My Elective Experience

Hi! My name is Shu Yoong. And I had an ahh-maa- zinggg elective experience! My six weeks

were split between two different disciplines, and in two different places separated by our vast

South China Sea.

The initial selection was extremely difficult despite narrowing my choices down to hospitals

within Malaysia. Too many places to choose from, and from all sorts of interesting disciplines

(some I’d never get to experience, ever, apart from an elective experience), and on top of

that, figuring out how I can get the balance right between a holiday versus doing some

serious learning – that said, you can see why I was simply spoilt for choice! And one more

thing you should know about me, I’m impossibly indecisive! Oh no!

After months (yes, months!) of deliberation, bouncing from one decision to another, I decided

on doing Medicine at the Duchess of Kent Hospital (HDUK), Sandakan and Psychiatry at

Hospital Bahagia Ulu Kinta (HBUK), Tanjung Rambutan.

First stop, Sabah! Getting off the plane in Kota Kinabalu, I met up with an old friend, working

as a houseman at the Queen Elizabeth Hospital. Long time no see indeed. Bunked at his

place, met his housemate’s little puppy. She was all excited as all puppies are, but my oh

my, was she a stinky thing. So I gave the little thing a nice hot shower. You’re probably

thinking to yourself, what’s the relevance of all this? It’s part of my experience, and you

asked for it! Hehh!!!

Alright, let’s fast forward now to Sandakan. The next day, I arrived pretty late after dinner,

and pleasantly found myself in a clean and neat flat, huge thanks to the two boys Chew

Kwee and Kelvin who were to become my housemates for the next three weeks. It was as

local an area as you could get. Walking along the corridor, I spied at my neighbour’s

newborn baby, and as we lazed in the living room in the evenings, our neighbourhood kids

raced along the same corridor, showing off their skateboarding skills.

We arrived at the Duchess of Kent Hospital at 8am everyday, 10 minutes ride on the local

bus (a van actually), which surprising, runs pretty frequently. In the medical ward, the Sisters

and Matron were very welcoming. They were always looking out for us. They were our ward

mamas. The best part was when we asked in regards to wearing our white coats, Sister Jess

said “tempat ni macam sauna la”. We got the message, and we loved it! Yayyy, no white

coats for the month! And as we observed later in the wards, none of the housemen wore

them either.

The number of houseman to patient ratio is much smaller compared to that in Penang

General Hospital. Hence, following the specialist rounds was a good learning experience.

Not only could we clearly hear the specialists advising patients, instructing management and

teaching their housemen, they could even afford us, medical students, personal attention.

It was interesting to come across demographically different cases compared to what I would

normally encounter in Peninsular Malaysia. Throughout the three weeks, there were multiple

cases of malaria, and ironically none of dengue. At least two cases were of the parasite

species Plasmodium malariae, and one case of Plasmodium knowlesi – all the rarer!

There was another case. A sad one. The man was a foreigner who had been living with

leprosy for a few years, on a multi drug therapy (MDT) regimen. I cannot recall his reason for

admission. The history was a long one. He was placed in an isolation room. He wasn’t doing

too well, they said. As I peered in from across the glass window that separated him from us,

I saw that his digits were clawed and atrophied, his face was disfigured, his eyes were a

shadowy white in places where it should have been pigmented, and he was in pain from

ulcers over his body.

He was succumbing to sepsis. He had no family here. No one to pay for his treatment in

hospital. The directive was that foreigners are not offered free medical care. The medical

team’s hands were tied. The specialist tried to appeal. But her request was denied. They

were not allowed to treat. We watched the man deteriorate day by day, till one morning, he

passed. His was a slow, painful, lonely death.

I peered in from across the glass window one last time. A white sheet was already draped

across his face and body, waiting to be sent to the mortuary.

I was angry inside. Disappointed. It was a sad day.

*pause*

Our weekends were for travel. We booked a 3 days 2 nights package for a Kinabatangan

River experience. Funnily enough, we were the only local Malaysians among the foreign

travellers there. And I must boast that we played our local student card well. We bargained

persistently and got ourselves a pretty good discount. We were extremely pleased. Thankful

we can count our blessings!

