means sleep. This ismisleading% 9ecause hpnosis% as a phenomenon% is not a form of sleepD rather% it is acomplex process of attentive% receptive concentration. Although peripheral a7areness isreduced in sleep and hpnosis% focal attention% 7hich is diffuse in sleep% is heightenedduring the hpnotic trance. Since the das of $ran Anton Mesmer% techniCues of tranceinduction and the use of trance phenomena for pschotherapeutic change have 9eenconfused. This has led to a lac6 of understanding of the differences 9et7een aspects of thehpnotic experience that are influenced 9 the therapist and those that are due to the

individual's degree of hpnotia9ilit% personalit stle% and motivation. The hpnotist doesnot pro;ect hpnosis onto the su9;ect. The role of the hpnotist is rather to assess anindividual's inherent 9iological capacit for trance and to teach the patient ho7 to use it in agiven pschotherapeutic program.

The therapist must reassure the su9;ect that he or she 7ill not 9e em9arrassed or humiliated% 7ill not 9e as6ed to do anthing he or she 7ould not 7ant to do in the 7a6ingstate% and that it 7ill 9e a temporar procedure onl. Some su9;ects ma 9e concerned thatif the can 9e hpnotied% it sho7s the are 7ea6 or stupid. *n the contrar% therapistsexplain that onl su9;ects 7ho can strongl focus their attention can 9e hpnotied.+pnotherap 9rings the patient to an a7areness of the feelings and desires of their unconscious mind. It ena9les them to reframe an experience -e.g.% 7ith famil% friends%co7or6ers or proto?experience% laden 7ith distressing feelings or conflict% into a positiveone. The patient is 9rought to see and feel memories of the past% place them into their present% pro;ect them into their future life% and understand and reframe them. The patient


Le$%ure 5 H+#n"sis

Dr1 'r1 C"2"r'a Bagus :a+a Les*ana4 S#K:

13




activel expresses emotions from their unconscious mind% and develops a differentunderstanding of these memories. The hpnotic state further ena9les them to modif pastsituations and feelings% and record these as ne7l changed in conscious memor.

Treatment using hpnosis involves not merel a9reaction of trauma% 9ut also 7or6ing

through it 9 assisting 7ith the management of uncomforta9le affect% enhancing patients'

control over it% and ena9ling them to cognitivel restructure its meaning. =atharsis is a9eginning 9ut not an end in itself% and it can lead to retraumatiation if it is not accompanied

9 support in managing affective response% control over the accessing of traumatic

memories% and help in 7or6ing through them.





Learning #r"gra*

THE BALINESE TRADITIONAL MEDICINE

I )oman Adiputra

INTRODUCTION

In ever nation or su9?nation there is a traditional 7a to remed the aillment or

illnesses or diseases. The intended 6no7ledge is handed do7n generation to generation%

informs of traditions and it's practices. The traditions might 9e 7ritten or spo6en orall. In

case the source of traditional healing 6no7ledge is 7ritten% there is a factual thing that those

information is 7ritten on a various of materials. $or example in the :alinese the intended6no7ledge is 7ritten on a palm leaf -lontar. In other su9?ethnic ma use s6in of tree or

other materials.

The :alinese traditional 6no7ledges had 9een 6no7n since those da. It is generall 6no7n

as usadha% 7hich is means medicines.

It is a matter of cultureD culture of people 7ho 9elieve on that. <enerall the :alinesedo 9elieve on traditional healing due to the fact that there are three 9asic elements for theit's efficac. The elements are@ 1 the source of 6no7ledgeD 2 the providerD and 3 theconsumer.

The source of 6no7ledge informs 7ritten materials 7hich called usadha. There areman 6inds of usadha. :elong to the usadha group are@ 1 general 6no7ledge -tat7a% suchas 9rahmanda tat7a -cosmolog% atma tat7a -soul% 7rehaspati tat7a -philosoph% a;isang6ha -philosoph% 7ariga -caleder% agama -religion% r7a 9hineda -philosophD 2

medical 6no7ledge@ such as panca maha 9huta -medical phsic% saras7ati -anatom%sastra sanga -anatom% 9u7ana mah9ah -patholog% pinarah pitu -patophsiolog%6ahilangan 6a7ah -pathopaJhsiolog% and pati urip -patho?phsiolog' taru premana%sundari si6sa% -the great pharmacopea% 9udha 6ecapi% 6alimaha usadha?usadhi -thecomplete medical 6no7ledgeD 3 summar -6aputusan such as 6aputusan punggung ti7as.The naming sstem of usadha is 9ased on@ a the su9;ect to 9e treatedD 9 9 using thename of color.:ased on su9;ect to 9e treated there are classification of usadha as the follo7ings@ 1usadha rare -paediatricsD 2 usadha dalem -internal medicineD 3 usadha 9uduh -mentalillnessD 4 usadha gondong -goitre diseaseD ! usadha 6ecacar -smallpoxD " usadha ila-lepro% " usadha cu6il da6i -dermatologD usadha mana6 -o9stetrics% 0 usadha6amatus -venerolog.


Le$%ure 6

;h+ %ra'i%i"nal healing s%ill use' in Bali<

Pr"&1 Dr1 'r1 I N+"*an A'i#u%ra4 MOH4PFK4S#Erg

1!




:ased on color name% there are usadha classification as the follo7ings@ 1 usadha6uningKelo7 -paediatricsD 2 usadha putihK7hite -for adolescentD 3 usadha 9angKred - for adultD 4 usadha cemengK9lac6 -geriatrics. All of those su9;ect must 9e studied 9 those 7ho li6e to 9ecome a traditional healer or 9alian. :alian in this case is called :alian #sadha.

In fact in :ali there are man tpe of traditional healers% such as 1 :alian #sadha%7ho are eCuivalent to medical doctorD the 9ecome :alian after a long and hard stud onthe usadha. 2 :alian ,eta6son% a traditional healer 9 incidentl he -she got a magicalthing% 9 7hich he -she has a po7er and capa9ilit to cure an illness person. This 6ind of :alian can not 9e duplicated. 3 :alian Mana6% traditional healer 7ho specialiing in deliveras a mid7ife. 4 :alian elung% as a 9one setter for patient suffering from a fracture. ! :aliantenung% those 7ho are offering the service as a fortune tellerD " :alian engengan% those7ho are .........ho 7ill 9ecome a :alianE

Theoreticall% ever 9od and 9oth sexes% 7ho learn a9out the sources of traditional6no7ledges could 9ecome a :alian. :ut% as a preference there are a certain pre?reCuirements such as there is a gnealogD it means that the candidate should has

ancester as a :alianD the candicate also should pass 9 the general 6no7ledge first% and theage should at the late of thirt. The candidate also shoul directl to approach a :alian 7ho7ill 9ecome his -her teacher during the learning process. The process of learning is verver informal. &venthough% there is a process of evaluation of the learning processs% 7hichcan 9e done 9 9oth 7as -candidate and the teacher. hen a candidate is allo7ed topractice 7hat he or she 9eing studied is depend on evaluation process.

=onsumer in this case are the :alinese 7ho are 9elieve on the traditional healing%7ithout considering the educational level% economic class% rescidences -in the to7n or rural. #suall% the :alinese ma come to :alian at the 9eginning of suffering% or at the latestage after getting some medical doctor helps% 9ut% 7ithout an improvement. The consumer in this case are a6sing the help of the traditional healer not onl for the illnesses% 9ut also for other thing such as consultation in conducting a ceremon% as6ing time to start an activit

for a 9etter result. *r might 9e also for as6ing as a mediator for a certain porpuse.

In offering the service a :alian ma examining the patient. The procedure for that iseCuivalent to 7hat the M( is doing. It consist of@ 1 intervie7ing -anamnesisD 2 inspecting-9 7atching or seingD 3 palpatingD 4 percussing% ! auscultating. Another additionalexamination such as environmental condition is also done. #suall intervie7 is done in alonger time. After a diagnose had 9een done the :alian 7ill give a treatment to the patient in hand. Thetreatment procedure consist of a medication using her9als or other material such asminerals% oils% and part of animals' organD it can 9e for causative therapD smptomatictherap and supportive therapD 9 religious ceremon such as purification. The drugs usedis given 9 the traditional healer 9ased on their prescriptions.

In doing their ;o9s the traditional healer has never see6 for mone. Therefore% thereis no exact tariffD the patient usuall offer the pament informs of in natural things.


Lecture 5 :

A Balian is *"rall+ $"n'u$%

Pr"&1 Dr. dr. I Nyoman Adiputra, MOH,PFK,SpEr

1"




Another hint that the traditional healer do their ;o9 in moral conduct is that 7henever he-she 6no7s the cause of the sic6ness % he or she 7ill not tell to an others or if it must 9eopen ;ust for the limited one. +e or she al7as advice to 9e 6ept secretl for the 9etter future relationship. The traditional healer al7as to offer his or her service in accordance tothe ethic and moral guidances. In doing so% he or she should also 6no7 the calender and it'spractice. +e or she is mastering on some other topics for example as mediator to the evil or devil spirits% 6no7s a9out the future -fortune teller% as a consultant for the villiger% as anartist% as a priest% as a village council% as a village administrator and as a informal leader inthe village.

