post flood- the suffer begin

Our hospital was not threathen during the flood... but we were affected after the flood....

There were 2 xiang(or so call district) flooded during the typhoon. It was regular for the LB area to be flooded during the typhoon as the local govt could not restructure the landscaping. The LB district is packed with fishbed and no one could asked them to shut down. So nothing much to shout. However the dike along the JD district collapsed during the typhoon(it was bad time - high tide + typhoon). The seawater had poured into the village along the seaside. The flood had cause the mud to precipitate all over - including the drain. The whole drainage system was packed with mud. The water could not be drained and only the sun and natural absorbing power of the soil could do the job.

this was taken outside the medical depot I went to support..

mud and water....despite the hot sun..

The road leading to my ex-hospital(regional grade) was shut down due to the muddy condition and water(yes, dead water). Peoples around this area would had to spent 1 hrs+ on the journey to reach there. Those peoples had opted to come to us instead. The ED pt amount had doubled and sometimes triple since the flood. Those peoples living in the flooded area were offered free(yes no registration fee, no self burden fee) treatment - so they come as they like, if they are in a rush - they opt for ED; a really abuse of privillege but they were the ones who suffered most . As a resident who could still stay in his own decent house ( vs in a muddy house / salvation center ), I am in no position to tell this peoples to wait for OPD....
Well, the shifts were bad since then --- servicemen coming for tetanus jab(what can I said , the army medical corps should have given them a prophylaxis before they entered the region to help...), cellulitis , infected wound... and lately gastroenteritis....well, all sort of disease expected in a disaster area spreaded out in front of me...a real good experience to practice...

rumours said that it would take few months before the road would be reopened and till then, we need to tolerate... But I am sure our management is enjoying the current situation as the patients were pouring in like dont know what and we were always packed with in patient...

hospital evaluation

the final day had come... the 2 of the 3 connecting road were opened and the committee had decided to come for the review...

I was post call and had to stay back during the process...a stress for me... 

I was posted to ICU as planned. My official title was physician responsible for ICU. The title was set by the hospital evaluation committee and had to meet the following criteria:

1.Pt in the ICU had to be placed under the service of the physician

2.The physician could only had 2 session of OPD

3.The physician could not intake patient outside the ICU

that was the reason the management stopped me from doing any warded patient care since 4 months ago. As the hospital had tried to cut the cost and my overlap time of work with Lem was greatly reduced, caring patient in the ward had become a stress for me, eventhough those patient under my service were all from nursing home, mostly bed-ridden. My working hours could not let me to come everyday to see my patients. I did grumbled about the situation but I could do nothing - the cut of working hours was minor and I gained some from the Hemodialysis round ( still it was negative in total).

Post call with a heavy body and mind and I still did a solid round in the ICU. I was darn tired and slept in the conference room after 11:00am. The lunch suckes - a cake and bread combo box. The excuse was -  loads of oily lunchbox with rice would make the garbage bin looked bad.

 The committee member came to ICU by 1:30pm and selected a case. I was told he is a oncologist and professor in a medical university. He had asked a few question about the admin of the ICU and proceeded to his rounds .He had stood in front a bed who looked chronicly ill(medical case)...but fortunately for us, he took the wrong chart (the neighbour bed) and started to flip . The case of a patient with traumatic brain injury and liver laceration. The charting was done in totally POMR method and he could only pick some minor fault which I did not chart clearly. After some comments, he had looked at his watch and decided not to "torment" us any further...It was a relief, a lot of the charting was not done in the POMR form ( I had left the ICU for quite sometimes) and some of the admin malpractice would be noticed if he really looked into it...

 The evaluation dragged on till 4 something and the feedback session began. Most of us did ok (cant be flawless...) but one of the floor did a major mess up... When the nursing committee member asked about the nurse how they get their drug after the doctor prescribed it, one of the nurses was so big-headed and told the member that they could key in a temporary prescription to pick up medication- it was violation of the medical practice: prescription could only be written/issued by doctors... Well, a bad mark on our review....Hopefully the committee would taken it as a minor malpractice and would give us a pass. A fail would mean a review again in 3 -6 months time... there was a teaching hospital which did something similiar few years ago and suffered from it...

I did my part but I don't think anyone would really notice it, but the most important part was - I did not make any major mistake.... but the electronic prescription system was screwed up by a nurse and I felt a little drawback...a review of the system was needed and I need to do something about it

The 88 flood .. 2

Although the bridge was sealed and reopen, all of the staff physician/surgeon were still able to get to work…

The newly appointed minister of health had visited the south and came to our hospital. Lem had even shake his hand… He is one of the public health expect – most of us had bought his book during our statistic class. He had bought some news – intake every patient we could and unless necessary , do not transfer case, the 4 medical centers in Kaohsiung were packed with patients. The Kaohsiung county was badly hit at that time – a village was buried under a debris flow(massive land slide – mud flow like lava …) rumors said thousand were buried under. The minister had promised us that the medical fee would be paid under special scheme. We do not have to worry about hitting over the budget…a good news for the hospital.

The ED was crowded since that day , daily patient rose from 40 to 100 /day. Beds were always tight and patient waiting in ED become more. The key problem was the transport. The road connecting to the Dong Gang town was cut off by the flood. My ex hospital is one of the major regional hospital around our region. The local peoples who frequently travel there have to detour and spent more than 30 mins on the journey. These peoples had sought medical treatment to our hospital and our loading had doubled.

