It Is Not Easy When You Are a Bipolar

It’s not easy living with bipolar I, but here are some things I’ve learned throughout my struggle. If you also have bipolar I, you may want to consider sharing these points with your own friends and family to help them understand what you are dealing with.

Around 1% of us will develop bipolar disorder, formerly known as manic depression. People with bipolar experience both episodes of severe depression, and episodes of mania – overwhelming joy, excitement or happiness, huge energy, a reduced need for sleep, and reduced inhibitions.

The experience of bipolar is uniquely personal. No two people have exactly the same experience. Bipolar disorder has been associated with genius and with creativity. It is certainly true that a number of contemporary high achievers and creatives have spoken of their experiences, and throughout history it is possible to recognise bipolar type traits in the artistic, political and academic spheres. But what is it actually like?

Bipolar disorder (formerly called manic-depressive illness or manic depression) is a mental disorder that causes unusual shifts in mood, energy, activity levels, concentration, and the ability to carry out day-to-day tasks. There are three types of bipolar disorder. All three types involve clear changes in mood, energy, and activity levels.

These moods range from periods of extremely “up,” elated, irritable, or energized behaviour (known as manic episodes) to very “down,” sad, indifferent, or hopeless periods (known as depressive episodes). Less severe manic periods are known as hypomanic episodes.

Bipolar disorder is typically diagnosed during late adolescence (teen years) or early adulthood. Occasionally, bipolar symptoms can appear in children. Bipolar disorder can also first appear during a woman’s pregnancy or following childbirth. Although the symptoms may vary over time, bipolar disorder usually requires lifelong treatment. Following a prescribed treatment plan can help people manage their symptoms and improve their quality of life.

People with bipolar disorder experience periods of unusually intense emotion, changes in sleep patterns and activity levels, and uncharacteristic behaviours—often without recognizing their likely harmful or undesirable effects. These distinct periods are called “mood episodes.” Mood episodes are very different from the moods and behaviours that are typical for the person. During an episode, the symptoms last every day for most of the day. Episodes may also last for longer periods, such as several days or weeks.

Sometimes people experience both manic and depressive symptoms in the same episode. This kind of episode is called an episode with mixed features. People experiencing an episode with mixed features may feel very sad, empty, or hopeless, while, at the same, time feeling extremely energized. A person may have bipolar disorder even if their symptoms are less extreme. For example, some people with bipolar disorder (Bipolar II) experience hypomania, a less severe form of mania. During a hypomanic episode, a person may feel very good, be able to get things done, and keep up with day-to-day life. The person may not feel that anything is wrong, but family and friends may recognize the changes in mood or activity levels as possible bipolar disorder. Without proper treatment, people with hypomania can develop severe mania or depression.

Proper diagnosis and treatment can help people with bipolar disorder lead healthy and active lives. Talking with a doctor or other licensed health care provider is the first step. The health care provider can complete a physical exam and order necessary medical tests to rule out other conditions.

The health care provider may then conduct a mental health evaluation or provide a referral to a trained mental health care provider, such as a psychiatrist, psychologist, or clinical social worker who has experience in diagnosing and treating bipolar disorder. Mental health care providers usually diagnose bipolar disorder based on a person’s symptoms, lifetime history, experiences, and, in some cases, family history. Accurate diagnosis in youth is particularly important.

Researchers are studying the possible causes of bipolar disorder. Most agree that there is no single cause and it is likely that many factors contribute to a person’s chance of having the illness.

  • Brain Structure and Functioning:Some studies indicate that the brains of people with bipolar disorder may differ from the brains of people who do not have bipolar disorder or any other mental disorder. Learning more about these differences may help scientists understand bipolar disorder and determine which treatments will work best. At this time, health care providers base the diagnosis and treatment plan on a person’s symptoms and history, rather than brain imaging or other diagnostic tests.
  • Genetics:Some research suggests that people with certain genes are more likely to develop bipolar disorder. Research also shows that people who have a parent or sibling with bipolar disorder have an increased chance of having the disorder themselves. Many genes are involved, and no one gene can cause the disorder. Learning more about how genes play a role in bipolar disorder may help researchers develop new treatments.

Treatment can help many people, including those with the most severe forms of bipolar disorder. An effective treatment plan usually includes a combination of medication and psychotherapy, also called “talk therapy.” Bipolar disorder is a lifelong illness. Episodes of mania and depression typically come back over time. Between episodes, many people with bipolar disorder are free of mood changes, but some people may have lingering symptoms. Long-term, continuous treatment can help people manage these symptoms.

Certain medications can help manage symptoms of bipolar disorder. Some people may need to try several different medications and work with their health care provider before finding medications that work best.

Medications generally used to treat bipolar disorder include mood stabilizers and second-generation (“atypical”) antipsychotics. Treatment plans may also include medications that target sleep or anxiety. Health care providers often prescribe antidepressant medication to treat depressive episodes in bipolar disorder, combining the antidepressant with a mood stabilizer to prevent triggering a manic episode.

