A Vaccine EduTalk

It took me 1 night to get my slides together and another 1 night to polish my speech throughout the slide show. I was preparing for a 1 hour talk although it really came down to only 30 minutes on that day. The outline of my talk included an overview of the PICK policy which is Malaysia’s mass vaccination programme, the nature of the COVID-19 disease and a touch on the vaccine. Highlighting more of Pfizer-BioNTech’s vaccine since that is the one we are getting for Phase 1.

I will be part of the Vaccinator Team for Phase 1. Which means I will be among the first few who will be vaccinated TODAY. It will be an opportunity for the team to go through the system, walk with the flow and see where our potential pitfalls are. As a patient myself, I think it matters where we sit and how long we wait. It is those little logistics that will contribute to the success or failure of the activity carried out. Of course, having a fantastic leadership is important too. I will update on how it goes in my other blog post later.

On a less informal initiative, I recorded a video of myself in a non moving car talking about the same thing. Only, it is presented in the Sarawakian Malay dialect. Hoping to educate my relatives, family and friends who is more well versed in the language. Not really the general public of Sarawak. Ha ha.

The vaccine is not compulsary.

As we are also aware that there no data on the safety of it onto certain populations especially the pregnant and lactating mothers and children. Those with severe allergies are also not advisable to get the vaccine.

The aim is to get at least 70% population coverage by next year for the herd immunity to work.

My take on this is as a social responsibility to protect those who cannot protect themselves and those who do not have loved ones to do it for them.

Malaysia starts COVID vaccines in crucial week for Asian jabs - Nikkei Asia
Prime Minister of Malaysia taking his vaccine shot. I admire the stability of this senior nurses hand – I wouldn’t be able to do the same.. her technique is clinical ART!!

Liar liar

This needs to be documented. Of patients who lie.

As healthcare workers that becomes the first point of contact for patients, it is of paramount importance that we should be informed of risky health points. Nowadays, Covid-19 is one of them. Every time a patient walks into our primary care facility, it has become a norm to ask if they have been in contact with those who are Covid-19 patients or suspected of Covid-19. It is a simple yes or no so that we could decide whether we need to attend the patient wearing the full astronaut PPE or the basic PPE. It’s a cost and personal health issue.

When a patient fails to declare this, it will put me, my family and other patients that I see, at a risk of getting Covid-19. You need only one HCW at a facility to get it before the whole centre shuts down. So honestly, I don’t want that to happen. While I may remain healthy and asymptomatic, others may not be that lucky.

Last week I was in charge of Fever Counter. This means we see all patients who present with fever, upper respiratory tract infections, those who come for other ailments but with the said symptoms, those who come from high risk areas with/without symptoms and whoever that fits the bill. I was dismayed by two separate encounters. But I will share only one story today. And of how thankful I am for gut instincts especially with this 1st family.

Photo by Anna Shvets on Pexels.com

She was a lady in her 50s who had underlying non communicable diseases. Unfortunately, she defaulted her appointments at our facility and bought the meds at her nearby pharmacy. She presented with undocumented temperature and URTI symptoms and mentioned a short trip to pick up her son from a high risk area because PKP was due soon. Her son, according to her, was well with no symptoms. I asked the lady to come back in 2 days time to repeat another set of bloods because her counts were a bit low and I was more suspicious of dengue.

The next time she came, she brought over this son. To be honest, we wouldn’t have known this if I hadn’t ask her back ‘how old was her son and why did she had to fetch him?”. That’s when she pointed to the young lad beside her and said,” this is my son “. Suddenly bells just started buzzing in my head. There was a knot in my stomach that signaled me something is wrong somewhere.

