Monday, March 19, 2007

morgue in clarke quay singapore?

i came across this interesting joint when i visited Clarke quay in Singapore this week... to my shocking, the business is a pub and the deco is amazing with all stuff simulate hospital/clinic setting! the counter is a morgue!! they even have drip stands and blood(artificial blood bag) hanging on the stands beside the hospital bed which had been converted to be sofa for customers to sit on it!! Funny thing is lots of people are there and they don't mind to be in the 'hospital' and drink beer/alcohol....not 'pantang' at all that lots of alcohol might lead them to real hospital one fine day???

Tuesday, February 27, 2007

What have we done?

HAART has proven efficacy in controlling HIV disease since 1996. HAART improved quality of life of HIV affected patients and maintain health with sustainable viral suppression as long as possible! EVERYONE knows this!

Thinking that we are doing some thing good to those neglected and forgotten patients by giving them a second chance of life with HAART....yes, majority of our petients apprciate the chance that HAART provided them! HOWEVER, there is always the other side of the story....

Within this short week after CNY, I have heard 3 bad news about my patients...

  1. a HIV patient on treatment doing well with HAART for the past 3 years ( with history of systemic fungal infection when he presented, death was so near to him) now was caught in the prison on CNY eve night for robbery crime with pistol!! He is well enough to rob others.... now his HAART is free, yet he needs money and he robbed!! Sigh!!
  2. anothe HIV patient plan to initiate HAART today did not turn up for appointemtn because he was caught in the prison for breaking into other people house during CNY!! He is not so well, but still plan to rob!!
  3. the shocking story is this.... I got a call from one of my counselor nurse regarding a man (Muslim) on HAART for the past 3 years, well with CD4 count of more than 600, came to see us 3 years ago diagnosed after the first wife found out to be HIV positive antenatal and from there his second wife also was detected HIV positive, yet they all happily planned a big family with 2 children each, and all the time they had been advised not to conceive anymore....the man feels well, refused to use condom and no contraception at all, claim religion not allowing them to do so! Then here came the shocking news....he married the THIRD wife!! And this time the third wife is referred from OBGYN as HIV positive diagnosed antenatally!! When questioned the lady, she came out with the NOTORIOUS name of the MAN!! Then he came to us and told us off after we asked him why he did so!! He said that he IS GREAT and FEELS GREAT with energy and he plans to marry the fourth wife soon!!! MY goodness! What have I done to create such egoistic monster!! Shall I stop his treatment? Make him ill? Or go to the court to stop this man from marrying the 4th one to prevent an innocent girl form becoming HIV?? WHAT had happened??
Are we making them feel good to do all sinful things in life?? Makes me think many times before I make such decision to treat now!!

drug rash

I met this patient in my clinic today, he took Bactrim for the past 21 days with high dose for PCP, this developed only after he completed high dose Bactrim, sometimes I felt difficult as we as a clinician tend to give hope and urge patient to be on HAART as soon as possible, however, when this came, we need to stop our urgency to initiate any HAART till all the rash subsided!

Once I came to meet this patient whom we all clinician had advised again and again for him to be put on HAART, and when he was ready, he developed this with one of the medicine, this made him lost all his confidence in us as clinician! Difficult, yet we need to be very careful of our treatment counseling prior to starting the patient on treatment even though we are very keen, yet the patient readiness and understanding will determine the successful of our treatment, NOT the clinician!!

Monday, February 26, 2007

busy busy year

Happy Boar year!!

So busy lately, I have lost my right hand man to HSB... Hope he is well there, I heard he is now slimmer, well when I was in HKL doing the same training, I was the slimmest at that time...thinking back when I was in SARS team in HKL, I was the STAR in most of the magazines and TV shows and newspapers, and I was very slim at that time, well after delivered my little angel 2 and half years ago, I could not get back in shape, now this year, i will be forcing myself to be more discipline in dieting... allot of colleagues are very encouraging, including one of my good friend even said that she will spanked me if I eat more than I should...thank you!

I saw my husband who lost weight a lot lately due to disease... from 75 kg down to 59 kg now, and the waist from 35 inch to 29 inch, this drives me more to loose weight in order to catch up or better down with him! I am worry however, he is really positive about his life, I should be living my life with him to the greatest while I can! However, my work is really driving me away from family life! As I said, KKM is Kementerian Kuat Meeting!

Just wish I will have my right wing back.... then I can do some quality work here, if not, I am not sure whether I am doing everything well or nothing is good after all the effort!!

This year should be a new start for me and for my husband, and I am planning to set up a place for my unit and clinic, just wish everything will be smooth for me this year as In feng shui predicted!

happy New Year to all who read my blog!

May everyone have happiness and health then wealth in this year of golden boar!

homophobia?? Definitely NOT!

i was asked about this on last Friday in my clinic by a good friend of mine who works together with me! I was shocked by his question as I thought I have always been open about my view on MSM! I am NOT a homophobia, may be some times I was joking with some of my other friends about this or that persons preference in sexual activity, however, I am definitely not homophobia and i am in a field that meet a lot of MSM, I am not judgemental by any chance and will never be judgemental on those who prefer to practice MSM! i hope by stating this people whom I might offended will forgive me and be more understanding about me and of course trust must be earned, and I hope I will earn your trust if you are one MSM who decided to be open about it to me one of this days!!

