Wednesday, September 29, 2021

My first experience kot on Business Class

The reason I'm blogging this down was because I guess my jakun experience being on a long haul business class. Hahaha Selalu teringin nak upgrade but was never lucky enough in all my travels before this. It was economy all the way 😀 I mean most of the time its just about sitting at your seat for that long period of time kan, why spend more? haha But I have to say my worst flight so far was the one to Kiev!! BEing in economy is not too bad. We'll always be praying for luck were when the flights were not full so we had the whole row to us to lie down for sleep! 
So yes, I got excited when I first receive the itenary. Wah business class best ni! hahaha But being tired and all, perhaps theres not much difference as we tend to sleep je pun on the flight. The long lay over in Istanbul was certainly the difference. I can say that I've experienced both being a budget traveller and a business class passanger in Istanbul airport.
I was a bit dissapointed when I boarded the flight and the seats were not the cocooned ones! Hahaha tak bersyukur betul! But of course it was spacious and for the 2nd leg to KL I did hot have anybody next to me nor behind me. Therefore social distancing habis! Food was good and bole mintak free flow drinks haha If I was younger perhaps I would be awake all night ordering food and drinks but im not anymore budak2 kan hahaha 
The lounge in Istanbul airport was certainly big! Besar gile. I tried to get one of the suites but apparently my flight to KL did not count. But like why? I did argue at the counter but still tak dapat lah. But not too bad really. There were lots of places that we can lie down anyway. And the free flow food buffet was super nice! Haha first time pergi amik I was a bit tamak.. so stuffed myself sampai nak muntah hahaha I had my shower before boarding the flight. It was certainly a comfortable shower facilities they had and it certainly refreshen me up so much.
Slept comfortably most of the time on the 10 hours flight. Totally an awesome experience. Not really sure whether Ill enjoy this again but I do cherish the experience and service. 

Stranded in Dushanbe

As I've mentioned before, we did not really know at that time whether we could exit Afghanistan. The possibility of being stranded in Khost for months was possible. Yes there was a new government but the issue was how the government operations would run was still in the unknown. Until now it is still not clear with various teething issues still unresolved. Memang kena start buat buku How to run a country after takeover 101 I suppose haha
Anyway, our exit plan was informed only 24hours before we left. Most of us would only be convinced when we are really out of the country! I have to pity my colleagues who has been stranded since 15th of August! And we arrived in Dushanbe at night on the 8th of September. Perhaps I will share later my experience when we were in Mazar-I-Sharif airport! It was really interesting haha
There we were in Dushanbe and because of the unconfirmed and unreliable possibility, we were not booked for any flight out of Dushanbe before our arrival. Flights were scarce and also full. Hence it was unly a week after that most of us were scheduled to fly back to our own countries. 1 week here? What could I do? Well to be honest, the hiking trails and countryside was tempting. In any other time I would have grabbed the opportunity to do so. Unfortunately, its covid era. Eventhough most of the people in Dushanbe claim that it is not there anymore (with their liberal stance of not making it compulsory to wear masks) I was not willing to risk that. Imagine, pergi jalan-jalan and when the PCR test taken before the date of departure, it is positive! Nightmare tu hahaha
Hence it was only in this central town that I move about until I can be a tourist guide lah haha Its a nice city as it was obvious what the Soviets did to build up its town. Large parks with beautiful fountains all around and from what I saw a thriving city in central Asia. We were lucky that when we arrived it was independence day in Dushanbe! Hence their 30th celebration and spectacular fireworks on the night! 2-3 hari cukuplah.. But 1 whole week? haha That was the start of my mental torture! But I am thankful that somehow I was given this opportunity to travel when everybody else was at home due to Covid19.

Back home and HSO14

I arrived in Malaysia on the 17th of September after a really long layover flight via Istanbul. Imagine being in Istanbul airport for 16 hours! I was lucky though as it was not as bad as my initial flight because this time around I was in business class:) Hence the lounge was superbly comfortable! The first time around I was loitering around, sleeping here and there for that total amount in various aras of the airport. But being named as the best airport in 2021 certainly was spot on because despite my loitering experience, the facilities were really good.

