Wednesday, September 12, 2012

Memahami Penjagaan Bayi

Saya terfikir untuk memulakan kolum ini untuk menjawab banyak persoalan yang sering diajukan . Tambah tambah lagi bila anak saudara dah mula dapat baby.

Baru lah saya rasa pengalaman kami membesarkan 6 anak menjadi pengalaman berguna untuk bantu orang lain

Soalan soalan lazim

1) Baby baru lahir tapi tak pandai hisap susu ibu. Cukup mengecewakan siibu. Macamana nak dibuat?

Jawapannya :

     Setiap bayi yang normal diberikan satu tindakbalas otomatik untuk menghisap susu. Cara mengujinya senang sahaja. Usapkan jari kepipi bayi. Secara otomatik dian akan palingkan mukanya kearah jari yang mengusap pipinya. Inilah tindakbalas otomatik.

    Bayi yang lapar tentu akan minum susu, kecuali kalau dia sakit. Selalunya dia akan rasa lapar setiap 2 atau 3 jam

Jadi, kalau dia menangis tak sampai pun 2 jam lepas menyusu, tangisan tu mungkin bukan sebab lapar. Kalau diberikan susu pun dia tak akan hisap. Kalau dihisap pun , mungkin kerana terpaksa.

Saya pernah lihat seorang bayi kecil yang diberi susu setiap kali dia menangis secara terpaksa. Dia minum juga, hingga perut jadi buncit dan muntah. Doktor namakan ini sebagai overfeeding.

Jadi kalau menangis, periksa lampinnya. Pastikan tak kotor. Pastikan tangisan bukan kerana panas. Kalau siibu rasakan tangisan itu betul betul tangisan lapar, maka usapkan pipinya dengan puting susu ( sewajarnya susu ibu). Maka dia akan mula hisap.

Pastikan mulutnya berada disekitar kawasan puting susu untuk pastikan tenaga hisapannya itu seolah seolah dia memerah susu ibu. Ini tidak akan berlaku kalau puting susu berada betul betul dalam mulutnya. Ini bukan proses memerah. Ibu akan rasa sakit

Bila sakit, air susu akan jadi kurang. Bayi jadi lapar dan akan terus menangis

Bersambung.........

Bahagian 2

1) Saya tak cukup susu. Bila patut mulakan susu formula

Jawapan: Pernah tak kita tengok mamalia lain, seperti kucing yang comel. Siibu sering lahirkan anak, lebih dari satu. Pun begitu, susunya selalunya cukup untuk semua anak yang comel.Mungkin agak kasar membuat perumpamaan begini.

Susu  ibu akan cukup dalam keadaan begini :

 a) Keadaan emosinya mantap. Gembira dengan penjagaan bayi serta jauh dari sebarang kegusaran.

 b) Bayinya cukup mahir menghisap susunya. Lagi banyak susu yang dihisap sepenuhnya, lagi banyak susu yang akan dibuat dalam payu dara

 c) Pengalaman penyusuan menyeronokkan., bukan menyakitkan. Kesakitan akan menghantar deria negatif ke bahagian otak dan saraf. Langsung, pembuatan susu dalam payu dara di perlahankan sebagai mematuhi arahan dari otak dan saraf.,Ini adalah  satu tindakan naluri untuk meredakan kesakitan siibu

 d) Siibu mempunyai bekalan air yang cukup.Air susu yang diminum bayi ,  puncanya dari bekalan air siibu. Ibu yang kurang minum air, atau dalam keadaan yang panas, sentiasa berpeluh, tentu nya perlukan lebih air untuk proses pembikinan susu

Susu formula pun bagus, dalam keadaan terpaksa Namun sudah kerapkali terbukti, penyusuan susu ibu bakal jadikan anak lebih bijak IQ nya. Cuba sedaya mungkin. Berbaloi.

Bersambung...

