Why treat houseman shabbily? - a reply to R.K.S.

I'll like to respond to a letter in The Star:

Why treat housemen shabbily?

THERE has been so much hype on the tough life a houseman faces.

As a parent of a final-year student, l totally agree how depressing it can be for young housemen just graduated after a gruelling five to six years of study – and not all are government sponsored – to be treated so shabbily that they would want to leave the service, no thanks to the system.

Even as final-year students, they are sent to hospitals and are kept on their toes for anything between 10 and 12 hours a day without a weekend off.

How do you expect them to study with the exams around the corner? Mind you, most students already decide to leave as soon as they graduate.

To make matters worse, the consultant comes in and verbally abuses those poor housemen who have been in the hospital for over 24 to 40 hours.

They are even called “stupid” and “donkey” in front of their patients!

It is really absurd to be made to work continuously in the most inhuman manner, depriving them of sleep and rest.

What irks me most is why aren’t housemen subjected to the same labour laws of the country as other civil servants – eight hours of work and overtime to be paid for on-call duty and a rest day in between calls?

Why is it so difficult for us to follow the foreign practice in which housemanship is for one year and subsequently, the houseman can decide whether he or she wants to continue or leave the service.

Come on, doctors need a life too!

R.K.S.,
Bidor, Perak.

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Dear R.K.S,

Speaking from the point of view of a final year student, I think final year students are expected to performed almost like a doctor, perhaps the reason why they were sent to hospital for 10-12 hours each day. It gives them early exposure of what they will be facing during housemanship, therefore, they will not get a ‘cultural shock’ when they step into the working environment. I am not too sure about your son/daughter, but from where I was trained (UKM-University Kebangsaan Malaysia/National University of Malaysia) we were even expected to be oncalls. In my opinion, it is worth it, to attend these calls, when there are consultants to teach us during these calls. In fact, I enjoyed on-calls very much, as we get to see many cases at night, and we get to learn a lot more. Especially during O&G (obstetric & gynaecology) where we do Labour room calls...The thing is, medical school is very much different from high school, or other courses, perhaps. The knowledge and skills we need to obtain, are not merely from textbooks per se. Ward works, clinics, theaters, clerking patients, case presentations, are very important too. I guess many students would agree that they preferred their clinical years to pre-clinical years.

About verbal abuse, do bear in mind that not all consultants are like that. I have seen consultants who give compliments and encouragements to students and housemen. I believed that consultants/ MO should be more careful in their choice of vocabulary, especially when addressing other doctors as they are all colleagues. I had once had my share of embarrassment, when my friends and I were called ‘brainless’ during my medical school years, but I guess, we deserved that, as we just started our posting and had very little knowledge at that time, being third years. I was indeed motivated to work harder and prove myself. But that was being a student. However, I guess, for the doctors, and the house officers, surely, they deserved more respect.

The working hours, I must agree, is crazy. Sometimes, to think of it, would you want to be treated by a doctor who had back to back calls? a doctor who had not been sleeping well for the past 48 hours? That thought itself is scary I suppose. It comes back again, to our health system. The government trained many doctors yearly, sent many overseas, yet there were never enough housemen. It is about time they ask the question – WHY? A huge proportion of the people chose to do their housemanship overseas, get their post graduate degree and return to out country as specialist. Some perhaps, never return. Why you may ask? The answers are very obvious, other country offers more.

You know, when compared the salary of house officers in Malaysia to other countries in Asia, Malaysia ranked third from the bottom, following Indonesia and the Philippines. Housemen in Korea is earning 6 times more the salary than those in Malaysia.

Today, we even have patients complaining about doctors... sometimes, they forgot that, doctors are humans too! and yet, they really need encouragements from time to time, and they too need acknowledgements, appreciations... very much indeed... to boost them on, help them get by...

You know, if the conditions is not that bad… and the pay is more or less the same, and opportunities for a postgraduate program good, I am sure that many doctors will opt to stay in our country… thus more doctors, less workload, less stress, happier doctors, happier superiors,.. see the cycle? I hope the people up there will put some thoughts into it… and i hope that more and more doctor would opt to stay back and serve the rakyat... together, we can make a difference...

Yours sincerely,

shinyin WU

xrays

I did a very interesting short case today.... the chest x-ray findings lagi interesting!
take a guess~

Most miserable 2 and a half hours of my life!

