Last Wednesday, my friends and I went to Rumah Ehsan in Dungun, Terengganu as part of our medical curriculum in Family Medicine posting. The journey took about 1 hour and 30 minutes by bus. We stayed there for a night and went back to Kuantan on Thursday evening.
While we were there, Dr.Samsul was our supervisor. We followed his ward rounds and discussed about problems and diseases among geriatic population.
Rumah Ehsan consists of 4 wards - A, B, C and D. The total patients are about 120, in which Malays are the majority. We visited all the four wards and met some patients. Some of us also get the chance to examine them. I got to do cardiovascular examination on a Sarawakian elderly with thyroid swelling. Her first and second heart sounds were heard with no murmur, but her pulse was irregularly irregular (I totally missed that!). Most of us already forgot how to do complete physical examinations since we had not been posted in the hospital wards for almost a year now =..=''
In male wards, you can see that most of the uncles were immobilised. Some of them were paralysed, some can use wheelchair, only a few can walk by themselves. Bed sores and impacted faeces (which may progress to intestinal obstruction if left untreated) are the main problems among patients who are confined to bed.
In female wards, the environment was different. Nice smells, beautiful wall decorations and smiling aunties greeted you. Most of them were on bed too, and Dr.Samsul said that the main problem here is osteoporosis - post-menopausal women, immobilization, lack of sunlight.
We met patients with hemiparesis, metabolic syndrome, hepatitis, Argyll-Robertson pupil, chronic kidney disease, suspected breast malignancy, hyperthyroidism among many.
The most interesting part in Family Medicine posting is that you manage patients in two different ways : Patient-Centered Management and Disease-Centered Management. Doctors nowadays focus more on disease rather than the patient himself. When you treat patient based on diseases, you prescribe appropriate medicines for their conditions. But when you treat patient, you will consider other things like their dietary intake, sedentary lifestyle, smoking and alcohol intake, depression, stress management among many. You have to focus more on their social background.
Let me tell you an example of a patient we met. There was this 48-year-old Malay man who was lying on bed, immobilized. He was paraplegic (cannot move both legs). He used wheelchair to move around. He can eat, get dressed, take bath and do everyday activities by himself. Dr.Samsul then asked each one of us to ask only one question to him. We were so focused on the cause of his disease and other underlying medical conditions, until we missed to dig deeper into his social history.
It turned out that back in his younger days, he worked as a tourist guide in Tioman Island. He smoked, drank alcohol and admitted to having unprotected casual sex with the tourists. When asked about his prayers, he said that he never performed solah. He was too lazy to observe his prayers. When asked whether he wanted to get married back in the day, he said that he didnt feel the need to get married because he was happy, he got all the things he needed to make him feel happy. He is still single up till now.
Although the story he told us was in no way related to the cause of his paraplegic state (it was due to trauma), we felt like we had found the missing pieces of information. He also had hepatitis - that explained it.
Social history of a patient plays an important role when we want to manage patient as a whole.
Here are some pictures I got from Facebook page of Rumah Ehsan:
An experience that I will never forget was the time when it was my turn to ask a question to a Malay elderly on his bed. I asked him whether he is married, and he said yes. Then I asked whether he has any children, and he said yes. So another appropriate question would be, 'where is your child now?'. I asked him that.
Suddenly, he burst out crying in front of us.
I was speechless and teared up as well. I quickly hide myself behind my friends, because I was too emotional to continue. I should have maintained my professionalism and ask further, I know. Argh I hate myself and I wish I was stronger.
It is a sad thing when the only child you have does not even bother to pay you a visit when you are sick. The uncle was divorced when he had stroke. We can see that he missed his wife, and his child dearly.
It is sad when you have no one who is willing to take care of you when you get old. It is even more sad when your children have the heart to send you to an old folk's home when you are old and sick.
It all comes down to the need of building a strong family institution. Educate your children well, and teach them Islamic values. The most important thing - Marry a good husband, the one who will bring you and your family to Jannah :)
Not enough with Pandas issue, now we have Porcine DNA in Cadbury Chocolate.
Malaysia oh Malaysia.