New Year 2011

HAPPY NEW YEAR 2011 TO ALL MALAYSIAN ESPECIALLY MY FAMILY, FRIENDS AND MY STUDENTS. I wish this year will bring us prosperity, more love and happiness as well as above all, good health. New year is a new beginning. Plan our life and schedule them properly so that we don't waste the time that we have. The time won't wait for us. Time flies. So fast, the 2010 has left us without saying goodbye. Some of us celebrated the new year as if there will be the last year for them and for others, they just sit back, stay home with their families or stay all alone thinking what's next and try to come out with new resolutions. Some of us will recollect what had happened in the previous year and set a goal for this new year, with intention to liberate their energy and to inspire their hope for a better future in 2011. Remember we are the navigators of our time. Navigate the time carefully and intelligently. To make the best use of time, we need to live each moment as if it is vitally important. Always look at thing in a positive manner. Like most of the religious people used to say, "setiap apa yang berlaku keatas kita, berkemungkinan ada hikmah disebaliknya, Hanya Tuhan yang maha agong lagi maha mengetahui". Some people said that we need to create our future from the future and not from the past but I think we still need to look at our past to guide us in making a better future so that we won't make the same mistake that we did before if there is any. Live as if you are living for the second time and as though you had acted wrongly the first time and wanted to do better this year. We need to set our target or goal. The greater danger for most of us is not that our aims is too high and we miss it but that it is too low and we reach it. You don't have to worry because HE is always be there for you in all situation like a lyric in a song by Mahzin because that's HIS promise to all of us. All mighty God, the most forgiving and merciful. We "tadbir" our live and God will create a "takdir" for you based on what your "tadbir". Subhanallah.....Live is always a balance. Even God creations also always come with balance if you realise it. Look at the flowers and you will understand what I meant. Life is meaningless unless you bring the meaning into it. The meaning of life is whatever you ascribe it to be and being alive here today in the new year is the meaning. Nothing is extreme. Today is 1.1.11. Beautiful sequent of numbers. All of us want to be number one in whatever we do. All the best to all of you and may God be always be there for you. The late Mother Teresa have said, "it isn't how much we do, but how much love we put onto what we do that really counts". HAPPY NEW YEAR 2011.

Ho..ho..ho...holiday

I promised my children for so many times to take them for a holiday but due to many unavoidable circumstances, I didn't manage to do so. I was supposed to take them to Gold Coast Australia many years back as a present for doing very well in their exam but I could not get the right time. I have been busy with my work all year round. So this year, I promised them that I will bring them to Kota Kinabalu, Sabah instead. They were so excited about it because it has been so long we didn't go any where for a holiday. I booked the hotel and the flight ticket very early because I am afraid that I won't get the tickets because it is going to be a school holiday end of teh year when Iya and Ana are on semester break. So, the time has come and last week my family and I went to KK. On the way to the airport, Ana and Iya were quarreled with each other, arguing who is going to sit with me. We arrived just on time. At the end, none of them can sit with me because there were no more sits available for us to sit together. All of us have to sit with someone else. The service in the flight was horrible. The air stewards were terrible. They talked a lot with each other and it was so noisy. They didn't do their job properly because they were busy chatting with each other. The situation destroyed my mood and my excitement vanished suddenly. I slept the whole journey to KK. We reached KK around 12.30 am . We took a taxi to the Le Meridian Hotel. I stayed in the hotel before and found the hotel to be quite nice. The breakfast in the hotel was fantastic. My children love it. I don't really care how I feel but I want Iya and Ana to enjoy their stay in KK. On the first day we hired a limo to take us around. The weather was a bit hot but comfortable. We went to the Mount Kinabalu Park , Kundasang Memorial Park and the Poring Hot Spring Park. The scenery at the Mount Kinabalu Park was beautiful and the temperature was cold, colder than Genting Highland I think. Beautiful wild orchids in the garden that I enjoyed to look at. At the Kundasang Memorial Park, there were so many beautiful flowers. Iya enjoyed to be in the park. She loves history. The park was built in the remembrance of the Australian Army who died during the World War ll. A total of 2484 Australian soldiers died in Kundasang. Some of them were cruelly slaughtered to death during the Japanese occupation. After the memorial park, we went to the Poring Hot Spring. To my surprise, there were so many people. Most of them came with their families. We can do so many activities including jungle tracking, swimming and dining as well as shopping. We decided to go for a canopy walk. It was tough. We have to climb up the hill, jungle tracking and passed a canopy which is the bridge made up from rope connecting a tree to another, hanging in the air. I have to stopped several time to catch a breath. Iya and Ana as bad. We have to drag ourself up the hill. When we walked on the canopy, its move from side to side. It was a scary experience but all of us made it till the end. We were so exhausted, sweating away and something happened to Iya, her legs were shaking when we went down the hill. It was so funny and she could not controlled it. Accumulation of lactic acid I guess, still practicing my medical knowledge. I am a doctor bah....Our stamina were zero. I told everyone that we have to do something about it. Need to build up the stamina again. Must go jogging, must....must... I talked to myself. But whatever it was, it was fun. No phone calls from the hospital. We came back to the hotel late in the evening. Ana wanted to eat lobster so much with butter and cheese. So we went to the nearby Seafood restaurant and the dinner cost me RM480 for 4 persons. The price of the lobster alone was RM280. However, it was worth paying. I could see my children enjoyed the dinner very much. I felt that I couldn't walked to the hotel because I was so full and tired. Near the hotel, there was a night market but too tired to explore that night. We just went back to the hotel and slept. The next morning, after breakfast, we rented a car and my husband drove us around KK to see some interesting places. One of the most interesting place is the Green Connection where they keep varieties of fishes and other sea creatures including corals. You also can have the opportunity to hold a python. Ana did. She was brave enough to hold it with her hand but Iya and I were scared. Not only scared but we hated it. I guess the snakes also wouldn't like us to hold them. We were given a chance to see how the divers feed the fishes and turtle in the aquarium. The name of the turtle is gangster, 15 years of age. Still young. For the first time I saw belangkas. When I saw it, I remember my brother abang Madin and his wife Kak Atan. They were given a nickname of belangkas because they always being seen and do things together. Now I know what they meant. The male and female belangkas cannot be separated. They stuck with each other till they die. Interesting indeed. One thing about KK that I notice is, the people are friendly. Their mosques are beautiful. However, many of them are Christian. There are so many small churches around KK. We celebrated Christmas in KK. At night, we went to the nearby night market for shopping. We bought souvenirs for everyone at home. Overall, the holiday that I have in Sabah with my family is a memorable one and I enjoyed it very much. I hope I can do it again with my children somewhere else next year. I do hope.........

There goes my day

It was really a busy month for me in late November until middle of December. I was away from the hospital most of the time because of meetings. So many meetings to attend. I have to do adjustment to my daily work activities including my clinics and teaching commitment to year 5 UPM medical students. Last Friday, I took them for bedside teaching in replacement of the last class that I missed. There were 5 students, 2 Malays and 3 Chinese. I took them to the first case. It was a neurology case. My patient that I really like and love. I asked for anyone of them to volunteer to do the physical examination. Suddenly, one the student told me that they have done the case with Dr.Amir, my paediatric cardiologist. Well I said " Even though you have done the case, its doesn't mean that you have learned everything about the case and you don't want to know about the case anymore. Very well children, in view that you have known the case so well because Dr.Amir has taught you so well, please show me that you can do this case excellently". One of the girl volunteered to perform the physical examination over 8 minutes on that patient. It was a neurological examination. As I thought, I could see she fumbled and didn't know where to start and what to do. The physical examination was a total disaster as if she had never done it before. As a fifth year medical student, she failed to elicit the muscle tone, reflexes and strength for both upper and lower limbs. She failed to check for any signs that could have helped her in determining the possible causes of the neurological deficits in the patient. Whatever things that Dr.Amir have taught them a day before didn't seem to get into their grey matter. We spent almost one hour with that case. All the time, I was trying to dig and dig for the answer. I asked questions but I have to answer them back. What I can say is that, their basic knowledge is terribly poor. Lack of practice and reading on top of a concrete mind set. Too far being critical. We just did one case but I felt I lost all of my power. I choose another case, a respiratory case, an Indian baby. Another girl volunteered to do it and the rest of the students observed how she did it. I sat on a chair while I was watching the girl's performance. Suddenly I over heard the two Chinese students were talking to each other in Chinese ignoring me and the rest of their friends as well as the patient's mother. They were having a conversation that I didn't really know on what matter. Both of them didn't even care and respected me as a teacher. My eyes turned round and big. I was mad and very angry. Obviously I scolded them with a undefinable voice. It is not that I hate the language but the situation is not right. We were in the middle of class, a formal setting. They should be using a language that everybody understand, Malay or English. They were so insensitive. They are free to speak any language they wanted else where but not in the class. Its really make me angry and fuming. I told them off and asked them to apologize to their friends and the patient. I don't know whether this is a product of one Malaysia or what. My mood to teach disappeared suddenly. I remembered what Iya told me a few weeks ag0. She complained to me that her Chinese friends in class asked question to the lecturer in Chinese ignoring the rest of the students who didn't speak mandarin. To her surprise, one of the lecturer answer them back in mandarin. The rest of the students who didn't understand were puzzled and asked each other for the meaning. She said she hated it. She didn't expect it to happen in the university. What type of teacher is this? Some more, its happened in UPM, Universiti Putra Malaysia. How could that be? However she said, there was this only one Chinese lecture scolded the student for asking question in mandarin. He also said the same thing that I said to the students during my class. I feel that I want to make a formal complaint to the Dean or VC. We are not preventing other races to speak their mother tongue languages but use them in a proper situation. Please respect your other colleagues. Please be a little bit sensitive. I think the students should be taught on manners and social respect toward their friends and teachers. The university should do something about it. Unless they don't really care and think that it is a small matter. Well, for me I hope it won't happen again during my class otherwise I chase them out..............

