Half dead

Today we celebrate the 52nd Independence Day of our nation.

Alas, after 52 years, the nation is more ‘dead’ than alive.

Consider the recent events:

Villagers cheated of their land
Orang Asli cry rape of their women and land, and no one bothers
Starvation in a land of plenty
A coup de tat most foul in the Silver State
Too many buy by-elections
Girlfriend being filmed naked by boyfriend, and the latter goes missing
Indicted lawyers disappearing into thin air
Bali mansions abound
Dentist that earns > RM50K per month
People dying from falls
Inquest after inquest after inquest and nothing happens; the word ‘inquest’ is as common as toilet paper
Drinking beer whipped up an international storm
Beer drinking is a crime whereas corruption is not
Frogs a-hopping, on to greener lotus leaves (and no one wants to use an amphibian-cide)
Major landslides and before the dust has settled, we are building on hills again
Comic books seized because people don’t find them funny
Donations = bribes = kickbacks = donations
RM 112 is kickback and the back gets kicked
Malay, then English, and then Malay while the children suffers
Political parties are roads to heaven or paradise or to hell, if you are not in that party
Universities churning out useless unemployable graduates
We want to build bridges all over the place while neglecting basic facilities for the people
The nation is besieged by a deadly flu while deadlier diseases like HIV and dengue are pushed to the back burner
Soaring crime rates and they wanna reduce it by merely 20%
Soaring inflation and they wanna increase everything by >20%
We’ve become a minority in our own pasar malam, China town, Golden Triangle…
And people marched with a severed bovine head!

We have scarred you much, my motherland.
May the scars be given time to heal.
We are terribly sorry.

We wish you healthier days ahead; crime-free days, hate-free days, rempit-free days, haze-free days, discrimination-free days and corruption-free days.

Happy Birthday, Malaysia.

Mon, 310809 @ 0700

Madonna jeered but Jimbo cheered

I’m not a big fan of Madonna, but I applaud what she did (even when thousands of her fans disliked what she did)!

Take a read: Madonna Booed

Smooth or Hairy?

Jimbo stumbled upon this website, selling hair removal product for men!

Gasp!

Whatever for?!!!

It’s almost hilarious, when Jimbo thought about this. But then again, there are friends of Jimbo who, being rather hirsute, do wish to have some of the hair removed permanently! Come to think of it, Jimbo has a patient who went for electrolysis to remove hair from his body because ‘he couldn’t stand the sight of them’.

Ouch!

Basically, it’s human nature.
Hairy people wanna be smooth.
Smooth people wanna be a little hairier.
Tall people wanna be a bit shorter (Jimbo being 6 foot tall, hated those mini-buses days)
Not so tall people wanna be taller.
Thin people wanna be a bit more ‘berisi’ (Jimbo took weight gainers when he was young – they did not work)
‘Berisi’ people wanna be thinner.
People with dark skin wanna be fair.
People who are fair wanna roast their skin under the sun.
People with single eye lid want double ones.
Those with double want triple ones…

And the list goes on.

Jimbo is surfing the net to look for products that would help him cultivate some body hair (for that perceived macho factor) – and nope, minyak sapi and VSOP do not work. (He’s tried them!) or he might go the other extreme and get a Brazilian* done. Ouch!

LOL!!!!

Fri, 280809 @ 0700

*Jimbo first learned that a Brazilian does not refer to a South American citizen but something far more painful, on the hit TV series Las Vegas! (Now who says TV is bad for you?)

Eye Speak

Now that all hospital staff have to wear a 3-ply surgical mask when working, all we could see of each other are only the eyes.

Come to think of it, Jimbo still doesn’t know what his quite efficient house officer looks like coz all he saw of her the last 2 days were her eyes!

Jimbo discovered that the eyes can convey a multitude of emotions. This morning, during the ward rounds, he paid a lot of attention to the eyes of his patients and their carers.

The eyes of a patient newly diagnosed with liver cancer registered resigned acceptance, gratitude and sadness but strangely no fear, as Jimbo told him that a CT scan confirms what he and his team have suspected and that they will try and see what else can be done by consulting the experts elsewhere; meanwhile they will try and build up his nutritional status.

The eyes of a man who has just been told he has HIV, Hepatitis B and C got teary and fearful.

