Monday, August 24, 2015

Infections and Inequalities

It is true that people who are in the ‘same boat’ understands each other more, I am speaking in terms of patients having the same disease. For the past few weeks I have been working at the infectious disease ward at the National Leprosy Centre. It used to be filled with leprosy patients, it now admits patients with the more common infectious disease of today: those affected with HIV/AIDS. Located near Sungai Buloh Prison, the main prison of Malaysia, it also houses a lot of sick inmates and convicts from the prison. My ward, ward 54 has patients which are mostly HIV positive, and some of them have been there for a long time. Sometimes they are just waiting a place for them to stay when they are discharged from the wards.

I have been observing them for awhile now, and I can say that I have never worked in a ward where patients really care for each other. I had a patient with cerebral toxoplasmosis which damaged his brain function to the extent that he could not control his hands while feeding. Every time food is served, the patient next to him would sit beside, and slowly feed him before taking his own meal. Another day, a patient had vomited on the floor, suffering the side effects from the new HIV drug that we started, and the next thing that happened was the patient next to him ran to the toilet. I thought that he couldn’t stand the awful smell, but instead he came back with a mop and cleaned up the vomit right away.

National Leprosy Centre, Sungai Buloh
Last weekend I was letting another HIV patient home, and I saw him exchanging phone number with the patient in front of him. I kiddingly asked him: “eh, tuka nombor ni sebab nanti nak masuk balik ke?” (exchanging numbers because you want to come back here, do you?). His answer touched me. He actually found out that the other patient had been in the wards for months only because of placement issue: he does not have a place to stay if we let him go. So he took the other patient’s number, because he knows a relative who owns a home for the disabled. Once he is out, he said he will persuade his relative to let the guy stay at that home. He is just worried because of his friend’s HIV status, whether his relative would consider letting him stay.

In the beginning I was afraid to work in a ward full of convicts, prisoners, and drug addicts. But it is only after talking to the patients, knowing their social issues, getting to know them as individuals instead of diseases, that I see another side of them. Not all of them are bad. One convict was running away from the police stealing a hi-fi audio player. When the police snatched him, he accidentally dropped the hi-fi on the police’s foot, and now he is charged with ‘police assault’ that gives him heavier punishment and more years in jail. He regretted his act until today. Even if they were bad in the past, it doesn’t mean that they still are. I see some who was constantly reading the Quran and makes the effort to pray 5 times a day. As I mentioned before, some of them really took care of their friends. We cannot stigmatize these people, who we are to judge them based on the disease that they have? Prophet Muhammad SAW once said:

O people! All of you are the children of Adam. You are like equal wheat grains in a bowl ... No one has any superiority over anyone else, except in religion and heedfulness. In order to consider someone a wicked person, it suffices that he humiliates other people, is mean with money, bad-tempered and exceeds the limits.(Narrated by Abu Hurayrah (r.a.), Ahmad, Abu Dawud, 4/331)

These are the people who are the most vulnerable, the most stigmatized, shunned from the outside community. As a doctor, I swore not to treat these patients any differently than how I treat the others: VIPs and ministers alike. My times in Indonesia and Cambodia has carved a different way of how I approach these diseases. I would not jump at the moment a new drug for HIV, or TB, or malaria has been launched. I would only jump in joy if these drugs could reach the ones most vulnerable to these diseases: the poor, the homeless, the prisoners. I know it takes a lot of effort to ditch the stigma that we have towards these people, especially those affected with HIV, but once you talk to them you will realize that they are no more different than you: with hopes for the future, with families, friends and a job to keep. If we keep stigmatizing others and deny them of adequate treatment, I guess as they slowly feed another friend who are much worse than them, in their eyes, all they can see...is their future self

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

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