Salam Aidilfitri 2009

Maaf Zahir& Batin!!
MAfeitz Mamat

Syawal eve

Holiday mood was in the air. I was still working today because it was pointless to take leave as I'll be celebrating in KL this year. Wifey is covering locum for the first 3 days of raya which I don't mind because it would be a start to more prosperous time to come.. hahahahah We would only go back to Muar later to visit Maktuk and the rest of the Atuks who alhamdulillah is still around.
My OFMS list was supposed to be at least an 8 hour job but it was cut short to less than 5 hours due to unexpected exploration which revealed minor repair job than was intended. MY boss for the day,Vas even let me off early which was nice of him to do so! Thanx Vas!!
It was nice to see the OT decorated in such a way to sooth those who this year would be working on Aidilfitri period. Ex
To the Nursing and Supporting staff of UMMC OT, Salam Aidilfitri and Maaf Zahir Batin!!

Remembering Salzburg

And to think that I was in Salzburg last week!!!

I reckon we chose the best congress to go; My interest is regional anaesthesia and Salzburg, Austria was definitely the place to be at. Mind you, we attended the congress on its full 3 days in contrast with people's perception that the congress was just an excuse to visit Europe( which was in a way) but we did not forgo the academic reason to be there. It was a mind opening experience as we got to meet the who's who in regional anaesthesia.The knowledge sharing session was simply awesome as these are the real experts.In Malaysia, we don't have anybody who is comparable yet; the nearest would be my Sifu, Ling!! Hahaha

with the living legends or RA!!

who's the cadaver?

modern state of the art congress centre
Salzburg is a beautiful town with its surrounding scenery simply breathtaking. It's the birth place of Mozart and was made famous by the movie the Sound of Music! The rich tradition of culture was obvious and highlighted to visiting tourist. We were lucky that during the opening ceremony, we were entertained by the city orchestra and soprano who delighted us with Mozart's and Hyden's piece.( save duit..hahaha)
Being typical Malaysians, we really used the one day Salzburg card!! hahaha With euro 24 spent, we went for the expensive trips to cover our cost namely Mt Unternsberg, river cruise and to the top of Salzbur fortress! We did visit the museums but as the majority of us were not that ken on history of arts, it was just for "cukup syarat"..eg Mozart's home, Mozart's museum, Salzburg museum etc)

Unternsberg cable car station top

river cruise

on top of Hohensalzburg

We did not miss the modern part of the city as well witha visit to Europark, world's best shopping complex !! ( budak2 bandar betul) and why not to its IKEA as well? hahaha we had iftar there for rememberance :)
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We were due to go to Eidelweiss, Grossglachner via the scenery route which is legendary. Unfortunately, it was cancelled as the road was closd due to bad weather. We were dissapointed initially but Shahnaz came with a bright idea that we go to Munich!! After surfing , I found that it was just nearby with a 2 hour train! So 2 countries at once!! Why not?

We were surprised when we only had to pay euro 30 for 3 of us to and fro to Munich. Apparently it was a special day-return pass for 5s! We boarded the double decker train and obviously sat on the top deck.. hahahaha I really love the superfast euro trains..:)
Munich is a modern city and not really a tourist attraction. I guess maybe i would not have the opportunity to visit this town more famous for football then anything else ( of course, there was the Munich 72 incident of terrorism as well..). Shahnaz was keen for Munich because of BMW welt, a centre for BMW lovers! There was the museum and showroom which showed the best of BMW!! If we had more time, we culd have visited its plant hahaha hmm.. my future car perhaps?

in front of the huge BMW complex

home of Bayern Munchen.. we should have gone at night to see the colourful display..

Marienplatz, Munich

Munchen by night..
We had iftar at a kebab shop near the train station called Taknakmakan( or something like that..hahaha) The interesting about that shop was it sold not just Halal Turkish delight but chinese as well.Apparently, the owner was half german with his wife from China, chinese-muslim. They were very friendly and I do recommend that place if you happen to be there. :)

I really enjoyed this experience and was thankful having to great colleagues who were great travel partners. It was full of fun and laughter with serious touches when needed. We maximized our time there and I wuld not have thought, after leaving UK 10 years ago to have this opportunity again to explore. The trip made me felt 20 again:
i) the "Usain Bolt" sprint in Schipol, Amsterdam to avoid missing the plane; damn BIG airport!!
ii) my luggage which did not arrive in Vienna in time that became my trump card to explore Vienna before taking the scenic 3 hour train to Salzburg
iii) the 30min hike to Mt Hochtron from Unternsberg and witness the beautiful scenic Austrian Alps
iv) backpacker style walk in Munich catching time to visit selected attractions..
Wow.. Alhamdulillah and that just the list on top of my head which is just the tip of the iceberg! Ramadhan in Europe was also rejuvenating and challenging! I thank god for this opportunit which was a good time out before I endure my coming months towards my finals.. :)

Back in town..

