Archive for the doctoring tales Category

No Death, or so it seems…

Posted in Bo, caffeine, cloudy days, doctoring tales, Ebola, Gondama Referral Centre, MSF, penny for my thoughts, Sierra Leone on August 15, 2014 by twotwoeight

25th July 201420140808-115958 am-43198765.jpg

The last hour — sitting at the porch outside the doctor’s office in Gondama Referral Centre (GRC), sipping hot “Starbucks Americano” and listening to Jacky Cheung on my iPod shuffle while writing down hand-over notes from the night. The last hour of my first night shift in GRC. No deaths. Dare I count my chickens before they hatch? After all, there is another 55 minutes to go before 8am. And anything can happen. Keeping my fingers crossed.

Most of the doctors and nurses who work here have attended more resuscitations, or rather, witnessed more deaths in the few months of working here compared to in their entire working lives. Judging from previous years, the numbers are expected to rise in the rainy season as this brings a surge of severe malaria and pneumonia cases, but on the contrary, the wards are quieter than ever this year. Under normal circumstances, this would be something good. A quiet hospital with low bed occupancy rate…who wouldn’t want that?

Unfortunately, this unnatural apparent peace does not reflect a healthier population or availability of better health facilities at this point in time. Admissions are significantly less because the people are not seeking treatment – not at hospitals, at least. Why? Because they are terrified of the deadly Ebola. There are many myths and rumours related to this disease; some don’t believe the virus exists, some say it is an act of with craft or supernatural in origin, some say it is a conspiracy designed by the authorities for population control, some say it is purely a scam of healthcare workers and scientists for research – the list is endless. The worst of them all, is that many of them believe that if you go to a hospital, you will get injected with the Ebola virus there.

Whichever the story, the devastating outcome is that these beliefs keep them from bringing their children to the hospital, even when their child is critically ill. They’d rather let their children die at home or go to traditional healers than risk coming to the hospital. As a result of this, they die from potentially treatable diseases like malaria, pneumonia or gastroenteritis which are so prevalent in this community. It is tragic to know that there are so many preventable deaths out there – that every empty bed we see in the ward could mean that there is a child out there who is denied proper treatment because of false beliefs.

Ebola is a deadly virus indeed. Once infected, the mortality rate is high. But the destructive path it leaves behind without even needing to infect the individual is more terrifying, and this deadliness grows silently, unseen and unheard. When will this destruction end? Only time will tell. Until then, we continue to pray for the number of admissions in our wards to increase, so that less lives will be lost unnecessarily. Ironic, I know.

 

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Co-habitating with Ebola

Posted in Bo, doctoring tales, Ebola, Gondama Referral Centre, MSF, penny for my thoughts, Sierra Leone on August 15, 2014 by twotwoeight

15th July 2014

The lights go out and the fan slows to a complete stop within minutes. It’s 5pm. That’s the time that the generator goes off every day for an hour and a half in the evenings, and 2 hours in the morning. Today the sweltering heat doesn’t bother me because it has been raining steadily almost the entire day, and the breeze that accompanies the pitter patter of raindrops is much welcomed. Sitting at the terrace behind the house, listening to Phantom of the Opera and sipping hot coffee – this almost feels like home. Except that the very visible barbed wires all around the perimeter of the house is a stark reminder that I’m continents away from home.

20140815-111011 am-40211587.jpgThe first week working at Gondama Referral Centre here in Bo has been interesting, notwithstanding the ominous presence of Ebola that is creeping too close for comfort, overshadowing everything in its path. Talking about Sierra Leone at present time without mentioning Ebola would be like ignoring the elephant in the room but I am going to do just that. For underneath the wave of chaos and feelings-of-impending-doom that Ebola brings, the normalcy of the original needs of the hospital persists — providing acute healthcare to children stricken with diseases endemic to the region. Practicing medicine in the local context is going to be a new experience and somewhat of a challenge – not only because of the difference in severity and types of diseases here, but more of facing the brutal reality of our limitations here. The old adage “You cannot save everyone” has never been so true. What remains is, who can you save?