(picture by hannusaaski)

I have a terrible toothache. I can feel as if my face is asymmetrically swollen. The pain, intense, that I cannot clench my teeth, or close my mouth. Eating has became a torturous luxury. The regular drugs and cold therapy did not offer much relieve.

This toothache did not come suddenly. I would have to flash back 2 months back.

~2 months ago~

So, on the first week of Medical posting, I had some free time. So, honey and I decided to see the dentist. I wanted to do some scaling. I liked the feeling of my teeth feeling all sparkling white after scaling, you know, with that -‘shing’ *blink* *blink* feel..

Upon arriving at the dentist, a quick examination was done and I was told that I had some tiny holes in my teeth. So, the doctor, she asked whether I would want them filled. Well, the holes were not causing any pain (at all!), but the doctor was very convinced that in a matter of time, it would. Besides, being human, when you were told that there was a problem somewhere and that problem can be fixed, naturally, you say, ‘okay’. So, that was what I did.

The doctor gave me a number and sent me upstairs. I was approached by a cute, sweet girl. She introduced herself as a third year dentistry student. Let’s call her DS (Dental Student). She wanted to take some history, so, I agreed to her. I know how it is like, being a student, I mean,after all, I AM a student. So, we should never reject one of us, right? What I did not know was a dentist had to take such a long history, and a couple of other things. The history included past medical history, past surgical history, allergy history, family history, social history, etc… almost similar to the history that we, medical students take.. only that it was more superficial, and they had an additional: past dental history.

Later on, DS sat me on the couch. The next thing I saw was she, reaching out for the handpiece. Then I was like, *blink* *blink* - OMG! are YOU going to do my fillings for me??? YOU of all people??? NO WAY!! - My heart was screaming aloud: But I thought you were just a 3^rd year.. where are your seniors? where is your supervisor?? Have you practiced on enough fake teeth or models? Shouldn’t your supervisor be supervising you??? What if you introduced a focus of infection or injured some nerves?? I don’t know… millions of thoughts ran through my head, millions, clouding, debating through my mind, so many that I cannot tell them apart, which was true, which wasn’t. But one dominant thought stood out: ‘TRUST THAT GIRL!’ –which 2 months later, I totally regretted…

Actually, it did not take me 2 months to regret. 2 hours later, I was already regretting,.

(picture by kizioko)

DS tied some metal ring around my teeth. Then put a frame around it. She tied a pink sheet of plastic cloth across it, sort of making a tent. I suppose, that was to reduce the risk of infection, by creating a barrier between the saliva, which is rich in organism, and the operating site.

I CURSED THE PERSON WHO INVENTED THIS DARN TECHNIQUE!!! (I mean, we can’t always put the blame on the small girl, can we?) WHO INVENTED THIS TECHNIQUE?? Have you ever, EVER considered the misery of having your mouth opened for 2 and a half long hours, and having your mouth numbed? The saliva all accumulated, stucked at the back of the throat, no suction done… and for asthmatic patient like me, nothing scares me more than the feeling of not being able to breathe, the feeling of overflowing saliva clogging the airway.. how miserable it was….

You can give me statistics of studies, researches on how great it had reduced the risk of infection, blah, blah, blah,… but still, from a consumer’s point of view, this is a stupid, miserable technique!

So yes, I CURSED THE PERSON WHO INVENTED THIS TECHNIQUE!

Guess what? This process was not the worse thing, not yet.. Each time she accidentally touch my gum with that horrifying handpiece, I would wince and let a cry of pain. Okay, maybe I did had a very low threshold for pain, but was I SUPPOSE to feel pain??? Didn’t she just inject some local to numb the pain?? Why the hell was it still painful????

And guess what? Despite the pain, shinyin actually persevered… with this mental thing going on: 5 more minutes, don’t panic… it’ll be over soon.. this is a dream~ you are on a beach~~ breathe in, breathe out~ I tried the relaxation techniques and every possible CBT I read from my psychiatry textbooks.. I would even hypnotize myself if I knew how… ‘sabar’~~

And later on, I heard the scariest vocabulary ever existed in the English Dictionary: ‘OPHS!!’

And DS started stuffing my mouth with gauze and cotton.

I think at this point, I was allowed to panic, because,... she did.

