Week 13 : A walk to the workplace.

 

Let's talk about mundane walking to work that I did for the past these few days.No thanks to the motorcycle that didn't want to start. Walking out from the house, one could see foliage, left and right.

 Turning left at the end of the road, it's another 50 metres walk. Another 2 turns and 100 metres walk, I reached a pedestrian lane.

Nice tree, wasn't it?

 I walked onto another pedestratian lane. A long, 300 metres lane adjacent to the airstrip.

The Marudi Airport was right at the end of the pedestrian lane.

Crossing across the road at the airport, I would reach the hospital's carpark.

A 15-min walk to the hospital.

Week 12 : Gram staining

Day 1 : Receiving specimens at the bacteriology Section.

Samples include sputum, throat swab, blood culture, high vaginal swab, pus swab, stool, rectal swab, urine, ear swab, cord swab, urethral swab, eye swab and wound swab.

Upon entering patients' details into the record book, blood agar and macConkey agar were prepared.

Streaking on both agar was made.

Day 2. Plate checking. A single colony was taken for Gram staining.

Thin layer of cells from the single colony was made onto the slide and put on the staining station.

First, crystal violet solution was applied and stained for a minute.

Solution was discarded and rinsed thoroughly under running water.















Same procedure was repeated with Lugol's iodine, acetone and safranin O dye. Slides were dried with paper tower and checked under the microscope.

Numerous organism

Should a good single colony was taken, only one organism will be seen under the microscope.

Week 12 - Learning bacteriology continues

Attachment students inoculating bacteria into triple sugar iron agar

I am learning more than 20 organisms commonly found in the medical lab. Gram staining. Biochemical tests. Sensitivity and Resistance.

I am presenting CME today entitled " Reasons for Rejection of Samples in Hospital Marudi".

Early morning view of the landstrip

The borrowed motrocycle is breaking down again. And again. The battery was changed hardly 2 weeks ago. I had to walk back to my rented place again last night. I tried to start again this morning but it just hardly barged.

Week 11 : Monday

I really could not recall the last time I read anything on Microbiology or rather Bacteriology. Probably 15 years ago. Now, I had to checked all the microorganism again. Starting with Staphylococcus aureus. I didn't take a very nice Gram positive-stained picture last week.

I asked the attachment students to write up all the Gram positive and Gram negative organisms. And to draw their morphologies, They didn't do their homeworks. I gave them another day to make the chart.

Another meeting from the administrative staff tomorrow.

Week 10 - Wednesday

 

Blood procurement is a very tough job to do. Apart from many guidelines and procedures to understand, searching for a blood donor is very difficult. My staff told me before "It's far much easier to ask a person to give me a ten ringgit bill rather than a pint of blood."

I managed to liase with the police headquarter in Marudi to have a blood donation drive in their working community. After the day ended, we managed to collect 15 pints of blood, mainly blood group O+. It was a great sense of relief. We were so short of O+ blood group currently. Much paperwork needed to be done to make this drive a reality.

We currently only did a forward blood grouping. I am pursuing a reverse blood grouping too. As well as screening cells for GSH.My senior staff Rosidi assisted me much in explaining in detail the steps and reagents required for the bench work.

Big shots are coming to the Hospital again and we're told to dress up and act professionally.

Biochemistry results are in excellent region except magnesium with is much lower than expected.

I learnt Reticulocyte Count and spent much time researching on the issue. I even managed to give a hands-on workshop to my nine staff as to standardize the way of cell counting as the variations among the JTMP are too far apart.

I am still learning the art of interpreting the PBF. Anisocytosis. Anisopoikilocytosis. Nothing made sense to me at first but I am grasping the cells structure. Target cell. Cigar shaped cell. Lacrymocyte.

Week 8: Thursday

Latest Biorad EQAS and day to day internal QC results are indicating we are on the right path for the FBC automated tests. Earlier, RBC and HCT readings were most probably 20% lower than supposedly result. Adjusting the parameters readings were the right thing to do.

I checked on the brand used to test urine glucose and urine protein in the in patients wards. Discrepancies were found. Negative result obtained in the lab was reported as positive in the word. A positive glucose sample was reported as negative in most wards. All results shall be forwarded to hospital's POCT committee for further action.

Sape performance

Last night, I went to Malam Kebudayaan 1Malaysia in the Stadium. It was an enjoyable night. The smooth sweet sound of sape and the Orang Ulu's dances. It had been awhile since I had the feel good feeling. But the performaces started late. And I went home earlier for a good rest after some five performances.

