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such callous implementation
such a betrayal to the rakyat’s trust, going back on the promise made pre-March GE.
here’s some quotes from around the blog..
"The rakyat may not be able to fully appreciate the impact of
curtailment of freedom of association, assembly or expression. But
there is no doubt that every single rakyat will feel the impact on this
occasion."
"Tightening more means go without transport, or a meal and is not as
simple as counting 1, 2, 3, or just take away the 3 and you have 2."

Now emotion aside, was it imminent? highly probable. and was it avoidable? maybe, but maybe not. but should things turn out as they did? definitely not.

Personally, I don’t have anything to lose from this new development. I don’t own a car. Heck I don’t even live in the country. But a year or two from now, when I earn a car, I expect to drive it around town and go balik kampung without spending a fortune, and treat my family to nasik lemak and teh tarik for breakfast at a decent price.

Will I be able to do that at RM 2,500 a month salary when the petrol price is RM2.73 a litre? I doubt so
Will I be able to do that at a GBP 2,000 a month salary when the petrol price is GBP 1.10 a litre? yes, i think so(but not nasik lemak for breakfast or balik campung by car though, realistically!)

So i am not surprised why Malaysian are immigrating by the drove, and those who are already abroad refuse to come home. It’s the freaking living cost! If I can have my mum and dad and my favourite nasik lemak warung relocated here, I’ll stay here indefinitely no problemo!(such patriotism..bravo!)

But no I’m not going to do that. Let’s go home and open up the eyes of my fellow contrymen and women, that there is another way of doing things. It is practised in other countries. and sooner or latter it will find its way to mine, God willing.

It is called-evidence based practise, good governance, and transparency.

Evidence-based practise: people do it like that there, and it works!let’s replicate the environment, draft the guidelines, and do exactly what they do
Good governance: Are we doing things as we say we should do it. If yes, good, le’s clap each other on the backs. If not, here’s how we are going to change for the better
Transparency: whose money are we using? who elect us to do this job?who are we answerable to? The rakyat! show them what we have been doing so far and see if they approve.

and if all three has happened since 1974, I am pretty certain that the profit petronas inject into the government year after year can last till this very day and fund the petrol subsidy for the rakyat.

dispatches featured another brilliant reporting today, on war-torn somalia. the street fightings do not differentiate civilians from fighters, children from abled-bodied men, women sneaking out to buy cooking oils from armed militias. it is such a mess. it is so very sad.

i don’t bother to find out the cause of the conflict. i don’t even bother to try. because injustice and indiscriminate killings do not and will never, have a justifiable cause.

the men are fighting in the street of mogadishu. some are trying to make a living. the women and kids are left desolate in makeshift tents, made of twigs and canvas, in the outskirt of the city. their lives depend on international aids, which are not always forthcoming.  there is only one clinic for the whole population. the clinic only function is to force feed the malnourished kids.

These women and their kids, sit around under the heat of somalian sun, waiting for aids and their turn at the ‘clinic’. they all wear full hijab.

the top commanders in the governement who are claimed to be behind these fightings have names ranging from, abdullah, ahmad, yousuf and such. and the allegations associated to their names are wide-ranging; from cold-blooded murder, imprisonment and torture for ransom to blocking international aids. yet they blatantly tell the journalist that all these claims are baseless. then they jet off to their homes in the uk, saying that they are tired and need a holiday.

you may call me naive for believing everything i see and hear on tv. you may scrutinize how truthful is this western journalist reporting for a western television, making claims that ‘oppressive muslim government fighting against an al-qaeda sponsored terrorists and militias’.

but the images it showed are powerful enough to lead me to belief that grave human injustices are rampant there. and the fact that those who give the command, those who pull the trigger and those who took the bullet in their heads, chests or whatever share my religion sadden me the most.

there is also one chief surgeon in the only hospital in town being featured. he operated day in and out. he just operated on 3 trauma victims, whilst 3 others died on arrival to the hospital, and he said it had been a quiet day. asked whether he was tired of all this, he responded, ‘we will continue to help each other, peace will come’

i pray that nothing happens to him. bless his soul.

i also pray that i can become one tenth of the doctor he is.

Change is a scary thing. It may swing both ways. But there is no way of telling at the start. The alternative to change is stagnation. And that is an even scarier prospect.