I wanted to ask her whether is everything okay, but you see, my mouth was fixed in such position I could not talk, and I was literally choking on my own saliva, and something which tasted somewhat like blood.

DS disappeared from the cubical and came back with her supervisor.

This was when I started cursing the girl too.

The supervisor took a look at my teeth, shook his head and started lecturing. You should NOT have used that, that, that... You SHOULD have done this, this, this...This ring was of the wrong size and type. You SHOULD have used this, this, this instead. You should NOT have done this tooth first, instead you should have done this, this, this…. And later, he was even quizzing her on what were the consequences of her action.. and there she goes rattling a list of scary possible outcomes, which (touch wood!) I hope would never come true!!

OH MY GOD!! Would you stop scolding your student and come save me???

So, after that session, which seemed like eternity, he taught DS what should she do – ‘remove everything, and close it with a temporary filling’.

–huh? WTF??

So, I was miserably left alone with DS again, to clean up her very own mess… guess what? I get to go home with some pain killers –hooray! She gave me an appointment the week after.

(picture by FvT)

And do you think I would ever be SANE enough to go back?? I mean, if you had just escaped from Hell, and given a follow up one week later, would you go???

So, 2 months later, I suffered from the consequences of defaulting follow up.

Awww…. How my tooth hurts badly…

p/s: Bernard, you junior can be my worst nightmare!

Are housemans and doctors overworked and underpaid??

Okay, obviously, the answer to the above question is a big YES. Obviously, doctors are overworked and underpaid. SO overworked that it can become a occupational hazard

- working an extended shift of 24 hours more than doubles your risk of being in a car crash

Well, here's a good news for House Officers! Although after reading this piece of news, i was still skeptical whether is it really true that we will get the day off after a 24-hour duty? wow! i thought that it was only true for the anesthetist and psychiatrist.

Having optimal manageable working hours is good, not just for the doctors, but also the patients.

however, i thnk that the government should also address the issue of shortage of doctors.... when they reduced the working hours, the number of HOs for each shift would be dispersed, thus less HO, more workload.. is that even possible?? seriously, we need more doctors in the government sector (like we all don't already know that..)...

And you wonder why there are still so many students who want to take up medicine... but of course, you and i know, no matter how tough life is, this can be a very rewarding job ^^
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original article here

Thursday December 18, 2008

Day off after 24-hour duty for trainee doctors

KUALA TERENGGANU: Trainee doctors will now get a day off after carrying out their 24-hour on-call duty.
Health Minister Datuk Liow Tiong Lai said the directive will take effect immediately.
He said it applies only to housemen on active call and at the hospital the entire time.
“We will not let these trainee doctors be overworked. We will look into their welfare,” he told reporters yesterday after visiting the Sultanah Nur Zahirah Hospital.

Pleased to meet you: Liow shaking hand with hospital staff members during his visit to Sultanah Nur Zahirah Hospital in Kuala Terengganu yesterday.

Liow was asked to comment on grouses from trainee doctors that they sometimes had to work almost 24 hours and then report to their superiors the next day.
Some trainee doctors complained that they had to work seven days a week without a single rest day during their two-year stint in government hospitals as housemen.
Liow said trainee doctors should also be allowed to concentrate on getting the right exposure and medical proficiency by giving them off-days.
A trainee doctor at Sultanah Nur Zahirah Hospital, who only wanted to be known as Sally, said she was relieved to hear that the ministry would look into their welfare.
“Frankly, we are very exhausted as we have to focus on our training and also carry out clinical rounds frequently,” she said. “It is stressful.”
Sally said she and her colleagues were unable to pay attention during their stints due to fatigue and time constraints.
On another matter, Liow said about 4,000 Chikungunya cases were reported throughout the country this year.
He said the virus was first detected in Johor and spread to several states, the latest being Kedah.

Donating blood save lives - Nothing to lose but everything to give

There was a blood donation drive in UKMMC (University Kebangsaan Malaysia Medical Centre) this morning. So, guess what? YUP! Today's post is about encouraging you (and your friends and family) to donate blood.

If you are already a blood donor, i would like to congratulate you!! If you are not, do join me.. try donating blood~

Donating blood gives you one of the best feeling in the world. Knowing that with donating blood, you are saving lives, making a difference. One of the most common comments i get are : 'Donating blood is painful' or ' I am afraid or needles' or ' It is too troublesome'..