    

Thursday, November 10, 2011

HOSPITAL MESRA IBADAH - MENJADIKAN ESOK LEBIH BAIK DARI HARI INI

Saya diminta memberikan beberapa pandangan tentang konsep Hospital Mesra Ibadah (HMI) didalam satu Konvensyen Hospital Mesra Ibadah baru baru ini http://www.konvensyenhmi.kk.usm.my/program.php

Terus terang saya kata kan , saya agak asing dengan konsep ini, tetapi menyedari tentangnya bila ia diwar warkan diUSM beberapa tahun yang lalu. Sebagai pengamal perubatan diHospital USM, saya arif tentang usaha untuk merealisasikan konsep ini. Saya pernah tengok bungkusan-bungkusan mengandungi debu yang di tawarkan kepada pesakit untuk mudahkan mereka bertayammum. Saya sedar tentang bengkel bengkel untuk doktor atau jururawat tentang cara mudahkan ibadat bagi pesakit, atau tentang urusan kafankan mayat, ISO Mortuari dan banyak lagi. Banyak yang bagus dan menarik.

Tapi saya ada sedikit masalah dengan pemahaman ini .

Apa yang saya sebutkan dalam konvensyen diatas ialah beberapa pemerhatian yang disenaraikan dibawah:

1) Ada 2 dimensi kumpulan sasar yang perlu kita perhatikan dalam sesebuah institusi seperti hospital - pesakit dan perawat ( doktor, jururawat, attenden kesihatan, pekerja kontrak kebersihan dll ). Kemudahan untuk beribadah harus diberikan kepada kedua dua kumpulan sasar ini.

2) Ibadah itu amat luas maknanya, bukan hanya menjurus kepada ritual .Ibadah perawat ialah melalui sumbangan mereka dalam pekerjaan harian. Ia juga harus dimudah dan dimesrakan supaya tempoh mereka dihospital bukan sahaja dianggap sebagai tempoh cari makan, tetapi , lebih penting ialah; tempoh ini adalah ibadat mereka yang akan direkodkan dalam buku amalan.

3) Kemudahan untuk pesakit melakukan ritual ibadat tanpa gangguan dari penyakit amatlah perlu, tetapi pesakit yang terganggu emosinya semasa dalam rawatan dihospital tentunya tidak bersemangat untuk melakukan ritual tersebut , walau semudah mana pun ianya diharuskan; atau sebanyak mana bekalan 'debuan' yang kita bekalkan dalam wad hospital!

4) Pada saya prioriti nombor satu ialah untuk pastikan sesebuah hospital itu menjadikan perkhidmatan untuk pulihkan pesakit serta kemesraan untuk ahli keluarga pesakit satu agenda agong yang tiada kompromi.

5) Gangguan emosi kepada pesakit melalui kehadiran penuntut yang terlalu ramai, ruang klinik yang terlalu sempit, staf yang garang ; memaksa waris berjalan berliku liku hanya untuk melawat yang tersayang, atau kos rawatan yang tinggi yang dituntut berulang-ulang - tentunya bukan formula terbaik untuk memesrakan keadaan

6) Terganggu juga emosi sekiranya, sakitnya mereka itu terpaksa dipendam pendam; hanya kerana juru yang merawat mereka agak sukar untuk datang . Terlalu sibuk dengan KPI yang bermacam macam

7) Noktahnya mudah. Kita harus mesrakan suasana dan keadaan. Maka persoalan ibadah akan mesra dengan sendiri. Debu debuan akan dicari, perihal solat akan diteliti, hukum hakam tentu diperhati, soal iman tidak lagi diragui. Maka cabaran ini adalah khusus untuk kita yang mengetuai institusi; yang mempunyai kuasa dan kerusi tetapi harus diperkuatkan dengan integriti, kreativiti dan keterbukaan hati.

8) Bukan kah kita telah diperingatkan " Kemiskinan itu amat bahaya bagi keimanan". Keperitan dan sengsara bahana kemiskinan ( dalam berbagai bentuk, tentunya )membawa risiko kepada amalan yang penting kepada kejituan iman.

