The End of Things

With a very heavy heart I have to announce that there will discontinuity of my writings here on this blog. Already enough excuses have been uttered and chances have been given but the hiatus keeps getting longer and longer. Topics are scarce, diminishing in frequency; provoking thoughts are laughable in essence and clarity that it is increasingly embarrassing to write, let alone for readers to sully their eyes reading. 

                                                                                                                                                                                                                                                                                       

Sorry, did I say that it's only the end for things this year?

I will not promise to write more in the future, but as things stand, this blog is very much alive. To end this year, here's some updates about my life so far:

• Successfully moved into my new home. I spent a bit on grills, lamps and fans, air--conditioner, window tints, and kitchen renovation.
• As of now, my kitchen renovation I estimate to be 50% done. Considering I started hiring the damned contractors back in July, this is late. Very late.
• I had changed my mentor for Public Health logbook twice - and until I have transferred to PKD and not working in KK, my logbook will remain empty until the true End of Things.
• Naik pangkat to UD48 a few months back - now I feel old but still stupid at heart. 
• My weight inceased again - I'm too tired to get upset about it. Hmmmm.
• Will be having a very good news in two month's time, God willing. I will share more later.

Okay that's it for now bye bye!

Ladna

One day, the sister came to me to inform about a new antenatal case coming up that we were expected to handle. It's not always, but from time to time the sister will inform doctors of any foreseeable complicated antenatal cases so that extra care is required for those patients. As the patient is from my care zone, the sister came to me, all whisper-like, of which I initially thought, "eh, sister ada hot goss ke nak cerita?"

I am only just been working here for 1 year, 5 months, and 8 days. I am also not from here. I know nothing about some of the more distinguished local people here. So when she asked me whether I knew about this one particular patient that just became pregnant, I just politely shook my head. In my head, I was already making few educated guess about what high-risk conditions that the patient had in the past. On top of my list: uncontrolled DM, pre-eclampsia, anemic, some cardiovascular conditions, etc. 

It turned out she has a myriad of social and health issues. Something like a bad apple of the community. A heavy smoker that takes occasional drugs, having multiple partners, no family members, unmarried, moving places so often that it was hard for nurses to come and check on her, has uncontrolled diabetes, but most importantly were also pregnant. The nurses all had a collective groan when they talked about her. Everyone knows something about this woman, except me. It turns out that small communities really talk the loudest.

One of the earliest issues we had was her address. She had changed partner, meaning that the one she was staying with at that time was not the one who impregnated her. She doesn't have any home, so she stayed with her current partner. But often when the nurses came to do house visit, she's not at home. She also smokes a lot, and after repeated nagging from us she cut down the smoking. She complied with the hematinics, and she went for her appointments as instructed. 

Her diabetes was manageable, but it kept us on the edge of our seat throughout her pregnancy. Our next concern next was on postpartum, on how she is going to take care of the baby once delivered. We were unsure on her family support, the logistics, etc. But she assured us that she will stay with her partner's family. We were skeptical, but didn't press on.

Her labour went well in the end. The next time I saw her was during her baby's check-up. I did a small double take when I saw her. She looked different somehow. More reserved and looked at ease with herself. She was cooing her baby while waiting for their turn, and the baby looked very healthy. The nurses all cheered her on, and I thought to myself that she was alright after all. Of course, our next management is to make sure she registered with our PPC (Pre-Pregnancy Care), and to continue her diabetes treatment. 

This week I was informed that last weekend, she came to the clinic with her now 1 year old daughter, distraught and near panic. She was bathing her daughter that morning. When the water touched her daughter's body, she cried suddenly. Her private part was red and she cried in pain when her mother touched it lightly. Fearing the worst, she brought her straight to the clinic with the heavy suspicion that her 70 year-old father in law had molested her daughter. My MA who examined her daughter brought them to police station to lodge a report before referred her immediately to the tertiary hospital. 

I was stunned silent. How cruel it must be to have this wretched accident happened to your most loved one. Her life was hard enough, and when she finally had the chance to turn over a new leaf, this devil disguised as a decrepit old man dared to molest her child? Both of them are admitted to the ward for a few days before being discharged. While admitted, I asked the nurse for a daily update on her case.

This all happened end of last year. Much had happened since then, of which I think the outcome is much regrettable. When she was discharged, she made a decision to move to her brother’s place in another state. She gave no contact details that can be reached, and the name of health clinic that she’s supposed to go was not given. I suppose she wants nothing to do with us here, seeing that being in touch with us will also trigger her trauma. I pray that she and her daughter find solace at the new place, far from the evil human can make. 

