I just wonder how are students being taught in the interior schools.

I interviewed a 17 year old girl, a patient from a district, in the clinic. She is supposed to take her SPM examinations this year.

Me : Bila ambil SPM?
Her : Tak ambil dah. Henti sekolah dah.
Me: Kenapa?
Her : Tak pandai.
Me: PMR dapat apa?
Her : Dapat "telor" (giggling)
Me: Cikgu ada ajar? Kamu ada tanya?
Her : Cikgu kata siapa tak faham angkat tangan.
Me: Kamu ada angkat tangan?
Her : Tak
Me : Kamu tau baca dan tulis?
Her : Tak
Me: Jadi apa kamu buat hari-hari di sekolah?
Her : (Giggling)
Me : Bapa, mak kerja apa?
Her : Petani. Tanam padi.
Me : Di rumah kamu buat apa? Kamu ada tolong potong padi?
Her : Belum musim. Bulan dua-belas nanti...
Me : Tadi macam mana datang? Macam mana kamu balik?
Her : Ikut "Ngii...ngo...ngii...ngo" (giggling)
Me : Ikut ambulans kah?
Her : (Nodded)

After 17 years of schooling she cannot read and write. I tested her myself. She was very cheerful though. I could not detect even a hint of jealousy nor dissatisfaction. 

However I felt sad. How did this happen in our country? Poverty? Ignorance? Lack of opportunity? Neglected? Education system? Some population just don't realize that they have not been given a fair share of the socio-economic pie. Easy going people. Easy to be taken advantage of. The state's wealth plundered away while they are still in the dark. Obviously the "Dasar Ekonomi Baru" didn't reach here. She is a "Bumiputra" though.

Whatever happened to the fair distribution of wealth and opportunity? Looks like it is a skewed distribution.
 

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Does common courtesy and manners still matter today? Or have they given way in this "dog eat dog" world. Yeah, using vulgar language and signs are entertaining. It captures the attention and perhaps achieve the objective more clearly and faster. Some people seemed to idolize vulgarity, rudeness and brash language as though it is something great, something most people won't dare to do. So the person who does it must be brave, great and deserve to be idolized. Very "keng" as they say.

From our Member of Parliment, to even doctors, perhaps specialist and consultants too, we have seen such behaviour and language. An example of this is here. More often than not, it is spoken within an inner circle of pals. On and off we do blurt out some expletives, but is it great to make it as a habit? We have heard swearing, expletives, vulgarity uttered on a daily basis, most of the time behind close doors. The irony is that some people seemed to idolize people who uttered them, whether explicitly or secretly. What is so great about it? It is certainly easier to blurt out an expletive than to construct a courteous sentence.

I've had House Officers who came to the department, not bothering to introduce themselves to the Head of Department or their specialist and started working in the wards as though they place belong to them. Some do not even bother introducing themselves to the Sister of the wards either. For crying out loud, if you visit a friend's house, common courtesy dictates you inform the owner of the house that you are coming to visit, isn't it not?

How often do people remember to use the term "Thank you. I appreciate it"? Whatever happened to common courtesy and manners? Isn't there any other way to converse other than using expletives? Politeness may not be as entertaining as swearing but to me it indicates humbleness, softness in character and perhaps finesse. Although there are great pretenders out there, it isn't a reason not to be polite. I remember how I would receive a big slap on my face from my parents whenever I utter any languange which is remotely vulgar during my childhood. Alas we can't do that to the adults who uttered vulgarity at their whim and fancy.

However I can avoid people with only vulgarity in their vocabulary. If not I may forget how to converse in a civilized manner.

Thanks

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Recently another batch of medical students came for their clinical teaching in the hospital. I had the privilege of giving my 2 cents worth of bedside clinical teaching. There was a mixed composition of the students with regards to ethnicity and sex. Pretty well balanced. This was their first clinical bedside teaching so it wouldn't be fair to assess their knowledge or competence.

However I was appalled at the standard of their English. The Chinese students were no better than their Malay counterpart. The Chinese student could not even put together a decent short sentence of English. Fair enough clinical knowledge is not about language but we are learning clinical medicine in English and English is the medium of instruction and knowledge (at least to me). If the students were to learn clinical medicine in China, this probably wouldn't matter but the fact is the student is supposed to be learning in English.

