Tuesday, January 28, 2014

A-Team Mission to Ormoc, Leyte - Team no 13.

I would like to dedicate this entry to the A-Team and the Mercy Malaysia team in Ormoc, Leyte, Philippines. It was a definitely interesting experience that I had; sharing knowledge, learning new things, made lots of friends & depositing it in my memory bank.. as well as this blog entry for my future reference.
*based on a true story with credits to Ashraff :)
Typhoon Haiyan (Yolanda) devastated much of the island of Leyte on the 8th November 2013. Whilst the city of Tacloban took a direct hit and sustained severe damage and casualties, serious damage was also inflicted on the city of Ormoc approximately 100km away. There is one major hospital servicing Ormoc City and it sustained 90% damage. Our brief was to restore acute orthopaedic care in the wards and the operating theatre of ODH. Our team comprised of two orthopaedic surgeons, an anesthetist and a scrub nurse. Our complete team enabled us to function independently with minimal disruption to ODH staff.

I was the first to arrive in LCCT that evening. I could not recognize anybody who I can pinpoint to be from MERCY. The instruction was to meet up in front of Old White Town Coffee shop. I guess it was obvious that i was part of this mission when a gentleman from afar greeted me. It was Ilyaas and he asked.." MERCY?" and i just smiled! Not llong after that I saw Ashraff, an old acquantaince from my housemanship days in HKL. We have not met since then eventhough through facebook, we do know of each other's progress.

Not long after, the MERCY representative came with his obvious MERCY shirt.. haha and we we then brought to check in as well as briefing about the mission. We then met Zulkarnaen, a trained OT staff nurse from HUSM. He looked a bit shy but i knew he must be really determined to have come all the way and volunteer for this mission. The big surprise was when we were entrusted with an amanah which made me feel.. hey.. ni betul2 macam secret agent.. hahaha. The flight to Manila was alright and we arrived in Manila just in time for Subuh prayers. I must say i am impressed with the facilities provided for muslims to pray. Certainly amazing!

11/1/14 Saturday
We travelled on Cebu Pacific from Kuala Lumpur to Cebu via Manila, arriving at 8am. We were met at Cebu airport by members of Team 12 who were on their way out. A superly brief handover was performed on the premises of an international coffee chain. Honestly i was not too clear about the handover because the team were so keen to share everything that in the end, i maybe understood only one thing.. hahaha  We then departed via ferry and arrived in Ormoc at 2pm after a perilous 3 hour crossing of the channel between Cebu and Leyte.The sea was rough and we had a torrid time in the ferry. I could not have been more sea sick but somehow managed to control myself from vomiting. Ashraff and Ilyaas was sitting on the deck and when they were asked to put on the life jacket, it was not an easy task to accept that we were in a crap condition! hahaha
The weather looked gloomy when we arrived in Ormoc. The destruction caused was still visible eventhough it has been almost 2 months since Haiyan striked. We were met by the local Mercy representative YuShen and the local volunteers. Of course, everybody was shy and it was our first step in getting to know them. They are a bunch of enthusiastic and determined volunteers right from the moment we met them :) Right after checking into our accommodation we were accompanied by Dr Amir Adham (of team 12)  to ODH to visit the facilities and review the set up of the operating theatre. A brief ward round was done to get to know the in patients. Dinner was hosted by Yati, who was on hand to take over from YuShen who was supposed to be on the ferry that night which was cancelled.
I totally cannot imagine how chaotic it might have been when Yolanda striked. 90% of the hospital services were crippled with all the roofs gone. Mercy Malaysia was a major saviour by initiating the rehabilitation of the hospital, it was simple. Fix the roof first! And indeed they undertook the project really well.
I had to set my mind straight as the GA machines available are not working due to the disaster. This was a regional anaesthesia mission and i guess claiming to be one, this is where it should happen! 

