Early change..

 

I had Z service 1+ months ago – 3.5 years and I had completed 100,000km with it…Z is such a nice car – safety and driving fan. However the parts were so expansive and the hot weather of Taiwan is not really suitable for a European car. Just like our cardiologist T told me about his Volvo – good car but small problem here and there…I considered him as “car god” – he knew lots about car and an awesome driver. Don’t judge him by what he is driving ( a 10+ years old Nissan Primera P11 – sporty though, I saw him snake drive in front of me months ago…, he had a Volvo 460 before).

Few months ago, there were rumors that the OPEL dealer of Taiwan – YGM is not going to continue their dealership. The YGM is a subsidiary of the CCar (dealing with Mitsubishi and Nissan ). The CCar had however launched their own branded SUV+MPV(LUXGEN) 1 + years ago. Since then, the showroom and service center for OPEL had been shut down one by one. Last months, the rumor had become a truth. It means there would be no OPEL dealer in Taiwan after June. Market rumor had claimed that VW dealer would be taking over the dealership but next year.

My Z would become orphan, even though the service center had told me that they would continue to service my car but I felt unsecure as parts would need to be ordered and waiting time would be much longer….

I had to bring the date for change a little bit earlier(much earlier to be truth…).

My first consideration is definitely a 5+2 seaters. The +2 will definitely come in handy when there is visitors…. And the extra space could load our bicycle and camping equipment as needed….

But I still missed the SUV – better view and safer when driving over some muddy terrain. I had driven my kembara up to the highest road in the Malay Penisula - the Telekom Tower in Cameron highland - hell of an experience...so I had put an eye on SUV again...

It is hard to get a SUV c 5+2 seaters in Taiwan – not many selection . I did not consider any European brand – another walk over the plank trap, had to settle with local assembly one/Imported Asia model. One of my favorite is Land cruiser Prado -  however the only version here is the 4.0 one =>super petrol tiger….just had to skip it. The more fuel efficient selection is Pajero ( the only version is 3.2 diesel) but it cost about 220k RM…still way beyond my budget.

There were owner who add the 3 rows seat to their Outlander and RAV4, but it is not my option as I wish the seat could be completely hidden to the bunker..

There is one car left on the market with the basic requirement of mine – Hyundai Santa Fe. However, the only version is 2WD…. a little short of my expectation.

However last month, I saw the news over the net that a 4WD version speculated to be launch in May. The dealer had officially denied the plan but later I had got a affirmative news from a showroom manager through a church friend.

I took Ving to the showroom and arrange a test drive[2WD of coz..]. Darn, the engine was so quiet, I had a moment thought that it was a N/A engine instead of a diesel one. With 197 hp - >the pickup was good…

Ving did not suffer from any motion sickness and after some discussion we had decided to take the car….

come with twin exhaust ...

a roof spoiler....

10+days before the hand over – it was truly an agony waiting….

hang of it....

It was a busy evening, the ICU nurse had been calling 175 and 196 like don’t know what….well, I had just seen 2 biker who had wounded after they hit a dog. I saw a 2 ladies walked in to the ED with the nurse holding a blanket. I was right on my first guess - a baby was wrapped in the blanket.
The younger lady was the mother and the lady in her 40s was the granny. She had given birth to the child in the house – no one had known about her pregnancy until the crying of the baby shattered them. I did a quite survey over the body and found that she was fine with a little bit hypothermia.
We had no facilities to keep the baby warm, I ordered the nurse to shut off the centralized air-con and asked the nurse to use a heat lamp on the baby.
I then turned to the mother, she was comfortable but looked a little bit pale. I felt her abdomen and found that the uterus was poorly contracted. I started the massage and as the nurse to prepare the patient for me to perform a vaginal examination.
I was lucky – the massage did the job => the uterine started to harden…the vaginal tear was shallow….I did a repaired and the PV bleeding was greatly reduced after I removed abundant of blood clot….
The repair was smooth and I had referred the mother and child to a hospital c OnG and Paeds service….I still had the hang of it after all this year of leaving MOH…..I would have ended up doing nothing if I had had not do my time with the MOH….

crap.....

There was this nurse (so called A) who was considered as unfit months ago. The acting head nurse had decided to let her go. As the acting head nurse was one of the “GANG” member.[the gang had made up of a matron, a few head nurse and nurse leader].  A plot was set up – the management had offered an attendant job to A. They had advised A to take the job on the below ground

1.     She was incompetent

2.     Attendant work day shift only

The cons side was she had to tolerate a 30% cut of salary.

The part which pissed most of the staff was – the offer was made while she was pregnant…

Some had stood up and fight for her, but finally she accepted the offer and nothing much can be done….

Lately, she had wanted to apply for baby sitting leave…and the management had again tried to talk her out of it, by claiming that she was demoted and currently not confirmed on her current job….…however she had seek help and someone had looked up the relevant law and found that she was entitled to the leave and the managment had no right to refuse her application… she had decided to filed the application in written formally.....

 

Regarding baby sitting leave…

1.     Work more than 1 years in the setting

2.     Child/children is less than 3 years of age

3.     The spouse is working

The national labour insurance would pay 60% of the salary….

flood....

I had read from the internet sometimes ago….the Malaysian Govt. Hospital currently is being crowded with House officer…..really stunning news to me..I remembered the structure of a medical staff in a ward :  1 specialist with 2-3 medical officers plus 2-3 house officers. When time is bad, 1 house officer was allocated to a ward. In surgical ward the condition was bad, when this HO of the ward shared the calls, when there is 3 HOs, it would be 3 days per call, when there is 2 HO, it would be QOD, when there is 1 HO – than it would be real “HOUSE OFFICER”, hospital = house….10 HO in a ward means 3 calls per month and the experience earned from doing calls is definitely beyond imagination…..

