tag:blogger.com,1999:blog-78666794615232004852024-03-14T19:08:26.586+08:00Coffee TalkWhen caffeine does the talkingLutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.comBlogger146125tag:blogger.com,1999:blog-7866679461523200485.post-48184159096383405532019-12-15T23:26:00.002+08:002019-12-15T23:26:49.854+08:00Still here<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: "trebuchet ms", sans-serif; text-align: justify;">We took an evening stroll down the Tonle Sap river at Chroy
Changvar today. The exact same place I described in this </span><a href="http://lutfi-fadil.blogspot.com/2016/03/the-kind-of-day-i-wish-to-live-all-my.html" style="font-family: "trebuchet ms", sans-serif; text-align: justify;">blog
post</a><span style="font-family: "trebuchet ms", sans-serif; text-align: justify;"> where I wrote about ‘the kind of day I wish to live all my life’. Well,
guess what? 3 years later, I still get to live that kind of day, but with more fun
company with my wife and son by my side. We’ve been spending the last 4 months
in Phnom Penh, with some periods of time back in Malaysia (our visa only lasts
for 1 month per entry), and so far, it has been a pretty fun stay!</span><br />
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<span style="font-family: "trebuchet ms" , sans-serif;">I am here for my doctoral thesis project to enable
value-based health care at HBB Clinic. For that, I implemented a cloud
web-based electronic medical record (EMR) that I had developed myself (learned coding
from scratch, JavaScript to be precise – React.js to be even more precise). I
had to develop it myself because currently there’s no EMR that captures all the
data needed to assess value of care all in one system - including clinical
data, patient-reported outcomes, activity-based costing and timing data. <o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;"><i>Screenshot of sample patient from my EMR</i></span></td></tr>
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<span style="font-family: "trebuchet ms" , sans-serif;">Phnom Penh might not be the most convenient city to live in,
but I guess it is the activity that we do here every day that made the stay
more meaningful than living in a big city with a better amount of resource. There
is a different kind of satisfaction when you wake up in the morning and know
exactly what to do and being aware that every decision will make an observable
difference. Another huge plus-point is being able to do all this while being
flexible with our time - very important for a family with a one-and a half year
old!<o:p></o:p></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">I usually wake up early to make sure I wake up before Umar
does. I could get a solid couple hour of work done at this time. When Umar
wakes up, we get ready for breakfast. Kamaliah usually prepares breakfast while
I take Umar for shower, but sometimes we just get ready for the day and go to a
nearby ‘Mamak’ restaurant when we miss eating ‘roti canai’ and ‘the tarik’.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">While here, Kamaliah manages a hearing care center called
HCC, started by my family a year ago. She’s in charge of 3 full time staffs
working there, so sometimes she will have meetings with HCC staffs in the
morning, so we depart to HBB later in the afternoon. </span><o:p></o:p></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;"><i>Prof Sharaf, Malaysian Orthopedic Surgeon and long-time family friend, visits HCC</i></span></td></tr>
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<span style="font-family: "trebuchet ms" , sans-serif;">So, I am back to doing what I was doing 3 years ago, in charge
of the 5-staffed HBB Clinic. HBB is around 30 minutes away from HCC. We always
go there together. At HBB, I help the staff use the newly implemented EMR,
listen to their suggestions, teach them a bit on value-based care and do
meetings to discuss about HBB in general while Umar plays with the cat and Kamaliah
looks after him. Sometimes, we get visitors from Malaysia, so we take them for a tour around Phnom Penh and HBB.</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;"><i>Teaching the staff to use the EMR</i></span></td></tr>
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<span style="font-family: "trebuchet ms" , sans-serif;">During this time, I also oversee a renovation of the clinic.
It has been 4 years since the clinic was launched – it’s time for a new look!</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;"><i>Before</i></span></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;"><i>After</i></span></td></tr>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif;">Before</span></td></tr>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhv7e4UA5bz17tsWJy4ZwGC119OOJk780axC9AJGyJxUnbfUgGKJYNg0QEIbRNyfuWmp05PngfiKDXUStVe3aTUXFxGofGKr-gSJaGi4FCoIsk8PsgvAeZGtOswB1ixO6i3etosyEBt2sY/s1600/n.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1600" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhv7e4UA5bz17tsWJy4ZwGC119OOJk780axC9AJGyJxUnbfUgGKJYNg0QEIbRNyfuWmp05PngfiKDXUStVe3aTUXFxGofGKr-gSJaGi4FCoIsk8PsgvAeZGtOswB1ixO6i3etosyEBt2sY/s640/n.jpg" width="640" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;"><i>After</i></span></td></tr>
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<span style="font-family: "trebuchet ms" , sans-serif;">In the late afternoon, we take walks, sometimes along the
river like today, sometimes in shopping malls, or if we’re too lazy to walk we’ll
just hangout at one of the new hipster cafés or Boba tea joints. The shopping
mall is Umar’s favorite place because he gets to play at the indoor play area
called ‘Kidzoona’ which has all sorts playing props.</span><o:p></o:p></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: "trebuchet ms" , sans-serif; font-size: x-small;"><i>Umar playing doctor-making-burger</i></span></td></tr>
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<span style="font-family: "trebuchet ms" , sans-serif;">We are almost at the end of our stay in Phnom Penh. While I
won’t say that it is absolutely the best times of our lives, it is certainly a valuable
moment that we will cherish. I mean, life is Boston is good, it has everything
(thanks Amazon) and access to knowledge and learning is unbeaten anywhere else
in the world. But I can’t be totally flexible with my time because of class,
meetings and appointments. Nothing beats life back home in Malaysia too.
Nothing can replace the satisfaction of being close to your families and being
home where you truly belong. </span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">But living here in Phnom Penh is a unique
experience, where most of it has to do with the amount of time we get to spend
as a family. While doing work, we get to see every second of Umar growing up,
learning new things. Everything we do involves the whole family. It hasn’t
been all smooth, Umar has his tantrums and we get totally exhausted some days, each of us had times when we got really sick. But all in all, it is very unlikely that we will forget the times spent here. With HBB Clinic being here to stay, I guess we will always be coming back.</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com6tag:blogger.com,1999:blog-7866679461523200485.post-19103051359272662752017-11-10T10:00:00.000+08:002018-01-01T04:13:58.679+08:00Kamaliah's 27th Birthday<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "trebuchet ms" , sans-serif;">One morning not a long time ago, as I was preparing to go to class, I heard Kamaliah say:<br /><br />“Semalam abang tengok ratio lelaki:perempuan untuk predict anak kita boy/girl lagi ke??” (Were you looking at the male:female ratio to predict our baby’s gender again??).<br /><br />The previous night, we were surveying on Google for the best strollers around (still contemplating between Nuna and Uppababy). Somewhere along the way Kamaliah fell asleep, and suddenly I find myself pulling up graphs for the Malaysian population’s gender ratio and the predicted age-dependency ratio. The next morning, when Kamaliah saw all these graphs on her Macbook, she immediately knew what I was up to (it was not her first time seeing those graphs).<br /><br />Kamaliah will tell me that I am lame for predicting our child’s gender based on the latest ratio (107 males : 100 females), and for worrying too much that the high dependency ratio in 2050 will cause our child to be burdened by high taxes to finance healthcare for the old population (a positive argument for national health insurance).<br /><br />Such a pity marrying someone who’s so much into health economics! Kamaliah learned these less useful things from me, but on the other hand, what I learned from her is so so much more. Let me name a few. Kamaliah taught me to cook good Malaysian food. One of our favorite do-together thing now is our cooking! You see, I was hopeless before, but Kamaliah persisted in teaching me and now I can cook Malaysian food…not that great as her…but edible. I also always enjoyed going to the Asian grocery with her, and her eyes will lit with excitement and she will go “Abang, abang, abang tengok ni!” for every single item she found that is made in Malaysia.<br /><br />Another thing I learned from Kamaliah is to replace ‘screen time’ with ‘people time’. We spend so much more time together these days, and we had a lot of weekend adventures together. We went whale watching, strolled through Salem in the midst of Halloween season, watched our very first Broadway theatre in New York, went seafood hunting in Cape Cod, and drove through the roads to New Hampshire to admire the beauty of autumn foliage. One of best sayings we also learned from the whale-watching tour guide is that “sometimes people spend too much time looking at these whales on their phone screens that they forgot to enjoy the majestic experience of being in front of these big creatures”. Since then we put our phone down, enjoyed experiencing one of the largest animal on earth in front of our eyes, and do not care much anymore about likes and comments on social media. We’ve practiced living in the moment since then. It is so much fun when you have one person you can share all these great memories with. One like and live comment from her is all I need.<br /><br />However, all of these learning could not beat the exciting lesson of being future parents! We can’t wait to welcome our baby into this world. During our last doctor’s appointment, we can already see our baby move his/her hands. It was so surreal, and literally changed my perspective on life. For the first time it feels so real that we will be having someone who is totally dependent on us, everything we decide, everything we do will affect him/her. People say that once you have children, everything you do, you will have them in mind. I guess we can start to feel that.<br /><br />Happy birthday Kamaliah, my wife, my love. Thank you for being so strong, patient and supportive. I pray to Allah to always keep you within his blessings, each hour and every day, and be the light that guides you, each step along life’s way. Thank you for all the great times, and let’s look forward to growing up (and old) together as parents, insyaAllah!</span><br />
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com6tag:blogger.com,1999:blog-7866679461523200485.post-30221765775594566632017-05-05T23:03:00.000+08:002017-08-29T23:07:07.142+08:00Our First Wedding Anniversary<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif;">Last weekend Kamaliah and I celebrated our first wedding anniversary. We spent time on a private island north of Pulau Kapas in Terangganu. The trip was much more of a honeymoon than the one we had last year in Cambodia, which we end up seeing patients at their houses instead. People say the first year of marriage is the hardest, I guess because as in any process of learning, the beginning is the toughest part. It was even tougher because 2016 was a year of drastic change for me. Several months after we got married, Kamaliah found out that she was pregnant. Not long after, Hospitals Beyond Boundaries shot to international prominence. She was there in New York when it all happened. Kamaliah had to bear the brunt of me shifting attention from her to the public which constantly barrage me with questions, interview requests and speaking engagements.<br /><br />Upon returning to Malaysia, we received the distressing news that our baby's heart was no longer beating. It was such a hard thing to accept. At that same time, I was so occupied with prior speaking engagements and interviews, something that I regretted. I remembered the day she miscarried, I came back at night from a talk, and saw her crying on the bed. I was lost for words, and we only spent the night in silence, hugging each other till morning.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br />I still regret that I didn't spend my time at her side during the moment that she needed me most. But Kamaliah still stood by my side, and was always my number one supporter. She was always there to cheer me up with her wide smile. From the first day I met her, I've always had it in my mind that she is a person with an infectious smile. People just couldn't help smiling when they see her smile. She brings cheer to every room she enters, and I am blessed to have her exuding cheerfulness into every seconds of my life.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br />One year spending time with her, I realized that unconsciously, my life priority has slowly changed. If I can summarize everything she has taught me the past one year to one word, it would be: "humility". Being the super ambitious young man I used to be, it took a strong woman like her to change me. For the first time in my life, I find great satisfaction in fulfilling the need of someone other than myself. I begin to think as a couple, no longer as my own self. At a time that I thought I was "oh-so-human-look-at-me-I-am-humanitarian', she taught me what being a real human is all about. About sharing, caring about those who are close to us on top of caring for strangers, and knowing that no matter how amazing your life achievements are, it would be depressing if there is no one for you to share it with.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br />Kamaliah, I would like to thank you for holding on and teaching me what the real important things in life are. Thank you for being such a great wife, and I am looking forward to the years and experiences we'll forge ahead as husband and wife. Happy first anniversary to us, love you to bits!