44 posts tagged “health system”
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.
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.
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.
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 ;)
Aw huid, Aw houik, Ow shuek, muntah darah, vomit blood, hematemesis, nokoilob raha....all means the same thing - Blood gushing out from your upper orifice.
That's how I described the office efficiency.
Case 1: I applied for a promotion post - filled in the forms, which I downloaded and printed myself and send it to the relevent personnel in office within 3 working days of the advertisement. Closing date was 6 weeks away. Was assured everything was is order and would be "processed" asap.
2 DAYS before the closing date, a colleague checked out with the office and was told "Belum hantar ke Putrajayalah doktor...itu SKT belum cari dan isi. Orang yang buat itu cuti sakit! Mengandung...muntah muntah.Tak ada orang ganti"
Case 2: I applied for further training. Filled in the necessary forms, which I downloaded and printed myself, and handed up to the office to "process". Aaaah...yesterday the person who received my form, happened to meet me at a hall, "Arr...doktor, hari itu ada bagi saya borang pohon training ka? Saya ada jumpa dalam fail doktor. Masih mahu hantar ka?" I HANDED UP THE FORMS 6 MONTHS AGO.
Not that I'm bothered. In fact I've expected it. My many years in service has taught me something. To get things done in the bureaucratic way, one must make as many photocopies as possible and send to as many places and people as possible. It's like trying to dig for oil. Hopefully one of the many attempts will strike gold. There is no system. There is absolutely no connection between one department to another. In fact it is faster to send a snail mail from and to Putrajaya 2000km away than from someone in Putrajaya to pass it to another colleague sitting a few desks away.
I got what I wanted 6 months before someone at the office even took a look at my forms because I used the multi-hit theory. Just hit as many departments and people as possible. The more the better - the more chance you have to hit it right. Never depend on one. To those who put their faith in "The System", sorrylah.
Can really AW HUID.
And we are wondering why doctors are leaving in droves. Fed up.
Our esteemed Minister says civil servants can now take up part time job or businesses. Check out here
The last time I check when I was in Form 5, the rate for working in Pizza Hut was RM3.50 per hour. That was so looooong ago. KFC and Mc Donalds was a bit less.
Since I'm getting only RM50 for a 24 hour on call work, I might just request not to be put on call and perhaps work in Pizza Hut instead (RM3.50 per hour = RM84 per 24 hour), or KFC or Mc Donalds.
Problem is that patients might meet me in the Pizza Hut saying "Eh doctor, you're working here also ah?" Doesn't look very impressive huh?
Well I can then proceed to say "Yeah, let me recommend you some low fat pizzas. But if you choose this fatty one, you can later come to see me during office hours to get some anti-cholesterol medication"
"If you buy 3 pizzas, I'll throw in some cholesterol medication for you later free. And if you order this coca-cola, just take another half tablet of your diabetic medication"
Waiiiit a minute....just wait a minute. Maybe can work with these businesses too...more profitable lah.
"If you develop shortness of breath, you can see me also during office hours at this hospital"
"And If you buy 3 packs now, I'll throw in a Ventolin inhaler free of charge during office hours"
Hahahahahaahahahahahah.....just jokinglah. It's not ethical but it might not be that outrageous. Perhaps nurses or medical assistants may consider doing it. Seriously.
Let's see which part time job or business looks enticing...
I don't know if it's a coincidence or a result of the recent fuel price hike but ever since the price hike is announced by the government, my ward is packed like sardines. Not in a neat row on the floor, but in whatever position to accomodate as many as possible. And today for the very first time, for a very very long time...we ran out of camp beds! Mattress were literally put on the floor. The last time I remember this scenario was perhaps 7 years ago? It was made worse by the fact the a private medical center was desperately trying to transfer an ill, bed bound patient over to my ward. No prizes in guessing the reason lah. Can't blame them, they are not a charity organization. What to do? Take over lah...
Maybe I should make my own "incident report" and suggest my own remedial measures which would be umm...3 orang kongsi 2 katil? Hahahaahahahaha
On a more serious side perhaps sending them to district hospitals may sound good, but many refused because there are no specialists there and "tambang pergi balik mahal" - for those who are just waiting for something eg scans, endoscopies etc hahahaha.....back to fuel price again. They prefer to stay in hospital and wait for 2-3 days. Free food, got missy to call, got company to chit chat, can complain if service not good some more...
Desperately wanted to take a picture of the ward but then to protect the patient's privacy I refrained.
But ONE patient made my day. A really old charming cheerful lady who said "Saya mau balik jaga ayam saya...kalau tidak tiada orang jaga" and laughed. I asked how many chickens she has, she mumbled something and we laughed together. It is always the VERY ELDERLY "uneducated" village folks (ladies usually), many of whom can't even speak proper Bahasa, who have the most sense of humour. I salute them for having such a cheerful outlook and sense of humour even though their days are numbered. Perhaps we can learn something from them.