And how he can learn medicine in English when he cannot even put together a couple of English words decently? I cannot imagine how would he be able to clerk a patient in English. The same goes for students learning medicine in Indonesia and perhaps Russia. I was told in Indonesia, they used "Bahasa Indonesia" in their studies.

The standards of House Officers are also dropping fast. There used to be a time where senior doctors would say any Chinese student who graduated from the local premier University should be ok in terms of knowledge. If he is not, he is just plain lazy and would deserve some scolding. The reason behind this is obvious (no need to mention lah). However lately this is no longer true. I just wonder if the local universities are still getting the cream of the crop or have the cream left Malaysia and we are left with "beneath the cream"?

Anyway back to the topic, I'm sceptical whether the students understood even 30% of what I've explained due to their poor command of English. But at the end of the session they asked me if I could take them for another session! I'm only paid to teach them for 60 minutes and I've voluntarily extended the session to 90 minutes as an hour was grossly inadequate. Should I do charity work for another 90 minutes? Hmm....

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Rice, is something we may have taken for granted. In the era of MacDonalds, steakhouses, Japanese cuisine and fine dining, rice is something regarded as cheap food. It is not surprising to see people in buffets ignoring the rice and target the "expensive" food like meats and seafood instead. In the restaurant, we have often seen extra rice being asked and then not finished and left on the table.

In a country where natural resources are aplenty, yesterday I was given an insight on how a local family, as the guardian ( also known as "jaga")  of a probably multi-million dollars sports complex had for dinner. The local lady was given a room (more like a store room) beneath the spectator's seat to live. 3 elderly ladies were sitting around a discarded table and heaps of discarded chairs which was used once for some VIP parade in the stadium but were now left to rot. A couple of malnourished cats roamed nearby.

Maggi Mi

The lady had plain white rice for dinner with a bowl of Maggi Mi for company. Yup, plain white rice and maggi mi as the "vegetable". Something tugged at my heart. In our country where natural resources are aplenty, and multi billion mega projects are cropped up on a daily basis, this is something that should not happen. (to me at least)

Poverty is a disease which needs to be eradicated. When our country can boast the tallest and longest and can offer ONE MILLION RINGGIT to an Olympic gold medal, I can't help but wonder about the priorities our country is taking.

What is the point of having the most sophisticated scan machines and medications when patients do not even have proper nutritious food to eat due to poverty? Who benefits more from the the purchase of medications? The patients or the middleman or the pharmaceutical company? If you ask me, proper nutrition and food has more benefit than the few hundred ringgit anti-platelet agent. Proper nutrition and food is going to help the bed bound stroke patient with horrendous bed sores more than the few thousand ringgit of antibiotics.

Poverty is endemic around here. We have read about the apparent fair distribution of the country's wealth in various forms and agendas but to me what's more pertinent is the fair distribution of opportunity. Every citizen should be given equal opportunity to better themselves rather than dishing out money to them. If lazy people do not want to work despite given the opportunity then they themselves are to be blamed. But I can't help but feel that most people here  (especially locals) do not have the opportunity to better themselves as these opportunities are being siphoned by the "powerful connected" people leaving crumbs behind.

I'm sure many of our leaders' children are busy studying overseas while back at home there are so many children who are not schooling due to poverty. They have to find means to put food into their stomach instead. Some schools are in dilapidated conditions too.

With the rising price of rice, I'm not surprised if some poor village people may need to resort to eating tapioca to survive. Which reminds me of the time of the Japanese Occupation as told to me.

Poverty, is the world's most prevalent and deadliest disease. Not heart attacks. It is the greatest tragedy of all times if a person dies of malnutrition due to poverty in our country. Which I'm sure is under-reported.

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I was sponsored for a weekend talk held in a luxury hotel :) There has been on and off debates whether this is an unethical practice. In fact there has been an explicit circular from the director which barred doctors from accepting any form of sponsorship.