<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqSbAjLdkRFP40ZQx08YDVmVwDDMg6jLYQ6Nx94AJzSewfG-iKmXsO__E2CVXqEnTnynHZjYsoSacgUh7crppG1KGLqcTr-OGnhSUqOJ30431An9SjS9DNYi8n46Az9SyEE3IZ4sJQWGo/s1600/YATT5212.jpg"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhqSbAjLdkRFP40ZQx08YDVmVwDDMg6jLYQ6Nx94AJzSewfG-iKmXsO__E2CVXqEnTnynHZjYsoSacgUh7crppG1KGLqcTr-OGnhSUqOJ30431An9SjS9DNYi8n46Az9SyEE3IZ4sJQWGo/s640/YATT5212.jpg" /></a></span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-51339278797780366062016-09-02T22:13:00.002+08:002016-09-02T22:13:54.437+08:00Happiest Day of My Life<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif;">I remember every time I go to an old relative's house, wedding pictures were always the ones that is kept displayed in the bedroom, most likely on the vanity table. Those pictures were a window to a time period when they look really beautiful, and we'd say "lainnye muka atok masa muda!". Some of their spouses died when I was really small, and the pictures were the only way for me to see how they look.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">These digital age, we rarely get our photos printed, we always say we'll p<span class="text_exposed_show" style="display: inline;">rint them someday, but in the end never get the time and energy to actually go to a print shop and frame it. Someday, all those photos will be gone when our laptops breakdown...even the ones we thought will be safe in Cloud drives will disappear along with the login passwords that will be lost to dementia or death. In the end, physical printed photos will be the only evidence that we once lived.</span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">I don't know if I will ever go out to print another picture, but if I never did, this photo is enough to represent the life that I had lived...Someday, if I get to live long..if my grandchild or great grandchild sees this picture, I just want them to know, that what they see, is a snapshot of the happiest day of my life.</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com5tag:blogger.com,1999:blog-7866679461523200485.post-49820344379641440382016-07-25T18:25:00.004+08:002016-07-25T18:43:41.978+08:00Me Before You<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "trebuchet ms" , sans-serif;">Earlier this month, my wife pleaded to watch the movie <i>Me Before You</i>, an adaptation of a novel by the same title by Jojo Mayes. Although I was not always fond of book-to-movie adaptations (a cynical outlook that proliferated throughout the years precipitated by movie adaptations such as World War Z, Dreamcatcher and The Great Gatsby), I yielded to her persuasion and decided to give <i>Me Before You</i> a try. A smile settled across her face, her eyes creasing with pleasure as I told<span class="text_exposed_show" style="display: inline;"> her we were finally going to see the movie.</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">To my surprise, I actually enjoyed the movie, with some conversations in it stuck in my mind long after the credits finished rolling. A dialogue that made me reflect was towards the end of the movie, when Lou, who was taking care of Will, a young man progressively paralyzed from an accident (although not medically plausible, unless he suddenly caught Guillain-Barre syndrome, succumbed to a spine cancer or his spine decided to spontaneously degenerate at a young age), asked a question along the lines of “where would you wish to be if you were still healthy?”<br /><br />Will, who was a wealthy young banker, was portrayed as an avid traveller and an adrenaline junkie before he met with the accident. I expected him to answer things like skydiving in New Zealand, surfing in Hawaii or scuba diving in the Great Reef Barrier, but his answer perplexed me:</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">"Paris. I would sit outside a cafe in Le Marais and drink coffee and eat a plate of warm croissants with unsalted butter and strawberry jam. I want to be in Paris as me, the old me, if I shut my eyes now, I know exactly how it feels in that little square. I remember every sensation”</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">I could instantly relate to what he said.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">I guess that when our basic ability was taken away, the activities that seemed presumptuous and routine, were the ones that we miss doing the most. Not skydiving, not scuba diving, not wall climbing. When we are left paralyzed in a wheelchair, the thought of not being able to do simple things like having a cup of coffee in a café without the hassle of trying to fit behind the table, having someone to carry us up the curb, or the stresses brought by being unable to charge our electrical wheelchair because the plug won’t fit French electrical socket made us miss the person who we used to be most.</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;">Although I abjured the movie’s devastating ending that sort of advocate assisted suicide, I am glad that my wife brought me to see this movie for its message of gratitude. I pray we would all stay away from such debilitating disease, and still be able appreciate the little things in life and be thankful for what we have.</span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="color: #1d2129; line-height: 19.32px; text-align: left;"><i><span style="font-family: "trebuchet ms" , sans-serif; font-size: small;">The scene from the movie reminded me of my time in Geneva. After work, I would sit outside a cafe in Le Grand Rue, a cobbled-street alley in between teetering apartment blocks, to drink hot coffee and eat a plate of warm crepe with chocolate, banana and peanuts. It's one of the place I keep visiting when I closed my eyes.</span></i></span></td></tr>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-53723010483246750372016-03-01T06:29:00.000+08:002016-06-14T20:34:06.245+08:00The Kind of Day I Wish to Live All My Life<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "trebuchet ms" , sans-serif;">I spent the night at the clinic and woke up at 6 a.m. I woke up, washed my face and performed Subuh prayers. Later I boiled hot water and had my morning coffee overviewing the small lake by the clinic. The sun had began to rise and I enjoyed it listening to Sigur Ros on my phone while sipping one of the best Cambodian coffee. By 7 am our laboratory staff began sweeping the floor of the clinic. I cleaned and rearranged everything inside the clinic, and then went for a morning shower around 7.30. By the time I got out of the shower 2 patients were already at the waiting area. Lucky I slipped into my jeans and t-shirt in the toilet! I took off the towel from my neck and exchanged it with my stethoscope that has been hanging on the IV drip stand yesterday. It was last used on a student who came in the middle of the night. Now my stethoscope and I am ready to take on a new day. Our main doctor had to go to his university from morning till afternoon, hence I am the only doctor at the clinic. I had to depend the staff nurse to translate the patient’s history. I saw patients until 12pm, a total of 5 patients in the morning. One case of inguinal hernia, one case of UTI, a follow up for hypertension, a follow up for renal stone and a case highly suspicious of basal cell carcinoma, which I referred to a dermatologist for biopsy.<br /><br />At noon one of the obstetric and gynaecology doctors we interviewed and selected to employ last week came to discuss on her contract. We discussed and concluded the contract, and hired her as part of HBB staffs. Later I had lunch at the clinic with all our staffs and stole a bit of time to read on microfinance and community based health insurance since I have a meeting with one of the microfinance institutions in the evening. I performed zuhur prayer before the meeting. The meeting started at 2 pm. We discussed to start a community based health insurance for the community around our clinic. I am sure that this project could benefit the community tremendously. The meeting ended around 3.30 pm. I made my way back to HBB clinic, arriving at 4 pm. I took a short 15 minutes nap and woke up refreshed, and performed Asar prayers.<br /><br />After Asr prayers, I saw that our doctor has seen the last patient. We had our evening tea around 5 pm. By 6, all the staffs had gone back to their homes. I had nothing to do for the night so our male nurse invited me to follow him to take a walk by the junction of Phnom Penh’s 4 rivers. We took a bike there and walked along the river banks where there was stark contrast between the poor people in boat houses and the big hotels by the river. We went down to see the boat people and I decided to start a food package program for them the next time Malaysian volunteer comes.<br /><br />We walked until Maghrib and performed prayers at a nearby mosque. Then we went for dinner by the roadside. We saw one HBB medical student volunteer was eating there alone. We joined him, and I had a good Pho noodle. After dinner we went to Costa Coffee by the Royal Palace. I had a long talk with our male nurse about the future of HBB. We went back to HBB clinic around 10.30 pm. I prepared my sleeping blanket on the floor of the clinic, performed Isya and went to sleep, ready to take on tomorrow<br /><br /><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvbgdIoO8yTgtqWz37Xwj7vVHwcyXpr0qc5Fyof40qE7WUA_hxf-BMQNcs4voOnhqrL6B9wdWPBXYq9WaH4PzEajqoiF4h88OM_2lQFO-LnLKVS9D7z33W0pGwKeEHb7iAw-bc80eNiCw/s1600/12794531_10153884327735520_7427284068716467741_n.jpg"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgvbgdIoO8yTgtqWz37Xwj7vVHwcyXpr0qc5Fyof40qE7WUA_hxf-BMQNcs4voOnhqrL6B9wdWPBXYq9WaH4PzEajqoiF4h88OM_2lQFO-LnLKVS9D7z33W0pGwKeEHb7iAw-bc80eNiCw/s640/12794531_10153884327735520_7427284068716467741_n.jpg" /></a></span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com8tag:blogger.com,1999:blog-7866679461523200485.post-29259172131300087162016-02-10T16:27:00.002+08:002016-09-02T22:18:42.678+08:00Contradistinction<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "trebuchet ms" , sans-serif;">This old lady was lying on the bed when we came up to her house. We couldn't speak Khmer, hence we gestured our way, signaling that the food package were gifts for her. Then, we realized that she was too frail to walk. Wanting not to disturb her rest further, we made our way down from her house. It was then that she suddenly called 'wait!' in Khmer. To our surprise, she crawled her way to her door to see us go, and when she saw all 13 of us handling all these food packages...<span class="text_exposed_show" style="display: inline;">she started to cry. One of our doctors went back up and hugged her tight. It was one of those moments that I will remember for the rest of my life. A moment where I will always go back to when I feel dissatisfied with life. In the words of Leo Tolstoy:</span></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB_rEHNe6DzLFrXBff1E6khNR1stX0BOaBd2QKxM1WcDSjSnUBdtKG6bz4NWkQSnDmueN20Nzr2_Jz_lRB_oAOsW4N6TX0etjw6Tk4laDvFFz9imhqCsp21K1SL0VuHT6PUOeO2hvxOhY/s1600/DSC00159.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-left: 1em;"><span style="clear: left; float: left; font-family: "trebuchet ms" , sans-serif; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="356" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB_rEHNe6DzLFrXBff1E6khNR1stX0BOaBd2QKxM1WcDSjSnUBdtKG6bz4NWkQSnDmueN20Nzr2_Jz_lRB_oAOsW4N6TX0etjw6Tk4laDvFFz9imhqCsp21K1SL0VuHT6PUOeO2hvxOhY/s640/DSC00159.JPG" width="640" /></span></a><span style="font-family: "trebuchet ms" , sans-serif;">"In contrast with what I had seen in my circle, where the whole of life is passed in idleness, amusement, and dissatisfaction, I saw that the whole life of these people was passed in heavy labour, and that they were content with life. In contradistinction to the way in which people of our circle oppose fate and complain of it on account of deprivations and sufferings, these people accepted illness and sorrow without any perplexity or opposition, and with a quiet and firm conviction that all is good. In contradistinction to us, who the wiser we are the less we understand the meaning of life, and see some evil irony in the fact that we suffer and die, these folk live and suffer, and they approach death and suffering with tranquility and in most cases gladly. In complete contrast to my ignorance, they knew the meaning of life and death, labored quietly, endured deprivations and sufferings, and lived and died seeing therein not vanity but good…"</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-91224367437511912612016-01-15T14:36:00.003+08:002016-01-15T16:10:55.863+08:00A Guide to a Meaningful Life<div dir="ltr" style="text-align: left;" trbidi="on">
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">Upon reading articles about what makes a life of purpose and happiness, I tend to find recurring themes. People who are successful and perceived their lives as happy and
meaningful were the ones who never set money, social status and fame as their
life purpose. Here I have summed up the recurring characteristics I found about people
who reach the end of their lives feeling that they lived a meaningful life:<o:p></o:p></span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">1. They believe in a religion / God<o:p></o:p></span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">2. They have close relationships with
family, friends and the community<o:p></o:p></span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">3. They have a stable marriage<o:p></o:p></span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">4. They do what they love everyday; or
better, they make it their career<o:p></o:p></span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">5. Their daily working hours are flexible;
or better they are their own boss<o:p></o:p></span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">6. They often travel to discover new things</span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">7. They are easy to give charity</span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">8. They are debt-free (it is
interesting to note that this point still refers to money. But being debt-free doesn’t
mean being rich. It is about living within your own means. You don’t need to be
rich to be happy, but you do need to be free of debts)<o:p></o:p></span></span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">It is also important to discover these things when we are still young,