9) Soal kemudahan dan kemesraan suasana institusi sering dibelenggu oleh kekangan wang. Tapi bagi saya, kekurangan wang tidak semalang ketandusan idea dan kreativiti. Gembeling idea dan kreativiti untuk tujuan penjanaan wang; bukan semata mata bergantung kepada subsidi atau bajet kerajaan

ZH
11/11/11

Sunday, July 31, 2011

Mendidik Anak Secara Menyeronokkan- Zabidi Hussin.(Repeat Posting)

Mendidik Anak Secara Menyeronokkan

Saya kerap diminta berkongsi pengalaman , mendidik 6 anak melalui perspektif seorang doktor kanak-kanak yang faham tentang cara seorang anak berfikir dan bertindak. Pada saya mendidik seorang anak dengan memahami keadaan psikologi mereka amat menyeronokkan.

Keberkesanan sesuatu aspek pendidikan adalah hasil dari 'kemenangan' perang psikologi antara kita dan anak yang mahu kita didik.2) Ada beberapa perkara pokok yang harus diambil kira dalam pendidikan kanak-kanak. Diantaranya ialah

Faham akan kesediaan seorang anak itu menerima sesuatu mesej pendidikan dalam satu-satu masa tertentu. Anak yang letih, lapar atau mengantuk mustahil dapat menggarap sesuatu arahan bahan pendidikan. Langsung dia akan 'mendengarnya' tapi tidak 'mengikutnya'

Faham tahap perkembangan anak pada satu-satu tahap umur. Selalunya anak yang kecil, berumur 5 atau 6 tahun tidak faham istilah-istilah 'kabur' seperti 'jahat', 'buruk', 'baik', 'esok', 'lusa' dan sebagainya.

Cuba tunjukkan jari kita bila kita katakan kepada mereka yang satu-satu perkara akan terjadi 'lusa'. Agak mudah mereka memahami 'lusa' dengan cara begini dan ini akan mengelakkan dari mereka bertanya soalan yang sama bertalu-talu.

Kanak-kanak umpama alat perakam yang berkuasa tinggi. Segala bentuk percakapan, gaya bahasa, gaya berjalan orang disekelilingnya akan dirakam dan dijadikan ikutan amalan mereka. Oleh itu, adalah agak pelik bagi mereka sekiranya dipukul dan dimarahi oleh si ibu dengan arahan " jangan pukul adik!".

Dalam fikiran mereka, kalau ibu boleh pukul mereka , kenapa tidak, mereka tidak boleh pukul adik? Tahap fikiran yang simplistik , tapi releven dengan kemampuan kanak-kanak.c) Mudah difahami yang pendidikan kanak-kanak adalah umpama 'perang saraf' atau 'perang psikologi' yang amat menarik. Sekiranya kita kreatif dalam pendekatan psikologi ini ,maka mendidik anak menjadi senang dan menyeronokkan.d) Anak yang tidak mahu makan?

Gunakan pendekatan psikologi dan ubahkan arahan untuk makan dan ambil pendekatan yang boleh menjadikan suasana makan sesuatu yang seronok. Apa kata kalau makanan dalam pinggan itu kita andaikan sebagai 'monster' dan anak yang akan memakannya adalah 'ultraman'? atau gunakan cara lain yg difikirkan sesuai

Anak kecil selalunya gemar bertanding dan berlumba-lumba. Mereka seronok kalau menang.Apa kata kalau mereka dan kita 'berlumba' untuk ketempat mandi?

Saya yakin, arahan 'pergi mandi' yang kerap kali disanggah oleh seorang anak kecil akan bertukar menjadi satu perkara yang lebih positif; mereka mahu menang untuk ketempat mandi. Dan inilah yang kita mahukan.f) Usia 3-5 tahun adalah usia anak yang mahu gunakan 'kebebasan' yang baru mereka perolehi. Umur inilah mereka dah petah bercakap, pandai menyanggah arahan dengan perkataan"tak mahu". Masa inilah juga mereka sudah laju berjalan, malah mampu berlari.

