Friday, April 27, 2012

Proposal To Set Up The NGO Hospitals Beyond Boundaries

I am currently working on the proposal to set up an NGO I decided to name Hospitals Beyond Boundaries (HBB). This is part of the proposal that should give a brief description of what we aim to do. However, our main goal for now is to raise funds to build the hospital in Cambodia. The first meeting with the 'Board of Advisers' (which consists of family members for now) will be this weekend. Wish me luck!

The Proposed Logo for Hospitals Beyond Boundaries (HBB). H in the center sandwiched by two Bs, one of them mirrored, forming a shape of a butterfly.

Introduction
 
Hospitals Beyond Boundaries (HBB)’s mission is to help build hospitals in impoverished places and develop the surrounding community through sustainable health care services, financial aid and community development efforts. The hospitals that HBB envision to build are those that understand the local community and are able to develop them in ways that they can sustain health care efforts independently. Health is a basic human need. We believe that curing diseases also helps alleviate poverty. By providing hospitals in health care deprived communities, HBB hopes that it will serve as a stimulus for further efforts in improving not only the community’s health standards, but also the standards of living in general. HBB believes that an effective and sustainable healthcare can only be achieved with a strong understanding of the interaction between healthcare and the local culture, religion, social systems and economy. To achieve this, HBB strives to involve the local community as much as possible in building and the running of our hospitals.

Significance

 

Sustainable health care efforts
The need for an NGO that helps build hospitals in impoverished places arise with the realization that while many humanitarian missions are available, not many of those include ‘community development’ in their agenda. Most humanitarian mission responds to war, crisis, famine or disaster, but efforts in building back the society after these periods of turbulence are usually minimal or absent. Although some community do have hospitals, they are usually government-run and by standards of developing countries, lack many facilities, medications and face many impediments such as limited resources, limited workforce, poor health system and bureaucratic delays. By helping to build a private community-run hospital, more tolerant control of supplies, workforce and collaborations with other parties such as NGOs or donors are made possible. However, we also realize that while we provide a different approach in health care, the highest level of effectiveness can only be achieved establishing interaction with the national health system. Hence, HBB would strive to strengthen and complement the existing health care system in any countries we are in.

Empowering the community

The goal of HBB is to empower the community to take charge of their own healthcare. Because the health care workforce is usually scarce in developing countries, most government do not impose laws that prohibit non-medical personnel to become healthcare workers. The main function of these community health care workers would be to educate the community on health, refer patients to the hospital, and for those who could not come to the hospital, they will come to them. The community health care workers do not take over the work of doctors or nurses. As members of their own community, they serve as an important bridge that builds trust and links the hospital to the community. Transportation costs, cultural and religious beliefs, social stigma, discrimination and lack of information are examples of why the poor do not seek treatment. By involving the local community in the treatment of patients, these barriers would be addressed because they best understand the barriers to health faced by the local community.

Stimulating the local economy

Many missionary hospitals depend on the workforce of volunteers. However being labelled ‘volunteers’ would deny them from receiving any form of payments. We feel that although volunteering for the poor is a noble act that should demand no incentives, we also feel that it is right to pay health care workers for their hard service in taking care of patients and putting their lives at risk of contracting infectious diseases, just like any other health care workers in developed countries. The rationales behind paying the community healthcare workers are: 1) it would create paying jobs for the community and ultimately boosts the local economy. 2) With payments and increments based on time or performance, it reduces workforce turnover and the costs of finding replacements. 3) By releasing their minds of financial worries to take care of their family, they could focus on their work and perform their jobs at their best.

Tailor-made health care

Every community has its own health care difficulties. No one type of health care fits all. Diseases that are commonly treatable for the privileged may be lethal to the poor. Diseases that are relatively rare in developed countries are relatively common in the developing, for obvious reasons. By focusing health care on each specific community, we are able to recognize common disease patterns, create a system that addresses these diseases, and respond to those in need of urgent attention. By being a privately run community hospital, a more flexible and responsive management is possible where we tailor ourselves to current healthcare needs of the community.