12/1/14 Sunday
We commenced our duties in ODH at 8am starting with a full ward round of all the patients. Dressing of all postop (team 12s) patients ensued along with all other inpatients with wounds. We managed to discharge 2 patients who had plating tibia done and one patient who had plating femur done by team 12. We also managed to meet up and dress the wounds of both of team 12s outpatients, one being the child with severe contractures whom team 12 performed surgery on in a private hospital in Ormoc the week before and the other being the patient with a very large granulating wound of his right leg who refused a split skin graft. Right after rounds we met Dr Harry Solubon, the resident Orthoaedic Surgeon who dropped by the wards briefly. He explained that due to the effects of Typhoon Yolanda he had personal matters to attend to and was planning to drop by the hospital intermittently.
After lunch we started with surgeries; orthopaedics procedure with the local surgeon. After completing ourduties, we returned to base camp at 7pm. Honestly, i was a bit intimidated with the OR staff because it was a Sunday. She did not look too friendly and who actualy works on Sundays anyway? haha Luckily Dr Harry was around to help us be familiar with their system. I will never forget when Dr Harry goes... " KKOOOOOLLLLL.." haha
We said our goodbye to Sean and Evelyn, the team 12.5 who were due that night. The channel was not so forgiving as at that time low pressure was setting in. Yati thought it would have been good to send people away first before the ferries are cancelled because of the sea condition.
13/1/14 Monday
Our second working day in ODH commenced late at 9.00am due to a shoe emergency. One of our team members suffered a shoe failure that required immediate attention of a cobbler enroute to ODH. We started with routine rounds and dressing of wounds. Two patients were taken to surgery on this day. As we completed our work on time,we were able to report back early to base camp at an honourable time of 7pm. We were warming up in getting to know the OR staff in Ormoc. They are very nice people and it was not long before we were all sitting together in the rest room with our cup of coffee gossiping! I had my short discussion with the resident Anaesthetist, Dr Pelikano regarding the system and how it has been since the disaster.It was interesting to note about their health system and how things work in this Island of Leyte.
During debriefing, i guess this was where the A-Team was born! haha We somehow identified ourselves with the famous TV series and hence, the 4 of us.. The A-Team!!
14/1/14 Tuesday
We decided to cover the mobile clinic as a change of routine. The new covering team had their travels delayed and there were no medical personnels to run the mobile clinic. We stepped in to avoid cancellation of a very valuable programme. Eventhough our team comprise of specialized discipline doctors, we are still intouch with our bread and butter basics of MBBS.
We were brought by the DHO team to a distant district clinic which is in Hibanuan. The route was challenging and we survived the humps and bumps of uneven gravel! We even had to hold on to the boxes of supplies we brought during the journey before it becomes a hazard to the passengers!
The beautiful Barangay of Hibanuan is surrounded by sugar cane plantation. We held our mini clinic in the main church of the Barangay. We covered 155 patients til 4pm. The patients varied from a 1 month old baby to a 85 year old senior citizen of Ormoc. It was satisfying to treat the ones in need and to see how appreciative they were of our services.
On our way back, we had an emergency call for our multi-talented anaesthetist.. haha me lah!  for an emergency Caesarean Section. There was no government anaesthetist cover on that day. It was unfortunate that the patient could not afford the private anaesthetist charges and she would have been delivered vaginally anyway. It was a 23 year old lady, G3P1, twin pregnancy with the indication of fetal distress for the Emergency Caesearean Section. Both the two babies and the mother was well post surgery.
The orthopaedics team did their PM rounds in preparation for surgeries to be done the next day. We met back at base camp at 9pm.

15/1/14 Wednesday
Still no sun when i woke up in the morning. We started the day with the usual ward rounds. The orthopods team were able to identify 4 orthopaedic cases needing surgical intervention. The team split into two and we set about dressing the wounds of cases done in the previous few days. We were pleasantly surprised to be joined by the resident orthopaedic surgeon for our first case. It was a give and take as Ashraff had his objective in doing the case together.
What happened next? well.. its always better when it is being written by a third party. Here I will share with you what was written by Ashraff and this is not a myth.. hahaha 

"Our second case was  a 24 year old gentleman with a closed fracture of the distal 3rd humerus on the right side sustained the night before. He complained of inability of extending the wrist and fingers. This case was particularly satisfying as our anaesthetist who was well versed in performing interscalene brachial plexus blocks via nerve stimulator guidance without an ultrasound machine; which allowed us to do the first upper limb operation in ODH since the tragedy of the Yolanda Hurricane. The local anesthetists were taught on the aspects of this block and they claimed that it was probably the first interscalene block ever performed on the island of Leyte. We performed an open reduction and internal fixation of the right humerus with a narrow DCP plate. Dr Mafeitz was mobbed by all the student nurses after successfully performing his block!"
16/1/14 Thursday
Our day started with the usual morning rounds and dressing. We were then driven by the very able Mercy drivers to the city of Tacloban to meet up with the Hospital director of Leyte Provincial Hospital (please see adjoining report). We were able to meet up with team 14 at Tacloban airport before returning to Ormoc at 8pm. It was devastating to see Tacloban and imagining how it was before the tragedy. The disaster was not unexpected but the magnitude of destruction was something unthinkable by the people.
We proceeded directly to ODH to review any new admissions and performed a right big toe ray amputation on a diabetic patient with big toe gangrene. We completed our work atmidnight and returned directly to the accommodation.
17/1/14 Friday
This was another busy day for us commencing at 8am with the usual rounds and wound dressings.I managed to perform another interscalene block for a humerus procedure and it was satisfying to do so. I guess my hardwork in performing nerve stimulator blocks during my Masters training really helped in this kind of situations when resources are limited.
We completed our work and returned to base camp at 7pm.It was sad to say goodbye but i guess we have done what we were meant to do here.

