Surplus of doctors in Malaysia

For Future Doctors: General Misconception of being a doctor PART 1

November 11, 2010 by Pagalavan Letchumanan

1) Guaranteed Job and Good salary/can make money

Many parents still believe that being a doctor guarantee their children’s future. Well, it may be so before but not in another 5-10 years time. You can read about these issues in my MMA articles column. 20 years ago we only had 3 medical schools producing about 400 doctors a year but now we have almost 30 medical schools in the country (the highest per capita population in the world). Last year alone, almost 4000 new doctors started housemanship in Ministry of Health (MOH). The number will further increase in coming years when all the medical schools start to produce their graduates. I believe it will reach a figure of 6000/year by 2015.

This is where issues arise. Even now, the MOH is struggling to place these doctors in various hospitals in the country. We have almost 30-40 houseofficers in each department now not knowing what to do every day. Their training is compromised and they are being released after that without proper training with license to kill! I may sound negative but this is the reality. Even district hospitals are being used to train houseofficers now, starting 2010. As you would have read in the papers recently of parents complaining that their child has been transferred to East Malaysia after completing housemanship, it is a known fact that the shortage of doctors at this point of time is in East Malaysia. As our MOH Director General had said, most doctors will be sent to Sabah and Sarawak from this year on wards.

What’s going to happen in the next few years? Again, my prediction is, there will be surplus of doctors by 2015. There will more bodies than post in MOH by 2015. Doctors most likely will need to queue up to be posted in government service. You will be sent to rural and East Malaysia to serve. Any appeal will not be entertained. If you think this would not happen, please look at the nurses! 5 years ago, the government began to approve numerous nursing colleges due to shortage of nurses. Now, we have surplus of nurses without any jobs. I know of nurses who are currently working in petrol stations! BTW, the MOH is currently considering introducing common entry exams for all medical graduates. Only those who pass this exam will be given housemanship post. This will happen soon.

Furthermore there may be a pay cut for doctors when all the post are filled. One of the allowance known as critical allowance of RM 750 will be removed once all the posts are filled. Critical allowance is never a fixed allowance and is usually reviewed every 3 years. As you know, the pharmacist’s critical allowance is going to be removed if not already.

I had one budding doctor who said that the reason she wanted to do medicine is because it is the only field where you have a guaranteed job and a starting salary of RM 6000. Well, I have talked about guaranteed job issue above but she is definitely wrong in stating that the starting salary. The starting salary of HO has gone up over the last 5 years; no doubt about it (please read my MMA article). However, the starting salary of HO currently is about RM 3500 to about RM4000 after including the on-call allowance. Remember, your salary only increases about RM 70/year. You will only reach a salary of RM 6000 after 7 years of service as a medical officer, when you are promoted to U48 according to current promotional prospect in civil service introduced end of last year! BTW, other than the difference of critical allowance, a doctor’s salary is only RM 200 more than a pharmacist in civil service!

2) Medical degree recognition

If I can’t work in Malaysia, I can go to Singapore or Australia to work, right?

Again, another misconception. Many do not know that medicine is a very peculiar field and cannot be compared to any other profession. In order for you to work in another country, your degree needs to be recognised by the Medical Council of the other country. If it is not recognised, you would not be able to work there. For your information, only UKM and UM degrees are recognised in Singapore.

Almost all medical degrees from Malaysia are NOT recognised elsewhere.Malaysia Boleh mah! Only Monash University Malaysia’s medical degree is recognised by Australian Medical Council and thus you would be able to work in Australia/New Zealand. Some of the private medical colleges do twinning programmes with external universities from Ireland/UK/India etc. These may be recognised depending on which degree and where you graduate from.

3) Housemanship & Compulsory service

I have mentioned a little about housemanship above. As you know the housemanship has been extended to 2 years since 2008. Even though it is good for your own training but it does prolong your future postgraduate training. After Housemanship you have to undergo another 2 years of compulsory service before you decide to resign for private practise or pursue your postgraduate degree. It is during this compulsory service that you will be posted to anywhere in the country.

Furthermore, housemanship is not an easy posting. Even though the numbers of HOs have increased tremendously over the last 2 years, it is still a very exhausting job. Many have had a mental breakdown during housemanship. I just heard of a houseman who is on psychiatric MC for the last 2 months! It seems she thought that being a doctor is just like sitting in a clinic and seeing cold cases (probably she thought she can become a GP immediately!)

4) Hard work and post graduate training

20-30 years ago, being an MBBS holder itself is good enough. You can easily open a clinic and become a GP and well respected by the community. But things are changing. Even GP practise is a speciality by itself in many countries (Master in Family Medicine/FRACGP etc). Malaysia is also moving towards that. Many patients are demanding and would prefer to see a specialist directly nowadays.