Research opportunities

Our hospitals could be a platform for doing research, whether clinical or epidemiologic studies. As in any other hospitals, collection of all patients’ data is essential. These data, combined with the experiences and findings could be used as research resources. We would like to facilitate affiliations with leading Malaysian Universities and researchers interested to do research in our hospital areas. This is especially rewarding for them since rural areas in South-East Asia are considered an untapped source for research. Scholarly articles, papers and other findings could be published and presented at international academic and scientific conferences and meeting to both to expand the global knowledge of rural health and to further promote our cause. 


Wednesday, April 18, 2012

Keperluan Sebuah Hospital Untuk Komuniti Islam Cham Di Kemboja

Seperti mana yang telah diberitahu pada entri saya yang lepas, saya bersama ibu dan bapa saya telah ke Kemboja pada hujung minggu yang lalu untuk melihat tapak cadangan pembinaan hospital di daerah Kampong Cham, Kemboja. Idea ini tercetus setelah seorang daripada warga Kemboja yang pernah menetap di Malaysia dan sangat fasih berbahasa Melayu, Ustaz Kauthar, dijemput ke rumah saya untuk menceritakan tentang keadaan sebenar orang Islam di Kemboja dari perspektif warga Islam Kemboja sendiri. Secara keseluruhannya, dia menyatakan terdapat banyak pertubuhan-pertubuhan NGO dari Malaysia yang telah melakukan bantuan amal untuk orang Islam di sana, termasuk memberi bantuan makanan, membina masjid, sekolah dan perpustakaan. Namun begitu, mereka masih menghadapi masalah yang besar yang sehingga kini masih belum dapat diselesaikan, iaitu mendapatkan rawatan perubatan dan kesihatan yang berterusan. Sesuatu yang benar-benar diperlukan oleh masyarakat di sana pada saat ini adalah sebuah hospital. Sebelum saya bercerita lebih lanjut tentang cadangan pembinaan hospital itu sendiri, eloklah jika saya memperkenalkan dahulu tentang komuniti Islam di Kemboja agar tujuan pembinaan hospital ini menjadi lebih jelas.

Di hadapan pejabat Al-Ihsan, sebuah pertubuhan yang diasaskan pada tahun 2001 oleh Ustaz Math Sales (berbaju dan berkopiah putih) dan bahagian pemudanya diketuai oleh anaknya, Ustaz Kauthar (memakai t-shirt biru berserta kopiah putih).
Boleh dikatakan keseluruhan orang Islam di Kemboja adalah dari keturunan Cham. Ada juga di kalangan mereka yang dari keturunan Jawa dan Khmer, namun kebanyakan mereka tinggal dan diserap di dalam komuniti Cham sehingga perbezaan keturunan ini semakin kabur. Komuniti Cham berasal dari kerajaan Champa, sebuah kerajaan maritim yang sangat masyur pada sekitar kurun ke-7 sehingga kejatuhannya pada tahun 1832. Kerajaan ini berpusat di kawasan yang kini letaknya Vietnam selatan. Seperti kebanyakan kerajaan-kerajaan lama yang wujud sekitar kurun ke-7, kerajaan Champa yang asalnya menganut agama Hindu-Buddha telah menjadi kerajaan Islam setelah pengislaman kerabat raja-rajanya oleh pedagang-pedangang Arab, India dan Melaka. Pada tahun 1471, kerajaan Vietnam semakin kuat dan berpengaruh dah akhirnya menghapuskan pusat kerajaan Cham utara, Vijaya. Setelah itu pada tahun 1832, saki-baki kerajaan Cham lain telah dihapuskan sama sekali. Pada selang waktu kejatuhan kerajaan Champa ke tangan Vietnam ini, kebanyakan orang Champa berhijrah ke tempat lain, dan kebanyakan akhirnya menetap di Kemboja. Ada juga yang ke Thailand dan Malaysia, terutama di Kelantan dan Terengganu, dan nada juga yang masih tinggal di Vietnam.

