Tuesday, April 26, 2016

Why I'm scared to go back to my own country to be a doctor

[WARNING: RANT BLOG POST]

As many of you know, I have passed my finals in medical school after 5 long years, and in July this year inshaAllah (God willing) I will be graduating with my medical degree. Hurrah! Now all should be rainbows and unicorns as I enter my brilliantly glowing career as a doctor right?




As a scholar from a certain government's department, I am bound by contract to return to my country after graduating to serve the government as a doctor for 10 years. That in itself is not a problem. I love my country, I miss it and would love to return and serve my people.

The problem is: everyone else back home keep telling me NOT TO COME BACK.



And by everyone else, I mean everyone. But most importantly, doctors who are in the early two years of training just after graduating medical school, which in Malaysia is called housemanship training (in the UK they call it the Foundation years). These housemen (HOs) are all my seniors and friends, and I value and trust their opinions. So when they tell me I'm better off staying in the UK, I'm obviously worried by this. Some of them were previously medical students trained in the UK or Ireland, others did their degree in Malaysia, but all agreed the working conditions as a HO in Malaysia is bad enough that they are actively encouraging me to abandon ship.

This is old news to you, if you're Malaysian and you are/know a doctor, or even if you just read the news/FB enough. They work extremely long hours and very few breaks (sometimes 24-25 hour shifts), they get bullied/insulted/humiliated by their senior colleagues publicly, and they get villified by patients who don't want to be the "guinea pigs" for these "inexperienced" doctors to "experiment" on.

Contrast that with the more humane working hours here (the longest shift I've seen is 13 hours) thanks to the European Working Hours Directive, no bullying culture, and patients who are always willing to let even medical students practice on them and saying "well you've got to learn". I can definitely see why staying in the UK seems like an obvious decision.

But what I don't understand is: WHY IS NO ONE DOING ANYTHING ABOUT IT IN MALAYSIA?


Everyone knows these conditions are not fair, not safe for both doctors and patients, and not conducive to attracting talented doctors to train in Malaysia and retain them in training. Everyone complains and rants about it. This has been going on for as long as I can remember (which due to my crap memory, is till high school).

But nothing's changed. Sure, they said they've made some changes ( read this Press Statement by the DG of Health:  https://kpkesihatan.com/2016/03/09/press-statement-dg-of-health-9-march-2016-strengthening-the-housemanship-training-programme/ ) but on the ground, it seems it is not enough.

Before I move on, note that this is a rant piece, where I am using this medium to just pour out my frustrations. However, if you have any advice or opinions, or know of any improvements in these issues, or if any of my information is incorrect, please comment or contact me to let me know.

Ok, here goes the rant:

1. Working hours

According to the Modified Flexi system introduced in 2013, HOs are expected to work 65-75 hours per week. However from the people I have spoken to working in different states, often they work longer hours than these. The problem is not just the total hours, but the length of each shift. If doctors are working 24 hour shifts, this is obviously not safe for patient care, nor for the doctors' wellbeing.


In what other high risk jobs would you get people working 24 hour shifts? Would you let a pilot who hasn't slept in 24 hours fly a plane, especially if they've been working those shifts for the past 3 days? But you'd let a doctor who hasn't gone home or had a good sleep for a whole day hold people's lives in their hand. Where's the logic in that?

And do not tell me: Oh but the older generation did that, and they were fine, doctors now are just pampered spoiled brats.

My mum used to walk to school for miles, sometimes barefoot. Did she expect me to do the same? Would anyone expect me to do the same? NO. There was a time people used to perform surgery and circumcisions without anaesthetics, would you like doctors to do that now? Obviously not. The older generation didn't have a choice, there were fewer doctors back then. We have a choice now.

The reason we strive for change and advancement is for our children and future generations to enjoy what we did not have, for them to enjoy a better quality of life. Why is it different then for doctors? Isn't the reason we try to send so many students on medical scholarships because we want more doctors, to improve the ratio of doctors to patients so we can improve medical care? Then why, despite INCREASING numbers of doctors graduating each year (apparently too many medical students) why are the working hours not improving? Surely we should be striving to maintain a workforce that is large enough to maintain humane working hours and yet still achieve quality patient care? And yet they complain we have too many graduates and not enough jobs to go around. Pah.

Reason #2 I keep hearing about why we need these ridiculous hours is: they need to work loads to gain enough experience.

