BISMILLAHIRRAHMAANIRRAHIIM
Elective posting is one of the postings in year 4. Actually, the elective posting was included in Community Medicine posting but we only can complete this posting at the end of year 4 after we finished the other postings. Actually, this posting has ended about less than a year ago and I'm already in semester 10 in year 5(final year). But during this MCO, due to COVID-19, I've decided to write on this. About my previous postings in year 4, I'll write that later, insyallah.
Usually, my friend from other universities completed their elective posting by doing attachment in hospital for a certain period of time during their semester break. On the other hand, the main objective of our Elective Posting is a little bit different from other universities which are to participate in the community
service program. To fulfil the assigned objective, we took the initiative to construct
the teamwork program that runs parallel with the concept of community service
morale.
During late April 2019, we began sorting out the needs for our elective program. Frequent discussions were actively made among all team members to figure out the suitable activities to be done, the location, time frame, budget (reminder to my juniors, the college and faculty didn't provide a budget to this posting, so you need to keep saving from the beginning) and logistics requirement involved. On top of that, we concentrated more on brainstorming the positive impact and mainly how the planned program would benefit us in the context of a medical student, so to speak. So, we came up with a plan to ask for some help from the public health sector. After a few formal attempts at approaching the staff from the respective sector, we were finally given a green light and guidance from Jabatan Kesihatan Negeri Pahang (JKNP) to do our elective project involving Orang Asli community in Cameron Highland. Official approval for the program was already made by JKNP, the next step would be to contact the respective district staff.
Following approval from JKNP, we were asked to independently contact the staffs in charge of PKD Cameron Highlands. Hence, some written documents were sent to PKD Cameron Highlands and Hospital Sultanah Hajjah Kalsom (HoshKa). Several other follow-ups via phone calls and emails were also made. After a few interactions of both parties with us, PKD Cameron Highlands with its humble decision, allowing us to join their medical team, Pasukan Bergerak Orang Asli (PBOA) and HoshKa also welcome our visitation.  |
| HOSHKA, CAMERON HIGHLANDS |
8 students working collectively as two teams, we joined venture
with Pasukan Bergerak Orang Asli (PBOA) making trips into several Orang Asli
villages located in Cameron Highlands District. On 31st of July 2019, Dr.
Nurkhaledatul Falah, a medical officer in charge for PBOA briefed us on things
that we should expect regarding the itinerary and program directives during our stay in Cameron Highlands. According to their plan, on 1st
of August, we should began our trip visiting the first two Orang Asli villages,
Kampung Chenan Cherah and Kampung Chenan Baru. On 5th of August 2019, we
will go to Kampung Terakit and our last pit stop before we head back to Kuantan is Kampung Cheros.
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| Briefing with Dr. Falah in PKD once we reached Cameron Highlands |
We officially began our elective posting on 31st of July until 5th of August. Our main task was to provide medical
check-up under PBOA supervision to Orang Asli during our visit to their
villages. We were also expected to learn the appropriate measures made by the public
health team (i.e. staffs of PBOA) in primary prevention of disease among Orang
Asli. Worth to mention, we also observe how to handle acute cases found during
visit and follow up on chronic cases among them, all to make sure that the
community receive just as equal health service as the rest of Malaysians
despite their location situated in a remote area.
Generally speaking, we all know how hospital and clinics are common places
where the citizen seek medical service. Little did we know, the truth about
medical service is that it actually goes beyond than just within the hospital
perimeter. For some doctors and healthcare team, they faced multiple challenges when going deep into the forest to reach those who are in need of
the very same amount of medical attention but too socially isolated
geographically. So in the situation where they are unable to reach us, we reach
them and provide what is expected to be the best of health care services to
them.
On our first day, as early as 7am, we assembled in PKD office first before we ride to the villages by a 4 wheel drive and a jeep. Dr Falah, a medical assistant, and a few nurses will follow this trip.