This draft has been sitting in my folder for 5 months, and in conjunction with Happy Mother’s Day. I dedicate this writing to remember the hardship all mothers endure in raising their children and hoping for a better treatment to the injustice that they have.

Red Clots of Sihr

When I was a kid, I used to read Mastika magazines that my family bought every month. I remembered there was a huge collection of Mastika in our library, kept in a closed section and tucked away at the bottom of the shelves. I didn’t just read the main story but all the articles in it. The scariest ones are always about the tortured deceased from the graves, the horrifying mutilations that happened to the sinners, the ghosts that prey on poor villagers, and also mystique tales of the pilgrims doing Hajj in Mekah.

It was a thralling experience, absorbing those stories. I came to learn that there are such things as witchcraft or black magic being practiced here in Malaysia. From movies and books I know pretty much these things exist in every culture around the world. Like Malaysia, our neighbouring countries like Thailand and Indonesia also have numerous pockets of communities who dwells deep in witchcraft.

In Islam, witchcraft or black magic (really, is there such thing as white magic?) is called sihr. I learnt in primary religious school as early as 7 years old that sihr is forbidden to be learnt and practiced. Sihr is even mentioned in the Quran (al-Baqarah, verse 102-103), meaning that it does exist. It’s not made up. But it is a haraam thing and should be avoided.

As I grow up and become a doctor, I become very skeptical about vague symptoms that the patients used when describing their ailment. It’s always about “angin” (wind) that strikes me off. Angin from the stomach can easily be interpreted as gassy abdomen, but some people use angin to describe abdominal pain as well. Angin in the muscles could be musculosketal pain or soft tissue injury in origin, angin in the head could be from migraine to vertigo. I usually became more bewilded and exasperated when the patient told me their angin moves from stomach to the arms, then to the back of their neck and up to the head. However, there are more established uses of the word angin in prescribing medical condition such as angin pasang (hernia) and angin ahmar (stroke).

It goes up to the point that I do believe sihr exists, but I don’t believe its manifestations upon the human body. It’s always science, science, science to me. Anything that seems “unnatural” as claimed by people is just unexplained and undiscovered logical science behind it that we simply don’t have enough information yet. As the saying goes, “Magic is just undiscovered science”. I doubt these alternative treatments that the patients went to. “It’s bogus, it’s a sham!” I curse to myself often. I struggled to understand how these people forsake modern medicine and cling on to shamans and religious treatment centres to treat their symptoms that us doctors can interpret, sometimes, as very obvious like a broken femur, hyperthyroidism, bipolar disorders, or cancer - until I saw this patient who came to the health clinic with sudden bouts of blood clots from her throat. 

It’s not coughing up blood nor blood vomitus. She didn’t have any cough or abdominal pain. The sudden sensation in her throat made her to expel blood with clots non-stop. It happened quite alarming one night, without any prior warning, when she was getting ready for bed. Before this she was fit as a fiddle. There is no constitutional symptoms, no coffee-stained vomitus or blackish stool, no loss of weight or appetite, nothing. The next day she straight came to the clinic and I attend to her at the ILI counter outside the facility because we have to always rule out tuberculosis (TB) first.

I was in my makeshift room that afternoon, doing my managerial work (I seldom see patients nowadays, woe is me) when my MA knocked my door and asked me to see this blood-coughing lady. After donning the PPEs required (FACE SHIELD! MASK! GLOVES! APRON!), I went outside to see a 50+ years old lady, holding a plastic bag in her hands. Every half a minute or so she spitted out into the plastic bag crimson clots that later I determined to be blood. 

The first thing she asked me, as soon as she mentioned that she is spitting? coughing out blood? is whether she has witchcraft done upon her (santau, in her exact words). Not whether she got TB or lung cancer or anything, but witchcraft. And she asked me, a medical doctor in half full PPEs, in such a straightaway manner that I had to reciprocate in similar fashion. In my most polite tone of voice, I confess that I know absolutely nothing on how to give a diagnosis of witchcraft to my patients that I see. But, I promised her that we would do everything that we could to rule out other equally sinister and ominous medical conditions that can explain her spitting out blood clots.

Further history taking was done and examination of the throat and the lungs are normal. As we don’t have x-ray facility here, I consulted my FMS whether I can proceed with my plan to send the patient straight away to a tertiary chest clinic centre. We decided that it was the best course of action and after I spoken with the doctor in charge of the chest clinic, I explained to her that she must be transferred to Taiping for a thorough examination and investigation.

