Satun revisited- > pre trip

Earlier this year, I was in a dilemma of going again to Satun or not. I realized that I would be called as I am the one of the best candidates and as I had promised the great one along the path, I knew it cannot be evaded.

However, deep in my heart, I was still praying that the tour would be postponed or someone would hop in and volunteered for the tour.

Well, in May, the most worried part had occurred when I discovered that the tour would be set on early September. That would be definitely a suffering one as I would go on a leave-packed call –leave-packed call working condition; the Sri Lanka trip was scheduled during mid of August.

The final moment came around July when the pastor in charge of the mission called up. She asked me if I was still with my previous church after the dispute. The second question was if I would still be willing to help out the Satun tour.

The positive answer slipped through my mouth under the lead of the great one. At some moment, I regretted my decision but yet, I realized that it is not my mission, it was mission dei….

The roster was an ugly one for August and September as I had predicted but yet it was still my destiny to face it…

The payback shift for the Sri Lanka trip was smooth and I don’t need to worry about the Satun tour as this time, the pastor in charge will be going with us; I just need to concentrate on my medical part.

I had 3 senior nurses with medical mission experience (they had taken the Bangladesh tour last year), 1 undergraduate, 1 medical researcher and the pastor on the team.

I thought I was well prepared this time with load of instrument (otoscope, funduscope, forceps, suture set…) and 2x of drugs , compared to the last trip; but yet, I was wrong again when I reached there….

Sri Lanka revisited

I had gone to Sri Lanka again last week….

It was my third visit to the land in 12 months. After the December medical relief mission last year, one of the team members had called up and asked me if we can do it again in the August. I answered to her plead after praying to the great one.

I did not plan for any personal trip as in the past; my shift was too packed and I was not in a mood to think about some side trip beside of the tour.

However when the schedule came out, I was surprised and again the great one have proven that he is the mighty jireh.

Unlike the previous trip, we would be taken to the world’s end, Galle and the Elephant orphanage….The new serving brother had heard my plead last year and he had changed the planning after taking over from the previous serving brother.

As usual the flight was tedious as we have to transit via HKG, BKK…but however the lodging was excellent this time. We had stayed in the Grand Oriental Hotel; which is more than 150 years old. The trip to Nurwara Eliya was less stressful as we had a stop in Kandy before the final ascend.

The medical service was a success even though we had utilized openemr as our charting system. We used a router with USB dongle as the LAN provider + a ultrabook as a server. It proved to run well with 2 clinics+registration+pharmacy. We use tablet and smart phone as our major input device and it has a great interface for users. However some tweaking is still needed and I would be learning php for future modification

The peak of the tour was the trip to World’s end. Again, I was puzzled but the decision of choosing the right route or the left route. Our local guide/brother in church, have suggested the right route…and indeed, it was the “right” choice. Although the right route took longer to reach world’s end but yet it had less ascend; it is a route smoother for the elder one. However the risk was we might not be able to reach the World’s end before the fog storm in…

With grace, all of us completed the walk and were still able to get to the world’s end in time and enjoyed the spectacular view (it was like 5 mins before the fog covered the view).

My advice to the world’s end:

1.To start early(as early as 5am)

2.Take the right path

We had the De Silva Special Burger during our stay and it was indeed up to standard and highly recommended.. The cons: the shop was too small for a large group like us.

The trip to Galle was an excellent one. We enjoyed a luxurious seafood meal with a great view along the beach. I was able to soak my foot in the Indian Ocean with the kids. However I missed the walk along the street. As usual, I enjoyed the food and took every chance of getting my hand on seeni sambol bun(sambal bun) and wadai.

The return flight was a tiresome as usual. We did not take a lodge in the Bandaranaike transit hotel but instead we took a rest in the Plaza Premium Lounge while transiting in Hong Kong. It was an amazing experience for everyone for us, the view and the food ( Yun ate 6 egg tarts, and the fishball kiewtiao was superb).

Well, while the rest of the family was taking a good sleep 1 day after the trip, I had returned to the desk..

The trip is a conclusion for us to Sri Lanka…but will it be the last ? I will let the great one lead…

stress....