Thus it is important that when you join medicine undergraduate degree, please be prepared to continue your education for another 10 years after graduation! In order for you to complete your postgraduate education, it will easily take another 10 years, assuming you pass all your exams in one try! So, don’t assume your education is only 5 years! MBBS do not mean anything now, in fact it is only considered as a diploma!

Getting into postgraduate training is also becoming increasing difficult. The number of places for Master’s programme is very much limited in local universities. The demand is greater than supply and of course don’ forget the quota system as well! Other than MRCP (UK) – internal medicine, MRCPCH (UK) – paediatric and MRCOG – Obstetric, you have to depend on local master’s programme for your speciality. Thus, you have a very limited option. With such a big number of doctors coming into the market now, I can assure you that getting a place for post graduate education is going to be a major problem in 2-3 years time! Be prepared.

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 2)

In this Part 2, I will write more about what to expect after finishing your 2 years Housemanship posting in Ministry of Health.

1) Compulsory Service

I am sure everyone knows about the compulsory service for doctors in government service. According to Medical Act 1970, a medical graduate has to undergo compulsory service with the government for at least 4 years. This includes the Housemanship which is now 2 years. This means that you need to serve the government for another 2 years before you decide to leave the service.

2) District/Rural postings

As I have said in my first part, after completion of your housemanship, you will likely be transferred to rural clinics or district hospitals. With the recent influx of large number of doctors, almost everyone will be transferred to rural areas, mainly Sabah and Sarawak. You can see this from various letters posted in almost every newspaper recently, embarrassingly by parents of “so-called” grown up doctors!

From my experience, district posting is a wonderful experience. Working alone without anyone to consult immediately, gives you a lot of experience. Remember, other than X-rays and some simple blood test, you don’t have anything else in these hospitals. Usually there will be about 3-5 Medical Officers (MO) in each district hospitals. When you are “on-call”, you are all alone and need to manage the A&E department as well as all the wards including obstetrics cases. It is really scary at times, especially if you are working in district hospitals which are far away from the nearest General Hospital. If you are preparing to sit for any exams then this is the time to do your revision as the workload is generally lower than in general hospitals.

The same goes for those who are posted to health clinics (Klinik Kesihatan). These clinics are usually situated in rural and semirural areas. Most of the time there will be 1-2 MOs in each clinic. The major bulk of patients that you see in these clinics are antenatal and outpatient cases. There will also be a lot of administrative work to do in these clinics including school visits, running various health campaigns and public health talks. In cases of any outbreaks, you will be called to assist in containing the outbreak. Basically you are the primary healthcare providers. Many doctors do not like the administrative work that they are supposed to do, and the meetings that you need to attend!

Even though it is a good experience to do rural/district postings, please do not stay long in these clinics/hospitals if you intend to do postgraduate studies. A maximum of 1 year should be adequate. The reason I say so is because you will lose the momentum to further your studies after some time of good life in these centres. Since the workload is lower, you will get carried away with relax life compared to your housemanship training.

This rural/district postings are usually given extra points when you apply for your Master’s programme even though it does not guarantee a place. At the same time you can use your free time to prepare for your exams like MRCP Part 1, MRCOG Part 1 etc etc. After passing your Part 1, you can request to be transferred to the General Hospital for continuation of your training. Again, this may become a problem in the future as the number of post may be limited and it may be increasingly difficult to get a place in bigger hospitals.

I think people who grumble about going to rural and district postings should just give-up medicine. If you choose medicine to help and treat sick people, then these postings is where you really see the real life of people. You will learn a lot about their social life and the struggle they go through daily which you do not see when you work in general hospitals. You will also realise that people here appreciate you better than urban people. I would advise each and every doctor to do rural/semirural and district postings for at least a year after completing your housemanship.

Next: Postgraduate training…………………

For Future Doctors: Housemanship, Medical Officer and Postgraduate Training (Part 3)

Let’s look at the postgraduate training in Malaysia. I have written about housemanship, district/rural postings and problems of oversupply of doctors in the near future. The issue of oversupply of doctors by 2015 will lead to another very big issue: postgraduate training. Many of the budding doctors and medical students are not aware that the postgraduate training in Malaysia has many limitations and problems. At this point of time, most postgraduate trainings are dependent on Master’s programme conducted by the local universities. Once upon a time, we were totally dependent on UK-based exams and training but unfortunately we lost it along the way. Currently, only MRCP (UK) – Internal Medicine, MRCPCH (UK) – Paediatric and MRCOG (UK) can be done in Malaysia. FRCS (for surgeons) used to be available to Malaysians but not anymore. None of our hospitals are recognised as a training centre for FRCS, which is now known as MRCS. Thus, for any surgical field in Malaysia, you will need to do Master’s programme!

MRCP (UK) – Internal Medicine

Membership of the Royal College of Physicians (UK) is a well-known exam all over the whole. It has a very strong reputation as an entry exam for speciality training in UK as well as in other parts of the world. It is conducted regularly, usually 3 times a year in various countries. Malaysia is one of the centres for the MRCP exams, all 3 parts.