A week or so later, I asked her to come to the clinic for a medical review. She was warded there for 5 days where she had to complete a course of IV antibiotics as they thought it could be CAP (lung infection). Blood investigations done had ruled out TB and cancer, but the chest x-ray doesn’t look good. But to know more, they are going to proceed with a detailed imaging HRCT and an echocardiogram sometime next year. 

When I saw her again, her blood cough had stopped. She said that after she got discharged, she went to local Darul Syifa’ (Islamic alternative treatment centre) to treat her ailment. The ustaz who treated her said  that she had fall under a witchcraft and a number of treatments is recommended for her. There are many types of local witchcraft, or sihr, and one of them is santau. Santau, or its other name tuju-tuju, is a poisoning type of witchcraft which can be delivered to the intended victim via food and drinks or through entities such as djinns.

At first I dismissed this talk of santau. But then my staff started telling me stories about how the place we are in is actually a hot zone for witchcraft. We are situated near the sea and traditionally, witchcraft ceremonies are done near the sea, where they can do things like sending offering to sea “deities”. Perhaps influenced by Hindu culture, of which you can see from how many of temples in Bali, Indonesia are constructed on a cliff or on the beach. 

Apparently, at the end of every year there is a spike (hihi, pun intended) of cases of santau. It is believed that those who learnt witchcraft are not the locals here, but outsiders who came to this place to practice what they are learning all year. I didn’t think witchcraft syllabus include a practical internship programme but these guys seemed eager to pass with flying colours. It is actually a concern in local communities that they are very much wary of any strangers coming here. My MA recalled the time when he was first moved into the quarters here when he got transferred. He was being stopped and interrogated by the local folks at a roadside warung, asking who he is and what he’s doing here until a senior colleague who with him explained to them that he was a new staff working at the clinic. The lady I saw thought that she might got it from a roadside eatery (warung makan) as well that she went to earlier that day. I forgot to ask which warung she went to lest I know now to avoid going. 

I don’t know how to detect poisoned food or drinks but there are untested claims of how to know whether there is santau in front of you or not. While there’s very little thing to do once we are targeted with a tuju-tuju (think of it as magic puffball of micropoison being cannoned into the air like a shooting star, hurtling towards the victim), I remembered when I was in Form 1 a batchmate of mine, Wawa, claimed that she and her family once saw a tuju-tuju in the air and they chanted “tuju-tuju pecah tujuh!” or something to break it off. Sounds really sketchy to me, but inherently it’s very super uber cool as well. I doubt Wawa still remembers this story, but somehow it stuck to my memories till now.

The usual treatment at Darul Syifa or any other Islamic alternative treatment centre involves the reading of ruqyahs, or in plain English, exorcism. Mind you this is nothing remotely similar to the Christian’s way of “THE CHRIST COMPELS YOU!” type of exorcism. Ruqyahs are verses of Quran which have protective and dispelling properties towards the devils and their associates. Even if one is not under witchcraft, it’s always a good practice to read the ruqyah verses regularly. 

Before we ended the review, she showed me the video when she was being treated at the Darul Syifa’. The video is grainy, but apparently the ustaz managed to take out something from her body. It looks like a really small insect, a-grain-of-fine-salt-sized white insect that moves around. I tried not to look skeptical in front of her, but as I already confess I know nothing about the realm of sihr and how to treat it, I remained expressionless. At that point I was already glad that at least she didn’t abandon modern medical treatment. What she does extra to get better is entirely up to her.

Wallahu a’lam (And Allah know best).

What Drives You?

There are many reasons why we are being driven to do things. Often, multiple factors play into it, thus culminating into a general direction that we decided to pursue. Some people only need few reasons to do what they want to do. Those reasons are usually the solid ones that born out of lifelong desire or fear. Some people need a lot of reasons before they can decide whether to do it or not. And there is also a selected few who don't need a reason to do things - they just do it regardless.

How do you know whether your decision to pursue something is a correct one?

It's hard for me. I always second-guessing things. I think I am comfortable at where I am now, but what if I can get more comfortable working at something else elsewhere? What if my future is entirely a different thing?

What if my future is already present? Do I have what it takes to finally put my foot down and declare that this is where I will live and die? I am struggling to decide where to plant my roots in. I am constantly on tenterhooks, mulling over and over about my life here. Sometimes I feel like I am in a bog - warm, relaxing muddy water to immersed in under hot baking sun but at the same time I'm suffocating my roots and lungs.

