Wrap My World Around You: November 2008

It has been a while since the last post. My apologies for that, hehe. I am back in Brunei for the past 2 weeks and have been super busy with the starting of my elective here. Rasanya macam orang keraja ada jua since it's following the office hours, staring from 8am-4:30pm, so whenever I returned home, I would be so tired from the day's activities, at times jalan-jalan ke kadai lagi apa, hehe, so updating my blog has always been put on hold. I have been spending the first two weeks of my elective at the Sungai Asam Health Centre, which ended yesterday. I have to say, I have learnt quite a lot from my time there. The staff are friendly, the doctors are always willing to answer my questions and queries and the atmosphere is really great. The first week of my stay there was mostly spent observing how the doctors as a general practitioner work and interact with the public. The second week was mostly spent doing history taking on the patients, then presenting the cases to any of the doctors available. They would usually explain the cases including the clinical signs and symptoms after the consultation which helps me to understand the cases furthermore. I spent most of my time at the outpatient department. Other times, I spent some time as well at the maternal care health clinic, during the antenatal, prenatal and post-natal sessions.

The health centre was quite far from the hospital. It takes 45 minutes to get there by car. The quickest way to get there would be by the hospital boat. I opted to go via the hospital boat, which comes and goes at specific times from the hospital jetty. My day would go like this; arrive at the hospital jetty by 7:20am, then get on the boat with other doctors and some nurses which will leave at 7:30am, make a stop at one of the water village jetty to pick some nurses, then arrive at the Health Clinic jetty by 7:45am. From 8am onwards, do whatever was scheduled for the day. At 10:30am, we would have a quick break at one of the rest room/kitchen, then get on seeing more patients. The clinic closes at 12:15pm. The hospital boat would leave the clinic jetty at 12:15pm for the hospital. At 1:30pm, the hospital boat leaves the hospital jetty for the Sg Asam Health Centre, arriving at 1:45pm. The clinic starts at 2pm till 4:30pm. Then at 4:30pm, we would then get on the boat at the jetty, stopping at one or two water village jetties before finally arriving at the hospital jetty.

The Health Centre is quite modern, including the outpatient services, dental clinic, dispensaries and maternal care health clinics. The main front entrance leads to the main road while the back entrance leads to the jetty and the water village. To clear some questions, the centre itself is on the land, but is accessible via land and water. It also caters to those living in the water village.

I think I managed to spend quite a lot of time with the doctors there, since we waited for the morning hospital boat together and went back to the hospital via the boat also together in the afternoon, aside from the usual clinic time. I was usually with Dr D, Dr J, Dr K and Dr E at the jetty. The water ride was not as choppy but at times ada jua masa perancitnya arah my baju and glasses. Nampak the water village, the Omar Ali Saifuddien mosque, yayasan complex, Mahkamah building and the Bandar from the boat ride. Oh and it is a free ride as well, hehehe. At times, when the water level is really shallow or "tuhur", we would need to disembark from another jetty further out front from the centre, so we have to walk along the "titian" passing some of the kampung air houses along the way.

From the elective, I learnt that a GP works differently than a normal doctor would. A GP would try to ask the right questions, diagnose, and manage the patient who came in to see them within a space of 10 minutes. This is done through years of experience and it is also important to follow your instincts. It requires great skills really. A GP would look at the picture as a whole, looking at any possible risks associated with the complaint presented, as well as advising the patient of the best management plan but at the same time, making sure that the patients believe that they have the power to make their own decision on whether to follow the doctor’s advise or not. A normal doctor who specialises in an area would have made a more thorough history taking than a GP would. A GP would have to know at least a little bit of everything, but they would need to be able to classify whether a case is surgical, neurological and so forth before referring the chronic cases to other specialists.

From some of the patients that I saw, the “flu” is a common occurrence as well as some diabetic (kencing manis) and hypertensive (darah tinggi) patients, some with rashes, low back pain, asthma and so on. According to my supervising doctor, the health care systems in other countries are quite developed with appointment systems and so forth in place. In Brunei, the patients can just come to the clinics and see the doctors, though some with follow ups will be given appointments and such. From what I can see from my first day, there seems to be a problem with compliance in terms of medication. Some of the patients admitted that they stopped taking medication when they feel that they are getting better, and only took them when the symptom arises back again, when they have actually been instructed to take their meds everyday. The doctor did talk about this being a problem in some of the cases that she has seen over the years. The social care system here is still underdeveloped as pointed out in certain cases.

