Jantung

Sudah genap 3 minggu sejak ku pulang ke tanah air tercinta. Aku hanya hari ini kembali menulis untuk menggerakkan otak menulisku sebelum ia berkarat. Lagipun, aku ingin berkongsi pendapatku mengenai penswastaan IJN. Penswastaan ini secara prinsipnya dipersetujui oleh kerajaan dimana Sime Darby telah menawar untuk membeli 51% share IJN dari kerajaan. Aku tidak tahu kenapa kerajaan ingin menswastakan badan tersebut. Secara umumnya, penswastaan diharapkan dapat meningkatkan mutu servis dan kecekapan badan korporat tersebut. Namun, sejarah menunjukkan penswastaan dinegara kita tidaklah berhasil begitu baik seperti yang dinyatakan pada blog Anwar Ibrahim. Tambahan pula, menurut Dr Mahathir, IJN tidaklah mengalami masalah dalam mengendalikan servisnya dengan cekap. Beliau juga menyoal apakah keuntungannya pada dua-dua pihak (kerajaan & Sime Darby) jika penswastaan ini diteruskan. Malah ada yang membuat spekulasi bahawa penswastaan ini diutarakan kerana ada yang akan mendapat $$$ daripada proses ini. Wallahua'alam. Apa yang aku risaukan, jika penswastaan ini diteruskan, dan jika Sime Darby dibenarkan, mereka tentu akan meningkatkan kos rawatan untuk menebus kembali laburan mereka. Jadi disarankan agar kepada perokok-perokok, berhentilah. Kurangkan makanan banyak lemak, gula ringkas, dan garam. Bersenam selalu. 

Kerjaya dengan Kementerian Kesihatan Malaysia

Hujung minggu lepas, aku pulang ke Dunedin untuk: (1) menghadiri ceramah "Kerjaya dengan KKM", (2) pengiklanan PPIM NZ bab pelajar, dan (3) jumpa kawan-kawan lama. Secara ringkasnya, kandungan ceramah (1) adalah seperti berikut:

1. Latihan siswazah (housemanship) adalah 2 tahun. Gred gaji adalah UD44 (sekitar RM4k selepas elaun).

2. Khidmat negara: 3 tahun wajib berkhidmat dengan negara (samada KKM, K Pertahanan Malaysia, Universiti-universiti awam) sebagai pegawai perubatan (Medical Officer) setelah tamat latihan siswazah. Rasanya naik gred gaji pada tahap ini.

3. Setelah selesai khidmat negara, pegawai perubatan boleh memilih untuk samada kekal menjadi pegawai perubatan, atau menjalani latihan kepakaran untuk menjadi pakar klinikal ataupun menjadi pegawai pentadbir.

4. Latihan kepakaran: syarat-syarat untuk memasuki latihan kepakaran: (1) telah selesai khidmat negara, (2) telah berkhidmat dalam bidang pengkhususan sekurang-kurangnya 1 tahun, (3) umur kurang dari 46 tahun ketika diterima untuk mulakan latihan. Disebabkan syarat (2), penceramah mencadangkan agar kita membuat keputusan awal-awal untuk memilih kepakaran kita dan berkhidmat di dalam bidang yang berkenaan ketika menjalani khidmat negara.

5. Nasihat kepada bakal houseman: berbaik dengan pekerja-pekerja hospital dan jururawat kerana merekalah yang akan membantu/menyusahkan anda bergantung pada sikap anda pada mereka.

Berikut adalah link untuk Yahoo Group Persatuan Perubatan Islam Malaysia Bab Pelajar New Zealand kepada mereka yang berminat untuk menyertai persatuan ini.

Click to join ppimnzsc

   

Obesity Cured!