People taking medication should:

  • Talk with their health care provider to understand the risks and benefits of the medication.
  • Tell their health care provider about any prescription drugs, over-the-counter medications, or supplements they are already taking.
  • Report any concerns about side effects to a health care provider right away. The health care provider may need to change the dose or try a different medication.
  • Remember that medication for bipolar disorder must be taken consistently, as prescribed, even when one is feeling well.

Avoid stopping a medication without talking to a health care provider first. Suddenly stopping a medication may lead to a “rebound” or worsening of bipolar disorder symptoms.

Beyond Treatment: Things You Can Do

  • Regular Exercise: Regular aerobic exercise, such as jogging, brisk walking, swimming, or bicycling, helps with depression and anxiety, promotes better sleep, and is healthy for your heart and brain. There is also some evidence that anaerobic exercise such as weightlifting, yoga, and Pilates can be helpful. Check with your health care provider before you start a new exercise regimen.
  • Keeping a Life Chart:Even with proper treatment, mood changes can occur. Treatment is more effective when a patient and health care provider work together and talk openly about concerns and choices. Keeping a life chart that records daily mood symptoms, treatments, sleep patterns, and life events can help patients and health care providers track and treat bipolar disorder over time. Patients can easily share data collected via smartphone apps – including self-reports, self- ratings, and activity data – with their health care providers and therapists.

If you have any symptoms of depression or mania, see your doctor or mental health professional. Bipolar disorder doesn’t get better on its own. Getting treatment from a mental health professional with experience in bipolar disorder can help you get your symptoms under control.

Where to get Airlines PCR Swabs for International Flights in Bali

Indonesia’s first class and award-winning airline Garuda Indonesia has taken a number of anticipatory steps and issued related policies in response to the outbreak of the Novel Coronavirus (COVID-19) in order to maintain a safe, secure environment for its customers, cabin crew, and other employees.

Passenger & Document Requirements

Garuda Indonesia ensures that it fully supports the Indonesian Government policy as well as local governments in order to prevent the spread of COVID-19 in Indonesia which stated in:

Satuan Tugas Penanganan COVID-19 (COVID-19 Handling Acceleration Force) letter SE No. 7 of 2021 concerning Travel Provisions Extension for Domestic People During the 2019 Corona Virus Disease (COVID-19) Pandemic
Satuan Tugas Penanganan COVID-19 (COVID-19 Handling Acceleration Force) letter SE No. 8 of 2021 concerning g the Health Protocols for International Traveler in Corona Virus Disease 2019 (COVID-19) Pandemic Period
Categories of people that are allowed to travel are as follows:

International Flight
Outbound Indonesia: requirements should refer to each destination country’s policy and information on the government, embassy, and related authority’s website or IATA Travel Center here.
According to the Singapore Authority, flight transit through Singapore Changi Airport is allowed under current terms and conditions.

According to the Thailand Authority, flight transit through Bangkok Suvarnabhumi Airport is temporary not allowed until further notice.
Inbound Indonesia: Refers to SE Satgas Penanganan Covid-19 No 8 of 2021, effective from 09 February 2021 until further notice, Foreigners (WNA) are not allowed to enter/transit in Indonesia. The exemption policy of foreigners permitted to enter Indonesia clicks the button Travel Restrictions to Indonesia below for detailed information.
While there is no restriction for Indonesian Citizens entering Indonesian territory, as long as it follows the document requirement.

Domestic Flight
Every person is eligible to travel as long as a Health Certificate with a COVID-19 free result is presented based on document requirements of each destination policy on the following table.
For departures from regions that do not have a COVID-19 test facility, may substitute it with a Health Certificate that shows symptoms-free of influenza-like illnesses issued by a hospital/community health center doctor.

Health Certificate Validity
Based on COVID-19 Handling Acceleration Force letter, the acceptable period of Health Certificates based on COVID-19 test type results are as follows:

Flights to Bali Island: health certificate of negative RT-PCR test results, issued within a maximum period of 2 x 24 hours before departure or negative results of the rapid antigen test, issued within a maximum period of 2 x 24 hours before departure.
Flights to other destination: health certificate of negative RT-PCR test results, issued within a maximum period of 3 x 24 hours before departure or negative results of the rapid antigen test, issued within a maximum period of 2 x 24 hours before departure, unless there are special provisions from local authorities.
For some destinations other additional/special requirements apply, detailed information in the table below.
Provisions for Health Care Facilities and Valid Health Certificates

All prospective Passengers must take a COVID-19 test (rapid antigen test or RT-PCR test) at a Health Service Facility recognized by the Ministry of Health of the Republic of Indonesia as a COVID-19 Testing Laboratory, please refer here.

Falsification of medical documents from the rapid antigen test or RT-PCR test for air travel is against the law. Each violation will be subjected to sanctions in accord with the applicable laws and regulations (Articles 263 and 268 of the Criminal Code in Making False Letters or Falsifying Letters).
The documenfs needed for air travels are listed on each airline’s website. We suggest you check thoroughly what are needed before travelling to save you time in the airport.