Daerah Kampong Cham

Kini, kawasan yang diduduki oleh orang Cham inilah yang dikenali sebagai daerah Kampong Cham. Kali pertama saya mendengar tentang Kampong Cham, saya terpedaya dengan nama ‘kampong’ di hadapannnya dengan menyangkakan ianya sebuah kampung kecil. Namun, Kampong Cham merupakan daerah yang besar, malah merupakan daerah ketiga terbesar di seluruh Kemboja dengan anggaran jumlah penduduk sebanyak 63,771 orang! Pusat daerah yang dikenali dgn nama yang sama, ‘Kampong Cham’, terletak 124 kilometer dari bandar Phnom Penh. Di dalam daerah ini, dianggarkan terdapat lebih 70 kampung-kampung kecil. Orang Cham bertutur dalam bahasa Cham. Saya memperhatikan bahawa bahasa Cham kedengaran lebih mirip dengan bahasa Melayu berbanding bahasa Khmer yang merupakan bahasa rasmi Kemboja. Saya diberitahu bahawa terdapat banyak perkataan Cham yang sama dengan bahasa Melayu. Oleh itu, orang Cham sangat mudah mempelajari bahasa Melayu. Terdapat juga orang Cham yang boleh bertutur fasih dalam Bahasa Melayu kerana pernah menuntut atau tinggal di Malaysia untuk jangka masa yang lama. Yang menariknya, ada juga antara mereka yang fasih bertutur bahasa Melayu dalam loghat Kedah, Kelantan atau Terengganu! Orang Cham mengamalkan ajaran Islam Sunni dan menganut mazhab Shafie’. Mereka menjalankan kesemua rukun Islam: mengucap dua kalimah syahadah, menunaikan solat fardu lima waktu, berpuasa pada bulan Ramadan, membayar zakat dan mengerjakan Haji di Mekah bagi mereka yang mampu. Shamsuddin Al-Ansari, seorang pakar geografi arab pada tahun 1325 mengatakan bahawa Islam datang ke Champa sejak zaman khalifah Usman dan Ali lagi. Pada hari ini, kebanyakan daripada orang Cham tinggal di kampung dan hidup dalam kemiskinan, maka tidak ramai yang mampu membayar zakat dan menunaikan haji. Kebayakan mereka yang di kampung bekerja sebagai petani dan nelayan, manakala mereka yang lebih dekat dengan kawasan bandar bekerja sebagai peniaga runcit dan restoran.
Orang Cham menunaikan yang solat di Masjid
Orang Cham merupakan puak minoriti di Kemboja. Statistik dari Kerajaan Kemboja menanggarkan hanya sebanyak 4% penduduk Kemboja adalah orang Cham. Namun anggaran dengan julat perbezaan yang sangat besar ini mungkin juga tidak tepat kerana ketiadaan system bancian yang sistematik dilakukan oleh kerajaan Kemboja. Tambahan pula, kebanyakan orang Cham tinggal di pedalaman, menyukarkan proses bancian. Kadar kelahiran orang Cham juga semakin bertambah manakala kadar kelahiran daripada penduduk Kemboja lainnya semakin berkurang, menjadikan peratusan populasi mereka semakin bertambah dari hari ke hari. Anehnya, dengan jumlah penduduk Islam yang begitu ramai (500,000 – 700,000 orang), tiada satu pun klinik atau hospital yang didirikan atau dikendalikan oleh doktor Islam. Faktor utama adalah kekurangan doktor Islam di negara mereka sendiri, yang juga diakibatkan oleh kurangnya peluang pembelajaran untuk anak-anak Cham yang hidup dalam kemiskinan.