The traditional healer 6no7s a9out the 9asic concept of health and illness. Anindividual is considered in a health condition if there is harmon or in a 9alance 9et7eenphsical and mental oneD or 9et7een micro?cosmic and macro?cosmic. If due to a certainthing there is disharmon or im9alance it 7ill cause a sic6ness. Therefore the treatment is9 change the disharmon into a harmonD or im9alance into a 9alance

The cause of the diseases traditionall% could 9e divided into t7o parts% namelinternall and externall. Internal cause% it is due to a dsharmon 9et7een the 6anda at-the four si9lings% panca maha 9huta -the five principle elements% sad ripu -the six

enemies% and sapta timira -the sevent sins. The external cause of disease interms of supranatural po7er% demons% evil spirits% toxic agents -from the plants% animals% metals% mineralsDenvironmental aspect such as mal?construction or mal?composition of house% 7ind or sin.

*ne thing should 6eep in mind is that in the usadha as a reference for the traditionalhealer is not al7as the dose of drug 7ritten completelD ho7 man leaves ho7 man gramof roots and ho7 man time given in a da.. That is as one disadvantage of the traditionalhealing process.





LEARNING TASKS

=ase

• Aunt Till is diagnosed 7ith 9reast cancer and is recommended to start

chemotherap and radiation treatments. Aunt Till 6no7s that chemotherap can

ma6e her feel horri9le and radiation can 9e painful. She is referred to a palliative

care program for smptom management and receives excellent treatment of her

chemotherap induced nausea% fatigue% and oral thrush -a east infection of the

mouth common in chemotherap patients. She is also visited 9 a Medical Social

or6er 7ho helps her complete her advance directives% ;ust in case she loses the

a9ilit to spea6 for herself. She gets 7ee6l visits from a chaplain 7ho pras 7ith her and discusses Aunt Till's theological Cuestions. ell% Aunt Till endured three

rounds of chemotherap and a 7ee6 of radiation 9ut her 9reast cancer is aggressive

and resistant to treatment. Aunt Till is told that she has six months to live and is

referred to hospice care. +ospice comes to Aunt Till's home and continues 7ith the

expert smptom management that the palliative care team started. The address

ne7 smptoms as the arise and 9egin to tal6 to Aunt Till a9out her impending death

and 7hat her goals and priorities are. +ospice helps Aunt Till to fulfill her life?long

dream of riding in a orsche and helps her reconcile 7ith her long estranged

daughter Talula. Aunt Till dies peacefull surrounded 9 her famil.

1. (escri9e the disease suffered aunt TellF

2. hat is recommended 9 doctor to treat aunt TellE

3. (escri9e the effect of treatment 7hich is recommended 9 doctorF

4. Aunt Till 6no7s that chemotherap can ma6e her feel horri9le and radiation can 9e

painful. (iscussed of this effect of treatment 6no7s 9 aunt TillF

!. (iscussed of east infection of the mouth ver common in chemotherap patientsF

". (escri9e 7hat alliative team 7ill do to aunt Tell 7hoHs suffered of late stage of

cancer diseaseF hat o9;ective of the strategiesF

. (iscuss 7h aunt Tell need hospice careF

0. hat 7ill the +ospice team ta6e care for aunt Tell conditionE

. Aunt Till dies peacefull surrounded 9 her famil. (iscussed of this statementF


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=ase @

Mr. ,etut% "/ ears old% hospitalied in Sanglah 7ith 5ung =ancer% stadium aliative sinceone month ago.+e 6no7 a9out his diagnosis and no other treatment -surger or chemotherap for him. +e7ant to die at home among his famil. The primar doctor consult him to aliative team.

5&A8)I)< TAS, @

1. (efinition of aliative Medicine.2. Ta6ing and formulate a complete histor of this case.3. Ma6e the plan for this patient.4. hat is our opinion 7hen the patient feel short of 9reath at home.

S&5$ ASS&SSM&)T @

1. hat do ou 6no7 a9out aliative MedicineE2. &xplain a9out aliative =are.3. (iscri9e 1/ -ten dimension of Lualit of 5ife -ennifer . =linich +arve

Schipper.

here is the place of aliative care and give the explaination.

.

(igne%%e / A 7oman% !! ears old diagnosed 7ith mestastastic 9reast cancer come to the emergencunit 7ith chief complain of loss of consciousness.

1. alliative care is necessaril multidisciplinar. hat does the principles of palliative

careE2. +percalcaemia is the commonest life threatening meta9olic disorder encountered in

patients 7ith cancer. hat is the presenting features of hpercalcaemiaE3. hat is the etiolog of hpercalcaemia in patient 7ith cancerE &xplain a9out itF4. &xplain the management of hpercalcaemia in the palliative careE


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Mrs. Ann is a 43?ear?old 7oman 7ith metastatic melanoma. She has completed t7occles of treatment 7ith a com9ination therap that she has tolerated not?Cuite 7ell. +er ma;or complaints had 9een fatigue% loss her 7eight and insomnia. :efore starting a thirdccle of treatment% she experienced some visual hallucination% and emotional distur9ances.The doctor presumed there are another metastatic site of disease in the 9rain. The drugresponses occur man distur9ances in her meta9olism% ma6e her nausea% and sometimevomiting.

According to the famil% all of information a9out the smptoms made her veranxious. That is the reason% her famil meet and as6 to the doctor to 6eep all the 9ad ne7sa9out her disease. The doctor must let onl the famil 6no7 the realit% and the patient onl6no7 the good ones% so she 7ill get 9etter improve and recover.

5earning Tas61. lease descri9e 7hat must the doctor said and explain to the famil2. lease give the 9est explanation to the patient% 7hile ou 6no7 she is in depressed

condition.3. h alliative care serves as a bridge 9et7een the therapist% the patient% and the

familE4. (epression and other mental disorders often complicate the treatment of medical

illness% and deviant illness 9ehavior such as suicide is a common pro9lem in patients7ho are organicall ill. hat 7ill ou suggest to the patient 7ho suffered thedisordersE

!. hen the 9est time ou give the 7orsening of smptoms to the patientsE". Is that necessar to report all the side effects of the medication% so the patient can

9e prepared 9eforeE. h must 7e give much attention to the palliative staff and care?giverE

Soon 7ill 9e added


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5earning Tas6

=ancer patients using or considering complementar or alternative therap. The patientsdiscuss this decision 7ith their doctor or nurse% as the 7ould an therapeutic approach.Some complementar and alternative therapies ma interfere 7ith standard treatment or ma 9e harmful 7hen used 7ith conventional treatment. It is also a good idea to 9ecomeinformed a9out the therap% including 7hether the results of scientific studies support theclaims that are made for it. As a doctor ou could explain this pro9lem. A. hat 9enefits can 9e expected from this therapE hat are the ris6s associated 7ith this therapE (o the 6no7n 9enefits out7eigh the ris6sE hat side effects can 9e expectedE

ill the therap interfere 7ith conventional treatmentE Is this therap part of a clinical trialE If so% 7ho is sponsoring the trialE ill the therap 9e covered 9 health insuranceE

:.hat the role of complementar therapies 9ello7 for =ancer patientsE Acupuncture &xercise &xpressive arts -art and 7ritingoga +umor therap

Massage therap Music therap Ligong 8eflexolog

5earning tas6

Man patients use her9al medicine 7ith conventional drugs in treating diseases% or use of her9al products and medications together. $or example% dia9etic patients might 9enefit fromta6ing ,orean red ginseng or anax ginseng 9ecause this her9 can lo7er 9lood sugar levels and might allo7 patients to rel on less medication.+o7ever% interactions 9et7een her9al products and medication can sometimes result inadverse clinical outcomes.

A. If ou to 9e a medical doctor% 7hat are our opinion a9out that case E:.1. hat is her9al medicineE2. +o7 do her9al medicine7or6E3. +o7 is her9al medicine sold in storesE

4. hat is the future of her9al medicineE


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=ase IMrs. ,. 7as a 44?ear?old 7ell?trained pschiatrist 7ith 4 ears of pschoanaltic training7ho had failed her 9oard examinations 2 ears in a ro7. This 7as especiall distur9ing9ecause she 7as 7ell informed and her colleagues 6ne7 her as a competent pschiatrist.>et something happened in the examination process that led to 9loc6ing and intellectualparalsis.

Luestion@1. &xplain treatment option for her condition2. &xplain the role of therapist3. &xplain ho7 to assess her hpnotic capacit

4. &xplain the restructuring of the pro9lems!. &xplain ho7 hpnotherap can help her pro9lems

=ase II And% 30 ears old7as a 7orld?class athlete 7ho collapsed suddenl inan alle. +e 7as9rought to a hospital emergenc room%7here he nearl died of internal 9leeding from almphomathe sie of a grapefruit in his a9domen. +e 7as hospitaliedand placed onchemotherap. +e 7as extremel anxious%and increasing doses of opiates had little effecton hispain. +e 7as literall clim9ing the 7allsN and alienatingthe nursing staff charged 7ithhis care. +is parents 7ereafraid that he 7as 9ecoming a drug addict.