It was a bit tricky though before coming back as I was not sure whether I would be in hotel compulsory quarantine of home quarantine. Reason being the scheme was only recently launched then. As usual it was carca marba but I really have thank the FB group of MSQG which really had loads of information that helped me to understand. Obviously whatever that was provided by MOH and Malaysian Immigration can be very confusing. A high kudos to Ed Adeeb, a senior of mine back home from primary school. Also the son to one of the memorable teachers in SMTTDI.
I qualified for HSO and I chose to serve it in Medini Johor. There are multiple reasons for this which I will not disclose lah here hahaha It will become a written evidence. But I am very thankful that I am not isolated in a hotel room somewhere in KL. That would have been unbearable and mind blowing. 
Alhamdulillah, I have been OK and fairly occupied that I did not blog until today! Haha Which is the last day of my quarantine. Both my PCR tests were negative and tomorrow I will obtain the Release order from the State Health Department.
Hopefully everything goes well and I should be back to my daily routine on Friday. It has been a really weird 3 weeks of waiting and not working for me. I hope I will straight away fit in to the hectic oncall lifestyle again. 



Why 400k in private ICUs for Covid 19. Thats the realistic cost.

We refer to the Parliamentary question and answer session on the 23rd September 2021 during the presentation of the health minister YB Khairy Jamaluddin. The private sector has again being demonised on the total cost of patients with Covid19 managed in the private hospital’s ICU.

We, the doctors, nurses, pharmacists, physiotherapists, radiographers, and many other allied health care colleagues together with our management teams have been working hand in hand with our public sector colleagues in battling the Covid-19 pandemic. And yet, the spotlight often times is not on the work that is put in but the economics of it all which is poorly understood by many.

Malaysians were shocked by the revelation that the cost of ICU care in the private hospital for Covid-19 patients amounting to RM400,000 which to us is not surprising at all. This is the truth whenever we take into account the ICU support and services, medication costs, disposable personal protective equipment used (imagine a team of at least 6 doctors and nurses changing twice into Tyvek suits just to do their daily rounds for a month for a seriously ill Category 5). These patients are at the extremes of their multiorgan failure and will need all kinds of expensive medications and organ support like haemodialysis, mechanical ventilation, tracheostomy, and Extracorporeal membrane oxygenation in some cases (ECMO), serial diagnostic imaging and the usage of continuous drug therapies on top of the multiple human resource for an average ICU stay of at least 10 days with some even requiring weeks to months before being discharged home. The only way to make the cost lower is not to initiate any of the therapy as outlined above, which is completely unthinkable and presents an ethical dilemma. As such, we take the approach of do first while at the same time inform the family about the cost implications as it comes.

If one refers to the cost incurred in developed hospital countries it would amount to a similar number. To simply assume that the RM 400,000 as taking advantage in making profit from the situation is totally absurd. Please understand that in healthcare economics, the revenue that is obtained by the private hospitals charging the patient does not equate to high profit as there will be expenditures that need to be calculated against which, at times we may even have to write off some bills as bad debts.

What the public may not realize or choose not to understand is the cost that the government spends for each patient that is admitted to ICU. The government would in principle subsidize if not absorb all cost of ICU care. This can be clearly seen in recent MOH efforts in their official patient bill which will show how much the real total cost of care is.

In 2020, we were not faced with these financial dilemmas as the instructions were clear that all Covid-19 patients were to be managed in public hospitals while the private hospitals can continue to focus on care for the non- Covid 19 patients which were also being compromised. However, during the Covid 19 peak surge that occurred in 2021, there were not enough ICU beds for ill Covid-19 patients in the 140 government hospitals. For the writer to allude that the patients had a choice is irresponsible. Both the patients and the hospitals had no choice at times but to we have to manage them as they came as there were simply nowhere else to go other than the option of languishing in an Emergency Department chair of a public hospital for a day or two before a bed is secured. It was that bad.