The working environment had been bad for the past few months; patients amount increased from less than 2000 to more than 2300. Our capacity is now 6 physicians and we have only 4. We had a brief discussion and concluded that we would need at least one more hand but compensation should be given during this waiting period. 
We have grafted a few version of compensation and submitted to the management. The compensation was around +12% . The management had later counter offer us with a raise of 5% + partial coverage of our shift；we would get an additional physician/surgeon covering for the weekend shift. If the coverage is not done, we would get further compensation. 
Not a satisfying one but still agreeable. 
However after 1 weeks, the covering helpers have backed away and we are on our own again + the pay...
Frankly said, we would preferred additional physician rather than raise as we are truly being stress out working in a patient overloaded environment....sooner or later we would end up in a medico-legal suit if the condition continue....

the protest....

There was this protest in front of the ministry of education by a bunch of high school chap recently...
They had urged the ministry of education to stop the implementation of the micro-modified high school history course outline or they will keep on the gathering....
The minor modification to the outline had been over exaggerated by the students that it had distorted the history of the local people ("Chinalized" the thought of high school student)
I had a brief discussion with Yun, and she had expressed concerned but yet disagreed with the act based on the below facts:
1.Those so -called rep do not represent the majority- because they are brave to stand out do not mean that they represent all the student
2.Those students treat other students as stupid -> other student accept what they are fed in the school, no ability to think...

Well, so far she is good and able to think independently...but maybe a little too independent for her age.....

The fun part is
1.the opposition which was backing the students had abandoned the group;  
2.the leader of the group had declared that they are backing out
3. TYPHOON is COMING.....
that leave the other students stranded in the dilemma....

Threat....

It was a rainy day as the typhoon missed the southern part of the island by inches… 2 ambulance arrived with 4 casualties while I was busy intubating a feverish patient with motor power of 3/3(both side).

A family of 4 from mainland heading south for a holiday; the master of B&B picked them up and while en-routing down south, the vehicle skidded and rammed onto the divider.

None of the backseat passenger had fastened their safety belt. The elder child was thrown out and landed outside the car. The father sitting in the front seat presented with chest pain and the mother and another younger child were noted with limbs pain.

I saw the elder child after the intubation and summoned for help from the ward. Our general surgeon came down as cavalry and saw the father.

The elder child had sustained multiple fractures over bilateral lower limbs. The mother and the younger child sustained contusion. The elder child had surprised me during the physical examination. Despite of his pain, he did not shade any tear. He spoke like a well educated British nobleman (not the slang, but the manner) and expressed a good control over his emotion. I told my staff  that the kid would be an elite of the elite later in his life….

The dad suffered from ribs fracture and pneumohemothorax. As usual my cavalry left me before he wrap up the kill; the chest tube was inserted later by me..

I had to refer the family up north later as my orthopedic surgeon doesn’t operate in the night….
The kids was a threat, at least to Xian and Yun in the future (if they are rival in same field); I had a chill over my back when flashing back the Q&A session with the kid.

convo trip..

The drive to the east coast was a tiresome one…as Yun need to attend classes, we have to pushed off late in the afternoon. The drive was smooth despite of the 70 km winding mountain route. We reached Yu Li for dinner after 4hrs of driving. Yu Li is famous for its noodle and Qing Chao(hot). The noodle tastes like wantan mee and we had found a local shop which is delicious during our last visit. We missed the Qian Chao as the shop opens at 9pm…

The rest of the 100km took 1hr40min and we reached the hotel at 8:30pm. We took a short trip to the night market nearby before we retreated to the room.

The buffet breakfast was great but it started late. I barely made it to the seminary but was still in time for the ceremony.

The ceremony was an exceptional one as most of the graduate were aborigine from different tribes. When a graduate was called, the audience would sing hymn from the tribe…I was the only foreign graduate this year.

We headed down south and take a rest in a resort near Chi Sang area. We took a bicycle ride at the famous “heaven road”; spectacular view and a good workout.

The journey back home was less stressful and we visited K city later in the night for a movie (insidious 3).

BBA....