Excuse me, that is NOT a valid reason. Yes, as is with all skilled occupations, practice makes perfect. The more hours worked, the more experience gained. That does not equal working people to beyond their limits, and beyond their rights to having a life outside work. The hours you need are naturally accumulated over years as you progress in your training. Those hours do not need to be accumulated in crazy marathon shifts, where you gain experience but you lose concentration and motivation (and lose having a LIFE). The experience gained should be in safe increments, and cannot be justified by doctors losing their passion and burning out, and patients suffering from errors due to fatigued doctors.

2. Bullying culture

It completely escapes me why this is even still around. Not just in any profession, but among doctors? It seems so absurd it's almost laughable. When I explain this culture to my non-Malaysian friends, they seem astounded by it, like it doesn't even make sense. And it really doesn't, considering doctors are supposed to be intelligent, compassionate and professional people.


Even medical students doing electives in hospitals have seen this, and my HO friends have sadly experienced it too. When your seniors who are the ones supposed to guide you and support you in your training, the ones you're supposed to turn to when you're lost, are the ones insulting and humiliating you in front of patients, tearing your confidence and patients' trust in you into pieces, how are you supposed to grow?  I'm not saying there aren't any mean or harsh seniors in the UK, but I personally have never seen or heard it being done in front of patients. It is simply unprofessional to act like that, there are proper ways and adab of correcting or criticizing someone's weakness or mistakes. In Islam, our religion teaches us that humiliating or revealing someone's weakness in public is not acceptable, that you should always try and protect someone's honor and dignity. Don't even get me started on doctors who actually physically lay a hand (or a book) on their juniors. Even if it's a light smack and doesn't hurt physically, it is absolutely unacceptable! They are not your children to hit or scold like little kids, they are your grown up colleagues, and should be treated as such.

And whenever someone says that "oh we went through the same thing, so we're just teaching them the way we were taught, it'll make them tough", THAT JUST GETS ME SO MAD. If you went through such horrible times, why on earth would you want to inflict that on someone else?

As a person who chose to go into a career of saving lives and should be caring in nature, why would you choose to make someone else suffer when you have the choice of making it better and easier for them?  It's the same thing as how our parents work hard to give us what they didn't have growing up, so should senior doctors be as nurturing and supportive to junior doctors to provide them with what they didn't have when they were training. It's repulsive how some people think just because they had a hard time, the juniors should suffer the same way too. That kind of mindset leads to stagnation and repressive working conditions, when we should be aiming for progress and development.

It's a sad situation when my friends at home are telling me to stay away, while my Singaporean friend has her seniors telling her confidently to come back home, that they've got better pay and conditions than the UK. Here in the UK this week, junior doctors are doing a full walkout strike for two days in protest of a new contract that will change Saturdays into normal hours (instead of antisocial hours with its accompanying premium pay) and also will stretch the workforce thinner to create a so-called "7 day service".  In Malaysia, junior doctors have been labouring under even worse conditions, but no significant improvements have been made, and policymakers have not even involved HOs in their negotiations and discussions.

I'm not saying doctors in Malaysia should go on a full walkout strike too (perhaps eventually :P), but it's time that something more concrete is done at the level of policymaking (and implementation), and this time it should be decisions made with the junior doctors, as well as integrating the ideas and solutions from those directly impacted: the HOs themselves.

It's time for doctors to save themselves now. 

P.S I'm really hoping for loads of heartwarming stories where people have had nice experiences being a doctor, but that doesn't mean the ugly stories aren't there too. Also, please please do let me know if it really isn't this bad or there has been loads of improvements but I'm just ignorant about it. I have never worked in Malaysia yet, so fellow Malaysians please share your stories with me.

[ Disclaimer: I have never worked/trained in Malaysia, everything here is based on what my trusted friends/seniors have told me. Thus they are technically hearsay/stories/personal experiences, and I know they may not be representative of everyone. However, they are from my trusted sources and they are experiences that I believe no one should have, hence the rant.]



Oh yeah I post. Long ranting posts.






Saturday, October 31, 2015

Tales of the Supernatural #5: Halloween Special

Today is Halloween, when people celebrate all that is scary and ghostly, and children (and some adults who never grew up) get to stuff themselves with free candy. I don't celebrate Halloween, I have no carved pumpkins nor am I dressing up in spooky costumes. However, in the spirit on this supernatural festival, I shall share my scariest personal story...

