Saturday, May 12, 2012

Selamat Hari Jururawat!

Assalamualaikum,

Selamat Hari Jururawat!

Entry kali ni saya khususkan untuk nurse2 yg banyak bagi tunjuk ajar kepada saya sepanjang kerjaya saya sebagai seorang doktor. Macam pelik kan? Nurse ajar doktor??

Saya mula bertugas sebagai houseman (doktor latihan siswazah) pada April 2002. Masa tu memang macam2 perasaan ada. Seronok sbb nak start keje, kecut perut sbb mcm tak tahu apa2 nak expect, bangga sbb dah jadi doktor dan mcm2 lagi. Saya graduate dari New Zealand, jadi sistem di sana amat berbeza, cara ambil darah berbeza, pesakit yang berbeza dan penyakit pun berbeza. Jadi bila nak start keje kat Malaysia ni memang menggerunkan terutamanya byk cerita2 mengenai doktor2 dan specialist2 yg garang2!


Saya mula bekerja di rotation Ortopedik. Masa di NZ cuma belajar 6 minggu aje Ortopedik ni. So, banyaaakk sangat tak tahu. Mcm2 tak tahu. Nasib baik la ramai nurse2 yang tolong ajar, mereka langsung tak kedekut ilmu especially bab2 labelling, discharge summary, nak call sape (protokol) etc. Kawan2 pun semua very helpful. Kalau kat bilik bedah, lagi la nurse2 byk bagi tunjukajar - cara2 nak scrub, gowning, dancing, nama2 instrument dan macam2 lagi. Kena tegur (dan kena marah pun ada...) memang selalu la...tapi tu asam garam kehidupan houseman la...takde houseman yang komplen2 mcm zaman sekarang ni...


Masa berlalu pantas.


Saya terus melalui kerjaya sebagai doktor. Dari seorang houseman (HO) di HTAA Kuantan kepada seorang pegawai perubatan (MO) di Mentakab, Temerloh, Selayang, Kuala Lumpur, PPUKM, Sungai Buloh dan sekarang sebagai seorang pakar Ortopedik di HoSHAS, Temerloh, Pahang, alhamdulilllah. Ramai nurse2 yg saya kenal masa HO dan MO dulu skrg dah jadi ketua jururawat (sister) dan pun. Jasa mereka tetap saya ingat hingga sekarang.


Saya kagum dengan dedikasi sebahagian besar daripada jururawat2 ni. Daripada pagi datang kerja, kemas katil patient, mandikan patient, serve ubat, buat dressing, hantar pesakit ke bilik bedah, xray, physioterapi dan lain2. Memang ada juga yang problematic, curi tulang, masalah attitude dan sebagainya, tapi majoritinya nurse2 yang saya kenal mmg bagus2. Dalam letih2 pun masih boleh memberikan senyuman kepada pesakit.


Ada nurse2 yang lebih tau mengenai pesakit berbanding HO. Ini tak dpat dinafikan. Nurse2 mmg banyak menegur HO terutamanya yang baru2, ramai HO yang ok, boleh menerima teguran, tapi tidak kurang juga yang susah nak terima hakikat ni. Saya mmg selalu ingatkan mereka supaya respect each other, terima teguran dengan hati terbuka dsb. Masing2 pasti ada melakukan kesalahan, yang penting we work as a team.


Kepada nurse2, bertugaslah dengan penuh tanggungjawab dan ikhlas. Kita semua akan disoal mengenai  tugas yang kita lakukan skrg. Jangan berkira dan curi tulang ketika bertugas. Ikut arahan yang doktor beri semasa rawatan pesakit tapi kalau ada kemusykilan, tegur lah. Doktor pun manusia biasa yg boleh melakukan kesilapan.


Finally, saya nak ucapkan Selamat Hari Jururawat kepada semua nurse2 yang bertugas. Terutamanya nurse2 yg pernah bagi tunjukajar kepada saya. Lets work together. You are the best!

Thursday, May 3, 2012

The Bomoh Land

Assalamualaikum,

It is the year 2012. As mentioned by the Health Minister a few days ago, Malaysia is producing 3500 doctors per year. This is aiming at getting a ratio of 1 doctor for every 400 Malaysians by 2020.  "WoW!! So many doctors!"

And yet, the mentality of many people has not change. Tonite, I have loss a patient. Not to disease nor death, but to the expertise of 'Bomoh'. This patient of mine has a fractured tibia and fibula (patah tulang kering/shin bone) at the distal end region, about 3cm from the ankle joint. It's swollen and deformed, and this patient of mine is only 14 years old. I'm planning to fix him up tomorrow. His name is already in the operation list.

 My medical officer (MO) has explained everything, all the possible complications that may occur if it is not fixed properly - malalignment (senget), shortening (pendek), instability and chronic pain etc....and yet, his FATHER said:

"Nope, we want to try bomoh first!"

Okeyy...fine by me... "discharge!"


I'm sure 3 months from now, or maybe earlier, he will come back. He will come back  to my clinic, alone. His father will not accompany him to my room.

5CM SHORT
Last month I had a 20 year old man came to my clinic 9 months post trauma with a fractured femur (his thigh bone). He came limping to my room, accompanied with his mum. His femur has already united with 5cm shortening.

"Doktor, tolong lah panjangkan balik kaki anak saya ni doktor...boleh tak doktor?" His mother plead.

"Kenapa makcik balik dulu? Kenapa pergi bomoh?" I asked nicely.

"Ayah dia la doktor, nak bawak jugak. Masa tu mmg doktor dah cakap, kena masuk besi kalau patah macam ni. Saya tak boleh kata apa la doktor, itu ayah dia"

His father was at home. So scared to come...shame on him. And I just go bla, bla, bla....for 10 minutes...

I don't mind if all patients go to bomoh, and all of them recovered well. Can walk normally, can function back into the society. The problem is that, when the damage is done, these patients come back to us for correction of the deformity. "Cisss!"

It will be messy and bloody if we wanna correct a malunited fracture. 400% more difficult and time consuming. "I dont want to do it, ask the bomoh to correct it for you!"

"XRAY PLEASE!"
Last week, 3 patients came to my clinic with their cast (Semen/plaster) already removed by bomoh.

"Doktor, tolong buat xray doktor. Bomoh suruh buat xray nak tengok patah dah baik ke belum". Bomoh suruh doktor buat xray?? Banyak cantik muka kau, kitaorg bagi treatment, korang buang, pergi bomoh, pastu datang sini nak xray sbb bomoh mintak xray...

"Kalau betul bomoh tu terer pakcik, dia mesti nampak patah tu macamana dah keadaannya! Tak pun suruh la dia xray sendiri!" Kadang2 aku sindir jugak patient2 ni...kui kui..

All the 3 patients' fractured bones angulated....senget la tu maksudnya.


It is so sad that the mentality of our people is still like this despite out medical advances. We have educate them during their stay with us. But still, a small percentage of our patients still believe in bomoh, more than us.


What is the SECRET OF BOMOH that our people trust them so much??? 

It is we do not explain enough?
Is it the infection that scare them?
It is the implant (metal/besi)?

Our people keep asking, "nanti petir ke, kilat ke, tak bahaya ke doktor? Nanti kilat tu sambar besi kat kaki anak makcik ni" Adoi!! Jawapan aku senang aje..."Makcik, cuba makcik pergi tanya sedara2 org2 yg mati kena panah petir tu, kat dalam kaki atau tangan diaorg ada tak besi!!"

I bet, 90% of these victims were metal-free. Just a bet.

What say you?