Well, I accepted it anyway. So did many consultants and even heads of departments from hospitals all over Malaysia including participants from Korea, India, Japan, among the many Asian countries. In any case, there was a disclaimer stating that the sponsorship is "not conditional upon any obligation to use, recommend, promote or purchase the product or intended to influence you to do so", which I take it as face value. In any case, it is the only opportunity to listen to 2 prominent researchers, one from Italy and the other from a renowned institution in Texas. I don't think the government can or rather will sponsor them to come to Malaysia for our benefit. Sure, the company promotes their product but it is also for the benefit of our patients. Sad to say without the pharmaceutical industry support, we will probably be still living beneath our coconut husks.

The hotel was luxurious. But the best part was meeting up with friends and have a good chat.

Hotel4

Hotel3

Hotel2

Hotel

It was great, but after 2 days I can't wait to get back to my spartan room. I suppose I'm comfortable with familiarity. I wasn't able to sleep well despite the luxurious bed and pillows. It just shows that money can't buy some things. There wasn't the familiar feel, familiar smell, familiar touch. And I didn't even use most of the things in the room.

However I managed to take a few snapshots of the surroundings with my camera ;)

Seaside2

Seaside

And not forgetting a couple of hornbills!!

Hornbills

Will I be addicted to a luxurious living? Will I get used to luxuries? If I know myself well enough I doubt it but only time will tell...hehe. But one thing is for sure, I'm not selling my soul for it.

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Reflections

Yeah, I get these bouts of reflections quite often. Thinking whether the career path that I've chosen is the correct path. Whether I'm still passionate in this field any longer. Honestly I don't know.

I cannot fathom how can some doctors in public hospitals go to work everyday doing rounds at 7am each day, seeing patients, then rush off to clinics to see patients again till past lunch, then doing a second round in the evening before going back AND THEN going for locum at night! In addition to the weekend locums!! They will be seeing patients every minute of their breathing lives. I think it's unhealthy and I just cannot bring myself to do that. Perhaps monetary reward is a very strong motivator to some people. But monetary reward is not about passion (maybe some people are passionate about money and what it can bring hahaha), it's about the necessity to survive and thrive in the rat race. Which is absolutely necessary, btw.

Passion is something you'd do without any rewards. You'd do it because you loved doing it. Not because someone asks you to. Not because you have to. But you want to.

I don't think I want to sacrifice every minute of my breathing life listening to complaints and ridiculous demands, plus practising defensive medicine to prevent lawsuits even if the monetary reward is good. My soul will wither away little by little. And I cannot live without a soul.

Nope, I need to breathe in the smell of flowers and fresh grass, to listen the endless waves at the seaside, to glance at the bright eyes of a dog, to pat its head, to feel the wind blowing against my cheeks, to have a great conversation. They are the food of my soul. Yeah right! - the only odour you'll smell in KL is the haze.

What would you do with passion? I keep thinking to myself again and again...to find the answer. I'm determined to move towards it even if I have to pay the price.

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In the mist of the frantic rat race, where the survival of the fittest prevails, I would often stop to ponder what is the meaning of life. Not because I cannot compete and win. I've been there, I've done that, since school days. Does winning the rat race give any meaning to life? Coincidentally a friend forwarded me this poster.

Life

Competition is part of life. It's not about personal satisfaction. It's about survival. I keep reminding myself. More so in an Asian country.

But is survival is all there is in life? Are we no more than ants struggling to survive for example? Hmm...tough question.

Decades ago, perhaps a lady would be esctatic in receiving a rose and card during courtship. (I might be wrong here  hehehe). If one were to do that today, chances are you're not gonna get any second chances. (Cheapskate would be the term used ). Cold hard cash or its equivalents will definitely work better nowadays hehehe. That's life in the rat race man.

Perhaps I should stop being so sentimental and get slapped hard again. Happens when my birthday is not far away and I'm moving another year closer to meet my maker.

Btw I shall be joining a squash competition soon against some great guys. It's not for money, fame, recognition or status. It's for personal satisfaction. That's the kind of competition I like hehe ;)

Red rose

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Timeless

Is it still rewarding to be a doctor? Does it still bring personal satisfaction? Is being a doctor still regarded as a noble profession? How does the community regard the medical profession nowadays? (We all know about the monetary satisfaction part :( When a mechanic increases his charges by 30% - here it's no big deal but if doctors increases their fee by 30%, prepare for a national backlash ).