Week 8 - Wednesday

I put up a Blood Stocks Indicator on the notice board outside the laboratory. We only have 11 screened blood products in the blood bank. With Group O at the very critical level. Last week, we went down to Miri Hospital to get blood supply as we are very short of supply. Today, our senior MLT, a regular blood donor, gave a pint of his blood. His a Group O. Managing a blood bank is no easy task. A lot knowledge needs to be applied. I am still trying to disseminate the newly acquired knowledge to the lab staff.

A senior MLT will be sent to the TB reference lab early September. Another junior lab technician went off today for her Malaria course in Kuching. A lot more new information to be digested when they come back to share their knowledge.

I ran a within run imprecision on the haematology analyser using a Biorad controls. CVs were acceptable and I keyed in the mean and SD for the WBC, RBC, HG, HCT and PLT for the three levels.

I made a drastic move today. I stopped running tests asked by the MA. It's high time to stop the practice. FLP, BUSE, Creat, UA, LFT and many other tests cannot simply be ordered by the MA. I only run and validated CHOL, GLUCOSE and at certain circumstances, BUSE results. I had complain from a MA specialising in managing DM patients. After asking opinions from senior doctor, he is allowed to order BUSE, Creat for diabetic patients.

CHOL, TG, AMYLASE reagents needed to be ordered. HDL calibrator too. Some paper works required by the state suthorities were dealt with swiftly and all needed information was passed to relevant persons.

Baram Regatta is round the corner. It's a 3 yearly affair and it brings life to this very sleepy riverine town.

I rode through the Marudi town last night and took a picture of the town's mascot depicting several natives paddling on a long sampan. I spent my after dinner time at the wharf with the town folks, looking at the paddlers hard at work.

The town is filled with outsiders, selling mostly finger food, clothes and souvenirs. Tents are set up in every corner of Marudi.

I spent a good RM2.50 for a corn cooked on a BBQ set and a RM1 of buntut ayam. Fingers crossed that I still well to go to work tomorrow.

Say a little prayer for you

Good Shepherd's Church : Front view

During the first week, my father and I went for Mass every morning. We also attended Mass on Wednesday's night. These days, I woke up late. I didn't attend Mass as frequent as I used to. But I managed to prepare myself early today.

Church's side view

Father Basil is the attending priest in Good Shepherd's Church. His sermon is short but very meaningful. And the words of God remind me of being humble. And I always realize that everything belongs to God after every difficult and happy days of life.

Left building: Catechist's office                         Right building: Father's house

I am always amazed at His decisions at many phases of my life. Of being able to work in Singapore, of getting married, of being a Daddy, of being a stay at home Dad, of being able to find accomodation in Kuching and Kubang Kerian, of working in Sibu, of working in Marudi, of having many helpful neighbours and collegues..

Week 8

Week 7 was a short working week for me as I flew to Kuching for the Transfusion Medicine Conference in Kota Samarahan.

I had managed to get all the JTMP to run a haematology external QC sample to make sure all of them did the correct way of sample mixing before running the haematology tests. All except one managed to get the platelet count correct. Levey-Jenning charts of the everyday run's QC were thoroughly explained. After checking internal QC and external QC, RBC and hematocrit results were at least 15% lower than the supposedly value. With the help of the biomedical technician, I pulled up the value of RBC and hematocrit of the Nihon Kohden analyser.

I'm happy with my learning pace of the erythrocyte sedimentation rate test and PT/PTT tests. However, technologists' manual way of testing PT and PTT tests are worrisome. I managed to negotiate for a semi automated machine to improve our PT/PTT results.

Blood banking practices in the hospital need to be improved after learning the updates of transfusion procedures and practices. I had requested to have a hands-on workshop to be done next month which will involve all the nurses and PPK of the hospital.

I had started validating the samples' results as I was gettting more confident with the external QC results.

Life in Marudi is getting mundane. I was getting more and more negative feedbacks from many improvement suggestions that I brought forward.

Tapah fish

Food in Marudi is not cheap either. A normal mixed rice costs RM5 and the menu remains more or less the same everyday. I tried to be adventurous by ordering the good riverine fish only to be disappointed by its taste. And its price!

Week 1 and Week 2 of works

Week 1

Monday : I reported duty on 30 June 2014 in Hospital Marudi. A big thank you to Bibi who made my transition into Hospital Marudi a very smooth one. I met Rosidi the MLT in charge of the lab.  I was briefed with the pathological services in the district hospital. I went through the EQAS reports of the biochemistry and haematology sections. I was briefed on the external QC for blood banking section. Everything seemed to be in order. There were some weaknesses on some components which I would look through. At 3.30 pm, Rosidi arranged a meeting with every MLTs. Everyone was dedicated with their works. Some asked questions which only showed that they are enthusiastic about their careers.