MRCP Part 1 can be taken about a year after your graduation. It is a theory paper. After passing your Part 1, you need to clear your Part 2 (written paper) and Part 3 (clinical) within 7 years. It is usually coordinated by University of Malaya, where the exams are usually held. Just for your info, the passing rate for MRCP (UK) is always around 45-50% worldwide! You need to have a proposer to sit for these exams, who can verify that you have undergone sufficient training to sit for the exam. If you fail miserably, your proposer will be notified.

Since MRCP (UK) is not a specialist exam in the UK, the Ministry of Health, Malaysia only recognises and gazette’s you as a specialist after undergoing further training of 18 months post MRCP (UK). You will need to submit a log book and recommendation by your HOD before being gazetted. This rule applies for all other overseas degrees which include MRCPCH and MRCOG. You need to undergo this gazettement process in order for you to be recognised as a Physician by the National Specialist Register (NSR).

MRCPCH (UK)

MRCPCH is similar to MRCP (UK) but meant for those who wants to become a Paediatrician. It‘s examination structure is similar to MRCP (UK).

MRCOG (UK)

MRCOG has 2 parts but the second part has both written and clinical component. However, you need to undergo training in O&G department for at least 4 years before being allowed to sit for Part 2 exams. One of the major issues in sitting for MRCOG is the fact that there are not many MRCOG holders in MOH to sign as a proposer for you!

Master’s programme

Now, this is where a big problem is going to appear soon. For all other fields, you are totally dependent on Master’s programme. This includes all surgical fields. Master’s programme is a fixed 4 year programme.

In order for you to be eligible to apply for the Master’s programme, you should have completed at least 3 years of service with good SKT marks of at least 85% and above, recommendation from Head of Department and confirmed in service. You also need to attend an exam or an interview before being selected for certain disciplines.

The major problem that I foresee in the future will be the number of places that are being offered. As of this year, the total number of places available is only 600, all disciplines included. Imagine, with 6000 new doctors coming into the market every year from now onwards, only 10% is going to get into the Master’s programme annually. Furthermore, you must understand that the selection process is never transparent, the typical Malaysian scenario as well as the quota system! Most of it is done by the Universities.

The government is planning to increase the number to 800 next year but the situation is rather critical in the Universities as there are not many Senior Professors to supervise the programme. I must say that the standard of Master’s graduates have dropped significantly over the last 5-10 years. We have Master’s graduates who can’t do surgery but have passed the exams! I just hope that the Master’s programme do not become another “specialists mill” like our undergraduate medical schools!

There are 2 types of Master’s programme, the open and closed system. In the closed system, you will do the entire 4 years within the university, like in UKM Hospital, UH and USM Hospital. The open system may have various programmes, like 2 years in MOH hospitals and another 2 years in the Universities etc. You may even do the entire 4 years in MOH hospitals for some of the fields.

After completing your Master’s programme, you need to undergo another 6 months of gazettement process before being recognised as a specialist. Furthermore, you will be bonded for 5-7 years for receiving scholarship during the programme, which is compulsory!

Subspecialty training

With the advancement in medical field, every discipline now has subspecialty training. As such, everyone will try to do certain subspecialty after gazettment as a specialist by MOH. Generally, the subspecialist training is about 3 years except for certain field like Cardiothoracic and Urology which may take 4 years. Again, whether you get a place or not depends on availability of post and demand for that particular field. For example, the waiting time for Gastroenterology training can even go as far as 1-2 years.

Recently, to overcome this major problem, MOH has taken another step backwards. You can only apply for subspecialty training 1 year after you have been gazetted as a specialist. For MRCP holders, this means 2 and half years after passing MRCP (UK)!

Usually, the subspecialty training is divided into 2 parts, the first part (the first 2 years) will be done locally and the 2nd part (remaining 1 year) will be done overseas. The MOH will provide a fully paid scholarship for overseas training of 1 year but you will be bonded for 3 years. If you have received undergraduate scholarship and Master’s scholarship, you will be bonded a total of 20 years in service!!

Singapore

One good advantage that we have is Singapore. Unfortunately, only UKM and UM undergraduate degrees are recognised in Singapore. Our Master’s degrees are NOT recognised elsewhere. Thus, we would not be able to work in Singapore with any other medical degrees or even with our Master’s degree.

However, Singapore does recognise MRCP, MRCPCH, MRCOG and MRCS. Thus, if you have any of these degrees, it supersedes the undergraduate degree and you should be able to get a job in Singapore. Singapore is also a recognised centre for MRCS Part 3 training, which you can’t do in Malaysia. So, if you have MRCS Part 1 & 2, you can go to Singapore to finish your MRCS training and sit for the Part 3.

I must say that Singapore’s postgraduate training is more structured and organised with their BST (Basic Specialist Training) and AST (Advanced Specialist Training) programmes. I have written about this in my MMA article “Back from the Future: From 1st world to 3rd world”.