Senang untuk lari dari melakukan sesuatu yang disuruh. Masa inilah juga kita boleh penat dengan kerenah mereka. Penat memberikan arahan yang tidak diendahkan. Penat sehinggakan kita mula gunakan kekerasan, ancaman atau menakut-nakutkan mereka dengan tahyul, atau perkara abstrak yang serupa

Kekerasan, ancaman atau takut menakutkan tidak perlu samasekali sekiranya kita faham kaedah psikologi dan tahu apa yang ada dalam fikiran mereka. Kaedah menakutkan kanak-kanak dengan hantu, 'polis' , 'doktor yang akan cucuk' kerap kita dengar. Ada ibu bapa yang gunakan kaedah ini untuk dapatkan 'menafaat'yang cepat; anak yang takut akan cepat patuhi arahan , sebab takut ' hantu', 'doktor' atau 'polis'

Namun agak janggal sekiranya kita takutkan mereka dengan sesuatu yang tidak perlu ditakuti hanya untuk dapatkan mereka lakukan sesuatu. Apa kata sekiranya mereka tidak lakukan perkara yang disuruh itu dan tiada pula 'hantu', 'polis' atau doktor' yang datang , seperti yang diancam? Tentunya ancaman itu dikira palsu dan pengalaman yang lebih mirip kepada penipuan. Maka 'halal'lah penipuan, sesuatu yang tidak mahu anak melakukanya. Tetapi kita yang lakukan.i) Yang baiknya kita cakap terus terang dan berikan cerita yang benar, kenapa sesuatu itu harus dilakukan.

Contohnya kita mahu anak mandi. Sebabnya, " nak suruh adik jadi bersih" . tapi anak diperingkat umur 3-5 tahun umumnya tak faham konsep 'bersih'. Terlalu abstrak bagi mereka.j) Apa kata kalau kita buat begini: "Cuba adik cium bau abah ni " . Dengan cara bermain-main , kita suruh dia cium bau badan abah sebelum mandi. Lepas itu kita suruh pula cium selepas mandi. Wangi selepas mandi itu akan buatkan satu contoh yang berkesan , bahawa macam ni maknanya 'bersih"

Saya dapati banyak perkara boleh selesai sekiranya kita kurangkan arahan yang abstrak kepada kanak-kanak kecil. Yang abstrak ni kita yang faham,tapi anak kecil mungkin tak faham. Diantara contoh konsep abstrak yang lain ialah : "jadi anak yang soleh" , " lintas jalan baik-baik",'makanlah betul-betul".l) "Soleh", "baik-baik", "Betul-betul" ni cukup luas maknanya. Anak kecil saya pernah 'menyergah' saya " Adik dah jalan baik-baik ni": yang dia maksudkan , dia dah berjalan dengan pakai selipar cara yang betul dan tidak terbalik. Sedangkan yang saya maksudkan, ialah " jangan berlari semasa lintas jalan"!

Saya cukup seronok, bila tanya semula seorang anak kecil: "baik tu apa agaknya" atau " Soleh tu apa ya?"

Dengan cara ini kita boleh semak kefahaman mereka, dan sesuaikan arahan kita dengan apa yang mereka fahamn) Anak kecil cukup cepat faham bila kita tunjuk apa yang kita mahukan dari mereka. Jangan beri arahan secara lisan sahaja . Contohnya kita mahukan mereka keemaskan barang permainan selepas bermain. Yang biasanya kita cakap " kemas barang permainan kamu tu". Kita tinggalkan mereka untuk mengemas.

Kadangnya menjadi, kadangnya tidak. Kadangnya dikemaskan,tapi tidak mengikut apa yang kita takrifkan sebagai kemaso) Cuba kaedah yang lebih menyeronokkan. "Jom kita kemas sama-sama; tengok siapa yang siap dulu" Lazimnya ajakan ini lebih merupakan ajakan untuk bertanding . Anak kecil suka dengan bentuk arahan sebegini. Pada peringkat permulaannya kita tunjukkan kepada mereka cara mengemas .

