Saturday, November 15, 2014

In Defense Of The Humble Doctors

"Mak Cik cek kejap ye".

This is not the first time I heard a doctor calling herself 'mak cik' when dealing with a patient, but every time I hear it, it is none other than from a Family Medicine doctor. Family Medicine is a medical specialty provides health care for the individuals based on knowledge of the patient in the context of the family and the community, disease prevention and health promotion.

They are the doctors that we first meet at the local Klinik Kesihatan, before we are referred to the hospitals, if necessary. They are the "gatekeepers" as what the medical fraternity likes to call, the ones who holds the dam to prevent a flood of patients to tertiary hospitals. Through emphasis on disease prevention and health promotion, they not only treat individuals but also the whole community. Family Medicine is an arm of medicine that is indispensable, but sadly are the heroes that are unsung.

Since Family Medicine doctors are the first to see patients, they can deal with any diseases under the sun. Hence in their training, they are required to do rotations for a couple of months in each department at tertiary hospitals. That is when I get to work with one of them, in the Paediatrics department, during one fine Saturday morning rounds:

"Mak Cik cek kejap ye"

She said again when dealing with a child. For some may argue it sounds unprofessional, lacks formality and all.

But I think to a child, it doesn't matter.

There is nothing wrong with it, and I think what is wrong is when a doctor is arrogant enough to be irritated when someone calls them 'Encik' or 'Puan'. She took time to talk with the mother, asking about the family, how they are supporting the child, socially and financially, in a very friendly and humble manner, like really talking to a 'mak cik'.
Being a doctor is a demanding job, I admit. The hospital can consume us and make us think that the wards, clinic and operation theatres are the only thing there is to life. Last week I was scrolling through the Facebook feed a post by a friend of mine caught my attention. It is about one surgeon, allegedly from my hospital, a tertiary centre, arrogantly bashing a Family Medicine doctor, labelling them as dumb and resistant to teachings.

It is quite common, when you spend too much time in the same place, with the same people, to develop an inflated sense of importance, putting yourself in the centre and thinking the world revolves around you, ignoring the fact that the outside world is bigger than what you see. Everyone is good at something, but not everything. It is not wise to judge that a chimpanzee is better than a dolphin based on a race to climb trees.

Respect must be earned, not forced. For many people, the more title you get, the more Dato' Dr, Professor Dr, and all sorts, the more respect you will earn. But for me, I can respect a doctor who is not a little bit annoyed when someone calls them 'Pak Cik'. I would hate it if I spend too much time inside that 4-walls of the hospital and develop this very false sense of self importance for myself. A way that I have found effective is to spend more time on the ground with the community through volunteer work, and secondly through traveling the world. That is how I think Family Medicine and Public Health doctors do it. It is a way to see that the world is wide, and what we do is just a speck of dust in this huge universe.

During my last call there was a death of a baby, which we failed to resuscitate after being exhausted of all efforts, and also a birth in the O&G ward, a premature, which we successfully resuscitated. It happened so spontaneously that the mother did not even make it to the labor room.

Moments of intense pressure makes time move so fast, you barely notice the clock ticking, during evening calls you come in when the sun is setting, go back when it's near noon the next day and punch in when the sun is setting again. I do enjoy the work, it made time felt worthwhile, but the most important thing is that it doesn't end there. It further values and add meaning to the moment when I am free to do what means most to me: treating the community and traveling the world.

Volunteer work and traveling should humble you. I am nonchalant when talking about my NGO trying to build a hospital in Cambodia because I went to South Africa and saw a kid of 17 years old who opened a school, and giving scholarships to people older than him. What I do is just 10% of what a 17 year old kid did. If that doesn't humble you, I don't know what does. We don't see this when we stay for too long in the same place with the same kind of people. Hence I always promise myself to use my free time for my NGO and for travel. It fights off arrogance. It makes me perfectly fine when people don't address me as 'doctor'. Call me "Pak Cik", I wouldn't mind. Because in front of the Creator, I am just a slave

Thursday, October 30, 2014

Welcome To Life, Baby

"Premature baby in room 4, os full!"

I heard someone shout as I was attending a case in the labor room nursery. From the footsteps, I fathom someone running nearer and nearer towards me.

"Doctor, you're from paediatrics, are you?"

