Mostly Unseen, Not Unknown

I went, I saw and I experienced. No i did not conquer :P

In the past if you had talked to me about the Orang Asli tribe, my knowledge about their origin, distribution, socioeconomic background and current status would be limited to the few malnourished children I saw in Hospital Teluk Intan during my medical school years. I knew they were not well off, but that was all.

Venturing into their houses and talking to them while they tell me about their ailments gave me a better idea. In many ways their conditions resemble some of the bumiputera people in the deep rural parts of Sarawak that I meet in Hospital Sibu.

I had expected to meet mostly aches and pains. Hence the load of painkillers I brought with me.
However, to my surprise, there were quite a number of poorly controlled or undiagnosed non communicable diseases among them as well!

So here you go, on my take of my past four days in Kahang, Bentong, Pulau Ketam and Carey Island. :P

1. The hypertensive folks
first reading: 170/100. confirmed by a near second reading. no anxiety, claims Pak. No symptoms. Pak cik slalu makan ikan masin/telur masin? Taakk.... jarang jarang... OR Ye... kalau tak, nak makan ape? (and there u go, unable to ask them to cut down on salted food bcz poverty is a limiting factor for them to eat healthy). however, one cannot let BP this high go uncontrolled. Referral letter to the PK it is. I could advise lifestyle change, advise him to get to the nearest PK in a week with the letter, but I could not take over a PK's ability to supply him with 3 months of anti HPT and monitor kidney function and complications. Nearest PK being 30mins/1 hour away on a borrowed motor vehicle for him.

the second type of HPT would be those who are known cases, diagnosed few yrs back, but defaulted treatment due to lack of awareness and logistics. Met a number of BP 200-220/120-140. Gave them Nifedipine and begged their kids or neighbours to shoot them to the nearest PK for proper Management.

Little did they know that the imminent risk of stroke, heart attack and kidney failure lurk at their door. Knock, knock who's there.

2. The long standing infection
Whether diagnosed or undiagnosed, they pose a huge threat to immediate contacts.
There were several highly suspicious of Pulmonary Tuberculosis (TB). Chronic cough for months that get relieved short term by Benadryl from PKs or OTC without TB workup. One fella had matted cervical lymph nodes, was cachexic and had even developed gastrointestinal symptoms.

The Hygiene Issue
Bcz of lack of proper tap water supply, they drink rain water, worst case being river water. The River, number one culprit in seeding potential deadly diseases among the folks. The rivers run through the oil palm plantation and reaches their homes, where water is used for any purpose you can possibly think of.
Now imagine a baby drinking river water. NoooOoooOoooooo

Scabies, Fungal infections, Infected wounds were common.

3. The Malnourished
There was a whole bunch of children on Carey Island and Pulau Ketam all below the 5th centile for height and weight to age. They were so tiny. They were no doubt the most adorable bunch of children i came across, huge starry eyes, toothy grin (they need serious dental intervention), frizzy hair. but their state of nourishment breaks your heart.
Referral for Food Basket!!!

3, The Unknown or Lesser Seen
Now among the few hundred we saw, one or two cases stood out.
One was what we thought was a cystic hygroma.
Another was a little girl with skin lesion that looked like warts.
Another was a 15 year old boy weighing 29kg and 130cm tall. (this one was less of a mystery but still warranted investigation)

My general thoughts and take backs?

- IT IS NOT EASY to be a General Practitioner. These guys are most important first liners in seeing patients and referring them to the upstream line when indicated.
Walao... Day 3 into the project and I was exhausted. Mentally, physically, emotionally. PK (polyclinics) need more support then you know.
And maybe I need to exercise to build up my stamina. hehe.

- There is still a lot of ground work required for the marginalised in society.
Look at you and me. Tech gadgets, proper homes, clean drinking water, hot showers, air conditioned rooms, the availability of the magic Panadol (grins) in nearby local stores to cure the headache and pains.

A villager's home (a self built hut on stilts) just got destroyed by a gust of strong wind 1 week ago, leaving him homeless. :(

Where the government refuse to provide, (or rather there is so much red tape that it takes 10 years to give someone a brick house) our compassion will have to provide.

- No one is less equal than another.
You, me, him. We all deserve education, security and love.

This trip gave us some food for thought for further improvement. In future, I think I would stock up more on antibacterial cream, anti hypertensive medication and deworming pills. :P

Who are we? We are called My3K (short for Pertubuhan Kebajikan dan Kesedaran Kesihatan Malaysia). We are an NGO pioneered by ppl in the healthcare line (pharmacists, doctors, audiologists, optometrists, dentists) in our university days with the primary goal of helping the Orang Asli ppl in unreachable areas. We are still small, starting up new and require volunteers and funds to get better equipment and medication for future projects. Equipments include dental treatment set for extraction/cleaning/patching (dont mind me for wrong term usage, i'm a doctor not a dentist hehe), eye check sets, glasses and lenses etc. We;re on facebook as www.facebook.com/ngomy3k

Let me know if u r interested to volunteer or contribute :) it will change your life.

Managed to throw in a bowl of Super Kitchen's Chilli Pan Mee before i left KL. :D owh the magical chilli flakes!

A short excerpt on the last four months of my HOship. Surgical department. I think those 4 months were filled with more drama than my entire past year of hoship could gather. hahah. There were ups and downs, but they made me stronger. No doubt I left with many lessons learnt, and many individuals that i am thankful for. :) Up next, emergency department. :P

Sealing the Cleft

One week back, I had the opportunity to assist a Plastic surgeon Mr Lim YK from Ipoh in a few surgeries including Cleft Lip repair, cleft palate repair (palatoplasty), release of burn contracture and excision of a few tumours over the facial region.