The eyes of a man with bilateral pneumothorax registered fear because he knew something far more insidious is happening inside him while the eyes of his wife showed great fear and concern.

The eyes of a intravenous drug user showed gratitude and acceptance when told he has to be on antibiotics for another 31 days for infective endocarditis.

The eyes of another intravenous drug user, flared angrily as he recoiled his hand in pain as well meaning medical assistant attempted to place an iv cannula into him. The anger in the eyes was rapidly replaced by understanding as Jimbo apologised for the pain caused and that a more experienced doctor would shortly attend to him.

The eyes of man with chronic liver disease showed displeasure when Jimbo told him that he has to be kept a day or two longer as some issues have not been sorted out for him.

The eyes of a young man with IDDM admitted with uncontrolled blood sugar showed amusement and a hint of mischief as Jimbo told him that his problem was due to his erratic diet and the timing of his erratic diet.

And what of Jimbo’s eyes?
He couldn’t see his own eyes but he fervently hoped that his eyes conveyed the right messages: that of empathy and reassurance that his patients are in the best of hands.

He certainly hopes so because of this H1N1 thingy is going to be with us for a while, he will have to get used to doing eye-speak.

Thurs, 270809 @ 1400

Doctor jokes

Some times we need to laugh at ourselves (and others!). Jimbo found a site with jokes about doctors and patients: Doctor Jokes

Antibiotic stewardship

Over the weekend, Jimbo attended a summit on infectious diseases in the Asia Pacific held in KL and we dedicated the entire first day to discussing Gram positive organisms and the second day to Gram negative organisms which are showing increasing drug resistance trends. The points highlighted repeatedly by the panel of experts include:
1. We are rapidly running out of options in term of antimicrobial choices
2. We are facing a number of super bugs that have attained higher virulence and higher resistance patterns because they readily accepts these genes from other bugs
3. We have to devise strategies to tackle this growing problem.

One of the strategy talked about in the summit was on ‘antibiotic stewardship’. The speaker pointed out that a ‘steward’ is like a servant, entrusted with something to take care for a duration of time and to use judiciously and wisely; because the entrusted something has a ‘finite lifespan’.

He further said that ‘in UK, we have taken cephalosporins off the list of available antibiotics because injudicious use of this class of antibiotics in the past, has rendered this class almost useless”; he further said that every antibiotic has a finite ‘life span’ after which it would be quite useless.

Hence the concept of stewardship.

One interesting point he raised in the talk was this: in his hospital, even the cleaner is empowered and bold enough to tell him (a consultant) to wash his hands, should he neglect to wash them!

This is something that probably will not happen in this country.

Jimbo was just telling his colleague during one of the tea breaks in between sessions that, if people would self-regulate, then the current problem would not be so big and terrible.

If doctors (or health care workers) would wash their hands often, then the spread of multi-resistant organisms from one patient to another or even from one ward to another, could be minimized.
If the public would self quarantine when they are down with influenza-like illness, the H1N1 may be better contained. Likewise, if they would wear a mask if they are symptomatic, then others would not be exposed to the virus so easily (incidentally, it was during that tea break also, that Jimbo observed a senior consultant coughing vigorously ONTO the variety of cookies on display without covering her mouth!!!).

And so, if a fly can try to wash its hand and legs, why can’t we?

Photos captured during another tea break in the recently concluded IMU exams.

Thurs, 270809 @ 0700

Latest IDSA guidelines in the management of Candidiasis

For those who are interested, here is the link to the latest (2009) guidelines for the management of Candidiasis released by the Infectious Diseases Society of America (IDSA). The last update was in 2004.

Guidelines for the management of Candidiasis 2009

Suck Ass

When Jimbo was in Bali attending the ICAAP, he attended a symposium which caters for those who are working with patients who are MSMs (men-who-have-sex-with-men). The hall was packed and many had to sit on the floor or stand at the back. The organisers underestimated the number of people who would be interested to attend the symposium.

One of the speaker on the panel that day was a young activist from our neighbouring country up North. He was very passionate about the work that he does and was very enthusiastic in sharing about his work.

Unfortunately, his less than good command of the English language failed him miserably. We could hardly understand what he was trying to say. At one point he said something like this:

“I am working in an NGO and we cater to some marginalized people, SUCK ASS the gay people, lesbian people, transgenders people….”