For someone who enjoys nature, greenery, jungles and trees, the night walk amidst the

chorus of cicadas, was, for me, a walk to remember *grinning at my brilliance with that

phrase*. A pair of kingfishers sat silently on a thin branch, a few inches above me, an arm’s

length away. That was the closest I’ve been to a bird in the wild. Birds are blind at night, said

our guide. In the mornings before dawn, we got on our boats for a cruise along the

Kinabatangan river. The heavy mist simply made the entire experience altogether dreamy.

If there was anything at all that I’d complain about, it’ll be mosquitoes! Those jungle blood-

suckers are quite something! The layer of insect repellent barely repelled them from

attacking my arms and legs. At the end of the morning jungle walk through the muddy trails,

the area of my popliteal fossa, laid bare between where my knee length pants end and those

knee-high boots, the region was covered with at least 50 concentrated bites. Imagine my

agony!

Before I forget a must-mention, we took another weekend off to Semporna, all to careful to

not let our parents know of our grand scheme. (It’s the recent happenings of pirates and

kidnaps, you see. Oh, but we were, we still are, young and reckless.) Driving back at the end

of the trip that Sunday night, Chew Kwee and I were many shades darker. Our backs were

burnt red and raw, but our faces plastered with an impish grin. We were certified Open

Water Divers.

Alright, the Sabah story has gone on for far too long. Next up, after a 2 week break back

home in Penang, I arrived in Hospital Bahagia Ulu Kinta, the infamous mental hospital of

Tanjung Rambutan.

I was excited alright! And not disappointed!

Of all the medical disciplines, Psychiatry is my favourite. It’s the one path I can see myself

going for in the long term. My first day, I met up with the Pengarah. My 3 weeks were

allocated between General Psychiatry, Forensic Psychiatry and Community Psychiatry.

Week one I tagged alongside a young specialist, Dr Ng, and her medical officers (MO) in

General Psychiatry. The male and female acute wards were our “base”, where we spent

most of our time doing rounds. Interesting would be an understatement in describing our

patients. Colourful, perhaps. Despite meeting the same patients everyday, there never was a

dull moment.

Ms A, gifted in many languages when it comes to music, would spontaneously break out in

spirited singing. That day, it was a Bollywood morning, her vocals carried well in that huge

open hall. Dancing around the pillars of the place, she was entertainment for everyone.

Then there was Mr B, whom, the medical officer says, has Antisocial Personality Disorder.

Over the years this young man has been a regular in the acute ward and drug rehabilitation

centres. He gets violent. His own parents are afraid of him. But a great actor he is, oh yes.

Manipulative, and well-played.

But Dr Ng knows him all too well, she doesn’t buy into his tears and pleas:

“If you’re acting out like this, not willing to cooperate and talk, I’m sending you back to Pusat

Serenti.”

“Ok laa, if that’s best for me,” he replies pitifully with tears streaming down his face.

For what manipulative strategy it was, I sure can’t comprehend. But he knows all too well that life back

at drug rehabilitation is akin to an army camp. So the next day he tries a new strategy.

Week two was Forensic Psychiatry under the legendary Dato’ Dr Suarn, one of Malaysia’s

first two forensic psychiatrists. Legend has it that when called on to testify in court one fine

day, a young lawyer on the defense was out to prove his worth, shooting our good old doctor

sly questions unrelated to his profession. My oh my, did that poor guy then get himself a

severe reprimand by Dato’ himself, in the middle of the court proceedings, and in front of the

judge! Now, that, is how legends are made.

In Forensic Psychiatry, I tagged along the MO Dr Calvin. He was very helpful and taught me a great deal. I saw how differently they managed their patients here. The aim was dual – to treat mental illness and assess mental capacity. Here I met my first case of malingering. It was amusing. He scored a zero on his MMSE and almost as badly on all 4 frontal, parietal, temporal, occipital lobes assessments. But then talks just fine, walks just fine, eats and grooms just fine, except when he is being assessed. Impressively horrible actor indeed! But to his credit, let’s just say, it’s not that easy faking one’s way into being of unsound mind. First, you’ve got to do it smart. Then 24/7, and consistently. With CCTVs in every crook and corner of the wards, I bet Leonardo di Caprio himself wouldn’t be able to pull it off.

Alright, I’ve reached my page limit. Hence, abruptly I end, with a Thanks for Reading!