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....