Kembara Doktor Muda Ep 2 : Di Daerah, Lain Bah

Assalamu’alaikum,

SAYA DARI METROPOLITAN

Sekali-sekala, doktor muda akan menghantar pesakit ke hospital besar untuk dirujuk. Maka terpaksa juga menghadap big boss(doktor pakar) di sana, yang sebelum ni hanya ‘layan’ di telefon saja. Kalau semasa latihan perubatan siswazah dulu, soalan di mana kamu belajar ditanya, sekarang pula big boss akan tanya boss kecil dari mana kamu tamat latihan.

“I have never seen you before!! Who are you, where are you from??!!” terjah doktor pakar. “I’m Doktor Muda. I’m from Hospital Metropolitan,” jawap saya. “Oohh........,” rendah suara doktor pakar.

Pelik saya rasa, doktor pakar tidak bertanya soalan bertali arus selepas itu. Rupanya ‘gah’ nama Hospital Metropolitan di sini.

Namun sebenarnya, doktor muda rasa tiada bezanya latihan di sini dan di sana. Malah mungkin pegawai perubatan siswazah dan juga pelajar perubatan di sini lebih terdedah. Penyakit-penyakit yang saya tidak pun terdedah sebelum ni.

Tidak kisah dari mana kita datang.
Kita akan lalui jalan yang sama jua akhirnya.

KENAPA LAMBAT BAH

Atas faktor sosial, pendidikan rendah, jarak tempat tinggal, ramai pesakit yang tiba di hospital daerah dalam keadaan yang teruk. Sepatutnya jika mereka datang awal, keadaan tidak akan jadi begitu.

Doktor muda pertama kali melihat pesakit yang mengalami ileus dan urinary retention disebabkan hyponatremia. Kerap melihat pesakit hypokalemia dengan adanya ECG changes. Penyakit setahap sedemikian disebabkan hanya oleh kekurangan garam, berlaku disebabkan kelambatan pesakit mendapatkan rawatan.

Kanak-kanak metropolitan yang mengalami bronchopneumonia tidak pernah doktor muda dengar crepitations pada paru-parunya. Ini kerana kebanyakan mereka semua adalah partially treated, mudah mendapat rawatan antibiotik sewaktu awal penyakit. Berlainan di sini.

Pengalaman merawat pesakit bleeding placenta previa major yang dibawa menaiki bot dari sebuah pulau berdekatan tidak dapat dilupakan. Setelah distabilkan di hospital daerah, kami perlu hantar ke hospital besar pula untuk rawatan selanjutnya. Perjalanan di dalam ambulan membuat doktor muda gemuruh dan risau kalau-kalau pesakit collapse dalam perjalanan.

Namun alhamdulillah pesakit berjaya diselamatkan.

THALAS, CHOLE DAN MALAR

Ingat lagi di Hospital Metropolitan dulu, apabila terdapat sebuah kes malaria di wad, doktor pakar perunding nasihat semua pegawai perubatan siswazah untuk pergi dan lihat kes tersebut kerana jarang berlaku kes demikian di bandar metropolitan. Di daerah tempat kerja doktor muda sini, demam malaria adalah kes endemik. Jadi semua pesakit demam akan diperiksa BSMP/BFMP untuk ditapis.

Jadi di sinilah doktor muda banyak belajar dengan melihat sendiri kes malaria teruk dengan komplikasi cerebral malaria, renal failure, anaemia, jaundice dan sebagainya. Dengan itu kita belajar tentang rawatannya menggunakan artesunate, artequin(gabungan artesunate dan mefloquin), riamate dan sebagainya.

Dan baru-baru ini pula, berlaku wabak cholera di daerah. Kalau sebelum ni di wad pediatrik Hospital Metropolitan hanya berbuih bertanyakan tanda-tanda cholera tetapi tidak pernah jumpa pun kesnya, tapi di sini dapat doktor muda lihat sendiri keadaan kanak-kanak dan dewasa yang mengalami jangkitan cholera. Dalam kes cholera, pesakit akan mengalami electrolyte imbalance yang teruk berbanding penyakit acute gastroenteritis lain. Mereka datang dengan Sodium 120-125 dan Potassium 2-2.5, dengan keadaan tidak bermaya.

