Aiming for 50% coverage of vaccination rate

I am keeping this here because they got my name right. Not Yasmeen or Jasmine.

So far, Melaka is at 48% of completed 2nd dose of the vaccine. Once the state reaches 50%, we could hopefully slide into the next phase of the National Recovery Plan. As someone working behind the scenes, the situation is not as rosy. Meeting targets means stretching ourselves short. Working on weekends and public holidays. It got to a point when my daughter told me one day to stop going to work. But I still had to leave after a lot of reassurance. I am still thankful that I could see her waking up and tucking her in bed at night. Some of the front liners do not have such luxury.

I am all for vaccination.

However, the current policy of mandatory vaccination to enter public premises and all, is something I feel needs to be scrutinized. The problem with such implementation at the society level is such that it can be too ‘strict’ so much so that it is not accepting isolated cases where members of the public who are not fit for vaccination. Which leaves the MOH again in figuring out a way of how to certify the medical conditions of these individuals. Do we have them assessed by certain specialists? Do they get a special certificate or memo regarding their health status? So far, since I am part of the mobile team, I have yet to come across these ‘special’ cases but I am sure I will encounter them in the near future.

My 2nd reel on Instagram

I don’t know how the youngsters do it. Doing a tik tok/reel one after the other. Such genius beings! How do they get the timing of the video and audio in sync? I had to refer to a tutorial to do the #add27photoschallenge. It took me about 3 trials to finally get it right, somehow. This 2nd reel is a snippet of how the district’s vaccine mobile team (technically, my team) goes about. I am still shooting and collecting videos to edit and make it into something I could put on Youtube. Aiming to upload a 10-minute video.

Our little team

A medical officer, a vaccination (nurse) and a driver. Sometimes, we have a medical assistant to help or NGO’s.

There are 2 medical officers – I take a turn with my colleagues so we could rest.

Mobile CAC in prison

An ad-hoc CAC mobile team was deployed to assess the well-being of prisoners diagnosed with Covid19. The team comprised of 6 medical officers with another 10 supporting members of medical assistants and nurses. The team was already gathered by 0830am. All ready to go by 0900 but was met with unforeseen circumstances. One is the limit of mobile phones to be brought inside the cell despite providing the clearance letter. We use mobile phones very heavily during CAC for consultations with specialists and entering data. Hence, the hard work only started at 1000am.

I was curious to know what each coloured uniform of the prisoners means. There were white, red, green, blue and purple. Interestingly, during each interaction, they appeared well-mannered and non-hostile. Perhaps it was because we were on the other side of the barrier. Lols. Most of the prisoners were well and at Covid Category 1. A few needed an admission at the Covid hospital. Transferring them is not an easy feat as they needed prison officers to guard each of these convicts.

I don’t really know how much these correctional officers earn. But I hope they are paid handsomely for the responsibilities they are shouldering. It’s like menjadi bapa yang penyayang tapi tegas. Tough love.

We wrapped things up by 1830. Everyone was exhausted, sweating and wrinkled from dehydration. No food, no water and no toilet break. That’s about 9 hours in PPE under the warm, tropical weather. I could only hope that in the near future, there would be better communication between both agencies. And that we have a commander on site who could help foresee the flow of things and keep the ball rolling. On top of making sure that the well-being of the team is well-taken care of. Although we were told that there was a musolla on-site, being a visitor there, it does feel a bit awkward to just doff out of our PPE and berkeliaran at the prison’s complex. It would help to have some sort of floor manager saying things like, “ok, table 2, doffing, gi makan, solat. come back in 20 mins”. Takdelah rasa bersalah sgt doffing while your friends are hard at work.

All in all, it was a great experience to do our jobs in a different environment. I wonder what other adhoc things we would be expecting in the future.

Vaccine Mobile Team

I have been absorbed into the vaccine mobile team at my current workplace. Somehow, my superior is convinced that I could contribute well as a vaccinator considering my previous participation as one in my past clinic. At the moment, the vaccine mobile team plays a role in going to the potential vaccinees who are having difficulties to go to the vaccination centre themselves. These group of people are usually part of the marginalized community. So far, the government mobile teams have been going to old folks home at nearby areas. This correlates with the objectives of PICK’s 2nd phase of vaccinating the elderly population and those with medical comorbidities. Soon, this service will be extended to those living in the very rural areas of the country, prisons and others.

The Ministry of Health (MOH) is also working closely with medical NGOs like IMARET and MERCY Malaysia to materialize these efforts. Once these NGOs can work independently, these outreach activities will be delegated to them so as the MOH team could concentrate on their respective vaccination centres.

