Malaysian Voters Living Overseas

Malaysians living overseas who are registered voters & have returned to Malaysia for not less than 30 days in the past 5 years, why not submit your Borang 1Bs (click link to download). The irky bit is filling up the dates of returning to Malaysia in the form, the reason yours truly was very tardy with submission. You can email or fax it in.
Exception of living in certain countries very close to Malaysia. Check out the link for details.
http://says.com/my/news/malaysia-ge14-postal-voting-application-open-to-all-malaysian-voters-living-overseas

According to the EC, applications will close on the day the Parliament is dissolved, and any applications received after midnight on that day would not be processed. All applications would be processed by the EC and applicants would be informed of their application status.

Parliament will be dissolved tomorrow, Sat, 7th April 2018.
Masih ada masa lagi! Lets exercise our rights as warganegara Malaysia 🙂

 
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World Autism Awareness Day

Yesterday was April Fool’s Day.
Today – Happy World Autism Awareness Day! ❤

What is to be happy about it? That we have more awareness, modalities of diagnosing Autism Spectrum Disorder (ASD), and early interventions to help children with autism cope and shine in this big bad world (which can be pretty scary to them) & assist their carers and family.
Do watch this animated introduction to autism video (translated into many languages), simple enough so even kids can understand: Amazing Things Happen – by Alexander Amelines.


Autism is a chronic condition, not exactly an illness. The way a person with ASD’s brain works is different. There isn’t a medication to ‘fix it’. With 1 in 160 children having ASD (WHO’s fact sheet – updated April 2017), everyone of us would have come across someone living with ASD – be it a child, adolescent, or adult. The TV series The Good Doctor & movies like Rain Man (hollywood) and My name is Khan (Bollywood) would have given us a glimpse of living with ASD, though not 100% accurate.

 

Lying across a broad spectrum, ASD is almost like the colours of rainbow – refractions of light in different wavelengths. One can find people living with ASD from highly functioning like in Asperger’s syndrome, to the severe end of profound intellectual impairment. They don’t have characteristic facies – no tell tale physical signs unlike Down Syndrome.
Often mislabeled as naughty kids in school, probably even in my schooldays when awareness was low. And punished for it too! Sad, isn’t it?

The million dollar question is – What causes Autism?
How can we prevent or cure it?

Research suggests there isn’t a single pinpoint cause for autism. Instead, it is multifactorial – with genetic cause believed to be one of it. The exact gene or pathway is still unknown. To date, there is no proven preventative methods or cure. As we speak, more research are underway.


This Mark Twain quote resonates with the outdated vaccine(MMR)-autism link myth.

“A lie can travel halfway around the world
while the truth is putting on its shoes.”
– Mark Twain

A case of fraudulent science! 😦
We still get a lot of antivaxxers quoting the infamous journal article by Andrew Wakefield published 20years ago on 28th February 1998, in The Lancet, a prestigious medical journal. The former British surgeon (gastroenterologist) & medical researcher falsified his findings – methodological flaws were identified in that study.

Unfortunately, it wasn’t until 2010 that the article was retracted by The Lancet (an apology was printed in the journal). Andrew Wakefield was struck off the UK’s General Medical Council registration in the same year too. As a result of one unethical paper published, loss of herd immunity resulted in many admissions for serious complications of preventable diseases like measles, and even some mortalities.

“Such claims prompted a slew of studies finding no evidence that MMR causes autism. For example, a 2014 meta-analysis in Vaccine examined studies involving a total of almost 1.3 million people. That same year, a paper in the Journal of the American Medical Association reported that no difference existed in autism rates between thousands of vaccinated and unvaccinated children.” – Four vaccine myths and where they came from, Science magazine.

More on vaccination myth busting – a link to Queensland government website.

Just like how autism is not due to vaccines, autism is NOT caused by bad parenting, nor dietary choiced. Period.


Autism can be diagnosed at any age. Often picked up due to developmental delays in a child especially delayed speech, we now have many advancement in diagnostic tools.

In ASD, the 3 main areas of development that is affected are:

  1. social interaction and communication
  2. delayed language development
  3. impaired imagination and play

Typically, they might seem shy, pointing out rather than verbally asking for things. Have certain repetitive play patterns or routines, even repeated the same word or phrase over and over again. They might get agitated at a change in routine – they seek familiarity and patterns.