Let me share with you my first blood taking experience few years back.. and take you on a journey of blood donation...

When i turned 18, the one thing i wanted to do (besides driving), was donating blood. You know, the way you want to enter the casino the moment you turn 21. It was like a must-do thing. Only that, i had a problem. Well, i was indeed afraid of needles, and i have a very, VERY low threshold for pain.

I have to admit, even now, i am still partly afraid of needle pricking. I know, it's irony, since i am already in Medical school and i am pricking patients everyday. Then i discovered ways to overcome the fear : Donating Blood does not have to be a nightmare

The first time i donated blood, obviously i looked away and prayed it'll all past ASAP. Surprisingly, it was not as pain as i expected. The thing is, unlike the usual blood taking at clinics, before blood donation, you would be injected lignocaine (a local analgesia) which would numb your arm. The injection is like the bit of a ant, not even a strong ant, rather like a weaken ant. And therefore, when they insert the needle, you feel nothing at all, NOTHING at all, seriously..

This time, i actually video-ed the whole process of the lignocaine and needle insertion, however, my Se 750i camera phone had failed me and the video cannot be played or uploaded.. sigh... Anyway, if shinyin is brave enough to record her ownself being pricked by a needle, blood donation to you is 'sap sap sui' lar...

So the process start with registration, and to see whether you are suitable for blood donation:




Generally, you are eligible to donate blood if

• You are in good health today
• You are between 18 to 60 years of age
• Your weight is above 45 kg
• You had more than 5 hours of sleep
• You are free from any medical problems: e.g. high blood pressure, heart disease, diabetes, operation less than 6 months ago
  
• You have not taken any antibiotics in the last one week or immunization in the past 3 weeks
  
• You are not pregnant or just delivered
• You have taken breakfast or light lunch before donating blood
• You are not menstruating
  
• You are not involved in any of the following activities:
  • Homosexual relationship
  • Bisexual relationship
  • Multiple sexual partners
  • Having sexual contact with those mentioned above
  • Drug abuse
• Interval between your last donation is more than 3 months

Then, your blood will be checked for blood grouping and whether your hemoglobin levels are adequate.

I am group B!

The last few times i wanted to donate blood, my Hb was not adequate.
But today, yeay! it sink instead of floats~

Adequte blood pressure... Mine was just borderline adequate today.. hehe...

Weight more than 45kg (i remembered boon lee often boost her weight before a blood donation, haha! coz she was just at the borderline)

Finally, you will be injected Lignocaine (local pain killer) - sting a little.
Then the needle for blood taking will be inserted, the needle looks scary but at this point, your arm is already numbed, so, no pain at all!! =)
You are required to do a pumping motion on the PVC tube with your hands
This process takes less than 10 minutes..

You can see your blood filling up the bag

Yeay! finally, the bag is full..

The tube is clamped. Before you realise, it's all over.

I'm proud of my bag of blood =)

i was wondering whether i should post the picture of the needle... okay lar, here it is.. i know it looked scary, but seriously, it's not painful :)

TA-DA!!!
At the end, got makan and certificate somemore...
but i think, we gain something more satisfying:
knowing that we had help someone else who was in need of blood

So, will i hear you donating blood too?
join me!
Donate blood- it's the gift of life!

p/s: oh yes, we won the debate!! hurray!!! :) with Lingesh and MK being best speakers :)
Related links:
Confidence can be made up, right?
Contraception should be allowed in unmarried sexually active adolescents - a debate

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Q&A

WHY IS IT IMPORTANT THAT I DONATE BLOOD?

Everyday someone depends on blood for life. Blood maybe needed for surgery, for an accident victim, or to help treat patients with leukemia, cancer, heart and liver diseases, and haemophilia. Your contribution could help save a life here.

AM I ELIGIBLE TO DONATE?

Yes. lf you are 18 years of age ( proof of age may be required)and weigh at least 45 kg. In general, medications in themselves are no cause for deferral. Rather acceptance or deferral is based on the underlying medical conditions.lf you are on any medications, please let us know at the blood drive.

AM I HEALTHY ENOUGH TO DONATE?

You should feel well if you plan to donate. Your health and safety are very important to us. You will be asked to complete a Donor consent form where professional health history will be asked. Your pulse and blood pressure and a drop of blood will be taken from you to test your haemoglobin. All information that you give is kept confidential.