I reconfirmed with the son, a young man in his 20s, of where he stayed in this ‘high risk area’ and his answer was totally different from what the mother told me a few days back. He had already declared earlier with the nurse that he had no contact with any Covid-19 cases but I asked him again ” Is there anything else you need to tell me, that I need to know?”. He said NO. That restless, suspicious feeling lingered. So, I directed him to the Covid-19 tent to wait for his turn and had his mother did the same too. I referred the case to my MALE COLLEAGUE who is in charge of any case who may need a swab test. I had to BOLD the male part because in this part of the city, patients still think that male docs are better than females, chinese docs are the smartest of all, docs serving the suburbs or rural areas graduated from the jungles and other prejudiced thoughts.

Guess what, the young man revealed that he went back to his hometown here because his housemates there all have Covid-19. When my colleague asked, why didn’t he said this earlier, he said “no one specifically asked me about it”

Well. That is just BULL *&%^*!! Did he expect a question like “what kind of house do you live in? do you share it with other people? is the housemate in Room 1 well? how about room2? room 3? ”

He and his mother ended up having a sample taken and well.. as you’d guess, they were both tested positive for Covid-19. I am concerned for the mother because she is at risk of deteriorating whilst the selfish son may survived this episode due to his young body.

I was disappointed with the young man’s attitude towards this pandemic. Undeniably, some patients do fare better than others but shouldn’t that trigger you to protect those at risk from harm?

Vaccine Survey among healthcare workers

We are currently riding the god-knows-how-many-wave of the Covid-19 virus. It seemed only yesterday we gave ourselves a pat on the back for winning the fight. However, as soon as we let our guard down – the virus strikes again. There are rumours of implementing the MCO again but at the expense of the economy which is a pain because we have just kick started the wheel.

Vaccine has been THE NEWS in the country lately. Malaysia with its slightly smaller budget will be securing the purchase of vaccines from various suppliers. The top two being Pfizer and Astra Zeneca. Healthcare workers will be among those to be vaccinated first. Hence, a survey was done in my clinic to see how many would want to be vaccinated with no WHY’s if they choose not to. It was a short questionnaire – basically one that just asks for your personal details. An interesting thing I find about the survey is of how we need to enter our postcodes. According to a friend, the data would be useful to see how much coverage the vaccine will have in the community within a given time. An epidemiologist would explain this better I guess.

It is understandably a decision that requires a huge leap of faith. The vaccine is new. Anything new freaks people out despite the amount of scrutiny it undergoes. What more with testimonials and conspiracy theories cropping up in mass media. I too have my concerns as to whether it will interact with my TB meds. However, I have faith that the MOH council which did a good job in not bringing in the dengue vaccine into the country will have also analyzed enough evidence to support their decision to purchase the Covid-19 vaccines.

I am sure we will get more information soon as the vaccines will start rolling out to HCW and the public by March 2021. Until then, life must go on within SOP.

Minci, the results came back positive

Apart from a positive UPT, the last thing you want to hear as a patient is that you are positive of something. (for the record, I am not pregnant). Especially now in this pandemic when it is dreadful to be positive of Covid-19. This is because the pathway upon diagnosis here in Malaysia is such that you would be whisked to the hospital and isolated for at least 10-14 days with monitoring in between. It is ugly if you have small children that are dependent on you and that you will have to be separated from them for a while. So yeah, now is not a good time to get Covid-19 eventhough you feel fine.

Anyway, I did the Covid-antibody test a few weeks ago. It was negative. So this entry is not about Covid-19.

The only positive investigation that is pinning on me now is my IGRA test. At the end of last month, a colleague was tested positive for pulmonary tuberculosis (PTB). It was initially just a screening test everyone had to do upon reporting themselves to a new workplace and this colleague coincidentally had symptoms as well. Once the colleague learned of the diagnosis, naturally, all close contacts at the workplace have to be tested including me since we share the same small room for prayers, eating and gossiping during lunch hours.

All the girls did the Mantoux test and chest Xray. Out of 8 girls who did this test, 2 of us had a positive Mantoux test (one of them is me of course) but we are asymptomatic of TB meaning we have no cough whatsoever. In fact, both of us have a really good appetite and a big waistline to begin with. We don’t look like the typical patient with active TB. Or maybe we are atypical? lols.. we could be.

