Saturday, August 29, 2015

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…

Saturday, August 8, 2015

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....

Wednesday, August 5, 2015

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....


Thursday, July 9, 2015

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.

Tuesday, June 30, 2015

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).

Sunday, June 14, 2015

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....

Wednesday, June 10, 2015

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...