Avoiding eye contact doesn’t mean they are rude. Same goes if they don’t catch your sarcasm of joke. Idioms are often lost on people with ASD as they tend take things literally.

When the routine is distrupted or they face sensory overload, they might go silent or exhibit stimming (repetitive body or object moment) behaviours to calm themselves down. These aren’t tantrums nor to irritate others.

Those are just some examples.

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Some children may fall in grey areas, and might need repeated assessment at an interval, before confirming the diagnosis of ASD. After ruling out hearing problems, usually a Paediatrician, (Behavioural) Psychologist, Speech Pathologist play essential role in confirming a diagnosis of ASD in a child. The above specialties, along with Occupational Therapist, a multidisciplinary team approach is often required in managing children with ASD. One can’t downplay the role of support groups either.
Your GP, as a gatekeeper help coordinate, and are available as first contact and support point throughout, for people with ASD and their families. Autism can co-present with other medical conditions too.


Although I was only a Paediatrics medical officer for 2 years, as a GP I find my experience in Paeds immensely helpful, (among others) in befriending people with special needs, and their families. Personally, no compliment is greater than the trust of a patient & their family.

People with autism aren’t weird. They are just like you and me. This is an important message for people who are living without autism, especially children. This will aid acceptance, and integration.

Instead of gawking at them, making fun, or being cross – Be a friend to them. And you might be invited to share a precious little piece of their amazing world 😀

 

 

Dedicating this article:
– To my patients who live with ASD – especially the child who ran and cowered upon first contact with me 2 years ago, but at our latest consult last month shared an interesting app on ipad with me. Despite the minimal eye contact,  trusts me enough to share honestly.
– To the family of my patients who live with ASD – especially the family who initially struggled with accepting the diagnosis, but is now beautifully supporting each other across 3-generations.
– To the family and friends of families of people living with autism who step up as respite as and when needed, just so the mom could attend a doctor’s appointment or have some me time for herself – hats off!
– To all healthcare professionals, social workers, teachers and anyone and everyone who’s work involves making the world a little friendlier place for people with ASD & their families.
🙂

Let’s spread the awareness!

References:
http://www.autismawareness.com.au/
– http://www.who.int/mediacentre/factsheets/autism-spectrum-disorders/en/
– https://www.rch.org.au/kidsinfo/fact_sheets/Autism_Spectrum_Disorder
– 
http://news.bbc.co.uk/2/hi/8700611.stm
– http://www.sciencemag.org/news/2017/04/four-vaccine-myths-and-where-they-came

– http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/F466A36DFA42DD93CA257F0F000216D7/$File/What-about-austism.pdf

Posted in Down Under, Myth - Busted!, Public Service Message | Leave a comment

Help – Little Akira who is fighting for survival

Dear readers,

I believe kindness is borderless. So, even if you spare $1 and 1 minute of your time, it will go a long way for this fighter bub Akira & her family.

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Summarizing some information from the fundraising page set up by mom – Little Akira fights for survival & update from bub’s dad.

How little is Akira?
Born at 27 weeks 6 days on 1st October 2017
Birth weight – 1.02kg
Latest weight – 1.088kg

Who is Akira?
A 1 month old plus Malaysian baby born in Japan due to unforeseen circumstances.

Where is Akira now?
In a hospital in Tokyo, in a NICU (neonatal intensive care unit).


Akira’s dad was my batchmate in University, and a practicing doctor in Malaysia.

Due to unforeseen circumstances, Akira, who is now 1month+, was born prematurely in Japan & now needs special care until she is big enough (when she is 2.5kg weight) to be discharged home.

Healthcare anywhere isn’t cheap for visitors. Health insurance unfortunately doesn’t cover childbirth & newborn. As such, the estimated total medical expenses for Akira is approximately ¥25 millions (around USD $225,000 or Ringgit Malaysia RM950,000).

That is almost RM1 million! No joke!

Both Akira’s parents are Malaysian government servants. Her dad is a doctor in a government hospital. I can’t imagine how they can afford the bill they will be slapped with when the happy day for Akira’s discharge arrives.
Being a doctor that helps many day in and day out, it is sad that we aren’t immune to paying medical bills!

The family still have a long way to go to achieve the sum required. They need another 60% of the amount. As most of their family & close friends have chipped in, they are hitting a plateau as far as contributions are concerned.