Lepas itu saya lazimnya melihat mereka akan membuat perkara itu dengan suruhan yang sedikit sahaja. Tak perlu disergah dan dimarah. Cuba cara yang lebih menyeronokkan ini.

Isu seterusnya:

Adakah anak kecil akan menjadi seorang yang materialistik bila kita kerap memberikan hadiah semasa kecil?

Boleh kah kita pukul seorang anak yang buat kesalahan?

Wajar kah kita latih anak untuk pakai pakaian menutup aurat dari kecil lagi?

Bagaimana untuk memastikan anak kecil makan ?

Anak yang sering gigit dan pukul rakan -rakan. Bagaimana cari menyelesaikannya?

Ikuti perbincangan blog ini seterusnya atau emailkan pertanyaan anda kepada

dr.zabidi@gmail.com



Saturday, July 23, 2011

Neurological Basis of Dyslexia- Zabidi-Hussin. A public lecture organized by Monash University and Malaysian Dyslexia Association 17th July 2011

THIS PRESENTATION AND ACCOMPANYING SLIDES MUST NOT PUBLISHED WITHOUT WRITTEN PERMISSION OF THE AUTHOR

The presentation reviews the essential process of childhood development to give better understanding of learning process, and reading abilities

· The human brain is the most complex structure that develops very early immediately after conception

· The brain undergoes rapid changes, increasing the number of cells and their interactions and aided by numerous essential nutrients


· Due to some , as yet unknown process, the brain organizes itself into perfect functional compartments. Each compartment communicates with one another in a very complicated manner and mediated through detailed biochemical process

· Learning is a complex process, but its abilities developed from the first day a baby is born. Multiple stimulus received by the baby from seeing, listening, feeling and sensing the environment that he lives in will all add up to the formation of memory for spoken and written words. Failure of this process will impair reading and other scholastic abilities


· A child’s brain could be best regarded as a very powerful tape recorder and will play back whatever it has recorded during appropriate times. This understanding is critical to understand attitude formation and behaviour development of a child.

· The normal development usually affects 5 main areas namely COGNITIVE (C), OPTIC (O), MOTOR (M), EMOTION AND PSYCHOCIAL (E) and LANGUAGE and HEARING (L). Each one of this can be assessed fairly accurately using appropriate developmental assessment sets such as the KIDDEQUIP DEVELOPMENTAL ASSESSMENT KITS. It is important for parents and health care providers to be able to assess these developmental sequences, as detection of early developmental delays is critical . Early delay may imply some interruption to learning abilities, some of which can be due to serious problems such as childhood blindness which may be that obvious to be seen.


· Continuous sensory input to the developing brain leads to formation of many interactions between the cells in the brain. These inputs ought to be given at the earliest opportunity during the period of childcare

· It is now known that the brains grows , not through having more cells, but through developing multiple cell-to-cell connections, aided by many factors such as nutrition and environmental stimulus
· Although many of the process of cell-to-cell connections are determined by the genes of the child, current researches have shown that environment stimulus and nutrition play critical roles, sometimes overriding genetic determinations. This knowledge should give motivation to families whose children are born with some genetics defect.

· As far as reading abilities are concerned, there are certain areas of the brain which appear to be ‘lit up’ when a child reads. In children with dyslexia, these areas appear ‘dimmed’


· The ‘dimming’ of these areas may well be genetically-determined as some genetics defects have been found in children with dyslexia. But while these areas do appear ‘dim’, some other areas in the brain appear to ‘light up’, indicating some compensation in someone who is dyslexic

· Dyslexic children do have some underlying ‘subtle’ problems in deep parts of their brain. The problems are not gross and not caused by anything that a mother could identify.


· We are all susceptible to minor errors in our brain circuit, bearing in mind the extremely complex structure of our brain and the fact that it consists of ‘electrically active wires’ packed within a small space ( the skull)!

