Adz Ariff (dot) Com

Prelude: In which I talk about work and tie it with a past experience, and I think this post is much more fitting of its title from a previous post with the same name. But no matter. Work, experience and humor for your complete wholesome meal today. And I don’t know why I never blog about this earlier. Guess O&G gave me enough creative juices for me to blog again…

There are a sudden of influx of foreigners coming to the government hospitals to seek treatment for whatever ailment there is. In my case, foreigners come to the department where I am currently posted in to deliver babies. Okay…acceptable.

But then, when they come in with zero knowledge in conversing in Malay or English, I’d have to take a deep breath and try sign languages. However, as patient as I can ever be (and nurses say that I do have that, no matter how frustrated I look) I still could not resist the urge to strangle those who came in at the dead of the night when I’m oncall with zero BM / English and expect me to know what the current problem is. I’d wonder, “Why me, why this is happening when I’m oncall, why isn’t there ferocious thunderstorms when I’m oncall…” Really…doctors are many things but psychic we are not. But at least, come experience, I could now hazard some guesses to why they are coming to the Patient Assessment Center… they are of course could either be, 1) having passage of show - that’s blood + mucus, or 2) contractions pain, or 3) leakage of liquor, or 4) two or three of those I mentioned earlier together, and the award-winning reason, 5) THE BABY IS COMING OUT!!

I really should probably consider learning Burmese as there are a lot of Burmese patients coming in. There was once when I was working - during office hour - when a Burmese couple came to PAC. It has become quite a normalcy if the patient does not speak a word of BM (they will gain the ability to at least say “sakit”, “ubat” or “baby” once the baby is out) but when the husband also knows zilch of the language then I knew we were having a situation. I was about to consider talking in ducks-and-chickens language when suddenly at the corner of my eyes I saw my lovable Burmese fellow houseman colleague (we were posted together in Orthopedics once, and when I was spirited away to O&G she went to do Paeds) walking past me. Quickly I grabbed her and requested a favor for her to do a quick interview to the patient. Luckily she was quite free and obliged and phew, one problem settled. The situation however got me into thinking.

Isn’t it about time already that the government consider posting a couple of translators to our local government hospitals? Being doctors alone can be a headache, we certainly don’t need another headache trying to figure out a patient who does not speak our tongue (or tongues… I had a fellow colleague who, out of frustration probably when dealing with a patient, keyed in the patient’s progress note - Language barrier, patient does not speak in Malay/English/Chinese/Tamil/Arabic). At least post translators to communicate in Burmese and Arabic (when my hospital is in question, dunno about other hospitals in KL but statistically Selayang does have quite a number of Burmese patients as of late).

However, deep down, I can relate to them. I was a foreigner when I was studying in Kursk, Russia. My mastery in Russian Language was enough to get by, I suppose, but it never was enough to get me excellent marks whenever I took the exams. Luckily I never got too sick to warrant admissions to the hospital - I could only imagine what I’d blurt out when asked by the doctors who couldn’t speak English, I’d probably either brought a dictionary with me or took the easy way out by requesting my English-speaking teacher-doctors to speak on my behalf. That was what I thought until I reached my fifth year of study. A close junior friend of mine back then who was in his second year came up to me requesting me to accompany him to the hospital for him to seek treatment for his chest pain. We went to the hospital and it was then I realized that I didn’t really know much of how was the procedure for us to see a doctor in the hospital - we’d usually go to our teachers or the clinician designated to cater for us foreign students, both options not available at the time this happened.

So here I was, practically blind as a bat in terms of knowing what to do, with a junior who hoped that his senior would know what to do in that time of crisis. I did manage to see one doctor there and relaying about our problem, and he was kind enough to examine my friend there. However the trouble came when the doctor requested for my friend to go for X- Rays, and we didn’t know where to go for X-Rays. Russian hospitals aren’t exactly like Malaysian Hospitals where everything under the sun was packed nicely inside one building - there they have specific places for specific specialties. It took us quite some time going back and forth to locate where exactly the X- Rays were done, and asking directions from many people didn’t seem to work as probably there could be some details that were lost in translation. Finally after seeing my friend having his bouts of chest pain again (the doctor we saw earlier today had said that he didn’t think it was heart related) with no medications, in the cold Russian winter, I finally caved and decided to just head back to the university and took him to see the 2nd year vice dean then (who so happened to be a cardiologist as well, and had taught me once or twice or so). I was scolded for not thinking of coming to her in the first place, and she took over the case. A day later, my junior told me what the diagnosis was: Costochondritis!

