My Blog

"Oxfam estimates that 48,000 of an anticipated 128,000 homes have been
built in Aceh, while 25,000 families remain homeless. Corruption,
misappropriation and the failure to deliver on promised aid have also
been blamed for slowing the pace of recovery." Al Jazeera

The opportunity to visit Aceh was really an eye opening experience for
me. Throughout my 21 years of existence, I thought I have seen it all;
the poor, the destitute, the deprived. I thought I am wise enough to
see that life isn’t all roses and honey, there are people out there who
really suffer. But to have the harsh reality being revealed to me one
after another, right in front of my very eyes was like a slap in the
face, an awakening from my naiveté and ignorance. I have heard about
the tsunami and how it wrecks destruction to everything in its path
countless of time before, but it never occurred to me the realness of
the human suffering behind each statistics of death and monetary lost
incurred. To be able to befriend the tsunami survivors and hear their
side of the story made my heart yearned with sympathy. Their stories
vary but they are under the same theme; stories of lost and more lost.
To be able to see the degree of destruction first hand can brought even
the proudest man to his knee, weeping for the inadequacy of himself, a
mere creation under the mercy of his Creator, the all knower capable of
all things. But my greatest grief and regret took root from the fact
that these courageous tsunami survivors who had been through so much
didn’t receive real support from those responsible to lessen their
burden and rebuild their shattered life.

The true scenario in Melabouh area 7 months after the tragedy; a main
road stretching only 6 km which links the city to nearby villages, used
everyday by school children and adult workers alike was still in a very
bad condition, exactly like it was when the tsunami wave left it.
Almost 40% of a village’s remaining population have been living in
white, triangle shaped, suitable-for-camping UNICEF tents for the past
7 months, and didn’t look like they are going anywhere anytime soon.
And as for the ‘luckier’ others, they got a room (or shall I say a
cell) in barracks, or long houses. You guessed it right folks, of
course there is neither running water nor electricity, and the water
from the wells is murky brown (again, if they are lucky, they get a
well with water that is of lighter shade of brown). I have been in one
of the room in barracks for 20 minutes and already I was claustrophobic
and anxious to get out. The inside is small, dreary, grim. Imagine
living everyday of your life in that condition, having no need to get
out because there is no job left to do, remembering the loved ones who
lost their life to the tsunami, some with the bodies found and safely
buried but others drifted to God knows where, revisualizing the
horrifying scene brought by the disaster day in day out….any normal
person can lose his/her sanity!

Where has all the donation money gone? Where are the leaders who were
being put in their thrones by the suffering people in the first place,
believing in the promise that their leaders will stand by them in
happiness and in grief? To unravel the whys and hows this unfairness
came about will require a political analyst that has studied the plight
of the Achehnese extensively over many years. Based on what little
knowledge I have on the subject area, Wilayah Istimewa Aceh has always
been disregarded and overlooked in every aspects of development by
Indonesian Government since 3 decades ago when Gerakan Aceh Merdeka
(GAM) resorted to military approach. The government saw it as a way to
dismantle the organization and to lessen the resistance, yet GAM saw
the oppression as a calling for them to put on more pressure to
override the corrupt government and have Aceh for themselves. The Aceh
people were trapped in the ongoing battle, bereft of any means to get
themselves out of the very troubling situation. The government’s lack
of enthusiasm to develop Aceh can be seen everywhere. The villages that
we past on the journey between Medanand Melabouh adequately pictured
how impoverished and lacking the condition of the people are.

Looking back, I used to find myself questioning again and again why
all the destructions have to come about. Why are all the sufferings in
muslim countries across the globe right now have yet to come to an end.
And a question by a friend of mine who is an atheist kept lingering in
mind; “if there is a god at all, why does He let sufferings and
unfairness befell His people?”- a question asked so innocently yet I
wasn’t able to reply adequately due the lack of knowledge and
understanding in my path. To have faith means to believe unquestionably
in the oneness of Allah swt and all the attributes ascribed to Him and
Him only, including his qada’ and qadr, and yet I still cannot subdue
the disquieting confusion deep within. It was my hope when I took the
flight bound to Medan on that fateful Tuesday morning to find for
myself an answer to feed my confused mind, hence showering light unto
my heart so that I will understand and believe with absolute
resoluteness. I dare not say that the 10 days trip bestow me a perfect
answer to all my questions that I am now a believer in the truest
sense, yet the lessons I learned from it have knocked some sense into
my mind to help me with my quest to be a better person and muslim. In
this paragraph taken from an article by Abdal Hakim Murad in which he
aptly reflected on the uncertainties I put forward earlier.