Passengers are expected to prepare a copy and original copy of the documents prior to arrival at the departure airport and present it upon check-in. Garuda Indonesia is not responsible for any lack or mistake on any of the required documents and has the right to cancel the flight of any passenger that does not meet the requirement.

Wear Masks Onboard & in Airport Area
Every passenger is required to put on a mask at the airport and during flight. Garuda Indonesia also urges passengers to prepare their own masks as well as their own personal hygiene kits according to their individual needs before the flight.

For those of you entering Indonesia and or flying domestic flights within Indonesia, you are required to fill a Health Alert Card from the Indonesian Ministry of Health. It is no longer possible to fill in manually, therefore we suggest using E-HAC (Electronic Health Alert Card) that can be accessed on:
• Indonesian Ministry of Health official web
or you can also install the E-HAC app on your smartphone that can be downloaded on the following links:
• Android Play Store
• Apple App Store

E-HAC filling can be done before you travel, during the departure or during the arrival process before the Port Health Authority (KKP) checkpoint.
For domestic flights, on some airports, passengers are required to go through a Health Certificate verification & validation process by Health Port Authority or local authorities.
For flights departing from Soekarno-Hatta International Airport (CGK), the verification & validation process will be done by Soekarno-Hatta Health Port Authority at Gate 3 Terminal 3 building.

Now you can directly validate the health test results on the e-HAC application at the check-in counter at Soekarno Hatta Airport (CGK) Terminal 3 if you already have the QR Code of the medical test results.
Following are the steps for electronic validation:
Show test results on: Health Passport menu> List of Lab Test > Applicable test results will appear green, OR
Scan the barcode on: VaksinKu Menu> QR Code Certificate
If you don’t find a Covid-19 test result like the steps above, you must manually validate at the KKP counter.

Install Peduli lindungi App
Every passenger is suggested to install the official PeduliLindungi app from the Indonesian government on their phone that can be downloaded on either Android Play Store and Apple App Store.
Furthermore, there are currently some routes that are not available at the moment, so be sure to check on the airline’s website.

If you are planning to fly out of Bali, though, you might want to get a PCR test elsewhere in prior of coming to the airport. Based on our experience, the testing post at the airport can be packed with travellers and take a lot of waiting time before you finally get your turn. Get the test coveniently done in your home by the trusty team from Unicare Clinic Bali.

There are three types of test that yku can get: a Rapid Test and a Swab Antigen Test.
The Rapid Test, which is an inexpensive test required for domestic travel in Indonesia, regularly takes about 10 minutes for it to get done. This test looks for evidence of past infection and antibodies the body uses to fight off COVID-19.

A blood sample (often using pin prick on the finger) is taken at time of testing. A positive test may mean an Antigen or Swab test is needed to confirm active infection; however, a negative result is not necessarily a guarantee that there is no current active infection as it only tests for antibodies / past infection. Price starts from IDR 148K.

The Swab Antigen Test is a little bit more expensive test to check for active COVID-19 infection that usually takes around 20 minutes, and it particulary looks for an active COVID-19 infection in which nasal or throat swab is taken for testing.

A negative results means the patient didn’t have COVID-19 at time of testing. Price starts from IDR 235K
The most expensive one, PCR Swab Test, is often required for most international travel requirements. A regular test may take 2 – 3 days before you can get the result, but there is an express option that will only take 24 hours for the result.

This test looks for Active COVID-19 infection, in which a nasal or throat swab is taken for testing.
A negative results means the patient didn’t have COVID-19 at time of testing. Price IDR 1399K.
All Covid-19 Tests from Unicare Clinic are administered by professional with a starting price of Rp 248,000 including on-call fee if you want to do it in your home. We give faster result to save you more time and a 24 hours services is available. Additional fee may be charged if additional therapy is needed.

We hope this article will help you with your travel plans. Until next time, stay safe, and stay healthy!

Bali Is Open for Domestic Travellers

Bali Is Open for Domestic Travellers

As you may have noticed before, Bali has reopened the gate for domestic travellers from all across the country.

Done with strict procedures under the C-19 health protocols, this has been a bittersweet progress that we all have to embrace for the time being. Admittedly, these waves of local tourists coming to the island have given some of us a room to breathe, even if just a little. Cafés and restaurants have been reopening here and there, as well as the previously dead and darkened hotels. Small shops have seen some increase in their pockets, and so have those in the entertainment industry. Live music are back in the busiest places, just like the old time.

However, due to the mass of people coming from Indonesia’s red zones Jakarta and Surabaya, the number of C-19 victims have also sky-rocketed these past couple of months; delivering Bali to the top three regions of highest death tolls in the whole country, just after East Java and Jakarta. Now this sure raise some questions. Have we done enough to protect this island, or have we jeopardized its people for the sake of financial stability? It all depends on how we see things, really.

As of 14 September, the official tally has reported a total of 7,226 cases in Bali, where the population is around more than 4.2 million. With 3,388 cases of recovery, Bali’s recovery rate is at an encouraging 78.7 percent. If you are reading this as a preparation for your upcoming trip to Bali, here are the requirements that you need to provide before stepping into the welcome gate.