HOW LONG DOES IT TAKE TO DONATE?

The procedure itself takes between 7 10 minutes. How ever, you should plan to spend at least an hour at the blood drive.

DOES THE NEEDLE HURT?

There is a little sting when the needle is inserted, but there is no pain or stinging after that.

HOW MUCH BLOOD IS TAKEN?

About 450 ml, which is a little less than a pint. Adults usually have 5 litres (10 -12 pints) in their body. Some may only be allowed to donate 300 ml for various reasons.

HOW WILL I FEEL AFTER DONATING?

Most people feel great! Eat breakfast or light lunch before donating, and you should feel fine. Having eaten makes a big difference in how you feel afterwards.

HOW SOON AFTER DONATING CAN I PRACTICE SPORTS?

You are advised to avoid heavy muscular or strenuous activities such as lifting, pushing or picking up heavy objects for 5 hours after giving blood. During plenty of fluids for the next 24 hours.

HOW LONG DOES IT TAKE TO REPLENISH THE BLOOD THAT I HAVE DONATED?

lt takes about 24 hours for your body to replace your blood volume or plasma. You should drink an extra four glasses of non-alcoholic fluids. Your body needs about 4 -B weeks to replace the red cells before you can donate again. You can donate again after 12 weeks.

WHAT HAPPENS TO MY BLOOD AFTER DONATING?

Your blood is tested for blood type, syphilis, hepatitis viruses, the AlDS viruses (HIV).Then your blood is stored for use. Your blood can be used either as whole blood to help one patient or after separation into components (red cells, platelets, plasma), to help several patients.

References:
Pusat Darah Negara

Contraception should be allowed in unmarried sexually active adolescent. - a debate

Thank you all for the kind wishes and luck =) Today was indeed a pleasant experience.

Can you imagine? Reading the whole format for a parliamentary debate, researching, preparing speech and practicing all in one night? I was indeed crazy…

I would like to thank Lingesh for helping me with this debate.I owed this to him. Seriously, before this, I didn’t even know the format for a parliamentary debate. And I am glad that I was assigned a part which could be pre-prepared. and Lingesh had this theory that 'to overcome stage fright, you must scare or 'frighten' the stage first. :)

The wait could be rather stressful. I hate it when I had to rush back to my room, in between brunch, in heels, because of some stupid thing, and rush back for the debate. Anyway, I’ll leave that story for another day.

The hall was exceptionally cold today. I tried to reassure myself repeatedly, ‘this is okay’. Eventually, the atmosphere became more relaxed.

Special thanks to my friends and zhimuis who where cheering back there.. hehe... and thanks to everyone who offered a pat on the shoulder and help relieve the anxiety..

May Luu commented that my performance was more like giving a speech, like story telling, rather than debating, haha! If you can read Chinese, you can check out her interesting blog post of the whole event. Very entertaining description..

I guess I lacked the ‘powerful voice’ and the style (gaya).. Unlike Ija and MK who memang got gaya… Lingesh don’t need to say lah.. he memang pro one…. and I lacked ‘witty-ness’ too! Hah!! I am really really glad to have Lingesh and Ija on the team! (if you know what I mean, hehe) We were against Ihsani, Jie Ying and Yee Cherng. It was great, the debate.. I finally understood the ‘adrenaline rush’ which Lingesh described the day before.
Amirtha did a really good wrap up for her team. And I think Susan looked quite cute up there…


Conclusions:

1. Debating is fun!
2. I am a writer, not a debater
3. Becoming a debater does not happen overnight.
4. I am not really good at spontaneous crapping
5. I cannot be a lawyer/politician/sales person

I do not really agree with part of what I said during the debate. (OF COURSE WE SHOULD NOT HAPPILY GIVE OUT FREE CONDOMS VIA VENDING MACHINE WITHOUT ESTABLISHING PROPER SEX EDUCATION!!) Then again, this is just a game. =P

p/s: There is a poll on the right middle column of this page on premarital sex (nuffnang poll). Do feel free to fill it up. thank you. =)

Here is part of the content of the debate; you may read on if you are interested, it’s a little lengthy:

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Contraception should be allowed in unmarried sexually active adolescent.

Good morning Mr Speaker, fellow team members, worthy opposition, and members of the house. We, the government, stand here today, to support the motion, ‘Contraception should not be allowed in unmarried sexually active adolescent.’