For all of you out there; budding doctors, medical students, houseofficers and medical officers; the future is very bleak for the medical field in Malaysia. The oversupply of doctors will get to you sooner or later. My advice to those who insist on doing medicine for passion is to choose an undergraduate course that is recognised internationally. Then, pursue a postgraduate degree that is also recognised internationally. If not, you will end up with a lot of frustration in the future. Jobless doctors in the future will be a reality!

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The Traumatic Experience of Merapi Eruption- A view from the Survivor

“When I was at the first evacuation camp, I could hear the rumble non-stop for 48 hours. I just couldn’t close my eyes at night!”

“I was very lucky. If I left 10 minutes later, I would have been killed by the gembel wedus !

Merapi-Strikes-Again-with-over-50-Dead

On 26 October and 5 November 2010, the most active volcano in the world, Mt.Merapi, erupted with the highest intensity in a century. The immediate effects were devastating. It claimed the lives of at least 353 people, majority of them being burnt by the hot pyroclastic flow. A lot more were injured due to burns and respiratory problems. Residents staying within 20km from the summit of the volcano were evacuated to safer distance and this accounts for about 400,000 evacuees.

The ash splashed into the sky has spread as far as 30km. Yogyakarta, a city at the southern side of the volcano, was covered by ash during the event. Magelang, another city at the west of the volcano, received a heavier impact, recording ash fall as thick as 4cm. The air quality was so bad that the Jakarta International Airport has suspended all its international and domestic flight. The nearer airport such as Yogyakarta Airport and Solo Airport were forced to close due to the low visibility around the region. The economic loss was eminent.

On the media, we were constantly updated about the death toll, the progress of the volcanic activity and the disaster management by the government. Little was reported about the condition of the evacuation camp and even less is known about the problems faced by the victims. To gain an insight into the life encounter of the victims, I have visited the main evacuation camp, Posko Maguwoharjo, to conduct interviews with the evacuees there.

merapi victim evacuation camp

(Muslim woman praying in Posko Maguwoharjo, main evacuation camp)

It was in the night of 14 Dec 2010 when I met Ibu Suriyati. She was walking on the corridor after attending Islam seminar conducted by the local religion teacher. I introduced myself to her as a student of the UGM medical faculty. I explained that the purpose of the interview is to gather information for my school assignment and the same material will also be used to fuel the donation drive for the Merapi Victims.

Her response was very welcoming. She was very interested to tell us her story before and after the eruption of Mt. Merapi. She started by explaining her involvement in the mitigation effort to evacuate the villagers.

“I was part of the Communication Team that delivered the information about the update of the Merapi status to the local people. When the danger level was raised to level 2 (waspada), the head of the National Disaster Management Agency (BNPB) has ordered notification to the local people about the potential eruption and the evacuation plan”, said the 36- year- old woman.

The local government was taking this matter seriously. Talks were conducted in almost every village during the mitigation stage. Local warning system was established to alert the villagers in the case of a need to evacuate.

“When the Status was raised to Level 3, my family felt rather uneasy about it. We live in Desa Umbulharjo, about 4 km from the summit of Merapi. If there were a serious eruption, our lives would be at risk. What would happen to my cows and my house? The thought of this made me very stressed and I can’t sleep at night. My husband also became more sensitive and temperamental. He got angry easily with small matters. I understand that he was stressed with the volcano”, added Ibu Suriyati.

“So Ibu, can you tell me the situation when the Merapi erupted? Did you see the lava flow? From my place, I only experienced the raining of ash and tiny rocks”, I asked the woman.

merapi lava flow

“That was the scariest event that I ever experience. The land was shaking, as if having an earthquake. I can clearly see the arch gate at the entrance of the village swinging from side to side. From the direction of the volcano, I could hear the thunder sound. It was raining at that time. So I thought it was because of the usual thunder accompanying the rain. However, the rumble lasted for quite some time, which is atypical for normal rain. My neighbour later told me that it was the eruption sound of Merapi. I also see multiple lightning striking near the volcano”, recalled Ibu Suriyati in slight fear.

She did not observe the lava flow because of the thick clouds surrounding the volcano. It was a traumatic experience to be shaken by the tectonic earthquake. When somebody dropped an object in the house and produced a loud noise, she would be shocked, fearing that the volcano erupts again. The neighbourhood was clouded with uncertainty awaiting instruction from the local government to evacuate.

Nevertheless, Ibu Suriyati was aware of her responsibility to evacuate the local villagers when she received instruction from the Head of District. People from the village were moving to an evacuation camp located about 10km from the summit of Mt.Merapi. However, there was a problem. The well-respected elder from the community, Mbah Maridjan refused to leave his house. He was the spiritual guardian or “gatekeeper” of the volcano, appointed by the King of Yogyakarta, Sri Sultan Hamengkubuwono IX. The late Mbah Maridjan advised other villagers to leave, but he himself insisted to stay.