We welcome any initiatives as suggested by YB Khairy Jamaluddin in Parliament that the government is studying ways to help the family with these bills. It was a crisis that the MOH had to act upon and if the government can use some of the taxpayer’s money towards this, it would be beneficial as the other way to look at is that the patients only ended in a private hospital ICU because there were no ICU beds available elsewhere. This, despite the fact that over a two-year period, almost half a billion ringgit was spent to increase the capacity and the number of ICU facilities to cater for the Covid 19 patients with the total ICU beds now double the number of ICU beds we had in 2019. It was a crisis that the author of the article chose to ignore.

When the Emergency Ordinance was announced, there was a possibility that private hospitals may potentially be taken over by the Government under Section 3 of the Act. The only drawback to this was who will fund the private hospitals for all costs incurred as the sustainability of these centres is upon the payment of the services which is provided. There are no taxpayers money involved here. These facilities also pay their corporate taxes to the government as well so by taking over, you’re effectively shutting out one revenue stream to the government. If these healthcare facilities are taken over without proper planning of their cash flow and reserves, Malaysia will end up with these hospitals closed or bankrupt thus further burdening the public health system where everyone will flock to the public hospitals and leading to a collapse of the entire healthcare system.

What the Covid-19 pandemic has exposed is how expensive healthcare can be and the current system we have may not be suitable for the government to sustain anymore. This is the hard truth, and politicians from both sides of the divide are well aware of this. They have chosen to sidestep the issue for far too long instead of trying to find meaningful ways to engage with the stakeholders and come up with a long-term solution. As some of these decisions are politically unpopular, the punches are then directed to the people who are actually sweating it out in the PPEs in trying to make a difference and saving the patients’ lives. The politicians do not see the mental impact that the Covid -19 pandemic has had on the private healthcare sector as well. We too go home with a heavy heart as well every time we lose a patient, no different from our public sector colleagues just because its private healthcare.

Whether we like it or not, running a private hospital is a business, and like any business’s profitability must be taken into consideration to guarantee the sustainability and continuity of such business. Issues such as the return of investment, upgrading and investing in newer technology and staff training is factored in to. This is all done to ensure patients get the best of the best. The cost in government hospital is actually nearly the same as that in private hospitals or slightly lower as the public hospitals buys in large numbers and bulk allowing some discounts in consumables but in general the cost is about the same. But such “cost saving” may actually be lost when we look in detail at how such items are actually being used in a clinical setting.

Most if not all those who work in private hospitals knows and understands the issue of cost. It is ingrain in our psyche’. The cost to the patient and to the hospital is taken into account at every step of the patient’s treatment. From the moment of admission right up to discharge and post discharge care and follow up. We do what is needed and indicated in achieving the best possible outcome in patient care and treatment. The care and treatment given is not compromised or substandard.

We would like to end this letter by saying that post pandemic, we can’t go back to business as usual. The public need to understand that healthcare is an investment, and the burden of the financial cost will need to be shared by all in order to make it sustainable. The government has done its part thus far, but it can be better. We need the political will to institute meaningful reforms involving both public and private sectors to continue to make the healthcare system in Malaysia the envy of even the most advanced developed countries in the world. Let’s not wait for the next big healthcare crisis to hit us before we make those necessary reforms. We now have a new Health Minister and judging by his first few weeks in office, we remain optimistic that things may change for the better under his watch.

Dr Mafeitzeral Mamat,

Dr Gunalan Palari Arumugam,

Dr Syed Rozaidi Wafa,

Dr Shahridan Fathil

 

Consultant Anaesthesiologists in Private Practice 

Saturday, September 11, 2021

Patience is virtue

Being patient is definitely a thing that I unlearnt and relearnt in my involvement with emergency response and humanitarian response. The level of patience is totally of a different level and I would never have thought I would be able to cope the way I've done so far. Things that is planned can really go haywire and you are left with the option of plan and wait. Wait. and wait. hahaha Gila lama nak tunggu for things to work or what was planned to receive any confirmation. 