Sepanjang di Hospital Metropolitan, seingat doktor muda, hanya pernah jumpa satu pesakit Thalassemia masuk ke wad untuk transfusi darah. Di hospital daerah sini, doktor muda jumpai ramai pesakit kanak-kanak yang mengalami Thalassemia. Di daerah, berlaku banyak perkahwinan di kalangan saudara mara atau sekampung atau sebangsa, maka kebarangkalian untuk menghidap penyakit Thalassemia adalah lebih tinggi.

Doktor muda belajar tentang proses penapisan kes Thalassemia, lawatan lanjut mereka, ubat-ubatan dan sebagainya.

Si ibu berkata,”Aku ni endak pandai, baca huruf, nombor pun tidak reti. Anak aku pergi sekolah. Dialah yang tolong tunjuk nombor giliran ini,” setelah ditanya kenapa lambat masuk bilik setelah nombor dipanggil. “Nanti kamu besar, pastikan anak kamu lagi pandai daripada kamu,” kata doktor muda pada anak ibu tersebut. Dia tersenyum.

Bangunlah anak bangsa. Jadilah generasi gemilang
yang cintakan negara, bukan khianati.

Kemudian doktor muda perasan yang anak tersebut sebenarnya menghidap Beta-Thalassemia major.  Rasa tidak sedap hati. Adakah doktor muda telah berikan harapan palsu pada anak tersebut? Apakah prognosis beliau?

CHA CING

Ramai kanak-kanak dibawa ibubapa mereka untuk mendapat rawatan demam, batuk dan selsema. Ada sesetengahnya doktor muda perasan, datang dengan kurus kering dan pucat.

Apabila disemak full blood count(FBC), ramai yang Hemoglobin-nya(Hb) rendah 7-8 g/dL. Mean cell volume(MCV) dan mean cell hemoglobin(MCH) juga rendah. Apabila diselidik lagi iron workout dan peripheral blood film menunjuk ke arah iron deficiency anaemia. Status kehidupan yang rendah tampak memberi kesan pada nutrisi anak-anak di daerah.

Jika diselidik lagi, eosinophil count juga tinggi, menyebabkan kita suspek infestasi cacing atau helminthiasis. Bila ditanya ibunya, ada yang kata anaknya ada muntah dan buang air besar keluar cacing. Ada yang sudah besar pun datang berkaki ayam, tidak berkasut. Ada penolong pegawai perubatan(MA) simpati dan hulur RM10 pada budak itu untuk dibeli kasut.

Salah satu differential diagnosis untuk sakit perut di kalangan kanak-kanak di daerah adalah acute pancreatitis. Ianya disebabkan mechanical obstruction oleh cacing. Doktor muda ada lihat satu kes budak umur 7 tahun dengan serum amylase >> 2000.

Dunia kanak-kanak dan doktor di daerah lain daripada kanak-kanak dan doktor di kota metropolitan.

SYUKUR

Pesakit-pesakit di daerah secara umumnya lebih menghargai doktor. Kadang-kadang doktor muda tidak sempat pun habis cakap, pesakit sudah ucap berbanyak-banyak terima kasih.

Ada sekali doktor muda ‘basuh’ betul-betul seorang pakcik yang degil tidak menjaga penyakit kencing manisnya. Pakcik tu senyap dengar saja. Kemudian baru rakan sekerja beritahu pakcik tersebut antara orang-orang kaya di daerah. Tercengang doktor muda bila dengar. Nasib baik pakcik tu tidak buat aduan.