Luestion@

1. &xplain treatment option for her condition2. &xplain the role of therapist3. &xplain ho7 to assess her hpnotic capacit4. &xplain the restructuring of the pro9lems!. &xplain ho7 hpnotherap can help her pro9lems

Self?assessment@1. &xplain principles of pschotherap 7ith hpnosis2. &xplain the use of hpnosis in forensic pschiatr3. &xplain a9out hpnotic dissociation4. &xplain some indication for hpnosis use

!. &xplain a9out hpnotic induction profile


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1. +o7 does the traditional medicine still function in :aliE

2. Mention the 9asic elements 7hich ma6e it functionF3. (iscuss the traditional 6no7ledges of the :alinese traditional medicine ou 6no7%

and itHs correspondences to the modern medicine.4. (iscuss ho7 the classification of usadha is done% and give some example

accordinglF!. =lassif the traditional healer in :ali ou 6no7 and discuss 7hat is -are the

advantages disadvantages of those tpes.". :efore some one 9ecome a traditional healer -:alian could ou summarie ho7

the process he or she didEhat do ou thing% 7hether a :alian is a professional one or notE0 &la9orate ho7 the diagnosis is made 9 a :alian #sadhaE

According to the traditional 6no7ledges% could ou summarie the cause of diseaseE1/ Tr to compare the modern aspect and the traditional aspect of diseaseaetiologE11Tr to explain the pathogenesis of disease traditionallE12. +o7 man roles or functions of :alian #sadha do ou 6no7E13. Tr to find out that the :alian #sadha is morall conduct. Supports our opinionF14. Is there an fixed?tariff for :alia; #sadha in offering his or her servicesE

1. +o7 the process of healing is done 9 :alian #sadha in :aliE2. hat 6ind of materials for medication used 9 a :alian #sadha that ou

6no7E3. Is there an source of traditional 6no7ledge for medicinal plants in :aliE4. (iscuss the role of the medicinal plants ou 6no7F!. (iscuss ho7 the patient shall use the her9al medicine as ou 6no7F

". (iscuss the dosage of drug used in the source of 6no7ledgestraditionallF

. +o7 the medicinal plantsH effect could 9e estimatedE Is there an hintpracticallE

0. Tr to compare the traditional medicine and modern medicineF.

TIME TABLE


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23




FORENSIC

N" DATE)Le$%ure

LEC

LECTURETOPIC

CLASS B CLASS A

TIM& A=TIBITI&S TIM& A=TIBITI&S

1 Tuesda 5ecture 1 @Introductionto $orensicMedicine5ecture 2 @&thics in$orensicMedicine

/0.//?/0.3/ 5ecture 1 /.//?/.3/ 5ecture 1

/0.3/?/// 5ecture 2 /.3/?1/.// 5ecture 2

an% 22/1! /.//?1/.3/


Studentro;ect

dr. +en6%Sp.$.%M.:&th%$A=5M

1/.3/?12.// S<( 12.//?13.3/Independent5earning

12.//?12.3/ :rea6 13.3/?1!.// S<(

12.3/?14.//Studentro;ect 113/?12.// :rea6

14.//?1!.//

lanar

Session 1!.//?1".//

lenar

Session

2 ednesda

5ecture @ Aspe6Medi6olegal,ematian

/0.//?/.// 5ecture /.//?1/.// 5ecture

an% 202/1! /?//?1/.//


Studentro;ect

dr. (udut8ustadi%Sp$


12.//?12.3/ :rea6 13.3/?1!.// S<(

12.3/?14.//Studentro;ect 11.3/.12.// :rea6

14.//?1!.// leanarSession

1!.//?1".// leanarSession

3 Thursda5ecture @ Asfi6sia danTenggelam

/0.//?/.// 5ecture /.//.1/.// 5ecture

an% 22/1! /.//?1/.3/


Studentro;ect

dr. ,unthi>ulianti%Sp,$


12.//?12.3/ :rea6 13.3/?1!.// S<(


14.//?1!.//

lenar

Session 1!.//?1".//

lenar

Session4 $rida 5ecture @

,e6erasan$isi6-enganiaaan dan,e;ahatanSe6sual-Sexual Assault

/0.//?/.// 5ecture /.//?1/.// 5ecture

an% 3/2/1! /.//?1/.3/


Studentro;ect

(r. Ida:agus utu Alit% sp$%($M

1/.3/?12.// S<( 12.//?13.3/Indenpendent 5earning

12.//?12.3/ :rea6 13.3/?1!.// S<(


14.//?1!.//

leanar

Session 1!.//?1".//

leanar

Session! Monda 5ecture 1 @ /0.//?/0.3/ 5ecture 1 /.//?/.3/ 5ecture 1





Sudden(eath

5ecture 2 @$orensicToxicolog

/0.3/?/// 5ecture 2 /.3/?1/.// 5ecture 2

e9% /22/1!

/.//?1/.3/ Individual5earning

1/.//?11.3/ Studentro;ect

dr. +en6%Sp.$.%M.:&th%$A=5M

1/.3/?12.// S<( 12.//?13.3/ Independent5earning

12.//?12.3/ :rea6 13.3/?1!.// S<(


14.//?1!.// leanarSession

1!.//?1".// leanarSession


#daana #niversit $acult of Medicine% M&# 2!




A9stra ct$orensic medicine is a 9ranch of medicine specialising in the application of medical6no7ledge for the purposes of administration of the la7 and ;udicial proceeding. In order tosolve criminal cases related to human 9od% investigators usuall see6 medical advice fromphsicians since the doctors have a thorough 6no7ledge of human 9od. Therefore% onlmedical officers are authorised to examine the human 9od 9ecause of their competenc.

The relationship 9et7een medicine and la7 has 9een noted since 3/// := in &gpt%:a9lon% <reece% 8ome% and the Middle &ast. At that time% medicine 7as stronglinfluenced 9 religion% superstition% and magic. The priest% as the intermediar 9et7een <odand man% had a dual function as the phsician and the ;urist. Thus% at that moment%

scientific method has not et 9een adapted for medico?legal investigation.

The pioneer of scientific medico?legal death investigation 7as 9egun in =hina in 123"%7hich 7as follo7ed 9 a tremendous development of forensic medicine in &urope. In the#S% histor recorded that the application of scientific forensic evidence in the court 7as lessdeveloped 9ecause of political interest.

In Indonesia% forensic medicine 7as first introduced in the (utch =olonial &ra around 12/9 +..$.8oll in ST*BIA. 5ater% this field of stud 7as continuousl gro7ing 7hich producedman forensic medicine specialists. Su9seCuentl% the esta9lished erhimpunan (o6ter $orensi6 Indonesia -($I in 1/. In order to fulfil the need of forensic services in societ%($I has founded five divisions% namel forensic patholog% clinical forensic medicine%

forensic serolog and 9io?molecular% forensic toxicolog% ethics and medico?legal.

In general% there are t7o roles of medical officers@ as an assessing phsician and as acertifing phsician. If medical doctors are reCuested to assist the ;udicial proceedings% themust collect ever scientific evidence 9 documenting and analsing an information% facts%and findings. $inall% ever step of these processes is concluded in medical certificate or medico?legal report.

8eferences@1. Sampurna :% Samsu O. eranan Ilmu $orensi6 (alam enega6an +u6um. a6arta@

:agian ,edo6teran $orensi6 $a6ultas ,edo6teran #niversitas IndonesiaD 2//3.2. ,night :. $orensic patholog. Second &dition. <reat :ritain@ ArnoldD 2//4.

3. Smith S. The +istor and (evelopment of $orensic Medicine. :ritish Medicalournal. Mar 24% 1!1D 1-4/@ !P"/.

4. :uchanan (. $orensic Medicine@ A =linicianHs Bie7. In@ 5egal and $orensic Medicine.:eran 8<% editor. :erlin@ Springer?BerlagD 2/13.

!. :eran 8<. Analsis ? hat Is 5egal MedicineE ournal of $orensic and 5egalMedicine. 2//0D 1!-3@ 1!0?"2.

". echt =+. The +istor of 5egal Medicine. Am Acad schiatr 5a7. 2//!D 33@24!P!1.

5earning *utcomes A9le to understand the definition% concept% and scope of forensic medicine.

A9le to understand the role of phsician to assist la7 enforcement and legalproceeding


Le$%ure In%r"'u$%i"n %" F"rensi$ Me'i$ine'r1 Hen2+4 S#1F14 M4BE%h14 FACLM1

2"




5earning Tas6

Bignette A?20?ear?old manHs dead 9od 7ith a gunshot 7ound in his left chest has 9een transferredto the department of forensic medicine. The investigator as6s ou as a medical officer toissue a medico?legal report -Visum et Repertum.