ICU

The ICU, which is lined by ‘couches’ (name given to a small high cot) on one side for the more ill children, and ‘beds’ on the other side for those less critical is filled with semi-comatose children. Juggling a few diagnoses of severe malaria, severe sepsis, severe acute malnutrition, severe anaemia, severe pneumonia and herbal intoxication each, these children are cheating death for every single day that they manage to pull through, and those who survive, do, because of the right combination of strong will and lots of good luck because medicinally, there is not much that we can do for them. Other than antibiotics, antimalarials plus a cocktail of other drugs and supportive treatment, we have no ventilators, no means for dialysis, no monitors, no scans and only a handful of fundamental laboratory investigations available. Meaning other than relying on your good clinical acumen, you are left with a whole lot of guesswork. Which also means, when the CHO (Clinical Health Officer) calls you to review a patient because he is critical and is in respiratory failure, instead of securing the airway, taking over the work of breathing and connecting the child to a ventilator to ensure there is adequate oxygenation to his vital organs while you treat the infection, you can only pray that either the child has a fighting spirit that is unbeatable and defies the odds, or that he dies soon, and as peacefully as possible. Mostly, it’s the latter that happens. I silently cringe on the inside and gulp down an uncomfortable feeling of helplessness after I examined the boy and told the CHO that I have nothing more to add to the current plan. LGD – Let God decide. I remember we had laughed about this ‘plan of management’ one of the consultants wrote in the case sheet when we were interns. Well, never has it been more real than now.

I watch as one young mother sitting at the side of her child calmly shakes his scrawny limp body intermittently with great force, trying to prevent him from drifting into a permanent sleep – her boy, who is semi-conscious from the severe malaria that has affected his brain and causing him to have seizures despite the repeated doses of anticonvulsants lies in a fetal position on the couch with a dazed look and grunts weakly only occasionally.

I marvel at how the mothers take it all in. They remain unshaken when watching their child moan in pain from the severe skin infection that is eating away at their flesh leaving huge gaping wounds on their tiny bodies, they remain strong and resolute when sitting vigil at their child’s bedside watching while their child is struggling to breathe with each shallow breath, they watch in a helpless surrender as their child’s life slips away in front of their eyes and although visibly upset, they show tremendous strength and maintain such a calm façade that it is unfathomable.

Life is cheap. It’s disgusting but it’s true.  Death is a common occurrence here that a day with no mortality is a rarity. It is ironic that somewhere, someone is complaining that their doctor’s manners was less than satisfactory or is demanding for a private hospital room, when at that exact moment, maybe not even halfway across the globe, a child is fighting to survive despite the odds, weakened from the start by severe malnutrition from the impoverished state of living, denied of what the ideals of basic healthcare needs is to the more privileged and leaving it all up to fate. What is deemed to be a basic necessity for some that it would be absurd to be without, can, and is indeed a dream which may be forever unattainable by another. Sadly, this is not a touching story with a happy ending. This is a tale of two worlds which ideally should be one, and a witness of the continuous struggles of humanity in trying to narrow the gap between the two. A couple of months ago, I laughed when my houseman said during a case presentation that the patient is from Utopia (it was, in fact Ethiopia) and I had to explain that Utopia is an ideal that does not exist, but in retrospect, wouldn’t it be nice if I was wrong, and that there is a Utopia after all?

 

Slithery tales — saving grace for an exasperating day

Posted in doctoring tales on November 12, 2013 by twotwoeight

Today and me started off on the wrong foot.  Thankfully, it didn’t stay that way.

After finishing a particularly exasperating rounds this afternoon, I was hungry and tired and answering phone calls and questions/updates from the house officers when one of them came up to me with a rather serious expression on her face…

HO : Dr.Wong…the lab called and informed that they rejected our sample..

Me : Huh? Which sample?

HO : The snake.

Me : HAH??? *look of disbelief* You sent the snake to the lab? Why? You want them to do frozen cross-sections and confirm it’s a snake? Or do culture and sensitivity on the tissue swab??

(Just in case you are wondering if we have snakes at our disposal or this is the norm, we had a patient who was admitted for alleged snake bite and the family brought the culprit — a baby snake — with its head crushed by a stone)

Me : Anyway, quickly go take the snake back! Luckily I didn’t get a call from the pathologist asking why I pranked her! And remember to dispose of it properly.  Please find out if it should be discarded as clinical waste, normal household waste or thrown into the sharps bin!!! *with a straight face*

*sweat*!! Okay, but I must say it really made me laugh…and brightened up my day.

😉

On an unrelated note, I was teaching a life support course the other day and we were doing simulations of emergency scenarios with mannequins and one of the scenarios involved a boy having an open/sucking chest injury.  So, halfway through the simulation, I signalled to my colleague to emulate the hissing  sound of a sucking chest wound.  The candidate looked briefly at her, and then ignored her completely and continued on.  After the simulation was over, we sat down for a debriefing and I asked the candidate if he noticed the hissing sound.  He said he was puzzled as to what the sound was and was looking around hard trying to figure out what it was!! I asked him “I mean, you didn’t think we would put a snake in the room, right?” Hahahahaha!!!

snakecanes

PS/ I’m not sure how they disposed the snake though… Where would you have put it? 😉

Ambitions

Posted in doctoring tales, kidz talk on January 3, 2013 by twotwoeight

This morning, while in clinic, I had the most amusing conversation with a 6 years old boy. He was a jolly and chatty little fella, under follow-up for asthma.  The moment he walked into my room, he sat down and put my stethoscope on his ears.

