Break On Through

I'd worked as an houseman in Kuantan Hospital Tengku Ampuan Afzan for exactly a month now. I started working in ward on 5th July, till today. However i have officially been a government servant since 21st of June, on the first day of Induction (and my salary had basically started counting from 12 am on the same day). Then the first week since i reported to this hospital on 27th June has been for some infectious control programs, and practice of blood taking at the Ambulatory Care Center, which is super super chilled. So basically, i had started the real HO life on the 5th of July.

The first one month of 'life' was like the 'sohai' period (stupid and useless period). It was for me just about familiarizing with the whole new system, new places, new people, new languages. One of the thing that surprised me was the extensive use of medical abbreviations (many of which are not even internationally standard ones, eg BUSE, COROS, CBD, BO, Branulla, Lytic Cocktail, BHT etc etc). Even by checking the name on the internet, it doesn't show any results. All used in this primitive Malaysia only ma. Why Malaysia medical system is staying under its own roof using stupid terms like that and make life harder for people from oversea?

Second is the language. Yes, my own Malaysian national language. My Malay sucks. In the beginning, the way i clerk case is almost similar to the way i clerk in Kanada language when i was in Mangalore. The funny thing is some doctors here actually present a case in malay mixed with english. and almost all nurses speak in malay only. It took me quite sometime to actually able to speak in sentences. Imagine that!

Next is the drug names. It should be a standard of using only generic names! However, those names in the med chart was all in brands, which are totally aliens to me. I have to spend time to open the Medscape, or search online through my phone, or check the MIMS to have the slightest ideas what is what. Funny thing is, some of the brand names are no longer available in pharmacy. Why no more branded drugs? Because government is going to bankrupt soon!! They now give only generic drugs (cheap ma). Medscape on my ipod has especially been super useful for me in searching for generic drug names, the dosage, the indications and contraindications etc etc. Of course, the pharmacist has called me numerous times in the to rectify on the dosage of my prescriptions etc.

Then it's the paper work!! Lab forms! Reporting of certain diseases! Reviews! Entries! Radiology appointment! Lab report tracing forms! Discharge summaries! Way too many kinds of forms to be filled! Most of them need a carbon copy, IC number, diagnosis, and stamp. I find filling forms a big nuisance, had tried to cut down on some details to cut short the time spent but got screwed so many times by the lab. In private hospital in India i worked, u just need to put stickers (containing all the pt's details) on the forms, and tick whatever investigation you need on the form. Life was so easy back then.

The next thing is the blood taking. I don't know is it because of my skills has dropped, or the difference between Malaysian and Indian patients' blood vessels. Taking blood in India is to me a super easy job, and if u cant do it, there are nurses or colleagues to help u. But here, taking blood seems like a big job to me. You need to push the whole trolley and carry more stuffs to the pt's bed. Very often, i failed in collecting blood -it's either no veins are visible, or even though i am confident that i poked the right place, only bubbles of blood enters! Sometimes taking a pt's blood or inserting the cannula can take more than 30 mins for me. There were times when i failed and tried to ask for nurse's help, only to find out non of the staff nurses know how to take blood! Gonna ask the other HOs? Everyone is way too busy doing their work. Gonna ask MO? no way, it's a shame! So in the end? You are stuck with the pt and start trying from wrist area to elbow area to femoral to arterial blood. The whole thing of blood taking is just damn frustrating for me.

Next is the my knowledge. I had basically started out with zero knowledge here. That's because the 1 year of internship in India is way too relaxing, and do not require any studying. As an intern in India, you need not to be responsible for the pt management. You do not even need to know anything about the pt and still able to survive. Internship for Indians is just the 'break' after the hectic final year MBBS as well as the time to study for entrance PG exams (which do not apply for us foreigners). One thing i especially do not know is ECG! In KMC, we only need to know MI and count the rate to pass our spotters exam. I somehow realized almost everyone here can read ECG as easily as ABC. Just a few glimpse they can know what the ECG shows. For me, i even forgot how to count the heart rate!! That's what scare me the most, and i do not even have a book to read bout ECG except my iOS app - ECG Guide. There are so many cardiac pt who need daily ECGs, and when i asked to describe about the changes, i would be stunned.