Its totally chaotic in the ways of managing expectations. Never easy though and it can be really frustrating at times where it challenges your mental health to the maximum. I guess partly I am doing it not as my full time career but juggling my life with the normality that should go on. More so in this pandemic era. There are so many things to consider and I am in a way risking and exposing myself to possible simple issues that can affect my future. But i guess its carpe diem isn't it? Asking if I regret doing all this? Hell NO!! Haha I would do it all over again because it is definitely once in a lifetime experience! 

I was aware of this risk before coming. Though there was a miscalculation of how fast the situation grew and I was stuck in the middle of it! Its world history happening and still ongoing. Though my contribution when I was there may not be as significant as the ones where the bigger authorities are doing negotiations, fights etc but What i learnt most was what normal people really hope and want. They want the same thing as what we others want in our lives! Nothing different! Its just being the pawns and insignificants, hence it is just going to be their life story and livelihood of their future generation.

Despite out of the country, it is not easy to catch the first plane out due to what has happened to the world since 2020, the pandemic. Again, another period of waiting to be endevoured despite my mind already fixed to home at the moment. It can be a different future for me back home to but I guess its time to crawl back into my reality.  

The real last day

8 September was my last day in the land of the Afghans. After multiple cancellations of movement, this was the day that we were told the evening before of our possible movement. Having gone through few disappointments, I tried not to be to optimistic and did not really inform anybody about the possible movement.
And yes, we were to be moved by 1pm and it became surreal. My heart was pounding both on the still uncertainty as well as the sadness of leaving this setup I have been in the past 2 months. Our movement to the airport was smooth and still I was pessimistic that the plane may not arrive!

When the time came, it was such a relief but we knew that unless we were off from the next airport, then only can we feel we are safely out. Things that came about internationally in that past 24 hours certainly did not offer much hope for the smooth movement!
Alhamdulillah, we arrived in Dushanbe circa 730pm (airport ni pun satu hal, buka malam je! hahaha )

And then only, it sunk in. My mission in Afghanistan is over.. for now. 

The hope


Thursday, September 02, 2021

Kemana kita anak-anak Pashtun


** 90% of Afghans live below the poverty line. 

Last Day yang tak jadi

Sharing few of the pictures when I thought it was my last official day in this project. I really do appreciate the brotherhood and friendship that was offered. Certainly an eye opener and made me feeling more humble and being thankful to god for what he has given me so far.
My boyz :)
Pharmacist & PMR
The amazing cooks
FieldCo office

31 August with a different meaning in 2021

Malaysia celebrated Merdeka last Tuesday on 31st of August. Coincidentally, it was another significant date in where I am at the moment. They have had a number of significant dates being free from oppressors over the years and 31 August 2021 was the latest of their struggles and tragic history. Malaysia is indeed very lucky in her 64 years of independence that we never really had a dampering crisis that tore the country apart literally. What had happened since 2018 is too miniscule compared to Afghanistan. They have been fighting all their might in the last 40 years. The unfortunate effect is very catastrophic to their mental well being for their proud tradition and civilization.
I was supposed to leave Afghanistan too on 31st of August as planned. Though things were uncertain since the 15th (the collapse of the Afghanistan government) but the expectations of how things would be bloody and messy did not happen. This was certainly a surprise to all especially the Afghans themselves. Being on the ground with functioning working people, it has been very eye opening experience to have an insight of what common Afghans want. I can tell you that its just the same like any other individual in the world. Nobody wants war and dysregulation of the society. Nobody wants unclear future for the next generation. Nobody wants to be isolated from the world. Its about family, national pride and overall wellness. We are all humans. We are all the same with the basic tank that needs to be filled. 
So when will i be leaving this land of the Pashtuns? At the moment nobody can give me the timeline nor answers. Its a very complicated situation at the moment. Taliban 2.0 is certainly doing the steps "by the book" to make themselves legitimate and recognized by the world. A feature perhaps surprised the present global powers who are definitely suspicious of their proven past. The world then must show their compassion and maturity to uphold the principles of "real" human rights and impartiality. It is definitely interesting times ahead. But this no government situation is Afghan for the last 2 weeks is not good too! It is for this reason that I am not able to exit as planned. 
I guess the next time we say "Merdeka" in Malaysia, we really have to dive deep to ponder, do we really appreciate what "Merdeka" means. :)

