My time in Song....maybe its time to move on

At KK Tekalit with a Hypertensive patient

Just got back from another week long medical trip up Katibas river. This was my third and most likely last trip up there. I’ve already applied to be transferred back to Sibu hospital. Heard that it will go through somewhere in july or august. But knowing how bureaucratic JKNS (Jabatan Kesihatan Negeri Sarawak) can be, i won’t be surprise if im transferred later.

I’ve been here for 10 months now. I know I volunteered to come to Song in the first place but a big part of me tells me that my time here is up. My long term goal is to be a surgeon. I realised I’m not the type of doctor who can sit in a clinic the whole day. It bores me.

Another reason is that I feel I’ve done all i can do to improve the health care here. This place probably needs a new MO with new ideas and direction to make health care here better.  Remaining here would just mean I’m holding up in my comfort zone and I wouldn’t be able to progress anymore.

         Got caught in a tropical thunderstom on the way from Tekalit to Bangkit. No choice to continue in the rain. My yellow arse was freezing out there.                                                

When i was first transferred here, the clinic didn’t have much despite it being such a beautiful clinic. We have patients up river in the ulu areas that have not seen a doctor in their entire life. There was no X-ray or organism culture facility. No infusion pump, no CTG, no ARM stick. The MAs didn’t have a proper guideline on how to follow up on hypertensive and diabetic patients. There was a gross lacking of emergency drug. We had a 10 year old speedboat with an equally old engine which breaks down after a single emergency trip.

All these are vital for a clinic such as KK Song since we have no road access to any hospital.  If there was an emergency and we can’t transfer the patient due to engine boat failure or bad weather, all these instruments are necessary to make a diagnosis and keep the patient alive and stable until transfer to a hospital.

I remember a case where a patient collapsed in my clinic in the middle of the night. We had to start her on inotropic support to increase her blood pressure but we didn’t have any dopamine or dobutamine. All we had was adrenaline but we had no infusion pump to administer the drug. So we had to inject 5 ampules of adrenaline into a pint of normal saline and titrate it that way. It was a rather crude and unorthodox way to do things but what choice have i got. I just wanted to save her in any way possible.  Her BP and heart rate went up and down depending on the position of her hand and IV line. We wasted a lot of time as well looking for another speedboat because the clinic’s speedboat broke down again after transferring a patient few hours before that. We finally managed to get a speedboat from a logging company. Unfortunately, we didn’t manage to save her. She passed away at the wharf while we were about to transport her. 

Had a time of my life at the waterfall in Sungai Engkaroh, near Bangkit.

Now, we have most (I stress on the word MOST) of the instruments that we need, we are able to provide better health care to the people here. We have a new speedboat (albeit a very small one) with a new 80hp engine. The old boat has been send for a very much needed servicing in Sibu. We have yet to receive our Xray machine but my boss has confirmed with me that Song will be receiving it in the new future. Guess the new MO and people of Song will benefit from it.

We have also started on a 3 monthly mobile medical to Ulu Katibas specifically targeting poorly controlled hypertensive and diabetic patients who are financially poor and can’t come down to Song for follow up. We use the 4 Klinik Kesihatan (Tekalit, Bangkit, Engkuah and Chemanong) as a focal point for these patients to gather and see me. Patients with good BP and glucose control will be seen by the MAs.

In the first visit, i saw a total of 210 patients with 90% of them for poorly controlled blood pressure and diabetes. In my most recent visit, i saw only 135 patients with roughly around 85% for poorly controlled blood pressure and diabetes. The number of MO cases has reduced but MA cases still remain the same. That means just after 2 medical camps, we were able to reduce the number of poorly controlled hypertension and diabetes patients by 60%.

The beauty of mother nature. I've fallen in love with Sarawak and cant get enough of her natural beauty

We also started taking blood specimen on the 2^nd visit onwards to check for their renal function. We managed to detect 8 cases of renal impairment and those patients were informed of their condition and are under close follow up in Song. Those who need specialise care were referred to Sibu for further management.

During these visits we also have informal CMEs (continuous medical education) for the MAs in the clinic so that they can better pick up red flag symptoms and signs and refer the cases to me early so as to prevent the patient from deteriorating further.

We also invited the dental team along with us. It’s always more fun to have the dental team around. The bigger the group the merrier it is. There was once case where a patient had been suffering from a toothache for 4 years but he couldn’t afford the RM20 fare to go down to Song to have his tooth extracted. When it was finally removed he was so dam happy and he was later cursing the tooth for the pain all these years. What a sight....

I guess another reason i want to go back is because i want to be a surgeon eventually. Seeing diabetic and hypertensive patients who refuse to take their meds days in and day out irritates me. I feel claustrophobic stucked in the clinic all day long. And looking at how my friend from the same batch as me and my juniors getting better and better in surgery makes me feel kind of left behind. The desire to go back and make up for lost time is strong. 

This is the life man. Just lying there and fishing without a care in the world with the sunset as your companion,  the breeze caressing your face and the melody of a running river in your ears. 

But at the same time there is a small part of me who still wants to stay for just a little while longer. I just found out i failed my MRCS exam. Will be re-sitting the exam in September. I’ll definitely have more time to study here than when i go back to sibu.

Another reason is that ive came out with a new idea. There are many other smaller tributaries along the rejang river  which stretch for kilometres with few longhouses deep in it. To travel to those longhouses one would need to travel by longboat and if the water level is low, you are required to push the boat for an hour or two. 

Im planning a medical trip to Sungai Lajan next month. The furthest longhouse(Rh. Jipon, what a name)  is 4 hours from Song. Need to take a 2 hour boat ride followed by 2 hours of hiking in the jungle to reach that longhouse. This is a pilot project. If i feel there is a need to conduct such a clinic, then will do so once every month for each river under Song KK. but can only carry out the project if im still in Song.

All up to God how long he wants to keep me here.