"Uh yes"

"There's a premature in labor, os full! We've tried to call your medical officer but couldn't get to her"

My heart started to race. Like a reflex, I reached for my phone and tried to call my medical officer. I cannot be attending a premature baby by myself. I was not trained to. A baby born premature can be born with so many complications and the first few minutes after they are born are the critical period that could determine life and death of a baby.

"Sorry, the number you have dialed cannot be reached". My heart starts to beat faster and faster.

"They are calling you doctor!". I had no choice but to run towards the labor room.

"Is paediatrics here?, baby's coming out!", I heard the obstetrician shout.

"Yes, yes, here he is! Don't worry!"

'What the heck', I thought. Don't worry? This is just my 3rd day in paediatrics, I am still tagging and the only newborn resuscitation I know was my crash-course study before my final exams in medical school. The O&G houseman are still trying to call my Medical officer, but to no avail

"Oh, heck" I thought and wore the gloves anyway.

"Paeds, standby, baby's coming out!"

I saw the head emerging as the mother continues to push. Swiftly, after a few seconds the obstetrician delivered the baby out. But something was wrong. The baby was not crying. Hastily, they showed the newborn to the mother, exposing the genitalia.

"Ma'am tell us if it's a boy or a girl? Now!"

Either the mother was too exhausted or she couldn't comprehend the obstetrician's question, she went silent.

"MA'AM IS THIS A BOY OR A GIRL?"

The mother still looked confused.

"Oh whatever, it's a boy!" said the obstetrician. "Baby's not crying, let paediatrics take over!"

"Oh boy" I whispered under my breath. They still couldn't contact my superior. They handed me the baby, and I rushed the baby towards the open hood warmer where all the neonatal resuscitation equipment are.

It is true that in the moment of intense pressure, memories of knowledge you never thought you had in your brain came to emerge out of nowhere. Utilizing everything I know from medical school, after a a minute or two, the baby started to cry. Loudly. His skin turned from bluish to pink. I have never felt so relieved to hear a cry so loud.

It was an intense moment. 3rd day in paediatrics. What a start. Later I learned that the mother was actually unmarried, it was a case of unplanned pregnancy, and hence left the baby fatherless. Sadly, the mother is actualy a Malay Muslim. The nurses told me that I should recite the azan to the newborn baby. So I did,

"Allahu Akbar, Allahu Akbar
(Allah is the greatest, Allah is the greatest)

Allahu Akbar, Allahu Akbar
(Allah is the greatest, Allah is the greatest)

Ashadu An La Illaha Illallah
(I witness that there is no god but Allah)

Ashadu An La Illaha Illallah
(I witness that there is no god but Allah)

Ashadu Anna Muhammad-ar-Rasool-ul-Allah
(I witness that Muhammad is prophet of Allah)

Ashadu Anna Muhammad-ar-Rasool-ul-Allah
(I witness that Muhammad is the prophet of Allah)

Hayya 'Alas Salat
(Come towards the prayers)

Hayya 'Alas Salat
(Come towards the prayers)

Hayya 'Alal Falah
(Come towards the success)

Hayya 'Alal Falah
(Come towards the success)

Allahu Akbar, Allahu Akbar
(Allah is the greatest, Allah is the greatest)

La Illaha Illaallah
(There is no god but Allah)

The baby that was just now crying was silent as I recited the azan. His eyes are wide open, as if listening intently to the words.

With the words of Allah, we welcome you to life

Tuesday, July 29, 2014

As a Humanitarian, I Support Hamas

Most Malaysians are well aware of the whole Palestinian-Israeli conflict, but friends outside the country often asked me about my opinion and are surprised when I told them I support what Hamas is doing. Most are still misled by mainstream media which portray Hamas as a terrorist group organization, and they think that seeing me as who talks about health care and do humanitarian work, supporting Hamas is contradicting what I do. Here is my take on why as a so-called 'humanitarian', I support Hamas:

This war is not just about stopping missiles and prevent death from missiles. Ceasefire has been done every now and then, dozens of time, but when there is no death by missiles, Israel moves on to kill Palestinians by slow, painful death: blockade of land, sea and air, cutting off supply of food, medicine, electricity and materials for shelter. The biggest hospital in Gaza is still running on equipment that you might thought came out from medical museums. Gaza is trapped, nothing can go in, Gazans are not free to go out. Palestinians has tried to negotiate this with Israel for 40 years to end the blockade and let Palestinians be free to live, trade and travel freely. But after 40 damn years, Israel still won't compromise. How long more can they stand it? Negotiations don't work. Hamas don't attack for no reason, they want Israel to lift the blockage of land, sea and air. They won't stop until they have that basic freedom to live. They want basic health. The definition of health by the WHO is Health is "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". What is the use of another ceasefire, when they know they will still be killed by Israelis by a slow and painful death?