In retrospect, people who affect change may be celebrated for their daringness and courage.Alternatively they may be remembered forever for their misguided bravado. But the people who remain in status quo will and forever be, well, the same- never knowing of any other way.

But one positive lesson has came out of all this. Gone are the days of hang tuahs. Gone are the days when the sultan said, ‘collect 7 big pots of mosquitoes’ livers and hang tuah would say, ‘yes sir’. We saw the birth of a generation that would answer the sultan with, ‘what for o’ my dear sultan? give me a good reason for doing that and i’ll think about it first’.

We learn that respect and trust have to be earned. Work for our cause and we will support you all the way. Deviate from it and we won’t hesitate to turn our backs.

To the new victors, please learn that lesson. You can count on us to be your judge again. 5 years isn’t a long time. Start working for our cause now.

sincerely yours,
the gadis-gadis kampung who have to cry into 7 big pots.

i was over the moon when i found it there! i guess this is why so many people decide to write books, journals, scripts and what not. the feeling you get to find it published is absolutely thrilling.

anyway this is what i am talking about http://www.thelancetstudent.com/2008/02/28/tuberculosis-in-two-countries-the-uk-and-malaysia/
it’s not that exciting though. just me lamenting/critiscizing/commenting/brooding about things-not much different from this blog. but it’s the first ‘fruit of my thought’ that got published ’somewhere’-not just this lame blog of mine, so that’s definitely something to celebrate.

and as i said, hopefully it’s the first of many. now i can start dreaming of the lancet (the real one of course). well it never hurt to dream big, ain’t it?

it’s that age between 21 and 25. at times it seems like life is passing you by, and there’s nothing you can do to stop it from slipping from your fingers. but at times life seems to arrive at a standstill, and you are willing it to  go quickly because you can’t wait to see what tomorrow will bring.

you feel like you are old enough to face the world and everything in it on your own. you are invincible. but at times all you want to do is go to mummy for a cuddle.

you are matured enough to see that you are only one of billions. whatever you do don’t matter much. the world is beyond saving. but at times you believe with the greatest conviction that you are going to make a difference, and you are meant for something good, something big, and change lives.

you feel like you have lived enough to lose enough. just when you feel like you are over that something and someone you have lost, a little trip down memory lane could bring all the emotions afresh, and it threw you.
after you lock the memory back safely into the back of your head, you become painfully aware that it is an ongoing process. right here, right now, you are losing something and someone, bits by bits. and there’s nothing you can do about it.

you feel like you are already set in your ways. you are what you are and everyone can either take it or leave it. but at times you feel like your own self feels like a complete stranger. and you miss the little child you once were.

you work your ass off  towards achieving your dreams and aspirations. nothing else matters. but at times you get a nagging voice that that ask you does it matter all that much? why not live for here and now. and the future doesn’t seem to be that important anymore.

you are proud of what you have done and what you have achieved. but at times you can’t help but ask yourself; what ifs, why didn’t i and why  did i..and you are clouded with regret. only now you understand that it is the worst feeling in the world.

++like i said, i like to get philosophical once in a while.

It has only been 3 weeks. well, almost. the extended hari raya and christmas break aside. the experience in melacca general hospital is priceless. i have encountered many things that i think will remain etched in my mind for a long long time. it was as close to having a culture shock as one who comes from the same culture can get, if you know what i’m sayin’. here are just some bits and pieces.

countless men, some almost reaching their 60’s, with HIV due to past, and some still are, IVDU. one came in with meningitis symptoms, a ‘buang daerah’ case due to previous drug traficking (i dont even know such things exist!) another has had tb before, defaulted treatment, and came in again with tension pneumothorax secondary to ptb. countless others whose cd4 is closing to 400. none of those who i met are on HAART treatment.

this old chap had copd for a long time. then he came in with community acquired peumonia. try the curb score; he scored positive in all parameters. the oxygen saturations was also very low. CXR findings confirm bilateral lung involvement. he was pulling off his biPap machine all the time because he was confused. yet 2 days later he self-discharged (must be his relatives who made the decision-he was confused!), against medical advice.