Boy was I INSPIRED.

*cue light shining down from above with heavenly background acapella

I was reduced to that little girl with huge shimmering eyes staring in awe at the face i mean work of the surgeon.

It all happened during the cleft lip repair for a little boy at the mere age of 7 months.

The child had cleft lip where there was a ~1cm gap at the philtrum.

So the surgeon skillfully made a few markings on the child's lips and the magic began. Some parts were excised to finally seal up the defect and post operatively, the baby looked just like any other baby with perfect lips!

Imagine if this child had to face the world, go to preschool, grow up, work with the cleft lip defect. Cosmetically, antagonising for the child. Society is ruthless. They treat ppl based on appearances. There will be stigmatisation, jeering and it takes a measure of will power to overcome that. Other than that it will affect the child's speech and to an extent swallowing/chewing.

So there I was thinking in awe that this surgeon practically changed the child's life. I was in cloud nine that day. Even seriously considered taking up plastic surgery that time hehe. But that is another story.

This would be what I'd say to be THE week in my current surgical posting. Beautiful works by beautiful people to recreate beautiful lives.

Planned and Wanted?

Coming to the end of my Obgyn rotation. Highly adrenaline fueled. Extremely hormonal. The estrogen progesterone and FSH imbalance. Overbearing cortisols. Results include a 4 month period of amenorrhea xD weight gain, hair loss, cold intolerance (to the freezing labour room) and eye bags that require both Meitu Xiuxiu Plus concealer to erase.

Despite that I got to say that i'm thankful for a bunch of warm bosses who actually care if we have taken our lunches. Infrequent moments during the less crazy days, but still great to be on the receiving end of kindness. Funny tho that this tiny trace of humanity's enough to amaze u. lol. what have we become. I guess i reached the point of familiarity that breeds comfort to the wards. Still have three more working days in the department (that i am praying really hard for peacefulness). Thank you Jesus for getting me thus far. phewh. 

It was back to teamwork teamwork teamwork in obgyn. there are times u feel like hugging ur colleague so tight for going the extra mile for u. there are times u tell urself its ok bcz u have been on the receiving end. whatever shit happens, u gotta js suck in any anger/frustration/hairpullingurge and keep going n do the best u can. 

Certain groups of patients or rather mothers, brought together with them a myriad of social issues. Unplanned teenage pregnancy (making it legally statutory rape?), marriage without certificates, single motherhood, unidentified mental retardation that was never brought to seek treatment since birth, the list goes on, sometimes its so absurd that u wonder if there's any hope left to educate, empower and gradually improve the people's socioeconomic status and quality of life. it's like a vicious cycle that the people are stuck in. Most of these girls live in the rural areas, get minimal basic schooling and grow up without dreams. the end point basically stops at getting a partner, getting married and having kids. they're home makers, the husband (or partner in cases where they dont register and get a legal marriage cert. honestly most ppl seem to be happy with being married the traditional way without a legal document, not realizing that they lose their rights in the event of abandonment by their partners. sad right) is the breadwinner. most doing hard labour. they dont do proper birth control (lack of awareness of the importance of birth control i suppose) and end up having one child per year. countless mothers at a mere age of 25 already having 5-6 children. someone tell me how they cope without going bonkers. it feels weird asking a 25 year old lady whether she has completed her family and would like to do BTL (tubal ligation). but its also irresponsible not to (right??). it's like u can already forsee her having 10 kids before she decides to BTL.

some liberal folks might argue that it's their right to have as many kids as they want, etc... but anyone can do the math and know that those children are going to grow up without the undivided attention and development every child deserves. most will be left to fend for themselves, get the basic formal education without guidance to dream big and achieve greater things. (i'm talking about the girls especially). and the vicious cycle continues.

we tried advising these ladies. birth control, its importance, female rights, the importance of getting a marriage certificate. social worker referral. get proper antenatal check up for ur baby. etc. to no avail. :S

so that's the ob experience in hospital sibu for u.

Celebrated my bday with lovely friends in sibu :)

the lovely girls from my cell group

alex em and ek guan

warm colleagues mostly from my first ortho posting (missing those days)

and celebrated with the family back home

Off to surgery next. Wish me luck! hee.

the Bomoh still wins

Looks like university memories never leave u. cz those were one of the best times u went through in the short 25 years lived so far. was looking through some old photos, brought a huge smile plastered onto my face.

on and off I'm being reminded that trust takes the lead in any decision ppl make. in the past 2 months of work in sibu, i've seen several, not just one, cases where patients decide to default treatment or refuse surgery bcz they opted for traditional medical treatment. Not the traditional medicine degree holder, but bomohs, massage men, kung fu master of sorts who practise in most often, the outskirts or rural areas. they live in vicinity of the folks, know them, interacted with them and have a strong relationship with them, prolly since the old great grandmother days where the practice was passed down through generations. (apologies if my sentences are incoherent/filled with grammatical error. rushing for time but kiasu wana post this up).and these cases aren't petty muscle aches that relief with analgesia / traditional meds that are pumped filled with steroids that give instantaneous and temporary relief, thus being dubbed 'magical' and making these medicine masters infamous for healing. these are cases of bone fractures with complete displacement / un-united fractures that need osteoclasis (breaking the bone, realignment to straighten it, and holding it together again in the correct alignment with plate n screws). there's a risk of bone deformity, limb shortening, malunion of bone. the patients are young (teens) who cannot make proper judgement (okla maybe they can). but they're influenced by ppl who're close to them. aunties n uncles n neighbours who have had 'similar' experiences with the medicine man in the kampung whose bone have healed nicely. obviously those were close fractures with minimal displacement that can unite on their own without much intervention other than splints.