Then is the whole big issue about the work load. We work up to 90+ hours a week easily. It's a big contrast from the easy go lucky internship life in India. In India, you are only expected to do 3 things: collect and send blood, collect reports, and write discharge. (plus some procedures and history taking). Interns in India are still considered 'spoon-fed' by PGs. "Do what you are told, and leave the rest to the PGs, cause you are totally irresponsible for the patients' management". However, doctors here are expected to be pro-active, to walk the extra miles, and at the same time there's absolutely no one to ask you what to do and what not to. You are expected to learn from colleagues or by yourselves through the hard way. Here we have to do every single thing!! Starting from when the pt got admitted, clerk the case; take the blood; take the blood samples all the way to the lab (if needed STAT); come up do the rounds with MO; then do the rounds with Specialists; then take blood again (if newly ordered by specialist), get the radio appointments by going all the way to Radiology dept and present the case to radiologist and get his/her signature after some screwing and come up again with the appointment letter; then refer the case to another dept by calling up the MOs and present the case via phone and get some screwing; then fill up tracer forms and go all the way down to lab to trace the lab reports wanted by the supervisors STAT; then asked by nurse to change the cannula of another pt who just got blocked; then write the discharge of some other pt; then go and do some procedures (you are expected to perform Paracentesis,Thoracocentesis, Peritoneal Dialysis, CVP perfectly, plus maybe BMAT and LP) for the pt who need it; then follow the MO to see the case i just referred earlier; then carry out again whatever is ordered by him/her; then go and clerk another new admissions..... the list goes on until you forgot your lunch and suddenly realized it was already 6pm. Until the next morning, during the specialist round then only you found out you forgot to carry out something for that pt and then get screwed again.

Another thing i would like to stress on is the job scope of nurses. As of today, there is already overloading of nurses in Malaysia, and they have started with shift systems early on. Imagine around 7 -8 staff nurses for each ward of around 40 patients, plus few students nurses. The shocking thing to me is that, the nurses here do so little! All they do is monitoring of V/S, cleaning up the mess of the pt, changing their bed sheets, giving them med, and doing paperwork, plenty of paperwork! Sometimes, the nurse do not even need to be on pt's bed and get all her job done at the counter with the file. It's not hard to see all the nurses just handing around the counter chatting while doing some 'serious' paperwork. The staff nurses do not even know how to take blood. It is only those senior 'sisters' that had did all the blood taking and pt care years ago before the whole system changed. Even the 'sisters' themselves admit that they no longer enjoy working in govt hospitals cz all they do is paper paper paper bullshits. 

Currently, i am glad i'd passed the 'dumb' period of being a houseman as a first poster from a foreign system. I am now more in sync with the way things works, able to find time for my lunch, able to read up a bit, and able to walk a bit slower. But, there are still too much for me to learn and know. I'd already had 4 times on call, thank god no pt has died under me, and for each call i was able to sleep (which is rare for other people). I now have some juniors already, and i am expected to start teaching them, which i did. Started having more friends, able to have more confidence in prescribing without asking, or suggest new diagnosis and drugs. But of course, i still get some screwing sometimes, mainly for forgetting to do something (who doesn't?)

Generally i am super thankful to have Medical as my first posting. It is the busiest posting among all, the hardest to get adjusted to, with the most work to carry out, and most brain power needed. However, the MOs and specialists are all very nice. They are willing to teach, to correct, and the way they screw is considered 'nice' as compared to other dept. People say, if you survived Medical, nothing else would be a problem. And i rightly hope so.

1st of September onwards, all HO in Malaysia will start the "shift system". There will be no more On-Calls. No more 90 hours per week. No more On-Call allowances (which can easily go up to RM1000 per month). Maybe the Critical allowance (RM750) will be waived off as well from our salary. Everyone work 8-10 hrs a day. More 'life', more sleep. What claimed by our Health Minister is that, the shift system is for our own good!! He wants the specialist to have more rounds in a day, can teach more personally, and reduce our work load due to all the complaints he received every second from HOs complaining about being bullied, treated unfairly, stressed, mental break down, gone psycho etc. But i do not think it's the main reason. The main main reason is that - our government has no money! No money to pay for our On-Calls, which is RM100 per calls. Like this, the government can save up to RM50 millions per year! This government is going to be thrown out soon, so they must suck as much as possible while they still can.