Ternampak saya seorang kanak-kanak kecil yang mempunyai enam jari(polydactily). Doktor muda, yang dulunya pernah bekerja selama sebulan di bawah orthopaedic paeds, pun bertanya, “Mamak ada buat temujanji dengan doktor tulang? Ada rancang nak buangnya?” “Eh buat apa? Bersyukurlah Allah bagi dia macam tu,” dengan penuh yakin kata ibunya.

Tersengih malu saya. Mungkin ada perkara di dunia ini yang tidak perlu dirawat sebenarnya. Yang perlu dirawat adalah hati.

Pokok tidak mengadu nasib dibesarkan di dalam longkang.
Sebaliknya berusaha tumbuh mencari mentari. Bersyukurlah.

Seorang makcik meracau di wad. Buah pinggangnya semakin rosak. Blood urea pesakit mencecah 60. Makcik mengalami uraemic encephalopathy. Namun kami tidak dapat berbuat apa-apa kerana beliau bukan warganegara. Suaminya tidak mampu untuk menanggung kos rawatan jika dirujuk ke hospital besar.

Di daerah dan di negeri ini, terdapat ramai pendatang asing. Kerajaan tidak mampu untuk menampung mereka, maka untuk mendapatkan rawatan, mereka perlu membayar lebih berbanding warga tempatan.

“Takpelah........ kalau memang sudah ajalnya, kita tidak boleh buat apa-apa juga,” kata suaminya. Sebak hati doktor muda mendengar kata-kata pakcik menerima takdir. Sedangkan doktor muda tahu ada ikhtiar untuk menyelamatkan isterinya. Namun yang menghalangnya adalah duit.

CERITA ASAL

Mungkinkah begini cerita asalnya. Suatu ketika dahulu, di sebuah daerah, manusia melihat kehidupan itu bermula dengan kelahiran dan berakhir dengan kematian. Hidup dengan bersyukur apa yang ada dan ketahui kematian adalah kepastian. Tabib dan bidan membantu setakat yang mereka mampu dan menyerahkan selebihnya pada takdir. Manusia meninggal dunia dengan penerimaan.

Sebuah perkampungan..... suatu ketika dulu.

Kemudian daerah itu membangun maju dan penduduknya hidup senang. Kehidupan bermula dengan kelahiran yang sempurna, hidup yang mewah dan kematian ditangguh-tangguhkan. Adalah tugas doktor untuk merawat penyakit, menghindar kematian dan memulihkan kesempurnaan. Jika doktor tersilap dan gagal, jangan salahkan takdir. Manusia meninggal dunia dengan tidak berpuas hati.

Pada suatu ketika dulu.......

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Pesakit Tak Dengar Cakap?

Atau doktor yang tak pandai bercakap?

Pentingnya Komunikasi Berkesan

Sewaktu saya berada di sebuah klinik kerajaan untuk posting terbaru saya, Primary Care Posting, saya bertemu dengan seorang lelaki berbangsa Cina, saya namakan dia Mr M.

Sebelum Mr M masuk ke dalam bilik rawatan lagi, kakitangan klinik ada memberitahu saya pasal Mr M. "Kes menarik" kata mereka.

Dan saat Mr M datang saya teruja apa yang menarik tentang Mr M.

Mr M datang masuk ke bilik rawatan menggunakan kerusi roda. Sebelah kakinya berbalut dan sebelah lagi sudah dipotong paras bawah lutut. Dia tidak banyak bercakap, hanya tunduk, tidak menjawab bila ditanya dan hanya minta untuk kakinya dicuci. Apa yang menariknya tentang Mr M?

Jika anda mempunyai medical background anda akan faham dan jelas betapa sinonimnya pesakit diabetes dengan ulcer di kaki. Bagi yang non medical, pesakit diabetes melitus yang tidak mengawal paras gula dalam dalam darah dan tidak memiliki etika penjagaan kaki yang betul boleh kerap kali mendapat ulcer atau luka di kaki yang sukar untuk sembuh. Bahkan ia boleh bernanah, bengkak dan merebak lebih teruk.'