the first few times I felt really frustrated. i was going on n on counselling the family, relatives, the patient. not to refuse surgery.

long story short, efforts were in vain. they requested to leave the hospital.

oh the frustration.

it was later on I realised it's a common practice. for folks to seek traditional healing rather than 'western' medicine. it's the element of trust we still cannot beat bcz i don't know, we lack the common touch, don't speak their lingo, don't fully understand their culture, have different skin colour (we cannot deny that there is an inherent unspoken bond that unite ppl of the same race together) etc.

all i could do was tell the patient that in the event the traditional medicine doesnt work, do not hesitate to come back.

Patient's autonomy after all. Sigh. hvg said that i don't deny that physical treatment doesn't constitute 100% of a healing process. there's still the human mental emotional factor.

Saratok Medical Mission

Post mission trip, you know that it'll be just moments when the post trip syndrome kicks in. hehe. Feeling slightly light headed and surreal at the moment. The past 2 days have been eye opening and needless to say much fun. :)

Looking not so far back, I'm extremely grateful for the opportunity to join the Msian Medical Fellowship in their mission to Kuching. We visited two villages near the town of Saratok, which is about just 3 hours away from Sibu and 40mins away from Sarikei. Somehow i feel that this wasn't just mere coincidence that i stumbled upon this opportunity when Sun asked some of us if we were interested after her f6 classmate Nicky asked her.

This experience taught me several things about the way of life of the Ibans living in longhouses not far off from the small towns in Swak. the one we visited was relatively modern, being bricked walled and having electricity. i realised tho that clean water supply wasn't readily and abundantly available. the longhouse concept was still there, with one longhouse having about 20 plus minus rooms, each housing one family and sharing a common area in front. In a team consisting of medical students and doctor, we ran a health clinic with supplies of mostly OTC drugs, did simple health talks and played games with the children. So this was what I realised in hindsight of the health check we did. Most of the villagers needed a place to share their problems, be it strictly medical problems, or plain emotional ones. They are not entirely desolated, with a hospital available 1 hour away. But fact is, simple medical supplies such as Paracetamol, vitamins and gastric meds are not within reach of your fav pharmacy store. logically, Paracetamol isn't really worth travelling on a 2 hour return trip to the nearest clinic. therefore, magic PCMs that relieve the aches and pains that seem so insignificant to us city folks is a fairly big deal to them. imagine having a splitting headache and not having any painkillers around. xS

It is quite rare to pick up serious illness among them cz those who're really ill would've gone to the hospital. they're fairly compliant to their anti hypertensive meds. but having a doctor to just follow up on them and encourage them to reassure them that they're doing fine and doing well by being medically compliant is a boost to them. things like sleeping problems that you know you can't really treat come up in the conversation. you know you can't offer definite solutions, but at least you can hear them out, ask them if they're stressed out, listen to their problems and offer a simple prayer. it's the psychological aspect that makes the bigger difference here. this is where human touch does wonders that the most intelligent robots cant.

cute children :P

I also come to appreciate the simple faith and sincerity they have, hosting us with amazing hospitality. had several endearing moments chatting with them. simply love the children who mostly have large curious eyes (oh so cute). plus the cats there are really cute and clean xP i think some of my coursemates would've catnapped them back if they saw them. also sat through an Iban service and cell group and sang Iban songs. :D hehe. and not to forget the Iban dishes we got to savour. (camera's spoilt so i shall wait for pictures from the others) one of them is pulut rice in monkey cups (periuk kera). thr's also fried ginger, pucuk ubi, bamboo catfish, bamboo chicken. several others. supercalifragilisticexpedidelicious!

ah thr u go. the rice in the monkey cups. :P

on top of that I think what made the trip most memorable is the friendship made. :) most awesome fun loving teammates in this trip. honestly missing everyone already. i'm personally encouraged spiritually by the pastors in the team and teammates who are really passionate in walking the talk. in the Iban service on sun morning, a girl approached us to say that our testimonies spoke into her situation and encouraged her to continue serving Him as she takes her next step into UPSI next month. It couldn't be more mind blowing to see how God puts everything into place to encourage His children. What more can I say. Simply blessed. :)

the team with pastor and his family and church mbrs.

note: what i'm sharing is very specific to the area i visited, it probably (or most definitely) doesn't reflect the conditions of the longhouses in other areas. Swak is afterall very diversified with widespread population.

with Pastor Henli who ferried us down in the 5 long hour journey
huge thx to Xun Jin who provided great insight and words of wisdom throughout the trip, Nicky for leading the team, also bernard for throwing in Counterpain meds into the drug collection. :P

If u're interested to know more about MMF, visit their website here

It might be the end, but it's beautiful. :)

yups. this was coming. :P the sentimental reflective writing that's gonna come out when farewell's imminent. Before I start packing my bags, I have to do some justice to the amazing 5 yrs I've had by writing all these down. :)

Results were announced in the auditorium this morning. 226 of us made it! Freshly graduated Doctors from UKM. Just feel honoured to have shared the past 5 years with an amazing bunch of people. To be honest, I can't bring myself to pack my bags, knowing that things are never going to be the same from here. New chapter, new challenges, new friends. Darn, getting emotional writing this.