Blackouts occur a bit too frequently for my taste in my house back in Malaysia. Aside from losing the fan and air-conditioning and ending up feeling like we're in a sauna, blackouts also mean we lose all the lights if it happened at night. They can last from 30 minutes to a few hours, so we always have some spare candles in a drawer ready to be used in an emergency. One night when another blackout happened just before my family were going off to bed, we decided not to use the candles since we were all going to be asleep soon. My sister, being a scaredy cat, begged me to sleep with her in her room. A storm was raging outside, lashing at the windows and occasionally blasts of lightning would turn the room white with sudden brilliance, making her even more terrified. Feeling bad for her,  I conceded to her request.

Now I never have been fond of my sister's room. She had one mirror facing the bed, and another mirror on the closet, which faced the windows. I hated having so many mirrors (I was very superstitious about mirrors) and I didn't like looking at the window's reflection in the mirror. She also did not have any heavy curtains on, just a see-through white lace curtain which basically meant you can see everything outside even with it drawn. I slept on the side nearest to the closet, while she slept on the side closer to the window. We both slowly nodded off, and were fast asleep.

I don't know how much time passed, but something woke me in the middle of the night. At first, I couldn't figure what woke me. Then I heard it again. Someone was knocking. Someone was knocking on the window. We lived on the 4th floor of our apartment block. As this slowly dawned on my sleep-addled brain, my eyes opened wider. I could see the windows in the mirror opposite me, but everything was so dark, and the rain was still pouring heavily from the skies. Suddenly, lightning bloomed in the sky, illuminating the window. Then I saw it. A hand, just a hand, knocking on the window. It looked really thin, just skin and bones, and all I could see of it was its outline, from a fist to an elbow. Heart pounding, cold sweat on my brow, chills down my spine. I closed my eyes again, refusing to look at the mirror. I pretended to be asleep, prayers repeated again and again on my lips. The knocking eventually stopped. Heaving a sigh of relief, I relaxed and snuggled into the covers.

It was not over yet though.

Nails scraped on glass. A horrible screeching sound that grated on my nerves and turned them raw with fear. I couldn't help it, I had to see. I opened my eyes, and there in the mirror I could see two hands now, both scratching on the glass, making that ghastly sound. Then, to my horror, I could see a head slowly coming up from underneath the windows. Before I could see more, I squeezed my eyes shut again. I don't think I could handle looking at a face of...whatever that is outside the window. The scratching grew more frenzied, but I kept my eyes closed, my body completely still. I never ceased muttering prayers under my breath. I don't know how long it lasted, all sense of time was numbed by the fear. Somehow I must have fell asleep, because the next thing I realized was waking up to sunshine streaming in. I checked the windows for nail marks, considering how loud it sounded I thought the glass must be scored with lines. But there was nothing. My annoying sister slept through the whole thing, lucky girl.

I told someone about it, and they half-jokingly said that perhaps "it" was looking for some shelter from the storm and wanted to come in. I told them that wasn't funny at all.

So if someone knocks on your window tonight, be careful. It might not be a trick-or-treat...

Happy Halloween!

Monday, September 14, 2015

Tales of the Supernatural #4: Go Bump in the Night

Have you got an attic in your house? If you do, and you get scared easily, you might want to avoid this story...

I live in an apartment in Malaysia, on the top floor of our block. Above our flat, there is a large empty space, just below the roof, where the reserve water tanks for the whole building is stored. There is nothing else in this space, just the occasional bird nest and lots of spiders and cobwebs. The only way to access this "attic" space is by climbing up a ladder and going through one of the loose ceiling panels above my balcony.

One night, a typhoon was raging outside in full frenzy, rain lashing against my windows. I was just lying in bed, revising some History for exams (yes, I study in bed, and yes I know it's an awful habit). I was getting increasingly bored (sorry, History teachers!) and as it was getting late, my eyelids were starting to droop.

Suddenly, I heard the sound. It was a deep thundering sound, and initially I thought it was just thunder. Then I heard it again. It sounded like something really big and heavy was rolling on the floor...no, on the ceiling. I stared up at the ceiling, but of course without any X-ray vision I could tell if there was something in the attic space above my room. I listened intently for a few minutes, but there was only silence. I turned back to my book, trying to finish the chapter.

I heard it again, this time for a much longer duration. I could clearly discern that the sound seemed to be moving, like something was rolling from one end of the ceiling to the other. The logical part of my brain took over as I realized that there were large water tanks up there. Fearing that one may have toppled over due to the strong winds, I went to find my dad. Obviously I didn't want a mini flood to happen in the attic and leak down my ceiling.