Having worked in a Paediatrics department & handling premature newborns like Akira day in day out for almost 2 years, there are babies who are more prematured that we have taken care of and seen them grow up healthy and strong in the upcoming years 🙂

However, the emotional (and financial ordeal) Akira’s parents & their near and dears are going through right now is unimaginable! Doesn’t help that the family is facing flood back in their hometown in Penang now too.

Your contribution will be of great help to the family & in getting little Akira home when she is ready! Details on how to lend your contribution (bank transfer or credit card via gogetfunding page) & mom’s story can be found here : Little Akira fights for survival

***

If 1 person donates $1, it will go a long way. If a million people donate RM1 each, that will reach the target in the blink of an eye. To quote the crowdfunding page :
“Did you know that a 10 second Facebook share raises an average of $25??”

I found out that Akira means ‘Graceful Strength’ in Sanskrit. As she lives up to her name, May God be with her & her family.

Keep Akira in your prayers & do share on this link.
Thank you!

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‘Rude’ is an understatement.

Never thought I would actually have to put this up – one day! July the 13th, 2017 is the fateful day! With the mayhem that it was, it is a wonder that it was a Thursay, and not Friday the 13th :p

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Many a days, I’ve been irritated and irritated-politely ask patients to continue their conversation or pick up that call later. That wasn’t the issue today, though. Should have been NO GADGETS during consultations – I might create my own – Grrrr.

***

Ranting time, here goes:

She walked in with her semi-cracked-screen tablet into my room.

In the first quarter of my work shift today, within minutes of being seated, she was complaining about my colleague that I referred her to for a procedure – my RED FLAG mode was on! I defended my colleague (as per professional ethics) & in fact apologized on the other doctor’s & clinic’s behalf for her feeling that way (she claimed she was treated rudely and made to wait without having the procedure done, not once but twice).
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While I was having a look at her results, asking further history, and printing out some documents, madam was meddling with her tablet while talking (mostly complaining) to me. I was irritated, thinking ‘Behaving like a teenager, who doesn’t know what respect is’, but decided to keep quiet.

While auscultating her lungs from her side, she was still holding the tablet & that is when I noticed there was a moving image of hersef on the tablet – she was viewing a video of herself she recorded earlier! And I saw my wall-mounted otoscope & opthalmoscope on her screen background!!

She finally placed her tablet down when I queried, saying that is her own recording, nothing to do with me. The video recording was still running silently.
I completed auscultation (I guess I did my job still, despite my prejudice & irritation) & 
kindly asked her to delete the video.
Sshe said it is her own thing, nothing to do with me.

I asked her to show the video to me, she showed the first file, her mouth was moving as if she was talking – but it was a silent version. Horrors of all horrors, I saw part of the comment accompanying the moving image on her tab “Hey guys, …see an X’s nose…(few sentences long – a paragraph) following that, which I couldn’t read as she hid the comment & it started playing just the silent video.

?life recording
?uploaded to social media
I masked my pissed-offness & still politely requested her to delete it NOW.
Once again, she challenged me that it has nothing to do with meI said it is unethical of her to record something in my room (during a doctor’s consultation) without my permission, as there would be background noises of our conversation.

That is when I lost it.
She : Don’t worry, I didn’t record you. I just recorded myself.
I      : sarcastically Just because I don’t have a sign up saying you can’t record, doesn’t mean you can do it.
She : rudely Yes, you don’t have a notice in here. I know my rights

I      : It is common (almost said common sense) courtesy & knowledge

She : You don’t have to worry, I didn’t say I am at this doctors

I requested her to show me the video with volume & the words she has typed (I reached out for her to show me). She hurriedly pulled her tablet away & packed it into her bag, saying “You aren’t touching my tablet!”

I firmly told her to delete it now in front of me.

She : I know my rights. You just give me my MC

That was her agenda all long for the day, which I sensed from the beginning.
I       : I can’t help you as you are rude

She stomped out saying she will see another doctor to get her MC.

*
Still couldn’t find the exact sign I am looking for – no use of gadgets/photos/recording during consultation (unless if you are a kid accompanying parents, then keep the volume minimal). 
This is probably the closest to what I am looking for:
No Cameras No Cell Phone No Video Sign

Source: http://www.mysecuritysign.com/fos/no-cameras-no-cell-phone-no-video-sign/sku-s-8871.as

But then again, some smart-arse might say “There is no ‘No Tablet’ sign”
ROLL EYES!