The Balinese government mandates anyone traveling to Bali via Ngurah Rai airport to fulfill several requirements. According to Indonesia Tourism official website, these include:

– Obtaining unique QR Code. They are required to fill in an application form to obtain a QR code, which will then become a proof that each upcoming visitor has submitted the application form.

– Presenting COVID-19 negative certificate (PCR). Upcoming visitors going to the island by air must present a COVID-19 negative certificate that has been subjected to the Polymerase Chain Reaction (PCR) from a government hospital laboratory or a COVID-19 Task Force designated laboratory. The COVID-19 negative certificate has a validity period of seven days from the time of arrival at one of the sea or airports of Bali.

From what we know, there are several domestic flight schedules operated by a few local airlines. The country’s national carrier, Garuda Indonesia, is among the airline resuming domestic operations. It has also implemented social distancing procedure in the cabin, including blocking out the middle seats.

Visas on arrival to Bali were halted on 20 March 2020 while The Ngurah Rai airport remains open. There is still a travel restriction in place for Indonesia where passengers are not allowed to transit or enter the country, with a few exceptions. Bali relies heavily on

tourism and welcomed 6.3 million foreign visitors last year, so the pandemic has a quite huge impact on local economy. Since 31 July, Bali has opened its borders only to domestic travelers and the statistics have shown encouraging figures in relation to Bali’s Covid-19 cases for the last two weeks.

International tourists remain banned from visiting Bali for the remainder of 2020. In line with the policy of the Government of Indonesia, Bali has postponed its September 11 international reopening until the year 2021. Other than that, the Balinese government has released a statement detailing who and what are allowed to enter the island. They include transports of basic security, logistical, and medical purposes, diplomatic personnel, personnel working for government projects, and personnel related to COVID-19 aid management.

The Vice Governor of Bali in a conference feed also added that entries are allowed for patients in need of emergency help, passengers attending to urgent matters like death or illness in the immediate family, and repatriated migrant workers and overseas Indonesian students.

The Governor of Bali stated that reopening Bali will come in stages and tourism may be the last sector to be fully opened. To local media, he said that the tentative plan is to open to domestic tourists in August and foreign visitors in September 2020. However, the local government said they’re in “no rush”, opting to focus on successfully flattening the curve and carefully considering their options.

To prepare for future reopening, Indonesia’s Tourism and Creative Economy Ministry has proposed a programme of Cleanliness, Health, and Safety (CHS), referring to their pledge to ensure the cleanliness of all tourist spots, provide health checks for all visitors, and guarantee the safety of tourists and locals alike across the archipelago. Bali as the top tourist destination in the country will be the first to implement the CHS procedures, particularly in Nusa Dua area.

The first phase has commenced on July 9 and has seen limited reopenings of the following sectors: a) health; b) government office; c) customs and religion; d) finance, industry, trade, logistics, transportation, cooperatives, Micro Small and Medium Enterprises (MSME), traditional markets, modern markets, restaurants and stalls; e) agriculture, plantations, marine/fisheries, and animal husbandry; and f) services and construction.

The second phase has commenced on July 31 with Indonesian tourists allowed to visit the island. The third and final phase will commence on September 11, 2020, by which time the provincial government of Bali is expected to open its borders to international and domestic tourists alike. As aforementioned, international tourists will not be able to visit Bali until at least 2021.

There, we hope you get the information you need in regard of Bali’s travel reopening. Stay safe, and see you next time!

Tips on How to Choose the Best Clinic for Travelers While travelling

Tips on How to Choose the Best Clinic for Travelers While travelling

Many people tend to travel abroad without much thought as to how they will protect their health during their trip.

However, consulting a travel health specialist is key to having a successful and safe trip. Even if the specialist just imparts advice to the traveler, the specialist will still be providing him or her with the tools needed to stay healthy overseas. When in need of the expertise provided by a travel health clinic, how do you choose the right one?

That intimate knowledge can make a big difference to your health. Studies show that when people’s access to the right and best clinic for them improves, their risk of dying of cancer, heart disease and strokes declines. And Medicare Advantage members with a primary care physician are more likely to benefit from coordinated care and to have a positive health care experience.

Just like when choosing a doctor or a hospital, you want the assurance that the choice you are making when choosing a travel clinic will be suitable for your needs. The last thing you want is to trust quacks with your travel health and due to this, it is imperative to be cautious when considering a travel health clinic. Here are some of the factors to consider:

  1. Ask around.

The first step to finding a great doctor: Talk to your family and friends about their great doctors while they travel in to the same destination you are about to visit. A recommendation from someone you trust is a great way to identify a highly skilled, helpful physician. But remember: Every person is different. Just because a doctor was perfect for your neighbor or your best friend doesn’t mean that he or she is right for you.