But why shouldn't I stay where I am now? I have a stable 9-5 job with weekends off, my locum days are guaranteed every month, a nice small rented house to live in, and it's within acceptable distance to Penang island. My bosses are nice, my colleagues and staff are helpful, and my patients are minimal. Day in and day out being a doctor at a health clinic does not seem like a bad career.

The thing is, I don't see a lot of elderly doctor working at health clinics. So far, there's no doctors over the age 50 that I see working at clinics. Where do they go? Did they get transferred to the PKDs or the JKNs? Or were all of them continued their study and underwent master program? I know a number of them resigned and focused on doing private practice. I don't think I ever saw a contented older doctor who has already worked at health clinic for 20 years.

I'm afraid later on in my 50s I will regret for staying where I am now. That I easily feel adequate and comfortable, not pursuing more than what I am being offered at. I'm afraid that I won't be at ease with what I only have, that I will always lament on how different it might be if only I dared to pursue anything, and I mean any specialty, and be more than just a health clinic doctor.

If I close my eyes and my lingering mind, I will not be having this much of a fret. But the achievement of my acquaintances and colleagues in terms of their advancement in careers is slightly more difficult to ignore. Whenever I read their posts or saw them in my timeline, that jealousy seeps in. I recently congratulated my ex-colleague for successfully securing a slot for an FMS parallel program trainee. In our conversation, he jokingly encouraged me to work with him again in the future, him being an FMS and me a YM in charge of the clinic.

I know he didn't mean it, but the mere thought of him lording over me makes my skin crawl. Upon all the petty reasons that exist in the world, this is it. This is the one reason that finally drove me to decide on taking the Medex paper this year. 

Virus and I

We are entering the second half of the year so far, and I believe we all agree that this year is just unbelievable. What were we thinking in January, to be scared of the possibility of the third world war when we were already at war with the pandemic? This viral enemy that kill indiscriminately, at times insidious and covert, rapidly and surely draining our finite resources to combat it.

I was unfortunate to be absent from writing for too long. With the virus occupying most of my responsibility at work, I was dismayed when my laptop broke down in March. With almost half of the services in the country halted to contain the spread of the virus, I was left at the mercy of the clinic's computer to do my work. Writing about my travelog will have to stop, for now, seeing that all my pictures and videos are stored locally in the old laptop.

For me, all of these started last year when we are dividing our work portfolios. Before this, I am responsible for managing verbal autopsies in our health clinic, along with other two minor portfolios that I haven't been briefed about. Then, I was tasked to handle infectious diseases as well. Prior COVID-19, our infectious disease folder include ebola and MERS-COV guidelines, forms, and work flowcharts. In December, 2019 nCOV was added to the list. I was okay with all this because we never thought it was going to hit us big at that time.

Because I handled 2019-nCOV (later coined to COVID-19) for my health clinic at that time, I had to attend all district level meetings pertaining to this virus. I was responsible to make sure our health clinic is ready to attend COVID-19 cases at all time. Thus, my work slowly piled up from setting up camps outside clinic, making flowcharts and flow map, updating the staff regarding changes in PKD directives, addressing issues and concerns, making rosters, and also managing the 'front line' allowances for the staff. I was put in a different position because in other clinics, the ones who handle COVID-19 are all the MOICs (MO In Charge) while I just handle one portfolio, not the whole clinic.

But I was lucky, in a lot of ways. Yes, the pandemic surged in March and early April but the cases are significantly low in my district. My clinic, in particular, although it is the third busiest in the district it is still way under capacity. I consider my clinic as a rural clinic, even though the building is new and fancier than the others. Changes in how clinics operate during movement control order (MCO) to combat the spread of the virus also have seen a dramatic decrease of patients that come to to the clinic seeking treatment.

We still saw some actions, tho. Those PPEs that are sweaty and stuffy? Yes, we all wear that as well. Bringing suspected patients into isolation bay, referring to our FMSes through plastic-wrapped phone and distorted voice, deconning (decontaminate) ourselves once patient had safely been brought away by ambulance - we all done that except making selfies, that is. I find it to be callous of me to have selfies in PPEs, simply because I think we are fortunate enough not to wear that too often.

Personally, COVID-19 affected me greatly in other ways. Firstly, my parents in law had planned for them together with my wife and I to do Umrah pilgrimage back in March. I had already had my leaves approved and I drove from Penang back to KL on the weekends we are scheduled to fly. The day before our departure, Saudi Arabia had barred all pilgrims from entering Mecca and Madina, the two Holy cities in Islam. Further confirmation with our pilgrimage tour company had reaffirmed the worst - our Umrah was cancelled until further notice.