Live and let live is my motto in this blog, and I mean it when I publish it, what it means please refer this blog in the past post!

Tuesday, January 16, 2007

white islands in the sea of red- DHF

now is hard to find this.... saw it during my round in one of dengue haemorrahgic fever! classical white islands in the sea of red!

dengue nightmare

thought the outbreak is under control when I saw the number of patient being admitted after new year had reduced. Too bad, it was a temporary phenomena when I saw a sudden surge of patient admission since last week. There are more patient being admitted to ICU care of severe dengue haemorrhagic fever and dengue shock syndrome, with a total of 24 admissions to ICU alone last year, and a total of 907 admissions to Penang Hospital (adult figure)!!

Is anyone out there really working to reduce this outbreak? I am tired of receiving patients now! We as a clinicians are the receiving party, if the prevention is good, then the whole situation will not be as bad!!

So I have decided to write a love letter to the authority to look into this matter, however, we will not have the situation being controlled if everyone in this community did not participate in bringing the outbreak to a stop! First, start from our own backyard, make sure there will be no place for aedes to breed! (I am asking my maid to make sure all water container to be removed, all drains to be cleared) and the health authority really need to work their way harder by not only fogging but also making sure to check all premises to get rid of the breeding ground!

Now my ward is mad house....and everyday, the doctors are paying more attention on discharging the patients back home earlier and putting ourselves at risk of malpractice rather than treating the patients properly, just to make way for all dengue cases!! The whole system is going to break down if the situation gets worse....pray hard for ourselves and for the patients!

Thursday, January 11, 2007

live and let live

when we live and let live, we don't need to criticize, judge and condemn others. we have no need to control over them or try to make them conform to our thinking. We let others live their own life and we live ours.
Live and let live is one of the keys to peace in our life. when we practice tolerance in our lives, we are liberated to work on our own issues!

I read this and understood this when I am involved in treating HIV/AIDS patients!

Wednesday, January 10, 2007


I met a patient the other day when I was in a hurry to go off for ward rounds. I did not have my clinic day on that afternoon, however, he was sick and needed my attention right away as my nurse told me that he was not well clinically!

I entered the room and I met these 2 guys, one sitting and another one standing. I knew the one sitting was ill, most likely he had an opportunistic infection now. I presumed the brother whom the man standing beside the patient knew his status since he gave me the referral letter from the private physician.

So there i asked him loudly, when was his last test of HIV negative before this current test! He denied he has HIV.... And I told him that the letter stated that he was diagnosed HIV in private hospital! Then I saw his face grimacing and winking at me, putting his palm together praying to me begging me not to say anymore....oops then I realized I have breached the confidentiality about the disease to his brother and his brother apparently did not know his status!

I became panicked, I asked the brother to leave us alone in the room, and I apologize to him! However, he asked me not to let his brother know and he will tell the wife afterwards about his status!

Today, I received a call from oversea (patient is from oversea) and the lady claimed that she is the wife of that patient! She is very anxious as she told me that the brother of the patient called her up to inform her that he had over heard the conversation! She wanted to confirm the husband status! i cannot disclose over the phone, however, I really feel bad about the whole situation! YES! The spouse had the right to be informed about the status so that he or she could go for screening immediately. However, I always give time for the pateint to disclose the status themselves to their spouse, if not, I will bring them together and counsel them!

Some one asked me before, isn't it important to let the other family members who might be taking care of the patient while cleaning and sponging? The truth is, this disease does not spread by sponging and cleaning the patient! However, our health side workers are wearing gloves even nursing am I going to sound convincing to the relatives??

In my opinion, the spouse should be informed by all means, however, if the patient refuse the let the family know, we as a clinician who treat them should respect their wish!

In this case....I will have a tough time....Have not really told him about the wife calling me up!!

The point is, Do NOT assume that all patient relatives who came with them knew the status!!

Some one told me, ASSUME is making an ASS Out of U and Me!!!

Tuesday, January 09, 2007

is private treatment better?

at around 4 pm today, I was asked to review a patient referred from a private hospital for retroviral illness that was recently diagnosed! The reason why I need to see this patient particularly was .....urgent changes need to be set!!

The patient came all the way from Medan, visit ted local private hospital for treatment twice and was not counselled properly for Anti retroviral treatment, so he happily took his medicine one at a time, and took wrong dose, wrong timing, and wrong way!! Now he had to pay the price of creating resistant virus and made his regime less potent at present....was it his fault? Or was this the Private Physician who earned lots and lots of money from these patient but yet did not give proper counselling and proper treatment for those who had paid them???

This was not my first encounter and within the last month, I had been receiving 3 or more such cases from private physician, either they had sucked their patient dried of money only then they referred to me, or when the patient was too ill and will increase their mortality rate in their hospital, I was really frustrated with this situation!

Anyway, my duty is to serve the public, so does not matter whether I am OK or not, I will still provide my best call best if I can in this shortage of man power in general hospital! Just wish there is some private physician with more ethic will refer those patient earlier before damage is done! The patient will be the one who suffers!