19th birthday of my daughters

23rd November 2010, my family and I had dinner in EQ Hotel Bangi to celebrate my twins birthday. Being a very busy mother, I only managed to take them to EQ Bangi instead of Shangri La Hotel, the lemon grass restaurant that they love to go. From PD, after the NHMS lV meeting, I have to rush to KL for another meeting at 2.30pm. After the meeting, rushing to fetch Iya in college for the dinner. Ana and my husband were waiting for us at the hotel. After the dinner, off to PD again. However, I decided not to go back to PD that night because it was too late. I went back to PD the next morning just on time for the meeting.
The dinner went well. We had a lovely night and enjoyed the food. My children wanted me to sing the birthday song that I have been practicing for the last a few days loudly but too shy to do it. I sang the song with my very soft and low voice so that they won't get disappointed. There were so many people at the restaurant. Who knows, there will be someone who know me there. Now Ana and Iya are 19. It is an interesting age but more responsibilities. They already in college. They have to realise that education is the most important thing in determining their future. They have to know to divide their time appropriately. Time won't wait for you children. Your are the navigator. Therefore, navigate your time properly. Without you realising it, next year you will be 20 years. There goes your teen. I guess next year, we can have more meaningful birthday celebration. I hope, they will get more mature with the increase of their age. Children nowadays take so long to mature. They should be able to think and decide what best for them and how to run their live. For their birthday at 19th, both of them already have cars. Mobility is no longer a problem but don't miss used it. I hope and pray that they don't miss used the freedom that I gave them. When I was 19th, I have nothing except my myself and my parents didn't remember my birthday. I didn't blame them because they were too busy taking care all of us and providing us with all that we need. I have to encourage myself to study for my future. One thing that was always in my mind was to make my family proud of me and I will be able to take care of them when my parents were old. They didn't ask for reimbursement but I believe that is our duty to look after them after all the suffering and heart broken situations that they have gone through to make me what I am now. My mom can't read and write. The only thing that she can write is an alphabet "A" for Aishah, her name. But it was really amazed me when it come to going to school and doing your school homework, she will be making a lot of noise to remind us again and again. Nagging was normal for her until we got use to it. I don't want to nag too much to Ana and Iya. I showed them a good example. Action is better than words. If they are observant enough, they will know it. I want them to follow the path that already made for them. I guess as a mother, I have to make sure that they don't fall to far away from the principle that I have already made for them. If they do, I will have to bring them back to the original path no matter how. Whatever it is, I know that I have to let them go slowly and guide them along the way. Ana, if you listen to Ibu, I am very sure that you will be successful in your future. Don't under estimate your specialty and talent. I know you have that potential in you, it is just a matter whether you realise it early or late. If you don't, you have to face it with courage and positive thought and remember Allah is always with you. You will dtermine your future. You have to learn to "tadbir" and Allah will fulfill your wish as you asked for. Tuhan yang maha pengasih lagi maha penyayang. For Iya, ibu hope that you will become a successful doctor in the future. If so, better than I am. However, you should change your attitude and your temper. I know that this bad temper thing runs in the family but you can change it if you want to. As a doctor, you need to be patient and more caring. Listen first before jumping into conclusion. Don't be selfish. Be more responsible for yourself as well others who are meaningful to you. Being a big sister, please advice and take care of your only sister and don't bully her. Tell her your wisdom. You have to be patient with her. Never give up. So good luck children and Ibu hope that you will become daughters that every mothers would like to have. May God bless you always and many happy returns. Selamat Harijadi and Panjang umur.

Full registration for doctors

Again I was invited to be one of the medical review panel by MMC. I don't know why they like to ask me to be one of the panel. I guess, I have difficulty in saying NO because not many consultants would like to take this task, trying to make recommendations for the future of these "problematic" doctors. Today, we interviewed 6 doctors who wanted to be given their full registration as a medical doctor so that they can safely practice. Out of 6 cases, only one case has truly unavoidable medical problem but the rest have psychiatric problem. Most of them have major depressive disorders or traumatic disorders. Basically they have poor coping ability towards stress and pressure at work as a doctor. In another word, they are so fragile. The job of a doctor is too much to handle. I wonder whether these doctors were exposed to the life of the doctor during their medical school days. Being a qualified doctor but not being able to do clinical work and treat patient, what do we call them? They refused to do on-call duty because too tiring and stressful. These groups of doctors are still being employed by the ministry and put them in the non-clinical areas such as resource center, CSSD, administration and take a role of a health education officer. Some of them are still on anti-depression. Worse still, some of these doctors have bipolar mood disorders and yet the psychiatrist still feel that they can perform their duties as a doctor provided they are on medication and therapy. How sure are we that they will be compliance to their medication. God only knows. The moment they have their full registration, they are free to do whatever they like out there. They already given a license to kill. It is a tough decision of the panel members to make decision on the future of these doctors. How to make our children stronger spiritually and physically probably will have to start from home. Parents play an important role in their children development. Proper up bringing is deems important and necessary to break this chain of depressive future generation of doctors.

Program Pembangunan Keluarga organised by PUSPANITA HSDG

Last Saturday on the 30th October, HSDG PUSPANITA organised by my dearest friend Dr.Saraiza a wonderful informative programme for children and adult especially for parents on issues of parenting. How to become a responsible parents and how the children can be successful in their life. It was an excellent programme with lectures and activities. However, I was quite disappointed because the turn up was very poor. By right, the parents supposed to come together with their children but only very few came. No fathers. There were supposedly 100 participants registered but only less than 50 came. We invited 2 good and excellent speakers who almost always come up on Astro Awani. During the session and the lectures, from my observation, probably only less than 30% of them was paying attention and really listening. Most of the children didn't really bother. Sometimes they make fun of what was being said. Majority of these children belongs to the families who are staying in the hospital quarters. They came on their own. I really enjoyed the lectures given by the two speakers but at the same time I continued my observation, make my own analysis of the children's behavior. Some of the children I know their mothers and some I don't. Some how I know how are they being brought up. I can clearly see who are clever and who are not. I know I might be wrong but I do have strong feeling about it. Anyway, many people especially those from the quarters are not interested to get involve in educational programme like this. They prefer entertainment program rather than educational programme. We cannot force people to learn and improve themselves. They should have their own initiative to improve and learn from someone experiences by participating in a very good programme like this because if we want to read from books, it will just not going to work to some of us. All of us should remember that our minds are like parachute. They only function when open. Therefore, we must have an open mind to learn more and more because knowledge is so important for survival. We have to make the best use of time, we need to live each moment as if it is vitally important especially in gaining knowledge. In this situation, people bring knowledge to you but you don't want it. It is really a waste of an effort. I guess I have to accept that not all of us think and behave the same way. How are you going to live or the future that your creating is your own choice......hopefully it will be the right choice.......

