Tuesday, July 28, 2015

Sleeping With A Mosquito

"Doktor, buat la dengue notification cepat. Patient dah 2 hari dalam wad takde orang pon buat"

In the midst of my hectic day, with a few CT-scans to request, a patient who wants 'at own risk' discharge, another demanded to change beds, I grudgingly did the dengue notification, and sent it.

It seems like a mindless act. Tick a few boxes, put in some numbers, and send it. For us as housemans, it feels like a mundane and repetitive procedure.

But today, listening to lectures on global health diplomacy made me reflect. What I love about attending these global public health lectures is that it makes you learn something that you already know, but not realize.

In all these big conferences at the WHO, or even at the UN, delegates will almost always start with statistical data to prove their point: "In 2014 the WHO stated that the mortality caused by dengue is...etc etc etc"...the "the UN estimates the lives loss by Malaria is...etc etc etc"

We quote the WHO, other research organizations, but to think of it, do these data come them? No. It comes from us, the ones even at the ground most level of the Ministry of Health.

In my current situation, it feels like I'm walking along the river, then hearing a person shouts for help because he's drowning. So I jumped in and pulled him out. Successfully resuscitate him back to life. Then I hear another person shouts for help and saw another one in the river. I went in again. Then there is another one...and another one. I was too busy saving the drowning ones, I forgot to wonder, who the heck is up the stream pushing all these people into the river?

The drowning ones could be the ones affected by dengue, it could apply to other diseases as well.  The ones pushing them in, are the social determinants...it could be the environment, it could be the economy, the governance etc etc. Right now I am busy saving the drowning ones, but someday hoping I can be the one going upstream to see 'who the heck' is pushing them in'.

Malaysia is trying to put the dengue epidemic higher on the global agenda, and we all play a role in this, even you, houseman! Even the staff nurse who reminded you to do the dengue notification. Without reporting we have no data to speak of, and it will never be on the global agenda. We all in the Ministry of Health play a significant role, no matter what your position is. So never feel your role is too small for the betterment of the nation's health. As an African proverb goes: "If you feel that you are too small to make a difference, try sleeping in a closed room with a mosquito"

Thursday, June 11, 2015

Remember This Moment

The day was coming to an end. The construction workers, tired and wary after a long day doing the final touch for our clinic, were having their much-delayed lunch by a serene pond next to our clinic. As the sun sets over the horizon, I sat down on some wooden planks, looked around, still finding it hard to believe that in this foreign place, we have a piece of land we can call our own.

I began to wonder when did all of this began. Was it three, four  years ago? Must have been four. Yes, Hospitals Beyond Boundaries was establised three years ago, but it was four years ago a stranger known as Ustaz Kausar came to my house to tell a story of suffering. I sat at the back during my family's usrah, listening intently to his story about the suffering of the Cham ethnic minority of Cambodia. Ustaz Kausar almost did not notice me, and I did not expect him to notice me too. We would never have guessed that 4 years ahead, we would become like brothers, working together to make our dreams of having our own health centre a reality.

Many have asked "Why Cambodia?" and I wish I could have just answered "because Ustaz Kausar took me here". But it was more complicated than that, involving much more people than the both of us. I have brought many people along with me in this journey, some of those that I knew I would be hanging around for the rest of my life. HBB became a family, growing bigger and bigger, and tomorrow we would be receiving 60 volunteers from Malaysia, each and everyone believing in this cause that 3 years ago was just a dream of a bunch of students.

I swear I have never felt a stronger sense of purpose in my life. HBB is the reason I stay awake at night, and it is the motivation for me to wake up in the morning. Simple things we did today, like going to the store in Phnom Penh to buy PCs for our clinic felt so meaningful. As I ride the tuk-tuk, I felt the wind rush over my skin, knowing each mile I go for the purpose of our clinic might make someone's life better.

With HBB, I didn't have to compartmentalize any of my life's ambitions: personal, professional or philanthropic. I don't have to choose between work and family. I don't have to choose between making money or doing charity. They all converged in a single mission. HBB started with my family, it bonds our family together, and I would only marry someone who understands and interested in this work we do.

Today is a snapshot of these purposeful moments. I was not bounded by the ticking clock. All I knew was that I need to get to the pharmacy to stock up on medications, to the IT store to buy PCs and the electrical shop to buy floodlights before the sun sets. Like the birds and the bees, I am free from the fear that plagues men: the fear that time is running out.