Allah has names of beauty the Compassionate, the Gentle, the
Merciful and many others. But He also has names of Rigour; the
Overwhelming, the Just, the Avenger. The world in which we live in
exists as the interactions and manifestations of all the Divine
attributes. Hence it is a place of ease and hardship, of joy and
sorrow. It has to be this way. A world in which there is only ease
could nott be a place in which we could discover ourselves to be true
human beings. It is only by experiencing hardship, and lost, and
bereavement and disease, that we rise above our egos, and show that we
can live for others, and for principles, rather than only for ourselves.

Hence the tsunami wave that hit Asia last 2 years, in accordance to the
opinion of many, might be a test to us human beings. For the survivors
it might be a test of faith, to see whether they will hold steadfastly
to their belief and still submit to Allah swt wholeheartedly even in
this time of trials. For us who were saved from the wave and still have
a lot to live for, it might be a test of courage and compassion;
whether we can still feel empathy towards the sufferings of others,
whether we can spare some of our material possessions to give sincerely
to those in need, whether we have time and energy to spare to fight for
their cause and ease their hardships. And in the process, a beautiful
Islamic ukhuwah and spirit of togetherness shall take form, indeed a
blessing from Allah swt.

it seems like a long time since i post anything. the reason being, nothing particularly interesting happen to the past couple of weeks of my life, sadly. except for the few occasional exciting things that happen in clinic and wards, like doing a PR (or DRE) exam the other day- i was so excited because i can honestly feel the prostate, no kidding! gosh, funny how silly things that i take delight in doing are what most others find gross and indespicable.

the last day i was at the gp, i followed the district nurse on house visits-mostly changing bandages on leg ulcers. our last stop was at a residential home, to check on this lady’s wound. it turned out that she and the rest of the resident were in the living room, they were about to play a game or something. the instant she saw us approaching, she took one long look at me and said, "you are not supposed to wear that!" ooh not again. i made sure my smile did not wane, never mind all the other silver-haired ladies and gents in the room who were looking at me now. hmm, what shouls i reply to that.

then i t occured to me. she mistaken my headscarf for a niqab. thanks very much Jack Straw. "but you can still see the whole of my face, cant you?" still smiling, still smiling. i didnt remember exactly what she said next, but something along the line of..still you are not supposed to wear tht. this is one tough lady, no chance at all to sway her opinion!

but i wasn’t angry at all, not the tiniest bit, not like the last time. i could say clearly that what she said to me was out of curiousity, out of not knowig. it is only natural for people to be afraid of things they don’t know. then they make all sorts of assumptions, mostly influenced by what the media feed to the public. i wander, when she saw mw that day, whether she imagined me as a terrorist with guns underneath my hijab, or a freak who dare to dress differently from the the rest.

almost the same thing happened ages ago, when i worked in mri. i remembered her frown when i walked into the room. the she asked, what are you wearing? so i told her. why wear it? she asked next. because god said i should, i replied. what kind of stupid god ask you to do that? i could feel my blood rising to my head. i was tempted to say, the same good that you will meet soon, sick woman! but before i can say that, the other nurse with me chirped in, now dont be nasty, isnt it nice she have it to keep her neck warm in this cold weather! a minute after, all three of us in the room were laughing (i forgot at what)

i cant help but wander if the nurse didnt but in like she did, whether i would have a heated, pointless argument with the lady. the funny thing is,i was about to combat her remark with an even ruder remark, but what will come out of that? there she was, already forming all sorts of bad assumptions about that freak girl wearing the hijab, and i was about to confirm all that by acting rude.

before coming to this country i never imagine i would be put up on spotlight like that, being questioned about things i do and wear, and to an extent, questioning my own faith. it is all as well, because now i make an effort to think about what i do and wear and say myself, and not just go blindly through life like i always had.
like wering a hijab, it is something i have done days in days out without giving it a second thought. one of those things that is taken for granted. if i was to answer honestly i would have said, no i didnt want to wear it but my mom made me and now i have started wearing it, i feel awkward to take it off. i tried that and my friend said, if thats the case what’s stopping you now, your parents are not here..(speaking of the devil..)