Assignments@1. hat is the definition of forensic medicineE2. h does the investigator as6 for a medico?legal report (Visum et Repertum)E hat

is the legal 9asisE3. In relation to this case% please mention and explain an scientific evidence 7hich

must 9e documented in the medico?legal report (Visum et RepertumF

Self Assessment1. &xplain the histor of forensic medicineF2. &xplain the legal proofing sstem in IndonesiaF

3. Mention and explain the divisions of forensic medicineF4. Mention and explain the scope% role% and dut of forensic medicineF

A9stra ct Aristotle has argued that everthing in this life has an end or a goal -telos. According to

him% the ultimate goal of human life is to achieve human flourishing - eudaimonia. This goalcould 9e achieved if one can fulfill hisKher role to 9e functioning 7ell as a human 9eing inaccordance 7ith hisKher specific specialties. $or instances% the function of a good 6nife is tocut 7ell% and the function of a good doctor is to treat the patient 7ell.

The main purpose of forensic medicine is to assist the administration of the la7 and ;udicialproceeding. +ence% a good forensic medicine specialist is a doctor 7ho is useful to assistla7 enforcement. This goal can 9e accomplished 9 appling ethical principle 7henconducting forensic medical service 7hich leads to good forensic medical practice. In dailpractice% ethics in forensic medicine has specific and uniCue characteristics 9ecause of theinteraction 9et7een forensic practitioners and investigators% and dualism role 9et7eenpatient and victimKperpetrator. This uniCueness is formed as a conseCuence of the specific

role of forensic phsician that is as a certifing doctor. Therefore% the principles of professionalism% o9;ectivit% impartialit% as 7ell as intra? and inter? professional team7or6are the core su9stances of the code of ethics of forensic medicine.

$orensic medicine phsicians% either clinical forensic medicine practitioners or forensicpathologists% freCuentl encounter man ethical dilemmas. The four principles of 9iomedicalethics% introduced 9 :eauchamp and =hildress could 9e applied to resolve these moraldisputes 7hile performing clinical forensic medicine practice since these principles%historicall% 7ere formulated to protect living research su9;ects. The four principles couldalso 9e utilied 9 forensic pathologists to respect the dead. These 9asic moral principlescom9ined 7ith the code of conduct for forensic mortuar personnel can 9e applied to ma6edecisions 7hen dealing 7ith ethical Cuandaries 7hich arise 7hile dealing 7ith the dead 9odas 7ell as interacting 7ith the grieving families.


Le$%ure E%hi$s in F"rensi$ Me'i$ine'r1 Hen2+4 S#1F14 M4BE%h14 FACLM1

2




8eferences@1. Aristotle. excerpt from )ichomachean &thics. In@ =ahn SM% editor. =lassics of

olitical and Moral hilosoph. )e7 >or6@ *xford #niversit ressD 2//2. p. 102?221.2. :eauchamp T5% =hildress $. The rinciples of :iomedical &thics th ed. )e7 >or6@

*xford #niversit ressD 2/13.3. &l?)ageh M% 5inehan :% =ordner S% ells (% Mc,elvie +. &thical ractice in

5a9orator Medicine and $orensic atholog. +* 8egional u9licationsD 1.4. ,ode &ti6 ,edo6teran $orensi6 IndonesiaD 2//4.

5earning *utcomes A9le to act and 9ehave in accordance 7ith the highest ethical standards of forensic

medicine. A9le to act and 9ehave in line 7ith the 9asic principle of medical ethics and

Indonesian ethical guidelines for forensic medicine practitioners. A9le to resolve ethical issues faced 7hile conducting forensic medicine practice.

5earning Tas6

Bignette 1 A 30?ear?old?7oman has 9een ta6en 9 a police to the hospital 7ith an allegation of adulter. The investigator as6s the doctor to issue a medico?legal report -Visum et Repertum. #nfortunatel% the 7oman refutes genitalia examination planned 9 phsician%including collecting samples and ta6ing photographs for evidence.

Assignments@1. hat is the ethical issue in this caseE2. hat is the conflict 9et7een ethical principles in this caseE3. hat is our decision in this situationE &xplain our ;ustificationF

Bignette 2 A?20?ear?old manHs dead 9od 7ith a gunshot 7ound in his left chest has 9een transferredto the department of forensic medicine. The investigator as6s ou as a medical officer toperform an autops. +o7ever% his relatives do not give their permission to conduct theautops.

Assignments@1. hat is the ethical issue in this caseE2. hat is the conflict 9et7een ethical principles in this caseE3. hat is our decision in this situationE &xplain our ;ustificationF

Self Assessment1. Mention the 9asic moral principles contained in several articles of Indonesian ethical

guidelines for forensic medicine practitioners 9elo7F2. (o6ter forensi6 harus tetap o9;e6tif dan mengguna6an 6emampuanna se9ai6?

9ai6na sehingga 6eadilan dapat dilaani dengan fa6ta 6edo6teran forensi6 anga6urat.

3. ,eterangan ahli dan atau visum et repertum ang dia;u6an 6e depan pengadilanharus merupa6an 6eterangan ahli ang independen dan imparsial dan ;uga harusterlihat demi6ian -should 9e and should 9e seen to 9e% tida6 dipengaruhi oleh apadan siapapun% 9ai6 9entu6 maupun isina.

4. Se9agai sa6si ahli% do6ter forensi6 harus mem9eri6an 9antuan ang independen6epada pengadilan dengan pendapatna ang o9;e6tif dan tida6 9ias% serta tida6

se6ali?6ali 9erperan se9agai advo6at.





!. Se9agai sa6si ahli% do6ter forensi6 harus mena;i6an fa6ta ang o9;e6tif danmeneluruh serta dasar pemi6iran dan sum9er dari mana pendapatnadi6emu6a6an.

". Se9agai sa6si ahli% do6ter forensi6 harus dapat men;elas6an sedemi6ian rupadengan tida6 men;a7a9 pertanaan atau menerang6an masalah ang 9erada di luar 6eahlianna.

. Se9agai sa6si ahli% do6ter forensi6 harus memasti6an 9ah7a 6eteranganna adalah9enar% seluruhna 9enar dan tiada lain selain 9enar.

0. (o6ter forensi6 harus mendu6ung se;a7atna ang telah mela6u6an profesinasesuai dengan standar tetapi memperoleh pene6anan oleh piha6 lain sehingga6e9e9asan profesina terganggu.

LECTURE ASPEK MEDIKOLEGAL KEMATIANOleh 'r1 Du'u% Rus%+a'i4 S#F

A9stra6

(i Indonesia% menurut asal 11 #ndang?#ndang )o. 3" tahun 2// tentang ,esehatan%seseorang dinata6an telah meninggal apa9ila fungsi ;antung?sir6ulasi dan sistempernapasan ter9u6ti telah 9erhenti secara permanen% atau apa9ila 6ematian 9atang ota6telah dapat di9u6ti6an. Thanatologi adalah ilmu ang mempela;ari tentang 6ematian danperu9ahan ang ter;adi setelah 6ematian dan fa6tor?fa6tor ang mempengaruhi peru9ahanterse9ut. Ada 9e9erapa ;enis 6ematian aitu Mati Somatis K Mati ,linis% Mati Seluler K MatiMole6uler% Mati Sere9ral K Mati *ta6% Mati :atang *ta6 . Mati Suri K Mati Semu. Terdapataspe6 medi6olegal dari peristi7a 6ematian dan isu?isu ter6ait 6ematian aitu =ara,ematian% ene9a9 ,ematian% Me6anisme ,ematian% 5o6asi ,ematian dan ,onse6uensi,ematian. #ntu6 men;a7a9 isu?isu terse9ut lang6ah ang sangat penting pada investigasi6ematian adalah pemeri6saan ;enaah. emeri6saan ;enaah leng6ap -otopsi meliputipemeri6saan luar% pemeri6saan dalam dan pemeri6saan la9oratorium penun;ang. Masing?

masing pemeri6saan tida6 dapat 9erdiri sendiri% merupa6an satu 6esatuan sehinggadidapat6an 6esimpulan se9a9% me6anisme dan per6iraan cara 6ematian. (o6ter seringdimintai 9antuan untu6 mela6u6an pemeri6saan ;enaah 6arena dianggap ang palingmengetahui mengenai selu6 9elu6 tu9uh manusia. enidi6 9ila ingin meminta 9antuando6ter dalam memeri6sa ;enaah harus sesuai dengan prosedur medi6olegal ang 9erla6u.

ada 6ondisi 9encana massal atau ;enaah tida6 di6enal peran pemeri6saan identifi6asisangatlah penting. Identifi6asi forensi6 merupa6an upaa ang dila6u6an dengan tu;uanuntu6 menentu6an identitas seseorang% 6arena identitas adalah ha6 asasi manusia% ha6 dan6e7a;i9an hu6um negara% menentu6an status 6eluarga - ana6% istri K suami % status social%dan penentuan lang6ah dalam penidi6an. Tu;uan utama dalam proses identifi6asi adalahpada 6asus ang 9u6an pidana agar 6or9an dapat diserah6an 6epada piha6 6eluarga untu6

ditinda6 lan;uti seperti dila6u6an pengu9uran% 6remasi% penelesaian 6laim asuransi ataumasalah 7aris% dan lain?lain. Sedang6an pada 6asus pidana% identifi6asi 6or9an merupa6anhal pertama ang perlu dila6u6an se9elum menemu6an tersang6a -se9agai lang6ah a7aldalam proses penidi6an.rinsip?prinsip dalam proses identifi6asi adalah D

• engumpulan (ata ost Mortem

Merupa6an data 9erupa hasil dari pemeri6saan maat% 9agian maat atau 6erang6a angmeliputi data tentang 6eadaan umum dan 6eadaan 6husus

• engumpulan (ata Ante Mortem

Merupa6an data 9erupa informasi dari piha6 6eluarga ang merasa 6ehilangan anggota6eluargana tentang data 6eluarga% data pe6er;aan% data polisi% data medisKgigi 9ai6

termasu6 $oto rontgen% 5a9oratorium dan data 9enda P 9enda mili6 6or9an danse9againa.





