Thursday, December 12, 2013

“We Actually Get Stupider When We Work Too Much”: The Case of House Officers

I have a habit of eating vegetables on the plate after I have finished eating everything else. It is surprising that many times when I eat with my friends, while I am wholly enjoying the ‘ayam masak merah’ with steamy rice, leaving the vegetables at the side to be consumed later, they would jokingly point out “Ha, you don’t eat vegetables? I thought doctors always ask people to eat healthy food?” This is a simple case of a common people assuming the doctors are not walking their talk. We have all heard the story of the heart surgeon who smokes a lot, the physician who is too obese, the psychiatrist who is always depressed and all those sorts of irony. As doctors, we always advice people to maintain a healthy lifestyle: Go for workouts, do not eat fast food, eat home-cooked meals, spend time with family and friends. But surprisingly, as we tell people all these things, deep in our minds, we say to ourselves “yeah good luck with that, even I have no time for those”.

Recently there has been a lot of commotion about the incompetence of Malaysian House Officers. We had the same furor half a decade ago, and the solution thought by the Malaysian Medical Council and Ministry of Health is that the House Officers need more exposure. Hence, from the one-year housemanship time period, it was increased to two years. Then a few years down the road comes again the same complaint. The assumption? Still need more exposure. We cannot increase the number of years (been there, done that). Hence, the suggestion was to increase the hours.

Doctors are not manual labors. Every decision we make may mean life and death to somebody. Tasha Eurich, a Ph.D. holder in psychology and author of a new book ‘Bankable Leadership’ go as far to say that “We actually get stupider when we work too much”. No matter how competent a doctor is, no patient wants a half-asleep doctor taking their bloods. The decision-making of a person is severely impaired simply because of sleep deprivation. I am a coffee lover and am familiar to the adage: “Drink coffee and keep working, you can sleep when you are dead!”, but research shows that even stimulants do not help. The researchers at Harvard Medical School recently found out that people who were sleep deprived might as well make a random decision. They performed less well as compared to those who had enough sleep even when given stimulants. Then when they were given a long period of recovery sleep, baseline decision making skills are back to normal.

As for the house officers themselves, studies show that over time, working long hours can increase their risk of depression, heart attack, and heart disease. It also increases the risk of road traffic accidents. This might not be proven yet in Malaysia, but with all the same stories I receive from house officers, I think a research should be done on how many housemen fell asleep at the traffic light back from a long day at work. It is downright dangerous. House officers, they have gym memberships but never had the time to go, they learn to cook healthy foods when we were students but now we are going to have to forget all of them, they have good friends and families, but never have time to see them. They go out of the house before the family wakes up, and come back at night after they have slept.  For those with spouses, an article on Harvard Business Review reveals that 50% of workers who work more than 40 hours a week are so depleted and drained when they get home at night that they’re speechless, incapable of conversation. Can you imagine how this will take a toll on relationships? How are we supposed to take care of other people when we do not have the time to keep ourselves healthy?

Realizing the bad effects of working long hours of health, we should forget the idea that to increase competency we should increase the number of working hours. It is not the hours that are at fault but the years before they graduated from the medical schools. We have too many students graduating from unrecognized Universities, too many private medical schools sprouting out without the capacity of enough lecturers to teach, too many students in a teaching hospital wards, and such. In recent years, the health indicators of Malaysians have seen good progress. Working here at the World Health Organization, Malaysia is always held in high regards when it comes to health care. It makes me proud being a Malaysian. House officers are too used to being told by specialists: “during the old days, I am the only doctor in the ward, worked on call 2 days straight”. Well then, look at the Life Expectancy, Malaysian Maternal Mortality Rate, Deaths of Children Under-5 and Prevalence of Infectious Diseases in the old days. If you want everything to be ‘like the old days’, would you also like our health indicators and life expectancy to regress back to the ‘old days?’. Doctors are also human beings included in all statistics on health indicators.

Going back to the conversation that I had with my friends as I was eating ‘ayam masak merah’, I wish someday I can fork the vegetables into my mouth, eat it all and say “Yes, I eat vegetables, I exercise at the gym 3 times a week, I usually cook my own food, and I usually go jogging on weekends when I am not working”. “Gosh, you are a doctor, you have time for that?”

“Yes, a doctor  is an advocator for health, no?”


1. The impact of sleep deprivation on decision making: A review. Harrison, Yvonne; Horne, James A. Journal of Experimental Psychology: Applied, Vol 6(3), Sep 2000

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The Long Work Hours Culture: Causes, Consequences and ChoicesBingley, United KingdomEmerald Group Publishing Ltd2008.