#whencommonsenseaintcommon

Posted in All in a Day's Work, Oz GP | Leave a comment

A Random Stranger

After handing over my car-key for service, was in line at the coffee machine when this elderly (old-old) gentleman, X caught my eyes. The manager was personally attending to him, making him a cuppa off the Nespresso machine. X was regaling a story about his 98year old friend, this lady who…blah blah blah.

With my hot cup of wake-me-up expresso in hand, I headed to the lounge & as what most of us are guilty of doing, started scrolling my phone. All along, couldn’t help noticing X out of the corner of my eyes & unintentionally eavesdropping on their general chats.

I smiled as X took the seat opposite myself.

X    : (returning my smile) Are you a customer here?
Me : Yes, I am (shutting my phone cover)
X    : Me too.
Pause. He took his seat.
X    : Are you buying a car?
Me : Nah…servicing.
X    : Must be a pretty new car.
Me : Almost 4 year old.
X    : If you had a car as old as mine, you’d just want it to not break down anywhere. Laughs
What I don’t like is coming back with a complaint. I was here yesterday. But, well…small issue.
Me : Oh dear. What happened?
X    : looking awkward. It would be very inappropriate of me to speak about it. Look, these guys are good. It is just a small matter. I shouldn’t speak of it.

But I reckon my question scared him! He stopped speaking to me after that, and didn’t entertain my small chats much.

*

Well, Mr Grandpa impressed me big time! 😀

We are a generation of keyboard warriors! Very quick to comment or pass judgements, and make them viral in social medias & make a big hoo haa – a mountain out of a molehill, often. I admired X’s principle there.

I can’t remember when was the last time I made small talk to a stranger who isn’t a customer service person or because you had to. Oh no, I’m lying – there was this young-old gentleman I struck up a conversation with 2 weeks ago while queuing up at the bank. But, you get my drift? It is sooooo rare! I usually check out my social media, or catch up on reading up some interesting article when stuck in queue or am waiting for something or someone. Just like most of us – it is my phone that has my attention! Sad, uh…

Unlike the pre-technology-boom era! Where people, even strangers actually speak to each other to while away time. Nowadays it is common to see families & friends hanging out together in the physical sense, but each to his/her phone. We spend more time virtually than with one another. That is really sad when people do not value those who are in front of them, but glued to their phones instead.

Image result for family phone hang out

Seriously, we must be the most technologically evolved, yet poorest generation when it comes to real-life communications.

*

Back in the car showroom…

X got attention from all the staffs.

As he was leaving, manager told X, “Don’t worry, I’m sure you will bring in your car for service when you turn 100 years old.”

How sweet.

#heartwarming

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The Miracle of Gratitude

Thursday morning, I shared a post that appeared on my Facebook Memory from 1 year ago. Sharing the screenshots here. Kindly disregard the grammatical errors :0

Screenshot_2017-06-29-23-42-46_LI

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Screenshot_2017-06-29-23-45-48-1

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Screenshot_2017-06-29-23-43-46

In the past year, I’ve treated their 4th family member too, which makes it all of them.


This evening at work, I saw the very patient’s name on my appointment list. That did put a smile on my face 🙂

Little did I suspect after running on time till 750pm, the rest of the night would be a craze! After a maddening hour of attending to emergencies & seeing patients who took longer than their allocated 10 minutes, it was her turn. I was apologizing profusely as she was waiting more than half an hour, actually, close to an hour!

Never in my wildest dreams – such a serendipity!! On the very night after sharing the memory too – WOW!

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She was in last week accompanying her husband who was unwell. That was one week into yet another nasty coughing episode (which finally almost stopped today!)
And today she brought me her homemade remedy of lemon-honey-seasalt as a get-well-soon little something (hope you have already recovered, but you can use this for the future)!
Now now, isn’t that sweetness overload? 🙂

This patient definitely made my day! Blessed I am…

She made me appreciate the law of Miracle too – GRATITUDE!

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The Big-C

The year I entered Medical School…
I had an aunty who was battling terminal cancer. Lost her at the beginning of that year – 2002. Hardly a month after she turned 49!

