Saturday, August 27, 2011

travel smart

this 72-yr-old indonesian lady was on vacation when she tripped & fell, breaking her hip bone. surgery was carried out the same day she was admitted.

now, she needs to rest & rehabilitate. she can't bear weight on the affected leg for 6 weeks, which means she'll need either crutches or a wheel-chair. that probably means she can't fly home using low-cost terminals that don't utilise sky-bridges; getting into the plane on crutches or on a wheel-chair would not be possible.

and, before all that, there's still the hospital bill to contend with.

herein lies the problem. she doesn't have travel insurance. which means, she has to foot the hospital bill, buy a new (full fare) plane ticket & everything else in between, eg. hotel accomodation on discharge. as i explained the logistics of the transfer out of hospital after discharge, i could see the pained grimace on her face.

a lot of these hassles would have been taken care of had she bought travel insurance. for only a small fee (eg. rm50 for asia for up to 10 days coverage) the cost of any medical expenses, lost luggage, missed or cancelled flights would be compensated by the insurer. that's a small price to pay for peace of mind, considering if say, you've paid rm3k+ for a skiing vacation to korea.

this lady's additional expenses for the mishap would easily amount to rm10k.

Monday, August 22, 2011

so near, & yet.....

we went down to visit the girl who just finished her Prelims (aka trial exams). we were in vivo city where the boy usually ask to ride on the sentosa express. we've not been on the express for some time, so he was thrilled when there was a stop for universal studios. we got off this stop just to check out the theme park.

of course, he couldn't help posing. & i think he was salivating, too...

i would too, if i were a kid!

PS. universal studios wasn't in our plans for this trip, but it could be in a future trip.

Friday, August 19, 2011

transferring out

we do that quite often.

that is, transferring patients, invariably from the ICU, to a public hospital. sometimes, the patients are doing well except that the bill is getting to be a burden for the family. but more often than not, the patients aren't doing well; remaining in the ICU with no obvious light seen in the proverbial tunnel & with a big hole burning in the pocket, moving to a public hospital is the only way out.

also we have a situation here that is far from satisfactory. there are 4 neurosurgeons in the state & all of them are in private practice. so, if there are patients with serious head injury but who cannot afford the exorbitant private hospital bill, they get the initial immediate treatment at the local emergency department but will need to make the 100km+ journey to a neighbouring state for definitive neurosurgical management. all that delay will not improve functional or survival outcome for such patients.

so, it is with some sadness that we had to transfer out one such person yesterday. he had emergency brain surgery done & was not recovering well. staying in the ICU has been taxing on the family finances & after 10 days, they have no choice but to move to a public hospital in another state.

if only there were a neurosurgeon at the local hospital, the initial surgery & subsequent rehabilitation would have been done at an affordable cost. at least, the average man on the street would have been given a better chance at survival.

so, in this respect, it's easy for me to see why people harbour so much disdain for submarines, national service programs, overseas study trips & 100-storey towers. what good is all that when their right to proper medical care is eroded by the day.

Saturday, August 13, 2011


i heard this on the radio on the way to work, that imitation iPhone 5s are readily available in China now, even as Apple has yet to officially sell the phones. not at all surprising since even fake Apple & Ikea stores have been reported to operate there as well. read here & here.

before we shake our heads & go tsk-tsk at the Chinese, we have our own claim to infamy as well, like fake DVDs of movies that aren't even officially released yet. don't forget we have fake people as well, like bogus taxi & bus drivers who attack female passengers, bogus doctors who are actually medical assistants or med school dropouts, & bogus engineers who build leaking roofs & cracked support beams, just to name a few.

but i think the biggest fakes are the bogus politicians who do not look after the rakyat's interest. they make policies that don't benefit anyone except select groups - they roll out unity programs that disunite the various communities, build aesthetic but non-functional megastructures instead of schools & hospitals, & train undergraduates who are largely unemployable.

