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 ...