Hole in the ground.

community health survey started in sabak bernam today. amidst the beautiful paddy fields that stretched from end to end and nvrending-ness, were village folks that lived a simple semi urban to rural life.

in one of the houses my group surveyed, there was a lady with 9 children. left by her husband (for another wife) and surviving on a meager RM500 a month from gov social service.

RM500 divided by 10 ppl = RM50

divide that by 30 days in a month.

that leaves every individual in that household with less than RM2 a DAY to survive on.

:S

when we asked about her diet, we found out her family only eats chicken / fish ONCE a MONTH.

fruits and vegetables: also ONCE a MONTH if they have extra money.

*dumbfounded*

i look into my own lifestyle and find that i have taken everything in my life for granted.

the way i manage my finances and the ppl who love me.

Transitioning

how good are you in dealing with transitions?

transition here refers to any situation whr u're out of ur comfort zone / am in a new place / far from ur very close friends for a period of time for say, more than 2 weeks.

some face transitions with excitement, zeal, enthusiasm.

some fall into a temporary state of depression / emo-ness before picking themselves up on their feet once again and looking forward to potential opportunities.

as u journey towards the new unfamiliar setting, the adrenaline builds up and u feel urself pulsating, heart beating hard and fast.

the series of events that follow now depend on how well u can identify with the place / people. how much you were made to feel at home / how occupied you are / how exhilarating the events in that new place are.

if u're undergoing a transition, all the best! :) i am too. just a v small one lol. its day 1 in tanjung karang, my public health posting. a pretty far from urban area 1.5 hours from cheras. i miss the hospital and the house mates chatter and the cicak screaming / cicak acting ppl already. haha. bt am looking fwd to a taste of public health and the awesomely cheap seafood ard here as well.

we're going to satay hut tonight! now that must ring a really loud bell in some of you. :P

Not Your Average Superhero

You've come across articles of Everyday Superheroes in the Reader's Digest:

- not so ordinary ppl who have saved a person's life, ppl who devoted themselves to the community serving others, ppl who touched lives in one way or another. the community is blessed with more warmth and care with these ppl.

i found superheroes in the heart of somewhr in btwn Cheras and Kajang today. at a shelter home for pregnant teenagers.

ever wondered how it's like to make a mistake as a teenager, something irreversible and comes with societal taunt and emotional trauma. to suddenly one day realize your urine pregnancy test tested positive. u're 15 years old, madly in love with raging hormones, i blame the current societal scene for the lack of exposure of teens to contraception. ur world feels like its being torn apart. u feel lost, u don't know what to do, you're paralyzed with fear.

http://search.independent.co.uk/topic/teenage-pregnancy

or u feel that no one understands you, your family neglects you, you decide to run away from home with your boyfriend. 1 week later, u find out it is the biggest mistake of ur life when you were forced into prostitution with no means of escape. ur body, mind and soul is tormented by the sexual abuse u're made to live through every single day. when you tried to protect urself, u were beaten and tortured. u can only cry urself to sleep each day as a means to comfort and express urself.

u were just, a teenager, who made that mistake bcz at that moment, adrenaline and sex hormones overpowered your capacity for rational judgement.

now how would you survive that ordeal?

someway, somehow, these teens have to move on in life, pick themselves up, put the past behind them and have a future plan for themselves. bcz their life doesnt end thr. there's still at least 75% more of life to go.

if u're lucky, u have a shelter home whr you receive protection and rehabilitation. you have a support group consisting of other teens like you who understand what you're going thru. you have a family that supports you, counselors to give u advice, ppl to guide u in picking up the pieces of ur life and start anew.

but even with that so called 'luck', it takes great courage to forget the past and move on. esp if you were betrayed and forced into prostitution. will you be able to start trusting ppl again? you are fragile. another storm can easily shake you and tear your foundation apart.

we have not even considered those teens who did not step forward to seek support. they went thru the whole ordeal alone. probably surrounded by darkness and a sense of hopelessness.