By ‘contraception’, we meant promoting safe sex amongst unmarried sexually active adolescent, by means of distributing free condoms, in secondary schools. We defined adolescents as people between 13 to 19 years of age.

I shall illustrate the problem and the extend of the problem. Why we need to address this issue? Why is it the responsible of the government to protect the society? And how, how are we going to do it?

My second speaker shall later bring you a journey, a journey to understand the social economy implication of this problem to the government and the society. While my third speaker shall rebut arguments from the opposition.

More and more of today’s adolescents are sexually aware and engaged in sexual activities, furthermore with unfiltered mass media, especially via the internet. We cannot control the global stream of information, but we can, at least, prevent complications from unprotected sex amongst adolescents.

To presume that adolescents will be prevented from experimenting with sex if they are denied access to contraception is simply ridiculous!

The second National Health and Morbidity study in 1996 showed that 600 out of 10000 secondary school students had premarital sexual experience.

A national study on the reproductive health of adolescents in Malaysia conducted by LPPKN, National Population and Family Development Board Malaysia, in 1994, had found that 20% of young people had their first sexual intercourse between the age of 15-18 years old.

In a study lead by University Putra Malaysia’s Associate Professor, Dr Lekhang Rampal, in 2004, on the behavioural risk that could lead to HIV infection, it was found that out of 18805 respondents, 34% had their first sexual experience from the age group 16-18 years old, while 8.4% were below 15 years of age. What was more shocking was 80%, I repeat 80%, of them did not use any form of contraception!

One third thought that condoms cannot help prevent HIV spread. A quarter said that a person can be infected by HIV though mosquito bites, fleas or bed bugs.

In October this year, there was the emergence of 3 videos of secondary school students, in uniforms, engaging in extreme sexual acts in the classrooms.

These are VERY real events happening in our country. And this may be just the tip of the iceberg. Indeed our adolescents are very sexually active, yet, very very ignorant.

POI: Offering contraception to them will increase the amount of sexual activity amongst them, thus encouraging them.

Reply: Experimentation with sex is independent of condom. It is derived from exposure to sex, and not merely a piece of rubber.

Reducing access to contraception will certainly not dissuade an adolescent from having sex. Unprotected sex eventually leads to unwanted pregnancies, unsafe abortion, sexually transmitted diseases and HIV infection. The end results are obvious. Very likely you get a very young girl, going through the emotional trauma of an unwanted pregnancy and a child growing up in a non-conducive environment. This is assuming that the mother had a safe delivery. However, life is not a bed of roses. According to WHO, 75000 women die daily from unsafe abortion.

Therefore, the government felt that it is our paternalistic duty to protect our younger generation. While regulations were made for motorist to wear helmet and drivers to buckle up, it is our duty to stand up and promote safe sex. It is our duty to offer these unmarried sexually active adolescents the benefit of putting on a condom.

With this, we would like to propose distribution of free condoms in secondary schools, accompanying pamphlets on sexual education, the proper use of condoms and the consequences of unprotected sex. Contacts for further information, sex education and support groups shall be also made available. These shall he distributed via vending machines in secondary schools. A condom, when purchased in bulk, would cost the government only a minute amount of 20-30 cents each, being a very cheap and effective method of contraception.

Ignoring this problem and denying access to contraception would only push these naive adolescents further underground. If these sexually active teenagers are going to have sex anyway, we rather let it be safe sex. We cannot afford risking them suffering from the consequences of unprotected sex.

I would like to emphasize that we are not promoting or discouraging sex per se, but we are promoting safe sex amongst sexually active adolescents.

This house would
1. Allow contraception in unmarried sexually active adolescents
2. Promote safe sex amongst adolescents via free condoms distribution in secondary schools, with accompanying pamphlets on sex education, proper use of condoms, the consequences of unprotected sex and contacts for further information and support group.

We support the motion that contraception should be allowed in unmarried sexually active adolescents.

Thank you.
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We, the government, had painted the picture of the problems that arises from unprotected sex. We have illustrated the social and economy implication of this problem to the government and the society; the emotional and financial stress rest upon single mothers who are rejected by their families; the risk of STD and HIV infection; the impact of a child growing up in an incomplete family; the desperation leading to abortion and ‘baby dumping’; the financial burden arrowed back to the government to support these unwanted unwedded mothers, unwanted children.