BBA  = bachelor of business administration Born before Arrival (to hospital)
Well, I was catching a nap when the nurse yelled from outside--> baby born before arrival...
My nurse asked me -> should we take it ?, I gave them a positive answer...Why did they ask? because some of my colleague would requested a immediate referral without managing the duo...
Well,  as usual, everything was not smooth, lack of cord clamp, lack of catgut, lack of big towel , lack of weighing scale, lack of...with grace, everything was fine.
I had recently read about the training of house officer back in Malaysia; 20% drop out rate during house officer stage. I think load of Malaysia senior doctor could not imaging why house officer quit when they are only in charge of less than 10 patients. We were looking after 15 beds ( plus 10 patients laying on the floor , in between beds) in the medical and surgical ward during my training days. Massive exposure and management of cases is the key to a good training and retention of skill.
Well, those golden days of training are over....

High STake

Shift had become more hazardous lately...I told Lem that we would end up with a medical suit sooner or later as everyone of us is over stressed.

Many weeks ago, there was this trio who came to ED; middle-aged male, aged lady and a girl. I thought was it was a combo of granny, son and grandson and I was wrong.

The girl had presented with a laceration over her lips. The middle-aged male did the talking first – he identified himself as Dr C from the local dental clinic. He had accidentally injured the girl while managing the caries. I could feel the fear as his voice was “shivering”. The lady appeared to be the granny of the girl and was worried about the wound. I reassured her that the lips seldom leave any scar and we would take a good care of the patient. I had taken the girl to the OT for suture and the duo follow us into the room. The dentist had however requested impolitely that he wanted to stay and I had without hesitate asked him to leave. In most of the case, I would invited the doctor to stay but his attitude irritated me somehow….

The procedure was a smooth one and later the father of the girl arrived. He was specifically told the dentists that he had never read news about injury of lips during dental procedure…he specifically told the dentist that there is definitely negligence in it. The dentist just stared at the father blankly and did not reply….

He should have apologized and battered his own chest while telling the girl’s father that he would responsible till world’s end regarding the wound, this is what we were taught in the past when encountering medico-legal case...

The case reminded me that to be careful as our stake have become higher due to overcrowding in the ED.

K had encountered a case last week; pt had expired and luckily the family did not take any action...

convo...

I had handed in my final report and concluded the course last week. The whole family is coming for the convocation. Xian convocation is on the night of 16^th and mine is on the 18^th morning. We would be heading east at noon of 17^th…..as 19^th is a public holiday, I planned to take a 3d2n tour with my family during this occasion to the east coast.

The course was really a challenge for me, struggling between night shifts, post calls and fighting the sleeping worm during lectures.

There were a few occasions which I thought of quitting but yet I managed to get through it.

There were 24 of us in the beginning; later 7 quit and only 10 of us managed to graduate this year….

It is s milestone for me….after years of graduating from college, I was still able to complete a post graduate course which is entirely different from my basic course..

why I choose my career ?

Xian had come to me last week and ask me if  he could interview me for his school project....
There was no excuse for me to reject his plead and I gladly comply... One of his question was why I choose to become a doctor....
I gave him a simple answer --- for money .... Xian was not surprise with my answer as I had told him before that I am not a person with noble thought wishing to save life.
During my childhood; doctor was indeed a money making business. Don't need to become a specialist, just graduate and serve the government services then  "VOLLA"... you open up a clinic and live happily ever after....
I had tried my luck in the homeland; but I am not the working hard and living hard type... There were nights when I felt sorry looking at Ving and Yun sleeping calmly in the rented House in Tg Malim. At the end of the service, I kept asking myself, could I provide them with a better life ? and I made my choice..
Nowadays, Malaysia is flooded with doctors, some senior doctors had tried to talk young people out of bearing the dream to become a doctor....but yet if you are dedicated, 100% confirm and 100% confirm very sure, there is a place where you can pursue medical dream without paying a heavy price and risk of being jobless ---> to do medicine in Taiwan....
The tuition fee for medical school in Taiwan is one of the cheapest in the world; less than RM 200000(6 years). The career path is smooth, tons of resident post waiting for the grads[foreign grads are welcome to apply, no restriction],(90% of medical grad completed a residential training)...
Well, the pay for trainee resident is RM9000-12000 (compare to entree salary of RM2500  of an average college grad). 
The salary of attending specialist varies...but mostly above RM15000 depends on where you work and how you work...
The price.-> being home sick from time to time....