It was hard to see a dynamic woman bedridden, suffering in pain…to say the least. Berat mata memandang, berat lagi bahu memikul. Literally means ‘as hard as it is on the eyes that see it, the harder it is on the shoulders that carry it’. 

The Big-C! How I hate it…I am sure everyone does.


So, I entered Medical school with the thought of ‘helping people’. Losing a mother figure that I’ve had all my life made me take cancer seriously.  That was one reason I chose palliative care for my electives in Uni. I learnt an essential life lesson : It is from those who are dying that you learn how to live!

All along the journey (student & work-life), determined to do my best for each patient, as if they were a family member (for most of them, anyway).

Perhaps a tad selfish too.
You pray someone else will take bloody good care of your family, near & far – Their Doctor!
You believe what goes round comes round.
We doctors often miss being there for even our family members who are near, due to work commitments. I’ve known doctors who continued working while their own appendix was rupturing…

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Fast forward many many years later…
It struck again, and again.

An uncle of mine – I couldn’t even attend the funeral as I was on-call & couldn’t change the weekend call at such short notice. Although I wasn’t close to him, he has always been kind to us.

Cousin’s Grandfather – the hospital detected Big-C incidentally, only towards the end of his life when he was admitted for pain.

Grandmother – while undergoing palliative radiotherapy.

The latter 2 people lived to a ripe old age.

My best friend’s daddy whom I met at my family wedding, and a day later – lost his battle only few months after being diagnosed!

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About 1 month ago, lost another aunty (my parent’s cousin) to a recurrence. Always enjoyed a good chat whenever we met at family events. She personally shared her journey after losing my best friend’s dad who had a somewhat similar disease, a day after his funeral, 2 years ago. Heard that she was ill again. Was intending to visit her when I go home soon, but it was never to be.
Rest In Peace _/_

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2 weeks ago…
Another aunty lost her battle to terminal cancer. Another mother figure. All her 3 kids are doctors! Sigh…and we couldn’t do anything, medically! She had to have the type that has very poor prognosis. Isn’t it painful to even read this?
She was only 56!

Thanks to my gem of a boss, I managed to visit her few weeks after her diagnosis – hardly 2 months before her time was up. I still can’t believe she is no more. I have good final memories of her…the last conversation was a short and sweet one during Mother’s Day. She was too ill & I never spoke to her again.
I was hoping against hope & keeping faith that I will get to spend some more time with her again during my upcoming planned holiday, that she will live on to see a few milestones in her family later this year. But…sigh! God had other plans.
Rest In Peace _/_

*
Again and again, it struck & won! Took away people close to me & makes me feel helpless.
A common denominator – some of the loveliest people on planet Earth. Nobody is perfect – they have their flaws. But, they aren’t the type to harm another.

And when it involves relatively young people who have yet to live for themselves – SIGHhhh! 60 or 65 is the official age to be considered old, isn’t it? Why this kind of suffering towards the end? I know…Buddha said Life is Suffering.
But, Karma??? my foot! I am losing Faith in Karma…

Especially when I see toxic people who make life hell for others, being blessed. Okay, so they might be suffering in other ways, that we bystanders can’t see…you say? That’s another story altogether.

Image result for karma is fake

That is, IF you Exist!

But for the nicest people, why of all the things, why Cancer? Why that much of suffering?! I continue questioning…


15 years since my first experience in losing a yet-to-be-old dear aunty to the big-C, and comparing with my latest loss merely few days after celebrating my 10th working anniversary, my thoughts are different now. Losing another yet-to-be-old darling aunty of mine, now my only thoughts are : What is the point of being a doctor?
Both of them came into the families before I was born. They have always been there as far as any memory or photo (of mine ) goes. And just like all the other dearly departed – they join the ‘Memories’ part of life. No more reality.

I hate you, big-C. I hate you from the bottom of my heart!

P.S: One thing that I hate more – Fake news about cures that belittle medical approach! Just like those anti-vaccine movements, I’m seeing alot of anti-cancer treatment posts on social media angerAlternative treatment as an adjunct is fine – Faith wins half the battle. Provided, it IS NOT harmful!!!

tomb

As the age old lesson goes : Treasure people. Tell & do things that you intend to without any delay. Show them the love NOW. Not when it is too late.
Live Life to the Fullest.

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