At the end of the day, it was the chickens that made my day.
Remember these familiar words? Yeah the famous words of mini buses' conductors in KL perhaps 10 years ago...the pink BMW (Bas Mini Wilayah) ones which will stop anywhere...yeah anywhere you ask even at the roundabout. Aahhh....the memories of my student days in Uni.
Today these magical words brought back those long lost memories. My ward is like those mini buses....boleh masuk...belakang boleh lagi...(Translated: Come in...can come in some more...behind can some more)...hahahaha...despite having camp beds on the floor till the nurses counter. A patient with oxygen was waiting on a stretcher waiting for a bed at the counter. It gets more amusing reading this where our Health Minister said Govt Hospitals were getting ready for increased volume due to the price hike/inflation. Yup we are still in the Bus Mini era. Masuk...masuk...belakang boleh lagi masuk...
Sad to say the measures taken by MOH are NOT WORKING. It's not just because 300 medical officers and 50 specialists resign every year. It is not just about getting enough doctors...To treat patients you need BEDS, you need MEDICATIONS, FUNDS $$$, DISPOSABLES, BLOOD BANK SUPPORT, LABS, DIAGNOSTIC EQUIPMENTS, LAB TECHNICIANS, NURSES, DIETITIANS and the whole lot..etc. Problem is we are still not past the "getting enough doctors" stage yet.
It's really no point getting enough doctors and cut down waiting time to 30 minutes then say no budget for medications, no beds, no scans available etc etc. Unless you want doctors to practise some traditional healing and use "miracle water" to do some chanting....ZAM ZAM ALA KA ZAM! and poof patient gets better! Hey, maybe that's what the MOH wants.
Currently also cannot cope already how to get ready some more ? Duh...
Some sort of healthcare financing scheme gotta be implemented soon.
Ah...the inevitable. The rise in petrol prices.
There will be 40% price increase in petrol (ULG 97) from RM1.92/litre to RM2.70/litre today but there will be a rebate of RM625 per year for each car below 200cc capacity.
Hmm...reminds me of the many "charity work" some of us did many times in the past. Frequently we had to drive about 30km to another hospital to see referrals. Initially we were only allowed to claim mileage, later it was changed to passive on-call claims. I remembered my claims for a couple of months' "expired" because I didn't have the time to drive there during office hours until the end of the "closing account date for that year". That is for Medical Officers.
For specialists though, currently we are doing "charity work" also. On calls for 2 hospitals but claiming only for one. The other hospital which is 30km away, mileage claim could be done if we did go there. But then we need to drive 30km x 2 (to and fro) to see a patient after office hours and then 30km x 2 again during office hours to hand in the mileage claims (a stack of them). Most of the time I just forgo the claims or just don't go. Too much hassle and not worth the effort nor trouble.
The amount that you can claim for a trip = 60km x 50 cents (say 50 cents/km, check out here) = RM30. But you actually travel 120km (additional 60km to hand in the claims during office hours!). With the petrol price of RM1.92/litre with a consumption of say 10km/litre ( your car damn efficient lah, and no jam) , you'll be spending RM1.92 x 12 litres = RM23. The RM30 ringgit mileage claim seems appropriate.
But with the petrol price increased to RM2.70/litre, you'll be spending RM2.70 x 12 litres = RM32.40. So essentially if the mileage claim remains unchanged, you'll be paying RM2.40 to go and see a patient. I repeat, you'll be paying to see the patient even if you claim mileage !!!
Don't know whether my calculations are correct or not.
Anyway it doesn't sound like a good deal to me and to quote someone, "What about the wear and tear to your car?"
Some of the reasons I gather from colleagues/friends who has left for down South.
1) The Ministry didn't pay a single cent for our postgrad studies but is utilizing our postgrad qualifications for FOC.
2) We are not asking for the sky but commensurate with our profession and qualifications, at least at par with other professionals.
3) The salary you get in S'pore in A YEAR is equivalent to 3-4 years work in Msia. We are not young any longer, we need to think of our financial security in the future. A classmate in other field is buying his 3rd condominium while we are still paying off our Proton.
4) The Ministry does not appreciate our services. Promises remain promises. Nothing ever materialize.
5) Promotion prospects here is ahem...extremely difficult due to some obvious reasons.
6) Intake for subspecialization is non-transparent, one moment they say you are eligable, another moment they say you're are not. Waiting for eternity in uncertainty is the norm.
7) Many senior consultants in the Ministry of Health has left for the private sector. Who is left to train us?
8) We have more than paid our dues from medical school in the form of our "national service" to the Ministry of Health.
How true! A friend echoed a common sentiment we should get slapped in our faces and wake up to the reality in life.
If we are only hoping for "altruistic" doctors to serve the nation, well, be prepared for a 2 years appointment. As it is now, in our general specialist clinics, appointments are as long as 8 months. Most doctors who stay back do so for family reasons or perhaps with plans to go to the private sector soon.