Dad took a flashlight, climbed up the ladder and opened the panel. Shining the light around and giving the attic a quick scan, he found nothing amiss. All 4 tanks were there, and all were upright, and there was nothing else there. Satisfied, I went back to my room. By this time, the storm had subsided, and the rain was slowing to a gentle drizzle. I turned off the lights, went under my covers, and settled to sleep.

My eyelids flew open. There's the sound again. Louder, and much longer now. It's rolling from one corner to the other, going faster and faster and faster. In the dark, I stared at the ceiling, my heart in my mouth. Squeezing my eyes tightly closed, I started reciting prayers. I could hear the rolling getting even faster now, and so loud I'm surprised the whole house didn't wake up. As I neared the end of my prayers, it suddenly slowed down, and when I finished it stopped abruptly. The sudden silence was deafening. Whatever "it" was, it stopped.

I never found out what "it" was (probably never would), and to this day I have never had such an experience again. But I'm glad "it" chose to stay in the attic instead of visiting me in my room...






Friday, September 11, 2015

The Magic of Ghibli and the Tortured Genius

If you know me, you'd know than I am a major anime fan. And of course, a major Ghibli fan. For those of you who don't know (gasp!) Studio Ghibli is an animation studio that have released countless animation films that have won accolades and hearts all over the world, and their biggest star is director, Miyazaki Hayao. If you have never watched a Ghibli movie or assume that animation films are only for kids, you are losing out on a magical world that will make such a deep impact on you. Give it a try, and I'd suggest either Spirited Away or My Neighbour Totoro as a start.

Anywhooo, I just watch a documentary about Miyazaki Hayao, focusing on him and Studio Ghibli as he makes his final feature film, The Wind Rises. It's a very special sneak peek into the mind of a creative genius whom one could say is the greatest living animator, and into the process that goes into a Ghibli film. This documentary, called The Kingdom of Dreams and Madness, is a work of art on it's own.

As one review put it: "it’s an emotional gut punch on par with anything from the director himself. The Kingdom of Dreams and Madness should be considered essential viewing for any Studio Ghibli fan, for whom it will stand alone as a captivating work in its own right."

 I'm not going to talk much about the documentary, as it is best enjoyed by watching it. But I am going to share some thoughts that Miyazaki shared, which have struck a deep chord within me.

"We're born with infinite possibilities, only to give up on one after another. To choose one thing means to give up on another. That's inevitable. But what can you do? That's what it is to live."

I think a lot of dilemmas we have, especially in our adolescent years, is the struggle to choose a path knowing that we have to give up on all the other paths, and the insecurity and doubt of not knowing whether the path we've chosen is the right path, because we've given up on the others. But as Miyazaki put it, that's what life is. You make a choice, never knowing what the future holds, and hoping that what you've chosen is what's right for you. Then you put your faith in God, and that He will give you what's best for you. That's how we live.

"Today, all of humanity's dreams are cursed somehow. Beautiful yet cursed dreams."

This gave me chills, because I could feel the steel of truth beneath the words. Here, Miyazaki was talking about how people who design planes and stuff with the best intentions, yet those planes are used as tools for industrial civilization, or worse, for war. (watch The Wind Rises and you'll get the war plane reference :P) So even the best intentions and dreams are cursed because they are vulnerable to being polluted and manipulated for the worst purposes and outcomes. Like dynamite, like electricity, heck, like the internet, tools are double-edged swords that can be used for good or evil. It's the curse of humanity, perhaps, as long as we are capable to be good or evil, to forever be caught between these opposing sides.

You hear the phrase "tortured genius", and I wondered why that phrase came into existence. Watching Miyazaki though, I think I understand. His colleagues call him an idealist, that he asks for the impossible from his staff. A genius' talent probably allows them to see a completely different world, and they see how perfection can be achieved. But because we're only human, that perfection will always be just out of reach. Despite reaching great heights far beyond others, they will never be satisfied or happy with it, because they can see what could be, they know there are greater heights. Yet they continue to struggle and strive for it,  and so end up a tortured genius. I'm no genius so I don't know if this is true, but it's what I felt when listening to Miyazaki talk about his work.

Ok, my feverish ravings will stop here. Just some thoughts I wanted to share. Now I shall go have a cup of tea while I contemplate these pearls of wisdom (?) and unravel the ball of jumbled up emotions this documentary has made in me.


