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Saturday, November 13, 2010

because I care

We know accurately when we know little;
with knowledge, doubt increases - Goethe

It all stems out from a link to a blog sent by a friend of mine several weeks ago. The blog is owned by a lady from the metropolitan city of Kuala Lumpur. She wrote anything about her experience, and for this time, her birth-giving experience.

She was in the later weeks of her pregnancy and the delivery was imminent. Like many other ladies, she hopes - or rather demands - a comfortable and rewarding experience while giving birth. This is a perfectly fine and reasonable thing to ask for.

To me, the only thing that could answer her call is a good obstetric care by the healthcare providers.

But it didn't happen in her case.

Her pregnancy was complicated by a condition known as pre-eclampsia. It is essentially a pregnancy-induced hypertension with protein leaking out from the body. Though it is common, it is a very serious thing and quite different from the hypertension in a non-pregnant state.

What makes it so bad is the complications. To name a few, they can range from as mild as nausea and headache, to the life-threatening convulsion and bursting liver, which will eventually and surely leads to - if not enough attention given and appropriate intervention done - the gruesome maternal death.

She shared the prejudice of all Malaysian ladies - and that also includes my mother - that the service in the government hospital is very, very bad. At times it could be unimaginably horrifying experience, especially with the junior doctors.

And her prejudice was proven to be true. She was admitted early for monitoring and possible option of early induction of labour. This is standard procedure throughout the country. But what is substandard here is the service that she got from the healthcare professionals, namely the doctors and nurses.

The main issue was the lack of communication between doctor and patient. Apparently from her rantings and complaints, it appears that she didn't have a clue about what's going to happen to her and it is only natural for her to think that all the investigations done and the long days of so-called monitoring was purposeless and a complete waste of time.

Obviously no one have sat with her and discussed about, say, the risk of premature delivery, what is the ideal time to induce the labour, what meds can be taken to lower her blood pressure down, does her condition warrants an operational delivery i.e. caesarean section and so on.

And things went from bad to worse when she heard the mismanagement by the junior doctors from other patients in the ward. All the bad things like horrible post-delivery wound repair (the episiotomy), the scoldings and barkings from nurses and doctors etc. have haunted her thoughts and emotions, and much to the detrimental of her anxiety and eventually her pre-eclamptic state.

Perhaps due to these things, she made up her mind to pack her things up and off she go to the private sector for 'better' care.

I'm happy to found that she got what she wants and finally gave birth to a lovely and healthy baby boy last week.

May Allah bless her life with happiness and soleh and taqwa children.



End of story. Now's my turn to talk.

I have to admit that these things happens. And before any house-officer (the juniormost doctor's rank in the hospital - sometimes lower than the janitor) kill me, I will be the first to acknowledge that it is not easy to work long shifts and under loads of heavy pressure . Accidents do, or rather prone to happen.

But it is not an excuse. Never.

To me, obstetric is a very specialised branch of healthcare. What makes it so special is that the stakes are high. Not only it involve a lot of people, the emotion runs deep in everyone who is at stake. It is not a surprise to note that this little department of the hospital 'scores' the highest number of lawsuits and complaints each consecutive year. Never fail I tell you.

Therefore, obviously, the demands of passionate and skilfull personnel from the medical fraternity is overwhelmingly high here. He or she must have sheer amount of interest when it comes to the care of pregnant ladies. Only passionate doctor, I think, will consciously and subconsciously try to avoid any mistake and negligence at anypoint of time, no matter how tired he or she is.

Previously, under the house-officer training scheme, obstetric and gynaecology was not among one of those 'statutory' rotations. Due to the alarmingly high number of incompetent young doctors (they said), it is felt that the training is not enough and the solution is to lengthen the training program from one year to two years.

That, I whole-heartedly concur.

But, and here's the big but, I cannot agree with the addition of mandatory obstetric and gynaecology rotation into the program.

If they say the fundamental concepts of basic medicine is consensusly lacking amongst the fresh graduates nowadays, wouldn't it be more logical and rational if we lengthen the medicine and surgical rotation instead of adding more specialised rotations?

Because, you see, from what I could gather from my experience with the house-officers, not many of them have the interest in the obstetric fields. Some of them are even depressed and in despair.

The common thought among them is "just get it over".

And if this sort of thinking occur, I'm afraid that it can only spell disaster to the quality of job given and also the public trust to the medical profession.

Like, how can a depressed and uninterested doctor who was just being demoralised by the scolds and shouts from a consultant can take care of a lady who is just about to bear down a baby at 3 am in the morning?

The chance for a comfortable care by the doctor is, at this moment, almost close to none.

I felt sorry for both.

Maybe people will shout at us from afar, that we should stop complaining. If you want to be a doctor, this is what you should expect.

I agree. But my point being that we should not force people to do obstetric care. It wouldn't make sense. And it would definitely serve no justice for both parties.

My final verdict is simple ; the rotation should be opened only for those who are genuinely interested in it.

I have seen women giving birth in various conditions, some are happy while others, or rather most of them, are crying in agonizing pain. You wouldn't want this to happen to you, your wife and etc.

I have spoken for, I believe, the good of our healthcare.

I ask Allah S.W.T for His guidance.


"...Thee do we worship, and Thine aid we seek. Show us the straight way; The way of those on whom Thou hast bestowed Thy Grace, those whose (portion) is not wrath, and who go not astray."

Al- Fatihah : 5 - 7

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