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| We help the staff to load the jeep with the equipment needed |
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| In front of PKD office in Tanah Rata, Cameron Highlands |
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| I prefer to ride this jeep compared to 4WD because it's more thrilling haha. But, it is not suitable for those who have motion sickness. I rode this jeep for 3 days in CH so I really miss this jeep thou :") |
We stop at Klinik Desa Kg. Leryar to take some equipment and follow up books (buku pink) for antenatal check-ups. We were told that pregnant mothers from Kg Chenan come to this clinic at least 2 weeks before the due date so that, if something happened to the mother, the nurse will take care of her. As we can see, a fully furnished small house for the pregnant mother located just next to the Klinik Desa Kg. Leryar. So the mothers will stay 2 weeks before due date until the postpartum period in that house.
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| In front of Klinik Desa Kg. Leryar |
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Our team with beloved Dr. Falah :)
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It took about 40 minutes of ride from Tanah Rata to the starting point of our trail. Once we reached the parking lot, we warm up first because it gonna take long trekking time to reach to the villages.
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| warm-up, short briefing and Doa before we start our trekking |
We have to walk
through difficult and challenging trails deep into the forest and it took about 2 hours of jungle trekking to reach the first village, Kampung Chenan Cerah.
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| We wore raincoat because it was raining at the beginning of our journey |
The
walking distance to Kampung Chenan Cerah is about 6 km and the team just bring the needed equipment such as medications, weighing scale, BP set, foods, a few cans
of formula milk, and etc. I also bring my saviour--> isotonic drink and energy bar for a fast energy top up hehe. We have to cross three rivers with no proper
bridge and it was a very thrilling experience. I was so sad because these 2 videos are too small, cuz I really want to show how we cross the river šš¢š¢ We heard that one of the staffs was once fell into the rushing stream but fortunately that person was not seriously injured.
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| We have to cross 3 streams. and of course, this is the easiest one lol. |
We were overwhelmed by their sacrifices in giving the very best
treatment to the Orang Asli that are waiting for them in the forest. Actually, they have
listed several villages they have to visit every week per month, and every
village is different in terms of distance and terrain. We cannot even imagine how the team is going through these challenging experiences every month. As
we observe this situation as a medical student, we must be mentally and
physically prepared and ready to face any challenges in giving healthcare
services to the patient regardless of their location. I even started to imagine if one day I'll be posted here, I'm sure I need to be fit enough before going to the jungle trekking every week thou hmmmš
I can't imagine how pregnant mothers go down this trail and climb the steep cliffs while carrying a baby in their womb š£ Even me myself, I was exhausted like......š«.
After 30 minutes of trekking, we reached the first and small village, Kg. Chenan Baru. We took some rest there and we continue our journey back.
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Our pitstop in Kg. Chenan Baru
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In Kg. Chenan Baru
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| We took brunch beside the river ( actually this is on the way back lol) |
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| Actually, the heaviest thing to carry is a bag of medicine, so the boys took turn to carry it |
Alahamdulillah ! Finally we reach Kg. Chenan Cerah after 2 hours of challenging trekking >_< (read as : I wanna cry huwa. K lol). The village is located on the hillside and we need to climb to reach the terrain.
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Kg. Chenan Cerah. FYI, this village is the furthest village in Cameron Highland.
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| One of the staff told us that usually, they didn't use this trail because there is another shorter pathway to that village. But to give us the new experience, they chose this trail haha (now how I'm gonna react to this info?! lol š) Btw, I didn't regret at all after trekking for 2 hours just to see this view š |
In this rural area, one thing that I've learnt is you need to use what is available in front of us so that our work can be quickly and effectively done. The staff just sit on the mat to do the check-ups to the villagers. Due to the uneven surface of the ground, they also took 1 table to make it even for weighing.
