Of growth and pain

 8000km away from home

1 step away from my dreams

The pressure to pass this exam is real.. yet deep down am i ready to leave my home? 

Its liberating not to be working, away from the same mundane environment.. i realised how much tunnel vision i had.. in borneo, the priority was work and to earn money. Once i step out from the normality i see a whole new world out here. More importantly i see the sparkle in the eyes of the people working here, irrespective how big or small their work is. It reminds me what ive lost in the process... ive lost that sense of pride to serve, that is how toxic our system is. 

Yes its not easy here, the rising cost, to be another brown black yellow here. People here seems to acknowledge that everyone is respected around here and everyone is trying to live their best.. and this is exactly what i lost. The voice to voice out what i truly think without fear. The liberation of being truly me.. honestly i think ive been moulded to be a yes man far beyond recognition.. 

The journey here was a fun one. Bonded with people i briefly met. It made me sad that we will be parting ways soon.. a part of me wish that the house would not be so silent than before. I think i also lost friendships along the way... sometimes i think its because ive been stiffled sick with environment that i just kept on working. Only now can i process my emotions properly and weigh my life priorities. Alas this is a journey i need to continue by my own. I wonder where was the person who used to jump into uncertainties went.. as i age, being alone and uncertain futures make me wary. I sometimes wonder if i can really finish this race i started.

I am thankful i had this brief moment of space to reflect on. Whatever happens i will just perform the best and see what comes. 

Reflections on dementia

With the increasing aging population worldwide, its not a surprise dementia cases are increasing as well. Eventually, all of us will end up being a caregiver at some point in our lives. 

The hardest hit would be on the 'Sandwich generation', a generation that takes care of their elderly parents while also trying to raise their younger generation. I would say the responsibilities are twice as heavy. 

I would also highlight that most of the caregivers are leaning towards the older age, its not uncommon these days to see a 60year old taking care of a 80 year old.. 

Hence, my highlight that caregiver themselves should be supported and evaluated throughout their caregiving journey. In all honesty, how often do we focus on caregivers?

As clinicians, once we diagnose dementia, we tend to focus on our patient as our whole entire universe. What can we do for a change to make our care extend towards caregivers?

-care giver assessment (screen for their physical and mental suitability). This includes screening caregivers for mental health issues and cognitive impairment. 

-educating care givers on the challenging journey ahead, preparing them on their role transitions and educating them on the basics of dementia

-mobilising their supports (genogram to understand family dynamics, atlas caremaps). 

-educating about burnout (ways to seek external help, community supports that are available)

-psychotherapies including family therapies. 

-grief work (ways to cope with deterioration due to progression of dementia and ultimately loss)

-addressing ethical dilemmas (autonomy vs safety, justice)

Having said all of the above, the most important intervention is having community support. As we can see the level of care for dementia highlights community involvement from level 1-3. Only level 4 is specialised care.

Without community cohesion, we will not be able to deliver dementia care which is comprehensive, hollistic and inclusive. Afterall dementia not only affects the person but it changes everyone. 

For more indepth information, kindly refer to the textbook titled family caregiver distress by dollores gallagher-thompson et al. 

My reflection on mental health crisis

Is mental health issues on the rise?

YES..

Is it tiring to work in a mental health setting?

YES

Ever wonder why mental health issues are rising?

YES.. all the time

How did this reflection of mine started? 

Well, it began because my boss mentioned about the decline of the fabrics of our society, the moving of collective communities into a single nuclear family.. and now, everyone is for himself mentality. Which leave the responsibilities of caring for the unfortunate to goverments and the state. 

Will goverments be able to take care of every mental health sufferer?

Hopeful is an optimistic word..

in the long run, i think its quite pessimistic

I had the joy of reading a book called 'Has medicine lost its mind?', written by Robert C Smith.. 

It was an illuminating discovery..

The issues highlighted were

1. We have been taught to seperate physical and mental health as seperate entities

-kindly read the book for a lengthy history of this. it puts things into perspective

2. The stigma exist even in the medical fraternity

-true, i've experienced first hand how other departments undermine by skills just because i'm in psych. Those insinuating comments that i can 'read the mind', 'cure people just by talking'

3. Dr's themselves have poor understanding on mental health issues

-true. i spent my medical school training with just 6 weeks of psychiatry out of 2.5 years in clinical years. i was trained in a traditional training system.

-i was lucky to get a psych case in my final year, i guess i was kind of interested..

-as medical student, psychiatry was facinating. however, there was  no continuity when i began entering housemanship.

-i had a steep curve when i was studying for my post grad exams as medical officer.. i had no clue about psych medications, let alone the topics out of depression, bipolar and schizophrenia

4. The overpowering emphasis on neurosciences

-medicine without science is quackery

-psych is a bridge between the mind and brain, over emphasizing on the brain alone kind of tip the scales.. 

-the drive away from psychoanalysis meant that talk therapies are declining, we resorted to a magic pill to solve our mental health issues..

5. Talk therapy is damn blood expensive

-trust me, therapy is time consuming. the billing is done per hour.. which leaves therapy only affordable for the rich.

