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

Hi there 2015

Hello 2015!
Still sounds a bit of an alien to the ears. But the coming year is no doubt going to be an interesting one. It's the year of another transition into trainee to registered Dr. :P

Its been a year plus settling in Sibu, found my comfort zone, built up great friendship, support and in my 4th posting of hoship now. Sibu is a great place. :) Great foochow food (cant doubt the foochow blood running in my veins anymore hehe). Seriously loads of good food here. Nothing beats mum's cooking thats for sure, but the hawker food here is great. It's not easy to stay slim in HOship anymore now. haha.

Malas to look retrospectively into 2014, so a retrospect of the past few weeks shall suffice. grins.
Awesome days catching The Hobbit (yes i am a die hard fan), Night at the museum (laughed my head off), Penguins (love the randomness). ok penguins was a bit more far back. hehe. any more upcoming good blockbusters?? (i should stop spending and start saving groans)

Had a awesome trip to Tioman this year with the debaters. And joined a camp with some orang asli folks in Selangor. was truly an eye opening experience.

I guess this year was a year of independence, getting accustomed and maturing as a working adult, financial control?? haha, and being awed by God's work in my life time and again.

Truly grateful for the awesome friends and colleagues I have met over the year. And grateful to the friends who still keep in touch, unwavered by distance separation.

Looking forward to greater things in the coming year.

Let's see if I get to
- Join the Miri jazz festival
- Hop on a trip to Melbourne
- Sit for an exam
- Catch the next Mission Impossible (or rather, any movie with Tom Cruise in it)
- Watch another Ben Stiller movie
- Catch any musical in KL or Spore

hmm that's all of the fun things i can think of atm.

Happy 2015 :)

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.

holiday rant

Ended my stint in Internal Medicine and heading on to obgyn tomorrow. how do i feel about it? Mixed feelings. there is the
- fear in anticipation of another new environment, new colleagues, new bosses new protocols
- excitement of re experiencing obgyn on another level
- missing the oddly comforting but familiar medical wards
couldn't help waking up today with a small amount of stress. the holiday withdrawal syndrome... >8/
cant help feeling dreary. is that a word? ahaha. dreadful + weary = dreary? not so dreadful. it's good to be home. i'm not weary. life just feels so mundane sometimes. like running on an endless track. you successfully reach one checkpoint, then u work towards reaching another. n it goes on. halfway in between you give urself a break, throw in a holiday or two to break the routine. on and off you go for something good for the boost. then u're back running on the track again. i don't dislike my routine, still ok with it i guess..
a few friends and i, we were just thinking about our job description. to be honest, I spend more time running up and down, filling forms, taking bloods and samples, calling up different parties etc than thinking or making decisions. i only think maybe 10-15% of the time i'm working. dont judge me. it's the nature of my current job. blame it on the lack of manpower or resources or the system. i dont know. ideally a training should probably equip me with skills on how to make better and safe decisions instead of train my stamina to join a marathon (and lose weight without trying too hard). of course there's always the 'if you take the extra initiative to learn, ask questions, study, research, challenge decisions (to an acceptable asian working culture extent)' out of ur current job description, you can always learn. there's the mentality that only smart/good/passionate/goldmedallist/distinction attaining people go to extra lengths to do that. but seriously, after a physically exhausting day's work, it takes super willpower to sit down n self study. and that's talking about self study. not about a mentoring system. now then people would put down a point that teaching or mentoring can only be done in teaching hospitals at an ideal capacity. in a non teaching hospital, superiors still pass on skills and knowledge through their decision making. true. but if you cut off the time spent running to the labs/tracing results by foot or via call/tracing old notes/tracing old films/tracing clinic cards/taking bloods (ok taking blood is a procedure afterall so its fine to take bloods)/running samples at the ABG machine (that works), you would have more time on ur hands to better communicate with patients, educate them proper about their illness, give holistic care, research about illnesses, generate discussion with ur colleagues/bosses, all that in the essence of becoming a safer doctor. some ppl may argue that you do that in ur medical school days, but u gotta rmb that the nature of this job requires lifelong and continuous learning. chucking the stereotypical asian kiasu mentality aside, most ppl love learning and teaching (maybe lol), and to pass on and educate another in order to work more effectively as a team is something invaluable.

That said, i'm not all hardcore into detesting doing all those manual stuffs cz well, we are still understaffed and who else to do all that if not the trainees lol. i will still do it with grit and hope my physical young? self will not fail me haha. thr's no doubt we hv more staff now compared to 5 yrs ago.

oh well. just some thoughts about a more ideal system. and ranting before i start tagging tmr. sigh. time to savour the remaining day. 8-)

a ton of ice might put out the fire

Patience is a virtue. patience is a virtue. patience is a virtue.

I literally say these words under my breath each time my adrenaline shoots up, precedented by the unexpected, the dreaded, the unbelievable things that happen when u dont need them to happen.

I'm reminded over and over again, to have grace, to forgive, to give ppl the benefit of the doubt. Because I probably have been in their shoes before, or will be in future.

I admire those who are happy go lucky. taking life as it goes along. unperturbed by changes and hiccups. willing to do extra works that are due bcz of changes, without hard feelings or resentment. shucks, things happen, i'm still alive and happy, no sweat.

If only I could just feel that way.

I tried hard to be easy going and take things in my stride. I seriously tried.

But today, I just felt like someone just threw a huge rock into my face. Here you go, Wham. buh-bye. who cares.

not exactly the most intellectual post lol. n me being really vague is probably confusing to you who's reading. sigh. but i js cant rant it out publicly. just feeling really mad right now. @@

need a breather. need a holiday. lol.

End of first posting, more to come

Completed ortho and entering IMed soon. Several take aways from the last posting:
1. work as a team
2. work with humility
3. treat all aspects
4. (always try to) stay positive in all circumstances

Without a doubt, I've enjoyed the last 4 months in ortho. thank you great bosses, colleagues, staff! :)

had a very friendly n approachable mentor :P

cny 2014 in kuching

my first cny in sibu, visiting my paternal relatives, catching up with local friends who came back n bringing the feast outside the hospital :)