Yup.. flew back on Sunday. Arrive in KL on Monday. On call Tuesday.. Wednesday macam nak mati!!! hahahaha I had it all wrong as i thought it would make me better to beat the jet lag but instead I've made it worse! I'm damn bloody knackered at the moment and my eyes are wide awake! My lips cracked because of my stubborness to not use the lip balm when I was there.. and i am hurting a lot !!
I will definitely blog about my Salzburg-Munich experience in my later posts.. but don't think i can do it now.. still uploading the pics to my facebook s well as my hard drive. 500++ pictures to download can be a wee lil bit too long :(
It's nearing Syawal now and I went to school for Tarawikh with the main objective : fulfilling my zakat to Ustaz Ahmad.. hehe Mafiz, Azad and Fiqar had already had their tun in the last 2 weeks, so it was me left. I chose the 27th night as well as 16th of September Malaysia day to sponsor "moreh" KFC for the kids! hahaha It was a good day to do it especially with SMTTDI's surrounding of tarawikh:) It brings a lot of memories which will account as events that happened 20 years ago!!!
Its unfortunate that this year we were not able to hold any Kamcheng ramadhan events.. insya allah , Syawal will bring us closer:)

Around the ESRA congress

excellent view of Salzburg from Festung HohenSalzburg


The Malaysian delegate

listed..ehehehe

proud to present..

Peter Hebbard came to view our poster.. he was the creator of the block we did

Anatomy institute

ESRA and the sound of cadavers

I am currently blogging from the comp terminals provided by the organizer. ( I'll post the pic later) I'm very impressed with this congress so far and it is certainly not just a learning experience; but to see consultants lead by example. They are marvellous speakers as well as demonstrators and it motivates one to be like them in the future. We went to the cadaver workshop and it was really good. Now I can see why anatomy is as important to anaesthetists!!!
We've just done our presentation session this morning and it was good. The judge seemed to be impressed with our subcostal TAP block and there is a tiny bit of hope that we might win one of the prizes?? HAHAHAHA Harapan menggunung ! :)
We are waiting for Shahnaz's turn to present. I will write later when we're back at the room tonight.

Salam dari Salzburg!!
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updated..

Untensberg.. i just had to do it!

I am currently very-very tired. It was a hectic day today, we really went all out to visit Salzburg;s attractions with our Salzburg card. Tomorrow till Saturday will be purely conference related and that was why since it was only registration and exam day today.

I managed to coax Shahnaz and Ling to climb up Untensberg.. the highest peak near Salzburg.Its a major attraction never to be missed! Indeed eventhough we were assisted by the really high cable car to 1778m, there was still a 30 minutes hike to be peak!!

Arrghh.. i am too sleepy to continue. I will blog more later tomorrow:)

The Journey to Salzburg.. the beginning

I am currently blogging from my room in Salzburg.With Ling and Shahnaz ;our poster presentation submission were successfully accepted and that became the trump card for our presence here. Regional anaesthesia recognition is fairly new in Malaysia and I guess the reason why we are enthusiastic in probably taking the subspeciality exams soon. Its not often that i have this chance to do 2 things together.. for my future career as well as my love of travelling.

Due to unfortunate miscommunication, I was alone on KLM while both of them flew with Lufthansa. My flight was from KLIA to Amsterdam and then to Vienna instead of Salzburg directly. I kinda enjoyed the flight and managed to sleep in the plane to avoid jet lag on arrival. However, the time of transfer was very short , less than 1 hour and I had a bad experience with the immigration. ( travelling alone, given that i have a BIN in my name as well as my Malaysian passport reporting my travels to indonesia .. high risk !!) I had to run all my might so that i don;t miss my flight.. Jauh gile from C17 to E78!! MAk aii... baru lepas sahur and i was so thirsty making that dash!! )

I arrived in Vienna in one piece, still trying to catch my breath and i guess because of Ramadhan..god was testing me again. My luggage was nowhere to be seen!! AAArrrghhh.. Apparently it was left behind because of the short transit time. I was assured by the KLM staff that my bag would be sent to my in the evening directly to the hotel where I am staying. Ok.. and next was my journey from Vienna to Salzburg.

