No Birth Cert No Fly,No Op

I cant believe how ridiculous this is.We had a patient today from Belaga , very very interior in the Kapit division,who doesnt own a birth cert,even his parents doesnt,it may come as a surprise to you but really it's still quite common here.

He was scheduled for an heart op in IJN,so naturally in order to fly over and for the expenses there he would require a birth cert or at least a letter from the tuai rumah stating that his family is actually a malaysian citizen.But the funny thing is his old tuai rumah had passed on and the new one just refused to help,hmmm.We were actually in quite a predicament, in the first place it's so difficult to get a operation slot and the flight tickets were booked then cancelled,all sorts of unnecessary expences.

Batang Ai at sunset

We found the whole thing really ridiculous,he was born in a government hospital,checked by a government doctor,had an under-7 card during his delivery,yet we couldnt prove his identity.It's a good thing my specialist and bosses spoke to the concerned YB od the place and we managed to get things settled,otherwise he would be another  denied of seeking treatment which rightfully he deserves as a citizen.

This is just an example of how despite the rest of the country progressing,everyone is suppose to get equal chance at health,it isnt so.The children in Sabah and Sarawak are not candidates for liver transplants only because of the logistics and it's next to impossible for them to come for follow-up despite being able to do the operation,it's really sad wouldnt you agree.Don't they have equal rights just like every single one of us.

Batang ai dam Sarawak

When we send our patients for future follow-up or when they're being discharged there's so much for us to look into,there is another patient of mine who stays interior of Kapit as well. Their journey to Kuching for follow-up includes having to take an express boat from their place to a logging camp,that too depending on the weather,then follow the logging camp company truck for another 2hours to reach Kapit town,stay a day there wherever they can,take a 3hour boat ride to Sibu,then another 6hours bus to Kuching,and mind you this is only for one follow-up.Imagine the cost of travelling,what about if they're really sick....It doesnt suprise us when they say they had enough,who wouldn.....


"IT'S UP TO ALL OF US TO CHANGE , HELP WHERE WE CAN AND TO STOP POINTING FINGERS AT ONE ANOTHER" , CHANGE DOESNT HAPPEN OVERNIGHT BUT IT HAS TO START SOMEWHERE  :))           - Sangeetha Siniah-

It start's Now .....

And the time has come to start calls in paeds , how do i feel , hmmm actually not as scared as i should be i guess,probably cause i have my exams as a distraction.Just like that it's already the 3rd chinese new year i'm celebrating in sibu,where did time go ??? But never before in any other place have i seen people play that much of fire-works,hoping i'l get to see it from the hospital,with the kids.

On the brighter side after so many years my collegues all get to be off for their reunion dinner,finally a non-chinese in the department :) works both ways cause i wouldn't have to fight with anyone for deepavali and other holidays either.Have a very motivating and dedicated team of specialists and collegues,so happy to have joined them finally.

So we shall see what happens tomorrow,good or bad it'l be another milestone in my future and the journey continues.

"Have a prosperous RABBITY new year " and have an orange or even a carrot on me:)

 

The Step Forward..........

Coming back into the paediatric department after 2and 1/2 years as an MO is like i'm coming back home again,all new/different/tons to read up on,but it's different.Something me ex boss said, when you do something your passionate about it's almost like falling in love again.Ahhh how true.I guess i definately love babies more than i love adults:)

Come a long way since me 1st houseman posting in paediatric 2years ago......

Why we became doctors.....

To honour the code,to serve the people,to get rich quick,past life changing experiences.We all have our reasons,no right and no wrong,just as long we're happy with the reasons we choose individually that's all matters.It would definately help to care a bit more,but a lot of factors come to play,we have our own stressors,problems,if we cant deal with our own how do we give the best to others.We all handle stress in different ways

Saying is always easy but it's practising what we say is the hardest.At the end work will always be work,we need to find that fine balance between work and play otherwise we'll be sucked into work so much it wont make us a better person at all,probably even make us bitter,passionless,revengfull,sad,depressed.So even if we're not into settling down we should do things to occupy ourselves or like they say an idle mind does worrying things.It could be anything finding a hobby,exercise,hanging out with friends,travelling,sigh anything except nothing:)

Good things,happy times will come,we just need to patiently wait for it.Bad times/worst moments will eventually pass.It helps having wishfull thinking and of course a little faith:)

The guy who should but couldn't survive..........

