Monday, June 2, 2008

Hospital Gombak trip (2nd til 4th of June 08')

Last group to go this hospital. Hence, comments bout this place are already in the air made by other groups. “Boring…”, “go there early, come back also early…”, “wasting time…”, all these negative comments gave a very negative feeling at the beginning.

Briefly about Hospital Gombak, it is currently the only Hospital in the world treating only aboriginal people (Orang Asli). Dr.Sheerenam (can’t remember exact spelling), public health specialist given us a talk before clerking patients. She emphasized on this hospital isn’t under the ministry of health but under ministry of aborigine (Jabatan Hal Ehwal Orang Asli- JHEOA). This hospital was originally started at Pahang around 1930-1950 by this English guy- Dr. Bourton. The most significant difference about this hospital and others is that they are searching for Orang Asli Patients to give treatment. Patients like us, go hospital without being invited by health workers. They actually go to their kampong fetching them out and then supply them with food and treatment and send them back home.

Ques: how many aborigines in peninsular Malaysia?
Around 150,000. 1.5 or 15 or 0.15% of the population in Malaysia.

Ques: where do they live?
It is divided into 3 types: interior, fringes and urban type. Interior are places where helicopters are required to access, fringes places only allowed 4-wheel-drive cars to go in. At the beginning, they were using the Air Force big huge helicopters, but because of availability usage, they bought a small private helicopter located in Terminal 3, Ampang, for access. If I’m not wrong, every year RM900,000 is paid into this helicopter.
Aborigine people is like that, they will never come out and see doctor when they are sick, only when they are very ill and if only it is accessible, they will come to this hospital. This is the reason why they need to search for them and take care of their health. *Beware, it is not only the patient who come out, everyone in the family will follow if one of them sick.* so, the third difference about this hospital is transition wad, place for their family members to stay.

Ques: Do they pay for everything?
Tricky. In private as well as government hospitals, we paid for screening, consultant fees, medicine, surgery, and hospital stay, basically everything. About 77% of orang asli are self-employed, they hunt things for survival, income of them are basically less than our poor people, which is

Ques: what are the most common communicable diseases?
Malaria, Leprosy (19.3 out of 100,000 people) and TB (103 out of 100,000 people). However, due to epidemiological transition, non-communicable diseases like DM, HTN and obesity strike them. Altogether, they have this double attack.

It took Von Vee 37mins from Vista Komenwel B to Hospital Gombak, which is farther than Klang Gate. First impression to this hospital wasn’t that bad as the rumors in the air. It’s quite clean compared to Hospital Seremban, probably because Serembam is congested with patients. The air was fresh and cleans on my first step out of Siew May’s car. While waiting for our doctor and other group members, general inspection around this hospital was done. This Malaysia government is rich le… they got mostly 4 wheel drive (ford, Toyota) as their ambulance with few van type of ambulance. 3 blocks of building here. Chance to visit 2 of them today. The first block has general, maternal, pediatrics and infectious diseases wad. Assembly place is at pediatrics floor. First thing to observe in this beautiful morning was PLACENTA. A mother had just delivered a baby this morning. Placenta with a cauliflower like umbilical (if not wrong) is dropped off after delivery. Quite disgusting to see this rubbery brunch of ‘cauliflower’ in the morning without breakfast. Grouped into 2, first group has 10 people, and the second group has 16people. Out patient department was the ‘target zone’ this morning and Dr.Khairi (don’t know how to spell his name) is our ‘commander’ for first group. Mission was to ‘shoot’ at least one patient among 2 people (clerking) and present it to the ‘commander’. Yap, Siew May, Huong Wei and blogger got 3 very common chief compliant histories. Yet it is common, after discussion with Dr., we realized that it was hmm… incomplete histories. 40 y/o and 22y/o male diagnosed with HTN few months ago came here for follow-ups. Another 29 y/o male, aborigine with unexplained dizziness and headache. 22 with HTN? Oops~ so young? Ok, probably due to genetics or if it is a secondary cause of HTN. Never thought of that until Dr. asked us. Shame on us. Haha… After followed the 40 y/o guy into Dr.’s room and were told that the patient wasn’t taking any medicine for HTN b4 this. Human lies. -_-lll …

And then the last guy with unexplained dizziness and headache for 3 months had a week stay in this hospital because were suspected to have dengue fever, discharged but the headache yet gone. Couldn’t figure out the cause of this. ‘Commander’ suspected it would be anemia. If it is the case, then why it was not diagnosed at the time they check for dengue by pricking the patient?

During our discussion, we talked bout DM (5 main symptoms: vision, polyuria, thirsty, bleed easily, malaise). Old people with general malaise are to be suspect with DM, told by ‘commander’. What is normal glucose level then? 4.2 to 6.2 but this old male had 7.9 value, 3 and half hours after breakfast. Then, commander also mentioned that ACEI is the first choice for HTN.

Discussed also about differentiation between dengue and malaria, scabies, gout, OA, RA

Mission completed and left hospital around 1pm.

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