Saturday, June 6, 2015

Tales of the Supernatural #3: Don't Forget the Password

Summer is coming soon, and for those countries with four seasons, summer is the season for camps. In Malaysia, where it is eternally summer, camps obviously run year round. Most kids have been to at least one camping trip, either organised by family or by their schools. 

Being the superstitious lot that we are, whenever there is a camp in a remote jungle or beach area, we will always get the "rules to respect" talk on the first day. Nature is to be respected, and we are not "alone" in wherever we are. Everyone is warned not to be disrespectful, such as making too much noise, making rude or distasteful comments or jokes, dressing inappropriately or doing inappropriate *ehem* things. 

Another thing that they also did is to give a "password" to all campers. This is usually a simple word or phrase, easy to remember, such as Coca-cola. The point of the password is to identify whoever we were speaking to as a real human camper and not some....other entity. We were advised that whenever speaking to someone after dark, we should first verify that they are humans by asking them the password. If they got it wrong, well...start running. Or screaming. Or both.

I remember thinking at the time, that if they were announcing it out loud to all the campers, surely all the other "beings" around us could hear too, but oh well, it was almost like a camp tradition. It was not questioned.

One time, I was in such a camp, with such a rule, situated on a beach. It was a school event, and I was there with loads of other students. After all the evening activities had ended, it was time to sleep. As girls are wont to do, we were having a short gossip session before bed, giggling and whispering in our camps. One of the girls felt the need to go to the toilet, and being a scaredy cat, she insisted one of us go with her. So the pair of them left, and we continue our gossiping.

Around 15 minutes later, one of the girls came back alone, and asked if the other had came back before her. We said she hadn't, and then started to worry. Four of us, including the first girl, then went off to look for her. We saw her coming back from the direction of the toilet, and breathed a sigh of relief. As a joke, one of the girls said, " We thought you might have been kidnapped by spirits!" We all laughed, and another one said, "Guess we better check! What's the password?"

"Gula-gula." 

We all stopped laughing. 

We ran.

The missing girl was later found back at the camp, sleeping. She didn't remember how or when she came back from the toilet. No one mentioned the incident to her, and we never spoke about it ever again. 

So, kids, whenever you go to a camp, remember to respect nature and follow the rules given. And don't ever forget the password. 

*Note: Gula-gula means candy in Malay. The actual password for that camp was Coca-cola, in case you were wondering.* 


Wednesday, May 20, 2015

Look around you


When you see motes of dust floating in a ray of sunlight, 
does it make you think they're dancing and puts a little smile on your face?


When you look at the night sky and see the millions of stars twinkling at you,
can you feel the entire universe expanding outwards all around you?


When you stand at the top of a summit and see the land stretching endlessly below you, 
does it make you gasp in awe and take your breath away?


When you stare out to the sea and hear the waves crash, 
does it fill your heart with indescribable emotion and make your spirit soar?


When autumn comes and the leaves turn into brilliant shades and fall, 
do you feel inexplicably nostalgic and just a little bit more grown-up?

Because if you feel none of these things, 
   if nature and everything around you 
    don't have any effect on your heart and soul, 
      then the beauty of the world is wasted on you, 
        and you don't know how much you're missing. 

"If then, I were asked for the most important advice I could give, that which I considered the most useful to the men of our century, I should simply say: In the name of God, stop a moment, cease your work, look around you."   
- Leo Tolstoy


Oil and Water

You know how oil and water don't mix?

Oil is less dense than water, so oil will float on top of water. This video demonstrates that very clearly.

We use the analogy of oil and water to describe people or ideas that just cannot get along, to convey that concept that the two things are innately incompatible.
But oil and water can mix. My makeup remover uses this concept to remove my waterproof makeup. All you have to do is shake the bottle hard and for a while, oil and water mixes together and works in harmony to remove my makeup with minimal effort. Pretty impressive for two innately incompatible liquids.

I'm sure you've seen it before too. Petrol spilled on water, creating iridescent colours, like molten rainbow. Again, the contrast between incompatibility and harmony is clear; in fact it is that incompatibility itself creating the beauty and harmonious colours.

I'm sure people are like that too. That's why they say "opposites attract", but perhaps it should also say "opposites complement each other". What is lacking in one is present in the other, and the two opposing nature's working together creates a whole new harmony.

But then again, my sister and I are complete opposites and we fight all the time, so perhaps not all opposites work very well together?