Thursday, April 10, 2008

Of animals and maldistribution of healthcare

I promised to talk about the animal planet in teluk intan a few posts ago and let me just share a few glimpse of the abundance of wildlife here and then i will whine about the disparity of healthcare in Malaysia.

First stop, hornbills. Don't be surprised to see these cute, tottering birds here. My first encounter with hornbills in Peninsular was on my way home from work when I see a pair of beaks crossing the road. I blinked and looked my delight, it was a hornbill with oversize beak (esp in comparison to its body) balancing on the ground. Magnificent birds do look adorable and clumsy as on the ground. The next few days, I would see at least 6 or 7 of them lounging outside the ward as I do my ward rounds. You can say that I was a bit distracted by the heart-warming, interesting 'zoo' outside.

Then I had the opportunity of 'saving' a puppy which has fallen into a drain as a group of wild but harmless dogs are roaming the hospital compound as I speak. The puppy ran away eventually but that was an inspiring, 'heroic' moment for me (haha..)

A few weeks ago, during the heights of winter, a huge colony of herons were occupying the flat, marshy grounds facing my room. There was this beautiful moment of the huge flock of herons lifting up in flight as I walked to work during a misty, quiet morning. Awww...really a National Geographic moment. Too bad I don't have a proper camera for times such as these.

Last week, my flatmates and I were shocked to find out that there was a king cobra slithering around the car-shed behind my house. Its diameter was larger than car tyre. I was told that a surgeon once found more than 50 snakes in his bungalow in the late 90s. Scary...

I guess part of the reason why there are so many animals making their habitat on hospital grounds is mainly because of the oil palm estates surrounding the hospital.

Yet most importantly, there was this issue that has been neglected by the health dept for a very long time. For me who deals with fatal accidents, severe head injuries, multiple intra-abdominal traumas, there is a very important role for urgent CT scan facility. However, after 3-4 years of broken promises, there is still no CT scan machine in a big hospital such as this. We have surgeons, anaesthetists, ICU, radiologists and so on, but no CT scan. Some of the smaller hospitals in Perlis or Pahang, has big, hi-tech MRIs (which cost more) but no CT scanner for Teluk Intan.

So instead of obtaining a clear view of the extent of injuries, we have to rely on limited clinical skills and send our relatively unstable patients out to Ipoh with the poor houseman. Each time a houseman goes out with a patient, I worry for them as I remember the story of the girl houseman who accompanied a patient and died in the ambulance crash. The moment I send my house officer out, I pray that the patient and the staff accompanying them will be safe and sound.
Furthermore, the hours needed to transfer the patient, reassessment by another doctor (of same standard of clinical skills) and wait for the scan room would further exacerbate the patient's fragile condition. Obviously some of them do require admission for care in Hospital Ipoh but a significant number of patients were bundled back to Teluk Intan for observation.

Sigh...sometimes I feel that we are fighting a losing battle. Some of my colleagues feel that there were no changes in the previous government and hope for a change after the remarkable political tsunami while some cynical ones feel that things are not going to change much as the same federal govt remained in control, esp in the ministry of health.

Approaching the final year of my compulsory govt service makes me wonder: what can our leaders do to retain all the excellent, dedicated doctors instead of 'shooing' them off to the private healthcare earlier? One of the major reasons why someone who is so driven to serve unselfishly to leave the service is because of unfulfilled dreams and disillusionment.

As for me, I will keep on smiling and giving the best clinical care that I could possibly deliver. After all, each of us must fully utilize and develop the talents and attitude that God has given us and serve the people to the best.

Oh by the way, that picture of me holding the cage on a boat was taken in Sabah during a river cruise and it was highly memorable as I threw the only cage that caught a crab!! If only all the nets that I cast can yield such happy bounty....

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