One HO would be taking care of 15-30 patients during those days… really busy but good learning environment…. The report claimed that 1 HO caring of only 2 patients….A bad consequence resulting of flourishing of medical school in Malaysia….There were 1 twin linked at my time –the IMU, the affordable one opted to do their senior year in the overseas, many of them obtaining a foreign degree and practicing license elsewhere. Some of them stayed back…. Later on load of private and govt medical school were set up to resolved the doctor shortage….the strategic was a successful in a sense that there were so many HO (and later MO) but there is still short of specialist….the final consequences is load of GP flooding the market….specialist is definitely commanding high fee at the moment; my mother in law told me she was admitted overnight (2d1N stay). The consultation fee was RM 400, 2 visits per day, 1 visit = RM100 in the ward…..our local NHI pay is RM 30-50 per day per caring an in house patient(specialist price of coz...)

I met one of my senior(neurosurgeon) during my last visit back to Malaysia at the airport. He told me a medical center run by one of our senior in Kedah offered him a pay of RM20000/months (guarantee minimum wage).

It would be a very bad practicing condition later on as the base of pyramid had become wider……GP earning less and competition and.....

Sometimes I would think of getting a job back in Malaysia, but my only option would be the govt service….. Just couldn’t bare to earn those money in a private practice…. Only the affordable being served….but still, it would be going back to the bureaucrat working environment, fighting for promoting(not for the pay but for the calls – more senior = less night calls..) and retiring at the age of 56 and wandering which medical center to practice in(back to what I dislike at the first place...)

If everything goes smooth, I would be saving enough studying fund for the kiddos by the age of 55 and maybe I would try to get a contract specialist job with the MOH then.….

from 1 to 3.....

 

Well, we had 2 colleagues reported in earlier this month. Two head of department was introduced. 2 middle-aged ladies with nursing background were introduced to us during the morning conference.

One was designated as head of admin, there other was introduced as head of medical affair.

The head of admin is posted to 2^nd flood admin room and in charge of admin and insurance claims(from the national health bureau).  The head of medical affair is posted to a desk just behind the registration counter. I could see their daily task were previously oversee by our ex- dept. supt. Of admin. Lem and I had a chat few days ago when we learnt about their present. It is a 1 for 3 situation. 3 persons doing 1 man jobs. Will it be more efficiency ? Time will tell, but the costing is definitely more .....

I had a call from our ex-dep supt last week, he had gone back to a small hospital where he had started….

confident ?

I saw the so called Anwar video clip…. The scenario looked like a very cheap joint – with the OKT leading the male into the room. The belly was way too big…. Definitely not him….Another tactic to defame someone…Sadly too said, the relevant party is so uncertain that they need to use such dirty trick to win….

GUTS......

 

I had attended this combined emergency network conference last week. Most of the time Lem would attend such meeting but since he is doing day shift he had asked me if I wanted to go. It was Thursday which I went off by 9am(by 8 to be exact, but I had to attend the weekly conference). The meeting was scheduled at 2 and end at 5. I could catch a few hour sleep but I had this class with the elder of the Church by 10, so the rest should be minimal.  Anyway, I took the offer when Lem asked me as he told me that the management would provide a 4 hours working pay. I am still 8 hrs short from the 180 hrs, so I took the offer. 4 hospitals were chosen to present a case each. I had prepared an AMI case which I had called up 5 hospitals before that patient was accepted.

The local rescue service also brought up a case which really stunt every one of us…

There was this 20+ young lady who is G1P0 currently bearing a twins. One of the twins had lost sign of life at 6 months. To salvage the other twins, the obstetrician had chosen to continue the pregnancy and let the still birth remained in the womb(it was a boy and a girl twins…)

At about 9+ months, the mother had visited a local hospital O&G clinic complaining of low abdominal pain. The obstetrician had seen her and discharged her. She returned to her house and found that the pain had become worsen and contraction was noted. A she was facing financial difficulty she had opted to call the local ambulance instead of going up north to a bigger hospital by herself even though the obstetrician had strongly recommended that if she gone into labour she should go to a bigger hospital for delivery.

The local rescue ambulance had responded to the call and she was sent to the local hospital which she had visited earlier that day. She was sent to the ED and the ED physician had called up the obstetrician for a consult. The obstetrician had told the ED physician that he had seen her earlier and nothing can be done by him as in his opinion, such case should be handled in a bigger hospital WITHOUT SEEING THE PATIENT IN THE ED.

The ED physician after receiving such call had asked the local rescue ambulance to sent the patient up north.

The rescue service had reluctantly accepted the situation and sent the patient over. The still birth was delivered on the way…..

The unacceptable and inappropriate part was – NOTHING WAS DONE during the patient transit in the ED, NO DRIP nor EXAMINATION DONE – not even a VE(vaginal examination…)

A very unethical thing to be done – just because the obstetrician was negligence and the ED physician had NO BALLS to do something which he had omitted in his training causing him INCAPABLE and INCOMPETENCE on his job…..

I shook my head – he is just peak of the ice burg, there are still many many incapable and incompetence board certified ED physician current working elsewhere….they would hesitate to raise their hand if an obstetric condition came in front of them and they would chose to pretend that they are not a doctor if no one recognized them….

Really wanted to speak out the full KNNECB word in front of them….