• er9andingan (ata Ante Mortem dan (ata ost Mortem - 8e6onsiliasi

8eferences@1. :udianto A% idiatma6a % Sudiono S% inardi T% MunHim A% Sidhi% +ertian S% et al.

Ilmu 6edo6teran forensi6. $irst &dition. a6arta@ :agian ,edo6teran $orensi6$a6ultas ,edo6teran #niversitas IndonesiaD 1.

2. Sampurna :% Samsu O. eranan Ilmu $orensi6 (alam enega6an +u6um. a6arta@:agian ,edo6teran $orensi6 $a6ultas ,edo6teran #niversitas IndonesiaD 2//3

3. Shepherd 8. SimpsonHs forensic medicine. T7elfth &dition. <reat :ritain@ ArnoldD2//3.

4. ,night :. $orensic patholog. Second &dition. <reat :ritain@ ArnoldD 2//4.!. (i Maio B% (i Maio (. $orensic patholog. Second &dition. #SA@ =8= ressD 2//1

5earning *9;ective @

1. Mampu men;elas6an aspe6 medi6olegal dari peristi7a 6ematian2. Mampu men;elas6an cara penentuan 6ematian

3. Mampu men;elas6an ;enis?;enis 6ematian4. Mampu men;elas6an per6iraaan 7a6tu 6ematian -ost Mortem Interval!. Mampu men;elas6an mem9eda6an cara 6ematian% se9a9 6ematian dan

me6anisme 6ematian". Mampu men;elas6an proses identifi6asi. Mampu men;elas6an peran do6ter dalam proses identifi6asi0. Mampu men;elas6an ;enis?;enis identifier . Mampu men;elas6an manfaat identifi6asi

S6enario 1 @

(o6ter Ahmad 9e6er;a dise9uah 8S#(. ada suatu hari saat ;aga di I<( datang pasien

dalam 6eadaan tida6 sadar% diantar 6eluargana dengan 6eterangan megalami 6ecela6aanlalu lintas se6itar 1 ;am ang lalu. ada saat diperi6sa ternata pasien sudah dalam6eadaan meninggal atau (eath *n Arrival -(*A.

Assignments @

1. :agaimana6ah carana do6ter Ahmad menentu6an 9ah7a telah ter;adi 6ematian6linis pada pasien terse9utE

2. elas6an peru9ahan?peru9ahan ang ter;adi apa9ila seseorang telah meninggaldunia dan cara memasti6an telah ter;adi 6ematianF

3. :ila 6eluarga meminta Surat ,eterangan ,ematian% apa6ah 9oleh langsungditer9it6anE elas6anF

4. ada pemeri6saan luar ditemu6an 9erupa le9am maat 9er7arna merah 6eungguanpada tu9uh 9agian 9ela6ang ang hilangpada pene6anan dan 6a6u maat angmudah dila7an% tentu6an per6iraan 7a6tu 6ematian pasien terse9utF

!. elas6an pengertian dan ;enis ;enis dari cara 6ematian% se9a9 6ematian danme6anisme 6ematianF

S6enario 2 @

enaah la6i?la6i ditemu6an dise9uah tanah 6osong. etugas 6epolisian setempat 6esulitanmenentu6an identitas la6i?la6i terse9ut 6arena pada diperi6sa tida6 mem9a7a do6umenidentitas ataupun tanda pengenal. enaah 6emudian dieva6uasi 6e 8S#( untu6 dila6u6an

pemeri6saan forensi6.

#daana #niversit $acult of Medicine% M&# 3/




Assignments @

1. ada pemeri6saan luar ;enaah% se9ut6an dan ;elas6an hal?hal ang men;adipetun;u6 identifier agar identitas ;enaah dapat di6etahuiF

2. (ata Ante Mortem apa sa;a6ah ang diperlu6an agar dapat di6etahui identitas ;enaah terse9utE

3. (apat6ah diter9it6an Surat ,eterangan ,ematian pada ;enaah ang 9elumdi6enalE elas6an alasannaF

4. :agaimana6ah carana menentu6an identitas ;enaah ang 9elum di6enal terse9utE

LECTURE ASFIKSIA DAN TENGGELAMOleh 'r1 Kun%hi 7ulian%i4 S#KF

A9stra6 Asfi6sia adalah suatu 6eadaan ang menim9ul6an halangan dalam pertu6aran gas di

saluran nafas atau di paru?paru. ,eadaan terse9ut menim9ul6an pening6atan 6adar =* 2disertai penurunan 6adar *2 dalam darah. ene9a9 asfi6sia dapat 9er9agai macamdiantarana adalah me6ani6% 9er9agai pena6it% o9at?o9atan dan trauma listri6. (ise9utasfi6sia me6ani6 9ila pene9a9na adalah sum9atan me6ani6 pada saluran nafas. Menurutleta6 sum9atanna asfi6sia me6ani6 di9eda6an men;adi @ gagging% cho6ing% smothering-9e6ap% throttling or manual strangulation -ce6i6% strangulation 9 ligature -;erat% hanging-gantung% traumati6 asfi6sia -fi6sasi otot pernafasan dada dan perut serta sufo6asi.

Tenggelam -dro7ning adalah masu6na cairan ang cu6up 9ana6 6e dalam saluran nafashingga 6e paru?paru. ,eadaan dimana tu9uh seluruhna masu6 6e dalam air 9elum tentumenun;u66an orang terse9ut tenggelam% se9ali6na tu9uh ang tida6 sepenuhna masu66e dalam air dapat merupa6an peristi7a tenggelam. Masu6na air 6e dalam saluran nafas

hingga 6e paru?paru menim9ul6an me6anisme ang tida6 serupa denganasfi6sia me6ani6% 6arenana tenggelam tida6 dimasu6an 6e dalam pene9a9 angmenim9ul6an asfi6sia.



2. Sampurna :% Samsu O. eranan Ilmu $orensi6 (alam enega6an +u6um. a6arta@:agian ,edo6teran $orensi6 $a6ultas ,edo6teran #niversitas IndonesiaD 2//3

3. Idries AM% T;iptomartono A5% editors. enerapan Ilmu ,edo6teran $orensi6 dalamroses enidi6an. a6arta@ =B Sagung SetoD 2//0


!. ,night :. $orensic patholog. Second &dition. <reat :ritain@ ArnoldD 2//4.". (i Maio B% (i Maio (. $orensic patholog. Second &dition. #SA@ =8= ressD 2//1.


1. Memahami pengertian dan 6lasifi6asi asfi6sia me6ani62. Mampu men;elas6an per9edaan masing?masing ;enis asfi6sia me6ani63. Memahami pengertian dan 6lasifi6asi tenggelam4. Mampu men;elas6an me6anisme 6ematian pada tenggelam di air ta7ar

dan di air asin.!. Mampu mene9ut6an temuan postmortem pada 6or9an tenggelam





". Mampu men;elas6an pemeri6saan getah paru dan diatom pada 6asustenggelam

S6enario 1 @

enaah Tn. IM( datang diantar oleh penidi6 dari 6epolisan 6e Instalasi ,edo6teran$orensi6 8S#( dengan mem9a7a Surat ermintaan Bisum et 8epertum enaah. (ari6eterangan polisi ang mengantar% ;enaah ditemu6an dalam posisi setengah dudu6 di9a7ah pohon mangga pada 6e9un ang ;auh dari pemu6iman dengan tali melilit dilehernaang dii6at6an pada dahan terendah dari pohon mangga terse9ut. (ari pemeri6saandidapat6an @

• 5e9am maat pada pinggang% 9o6ong% 6edua lengan 9a7ah sampai u;ung ;ari dan

6edua tung6ai% 7arna merah 6eunguan ang tida6 hilang pada pene6anan. 5e9ammaat tida6 tampa6 pada 6edua telapa6 6a6i

• ,a6u maat pada seluruh tu9uh

• em9usu6an tida6 ada

• Se9uah lu6a lecet te6an ang meling6ari leher secara tida6 penuh dari arah depan

9a7ah 6e 9ela6ang atas.

• Tida6 ditemu6an lu6a?lu6a lain.