  1. Map it out.

Since you’ll be visiting your primary care doctor for everyday health needs, it’s important that he or she be located somewhere convenient to you find the clinic as close as possible within your place or region that you are in. You won’t want to travel very far when you’re not feeling good. And if your doctor’s office is conveniently located, you’ll be more inclined to keep appointments for physicals and other preventive care when you’re healthy. If you’re enrolled in a Medicare Advantage plan, check if it offers transportation benefits, which can come in handy if you need help getting to and from your doctor appointments. You should visit a travel clinic at least four weeks before your date of departure, and this is where the location of the clinic comes in.

Other than the initial vaccination, booster shots may be necessary to enhance your levels of immunity against the potential risks you may face, and the last thing you want is to spend a lot of time traveling to get the shots. It will be more convenient if you choose a clinic closer to you and one that you can access without any hassles.

  1. Make sure you’ve got coverage.

Once you’ve identified some possible candidates, check whether they work with your health plan. If you have traditional Medicare, call the clinic’s office and ask they accepts Medicare patients. If you have a Medicare Advantage plan, call your insurance provider or check your plan’s website to see if the clinic is in your plan’s network. Most plans charge more if you see a clinic outside the network, and some won’t cover out-of-network care at all, so it’s important to take this step before scheduling an appointment.

  1. Do a quality check.

When you are choosing a travel health clinic, you will want to find a clinic that makes proper healthcare its main priority. The specialists should listen to your concerns, talk to you about your medical history and should assess the current state of your health. You should never feel rushed or belittled for not knowing about any aspect of travel medicine; the clinic’s main goal should be to help you stay healthy through proper education and preparation.

Chances are you wouldn’t hire someone to make repairs in your home without doing a little research into the quality of their work. So why would you choose a clinic without doing the same? If you have a Medicare Advantage plan, check with your insurance company to see if they have any information about the quality ratings of specific primary care clinic in your network.

You can also use the clinic compare tool on to see if the clinic has participated in any activities that indicate he or she provides high-quality care.

Finally, check to see whether the clinic is board-certified through the Certification Matters site, which the International Board of Medical Specialties maintains. Usually the great clinic will have a great and board-certified doctor which will always be available in their clinic. Board-certified primary care doctors have not only met the licensing requirements of their states, but also passed comprehensive exams in internal medicine. Doctors also have to keep up with the latest developments in their fields to maintain their certification, so you can be sure they’re giving you up-to-date advice.

  1. Check about how many Industry Expertise does the Clinic Have

You will want to find a travel health specialist who works in a clinic with significant experience and comprehensive knowledge in the travel medicine industry and preventative care. Ideally, the clinic would focus solely on travel medicine and travel health, and be knowledgeable on conditions pertaining to your destinations, including any layovers. You will have a great experience if you work with a travel health clinic that has demonstrated experience and comprehensive knowledge on matters dealing with travel medicine. The clinic should ideally be focused on travel health and travel medicine, and they should have a lot of information about the requirements in various destinations around the globe. This is how you will know if you will be adequately covered before you head on your trip.

  1. Asking about the Yellow Fever Vaccine

If you have plans to travel to Africa, Southeast Asia or Latin America, you will need to consider a vaccination for yellow fever. These immunizations are only provided by authorized providers who are recognized by the U.S. Yellow Fever Vaccination Registry. This registry is monitored by the Center for Disease Control and individual state health departments, ensuring the quality and safety of the vaccine that is administered to high-risk groups.

  1. Check if You Can Get All the Vaccines that You Needed

A good travel health clinic will provide far more than routine vaccinations such as hepatitis A and B, tetanus/diphtheria, HPV, measles, mumps, rubella, shingles and polio. The travel health specialists there should be qualified to give you specialty vaccinations against Japanese encephalitis, yellow fever, rabies, typhoid and anthrax. They should also be able to assess your needs and provide you with the appropriate prophylactic medication for malaria, antibiotics for traveler’s diarrhea, and other travel supplies, as appropriate.

  1. Keep your needs in mind.

Every person has unique health needs, and those needs change as people age. We suggest asking the clinic about their specialties or areas of interest. Example: Some clinics are really good at sports medicine, but if you’re not a serious athlete in your senior years, that may not be helpful to you, or some clinics, on the other hand, may have a special interest in diabetes care or have a large population of diabetics in their practice. Those are things to ask when you call or make an appointment with the clinic for the first time. And if you have multiple complex medical issues, you may benefit from seeing a clinic with more than 5 years of experience in handling patient, since your needs will be so complex or need another further assistance.


Once you have found a clinic that seems to be a good fit for you, call the local office to schedule your appointment. To measure the quality of your visit after the appointment, ask yourself these questions:

  1. Did the travel health specialist give you a chance to ask questions?
  2. Did you feel the specialist was listening to you?
  3. Did the specialist seem comfortable answering your questions?
  4. Did the travel health specialist talk to you in a way that you could understand?
  5. Did you feel the specialist spent enough time with you?

If the answer to the above questions is yes, the clinic is a certified yellow fever provider, they offer all of your vaccines in one stop and the clinic is close to your home or office, then it sounds like you have found the clinic that is right for you. Happy and safe travels!