i herald these teens as superheroes for being able to brush away the dirt, stand up strong and say, I can do this, because life goes on. and these teens are the ones who propagate the message of hope to the rest of teens like them.

what the society needs to do, is to stop the stigmatization, discrimination, embrace these teens with open arms and tell them its alright we know you made a mistake and give them the emotional support they need. what ppl are doing to shun pregnant teens is doing absolutely Nothing to help the situation. i respect religious and cultural point of views (i am in no way promoting teen pregnancy) but hey we need to solve the problem that's in front of us now: pregnant teens exist in the country and we need to help them.

focus efforts on rehabilitation and protection.

if u want to reduce teen pregnancy, 1. promote abstinence. 2. increase education on contraceptive methods.

our country actively does no. 1.

No. 2 is swept under the carpet bcz ppl are afraid that it will promote sexual intercourse.

but sexual intercourse is happening among teens bcz raging hormones are beyond the control of the government or society for that matter.

start spreading the word on contraception!

http://www.healthofchildren.com/C/Contraception.html

heck i had no idea morning pills are safe for consumption until i entered medical sch. i used to think it was toxic or sth. (yes i was a pretty blur case but i'm sure i'm not the only one.) everyone laughs when u hold up a condom but there is a dying need to educate ppl on putting them on the correct way.

if we want to create a change in society, we need to change our mindsets 1st. then only start claiming that we want to sincerely help these teenagers.

Life isnt easy as a teen. we all know.

When to Hit the Panic Button

i always admire ppl who handle stress reli well.

those ppl who when challenges come, they think of a solution on the spot, have plan A, B and C, and they just carry it out and sit back and wait to see what happens. The outcome, whether good or bad, they seize it as an opportunity, think of another solution, and have more Plan As, Bs and Cs.

and in that process, no worries, no getting agitated, no binging lol, maybe just bouts of adrenaline rushes that comes but goes.

heck i wish i were like that!

but i guess thru time, my stress-in-crisis level has declined from the 1st time i set foot in university while i take up some responsibilities here and there, was forced into stressful situations and learned to handle them. i used to be reli uptight about punctuality, meeting deadlines, ppl being responsible, but no thankfully i'm not such a perfectionist for details. i get reli stressed up when things dont work out the way i expect them to.

but i learnt that nobody's perfect, anything that possibly can happen can happen, sometimes things u thought impossible can also happen, and i myself aint perfect. so sometimes ppl also have to put up with my imperfections.

so i need to give leeway for mistakes, expect ppl not to be punctual for the time set but still on time for the real time lol, set very early deadlines for ppl to not meet that deadline but still adhere to the real deadline, and allow the possibles to surprise me and challenge my ability to think fast and act quickly.

i still get reli stressed and panic in as-defined-by-me-crisis situations.

but i thank God for ppl i work with who are not like me haha. i learn from them to remain calm, take things easy and hope for the best. save the panicking for when things REAlly dont work out and there are no possible Plan As, Bs, Cs. :P

well thr isnt anything impossible with prayer. God I want to not panic. :P

on a 2nd thought, does panic bring u away from danger? is there a mild sort of panic thats enough to scare u to do sth but u stil maintain enough calmness to think properly and execute. is that considered panic? Maybe its called Super Acute Panic. or Subclinical acute Panic. ok i need to stop ranting.

Volcano pls don't erupt anymore. i wana go to Bali.

too much. or not.

why do i always end up doing multiple co-curricular activities during my study and exam week. the trend hasnt stopped. i wonder when it will. then again i've learnt lots from doing things this way. but at some point u tend to feel agitated and u just want to rant it out loud, take a breather and go back to doing it again.

Aaaaaaaaaaaaarrrrrrrrrrrrrrrrrggggggggggggggggghhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhhh!

there. done. sigh... study.