Recently a promotion exercise application was advertised in the Ministry of Health's website. Most of us submitted to the Hospital Administration Office within a week. Closing date was about a month and a half away. Two days before the closing date, a colleague found out our application has not been even submitted by the hospital office to the relevant departments yet! Efficiency Malaysian style.
I wouldn't bet on this proposal to materialize anytime soon, if it ever will. Proposals will remain proposals.
Just a funny poem I got from this blog which crudely illustrates the affairs of things in Malaysia.
Boleh Goes To Court
Boleh Only Good At Simply Tok
Boleh Only Good At Toking Cock
Boleh Took The Neighbour Go To Court
Neighbour Got The Island Boleh Got The Rock
Boleh Blame The Lawyer Not Prepared
Because Lingam Was Not Even There
Boleh Blame The Court Not Fair
Because Fairuz Was Not Sitting There
And talking about purchasing power in Malaysia, it's getting less compared to our neighbour down South. This is the receipt I got for ordering 2 glasses of "Lo Hon Koh" with ice in an open air hawker centre cum restaurant with plastic stools. 5% government tax?!! Half a glass of some "buang panas" drink topped up with ice is RM2 now. It's for "buang panas" alright, to cool down the customer after he sees the bill hahahahaha...
I just met a good friend, an old classmate from medical school.
He was one of the hard working ones, and brilliant too. He was working in a "not so small" district hospital. He took his MRCP on his own accord, with his own money, in his own time and passed. He kept his hopes to subspecialize in either the Ministry of Health or the Universities. His first application was rejected by the University. He was kept waiting....waiting even long after his gazettement. His hopes for promotion to U48 which was due to him was nowhere to be seen despite many phone calls.
Finally he wrote in an application to S'pore. In a "never seen before in Malaysia" efficiency, he was replied the very next day with the details of his queries. And so he is jumping ship to S'pore which is offering five times the salary he is getting now in addition to a place to subspecialize. I have never expected him to jump ship.
This is one of my many classmates who has moved down south. And we are wondering why the brain drain and this happening. Malaysia doesn't appreciates a diamond when it sees one. We keep importing sand and exporting diamonds.
One thing's for sure, doctors who stay in the Ministry of Health ain't doing it out of love for the Ministry.
Was on-call with a Medical Officer recently and she updated her facebook with this ;
" will throw her phone if it rings again about some bloody bastard who wants to leave the hospital to sign some stupid document with his *ucking lawyer "
Here's her blog. For those readers with a low tolerance with word that rhymes with LUCK, a word of advice - brace yourselves hahahahaha.
Which brings to mind a rather outdated procedure in the hospital. Any patient who abscond from hospital will be reported to the police (Yeah, and what will the police do about it?). Any patient who wants to leave or be discharged from the hospital will need to sign the "Against Medical Advice" or "At Own Risk" form and countersigned by a doctor of the ward. Perhaps reporting the absconding patient with public health interest (infectious disease, psychiatric patients, medico-legal cases etc) to the police is understandable but for other reasons it's rather pointless. For example those patients with heart failure or poorly controlled diabetes who abscond because they feel they are fine.
Reminds me of ONE tuberculosis patient in the US not too long ago who absconded across the Atlantic and was pursued relentlessly by the police till he was caught. We have a Multi Drug Resistant tuberculosis patient (as far as I personally know) running around the state without any problems, not to mention the NUMEROUS active tuberculosis patients who are assimilated with the public without problems too.
Back to the topic, I truly believe patients are responsible for their own health. Many times, relatives force the patient to be admitted against his will and then not surprisingly the patient will ask for a AOR discharge ASAP which irritates everyone to their limit. I mean if you don't want to be admitted just say so!!! Don't get yourself admitted to avoid argument but the moment your "relatives" leave, you ask for a discharge. Does anybody realize the amount of work that is involved (plus paperwork) if you are admitted and then discharged after an hour ? Not to mention wasting bed space (and preventing other people from being admitted), wasting tons of papers, wasting water and detergents to wash your bedsheet (which was used for an hour) plus lots of other nursing work? This is blatant abuse of a public facility and people like that should be penalized severely.
Another version of the same thing is patients who want to leave the hospital to settle some personal stuffs - seeing his lawyer, going to the bank, visit their "relatives", sign some documents, even to do BUSINESS!!! - some mega businessman he is ! These patients like to walk in and out of the hospital at their whim and fancy.
I say whoever walks out of the hospital consider it an AOR discharge immediately without hesitation. No need signatures or anything. And patients who walk out cannot be readmitted again to the same hospital for say 72 hours. Since they are well enough to walk out they must be fine. Don't bloody waste our time which can be used more productively with patients who actually wants treatment. And whoever who wants to leave, just open the doors to them on the condition they cannot be readmitted to the same hospital again for 72 hours.
Problem solved.