Anyway, back to my reason of posting this in the first place: I think it’s about time our big shots running the country consider putting in a couple of translators in our hospital to facilitate history taking. That would solve one language-related problem around here. However it won’t solve the other language-related problem we have, and that’s got nothing to do with the locals. It’s with…yup…our very own people. What the heck, you say? Surely we don’t have this problem with the locals too? Unfortunately, yes. Take this for an example.

I was on-call, and at 2 AM one patient came in. Brief history from the nurse at the counter said that she is a pseudo-primigravida, meaning that while she has not delivered before she has had history of abortion. Okay. No big deal. She’s a Malaysian anyway who has just came back from the United Kingdom. Okay. Still no big deal. Shouldn’t be much trouble to get history from her. Then problem number one came. At roughly 32 week point of gestation, she had no antenatal book. She claimed that she did go for checkups while she was in UK, but was not given any antenatal book. No referral letter either. No nothing. I’d expect if she did go for checkups there - she did say she went to the same doctor three times - if she planned things properly she would probably have mentioned to her doctor that she was going to go back to Malaysia permanently, and the doctor being the sensible, rational doctor I’d have hoped that at least the doctor would provide a referral letter briefly stating about the current situation, past medical/surgical history and latest findings. But without the book, I’d have to take her history from scratch…which still is okay, because we do that everyday anyway. But the book provides us with more details, accurate numbers, some lab findings that of course we do not expect the patient to remember… I’d have to rely solely on the patient’s words this time around. It was then the major problem began to show…

Usually, I’d begin greeting and questioning my patients in Bahasa Malaysia. She stared at me, looking flabbergasted at first before managing a reply with somewhat incoherent but still understandable BM. Then I remembered that she just got back from UK and might not be quite proficient in the mother tongue, so I (kindly, neh) asked whether she’d be more comfortable in English, and proceeded to ask her more questions. In full-sentenced English, mind you, since here I got a patient who just came back from UK so I figured she’d be more comfortable with real English rather than Manglish. And what did I get in return was the patient looking at me scrunching her face in disbelief and her eyes went to my nametag. I looked down and saw the back of my nametag was facing the patient, so I turned it around so that she could see my name. And when she saw my name, I guess it dawned to her that she had made a mistake in regards of what race I am. Then my MO stepped in, thinking that I might have some problem regarding to the patient (probably because I took more time than I usually would). Mind you, my MO has a name which denotes one race while appearance-wise shows another. So he kindly took over, and with brilliant mixture of Manglish and another language (after Malay and English), he managed to get enough history and said to me that he’d cover this patient and suggested for me to go see the other patient. Hmm…..

Feeling rather dejected, I went to the staff nurse and whispered in a huff, “BM dah kurang, BI pun tak boleh sangat. Apa benda lah dia ni buat DUA TAHUN kat UK tu? Masa saya cakap BI, dia tengok kat saya macam saya mencarut kat dia, kak”. Staff nurse merely offered a sympathetic smile - they had dealt with the patient earlier and knew what I was talking about, and assured me that what I speak out in both languages were comprehensible enough for her school-going children, primary and secondary school both. It was assuring at first, but then again, could that also be the problem. Another staff nurse, more experienced, nonchalantly offered that sometimes some patients just didn’t want to bother using a language they were having difficulty to speak in, preferring to wait until a staff with the capability to speak in the language they are most proficient in to come by. They can actually speak in BM or BI or both fine when they’re not in pain.

Hello. 1Malaysia? “Campak kat Russia dorang ni baru tahu,” I replied to the staff nurses.

“Lepas settlekan patient yang lagi satu tu doctor pergilah solat Isyak ye,” the kind staff nurse offered.

I nodded and whispered a mantra to myself, I love my job, I love my job, I love my job…

Sekali terjadi camni….hmm…there was something that happened sorta kinda like this - a patient claimed seeing hantu when she was delivering and went hysterical - luckily not when I was oncall.