4 just nice but 21 is messy

Almost everyday my specialists will tell me about how terrible the HOs nowadays. Previously we have only 10 HOs at one time to torture us but currently we have sudden influx of them. 50% of them are first poster, freshly from medical school. I have 2 general paediatric wards and one NICU, such a small unit. I am scared that soon the number of HOs will out number the patients. I keep telling our hospital director that we can't really teach the HOs properly because we don't have enough patients for them to learn. They are suppose to do minimum 8 calls by regulation but they only did 4 or five calls the most per month. Each HOs will be in-charge of the most 4 patients. Well, with that number of patients that they have to look after, they still can't even remember or know what's going on with the patients. The antibiotics the patient is on and the number of days that the patient already in the ward. Worst still, they don't even examine the patient to know the patient's progress. Don't ask about disease, forget about it because the normal values also they don't know. There are so many protocols and informations available in the ward for their day to day work but they hardly used it. Basically, they know nothing. Very poor basic medical knowledge, bad attitude, no pro-activeness, lazy and some of them worst, beyond economic repair. We do have the numbers but where is the quality. We really have a tough time teaching them. You ask questions, never get any answer. Silent or you have to answer yourself. Fine, probably, we need to teach them and show them the way. Yes, we did that with difficulties. We have to teach even the basic medical knowledge such as how to differentiate between stridor and wheezing, petechiae and purpura, pallor and jaundice, crepitations and rhonchi and many others. Showed them how to take good relevant clinical history and to do proper physical examination in which all these should have been taught in the medical school. By right, my job is to teach and guide them in applying their knowledge to the real patients. But the situation is so different because there is no knowledge or skill to apply. Whether we like it or not we still have to teach them otherwise the patients will be in danger. We can't be there to hold their hand forever. After 2 months, probably 1 or 2 will improve but the rest remained the same. DG advice us to treat them nicely and give them TLC. Yes, we did that as well but nothing happen. If we increase a bit of our voice, because one or twice or sometimes you lost your patience, the eyes start to turn red and some of them will just cry out loud. Every day during the rounds, my specialists and I keep on repeating again and again but it doesn't seem to get into their grey matter. I really don't know who to blame. The HOs themselves or the universities or the new medical curriculum? For how long that we specialists have to go through this?. Looking after 4 patients they said too busy and tiring. 4 calls is too many until they don't have a social life. Give them more, the parents will come and threaten you that they will make a police report for torturing their children. Teaching was taken as torturing. Nothing seems right. I continue to encourage my specialists and medical officers not to give up on the HOs. Keep reminding them that it is our duty and responsibilities to train and teach them but I don't know for how long. I am so scared to think about the future generation of doctors that will treat me when I get old or treating my grandchildren when they are sick. I wonder how they pass their exam in the first place. No doubt, as a lecturer or teacher, we want all our students to pass the exam but we shouldn't compromise on the quality. Recently, I was one of the examiner in the final medical professional exam of one of the university. During the examination, the external examiner from oversea whispered to me commenting on the students performance during the exam. He was shaking his head. My colleagues failed few of the students during the exam but to our surprise, all of them pass their exam. This is just because their continuous assessments are good and the final exam only carries 20% mark. It is not that I don't want them to pass their exam but we should have some standards for our future doctors. I wonder why in the first place we need to carry out the final exam if we already know that the students are already pass their exam prior to sitting it. Are we doing it just for the sake of fulfilling the requirement by the board. May God bless our children.

Geared toward professional medical exam

5 more days before Hari Raya aidilfitri celebration. During fasting month, KKM and people used to refer it to "Kementerian Kuat Makan", not many meetings being conducted. Therefore, I have more free time so called, to teach the medical students especially from the CUCMS. I hope it is the correct short form. I have difficulty in remembering that. Well, it doesn't really matter. I have the last group for this semester before they sit for their professional exam this October. They have been with me before but not specifically the 6 of them in my group. Sharmila, Nadhila (always mistaken with Dhalila), Reen, Shamson (so difficult to pronounce his name and I called him Simpson instead), Zaimi and Khairuddin whom I called Kay. I can see the girls were more proactive, energetic and geared for the exam but not the men. I am not sure whether it is due to fasting month or something else. I hope someone will kick their butts to be more focus and prepare for the coming exam. I guess, girls are doing better than men. I am saying this not because I am a woman or I am sexist, but majority of them from my observation either from CUCMS or UPM, girls are better. Sharmila, she is a funny girl, but very brave and trying her very best to achieve the standard that we wanted. Same as Nadhila. Nadhila still unsure and worry to say or voice out her views. Reen is a quiet girl. I know she knows about many things but too difficult to find the right words to express her opinion. The boys are followers. Zaimi, I think he is thinking in Malay and translated it to English during his presentation. No doubt English is our second language, in medicine, you have no choice. We have to speak English. My English too is not so good but I speak with my family members in English so that I will get better and better. I was from a malay medium school before in so remote kampung school. Used to get so depressed when I couldn't find the right words to say. But, with great determination, perseverance and believing in own self, I managed to improve my English. Now, I can deliver lectures in the international congresses without problem. When my children were still in the primary and secondary school, I used to create an English week at home where everyone have to speak English. If they did speak Malay, their pocket money was cut off. It was so funny because during the so call English week, the house was so quite. Very minimal conversation could be heard. They were using sign languages. Later, when they became more confidence, with the encouragement from the aunties and uncles, alhamdulillah, their English are not so bad after all. So nothing is impossible as long as you asked for it and go for it. It just need a little bit of commitment in whatever you do. Take every matters seriously and you will succeed.

Patriotic thought

Today is our country's independent day. Merdeka! merdeka! merdeka! I thought I want to take leave yesterday because I want to sit down and feel the meaning of merdeka. "Nak menghayati rasa kemerdekaan". But I changed my mind and cancelled leave because I have students to teach. It is more important to me. At the same time I still can continue to be patriotic. Due to Hari Raya holidays, there will be not enough time for them to prepare before the final exam. Teaching is absolutely tiring. When I came back in the evening, I missed my tarawih prayer due to exhaustion. I went to sleep early. I hope whatever I taught my students yesterday will help them in their coming exam and identify their deficiencies. From my opinion, minimal improvement is still an improvement. Take it as a challenge.

Basically, what I want to say is all about yearly event that we celebrated, month of August, merdeka month. I am very proud to be born here. Even though, originally, my great grandfather and grandfather came from Sumatra, Indonesia. My Dad this year 2010 already 90 years of age and he was born here. Feeling of love for Malaysia was stressed on me by my Dad. He, those days generation definitely know what "Merdeka" really mean. He went through a lot and managed to see the changes in our country before and after independence. From my opinion, merdeka means that you are free in your thinking process, free to express your feeling and free to do anything at all that beneficial to you and to others, as long as you are not going away from the right principles based on our culture, religion and values. Last Saturday, on the way to Selayang, I didn't see many "jalur gemilang" waving in front or on top of the commercial buildings along the road. A few houses did have "jalur gemilang". This scenery is so much different from Dr.M era as a Prime Minister. During that time, even though we were asked to put "jalur gemilang", but we put it up anyway because we did feel proud to do so. Now, people don't respect our "jalur gemilang" anymore. I am not talking about other people but Malaysian themselves. They don't even bother to put up our flag in the month of August. Our leaders don't really put stress on it. People take it very likely. That the reason why Indonesian dare enough to do all sort of terrible things to our "jalur gemilang", the pride and the maruah of our country. All Malaysian do nothing about it. We just sit back and be patience. The Indonesian government couldn't care less. If they think that our relationship with them means so much to them, they should have done something about it. However, they did nothing. Our children should be reminded all the time on the importance of "merdeka day". They feel so complaisant with the life style that they have. Today, my hospital, organised by the O&G department celebrating the merdeka babies that delivered in our hospital. I guess, the parents should be the one, responsible to instill the feeling of love to this country so that they don't forget the root.

Current medical students - the way I see

I left my medical school for almost 24 years now. I still remember my lecturer taught me about pathogenesis of many diseases in reference to the normal physiology and function of specific organs. They taught me to be critical and analytical about every single problems. All the time we were reminded that not everything in medicine is definitely 100% correct. Some of the cases are straight forward and you can make the diagnosis or conclusion almost immediately. However, some of the problems tend to be a little bit complicated that require your ability to formulate and putting a serious thought into it based on your knowledge, experience and your readings to come up with the nearest possible answer. This is where the arguments and discussions are important. Obviously, at the end of the day, you will get the final diagnosis after specific test or gold standard test performed. The process of getting to the final diagnosis require a flexibility in thinking and the student must be able to reason it out to support their argument. That's the reason why in the medical school, first thing that you need to learn during your clinical years is taking a history from the patient followed by physical examination. Occasionally, you don't need to do any investigations to confirm the diagnosis. 95% you will be able to make a correct diagnosis after history taking and physical examination. All the student should develop the skill in getting relevant informations from patient and confirm it with physical examination to further strengthened the evidence. A doctor is just like the CSI officer who are trying to gather all the evidences and come up with the most possible diagnosis. It is an interesting process. Some of the diseases have overlapping clinical features and biochemical derangement, but you need to choose the most likely diagnosis. Of course, if we can do a specific test for the confirmation, finally we will get the right diagnosis. In order to go through these processes, we have to strengthened our basic knowledge on physiology, pathology, biochemistry and not to forget human anatomy. I always reminded my students on the basic things in medicine. We have to remember everything that we have learned in the early years of medical school. In order to recognise abnormalities, we have to know the normality first. Otherwise, we can't make any conclusion out of it. It is not an easy task. Students nowadays, are very poor in applying knowledge to patient. All of them are so call 4 flat students. They read a lot but unable to identify the relevancy of such informations to the patients. They have tunnel vision. Their arguments and discussion on certain diseases are very immature. Overlapping of symptoms and clinical signs are too much to handle. They easily get confused. Mind you, they are 4 flat students. Worse still if they don't have interest in the subject or in medicine. They do medicine for different purposes. Peer pressure or parents pressure. I take final year medical students from the public as well as private universities. They are equally bad but the public university do slightly better.....It is worrying situation. Probably, we need to look back at the presence curriculum or something have to be done. We have seen the prove from the quality of housemen that we have nowadays. The quality of our doctors are deteriorating, not only in skill but in knowledge, soft skill and attitudes. How much we specialists in the government hospitals can teach and guide them in 4 months posting if their basic medical knowledge is almost 0%. It is a tough job.......good luck to all of us ...