What is dental PPE and why is it so important for Unicare Clinic?

Personal protective equipment (PPE) offers a way of reducing the infection when treating patients, by minimizing exposure to contaminated body fluids. During epidemics/pandemics of highly infectious diseases, such as COVID-19, health care workers (HCW) are at greater risk of infection than the general population.

The recently published Cochrane Review (Verbeek et al, 2020), aimed to evaluate which type of full-body PPE and which method of donning (putting on) or doffing (removing) PPE have the least risk of contamination or infection for HCW, and which training methods increase compliance with PPE protocols. For COVID-19, this entails preventing droplets from entering mouth, nose or eyes and preventing them from contaminating the skin elsewhere.

Dentists and members of the dental team work in close proximity, usually face-to-face, with patients often for sustained periods of time. As part of routine care, they are exposed to saliva and blood and carry out aerosol-generating procedures (e.g. use of high-speed air rotors and ultrasonic scalers), making the findings of this review highly relevant to them.

PPE is part of Standard Precaution for infection and control. In tandem with other measures such as good ventilations, correct handling of waste, immunizations and correct working practices, PPE can help minimize the possibility of exposure to infections.

The term PPE is used to describe all protective equipment a dentist or dental nurse may use in the surgery. Typically, this might include the following elements :

  • PPE for Eyes – goggles, visors. Normal glasses do not provide sufficient eye protection so goggles or visors should be worn during treatments and when manually cleaning instruments. Patients should be given eye protection prior to any examination or treatment.
  • PPE for Hands – sterile, single use gloves. These should be put on at the start of treatment and removed at the end. They need to be removed aseptically so that the outside of the glove isn’t touched by bare skin. Sterile gloves are needed for invasive surgery while heavy duty gloves are required for cleaning of dental instruments.
  • PPE for the face – masks and respirators. Conventional single use masks provide barriers against splatter but do not generally protect the wearer effectively against aerosol inhalation. Respirator masks filter inhaled air and remove microbes.
  • PPE for the body – aprons, gowns. Aprons or gowns are often wore over the top of dental uniforms to act as barrier to fluids.

There are several aspects to be aware of concerning the use of PPE. The order of putting on and removing PPE is vital in order to prevent the spread of infection. These following sequences were advised :

  • For putting on PPE the order is uniform-apron-mask-eye protection then gloves.
  • For removing PPE the order is gloves-apron-eye protection-mask-uniform.

Throughout the process, it is important to keep hands away from the face and limit any surfaces touched in the patient environment. Gloves should be change if they become torn or highly contaminated, and always between patients. Hands should be cleaned after disposing of gloves.

Single use items should be disposed as hazardous clinical waste and managed according to practice waste management policy.

The masks and gloves protect the dental team from any contact with blood, saliva, mucous and other bodily fluids. These fluids can contain viruses and bacteria that can spread infection; many illnesses can only be spread by direct contact between bodily fluids.

PPE protects patients too. The gloves your dentist and team use are sterile, which limits the chances that you’ll contract an illness from them. This is especially important for immune compromised individuals. Sterile gloves are used for each patient and are always discarded after use.

Your dentist will always wear PPE whether or not you display symptoms of an illness. Infection control requires that every patient is infected. You must let your dentist know if you have an illness before your visit so you and they can plan appropriately.

The amount of PPE your dentist will wear can vary significantly depending on your health conditions. People with highly infectious or dangerous diseases would be treated by medical professionals wearing significantly more PPE than with patients who seem healthy.

Standard PPE equipment doesn’t protect your dentist from every type of infection. You’ve probably heard that most masks don’t protect adequately from airborne infections – they only act as barriers for fluids. That’s why there’s a growing need in the current environment for specialized PPE like N95 masks.

The chain of infection

In addition to following safety protocols, it is worthwhile to remember the difference between bacteria and viruses when thinking about the chain of infection. Although both are microbes with the potential to cause infections, they behave in very different ways. Viruses, such as the novel coronavirus, are smaller than even the smallest of bacteria, reproduce quickly by using host cells to make new viruses, and are much more likely to cause disease. In general, viral infections are also more challenging to treat due to their tiny size and as they reproduce inside of cells.

The chain of infection refers to the series of events that allow pathogens to cause infection in a person. This chain begins with an infectious agent, or pathogen, finding a “portal of exit.” Upon finding this exit, the pathogen can leave its reservoir and travel through space. As it travels, whether by direct or indirect contact, it searches for a “portal of entry” and enters a new, susceptible host.

This may sound complicated, but it can happen within an instant. The easiest way to stop pathogens from spreading is to interrupt the chain through understanding the portals of exit and entry and modes of viral transmission and adopt the appropriate infection control measures.

Some ways to break the cycle of infection include eliminating the agent at its source of transmission, protecting portals of entry, and increasing the host’s defense so that there are fewer new and susceptible hosts. We examine how dental professionals can increase their defenses against infection in the workplace.