Obesity is up there among the most problematic public health problems that plagued most parts of the world now. Complications related to obesity is plenty - sleep apnoea, increased risk diabetes, IHD, osteoarthritis, almost virtually every disease there is. OK, a bit hyperbolic there, but the point is it is a HUGE problem. (see what I did there). The prevalence of obesity and overweight is as follow:
US: (2004) = 116 million people or 64.5% of population
China: (2004) = 27.3% of population ("reference")
MYS: (2008) = 50% of population (from my memory of a result from a recent public health survey. I can't be bothered to find a 'proper' reference)

But there is a cure. And it's all natural so it must be good for you:

Freezing

Winter has set in NZ and OMG it's freezing. My current flat doesn't seem to have any insulation at all! No wonder it's cheap. I think I have bitched about this before but there you go, it's cold. It reminded me of those flats in Dunedin that looked a century old and possibly has no insulation as well. Even when using winter duvet, I remembered needing to wear jerseys and sometime thermal to go to sleep back in those days. History repeats itself again as I have to resort to the same thing again. Anyway, in 3 days time I will be sitting 2 psych tests and 1 pathology test so wish me luck. Psych is never my cup of tea with all those weird disease classifications that make it look quite artificial. I don't have much insight into the subject though but as patients can have psychological problems intermingling with 'real' medical problems then it is an essential knowledge a doctor must acquire.
While chilling in between my studies, I have made progress on reading that book by Michael Legat on writing. So far, the advice I can remember at the moment is read your workout loud to appraise your writing - suitability of style, proper use of words, character of composition, flow of story. So far, the content of the book focuses on writing fictional works, such as novel, but what I am interested in writing is an intriguing informational composition.
No witty/funny photo for the entry today as my Internet connection has clock down again. I was going to share a particular blog to you but I refrained as it has some joke with sexual theme that I think would be sinful for me to promote. I just leave you here bewildered by that unnecessary comment.

Strike ended

The argument against the strike was that such action would:
1. harm patients
2. degrade trust between docs and patient
3. destroy the image of medics as an altruistic profession
4. placing patient as 'ransom'
5. docs are already overpaid
One of of my teachers here proposed that the strike action should be considered in an utilitarian light, which means if the long-term benefit far outweigh the short-term damages then the action can be justified. I totally agree with him (I'm sure he's not reading this blog - I'm not looking for favours here :D) and I felt halting brain drain is better in the long-term than the inconvenience of a 48-hour strike. Malaysia too is suffering from brain-drain, in fact it is far worse than NZ. 4 years ago, a Malaysian public health officer told me that the turnover of doctor from public health service to private sector or oversea is 1 doctor per day! I'm pretty sure the trends remain more or less the same. The problem is further exacerbated by the stop-gap measures taken to fill the void created. One of them is restricting specialist training in Malaysia in order to ensure there are enough junior doctors around. This only result in more turnovers as junior doctors are drove out due to poor prospect. NB: My knowledge on Malaysian health system were mostly anecdotes from people who used to work/studied there and is dated to at least 1-2 years ago. Recently, a pay rise were given to civil servant in Malaysia including doctors, which saw them gaining a quite significant increase in wage. However, the housemanship (internship) years were extended to 2 years as there were quite a number of high profile cases of medical misadventure during election year.
Some idea taken from:
Frizelle, F. Is it ethicals for doctors to strike? NZ med J 2006; 119(1236):1-2

Photo taken from http://www.engrish.com/ and is copyrighted to them.

RMO strike continued

I felt the repercussion of the strike today as one of my class was canceled because there wasn't enough workforce. Continuing from the last entry, with the mounting debt and low wages, most NZ graduates ends up leaving the country, mostly to Australia due to the fact that NZ graduate could work straight away there without requiring to undergo any examination, or doing locum. In the end result, the health service ends up with shortages of medical personnel while those on locum used to fill these gaps were generally more expensive (3x normal wage) and recruitment drive targeting foreign doctors also drains money. To stop this trend, RDA felt that wage increase is needed to help retain doctors. In my opinion, NZ may not be able to match the wage that Australia or other richer countries are offering to their doctors but with the modest increase, it should help to ease the burden of student loan debt and facilitate retaining those who do wish to stay but were forced to because of financial restrain. There is nothing that could be done to those who do wish to go oversea for the money. It is also good to note that not many medics are in it for the money, in fact, I think it is foolish to do so as the money isn't here and with the intellectual prowess most medics have, other professions are better suited for that.

Some of public opinion on the RMO strike on NZHerald: Here

--- to be continued.

Yeah, I prefer Camel too:

Not. Some docs do smoke though and my colleagues and classmates do - in fact one of the surgeon i know who-amputate-legs-of-smokers smoke (not for fun but because their legs are stuffed - smoking cause your blood vessel to block off esp at the legs), so it's not surprising with all those anti-smoking adverts and campaign out there, smoking remain prevalent in the society.