However, according to the condition in Kuantan, there are not enough HO to shift thrice a day. We now have 4 HO per ward containing 40 pt. Each HO will be in charge of around 10 pt max. If you divide the 4 person into 3 shifts, which means a single HO for the whole ward? How will the quality of work be? It will lead to more pass-overs, reduce of responsibility, and less closely monitored by specialists. So in the end, who will suffer? The patients. Treatment plan will be delayed. The pt will be like a ball passed around the HOs. This is because it is impossible for 1-2 HO to cover the whole ward and at the same time complete all the works i aforementioned within that few hours time. Yes, we will have more time for ourselves and family and friends, continue with our social life and whatever hobby we used to had. But how about the quality of healthcare? Already the healthcare in Malaysia is down the drain as we can read about it every single day. How much worse will everything become? Day by day, more and more HOs are being produced both from local private unis as well as foreign ones. How will the future doctors be? Will we be able to be up to par and be "safe doctors"? Everything is going to be more and more gloomy, especially for us young HOs' future in Malaysia. Last week, there was a bad news for us HO in medical ward of HTAA. As of now, we have 7 HOs on call per day, and the 7 person is so so just enough to cover the all 4 wards, the periphery, and the dengue ward. But, there was an order from i don't know how high above, to cut down on the number of HOs on call per day to 4. Yes, reduced by half to 4!! @#$^%&*. The reason being? The hospital, or i don't know where, is out of budget! They cannot afford to pay RM300 more per day even for this one last month before the shift system starts! What kind of fucking bullshit is this! Where does all the money goes? Buying nice rings and big houses for the politicians themselves right??

How i wish life would be just like internship in India. Go to work at 9, come back at 5. Plenty of time to have a cup of coffee and lunch in between. Just doing the job of a 'clerk' instead of doctors. Come home play sports, play games, watch movies, go out for dinner, come back late night and sleep. But of course that's the difference between the US system of India and the old UK system of Malaysia. At least in India, we can become a specialist in no time, but in Malaysia, you might easily get stuck of being a what they call 'chronic MO', going no where and doing all the hard work. That's the frustrating and gloomy part of being a Houseman in Malaysia. Less pay, more work, no pride, little future, and your hireachy in the hospital is in fact lower than the nurses.

p/s: all these experiences are applicable to Kuantan HTAA Medical unit only. I do not know how are the other Mangaloreans doing, as i seldom hear from them. (maybe d/t superbly busyness?)

Sad But True

Now that i finally graduated, i am reluctant to start working or practicing as a medical personnel. I hate having to do 2 years of Housemanship here. I hate the Malaysia medical system, disappointed with the Malaysian government, and not wanting to even live in Malaysia altogether. I have read too many articles and news about the Housemanship in Malaysia, the broken medical system here. I hate having need to work like a dog, have every-other-day 'on call' which means work 36 hours non stop. I hate that i will not be treated fairly, not paid handsomely, not taught sincerely by specialist, and not appreciated by the hospital staffs and the public. Frankly speaking, I regretted choosing this field altogether. Even in my batch, around 30-40% of the students regretted entering this field. I have gone through the hectic schooling life, the demanding exams, the tiring clinical practice. The worst thing is that after studied like mad for the last 5 years, it doesn't mean anything. The MBBS degree, which everyone else thought is a big "wow", is nothing but a passport to enter another deeper layer of hell.

Now, there are way too many HOs in Malaysia, and too few MOs and Specialist. In 2015, there will be surplus of doctors in Malaysia. 5 years ago, there are only 5 universities in Malaysia, both private and government, which provide Medical degree. In 5 years time, the number had increased to 15. There are hundreds of undergraduates still to graduate from the unis and colleges, not counting those who went for study abroad. It wont be long before we see doctors unemployed on the streets, because the number is too great but the posts provided by MOH is limited. Imagine seeing doctors, after studied so hard, have to search for jobs in unrelated field. The phenomena will be the same as the nurses in Malaysia right now. 

Becoming a newly graduated doctor in Malaysia now, is to me, like a never-never land, because you will mostly end up no where. Last time, having an MBBS degree is more than enough. You can open a clinic, and your life will prosper. Now, the patients demand more; they are more well informed, more educated, and knows how to fight for their rights. People nowadays would always prefer to search a specialist's advice rather than a normal physician. However, even after houseman, a Malaysia Houseman has very very limited chances to further his/her career. Now, as of 2011, there are already 7000+ HO, but only 800 seats of master scholarship provided by the Malaysia Medical Council. Talking bout competition? Unfairness? Racism? Cables and Connections? There's no need of explaining it further. Worse, EVERY single masters abroad are NOT recognized in this Bolehland, except 3 from UK: MRCP, MRCPCH, MRCOG (and they're going to de-recognize MRCPCH anytime soon. The phenomenon will continue to be the same - many many HO's and MO's, but still very limited Specialists. Why are there so many of the Malaysian 'genius' doctors who studied abroad do not come back to serve Malaysia? That's because the whole system is screwed up. The pay elsewhere is much higher, you are protected better, and have less working hours. So, i would tell everyone, including myself, if possible, if financially able, leave. Leave this Bolehland where nothing is boleh, and never never come back again. The government is screwed up, whole Malaysia is hopeless.