the earlier we set out how we want our lives to be, the higher chance that we
will be successful. Once we are aware of these things, we are able to escape
the ‘rat-race’ of our career and be above it. </span></span><span style="font-family: 'Trebuchet MS', sans-serif;">You
will soon discover the false things that people think is important. The fact is, what a person thinks as important in a career, might not
seem important to another. </span></div>
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<span style="font-family: 'Trebuchet MS', sans-serif;">So if what you pursue is social recognition in
career, you would most likely fail, because the one you are trying to impress
is a just a small fraction of the worldwide population, whereas people outside your field wouldn't care much about your position in the company / government. What people care is how much you have touched their lives.</span></div>
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<span lang="EN-GB"><span style="font-family: Trebuchet MS, sans-serif;">So I hope this serve as a simple guide and
reminder to the youths, and I will end by attaching a poster of this beautiful
manifesto on living a full life:</span><o:p></o:p></span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com2tag:blogger.com,1999:blog-7866679461523200485.post-10490304951967277332016-01-01T18:07:00.000+08:002016-01-15T14:40:49.965+08:00First Day of 2016, Full of Optimism!<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif; font-size: small;"><span style="font-weight: normal;">As I am writing this, I am sitting at HBB Clinic Phnom Penh,
on 1<sup>st</sup> January 2016, 3.35 PM. The weather has been very good
throughout the day, clear skies, warm but windy. One side of our clinic is
surrounded by water, which makes the environment around our clinic yet cooler
and serene.</span><span style="font-weight: normal;"><br />The clinic is much lively today, with our HBB team members,
HBB clinic staffs, and 30 volunteers from 3 different universities all
gathering here for a briefing followed by training session for a community
survey around the clinic area tomorrow. Perhaps seeing the crowd of people at
our clinic, many of the local kids also came to see what was going on, and in
the end joined us at our clinic.</span><span style="font-weight: normal;"><br />All of them just had lunch at our clinic this afternoon,
followed by a briefing session led by my cousin who volunteered with us for the
past 2 weeks. Right now the 30 of them are broken down to 5 groups, each having
their training session at different parts of the clinic. Some stayed at the
lunch place, some into the meeting room, some went to our consultation room.</span></span></h2>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxkZnXZJBWnfND0zcrJan24M_ZDPbrVoiS1iyJuK5w_OfxwTV2SmA70VUAfYdFwwa7QPc_Inaby2wGx5SoQRpDbIcdnfJLss4jb0awdc_-mP3_cI2ZSAv8tbge73D8wQBWWNgfmH8tO4o/s1600/DSC09604.JPG" imageanchor="1" style="font-weight: normal; margin-left: 1em; margin-right: 1em; text-align: center;"><span style="font-family: Trebuchet MS, sans-serif; font-size: small;"><img border="0" height="356" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxkZnXZJBWnfND0zcrJan24M_ZDPbrVoiS1iyJuK5w_OfxwTV2SmA70VUAfYdFwwa7QPc_Inaby2wGx5SoQRpDbIcdnfJLss4jb0awdc_-mP3_cI2ZSAv8tbge73D8wQBWWNgfmH8tO4o/s640/DSC09604.JPG" width="640" /></span></a></h2>
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<span style="font-family: Trebuchet MS, sans-serif; font-size: small; font-weight: normal;">I love to see all these students at work, and am very
thankful for their hard work for HBB. As I look around the clinic, I see faces
full of hope and lighted up with excitement. As I sit here writing at the
consultation table as each group is having their own session, an overwhelming
feeling came over me. It is the kind of feeling that I can never begin to
explain. A feeling of happiness, thankfulness, peacefulness and purpose. It
feels good to leverage a whole group of talented people coming from all corners
of Malaysia, to come here to a piece of foreign land 2000 kilometres from home
to do this house-to-house survey and medical check-up.<br /><br />I know I can never capture this moment into a single
picture, and the only way to do justice is to write about it.<br /><br />Right from the beginning, I know I want to do this all my
life. I want to spend a lifetime of service, not just doing it myself, but
influencing and convincing more and more people to do the same. For all of us, HBB
is not just an organization, it has a lot more to do with our personal lives.
We didn't have to compartmentalize any of our life’s ambitions: family, good
friends, professional passion or philanthropic mission. They all converged into
a single goal. Someday when I can sustain HBB to be a full-time career, I will
never again have to choose the time between family, friends, work, and charity.
With HBB, it all converges into one. I guess this convergence will be my new
year’s resolution…this year and years ahead<br /></span></h2>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-14879192134052406762015-12-21T17:39:00.000+08:002015-12-21T17:50:21.147+08:00Health in All Policies (HiAP) in Malaysia: Now More Than Ever<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif;">I refer to the statement made by our Deputy Director-General of Health, Datuk Dr Lokman Hakim in the New Strait Times article ‘<a href="http://www.nst.com.my/news/2015/12/117815/multi-agency-effort-needed-tackle-diseases-says-deputy-d-g" target="_blank">Multi-agency Effort Needed to Tackle Diseases</a>’ on 18 December 2015. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">In the wake of recent national issues that directly affects health such as that of vape, bauxite mining and leptospirosis, the Deputy Health Director-General's comment on the necessity of multi-agency effort to combat diseases came at fitting time. Although the focus of his comments was on leptospirosis, there is a larger and growing national concerns that commends such effort: non-communicable diseases such as diabetes and hypertension (NCDs) is on the rise, infectious diseases such as dengue and leptospirosis is becoming epidemic across the country, health care costs are spiralling up, inequities are growing. On top of that, we face urgent environmental problems that contributes directly to health hazards: the recent haze, bauxite mining in Kuantan, water contamination to name a few.</span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span>
<span style="font-family: Trebuchet MS, sans-serif;">Lacking the mandate, authority and organizational capacity, the prevention of these issues that require nation-wide interventions are largely beyond the power of Ministry of Health. We as medical doctors can plead for things like lifestyle changes, tough legislation against vaping, high taxation for tobacco, but we cannot re-engineer social and political environments in ways that puts health at its core.</span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span>
<span style="font-family: Trebuchet MS, sans-serif;">Many developed nations have long recognized the importance of inter-sectoral efforts in tackling diseases and can be traced back to the 1978 World Health Organization (WHO) Alma-Ata declaration that formally acknowledges of the importance of intersectoral action for health. It was later carried forward in the Ottawa Charter for Health Promotion (adopted in Ottawa in 1986), which discussed “healthy public policies” as a key area for health promotion, and gave rise to the concept of “Health in all Policies” (HiAP) in 2006 during the Finnish Presidency of the EU.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">The WHO defines HiAP as “an approach to public policies across sectors that systematically takes into account the health implications of decisions, seeks synergies, and avoids harmful health impacts, in order to improve population health and health equity”. An early example is the “North Karelia Project” launched in 1972 aimed to reduce the impact of coronary heart disease in the Finnish region of North Karelia through engaging other sectors such as community organizations, dairy and meat producers, schools to improve community health. The project, which involved the support of the Finnish authorities and the WHO, resulted in significant reductions in cardiovascular disease mortality and has been noted as a successful model for cross-sector collaboration.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Some may argue that we already have elements of HiAP in place, taking an example when the Ministry of Health collaborates with the Ministry of Education to promote health education, dental health and routine immunizations. However, HiAP is more than a collaboration between 2 agencies. HiAP in other countries has moved on to centralize health efforts by establishing councils chaired by the Health Minister, with members from each ministries and agencies that affect health and wellbeing, such as the Ministry of Agriculture, Forestry, Rural and Regional Development, Urban Wellbeing and Housing, Domestic Trade, and even including the local authorities and city planners to convene at least twice a year to discuss the current national issues that affects health of citizens either directly or indirectly.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">Back to our beloved country Malaysia, taking example of issues such as vaping and bauxite mining in which there is still no coherent effort between agencies and ministries to tackle the problem, it is evident that it is high time we adapt HiAP in our approach to become a developed nation by 2020. A developed nation is not only a country that is economically sound, but also a country in which its citizens are physically and mentally healthy, as reflected by its citizens’ life expectancy.</span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span>
<span style="font-family: Trebuchet MS, sans-serif;">While serving as an intern at the Social Determinants of Health Unit in WHO headquarters in Geneva, I had the chance to be a part of a working group that examines case studies relating to HiAP in developing countries. I have noticed that while HiAP is a new concept to the developing world, many are already approaching the WHO for advise and technical assistance to start implement HiAP in their respective countries. Each countries has their own social, political and economic factors that affects health. What works in one country might not work in another, however I do not see why we shouldn't start by asking for assistance. Health is a core element in people’s well-being and happiness. In the end, policies made in regard of health is not about political, social and economic interests. It is about ensuring that we leave behind a healthier world to live in, for or children and future generations to come.</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com0tag:blogger.com,1999:blog-7866679461523200485.post-63425037471847311472015-12-14T20:53:00.001+08:002015-12-14T23:50:50.928+08:00Laying the Foundation of Social Health Enterprises (SHE) in Developing Countries. Paving a way for Universal Health Coverage?<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: "trebuchet ms" , sans-serif;">I have been tinkering around with this concept called “Social
Health Enterprise”, finding ways for it to be applied to <a href="http://www.hbb.org.my/" target="_blank">Hospitals Beyond Boundaries</a>. Social Health Enterprise is actually a new term that has never used it before in literature or research. <span style="background-color: white; line-height: 17.12px;">It just struck me that they always use the term 'social enterprise within health care' in literature and researches, figured it would be too long to write.</span><span style="background-color: white; line-height: 17.12px;"> So for the purpose of brevity, I shall introduce the term </span>“Social Health Enterprise”, in short SHE.</span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Social Health Enterprise is derived from the concept of Social Enterprise. Many of us are not yet familiar to the basic concept of
‘social enterprise’ itself, so here's me trying my best to put it in simple terms:</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="font-family: "trebuchet ms" , sans-serif;">Social business / enterprise is a midway between a charity and a
business. It is like a charity in terms that it does good and solves a social problem, but it is business-like in which it operates as a business, generating profits from sales of products or service. The unique feature is that all profit cannot be taken as dividends by investors/shareholders, instead it is reinvested in the business, </span><span style="font-family: "trebuchet ms" , sans-serif; line-height: 17.12px;">for the improvement and extension of services or used for programs that benefit of the wider community. </span><span style="font-family: "trebuchet ms" , sans-serif;">In his book, Nobel Prize Winner Professor Muhammad Yunus characterizes social business
as an enterprise created and designed to address a social problem, and it is a
non-loss, non-dividend company, i.e. it is financially self-sustainable. All
profits generated by the business are reinvested in the business itself (or
used to start other social businesses), with the aim of increasing impact on
the community.</span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Now you may ask why am I alternating between the terms
‘social business’ and ‘social enterprise’? People have long discussions on the
use and differences between these terms. I am not going to elaborate on these
discussions, but simply put, social business is the brainchild of Professor
Muhammad Yunus and the business has to stick to these 7 principles:</span></div>
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<span style="text-indent: -18pt;"><span style="font-family: Trebuchet MS, sans-serif;">1. Business objective will be to overcome poverty,
or one or more problems (such as education, health, technology access, and
environment) which threaten people and society; not profit maximization</span></span></div>
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<span style="text-indent: -18pt;"><span style="font-family: Trebuchet MS, sans-serif;">2. Financial and economic sustainability</span></span></div>
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<span style="text-indent: -18pt;"><span style="font-family: Trebuchet MS, sans-serif;">3. Investors get back their investment amount only.