Me : Sihat kah hari ini? (Are you well today?)

Him : Sihat… (I’m well)

Me : Ada guna ubat pam kah? (Did you use your inhalers?)

Him : Ada…dua igek setiap hari! (Yes, 2 times a day)

Me : Wah…bagus! (Wow, good!)

(seeing his obsession with my stethoscope…)

Me : Kamu mahu jadi doktor ka, bila sudah besar? (Do you want to be a doctor when you grow up?)

Him : (in a resounding voice as if I have just made the most silly suggestion in the world) TIDAK!!! (No!!!)

Me : Habis, kamu nak jadi apa nanti? (Then what do you want to be?)

Him : Saya mahu jadi LANUN!!! (very proudly!) (I want to be a pirate!!!)

Me : *stunned* Kamu mahu jadi lanun? Kamu tahu apa tu lanun kah??? (You want to be a pirate? Do you know what a pirate is???)

Him : Upin dan Ipin jadi lanun.  Saya pun mahu jadi lanun!!! Lanun hebat!!! (Upin and Ipin became pirates.  I also want to be a pirate!!! Pirates are great!!!)

Me : *bengang*…

Reminded me of the time one of my friends told me that when she was in primary school and the teacher asked all the children what were their ambitions, one boy excitedly said “Communist!” and the teacher was speechless.

kid brain

Little kids’ minds are like sponges…they silently absorb their surroundings at a speed which will leave you astounded — maybe a word said in passing, a phrase overheard, an idolized cartoon character.  Be careful what you expose them to…or you might find yourself with a pirate on your hands!

pirate-flag

😉

PS/ Just yesterday, I saw one of my patients reading a comic book with the title “Kisah ayah masuk hospital sakit buasir” (The tale of father being admitted for haemorrhoids).

A thousand question marks on my face…

The harsh reality.

Posted in doctoring tales, the box of chocolates known as life on July 15, 2012 by twotwoeight

Oh, he was shot dead.

She answered in a as-a-matter-of-fact manner when I asked why is her husband not around anymore. I asked about her husband’s health because she had brought up some gynaecological complaints and it was prudent to know about her partner as well. I was surprised when she said she doesn’t have a husband, as her baby who is my patient was only a couple of months old. Thinking that perhaps they were separated, I asked if he was still in the picture and that was when she told me that he had died. I asked if it was because of an illness, and I was even more surprised when she told me he was shot.

While hunting.

Curious, I asked if it was a hunting accident. And she continued to tell me in an apathetic manner that it was not an accident, he was hunted and shot dead. By a man who had killed many others. Killed over what, I asked? She shrugged and said, who knows, maybe because that man was envious that my father in law had caught a lot of fishes. She continued to tell me that the man who shot her husband was still scot-free as he had friends in high places!

This mother of 5 who is barely in her 30s has since moved back to her mother’s home with her children and making ends meet on the allowance that social welfare provides for single mothers. She is not able to work as she has to look after her children who are still young. There’s this saying in Malay that goes kais pagi, makan pagi. But in her case, there isn’t even a chance to kais. There’s no ‘crying over spilt milk’, so to speak — she did not have the luxury of brooding, and wondering why she has been dealt such a cruel blow. She just resigned to fate. Life must go on, and for her children and herself, a world of uncertainties lies ahead.

Then there’s this mother of 8 children — the youngest, an 8 month old boy who became my patient. I’m sure when she woke up that morning, she never thought she would be spending the weekend in the hospital. The 8 month old baby, was referred to us as he was only 3.5kg. Mother said that he was on formula feeding and some nestum. She didn’t appear concerned about his weight and feeding patterns. When we asked about details of the feeding, she whipped out a new can of Pediasure (a high-end formula milk for children) and said she had switched him to this milk for the last 1 month.

Father doesn’t have a stable income. He does odd jobs on demand. Mother occasionally gets asked to help out in the plantation and gets some income from there. They aren’t able to farm as they live in a rented place. While she is away from home, her physically impaired 9 year old son will look after the younger siblings, including feeding this baby. When I told her we will get the medical social worker to talk to them and see how they can help, her immediate question was “Are they going to take him away from us?”. These poor parents must have been worried sick the whole day, from the moment the community nurses went to their home and brought them to the polyclinic and subsequently the hospital — fearing that they will be separated from their child. It must be because of this that they somehow managed to get a can of Pediasure to try and convince us they are doing the best for their baby. Or maybe it’s pride. The father slept in the corridor last night because they live too far away for him to go home and come back again when his baby is discharged.

