Monday, March 07, 2011


Roughly 60km from Mukah lies a small town that is full of juxtapositions and contradictions that it truly epitomises the spirit of 1Malaysia: no matter rich or poor, we both can live together.

On one hand, there are old wooden kampong houses like this dotting the riverside; this one looks as if it’s on the verge of jumping into the cool inviting river for a swim.


On the other hand, there’s these big factories so modern that it looks like a foreign body being wrongly transplanted here due to someone mistakenly interpreting the Sarawak map wrongly.


Balingian looks and feels like a sleepy hollow, with its row of 1960s wooden cowboy style shop-houses right by the river- an exact carbon copy of other little towns in Sarawak right to the ubiquitous Chinese temple. Occupants were seen lounging on wooden chairs, reading newspapers and bantering with their neighbours.



There’s also a new bazaar, but it bore semblance to a dead town – concrete buildings that had more swallows around it that humans. Most of the shoplots were unoccupied or closed – the one ones open this Sunday morning were a couple of coffee shops.


However be warned, despite its another-village-next-door unassuming facade, Balingian is literally an underdog powerhouse - home to a Metal factory, Aluminium factory and Coal factory. The polluting impacts of these factories on the pristine village are stuffs of urban legend – stories of dying yellowing trees and shrouding smokes that lives up to Balingian’s Chinese translation - 万里烟 (Ten thousand miles of smoke) filled coffeehouses chats in Mukah. Yet to my disappointment, throughout the whole road to Balingian, the only scenery greeting me were green trees and clear air.

Besides these factories, there are also some high class condominiums puncturing the continuous roadside greeneries. But instead of serving as dwellings for humans, these are condos for swallows.  Bird nest is a huge business around Mukah. But i did wonder how does the caretakers and builders and villages living in dilapidated wooden houses with attap roofs nearby felt about their high class neighbours living in brick and concrete condos… Such was the difference between the haves and have nots…


This is Balingian’s Health Clinic.


Some patients having hypertension and diabetes follow-ups here had to go all the way to Mukah (to see me) for their medications because they do not have any pharmacy dispensers here. From today onwards I guess I won’t give them any more IOUs after seeing the distance they had to cover and the obvious lack of public transport. I guess this is called going down the field to step into the shoes of patients. =)

Wednesday, March 02, 2011

Working in a pharmacy: a day’s journal


7.40am Reached the pharmacy with half cup coffee in hand. Switched on the lights, air conditioner  and computer. Glanced through the to-do list today. 10 items. Put a star on the urgent ones. Started to pore through the financial reports from pharmacy store. Found discrepancies. Again. Sigh.

7.55am A staff came in to give an idea on how to reduce the amount of waiting time at Out-patient pharmacy. Quite interesting. Happy that they are really thinking innovatively to solve the persistent problem.

8.15am Reached male ward for ward round prep. Scanned though patient’s medication chart and profiles. Two  interesting admissions last night. One was nephrotic syndrome. I adored kidneys. Made a note to clerk it later.

8.45am Met up with a few sectional heads to explain the non-drug expenditure report that HQ requires then to fill. My style: preferred to go through with them thoroughly with real time examples – way better than just throw the instruction paper to them.  Reward: they sent it in in the afternoon even though deadline is 3 days away.

9.15am Back to out-patient pharmacy. Started dispensing to patients from out-patients clinic. Today was diabetes day. Quite busy.  One patient had high blood glucose level despite on high dose insulin. Suspected non-compliance. Roped in to counsel. Re-teach technique and stressed on the importance of taking the shots on time.

10.30am Out-patient crowd thinned. Back to the ward to catch tail-end of ward round. Queried doctor on plan for some patients. One patient was going home with a newly prescribed MDI Salbutamol. Sat down with patient to do bedside counseling. Went through asthma in layman’s term with him – used the blocked pipe analogy. Demonstrated three times before patient fairly competent.

11.00am Another bad news. The weighing scale is broken! Called HQ. Can’t buy another one at the moment because its too expensive. Oh no….

11.15am Back to office intending to do some paperwork. Doctor rang for drug info – answered the query. Staff came in saying a patient is reluctant to inject IM Provera, due to fact that prior injection resulted in prolonged fever. Went through case notes, found out the previous injection was IM Lucrin. Confirmed correct medication was ordered with doctor, then assured patient while personally escorting her to see the nurse administering the injection.

11.40am Patient newly started on Humapen requiring counselling. No prior experience but very willing to learn. Went through the whole gamut with her: what is diabetes, why need to treat, the goals of treatment, what is insulin, how to prep pen, how to inject, where to inject, what to do on sick days and detection and treatment of hypoglycaemia. Took a full half an hour.

12.15am Returned to office desperately wanting to finish the items on “to-do” list. Called some wards to tell them their Diazepam had expired, better come and exchange. Indented the drug to them. Packed some dangerous drug (DD) tablets that is low on stock. Prepared the specifications output report for admin. Did counselling statistics – 37 patients counselled thus far these 2 months, on the right path to hit the 200 target I set for this year. 

1.00pm It’s Lunch time! Went home to have a healthy meal of chicken breast fillet salad with French dressing.

1.50pm Back to office to read up some articles on nephrotic syndrome to make sure patient is managed correctly.Dalat Hospital (a small Hosp nearby) called to borrow Potassium Chloride mixture. Gave them three litres in exchange of loaning their weighing scale. Agreed. Problems solved with mutual benefits.

2.30pm When to pharmacy store to go through the report with the staff there in detail, to find out the source of the discrepancies. All the figures made my head spin.

3.00pm A visit to the inpatient pharmacy. Taught the staff there how to use a min-max thermometer – newly acquired to ensure better management of cold chain item.  Collected all February scripts to scan through for prescribing patterns.

3.30pm Afternoon ward round. Went to 3 wards: Male, Female and Paed. Go through new cases in male and all cases in female and paed. Only found a small problem, doctor indenting methyldopa as metformin. But nurses were alert to it anyway.

4.15pm  Paperwork, paperwork and never-ending paperwork. Rearranged the mountains of paper on my table. Filed noted items. Printed out notice for the next Continuous Professional Development (CPD) presentation. Aimed to do twice per month so that every staff can collect more than 30 points per year. Its next Monday and I will be presenting. Sigh… need to go home and prepare. 

5.00pm Yes! Time to go home. Managed to finish 5 items on the to-do list. 50 percent…not bad. Did a new one for the next day. 5+3 = 8 items =(

My days had been action-packed like this for the last month. Anyone interested to be the only pharmacist in a district hospital? ^^