The past 5 yrs have been an adventurous ride. I can say I come out of it different, if not more solidified, mature and knowledgeable. (thank goodness lol, it'd be a disaster if i didn't)

1. Crazy friends who rock my world.
2. Inspiring lecturers. some really handsome ones. grins. and a Dean who rocks the guitar! Prof Raymond.... swoons......
3. Strategic and really comfortable air-conned Hospital UKM.
4. Cell group friends and my shepherds who keep me growing in my journey as a Christian.

How can I not miss that?

There're far too many memories of this place I've called home and with the family I have here. Definitely will be one of my best days in many years to come.

I love you UKM. I love you beloved batchmates, housemates. muah muah muah xoxoxo

Breathe in, breathe out. Time to start a new chapter of life. Gonna partay, kick off my shoes, scream my lungs out and take in the wonders of the world for the next 2 months, then, put on the white coat (germ free hopefully? :P) and badge that carries the responsibility of human lives for the many decades to come. After several years, I've dare say found my purpose in life. To serve God in the marketplace in the healthcare system. Looking forward to learn more and experience greater things. Working world, here I come. Fellow Doctors, I'm coming to join you all...! aiyyyeeeee! xD i mean, wheeee! i mean, Hi :) yes I am sensible. :P

In the meantime, I gotta figure out how to pack my things back to Kuching xP go home to vote! then enjoy a trip to Krabi and Cameron with some great company, and then head back home to spend time with the family. :) Thanks mum and dad.

A Toy Snake Grabbed My Attention

Day 1 of Life in the primary clinics.

Look what I found in one of the rooms :P Ikea product!

Basically experienced the helter skelter of a clinic trying to finish 100+ cases within a morning with patients constantly coming into the room asking if their turns were coming. fooh.... talk about pressure.... (reminds me of the Spine and ophthal Clinic in hukm. tho that was 100+ per day divided among 4 Drs. In the klinik kesihatan it's 100+ per doctor)
As much as I imagined primary healthcare to be a place where patients come to u for anything, any problem, like for anything at all, where they rant out their problems, physical, psycho social issues unlimited, bcz u're the first person in line to meet them before they get filtered out to specialized fields in bigger hospitals if they require more advanced management, it is a far far cry from that.
Basically the doctor tries as fast as she can to diagnose the patient, prescribe and off u go. Next patient. Next. and the next. and the next. U get the idea. In that process, the stack of files of patients waiting in line to see the dr forms a steadily rising mount on the doctor's table.

aaaaanyhow..... lots to read lots to read @.@

Kumar and Clark came over to UKM to promote their latest edition last week. :P

Leaving behind memories from Obgyn with the lovely Dr. Nirmala and Dr. Yuli.
we didnt manage to get a picture with Prof Norzi. Quote: You'll get a photo with me After u pass the professional exams...! Dr. Ng who was there taking a snap with his students declared after she left: Ah... I know all my students will pass.. Ahh.. evilness.. >.<

Ah oops ok study study study lalalalala.....
As we were relatively early (n since we passed by a kopitiam), secretly grabbed breakfast before getting to the clinic today. :D happiness!

On a random note, these cookies are simply supercalifragilisticexpididadocious yums! sheets of honey coated almond flakes. discovered them when I was oncall and one of the nurses offered them to me. Immediately fell in love with them. am I crazy of what xP

And experienced the best of reconciliations yesterday. Felt a huge rock being lifted off my shoulders the moment I said sorry, shed tears of relief and came to good terms again with someone I had wronged. Thank you Lord :)

Wkend Rant

*stretch*
It's a beautiful Saturday morning!

Can finally wake up and do everything slowly and leisurely. Crawled out of bed, had a chat over breakfast, checked the email and read the news. Sigh of relief.. :)

The past week has been needless to say eventful, interesting, busy? By Friday noon, it suddenly hit me that it's FRIDAY FRIDAY! xD

Was a first for me to be oncall in the ward as a houseman-to-be last thurday. previous oncalls since 3rd yr just involved clerking new admissions and following the night ward round. This oncall above that involved doing oncall reviews in the clerksheet, informing the MO about any issues that crop up, taking the bloods ordered that day round the clock. It was a pretty silent night, only 1 new admission. I managed to get everything done by 12am. (super slow of me) then decided to get sleep - borrowed an empty bed in the ward to sleep on. hehe. the nurses were pretty nice. said they would wake me up if there were any new admissions.

Now to a good night's sleep.... Heck NO.. Everytime the phone in the ward rang, I thought: NEW ADmission! mentally prepared to jump out of the bed but the nurse never called so okay nvm. I was in my formal attire for the next day (didnt think I'd have time to go back) n I didnt wana get it all crumpled so I lay in bed really still like a log. lol. and bcz the ward had many newly delivered babies, they were taking turns to wail (ok i mean cry) all night. like non stop. my mind said 'baby stop crying stop crying stop crying plssss..... xS' in short, didnt sleep at all. maybe just a few winks here and there.

medical students from any other places would be thinking - nyeh.... isnt that how oncalls are like like since entering clinical years? well i guess that's true. but previously I was never involved in actively reviewing patients and being the primary person to see the patient in the ward without the HO around. just a different feeling. had a taste of how HO life will be like - on a really quiet inactive oncall. quite thankful for the experience. lol. tho i know this is a far cry from how actual HO life will be like. :P throughout the night i was just thinking - no more admissions, no more admissions, no emergencies pls.... versus the medical student's mind which goes - emergencies pls!!! xP

the next day ensued with grand ward round with the specialist/consultant. despite being prepared, knowing the case, I just couldn't help feeling nervous. it was a mixture of postcall tiredness with sympathetic reflex in anticipation of the wardround. i was tired but couldnt sleep. hungry but nauseous and couldnt eat. wanted to study but mind couldnt work. lol.

survived ward round. managed to screw 1 case presentation but the 2nd one was ok. sort of phew. had the slowest longest lunch ever in the entire week. walked to the dept for class with jelly legs. declared freedom at 6pm.

life is good. :) doctors are nice. just slightly tiring and lesser time to sit down to study proper. yup all's good. :) Saturday I love you! (was supposed to be oncall again today but someone took over. yay!)

they have Tapas, stews, grills and creamy Risotto.