Assignments

1. Informasi apa lagi ang perlu digali pada 6asus iniF2. Se9elum mela6u6an pemeri6saan ;enaah apa ang perlu diperhati6an do6terF3. :erdasar6an gam9aran dan pola lu6ana termasu6 dalam asfi6sia me6ani6 ang

mana 6asus ini% 9eri6an alasannaF4. :erdasar6an pemeri6saan ;enaah% tentu6an dan ;elas6an per6iaraan cara 6ematian

pada 6asus iniF

Self assessment

1. Se9ut6an 6lasifi6asi asfi6sia me6ani6F2. elas6an pengertian masing?masing 6lasifi6asi asfi6sia me6ani6F3. elas6an per9edaan antara gaging dan cho6ingF4. elas6an per9edaan ce6i6% gantung dan ;eratF!. :erdasar6an leta6 simpul dan posisi ;enaah% ;elas6an pem9agian tipe gantung

-hangingF". Se9ut6an temuan postmortem pada ;enaah ang meninggal a6i9at asfi6siaF

S6enario 2 @

enaah Tn. I,( datang diantar oleh penidi6 dari 6epolisan 6e Instalasi ,edo6teran$orensi6 8S#( dengan mem9a7a Surat ermintaan Bisum et 8epertum enaah. (ari6eterangan polisi ang mengantar% ;enaah ditemu6an tergeleta6 di pantai.

Assignments@

1. elas6an apa ang perlu diperhati6an oleh seorang do6ter% saat mela6u6anpemeri6saan luar ;enaah pada 6asus iniF

2. :agaimana cara menenentu6an pene9a9 6ematian pada 6asus iniF3. Mengapa tu9uh ang ditemu6an di dalam air 9elum tentu meninggal 6arena

tenggelamF

Self assessment





1. elas6an per9edaan me6anisme 6ematian pada tenggelam di air ta7ar dan air asin F2. elas6an per9edaan me6anisme 6ematian pada asfi6sia me6ani6 dan tenggelam F3. Se9ut6an temuan postmortem pada ;enaah ang ditemu6an di airF4. Se9ut6an temuan postmortem pada ;enaah ang meninggal 6arena tenggelamF!. elas6an cara pemeri6saan getah paruF". elas6an cara pemeri6saan diatom F. elas6an per9edaan 6ecepatan pem9usu6an di dalam tanah% di atas permu6aan

tanah -suhu ling6ungan dan di dalam airF

LECTURE KEKERASAN FISIK -PENGANIA7AAN. DAN KE:AHATAN SEKSUAL-SEUAL ASSAULT.Oleh 'r1 I'a Bagus Pu%u Ali%4S#F1DFM

,e6erasan fisi6 dapat ter;adi dimana?mana% 9ai6 dalam 9entu6 penganiaaan atau6e6erasan fisi6 di dalam rumah tangga -domestic violence. ,e6erasan fisi6 ang senga;a

dila6u6an untu6 menim9ul6an penderitaan pada 6or9an dise9ut penganiaaan -torture.enganiaaan menim9ul6an lu6a?lu6a diluar tu9uh dan ;uga 9isa mengenai organ dalam-organ visceral dan 9ah6an 6ematian.

:erdasar6an pene9a9 lu6a% lu6a di9eda6an men;adi 5u6a Me6anis% 5u6a $isi6 dan 5u6a,imia. 5u6a Me6anis dapat dise9a96an oleh 6e6erasan tumpul -blunt force trauma.,e6erasan ta;am -sharp force trauma dan lu6a tem9a6. 5u6a $isi6 dapat dise9a96a9 olehsuhu% ele6tri6 dan 9arotrauma. Sedang6an lu6a 6imia dapat dise9a96an at asam 6uat dan:asa 6uat.

5u6a adalah salah satu 9u6ti medis dari 6asus tinda6 pidana penganiaaan disampinga6i9at ang ditim9ul6anna.Sehu9ungan dengan 9u6ti medis% 5u6a memili6i 9er9agai sifat

aitu se9agai 9u6ti transient% 9u6ti pola% 9u6ti 6onta6 dan 9u6ti 6ondisional. 5u6a se9agai9u6ti transient 6arena lu6a cepat mengalami peru9ahan aitu menem9uh atau mengalami6ompli6asi pada 6or9an hidup atau 9eru9ah 6arena proses pem9usu6an pada 6or9anmeninggal. :u6ti pola menun;u66an ter;adina lu6a mengi6uti pola?pola tertentu 9ai6 9entu6maupun distri9usina. ola 9enda pene9a9%pola lu6a penaniaaan%pola lu6a a6i9at usaha9unuh diri atau a6i9at 6ecela6aan dapat ditentu6an dari gam9aranna. 5u6a ;uga se9agai9u6ti 6ondisional aitu 9u6ti ang dipengaruhi oleh 9er9agai factor. #sia dan status6esehatan 6or9an merupa6an salah satu factor ang mempengaruhi gam9aran lu6a.

,asus penganiaaan adalah tinda6 pidana dengan deli6 material dimanapertangung;a7a9an pela6u 6arena a6i9at dari per9uatanna. emeri6saan terhadap 6or9antinda6 pidana penganiaaan adalah 6e7a;i9an hu6um 9agi do6ter% ma6a seorang do6ter

harus -o9ligasi 9ertanggung ;a7a9 untu6 memeri6sa% mendo6umentasi6an danmenginterpretasi6an lu6a untu6 6epentingan penega6an hu6um. Interpretasi a6i9at darilu6a ang men;adi 9u6ti hu6um -legal evidence adalah dera;at lu6a atau 6ualifi6asi lu6aang a6an mem9eri6an 6ea6inan +a6im di engadilan.

Setelah ditetap6an #ndang?undang erlindungan Ana6 -## A dan enghapusan,e6erasan dalam 8umah Tangga -## ,(8T% ma6a 6e6erasan di9eda6an men;adi9e9erapa 9entu6 6e6erasan aitu @ ,e6erasan $isi6% ,e6erasan si6ologis%,e6erasanse6sual dan penelantaran -negligence serta perampasan 6emerde6aan. Selain 6e6erasanfisi6% 6e6erasan se6sual memili6i ang6a 6e;adian ang tinggi terutama pada 6or9an ana6?ana6. ,omnas erlindungan Ana6 menata6an tahun 2/14% Indonesia sudah mengalami6edaruratan 6e6erasan se6sual ana6.





Secara hu6um% 6e;ahatan se6sual adalah 6e;ahatan ang menentang 6ehenda6 -crimeagainst will dan 6e;ahatan terhadap 6epemili6an -crime against property . ,e;ahatan angmenentang 6ehenda6 apa9ila hu9ungan se6sual dila6u6an tanpa persetu;uan -without consent atau diperoleh dari persetu;uan ang tida6 sah. ersetu;uan ang sah harusmemenuhi sarat Alamiah -natural % spontan% tida6 ada 6eraguan -unequivocal dan atas6einginan sendiri -volunteer . ersetu;uan tida6 sah 9ila diperoleh dengan 6e6erasan-force% ancaman 6e6erasan -fear dan tipu daa -fraud .

,e;ahatan se6sual se9agai 6e;ahatan terhadap 6epemili6an -crime against property apa9ilahu9ungan se6sual dila6u6an terhadap pasangan ang sudah dalam i6atan per6a7inan angsah% termasu6 dalam hal ini adalah perseling6uhan -overspel). *verspel 9ersifat (eli6aduan ang hana 9isa dipidana6an 9ila salah satu pasangan merasa dirugi6an.

er6osaan -rape adalah salah satu 9entu6 dari 6e;ahatan se6sual ang menentang6ehenda6. +u6um di Indonesia memandang per6osaan dari persepsi tertentu ang mung6in9er9eda dengan pandangan hu6um di )egara?negara lain. er6osaan di Indonesia adalahpela6una la6i?la6i -male crime%diluar per6a7inan -extra marital crime%hana le7at genito?

genital -intravaginal crime dan tanpa persetu;uan -without consent .