In every day's newspaper, we can see that many people are complaining bout the deteriorating quality of the health care in the country, and most of the fingers are pointed towards us, the Housemans. But i can understand why. It's all because in the first place, a HO basically dont know anything, have no experiences, naive, and yet we are overworked (36 hours without any rest, no time for even a drink), not guided well by our supervisors, not encouraged but discouraged, being despised by even the nurses, over-stressed. There are many HO who are depressed, or even gone crazy, quit, became suicidal etc. Statistic shows 60% of HO seeks psychiatry consultation. How can a mere young person handle so much, and yet without any support from their supervisors, but being scolded, kicked around, insulted all the time by them. Today, most of the old doctors holding high posts are totally crazy, inhumane, irresponsible, inconsiderate in their behavior towards HOs. And as the HOs are being treated like shit, they would later become the same and take revenge on their juniors, and the vicious cycle goes on.

Last week, i was called up for the Induction Course in Hotel Midah, KL.. It was a 4 days induction course .. It was fun, resourceful, and at the same time, stomach filling.. One of the things we are taught about is 'Soft-skills', which means ways to communicate, ways to engage and be empathy towards patients. All these qualities are totally neglected by the Indian medical system i was used to, where everything is just about how much you study. Today, a doctor's job is not only about auscultating with stethoscope and prescribing drugs, but to 'talk' and behave humbly and nicely. Knowledge no longer counts much because anyone can know anything by just a click of mouse. It is about how you talk, how you present yourself, how to approach, how you keep silent and listen, how to touch, and what to avoid doing. Besides, we also informed that the On-Call system is going to be cancelled altogether, and be changed to Shift-system, where HOs work in 8 hours shifts rotation. Yes, it is a good news that we will not be too tired and can have some 'life', but the negative side is that, there will no longer be any On-Call allowances, which means around RM1000 loss per month.

I reported to duty at Hospital Tengku Ampuan Afzan Kuantan on Monday, 27th June.. This time, there were only 2 of us who reported to Kuantan GH- me, and another Malay friend Hamid. The first day was all about formality and documentations. Had to go to KWSP, the bank, and fill up a bunch of forms at the admin section of the hospital. That's all we did that day.

2nd day, we had a briefing on Standard Precautions practices. It was about what to do and what not to, all the steps of hand washing, way of handling needles, way of throwing medical waste, ways to protect oneself etc. All these qualities are again, over looked by the Indian system, where you simply throw anything anywhere, and nothing is being stressed upon. Before we start our posting, in Kuantan, there's a new rule that states that all new HOs are to be placed in the Blood Collection Room to collect at least the blood of 50 patients. Having done that only we are allowed to meet the head of the hospital for posting in a particular department. The purpose of it is to prepare the new HOs to work efficiently in terms of dealing with needles well, collecting blood skillfully, and dispense each waste in particular bins, ultimately to minimize the incidence of sharp injuries in the hospital to 0. So for now, we're just chilling around, taking blood in a small AC room, chatting with the staff nurse, and leave at 4 something. We both had reached the target in just 2 days, but we plan to linger on till Friday, then we will have holiday on Sat & Sun, and to meet the head only next Monday, so that we can continue chilling around, jobless, tension-less, at the same time getting familiar with the hospital surroundings, prepare ourselves knowledge wise and rest while we still can, before we enter hell.

Since i came back to Malaysia, many juniors asked me for my advices as they are also interested in becoming a doctor. My first thing telling them would be: think again! it's better not! There's no future! And if they really want to be a doctor for whatever noble reason? Go study abroad, and never come back!!

So, since my foot is stuck in this puddle of mud, how can i drag myself forward?
1. Keep thinking and setting sights on my goals: To be an eye specialist, work in a private hospital, earn a lot to have a good living, have much free time for myself and loving family, and be respected and appreciated by the public for my good service.
2. Pray. Pray to God for strength, guidance, skills, wisdom, knowledge; to show me favor, to pave the path straight for me, to help me achieve my goals.
3. Think of the On-Call system as a chance to earn more while i can, as the shift-system is just around the corner.
4. It is my calling to be in this healing ministry of Him. Spread His love with my open heart, let people feel that i am different, and may many be healed under my care.
5. Keep reminding myself i am getting paid. I am currently stay at home, have a super nice room with all new furniture and bed, and i do not need to use a single cent by logic. I can save up a lot in 2 years time, i will invest, and get a Toyota Altis after that to reward myself! 
6. Will keep energy bars and loads of water in my bag, to keep me going on.

Goodbye Yellow Brick Road

Reached Malaysia!! A new leaf of life starts now..

