Monday, April 16, 2012

The village with no car

It was a nice coincidence that I got to celebrate the start of my fourth year in service as a pharmacist with an unique ‘job’ experience.

As the title suggests, I got to follow a mobile doctor clinic to some of the rural villages near Daro.

It all started on a Monday morning with an one hour long boat trip out to the South China Sea.


Our destination is a village on an island as big as Langkawi, but as places in Sarawak generally are, a thousand times more underdeveloped.


Welcome to Kampung Bruit, a sleepy village on the eponymous island of Bruit, a few kilometres away from the town of Daro by boat.


Kampung Bruit is a fishing village, where there are more boats than any other forms of transportations.


During our visit, it was the prawn season, and we can see returning fishermen with their boatful of catch-of-the-day.


The village was also famous for their dried fish, which they processed in big open BBQ pits by the roadside.


The trip was a real eye opener, because it was quite hard for us city slickers to imagine that in the 21st century and nearly 50 years post independence era, there is still a populated place of 2000 people without piped water nor car.


The roads in Bruit were uneven and crumbling, and in places rickety bridges had to be built so that crossings are possible. The only streetlight in the whole kampung is as depicted in the photo below.


Imagine if you live in this house, and had to navigate this road to and fro everyday. Notice too the numerous blue water tanks, it was the hallmark of every single house in the village.


I was there to visit the government health clinic situated on the island, which looked like this:


My main role during the visit is to teach the villages how to use and better understand the medications they are taking, a campaign known as “Know your medicines”. Even though most of them are not well educated, they are quite receptive to the talk. 


The trip was a novel experience, because it added another dimension to my appreciation of how the health service works and the hardships some citizens faced just to see the doctor when they are sick.

There are just so many basic challenges they faced to get something we take for granted – accessibility to healthcare, be it the price of the boat petrol, the tide, the weather, the long journey, their lack of education and insight of their medical conditions.

We grumbled and scolded when they missed their appointments or wanted full supplies of medicine. We thought that they couldn’t care less about their diseases or are just plain lazy; but little do we pause to think or are willing to find out the reasons behind it - and the reasons can be harrowing.

I think we all need trips to places like this to get better connected to the real world and people we are serving. Only that we will realise what we should focused on in our jobs and care for our patients just a little bit more.


Exactly two years after I was supposed to be posted there, I finally set foot in Daro.


It immediately feels like ‘home’ because just like Mukah, they have a fish as a mascot.


The typical temple by the river, characteristic of all towns in Sarawak.


Rustic petrol station. Definitely not your usual Petronas or Shell station.


The famous one and only bank in Daro.


The town centre is a mix of old..


and new.


Drum-roll…. this is where I was ‘supposed’ to work - KK Daro.


And possibly I will go here too… this is Hospital Daro, which was painted in a brilliant shade of fushia pink.


Overall Daro was a quiet little town, slow paced (no coffee shop opens at 7am) with a really laid back feel to it. Its all relaxed and stressed free. But possibly not for long term stay =)

Wednesday, April 04, 2012

The measurement of quality makes the actual work less quality

In any given day in any given government pharmacy in Malaysia, this is what you will hear over the counter.

Puan Husnahkah? Selamat pagi. Apa khabar makcik?

Khabar baik.

Bagus. saya telah memeriksa semua ubat kamu, dan mendapati semua ubat adalah sama seperti kali yang lepas. Makcik ada makan dua jenis ubat untuk kencing manis, iaitu Gliclazide dan Metformin. Bolehkah makcik memberitahu saya macam mana biasanya makcik ambil ubat ini?

Yang putih besar besar ini makcik makan 2 biji 2 kali sehari, yang ini… makcik macam tidak pernak nampak..

Oh… lupa beritahu, ubat ini ada tukar baju sikit. sebelum ini, ia berbaju biru dan sekarang berbaju hijau. Ikut fesyen raya. Tetapi cara makan dan bilangan yang makan masih sama.

Oh…. patutlah..

Makcik, sekarang ini, kami tidak dapat memberi ubat kamu secara penuh. Hanya dapat bagi satu bulan sahaja, kerana kerajaan takut bazir duit. Perlu hutang ya… bila ubat makcik habis, boleh bawa preskripsi ini datang balik farmasi dan ambil ubat. Tarikh dia ada tulis di sini. Jika makcik ada ubat lebih di rumah tolong pulangkan juga. Jangan membazir ya. Makcik juga ada tengok tak tanda harga ini?  Sekarang semua ubat ada tanda harga supaya makcik tahu berapa nilai ubat-ubat yang makcik makan ini supaya makcik akan menghargainya...

Oh… perlu datang balik… bolehkah anak saya datang ambil?

Boleh..asalkan dia bawa preskripsi ini sahaja.. anak tahu SMS tak? Kalau tahu, kami ada satu sistem baru, di mana dia boleh SMS beritahu bila mahu datang ambil ubat. Dengan sistem ini, kami akan siap bungkus ubat dahulu sebelum dia datang. Dia hanya perlu datang pada masa yang ditetapkan sahaja dan tidak perlu beratur.

Tidak apa la…

Ada apa-apa lagi makcik?Jika tidak ada bolehkan makcik masuk sekejap? Kami sekarang sedang buat satu kajian kepuasan pelanggan. Tidak lama punya hanya lebih kurang 40 soalan dan 6 muka surat sahaja… lebih kurang 1 jam akan habislah. Kami amat perlukan maklum balas makcik supaya kami dapat tahu kelemahan diri sendiri dan memberi perkhidmatan yang lebih baik….

And poor illiterate makcik had to sit though the hour long session listening to a pissed off pharmacist rattling through survey questions and answering something she doesn’t care about. She cares more about having full supply of medications so that she doesn’t have to fork up RM30 more to come again just to take her meds than whether we have clean toilets or television set to keep her entertained.

Sometimes, I think its better we rebrand ourselves as Marketing Executives rather than Pharmacists.

In our quest to serve better, I think we had deviate too much from our core purpose. We had literally missed the forest for the trees.

We want to increase the quality of our service, which is good, but ironically, I think that the process to improve the service is hurting the service.

Nowadays we were squeezed and squashed in a pressure cooker, pressured by the waiting time KPI on one side (every patient to get their meds within 30 minutes) and promoting all the value-added services (which is also another KPI). Something gotta give. So what gives? The quality of the dispensing we provide to the patients. The time that we are supposed to put in to show empathy, to delve further and to understand the problems of our patients is sacrificed. For what? For better quality services.

May I ask: What is our core service again?

Haih. I hate to rant but enough is enough. Now we are supposed to measure the quality of our service with a six pages long standardised questionnaire. 400 of them by the middle of May. Personally, I like surveys and measurements, because as pharmacists, we are champions of evidenced based practice. But surveys should always adhere to the KISS principle, and not something so long worded and jargon loaded and so small font and so comprehensive.

The tool to measure whether we practice patient orientated care is so not patient orientated that I feel embarrassed to use it. And angry because it will further erode the time  I had to spend with my patients.

But well, as government servants usually say in the end, kami hanya menurut perintah…