No dividend is given beyond investment money</span></span></div>
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<span style="text-indent: -18pt;"><span style="font-family: Trebuchet MS, sans-serif;">4. When investment amount is paid back, company
profit stays with the company for expansion and improvement</span></span></div>
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<span style="text-indent: -18pt;"><span style="font-family: Trebuchet MS, sans-serif;">5. Gender sensitive and environmentally conscious</span></span></div>
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<span style="text-indent: -18pt;"><span style="font-family: Trebuchet MS, sans-serif;">6. Workforce gets market wage with better working
conditions</span></span></div>
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<span style="text-indent: -18pt;"><span style="font-family: Trebuchet MS, sans-serif;">7. ...Do it with joy</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span class="apple-converted-space"><span style="background: white; line-height: 107%;"><span style="font-family: Trebuchet MS, sans-serif; line-height: normal;"><br /></span></span></span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span class="apple-converted-space"><span style="background: white; font-family: Trebuchet MS, sans-serif; line-height: 107%;"><span style="line-height: normal;">I believe that social enterprises are similar, but they hang more loosely around these principles. For the sake of discussion, I stick to Social Business when describing business in relation to Prof Yunus’ endeavor</span><span style="line-height: normal;">, and social enterprise to describe those businesses in general. Generally, I am referring to the same thing. </span></span></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">So, when it comes to business and charity in healthcare, I like to ask this question:</span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span class="apple-converted-space"><span style="background: white; font-family: Trebuchet MS, sans-serif; line-height: 17.12px;"><b>“Why is it that you can find thirst-quenching 1 dollar can of Coca-Cola anywhere in the world, but not life-saving 12-cents malaria medicines?</b></span></span></span></div>
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<span class="apple-converted-space"><span style="background: white; line-height: 107%;"><span style="font-family: Trebuchet MS, sans-serif;">In his book ‘The White
Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Ill and
So Little Good’, William Easterly poses a similar question (he used Harry Potter book analogy, not a fan, sorry!) that becomes a central
theme in his book. Easterly hails Professor Muhammad Yunus as a ‘searcher’ who can afford to solve these kind of problems by combining innovative entrepreneurship skills to solve a public problem, through his breakthrough idea on microcredit, and later social businesses.</span></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span class="apple-converted-space"><span style="background: white; line-height: 107%;">Actually, I have been thinking about this concept of social business within health care since HBB's inception in 2012. I think HBB was born at the right time when social entrepreunership was at its infancy and growing well in Malaysia. Thanks to myHarapan, HBB's mentor organization, I managed to </span></span>meet Professor Muhammad Yunus the father of social business himself. I met him in South
Africa on October 2013, at the back of a stage, at a moment when I was freaking out because it was nearly my turn to talk to more than
1000 audience in the hall. I
did not have much time and explained all
about HBB to him as brief as I can. I asked him a few things about his theory
on social business. I asked him where I can go to learn best about
social enterprise. He told me the best place to learn is to go back to the community I am trying to serve and learn
from them. Wow, okay that was profound. I was thinking of Stanford or something. That is the beauty of social
business. It is innovative and tailors to the community that the best way to learn is to be on the ground. It is not rigid that you have to go and
sit in classes all day long.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF_-IUo7Nk5JuplOYggMQviSPh9hzmTOhgUB4XlsjS33U0hB9MNTB4BaNU5ESMe9KR_zrV-8aKnDPgy_vxpMmQHDw8C4uD38jB854EvRmKgERpaqkya3NAFP5Rf17gR9CasUyPjcGz6iA/s1600/2013-10-03+17.37.26.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="color: black; font-family: Trebuchet MS, sans-serif;"><img border="0" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgF_-IUo7Nk5JuplOYggMQviSPh9hzmTOhgUB4XlsjS33U0hB9MNTB4BaNU5ESMe9KR_zrV-8aKnDPgy_vxpMmQHDw8C4uD38jB854EvRmKgERpaqkya3NAFP5Rf17gR9CasUyPjcGz6iA/s640/2013-10-03+17.37.26.jpg" width="640" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><i><span style="font-family: Trebuchet MS, sans-serif; font-size: small;">Professor Muhammad Yunus and I at the backstage during One Young World Summit in South Africa. Seconds before my turn to talk</span></i></td></tr>
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<span style="font-family: Trebuchet MS, sans-serif;"><span class="apple-converted-space" style="font-family: "trebuchet ms" , sans-serif;"><span style="background: white; line-height: 107%;">The hype of social enterprises escalated when Obama came to Malaysia, </span></span><span style="background-color: white; line-height: 17.12px;">the first sitting president to do so since 1966, for </span><span style="background-color: white; line-height: 17.12px;">the fourth Global Entrepreneurship Summit (GES) in Kuala Lumpur.</span><span style="background-color: white; line-height: 107%;"> It was then that the </span><span style="font-family: "trebuchet ms" , sans-serif;">Malaysian Global Innovation & Creativity Centre </span><span style="background-color: white; line-height: 107%;">(MaGIC) was first announced, and in the Budget 2014 proposal later that month, Prime Minister Najib Razak announced an
RM50-million (US$15.3-million) allocation for it. </span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span class="apple-converted-space"><span style="background: white;"><span style="line-height: 107%;">MaGIC's mandate is to encourage innovative start-ups and entrepreneurship in general, however a lot of attention was given to social </span><span style="line-height: 17.12px;">enterprises</span><span style="line-height: 107%;"> as a way to solve community's problems. </span></span></span><span style="background-color: white; line-height: 107%;">Unfortunately,
health care in social enterprises was quite in the side line. For example, a statement from the </span><span style="background-color: white; line-height: 17.12px;">Secretary-General of the Treasury at MoF during MaGIC's launch was: </span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; line-height: 17.12px;">"</span><span style="background-color: white; line-height: 107%;">MaGIC would be an
independent body that will act as a one-stop centre for all kinds of
entrepreneurs – not necessarily just high-tech and those related to ICT, but
also entrepreneurs dedicated to the services sector, agro-based products,
logistics and so on,” </span></span></div>
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<span style="background-color: white; line-height: 107%;"><span style="font-family: Trebuchet MS, sans-serif;">...And so, health care is part of that
‘so-on’ sector.</span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; line-height: 107%;">Since then I spent a lot of time researching social enterprises in healthcare throughout the years. They are quite a lot actually, and it has been around for quite some time in the developed world. For example, i</span><span class="apple-converted-space"><span style="background: white; line-height: 107%;">t was being promoted in
the UK in 2005 by former NHS Chief Executive Sir Nigel Crisp, followed by
statement by the Secretary of State Andrew Lansley declaring a wish to
transform the NHS into ‘the largest social enterprise sector in the world’. However, despite from various efforts from the Department of
Health, such as Social Enterprise Investment Fund (SEIF) and The Right to
Request programme, there is still inadequate evidence to support the effectiveness
of social entrepreneurship within healthcare in the UK. One of
the main reasons being the UK already has a strong public-funded healthcare
provided by the National Health Service (NHS), putting the</span></span><span class="apple-converted-space"><span style="background: white; color: #252525; line-height: 107%;"> </span></span><span style="background: white; color: #252525; line-height: 107%;">private healthcare sector, in which social enterprises
operates in, considerably smaller and less extensive than its public
equivalent.</span><span class="apple-converted-space"><span style="background: white; line-height: 107%;"> </span></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span class="apple-converted-space"><span style="background: white; line-height: 107%;">Furthermore, many social
enterprises are public service mutuals or ‘spin-outs’ from the NHS, which are organisations
which have left the public sector (i.e. spun out) but continue to deliver
public services. As a result, the responsibility of initiating
social enterprises within healthcare in the UK are put to mainly former NHS
staffs, clinicians, those who mostly don’t have the courage to start their own social business when they are already comfortable in the NHS. </span></span><span style="background-color: white; line-height: 107%;">Because of the public’s accustomization to the NHS branding
in which the majority of health services in the UK are under, social
enterprises also lacks the confidence that the NHS branding provides. </span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span class="apple-converted-space"><span style="background: white; line-height: 107%;">I believe that social entrepreneurship
can play a more effective role in the health care of developing countries, like most countries in Southeast Asia, including Malaysia. This is because, in contrast to developed nations, many developing countries adapt a two-tier health
care system where </span></span><span style="background-color: white; line-height: 17.12px;">they have a quite seperated public and private funded health care system</span><span class="apple-converted-space"><span style="background: white; line-height: 107%;">. Those who could afford purchase additional health care services or receive better quality
and faster access thorough the private health care. Those who could not afford will have to go to the public healthcare, which are multiple times more crowded than the private. </span></span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="font-family: "trebuchet ms" , sans-serif;"><span style="background-color: white; line-height: 107%;">To date, there has been no coherent and strong effort to utilize
social enterprise in health care in two-tier
health care systems, when in fact, developing countries have a backdrop of public institutions
becoming increasingly viewed as inefficient, ineffective and unresponsive, and
the private sector becoming more profit-oriented and only caters to those who
could afford health care. </span></span><span class="apple-converted-space" style="font-family: "trebuchet ms" , sans-serif;"><span style="background: white; line-height: 107%;">So there is a huge gap here and there is a need for a health care system that
bridges between the two. Even in Malaysia, the private spending for
health has overtaken the public spending since 2004. In absence of health
financing reform, our health system will likely become increasingly privatized
both in funding and service delivery.</span></span><span class="apple-converted-space" style="font-family: "trebuchet ms" , sans-serif;"><span lang="EN-GB" style="background: white; line-height: 107%;"> The public
sector has only about 10% of primary care clinics but handle almost 40% of
outpatient visits. The public clinics manage larger proportions of chronic
diseases as compared to the private sector. We have tried to solve this problem by proposing 1 Care for 1 Malaysia system, but it got a strong opposition from the public, because perhaps it is too big a change to happen in an instant. </span></span><span style="background-color: white;"><span style="font-family: "trebuchet ms" , sans-serif;"><span style="line-height: 107%;">I think a social health enterprise can be an alternative by bridging the public and private one step at a time, encouraging private practitioners to play a role in public service, and </span><span style="line-height: 17.12px;">benefiting</span><span style="line-height: 107%;"> their business at the same time. </span></span></span></span></div>
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<span style="background-color: white; line-height: 17.12px;"><span style="font-family: Trebuchet MS, sans-serif;">So here is my definition of Social Health Enterprise (SHE):</span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b><span class="apple-converted-space"><span style="background: white; line-height: 107%;">A social health
enterprise is a healthcare business with an objective to fulfil a public health
purpose. It uses market-based mechanisms to operate, but its aim is to solve a community’s</span></span><span class="apple-converted-space"><span style="background: white; line-height: 107%;"> </span></span></b><span class="apple-converted-space"><span style="background: white; line-height: 107%;"><b>health problems. Profits are reinvested for the improvement
and extension of services or used for public health programs for the benefit of
the wider community.</b><o:p></o:p></span></span></span></div>
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<span style="background-color: white; line-height: 107%;"><span style="font-family: Trebuchet MS, sans-serif;">Inspired by Prof Yunus' 7 Principles of Social Business, I came up with the characteristics of a 'Social Health Enterprise', in which HBB clinic will operate like:</span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">1. Starts as
a primary health care facility, with operations guided by a Family
Medicine Specialist (FMS) and a Public Health Physician<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">2. The
objective of the healthcare business is to overcome a community’s public health
problems; not for profit maximization<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">3. The
health care business attains financial and economic sustainability without
depending on continuous donations<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">4. Profits
are reinvested for the improvement and extension of services or used for public