Adios India!! The place I've been for 5 and half years. The place I felt sad to land on at first; then slowly blended in quite well; at the same time experienced so much of the 'incredible' Indian ways which i adore some but mostly got sick of; at last relief and ready to leave it; but still misses many essences of it (especially the food and friends and places I felt so familiar with)... My experiences of India will always be cherished, learned from, recalled, retold, maybe revisited, but I don't think it will be missed..

Subterranean Homesick Blues

One thing i'll miss the most in India is my room..

305B Sturrock Hostel
A room famous for it's cleanliness, neatness and openness
A room that earned me my MBBS degree
A room i spent my sleepless nights burying my head in the medical books
A room where all my sweat, tears, and saliva are shed
A room where loud speakers and heavy guitar are played
A room that connects me to what's happening around the world
A room where i spent enormous amount on online shopping
A room where many many video games are played and accomplished
A room of numerous sessions of gaming, eating, drinking, movie, football, chatting, gossiping
A room where most birthdays are celebrated
A room where food products are cleaned, cut, cooked, served and kept
A room that belongs to Liverpool FC

A room of which the bed is so soft that everyone wants to sleep on
A room at which the i spent a lot to make it different and comfy

A room at which constant changes are made throughout the 5.5 year
A room i feel so comfortable with i would call home

2005, when i first moved in:

simple bed

Acer laptop; an EPL time table and other stuffs from Msia

2006

The other life forms - fishy!!

My baby moved in - Fender Squier Strat

2008:

Dell laptop; laptop stand, gaming mouse, new speakers, executive chair

 BIG magic mirror on the wall

A gym set

Mouse at tray; 320gb ext hdd; ipod classic; Creative sound card

a bag of human on my bed

My birthday with Goan wine

 2009, the room painted blue:

a totally silent, night glowing wall clock

2 artistic photo frames

fridge; guitar; books; chairs

a tinge of dark blue pillar, shoe rack

wardrobe; luggage; huge mirror; new yellow night light

new natural fluorescent light tube

22" monitor; 1TB ext hdd; laptop on fridge

studying

 

playing

2011, the last days in India:

the high end desktop PC in an old ugly cheap Cooler Master case on fridge

the collection of my original games

the new white computer casing; XBOX controller

Altec Lansing speaker shipped home, using a temporary speaker belonging to my friend

all my books and games shipped back; a stack of GQ magazines

the Liverpool wardrobe; the belt hook

the guitar (guitar pedal sent back); the side table and the bed

the air cond essential for my sleeps

fridge

the sink, the cooking stuffs and the facial stuffs

my cooking ingredients on my shoe rack

private businesses

a session of red wine for farewell

p/s: For Facebook Notes' better view, click on "View Original Post"

Eight Days A Week

I'd completed my 365 days of internship here in mangalore, and am now in my one month extensions in comm med and pediatrics, 2 weeks each, which since the beginning of March, I hardly attend. The last one year of working experience was half busy, half free; half happy, half depressing; half useful, half useless. Most the postings i work every single days, eight days a week, while some of them has free Sundays. Most of them are half day duty, while some are 12-freaking long hours. Some of them you work constantly non stop, while some you don't even need to go.

There had been various pros and cons working here in the local hospitals, both private KMC hospitals (KMC Attavar & UMC Jyothi) and government hospitals (Wenlock hospital & Lady Goshen Hospital).

Out of the one  long year, most of my time are spent in KMC Attavar (medicine 1.5 months, Orthopedic 1 month, pediatric 10 days, 1.5 months surgery, Ent, ophthalmology & psychiatry 2 weeks each, and obstetrics gynaec 2 weeks).
KMC Attavar is the main teaching hospital of KMC and it's where most staffs work full time at. My job there is working under the Post Grads, mainly filling the enormous types of investigation forms, collecting the lab report from the computer system, doing dressings, assisting surgeries, and preparing discharge summaries. I don't really see the patients, or do any examination unless asked to do so. Working hours is normally 9 to 5, but most the time I can leave at noon if there's other intern covering the afternoon shift. I always take my chance to go to the coffee stall or the canteen whenever I'm free, to accompany Caryn if she's also posted there or just to hang out with friends or solely fill my empty stomach. Though the amount of pt is not many and you don't get to see as various kinds of rare diseases plus you don't do as much as in govt hospital, I enjoyed working there as it's quite hygienic, has many nurses to help you out, being able to communicate with some pt in English, and you can always chill out as your time is not occupied by doing some unnecessary stuffs like in govt hospital. Pt here are normally middle class, and care for the pt are primarily done by PGs. Most the time the prof get to know the case only during their rounds. In fact, the number of pt in certain department or units here are so low they don't fulfill the quota of MCI, and you can observe all the funny way they trying to fill the empty beds with camp pt or just some random old man from the Charity organization of the hospital. One stupid thing is that the big hospital don't even have a proper lab, and they're only able to do some simple blood and urine and stool test. How dumb is it. All reports have to be sent to the central lab in UMC, and there comes all the delay in collecting reports. Imagine one pt is critically ill and we need to know some lab values but the report is not updated in computer, then you call the lab but it take half day to pick up, or they'll simply drop your call or they'll talk in a very rude tone. I hate collecting reports as i find them annoying due to the faulty hospital system.