18/1/14 Saturday
This was to be our final day in ODH. All the patients had been operated on and were given plans once we were to leave. All the fractured patients were discharged home well with antibiotics. We completed an instrument inventory and moved all the surgical sets to base camp. We also presented a large bouquet of flowers to yati.
We then received the bad news that night during debriefing as all ferries were cancelled and all flights were suspended. Haha What a way to finish off the trip! We did our planning that night on Sunday was a que sera sera day.
 19/1/14 Sunday
We were off from Ormoc at 5am in the morning. Our destination was Tacloban International Airport with 100% uncertainty. Typhoon Agaton hit Mindanao the night before and all ferries were cancelled. Pak Azam told us to be at the airport and gamble your chances! Haha This was something I've not done before and I guess it was worth trying. We tried to get on the 9am Philippines Airline to Manila but it was not possible as we were no 25 on the waiting list.
Never would I have thought, at 11.59am in Tacloban airport without any tickets knowing what will happen next and what will be. And by Allah's grace, there was suddenly an Air Asia Zest flight that touched down at 1230 and 1300pm flight to Manila. And again b Allah's grace, we were in Manila at 5pm, waiting at the boarding gate to fly back home to KL! Sbhanallah.. Allah is great!

My take of this whole experience? Honestly it was my dream to be part of missions like this. I have always envisioned myself to experience such situations and Alhamdulillah, it was granted. I learnt a lot of things, be it material or emotional; and i guess it is part of my journey in life to experience such a thing. I was lucky that the group I was with were all enthusiastic and dynamic. we all had fun, laughter but all in a good manner and choice. Thank you very much MERCY MALAYSIA for the opportunity. 
I live to tell the tale....

Displaying Medical Report -The A team (11 - 19 Jan 2014).docx.

Thursday, January 23, 2014

Frozen in time

I really do love this picture taken by a friend of mine. There was no wind at all but the landscape showed otherwise. It was as if everything stopped when it happened. The wrath of Yolanda/Haiyan was certainly felt by the Leyte Islanders, Philippines.
I had an interesting experience when I was there last week circa 10-19 January 2014.I really wanna share on what had transpired during that trip but i need to check first on how I should word it without putting myself into trouble. :)

*Thanx Amir for this pic.

Tuesday, January 07, 2014

Going around Yangon 2

As i was in Yangon for only short 3 days, I hadto maximize my time here. Woke up early the next day and had a short run around the People's Square & Park which was just in front our hotel.The weather was really nice for a run and it reminded me of Perth :)Running around in the botanical garden was fun! A lot of locals would just go out and have a morning walk and facilities such as this is essential to lead a simple life.
 Immediately after breakfast, I decided to go to the city and finish up the minimum list of things to do in Yangon! The river Yangon was my first destination and when i arrived there, i understood why it is not highlighted as the place to go. Im sure because of time, the river is how it is at the moment. It is dirty and serves as the gateway for trade. There were lots of cargo ships and you can see why it must have been the port to be in the 19th century. The British was smart to have taken this place and developed it. There were lots of colonial building, really old and instantly you knew how important this place was to the empire then. 
 The next destination would certainly be the centre of the city, where Sule Pagoda is located. During the 8888 Uprising, the pagoda was an organizing point and destination selected on the basis of its location and symbolic meaning. In 2007, during the Saffron Revolution, the Sule Pagoda was again utilized as a rallying point for the pro-democracy demonstrations. Many thousands of monks gathered to pray around the pagoda. Both had brutal endings but hey.. it is the history of this place!
 Interestingly, there is a BIG MOSQUE just beside Sule Pagoda.If i had known earlier, I would have rushed for Friday prayers on my arrival! The mosque is huge and that tells you how big the population of Muslims here in Yangon; either by history or the current state. Being in a 98% Buddhist country, it is such a priviledge to see a mosque in the middle of the city next to the historical Pagoda they have.
 A visit to Bogyoke Aung Sang market is a must for any tourist. It is sitted in a colonial building, hence why it was known as the Scott market before. The ground floor and the first floor are lined with small antique shops selling old coins, bank-notes, postage stamps and medals. In the middle of the market are jewellers, selling famous Burmese jade, Burmese rubies and other precious stones. The rest are art galleries, handicraft shops, restaurants and clothes stores. The new wing of the market, across Bogyoke Aung San Market Road, houses shops that sell medicine, foodstuffs, garments and foreign goods.
Sadly, that was the end of my trip to Yangon. We spent 2 hours here and rushed back to the hotel to rush to the airport! I certainly enjoyed this short trip, and i guess holds the window to the coming new year 2014 :) 

