Generic drugs

Today is Tuesday, date of 11.1.11. As usual, grand round that I have to do in the morning. All my specialists were around. They have informed me earlier that the ward was full. I went to the GICU first to see 2 of my patients who were ventilated. One baby with intracranial bleed was recovering, extubated and ready to be transferred back to the ward. However, I have no idea how bad is the outcome of the bleeding to the neurological development of this baby. No matter how much we give public education on the use of cradle either in the newspapers, magazines, health articles, forum and etc..etc , still people don't really learn. I hope the baby will recover completely without any neurological deficit. My other patient was not doing very well. The lungs were so bad. He was in HFOV and all the lung medications that he required. He still developed multiple episodes of severe bronchospasms that required resuscitation. The bronchodilators didn't seem to work even though maximised. A real headache. We were using all generic drugs without proper QC. Sometimes it work and sometimes it doesn't. I wonder, how could we rely on medications with no proper QC to be used in the treatment of life threatening situation. No doubt that we are looking for cheaper drugs and I am not saying that generic drugs are all not good but we have to be more selective for the acute life threatening situations like my patient suffered of. I guess the government should look into this matter. We make complaints but no action taken. Sometimes I feel that we are not being fair to the patient. Just changing combivent generic to the berodua original product, the child has less severe bronchospasms. We managed to bring down the dose of intravenous ventolin that make the child tachycardic. In my experience, Astalin, the generic for ventolin is never work mostly for my severe asthmatic patients. I have to ask my MO to go and buy ventolin ori from the pharmacy in Kajang because we have no more stock in the hospital. the hospital is getting the generic astalin from pharmaniaga. Probably astalin can be used in milder cases but not in severe cases and life threatening situation like this. Well, this limitation make us feel so frustrated as a doctor who really want our patient to get better and out from the danger. When you talk to the parents, your heart will just go......don't know what to say. There are many other instances that related to the use of generic drugs. For example, drugs for sedation. You need to give a very high dose to sedate the patients. Sometimes, despite that high dose, the patient failed to be sedated. Sometimes, with the correct dose, they took few days to wake up. Many radiological appointments such as MRI or CT need to be cancelled as the child failed sedation. Or if they do get sedated, the effect of the drug only apparent after a few hours post injection of the drugs. Basically, rescheduling of appointments are very common and my MOs are quite used to it but it is not cost effective because for any procedures, the parents have to take leave and many other arrangements have to be made. Frustration, anger, .......for how long? Malaysia boleh!!!

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.......