Wrapping up and moving on...

We had entered the final stage of the course after my last trip to the east. 2 more weekends to spend and it is over…

I did not drive this time and took the train. It was a relaxing 4 hrs ride..The lodging was excellent as the new building of the missionary had received its permit of use The 8 hrs lecture by Pater Dr Anselm Grun was an excellent one; it fortified what I learnt from the past.

However toward the end of the course, I am not filled with the sensation of joy; the church was chilled with the sensation of chaos.

Accusations and allegations were spread and matters were taken into hand of human instead of Godly way. Breach of trust was noted between the elder and deacons. Later spread among the members. As a student of missionary I voiced out regarding the matter by referring to the holy book but yet the elder neglected my bid… A final blow was delivered 2 weeks ago and I decided to leave the church I was serving…

The key person is the Elder who insisted his way…. There were many settings and rules which were at the grey area according to the holy book; that was the major cause leading to the current chaotic state. When I pointed out to the Elder in charge, he had chosen to ignored my plead. I had done a few discussion with various members, deacons but it all ended without progression.

relax over it is

It was not the worst nightmare but yet it does troubled everyone of us..

After 1+ month of enjoying a "relaxing" working environment, our new colleague had made his decision. "Relaxing" is an relative word when referring to the working environment in ED; The ED can be packed with uncomfortable amount of patient but yet the ED physician could manage the patient without stress...

With the joining of 5th staff; 2 staffs were posted over half of the shifts.

It was an enjoyable experience and we managed to survive the CNY shifts.

When L finalized his decision at the end of Feb. We had tried to "hold him" back but yet we didn't; we discovered some facts: He got paid less when he came to join us (Contrary to what we acknowledge in the beginning). The driving time is more and the pay is less and we had nothing left to lure him to stay back.

However this is not the worst.... the worst part was : the management had asked him to leave one month early at the end of the month....So the chaos begin - shuffling of the new roster 2 days before the end of the month and we were back to square minus one again.

We would be no ground to get anyone for the rest of the year; we are further away from K city and the pay is less than our competitor (our competitor is closer to K city with 7 staffs[they are now -1 and in urgent of getting another one] serving the same amount of patients [cruel fact; we had only 4 staff.. less pay and 2x of the patient load....]

13/13.....

I still remembered the anxiety of doing my first call….The question I asked was, “Can I survived the shift ?”. Since then I had asked the question over and over again; The last time I did so was about 4 weeks ago when I saw the roster….

Working in ED, always complied to the rule of “come out to walk, one will have to pay back somedays…” ; A long break means a long shift. 

I had doubt that I could complete the 13 shifts(5D8N in 14 days....(not to mentioned that 5 of those is around the New Year where the patient amount is estimated at 160-200/day) when I saw the roster, but nothing can be shout, I asked for it..

Usually, I would be very tired on D3 of the night shift and most probably would be suffering from severe headache and dizziness during evening and hoping the shift would be over soon. However, after using the technique I learnt from the Chinese doctor in Sri Lanka, I was able to regain my vitality during this period....

Well, I am now doing the 13^th of the 13 shifts and still feeling refreshing…praise the great one…..

back from home...

Finally I am back to the desk..

The trip did not started smooth as we had to travel up to K city for Xian tooth removal, it had taken a good few hours and we had reached home by 10+….

It was a 4 hrs nap before I woke up and started the pre-flight check.

The sleep on the flight was not a smooth one and when I hopped into the Sylphy, I had doubt that I could complete the 300km drive. Even though with doubt, we had stopped over at the Empayer Siew Pao Town for the crab meal (cheap and big….trust me, for rm68 per kg, it worth every penny).

The drive after Malacca was more stressful as the highway had narrowed into 2 lane instead of 3. I dare not keep to the inner lane and from time to time, I need to overtake those truckers.

We finally arrived at Kulai at almost 11.

The stay in Kulai was a new experience as I had never have a good look around that area.

I proceeded to Avillion for a night stay and travel up north to Klang to visit my in law….