Going around Yangon 1

It used to be known as Rangoon. The country used to be called Burma. The literature and 19th Century literature would describe this city as a busy metropolis. The romantism of the British Empire was built around Rangoon. The history is interesting and of course when given the opportunity to visit this city, I was more than happy to be so. I guess when you do have work to do in exquisite places, the opportunity to look around should not be missed!
The first thing you'd be surprised to see about Yangon is how big the roads are. It was definitely built before its time, having 2-3 way per side lanes. The best thing is if you are driving, you'd be on the right side of the road. You may think that aha.. just like the Americans but surprisingly most of the cars are not left hand rive but right hand drive! Imagine the confusion if I were to drive here.. haha

 We were celebrated in a local restaurant in the vicinity of Kandawgi Lake, Yangon. One of the 2 artificial lakes that was built with the objective to provide clean water to the residents; obviously duringthe British colonial years. The food was pretty similar to ours, in fact much more similarity if compared to the authentic thai food. The ambience of the restaurant called white rice was also great; in a bamboo shaped dome restaurant.We retired early that night to prepare for the workshop :)
 Of course, after the workshop is done it was being a tourist time! haha we were told to visit the Shwedagon Pagoda at night as the lights would light it up really well. I've been to a lot of Pagoda in recent years but this Pagoda in yangon is certainly the biggest I have been too! We can see how bright the Pagoda is at night, it was the only well lighted place at night! Walking to it from our hotel was a decent 10 minutes and as the weather here is comfortable, it was so much convenient after dinner.
According to legend,the Shwedagon Pagoda has existed for more than 2,600 years, making it the oldest historical pagoda in Burma and the world! Civilization had started here long time ago and i am sure, one way or another the generation of Myanmarese is a matured one. I have always been fascinated by the Indo-China history and comin to these places is certainly an eye opener to see what they have achieved even from then.
The Pagoda complex is SUPER-HUGE! Besar gile! 3 escalators up from the ( ican't remember East or West now.. haha) gate.I've never been to a pagoda with such magnitude and i do respect how they managed to make the place for their locals to visit at night. Most of the visitors were the locals and only a flock of foreign tourists.
 It was very beautiful at night, the contrast of gold vs the dark night sky was just superb. I am truly amazed by the architecture and howthey have planned it. Certainly a strong base history and I am glad to have been here!

U/S Regional Anaesthesia Workshop in Yangon

28 December 2013, I was priviledged to be invited to speak at a workshop in Yangon. When Shah asked if any of us were interested to represent SIGRA in Myanmar, i was pretty much excited. Why? There are a lot of things we have heard about Myanmar; and just post 1 week after SEA Games it would be interesting to be in the former capital city of Myanmar! I would love to see what Yangon is all about, a country with a rich heritage and conquest history.3 days before New Year isn't a bad time to be in Yangon!

The Workshop was held in Summit Parkview Hotel which was just opposite the People's Park and the huge Pagoda. Anaesthetists around Yangon and Mandalay came to participate in this rare event for them. After the recent lifting of the trade embargo by UN, the country is now more accepting of foreign investment and product. Thus, GE ( the company who sponsored me) were keen to help them to be introduced to Regional Anaesthesia via Ultrasound. Ms Kim who is the GE educator became my host when i was there.

 It was nic e to have met up with my fellow colleagues from Myanmar. Little is known about what they do but I'm sure they are very busy with their daily practices. The stories i share with them is similar to mine which tells me that wherever we are , the problems will be the same! haha What was interesting is how most of them still use the landmark Paraesthesia technique. According to one consultant, to use the nerve stimulator they would need to buy the needles which is out of the hospital budget. However, with ultrasound they can just invest on one machine and use it to confirm their deposition of the local anaesthetic agent!