Jimbo, who was seated, was stunned! He turned to the guy who was seated next to him and asked:

“Did you hear what I heard?”
“What?”, came the reply (he wasn’t paying attention)

Then the speaker went on again:

“Our work include doing some work SUCK ASS, publicity, advocacy, distributing condoms in places, SUCK ASS bars, saunas….”

“There!”, Jimbo exclaimed.
“Did he just say ‘suck ass’”, Jimbo added.
“Yeah, I believe he did!”, replied the equally stunned man!

LOL!

See, that’s why we need to teach people to speak proper English, so that they won’t make a boo-boo in meetings SUCK ASS (such as) this one. LOL!

Wed, 260809 @ 0700

Latest WHO guidelines for treatment of H1N1

For those who are interested, below is the pdf file released by WHO on management of the Influenza A(H1N1).

WHO guidelines for treatment of H1N1- 20 August 2009

Stigmatization

UPDATED 27 August 2009
This post has generated a lot of comments, both positive and otherwise; which was not the intention of the author. Those who know the author well would know he is not a malicious person. This post was written to express what he felt as a ‘HIV patient’, albeit for a short while but unfortunately has been construed by some to be a form of personal attack against another esteemed profession. As such, the author humbly apologises to those who felt slighted; also to his HIV patients (who also reads his blog and are a silent majority) as his attempt to raise a pertinent issue for them has gone awry; while remaining extremely grateful to all who have commented for their courage and conviction in speaking up without resorting to malice and name calling ~ that is the kind of people we need. While this post will remain, no more comments shall be entertained. Thank you.

Jimbo had a unique experience yesterday. One of his HIV patient called him on Saturday to say he could not pick up his medications as he is tied down with work and asked if Jimbo would mind picking it up for him from the pharmacy and pass it to him the next time he is in KL.

Jimbo has a lot of outstation patients in his HIV clinic. It is something unique in HIV clinics all over the world where patients actually choose to follow up at a HIV clinic far far away from their place of residence.

Why?

Mainly because they are afraid they might bump into somebody they know in the clinic! Imagine this: you are seated waiting for your appointment and lo and behold, across you is seated one of your previous fling! Not a good situation to be in.

Anyway, back to this story. Jimbo said yes, and so on Monday, Jimbo dutifully filled out a prescription and brought it to the pharmacy to get the medications.

At the number counter, Jimbo was accosted by 2 (obviously newbie) pharmacy students in face mask standing just before the number counter. One of them practically took the prescription slip right out of Jimbo’s hands without so much as a “Hello, good morning sir, may I have a look at your prescription slip?” or “Sir, we are pharmacy students engaged in a research, do you mind if I take a look at your prescription?”.

Jimbo tried to explain that the prescription is for one of his patients. They obviously failed to recognise Jimbo (quite understandable as Jimbo was not wearing a tie, or a white coat, or a face mask, or a stethoscope hung limply around his neck and his name tag is clipped to his belt rather than dangle from the pocket ~ why be conventional?!) and so, ignored Jimbo’s explanation and proceeded to look at the prescription slip and asked, “Is this yours?”

Jimbo was a little annoyed, firstly at their lack of courtesy and manners and secondly, they have invaded the privacy of a person by looking in at the prescription without permission. Every prescription is the right of a patient and no body should look into it unless authorised.

On seeing the prescription is of no relation to their research project, they returned the slip to Jimbo and the latter got a number, told the pharmacist that he will wait for the medicine and sat down to wait.(He didn’t want to be given preferential treatment though he wished fervently that the hospital would have a ‘staff lane’).

His number came a short while later.

Jimbo got up, went to the relevant counter, presented his number, looked at the pharmacist (in face mask ~ gosh, you can’t recognise anyone anymore these days) and said:

“Thank you very much, it’s for my patient. I am doing him a favour by picking up his medicine as he can’t come personally to collect it”

The pharmacist, also failing to recognise Jimbo, gave him a strange look.

The look that says:

“Yeah right, and I’m Obama’s wife”.
“I wonder how you got HIV”
“He must be gay”
“Just come clean and say the prescription is yours”
“No need to cook up some far fetched cock and bull story”

Jimbo left the counter, clutching the bag of medicine and feeling really strange.

Is this what his patients go through each time they collect their medicine? (Jimbo knows for a fact that some of his patients are put through hell when they go for venesection)

Sigh….

Tues, 250809 @ 0700