Kebanyakan orang Cham menyara diri dengan menangkap ikan di Tasik Tonle Sap (photo courtesy of Nigel Dickinson)
Di sini saya akan mula membicarakan apa perlunya sebuah hospital di daerah Kampong Cham. Dari segi geografi, mereka yang menetap di kampung-kampung pedalaman harus berjalan jauh untuk mendapatkan rawatan di bandar Phnom Penh. Dari kawasan kampung, ia mengambil masa paling kurang 2 jam, dan dari kampung yang terletak di kawasan pedalaman, ianya boleh mengambil masa lebih 5 jam. Kerana kos yang mahal untuk perjalanan ini, kebanyakan mereka pada akhirnya tidak mencari rawatan untuk penyakit-penyakit yang mereka hadapi. Bagi yang mampu pula, mereka terpaksa berhadapan dengan karenah birokrasi dan diskriminasi oleh pengendali di hospital kerajaan yang kebanyakannya tidak memahami Islam dan memandang rendah terhadap orang Islam Cham. Melalui beberapa temu ramah saya terhadap orang di sana, mereka menceritakan kisah-kisah pahit ketika mendapatkan rawatan. Kebanyakan mereka dilayan dengan kasar hanya kerana memakai tudung atau hijab. Keadaan ini menjadi serius sehinggakan kebanyakan mereka terpaksa membuka hijab ketika berada di kawasan hospital bagi mengelakkan layanan buruk dan diskriminasi pihak hospital. Masalah yang lebih besar timbul apabila adanya ibu yang hendak bersalin. Kerana ketidakfahaman kebanyakan orang di Kemboja terhadap Islam, maruah pesakit, terutama ketika bersalin tidak begitu dititik-beratkan. Suatu kisah sedih yang dikongsikan oleh seorang penduduk di sana adalah pada suatu ketika, seorang ibu yang bersalin bukan sahaja dijaga dan bayinya disambut oleh doktor lelaki (ini masih boleh diterima), namun turut diperhatikan oleh 10 orang doktor pelatih di dalam bilik bersalin tersebut yang kesemuanya lelaki! Memanglah keadaan ini dikira sebagai darurat, dan mungkin memang niat kesemua doktor pelatih tersebut hanyalah untuk belajar, namun alangkah baiknya sekiranya ibu yang bersalin mempunyai pilihan untuk mendapatkan rawatan dan bersalin di sebuah hospital yang menitik beratkan adab di dalam Islam selain juga menitik beratkan pengajaran.

Ibu saya (paling kiri) bersama kaum hawa Kampong Cham
Keperluan untuk sebuah hospital juga timbul dengan bertambah jumlah dan saratnya penyakit yang dihadapi oleh kanak-kanak. Hasil temuramah saya mendapati kebanyakan anak-anak menghidapi penyakit saluran permakanan, penyakit kulit, kekurangan nutrisi dan penyakit berjangkit. Penyakit berjangkitan seperti jangkitan cacing pernah diberi perhatian oleh sebuah pertubuhan NGO di Malaysia di mana mereka membekalkan ubat-ubat cacing kepada kanak-kanak di sana. Namun, seperti juga bantuan kemanusiaan lain, kelangsungan dan keberterusan usaha-usaha ini amat sukar dengan tiadanya pertubuhan tetap yang mengendalikan usaha-usaha ini yang berpangkalan di Kemboja. Oleh itu, kebanyakan usaha-usaha ini hanya dilakukan paling banyak setahun sekali sedangkan pesakit memerlukan ‘follow-up’ atau perhatian perubatan yang berterusan.

Ustaz Kauthar menunjukkan tanah yang dicadangkan menjadi tapak penubuhan hospital
Terdapat juga beberapa lagi kisah yang mungkin saya akan kongsikan di entri-entri akan datang. Saya berharap agar idea dan usaha untuk membina sebuah hospital di sana akan menjadi kenyataan pada suatu hari nanti. Saya sedar bahawa usaha ini amat sukar dan mungkin memakan masa bertahun-tahun melihat kepada proses penubuhan hospital di Malaysia sendiri. Namun begitu, saya berharap segala usaha ini tidak akan menjadi sia-sia. Sebagai permulaan, saya akan berusaha untuk menubuhkan sebuah badan NGO yang berperanan memantau, mengendali dan mengutip derma untuk tujuan pembinaan hospital. Saya juga memerlukan bantuan orang ramai untuk menyebarkan maklumat tentang komuniti Islam di sana dan juga tentang pembinaan hospital ini. Diharap semua usaha ini diberkati oleh Allah SWT, insyaAllah. 