· Dyslexic children do have some underlying ‘subtle’ problems in deep parts of their brain. The problems are not gross and not caused by anything that a mother could identify.


· We are all susceptible to minor errors in our brain circuit, bearing in mind the extremely complex structure of our brain and the fact that it consists of ‘electrically active wires’ packed within a small space ( the skull)!

· A dyslexic child is not simply ‘lazy’ in the ordinary sense of the word but does not see written words like you and me. This is seen from some of their copying skills.


· Some of them can do complicated tasks of mending a bicycle, which cannot always be done by professors of medicine!

· Part of their ‘disabilities’ involve having problems with recognizing “left’ and “right”- the so-called ‘handedness confusion, so typical of dyslexics


· The visual pathway in children with dyslexia have been known to be slightly affected. They are certainly not considered visually handicapped, but some may benefit from wearing vision filters . The exact mechanism of this is unknown and more scientific studies ought to be done before this becomes a definitive treatment

· Based on the above understanding of the brain and how it develops to achieve reading and academic abilities, the treatment of dyslexic children ought to use multiple sensory retraining methods. There are quite a number of such methods available and through perseverance and psychological support, a dyslexic child should gain enough confidence although his reading ability is significantly impaired


· As the brain communicates freely from left to right, back and forth, a single approach in training is clearly not logical in the treatment of dyslexia. The main aim is to give enough time for other parts of the brain to be able to take over the function of some deficient parts of the same brain.

· If a 60 year-old man with a stroke can recover and walks unaided after 12 months of intensive physical and psychological rehabilitation, it is then perfectly logical for a child with dyslexia to improve after intensive retraining a and psychological training too.

Malnutrition Slides

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Posted by Picasa

Malnutrition in Malaysian Children- An Overview - Zabidi-Hussin

This lecture was delivered during the Malaysian Dieticians Conference held in Sarawak on 21st July 2011

NO PARTS OF THIS WRITE UP CAN BE PUBLISHED WITHOUT WRITTEN PERMISSION FROM THE AUTHOR
SLIDES FROM THE PRESENTATION WILL BE DOWNLOADED IN DUE COURSE

1) Malnutrition is never an ending problem. The World Food and Agriculture Organisatiion in 2010 estimates that up to 13% of the world population and 70% are in Asia and the Pacific 1

2) The trouble is that these children are usually in a rather secluded areas, the rural communities, or suburban settings, hence “Invisible and Excluded “from the main glare of attention 2

3) Despite great achievements in our health data, often praised by most world authorities, our Minister of Health in 2010 lamented that nutrition problem especially underweight and stunting is still a major threat to our nation’s well being. Estimates put it at 130000 malnutrition children registered over the past decade. This could well be underestimated. The latest National Health and Morbidity survey of 21000 children in 2006 puts malnutrition at 12.9%. Stunting was estimated to be at 17.2%. T he survey highlighted the same issues of growth faltering after 6 months of age ( reflecting improper complementary feeding )and severe malnutrition among infants in rural and underserved areas. Chronic malnutrition manifested by stunting has virtually unchanged over the preceding decade 3

4) It appears that these seemingly “lack of progress” is seen in the background of the manifest National Action Plan 2006 -2015. More worryingly too, is the concomitant rise in the prevalence of obesity among children

REGIONAL HEALTH INEQUALITIES

5) Working in the state of Kelantan for the past 20 years, convinced me those regional economic disparities has resulted in frightening degrees of problems that stemmed from the basic problem of malnutrition. Kelantan’s GDP per capita stands at RM3761, compared with Malaysia’s figures at RM8962 in 2000 ( EPU data for 9th Malaysia Plan ).Moderate to severe malnutrition has been discovered to even 30% in some of the deprived areas such as Tumpat and some parts of ‘urban’ Kota Bharu. 4, 5


6) The World Bank in 2009 noted that” regional poverty remains a stumbling block in Malaysia’s bid to become a high income nation, despite the country’s progress in bringing down poverty levels nationwide” 6