& in these difficult times, they prod us into austerity drive while they splurge.

this is the usual fate of seized fake dvds.....

if only those uniformed fellas show equal conviction with fake politicians.

Wednesday, August 10, 2011

Déjà vu

i was in a "flash-back" situation today.

this young lady was due to have a caesarean section at a private maternity home yesterday in another state. unfortunately, the anaesthetic was unsucessfully administered & the surgery had to be cancelled. she was subsequently referred to this medical centre for further management.

as i spoke to her, the memories of those early days came flooding back - when, as a trainee specialist, i used to go around doing locums at various GP clinics & maternity homes. it was hard work but the tax-free income lucrative - one session done on a day-off would cover a whole month's room rental, & then some.

the obstetrician assistant at that maternity home must have been a junior trainee, like i was many years ago. the arrangement was a win-win situation - the obstetrician pays below-market rate for the assistant, who would be more than happy to supplement the income from the day job.

except when something unexpected like this happens.

anyway, for today, we are just glad to help in the safe delivery of a healthy bouncing boy!

Tuesday, August 09, 2011


he's only 48 years old. yet, he's had diabetes & hypertension for over 10 years! last year, he had chest pain & an angiogram showed he has 4-vessel heart disease. he subsequently had angioplasty with stenting to the diseased vessels. now, he's on a total of 7 different tablets - 2 each for diabetes, hypertension & blood-thinning & 1 for cholesterol.

but i don't think he's duly worried because since the angioplasty last year, he's put on another 20kg!! after minor surgery today, he was panting & gasping for breath - symptoms pointing to poor cardiorespiratory health.

i dread to think what might happen after MAJOR surgery. but if he's not careful, he might not live long enough for another surgery. i suspect part of his indiscretion is that his employer is footing his medical bills & he probably has the misconception that as long as he faithfully takes his pills, all will be well irrespective of his undisciplined lifestyle. like a panacea.

in the brief period of time that i spoke with him, i explained that his diabetes, hypertension & obesity all add to the risks to his life & outcomes include a heart attack, stroke or even sudden death. how he deals with this information is entirely up to him.

if i meet him again, i'll post an update.

Monday, August 08, 2011


that's the medical term for vomitting blood.

no, none of my patients is suffering from this, thank goodness! but that was how i felt today. the hokkiens call this feeling "thor huek."

if you've been warded in a hospital, you'd know when things don't go right. they dish out porridge when you ordered western, the medications are served hours late, or worse, omitted altogether, or they have to repeat a test because they didn't do it properly the 1st time. and, your doctor still doesn't know what's wrong with you.

these little glitches become magnified in critical areas like the ICU, operation theaters or emergency department, where a error of judgement, however slight, can make a difference between life & death.

i had the misfortune of being in that position today. the patient was seriously ill but the senior nurse attending to the patient with me was totally out of sync with the situation - not thinking, not pro-active & certainly not competent. i had to give explicit instruction every step of the way & this was a senior nurse who teaches other nurses the tricks of the trade.

i'm just glad i don't have to throw up do this too often. 

Sunday, August 07, 2011

oh no! another turnaround?

we are really going nowhere!

after all the flip-flops, are we re-visiting the issue of the teaching of english again? DPM & minister for education just directed the DG to re-evaluate this issue, after discovering that students up to the level of tertiary education are not able to communicate comfortably in english.

no one's actually surprise - the rot started from 1970 & except for a brief reprieve from 2003 till 2009, english has been on a slippery slope.

or, could this be an election ploy? either way, a generation & a half of students have suffered the ignominy of inability to read, write & speak the international language of science & commerce.

nothing short of a strong political will can reverse this.

Friday, August 05, 2011

the 7 blunders

The seven blunders of the world was a list Mahatma Gandhi reportedly gave to his grandson Arun Gandhi, written on a piece of paper, on their final day together, not too long before his assassination. In his final years, the elder Gandhi kept his grandson close at hand and set aside an hour everyday to be alone with the boy.








makes a lot of sense, don't they? how many of the above do you think apply to our country?