The quarantine, or the MCO, came in two-week stages. Among the many restrictions imposed to the public, the one affecting me the most is the interstate travel ban. My wife and I are working in different states and usually, one of us will take turns travelling to each other every two weeks. The ban was lifted partially in May to allow couples like us to travel home to our significant others. Thus, after almost two months of not seeing each other, my wife finally drove all the way from KL to Penang to meet me. Such reunion was special and holds a different significance to both of us.

In term of career-wise, both of us are working in essential services, although in different fields. Our finances are not affected at all during this troubling times and for that we are very grateful. My locum hours are cut shorter by two hours in view of the locum clinic has to be closed earlier than normal, meaning I am losing around 20% of my usual locum income. Despite that, my salary was adjusted in May, making me earning back what I was due starting from October last year. Together with the COVID-19 allowances and Eid bonus, I have enough as usual.

Seeing the trend of the cases in the past two weeks, our district is currently in the process of preparing for post-COVID health clinic settings. The new norms must stay and changes must be done to ensure all clinics stay ready to accept any unforeseeable events like a new surge of infection in the future. The task fall back to my colleague who is the MOIC for the clinic. I gradually had more free time on my hands due to this, and I hope that a vaccine is found soon so that we can contain this more properly and surely. With this I end my writing for now. Stay vigilant and stay safe, everyone.

 

Work Diary at Klinik Kesihatan

0645

Left home for work. Made a hot milo drink beforehand to drink while driving, with its liquid steaming warm and cozy in the black tumbler. Had to endure exactly 11 traffic lights during the drive, which depending on luck, will almost all turn green or red upon approaching the lights. The drive usually on a happy side of note thanks to the radio morning talk show and the calming paddy field scenery along the way. Sometimes curses words were uttered as I had to tow in line the tortoise-pace of village folks cycling or riding motorcycle in the middle of the village town road.

0735

Arrived at KK. Parked the car at the back of the main building at the usual spot. No roof or anything, but it's the closest spot to the building. Do I worry about the scorch of the sun baking the insides of my car and melting my wipers? Yes. Will I do something about it? Nah, fam. Punched in for the day and went to my room. Brought out my laptop, plugged the cable in, refilled my cheap-ass China-made humidifier with the tap water at the sink behind my chair, switched on Spotify and picked the Malay classic playlist.

0745

Walked to the shop lot next to the KK compound as my only sole sorry excuse of exercising. There's only three things to do in one of these days. It's either a walk to the bank to deposit my hard-earned locum money or going to the 7-11 store to buy sambal ikan bilis bread, or a walk across the road to buy kuih. 

0800

The official starting working hours of klinik kesihatan. Usually patients already came as early as 7.30 am (you people are insane) where they will register first, wait for their turn to have vital signs taken, then wait some more before being called for blood test or nurse check up or to be seen by doctors, respectively. Sometimes there are other things to attend to so early in the morning such as quick meeting among us doctors, other portfolio tasks or auditing work that need to be updated. Or it could be just a casual morning with casual conversation all around.

0830

Started seeing patients. Here we see patients according to the zones covered. There are two zones, each covering a number of villages. I cover Zone 1, meaning all patients who come from Zone 1 will be seen by me. The two big chunks of cases I see are of NCD and MCH. NCD is non-communicating diseases such as diabetes mellitus, hypertension and cholesterolaemia. Those big three is usually coined as penyakit tiga serangkai. MCH stands for Maternal and Child Health, and that includes seeing pregnant mother, postnatal cases, family planning, and child development milestones. 

I hated my O&G posting when I was a houseman. I hated kids as well, despite it was a smooth sailing during my posting in Paeds back then. Just my luck to land at KK to do this day by day! But I kinda enjoy it. No lousy rounds, no shouting or telling offs, and definitely no malignant people. I do feel intimidated and unprepared from time to time, but I think I gradually do okay. I make sure my documentation is thorough, so that hospitals won't question my management here. Ye la, MO KK kan MO cabuk je.

1200

Patients started to dwindle in numbers. On better days, I became jobless as early as 11.30 am. On bad days, I finished seeing patient exactly at 1 pm, which then I proceeded to have my lunch.