What's with counter-attacking with attacking schools, playground and hospitals? "Targeting the command and control center of Hamas" they say. Is it possible that playgrounds and beaches are a "command and contol centre" of Hamas? Do they hide weapons in sandboxes? In the beach sand? Are little kids playing with their friends in sandboxes a threat to Israel? How about the United Nations school? Do you think the UN would let Hamas hide weapons in their school? 

To my international friends who knows me as a humanitarian, you might think it is ironic for me to support Hamas and the Al-Qassam brigade. But I do support them, because their demand to lift off the blockade is for them to live a safe and healthy lives for their people. How would you feel when you are cut off supply from food, medicine and shelter in your own damn country? Hamas has to retaliate because the UN can't do much. Some of you has been with me in Geneva, and you know how the talks go. They come out with resolutions and resolutions, but in the end, the ones who decides to comply or not are the respective governments in the countries themselves. They can talk all they want, but Israel feel that they have no obligation to comply to these resolutions.

It is tiring to write things like this every year, then it dies out when ceasefire is reached, and Palestinians continue to die of inadequate nutrition and healthcare. Supporting Hamas does not contradict with what I do, in fact it is in line with my belief that everybody deserves good health. Not just people in Africa who has to walk miles to fetch water, not just people in South America who live in Shantytowns with holes in their roof, not just people in India who has to travel far to see a doctor. This is Gaza, water supplies are cut off, their roofs are full of holes made by Israeli missiles, and traveling to see a doctor? I'm sorry the hospital has just been bombed

Monday, July 21, 2014

Bringing Me Down

Once while I was working I witnessed the most insensitive way a doctor breaks bad news of having terminal cancer to a girl of my age. Funny thing is that I don't realize how wrong it was until I had my off-day some days later to ponder upon what had happened. The patient was my age, and the way she was told that she was going to die was so detached of humanity. The frustrating thing is that it was too common, that none of my colleagues commented on it, like it was the most normal thing to do. I don't fully blame the doctor or my friends, because it is too typical here. Maybe because terminal cancer is too common, but then again how did people do it in other places? I might not even thought of this if I haven't been around traveling

I am afraid of what our culture has become, but I am more afraid that being surrounded with this culture every single day, from 5 a.m. to 7 p.m, my brain is slowly accepting it. I've already started showing signs and symptoms. Why did it take a few days, and a day-off for me to realize how wrong it was? I would have straight away tell my colleagues "Isn't that wrong?". But being too busy with hospital work, everyone kept silent. I read again what I wrote while I was working for the WHO: "We Actually Get Stupider When We Work Too Much: The Case of House Officers", and I could imagine myself a few months ago being disappointed with my future self for succumbing into a life too busy, it sucks the life and humanity out of me.

Oh Allah, please save me from this, let me save lives without turning into one selfish, insensitive bastard

Saturday, April 26, 2014

The Designer In Me Part III

So this is the third time I decorate my living space. The first was my room in Bandung, where I lived there for 3 years. Then in Kolej Kediaman Tun Dr Ismail UKM in Cheras, Kuala Lumpur, where I stayed for another 3 years, and now this is my living space in Kuarters Integrasi Hospital Sungai Buloh. As compared to my other rooms, you might realize that this time I swerve away from my favorite colors white, red and black. My room is totally green now. It is not that I suddenly become an environmentalist after working under the department of environment and social determinants of health in Geneva, lol, but the room was already painted green when I went in. Furthermore, look at the view outside, it's so green. Sungai Buloh is well known in the Klang Valley for people to buy plants. In fact, my father always buy plants here until this day. So I decided to bring the green into my room! Here it is. I am not paid by Ikea but Ikea is just 15 minutes from here and most of the things I buy is from there