A sip off the spoon in ObGyn.

What crosses your mind when you're thrown the word:

CONTRACEPTIVE PILL

Now we'd think: Preventing pregnancy!

For those who wana enjoy a sex life without worrying about the consequences of being impregnated. 

Now think about your ex classmate back in primary school who was the 5th sibling out of 8 children where brothers and sisters are on the average 1-2 years apart. 

The lady with 3 children all 1 year apart.

The 45 year old aunty who accidentally had a small cute baby when her next youngest child's already entering adolescence.
Someone you know who tried to abort her child upon finding out she's pregnant bcz she simply cannot afford to have a/another child.

Ahhhh.... family planning. :) The importance of it to 

- prevent urself from going crazy taking care of 3 toddlers at the same time while breastfeeding

- give some rest to your uterus after bearing a 2-3kg child for 9 months. 

- give yourself a break from carrying 2-3kgs with you everywhere.

- lower the risk of your baby suffering from syndromic illness due to pregnancy at an advanced age.

- prevent women from having to suffer from the physical and emotional trauma of illegal abortion (attempts). thank you Dr. Ting for the insight. i can't imagine how I could have completely missed out on this one. 

now of course ultimately it's so that your sex life doesn't come to a halt either. 

i'll just mention a few contraceptive options over here. for the benefit of single ladies, future mothers, friends who are mothers, people who love mothers, u get the point. :P 

just a disclaimer- i'm not trying to promote any1 of them or discuss the medical benefits and cons. just sharing some information i think would be useful.

The Pill - suitable only if you can commit yourself to popping a pill EVERYDAY. say if you're a really busy person, and u wana have a spacing of 3 years from ur last child, not a good option to think you're going to remember popping a pill every single day for the next 3 yrs. thr're other options for u. 

The Jab - it's 3 monthly. called Depo-Provera. however it's known to disrupt your menses and cause continuous spotting.

The Under the skin rod - Called Implanon. very convenient. it's a tiny rod like 4cm long, 1mm diameter inserted under your skin under ur arm. it works for 3 years. u can come to the clinic, get it inserted in 5 minutes, and forget about it for the next 3 years. instantly protects you from conception. but costs few hundred ringgit.

The intrauterine implant - There's one made of copper, lasts 2-3 years, about rm35. side effect, causes irregular bleeding (menses). Another one called Mirena, is sort of a plastic-ky material, works for 5 years, has an added benefit of thinning your uterus tissue lining and preventing endometrial cancer. costs about rm500+.  Intrauterine implants are also useful cz u can have them inserted in a clinic in just about 10-15 minutes and forget about it. 

The Vaginal Ring - it can be self inserted for 3 weeks and removed for 1 week every month. unsure about the price though.

of course there's the use of condoms / timing ur period. but that provides less of a guarantee. haha condom salespersons might beg to differ. but that's the general opinion. 

What's this got to do with me?

It's my duty as a future doctor who might see any woman in the clinic / hospital to counsel them about the importance of having family planning and guiding them in choosing the most suitable contraceptive method for themselves. the problem that arises esp in our country is the association of contraceptions with immoral activities. lol. not true! the ultimate goal is to see every woman in this country getting pregnant only when she can afford to and when she wants to. Quoting my Prof, women should enjoy their pregnancy. it shouldn't be a chore. our government hospitals subsidises contraceptions! it's a shame to not have them advocated to our women out there. 

Plan mothers, plan! Empower yourselves! :D

*most ppl are afraid of contraceptives because they're worried of the side effects. contrary to that, side effects are actually really minimal. benefits outweigh them. contraceptives, depending on the type you choose can lower your risk for certain cancers, fibroids, regulate your menses well, clear your acne etc. :)

Ironically, the very next day after my class/workshop on contraception, we had a lecture on Infertility. What a stark contrast! At the very end of the spectrum of women with too many children, you have the couple who's spending a fortune to have their own child. Nothing beats having a child of your own flesh and blood I suppose. (Honestly, after attaching at the labour room and watching the child delivery process, I am freaking scared to get pregnant and deliver my own child. cannot imagine myself going through all that pain!!! (and being screamed at by (well meaning i know) midwives and doctors who wana get my baby out safely)) Thank my mum deep down from the bottom of my heart for going through labour pain for me. If you're wondering what's the ultimate solution to get sexually driven teenagers to sexually abstain, get them to watch a baby delivery.
errr.... enough about sex lol. 