I gave the floodlight to the construction workers before the sun hides away its light. They would put up the lights tonight, shining our clinic out of the darkness of the night, and here I am, sitting on the wooden planks, as the evening Cambodian wind blows softly as my thumbs pound on this small screen, trying my best to describe the day I had.

Some people struggle hard in life to find their purpose, some make it to death without even discovering it. I believe I have found mine, but the road ahead of me is still long, and there will be a lot of forks on the road, difficult decisions to make. The purpose of me writing this is to remind my future self facing those moments. Remember today, 2 days before the launching of HBB's first clinic. If I lost my way, remember this day. The day I feel so alive, so purposeful, so confident that this is what I want to spend my life doing. If I lost my way, may this writing bring me back to this moment, and make me discover back my purpose...

Saturday, April 4, 2015

Keep Calm and Finish Housemanship

Today, as I was doing my job in the wards one of my colleague made a quick remark of me "well, you seem to enjoy working". I was putting notes on the computer, while playing Echosmith's Bright on low volume on the phone in my pocket. Head bobbing to the tune.

Yeah, I was happy.

I gave it a thought, just a year ago, I hated my job. I woke up feeling nauseous, trying to brush my teeth was a challenge as to not induce vomiting. I had palpitations as I near the hospital entrance. I jumped at every notice the staff nurse gave "Doctor blood pressure patient bed 3 low", "Doctor, temperature patient bed 6 spike", "Doctor, doctor, doctorrrr mana discharge note???". It was overwhelmingly crazy, I admit it was a tough environment.

Today, I admit I am still not one of those passionate and dedicated houseman who would stay back at the hospital to learn something new. I finish my work fast, to get back on time to go for my NGO meetings, to reply emails, to get in touch with investors, to prepare for my next talk. But at least I no longer hate my job. It instead felt fulfilling. Morning drives used to be full of wary imaginations of how the ward would be full, how the rounds would be horrible. Now I drive to work with my brain thinking about...nothing. What will be will be.

I guess as you expose your brain long enough to any challenging environment, your brain will adapt to it sooner or later. The secret is to keep pushing on. The moment where you feel that you are losing out and about to give up, that was when you push the hardest.

For those new houseman out there just starting out, if you feel that you are living through hell, I understand, I was once just like you. But if you keep pushing on you will see enough patients and learn and identify patterns of diseases, patterns that allows you to predict the next course of treatment you should initiate. Patterns that are, in a sense...remarkably beautiful as you discover and bow down to Allah's promise that there is a cure for every illness in this world except for death.

So keep marching on until the sun comes out, and one day, you will be able to say to the staff nurse, with confident, in a most calm and collected manner..."rilex, run 1 pint normal saline dulu, slow sikit ah"

Thursday, April 2, 2015

The Best Job in The World

Last week Hospitals Beyond Boundaries​ produced its first paycheck to its first employee, a local Cambodian Medical Officer in Phnom Penh. We have come a long way from being an NGO founded by 2 medical students, to a group of 13 young professionals that works on voluntary basis, and now an international organization that creates employment for local communities in low-income nations. It feels great to realize that we are creating something that could change the core of people's lives. In the Malaysian landscape where financial security is becoming more and more a rarity, a place where even being a doctor does not give you job security, we, the youth are defiant on permanently being job seekers. We are slowly becoming job creators. Crafting what could probably be...the best job in the world

Wednesday, February 11, 2015

The Rise of the Gen-Y Doctors: Stop Scaring Us Off!

Since I have been working in the hospital for the past one year, I can’t help to notice the burgeoning number of medical students exhibiting these non-purposeful movements inside the wards. There could be up to 50 medical students in the ward at one time, from various universities, private and public alike. While to some of my colleagues, these students are a nuisance and just slow down our work, I actually don’t mind having them around, because not too long ago I was like them too. I understand how it feels to be there to get your cases for teachings, to fill in log-books, to be eager to learn or do something, do some real doctoring. But I can’t help to think “wow, all these people will become doctors? There are 2 to 3-fold more of them in the ward compared to patients!”