My children that I adore so much

Over the years, I wish to have one big family like my parents. There are nine of us, 4 boys and 5 girls. But when it comes to me, I only managed to get 2 of my own, double joy, a twin girls that colour my life. I had two abortions after the twins. I pray to God all the time, to give me two sons to replace my two abortions that I had. I was waiting for so long for the moment of truth. God answered my prayer. Instead of giving me 2, HE gave me 3 sons. Even though God gave me the over grown sons, I love them like my own. Of course, all my sons have their biological parents but I love and care for them like my own. I will make sure that they become successful in their life. Share my wisdom and be there for them when I am needed. They are lovely children. I am truly blessed. I don't really care what people say about having over grown sons. What important to me is, my happiness and their success. I have plenty of love to be given away. Rather than waste it, make as well give it to someone that you love and care, my children. Not to forget my nieces and nephews that I love and care too. Let me introduce you to my children. The beauty about them is, there are not the same including my twin girls. Just imagine, I have to deal with five characters and five taste of things. It was fun. All five of them are already grown up. Eldest among all is Along (Dee) followed by Aniep, Aiman and the twins. If you see them, you can imagine how close they are. They shared a lot of things together. They care about each other. They behave like they are "true" siblings. That's what I wanted anyway. Probably, many people won't understand and won't know how deep their relationship is.Only me and them know. If you see them, you will see how close they are. As far as I am concern, they are my children. As I mentioned before, when I decided to do good to people, I will never look back. I am throwing a stone remember, into the ocean and not throwing a boomerang. I will tell you about them .....sometimes...

When you do good to others - don't look back

I have many friends, closest to me and far away from me. Not to forget, my family members who always be there for me in every situation and circumstances without prejudice. I learned a lot from them. They have different characters and different ways in expressing their feelings and views. Of course, I have my own ways. The way I see, the way I acted and my views on certain things are very much influenced by the way I was brought up by my beloved mum and dad. It is also derived from my own experience as well as from my readings. Definitely, genetic configuration also play an important part in my life. However I am blessed because I think I have more of my Dad rather than my Mum. My siblings admitted it too. My mum is a very fierce lady and sharp but of course she has a lot of positive values that she taught my siblings and me during our childhood days especially how to respect people older than you as well as your brothers and sisters. No matter how terrible your brothers and sisters treating you, no matter how serious the argument is, or so much different views we had on certain matters, at the end we are still one family and should love each other. Your family will come first before anything else. I absolutely agreed with my mum on that matter. My dad used to say to me that when you want to help or do good to people, do it sincerely. You shouldn't do it for names or recognition. If you already did it, you don't have to mention about it all the time, again and again on how good you are. As a doctor, a profession that my Dad taught when I was in primary school when he mentioned it to me, is the best profession for me, for sure I have done a lot of good things to my patients, for my friends and many more. Not to forget my students. Well, I definitely don't want to hurt or causing any trouble to anyone. I love to help anyone in needs. When I do good things to people I will never look back or mention about it because if you start to talk about it, it is no longer relevant as I see it. Doing good to others, the way I see it is like throwing a stone into an ocean and not like throwing a boomerang. Why I say that because if you throw a stone into the ocean, no matter how hard you try to discover it, you will not be able to find it. The stone is too small in comparison to the big ocean. Whatever the good things you do, in the eyes of God, it is just a small thing compared to the wealth and good health that HE, almighty gave us. Furthermore, don't do good the way you throw a boomerang where you are expecting something in return. If you do good things to people the way you throw a boomerang, make as well don't do it. No one is forcing you anyway.....the way I see it..

Merdeka! merdeka!! merdeka!!!

This year, 2010 is a busy year. As a doctor, we were warned by the Selangor State Director of Health on the outbreak of dengue in Selangor. We, in the paediatric are well prepared for the circumstances of many admissions to the ward. But the most exciting about 2010 is fasting month falls in the month of August, our merdeka month. Month for you to be more patriotic in your thinking and act. We love our country very much the way we love ourselves. All of us should, if we call ourselves a Malaysian. This year, we are going to celebrate our 53rd merdeka year. During this period of time, our leaders keep on changing depending on the election result. Whatever it is, all of our leaders, their aim is almost the same, trying their very hard to bring up Malaysia to the eye of the world. It is just the methods and approaches that they used are different. They want to maintain the stability and improve the economy of the country. Different leaders have different styles and vision as well as mission. Under this current leader, we are talking about One Malaysia or Satu Malaysia where the motto is "rakyat diutamakan, pencapaian didahulukan. I read in the newspaper about this concept. I don't really get it till now. My view is, I think all of our previous leaders have the same mission. It is just that, it was not written on paper. Any development they make, is for people of this country. Us. We, as the citizen of our beloved country, Malaysia enjoy all the good things that our leaders have done. Of course, if we want to do anything, we will do something that is achievable. Don't waste our time trying to achieve something impossible to achieve at this current time because after spending so much of money, time, effort and resources, at the end of the day, all the these will go into the drain. A lot of money will be wasted which are people's money.

I want to share my view about language. 53 years merdeka, it is not a short period of time. There are many changes were made to improve our education level in this country. We read in the newspaper, several changes need to be done to achieve the best educational status of the people. I don't know whether we are progressing well or regressing. Lets talk about Malay language, our national language. During my primary and secondary school, all the students, Malay, Chinese and Indian could speak malay very well. I have many friends from other races in school as well as in my village. We were so close with each other. No worries. Now, when it's come to my children, they have no opportunity to have friends from different races except 1 or 2 that they met in the boarding school. Even when they entered university, they don't really know how to make friend with their colleagues from different races. I really pity them. Some of them can't even speak Malay well despite being accepted to the university. Well,I am saying not all of them. When we talk about national language, we expected all of these students should be able to speak well in bahasa. My daughter said to me one day "Ibu, I really got fed up with my group because they speak Chinese among them selves during the discussion just because they are the majorities in my group. How about us, me and my Indian friend. Why can't they speak the language that everyone can understand". To some people, probably this is a small matter but to me it is an issue. This is happening everywhere I guess. What has gone wrong?. Well, we are free to speak whatever language we want but when it's come to the group discussion, we should know what bahasa we should be using so that everyone can understand. Insensitivity like this basically developed from the primary and secondary school. Here, we are talking about one Malaysia. Together, we are one. I thought, with the development of good school curriculum, this scenario won't happen. Bahasa Melayu is the national language and it should be the duty of all Malaysian, if you call yourself Malaysian, to learn. I meant all of us. English is the second language, so learn it by hard.

Let me tell you a story. Recently, there was a Chinese boy, 8 years old admitted to my ward. He was suspected to have leukemia. He was such a lovely boy. He understand Malay and English well but can't say the words. We were having problem with the mother because we wanted to explain to her about the child's condition and the plan for him, we could not do it because she said "tak pandai Melayu dan tak pandai olang putih". I asked her"sikit-sikit boleh tak atau kita cakap dengan suami". She said,"suami kerja". Then, I looked around to find my houseman. I have two Chinese HO. So, I call the first one to explain to the mother the situation of the child. To my surprise, she can't speak mandarin or any other Chinese languages. I call the second HO. Initially, I didn't want to call him because I didn't trust him at all to convey the message to the mother. I was worried that he would gave a wrong information. However, I had no choice. True enough, after the explanation done by my second HO, the mother requested to go home with the child. I talked to the mother again in Malay and persuaded her to stay for the sake of the child. I called my medical student, the last resort, a Chinese to talk to the mother to make her understand the situation, but to my disappointment, he also couldn't speak Chinese. "shame on you" I scolded my student. The mother is a young mother. I reckon she must has gone to school because she was reading a Chinese newspaper and magazine. 53 years of independent and yet we still have this scenario. What had went wrong? Whose fault is this? Which direction are we heading for? We are no here no there. By right, anyone who are born here should know at least 2 languages. One, their mother tongue language and the other one is our national language which is Bahasa Melayu. Is it so difficult to speak bahasa? If yes, why the Nepalist or the Bangladeshies or even the Chinese foreigners can speak bahasa only in a few months they are here in our country, but not us, who are born, eat, work and stay here for the rest of our life. I wonder.......??!!