I decided to use the train as it should be a good experience crossing through Austria. From the airport i took a shuttle directly to Wien WesBanhouf . The good thing about europe rail is its easy to plan your trip!(learnt from my UK experience in the past).And of course, being sehelai sepinggang i decided to tour as much as possible of Vienna in that short one hour! This was not in my original plan considering my big luggage. I went around and of course got carried away.. so again I was running again to catch my train!! Hahahahaha Gila dahaga woo.. but that was never the reason for me to give up on my fasting! Weather was too excellent that it was definitely too hot! Apparently there is an ongoing heat wave.

The 2 hour train trip was good as the scenary was excellent. I arrived in Salzburg train station 230pm and both Shahnaz and Ling were waiting at the hotel. Luckily Garni Evido was so near to the station that i can spot it right away! ( Off colour red building..mind you in Europe!!)

We went around Salzburg old town later that evening and had my iftar. My legs were so gello by then because of my persistent walk through out the day!!

Both Ling and Shahnza is fast asleep and I am about to join them soon. Tomorrow will be the registration day and i believe there will be more adventure to come.. :)

The smelly call courtesy of Fournier..

Yup.. I am back in the general pool and of course to start it off, I was oncall yesterday. I had 2 excellent colleagues with me and the call was uneventful. But then.. we had loooongg cases to do.. which can be a bummer as weget bored easily! When we anaesthetist do a good job, everything is under control and when there is no internet access in the OT , it can be really LONG!
Of course in every call there will always be one case that you'll remember.. and this case I am about to blog will be something i will cherish and of course live to tell the tale. We had a 45 year old man who came with a really bad scrotal swelling; he was suffering from sepsis 2o to Fournier's gangrene.
When I passed through the reception, there was this strong stench which i could not really point out to what it was. It had the nasi goreng ikan masin smell and i thought it was brought about by the numerous order our boy got from Kampung Kerinci Bazaar. The mystery came to a discovery as i was seeing this man.. in pain and looked very ill.. it ws from him!! The gangrene stench was very pungent as it made a lot of heads turn when they passed the reception.
And of course.. during the procedure.. Ya Allah... the smell of pus and faeces was so bad that you can sense it from 3 OTs away and that is from outside! To be in the OT was a punishment as the air was filled with the septic molecule ! It was really bad that a bypass colostomy had to be done as the communication between pus and faeces was there.. it was SO DIRTY.. and of course, the cocktail combination giving an olfactory high stimulation.
I went in.. went out.. the smell stuck on my srubs and i needed to change m scrubs to get the feeling off ! The urosurgeon kept smelling his fingers after the op.. and repeatedly tried to wash it off to much avail! Hahahaha GILA BUSUK!!!!!
I will always remember this Fournier.. oh Fournier..
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I was given the opportunity by my department to speak in this morning's University CME regarding Do not resuscitate orders. Its not frequent you get trainees to address the UMMC staff on Wednesday mornings.To my surprise before i went into the UMMC auditorium, I saw the poster and..hahaha.. the big topic was LECTURE !!! I am giving my GRAND LECTURE? HAhahahahaha . The "speaker by" part was an English letdown as this poster was for public viewing! I guess UMMC must next time strictly vet simple English mistakes like this to avoid embarrasment to the institution.( you know how irritating hearing THATS MEAN??!!)
Being post call, i was a bit groggy to start off with.Of course, the audience was not as full as the H1N1 talk but it was adequate for me to convey my point.I've always enjoyed speaking in public and this time around I shared ith them 2 video clips.. one was of Mr Bean doing CPR ( which was hillarious) and the other, from grey's anatomy on DNR which i topped up with the frankenstein IT'S ALIVE classic! I was nervous to start off with but i guess i did OK. Its fun to do this once in a while and of course, will be another additional point in my CV...