The glut of new medical school graduates is obviously not breaking news. I brought up this issue back when I was the President of the MMA Medical Student Society in 2011. Although I am still worried about the glut of new doctors coming in, I do not agree that scaring these doctors-to-be into quitting medicine and find something else to do is the way to go. I don’t think it helps those whose parents has invested a lot in sending their children to medical school, using all their savings, and having high hopes for their children to be the first doctor in the family.

We should stop scaring future doctors that there will be no more jobs for them in the future. If we limit ourselves to the thinking of medicine involves only being in the mainstream specialties like being a cardiologist, neurologist, surgeon, paediatrician and the likes, yes there will be not enough places for all of us. But the new generation of doctors must see medicine as a much wider field, much of it unexplored, and any of our innate talents can be incorporated to advance this discipline of saving lives. Let's face it. Everyone is a genius in their own fields of interest. Even though you are erupting enthusiastic about doing hard-core clinical medicine, there must be certain departments in the hospital that brings you down to the level that made you think twice about being a full-fledged doctor. Forcing someone to be an outstanding doctor in a department that he or she is not interested in is like forcing Stephen Hawking to paint and Picasso to explain about the beginnings of the universe.

We are aspiring to be a first-world country, but we are still having the third-world way of seeing things. We still look at the less-mainstream specialty as ‘second-class’: the pathologists, basic medical scientists, pharmacologists, haematologists, public health specialists, family medicine specialists, etc. When one of my friends aspires to become a haematologist, my colleagues automatically thought that he just wants to be lazy and sit around answering the phone from house officers who need MO code for their blood investigations. Truth is, haematology is a far more challenging field, and I had witnessed it myself when I met with Dr Noryati Abu Amin when I worked for the WHO. She is a dedicated and highly respected Malaysian haematologist that has served the World Health Organization HQ in Geneva for more than 10 years, creating guidelines and protocols for safe blood transfusion that is strictly followed around the world. She is currently the head of National Blood Bank Malaysia. You see, some good students with good memories are born to become protocol-memorizers. Some that are not that good memorizers but are greater on the innovation side are born to become protocol-developers.

In the first world countries, many ‘less-mainstream’ specialty doctors, the researchers especially, achieve great things in the field of medicine, winning the Nobel Prize in Medicine. In some first world countries, you need to have a degree in something else before you can enroll into a medical school. They are very supportive of inter-disciplinary application of knowledge. Every medical student knows David Netter. He took a degree in arts before doing medicine. As a result, he incorporated art into anatomy, and hence produced one of the main references for anatomy that all medical students around the world use. In Malaysia, when you are interested in something different from the mainstream, people label you as ‘not a real doctor’. When one of my MO was transferred department to join the CRC (Clinical Research Centre), the other specialist and MOs looked to him as ‘too weak for the department’, ‘not doing a true doctor’s job’, because he is more interested in doing research. For me, medicine has to incorporate 2 main values: service and academic. Service is important, but if everyone’s doing service, who is going to develop medicine further? As we move on to become a developed nation, our health care must evolve to become that of a developed country, where research comes hand in hand with service. Maybe we need more doctors to study Tropical Medicine and learn ways to stop the epidemic of dengue instead of adding more beds to the hospital, maybe we need more doctors to research the antimicrobial resistance in the hospitals, maybe we need another doctor to even take up politics and revive the old days where Malaysia moves forward at a fast rate, lead by a medical doctor. Smart people are smart enough not to do medicine if we scare them off. If we keep scaring them off, the only ones left to do medicine are the dumb ones who don’t care about their future.

When we see the medical field as a vast, largely unexplored area of knowledge, we will see its job opportunities in abundance. So medical students, or all those aspiring to be doctors, come, come from where ever you are. No matter where you graduate from: Indonesia, India, Czech, Russia, everyone has their own talent that can be incorporated into the field of medicine. Only if we open our minds and see medicine as a wider field. We are the Generation-Y doctors. Maybe a Nobel Prize is within the reach of our generation. In the words of the Irish singer Damien Rice in his song ‘Trusty and True’:

“Come, let yourself be wrong
Come, it's already begun
Come, come alone
Come with fear, come with love
Come however you are
Just come, come alone
Come with friends, come with foes
Come however you are
Just come, come alone
Come with me, then let go
Come however you are
Just come, come alone
Come so carefully closed
Come however you are
Just come…”

Popular Posts