Photo Mbah Maridjan, Juru Kunci Gunung Merapi Menjadi Korban Gunung Merapi

(Mbah Maridjan, spiritual guardian of Mt. Merapi)

Ibu Suriyati attempted to persuade Mbah Maridjan to evacuate, but gave up after understanding that Mbah Maridjan was determined to stand on his position even till his death. She left the village in time before the deadly pyroclastic flow struck the village.

“I was very lucky. If I left 10 minutes later, I would have been killed by the gembel wedus (pyroclastic flow)! Thank God that my family is safe”, said the woman in relief.

The first eruption was just the beginning of her nightmare. Over the course of two weeks, due to increasing intensity of the eruption and expansion of the danger zone, she was shifted 7 times from a nearer evacuation camp to further evacuation camps, before finally settling down at the main evacuation camp, Posko Maguwoharjo. In addition to the psychological trauma caused by the eruption, the frequent reallocation and re-adaptation to new environment contributed to her weariness and distress.

During the interview, I happened to meet her husband, Pak Tono. So I took the opportunity to understand the perspective of the man. I inquired about his feelings about this incident and how he was coping with it. He looked rather calm in answering my questions, probably having accepted the reality after spending 8 weeks in evacuation camp.

“The eruption this time was much stronger than the previous eruptions. When I was at the first evacuation camp, I could hear the rumble non-stop for 48 hours. I just couldn’t close my eyes at night! The eruption has taken away everything we have. The whole village was destroyed by the pyroclastic flow. Basically there is nothing left on the ground. I have worked so hard over the years to accumulate such wealth, but it just return to the point zero. Morning I milk the cows, like the rest of the people in the village. Afternoon I will go to the valley to collect sand for sale. In the evening, I will collect grass to feed the livestock. Now I don’t know what I can do for a living. The cows are dead.” said Pak Tono.

merapi kinahrejo village

(the view of Desa Kinahrejo after the eruption)

“So how long will you be staying here? What is the plan for the future? Are you getting any form of help from the government?” I asked.

“In the day I will go to work at the shelter construction area. The government is planning to build 300 unit of temporary shelter for us. So far we have only completed 50 units. I think we will have to stay in the evacuation camp for another 6 months. When the shelters are completed, we will shift to the shelter. President Susilo Bambang Yudhoyono (SBY) has given his words to replace our livestock. I really hope he will deliver what he promised. So far we haven’t received any information about the reimbursement”, replied Pak Tono.

I continued by asking Ibu Suriyati whether she will want to go back to her village. She thought for a while and gave a negative response. She explained that the volcano will erupt every 4-5 years. She cannot imagine that she has to flee from the Merapi every half a decade. It was such a traumatic experience. Furthermore, whatever property she has will be destroyed.

“What is the purpose of working so hard to accumulate wealth? In the end, I will lose everything when Merapi erupts again. My efforts will just go to waste! I will never want to experience this again!” exclaimed Ibu Suriyati.

She later added that there is a misconception of the public regarding people from Cakringan (the district which her village belongs to).

“They said people from Cakringan value their property more than their lives. Because of that some villagers were killed by the pyroclastic flow when they returned to their house to feed the livestock after the first eruption. This is NOT TRUE! It is not because we care more about our property than our lives. It is because of the bond we share with our animals. Every day we feed them with grass. They are like part of the family. Would you be so cruel to let your family members starve?” said the woman in defence of the accusation.

merapi cow

It is common for the victims to have psychological problem after a traumatic experience. There is a psychological station set up at the evacuation camp to cater to the mental health of the evacuees. The psychologist has conducted psychological screening to identify those who need intervention. Ibu Suriyati admitted that she was diagnosed with depression. The common approach used by the psychologist to address this issue is correlating the disastrous event as the will of God. It became easier to accept the tragedy when believing that it is part of God’s plan.

Ibu Suriyati elaborated that her condition has improved after getting counselling from the psychologist. The religion seminar had given much console and comfort to her. Getting her mind occupied with activities such as sewing helped her to recover from the depression.

Merapi Sewing class

(Sewing class conducted at Posko Maguwoharjo)

Before ending the interview, I asked what kind of help she needs from the public. She said that the logistic at the camp was quite sufficient. The food supply is supported by the government. It would be best if the fund can be channelled into the redevelopment of the community. Donation should be given directly to the recipients or to the head of village for distribution. The posko did not give any money to the evacuees. From here, I can sense her doubt about financial management of the evacuation camp. It is understandable that the money donated to the evacuation camp will be used for the maintenance of the camp, not for the redevelopment since the evacuation camp is expected to operate for the next 6 months.

Evacuees at Posco Maguwoharjo copy

In conclusion, the interview has revealed that the victims were traumatized by the eruption, and the victims are reluctant to return to their village in fear of the next eruption. Economy activities were disrupted as the livestock were killed. They are short of money to rebuild their previous economy. Modal is needed to buy new livestock. Hopefully when President SBY replaces the livestock as he promised, the rehabilitation of the affected will be completed and economy activity can resume as the past.