Sunday, August 22, 2021

We should be thankful how peaceful Malaysia is

It was not just Afghanistan news making the headlines in international news. Malaysia had her own share with the immediate news after the Afghan Taliban takeover. Our political turmoil is legendary. Since we voted in 2018, we have had 3 governments! 1 vote equals to 3 governments they say! Certainly worth it ! haha The famous Langkah Sheraton 2020 has now been takeover by deceit and treachery politics ( the way i see it) when all sides are trying to play out each other. At the end of the day I must symphatize PM tepi as again, with the downfall of TSMY - he is still not the PM.
Who would have thought, Pak Long Mail - the ever loving character that tells us about all sorts of SOP and the PKs is no the Prime Minister of Malaysia. I reckon nobody would have predicted this in a thousand years. Names like Anwar Ibrahim, Hishamuddin or KJ would be in everybody's mind but I guess its Ismail Sabri's rezeki to be the PM of Malaysia.
I guess opportunity goes to those who knocks it, right time right place. Of course it looks stupid, when after all the ruckus and political manouvers; at the end of the day the Deputy Prime Minister of the previous government ousted is now the Prime Minister of Malaysia. Macam tu je. haha
In contrast with what is happening in Afghanistan, there's no life loss or bloody tragedies. But our economy now is bleeding hence we definitely need a miracle strategy to rise from the effects of Covid pandemic which is nearing to its second year soon. 
At the end of the day, politicians are politicians. It is about power. Never about the country or idealism that they claim to uphold. It is proven so much in this power tussle from both the government and the opposition side. Sama je. I'm sure a lot of Malaysians dah menyampah and getting sick of the fiasco. However, we tend to be very forgivable too hence I do not see any possible "rakyat" revolution that will come about because of what had just happened. we are different from our neighbours. I always believe this results from the creation of majoritily middle class in our society.
Welcome DS Ismail Sabri, the 9th Prime Minister of Malaysia... but how long will he be one? 

Wednesday, August 18, 2021

Winds of change

Its 18 of August today. Its a different country of what it was a few days back. You know that the Taliban were going to takeover the country but nobody predicted the pace that it went. There are many factors that may contribute to this but I will not really comment on it. There are many opinions in the cyberspace on why it has happened the way it is now. 
The only thing that I can share at the moment is, in my place everything is going back to normal. Normal in the sense of the livelihood, shops are open, markets are as usual noisy, schools and universities resumed their sessions. However you can sense the caution as people are waiting what will be in store for them. The previous government of 1996-2001 comes back into mind with the restrictions and things that they did. Most Afghans had bitter memories of such. 
Perhaps what is giving hope at the moment is how the changeover of the government went. MAybe for the first time since many many years that it went peaceful. Of course there were casualties in the battles of the big cities before 15th but it is not as bloody as how it was with the latest takeovers in the past few decade. 
We had our scare 1 day after the country takeover in Kabul. The Taliban who took over the city announced in a panic mode urging everybody to go home and close the shops. The Talibs left their post and assembled in the main government offices occupied the previous day preparing to defend it. It was rumoured that maybe the city would be under attack by the special forces. There was panic in the air. People were crying and scared especially of the loved ones they left at home. It was very nervy with the continuous sound of rifle shot in the air for alarming purposes. We were into our contingency plan of worst case scenario and getting ready to occupy our saferoom.
There was more sense of all parties on the risk and benefits of such action. Multiple elders went to negotiate and brokered a peaceful outcome of this. The convoy never reached town and we were all very relieved. Me? Yup probably the first time I felt a bit tachycardic and worried. 
But What am I really worried about? Dunno really and it is interesting when I start exploring what I felt the other day. To say that I am afraid of death? not really honestly. To me its god's will and up to him of where and when it can be. Anytime really anywhere. Even in the best of securities and situation.
The press conference yesterday gave a glimpse of how Taliban reckon they would want to be perceived as. It was all about reassurance of all questions that come into mind. We can only hope for the best in this country. They have suffered enough, it is time to rebuild it properly and it needs a lot of willpower from all to unite together in this fascinating magical land. 