During my visit to the centre's dispensary, the diabetic and the hypertensive medications are the most "popular" medications given out on a daily basis, in addition to the usual flu and cold medicines.

During my stay at the maternal care health clinic, I stayed with Dr Z who keeps calling everyone "dear" that you couldn't help but warm up to her. We saw pregnant mothers who came in at different weeks of gestation period (pregnancy). I observed as the doctor interacted with the patients. Some of the mothers were rather hypertensive (high blood pressure), so some of them have to be sent to the hospital for a few hours of rest. Some of the mothers were underweight and were advised to eat more and sit with the dietician to discuss their eating habits. She also explained the differences in the uterus between tall and short statured mothers. For short-statured woman (148cm and below), their uterus is much smaller and narrower and thus risks of complications during pregnancy is higher. Mothers are also required to take supplements such as folate which is important in the proper development of the baby’s brain. She also explained the classification of mothers depending of their age. Under 20 years being underage pregnancy, and over 35 years being elderly pregnancy which included certain risks of the baby having down syndrome, heart problems, etc. The stuff that she said does correlate with some of the stuff that I have learned this year, thus this helps in my further understanding in the subject. She taught me on how to check whether the baby is in the right position for birth by palpating the mother’s tummy. This includes ensuring that the baby’s head is at the bottom, near the pubic bone. In one of the cases, the baby was in the transverse position, which may be difficult at the time of birth. She also showed how the ultra sound was used and how to identify the head, limbs, abdomen, back musculature, heart of the baby and so on. We could actually estimate the weight of the baby at the time of the ultra sound as well, which is pretty cool, hehe. The normal weight of a baby at the time of birth would be between 2.5-4kg. The position of the placenta (tebuni) would also affect the smoothness of delivery. Normal placement would be on top of the uterus. Lower placement such as at the side of the uterus would be dangerous as this may lead to the loss of a lot of the mother’s blood during birth. I am boring you, am I not? Hahaha… She went on to explain on the careful removal of the placenta from the mother’s womb after birth and lots of other interesting facts about pregnancy and birth. Oh and she also absolutely forbids mothers from “berurut kampong” during pregnancy. Somehow I forgot to ask why…

There are a few memorable events during my elective there. One early morning, when it was raining quite lightly, we spotted not 2 or 3, but 6-7 monkeys playing on top of the roof of the boat shed not far from where we were standing on the hospital jetty, playfully passing a few fruits among themselves! haha.. Dr E said that sometimes occurs. That was the only time that I managed to spot the playful monkeys the whole 2 weeks I was there. Another interesting event occured just yesterday. While we were on the boat early in the morning, the boat driver spotted smoke from the distance and suddenly shouted, "Fire! Fire!" Everyone on the boat immediately craned their necks to see out front much better. True to his words, a house on the water village was on fire! I could see smoke billowing from almost every corners of the house and fire can be seen from a nearby window. The boat driver slowed the boat as we neared the house and shouted for someone to call the fire department. A few boats or "tambangs" were seen floating around the place. Some of the water village people were seen out and about near the house on fire and some were seen on the phone. It appeared like there was no one in the house at the time of the fire or the owner may have escaped from the fire. We don't really know the whole story at that moment. No bombas or fire fighters were seen at that time. We then continued on our boat ride towards the health centre. I usually spent my lunch time there, since it would take a lot of time to commute back and forth home. There are no cafeterias available, but a small "koperasi" selling the usual "nasi" ayam, etc and mee as well as some kuehs and snacks is available.

Like I said before, I have learnt quite a lot from my elective at the clinic and I am feeling more confident with some of the experiences that I have had in doing history taking. I have to admit that I am feeling quite sad to leave everybody after getting to know them these past 2 weeks. Tomorrow I will be starting on another 2 weeks of elective at the gastroenterology department at the main hospital.