1300

Oooh, here came the one-hour lunch break. Walked across the road to tapau lunch food. White rice with either chicken or beef with vegetables usually cost me RM4 - RM5.50. Went back to my desk, ate my lunch with much gusto. Once full, I walked to the bed in the room. It was time for daily siesta. Oh yesssss...

1415

Woke up groggily. It's always a good nap if I managed to score one or two dreams in it. Went upstairs to pray Zuhur. Aha, an empty office chair! A lil quick nap of 10 minutes after prayer then.

1430

Patients started to wait outside the door. It's time to see them. Mood still over on the high side, because it's only for another 2 hours and half before finishing work.

1630

No more patients in the clinic. Went upstairs to pray Asar. Started to pack my things.

1657

Switched off the air-conditioners and humidifier. By the time I reached the attendance clocking machine, it would be exactly at 1700 (it comes with a lot of practice of going back exactly on time LOL). Once the machine said, "thank you", I walked to my car, started the engine, and drove away without a backward glance.

1700

The official closing hour of a klinik kesihatan. 

1740

Reached home or locum clinic.

Part 4- Settling In [end]

On my second day of working in KK, I ran down a man with my car.

It was just after work. My fingerprint ID was not registered in the system yet, so I just walked out the clinic once the clock stroke 5 pm. I parked my car in front of the main building; the sheltered parking slots for medical officers were full and I don't have my favourite parking place yet.

My mind was in a dazed. After two days of learning the ropes of working in KK, I more or less managed to function serving the locals here, albeit only at 60% efficiency I gathered. I learnt the basics of antenatal ultrasound scanning, doing the RMEs (routine medical examination) for both the pregnant ladies and children, managing the diabetes mellitus and hypertension patients, and knowing when to refer to the district hospital or the tertiary hospital.

Before I reversed the car, I had checked the rear mirror and it was clear. But stupid me didn't realized that I did a left turn reverse. And who was there, minding his own business as he was putting his medicine into the basket case of the motorbike but an elderly gentleman with a DISABILITY?

The crash was soft but unmistakably "crunchy". I thought I only ran over a parked motorbike. I quickly went out to inspect the bike but to my absolute horror there's a man lying on the ground, his already deformed left leg pinned down by his own bike. I heaved up the bike, releasing the man from the weight and the other staff, who quickly went out to see what's going on, helped the poor man on his ground.


We assessed the man and he was fine. He repeatedly said he was fine, that he had nothing serious. But I was chagrined and feeling dreadful. The old man then rode his bike off with his broken side mirror without me having the chance to give him some money. There's a slight dent at my car's bumper but the dent in my heart was much bigger.


I met the old man, again, last month when he came for his appointment. Turned out he was in my care zone (I covered a certain radius of area here that covers a number of villages, including the one this old man from) and I was free to see him. When he came in to the room and sat down, as soon as we had eye contact both of us were remembering the day I ran him over. Both of us smiled sheepishly and we ended the consultation with a laugh.


There's too much to tell about what's happening in the last 4 months of me working here in KK. Much of it is uneventful. At times I do miss the craziness and the peculiarity of the cases found back in Klang, but with the advantages of lunch break, acceptable patient load and the very fact that I can go back home by 5pm sharp on weekdays (weekends off, uolls), I am liking this new workplace very much so.


With it, however, came an end for my ambition to pursue FRCEM papers. I took a few months to come to term with it, and as of now, I am not looking to pursue any paper, not even FMS. This might change in the future, but for now I am very much in the knee-deep preparing for a big chapter in my life and what may come later will just have to wait.


That's it for my last part of new MOship transfer posts. I will be posting less frequently about my work here (seeing that there's hardly exciting thing to talk about) and I foresee that I will actually post only 3-4 posts per year. This blog is far from dead, though. Just drop a comment if you guys have any suggestion/question and thank you for reading!

Part 2 - Reporting In

After a scrambling long drive from JKN, I finally arrived at the district PKD around lunch time. Two colleagues of mine, Y and N, were also stationed at the same district as I and we agreed to meet at the PKD office after 2 pm. When I arrived, they weren't there yet and I hadn't had my lunch so I wanted to go somewhere first to eat. Luckily, beside the PKD there is a Mydin mall building. I never saw a Mydin mall this big anywhere in the Klang valley - I know there's a huuuuuge one in Kuala Terengganu but this one was maybe 4 or 5-storey tall.