Tuesday: After going through the QC procedures, I managed to find the problems faced by the haematology staff. I rectified it and I looked forward towards the next EQAS report. I stayed with the biochemistry section MLT to get more insight of her works. I initiated a research project which we would be looking at the rate of hemolysis in Hospital Marudi and searched for oppurtunities for quality improvement.

Wednesday : I initiated method validation experiments for biochemistry tests. Linearity, Recovery and Imprecision. Need to look for patients' serum which had high and low levels of medically importance. Two research projects were initiated with Blood banking and Bacteriology MLTs

Thursday: Bengkel "Method Validation and QC interpretation" structure and committee members finalised. Rosidi, Mahdi and I would be the speakers. A research project on Thalassemia was initiated with Rosidi while another Malaria retrospective study with Nancy. Method validation experiments with total and direct bilirubin on going. Imprecision for all biochemistry analytes ongoing.

Friday : I sent down samples for HepB and HepC screening as well as well as T4 and TSH to Hospital Miri and had discussions with Mat Akon and Dr. Adzly.


Week 2

Monday : Started writing abstract for the hemolysis project. Checking on the method validation experiments. Checking the QC on the analysers. Observing the streaking on the agar. Checking on the AFB tests. Talked to Dr. Tung. He requested D-Dimer test and Hep A test. We promptly asked for quotations and proceeded with the purchase of kits.

Tuesday : Finished with the retrospective study of laboratory diagnosis and prevalence of ocular infections in Hospital Marudi, a district hospital in Sarawak.

Wednesday  : Met Mr Lim the AA of Hospital Marudi. Met Cikgu John Liew, a donor and asked for possibility of creating awareness among Form Six students and teachers in SMK Marudi to donate blood. Numbers of donors are declining now. Took self pictures for name tag. Ordered biochemistry reagents from MUSB. I would like to try out the third party reagents to reduce the monetary burden as many of the reagents are branded ones.

Thursday : I talked to staff nurses in paediatrics ward regarding the purchase of tubes for paediatrics use. We agreed to buy the EDTA tube for paediatrics (which cost us RM895 per item) for this year. Doing the statistics for the linearity of Total bilirubin, Direct bilirubin, urea and alkaline phosphatase tests.Confirming with the SMK Marudi that I would be giving talk "Donate Blood Saves 3 Lives" next Wednesday. Attending CME in the afternoon.


 Every morning, I went to the wharf to watch the fishermen coming in to sell their catch. It's a new experience to me to see the fish jumping around. Talked about freshness!

Left: Fishermen unloading their catch Right: Biawang selling for RM8 per kg

Journey to Marudi by car

After confirming my penempatan with Puan Amelna at 4.45pm on Friday, we departed from Sibu to Miri on Sunday. My father and my Jacob came along with me. I stuffed all Jacob's toys and belongings into the car the night before; as much as I could.

Weather was fine. Cloudy and cool. We took slightly more than six hours to reach Miri after stopping for breakfast at the Hospital Bintulu's canteen. Thank God for our safe journey. Jacob was behaving himself and sat on the baby seat while munching titbits.

We spent the afternoon at my Grandma's place. I bathed Jacob before going off for sumptuous dinner in town. We reached Lutong by 10 pm. Wife and Darrien would be coming to Miri in a few days' more. She hadn't seen Jacob for a good 4 weeks.

As I retired for the night, my heart was full of anxiety on how bad the road to Marudi. Some said the road was tarred while others said the road was thinly tarred and not so safe to drive using saloon car. I searched through the Internet and the road seemed fine to drive on.

At 7.30am the next day, my father and I were driving towards Lambir. We stopped by the roadside to ask for direction from a kind Water Board staff. Signage was bad. There wasn't a proper signage showing the direction towards Marudi.

I was surprised that the road towards Marudi was actually good.

Tarred road towards Marudi

I was blown away with the outside view.

Great potential for eco tourism

After driving for a good 1.5 hours, we reached a ferry point. Interestingly, the ferry was actually being pulled across the river using chain.

The engine used to pull the chain

Closed up look at the engine

RM15-ride across the first river

We drove on a road filled with tiny potholes. I was driving at the rate of 30km per hour. Soon, we reached another ferry point. A much wider river compared to the earlier one. We were charged another RM15 per car for the ferry ride.

Second ferry

It would be a short ride to Marudi town after the second ferry ride.

We were still in one piece after a good two hours' ride. A good day to start my new life in Marudi.

Hello Hospital Marudi