Thank God for good cooling weather today. :)

Before the 1st half ends.

it's the last day of O&G posting today. and i cant believe that wow time flew and i've gone through 2 postings already.

as i look back, i truly thank God for blessing me with smooth sailing postings and granting me what was the best to mold me / shape me in my education in the beginning of this clinical year.

i thank God for

1. having surgery as my 1st posting.

it was a stepping stone, a cushion where i could take time to adjust myself to clinical year lifestyle and schedules. although it was only in week 4 that i sort of started to get the hang of it, i had 4 more weeks to catch up on things.

balancing between the 101 different advice from seniors and friends, in the midst of confusion between 'u should stay in ur room the first few weeks and study 1st b4 going to the wards' and 'u should go to the wards everyday and learn from the patients. they are ur books.' and 'just clerk one case a day then go back study' etc.. it was pretty confusing trying to balance out between everything. whn in surgery u have clinics, wards, OT, teaching. u can do anything u want, anytime, at ur own expense.

clinical years throws u an 8 week syllabus at the beginning of ur posting, and its up to you how u wana finish studying / mastering all the 'must knows' etc by the end of it. gone are the days of scheduled day to day classes and lectures and syllabus. it's totally flexible and entirely up to you how you wana study.

you get reli lost in the beginning bcz u're overwhelmed by the 8 week workload thats thrown to you in the beginning. but as time passes and u slowly cover the syllabus bit by bit, the pressure wears off.

surgery posting was a platform for me to build up my confidence.

i thank God for

2. very nice supervisors.

Ms. Farrah and Mr. Azlan both gave teachings once a week throughout the posting, and were very approachable and friendly. it spared me brain cells needed to overcome intimidation and gave me more confidence.

3. O&G posting

being my 2nd posting gave me a 1 week's holiday in the middle of the posting. whr i could use the holidays to be oncall and finish up the deliveries i needed to conduct. phew no more oncalls after hari raya hols.

4. a great supervisor

whom i feared from week 1 and actually still to a certain extent until now but lesser hehe. Dr. Rahana was strict and i was really fearful of uttering silly things or asking silly questions or presenting horribly in front of her. and the fear made me study and study and study and gave me insomnia and drove me to maximum will to study even when my eyes wanted to shut themselves after 7pm at night. i would force my eyes to stay open and my brain to accept information and retire to bed thinking what i have not covered. n jump out of bed at 6am before my alarm even rang to run to ward to cover beds everyday for her ward rounds.

the fear was good. it pushed me to work hard.

waking up at 6am was good. it gives me an early head off start of the day.

ward rounds everyday was good. i had more chances to present cases and brush up my presentation skills.

4. for manageable cases to present.

case presentation was a bit rough here and there but still alright.

there was a time that the patient in the bed i was not covering , but i covered for fun bcz i was looking for a Placenta Previa case to present, suddenly appeared in the bed i was suppose to cover the next morning. so i didnt have to prepare anything much that morning, and just had a brief look at her updates. wow talk about miracles.

5. for my short case

under Prof Hatta. who was nice and very pleasant and helpful and that took away my nervousness.

6. for great groupmates.

both in surgery and O&G. i enjoyed the teamwork and in sharing the anxiety and fun together. i am grateful for the opportunity to get to noe my coursemates a lot better by being in the same group as them in these postings.

7. how could i forget? for finally understanding a childbirth's / labour pain.

i salute all mothers in this world. just looking at how much they suffer, the face of agony and nearly giving up when having contraction pain for 8 hours before delivering the baby is enough to make any teenager abstain from premarital sex. i tink? lol. the but yeah, it looks reli reli painful...! gosh, thank you mum..!

8. very helpful 5th year seniors

who are reli very competent and i reli look up to them. the way they carry themselves, the knowledge they have and the time that they're willing to spend to give out pointers and teach lost juniors.

