Abang Zul. Plight of the Society and Health Care.

I received a text message today from Dr Samsul this evening:

"Pesakit name Zulfikli tu sudah pun meninggal dunia ptg tadi."

We met Abang Zul the first time at KK Balok while we were undergoing our Family Medicine posting last year. He came for his regular diabetic check-up there. The last time I saw him and his mother was when he was admitted under nephrology in the medical ward I think earlier this year. He was undergoing dialysis.

The 32 year-old gentleman was diagnosed with diabetes since 11 years-old and had multiple complications related to diabetes including carbuncle, amputation, retinopathy, dyslipidemia, his latest complication being nephropathy and was under follow-up by multiple discipline including medicine, orthopedics, opthalmology, and dermatology. He was on insulin but his glucose level remained poorly controlled.

Ever since he was diagnosed his problems only progressed first taking his limbs, then his eyes, his kidney functions, then finally his life.
I'm not sure of the CoD but it might have been due to nephropathy as he was said to have uremic symptoms. A friend who was oncall in the A&E later told me that she met the patient who was brought in pulseless. Efforts to resuscitate him failed and he was then pronounced dead..

A lot of groups had come to visit him and write our home visit report including my own group.

He lived in Balok, Kuantan in a single storey-wooden kampung style house. His house was built next to a two-storey bungalow belonging to his uncle if I'm not mistaken. Next to it, his house looked like a shack. To get to his place you had to drive next to Muslim cemetery (which hada graffiti painted to its entrance wall saying "Jalan Rempit"). You can't see his house from the road. The first time we went we didn't really believe it was a house. The patient lived alone with his mother. His father had passed away a long time ago. His siblings mostly lived elsewhere raising their own families and working. The patient didn't have his own transportation and relied on his brother who came quite seldom to bring him for his checkups. His income mainly came in the form of contributions from his family members. His mother is unemployed and spent most of her time caring for his debilitated son.

He was a sporting chap. Not to say lively but humble and responded to us well despite having seen many students before us whom I'm sure had asked the same thing over and over. From the outside he didn't looked depressed. But when I asked him how he felt during one of our chats, he did indeed felt sad for his condition (which might be an understatement). I cannot imagine going through a debilitating illness at his age. He was as a friend rightly said, was a fighter surviving as long as he did.

A friend and I along with Dr Samsul and his wife went to visit the family just about an hour ago. I'm not sure if that'll be the last time I'll ever see the place.

I've been to funerals a few times and it was usually full. When we went there I only counted less than 20. It could be that news did not spread quick enough or relatives were living far away. Dr said that if it were a Dato' people would've flocked and ran to pay respect to him. But who was Abang Zul in this world?

We went inside to have a final look. He looked just the same as before. I felt immensely emotional at the time although we were nowhere related except through religion. After a few more minutes we said goodbye. I could only wonder how the mother felt. It might be for the best for her and her son? Only Allah knows.

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I think Ive written this something similar about Zul in an older blog post but I guessed I would like to re-highlight the plight of our community and health system.

Poverty is still a major issue in this country.
Education of health is poor.
Health delivery is also still poor.

The way I say it sounds like we live in a poor country. Unlike what we aim to achieve by 2020.

For En. Zul, the fact that he has suffered multiple complications from poorly controlled diabetes reflects the level of health care we have in this country. I am sure this is not an isolated case but just an example of numerous other similar cases of patients without the resources to care for their illness.

I only wish I had the statistics to back my claims but I think reading tabloids and newspaper, just strongly around the rural areas, working in the hospital and district clinic may reveal the reality of our country.

This is indeed pretty sad.

Im not writing this to blame anybody in particular but I think that the community and government is responsible in bringing ourselves out of this sorry state we're in. There will always be something we can contribute. Being an idealist, I believe that small things when done in large amount by a lot of people can make a mountain move. This can only happen when people are conscious of their surroundings and have the conscience to help make a difference.

I'm in a way grateful that my exposure during my medical training had helped a bit in opening my eyes and Im sure it will be opened wider still when I start working. Ive been talking a lot but have I initiated any real actions? I do hope that in the future when I've started working that I can make that difference though the road there will never be smooth and there will always be tribulations.

Meanwhile I can only pray and hope for the best for ALL of us.

Health is God's Grace.

As I write this down, I have no idea as to what title best suit this article. Perhaps I'll have an insight as I go on.

I have a friend. I'm not very close to her but we did go to Yogjakarta together and we undergo pediatrics for a week at Wirosaban hospital and teamworked on a seminar on thalassaemia. She is a big sized woman, very active constantly on the lookout for adventure. She has been to Cambodia for a mass circumcision program and other community activities that I am not aware though I'm sure her, being in the facilitator club has organized a number of moderating programs.

Recently, she was diagnosed with Hodgkin Lymphoma. She requires chemotherapy.

Being a medical student, we're always on a lookout (well not always) for interesting cases or those cases where you happen to read in the textbooks but never seen in real life. In my time doing internal medicine or pediatrics, I could not recall having seen a patient diagnosed with Hodgkin's lymphoma (kantoi x gi ward sgt), most that I've seen are non-Hodgkin's which carries a better prognosis than its counterpart.

Never did I expect it to hit a classmate who has undergone 5 years of medical education with me. She was so near the end but had to take leave for whatever purposes to handle her illness.

A disease, those that you see in the hospital or in the textbook, may hit ANYONE. I most often hear patients saying, "Eh, doktor pon boleh sakit ke?" whenever one of us sniffles. Now one of us has cancer. Being a medical student or doctor does not make you impervious to disease. We are all just HUMAN.

I always imagined what would it be like if I knew I had cancer had my time is borrowed. Would I fervorously study or find out more about the world? Would I become more religious and pray more 'Khushukly?' Would I use whatever time I have to make a difference to the world? Would I perform an act of self-sacrifice and throw myself into a war hoping to die in martyrdom?

Would being terminally ill change someone?

I wouldn't know. I'm not terminally ill.

But seeing my friend a few days ago. She lost weight. She looked tired after her laparatomy done just to take a biopsy sample of the paraaortic nodes. She still haven't undergone her chemotherapy regime yet which will definitely drain even more of her energy. And I have no idea what her psychological state of mind is like.

And when I think about it. I doubt I'll be strong enough to do anything when I'm sick. I falter with even a simple bacterial pharyngitis.

One of a Muslim's right is to be visited when he/she falls sick. In this context I see two important reasons. One, the most obvious is to provide moral support for the sickly. Two, is to remind ourselves that, a lot of times, we can only perform well when we are healthy. And we will never forever be healthy.

Reminds me of Ust Chowdry giving an analogy during the Al-Khauthar course I attended. Why would God make us sick? Why does He send down disaster if He is so Graceful? He has been graceful to provide us health. He is not obliged to forever pour His grace. Whenever He likes, he may just turn off His Grace. Although even that to those who are patient and in remembrance will also see that as a Grace, whether its near or farther into the future. Allah knows best.

While His Grace is still turned on, we should attempt to do our best in this life we have been granted. To wait for a life changing event to change us is, to me now, a silly notion. An stupid excuse not to do things RIGHT NOW, AT THE MOMENT!

What has befallen my friend perhaps serve to be a hidden agenda that Allah has prepared not only for her, but those around her. It has certainly in a way remind me of Allah's Almighty power although for how long I shall remain in remembrance I can only pray that I continue to have this insight.

I pray the best of health not only for my dear, friend, but to my colleagues, friends, teachers, my family (who are also mostly ill even if they do not know it), and myself. So that we may strive to improve and do our best in our good health.

Amin.