THE GROWTH MONITOR SOFTWARE

7) Researchers in Universiti Sains Malaysia have developed simple open-access software that is useful to capture anthropometric data of children seen in the vast network of clinics in hthe country. This Growth Monitor software has potential in giving a nationwide picture of the extent of nutrition problem among children .Linking this data to the Geographic Information System (GIS) further gives an in-depth analysis of geographic influence and possibility of developing Risk-Factor analysis and thus carefully-targeted intervention. A recently-completed study in 12 clinics in Kota Bharu also noted that the mean prevalence of malnutrition stands at almost 15% , most of the children reside in the densely-populated areas of the city. Early data also shows that up to 20% of the severely malnourished children are iron-deficient 7

ORANG ASLI AND THE HANDICAPED

8) 2 groups of underserved: The Orang Asli population and the handicapped shows high prevalence of malnutrition with serious co-morbidities. 45.9% of the 130000 children malnourished over the last decade were among the orang asli population (Deputy Minister of Health 2010.The Star )


9) In as much as there is a detailed risk map analysis in some states, more data is needed to decipher malnutrition in other states such as Sabah where 20% of population lives under the poverty line and represents 42% of Malaysia’s total poor , or the urban poor.

10) Our recent and ongoing study on the handicapped in Kelantan communities discovered that up to 80% of them are malnourished, making rehabilitation efforts difficult and potentially disappointing. We also discovered that among over 400 children admitted to a tertiary centre for various physical illnesses, 25 % of them are malnourished. 10% are stunted.

11) The Malaysian authorities has recognized the tenacious problem of malnutrition and its counterpart, the obesity epidemic and are putting active efforts to alleviate this to meet the Millennium Development Goal target by 2015

NEW APPROACHES NEEDED

12) I feel that efforts to alleviate malnutrition ought to move from the culture of ‘giving’ such as the Food Basket, food subsidy etc, to creating the culture of empowering people on their health matters. Psychological approaches ought to be enhanced in the training of our health personnel, and equip them with the knowledge of child development.

13) We have experimented this through the launching of COMEL Carnival recently. In this carnival-type approach, families of malnourished children were invited to participate in health i exhibition and fun-type activities where subtle intervention involving knowledge empowerment of families were emphasized. The outcome of this approach will be closely watched.

REFERENCES

1) The State of Food Insecurity in the World. FAO October 2010
2) UNICEF, The State of World Children 2006
3) Khor GL et al. Nutritional Status of Children under 5 years in Malaysia: Anthropometric Analysis from the Third National Heath and Morbidity Survey III (NHMS2006) Mal J Nutr 15(2): 121-126;2009
4) Cheah Whye Lian, Wan Manan Wan Muda , Zabidi-Hussin ZAMH, Chang Kam Hock
A Qualitative Study on Malnutrition in Children from the Perspectives of Health Workers in Tumpat, Kelantan Mal J Nutr 13(1): 19-28, 2007
5) Factors Associated With Undernutrition Among Children in a Rural District of Kelantan, Malaysia.
Whye Lian C, Wan Muda WA, Mohd Hussin ZA, Ching Thon C.
6) World Bank 2009
7) Comput Methods Programs Biomed. 2009 Jan;93(1):83-92. Epub 2008 Sep 11.
Development and implementation of a web-based system to study children with malnutrition.
Syed-Mohamad SM.