Secara meng6husus -lex spesialis% ## perlindungan Ana6 dan ## ,(8T menata6an6e6erasan se6sual ;uga termasu6 mema6sa 7anita 9erhu9ungan se6sual dengan orang lainuntu6 tu;uan tertentu termasu6 pen;ualan orang -human traficing

eran do6ter dalam 6asus 6e;ahatan se6sual adalah mem9antu proses pem9u6tian hu6umterhadap 6asus terse9ut. em9u6tian hu6um adalah mem9u6ti6an memang 9enar tinda6pidana -6e;ahatan se6sual itu ter;adi dan memang 9enar tersang6a adalah pela6una.(alam mem9u6ti6an ter;adina 6e;ahat se6sual% seorang do6ter harus mem9eri6an 9u6ti?9u6ti medis 9erupa tanda 6ede7asaan 6or9an% ada tida6na tanda?tanda 6e6erasan%adatida6na tanda persetu9uhan%7a6tu ter;adina persetu9uhan dan a6i9at persetu9uhan 9ila

ditemu6an. Tanda 6ede7asaan untu6 mem9u6ti6an 6onpeten atau tida6na 6or9an dalammem9eri6an persetu;uan dila6u6anna hu9ungan se6sual. Tanda 6e6erasan adalah 9u6timedis ang menun;u66an 6or9an tida6 setu;u -without consent ang dapat 9erupa lu6a?lu6a terutama pada daerah extra?aerogen atau tanda 6eracunan ang menurun6an6esadaran 6or9an. :u6ti persetu9uhan dapat 9erupa tanda penetrasi dan atau tandae;a6ulasi.a6tu persetu9uhan dapat di9u6ti6an dengan proses penem9uhan padagenetalia atau 6ara6teristi6 dari 6omponen mani ang diperi6sa di la9oratorium.Mem9u6ti6an pela6u dengan memeri6sa tersang6a 9ai6 pemeri6saan fisi6 maupunpemeri6saan penun;ang terhadap 9u6ti runut -trace evidence ang didapat6an. Adanalu6a?lu6a a6i9at perla7anan 6or9an%adana sel epithel vagina pada glans penis ataupemeri6saan serologi dan mole6uler -()A dapat mem9u6ti6an tersang6a se9agai pela6u.


Ilmu 6edo6teran forensi6. 1st ed. a6arta@ :agian ,edo6teran $orensi6 $a6ultas,edo6teran #niversitas IndonesiaD 1.

2. Idries AM. edoman ilmu 6edo6teran forensi6. 1st ed. a6arta@ :inarupa A6saraD1.

3. Sampurna :% Samsu O. eranan ilmu forensi6 dalam penega6an hu6um@ se9uahpengantar. a6artaD 2//3.


!. ,night :. $orensic patholog. Second &dition. <reat :ritain@ ArnoldD 1".". (i Maio B% (i Maio (. $orensic patholog. Second &dition. #SA@ =8= ressD 2///. Angelo <%&lia9eth M% anica :. Sexual Assault%<. Medical u9lishing IncD2//0.






1. Mampu memahami dan men;elas6an lu6a se9agai 9u6ti medis2. Mampu memahami dan men;elas6an des6ripsi lu6a sesuai dengan interpretasi

medi6olegal serta alasanna -reasoning 3. Mampu memahami dan men;elas6an 6ualifi6asi atau dera;at lu6a.4. Mampu mem9uat 6esimpulan dalam Bisum et 8epertum erlu6aan 9erdasar6an

!edical Reasoning dan "egal Reasoning .!. Mampu memahami dan men;elas6an tentang aspe6 Medi6o legal 6e;ahatan sexual". Mampu memahami dan men;elas6an prosedur pemeri6saan 6or9an 6e;ahatan

se6sual. Mampu memahami dan men;elas6an pemeri6saan terhadap 6or9an 6e;ahatan

se6sual

0. Mampu memahami dan men;elas6an pemeri6saan penun;ang pada 6or9an6e;ahatan se6sual dan interpretasina

S6enario 1 @

Seorang la6i?la6i% umur 3! tahun% dipu6ul dengan 9alo6 6au oleh teman se6er;ana 6arenaalasan 6ecem9uruan terhadap pacarna. ,or9an mengalami lu6a?lu6a memar dan patahtulang iga ruas 6etiga dan 6eempat 6anan. ada pemeri6saan penun;ang ditemu6anhemato?thorax 6anan dengan per6iraan perdarahan !// cc. ada 6epala dengan =T scanditemu6an perdarahan epidural dan tanda patah tulang dasar teng6ora6. ada 6or9andila6u6an pemasangan S( dan operasi Trepanasi untu6 menghilang6an perdarahanintra6ranialna.

Assignments@

1. elas6an 6onsep dualism 9iomedi6 pada 6asus terse9ut diatas2. elas6an prosedur pemeri6saan orang terse9ut diatas se9agai 6or9an.3. :agaimana cara mendes6ripsi6an lu6a pada 6or9an terse9ut4. :agaimana interpretasi 6ualifi6asi atau dera;at lu6a pada 6or9an terse9ut

Self Assessment @

1. elas6an hu9ungan pandangan medis dan pandangan hu6um terhadap lu6a2. elas6an alasan hu6um -"egal reasoning dari lu6a 8ingan% Sedang dan :erat

3. elas6an apli6asi Acuan Medis :a6u T8ISS%5eefort%T:SA%TS%TS( dalammem9uat 6ualifi6asi lu6a

S6enario 2 @

Seorang ana6 7anita% umur " tahun dia;a6 oleh orangtuana 6e I8( 8umah Sa6it 6arenadicurigai telah ter;adi pelecehan se6sual oleh tetanggana. *rang tua 6or9an sudahmelapor 6e olisi dan dating 6e rumah sa6it dengan mem9a7a Surat permintaan Bisum-SB. ada heteroanamnesis% orang tua 6or9an menata6an melihat ana6na dipang6udalam 6eadaan telan;ang oleh tetanggana se6itar empat ;am se9elum 6e rumah sa6it.ada pemeri6saan fisi6 6eadaan umum ana6 dalam 9atas normal. ada pemeri6saangne6ologis ditemu6an 9erca6 pada hmen arah ;am " sesuai dengan arah ;arum ;am.

#daana #niversit $acult of Medicine% M&# 3!




Assignments@

1. Informasi apa sa;a ang masih perlu digali sehu9ungan 6asus diatas.2. emeri6saan apa sa;a ang dila6u6an untu6 mem9eri6an 9u6ti medis 6asus

6e;ahatan se6sual terse9ut diatas.3. elas6an 9agaimana cara pemeri6saan gne6ologis pada 6or9an diatas dan

;elas6an alasan prosedur terse9ut.4. ,elainan?6elainan apa sa;a ang mung6in didapat6an pada pemeri6saan

genetalia dan pada hmen -selaput dara pada 6or9an ana6 terse9ut!. emeri6saan penun;ang apa ang diperlu6an dalam pem9u6tian 6asus terse9ut". elas6an a6i9at ang mung6in ter;adi pada 6asus 6e;ahatan se6sual.

Self Assessment @

1. Apa6ah definisi ,e;ahatan se6sual2. elas6an aspe6 Medi6o 5egal 6e;ahatan se6sual3. elas6an 9u6ti?9u6ti pada 6or9an ang mem9u6ti6an 6ede7asaan4. elas6an 9u6ti?9u6ti pada 6or9an ang menun;u66an tanda 6e6erasan!. elas6an 9u6ti?9u6ti pada 6or9an ang menun;u66an tanda persetu9uhan". elas6an pengertian penetrasi partialKminimal dan penetrasi 6omplit. elas6an 9u6ti?9u6ti ang signifi6ans mem9u6ti6an 6e;ahatan se6sual0. elas6an 9u6ti?9u6ti ang mem9u6ti6an 7a6tu ter;adina persetu9uhan. elas6an pemeri6saan anus dan temuan ang mung6in didapat6an.

A9stra ctSudden death could 9e defined as an instantaneous and unexpected death 7ithout ano9vious illness or preexisting condition 7hich leads to death. +istoricall% the term suddendeathN is derived from sudden unexpected natural deathN% indicating the cause of death isnatural. Although 9 definition sudden death could 9e assumed as natural% in realit% eversudden death case should 9e treated as unnatural manner of death or unexplained death9ecause anone could die antime and an7here 7ithout an 6no7n cause. <enerall

spea6ing% instantaneous death might 9e caused 9 diseases% phsiological and 9iochemicaldisorders as a result of certain su9stances -poisons% or triggers 7hich 7orsen thepatholog of the disease -trauma K stressors K phsical activit.

Sudden death 7ill 9e considered as natural if it is preceded 9 specific smptoms K signs%confirmed as a disease 9ased on histor from medical record% and 7itnessed 9 doctors inclinics K primar health care K hospital. +o7ever% if the death occurred 7ithout medicalhistor and 7ithout 7itnesses% it is vitall important to investigate the possi9ilit of criminalacts in relation to the sudden death. Articles 133 and 134 Indonesian =riminal rocedure=ode has authoried the investigators to see6 phsiciansH assistance to determine thecause of death.

The role of medical officers to assist the investigators in this case is appling the 9est6no7ledge of medicine. hsicians should 9e a9le to esta9lish the initial diagnosis of cause


Le$%ure Su''en Dea%h'r1 Hen2+4 S#1F14 M4BE%h14 FACLM1

3"




of death properl. It could 9e estimated 9 conducting epidemiological stud% ta6ing historfrom close relatives K investigators K 7itnesses% and performing the external examination of the 9od. Moreover% 9lood and urine samples should 9e dra7n from the 9od for further la9orator testing to confirm the diagnosis. After7ards% general practitioners should refer the case to forensic medicine specialists to reveal the definite cause of death.




3. ,night :. $orensic patholog. Second &dition. <reat :ritain@ ArnoldD 1".4. (i Maio B% (i Maio (. $orensic patholog. Second &dition. #SA@ =8= ressD 2//1.

5earning *utcomes A9le to understand and explain a9out unexplained death.