health programs for the benefit of the wider community<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">5. Investors
can only get back their investment amount. No dividend is given beyond
investment money.<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">6. Staffs receives
monthly salary based on the country’s market wage with increments based on time
or performance. No bonuses are given as any surpluses are reinvested<o:p></o:p></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">7. Strives
to achieve Universal Health Coverage (UHC), by working with other private
sectors and the local government.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Now point number 7 is very important as I find it missing from the many social enterprises in health care in developing nations. I find that many social enterprises in healthcare in developing countries too disease-specific. They usually focus on eradicating a single disease, like malaria, HIV, TB, treat cataract, saving children with thalassemias. SHEs must be more than that, it has to provide a social safety net, so that the poor, no matter what disease they have, can afford health care for their disease. This is in line with the concept of Universal Health Care (UHC). </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">UHC is defined by the World Health Organization as:</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; color: #333333; line-height: 18px;">"E</span><span style="background-color: white; color: #333333; line-height: 18px;">nsuring that all people can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose the user to financial hardship"</span></span></div>
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<span style="line-height: 107%;"><span style="font-family: Trebuchet MS, sans-serif;">UHC is firmly based on the WHO constitution of 1948 declaring health a
fundamental human right and on the Health for All agenda set by the Alma-Ata
declaration in 1978. The DG of the WHO, Dr Margaret Chan went as far as to say: </span></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; color: #333333; font-style: inherit; font-weight: inherit; line-height: 18px;">"Universal coverage is the single most powerful concept that public health has to offer. </span><span style="background-color: white; color: #333333; font-style: inherit; font-weight: inherit; line-height: 18px;">It is the best way to cement the health gains made during the previous decade. It operationalizes the highest ethical principles of public health. It is a powerful social equalizer and the ultimate expression of fairness"</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="background-color: white; font-family: Trebuchet MS, sans-serif; line-height: 17.12px;">My former boss at the WHO in Geneva loves discussing about UHC when I was there, and he gave me an article written by a health economist called David Stuckler, discussing a lot about the three dimensions of UHC. Upon reading his article I was interested in the financing part of UHC. There are many methods to finance UHC, most commonly used are social health insurance, tax-based, single payers, but what interest me the most is: "community based health insurance". I think it best fits what we are trying to do at HBB .</span></span></div>
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<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif; font-size: small;"><i>Dr Eugenio and Victoria, former bosses at the WHO</i></span></td></tr>
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<span style="background-color: white; font-family: Trebuchet MS, sans-serif; line-height: 17.12px;">As with everything, theories must be tested and tried, and that is exactly what HBB will be trying to do. For our clinic, we are going to devise a community based health insurance system that works best for vulnerable communities. Since currently we are focusing on maternal and child health, perhaps we will start by insuring pregnant mother and their newborn child against catastrophic healthcare cost in the event that complications arises. Then we can extend to the general population. Step by step, we are going to keep revising the system until it is workable and replicable to other communities at large, until it can be adapted to the whole nation; which is the aim of UHC.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; line-height: 17.12px;">I think this field of SHE can be grown and tried on small communities, and extend from there. I would like to develop further this concept of SHEs and find out its challenges. I would like to spark a discussion on this. For example, if we can get all private practitioners to run SHEs and play a role in public health, what is it that they get other than satisfaction in helping patients who could not afford? The government has to come out with an appealing agreement or incentive, like NHS's '</span><span style="background-color: white; line-height: 17.12px;">The Right to Request programme' and their health departments's </span><span style="background-color: white; line-height: 17.12px;">Social Enterprise Investment Fund (SEIF).</span></span></div>
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<span style="font-family: "trebuchet ms" , sans-serif;"><span style="background-color: white; font-family: Trebuchet MS, sans-serif; line-height: 17.12px;">I believe this concept of SHE looks promising can be further developed (if I am not optimist about my own idea, nobody will, right?). Healthcare sector is also a very promising sector for social entrepreneurship because it affects the livelihood of a person directly. I am no expert in health financing and health economics. Maybe if I become one someday I can start publishing papers in journals, or better yet write books about SHEs. But for now I do need your opinions. There might be organizations out there that is doing something similar, and maybe everything I wrote above has already been thought up by another organization. But it doesn't matter and that is the beauty of social businesses. We do not compete with each other because we know that we are all trying to achieve the same objectives. So if you have any feedbacks, comments, suggested case studies, do let me know</span></span><br />
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com2tag:blogger.com,1999:blog-7866679461523200485.post-81949214678258360192015-09-14T18:39:00.001+08:002015-09-14T18:39:09.516+08:00Of Personal Love, Professional Passion & Philanthropic Mission<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhk7-CEiCyEPbzA1VX8GqfhFtk3gRHDwbJfFN5wDH6o0YXRsEbvFqF-CXoI7GA5dzDjloyc2b98fTJ02LYjqXNB56hC-cgmse3d1YuBW-qKTjBLY6zq0-CumF1T5yKoBOGn9WVKk9q7zko/s1600/PhotoGrid_1442220614360.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Trebuchet MS, sans-serif;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhk7-CEiCyEPbzA1VX8GqfhFtk3gRHDwbJfFN5wDH6o0YXRsEbvFqF-CXoI7GA5dzDjloyc2b98fTJ02LYjqXNB56hC-cgmse3d1YuBW-qKTjBLY6zq0-CumF1T5yKoBOGn9WVKk9q7zko/s400/PhotoGrid_1442220614360.jpg" width="400" /></span></a></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; color: #222222;">This picture was taken the night after <a href="http://www.hbb.org.my/" target="_blank">Hospitals Beyond Boundaries</a> launched its first clinic in Cambodia. Seen here is my dear fiance holding my cute little nephew, Imtiyaz while we were having a meeting at a Malaysian restaurant in down town Phnom Penh. I remember it as one of the happiest days of my life as we celebrate the launch of our very first clinic.</span></span></div>
<span style="font-family: Trebuchet MS, sans-serif;"><br style="background-color: white; color: #222222;" /></span><span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; color: #222222;">Life is beautiful when you have someone to share the most meaningful moments in life with. It is the more beautiful when that someone not only understands your passion for a cause, but even being a part of it. The first time my fiance saw me in person was in 2012. I was a 4th year medical student and during the moment that she saw me, I was drenched in sweat, presenting a research study on the epidemiology of tuberculosis in Kuala Lumpur. I did not notice her at the time as I was nervously focusing on the panel of judges, and we didn't get to talk to each other that day.</span></span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br style="background-color: white; color: #222222;" /></span><span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; color: #222222;">Few years down the line, fate intertwined our path and we meet again in Sungai Buloh Hospital where we worked. She showed me a picture of my tuberculosis research presentation she took 2 years ago in her cracked-screen Samsung S2 and asked: "remember this?". At that time I was working in the surgical department, and being too long in the world of blood and flesh inside the operating theatre, the picture brought back the memories of how happy I was working on something I was truly passionate about.</span></span><span style="font-family: Trebuchet MS, sans-serif;"><br style="background-color: white; color: #222222;" /></span><span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; color: #222222;"><br /></span></span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; color: #222222;">She went on reminding me of my "public-speaking for a cause" workshops to raise funds for HBB, in which she registered as a participant but in the end had to pull out the last minute because of unscheduled classes. From that moment on, I knew I would want to spend the rest of my life with this girl. Someone who is not just supportive of my work but always reminds me of my life purpose. With her, I didn't have to compartmentalize any of my life's ambitions: personal love, professional passion or philanthropic mission. They all converged into a single goal.</span></span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br style="background-color: white; color: #222222;" /></span><span style="font-family: Trebuchet MS, sans-serif;"><span style="background-color: white; color: #222222;">Like my parents and siblings who are all into HBB, she would be a perfect addition to the family. My parents has been very supportive of our relationship, and all of this wouldn't be possible without my loving mother who did all the engagement and wedding arrangements (remember how I thought 'cincin belah rotan' was to be bought in a souvenir shop? She knows her son is hopeless). </span></span><span style="background-color: white; color: #222222; font-family: 'Trebuchet MS', sans-serif;">Getting engaged is only the beginning, there is still a lot to go through and of course, life after marriage is the real challenge. But I believe with the blessing of our families, we will make it through until our marriage next year, insyaAllah</span><br />
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com5tag:blogger.com,1999:blog-7866679461523200485.post-50442087830758701862015-09-08T09:15:00.000+08:002015-09-08T11:10:49.635+08:00The Best Job In The World - Part II<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: 'Trebuchet MS', sans-serif;">2 years ago, I unpacked my bags in a tent in the middle of the African savanna, waking up to giraffes, hippos and rhinos in my backyard. I took showers under the blazing sun, and gathered around campfires at night, writing in my journal about what I have discovered so far, with a good cup of coffee by my side, under the shining stars.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Being in the wild, it doesn't matter where I was, in Africa, Cambodia, Indonesia, rural Malaysia, I've always brought along my stethoscope and a first aid kit. I never ran into any misfortunes among my team members having a heart attack or anything, but, just in case. Those times, I feel like I belong.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">I wish to become a doctor in these settings, not just treating patients, but being involved in the intricate ecology system that makes or breaks a disease cycle. Identifying mosquitoes, vectors, worms, bacterias, other parasites. Identifying patients affected by these disease, examining them and able to come up with an accurate provisional diagnosis on the spot, being able to treat them. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Truly, the best feeling is when you see a person suffering from a disease in front of you and having the exact knowledge on how to alleviate that suffering. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">I would also love to have a team that travels around the world to identify disease outbreaks, mapping them on the map using GIS system, doing statistical analysis, or even identifying new infectious disease agents or vectors. Walking up hills over hills for a house visit, walking down rivers to find a source of contamination, and later putting them into research, publishing journals and contribute to the overall knowledge of the medical fraternity.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Too idealistic, I know. There might not be a job opportunity like that in Malaysia, but if there really isn't any, then I wish to create it with HBB. We've already started regular de-worming programs to the rural kids, at least once a year, every time our team comes for mobile clinics. We distribute free anti-helminths to those who often get infested by worms due to poor sanitation and inadequate personal hygiene.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">I have been very very busy these past few months with clinical work, especially with the surmounting cases of dengue fever admitted to our wards. I admit for the past few months I haven't been able to attend much to my real passion. But I believe all of this is necessary for the knowledge that I gain on infectious disease. Last week I spoke to my infectious disease specialist and we came up to the topic of my future plans. I told him about my interest in tropical medicine and global health, epidemiology and stuff. His face gleamed with delight and said "You have come to the right place!". He meant being in Hospital Sungai Buloh, the center for infectious disease in Malaysia. He even told me that if there is anything he would do differently in life, he would have gone into the field of epidemiology.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">My 2 years compulsory training in hospitals will end early next year, I am thinking of taking a long leave again to focus again on HBB, and with the knowledge I have gained, build our clinic up, growing from strength to strength each day, without the constrain of time, pressure of bosses, peers and colleagues. Purely driven by curiosity, passion and purpose. I will be back soon</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-91906120222102099382015-08-24T21:57:00.000+08:002015-09-08T07:03:28.104+08:00Infections and Inequalities<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif;">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 <st1:country-region w:st="on">Malaysia</st1:country-region>, 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. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">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. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5S8GUAt99XTmIyHGXNITD-EsJlKHsSCQgfteqMNlyo0yYHDfGe3d77uKXWvB5M5rEQRGtyuJyezZpH3PMOAUd-sxoLh3sS4_VoKUt2WfGKTisQeHWKsc7L5kGl6dEsV9xsK1TEkAxA98/s1600/01.png" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: Trebuchet MS, sans-serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5S8GUAt99XTmIyHGXNITD-EsJlKHsSCQgfteqMNlyo0yYHDfGe3d77uKXWvB5M5rEQRGtyuJyezZpH3PMOAUd-sxoLh3sS4_VoKUt2WfGKTisQeHWKsc7L5kGl6dEsV9xsK1TEkAxA98/s1600/01.png" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Trebuchet MS, sans-serif; font-size: small;"><i>National Leprosy Centre, Sungai Buloh</i></span></td></tr>