Wednesday, August 11, 2021

Another goodbye as time is due

The week before it was our HR, this week it was our PC. Caroline! She has been here for almost a year and it is time to continue life and time for her to go home. This is my first mission and I must say that she had certainly brought a lot of encouragement to ease me into this project. Of course we started off with Covid issues but all seemed to fall into place.
The current period is certainly a trying times for the country as things continue to be volatile. But the setup is very ready for any possibilities. 
We had our customary BBQ 2 weeks in a row and i suppose will be some sort of tradition to celebrate in this isolated compound in between the uncertainties. Thank you Caroline for all your hardwork and we wish you the best in the coming future :) We will definitely miss your energy!

Tuesday, August 03, 2021

An enlightening BBQ to remember

It was Franci's farewell after 9 months on this project and I must say it was a lot of fun from planning, to preparing to executing and we ended it with a wonderful movie.
All that with no disruption from the OT over the weekend ! It was the day that i really ate up well haha


500 days of MCO

It has been more than 500 days now and the numbers are just creeping up. Its overwhelming all the hospitals and honestly I dont think the authorities really know what to do except just bracing for the impact.
My Covid19 story so far...

The education initiative: Intensive care for non intensivist in Covid ICU

It was supposed to be a small affair. Perhaps only a virtual talk to the new HPKK MOs who are coming in droves to open up more critical beds in HPKK. SOmehow, it became a viral thingy where it was up in even my mum's Whatsapp group? (Like what?? )
I must congratulate this lot for their initiative and perhaps the most congested zoom session we ever had. The youtube live viewers were consistently more than 1.5k in the 8 hours of streaming? Bayangkan.
I had to wake up early as 5 am  here is 830am in Malaysia. Keranamu Malaysia and luckily there were no cases during that time.
Alhamdulillah, Glad that I was involved in this sharing session and hopefully it would bring benefit and some guidance to the newbies (yang terpaksa) on the job.

A month since I've been away

Its almost a month that I am out of the country. Surprisingly it did not feel that long. Surprisingly I am fairly comfortable with where I am. Away from the typical hustle bustle of normal life but in a fairly demanding job to ensure that the medical services go well and without hiccups.
Surviving the first month without severe reprecussion is good enough I reckon but it is something to be expected. There were few dodgy ones but Alhamdulillah it was managed accordingly and patient was well.
After one month my relationship with the guys here has been well. It is fun to have them as colleagues and they do really look up to me for guidance. They are good enough to run the centre and I am sure they will continue to excel and flourish. Its interesting to see how they have progressed based on the progress report that I have been briefed from previous expats in a space of 4 years. 
The overall condition in the country can be a bit dodgy looking at daily updates on FB, twitter and mainstream news. Somehow whatever happens, this area that I am at maybe the last to be fought over and I am waiting patiently what will be the outcome.
How about myself? I believe it is such a rebreather for me to reset and reflecting back on my life. I have certainly not spoken Malay for a month now (maybe short ones on the phone) but otherwise it is interesting how English becomes the bridging language between the European expats, local Nationals and myself. Such a unifying language in the current context.