Anyway, I searched over the Google Maps and found out that this Mydin mall is the only mall-like structure in the town. Upon entering, I quickly realised that the only thing worth to be excited about this mall is the Mydin itself. The rest of the shops inside this "mall" are so.. disappointing. The town itself is quite a medium size one, actually, with blocks of shop lots that kind of have everything that you need. I counted a number of banks, restaurants, hardware shops, furniture shops, etc. But no malls. I saw one KFC franchise, no McDonalds, no Starbucks, no TGV or GSC cinemas (not even an MBO). But this town is the closest to Penang (is this a clue enough to guess where I am now?), which by my standard is similar to KL thus should offer me more of a city life that I am forever addicted to have.

Me hyping myself helplessly while my inner me just groan at this town

At around 3 pm, the three of us went to meet the boss of the PKD, Dr Z who is also a PKD. Not to confuse anyone here, but his title is the Pegawai Kesihatan Daerah of the Pejabat Kesihatan Darah here. He's so friendly and enthusiastic about us reporting in here. We were midway of listening to the introduction of PKD organization and filling out forms when more MOs came to report in as well. He was jubilant. In total, there's seven of us newly transferred here and they (the PKD people) were very happy in assigning us to the various KKs that are under this district's PKD.

There is a total of 10 KKs under this PKD and they are divided geographically into two and named as KK Laut and KK Darat respectively. I was assigned to this particular KK Laut (literally, my KK is very near the beach) because they needed a male doctor to balance out the doctors there. I did not have a say in this matter, unfortunately, unlike the rest of my colleagues. My face cracked a little and I felt myself showing a disgruntled face to my new boss - I told you I had this terrible poker face that is very much loathed by so many people. But I couldn't help it. This KK is so far to the west that it took me a solid 45-minute drive from my rented house (more on this in next blog post!).


You will be directed to a Pegawai Tadbir (PT) who usually is assigned to handle all MO-related matters. That person is the most important person that you need to remember when handling with matters related to the PKD, apart from your bosses. They will handle a number of things that need to be cleared out when first reporting in to a new place. In no order of importance, it include:

• delivering the letter from state JKN that says you are to serve at that particular district
• HRMIS update
• CPD points of the next year
• transfer claim
• new KKM ID (passport photograph required)

Of those, the most exciting part but equally exhausting to complete is the transfer claim. The PT will ask you for a screenshot of the kilometres travelled from your home to the state JKN, from JKN to your district PKD, and finally from your district PKD to your KK. They will also need a copy of Touch&Go transaction, the original invoice of the first three-day hotel stay, a copy of your car VOC (vehicle owner certificate), the letter from the JKN and the letter from SPA. They will calculate how much you can claim, taking into factor of your car type (mine is less than 1000cc, so it's a C class or something) and they will also include meal allowance.

"Finally, all documents are here!"

But once all those done and dusted, just wait for the claim process to be approved in a week. The claim is noticeably more than you had spent. It's more due to the fact that we do not take into account about the meal allowance, lodging and etc. I'm not complaining, though, cuz I need that money HAHAH. This whole transfer thing just sucked all my savings into oblivion. So, a word of advice, do a bit of saving 3-4 months prior your transfer!

It's funny how much screaming I have done whenever I went to the ATMs

Another very, very important aspect that you need to highlight quickly during reporting in is that to REQUEST FOR THE WHOLE FIRST WEEK OFF! Again, I remind you, this is very important. Know your right to request. I was fortunate to ask one of my ex-colleagues at my previous hospital about the whole process of transferring. He said that not all PKD or the KK allow for day-off request, which is totally absurd and cruel. He had to argue at the PKD and threatened not to come to work anyway if he was denied the off-days. He eventually got it. Imagine you just had travelled tens or hundreds of kilometres, even, and they had the audacity to ask you to work the very next day? You don't even know the area, you don't have any place to stay, where to find food, etc. So do the sensible thing - ask for the whole week off.


I quickly asked for the week off on behalf of all of us. We are lucky that there is no KK that operates past 5pm on weekdays and none have to work on weekends, so our weekends is pretty much untouchables. We were granted the whole week off except on Thursday and Friday as half day as we had to attend an orientation course for the monthly new staff transfer. That's cool.

After the business at PKD concluded, I decided not to visit my KK just yet. It was already late in the afternoon and I did not have any place to stay yet. A quick thinking and I decided to find a budget hotel to stay at Bukit Mertajam, Penang. I didn't care that it was far. I didn't care that I had to pay toll and had to suffer traffic jams. The sight of Starbucks, McDonalds, and Xin Fu Tang (even though I stopped drinking boba teas long time ago and never join the bandwagon) just somehow soothed my soul and calmed my mind. I found a sensible hotel there and booked for a two night stay. I had a quick dinner, showered and went to bed.