Making the right choice

I love to share with my children and others what I have read in the book. Previously, I have no time to read other books than medical books. Now, I have a little bit of extra time, I want to improve my knowledge on the moral, social and emotional aspect of life. I want to improve myself in many areas that I feel a lot of deficiencies. I want to be a better person than what I am now. I want to do good to people who need my help because I know that the greatest good you can do for others is not to share your riches but to reveal to him or her his/her own. When we treat people with respect, indirectly we help them to gain confidence and reveal their inner potential. Everyone has the potential to become great or someone successful provided they believe in themselves and look at things in a positive manner. I remembered one quote by Lao-tzu saying "Knowing others is intelligent. Knowing yourself is true wisdom. Mastering others is strength and mastering yourself is true power". I really like this quote because I do believe that we have to know ourself first. Of course, knowing people around you is a bonus because it will help you to develop your inner power and determine your purpose. However, some of us rely too much on other people to make decision for us. Before he'she venture into something or making the most important decision in his/her life, rather than asking themselves what exactly they want, they will ask other people first, not really for opinion but asking others to make decision for them. Remember, mastering yourself is true power. Power doesn't have to show off. What its mean by power here is self confident, self-assuring, self-starting, self-stopping, self-warming and self-justifying. You will know when you have it. Most of us will be thinking "what people will say if I do this". We are trying very hard to please others rather than trying to please ourselves first. We should know what best for us. We are suppose to learn from people around us and decide what is the best for our future and not allowing the external forces to influence our decision. That was my advice to my niece Syimah sometimes ago when she was in great dilemma whether to do her master in US or to do master on the job. She asked many people for advice. Of course, she got many version of advices and opinions until at the end of the day she was still blur. Even worse when some of the remarks that she received from various people make her feel sad and miserable. She was still unable to choose which one to follow. Pressure all around and every corners of her. When she told me her problems and frustration, she was crying. At that time I knew that I have to do something about it. I gave my version of advice of course. Well, I am a very simple lady. I told her, it was up to her whether she want to follow my advice or vise versa. Thank God, being a smart girl, she made the right decision to continue working here and declined the offer to go abroad to further her study. She does her master locally as part time student. Now, she is in the second year and she is doing very well. It is tough but if she believe in herself, she will get what she wanted, insyaallah. I wasn't sure whether I told her or not that intelligent is just like a river. The deeper it is, the less noise it make. Just do whatever you think is right. Do you know 18/40/60 rule. I read about this rule somewhere, I can't remember. What it mean is "when you are 18, you are worry about what people thinking of you; when you are 40, you don't give a darn what anybody think of you; when you are 60, you realise that nobody's been thinking about you at all. So, don't waste your time trying to please others. Everything you do should be an expression of your purpose or destiny.

Antibodies - where did you come from?

Yesterday Sunday afternoon, when I having my nap, my daughter called me and woke me up because I received a phone call from hospital. I asked her "who is it". My daughter answered " Don't know. Man voice. I think Uncle Zainudin". I walked to the phone thinking Zainudin was on the line. Well, my daughter know that Zainudin is the only man in my department. If she heard a man voice, she will think that voice belongs to Zainudin. I picked up the phone and to my surprise, it was Dr. Amir, my paediatric cardiologist. He was on-call that day. He wanted to consult me regarding a new admission to the ward. Basically, he didn't know what else to do for one of our patient that was admitted with symptoms and signs of haemolysis. The child Hb was low 4gm/dl and the haemolytic process still present. He wanted to transfuse blood for the child but during cross-matching, the lab staff found the child's blood contained plenty of antibodies. It was very difficult to find a matching blood. The presence of antibodies in the child's blood him as well as me because the child had no history of getting any blood transfusion before to explain the situation. Of course we cannot leave the child without treatment. He need blood indeed. Otherwise, if the Hb drop further, the child will develop heart failure and die. It is a critical situation. I advised him to do a few things and no matter how to try to get the blood for the baby. Worse come to worse, we need to give 'O' negative blood as the last option. Dr.Amir sounded satisfied with my advice will do as told. Sometimes as consultant, I need to be ever ready when my advice is needed. After I put down the phone, I was still thinking about the patient. How does he gets antibodies in his blood. I tried to formulate something rational but still blur. Anyway, today morning, I went to the ward to see the child, to find out how he was doing. He was a lovely chubby boy, 9 months old. Very friendly but pale. He was not in cardiac failure. There was tinge of jaundice of his conjunctiva. I also saw a few bottles of dark-coloured urine sample on the table. My doctor managed to get the most suitable blood for the child last night, informed my HO. And another pack of blood was in reserve if we need to transfuse some more. Looking at the child, I knew that he still need another blood transfusion. I ordered them to proceed with the second blood transfusion in view of the child still pale and haemolising. All my doctors were around me, listening to the questions that I asked the mother. I was trying to find out the possible cause of the haemolysis and presence of antibodies in the child's blood. The only positive relevant finding that I managed to get was about the mother who had blood transfusion for the treatment of dengue haemorrhagic fever in one of the private hospital in Kajang. One year after that, she conceived this child. So, I really don't know whether the mother developed antibodies toward the blood transfusion that she had before, and these antibodies were transfered to the baby during pregnancy via the placenta. I really am not very sure. Furthermore, I was not told the type of antibodies in the child's blood. Not only the antibodies puzzled us but the haemolysis that has occurred in the child. We still cannot find the cause of it. Several investigations done did not help to determine the cause of haemolysis in this child. My postulation is that, it could be still due to G6PD deficiency, which is very common in our population to cause haemolysis even though in this child the result of the G6PD screening test at birth was negative. I don't know and till now, I have no definitive answer to it.

Learn from my grandsons Harith and Ryann (son of my niece and nephew

I have 7 grandchildren from my nieces and nephew. What I am going to tell you is about 2 of my grandsons that closest to me. I adore and admire them a lot. When I miss them, I will go to my brother's home to see both of them. They live together with their grandparents, my brother and my sister in-law who refuse to let them stay on their own. They just like twins brother. They fight and they hug. They also jealous with each other in many ways. But when it comes to food, they eat together. They shared breasts too. They can enjoy breast milk from both of their mama. These 2 boys are very lucky to have 2 mama, who love them very much, an ayah and a papa.Their age different is only 3 weeks. Talking about love, these two boys have all the love and attention that they need from all of us after their parents. One thing about them is, they love themselves. They admire themselves very much. A lot. Lets talk about Harith. Harith is a son of my niece Kak Ti. Kak Ti, is a lovely lady. She was so sweet when she was a child. Even now, she is still sweet. Always relax and easy but sometimes quite firm. Same with Harith. Happy go lucky. Acuna metata. No worries. Harith is a handsome boy. I think, when he grow up, he will break many girls heart. He loves to play with tractors and lorries. Heavy stuffs. But what I really want to tell you is, he is so self obsess. He loves to look at himself in the mirror. Make faces and laugh at it. He knew that all of us pay a lot of attention to him. He will try to draw your attention by doing many things such as run here, run there, throw things and never sit still. "Penuh kesanjungan", that the words we used to refer him to. He really admire himself a lot. He is still unable to talk in sentences but he knows how to express himself. One day, he was crying of something that I couldn't remember why. While crying, he was looking at the mirror and making faces and interestingly looking at himself but still continued crying. I really amaze. Start from young, he already learn to love himself and appreciate what God has given him and use it to the fullest. He is very playful like his mama. Everyone blaming me for him for not able to speak properly. because I talked to him using a language that me and him understand or both of us didn't understand either. No meaningful words such as achapacapa and many others. Well mind you, he seems to understand. Harith love to make people laugh. Different with Ryann, my other grandson. He belongs to my nephew Dek Aleem. Dek Aleem and his wife Kay Yun, that's what we call her, are a loving couple. Dek Aleem is a duplication of his father, my brother. He is a handsome man too. I am not lying. You will believe me when you see him. Therefore, his son, Ryann is a cute little boy. I really like and love both of them, Harith and Ryann very much. Nice to see them growing and develop into a toddlers. Interesting to look at them. Ryan is a smart boy. Proper in conduct even though he is only 2 years of age. If he wants something, he will ask politely for it. He is a clever boy. He is a clever boy. He also admire himself very much too, same like Harith. He love to post when you want to take his picture. He will give you the best post that he can make with a smile to kill, that kind of smile, you know what I mean. He is so cute. These two kids basically believe in themselves. They don't care what others think of them. They just do whatever are right at that point of time. The way they see it and try to do anything to get what they want. They will try all sort of things and give us the very best of things that they are good at. They keep on trying especially when its come to fix the toys. They never given up. I guess, we should follow them as well. You have to believe in yourself when no one else does. That's will make you a winner. We have to learn to get in touch with the thought within ourselves, and everything we do must have a purpose. To be on purpose, it means you are doing what you love to do, doing what you are good at and accomplishing what's important to you. Therefore, everything you do should be an expression of your purpose. Self respect is the fruit of discipline. A person who lives without discipline, will die without honour. Learn from my grandsons, Harith and Ryann. You will never regret. Believe me...