 

Donation Drive for PKPMI-CY Merapi Eruption Victims Funds

Posted in Disaster Management, Merapi Aid | Tagged , , , , , , , , , | 2 Comments

A Note to Block Coordinator 4.2

I have created this blog as a fulfilment of the Contract  for Block 4.2 thanks to Prof. Dr. Laksono. The main objective is to stimulate the student to write down opinion regarding the topics they have learn in Health System and Disaster Mangement. From the student perspective, I think writing blog is a brilliant idea to enhance understanding and application of the knowledge I learn in this block. It is an innovation from the Educator to stimulate learning process other than the usually-plain-and-boring lecture notes. I like it!

It is very easy to create a blog. Just go to Blogger.com or WordPress.com, fill in the necessary personal information, then a blog site is born. From this portal in the virtual network, we are able to communicate with the world. However, what is more difficult is to maintain the blog regularly. Writing a blog post requires initial research on the selected topic, brainstorming for the interesting points, mental processing (very time and energy consuming) to write down the words, adding some photos and links to make it interesting and JENG JENG, I would finally press the “Publish” button happily with much satisfaction.

After posting a few passage, it gets a bit annoying when nobody is reading my blog. For the hours and efforts I spent in crafting my blog post, and NOBODY is reading it? Motivation drops to zero. For a masterpiece that consumes at least 100 hours to complete, it will be a waste if Prof. Dr. Laksono is the only person reading it during the “judgement day”. Such a beauty should be shared with the world (…too exaggerative..), or at least with my peers in UGM medical school. Thus I did a little publicity at the Facebook network.

During the course of the block curriculum, it is unfortunate, yet fortunate that we experienced the Merapi eruption. The event is unfortunate because it has brought much harm to the the surrounding including lives losses and property damage. From the other perspective, I am thankful that I am safe, and I am able to grasp a stronger understanding from the lectures as they are immediately relevant.

Inspired by dr. Bambang Hasta Yoga during his lecture about “Disaster Management in Mental Health”, I took the initiative to organize a visit with my fellow classmates to Posko Maguwoharjo. I was truly touched by the amount of help people are willing to offer at the evacuation camp. There are many posts that offer education, social activities, logistic, medical aid and etc. The experience of seeing spirits of humanity gathered under one roof is really unforgettable.

I feel like helping. There must be something that I can do. Perhaps a little effort can bring a big change to the victims’ lives. I thought maybe I can utilize my current health blog to gather support to help the victims. Thus, with collaboration with the Malaysian Student Association, I launched an online donation drive to get funds for the Merapi Victims.

Donation Drive for PKPMI-CY Merapi Eruption Victims Funds

The effort was well supported. We managed to collect about 2.5 million rupiah from our family and friends. The money will be used to provide daily needs to the victims. I am truly happy to be part of the Merapi Relief effort. With fulfilment of the physical needs, hopefully the victims can overcome their mental trauma with much ease.

Lastly, I would like to conclude that the blogging experience is a fruitful one. I will continue blogging even after finishing this block because I see this as a good channel to educate the general people about health and its related issues. I would highly recommend the block coordinators to continue the implementation of the blog contract for the following batch for the benefits of better understanding, better application and sharing of knowledge to the world.

Written by,

P1080505

Chin Jian Wei (07/251669/KU/12260)

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My top rated posts (ranking starts from the highest views):

  1. You can HELP, I am SURE!
  2. Malaysia: Too many doctors, too few hospitals
  3. Sex Manual: Improve your intimacy with an Umbrella
  4. Psychological Problems at Merapi Evacuation Camp
  5. Visit to Posko Maguwoharjo

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List of the 20 Blog Posts for easy browsing.

Week 7: exam week

6 Dec 2010: Malaria Risk In Indonesia

Week 6:

Week 5:

Week 4:

Week 3 : School Holidays due to Merapi Eruption

Week 2:

Week 1:

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Malaria Risk in Indonesia

Before studying in Indonesia, I used to have the impression that the mosquito (Anopheles gambiae) that transmits Malaria live in every single part of Indonesia. It did make me worried for some time until my senior clarified to me that the urban area of Java Island is free of Malaria. Despite of that, I got really tensed up to see my friends admitted into hospital because of Dengue Hemorrhagic Fever- another mosquito borne disease, but by a different species (Aedes Mosquito).

I really like the idea of some scientists to kill all the mosquito in the world, for the good of mankind. Make them extinct and get rid of all the problems (Malaria, Dengue Fever, Yellow Fever, Japanese Encephalitis, West Nile virus, filariasis and etc) once and for all. While the scientists are battling the mosquitos, we have to protect ourselves from the infectious bite.