Some of these questions will haunt many doctors time and again. The times when we question our decision to stay in the ever litigatious, hostile and ever unthankful environment. How many times can one recall a deceased family thanking the doctor nowadays for trying his best ? ( may not be the best in the world, but probably his best under the severe limitations - whether in knowledge or facilities ). More often than not the deceased family nowadays would be finding fault if any negligence had occurred and whether some $$ can be made from it. Thanks to the adverse publicity of the medical profession by the press and the increasing borderless internet world. ( When can the public realize that some fantastic experimental therapy in USA is not offerred in the remote jungles of Borneo for instance?)

When the medical student excitement of a diagnostic problem is hampered by bureaucracy and limitations of the real world. Why do clinicians need to convince the radiologist about the need for a scan for instance? Or to convince a pathologist that the particular blood test is required? These are supposed to be supportive services for the clinicians...not a hampering services for the clinician. Why does this happen? Probably because funds/facilities are limited...clinicians have to compete with each other to get that elusive supportive service.(To be fair, some doctors ask for tests unreasonably too). It is understandable under the circumstances but is it understandable for the sick patients or their relatives? Problem arises for clinicians when the request is denied and sometimes as a result, a diagnosis cannot be reached conclusively. When the patient dies without a conclusive diagnosis, questions will arise from relatives why this and that wasn't/cannot be done !!! Aah...and then that familiar complain will come.

And if the clinician suggests the patient pays to get the supportive services/treatment in the private sector, the patient will ask why must he pay for such a service when is available in the public hospital !!! If it's that urgent, he should be entitled to that service in the public hospital for free!! Worse still the patient may think that the clinician is in cahoots with the private services/sector. It's a losing battle from the start for the clinician. It's a "can never win" situation in my opinion.

The brunt of all sides, from the "unsupportive services" to the administration to the discontented patient will fall to the clinician. Hospital administrators will always need to cut costs, limitating the clinician's choice of investigation/treatment while at the same time expecting the clinicians to fulfill "customer" satisfaction! What bullshit! It's like telling the clinician "You can't have this or that and that also because we don't have the funds but make sure you still treat the patient well (with what?) and still make him happy". Welcome to the real world! Costs of healthcare and patient's expectations have escalated. Public hospitals and doctors will bear the brunt of it.

Is it still rewarding to be a doctor? Do you expect doctors to be still enthusiastic? To add salt into injury, probably a mechanic charges more for his "consultation" than a GP doctor is allowed to.

Times have truly changed.

Changing times

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Kakakah. This is a funny statement. Here

"The country's poverty rate will increase from 3.7 per cent to 24.3 per cent if the poverty line is raised from the current RM800 to RM1,500 per household"

Why don't we just adjust the poverty line to RM100 per house hold so that our poverty rate is at 0.001%. Kakakah.

We can also adjust our SPM examinations passing mark to 1/100 so that our passing rate is 100%. Now everybody can pass! Kakakah.

And now we can impress everyone too!

Another funny statement here

"The inflation rate for the first five months of this year is 2.9 per cent, Second Finance Minister Tan Sri Nor Mohamed Yakcop said yesterday"

So if I follow the inflation rate of 2.9%, my favourite curry mee should cost RM5.66 (from RM5.50) and not RM6 now.

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Dazed

Sometimes you get the feeling that nobody really sits down to formulate at least a semi-permanent solution for our petrol price woes.

Firstly it was no selling to foreign registered cars within 50km of the border. ( Was Sabah/Sarawak considered? These two states have large borders with Indonesia and Brunei )

Then it was changed almost overnight. The petrol price was increased to RM2.70/litre and now everybody can buy!

Next there is a proposal for a two-tier pricing system, one for local cars, another for foreign cars.

Then there is the rebate system. First it was RM625 per car under 2000cc. Then it was announced the rebate would be extended to above 3000cc in Sabah/Sarawak. Now there is a RM200 reduction of road tax for 4x4 and trucks above 3000cc in Sabah/Sarawak.

When something is decided for certain, somebody please do let me know. I cannot keep up with the ever changing policies.

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