UMC hospital is the de facto higher end hospital owned by the college. I'd done my surgery posting here as well, and in that 1.5 months I'd been rushing btw 2 hospitals. Only higher class pt are able to afford to come here, and the pt do get primary attentions from the main doctors. But, this hospital building is super old and extremely narrow, and they'd been trying extremely hard to improve the aesthetic value of it by constantly making holes and patching up here and there. So imagine the constant drilling noise besides the ward. The OR is especially tight and limited that the surgeons hardly have a walking space. But at least the hospital has a air conditioned OPD, adequate blood bank, big central laboratory, fast elevators, private air cond ward etc to name a few. Things are done quite fast and efficiently here, but u can see many pt come just for some minor minor illness and the prof will do those minor minor procedures, of  which all these is impossible in govt set up. This hospital is like the main hub, where all lab reports are done here and entered into the system here. If one day the lab is burnt down, all the pt in any other hospital will just die. Besides, all kinds of propaganda and advertisement and sponsorship are being promoted to make this hospital famous and to  be the main money making machine of the college.

Government Wenlock Hospital is the scariest hospital i'd ever seen when i came. Old, ugly, dirty, dark, smelly, eerie. Thank God i wasn't posted in this hospital at all. I wouldn't want my shirts to stink every day the moment i step into this hospital. I was only posted here for 2 weeks in Casualty posting, something like an ER. Here YOU yourself have the primary care for the pt. Here u see all kinds of crazy cases ie RTA, fights, snake bites, burns, drunk, septicemia, poisoning, acute pain etc. Your job is basically do a triage on the pt, check their vitals, a brief history, refer to the PGs of respective department, and then whatever the PGs ask you to do. You can learn a lot of basic skills here, but the 12 hour duty time is also straining. Especially during middle of night while you are sleeping half way, a drunkard pt came in with head injuries, then after all the basic procedures are done, you have to suture the wound but the half conscious pt is rejecting to be treated, shouting around, moving vigorously around when you try to suture, or removing the bandage after you'd done a hard work to help. All these to me, are super annoying. I mean, why should i care if the pt don't care. He is drunk, lying on the road with a broken head, then some bystander just bring him in to ruin my life. Let them be, let them die if they wish to, let them leave without any treatment if they don't ask for it. Anyway, India has too many useless ppl and their population is over crowded, so it's fine to let all the lower class poor ppl die.

Now comes to Government Lady Goshen Hospital. I'm here for 1.5 months in O&G. It is an exclusively female hospital, so it's comparably cleaner than General Hospital. The ward duty is fine, you only work from 9am to 12pm, collect blood samples, write some lab forms and discharges and leave. But, there's is the Labor Theater posting of 2 weeks here for everyone, where you have to spend your 12 hour in the smelly, stuffy, unhygienic, narrow labor room. You have to constantly check the mothers' BP to rule our gestational hypertension, keep drawing blood for investigations, give the pt relative instructions to bring the blood sample to different labs outside, collecting reports on phone as they only have a computer and it's always unavailable, help the PGs buy tea and snacks, bringing and waiting for the pt for Ultrasound scan, getting signatures from different medical officers for different forms, shouting "Biki-biki!!(which means "push!!")"and holding the mother in labor , traveling to other hospitals to get blood for pt, and only occasionally, pull the baby out, and suture the episiotomy wound. Besides the last 2 things, others are to me extremely useless. If the hospital is more well equipped and the system has more sense, an electronic BP cuff will be available without me sending hours in taking BP one by one with the broken & inaccurate sphygmomanometer; blood samples will be sent to the lab INSIDE the hospital itself by nurses (no need for pt's relative to take a transport to travel to other lab outside, wait for the report, and come back to show them). Scanning will be done more readily all the time without need to call for radiologist to come and do the scan stat and i write down the report on some random paper on the spot. Collecting reports will be done in seconds using the computer rather than listening to the on-hold tone in the phone. Plus, i do not need to run here and there to get signatures which doesn't make sense if a centralized and standardized communication exist among all doctors. See, because the pt here are so poor that they cant pay a single cent for anything, i have to run up and down to get signatures so that whatever scanning, investigations, blood or surgeries can be done free, and the annoying part is sometimes you cant find the medical officer in charge at all for the signatures. All these are simply nuisance to me. I mean, if anyway the MO is going to sign, if anyway all the pt are not going to pay, what's the point of all these repetitive work which could be demolished right away. That's why i hate serving the poor. First of all, I cant communicate with the pt in whatever Indian local languages, I don't get to learn much of the essential knowledge on ways of managing the pt, and practice basic skills like delivering and suturing, but wasting your time running around hospital doing those extra useless work which are non existent in a more proper hospital setup.

