I'M BACK BITCHES

Kindly expect a new post in about a week or two. HAHAHAHA

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).

The Dog Days of 2020

Who knew that this is how the year goes by? 2020 so far is the bitchest, suckiest year I’ve ever had the misfortune to live in. I thought that with how 2019 had been the kindest, most wonderful year that graced me solid happiness (finishing housemanship with a bang, securing a permanent job, transferring to a chill environment, and most importantly getting married to my most beloved), that 2020 was gonna be the same but I couldn’t have been more mistaken.

And I sincerely thought that we had it all under control. We sacrificed a lot earlier this year, with the lockdowns and people adaping to the new norms. We even felt a tinge of pride when the world took a look at us and praised us on how we responded to the pandemic. Maybe this signals a new era where people finally accept that health is an important aspect of their lives.

But look at what happened to Sabah right after the election days. Despite recommendations and warning that the events would only escalate the risks of increasing trasmission of COVID-19, all of them took no heed. That’s when I knew that people are still not thinking that health is important. I know that before this people don’t think much about HEALTH in general, but in the wake of the fucking pandemic I thought that people will finally come around. Sadly it does not happen.

People only think of their health when they are in hospital, either because they are being admitted or they are visiting someone at the hospital. Sometimes they don’t even think of their health when they are sick. They will brush it off as there is a lot more things to do. More documents to be signed, more money to be made. They can hold it in, thinking that it might go away, or simply pop off some pills and they’ll be good as new.

What equally important as getting better when you are sick is taking a good care of yourself so that you don’t get sick in the first place. Or in other word, a prevention. They don’t think of that when Sabah happened. They are still, so sorrowfully ignorant and obstinate, flauntingly disregard the new norms that we begged them to comply. Always wear a mask whenever you have to go outside, but what do we see? Teachers in class, politicians in the field, sellers behind the counters - all of them disregard this. Some people still bumping fist, hugging the shoulders, hand in hand, and sitting closely together. People finding ratholes to bring their relatives in and out from the red zones when they know they can’t travel. I find this very upsetting.

What’s the use of our past sacrifice if this is how people respond to it? I am so tired and sick of it. This is not going to get any better any time soon by the way how it is going nowadays, and people who think otherwise is an ignorant piece of shit. This country doesn’t deserve nice things, because fuck you all you never take health seriously in the first place. I’m out. See you in another 3 months.

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.