Reaching your goal

Today is the fifth day of fasting in the holy Ramadhan. Time fly and leave you behind without you realizing it. That's the reason why I always reminded my children that if you want to do something, go ahead and do it. Don't try to wait for the perfect time because there will be no perfect time. I remembered the motivational book that I have read many months ago. There are 2 groups of people in the world. First, people who are included in the group of "ready, aim and fire" principle and the second group is using other principle which is"ready, fire and aim". There are many people in the first group where they are spending their whole life getting ready and getting perfect. They are waiting for the perfect time to act but all of us know that there will be no perfect time. So, this group of people will become a looser at the end of the day because they will miss the opportunities in front of them. In another word, they miss the boat. I taught my children to use the second principle in order to be successful in whatever they are doing, be it in their study or in their work. That phrase really taught me a lot of things. What we need to do is, get ready and decide what you want to achieve. Make reasonable plan but please don't take too long. Identify your target carefully and fire or go for it. After that then you see whether your bullet or your action hit the target or not. If you miss it, don't worry. What you need to do is, identify your mistakes or deficiency, determine how far it is from your goal and make some adjustments to get closer to your aim and fire or try again. Keep on firing or trying. Sooner or later, with God will, you will reach whatever you wanted, by making plenty of changes and adjustments rather than persistently waiting and trying to be perfect. If you try to be perfect like in the other group of people, you will end up aiming your target forever, scared to make mistake. At the end you will loose. No man ever became great or good except through many mistakes. Failure is an important part of the learning process. The reasons we know so much because we learned from our previous mistakes. However, don't make a habit trying to make mistake first before you can learn. Well of course, this is so true if you want to learn from your mistakes. Some people, the looser, make so many mistakes and never learned from their mistakes. They blame others for their failures and never blamed them self. Even though they are given so many chances, they don't take that chances seriously and at the end, they end up with nothing. One more thing, we also can learn from mistakes done by others. Blaming other people is a waste of time and a sterile act. Learn from the people around you. These experiences will guide you to achieve your purpose or destination. I have 4 children. When I talked to them about how to reach their targets and be successful person, of course, all of them will give me different reactions. My twins, the naughty most among them will be saying "oh no! not again" especially my Indian-like twin. The Chinese-like one will just smile and agreed completely to what the sister commented. She will listen no doubt but yet to follow. The eldest, Along, will listen and pay attention and try to make sense out of it. Angah, second son, smile and think of something else. Day dreaming. Always out of focus. Syimah, my dearest niece, always make fun to what I have said but I know, she agree and try to learn from it. She is such a happy young girl. Always has no confidence of her credibility and talent. But one thing about them, they are very good children, polite and well behave. As a mother, my children inspire me a lot. I learn from them too. They have very different characters and ways in thinking process. But whatever it is, I have done and taught them what I am supposed to do, now it is all up to them. They will have to make a decision whether they want "happiness and success" or they want "suffering and failure". One more thing that I always reminded them was "children, you have to respect and love yourself first before you can respect and love someone else". I guess, this is true, the way I see it. You have to set certain criteria on people or friends you want to be with. You have to put values on yourself high enough, the way my beloved niece, Syimah said one day. I love her very very much and absolutely agreed with her wisdom. I also love my other nieces and nephews as well. Nanti kecil hati pulak dia orang. She said "I know I am not pretty (I know she is pretty and adorable in her own ways), I know I am not so clever like my sister (she is clever, yes she is). but I do have certain standards that I want for anyone to be my friends or special boyfriend. I don't care what people say and I don't want to grab or take just anyone, just to please people or just for the sake of having a boyfriend. I won't do such a thing". I really like her. I definitely and completely agree with her. You have to love yourself. You deserve a better person, to be your friends. Don't put yourself too low. By doing this, it does not meant that you look down on people or you are too choosy. It is not true. It is just that you value yourself. Successful man used to say, "if you choose 5 loosers to be your friends, you will become an average of 5 of them. But if you choose 5 successful and clever men to be your friends, you will become an average of these 5 people". You just imagine that people that you are mixing with will have influences and determine the way you think, the way you act and the most important of all, determine your future. Everything that you experience today is the result of the choices that you have made in the past. I absolutely agree with it. I always reminded all of my children as well as Syimah, just like my own child, to have certain principle that they can follow, to be successful in life. Follow the closest example, our beloved prophet Muhammad SAW. Our religion taught us a lot how to survive and be successful in this world. If you follow that principle, you will never go wrong. Insyaallah....may God bless you, my children. The photo of my children including my niece, Syimah. They are so adorable, aren't they?. They are my inspirations, of course not to forget my beloved and dearest husband who was not in the photo (workerholic) but always in my mind, who is always there for me in all situations and circumstances as well as give me the support that I need.

Do I care or ada aku kesah!!

I have a terrible reputation to leave on. I am labeled as a nasty HOD who loves to extend houseman when they come to do their posting to my department. Even, the news spread to the other hospitals. They said that I am the most fierce person in town.. tigerest. Worse than a real tiger. Yes, I was born in the year of a tiger and I have extended 7 HO so far. Mind you, I was accused to be racist as well. Ada aku kesah?!! As far as HO is concerned, I have done my duty. I teach and guide them to be safe and competent doctors. If they cannot perform and unsafe, I will extend them for sure. The decision to extend HO is not an easy decision to make. Many procedures to be followed including take them for a viva session. It is done based on cumulative decision by all the specialists. Not my decision alone. Majority of our HOs nowadays. based on the one that I have. have poor knowledge including basic pathology, physiology and worst, anatomy. Poor in problems solving, no analytical thinking and have tunnel vision. Don't mention about bad attitude, so many of them. Psychiatric illness also have....They are crazy, in turn make you crazy too. Poor coping mechanisms. They just like robot, in fact worse than robot. Robot will do whatever you ask them to do because you programmed them that way but my HOs, most of them, no matter how many times you teach them, they still never learned and do the same mistake again and again until you yourself will develop epilepsy (sawan) trying to make them understand. You asked questions, you have to answer back otherwise, I have to continue doing my round forever. So difficult stimulate them. I am tired, really tired. Sometimes, we have to teach them from the basic. I wonder, if they can't learn in 5 years in medical school, do you think my specialists and I can do it in 4 months. By right, my duty as clinician is to teach them in the application of their medical knowledge to the clinical situations and patients. Who to be blamed? The parents who forced their children to take up medicine even though the child didn't want to, or the medical schools that rise like mushrooms with insufficient lecturers to teach the students in order to meet the demand to increase the quantity and ignoring the quality of the students produced. Is it something to do with the students selection? People have the perception that to be a doctor you must get very good result in the exam because the IPTA or IPTS will only take the cream among the cream. Well dear friends, it is only true for local universities but it doesn't really applicable to the "foreign universities". Not only the cream, the base of the cake also can become a doctor. Don't ask me how. I guess the issue is too sensitive . However, these cream also failed to be good doctor. Indirectly saying, to be a doctor, you must be good in all areas and aspects, not only in academic. For example, an 18A1 student also can become a prostitute, mind you. I feel parents and teachers must put other values in the all the best academic performers such as soft skill, stress coping ability, critical and analytical thinking processes, social, religious and cultural values and many others so that they can survive in this demanding world. Otherwise, our psychiatrist will be very busy treating and counseling these doctors like what happening now. Therefore, I will continue to extend them if they deserve to be extended. No mercy because I do this for the sake of our generation...... and for them as well. You have to be cruel to be good.

We are not the same

I did my ward round as usual. During the morning round, I will take the opportunity to teach my doctors and the medical students. Teaching is something that I enjoy and love to do. The young doctors, students and my staffs are giving me energy to carry on with my daily work. Toward the evening, normally I still feel that I am full of energy but most of my doctors already looking like dried flowers. They can't even smile. Most of them were getting ready to go home. I used to offer my students extra teaching in the evening especially when the final exam just around the corner, but none of them are interested. I smiled at them and said "very well, up to you children. I am willing to stay back if you want me to". You see, time has changed. During my student days, we have to find senior students or any lecturers with a kind heart to give us extra teaching. Now, teacher offer but no takers. So sad. Never mind. Let me tell you about one of my patient that I saw that morning during my round. I went closer to the bed and introduced myself to the mother. Her baby boy was sleeping. He was only 4 months old and was admitted for bad pneumonia. He was on cardiac monitor and on nasal oxygen supplementation. The mother appeared very anxious. I examined the baby and told her the progress. She asked me" doctor, kenapa anak saya jadi macam ni? Macam mana dia boleh dapat jangkitan paru-paru?". I knew the mother was so worried. I explained to her slowly on the possibilities the mechanism how the infection could have occurred. And then she replied"doctor, anak saya tak pernah dapat sakit teruk macam ni. Termasuk anak saya yang sulung. Dia sihat. Ini adalah kali pertama. Saya jaga anak saya dengan baik, doctor". I looked at her and smile. I told her not to feel guilty on what had happened to her son. It was not her fault. Germs were everywhere and the lungs are exposed to the environment. They can easily get infected by bacteria. I reassured her that her baby will get better with the treatment that we have started. I also told her that her first and second baby is different even though they come from the same parents. I also told her that in life, before you can experience a second time event, you must go through the first time experience. It is normal. I told her about my twins. My beloved twin girls. They are 18 years now. Both of them are completely different individual even though they grew in my womb at the same time. Phenotypically, they are different. One look like Indian with curly hair and the other one look like Chinese with straight hair. The foods that they like also different. The curly hair loves western foods but the other one loves spicy traditional foods. One has allergic disease as well as asthma but none in the other one. They grow up in the same environment, same exposure. same school, same food that they eat and of course, the same teaching and love. However, they are different in many ways. Their thinking process and behavior are completely different. In term of knowledge, also not the same. Basically, in another word, none of us are the same. We have to acknowledge the differences among our children as well as the people around. us. No matter how hard you try to make them to have the same character, you will fail. But you can make the difference smaller in scale. My twin girls that I truly love and admire. You can see the different. They inspire me.