Upon entering the obs and gynae posting 3 weeks back, I was thinking, nyeh... healthy pregnant mothers, palpating abdomens, feeling for fetal parts, fibroids... not my cup of tea. where is the essence of o&g?? why do people love this posting? how do i empathize with healthy ppl??

i guess i got my answer. Seeing Prof Har's passion in empowering women on family planning, another lecturer's passion in helping ppl get their own child, helping parents bring another life into the world - Safely, that kinda motivates and drives a sterling passion. (still not really my cup of tea, hehe, but i guess i appreciate this section of medicine more now)

On a different side, the past week has thought me something. I saw doctors who love teaching their subordinates because they believe in creating better doctors in each individual. I saw doctors and nurses who really care and advocate great practical advice to their patients. I saw people talking down and being nasty to those under them simply because they can. I saw the uncaring shouting and yelling threateningly at patients because they were screaming in pain. (not just the typical yelling at the patient to encourage her to bear down and push the baby out kinda yelling. like totally out of this world yelling with the 'shut up or i'll kill you' glare. :S)

and I know what kind of person I want to be. and what kind I don't want to end up as. and mentally prepare me for the types of people i'm bound to meet in future in my workplace. Competency is still the best policy. that said, my inherent fear for scary evil people needs to be overcome. and creating opportunities for myself to learn. at the current time, the 'i'm just a medical student so what I say might not be entirely accurate' immunity is still there to sorta save me. but it'll only last as long as up to next april -hopefully not longer come to think of it.

In Teluk Intan this weekend. Oh how I love the laid back atmosphere over here. :) (though thr is a tingling longing to go back to kl)

 teluk intan's mee rebus from a Chinese stall. nice :)

 went for ikan pari bakar last night near the jetty. tasty. but had expected it to be better. :P 

sent my brother off at the airport last wkend. see you in a year! :) sobs :( :) 

time to complete the case write up! 

EMSians, how i wish i'm at preaching camp!

Last but not least, Dear Jie, Happy Birthday to you for yesterday! :P

The Child In Me

I'm not pregnant.

Excuse the pun :P

Being thrown into a world or rather a ward of kids lets you act like a kid. :P

it's part of the reason I enjoyed the past 7 weeks in Peads. getting in touch with your childhood memories - don't rmb many details, but i rmb they were happy days. bits and pieces i recall are playing lego, hopscotch, rubber band skipping ropes and dancing rock n roll in a kindi graduation concert. (i seriously still dunno if that was a dream or for real cz i cant remember practising for it. a life mystery that will remain unsolved) 

I forgot how smart kids were. totally underestimated the intelligence of 6 year olds. I couldnt remember being that smart last time. we went to organise a Road Safety programme for the kids in one of the kindergartens in town yesterday and the kids like got all the answers correct. maybe kids today are smarter. xD

photo by Khai Pin

It also lets you dwell into the world of parents from different backgrounds with children with different conditions. 

The working parent who has to take nearly a week off work to stay in the hospital with her child with pneumonia

The parent in the state of shock after witnessing her child fitting

The parent who's willing to share her life experience in caring for her child with cerebral palsy

The parent who took a month off her job to transfer from JB to KL, staying in the hosp for that entire month bcz her child needed a surgery here. 

The hostile parent who doesn't let you lay a finger on her child - okla not hostile. protective may be a more accurate word. hehe. 

The parent who's poverty stricken and cannot afford to feed her child --> malnutrition

The parent who's a foreigner and can't afford to pay the costly medical fees for his child's serious medical illness.

The parent with social problems that affects her parenting ability.

The parent who's child was fine for the past 11 years but one fine day became paralysed and bed bound.

The abandon child from the orphanage who's development is delayed.

The unsuspecting parent whose child came in with joint pain and is devastated by the child's diagnosis of leukemia.

Other than the medical aspect, there're different issues to be dealt with in each case to ensure the child goes home safe and well. Treating the children came together with taking care of their parents and their environment.

Makes me reflect on all the sacrifices my parents made for me in the past. and even up to now. aww thanks mum and dad! :)

Kids in the ward get loads of gifts drg the bulan Ramadan before Raya, including this Tickle Me Elmo! (borrowed it for phototaking. but honestly, was really tempted to secretly bring one back home xP)

I mentioned about being captured by children innocence on facebook yesterday after the trip to the kindergarten. Darn! Those kids are so cute! 

When you ask, who wants to volunteer to come up sing a song? 

you get, Me Me Me!!! Pick me!!!

So i wondered where all the enthusiasm and liveliness in me dissipated to over the past 23 years of my life. :P there will be no place other than the kindergarten and maybe lower primary school where you'll witness this kind of enthusiasm in humans. at least that's what i think. 

when you ask, who's got a red car at home? a black car? a white car?

They run up to you and tell you, 'I got a black and red car.' Next child,'Mine is purple and white.' 'I got a motorcycle at home.' like with eagerness and happiness when you tell them Ooooh that's great! 

*omg so cute can die* *squeee*

And you can tell them anything and they'll believe you. grins...

though of course there are tough times when irritable children refuse to let you go near them and cry the minute they see you approaching. *faints*

wana get in touch with ur childhood days? visit a kindergarten one day. :P (though I did not think I could survive working in a kindergarten more than a day. too much energy needed)

Some toy vehicles we made for the kids for a road traffic simulation. credits to Khai Pin the man behind the cars.

Dropped by for Jalan Ampang's Yong Tau Fu after an exciting but energy draining session with the kids. 

My peads posting groupmates -1 person missing- and our lecturer Dr Juriza. a very patient and super awesome Dr. i love her sense of humour.

Managed to catch Cher and Mar-jie over the weekend before going home. :)

And run home for a week during the last Raya break. great time catching up with the family and friends. :)

Meanwhile, stress levels are mounting with unfinished studying from peads and the coming ObsGyn posting. gotta remember to stop acting like a kid from now. aww man... hello to chronic adrenaline rush!!