i realize now the answer would be faith. i need to see that there is goodness in it. that wearing a hijab is the best thing for me, eventhough i cant see it that way all the time. but most importantly, because that is what God ordains me to, plain and simple. (note to self; if thats the case, why are you not covering up properly all the time huh?!)

i have a burning aspiration to write more about preventive medicine, especially after the lecture we had to day on health economics. the basis is simple- to provide efficient, equitable healthcare to all. but the resources are limited and yet the cost of advanced and more efficient treatments are becoming more expensive than ever. in a country like Uk where healthcare is wholly funded by the government hence ensuring equity too all, the finite resource need the doctors to think twice before prescribing any treatment. it all comes down to rationing now. thus cost and effectiveness of each treatment need to be quantified so that doctors will have more knowledge (and confidence in their decisions) to prescribe or deny anybody a particular treatment. but at the end of the day, it all means that we are passing values on human life, by helping one to get better and condoning another to fate without doing anything.

but since i am now watching the simpsons quite happily, and would rather not subject my brains to excessive neural stimulation in order to get my thoughts written here, i’ll rather put up an article that appeared in the beat 2006. it was initially written by najlaa and since i like it soo much (and her birthday was yesterday! so this is more like a tribute, really), i’ll put it up here. so maybe sometimes later for the more intricate nevertheless interesting issues concerning health economics.

A few things I know now

They said we got to be responsible for every action we take. Learning to be
an adult is to accept any consequence of our actions, be it good or be it bad.
It is so easy to take in when something good happens in our life and yet when
it is hardship that we have to endure, letting go of our principles become an
easy way out. I guess that is why people say that only hardships and
tribulations could make the victory at the end sweeter, if we ever reach to it,
that is. Some people take this believe to heart, saying, what does not kill us
would only make us stronger.   

But in the end, it is up to us to fight our fight. This is when we need to
have faith that what Allah has planned for us is the best plan we can ever
wished for. Even when our mind battles so hard to deny this. Even when the
calamities that befell shaken us so bad that we are compelled to question, why
me? But do remember that patience is the virtue. With God’s will, everything
will fix itself accordingly in its mysterious ways and eventually things will
turn out to be fine. 

His help will come our way if we remain steadfast in our faith and
surrender ourself fully to Him.  

“On
no soul does God place a burden greater that it can bear” (1:285)

“O ye who believe!
Seek help with patient perseverance and prayer: for Allah is with those who
patiently persevere” (1:153)

“So
verily, with every difficulty there is relief” (94:6)

We may bend and we may stretch but
we will only break if we allow ourselves to. Look at the problem at hand with
an open heart. Never underestimate our strengths and ability to cope. Do not
just focus on the bad, bleak side of things. The light of hope will never shine
down on us if we don’t even bother to open the window. It is all a matter of
how we perceive things.

Ever heard of the man who felt really bad when he lost the only pair of
shoes he owned untill he saw another man with no legs? All the small and simple
things in life like smiling, joking, greetings, sunny days (you can add your
own choices) are free and are there to make up for the bad things. So relax,
pray to Allah, and try to solve the problems with any options available without
blaming or lashing out to others.Remember, even when we have pains, we don’t
have to be one.

my idea of a doctor’s life used to be a direct depiction of
scenes from er,

chicago

hope, house
and scrubs blended together. than i got chucked to gp for two whole weeks every
other month. i wouldnt say i enjoyed myself, far from it in fact. at first i
was clueless. then i sort of able to find my way around, barely so. after the
first week, i was already bored out of my mind, and luckily enough the two
weeks was over before i start to rot in that place.

then i got to be back again. this time around, i promised myself to keep an
open my mind, and an open heart. and surely enough, those who seek will find. i
start to pick up a thing or two about primary care. and interestingly, i
am able to form my own opinion about primary care, one that doesnt involve the
words ‘boring’ or ‘what’s the point’ or ‘i cant believe this patient!’ but my
initial take on gp being so rich that…and the end of that phrase ranging
from; they have a helicopter pad in their back yard, send all their children to
private school, to they have two mercedes each, well, that still holds. and
spending one whole morning in dr wright’s surgery has been one of the most
interesting clinic so far. by the way, he is a very old-school doctor who dont
know how to write a letter using the microsoft word, spend ages to input
patients’ data into the computer and is adamant tht the blood pressure
measuring machine is no good at all. and yet he is one of those gp who tap
dance in front of the patient (and me of course), always is 30 minutes behind
after the 3rd patient, and whose patronizing demeanor the patients expect and
welcome.