A9le to estimate the clinical diagnosis of sudden death. A9le to aptl manage and refer sudden death cases.

5earning Tas6

Bignette A?4!?ear?old man 7as found dead in his apartment room. +is stiff 9od 7as found in a9end position 7ith his right arm on the chest. The investigators ought to discover the causeof death so the send the 9od to our primar health care facilit.

Assignments@

1. Mention and explain an information 7hich should 9e collected to estimate thediagnosis of cause of deathF

2. Mention and explain ever focused step 7hile conducting external examination toestimate the diagnosis of cause of deathF

3. Mention and explain an la9orator test to estimate the diagnosis of cause of deathF4. :ased on our ans7er on Cuestions 1 P 3% please mention the possi9le diagnoses of

cause of deathF!. =hoose one of the possi9le diagnoses as our definitive diagnosis and then explain

ho7 ou esta9lish the diagnosisF

Self Assessment1. hat is the definition of sudden deathE2. Mention and explain the possi9ilities of cause of death in unexplained deathF3. Mention and explain the cause of sudden death in relation to cardiovascular sstemF4. Mention and explain the cause of sudden death in relation to central nervous

sstemF!. Mention and explain the cause of sudden death in relation to gastrointestinal and

hepato9iliar sstemsF". Mention and explain the cause of sudden death in relation to genitourinar sstemF. Mention and explain the cause of sudden death in relation to endocrine% hematolog%

and other sstemsF





A9stra ctToxicolog is a 9ranch of science dealing 7ith poison. +ence% forensic toxicolog can 9edefined as the application of toxicolog for the purposes of administration of the la7 and ;udicial proceeding. A 9roader definition concerned 7ith the source% nature% effects% clinicalsmptomsKsigns% treatment% and detection of poison. The definition of poison is eversu9stance 7hich influences the 9od chemicall and phsiologicall% 7hich in toxic doses%al7as lead to death or disease as a conseCuence of the malfunction of the 9od. +o7ever%in Indonesian ;urisdictions% there is no definition of poison. The merel mention poisoningN-article 133 Indonesian =riminal rocedure =ode and the deli9erate act of poisoningN

7hich is classified as an assault crime -articles 3!" Indonesian enal =ode.

hsicians 7ho stud forensic toxicolog should ans7er several Cuestions 7hich ariseduring the investigation% including@ 7hether the victim has 9een poisoned intentionall%unintentionall% or self?poisoningE hat tpe of poison usedE +o7 does the toxic chemicalget into the 9odE hat are the effects of poison on the 9odE +o7 much is the lethal doseof this poisonE

&sta9lishing the clinical or postmortem diagnosis of intoxication is some7hat difficult due tothe difficult of o9taining historical data in relation to poisoning. Therefore% it is important tonote an specific smptoms and signs of poisoning in living su9;ects. Moreover% phsiciansshould carefull examine the dead 9od to notice specific findings% 9oth macroscopicall

and microscopicall% 7hich are specific for particular poison. The chemical analsis of remaining evidence -i.e residual vomit% food% and 9everages in crime scene is ver crucialto estimate the cause of death. In order to determine the cause of death% it must 9e proventhat the poison has 9een circulating throughout the 9od 9 performing la9orator test todemonstrate that the poison and its meta9olites are present in sufficient Cuantities indifferent 9od fluids and tissues.


Ilmu 6edo6teran forensi6. 1st ed. a6arta@ :agian ,edo6teran $orensi6 $a6ultas,edo6teran #niversitas IndonesiaD 1.

2. irasuta IMA<. :u6u A;ar Analisis To6si6ologi $orensi6. :u6it im9aran@ urusan

$armasi $MIA #niversitas #daanaD 2//0.3. <allo MA. +istor and scope of toxicolog. In@ =asarett (oull's Toxicolog@ The

:asic Science of oisons. th ed. ,laassen =(% editor. #SA@ Mc<ra7?+illD 2//0.4. Moffat A=% *sselton M(% iddop :% ic6ells S% )egrus A. Introduction to forensic

toxicolog. In@ =lar6e's Analtical $orensic Toxicolog. 2nd ed. )egrus A% ic6ells S%editors. <reat :ritain@ harmaceutical ressD 2/13.

5earning *utcomes A9le to understand and explain a9out forensic toxicolog.

A9le to estimate the clinical and postmortem diagnosis of poisoning.

A9le to aptl manage and refer poisoning cases.

5earning Tas6


Le$%ure F"rensi$ T"i$"l"g+

'r1 Hen2+4 S#1F14 M4BE%h14 FACLM1

30




Bignette A oung couple found dead in a luxur car 7ith the engine running. Several tin 7hite andello7 pills 7ere found inside the car.

Assignments@1. Mention and explain an information 7hich should 9e collected to estimate the

poisons 7hich cause the deathF2. Mention and explain ever focused step 7hile conducting external examination to

estimate the poisons 7hich cause the deathF3. Mention and explain an la9orator test to estimate the poisons 7hich cause the

deathF4. :ased on our ans7er on Cuestions 1 P 3% please mention the possi9le poisons

7hich cause the deathF!. =hoose one of the possi9le poisons as our definitive cause of death and then

explain ho7 ou esta9lish the diagnosisF

". &xplain the source% nature% port d entrQe% mechanism of action% and lethal dose of this poisonF. hat is the manner of death in this caseE &xplainF

Self Assessment1. hat is the meaning of poisoningE2. Mention and explain the classification of poisonF3. +o7 is the mechanism of action of =*% =)% heav metals% insecticides% 9ar9iturates%

alcohol% narcotics% pschotropic% and other addictive drugsF4. &xplain ever step to esta9lish the clinical diagnosis of =*% =)% heav metals%

insecticides% 9ar9iturates% alcohol% narcotics% pschotropic% and other addictive drugsintoxicationF

!. &xplain ever step to esta9lish the postmortem diagnosis of =*% =)% heav metals%insecticides% 9ar9iturates% alcohol% narcotics% pschotropic% and other addictive drugsintoxicationF

". &xplain the medico?legal management of poisoning caseF





~ CURRICULUM MAP ~

Sm!tr Proram or curricu"um #"oc$!

%& Senior Clerkship

' Senior Clerkship

( Senior clerkship

)

Medical

Emergency

(3 weeks)

BCS (1 weeks)

Special Topic:

-Trael medicine

(! weeks)

Elec"ie S"#dy $$$

(% weeks)

Clinic &rien"a"ion

(Clerkship)

(% weeks)

*

The 'espira"ory

Sys"em and

isorders( weeks)

BCS (1 weeks)

The

Cardioasc#lar

Sys"em andisorders

( weeks)

BCS (1 weeks)

The *rinary

Sys"em and

isorders(3 weeks)

BCS (1 weeks)

The 'eprod#c"ie

Sys"em and

isorders(3 weeks)

BCS (1 weeks)

5

Elec"ie S"#dy

$$

(1 weeks)

+limen"ary

, hepa"o-

iliary sys"ems

, disorders

( .eeks)

BCS (1 weeks)

The Endocrine

Sys"em/

Me"aolism and

isorders

( weeks)

BCS (1 weeks)

Clinical 0#"ri"ion

and isorders

(! weeks)

BCS (1 weeks)

Special Topic :

- allia"ie

medicine

-Compleme

n"ary ,

+l"erna"ie

Medicine

- 2orensic

(3 weeks)

Elec"ie

S"#dy $$

(1 weeks)

+

M#sc#loskele"al

sys"em ,

connec"ie

"iss#e disorders

( weeks)

BCS (1 weeks)

0e#roscience

and

ne#rological

disorders

( weeks)

BCS (1 weeks)

Behaior Change

and disorders

( weeks)

BCS(1 weeks)

The is#al

sys"em ,

disorders

(! weeks)

BCS

(1 weeks)

4ema"ologic

sys"em , disor-

ders , clinical

oncology

( weeks)

BCS (1 weeks)

$mm#ne

sys"em ,

disorders

(! weeks)

BCS(1 weeks)

$n5ec"ion

, in5ec"io#s

diseases

(6 weeks)

BCS (1 weeks)

The skin , hearing

sys"em

, disorders

(3 weeks)

BCS(1 weeks)

-

Medical

ro5essionalism

(! weeks)

BCS (1 weeks)

Eidence-ased

Medical rac"ice

(! weeks)

4eal"h Sys"em-

ased rac"ice

(3 weeks)

BCS (1 weeks)

Comm#ni"y-ased

prac"ice

( weeks)

Special Topic

- Ergonomi

- 7eria"ri

(! weeks)

Elec"ie

S"#dy $

(! weeks)

% S"#di#m

7enerale and

4#maniora

(3 weeks)

Medical

comm#nica"ion

(3 weeks)

BCS (1 weeks)

The cell

as ioche-

mical machinery

(3 weeks)

BCS(1 weeks)

7row"h

,

deelopmen"

( weeks)

BCS: (1 weeks)

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endidikan ancasila , 8ewarganegaraan (3 weeks)

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Spesial Topic Tayang by Gextha 9 Jan 20151