Jadi sebelah kaki Mr M yang berbalut itu sudahpun teruk. Kebanyakan kulit di kaki itu sudah tiada, menampakkan daging di bawahnya. Ada daging yang masih elok, dan ada yang sudahpun mati dan mula mereput. Saat saya buka balutan kakinya, bau yang kurang menyenangkan menerpa masuk ke hidung saya.

Soalan demi soalan saya lontarkan, contohnya kenapa dia tak mahu ke hospital? Dia diam. Saya ulang, dia masih diam. Saya provok, "sebab takut kena potong lagi sebelah?" dia angguk perlahan.

Bukan mudah untuk seorang manusia untuk kehilangan anggota. Walaupun anggota itu gagal berfungsi, kita masih mahu ia ada bersama kita.

Pesakit degil, atau mereka tidak tahu?

Mr M sebenarnya telah dirujuk ke hospital. Berkali-kali staf mengingatkan tiada apa yang boleh dilakukan di klinik dengan keadaan dia yang teruk. Dia memerlukan penjagaan hospital.Keadaan kakinya perlu dirawat, daging yang mati perlu dibuang di hospital. Klinik tidak punyai kemahiran dan peralatan yang sewajarnya.Dia masih enggan.

Saya faham, kakitangan klinik termasuk doktor mempunyai masa yang singkat untuk tiap pesakit. Sehari pesakit datang mencecah 400 orang sehari dan seorang doktor hanya memiliki masa kurang dari 7 minit untuk bertemu pesakit.

Dan oleh kerana saya ialah pelajar, saya boleh luangkan masa bersembang dengan Mr M. Untung saya baru habis posting orthopeadics jadi perihal Diabetic Foot Ulcer ni, saya tahu serba sedikit.

Saya terangkan pada pesakit, bagaimana luka yang tidak dirawat itu boleh merebak lebih jauh ke dalam tulang, ataupun menjangkiti struktur yang lain. Bagaimana dia boleh mendapat jangkitan kuman dalam darah yang boleh membawa maut.Saya tangkap gambar kaki MR M, dan tunjuk sendiri pada dia betapa teruknya kaki dia. Dan dia sendiri terkejut. Dan jelas saya tahu dari reaksinya, dia tidak tahu betapa seriusnya keadaan diri dia sekarang. Yang dia takutkan, "pergi hospital kaki kena potong."
 Di akhir sesi, dia kata pada saya dia mahu ke hospital.

Kakitangan kata, dia sekadar 'cakap', tapi sebenarnya dia degil. Saya tak tahu, saya tidak mahu menilai. Saya harap dia benar-benar ke hospital kerana 2 hari selepas itu saya tidak nampak dia lagi di klinik.

Sebenarnya banyak pesakit, enggan ke hospital kerana mereka mempunyai tanggapan tersendiri.

"doktor nak duit saja."
"saya kena sihir, tak perlu ke hospital."
"sikit-sikit potong, siapa mahu ke hospital?"
"selalu orang masuk hospital, mati. Macam jiran sebelah saya dulu."
"hopital kerajaan buat kerja sambil lewa."


Tujuan doktor merujuk pesakit ke hospital ialah kerana keadaan pesakit adalah serius, dan klinik tidak mampu menguruskan pesakit kerana ketiadaan kepakaran, alatan dan suasana yang sesuai.

Antara halangan kenapa pesakit enggan menurut saranan doktor

1. Kurang kefahaman
Dari segi kurangnya penjelasan doktor, latar belakang pesakit, atau pesakit tidak memahami penjelasan doktor dengan tepat.


2. Bias atau mitos
Pesakit mempunyai tanggapan buruk akibat dari pengalaman lepas, cerita orang ramai, dan fakta dari sumber yang tidak sahih.