Love Your Bones (and muscles)

looking at the whole picture, i think i finally understand why doctors fall in love with orthopedics. the mechanics of the body, fixing up fractures so that people can walk and use their hands again. it's all beautiful.

it only really caught me when mr azmi was talking about how paramedic training was a ground of focus in developed countries like the states, where policemen, firefighters know how to do cpr and know what to do in the event of some1 collapsing or in a motor vehicle accident. he told us about how he witnessed a person collapsing and within 5 minutes, a policeman arrived at the scene and performed resuscitation. 5 minutes later the ambulance arrived to give necessary support and transport the fella to the hospital. in episodes like this, every second counts in giving better outcome to the patient.
*cheers to all paramedics! booya!
this kinda superquick response to emergencies will prolly only happen here many yrs down the line?
at this point of time i am slightly confused to why the other dr.s thr werent the ones resuscitating the fella instead of the police..... ok maybe i didnt hear him correctly. lol. nvm. u get my point anws. :P

and the mechanics of how muscles work and bones growing and healing is pretty awesome. especially bone fracture healing in children. there was this child that broke the long bone of his leg (femur) and the bone was badly displaced.

3 months later it still looked pretty deformed even though the bone joined up together.

the parents wanted to sue the doctors. (i mean, yeah i understand. imagine if ur child's bone looked like this on xray. u would totally wana kill the dr.s) but knowing better from experience the doctors stood firm that the child didnt need any surgery or wadsoever invasive procedures to realign the bone.

A year later...... 

walah! it was back to normal. O.O Magic....!!

God is truly awesome.

and when mr azmi talked about the satisfaction he feels when seeing patients with horrible back pain relieved immediately after surgery, i started to get it. like, yeah... good feeling.. ok maybe i'm not really good in illustrating things but yeah nothing beats the satisfaction of seeing patients recover and having their quality of life restored. :)

bones are however still and will always be too heavy for me (all ATP drained from my body after doing 1 or a few knee examinations, legs are seriously really heavy. :S

*still hooked to WongFu productions videos
*and exam is still not over / not started

have a good weekend peeps! :)

*pictures not drawn according to scale so the thin bone in the 1st drawing didnt like become a huge monster bone after 1 year.

owh! and after experiencing how it feels like to have a cast on (i got into a fight.. :S shalisha was my back up - apparently she wasnt a very useful back up..)

kidding. the dr.s wanted us to get a feel of wearing a cast so that we'd understand what patients have2 go through. (i didnt make it through more than 2 hours and mine was only a half-cast not a full 1), i never ever ever want to get into accidents / fracture any bone in my body. wearing a cast is HORRIGIBLE VEGETABLE!!!! heavy and hot and cant bend ur joint and cant wet it cant do anything without looking like an elephant!!! and totally not outing/shopping-friendly. (okla maybe i'm exaggerating. xD but i sure hated it)

the picture was taken like 5 minutes after having the cast on when i was still happy. oh noes i posed really terribly Lala-ly here. >8( sorry.

owh ok this post is way too long already. bye bye!

Sanctuary

7 weeks in Peadiatrics posting, and i think i caught the gist of childcare and overcame the awkwardness of facing children. gist though i said, not the whole package. but a whiff that's substantial enough to bring back home from the wards. 

           

seeing children with chronic diseases makes you appreciate what you had in your childhood. and u kind of get the idea of what your parents had to go through raising u up (to ur twenties). man. *wipes sweat.

there were children w thalassaemia who had to go the hospital every month to get blood transfusion.

children who stayed in the wards for weeks for serious lung disease.

mothers taking care of their children with cerebral palsy- they grow to normal adult sizes but can't talk/walk/self care so they're wheelchair/bed bound.

parents with syndromic children.

parents with special children. seeing all these cases opens your eyes.

in the management of ill children, a huge bulk of it is in managing the parents emotionally, psychologically, socially. u got to really talk to the parents. understand their background, education level, occupation, financial limitations, how many other children they have, can they cope with bringing their child to the hospital every month, are they able to give enough attention to the sick child, do they have good family support.

i encountered a mother with 4 children with bronchial asthma: has 8 inhalers in the house. and she's got 2 make sure all her children take the inhaler puffs everyday twice a day. (i'd have gone bonkers if i had more than 5 inhalers ard my house)

a mother resigned from her job and committed herself to go to school and change diapers for her child everyday during his recess time. he has spina bifida (paralysed waist down including bladder control). other than physical needs, she's gotta deal with the child's emotional needs. bcz other than the paralysis, his IQ is normal. he's like any other children, who have peer pressure, the fear of being an outcast, self esteem issues etc. imagine urself to be the only person in the school wheelchair bound, and ur mother comes to change ur diapers for u everyday. it can be humiliating for him. and its not easy for the mother. but she's his motivator and stronghold. bcz she knows the moment she gives up, he gives up on himself. she's 1 strong woman. *salute

i imagine how mothers/fathers in the hospital feel when they see other babies around them growing and developing normally, talking, crawling while their 1 year old child looks different, doesnt talk, doesnt respond to them bcz she's syndromic. of course they love their child. but its not easy.

the emotional and psychological aspects are strong hard huge parts. and dr.s need to know how to handle and address them. it's all pretty overwhelming. i am moved whenever i see mothers taking care of their child with cerebral palsy. at least when we see how much the mother cares for the child, we know the child is in good hands.

the other side in peads: 

            

newborns. cutesie adorable newborns. they suckle at reflex when u put anything into their mouth. teehee. 

the art of coaxing babies? maybe just 60% there atm. kids love squeaky balls. babies love rattles. but if any1 starts crying, quickly give them back to their parents and runnn! unless u're in an exam. then u're trapped. xP 

having a short case next wk. keeping fingers crossed for a happy wont-cry baby. 

end of posting

Had my last class in Psychiatry today. Had a pleasant surprise :D

Got an adorable funny bunny bookmark from Dr Hazli for answering a question non-really-but-close-to-correctly. XD

For some weird reason I felt inclined to say Meow when looking at its adorable face.