Enough about dear old dr wright, let’s talk about primary/community care, where 90% of all patients’ care in this country take place.

1. I believe everyone has a right to being seen by a medical professional without substantial delay. this is what primary care in any community should strive to provide. fair enough, this need is catered for in Malaysia, but the patient has the added worry of having to pay for the consultation as well as the drugs prescribed, and the added anxiety of not knowing what the doctor would be like. the consultation and treatment will be free in any government clinics, but the waiting rooms are always jam-packed with patients.

thus i truly advocate the provision of family doctors in every community, where patients get to see a doctor, or any two or three doctors they know and have already form some sort of a rapport with. and the medical consultation should be free. health care provision is one of our basic rights. formal classrooom teaching takes place without the students having to pay their teachers at the end. the same should be said about general practitioners. paying for one’s own prescription drugs, with the aim that one would comply to the treatment, tht shouldn’t be a problem. however, the price of the drugs should be heavily subsidized, and in a developing country like Malaysia, further efforts should be made to widen the prospects and variability of cheaper generic drugs.

2. prevention medicine is the way forward. one of the thing that make hospital medicine so appealing to me is the fact that almost all the patients are acutely sick hence the need for cool life-saving measures like passing down the endotracheal tube, or putting CVP line in, or doing emergency surgery. however, these are all late-stage measures, those that invariably result in death or prolonging death, and maybe in few luckier ones; cure. when we think about it, more than half of these patients wouldnt be needing all the tubes or catheter or chest compression that can break a rib or two if adequate primary or secondary preventive treatments were intituted for them, if careful managemet plan was laid out on the day diagnosis were made, and if proper patients’ education was provided to make sure they take care of themselves the corect way. all this realization hit me when i sat in countless diabetic and hypertension clinic, consultations with patients having depression, copd, asthma, and many other chronic diseases.

for a diabetic patient for instance, their blood glucose(HBA1c), blood pressure and lipid profile is closely monitored every 6 month, ecg routinely, as well as screening for complications wverytime they see their gp. and the list of medications prescribed for them will fill up a whole A4 pad sometimes. as well as diet and lifestyle advice, their blood pressure kept vigorously low with ACEI or/and any other options like ARI or b-blocker or nifedipine, blood glucose kept in check with metformin mostly, or sulphonylureas or gliazide sometimes, statin is a must, aspirin/warfarin if they ever have problem with their heart before, add furosemide if cardiac failure is suspected, amitryptyline if they start getting nerve pains anywhere, and the list goes on. the good news? prescriptions for diabetics are free in this country. but the bad news? having to take down this drug cocktail every morning and night for the rest of my life wouldn’t be my idea of fun. but hey, if i am predicted to have three times-weekly renal dialysis in 10 years’ time, lose my vision in 15 years’ time, have to use diapers in 20 years’ time and have my leg cut off in 25 years’ time, i am not complaining!

i prone to get personal everytime i talk about diabetes. here these patients receive fantastic care and aggressive treatment, but my mother at home only take metformin. and i know for certain her lipid profile is less than satisfactory (i have an instinct that arcus senilis is developing in her eyes, but please god let me be wrong) and her blood pressure tend to go way over the moon sometimes. my dad doesnt even bother to have his blood glucose check, regardless of any horror stories i manage to come up with.

so whose fault is this. will my dad behave differently if he has got a good gp whom he trust, will he be seeking treatment this very instance if he is more properly informed and the clinics made more readily available? and for my mother, shouldnt she be started on antihypertensive and statin as well as the metformin, and proper care plan been drawn up for her?

3. at the end of the day, the attitude of the doctors, nurses and the other allied helath professionals whom the patients encounter will determine whether they will come back for further treatment. if a doctor reveal the diagnosis of diabetes to a patient by starting the phrase with, "your blood test result revealed that u have diabetes, which i already suspected, since you are downright fat and only eat meat and never exercise.."
the role of primary care doctors extend beyond making a diagnosis and prescribing treatment; for example dr hardwick take care of his patient’s cat when the patient need to admitted to hospital and dr wright spend an extra 10 minutes comforting a patient’s wife who started crying uncontrollably during consultation. so they are not merely doctor, they become a family’s friend. (plus the added benefit of getting expensive wines  and chocolates from patients every christmas-i want the choc not the wine thanks)