Contoh a. "makan ubat tak elok untuk badan, kerana ubat ada efek toksik, merosakkan buah
pinggang."

contoh b. vaksinasi boleh membuatkan anak yang dikandung cacat

3. Salah faham
Contoh, Encik B mengalami sakit kepala dan sentiasa mengantuk selepas diberikan ubat oleh doktor C. Kesimpulan Encik B adalah doktor C salah bagi ubat, dan doktor tidak mahir. Apa yang berlaku adalah kesan sampingan ubat, tapi doktor C tidak memberikan konsultasi secukupnya mengakibatkan kepada salah faham.

Dan banyak lagi.

Kekurangan ini dapat diatasi sekirangnya kepercayaan pesakit terhadap doktor dapat ditingkatkan, pesakit tahu membezakan antra fakta dan mitos, dan diharap suatu hari nanti dengan bertambahnya bilangan doktor, doktor akan mempunyai lebih masa dengan pesakit.

Allahu'alam..

Baca lanjut mengenai kaki diabetik di sini.

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Abortion: A Musllim Perspective

When I was a medical student, one of the classes that I most enjoyed was Medical Ethics. Love it!

There were no right or wrong answers. All that mattered was your ability to justify your views.

I remember how much I really loved one of the ethical issues being discussed during my Obs&Gyn rotation. It was about abortion.

The way the western think about abortion is way different than the way the average Muslim medical student think about abortion. Sexual freedom is taught to be their legal rights as consenting adults. Even though the legal age for sex in Australia is 16, a 14 years old can consent to medical treatment. Thus, in the western country, you can write a whole thesis centered on the debate that has been going on about abortion between those who are pro-life to those who are pro-choice.





In the ethics class they would create certain scenario and ask you to give your response and justification. One of the example of such scenario was something like this:

You are a GP in Tumba Rumba. One day a teenager aged 15 years old comes to you requesting for oral contraceptive as she has become sexually active. Even though you know that teenagers can consent for medical treatment at the age of 14, you are also fully aware that the legal age for sex is 16. Would you prescribe oral contraceptive for her? (this is when we will argue ad nauseam about whether we will prescribe the OCP or not. She is 15, so she can consent to medical treatment. However she is not yet legal for sex. After arguing for half an hour over the best course of action, the scenario would be continued)

You then decide not to prescribe oral contraceptive for her. Two months later she came to your practice crying about being pregnant and blaming you for not prescribing oral contraceptive for her. She would like to have an abortion. What would you do? (This is when argument becomes more heated. Sometimes you can almost see who are the Muslims – well, we are the obvious ones with our hijabs – who are the practicing Christians, who are the non-practicing Christians, who are atheist, and who are the non-conformists, just by hearing the way they give their opinions. It was very interesting, I assure you. Oh, I miss my Ethics class)

Do you think she should keep the baby? (This is when we get to talk about the rights of the unborn baby vs the rights of the mother. We can talk about whether abortion can be classified as murder. We can talk about at what gestational age would an unborn baby have any rights?)

Would you tell her parents? (Of course, confidentiality issues would be a MUST in all our Ethics scenarios.)

The issue of teenage pregnancy was being openly discussed in our O&G ethics class. When I was doing O&G rotation in Australia, I happened to keep track of the news in Malaysia…about the rampant discarding of newly born babies that was going on in our streets. Most SHAMFUL! I wonder what would the Western say about our so-called Muslim values if they know about these abominable acts committed by our teenagers.
I was a 4th year at that time when I blogged about that issue here:

http://afizaazmee.wordpress.com/2010/08/18/discarded-babies/

I almost forgot all about that issue once I have left my O&G rotation and moved on to Paediatrics.

However one day, when I had been back in Malaysia for over 1 year, I came across ANOTHER article about discarded baby. This time, it happened in my home town. It came out in Metro. The baby was being put in a bundle and placed under a tree at Klinik Kesihatan Bandar Alor Star. Alhamdulillah, the baby was still alive and well.

The news shook me to the core. I wonder about WHAT would my Australian friends think if they knew about these incidents that are taking place in our Muslim country?