The way they dry their OT drapes

count the number of people in the OT. Talking bout asepsis?

How the pt dry their sarees

the haunted corridor

the 'amazing' duty doctor's room

corridor as ward, sick

After 1 full year of internship, i can confidently proclaim that i do not learn much. I am not at all well equipped enough to manage a pt single handedly, from diagnosing, examining, prescribing, following-up to discharging him/her. I am not perfect enough on whatever clinical skills needed as i was not given enough chances to DO rather than observe. I had totally forgot 90% of whatever theory i learned in my Undergrad time. So what do the internship here prepared us out as?? Zero!! I would dare say the medical system here in KMC is totally broken, fool-UNproofed, and faulty. Intership, for Indian ppl, are just a 1 year break after their hectic final year MBBS, and as a time to study and take up PG entrance exam at the end of it. Moreover, internship in India can be totally skipped, if you have the right contacts and money.

So what have i done in this one year of internship??

• Gaming. I'd bought a new powerhouse gaming desktop PC and i'd gamed a good number of great games that i'd bought them originally. I play alone, i play with friends, i play online.
• Shopping. Both online and in-store. That's why my Rs8000 i get from college as stipend for internship plus JPA allowance is always finished.
• Hanging out. With Caryn or other friends. Drinking, dining, movie whatever you name..
• Simply resting, sleeping, chilling.
• Knowing new friends. PG or profs or co-interns i'd worked with/under. Yes, though i do not enjoy working in the hospitals here, i enjoyed working with many good doctors and fine people here.

In another month, i'll be going back Malaysia and start my houseman. I have to start from zero once again, both theoretically and practically. How well can i cope? how am i going to manage myself in the hectic 36 hours duty as the other fellow houseman in Malaysia? God Only Knows..

P/S: this is supposed to be broken down to many short entries throughout the year but i was too lazy to write any blog in the last one year. Pardon me for the length of the post.

Updated on 19th Mac:

All doctors have a right to be selective bout their patients.. doctor itself is a career, and in the end of the day, everyone needs money to survive.. that's what specialization is all about: you being more and more selective bout your pt according to your specialty but at the same time your patients scope is greatly narrowed down, mostly towards only the rich and affordable ones.. every doctors have different calling: some would volunteer themselves for free charity to help the poor or in war or disaster; while some would stay in the 5 star clinic treating specific patients..i am sure both are sincerely doing a favor for the community, just that different targets, and the former one is totally a big no for me..on the first day i stepped foot in India, i had much sympathy to the people here, but as years go by, as reality and adjustment and experiences got a hold on me, empathy towards the poor became deeply hidden.

I beg pardon for THAT harsh statement i made, which i do not meant all of it.. it was written solely out of frustration.. maybe the lack of elaborations made it a sick statement..i realized THAT line provoked many, which i do not meant to.. it was an ill written statement, and i feel sorry for it..
"I do not hate poor patients, but i despise a hospital that's full of poor ppl because of the many nuisance i experienced"
"i never refuse to treat poor pt, but i'm greatly annoyed when the pt is ignorant bout the whole sickness and treatment and advices.."
"i will not do harm to poor pt, but i do not disagree that if the poor and lowly ones are lesser, this country would definitely be a better place to live in, that's what civilization is all about"

P/S: i am no God, and i never meant to judge on people (yes i know i am critical and straight forward)..

P/P/S: i do not hate my one whole year of internship here in India, (but actually enjoyed it most the time). i'd never had any problem with the profs, not fought with any PGs or co-intern (which is extremely rare), but in fact i'd befriended many professors, PGs and batch mates (they are 'mostly' great doctors and friends).. i was never drained or exhausted by the end of the day but can still go out to enjoy almost every night, or play in the room (it was a very free working hours i would say, comparatively).  All the frustration in the above post came out because at the end of the day as i draw closer to return to Malaysia, i observed that i myself are totally unequipped to face the horrible Malaysia medical systems (which i know that it is totally a hectic, tiring, demanding, stupid and unfair system). I fear for the worse.. i really envy my friends here in India as they would already be recognized specialists by the time i finish my dog-manship in Malaysia..