he came in with STEMI, for the second time. the first one was less than 6 months ago. streptokinase cant be given again. alteplase is not available (good news-will be soon!)  cardiac cath and stenting is of course out of the question. he got heparin, despite the lack of evidence for giving him that. it’s better than nothing… the next appointment with a cardiologist will be in IJN, as there is no cardilogist around.

he is very skinny and frail, very breathless as well. he said the pain is unbearable. he was admitted again for the 6th time this year. the list of medical problems go on and on. but his CXR is the most interesting part. sitting right there is a very very big blob of white. oops that’s not the right way to describe a CXR. let’s start again. there is a homogenous left mediastinal opacity measuring almost 12 cm (i’m not kidding!) in its widest diameter. it shifts the trachea and the heart to the opposite side. the right diaphragm apears flat. the specialist said it’s aortic arch aneurysm because the outline follows the arch. the manipal college professor was adamant it is a lung ca. ct had been done but sadly the result could not be found anywhere.

and dont get me start on diabetic patients. if i guess any patients in the ward who are older than 40 as a diabetic, i would be right 80% of the time. and they are diabetic on spot diagnosis-that is how severe, or how poorly contolled their diabetis are. some with av fistula in situ-end stage renal failure. some with foot ulcers that stank the whole room and are definitely not pretty to look at. some are sitting prop up, breathing effortfully with JVP right under the auricle even when sitting-in heart failure.

almost all patients are sick, very very sick. there are lots and lots of signs to pick up. to illustrate my point bronchiectasis is diagnosed with CXR only, no need for high resolution CT at all (not that it is available anyway)because at that stage patients simple wouldn’t come to hospital, and would neither be admitted nor investigated as well.

and when the disease is at its severest form, or its most advanced stage, multiple organs are involved. no matter what treatment is instituted, adequate relief from symptoms are not possible, let alone cure. today this man with end stage renal failure complicating diabetis was admitted to the ward after 2 days in icu. he has et tube in situ, and the GCS is only 5. the wife already signed a do not resuscitate order. the young son, barely older than my little brother, ran out of the room, crying. and this is when medicine gets tough. it is easier to think of the patients as an assortment of symptoms, signs and investigation findings, like a puzzle waiting to be configured. when a man’s life is added into the equation, along with his past and his family, it takes another dimension altogether. it involves emotion.

so all in all, it has been really interesting. when i come back to the polished wards in RPH, the image of ward 3-3 in malacca gh will remain in mind. dont get me wrong, not all is bad. anti-tb drugs are free, and poor patients even get money for travel expenses. governement servants only have to pay rm4 for every day spent in hospital and the drugs are free as well. probably more about how things are run and paid for in another blog ya..

This week has been the last week before my Objective Structured Clinical Examination for Family and Children module. My week has been like this..

on monday i was in denial; exams? what exams?i don’t want to hear anything about it.

on tuesday i was angry;why must there be exams?why do i have to go through this?sod it!

on wednesday i was bargaining with God; please God, if u let me pass my exams i will be good and study hard next time.

on thursday i was sad and depressed; sobb sobb i want my mummy!

and on friday i sank into resigned acceptance; oh well..bring it on.whatever…

and to think that my life is boring and lacks drama..!

what i am writing is a little bit outdated. but hey, i am allowed to. i am doing graveyard shifts 5-7 days a week, and not being paid. who have got time to browse youtube or the news.

the my team 2 lads lost to indonesia team. 0-2!how dare them!i am fuming with anger when i found out.

i am not doing any more criticizing. my guess is they have had enough. i cringed when i read harakahdaily.net. there’s definitely some truth to it, no doubt.

but to grant someone a chance of a lifetime; to go board a flight for the first time (for many of them), to walk into the stadium they have heard about and seen so much on tv, to see their heroes played live in front of them, is nothing short of amazing. i applaud the idea. bare in mind these ‘kampung lads’, most of them from humble background, would have never in their wildest dream think this is possible.

but with all the privileges being endowed to them, i think it is not too much to ask of them to deliver. to play beautiful football. to let their aspirations and dreams translate into brilliant defending, precise passings, cheeky tackles and on the mark shot at the goal.but apparently this was not to be the case. sadly.for them, and for all malaysians who dream of a football team that can play in south africa in 2010.(not one that stays at #29 in Asia, for goodness sake!)