The next day then was the start of a brand new day which is The Hunt for a rental house. This will be covered in the next blog post, so that's it for now!


(read Part One - The Long Journey here)

Part One - The Long Journey

It has been almost a month since I received the transfer letter and started working at a new place. A month filled with multiple burnout drives back and forth, travelling to far and near places. The long travel, the reporting in, the hunt for a place to stay, and the settling in has kept me much occupied that I neglected to blog here. I've been meaning to write the whole experience of the transition between a floating MO to a regular MO post-transfer and now I got a bit of time to do just that.

I'm sure my batch's experience is different from the previous MOs because we are the first batch of contract HOs being offered a permanent posting as an MO. Everything is digital, too, with the offer letters and the transfer letter just needed to be printed. Once all the forms and letters are ready, I packed my essential belongings that can sustain me for a month, shoved them all into my tiny Viva car, bid my farewell and start driving.


I have to make multiple entries because there's so much to tell so here we go.


Part One: The Long Travel

When we first got transferred, we are supposed to come to the health state department (Jabatan Kesihatan Negeri) of the state that we got. I departed from home very early as I estimated it would took me 2 hours to reach there and it was. Upon arriving to the meeting hall, I was surprised to see there's a huge number of us (122 people!) got a transfer in this state and all I could think of was, uh oh.

Usually JKN people will receive around 20 people reporting in for transfer in a month. And there I was, among the sea of a hundred people and few colleagues who got the same state as I was, waiting for them to hand in the official transfer letter that tells us the district we are transferring to. A few of us managed to call the JKN beforehand to know which district they've got so no suspense there but to majority of us, we were all waiting anxiously for that damn letter.


In any KKM organization at state level, us doctors usually work either under Medical or Public Health. Those under Medical means they will work in hospitals. It can mean a district hospital, a tertiary one or above. If you got Medical, you will be told which department you got once you report in at the hospital. Public Health doctors are the front-liners who work in health clinics (klinik kesihatan). We were told that in view of a large number of us transferring at the same time, half of us will be transferred to klinik kesihatans and another half will be sent to the hospitals.


Priority for a hospital transfer was given to those who passed (parts) of professional papers like MRCP, MRCH, etc. and those who are contract-based MOs. The reason being is that for doctors who have passed first paper of MRCP, for instance, they will require more training at tertiary hospitals under a specialist guide. Meanwhile, those who are contract-based supposedly will also be sent to tertiary hospitals because they will need to be evaluated by a specialist before being offered a permanent post.


After I received the letter and learned of the far-away district I've been assigned, I straightaway left the JKN building and started driving away. Afterall, it would take another 2 hours roughly from JKN to the next reporting place. I've learnt later that some of us stayed behind at the JKN for "haggling" - they tried to swap placement among themselves on mutual agreement. Some would want someplace more south or more north, closer to the east or to west, for instance, depending on their preferences or personal circumstances. Some succeeded while some did not. There's no guarantee.

Imagine this was me driving not under lamp lights but under the basking sun

The journey further north was a bit quiet with a whip of whirlwind perturbing my mind. After all I was, at that moment in what I would call uncharted waters. I was wondering throughout the drive about what is it like working in klinik kesihatan in a less populated district. Would I be left frustrated, unable to cope with the limitation of a clinic setting? Would I be wondering aimlessly, go in and out of work without the crazy rush of emergency I normally had back when I was in ED? What about my future? My aim for a paper? What about settling down? Having a family? How must I proceed?


It was a totally different kind of journey with a different kind of feeling. When I first left the house in the wee hours of 4 am, I had an endgame. I had it all planned and prepped. I googled JKN days before departure, finding out the best route and how long the drive was, determining where to change clothes and gauging whether my packed bags are sufficient or not for the months ahead. I was confident. I was ready.


The second journey was not the same. I did not know where the place was. What's the people there like. I know for certain there are a number of KKs there and I don't know which one suits me the best, or whether I can choose which KK to serve in the first place. The more I traveled, the more alarmed I felt about the future that lies in front of me. The weather was not endearing, either. It was cruelly hot and dry. I felt my lips cracking and my shirt sticking to my body. I definitely did not smell pretty. But I drove on and on, until I reached my second destination of the day -  the district health office (Pejabat Kesihatan Daerah or PKD).





(to be continued in Part Two - Reporting In)