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| We also learnt new tips even during weighing. If the child is cranky and did not want to go up to the weighing scale, we ask the mother to carry the child and minus the mother's weight. |
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| Other tips are, you need to bring some sweets or biscuits to build rapport with the villagers, especially kids :) |
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| The staff nurses busy updating medical records |
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| look at this happy kid with his biscuits :D |
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| Building rapport with villagers |
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| We also took time to rest and eat before we head back to the jungle |
In view of Public Health perspective, the application of the principle of primary prevention is put to work in preventing the transmissible infectious disease such as malaria among the community. We were also given an opportunity to observe how blood film malaria test (BFMT) is done in rural settings. This is my first time observing this simple procedure, all this time I just learn it in our infectious disease lecture.
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| The villager assisting the staff to do BMFT |
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BMFT
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| BMFT |
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BMFT kit
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| One finger is pricked, a drop of blood taken and put on the glass slide |
The challenges faced by the medical staffs are how to ensure the villagers to come for an appointment at the government hospital despite the long-distance and long hour of walking especially antenatal check-up. They also faced challenges to advise the mothers to do family planning so that their children get the proper attention and nutrition from the mother. So we must learn from now on how to improve our communication skills with the patient and it is even better if we learn their language to lessen the language barrier so that we can easily build rapport with them and to counsel them correctly.
Furthermore, we observed what medicine they were taking into each
village. Some are basic medicines such as painkiller, antibiotics, antifungal,
anti-hypertensive, cough suppressant and antihistamine. In addition, we were
surprised by this so-called ābasic amenitiesā that actually covers quite a wide
variety of basic medical supplies such as anti-parasitic drugs, free formula
milk for the baby, iodized salt to reduce the incidence of goitre, and multivitamins to ensure their adequate nutrition.
After we stay for about 2 hours in Kg. Chenan Cerah, we're heading back to the previous village, Kg. Chenan Baru. In this village, only a few families living here. Actually, all of them were from Kg. Chenan Cerah but they built this new village so that it will be closer to the main road. We didn't do much here cuz we took a long break to rest our sore foot!
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Our last pitstop before heading back
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| Kg. Chenan Baru |
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We also took time to play with the children!
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And selfie? haha kbai. Other boys and staffs took a nap in the house. Yes, we're so tired.
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Like I said before, we just found out that every
pregnant mother must come two weeks earlier from their due date to stay in a free
transit house in Klinik Desa Kg. Leryar which is easily accessible by Jururawat
Masyarakat until the post-partum period is finished to ensure the health of the
mother and the baby are taken care to the end. Their care towards the villagers
is beyond our thinking because they really care for the villagers holistically.
Even though we have easily accessible healthcare facilities in the urban
area, we should not take that for granted. We must be grateful to our Creator
because He facilitates us with basic facilities and supplies, reachable
healthcare facilities, unlike Orang Asli who need to travel two hours by walking
and 40 minutes by driving just to seek for treatment.
Finally, we're heading back to our hotel and I decided to sit at the back of 4WD to rest my feet and to record the scenery! Here the video :
Other than primary objective going to Cameron Highland was to visit those villages, we also make use of our limited time thereby grabbing the opportunity volunteering as a technical team for the health carnival program known as Smoke Free Fun Run Cameron Highlands organized by Pejabat Kesihatan Daerah (PKD) Cameron Highlands. We were given a crucial task to set up the main booth one day prior to the program, which was on 2nd of August 2019. The program was held on the following day, 3rd of August with the total participation of 1000 people.
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| Preparation of Smoke Free Fun Run organised by PKDCH |
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Preparation of Smoke Free Fun Run organised by PKDCH
 | Preparation of Smoke Free Fun Run organised by PKDCH
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On 5th of August 2019, we went to Kampung Terakit. We ride the 4-wheel drive to the village. Even though the road is not properly paved, but it was still a lot better than walking right? With 4wd and jeep, it takes about 40 minutes to directly reach the village. No need to walk like previous villages.
In this village, the road and houses are more proper. The villagers even prepared one house to the Healthcare staffs to do medical check-up.