Norovirus

The hospital ward I'm attached to is currently suffering from norovirus outbreak and thus students are forbidden to enter there. Even though norovirus infection isn't normally fatal, especially for a young and healthy guy like me, it can be fatal to those frail elderly at the ward I'm working in. With the strike by the junior doctors tomorrow, I don't know if it will be worthwile turning up tomorrow.

Hauora Maori

Taking a break from my ramblings on my North Island Trip to write something about the 3 day course on Maori Health I just participated a few days ago. It’s like killing two birds with one stone as one might put it, as I could do revision as well as sharing this knowledge with the few readers of my blog here. The photo above is the marae (local hall for Maori) where I stayed for the course.

The course on Maori Health is part of my medical training. It aimed to train physicians that could practise in a culturally safe and competent manner. Such course was developed mainly due to (1) the health disparity that exist between Maori and non-Maori (ie NZ European) and (2) the NZ government obligation to honour the Treaty of Waitangi. The health disparity is such that Maori life expectancy is 10 year less of that of non-Maori. Some have associated this to lower socioeconomic status but statistics showed that when adjusting for socioeconomic status, the disparity remains. Others have associated it with the “warrior” gene or “diabetic/heart attack/etc” genes to explain the disparity. For them, Maori are just inherently vulnerable to diseases that plagued modern society. However, such thinking is non-constructive and only serves to push the disparity further. Another explanation is that the health system itself is constructed in a way that “institutional racism” was practised. This is not to say that the practitioners are bunch of racists, far from that, but the system itself is formed to cater for one particular ethnic group and thus leaving another deprived. Even if the practitioners were compassionate indiscriminately but the system they are working in does not favour the patient, it will remain a stumbling block for the patient to accept such practise and thus refuse to use it. Hence, Maori has the tendency to use less of health services compared to non-Maori. This often leads to late presentation and higher mortality. With this fault in mind, the whole health system needed a revamp and thus a few steps were taken. For instance, Maori health workers were introduced and their role was to advise practitioners on how to effectively deal with Maori patients. Maoris were also appointed to as members of District Health Board, the regional governing body of the health services in NZ, in order to ensure practices do not leave out Maoris. Furthermore, practitioners were also trained to be culturally safe and culturally competent in order to effectively engage with patients. Thus a course on Maori Health or “Hauora Maori” (Hauora = health in Te Reo, the Maori language) was developed. One aspect of the teaching is the introduction of the Maori Health model known as Te Whare Tapa Wha = the four cornerstone (Whare = building, wha = four). It basically means that Maori health is not only focused on the tinana (physical) aspect but also on hinengaro (mental), spiritual (wairua) and whanau (family) aspects. In order to engage Maori patient effectively, these four aspects must be taken into consideration in diagnosis process as well as the management. In addition, the approach to a Maori patient is different to non-Maori. One can develop better rapport if one engages in whakawhanaungatanga (building connection). This involves sharing your origin to the patient before proceeding to kaupapa (reason/cause of consultation, literally = reason). A practitioner should also be aware of Maori beliefs, values and experiences (MBVE) and how to handle these. One example of MBVE is the use of Te Reo and research has shown that acknowledging Maori patients use of Te Reo result in a more satisfactory consultation. One of the classes in that course that I just did thought us some Te Reo. Here are what I learnt:

Vowels:

E pronounced as better
I pronounced as feet
A pronounced as apple
O pronounced as whore (my tutor used this example)
U pronounced as food
AU pronounced as no

Consonants: H, K, M, N, P, R, T, W, NG, WH (pronounced as fart)

The syllables end when a vowel meets a consonant. Here is some Te Reo:
Tena Koe = hello to one person
Tena korua = hello to two people
Tena kotou = hello to more than two people
Kia ora = hello, be well.

GP

Time flies and another run is coming to an end. GP run was interesting and it did gave me quite valuable insight on the workings of GPs in NZ. It does cast a stark difference between GP practice in Malaysia and NZ. The former is more impersonal, detached and more of a quick-fix approach while the latter tends to be the opposite. Which one is better? I dont know. Circumstances are different for both countries. NZ is only 4 mil people compared to 25 mil of Msia, which translates to different time and resource pressures. But anecdotal experience suggest the NZ approach brings out better patient satisfaction and this measure is perhaps the best in demonstrating which system is better.