Thursday, April 12, 2012

My New Endeavour in Cambodia

Most of my bizarre ideas are like the finest of coffees. Both of them are brewed in cafes, and before that final process, it takes a lot of time to cultivate, process, grinded, tamped upon and put under pressure. As I was having my usual morning caffeine kick at a small sidewalk café in India, a flash of idea brewed upon me. It started by asking myself ‘how did I get here?’ followed by ‘what does this journey, that I have trotted so far for, means to me?’ The journey I thought of was not of my trip to get there in India. No, not that. I was thinking about the journey of my life, is this all to it?

I was in Mumbai for an International Workshop on Healthcare and Medical Education, so days before I had to listen to hours and hours of lecture on the Indian healthcare system by one of India’s prominent public health specialist. She explained about all the good side and also the lacunas in the country’s healthcare system. I have always been interested in the healthcare system everywhere I go to (I ended up learning more about the National Health Service, NHS in the UK when I am supposed to learn ENT there). Then we went to the slums area. The situation there is beyond words, the people were poor, living in small, dark spaces, some of them downright unhygienic. The words of the public health specialist kept resounding in my head: ‘’we are good on policies but rarely on implementation’’. Then I remembered these words from the Holy Quran:
O you who believe! Why do you say that which you do not do? It is most hateful to Allah that you should say that which you do not do. Surely Allah loves those who fight in His way in ranks as if they were a firm and compact wall (Quran, Ash Shaff [61]: 2-4)
I began to think about myself. Traveling the world, seeing new places, experiencing bizarre things, winning awards and speaking in public might seem fulfilling to me. But is that all to it? I can write pages and pages and speak for hours and hours on suggestions of policies that could improve the health care of those who are most deprived of, but is writing and talking all that I can do? What can I do to walk all my talk?

I have been thinking about that a lot lately.

A few months ago, a Muslim Cambodian was invited to our house to give an overview of the situation of the Muslim community there in Cambodia. The situation there is that while many missionaries from Malaysia were there to build schools, provide shelter and food, they still lack health care services. It felt like a calling to me to see what I can do. My father sparked the idea of building a charitable hospital there. However, he has his own new endeavour of setting up a medical school that he has less time to work on that idea. It came to me that maybe I can take over the project. That idea was cultivated, processed, grinded, tamped upon and put under pressure in my mind until the time in that café in Mumbai where I have decided that with guidance from the words of the Almighthy as stated in Ash Shaff [61]: 2-4, I will start this new endeavour. Health care is my specialty, I have the knowledge, and this is the time for me to put it to good use, ‘to fight in Allah’s way in ranks as if I am a firm and compact wall’. I am going to start saving the world by helping the most destitute people. I am going to start with Cambodia. This weekend, I will be going to Cambodia with my parents to visit the community there, assess the situation and start planning something. This is going to be a long endeavour. It might take months or years to see results, but I will strive to be persistent in this.

I might be young, I might be naïve, I might not have a clue of what lies ahead. But mainly what makes a weakness might also makes a strength, as how a strong sword can also be tempered into a strong shield. By not knowing what lies ahead, it keeps me going on to discover and keep challenging myself and asking ‘’what happens next?’’. For now, what happens next is that I am going to Cambodia, keep on writing and speaking about the situation there to raise funds, and set up something that could sustain the efforts physically and financially. Obviously, I cannot do this alone. I will need help from other people: friends, family and colleagues. It might not seem clear yet what sort of organization or foundation I am going to form, but I sure will know when I get back from Cambodia this weekend. Pray that Allah be with me. 