Well, the hospital evaluation was 4 days later after the flood. Nothing much we can do to help, as manpower could barely cover the hospital daily activities…even though the flood had heavily hit our area but the hospital evaluation committee had informed us that the evaluation would proceed as usual….a good and bad news…

The 88 flood....1

It was an ordinary typhoon day… I was thinking a piece and nice shift – when it is raining and windy, everybody stay in the house…but I was wrong..when I left the house at noon, the wind was darn strong and the rain was so heavy. I barely make it to the hospital. The news in the hospital was a little bit frightening… some of the nurse had taken leave as they could not make it out from the house…

In the night, the wind and rain did not get smaller. It was confusing, the typhoon was sweeping over the central part of Taiwan. We were at the outer skirt of the typhoon. But the weather forecast did warn the public about heavy rain in the southern part of Taiwan as the south west monsoon was harboring around the southern part.

The rain became more heavy but I did not have a good sleep as pt were pouring in despite the gust. I went to the car park to look at my car and I felt the strength of the wind… it almost tripped me over and me fall…

The morning was worst – 2 out of the 3 bridges that leading to north had been shut down. The LB bridge was always on the shut down list as the local area was always flooded during typhoon. The LB area is surrounded by fish bed …

This XP bridge I use regularly to work..half of the bridge was torn down and rebuild...

the XP bridge which I cross on a regular basis is classified as danger bridge years ago and when the river’s water level had risen to the naked steel rod (it is well below the supposed danger water level) it would be shut down. There was an incidence in the central part of Taiwan years ago when a bridge had fallen apart during a typhoon claiming life of a few car driver and passenger. So there was only 1 bridge left for me to get home. The locum doctor came a little bit late at 12:20pm and I started to rushed to the one and only bridge left (LLS bridge), rain heavier than yesterday. Unfortunately I was 20 mins too late – I was blocked by the police as the bridge was shut down 20 min before I hit the mark. I headed back to the hospital and slept at Lem’s quarters. I was depressed and did not get a good afternoon nap. I was thinking of reopening of the LLS bridge later on and enjoying a good father day’s dinner…

Well, my prayer did not come true.. I called the police duty center hourly hoping to get any good news of reopening of the bridge. I gave up at 6:00pm as the night was falling and rain was getting heavier then ever.

Our hospital superintendent and some of the staff physician had stayed back – a firepot dinner with bunch of good stuff but I was not in the mood of eating. I went to sleep by 10pm…The next day – the LLS bridge was reopened and I headed home by 8:30am… It was a shocking scenario for me when I drove pass the LLS bridge. I saw the river roaring itself passing under the bridge. A fall into the angry river would means fatal as even the best swimmer could not survive the current, further more there were rocks, logs and other materials which can give anyone an ICH/internal bleeding…

 

I was happy when I reached home… that was the worst I thought… but I was wrong again….The so call 88(Aug 8th) flood was much more severe then the 87 flood which hit Taiwan 50 years ago

Casualty department 2

Life in the casualty department was easy….. Most of the MO were easy going persons.. There was one of my high school senior working in the department then. SK was also a Taiwan grad. He had passed the examination and unfortunately 1 year earlier – his HO-ship was 3 years instead of One. The rules had changed 1 year later. Anyway, that was not his only bad luck – he was posted to KLGH and he had opted to travel to-fro from Klang. I heard that he was delayed in one of the department thus extending his HO-ship for another few months. He was competent as he had worked a few years roving in various small hospitals.

We helped out each other then.

There were 2 MO on each shift. Another MO was placed as duty MO. He worked from 8am-5pm. He would cover for all the post mortem case during the day time. The cases were triaged we would see the red then the yellow then the green. I dislike the system in fact. There was once a pakcik(uncle) who came for dizziness. A finger sugar was done and showed high. He was given a yellow tag and he was seen 3+ hrs later after registration.

I tried to see cases as fast as possible. But sometimes the staff couldn’t coup with it.

The medical assistants(MA) played an important role in the casualty department as half of the MO could not intubate properly. SK and I were the MA favorite as we could place any tube without them. I was not that happy actually as 2 things were bothering me then – my posting and part I(MRCP) examination.

I got my posting 2 months later and I was posted to Perak. I wanted Selangor badly as I thought living in my own house could save some expenses and household errand. I appealed but denied….

THE DAY...

The date is set – 13th August…. We were informed about the date last week…. DefCon1 now in our hospital. Everyone is reading over and over again. My assignment is simple, to be aide to KP.

KP is our cardiologist , ex-dep superintendent, Malaysian ..... He is in charge regarding the medicine part. He told me he wanted an aide. So I would accompanied him around. Ties and Shirt is mandatory as announced in the meeting. Worst part – I was post call and I needed to shape up. A tiring week for me though – I am doing EOD(every odd day call ) from Monday as Lem is enjoying his vacation back in Malaysia. Well, the 1st call was good and hopefully I am lucky during the 2nd and 3rd call.

Well, I been through the evaluation and I need to answer to the committee member regarding my program. I hope I can do a good presentation. After all , I got a medico-information manager certificate...thinking of doing master in medical informatic - my home medical college might be setting up one later....