Into my fourth ICU call,slowly gainning a little confidence,so much more to learn.Secretly even though paediatrics is my passion,i dont think i'l ever regret coming here and getting trained.

Of course as a houseman i'v always told myself i need to do my best,dont let anyone die,but somehow yesterday the feeling was different in the sense that even though i knew he had no chance of survival i desperately wanted him to,Was telling myself "NO GOD he must not die" and it's not about getting dragged into mortality review,it's just that inner feeling.

Cut the story short young guy,mid 20's,very severe meliodosis,with ARDS(for those who have no clue wht are these,kindly google it up)his lung were in a bad shape and of course not recovering,not to mention the systemic response to it,other major organs failing.

When it was time to tell the family,sigh as usual the hardest part,i'm one person who hates confrontation,and asking me to explain to the family,seriously i dont know how i do it in a serious face,when all i want is to cry with them.I'm not emotional in the sense that when it's time to let go it's time,heck i even think euthanasia is alright,but of course this is my blog and my thoughts.So i told them as usual,bla bla
"Kita tidak akan tekan tekan (No CPR) " , "Bagi ubat sahaja"
The mum and dad were so calm,said whatever is best,but shit at the corner of her eye i saw the tears"

So this was a new feeling that tugged in my heart,even brought some tears,i guess then i realise why it's so important to do your very best,but sometimes i guess no matter what or how much you do,god loves them more,and it just goes to show we're mere mortals,and we can only do so much,so better to let nature take it's course,and let go...........

On-call .......

I need to remember this moment because it's a day i have been dreading and thought impossible for me to do a month ago,but guess what it's over,there'l be more calls,more to learn,just need to calm down,breathe,not panic,and let the adrenaline take over.

So my first ICU call started with a bang,not sure why they all collapse one after another,but i still think it could have been worse.But then again current aim is to have less mortalities,and just survive till the next day.

Mystery illness ??

One by one they're dying,not even sure why anymore,the disease process has taken a dramatic turn.Are we dealing with a mutant strain,are we missing something important.This seems to be the unanswered questions lately.Hmmm the cases are starting to sound like what we read in some of the robin cook novels.They're deteriorating too fast,someone pointed out it's a failure of management,is it really??

The dreaded mosquitoe is the cause of all this.I wonder if people are aware of the bigger picture,all the meetings and the hoo haa about the deaths,do they realise it's all political,a downplay of urbanisation,failure of development.It's getting worse,but of course it's not being openly publicised,it cant be,because people will start questioning.But why shouldnt they,they have every right too.I understand it is everyone's responsibility,but the whole blame shouldnt be on the healthcare givers.since the disease is so rampant why are we not doing more research,and so on.We're paying millions of tax payers money to send people to space yet we fail in vector control,sigh such a shame.

It's so sad to see them die from such an illness,we're not even talking about HIV or H1n1,this seems to be a lot worse.In the meantime,of course the healthcare workers have to scratch their head and manage the best to avoid any more mortality before the HIGHER levels gets to them,but how do they do that, when they're not even sure what we're dealing with.The HIGHER levels need to realise statistic are just numbers,we're dealing with lives here.Prioritise,act fast,before more lives are lost

1st day MO life.......

I felt like i was going through first day of school.The feeling of being lost,getting into peoples's way,overload of information.

Somehow the transition from houseman to mo,guess i dont really feel it yet,probably when i start doing call's independently,which i'm expected to do very soon.I pity my collegues because of the general shortage of mo's everywhere(thanks to the maldistribution/lack of doctor's in sarawak)who have been doing so many calls.

I'm sure this feeling will eventually pass and hopefully i'l start learning fast enough.