For another weird reason the bunny doesn't have a tail.

?

Had an interesting 8 weeks in Psychiatry with Prof Hamid. All psychiatrists are super nice, patient, pleasant and did i mention, nice? grins.

It's the end of posting! Heading back to Kuching on sunday night. for a week.

After that Hello Ear Nose Throat, Eyes, Anesthetics! :D

The Unspoken

Language. By far the most essential tool for communication, to express thoughts, get what you need, get what you want, spread love, care, peace , provoke, poke fun, create parodies, in short, sth we cant do without.

the main ingredient needed in that recipe of communication is:

Being able to understand each other.

Not the deep understanding of feelings and all, but basically just simply understanding what the other person is saying.

In other words, i just had a language barrier crisis this morning.

Felt extremely helpless talking (if you call that talking) to an elderly Chinese lady who could only speak Cantonese (the full blown fluent Cantonese). she could understand a bit of Mandarin thank goodness. She was in the psychiatric ward on a wheelchair and i wanted to talk to her to ask her how she was doing, what brought her there, if she was ok. and basically to just be an ear for her in case she was lonely.

the outcome:

i solemnly vow to BUCK UP MY FREAKING CANTONESE AND HOKKIEN!!

poor aunty was lamenting her concerns and worries (i think) and all i could do was to nod my head, smile, show concerned and emphatic looks and make agreeing sounds (Mmm) and ask her about herself in mandarin in when i thought were the appropriate times.

ARGH! i could just slap myself for not actively learning up those dialects in my whole previous clinical year.

it's still not too late i guess.

Plans:

1. Force my friends to speak cantonese to me.

2. Download important cantonese and hokkien phrases from the net.

Anymore ideas? :P

Overcoming Addiction

i didn't mean for this blog to be filled with so much healthcare related stuff, but it seems like most of my inspirations / ideas to write come from there. pardon me. :)

i had an attachment at the Methadone Clinic this morning. it's a clinic where people with problems in drug addiction voluntarily come and seek treatment. They are assessed by a doctor and prescribed with Methadone, which is a drug that is chemically similar to Opioids (eg. Heroin, Morphine) but harmless. (relatively) it helps them combat the withdrawal symptoms of not taking say Heroin anymore and slowly wean off the addiction.

now when u think 'Drug Addicts' what comes to ur mind would be (well for most of us at least) shabby unkempt looking immoral hopeless criminals who in no way should be associated to us. in a less harsh way, it's pretty hard to be compassionate for this group of ppl.

do they deserve to be shunned by society?

can they control their addiction if they had immense will power?

who asked them to start taking drugs in the 1st place anw? it's their problem. is it?

Drug addicts caught by the police used to be thrown into cells and left 'cold turkey'. meaning, left to suffer the effects of drug withdrawal such as bodily pain, feeling as if a thousand needles were poking through ur body, u can roll around in agony take off all ur clothes and u would still feel that intense burning pricking pain that wont go away for all mercy. there would be secretions flowing out from ur nose and ur eyes tear non stop. u feel like u have no ounce of energy left in ur body to move. in more severe cases, they start vomiting and have diarrhea and start shaking.

I used to picture all these in fear, feeling slightly sorry for them but not really feeling much empathy.

There is another perspective to this.

Drug addiction is a disease. An illness, that requires treatment. Just as how ppl brought obesity to themselves by overeating and lacking exercise, or bringing lung cancer onto themselves by smoking cigarettes out of their fingers, drug addicts were thrown into this desperate abysmal, unable to climb out due to a wrong step in their past. perhaps due to immaturity / curiosity / lack of moral judgement / multifactorial stress etc.

In other words, leaving people with drug addiction problems to die with this problem / refusing to help them is inhumane.

To expect them to completely put a halt to this drug abuse would be like asking yourself not to sleep for 3 days. ok poor illustration. lol. but u get what i mean. the drugs affect a person's mental condition. and unfortunately ur mind is what controls ur body. so when ur mind goes haywire, so does ur body and its a whole vicious cycle.

The Methadone replacement therapy helps them to overcome the addiction. But not entirely so they still have to have self discipline and want to help themselves overcome it in order for it to work. The dose is slowly tapered off, however, it takes years for a person to completely overcome the addiction. They visit the clinic daily for a dose of methadone, a pink liquid that they gulp down in front of the pharmacist. those who're more stable are allowed to take home let's say 2 or 3 days of supply.

now this was a new aspect of humanity to me. i always thought of methadone clinics being a programme. not so afterall. it's a treatment. there's a difference if u get what i mean.

the downside though is that Methadone only helps Opioid addiction. for other drugs like Amphetamine, Benzodiazepine, Cocaine, Cannabis etc, there isnt yet a solution. in future perhaps hopefully. :)

it's a social phenomenon. we dont want it but it exists. and its rampant. prevention and cure needs to come hand in hand. and the best way to treat it is in a humane way.