1st H1N1 fatality for docs.. becareful to my fellow colleagues..

Alfatihah..
A doctor in Seremban just passed away because of H1N1. I'm not sure what were her risk factors but being the person who see multiple H1N1 patients everyday, health care workers are at the highest risk to get the infection. How well one copes with it, is entirely by chance as how the mutation pattern of any virus.
This latest casualty will cause major tremor to the medical fraternity. It is bad enough to be facing the risk ( as how we do everyday anyway) but with this evidence i wuld not be surprised if some doctors may opt out. I predict the new guideline from KKM will be ,doctors with high risk factors would be exempted from being in contact with possible infected patients.. I really dunno.
Its a mixture of signals with swine flu; between anotherbenign virus infection or a fatal one which nobody has the answer.

Happy 5th Birthday of my blog!!

mafeitz.blogspot.com is 5 years old! Coinciding the birth of my blog with the National day was a good idea as I have 2 things to celebrate :)
I've managed to keep it going so far.. alhamdulillah. Of course, facebook and twitter has taken over the popularity score amongst the masses, but i like blogs a lot. A lot of changes through out the years and compared to 2004, the alternative media is more powerful now!
It has been 5 years of my life in here ; not fully though but of course the memorable moments archived. I thank Allah for his blessings for the last years. I'm in specialty training with three beautiful kids. What can you ask for more?
Alhamdulillah..

Life can be cruel but we have to be thankful..

The orthopods posted a case; a 17 year old girl with advanced osteosarcoma which needed AKA. They needed to do it on a Sunday because it was oozing slowly; she had a histroy when at an acute stage her Hb was 3 !!!
I was very surprised when she arrived; an anaeroxic girl with a football ( literally) below her right knee. I wa surprised to see her in such look that my initial thought that she had some syndrome to start of with. Upon questioning her father, she was a normal child until about a year ago. They even had a biopsy done when it was very mild; just a small growth below the knee.
Father was not keen for any operation then and resorted to various traditional treatment. It was painful that she was bed bound and i guess , they let it grow and i don't know how they ignored it; the smelly and bloody growth! It grew and grew until one day , she was unconscious at home. The family brought her to the closest hospital, and yes..she needed at least 10 pints of blood before she was ok.
Doing the amputation was a big risk itself, she was merely 12kg in weight and i cannot afford to let her loose blood more than 500ml! That is nearly half her blood volume!! To see her in such a stage was sad; because she is still young but she was having bad contractures all over with bad bed sores! I have a feeling she was neglected because her hygiene was really bad and i felt so sad for her. Her prognosis was poor from her current condition.
" Doktor.. kalau kaki dia potong sikit je boleh tak?"
I was left speechless.. I don't know what to say.
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I was just lying on the bed; waiting for Subuh after my sahur when i received a phone call. Apparently an obstetric emergency! A patient who'd just delivered from another centre with Post Partum Haemorrhage was on her way to ou centre and needed blood urgently. I enquired where was my Obs Anaes oncall as I was the registrar that night ; and the obs staff mentioned they can't get through her.. OK i said.. but then i received a second call almost immediately.. saying that the lady had collapsed in the ambulance! I was telling them to divert and send the lady to our A@E..
i got a 3rd phone call.. the lady was already here and in labour room ! Arrrgghhh!! Why labour room? The most inadequate place for resuscitation ! I quickly dashed to the labour room which was situated miles away from the general OT..
True enough when i arrived, Rusnaini was leading the resuscitation ; them telling me she was cold and blue, pulseless on arrival. I had the defibrillator on and the ECG did show VF.. We CPRd and shocked her 5 times !!! It was bad , the young mother who'd just delivered their first baby could not have expected this to happen! We tried our best to revive her but it was futile from the start. We resuscitated her for 1 hour before calling it off.
The emotions of her family members upon receiving the news was bad.. and understandable. She was ok 4 hours before but now she was dead. Everybody was shocked!
Of course, there were a lot of questions on how it became this way but i don't think i can comment as I'm sure it'll be inquired soon enough.
I was very thirsty.. and it was just 7am.. what a day to start in Ramadhan... :) but i prevailed :)

"Feeling" the equipments

We recently had tutorial sessions to discuss and describe the anaesthetic equipments that we use everyday. It is an important yet vital part of our Part 2 exams and OMG!! I feel so incomplete and blur.. hahaha the main reason maybe because i never sat down and read properly dedicated literature or book on this topic. I thought my knowledge was fine but how wrong can i be !!!
As anaesthetist, we have to be really confident with the equipments that we use day in day out; I remember Dr Hashim my consultant in Selayang who's very good at it.. He knows everything ; fingertips wooo... The good thing about being comfortable with your equipment is, if something goes wrong you can identify it and rectify it ASAP! Instead , i too depend on the MA in charge or the nursing staff !! hahahaha Anaes Gen X lah ni..