The fight against infection begins with the implementation of the hierarchy of controls as follows :

  1.  Eliminate workplace conditions or contagious individuals that negatively impact well-being.
  1. Replace or substitute unsafe/unhealthy working practices with policies that improve the culture of safety and health in the workplace
  1. Redesign or rearrange the workplace to promote safer practices.
  1. Provide safety and health resources for employees.
  1. Encourage personal change, so that individuals will do their part to keep the office safe.

Following these control guidelines is the first step to bolstering your practice’s defenses against the spread of viral infections. The second step is to recognize and understand the unique dangers present in a dental office. The face-to-face nature of dentistry, in combination with the exposure to saliva, blood, and other bodily fluids, makes it very easy to transmit infections. As a result, dental professionals must adopt infection control measures to limit the airborne spread (often through aerosols), the contact spread, and the contamination of surfaces. Some protocols to protect against these transmissions of infection include the following.

Screening patients prior to their appointments

The best way to break the chain of infection is to prevent the introduction of the pathogens in the first place. Sick patients and employees should not enter the building. Screening patients, by asking basic triage questions before their appointments is the best way to determine if they are healthy enough to continue with their scheduled procedures. This does not mean only during a pandemic but forever!

Staying home if you are sick

Any employee that does not feel well should stay home. If you are ill, you are a potential hazard in the workplace and better serve everyone by isolating yourself and getting better.

 Practicing good hand hygiene

Oral professionals should properly wash or disinfect their hands before the patient examination, before starting any procedures, after touching the patient, and after touching any of the surrounding medical equipment.

Opting for procedures that create fewer aerosols, if possible

The aerosols and spatter created in many dental procedures can stay airborne for long periods, thereby creating a risk for the transmission of infection via the respiratory passages. Certain procedures, such as those that use ultrasonic scalers, air polishing, air abrasion, and air-water syringes, create more aerosols than others. During a pandemic or outbreak, it is wise to opt for methods that will create fewer airborne droplets.

Implementing preoperational mouth rinses before dental procedures

Preoperational antimicrobial mouth rinse may reduce the number of oral microbes present in the patient’s mouth. In procedures known to create more aerosols, a mouth rinse can limit exposure to pathogens.

Utilizing rubber dams

A rubber dam is a thin, six-inch, square sheet of latex used to isolate one or more teeth from the rest of the mouth during dental procedures. This isolation can reduce the likelihood of spreading bacteria and saliva from the patient’s mouth.

Disinfecting with strict safety measures

Regular cleaning of your office is always important and should follow the directions present on the cleaning and disinfectant supplies. When applicable, implement extra measures such as air cleaning systems to reduce the size of any bio aerosols that might be present in the air.

Reviewing the proper use of PPE

As stated earlier, PPE is the final defense, but it only works if used properly. Worn whenever there is potential for contact with spray or spatter, there must also be strict adherence to the guidelines for putting on, taking off, and disposing of the materials.

Preventative care is the best approach

Many may tell you that their protocols are good enough because no one has gotten sick. However, that attitude is not good enough. We cannot wait for someone to get sick before we decide to follow precautionary principles. Yes, it will require effort on our parts, but if COVID-19 has taught us anything, it is that that effort is vital for the continued health of our communities.

Even after all of this is over and we go back to “business as usual,” dental professionals need to re-evaluate their protocols and make sure that we are doing everything possible to protect workers and patients. Dental offices have characteristics that warrant additional infection control protocols and we must be aware of how our practices have the potential to aerosolize infectious aerosols and be a vector for disease.

Although COVID-19 may seem like a complete aberration, there have been other viruses throughout history that have changed the way we live. Nevertheless, we have survived and learned how to protect ourselves better.

Foreigner Family-of-four survive Bali lockdowns with a Story

To reduce the stress and tension for COVID-19, here we tell you the story about the British Family who survive beautifully during the lockdown phase.

A British family-of-four are isolating in an idyllic bamboo hut in Bali after fleeing the UK amid the coronavirus crisis. Corinne Pruden, 39, and her husband Dave, 49, bought a one-way ticket for them and their twin toddler sons on March 16, flying out that afternoon – eight days before the UK imposed its lockdown. The couple had been living in Budapest for the last five years, where they ran a cafe, but had let their apartment to go backpacking around South America for six months before the virus hit. They were staying with their family in the UK for a few days to say their goodbyes when the US imposed its foreign travel ban – meaning their flights were cancelled.

Speaking to the local news, Dave said they’d planned to go on an ‘adventure’ and felt they were ‘dressed up with nowhere to go’ – so decided to make last minute alternative arrangements and flew to Denpasar. ‘Our flights were cancelled, our cafe The Goat Herder was closed, and we were facing a lockdown, and we thought, we’ve got an adventure planned, we’ve told the boys, we’ve got to do something, we can’t just let this thing beat us, so we booked a ticket that day and flew to Bali later on that afternoon,’ he said.