We shall distribute free condoms in secondary schools with accompanying sexual education materials via vending machine.

The opposition had brought up several interesting points:

Firstly, promoting abstinence. Although abstinence is indeed the best form of contraception, however, as I had illustrated earlier, with hard facts from studies and the papers, we do not live in an ideal world. Today, the topic is about already sexually active adolescents, and what can we do for them. You cannot propose status quo, because status quo have shown to have failed. Abstinence and morality had failed.

You have talked about contraception being only for married couples. Again, our motion today is for already sexually active adolescents.

The opposition feared that when students were given access to contraception and knowledge on sexual education, they would engage in sexual practices. I would like to reemphasize that, reducing access to contraception will not, I repeat, will NOT, dissuade adolescents from having sex. In fact, given timely information, access to contraception and proper guidance would give positive effects, where children would be more responsible and careful when engaging in sexual activities.

Therefore, these adolescents have everything to gain, and nothing to lose.

We can ask many questions – why? We can give many reasons. However, seldom, the people would be given solutions. What can be done? And how can we address this issue? Putting a curtain across this problem, dismissing them and continuing living in ignorance would not work!

Therefore, today, the government offers a solution.

We the government felt the need to bravely face the hard facts and reality. No doubt we are dealing with very personal issues, but because of the social and economy and other ramification, we can no longer choose to ignore them. How many more adolescents should be left ignorant with unprotected sex?

We, the government believed that it is our duty to protect the younger generation, leaders of tomorrow. We have laid the tiles, strong and firm, and we hope that you shall lay your trust on us, and start walking.

Charlie Cham, our local artist once illustrated in his artwork, ‘Play safe, use Malaysian rubber’. ^^

Lastly, we believe that the motion still stand strong, contraception should be allowed in unmarried sexually active adolescents.

With that, I thank you.
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Stories from my childhood - Phagophobia

hp84 was asking me about the term for fear of swallowing pills, which reminded me of a childhood experience of mine... (yes, story time!)

Fear of swallowing pills = Phagophobia
(Phago = Swallowing) hence the term phagocytes,etc..
Phagophobia is a general term for fear of swallowing/eating
Fear of needles = Aichmophobia

So, when i was a little kid, (okay, maybe not so little) i had this fear of swallowing tablets. While other kids were showing off how they could swallow pills, some even without water, i would tolerate the syrup medication. And yes, the syrup medication tasted terrible (just like medicine!).

I remembered there was this one anti-pyretic medication (syrup paracetamol- for fever) which was pink in color. It smelled like strawberry but it tasted horrible! (i think, the pharmacist probably wanted to make it more acceptable to kids, unfortunately, it didn't work for me) It made me hated that smell, until now.. which explains why i do not drink strawberry-flavour products; eg: strawberry flavoured milk, strawberry-flavoured yogurt, strawberry-flavoured ais-cream, strawberry-flavoured what-eva... I am okay with the strawberry fruit though.. i mean the FRESH, REAL strawberries are good (especially when dipped and coated in melted cholocates)... it somehow tasted less artificial, i suppose... (great, now you think i am picky, to like strawberry fruit, but hated the strawberry-flavoured products)

Anyway, that's beside the point.. back to the story.... like i was saying, i had phagophobia. The pills just refused to go down my throat. Then, the pills melts, or regurgutates upwards, and i end up vomiting out the pill. Sis Benedict, the Philipino maid who babysit me back then, had this marvelous idea. She would asked me to open my mouth widely, and then, she would throw the pills right to the back of my throat, and make me drink a glass of water. The trick worked for a while. But, the problem arises when there is noone to throw that pill into my mouth. Occationally, the pill maybe missed aim, and get stucked at the sides of the mouth. Sometimes, the gag reflexes sets in, giving problems too!



So, today, now that i no longer have problems swallowing tablets, i shall share some tips with you on how to overcome this. This would come in handy if you have a younger bro/sis or a kid with this problem:

1. Phagophobia happens when someone is anxious about taking pills and tenses up. You can try relaxing by sucking on an ice-cube before swallowing, thus numbing your throat and reducing the sensitivity of gag reflexes.