 

Wednesday, April 4, 2012

The Mumbai Experience

I go wherever life takes me. Today, life takes me to India. As I am writing this, I can hear the continuous sounds of blaring horns from cars, taxis and autos alike. The sun shines on the dusty streets of Mumbai as I look outside my window. People are walking around doing their daily business. Some work, some beg, some lay idle on the streets. Mumbai is known as the financial capital of India, and the booming economy of the area is evidenced by massive constructions going on. There are the rich, the poor, and very little in between. I get to experience both the bright and dark side of Mumbai. From the highest point of a lounge of a 5-star hotel, to the shoddy, dark and cramped slums of Mumbai.

Some work, some beg, some lay idle on the streets, some do all of those
The city is complemented by its people whose personality is as dynamic as the city itself. Along my stay for the International Interactive Workshop (IIW) at the Four Season’s Hotel, I have met so many locals, most of them fellow medical students who were very hospitable towards us. There were four Malaysians in the workshop, and before me and my friend Hannan went here, we had no idea that the other 2 Malaysians, Jasmine and Manissa were coming. We met during the opening ceremony, and since then four of us would go around Mumbai together with guidance from the Indian IFMSA President, Pratap Naidu, who happens to be a Malaysian citizen studying in India.

From left: Me, Hannan, Pratap, Jasmine, Manissa
He recommended the prominent places in Mumbai, such as the residence of the Bollywood star Amitabh Bachan and Shah Rukh Khan, the prime area of Bandstand Beach, Linkin Road shopping area, the Gateway of India and the Taj Hotel. The colonial era feeling was apparent as we walk around the Gateway of India and The Taj Hotel, where the gateway was built to commemorate the arrival of King Henry V to India during colonial times. We had dinner at Leopold café, a very old café that existed since colonial times. The foods here are might look similar to the Indian food we have in Malaysia, but many are wrong if they thought the taste is the same. The unique taste of the original Indian food could not be replicated anywhere else, and I have fallen in love with the foods here.

Having Indian food at Leopold Cafe

This is NOT London. In front of The Taj Hotel

The Gateway of India
The next day we went into the slums of Mumbai. The slum visit was one of the most eye-opening experiences throughout my stay in India. I am sure many have seen the Oscar-winning movie ‘Slumdog Millionare’, and many might have thought the movie might have exaggerated a bit on the part where they portray the slums. But they did not. The slums were just as it was seen in the movie, small, dark rooms, cramped, shoddy and dirty. This is where the poor live, and I have so much sympathy for them. But what surprises me from our interaction (via a translator) is that they are quite happy with the way they live. Some did not even want to move out of the slums even if they have been given the resources to. I have also been told that the child actors in the movie Slumdog Millionaire were actual child from the slums and their parents refuse the royalty payments from the movie because they want their children to stay in the slums.

She is quite happy with her life
The children living in the slums
At night most of the workshop delegates and us went to the Aer Lounge at the roof of the Four Seasons Hotel. The view was amazing beyond words. I have always loved city lights and the view from up here serves the perfect place to chill out from days of conference workshops. Of course, the drinks to choose from were very limited, I would love to have coffee up here but the closest they have was a mixture of chocolate, hazelnut syrup and coconut. It seems like a weird combination, but it tasted amazing. We really had a good time that night, playing ‘Truth or Dare’, taking pictures and just talking, getting to know more about each other. It was a magnificent night.

At the roofs of the Four Seasons Hotel, Mumbai
The workshop itself was great in terms of content. I have always been interested in health policies and global health, and the workshop serves a great medium of understanding for me. I presented about the current Malaysian Healthcare but stopped short at 1 Care since there are still so many vagueness in the policy. I won the 'Best International Speaker' award for my presentation. Public speaking and presenting has always been my passion, and this serves as a motivation for me to live a life of traveling, writing (research and publications) and presenting.
Award Certificate
Before the presentation
Today is my last day in Mumbai, and our next stop is Bangalore. I choose to visit Bangalore because I have so many of my friends there, and it is actually the place where I was offered to study medicine at before I decided to switch to Indonesia-UKM Twinning Program. I tried to imagine my life if I chose India. How different my life would be?