Saturday, December 11, 2010

ETHICAL ISSUES IN HOUSEMANSHIP- SOME THOUGHTS AND REFLECTIONS


PROF ZABIDI – HUSSIN FRCPCH

CONSULTANT PAEDIATRICIAN AND PROFESSOR OF PAEDIATRICS

SCHOOL OF MEDICAL SCIENCES, UNIVERSITI SAINS MALAYSIA

dr.zabidi@gmail.com

zabidihussin@blogspot.com

LECTURE DELIVERED ON 11TH DEC 2010 UNIVERSITI SAINS MALAYSIA

· Ethics is linked to morality and judgments associated with it

· Everyone has his own moral values which has been nurtured over a period of time

· Every person’s moral values is unique and is normally determined by a number of factors including gender, culture, religious belief, environment and personal upbringing

· A medical student does not normally have an opportunity to exercise his moral judgment in dealing patient. Even if he does, that judgment does not influence the clinical management and care of his patient

· Ethical issues during period of studentship probably links to moral issues relevant to his personal conduct and its association to whosoever he in contact with. This may include issues such as truth telling, plagiarism, time-keeping, honesty, courtesy, empathy, respecting rights, communications and exploring insights of patients (MERCI checklist)

· Many of the issues of morality during the student days do not really matter to patient care

· The situation quickly changes as a student graduates

· Granting of a medical degree immediately empowers a student and unveils the cloak of uncertainty that has been covering him for at least 5 years

· He is now ready to make his own decision. Some of these decisions have to be made while he is at the front line of patient care, receiving patients at first point of contact and dealing with all the emotional issues surrounding a patient and his relatives

· This is the time when his moral judgments matter

· At the same time as he makes his judgments in his professional behaviour, his patients also judge him according to the scale of their moral judgments

· Judgment and evaluation of one’s moral standing can be gauged through a number of manifestations; from the way he dresses at work, the language he uses, gestures and body language, manner of interaction with peers and colleagues at work, note writings and phone calls and degree of urgencies in his actions. All of these carries significant weightage

· A patient who sees the first doctor on the scene who appears disheveled and unkempt would have a certain assumption and belief. Care of a sick person usually comes from an environment of clean and tidiness

· A houseman whose language lacks sufficient empathy and speaks in a language quite foreign to the patient he is in direct contact would transmit a certain message that can be adversely interpreted. Adverse interpretation may wrongly lack of interest and care, feeling of worthlessness, trust and confidence in the clinical management (remember the case of the doctor, declaring to his colleague that the hospital lacks fund, in full view of his acutely ill patient and his relatives). Casual statements such as “ I am only a houseman” or “My boss is not here and on holiday” would convey certain message to patients

· Patients normally take note the demeanor of the first doctor on the scene. Gestures and body language matter a great deal in transmitting sense of urgency and feeling of being taken care of. Most of these hidden issues relate directly to response to treatment and thus the speed of recovery from illness

· The environment within which a patient is being handled also carries significant value. Spilled bloods, and stained bed sheets, numerous indisposed used sharps would convey a situation of lacksidical approach to patient care, instill fear and reinforce negative values. A treatment room in full view of patient would also convey lack of sensitivity especially when painful procedures are carried out. An unnecessary large bandage over a small puncture mark would inevitably give a message that a big incision has been inflicted!

· A ward unguarded with laughter from doctors and health professionals would convey a sense of insensitivity and sometimes humiliation. This is especially true in situation of bereavement in an open ward

· A houseman is sometimes faced with ethical dilemma especially when his moral judgment may contradict that of his superiors. This can relate to issues in history-taking, physical findings and plan of clinical management. ( remember a case of a houseman who refuses to assist his consultant in a procedure as he feels that the procedure was unnecessary and unethical)

· Cultural and religious beliefs may also influence a houseman in his conduct. Care must be taken that these do not convey a negative connotation to his patient. Examples include statements such as “ I don’t work on certain days”, “ I am here now, even when I m not supposed to work”

· A houseman has to deal with colleagues (medical, nurses, support staff, administrators). His moral conduct will be transmitted to all those in contact with him. In an environment of close associates, judgments of others spreads quickly within an institution

· Ethical issues will also be relevant in dealing with those with financial interest in the clinical management of a patient ( insurance, pharmaceutical , companies dealing with equipments)

· Above all, the conduct of a houseman should exude a certain sense of flagship and icon for the medical profession, exhibit maturity and sensitivity that gives some reflection of humility between a care giver and those he cares for.

ZH

Dec 2010