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<span style="font-family: Trebuchet MS, sans-serif;">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.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">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:</span></div>
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<i><span style="font-family: Trebuchet MS, sans-serif;">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)</span></i></div>
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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 <st1:country-region w:st="on">Indonesia</st1:country-region> and <st1:country-region w:st="on"><st1:place w:st="on">Cambodia</st1:place></st1:country-region> 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 sel</span><span style="font-family: Arial, Helvetica, sans-serif;">f</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com4tag:blogger.com,1999:blog-7866679461523200485.post-11113436733985765692015-07-28T20:04:00.001+08:002015-07-28T20:04:45.850+08:00Sleeping With A Mosquito<p dir="ltr">"Doktor, buat la dengue notification cepat. Patient dah 2 hari dalam wad takde orang pon buat"</p>
<p dir="ltr">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.</p>
<p dir="ltr">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. </p>
<p dir="ltr">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. </p>
<p dir="ltr">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"</p>
<p dir="ltr">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.</p>
<p dir="ltr">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?</p>
<p dir="ltr">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'.</p>
<p dir="ltr">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"</p>
Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-20771848899577698302015-06-11T22:29:00.001+08:002015-06-11T22:50:37.102+08:00Remember This Moment<p dir="ltr">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.</p>
<p dir="ltr">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.</p>
<p dir="ltr">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.</p>
<p dir="ltr">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.</p>
<p dir="ltr">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.</p>
<p dir="ltr">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.</p>
<p dir="ltr">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. </p>
<p dir="ltr">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...</p>
<div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmqRHkyDNMkbG8RL-7OpPTIwMYAiYHN3TZqFtJawRBgTTehmJZAnVN-fcjV3hOL5rev22swUWKSnvzsP70TFn7PuY_jzmQWdBKbOG5iyu6YUxS_zVl3L_mfdUIQcn5xfz0_cBfgzjNaRs/s1600/20150611_181846.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"> <img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhmqRHkyDNMkbG8RL-7OpPTIwMYAiYHN3TZqFtJawRBgTTehmJZAnVN-fcjV3hOL5rev22swUWKSnvzsP70TFn7PuY_jzmQWdBKbOG5iyu6YUxS_zVl3L_mfdUIQcn5xfz0_cBfgzjNaRs/s640/20150611_181846.jpg"> </a> </div><div class="separator" style="clear: both; text-align: center;"> <a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhyphenhyphenxDsKdZsEyiMKSBswTpe4BEBZxkn139FvF5uSeTnV15Qnp5HBDksGSFUmOJFz9tfYEPY6qyKbn5MU7QF_p0kblYTSoCoKP8T6v8QxhGynJqyM4ltmpLvZSODPGMwyySVNGr-pvi9RlU/s1600/20150611_182003.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"> <img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhyphenhyphenxDsKdZsEyiMKSBswTpe4BEBZxkn139FvF5uSeTnV15Qnp5HBDksGSFUmOJFz9tfYEPY6qyKbn5MU7QF_p0kblYTSoCoKP8T6v8QxhGynJqyM4ltmpLvZSODPGMwyySVNGr-pvi9RlU/s640/20150611_182003.jpg"> </a> </div>Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com8tag:blogger.com,1999:blog-7866679461523200485.post-55532128143175738412015-04-04T19:41:00.003+08:002015-04-04T19:41:45.438+08:00Keep Calm and Finish Housemanship<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="orphans: 2; text-align: -webkit-auto; widows: 2;"><span style="font-family: Trebuchet MS, sans-serif;">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. <br /><br />Yeah, I was happy. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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. <br /><br />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"</span></span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com10tag:blogger.com,1999:blog-7866679461523200485.post-91816910920235279452015-04-02T19:40:00.001+08:002015-04-02T19:51:42.226+08:00The Best Job in The World<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaGCCzw_l3rzOmMq5da7UMrsimLfjB2FtuAGVAJrV6CSXf9KmixPmNOaagd-kKOVsx9_8LZqm7v_3SZdporcYAPYf1sERQYBIJuodtwBtIr6BcGjmXhyphenhyphen1F62QrM-0MlgvWizlLMWJ4c9U/s1600/DSC07852.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Trebuchet MS, sans-serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaGCCzw_l3rzOmMq5da7UMrsimLfjB2FtuAGVAJrV6CSXf9KmixPmNOaagd-kKOVsx9_8LZqm7v_3SZdporcYAPYf1sERQYBIJuodtwBtIr6BcGjmXhyphenhyphen1F62QrM-0MlgvWizlLMWJ4c9U/s1600/DSC07852.JPG" height="358" width="640"></span></a></div>
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<span style="font-family: Trebuchet MS, sans-serif;">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</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com2tag:blogger.com,1999:blog-7866679461523200485.post-71109094014208719292015-02-11T22:07:00.000+08:002015-09-08T07:04:39.994+08:00The Rise of the Gen-Y Doctors: Stop Scaring Us Off!<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif;">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.</span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br />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.</span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br />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 <st1:city w:st="on"><st1:place w:st="on">Geneva</st1:place></st1:city>
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 <st1:country-region w:st="on"><st1:place w:st="on">Malaysia</st1:place></st1:country-region>.
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.</span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br />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 <st1:country-region w:st="on"><st1:place w:st="on">Malaysia</st1:place></st1:country-region>, 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.</span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br />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: <st1:country-region w:st="on">Indonesia</st1:country-region>, <st1:country-region w:st="on">India</st1:country-region>, <st1:place w:st="on"><st1:city w:st="on">Czech</st1:city>,
<st1:country-region w:st="on">Russia</st1:country-region></st1:place>,
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’:</span><br />
<span style="font-family: Trebuchet MS, sans-serif;"><br /><i>“Come, let yourself be wrong</i><i>Come, it's already begun</i><i>Come, come alone</i><i>Come with fear, come with
love</i><i>Come however you are</i><i>Just come, come alone</i><i>Come with friends, come
with foes</i><i>Come however you are</i><i>Just come, come alone</i><i>Come with me, then let go</i><i>Come however you are</i><i>Just come, come alone</i><i>Come so carefully closed</i><i>Come however you are</i><i>Just come…”</i></span><br />
<h2>
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</h2>
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</div>
Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-56112865153052379092015-02-01T09:42:00.002+08:002015-02-01T09:50:37.337+08:00Another Year<div dir="ltr" style="text-align: left;" trbidi="on">
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">Scrolling through photos of Malaysian delegates at this year's WHO Executive Board Meeting, I only realized it has been a year since I was there. Time flies, life has been so much busier, life in the hospital is so much different. But I guess Allah has the best laid plans, everything has a reason. </span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">One instance is that I was involved in helping to draft a framework for WHO's Roll-back Malaria program in Geneva. I thought my ideas were good, but now I am back in my own country seeing how Malaria really looks like, I had to think twice. It's funny that we prescribe mosquito nets, and the mother tells me the mosquitoes are INSIDE the net, nets are too old and torn, some are even not used and are modified to become fishing nets! (the family originated from Indonesia, and they were back in their hometown at that time).</span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">In terms of my country's own public health threat, the past few months has been exhausting with the non-stop cases of dengue coming in. I did not work on something about dengue when I was in the WHO, and wished I had. The dengue epidemic in Malaysia has totally went out of hand, and it is frustrating to have the same child coming in with recurrent dengue, which he had a few years ago. I could get angry assuming that the parents did not do enough to protect the child, but on further questioning, the parents in fact had done their best to make their house aedes-free. But the problem is, what's the use if you are the only one working to eradicate aedes. The neighbours are still ignorant, the community does not care when a container with stagnant water is outside of their house compound. The community is still malaise about dengue when nobody in their family has died of dengue. They still wish for a miracle vaccine and the government to provide these to solve the problem. They haven't seen a mother crying in regret, asking for forgiveness in front of her daughter's dead body that has died of dengue.</span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">I did not experience this before, and never had a burning desire to solve this at a global level. I guess it is really helpful to be in contact with patients, knowing how they live, eat, sleep, how their socio-economic conditions are. As the words that is stuck at my supervisor's door at the WHO HQ: "Is it sufficient to treat patients and send them back to the conditions that makes them sick in the first place?". That is the thing that kept me going, what gets me through the long hours, sleepless nights, and all the unnecessary yelling and scolding. Another year to go. I'll be back</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com0tag:blogger.com,1999:blog-7866679461523200485.post-6036105337792008782015-01-03T20:10:00.001+08:002015-01-03T21:26:38.683+08:00Death of a Child<div dir="ltr" style="text-align: left;" trbidi="on">
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">"Ibu, jangan tinggalkan kakak"</span></div>
<div dir="ltr">
<span style="font-family: Trebuchet MS;"></span> </div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;">Mother, please don't leave me.</span></i></div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;"> </span></i></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">Words like this coming from the lips of a 4 year old girl a few hours before she died made me believe that sometimes children just have the ability to know that they will go soon. Adults have their own ways of dealing with impending death, but since being in Paediatrics, I cannot help to wonder how children deal with it.</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">It was a Tuesday morning, and I saw a small boy being pushed into the isolation room, a room reserved for children suspected to have a contagious disease. I was in charge of the cubicle opposite the isolation room, and saw that my colleague in charge of the isolation cubicle was quite busy attending another patient. I offered to help take blood investigations for the newly admitted patient and set a line through the veins to hyrate the child.</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">When I asked permission from the mother to bring the child into the procedure room, I saw her eyes was swollen, fresh tears. It is common for a mother to shed tears when seeing her child in pain. But I failed to recognize that the emotional suffering she endured was far deeper than I thought.</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">Blood taking in Paediatrics remain a challenging procedure for young doctors, not only because the veins are small, but also because children tend to resist aggressively. Restraining a child to take blood is not an easy task. With a bit of a struggle, luck, and the mother holding tight to the child, I managed to gain access of the veins through the small needle. I withdrew just enough blood be sent to the laboratory. However, to my disappointment the needle that I used to squeeze the blood out almost fell off, and as expected, a small bulge formed under the skin as I tried to push fluids in. It meant that I had to insert a new needle. I asked the mother is it okay to insert a new one. I was worried because she obviously seemed sad. But that was when she bursted into tears and said:</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">"Buatlah apa-apa saja untuk selamatkan anak saya ni doktor, kakak dia dah meninggal pagi tadi"</span></div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;"></span></i> </div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;">Do whatever you can to save him, Doctor. His sister just died this morning. </span></i></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">For a moment, my mind went into a halt. She started to burst into tears and hugged her son tightly and went on to say</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">"Kakak dah tak ada"</span></div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;"></span></i> </div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;">Sister is no more with us. </span></i></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">I did not know what to say except to whisper 'Inna lillahi wa inna ilayhi raji'un' (surely we belong to Allah and to Him shall we return). I focused on gaining access to another vein. To my relief, I managed to secure a line, and after cleaning up after the procedure, only then I managed to gather my thoughts and asked the mother what really happened. In a breaking voice, the mother told me that her 4 year old girl died this morning on the way to the hospital. She has been having fever for the past few days, but just when her fever started to settle down, that is when rashes appear on her palms and soles of her feet, with multiple ulcers breaking out in her mouth. She went to another hospital and the doctor diagnosed her as having the 'Hand, foot and mouth disease", by itself is self-limiting and rarely life threatening, and told the mother to rest assured as it will go away on its own.