2. RELAX before swallowing. Breathe in and out to calm yourself and reduce the tension.

3. Take a medium sip of water before attempt swollowing.

4. The RIGHT POSITION may help.Put the pill onto the centre of the tongue (yellow spot on picture) and take a big sip of water. Tilt your head slightly backwards, (not too far back) about 30 degrees, then swallow the whole thing down with a gulp.



5. If #4 failed, try tilting the head faster, like a jerk.

6. If #5 also failed, try to put the pill onto the tip of the tongue and take a small sip of water. Instead of tilting your head backwards, tilt your chin downwards towards the chest, eyes looking at your chest. The pill will naturally float upwards, towards the back of the mouth, and get swallowed naturally.

7. You can also try taking your pills with flavoured drinks like yogurt/ribena/fruit juice. It's like tricking your gag reflex to swallow them down.

8. Last but not least, PRACTICE, PRACTICE, PRACTICE!! You can practice swallowing by replacing the pills with small sweets easily available from the stores. Start with smaller sweets(eg: tic-tac), and slowly move on to bigger sweets.

9. If the child have phagophobia because of emotional reasons, counsel the child.

10. (open for suggestions)

*Note: a common practice of crushing the pills is NOT advisable.

All the best in overcoming your pills anxiety =)

Injections/blood taking DO NOT have to be a nightmare…

How to reduce pain in a patient when injecting /taking blood /inserting cannula? (for patients)

Aichmophobia- Fear of needles or pointed objects.

Injections/blood taking DO NOT have to be a nightmare…

I know the needle can be the scariest object in the world. It scares me too, sometimes, when I am at the receiving end. Honestly, I do have a very low threshold to pain. (which explains the way I abuse pain killers, but that’s another story).

There was once, i twisted my foot. The staff nurse inserted a cannula on my left hand. I was asked to get an xray of my foot at the radiology department. Upon arrival, i must have looked so in pain, that the radiologist thought i needed an x-ray of my arm (being surprised to see that the form requested for a right foot xray). I explained to him that it was the cannula. and yes, it was more painful that my sprained foot. So, since then, i developed some relaxation techniques to reduce pain during such procedures.

REMEMBER: Injections/blood taking DO NOT have to be a nightmare...

So, today, I shall blogged about how blood taking/injections can be less painful, or in simple words, how to overcome needlephobia (fear of needles):

1. RELAX. Tensed muscle makes it more difficult, especially the body naturally reacts by constricting the vessels.

2. TRUST your doctor. Fear and anxiety can amplify the pain intensity.

3. DO NOT LOOK at the needle / the syringe. Why choose to scare yourself?

4. DISTRACT YOURSELF. I like to talk to my doctor. I usually prefer my friend, Natalie to take blood for me. She’s very good at taking blood, almost minimal pain, I would say. She would distract me by asking what I did today, what I had for exams, etc...

5. Otherwise, THINK HAPPY THOUGHTS. Imagine yourself, in a garden, serene, surrounded by flowers. The breeze, cool and refreshing. The sun shining from above, reassuring. A butterfly flew down and lingers on your hand. It bit your hand, but it’s okay. You stared at its beautiful colorful wings, mesmerized by God’s creation.

6. Otherwise, try doing the minus 7 series… subtract 7 from 100 repeatedly (eg. 100-7 =93, 93-7 =86, 86-7 = 71, etc...) it’ll all be over even before you finish

7. Throughout the process, BREATHE IN AND OUT~ remain CALM at all time, find your ‘chi’...

8. NEVER WITHDRAW/PULL BACK your hand. NEVER!

9. At the end of everything, say ‘ Thank you, Doctor’. I know, this does not relieve the pain, but it feels good to hear that, hehe... =)

10. If all fails, there's always the lignocaine (local analgesia) patch for injections.. but i'm not sure about the price...

11. Other workable methods: hold a friend's hand, try ear piercings (the feeling is quite similar)

12. bet with your friend that you are not scare and stare at the needle while it sucks all the blood out (suggested by peanut)

13. try to ask for a lenglui/lengzai nurse/doctor if there is any! (suggested by peanut)

14. i tried LOOKING at my injection site when the doctor or the nurse poke or withdraw blood from me....then take few breaths, inhale and exhale slowly..my fear has gone! (suggested by chiiliyeow)

15. (open for any other suggestions)

I hope these tips would be useful to you, the next time you see your doctor for an injection / blood taking/ cannula insertion :) *all the best*