I enjoyed my time here and of course, I do looke forward to be in Yangon again some day :)

Wednesday, January 01, 2014

Hotdocs futsal 2013

Another cheat post which should have been in 2013.. hehehe
The students organized a futsal tournament and it was something we could not miss off! The training that we have put in the recent months of our weekly futsal need to be tested.We enrolled 2 teams and was confident that we could produce or prove something to students and staff.. haha Boy were we wrong.. hehehe 
 Commitment, fitness, teamwork and skill.. we may possess the 4th criteria but we were lacking in the other departments glaringly! haha We lost all our games but played full heartedly, chased after the ball hard and obtained bruises to prove our commitment to the game and team! The pitch was not perfect but as a student's tournament it should not be the main factor!

I enjoyed my night fully with the boys.. Imagine, a group of speicalists trying to rekindle the passion and feel for the game as of how it used to be..The bumps and humps we have now is certainly a pale shadow of how we used to be haha 

The sad thing about the whole thing was, it was sort of a farewell for Tengku, our respected senior who is moving to greener pasture. All the best Tengku and you will be sorely missed in the Faculty :(

Tanah Aina Fara Soraya holiday with the kids

This is a cheat post. It was supposed to be in the December entry but as I've reached my KPI, so I'm sneaking this post in the January 2014 to increase my 2014 blog entries.. hehehe

It was an outdoor type of holiday during Christmas. Wifey booked the place early in November and i managed to squeeze my schedule so that i can come for this holiday. It is a quiet place, can be a little bit expensive but my my it was worth all the money. This outdoor eco resort is situated in Raub, just off Bentong. Unless you are a web holiday browser, you would not know the existence of this place. It is quiet, really in the jungle but one can be really surprised with the facilities. Everything they mentioned and pictures you see in their website, is as it is if not better!

Getting there
If you follow the directions given in the website or the confirmation email, it was easy. It was very precisely described and it was not difficult if you look and trace the route on the map before hand. The signage was clear except the one after the Tanah Aina restaurant. We were not sure how far it was and after going into a town centre, you wonder if you have bypassed it. However when we were about 500m away from the parking, one should not miss the signboard.
Once arrived at the parking, you will be greeted by 4x4 and all your luggages will be brought by them or a special high powered truck. This was indeed a new experience for the kids and they thoroughly enjoyed it!

The chalets were superb. It depends on your party whether you come in big numbers or personally; and you'll be catered as such. There are also tents prepared for visitors if that is what you have in mind. It is very organized and i must say the staff were really helpful and freindly. We took the 6 pax chalet called Ulam Raja and it was excellent. What i liked most was the personal stairs to the river bank! It was superbly convenient and easy to get the kids down to be introduced what Malaysian rivers are about! We enjoyed our time there and had our dip twice a day! 
The toilets were also 6 star quality! No where in Malaysia you can find such toilet in an eco-resort. I really do salute the owners as I can see how they built up this place. Not for commercial reasons but in the mind of if they were themselves visitors on what they want it to be like.
 Food was of course another thing to mention. The charge were reasonable as the food was also 6 strar hotel type with dessert each time! I had to skip few meals because i have eaten too much and with no buring fat activities, my weight did sore up! hahaha
Besides dipping in the river with the kids (which should be the main reason for coming to an eco resort!) The activities were good and organized well. We had a river trekking trip to a waterfall. The support by the crew was excellent and all my kids were well taken care off up to the waterfall. At the waterfall, we were to take part in the leap of faith jump! A 17ft jump from a platform which looked easy but believe me you would be surprised to see how people would just chicken out! I enjoyed the activity really well and even Qayyum did his jump! haha Qaisya was about too but being 7, if she were to take the leap it wasa bonus.. Maybe not this time.

 A short morning walk and night walk was organized for us. It was the same route up and again they were very supportive of all team members to arrive at the destination. At night, we all closed our torches and observed the clear skies to amaze at the blinking stars. In the morning, we were appreciating the sunrise with fog on the horizon. It was nice and certainly enjoyable. It was simple but i guess enough as an introduction to the young ones.

The flying fox was another attraction. I never thought the kids would be daring enough to just have a go. I guess their swimming confidence paid their due as both of them enjoyed the ride really well! I was really surprised but at the same time happy for them. I have always enjoyed this activity and seeing them enjoying it is certainly a pleasure!

It was a surprise enjoyable weekend, something for the kids and they embraced it well. Defintely, i will look into something like this in our future trip.