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Long working hours and risk for hypertension in JapanJ Epidemiol Community Health 2001

Monday, November 25, 2013

Reviving the Politics of Responsibility

3rd week working at the World Health Organization (WHO) in Geneva, reading old reports, this particular paragraph made me proud to be Malaysian:

"on November 21, 1997, there was an official request to fund for an emergency rescue loan. Indonesia and Thailand signed up. Yet Malaysia did not. Amid mass demonstrations, the Malaysian prime minister Dr. Mahathir bin Mohamad, refused IMF assistance...It instead implemented a fiscal stimulus of 7 billion ringgit, including a boost to social safety net measures to mitigate the impact of the crisis...Malaysia took a dramatically different approach..Those choices helped prevent Malaysians from suffering the fate of Thailand, Indonesia and South Korea whose politicians chose to swallow the bitter pill of austerity. Indonesia and Thailand experienced significant increases in poverty and prevalence of malnutrition. Malaysia, by contrast expanded its food program to impoverished citizens and experienced a much smaller rise."

I like the old political landscape in Malaysia, where politicians decide on what they feel is right instead of what is popular. Sometimes radical decisions must be made, even if the decision seems to be less popular. Believe in what we feel is right, not fumble upon every demonstrations that threatens the number of votes. Leadership is not a popularity contest, especially when it involves the health of the whole nation. I am still waiting for a Malaysia that thrives on the politics of responsibility rather than popularity

Friday, October 18, 2013

My Stay With The Cape Malays

I will never forget my pleasant stay in Cape Town with the Cape Malays of South Africa. The hospitality of Dr Fahmi and Madam Fareeda will be impossible to be repaid. The offer to stay in their house during my arrival, all the delicious Cape-Malay food that they cook, that I often laugh to how much similar the names are: "begedil, belacan, sambal, bubur, etc', the crash course tour around Cape Town, tracing back the Malay heritage. It is so interesting how they always refer to themselves as the Malays to me, like "We the Malay men are always like this, and Malay women tend to be...this and that", like hey, you're talking to a Malay as well. Haha. No words can describe how blessed my stay in Cape Town was with them hosting me. I am so touched to know that Dr Fahmi is suffering from cancer and is in chemotherapy, but his energy in taking me around Cape Town is admirable. To dear readers, please pray for his health and longevity. Even though it was just for 4 days, they pretty much are like my African grandparents! One of the days they took me for a walk along Boulder's Beach to see the penguins:

Uncle Fahmi was very helpful and enthusiastic towards my cause. He got me a live interview at a South African radio station, set me a meeting with the Islamic Medical Association of South Africa, and took me to the free health clinic their association built to provide health for the poor and needy.

One day they took me to the Bokaap area, the Cape-Malays settlements. It is interesting to know that the Cape Malays originated from the Malaysia-Indonesia region during the Dutch Colonial times. Many of them are descendants of freedom fighters, religious leaders and prominent people who are sent off by the Dutch into exile to Cape Town. Many of the Malay words are still used such as 'terimakasih', 'meninggal', 'lebaran' and such. Bokaap consists of very colorful houses, with the background of the magnificent Table Mountain. 

On the last day, I went to the top of the mountain. The view up there is absolutely beautiful, like I am on an island in a sea of clouds! I went there early morning and it is almost just me up there, having the mountain all to myself ;)

My stay in Cape Town has been most wonderful. I truely think Cape Town is a place that is largely unexplored by Malaysian tourists because I rarely hear Malaysian coming to South Africa or Cape Town for holidays when it is absolutely the perfect place to be! I would really recommend a visit, because if given another chance, I will be here again for sure!

Thursday, October 10, 2013

The One Young World Summit, Johannesburg

One Young World has been the most eye-opening event I have ever been to. So many young people are doing amazing things across the world. I feel so small with the project that I am doing. But the good thing about feeling what you are doing is small as compared to others is that it feels more achievable. If other young people can do greater things than me, so then what is my excuse? The moment I stepped off the stage, streams of people came and told me words of hope, to continue what I am doing. But the best words came from the Father of social business himself: Professor Muhammad Yunus, whom I got to talk to backstage. He told me things will be tough, but to never lose faith in what you believe in. My speech can be viewed below at 14:44 minutes:

Living In My Dream House

I have always wanted to stay in a house over viewing the sea, with stables and green fields where horses graze, preferably set with a background of a huge majestic mountain. I never thought the dream came true for me, even though just for a 2 days stay. I  booked a hotel for my stay in Cape Town just through reviews on TripAdvisor, but little I know that it is actually a house, and as I am the only guest for the whole of my stay, I got the house all to myself! The house is situated in Noordhoek, a little bit far from the city centre of Cape Town, making it a very peaceful township. The best thing is that it overviews the sea on one side, and is surrounded by mountains on the other. So there is a horse on my backyard and I have no idea what to do with it. I think no amount of words can do justice towards how beautiful the place is, I'll let pictures do the talking, and this is the theme song for my stay here, Bic Runga's Listening For The Weather. For some reason the song reminds me of horse stables, haha and that is why it is the song of the day!:

Tuesday, October 1, 2013

The Time of My Life

Longest itinerary I ever had
In a few hours time, I will be starting on what I think would be one of the best times of my life. It will be a 4 months journey across the globe from Kuala Lumpur to Johannesburg to deliver my One Young World speech in front of the likes of Kofi Annan, Richard Branson, Professor Muhammad Yunus, Jamie Oliver and Bob Geldolf. Then to Kruger National Park, staying INSIDE the safari for 3 days to catch sight of the Big 5: the lion, African elephant, Cape buffalo, leopard, and rhinoceros. Then flying off to Cape town for my 3 days stay hosted by the Malay-African Cape people, to marvel over the magnificent Table Mountain and observe the cute penguins at Boulder Beach

Afterwards, I am going to Norway to deliver a Keynote Lecture at the Global Health and Vaccination Research Conference 2013 at the University of Bergen, riding what is deemed the best train ride views in the world from Oslo to Bergen. Perhaps I will visit the Fjords of Norway afterwards, one of the great natural wonders of the world.

Once I'm done in Norway, I would make my way back to South-east Asia, to Cambodia for Hospitals Beyond Boundaries Health Screening Project for 3 days. Then coming back to Malaysia for my convocation. Then I would attend the Global Social Business Summit in Kuala Lumpur, 7th-9th November as one of the 6 youth ambassador selected across the world by Nobel Laureate Professor Muhammad Yunus' The Grameen Creative Lab

On 11th November, I will fly off to Geneva, Switzerland to start my work as an intern at the World Health Organization (WHO). What happens afterwards? Only Allah knows. I am very thankful for all these opportunities He gave me. I've never felt so blessed in my life. Thank you to all my family members who supported me and believed in what I do

Wednesday, September 11, 2013

Of Mountains an Volcanoes: The Bromo Experience

The trip to Bromo was absolutely one of a kind experience. From the conference in Yogyakarta, I tagged along with my dear Indonesian friends Oghe and Yodha to the city of Malang 6 hours away. However, they both just recently went to Bromo. Luckily, there were also 4 other people already registered as we went to the tour agent, so my travel that day will be along with those other four.

I met all of them at 1 a.m. at their hotel and our tour starts at the same time. The journey to the top was freaking scary with narrow and bumpy roads. It was so dark all you can see are the stars and the path ahead shined by the jeep. It took 3 hours to get to the base point. We reached the base around 4, and there we met so many other people from other tours. They were all preparing for the last hike up to the top, and were having breakfast, coffee while waiting for the sun to rise around 5 a.m

We went to the top around 4.30 a.m. It was freezing cold, and the air up there was thin so we easily get breathless as we hiked up the hill. It was still dark, and the skies were amazingly clear. There were a lot of people up there waiting for the sunrise, watching the stars. The stars were beautiful, and we occasionally see shooting stars, and everybody will go ‘Oooh’ everytime they see one. It was kinda funny
Then, the first orange streak appears above the horizon. Sunrise was coming, everybody was so excited, I’ve never seen people so excited seeing a sunrise before, people usually dread waking up in the morning. Haha. As the sun came out, the grounds below became more and more visible. The mountains seems floating above the clouds. The view was absolutely amazing, I can never be able to describe it in words. We were there for almost 2 hours just marveling the beauty of Allah’s creation. 

 Then we went down by the jeep to one of the hills with the same view of Mount Bromo. I had a really nice coffee overviewing the volcano. Best coffee experience ever! As I was sitting there looking at the volcano I saw small miniature boxes moving around the volcano leaving the trail. I looked more carefully and realized, heck, it was the jeeps! I never realized the volcano is so freaking huge until I compare it with the size of the jeeps which looks so minute next to the volcano. Then we made it down to the volcano crater itself.

We stopped by at ground level near the volcano to have some breakfast. The place was like a desert, full of sands and dusts. We literally ate dust along with our breakfast. We took a few photos and continued our journey to the volcano crater.

We had to stop 2 km away from the crater and started hiking again. It was so tiring, but on top, we can see the crater so deep and scary you’re gonna be so dead if you slip into one of these  
Then we went down and passed through a somewhat grass field that looked that African savannah. It was beautiful as well, and we took a lot of pictures, and went ahead to see some of the hillside farms, watched the people growing various fruits and vegetables, and lastly went to a waterfall.

The trip has taught me that the Creator’s creation is so magnificent, amazing and huge and we are just a speck of dust in comparison to the universe he created. Sometimes when we are so stuck up in our daily life, we forget these things. We forget that your troubles is just a speck in a dust in a universe. I need to take times for this kind of trips once in awhile. It reminds me that whatever you face in life, there is always a way to get through it, and when you don’t, don’t worry. Life is so much worth living to see other beautiful things on earth

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