HAd a look at Basir's book( Shaikh and Baha). He actually bought it which cost a bomb!! Usually we'll be cheapskate and get a photocopy version of it but for this book; i reckon the original book make things crystal clear. I kinda like this book which is concise and full of colour pictures! However, when i tried to search it in our library; i'm dissappointed that we don't have it

I only managed to get WARD's from the department's library which is thicker and more detailed. I kinda like it too ..hahaha ( janji ada gambar kaler2 banyak..oklah tu) but it is a bit too bulky to bring around for short reads.
At least , i'm starting to be a bit serious with my reading.. I hope that it is a good sign! :)

One thousand million smiles

Read on the paper that TV3 will be showing a never been seen before concert by Arwah Sudirman.Cool i thought.. growing up seeing him performing creatively on TV was certainly an inspiration. He's a cool joe and watching this on Merdeka day will be fun and meaningful!
Alfatihah..

Be clean or exposed

Permatang Pasir by election result came out last night without a surprise. Being DSAI's homegrund, it would be unthinkable for PR to lose there unless there was a really BIG shift of opinion against him. For PR, the by elections so far has proved how influential they can be and should never be underestimated.Eventhough the mainstream media highlighted the glorious campaign & painted a rosy picture for BN; the situation is not BN's pot.
It was a bitter electorate experience for Rohaizat and it was not purely because of the lost which was in a way expected . The manner how his skeletons in the closet was brought out to the public really ruined his reputation. After he was introduced as a candidate, looking young and fresh ; glimmering with new hope.I guess the BN hardcore party goers were thinking the unthinkable to happen. He was up against the PAS candidate who lacked the firepower of a proper statesman.
When the bar council controversy came out, it was startling . Damage control was acceptable but of course one may question how in the hell did the vetting committee missed this? And the second wife issue... perrgghh.. sorry bang , that is a no-no especially among the malay lady voters. Rohaizat is definitely in trouble with his first wife as it is an issue which will hurt and pose humiliation! He was not able to answer to the allegations convincingly and even tried denying it.
The moral of the story: If you have a dodgy background or you did something really stupid before, own up before somebody else dig it up! Its the internet age and you cannot hide it... transparency they say....

Iftar 1 Ramadhan

Its 1st Ramadhan today and following the yearly tradition of this day, I present you my cooking !! ( cam sama last year jeee...) Hahahaha And of course, this is my first time embracing ramadhan in Bukit Jelutong.
Its good to get my kitchen especially the oven going again as it has always been the victim of hiatus and over-enthusiasm which produces nothing!
Ramadhan Al Mubarak to everyone!!

A physiological marvel: Sir Usain Bolt

World Athletics Championship Berlin 2009
World record times created :
100m : 9.58 200m : 19.19

Is he the greatest ever? Seeing him run is orgasmic!!!

Drs in and out

I came across Tun Dr. M's blog regarding doctors and when people touch this subject, i have a very strong opinion on this.

1. The grass is always greener on the other side. Money is always the main factor of any switch in any profession. Malaysian doctors who are currently working overseas were indoctrinate informally to work outside even before they start. This is more obvious to those who obtained their degree overseas. Parents who paid for their children’s education would expect none other less than this. Students under government scholarships meanwhile were planning their way out of the contract. This situation is not helped when the Malaysian health system itself is being ridiculed by our own medical professionals wherever they are!

2. It is a fact that once a medical student undergoes his/her training, it has always been about individualism. The target was to pass the MBBS exams, proceed to postgraduate and be a clinical consultant. Personal aim takes priority than mass aim. Never was there any formal approach to instill patriotism to serve the nation. Some would argue that this maybe idealistic and not realistic but why shouldn’t we? Why can’t we be proud of our country and whatever means we do should be for the country? Israelis do this very well and why should we not look up to this value?