well i guess, the lesson of the story is, there is no shortcut. success is not a given. talent doesn’t necessarily translates into victory.

it takes 5 years to train a doctor, no less. and probably that should be the case for footballers too. my team series provide entertainment and realized many young lads’ dreams, no doubt about it. but maybe a football academy is a better answer. not a haphazard 10 weeks training that promises glamour through tv appearance, more than anything else.

it is a tough call to make. to end up with a big wound going across the tummy that leaves the body almost incapacitated for 6 to 8 weeks, or to have 2nd, 3rd or even 4th degree tear down below that meddles with many bodily functions. one way or the other, things will never be the same again.

maybe it’s the obstetrician’s call, but it’s the mother who suffers the consequences. spending only a night on-call in the labour ward, i think i’ve seen enough. now i see all mothers under a new light. a different perspective. mothers worldwide, i respect thou. if you are even the tiniest bit selfish, or coward, human races would have been extinct aeons ago.

but the experience was amazing. probably one of the highlight of my medical student days. i used to laugh off the saying, whenever female med students or doctors see a baby being delivered, they will straight away fall under the spell of o&g. but now, to be honest, there’s some truth in it. seeing the mother holding her baby for the first time, having suffered the symptoms of pre-eclampsia for weeks on end, and having been induced with prostaglandin for the past 3 days, was nothing short of magical.

i know mama will never never read this, coz she’s terrified of this box with keyboards that can catch virus and crashes anytime. anyhow, thanks ma. for letting me be here and have my chance at life. and i only found out that she had pre-labour rupture of the membrane at 36 weeks as well. turns out i am not so uncomplicated after all. double thanks ma, for holding in there.

enough of this mushy mushy stuff. o&g can turn anyone soft.

p/s thanks for the birthday wishes, my lovelies
p/s2 al-fatihah to sweet nurin, please let there be no other child having to suffer such horror.

much to my dismay, the hols passed me by in a blink of an eye. more so because i’ve been a couch potato all summer. and now i have to welcomed myself to the world of pv bleed and foul-smelling discharge, quite reluctantly. i am still trying to get used to the idea of asking people questions that i wouldt dream to ask otherwise. and going through with examination without feeling awkward by the position of the patient. the first time i could felt myself turning red. without doubt, the nature of the specialty itself is very, how could i say it, intimate. i wouldnt know how i would hold up if i were a bloke. but from what i’ve learnt they are doing fine. enjoying themselves,in fact. no wonder its a male-dominated specialty.

i know for  fact that this one is definitely not for me. well never say no because you’ll never know what will happen in the future. but as of now, i just want this 7 weeks to be over so i could meet male patients again(one tht has not just came out of the womb). ha!

after 4 days, there’s really nothing much to tell. other than fibroids and polyps and breech babies, i have yet to encounter the less ‘bread n butter’ stuffs.

so lets move on. its merdeka day!!it has been 50 years. has it really been 50 years? yes it has. and i have lived almost 23 yrs out of it. although it’s class as normal today. although the docs, my mates and everyone else here are oblivious of the fact that 50 years ago today a small country has found its way out of british empirialism. (has we really??). they call themselves brittons, but they dont keep track of the country they used to colonized. ( i’m not blaming them. i mean, i wouldnt too, there’s just too many!) but they have to try to at least remember the few ones that have given them so much revenues, through tin and rubber for example.(malaysia lah, who else??) i mentioned this to who-was-it-the-other-day, but i was shuuhhed. so much for the thanks. grateful lots arent they. (not meant in sarcastic way)

what i’m trying to say was, even if i’m not there in dataran merdeka or klcc or wherever it is they are celebrating nowadays to shout ‘merdeka!’ on top of my lungs, nor did i watch the parade, i’m happy nonetheless to be seeing my nation has arrived at its 50th year with just minor glithches in its track record. not that i want to launch into wistful remarks like ‘ooh we r such a great nation and everyone else should copy us’, its an achievement one way or the other and we should feel proud. but lest not be idle as there is still much to be done. let’s make access to drugs and care in the community easier for diabetic patients, for a start. and certainly partying all night with beer bottles in hand on the eve of merdeka is not going to help our nation in any way. (or would it??)

well, what more can i say. praise to God we have come this far. happy merdeka day.