Purpose of life - my view

As a doctor and as a human being, I always amaze with people around me. The way they walk, their look, their behavior and their response to the environment. There are billion of people in the whole world and none of us are the same. We are different in many ways. Just simply look at the thumb print. Never the same and many more that I don't have to tell. The all mighty God has created us for a purpose. To achieve the purpose, we must follow certain principles. For muslim like me, I have to use the principles already outlined in the holy Quran. Whatever we do, we cannot run away from our believe in Allah. However, Allah has given all of us the most valuable organ ie the brain. You have to decide which principles you want to choose, based on your knowledge, experience and creativity of thinking process to achieve your purpose or destination. We have all the freedom to choose, freedom to love and freedom to do anything at all as long as we discipline ourselves and follow the principles that we already set up. We must have self respect because it is the fruit of discipline and sense of dignity. Who lives without discipline dies without honour. All of us want to be a winner. We have to believe in ourselves in order to make us a winner. Easy said than done. I know many of us so scared to make mistakes. Many of us want to be as perfect as possible. If you make mistakes, you will get into trouble and you will not be able to reach your destination or purpose. But mind you, no one is perfect and there will be no perfect time to do things. Don't be scared to make mistakes because failure is an important part of the learning process. There will always be a learning curve. No one ever became great or successful except through many mistakes that they have done. But of course this is only true if we learn from our mistake and try not to repeat it again and again. There are people continue to make mistake again and again and never learned from it. There are also people spending their whole life getting ready and getting perfect. They waited for the perfect time to act. But we know that there will be no perfect time. You have to grab any opportunities that pass by and try to make the best out of it. Occasionally we need to make some adjustments along the way to suit our purpose. "ready..fire ...aims is completely different from "ready...aims....fire". Which one you want to follow. It is all up to you. However, please remember that everything that we experience today is the result of the choices that we made in the past. In another word, everything you do is the reflection or the expression of your purpose. We only have control on three things in our life ie the thought that we think, the images that we visualized and the action we take. Try not to blame others because it is a waste of time. All these make us so much different from each other. Some of us will reach our purpose earlier, some will take a longer time and some will never reach their purpose or destination till God take away their life. Therefore, always bear in our mind that the price of being success is to keep it alive in our mind. Try not to be a failure.......

My beloved patient

For the last few months, I have been busy. The wards were full with patients. It was a Dengue season. There were so many dengue cases. Thank god, so far we have been doing very well and no mortality among our paediatric patients. However, we did get other cases as well which was related to infections such as lung infections, meningitis, URTI, and others. I want to share a story about one of my patient's parents. Of course, my job is to make my patient well without residual morbidity if possible. Deliver the best treatment that I can give based on the current development in medicine. My priority is the child whom I treated. On top of treating my patients, I will tell the parents of the child about the disease of their child and the treatment. My specialists will give the family of the child health education as well on the disease itself. I guess health education is far more important because it play an important role in prevention of a disease. Like many people say "prevention is better than cure". I absolutely agree with this phrase. Last week, middle of the night, 3 months old child was admitted to my ward presented with fever for 4 days and irritability. The child was seen by my senior MO who was on-call and a diagnosis of meningitis was made. She started the child on the treatment of meningitis. The next morning was Tuesday. As usual Tuesday is the day that I will do my grand round and teaching round with my doctors and medical students. I went to the child's bed. Both parents were there. I introduced myself to the parents and asked my HO to present the case to me. The presentation was good and clear. However. I noticed that the child was sleeping in a strange posture. I asked my HO whether lumbar puncture (ambil air tulang belakang - in malay word) was done or not. My HO said that the parents refused to give consent for the procedure and only that morning they agreeable after one of the consultant talked to them. I touched the child and turn her to supine position. To my supprise, I noted that the child's face was asymmetrical, deviated to the left. She was unable to close the right eye. She also had unequal pupils. One sided of the body was stiff. I think I don't have to tell the detail of the examination because many of you will not understand. I suspected that the child had more neurological problems. I asked my doctor to defer the lumbar puncture but instead to get an urgent CT brain. Our plan of management and suspicion was very well explained to the parents. Both parents are educated people and graduates. They appeared understood with the problem. My doctor managed to get an urgent CT brain that morning itself. However to my surprise, the CT result was reported as normal. I was in the meeting when I got the message. I was not happy because the clinical presentation did not correlate well with the CT findings. After the meeting. I looked at the CT brain myself and I felt the CT was not normal. The next day, we managed to get another radiologist to report the CT and true enough, it was not normal. I asked my consultant to explain to the parents the findings of the CT brain and told them the management that we were going to give to the child. The parents were not happy. They felt the child was being posses by spirit and wanted "AOR" at own risk discharge. My doctors were not happy. Once again my specialist explained to the parents. They insisted to go for the traditional treatment. As a doctor, our concern is the child. We tried to convinced them to stay in the ward so that we could continued the antibiotic. They agreeable to stay after so many discussion and explanation. We practically begging them to stay. Sometimes I asked myself, why do I have to do this and take the trouble to persuade them to stay. If I let them go, I will have one empty bed. Easy life for my doctors and nurses. I will be very happy if I have less patients to see. If the parents clever enough, they should be able to think rationally, for the sake of their child. Despite being educated and well informed, they just couldn't care less about the child. The whole family members think that the child was under the control of an evil spirit. They agreed to stay but refused any treatment from us. No blood taking and no setting lines. Scolded my nurses for no apparent reasons. The next morning, I talked again to the grandmother but failed to convince them to stay. Therefore, I allowed them to go home. No matter how you try, the baby still theirs. You as a doctor, can only do up to a certain limit. The rest, we leave it to the family and God. I can assure you that there are many more parents like this everyday that we have to deal with. Sometimes we given up on them. We pity the child. Occasionally some of them do come back to us in a bad state after taking "AOR" discharge. At that time you feel that you want to kill the parents...???..!!! frustrated.

Please, don't be like this parents. Think about your child's health. If you don't understand what's going on, ask again and again. We have to progress and not regress in our way of life.

Teachers oh teachers

Sometimes I hate to read the newspaper. Sensational issues are given priority in the tabloid newspaper. I just arrived home from work. I saw one of the famous tabloid newspaper on the table in my house. The front page news stated "school girl was raped by her teacher in the day light". I stopped and read through. However I stopped half way because I hate to read that kind of story. I am a paediatrician and I have seen worse than that. I was emotionally affected by the news on how the young school girl was raped by the most trusted person - her teacher. I just could not imagined how devastated the parents of this girl. The daughter that they love and care very much was sexually abused by a man whom they taught the most harmless and responsible person. Parents always look high on teaching profession because teachers make us what we are today. As a teacher, he should showed a good example to the students and taught them to be a better and successful person. The girl's future was ruined. Some of the cases of sexually abused child that I managed in my hospital, had to go for a serial of counseling sessions with the child psychiatrist. Some of them ended up in the sex business when they grow up. Public will look down on them. I always reminded my children to be careful and not to trust anyone else including their teachers or lecturers. I always reminded them not to see the lecturer alone. always bring friends along especially when the meeting is in the lecturer's room. I just wanted them to be more careful.