</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">However, that night she deteriorated quickly and started vomiting out blood. At the same time, the mother realizes that the younger brother had also started developing rashes on his hands, and to her suspicion, he has ulcers in his mouth too. That was when the little girl said to her mother "please don't leave me". The mother quickly called the ambulance to bring both children to the hospital.</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">On the way to the hospital, she died.</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">The mother went on to tell me that her neighbour's daughter had came to her house to play a few days before. She also had the same symptoms as her children. A few of my colleagues were aware of the case. We knew that Hand, Foot and Mouth disease (HFMD) rarely cause deaths. Judging from the bloody vomit which might indicate bleeding in her digestive tract, and also the high number of children around the area admitted to our wards with dengue, our best guess was that it was HFMD superimposed on dengue fever. In other words, it was dengue that caused her death, and already having her immune system weakened by dengue, she also contracted HFMD from the neighbour's daughter at the same time, so when she presented to the hospital with typical signs and symptoms of HFMD, the doctor was easily misled to NOT think of dengue and sent her home with the reassurance that it was HFMD.</span></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"></span> </div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;">The mother had stopped weeping by the time she finished telling me what happened. I accompanied her back to the isolation room. What she had told me shook me to the core. A lost of a child is tragic, but a soul of a sinless child is promised heaven, a soul that He calls <i>al-nafs al mutmaina</i>: the reassured soul, which is mentioned in the Quran:</span></div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;"></span></i> </div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;">"O reassured soul, return to your Lord, well-pleased and pleasing. And enter among My [righteous] servants. And enter My Paradise" - Quran, 89:27-30</span></i></div>
<div dir="ltr">
<span style="font-family: "Trebuchet MS", sans-serif;"><br />Nobody can promise you that they can still be here tomorrow. Nobody knows what tomorrow will bring. We keep on thinking that everything will be the same tomorrow as it is today. But the fact of life is that life can arbitrarily cut you off your air. When you have a few hours to live, what would you do? For an adult, mostly would choose to spend their time with their loved ones. The last phone call, the last dinner, the last "I love you mak, I love you ayah". But for a child...maybe all they can say is</span></div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;"></span></i> </div>
<div dir="ltr">
<i><span style="font-family: "Trebuchet MS", sans-serif;">"Ibu, jangan tinggalkan kakak"</span></i></div>
<div dir="ltr">
<em><span style="font-family: Trebuchet MS;"></span></em> </div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com4tag:blogger.com,1999:blog-7866679461523200485.post-8350375675818163502014-12-23T21:09:00.001+08:002014-12-24T21:52:59.437+08:00Finger Fashionista<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif;">In orthopaedics, we usually get called down to do a finger refashioning at the emergency department. Just like manicure, finger refashioning makes the fingers look better, except that instead of cutting the nails short, we cut the whole finger short. Our intentions were good though, these fingers were already cut in the first place. We make them look nicer and less prone to infection. A typical mechanism of injury would be that of fingers stuck in factory machines. These fingers look horrible before being refashioned, depending on which machines they were stuck in. Sometimes they are crushed by stamp print machines, shredded by paper shredder machines, lacerated by grass cutter machines, rolled flat by paper roller machines, but the worst one I have seen are the ones stuck in sugarcane machines. They are crushed and shredded at the same time.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">Usual patients are the migrant workers, because they are the ones working in factories to operate machines. It is sad to think that these people came here to Malaysia in search of a better future for their family but ended up losing a few fingers. </span><span style="font-family: 'Trebuchet MS', sans-serif;">So one day, I had a call to do a finger refashioning for a factory worker who got his fingers cut at a wood cutting factory . The poor guy was a Burmese, must be in his 30s. He was accompanied by a young man in neat corporate uniform, his supervisor. I learned from the supervisor that he just came from Myanmar and did not speak a word of Malay, and just a little bit of English. When saw him, he was in pain and had his right hand covered by a piece of cloth that was already half-soaked with blood. Slowly, I removed the piece of cloth and from the supervisor's story, what I saw was expected: the index finger was nearly total amputated. It was just dangling there, the only thing holding it in place is a layer of skin. The bone was totally crushed. But what bothers me is that the thumb was crushed as well. Of all the fingers of our hands, the thumb is the most that affect hand function. The level of amputation determines the extent of the functional deficit. I knew I had to take extra precaution to preserve the thumb length.</span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">So I asked the supervisor to wait outside while I do what needed to be done. To tell the truth, I liked being called to do finger refashioning. When I am in the sterile scrubs, in the silent procedure room with just the medical assistant and the patient, I feel at ease as the frantic noise of the ED department outside drowns out. I get to escape from the hectic wards for a while. I feel a sense of calm and focus as I start to wield the blade. </span><span style="font-family: 'Trebuchet MS', sans-serif;">In experienced hands, finger refashioning should take just about 30 minutes. I took a tad bit longer, but in moments of intense focus, you barely notice the time pass. The fingers were still oozing blood. In a nutshell, I gave anaesthetics to make the fingers feel numb and insensitive to pain, stopped the bleeding, crushed the bones to make it shorter than the surrounding skin, trimmed the ragged edge of the remaining skin and soft tissue to make it look smoother, at the same time creating a skin flap to close the gaping hole, and sew the opposing skin together. Convinced that the bleeding was secured, I covered it with topical antibiotic gel, and then with a white cotton gauze.</span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">I was satisfied with my finger work I did that day. I explained that he needs to take antibiotics as to prevent infection to the injured finger, and has to come to the local health clinic to get it cleaned up daily, and come again to our clinic to get the stitch removed and reassess the wound. I tried my best to explain to him in the simplest form of language. </span><span style="font-family: 'Trebuchet MS', sans-serif;">At the end of my explanation, I looked at him. He was looking at me with a blank stare. I looked at him, he looked at me. I was looking at him, he looked at me.</span></div>
<div style="text-align: left;">
<span style="font-family: 'Trebuchet MS', sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;"><i>Okay that's it, this guy does not understand a word I said.</i></span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><i><br /></i></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">Exhausted of all effort to communicate near the end of my work shift, I showed him the 'thumbs up' sign, and said "Okeh?". Although in pain, but perhaps still numbed by the local anaesthetic I gave him, he looked at his thumb, now made shorter, covered with white gauze, lifted it up, trying his best to show me a 'thumbs up', and said:</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><br /></span></div>
<div style="text-align: left;">
<span style="font-family: Trebuchet MS, sans-serif;">"Bagus!" (Good!)</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">With his other hand, he gave pat on my shoulders.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Well, that was unexpected.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">I called the supervisor in. I explained the same thing to him, hoping that he will have a way to communicate my instruction to this employee of his. I also mentioned to the supervisor that I had already explained to him, but I don't think he understood, and gave a quick remark that he understands the word "bagus" though. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">But the supervisor said "Uh, I don't think he understands the word, I think he was just imitating my boss".</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">"What do you mean?" I asked curiously.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">"You see, at the factory, at the end of the day our boss will give a thumbs up to those who worked well, before they end their shift, and will give them a pat at the shoulders. They then will happily go punch out their attendance card at the punching machine".</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">I laughed out loud, and the supervisor had no idea why. The Burmese guy was still smiling, I wonder if he understood what was the conversation about. So he was merely imitating his boss at the factory, guessing that "bagus" with a thumbs up is a sign of appreciation. Oh well at least I know it means I did good job. </span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">I looked at my watch and realized it was way pass my working hours. So after being told 'bagus!' and given that pat on the shoulders, I happily go punch out my attendance card at the punching machine, similar to what factory workers do every working day. In some way or another, we are all the same.<i> I am a cogwheel in a white coat in this machinery called the Malaysian health care system.</i></span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-62574613336310985732014-12-19T17:21:00.000+08:002014-12-24T12:32:02.591+08:00Superhero the Musical - The Story of the PPR Kids<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="font-family: Trebuchet MS, sans-serif;"><i>"The art of theatre humanises the human race" - Samad, main character in 'Superhero'</i></span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">After more than 2 hours watching the musical theatre "Superhero" at the National Museum's Auditorium, I still could not believe such a beautiful and lively performance come from the PPR kids of Kuala Lumpur. PPR, which stands for 'Projek Perumahan Rakyat' (People's Housing Project) is an effort by the government to relocate squatters to live in permanent homes with more "comfortable, relaxed and healthier environment". However, "comfortable, relaxed and healthier environment" is not easily achieved when their living space is cramped with limited number of rooms, air ventilation and space to move around. </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">With increasing family size, it is easy to feel suffocated living in such small spaces, which why children and teenagers who live in these places often spend most of their time outside their houses and explore the world on their own. While it is a good thing to explore the world, it can also be a risky business for kids when they are out and about without the supervision of their parents. Especially in this city of Kuala Lumpur. Kids can either find good inspiration outdoors and do something good with their lives, or make friends with the wrong people and end up getting involved with unhealthy activities, skip school and worse of all, commit crimes.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">On a couple of occasions, I gave talks to these PPR kids in programs that are organized by myHarapan (the Youth Trust Foundation). I was supposed to motivate them, but even before giving these talks, I knew I to had to crack my head on how to get these kids interested. I mean, come on, I talked to those people at myHarapan and they say it is hard enough for teachers to get attention of these kids in school. Why would they want to listen to some stranger coming to give so called 'motivation'? So I decided to scrape all my old scripts and decided to tell a different story. Unlike the speech I gave at MRSMs or high schools, I didn't focus on them to be successful just academically, but on being successful in doing anything that they are interested in. I know there are PPR kids who are academically brilliant, but for the majority of them who secretly have inborn talent, I encouraged them not to be afraid to do what they like, do their best in it, and make it productive. I told them the story of my good friend Jimmy, a chef with no academic qualifications, not even PMR or SPM, who ended up working as a sushi chef in Switzerland. My talk was about going all out in whatever you do. To my relief, I saw their gleaming eyes as they relate to my story, and I know I had their attention when one of them shouted "Mak saya jual laksa!", when I asked them if theu know anything about the food business. Best of all, I saw hope in their eyes.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">"Hanya perlu percaya!" (Just need to believe), shouted one of the character during the play. It became a theme of the musical theatre, that if you believe, anyone can become a hero. What send tears down many of the audiences is that these characters, they are not fictional. These kids are playing out what happens to be their own lives living as a PPR kid. They share their story of happiness and sadness, the hard life of their parents to make ends meet, the difficulties they face at school and much more. This musical theatre is organized by myHarapan and Revolution Stage. Through this project, the PPR kids undergo basic theatre workshops. The workshop is divided into 3 stages, and this musical performance is the 3rd stage. I cannot emphasise enough that this effort my myHarapan and Revolution Stage really bring out the best in these kids. I had a chance to talk to some of the kids and the organizers after the show. One of them pointed out how they can see with their own eyes the change in these kids as they go through the workshop. At first they weren't very involved, didn't talk much and were very shy onstage. Now, the audience can see first hand how confident these kids are on stage. With them being so young, there is no doubt that this kind of confidence will take them far in life. The kids told how life has changed for them ever since joining this project. Previously spending time loitering around with friends, smoking and 'rempit'ing around, they now have a productive outlet for their energy and creativity.</span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">It is hard not to believe in the theme "hanya perlu percaya" after the show ended, because you can see in front of you that these kids made it here to become so good in acting because they just believed. I admit I haven't seen that much theatrical plays in my life, but I can tell you that it was an awe-inspiring experience and I would not hesitate to recommend it to all of you loooking for a good way to spend your day. </span><br />