Price of food had risen sky high -> 1 Teh Ais, 2 Milo Ais[combo for our family] cost more than RM7 (>RM2 per pcs). A plate of whatever(fried Kuew Tew, Wantan Mee) cost RM4.5-RM5. Bao had gone up to RM1.5 per pcs….well, I am stunt by the price hike indeed….

Market is slow according to my bro in law who worked as a financial planner.

I need to admit that Malaysia is moving forward fast, the govt. has done a good job of introducing foreign fund and foreign worker.

The distance of going back home had become greater....

pre-flight anxiety

It was not a peaceful morning…I got up early as my stomach grumbled about the salty dried noodle I had last night. I managed to record down the detail of our passport before I left home. I did an early pass over and seen a hyperventilation young lady with chest pain before I started to logon to the CP website for check-in.

I had booked the cheapest ticket online thence I am not eligible for pre-flight seat selection; I had to wait until the online check-in to choose our seat. I had gone through this more than a dozen times and familiar with the routine. However each time is an agony as you don’t know if there is any suitable seat to choose from; traveling with kids mean you would need to sit together ( although both of them is old enough but yet it is uneasy to let them sit alone). I had a close one when there were only 8 seats left (luckily, there was still connected seat for me to choose from).

The check-in was the only thing which was smooth this morning and I was able to secure a row of connected seat for 4 of us.

There were lots of goodies about online check-in, no long queue at the check-in counter, late arrival at the airport, self selection of seat, but the process was actually stressful, lots of input to do(passport no., DOB etc)….

However the coolest part was to download the boarding pass onto our phone (saving a few trees…).

Home going ....

I will be setting my foot on the homeland in less than 1 week... 

It would be a different journey for everyone of us as we would be travelling down south to visit my parents in Johor. (they had moved back to Malaysia with my brother...)

We would rest for a few days and later travel back to Klang to visit my in law...

can't agree with them....

It all started 2 weeks ago when the chief of internal medicine presented a case in the case conference session.

It was a case of ac pul edema who was admitted to his service instead of admitting to the cardiology service. Lem did not do it on purpose as the cardiologist was on leave during the period.

After revealing the x-ray, the IM chief had invited our cardiologist to comment on it and sarcastically suggested that the cardiologist should give those emergency physicians who did not undergone sub-specialty training a lecture on how to differentiate pneumonia and pulmonary edema. (very irritating one - > when he had less patient, he would come to our department, asking for more admission to his service...)

Lem had walked out straight from the conference room. Boss had sensed his rage and later invited him for a deep discussion. After hearing all those unfair treatments by those physician/surgeons toward our department; Boss had done an interview tour and found that our new colleague was the main target.

The discussion did not end as my complaint against the radiologist was also referred.

Last week, the radiologists had sat down with us for a discussion. The process was a raging one, the senior radiologist had focus on how to prevent his ass from being poke being sued….I however strongly disagree with their argument – we would not put our impression on our xray report(CT, MRI excluded)…..

Well, although the ending was a positive one…

However I despise the senior radiologist view of prioritized on his ass on being sued or not….

surprise.

My sister in law paid us a visit last week; it was a surprise to us as the decision was made after the announcement of delay of school opening due to flood in Malaysia.

We had accepted guests from Malaysia in the past and showed them around the 3 counties nearby. The largest group we had treated was 4+1. The Z had taken us around (yes, 8+1…) from Tainan to Kending. This is the only reasons that I had stuck to a 7 seaters since I came back to work; we would be accepting parents, relative etc. and with the 7 seaters, I would be able to carry them around in one car instead of 2….

However, it was different this time; my sister in law had 4 kids and our guests no is 6…The plan of going out in one car is not going to come true this time…

Although the total amount of passenger is 10 but yet, we would have break as my brother in law would be going back 3 day earlier and my 2 kids would be going to school during 2 week days. That cut down the time of using both cars to 2 days.

With grace, we had successfully taken them to most of the spots pre-planned.

Fefe had successfully squeezed in 3 adults and 6 kids during our last few rides; everyone was still able to buckle up (2 sharing one belt…) during the tour.

The tour had interrupted my camping trip though; I was supposed to try out my weathermaster but still I praised lord for the amazing journey and experience...

I learnt a lot during this journey and so do my children….