GambarBeritaKoranJakarta20100826183700

(mosquito Anopheles that transmits Malaria)

I searched the internet and found out that WHO International Travel and Health Interactive Map offers some useful information about the distribution of Malaria infection.Malaria risk exists throughout the year in all areas of the five eastern provinces of (A) Maluku (B) North Maluku (C) Papua (D) West Papua and (E) East Nusa Tenggara. In the other parts of the country, there is malaria risk in some districts, except in Jakarta Municipality, big cities, and within the areas of the main tourist resorts.

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What a relieve for the tourists who wanna surf in the Bali beach, businessmen who wanna attend meeting in Jakarta and artists who wanna experience the culture in Jogjakarta. No extraordinary experience of having high fever and chilling in the middle of the night!

However, one of my DREAM vocation destination, Lombok Island, has high risk of malaria. Shall I risk my health for the beautiful beach? Hermm….hard decision… The Komodo Island that feature the Komodo Dragon is also rampant with Malaria. Sorry my big lizard, I can only see you in the Surabaya zoo, not in your hometown.

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How to prevent Malaria? First is to avoid the sinful kiss from the mosquito. Wear mosquito repellent and shield your sleeping area with mosquito net. Second is to kill the parasite (Plasmodium) that transmitted with the kiss. There are many options: atovaquone-proguanil chemoprophylaxis, doxycycline or mefloquine. Consult your doctor or the local health officer for the resistance pattern.

The drug resistance of Plasmodium is another headache for the scientists and doctors.

P. falciparum resistant to chloroquine and sulfadoxine-pyrimethamine has been reported. P. vivax resistant to chloroquine is also reported. I am not sure how fast can the pharmaceutical company produce new anti-malarial drug to cope with this resistance.

Perhaps a vaccine will put all this problem to an end. The richest guy on earth says that the vaccine may be ready in 3 years time. I really hope this would be a success. Thank you Bill Gates in advance!

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Sex Manual: Improve your intimacy with an Umbrella

Sex is good. Sex is wonderful. Sex is one of the most sought thing in the world.

Such exciting and pleasurable activity also comes with a risk.

A risk so great that it might destroy intimacy and ruin the relationship.

Nevertheless, it is not the End of The World.  Life still goes on. Some other people won’t even know that we have contracted the “risk”. Many still lead a normal life, with minimal disturbance on the society and career. Some are lucky enough to live up to the normal expectancy life-span.

We can still kiss. No problem in sharing food. We have no fear to hug. We are capable to love, and being loved.

It’s just that… we have a few little regrets…

We cannot donate blood to our loves when they bleed…

We have to take drugs regularly to prevent worsening of the condition…

We are constantly in fear that others might stigmatize us, viewing us as the untouchable…

If we know the protection measure earlier, we wouldn’t have to go through all this!

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Therefore, on the very special occasion of World AIDS Day, I would like to promote to you to use condom during sexual activity to prevent transmission of HIV and other sexually transmitted disease.

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And regarding the Umbrella, this is how you use it.

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“Sediakan payung sebelum Hujan”

(A malay proverb: prepare your umbrella before it rains!)

Reference: Word AIDS Day 2010

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Psychological Problems at Merapi Evacuation Camp

A natural disaster not only causes physical damage to lives and properties, it also leaves a mark in the mental stage of the affected. Due to less obvious nature of the psychological symptoms, many of these go unnoticed, in great contrast to the very recognizable physical symptoms such as severe burns or respiratory distress. Furthermore, the impact of the disaster on mental stage has a long lasting effects, for months or even years. Thus, it is very important for the society to understand this unspoken needs of the victims of the disaster.

My encounter with the Psychological Team in the Merapi Evacuation Camp (Posko Maguwoharjo) was an eye opener. The massive numbers of evacuees has raised various psychological problems to both the victims and the helping volunteers. The VOLUNTEERS also suffered psychological problems? YES, and I will explain it in the next few paragraphs.

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(Irene and Aisyah, who are very keen to interact with the children)

According to Ibu Nina, a psychologist from the District Health Office (Dinas Kesehatan Kabupaten Sleman), the evacuees can be categorized into 2 groups, which suffered different problems. The first group is made of people who are the direct victims of the volcano eruption. I shall call them as the “victims” from here on. The victims are the ones who stay in close proximity with the volcano, whose houses and property (livestock, farms) were destroyed by the eruption. Some of them even lose their loved ones in the disaster.

On the other hand, the second group is made of people who are evacuated due to the expansion of the danger zone up to 20km. They were instructed to leaves their premises and sheltered at the evacuation camp to avoid the pyroclastic flow (awan panas) that could possibly strike their houses. The pyroclastic flow is mixture of hot gases and dust, which can burn (up to 500 Celsius)  whatever material that is in its path. I shall call the second group as “evacuees” from here on.