Anyway, all 8 of us were asked to proceed with IGRA – an Interferon Gamma Release Assay blood test. I think both of us were kind of prepared to accept that the results might be positive. Indeed it was.

So, what is next?

Despite being asymptomatic, we still need to make sure that we have no active TB going on. That means reviewing the Chest Xray again with an extra pair of eyes to look for cavitation and taking a sputum AFB sample (if we have sputum to give- which we don’t). Once that has been excluded, then I would need to make a decision on whether I would agree to start on treatment for latent TB.

Latent TB is not infectious.

It means that at one point in life I was exposed to the bacteria which did not have enough capacity (gosh) to launch a full attack on my body to exhibit the TB disease. It’s like I caught the bug and it decided to go to sleep somewhere in my body. Waiting for the time to wake up and become powerful and active. So it will be up to me to try and kill it now before it decides to become evil and create havoc in my body. Anyway, I will only decide once my colleague in charge of TB review my Xray again later. We really need to make sure of this because the type of medicine and length of treatment regime differs.

This TB ball will start rolling next week into the new year. I guess this is the first chapter of my interesting 2021. I guess my WORD for 2021 has a big purpose this year. My word is RESILIENCE. My word for 2020 is THRIVE. Maybe that’s why the bacteria is thriving. lols.

I will give this chapter in my blog a hashtag. It will be #MinciBerTB

Lady M , from riches to rags

I had a lady, M and her one month baby coming in for the routine immunization jab. Long story short, her marriage is on the rocks and is heading for a divorce. Unfortunately it is not going anywhere because she doesn’t have the financial resources to proceed. Worser still, her support system is not that sturdy either. I can imagine that it has a lot to do with her choice of husband in the first place because it was after all, an intercountry, interracial and inter-religion union. It was not a smooth sailing journey to begin with and once it hits the rocks, she is pretty much on her own.

Having lived her previous life with a silver spoon in her mouth- I was able to witness how when adversity strikes, the high end members of the society also have a difficult time to adapt. It is evident when we see the ever gorgeous Ezuryn trying to teach her children the life of a humbled person, it is not easy, as it is not their world. Similar to Lady M. She is slowly being stripped off her Versace without her realizing it. I felt sorry for her because she has yet to grasp the concept of humility and come to terms that life will not be the same anymore. She has separated from her husband, not yet divorced but taking care of the kids with no allowance from her husband. She also doesn’t have a stable job and is living on the ‘savings’ that she have from her previous business venture. I had thought she should try reconnecting with her family despite what happened but only she’d know the extent of her family’s circumstances.

Lady M was a proud woman. I could sense that she actually needs help but refuse to ask for it. She is an independent woman and wants to make it on her own. I respect that although I think she can do better with a little lift. So, I did two things;

  • I asked if she would be interested to be in touch with our visiting social worker from JKM, the welfare department. They come once a month to the clinic to review cases that may require intervention on social issues that becomes a hindrance in tackling their health issues. She was initially hesitant but I convinced her that this could be a starting point to help her tackle her mess. After all, she had no inflowing income with two children to feed. It was the best I can do. She agreed to that.
  • Secondly, I sent some diapers and milk for her baby via a runner from Bungkusit. The brands for both items were on the pricey side but she claims it was the only thing that her baby could tolerate. I personally feel that there is room to explore on this part but due to time constraint during our consultation, I left it for other future sessions. I think she has already gone through enough during pregnancy and a month after postpartum is a crucial moment where we identify moms with postnatal depression. It’s a bit unwise to judge the choice of her diaper and milk brand during this stressful moments.

It is heartbreaking that some mothers have to endure these hard times after delivering a baby. It is not easy either to shift a lifestyle of vast riches to rags. I really hope that she will find in her heart the reason to reconnect with her loved ones so that her children will not suffer and live in resentment towards those living around them.