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Last shot with Dr Falah :)
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On the next day 6th August 2019, we went to Kampung Cheros. This village is located beside the main road and it was the most easily accessible village among all we've visited before. Most of the houses are PPR house and some of them still build their traditional house.
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Kampung Cheros
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| traditional house of Orang Asli in Kg Cheros |
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| nurses plotting growth chart based on the child's height and weight |
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| my signature pose with 'em lol (oh no, what I've taught them lol haha) |
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| Our happy face before realizing how 2020 and all the COVID19 things will hit our final year lol |
In addition to our stay at the district, we decided that it is worth our time to also pay a visit to Hospital Sultanah Hajjah Kalsom to gain knowledge on how a district hospital functioning. Our visit to the hospital on 2nd of August was nicely welcomed by the hospital staffs and importantly, we did learn a lot of informative values regarding the district hospital and it changes our view on how a district hospital operates.
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Briefing session
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HOSHKA
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| I think this hospital looks like hotel rather than a hospital ;p |
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| The quarters for the staffs, imagine you wake up in this morning view. Heaven ! |
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Emergency Dept. HOSHKA
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| If I'm not mistaken, there are about 40 beds in this hospital. We were shocked at first cuz we've been used to 40 beds in one Medical ward in HTAA(ofc, HTAA is a tertiary hospital lol) |
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Physiotherapy @HOSHKA
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Who agrees with me, this hospital looks like a resthouse? ok bai
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| In O&G Dept. HOSHKA |
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The nurses were so warm. They even welcomed us, the first medical students who visited them.
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During the hospital visit, we were exposed by Traditional and Complementary Medicine
Department that is part of the hospital. There are only a few hospitals in
Malaysia that recently introduced this branch of medicine and Hospital Sultanah
Hajjah Kalsom is one of them.
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Traditional medicine department
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Acupuncture and traditional massage are part of
this medicine. Therefore, as a modern medicine practitioner, we should not push
the alternative medicine. On the other hand, we should utilize them as part of
the complementary medicine to facilitate the healing process for the benefit of
the patient. As long as the treatment is under supervision of the physician,
there should be no problem for the patient to choose other types of alternative
medicine.
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| My colleague even try the acupuncture |
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Acupuncture needle
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We also learnt that the numbers of Medical Officer on duty are limited in
a district hospital. They were only 11 medical officers in 1 hospital if I'm not mistaken. They have no specialist to rely on to make a decision, so
they have to be wise enough to decide, either to keep the patient in their
hospital or to refer the patient to the tertiary hospital. During houseman ship,
they have to master the life-saving procedures as they have to do all the
procedures on their own since the responsibility lies on their shoulders if
they were posted in the district. So from now on, as a medical student, we must
study not just to excel in medical school but to prepare ourselves to treat the
patient on our own since everyone will depend on us in the future.
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The doctors also told us that any difficult cases will be referred to Hospital Ipoh. They even use the term"FLY to Ipoh" haha(you know how the roads in CH while riding an ambulance! Maybe I'll vomit right away......)
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| Such an informative visit, thank you staffs in HOSHKA ! |
To conclude, we would like to express gratitude from the bottom of our
hearts to our Most Gracious God for giving us this opportunity to make this
elective project happen successfully and safely. We were also thankful that Faculty
of Medicine makes a unique approach to Elective Posting, eventually allowing us
to learn and gain experiences outside from the hospital settings. Finally, we
realized how important the roles of community medicine as we experienced it
ourselves. We have become more open-minded and finally be able to view
healthcare services in a more holistic way and last but not least, this
experience gave us the chance to refresh ourselves before we enter our final
year.
P.S. : big thanks to my teammates ( Sarah, Husna, Yasmin, Firdaus, Mustaqim, Amir, Nizam).
.Photographs by Sarah & Firdaus & me.
ALHAMDULILLAH, thanks for reading :)
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