Many of the victims were diagnosed with depression, anxiety disorder and post-traumatic stress disorder. The victims were feeling sad about the loss of property and lives. Some of them were very moody and lost interest in any social activities. They were depressed and not interested in conversations. Besides, many of the victims are feeling anxious and distressed. They were worrying for the future because they no longer own a house to stay or have no modal to restart their agriculture activities. The extremely crowded condition in the evacuation camp rendered them restless. The lack of privacy and failure to adapt to the new environment contribute much to the anxiety.

Ibu Nina also reported that a few of the victims were feeling very scared when the reported flashed their camera. It is very common for the volcano eruption to be accompanied by light strike. The frequent flash reminded them of the fear during the eruption. These victims that suffered post-traumatic stress disorder were given counsel to ease their phobia.

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Meanwhile, the second group, the evacuees, has a lighter problem. Their houses were still intact and they were waiting for government instruction to return to their home. Some of them showed sign of anxiety and stress. Usually these anxious people will have sleeping difficulty and may wake up often throughout the night. A common problem worth noting is psychosomatic symptoms, which refers to the expression of physical symptoms that originate from the mental state. For example, headache that is due to stress; stomach ache due to anxiety; ingestion ( dyspepsia and diarrhea) due to stress.

After understanding about the minor mental problems from Ibu Nina, I screened for major mental problems. “Ibu, so far is there anybody that committed suicide or going crazy (psychotic), running around shouting or behave weirdly like seeing things (hallucination) ?” I asked.

“So far nobody has committed suicide. The severely depressed patients are checked by our psychology team worker. We approached them, talked to them and tried to make them speak out their problems. Usually the patients become better after voicing out. There was some psychotic episodes, but those are patients with psychotic history. So their illness is not directly due to the eruption. They forgot to take the drug due to urgent evacuation. These people have been referred to psychiatric ward in Dr. Sardjito Hospital. As for the hallucination, no such cases are reported”, replied Ibu Nina patiently.

“So Ibu, is there anything we can help as volunteers for the psychological post?”, I asked.

“Of course you can! Just talk with the people here! Especially the elderly. They are always yearning for interaction. Sometimes just by listening to their stories, you can make their days! If you do notice some problems with them, you can report to the psychological post. If you have problem with Java language, you may shift your attention to the adults and children. Most of them speak the Indonesian Language”, Ibu Nina explained.

My dear friends, have we found out how to contribute as volunteers? It’s time for some chit chat !

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To help with donation, please click here.

Donation Drive for PKPMI-CY Merapi Eruption Victims Funds

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You can HELP, I am SURE!

Currently there are about 45,000 Merapi Eruption victims staying in the evacuation camp, and 6000 of them are concentrated in the Main Evacuation Camp, Posko Maguwoharjo. Due to the prolonged period of disaster and slow recovery process, much of the voluntary work that peaked during the Eruption event has decreased significantly. I would like to grab this opportunity to tell you we need continuity in the voluntary work to help the recovery process.

Trust me, you are CAPABLE. Great things begin with small EFFORT. There are thousands ways you can CONTRIBUTE.

Be PROACTIVE, be the LEADER, to involve you and your peers in the humanity project.

YES, I am talking about YOU.

You are blessed with wonderful things in the world. You are willing to SHARE your fortune with the needy people. You are GENEROUS to provide WARMTH to the Merapi Victims who are shivering in cold and raining nights.

You have DECIDED to HELP. Time to make a MOVE.

Let’s START.

Here is a suggestion of what you can do as volunteers. Be creative and leave an IMPACT. You can make all the differences. BELIEVE in that.

1. Provide daily needs/ logistic for the evacuation camp. Here is the List of needed Items.

2. Fund raising for the victims

3. Cook for the evacuees. Don’t worry about cooking skill, you will guided there at the evacuation camp kitchen.

4. Pack rice for 6000 people, 3 times a day. Your helping hand really counts!

5. Be a teacher for the children at the Evacuation camp. Simple mathematics, language, drawing or even story telling.

6. Play with the children. Football, mini games, magic tricks or anything you can think of. Entertain them. Make them feel LOVED.

7. Interactive activities with the adults. Sewing class, chest competition, and so on. Some programmes are being arranged by UNY Mahasiswa post. They need volunteers to carry out the programme. Contact Pidi Winata (085643215534/ 081227227141) if interested.

8. Involve in the outdoor activities for the kids. It’s really boring at the evacuation camp. You can make their days Smile

9. Perform at the Entertainment Stage at night. No world-class artistic talents required. Audience guaranteed. Interested to get your first debut?

10. Talk with the victims. Console and comfort them. A great opportunity to improve your communication skills. Help to identify minor mental problems (eg depression, anxiety disorder) or potentially save a soul by preventing the idea of committing suicide. Be friends Smile

The list is very long and I just can’t list all of them here. The best way is for you to report to the Evacuation Camp. EXPERIENCE will tell you how you can help.

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Donation Drive for PKPMI-CY Merapi Eruption Victims Funds

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