Last week I shadowed my senior counterpart in learning the ways on how to manage these sessions. Starting from making the line-listing on Excel, ordering the vaccines and checking on the team for the day. The vaccine mobile team will consist of one medical officer, an assistant medical officer and two nurses. I have to learn everything as fast as I can on that day cause I will be on my own next week for 3 days in a row. I hope I don’t screw up. Allah, help…

I had the opportunity to meet up with the MERCY volunteers as well. Bless their soul for participating in the programme in their free time. They have a heart of gold. PICK is scheduled to go on till next year. Like it or not, the world needs to accept the new normal.

The perception of ICU care

An ex-colleague of mine, NS, just lost her beloved father to Covid-19 last week. I worked with NS briefly at a district hospital many years ago in the emergency unit. She left the unit for a dream to become an independent private medical practitioner on top of family commitments. Years passed. She did very well and from what I witnessed from afar, she has come to a stage that she is renowned as a local celebrity. The one with alhamdulilah, positive influence.

The challenges of becoming this public figure however comes with a price. Everything about her life and actions were scrutinized by netizens. I was so saddened to see how some of these people, who were not even there, were passing judgments on how she, a doctor, should manage her father’s condition. They screenshot her pictures and videos with her father and made it an ‘illustration’ to their own blog/ face book post about a topic that they want to talk about.

Netizen Comments

There was a comment on Habbatus Sauda (black seed), an alternative superfood that boasts a multitude of benefits. They were saying that because she is a doctor, this form of therapy was probably not put forth to her father causing him to succumb to his premature death. Then there were so called opinions that to put the father on a ventilator in ICU was a terrible idea because he looked fine! And that it was the ventilator that sped up his death. All these were said at the time when NS and her family was grieving. Some may say, just ignore it. However, in Malaysia, this is a big deal as social media is a heavily ingrained neo-culture in our everyday lives. I think we are like the top 5 users of social media in the world? Having someone posting on social media bad things about you is like having that person standing right next to you during the funeral. You could literally trigger someone to respond with just a few words on social media.

I have nothing against Habbatus Sauda. It has its benefits but like any form of food, it does have it’s limitations and you don’t treat something that needs a quick fix by consuming Habbatus Sauda while hoping that everything will be alright in a few minutes. We have to be realistic. What I am really bugged about is how people perceive the use of ICU care.

Who gets to go to Intensive Care Unit

ICU care is not for patients who, from the anaesthetists assessments are candidates heading towards imminent death. That is palliative care.

ICU is for those who are very ill but having the chance to pull it through and survive. We do have patients who are not ventilated in ICU because we anticipate a problem that could happen if the patient is managed in a normal ward and not monitored by the hour. For example, a patient with a long bone fracture. He may be alert and sitting up but he is at risk of a fat embolism from his injury. If his vitals are not monitored regularly, the early symptoms may be missed. Being on a ventilator per se is not an automatic ticket for a place in ICU. A patient could be ventilated in the wards for the comfort of the patient, to help the patient breath but they are not indicated for ICU care. The decision to intubate a patient is never an easy task. This is because it comes with its own risk and complication. But once a decision is made, they are always in the patients best of interest. Tak adalah orang suka2 nak masuk tube dan menyusahkan pesakit . Intubation requires preparation and a lot of planning regarding the patients care , the moment the team makes the step. It looks macam senang to the public when in fact, it is because the team are experienced and have been doing it for a long time.

How is ICU different from managements in the ward?

An ideal ICU set up is when you have 1 nurse caring for 1 patient. We are stretching these skilled nurses to a point of having 1 nurse caring for probably 3 patients. This nurse will be responsible to check on the patient from head to toe. From simple hygiene to matters as heavy as flow of inotropes and fluid. Every single input and output of the patient is measured. Apart from carrying out the doctor’s order, they are the eyes and ears that identify the turning point of the patient of whether they are getting better or worse. Every beep from the machines carry a different meaning and if a skilled person has worked in ICU for a long time, even the slight change in the beep tone was enough to warrant a concern from the nursing side. The problem will be highlighted to the intensivists for review and managed accordingly.

When I was a medical officer in the surgical department, one of the surgeons was very keen to learn the trick of the trade in managing pancreatitis. He wanted to lessen the burden on ICU by trying to manage his these patients in the general ward. He wanted to know what is ICU doing differently there so that he could emulate and bring on the practice in his ward. I never knew what was the final answer but I guess the strength of ICU lies in paying attention to the most meticulous detail in patient management. The drips per hour, the difference in pulse pressure, body temperature etc.

Photo by Tima Miroshnichenko on Pexels.com

NS’s father was a suitable candidate for ICU. I cannot see it as otherwise. He had a chance to survive but the impact of Covid-19 was greater. I could only pray that NS and her family forgive those who perceived his care pathway as detrimental to his condition. That they could grieve in peace and move forward as a family.