Teachers 30 years ago were so much different from current era. Many junior teachers nowadays are not as dedicated as my teachers many years ago. I respected my teachers even until now. I will never forget all my teachers who have a very significant role in my carrier and in my life after my family. I could not repay them back for all the knowledge and the passion that they have for me in making me a successful doctor. My primary school teachers, my secondary school teachers and all the professors in the medical faculty of UKM. They were so committed with their work and their profession. They sincerely guided my friends and I and ever willing to give an extra classes after office hour just to ensure that we pass our exam. Most of my teachers were very fierce but they were good teachers. Now, they are my friends and colleagues. I used to hear my children made terrible comments on their teachers. I am not saying that all teachers nowadays are not good. There are many of them are excellent teachers and committed to their work. However, there are significant numbers of them are incompetent and have poor attitude as well as poor knowledge. They became teachers or lectures not because they love the job but they have no choice for whatever reasons there may be. They don't teach the students sincerely. They prefer to be the receiver rather than the giver. Want more but give less. I didn't make this thing up but I got this feed back from my sister in-law who is a teacher herself and the headmaster in one of the school in Negeri Sembilan. She told me her frustration on the quality of teachers now. There are many problems related to the attitude of junior teachers. Not all of them but significant numbers. The junior teachers gave her more problems than the senior ones. Every now and then, their works need to be checked. They need to be encouraged and reminded all the time to be more proactive and committed in their work. This phenomena is not only apparent in schools but in all learning institutions. Medical schools are not excluded. It is a global issue. Students never respect their teachers anymore. I guess all these started from home. The way we bring up our children. Bad teachers produce bad students. Good teachers produce good students. Let us look at the houseman training now. Previously, the houseman training was only one year duration but now it is increased to 2 years training period. Why? This is due to the poor knowledge and skill among the medical students produced by the universities lately. On top of that, some of them have bad attitude. Be it local or overseas. One year term is not enough to make them a safe doctor and can stand alone managing patients in the peripheral clinic. Not only that, KKM has to come out with special programme to train them. The HO training give all the specialists and consultants a nightmare or even a night terror. The senior doctors have to do more teaching and guidance. We have to spoon feed them all the time. They took a longer duration of time to learn. Despite having 2 years HO training period, significant numbers of them got extended in some of the postings especially paediatric posting. Most of these housemen were good students to start with but obviously being a good student will not guarantee that they will become a good doctor. Sometimes we have to teach them from the basic. Their medical knowledge and skill can be considered as zero in some of them especially those who are graduated from some universities like Cairo, Indonesia and Russia. Being a senior doctor that have been in the service for more than 24 years, I can see the deterioration in the quality of the new generation of doctors in our country. I am very worry that if there is no measure taken by the higher authority to look into these problems before it is too late. I have a feeling that sooner or later, the HO training will be extended to 3 or 4 years because 2 years will be insufficient to train them. Otherwise, these future doctors will harm the patients instead of making them well and healthy.

When we talked about teacher, I classified them into 2 categories. The "formal teachers" are true teachers that teach in school, colleges and higher learning institutions where as the informal teachers consists of parents, friends and others who are also important in the making of great students. I guess all teachers should have positive attitude to improve their knowledge and skill in teaching from time to time. They have to be more proactive and should not take teaching profession likely. Our children is the future of our nation and all of us carry a great responsibility to turn them into the most valuable individual. Most of all, teachers shouldn't take advantage on their students. Instead, they should be their protector. Love them the way you love your own.

School Examination - my view

A few weeks ago, I read in the newspaper that our government was considering to abolish the UPSR and PMR examinations. Therefore, our children will have only SPM and STPM before they move on to enter the universities. I was very upset of these news. I know it didn't effect me so much because I don't have anymore younger children but what about my grandchildren. On the way to work on the next morning, I was thinking and thinking. What is going to happen to our future generation. I remembered when I was in the primary school and secondary school. I had to sit for standard 5 exam, SRP/LCE and SPM before I proceed to do my matriculation. I have many friends from different races, I meant Chinese and Indians. Not only Malay friends. Nowadays, looking at my children, currently they are 18 years of age, they only have malay friends. They have no opportunity to mix around with friends from different races. All these due to the education system that we have currently. Sometimes, I pity them. Most Chinese will attend Chinese school and Indians will go to Tamil school. When our children have to learn in English, many people were against it but as a mother, I can see that my girls have a better English. They have more confident to speak English in the public. As we can see it and whether we like it or not, English is our second language. Most books for references are in English. Job seekers are required to communicate in English. However, when there was pressure from certain group of people that their children could not cope and learned certain subjects in English, rather than looking into the basic of the problems, the government decided to change back to the original Malay language to please these people. Government should have put a lot of thought into these matter and did a survey why some students especially from the rural areas unable to cope with English subjects. From my observation in the school where my nephews and nieces schooling, some teachers who have to teach in English were not good in their English as well. So, how are they going to teach if they themselves are not good. The Ministry of Education should do something about training the teachers to speak English and teach the students accordingly.The respective teachers should be sent to courses to improve their skills. Only skilled teachers are chosen to teach the students in English language subjects. I am a doctor and we communicate in English during our work. I can see some of my HOs and MOs have poor English command. Eventhough there are good but they cannot express their views well. They struggle in their day to day work. They tend to go into the state of depression easily when they see their other collegues can speak English well. Their coping mechanisms also very poor. They have very low self esteem. Frequent modifications in the school curriculum won't give any good to anyone, instead it will do more harm, I think. Normally when changes are made, we need many years to evaluate the outcome of that particular changes and analyse them before new changes can be made for the benefit of all our children and our country indirectly. Changes are only required if they really necessary, not bacause of the change in the leadership in the Ministry of Education or just for the sake of making changes so that people will see it as if we are doing something regardless whether the changes are necessary or not. We should change for the better not for the worse. Regarding the abolishment of UPSR and PMR exams, I personally disagree with that decision. Examination is one of the way for us to assess our knowledge and progress in learning as well as in skill. No doubt examination is one of the stress factor in learning but at least we can know where our students stand in their understanding on certain subjects on top of the daily assessment. Our children need to be taught to cope with stress every now and then so that they will know how to deal with it wisely. Examination will encourage them directly to do better and to set their goal or target. It will give us the measurement of the students knowledge so that certain actions can be instituted to improve the results. Without examination, we have to rely on day to day assessment only. In my clinic, I managed to interview a few students who came for their follow up with their mothers. Majority of these students were so happy if there was no examination. They said they don't have to study so hard until SPM. They don't have to try to get good results because they will be in the same school until SPM. Teachers also have no target. Everybody will become so complesant, happy live and when SPM come, then only the teachers will start to struggle to finish whatever subjects they have have to teach before the exam. Later if the results of the students are not up to the standard, the passing marks will be reduce by the ministry so that the results will look good on paper. You just think what is going to happen to our beloved country in the future. I am scared...How about you?

My Dad

Today morning, 23/6/2010, I drove to work feeling so sleepy. I went to bed very late in the morning around 3 am. My beloved daddy had a fall from bed (for the second time) and sustained a deep cut on his left upper eye brow. The incident happened at about 10.30pm at night. My eldest brother Abang Ariff just left after visiting my parents. Every Tuesday night, he and wife will come back to my house to have dinner with us. My parents stay with me. Being the only doctor in my family, I am taking the responsibility to look after my parents. Furthermore, I felt that I am very fortunate to be given this opportunity to take care of them. My love to both of them is beyond description. Only the all mighty God knows. Everyday I pray so that they will be with me for the rest of my life. Back to the incident that night, my husband and I rushed to my Dad's room when we were informed by our daughters that their grandfather had fallen from the bed. When we reached the room, I saw my dad was in the pool of blood. So much bleeding from the laceration wound. He screamed in severe pain. My husband and I tried to stop the bleeding by applying a pressure on the wound. My husband cried because he couldn't stand to see my dad in that situation. I didn't loose my focus. I ask him to call for the ambulan from the nearby Klinik Kesihatan. While waiting for the paramedics to come, we carried him back to the bed. I used whatever things around me to stop the bleeding in which at last I managed to control it. While I was controlling the bleeding, I also have to control my feeling. I was so sad but too shy to cry. I ask my daughter Iya to call my youngest sister who is staying nearby and my eldest sister to come to my house. Within 30 minutes, my sisters and I gathered together and tried to calm my dad. He was in terrible pain. My youngest brother got to know about the incident, drove back home from KL. The staffs from the KK were very nice, professional and helpful. He treated my dad very well. My dad had 3 stitches on the forehead. They have to hold him down because he struggled. I guess, he was in severe pain. My dad behaving like a baby. I just couldn't stand to see him in pain. He tried to remove the bandage and the stitches. The wound bled again. I have to calm him down. I begged him not to do it because it would make thing worst. Being a senile old man, he just won't listen. This is the second time he fall from his bed. To prevent him from getting the third time, we decided to buy a special bed for him. I was given the task to find out the relevant information and buy the bed ASAP. We were scared that he wont be lucky next time. My brother told me" we cannot get mum and dad in the supermarket". I felt the same way too. This is the time for us to show our love to them. Our parents are responsible to make what we are now. Especially me. I am very close to my father since I was small. I followed him wherever he went including UMNO and PIBG meetings. He took me around the village on his huge motorbike. We shared a lot of things together. He would tried his very best to please me and to fulfill my request provided it was a reasonable one. Every Hari Raya celebration, instead of spending time and went raya to one house to another with friends, I would followed my dad to visit his brothers and sisters during raya. We went for raya prayer together. My dad is a wonderful father. He valued life differently from other people. The way he looked at things and came out with constructive ideas always make wonders. His wisdom amazed me. He is a man with a good heart and a very resourceful person. I used to ask him a lot of things that I want to know about our religion and our beloved prophet and the history of successful people. I was 7 years old then when my dad told me that becoming a doctor was the suitable profession for me. He said he just knew it. He advice me to study hard and smart so that I can serve the country and our people. At that time I was too young to know and understand. Furthermore, I didn't even know what doctor was. Now I realized that whatever my dad told me when I was small, slowly it become a reality now. Even though my dad is already senile and sometimes could not remember anything, I know he is always there for me. Love your parents and cherish the moments when you still have the time.