Corinne added that staying in the UK long term with their parents ‘wasn’t feasible’, and finding a place to rent in Europe would have been expensive – so they decided on Indonesia. ‘Bali was that option that, minus the healthcare – that was a huge concern – but it gave us the opportunity to stay somewhere for a relatively cheap price, surround the boys with nature, isolate ourselves relatively and just make sure that we stayed as far away from society as possible to give ourselves the chance to survive this thing,’ Corinne said, admitting that their travel insurance was void.

The family had to pack up and travel two hours from the south coast to London Heathrow, dropping off their rental car, all in a very tight timeframe. Corinne said it was a ‘really strange feeling’ because they family were doing the opposite of what everyone else was doing, with Brits returning home from all over the world. ‘We felt sort of courageous but perhaps being a little bit stupid or naive – it was quite hard to pigeonhole our actions and emotions and it was quite stressful,’ Corinne admitted. Writing on Instagram, she said: ‘As we took off from London, and arrived in Brunei for our transfer, we sat for six hours watching flight after flight being cancelled. Finally, an empty plane arrived and no more than 20 people, including us, boarded for Denpasar.  ‘Arriving in Bali was such a relief. It had been a stressful decision. We managed to get in with an extendable visa on arrival. Within two days, the visa scheme was cancelled for new arrivals.’

She told how they were offered a ‘really, really good’ price for an Airbnb in Ubud, which is located in the middle of rice fields and means they’re ‘totally isolated’.  Writing on Instagram, Corrine said: ‘There’s very little good news at the moment, so when we were offered to rent this beautiful bamboo house in the middle of rice fields for a fraction of the usual cost, we said yes! Through a small twist of fate, we’ve found ourselves in paradise.’ They had previously been staying near Denpasar, but found it too busy, before moving to Amed on the northeast coast of Bali.  The Prudens travelled to Ubud when the village chief of Amed imposed a total three-day lockdown preventing anyone from leaving their homes. Corinne said their bamboo home is perfect, adding that they’ve bought an inflatable swimming pool for the garden and receive fruit and vegetable deliveries from a Michelin star restaurant. The family spend their days walking among the rice fields, playing in the streams and immersing themselves in nature.

On a recent Instagram post, Corinne said: ‘Although the island is quiet, with next to no tourists, it still seems relaxed. Many of the shops, restaurants and cafés have closed.  ‘But sitting in our open-air house watching rice farmers go about their everyday activities is incredibly soothing. Every evening we are joined by frogs, lizards and even a resident bat.

The boys are more part of nature than we ever thought possible. And we have miles of farmers’ tracks, forest and rice fields to explore!’ Corinne said they have explained to their sons, who have been asking what is happening, that lots of people are getting ill, so they have to be careful what they touch. She said they feel lucky to be removed from the news of the coronavirus, but receive updates from their family. ‘If we didn’t talk to our family and we didn’t watch the news, we really wouldn’t be aware of anything happening here because we’re so isolated with this house,’ Corinne told Sky News.  ‘Whenever we get in contact with the real world, we see it’s pretty scary.’

What a beautiful story when we think of the situation right now. We hope that you have the same experience journey when you are in Bali during the lockdown time. Meanwhile you are in Bali please pay attention to the regulation that we have here, especially about your visa and your health. Contact your embassy whenever it is needed to get the first rescue during the pandemic. Now we will give you some advice when you are stay in Bali to do the prevention during the outbreak.

Wash your hands frequently with soap. This may seem obvious, but it’s about time we all started washing our hands properly. That means thoroughly lathering the backs of your hands, in-between your fingers, and under your nails. Scrub for at least 20 seconds and then dry your hands with a clean towel. Use a hand sanitizer if you can’t wash your hands immediately. Avoid crowded places and contact with people who are unwell.

Down with a fever, cough or the flu? Wear a mask and seek medical attention right away. If you haven’t been able to get your hands on a mask, cover your mouth with tissue paper whenever you cough or sneeze, and dispose of the tissue in a rubbish bin immediately.

Boost your immunity. A good one to practice not only during an outbreak but in everyday life too: boost your health and look after your immune system. Slurp on juices and coconuts (or even try one of Bali’s best juice cleanses), clock in enough exercise with an online class from one of Bali’s best gyms or yoga studios, and treat yourself to some stress-melting pampering with an at-home massage from one of Bali’s best spas. Top tip: try Indonesia’s age-old elixir of Jamu – a potent mixture of turmeric, tamarind, and sometimes ginger, lime and honey too. It’s an immunity-boosting traditional medicine that Indonesians swear by.

If you booked your Bali holiday before the Coronavirus outbreak, chances are, your insurance is still valid. For everyone else, you will need to confirm with your provider to determine whether any COVID-related issues will be covered – that includes medical treatment, flight cancellations, and even accommodation allowances if you happen to be held up anywhere. Luckily, many airlines and hotels are waiving cancellation fees and honoring refunds. Last but not least Listen to WHO & CDC. With so much misinformation and media hype out there, it’s important to listen to reputable sources. For all accurate updates, travel advice and support, check out WHO Indonesia and the Official CDC website.