3. One big factor for the medical-health sector brain drain is due to the lack of post graduate opportunities in Malaysia. A rigid hierarchical system is at place, hindering the ambitious to fast track their career climb. Opportunities would be denied even more with the increasing number of doctors that we produce every year. What happen is these doctors had to resort to overseas collegiate programmes which was designed to be “people-friendly” – anybody from anywhere can take the exams. One should realize that the reason why it is internationally recognized is because of history, past reputation and masses but not due to its quality. After spending a lot of money in getting the coveted qualification, it is of logic to reclaim the money by working there! Unfortunately, due to the financial stability and being in a system which recognize one’s talent; the thought of contributing to the country is lost. In fact, applying for PR or even citizenship comes into mind!

4. It is the thick colonial thinking we have which had encouraged the ongoing brain drain trend. This is unfortunately complemented by the rigid non-recognizing talent policy by the Ministry of health. There should be a paradigm shift to change this mindset and formulate a thorough plan even from medical schools to maintain the wealthy talent pool in the country. We’ve lost a lot of our talent to Singapore; look at their medical health system which has a huge number of our Malaysian doctors running it! Who else can we blame if not ourselves?

Feelings of ramadhan

Its ramadhan again ; time moves so fast that I can still remember what i wrote in my 1st of ramadhan entry last year! It looks like I may resort to cooking my own iftar tomorrow.. hhehehe
To all muslims; this is the month of full blessings. We are all encouraged to multiply our efforts in ibadah to take advantage of the "pahala" sale offered by Allah. It is a month of reflection; to look back at what you have achieved so far in life and evaluate it in tandem with god's will and not wrath.
I find ramadhan to be challenging every year ; i dunno why it is specifically during this month I am always tested. THe non-presence of satan is guranteed but still one has to fight within in finding the best solution for all. Its not easy to maintain one's composure. Sometimes thinking about it can make my mind go bonkers. Honestly i still can't figure why I am not insane by now..perhaps I am already!! hahahahaha Its easier to be misunderstood these days which i can't comprehend the facts. Once bitten twice shy they say..
Well, they don't call it ramadhan for nothing, right? hehehehe Ramadhan Al Mubarak to all my dear friends:)

QAS's Prep Course for egypt bound med students..

I was recently invited to attend and give short talks to future med students who are going to Egypt. I really am amazed by Allah's plan as I'm sure the organizers had never heard of me and vice-versa.It was also by chance that a friend of wifey called up and asking if any of us were interested. Apparently , those who were scheduled to take the session could not make it and the organizers had to look for last minute replacements.
I've always love to talk to future and current med students as I feel that at that very young age , you don't really know what "shit" you're getting into!! Its very nostalgic becuase I was in their shoes before. In a way , doing this regularly will keep me youthful! Getting information is the most important thing at this early stage because the idealism we had about being doctors at that age is totally false!! And med school itself is a torture and not for the weak soul !! THe idealism of doing good for mankind is not bed of roses! And this is just about going through med school as i did not intend to tell them yet about housemanship!!
I was entrusted to prepare short presentations about intro to Anatomy,PHysio,Histology and Biochemistry.. the core subjects as first years! My word.. it was not easy to prepare slides for this 4 "kena paksa belajar" subjects! It can be really boring you know!! Hahahaha I tried my best and thought real hard the day before.. how not to bore the kids and the challenging part was to keep them interested in the 4 hours !! Lama gila !!
I had to tell them the reality of med school ; its never going to be easy from day 1. The culture shock,struggles and perseverence of the prolonged period of training!! Hahaha I hope that i did not deter anybody from continuing!!
It was a good session.. the kids were enthusiastic and optimistic. I know they enjoyed my life- experience jokes( i am glad when they laughed.. kalau tak malu la ..lawak tak jadi..hehe) as well as the gory pictures from my collection for show!! I really hope that it was beneficial for them because i know i benefited from the seniors in UK while doing A-levels. Again, I am always overjoyed to share my thoughts with future docs. In Palembang last year , I had a session with the UNSRI kids.
To the Alexandria and Tanta Univ bound med students in September 2009, All the best and good luck in your quest to be doctors insya allah.
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**memories.. my superb HO team in UPM Surgical ward HKL.. thanx dr zek for the pic!!