They would take one look at the article I had written in my O&G portfolio and snickered at it. In my O&G Portfolio I had written my opinion on abortion, giving it the Islamic flavor that would reflect my upbringing. Below was what I had written, quite a sharp contrast to what I was taught in my Ethics class. But the thing I love about studying in Australia is, the freedom of having an opinion that is dissimilar to that of your teacher. As a Muslim studying in a Western country, people EXPECT me to have a different opinion in Ethical issues and most of the time, they can accept our views as long as we are prepared to defend it. So I wrote on Abortion, hoping that my professor would understand that as a Muslim, whatever was taught in the ethics class will have to be filtered through the eyes of Islamic Jurisprudence. I could not simply agree to the western ethical stand each and every time. Besides, I was not planning of practicing in Australia.

My professor actually commented on my portfolio saying ‘Excellent reflective process.’ It truly made my day. So here it is, my take on Abortion when I was a Muslim student in a foreign country. (Be warned, that I was writing for a western audience, so do expect some things to be out of the Malaysian context)



ABORTION: A Muslim Perspective

The fact is such that the only perfect contraception is saying NO.

While Islam permits preventing pregnancy for valid reasons, it does not allow doing violence to it once it occurs. However, if the pregnancy poses a risk to maternal health, then abortion must be performed.

In Islam we are allowed to use any contraception to prevent pregnancy, but Islam also recognizes that this contraception is not totally perfect. So, the guideline is, if you fall pregnant regardless of the use of contraception, you should not abort the baby, unless there’s a specific harm to the mother medically. In the case of rape, it can be optional, depending on what the mother wants and depending on whether the mother’s mental health would be affected by bearing the baby of her rapist. But all rape victims should take all the necessary precautions, for example, taking the morning-after pill.

According to European Council for Fatwa and Research:
“Indeed abortion is forbidden in Islam whether it be in the earlier stages of pregnancy or otherwise. The extent of sin incurred varies according to the stage of pregnancy, so that less sin would be incurred if the abortion took place during the early stages, while it becomes increasingly haram (unlawful) as the pregnancy advances. When the pregnancy reaches 120 days old, abortion becomes totally forbidden and is deemed a form of murder.
However, the only condition under which abortion is allowed is when there is acual threat to the life of the mother confirmed by an official medical report that if the pregnancy advances any further, the mother may die.”

If I ever become an O&G specialist, I shall never ever perform an abortion unless it specifically poses a medical problem to the mother.

If you got pregnant because you have been careless enough and foolish enough to not use contraception, why are you crying now? You know that every action has its own consequences and part of being a good responsible adult is to bear them with dignity.
I believe that there are consequences that you have to bear out of your freedom of choice. I find it amusing that a lot of people talk to me about how Muslim women are oppressed and they couldn’t choose their own course of action, yadda, yadda, yadda…

What they don’t know is that there are reasons why we don’t choose a particular action:

1)Because the action is against our belief. So in the first place, we choose to believe.
2)Because we know that there are great consequences that you need to bear out of your action.

So, if you think you can’t carry the responsibility of being a mother just yet, or that the father was not the ‘right man’ (whatever THAT means) or that this is not the ‘right time’, then why didn’t you take steps to prevent the pregnancy from happening in the first place.

Granted that sometimes despite of everything that you do, despite of all the contraception that you use, accidents happen.

But you KNOW that there’s a chance of that happening. Your doctor would have told you all the estimate percentage of failure of the contraception that you had chosen. Yet, you had used your freedom of choice to choose to take that risk.

And now that you have to bear the consequence, again you choose to exercise the same exact ‘freedom of choice’ to abort. When does this freedom of choice end? People use the same expression ad nauseam to justify every action they do (bad or otherwise).

Our freedom is limited by other people’s freedom. Our rights are limited by other people’s rights.

This is exactly when our freedom of choice ends. Now that you have borne a child, your rights are limited by the rights of the unborn child.

Now they get into the debate of whether or not an unborn child has any right. And if an unborn child has any rights, at what gestational stage?