Paradise City

Q: Describe India in colors:
A: Black (for the ones who walk); Brown (for the dirt they thread on), yellow (for the dust they breathe in)

"Imagine there's no clean air,
the whole world is yellow tinted,
it's hard if you breathe,
your nose blocked by black soot"

"Imagine there's no clear roads,
the sides are all dirt, the center are all holes,
when those lawless cars drive through,
your eye wouldn't see through."

"Imagine there are plenty of ugly buildings,
narrow, low, and holed,
wall from white turned yellow,
be extra careful when you enter down below"

"You may say they're constructing many new buildings,
but they're all interspersed among the old ones,
like a big new mall and around it are some old small ugly shops,
and the roads outside broken and crowded,
i hope some day they'll tear down all the old and unused ones,
and the world will be new and organized"

"Imagine you're in a car traveling on road,
the bus behind keep honking for nothing,
the rickshaw on your right trying to kiss you,
the car in front suddenly halt to pick someone,
and the pedestrians on the left sneak across your car not scared of dying."

"Imagine you can never see a proper dustbin,
rubbish exist at every inch of the earth,
cows and dogs scavenging the dump,
a naked fellow searching there and fighting for his lunch.

"Imagine the trees are gone and the sun red rod,
people walking around in long pants long sleeve as if they're not hot,

inside their mouth full of red disgusting paan, 

spitting their sputum or pan everywhere making the road look disgusting

taking a pee anywhere they want make the place smells like rum."

"Imagine a homeless family picnic at the round-about,
the father selling cotton buds to any car who would stop at the light,
the mother nursing a dying baby begging for money,
the sister drying their clothes on the road divider,
the lil brother lying on the road side playing with his mody dick."

"You may say all these are getting rarer or non-existence in big cities,
but i assure you it is there in any metropolitan here,
people are poor and low and they will always be,
development is fast but the old and ugly stay where it is,
people are still behaving the way they used to be,
India is just a third world country pretending as a uprising power wannabe."

Thank You for the Music

Today, CDs are obsolete.. CD Walkman is regarded as one of the stupidest tech of all time. 

Vinyl, despite its high fidelity, is near extinct. SACD or DVD-Audio which are aimed for audiophile, are dead too. Not to mention the low quality of radio, and the vulnerable cassettes. Blu-Ray is one of the top candidate set to be doomed in near future.

Today, online stores took over. iTunes Store is the number one highest music seller, Amazon.com comes second, and all shop retailer are suffering worse than ever before. For people who don't buy music, digital downloads or online streaming has become part and parcel of their life. Music has become a free industry, compared to "reserved-for-high-end-consumer-with hi-fi-players" of older times. iTunes Store is today the best online entertainment store, offering billions of Musics, Movies, TV Shows, Podcast, Lecture Notes, Apps, Games, Books. In terms of accessibility, productivity, usability, simplicity, longevity, affordability, exclusivity, Apple utterly nailed it.

When Apple launched iPod 9 years back, digital music players had been blooming, with products from Sony, Creative, Microsoft etc competing with the Apple's de-facto product. Today, Apple has won the music industry HANDS DOWN, the war is over. The ecosystem is simply too amazing it works under iTunes and with other Apple products are too user friendly. Somemore, what can beat the coolness, user-friendliness, functions, fun, capacity, battery life of an iPod Touch? An iPod, coupled with a good pair of earphone, is utterly unbeatable. iPod has become so important that whoever that do not own it, is totally considered not a music lover on-the-go.

my 4th gen iPod Touch 64GB

my Klipsch S4i earphone

Ppl who still buy CDs think that CD quality is still very much higher than MP3s etc, and you get to collect the nice booklet containing rare beautiful photos and lyrics. 

In 2009, Apple launched iTunes LP, an interactive digital booklet for albums.. In the beginning, every one thought it is just another fancy by-product of Apple, but after more than a year or so, more and more albums are getting exclusive LP contents, mainly containing bonus tracks and rare videos and beautiful photos and liner notes and lyrics. The music file of iTunes are right now at 256kbps AAC format, which is very near to CD quality (and that only if the listener listen through very high end speakers and have a very highly sensitive ears, can make out that very bit of difference). 

Yes, with iTunes LP, CDs have become TOTALLY obsolete. 

Here is the beautiful showcase of my personal collection of iTunes LP:

"thank you for the music
the songs I'm singing
thanks for all the joy they're bringing
who can live without it
I ask in all honesty
what would life be
without a song or a dance what are we
so I say thank you for the music
for giving it to me"