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<span style="font-family: Trebuchet MS, sans-serif;">The show is still happening until this weekend, 21st December 2014. Details is as in the poster below. Do come, and remember that the ticket sales will also go to this project's funds to enable them to do bigger projects and involve more PPR kids. With your help, more and more of these kids will become 'Superheroes' and lead them to better lives ahead </span><br />
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com1tag:blogger.com,1999:blog-7866679461523200485.post-87814882871494284872014-12-10T21:18:00.001+08:002014-12-24T13:33:40.181+08:00Idiot's Guide to Surviving Housemanship<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif;">What's with all this ruckus about houseman complaining about their housemanship training in the press, and MOs and specialists complaining about houseman in return? I admit housemanship can be challenging, especially for those who just started. I also admit that during my first posting even I harbor the thoughts of quitting. But I didn't, and I have never regretted the decision to stay on while some of my colleagues resigned. Almost half-way though my housemanship journey, I think I'd like to share a few things I've learned for the past one year. I call it the ' Idiot's Guide to Surviving Housemanship', inspired by the 'Idiot's Guide to' series:</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>1. Don't take negative comments and scoldings personally.</b><br />
You see, we live in an age where houseman are in excess. Every time a specialist or an MO scolds you, chances are, you are not the first one and unlikely to be the last one. Imagine, nowadays there can be up to 30 to 40 houseman in a certain department at a particular time. Without extension, every houseman will rotate in each department every 4 months. A specialist or an MO on average have to deal with on average 120 houseman per year. So there is a very high chance that whatever mistake you did has already been done by another houseman before, and the scolding is nothing directed solely for you. They just want you to improve, just like others who made it before you. So don't take things personal, they might have repeated the same comment and scolding for the 100th time. So don't go missing in action (MIA) everytime you get a bad scolding. It's nothing personal.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>2. MOs and specialist are not out there 'to get you'.</b><br />
Sometimes when we get real bad scoldings, we tend to think the MO or specialist has this certain mission to wipe us off this earth. We have this feeling that every time they feel our presence, they are there to get us, and when we are not around, they think of ways to make our life miserable. The truth is, specialists and MOs are human with their own personal life too. When we couldn't sleep at night thinking about how this particular MO will mess around with us during tomorrow's ward round, he or she might just be thinking about their next holiday destination, about their Master's application, or about their wedding plans. They don't have time to think about how to mess around with you. There are just better things to think about before bedtime. So don't waste your time at home worrying about tomorrow, instead be happy and spend time with your family and friends, like what your MO is doing.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>3. Forget that you were ever on the Dean's list, a 4-flat student or a batch leader during your medical school days</b><br />
While your achievements are good for motivation, as a houseman, you have to forget about all those because you start your journey just like everybody else, no more, no less. Because no matter how good you were, housemanship is a process of learning, and sooner or later you will tend to make mistakes. What matters is whether you learn from it or not. Many straight-A, 4-flat students just could not take housemanship and quit because they are not used to or have never tasted failure before. They are more vulnerable when faced with harsh scoldings, because they used to be so perfect in medical school. The less smarter ones are the resilient and tough ones because they have faced so many failures and scoldings during medical school that they feel like it is just another day in the life of a medical profession. So no matter how good or bad you were in medical school, forget about all that and start anew. An MD and MBBS is just a starting point. Now you are as dumb as everyone else and everyone else is as smart as you</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>4. Time is gold, steal it</b><br />
Don't be an idiot and hold your pee when things get too busy. Volunteer to send the bloods to the laboratory, and on the way back, stop by the loo. Contrary to public belief, doctors are not THAT busy all the time. There are always time when patients are less, workload is low, long interval in between patients. Learn to take a nap wherever you are, just make sure your phone is on full-blast volume. Learn to sleep anywhere EXCEPT where there is no line reception. The most important thing is to make yourself reachable. You're considered MIA when your colleagues and staff nurses couldn't reach you. I know many would not agree on taking a nap during working hours, but personally I think that if I really have no work to do, it is better to take a refreshing power nap than being physically and mentally exhausted, endangering the lives of patients.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>5. Your colleague will exaggerate everything</b><br />
Sometimes when you did a mistake, and then the next thing you have your colleague texting you asking "Hey what happened today, I heard this specialist was furious at you for bla bla bla". Unless you heard from the specialist yourself, usually the story is exaggerated as it goes through the grapevine from one person to another. Things are not always as bad as people tell you. This is another case of 'nothing is personal'. Others might have done a worse mistake than you, and what matters is not giving up, going MIA, but instead take it as a lesson learned.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>6. Everybody has their own problems to remember</b><br />
One of the worst thing that could happen to a houseman is a public scolding, in front of your colleagues, patients, staff nurses, MA, Radicare people, lol. But that, too, shall pass with time. Don't get too depressed and go MIA, because everybody gets their own dose of scoldings and no one has the time to remember yours. Don't believe me? Try telling one of your colleagues: "Man, I still feel really bad for the stupid thing I dad in the OT last month". Chances are, they will reply with "Uh, which stupid thing again?". "You know, when I threw the fibreoptic scope into the yellow bin and the surgeon was so furious I had to go down to Radicare and literally scourge through the piles of waste to retrieve it?". "Oh, that one!". Point is, no matter how stupid your mistake is, in a month you will have to trigger others to remember it. So just learn from mistakes, and don't worry about what others think. In the medical profession, everybody has their own problems to think of, they won't remember yours.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><b>7. You don't get extended because your boss hates you</b><br />
In the extreme case of being extended, don't feel so down too. You don't get extended because your superior hates you. If they really do hate you, they would have let you pass as soon as possible because they want you out of the department and never want to see your face again. An extension really means that they feel that there is something inadequate in you, and you might need more time to learn it.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">So fellow houseman, these are my 50 cents. Just remember, there are thousands of us, each and everyone with our own struggles, and we are all in this together. You are not alone. So cheer up, stop complaining too much, to the press especially, and may us all be great doctors for the better health care of our nation.</span></div>
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Lutfi Fadil Lokmanhttp://www.blogger.com/profile/17743303338089853258noreply@blogger.com15tag:blogger.com,1999:blog-7866679461523200485.post-3279029638876451342014-11-30T21:49:00.001+08:002014-12-24T12:31:24.912+08:00Chichen Itza<div dir="ltr" style="text-align: left;" trbidi="on">
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<span style="font-family: Trebuchet MS, sans-serif;">My favorite destinations when traveling in a foreign country are either beautiful nature or archeological sites. Both will make you rethink about your existence in this world, make you feel small, but at the same time calling you to do things bigger than yourself. In Mexico, I took a 2-hour journey from Cancun to the state of Yucatan to visit one of the most famous archeological sites in the world, dubbed one of the new 7 wonders of the world: Chichen Itza.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Remember all the havoc back in 2012, propagated by Hollywood that the world is going to end? It stems from here, Chichen Itza, built by the Mayans, where their numbered calendar ends at the year 2012. But according to our guide, the Mayans never said the world was going to end in 2012. For them, 2012 marks the end of an era.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">The Chichen Itza was most probably built around 7th century AD, during the golden age of Mayan culture. At the height of their civilization, the Mayans must have thought that their civilization would last until 2012, which then a new era will arrive. But it is a mystery to both them and us, how, having created the most unique written language, sophisticated art, architecture, mathematical and astronomical systems, the civilization disappear without a trace.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">As an example of the Mayan's extraordinary mathematical, astronomical and architectural feat, the four faces of the temple of Kukulkan have stairways with 91 steps each, which makes 364 steps total. Combined with a base platform on top of the pyramid that unites all four stairways, it comes to 365, the exact number of days in a solar year. Then At about 3 pm on March 20th and September 22nd the sunlight casts a series of shadows against the western balustrade of the main stairway, which creates an optical illusion of a 37-meter-long snake that follows the sun "slithering" down to its own head carved at the base of the staircase.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">When the Spanish conquerors came to discover this ancient site, and came in contact with the surviving Mayan people around the area who seem so humble and shows no evidence of sophisticated mathematical, astronomical or architectural knowledge, the first thing that came to their mind was that the Romans or Egyptians must have been here. For them, it is impossible for these people who seem to know nothing to build such a magnificent architectural masterpiece.</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;">Our tour guide went on to explain that the enemy of the Mayans are Mayans themselves. The Mayans divide themselves into different settlements, and there was no effort to unite them all. Fighting off each other might be the reason how they perished. He also mentioned that the decay in society might also be the cause, political tremors, greed, lust for power, etc, which today's society are also guilty of. Sometimes we are so proud of our achievements, but look at how our society is decaying? Chichen Itza serves as an evidence of how no achievements lasts in this world, even the most advanced civilization of an era. Everything is beautifully summed up in the Holy Quran, Surah As-Sajdah, Verse 26:</span></div>
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<span style="font-family: Trebuchet MS, sans-serif;"><i>Has it not become clear to them how many generations We destroyed before them, [as] they walk among their dwellings? Indeed in that are signs; then do they not hear?</i></span></blockquote>
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<span style="font-family: Trebuchet MS, sans-serif;">The people of the great Mayan civilization may have perished, but what lives on is their knowledge, passed down to generations until it is still used today. Perhaps knowledge is something which we humans are bound to discover and carry on from one generation to another. It is from our Creator, and never belongs to someone or a particular civilization. That is why I love traveling to places like this. It reminds us that no matter how smart we think we are, every single knowledge never belongs to us. So never be too proud, but keep on advancing knowledge. In the words of a Sufi poet, never let success go too much into your head, but don't let failure go too much into your heart.</span></div>
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