Tuesday, July 1, 2008

Saying farewell

Another close friend is leaving Teluk Intan for greener pastures up north. She is one of my makan buddy and a grand listener who listens to my many complaints, mumblings and grumblings. As of 1st july, I bid farewell to at least 7 friends who went off to work in bigger hospitals as they leave this town, one by one. One of my housemate is now in KL, busily treating sick children in the biggest hospital in our country while another is on her way out to Penang.

On the other hand, I am still here in Diamond Cove. Each day, I wonder when the transfer letter will come. As I do not intend to pull ‘strings’ or cables, I guess it will take some time. At least, I enjoyed (and still do!) my posting here (remember my long post about what I learnt here?). However, it’s also time for me to further my career. I know that once the letter arrives, we are not given much time to move. In fact, it is often backdated J. This is the normal fate of doctors in Malaysia. Most of us are not given much choice when it comes to posting. My boss has 3 little kids in KL but worked in Teluk Intan for more than 1 and a half year. He commutes almost weekly just to see his children. When his son fell sick, he could not even nurse his child.

For the sake of the community and the nation, we neglect our basic health and needs. Some family matters are put to the backburner for the sake of helping patients. It’s not that all patients are appreciative of what we do. In fact, some even question our judgment and repeatedly refuse interventions although we are doing our best for them.

We realize that some of us need to go to the smaller district to serve the people. What we are dissatisfied with is that those in contacts with ‘bosses’, those people with ‘cables’ to pull and those who have influential families seem to never leave the big towns. A few of my friends in the Klang Valley has never served in the small towns or kampongs. There need to be a revamp in how doctors are being posted around the country. Some of us feel that there should be a rotation system whereby everyone is required to serve in the districts for a reasonable period of them unless they have very concrete reasons to stay in the big towns. If not, why are we given the same pay regardless of where we serve? Why are we all called doctors?

Otherwise, a lot of less ‘well-connected’ doctors in the peripheries will feel marginalized and demotivated while the ‘upper crust’ or ‘higher society’ remain contented and pampered in the Klang Valley, etc. At least for now, this story has a happy ending as my boss successfully ‘win’ his appeal and he is now working nearer to his young family. How about many other silent doctors who remained in far-away hospitals, especially those in very rural areas in East Malaysia? When will they ever see justice being served?

On the other hand, in our practice, now all patients do accept our choice of treatment. No matter how much we trumpet evidence-based medicine and obtain the best advances in medical care, we still cannot change mindsets and attitudes. One of my patient was diagnosed with cancer of the colon, which is operable, but she refused surgery as her children and family members wanted to try alternative treatment. Another Orang Asli gentleman has operable pancreatic tumour but gave up because he feels that he is too old. He was 65 year-old.

How do we as doctors respond to this kind of scenario? When I was much junior in service, I will feel very disappointed that my patients do not want me to help them. At that point, I feel like I have failed them. As time goes by, I realized that I am also doing my best by offering kindly advices laced with empathy. By giving them informed choices, we give them control over their lives. Maybe that is the most important thing in their lives at the moment they discover that they are terminally ill. When someone is faced with a life-threatening illness, they often feel fearsome due to the lack of control and hopeless due to the looming disaster.

Therefore, giving them autonomy is not such a bad thing after all. As long as they are making valid decisions with a sound mind, the best that we could do is to respect their decision and wish them best of luck.

By the way, to my dear friends who are now chasing their dreams in bigger centres, to those of you following your heart’s desire, to my pals who is travelling on a different path in life from mine, this piece is dedicated to you. For you have proudly done your part for the poor and oft-neglected folks in the districts. May God be with you and take care...

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