Really, who is the best person to determine all that? To those who are religious, they would say God is the best person to determine that since He created us all. To those who are atheist, they would use another justification and their reasoning varies and their answers would range from the very beginning of conception to the start of implantation, to 20 weeks of gestational age.




You are getting into a gray area, a muddy water. In these circumstance, people then choose whatever they want to believe based on their own private justification. There’s no uniformity and no consistencies.

So, people should think twice before they say that all the religious restriction on a woman’s sexual expression is limiting their freedom of choice. In Islam, we prefer to prevent than cure. You don’t have to deal with all these mind-boggling issues if you choose to follow the guidelines in the first place, (though some might prefer to call it restrictions) i.e to be married before you have sex and to make sure that you are ready to bear children before having sex.

But problems arise when people don’t want to follow what they call as ‘restriction’ and when bad consequence happens as a result of them not following the initial restriction, they start thinking that the bad consequence is ANOTHER restriction that they need to escape from. This cycle would go on and on until we stop and realize that we should take responsibility from our choice.

Sometimes a teenager knows better. No matter how much people frown on teenage pregnancy in Australia, I applauded their decision to carry the pregnancy through, regardless. At least, THEY know the concept of taking responsibility for their choice. Responsibility is the first lesson of adulthood.

For all these reasons, I choose to never perform an abortion without any valid reasons other than ‘the pill doesn’t work’, and ‘this is not the right time’, or ‘I was not with the right man’. You knew coming in that no contraception is 100% effective, yet you chose to take that risk anyway, so bear the consequence in a mature adult manner (of course my whole behavior and intonation will be adjusted accordingly as a health professional who has to counsel these cases in a sensitive, empathetic style.)

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Patient's Story 2:the Doorless House

I was doing a routine ultrasound examination when a nurse knocked my door..

“Excuse me Doctor,but do you remember the baby that you referred for jaundice yesterday?The mother didn’t go to the hospital.”

“What? Why?” I was really angry as the case was considered semi urgent(referred to the hospital,but the patient can go by their own transport as we have limited staffs and transportation ourselves).

“She said she couldn’t find a car to bring them there.”

“But she said it was Okay..and they can go there by themselves…Ask her to go now.”

A few minutes later the nurse came back when I was writing my report..

“Excuse me again,but she said she can’t go today,maybe she can arrange for the transport tomorrow..can she go tomorrow?”

“No!the baby’s SB(serum bilirubin:an indicator of jaundice) had already raised..we can’t wait another night.” I was angrier as I thought I was dealing with another stubborn parent.

Then my assistant told me “Err..Doctor,I’ve visited her house last week..I don’t think they have their own transport,they have just moved here and currently living in a small house with all of their 6 children,the house doesn’t even have a proper door,only a drape hanged instead..”

“What? Why didn’t she told me yesterday”regretting my earlier outburst…but quickly understood..It was not the 1st case,many before had said they have no transport problem but after further questioning,we learnt that they had actually walked a few miles to my clinic.

Why they lied? Maybe because of pride,ignorance or even shame.

Just a few a weeks ago..a grandmother came and begged to see me,earlier I had diagnosed her grandson with nephrotic syndrome and referred him to a tertiary hospital about 80kms away.The mother told me that she can bring her son there that evening but she really can’t,no transport no money. All she did was cried when she arrived home and asked for the grandmother’s help,the mak cik then walked 2 miles to my clinic and asked for my help.

For both of these cases,we provided them transport,I’m not sure if I’ve breached any rules/SOPs,but in my clinic,if a patient can’t afford it,we’ll provide him/her a transport even just for a routine appointment.It’s the least thing we can do for these poor people.

Sometimes,I think it’s amusing that there are people in our country who are living in mansions worth millions or billions but at the same time there are still people who can’t even afford a door for their house or send their sick children to the hospital.

Meeting them day by day makes me thank Allah everyday for his blessings for me and my family,and hopefully by helping out with what I can ,will make up for some of my own Nikmat and Rahmat.

Wallahualam.

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