Life we didn't know.....

It's 7am,a saturday morning.You wake up listening to the sounds of the ambulance outside your window.You ask yourself everyday why do i have to live in the hospital,of course ur voice tells you back,where else do you expect to stay,your not in the city your in some rural district in sarawak.You have no LIFE.

Eveything revolves around the hospital.Yesterday was friday a full working day plus you were doing passive call(standby for any emergencies,escorting unstable patients/intubated patients to the nearest referral hospital - sometimes upto8hours journey by whatever transport you can think off ambulance/boat/helicopter).

Even after escorting you come back to see a full outpatient clinic( 150patients all eyes staring at you ).You look at them in you head you cursing them,why must you come today/this week.But they don't know you only have 2doctors running the whole hospital,doing back to back calls because another MO is on leave/on course.Then u think again WHY ME,why was i sent here,to this place,why cant they give us more doctors,how do they expect us to manage.

Even before you can think or pity yourself,you hear the dreaded phone ring.SHIT i havent even brushed my teeth.It's your MA,"Boss ada RTA case",u say u'l be there soon,then in your head you start cursing again(why must there be holidays,why must they drink and drive,why cant they leave me alone).

Oh and by the way today i'm doing my active call(Need to see all the new cases,handle all the ward problems,do the dreaded c-section,refer the cases to the referral hospital's)basically the person incharge of the whole hospital.

You attend the case,send the patient off to the referral hospital for a CT-brain.Attend to a few more cases in the emergency.It's 8am you Go to the wards,finish ward rounds,dischage as many patients as you can,refer the cases.

At 11am you come back to your quarters,have a quick shower,eat as fast as u can,try and do some laundry.

1pm - Before you know it they're calling again,thank GOD i'v eaten,this time a 3year old with asthma and what looks like influenza like illness,you tell the parents you want to admit the child but they say NO,it's the holidays,after explaining/re-explaining(although on your head u just want to hit some sense into them)they finally agreee.Phew.....

You go home to try and get a short nap,because there's nothing much else you can do,ur constantly in fear of that stupid PHONE call,praying that there wont be more cases.

Just as ur about to dream of that house by the beach,your dream job taking care of an island like Ben Southall the phone rings."New case boss- Maternity".You think to yourself havent i been praying hard enough,maternity cases are the hardest,it may seem relatively easy but if something goes wrong it goes wrong badly,worst part is there's 2 lives in your hand.So once again you go,scan the mother,so far ok baby's not too big,her OS is only 2cm dilated.

Of course in the emergency there were a few more cases waiting.
By the time u get back it's 7pm - another quick dinner,quick bath,surf the net.Attempt to rest.Ringggggggggggggg,that damn phone again,by now your just too tired,your body is aching,u have a headache.Your nurse says it's the mother earlier,the delivery is not going smoothly.Immediately ur adrenaline is back,you tell them to call the poor passive call MO to standby and get ready for c-section.

After assesing yourself,consulting with the specialist via phone you proceed with the c-section in fear again.Your passive call MO looks exhausted,u feel guilty but then again tomorrow that might be you.Thank god everything goes on smoothly.Both baby and mother are good.

It's already 2am,now your literally crawling back to your quarters,fatigue just wearing you out.This is already my 4th every other day active call,i still have 3 more to go,how am i going to do this.Even the money is not enough to tempt me,i just need my rest.....Praying the phone doesnt ring....still thinking where am i heading to....Thinking the whole cycle will repeat tomorrow...zzzzzzz



#This post is dedicated to those in the district's,it's not even axaggerating,i havent even done district posting but this is what my freinds go through,this is through the eyes and ears of an observer,it's very real.It's not easy when there's no one to watch over your back and very scary.There is no such thing as social life,quality of life,your so overworked you start thinking is all this even worth it anymore,is this why i became a doctor,it's very sad but true.Hopefully with more doctors coming out the maldistribution will even out especially in Sabah and Sarawak,otherwise it's going to be the same all over again#