9. very helpful coursemates

from the same posting who have helped me so much in sharing knowledge, opportunities, going through it together. for close friends in a different posting who gave me so much advice in going through the posting they have been through. wouldnt have made it without them.

thank God for bringing me through the first part of yr 3.

it's study week now and exams are in 1 week's time.

happy studying everyone! :)

after exams:

Bali trip! EAMSC paper! then Tanjung Karang..!

confidential?

i walked out of clinic day today feeling slightly bewildered over an uneasy patient encounter.

Miss A was a single 22 year old lady living with her parents. She has pseudocyosis (false pregnancy) and hepatomegaly (liver and spleen enlargement). She has an abdominal mass that has been increasing in size leading her to believe that she was pregnant. it was reli an incident of lots of coincidences bcz when she started missing her period, she was tested positive on the urine pregnancy test, scanned positive for pregnancy and had morning sickness of vomiting. and her abdomen has been increasing in size. and it was js not long after she had sexual intercourse. weirdly, she's been having intermittent pain n distension over the umbilical region over the past 2 years. the fact that she suspects herself to be pregnant and all the supporting facts were unknown to her parents and all the while they thought she was just suffering from the abdominal pain due to a complication from an appendisectomy 2 years ago.

she was accompanied by her mother to the clinic.

upon being interviewed by me in front of her mum before seeing the doctor, she did not disclose any facts about her suspecting herself to be pregnant. later her mum left us and twds the end of the clerking, i asked her the routine gynae question on whether she has had intercourse before. she replied yes. n i proceeded with routine ques of dyspareunia-pain/post coital bleed. and the history on her being positive on urine pregnancy test, the scan etc spilled out. n she told me her parents were unaware of all these. upon viewing the emergency unit admission clerking sheet i also thought it was reli weird for her to have a dating scan and positive urine pregnancy test and all that and proceed to enquire further about it.

i was wondering how i would present her history to the doctor in front of both her and her mum in the clinic later when it was her right to have all these information remaining confidential betwn doctor n patient.

in the end bcz her history was weird with the false postivie UPT and wrong scan done at GP and all that and the false pregnancy, i didnt get to present my case, but the doctor proceed to obtain history on her own. there was information on the false pregnancy blah on the admission clerking sheet at the emergency unit.

in the end obviously the mother found out she had intercourse before marriage, and her antenatal visits to the GP and all that.

even though she's 22 and working but it can be observed that she stil pretty much depends on her parents and are under their shadow. erm.

subsequent conversation proceed with the doctor discussing the case with the mother with occassional/very hardly references to the daughter. i was feeling very very uneasy at that point and wondering what was going to happen to the poor girl when they left the clinic.

i guess it was not going to be possible to keep the information from the mother as she had accompanied her daughter to the clinic. it was also probably safer for the mother to find out as she can advise her daughter about precautions drg intercourse etc. and the mother has the right to find out all these as her sole guardian.

but patient's confidentiality is also at question. the patient has the right to disclose all the above information to her mother herself instead of her mother finding out about it through the doctor. the patient has the right to have 1st hand discussion with the doctor instead of being just an occassional reference like a 3rd party. she has the right to obtain information on the risks of unprotected intercourse from the doctor without family intervention.

perhaps i'm not in the position to comment on this situation. sometime doctors cannot protect a patient's confidentiality if the patient themselves have brought their family members along with them to the check up. n in the clinic u have like 4 medical students tagging a doctor in a clinic, listening to every patient's details and management.

just felt reli bad for the girl. she was treated like a child and she was reli uneasy when being questioned about having SI and her reason for suspecting pregnancy. SI before marriage doesnt make u a criminal, but in Msian society you can get stigmatised quite badly and even be shunned by ur family. :(

Do we have enough safeguards to protect a patient's confidentiality? it's a two way thing i guess. it's the responsibility not of just the doctor but the patient herself. :S

on a brighter note, palpating an abdomen with polyhydramnios (excessive amniotic fluid) today has made my day. :) postive fluid thrill! blubb.