The Kind of Day I Wish to Live All My Life

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.

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.

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.

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

Contradistinction

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...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:

"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…"

A Guide to a Meaningful Life

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:

1. They believe in a religion / God

2. They have close relationships with family, friends and the community

3. They have a stable marriage

4. They do what they love everyday; or better, they make it their career

5. Their daily working hours are flexible; or better they are their own boss

6. They often travel to discover new things

7. They are easy to give charity

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)

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. 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. 

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.

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:

First Day of 2016, Full of Optimism!

As I am writing this, I am sitting at HBB Clinic Phnom Penh, on 1^st 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.
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.
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.

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.

I know I can never capture this moment into a single picture, and the only way to do justice is to write about it.

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

Health in All Policies (HiAP) in Malaysia: Now More Than Ever

I refer to the statement made by our Deputy Director-General of Health, Datuk Dr Lokman Hakim in the New Strait Times article ‘Multi-agency Effort Needed to Tackle Diseases’ on 18 December 2015.

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.

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.

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.

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.

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.

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.

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.