What’s going to happen when they go home? I honestly don’t know.

Some days we are reminded of the harsh reality of life, and the gravity of problems beyond our imagination. And then we are humbled by that realization and remember to be grateful for the abundance that we already have, but forgotten, when others are in need.

I’m thankful for these days.

This is my temporary home…

Posted in across the South China Sea, doctoring tales, professional tourist in the making, Sarikei, through the lens on July 7, 2012 by twotwoeight

it’s not where I belong,

windows and rooms, that I’m passin’ through,

This is just a stop, on the way to where I’m going…

– Carrie Underwood

I hear this song almost every night as I doze off as I haven’t gotten around to making a new jukebox CD and radio channels here are limited.  Funny thing is, this immediately came to my mind, when I sat down to write a little about Sarikei.  Maybe because this is precisely what Sarikei is to me now, a temporary home.

“Where on earth is Sarikei???” — I get this response so often whenever I tell people where I’m working, that after awhile, it didn’t surprise me anymore.  Some even ask if it was in Malaysia! Oh yes…from Timbuktu to Japan, the guesses have been rather interesting. I guess most people fell asleep during Geography class back then, huh? 😉

So, where IS Sarikei actually?

It is very much in Malaysia — Sarawak, East Malaysia to be exact. It is one of the 11 divisions of Sarawak and relatively small.

If Sarikei is new for you, then Julau, Pakan, Meradong, Entabai and Dabai (just to name a few) are new for me.  These are areas surrounding Sarikei and the reason I know them is because some of my patients are from here.  We always have this practise of asking where patients stay and how far they are from the hospital for discharge planning purposes, but I find that whenever I ask the latter here, I always follow up with the question “Balik rumah ambil masa berapa jam?” (How many hours does it take for you to get home?) because they will tell you “Rumah tidak jauh”  (My house is not far)…but actually it’s a couple of hours away. Distance is relative…bear that in mind.

You can go and Google all about the geography and history of this place, I won’t elaborate on that.  I will tell you some random observations that come to my mind, as a temporary resident.

The pace here is slow.  No one is really in a hurry to get to their destinations, barring emergencies.  Motorcyclists and cars cruise on the road, sometimes at 30 kmph and the rest just follow behind quietly.  Occasionally, you do see one or two ‘crazy’ drivers ;).

The town itself is concentrated around a few streets where most of the shops are located and one can cover the whole area on foot at a leisurely pace.  The place exudes an old-world charm…possibly due to the feeling of having traveled back in time when you walk along those streets.

You may want to think twice about lugging around a huge DSLR taking photos here though, because even when I whip out my trusty iPhone while marketing or walking around town, I garner quite a lot of stares. 😉

Actually, to be precise, my temporary home should be Hospital Sarikei, seeing as I spend maybe 90% of my time in the hospital grounds, so let me tell you more about the hospital.

The current hospital is a new one, having being operational since 2006.  It is located across the river (Sarikei river) from the town centre, and any place across the river is considered far.  The grounds are spacious, and there is ample space, not to mention parking!

The landscaping is gorgeous…from palm tree-lined roads…

to well-maintained plants…

to colourful flowers in bloom…

and even midin (wild edible fern) gardens at strategic locations! If you knew where to look, you will be rewarded with gorgeous views.

Of course, having no tall buildings for miles gives you an unobstructed view of the clever cloud formations,

sunrise and sunset.

(I can’t say much about sunrise seeing as I’m never up early enough to witness it, but I can tell you sunset here is gorgeous beyond words– the way the colour gradients subtly change is a joy to watch).

The people here are very friendly and greetings along the corridor are a routine.  Even the canteen auntie is extremely nice and her food is beyond canteen standards!

This hospital is probably one of the cleanest hospitals I have set foot in.  Every morning without fail, I see the cleaners wiping the countless numbers of window panes and I must say, I bump into cleaners here more often than I bump into doctors or nurses or even patients!

Our hospital has a capacity of 212 beds, but currently, due to lack of manpower, we are only able to utilize 168 beds.  Hopefully, in time, this hospital will be developed to its full potential.

So……..feel like coming to Sarikei for a visit yet? 😉 If you still need convincing, here’s something to whet your appetite…

Did I mention the food here is kinda great? 😉 Well, more on food next time!

The last 2 hours…

Posted in doctoring tales, penny for my thoughts on April 27, 2012 by twotwoeight

of a 6 and a half years journey.

20120427-023511 PM.jpg

Bittersweet, but I would do it all over again.