-why is it so expensive? because its really draining for therapist.. please do not picture a couch and a patient laying on it. there's alot of analysis to be done by listening and selecting what to say to acheive the therapeutic effect. 

The way forward?

Mental health is everyone's business.

Holistic treatment is key.. there goes the rationale for biopsychosocial model

It's not going to be treated by magic bullets, fancy retreats or any fancy products 

My takeaway, it takes small steps, sometimes 2 steps forward and 1 step backwards, humility and constant drive to be a better human to acheive the perfect mental health. And that formula varies from each one of us. 

Reflections part 2

 Ive always had a background thought that children are a screamy whiny spoilt bunch. In pediatrics, ive seen how everything needs to be precise and accurate. I foresee that life would not be much fun in the pediatric section. I entered my posting with 0 expectation, i just wanted to get it done and dusted.

Imagine my surprise when my supervisor posed the golden question to me, what did i want to achieve in the span of 4 months? Of all my encounters never had any of my supervisor ever asked me this. Wow i thought, what a great first impression made. I was truly in awe, finally someone wanted to engage me in my learning journey. This was how it got my curiosity started. To be honest, i dont think i gave much thought about my answer until after that. 

Neurodevelopmental disorders are the bread and butter of this department. The parental shock and despair upon receiving news that their child had a neurodevelopmemtal disorder, compounded by the anxiety if their child would ever lead a normal life, the sacrifices that has to be made to help their child fit into society were witnessed too often. Who could answer the question 'Dr, did i do something wrong during my pregnancy that might have caused it?' and look into the eyes of the crushed parents. The south part of the country fare slightly better than borneo partners, there was more awareness, more therapy options, more special school facilities. I was envious seeing how many people had more awareness and were more willing to bring their children to be screened. Socioeconomic standing also plays a role in the outcome, whichever parents that could afford to go for private therapy did have the upper hand. It dawned to be at times to think if free universal healthcare is still sustainable in the long run. 

Adolescence were the harder subcategory of patients. No wonder this period of growth was termed growing pains. Adolescence now had more challenges compared to the previous centuries, especially during the covid years. Self harm was rising as well as increased child abuse. 

Here, i learnt that it really takes a whole community to raise a child. The most effective interventions were done via a team. Each team member played an important role, contrary to the popular believe that doctors were in the highest hierachy. I had alot opportunities to take part in awareness programme which i truly appreciated. Colleagues and bosses were accomodating, giving me a pleasant working experience. 

-to be continued

Reflections

 The medical world can be a vortex which keeps churning you deeper until you lost all sense of control. I had so much things i love to do in my younger days, but one by one it was put off the shelve or postponed. The breaks were all replaced by more time working, more time spent on training activities or escapism through netflix. This was what i see when i look back now, the endless packing and moving with short getaways to attend important events but never truly able to stay for long. For some it might be described as part and parcel of training. To me now, i think this is how burnout was born. I wasnt even aware of burnout that time, thanks to covid, ive gained alot insight and i finally can see clearly.

I spent half of my 20s in Borneo. Starting off as a young aspiring doctor, ready to take off to serve the underprivilege citizens of our country, i arrived with alot of hopes of changing things for the better. Retrospectively now, i think i was abit too naiive. To think of it now, it might be similar to the 'white supremacy'. Even before i knew it, i found a home in Borneo, touched by their kindness and hospitality. Heck, it even manage to convinced me on cultural assimilation and diversity. Honestly, it became my comfort zone. 

When i finally decided what i want to do for life, the news about training outside Borneo gave me alot anxiety, multiple nights thinking about the what-ifs, the inferiority complex of maybe im not up to practise city medicine and the heart break of saying goodbyes to the friends ive made. I cried bucket loads, the grief came in pangs and waves. My comfy world that i had build felt like it was crashing down. 

I landed at the south part of the country, with loads of help from my parents who helped with my moving. I met a mutual friend and we hit it off together for our 1st posting. I was lucky to meet another human who knows how things in this state works. I started making friends from many introductions. This posting was the best place to get orientated to places, our job was mainly going for house visits. I could finally see on my own how rehabilitation and community care was being done for my patients. I was happy i wasnt confined by the walls of the hospitals. Here, being tactful and thinking out of the box were important. I was also seeing firsthand the stigma of mental illness from our community. When i described my experience to my friends, the response were alittle shocking. To them, they felt that i wasnt doing a doctors job. To me, it felt like i was contributing a small drop into an ocean, small but vital. I still believe that we had to be role models to empower the community and key decision makers to safeguard our patients. The idea of isolating people with mental illness by hospitalization or instuitionalising them is obsolete now. Mental health is everyones business and community plays a big part in sustaining their wellbeing. 

-to be continued

Lets start somewhere

When i was young, i dreamt often.. 

I dream of a path i would trot on.. 

How many hiatus ive taken, how many self doubt moments i had wasted,

And yet here i am, 

I chose exactly what i dreamt of.. 

Yet i still wonder about the purity of my intentions. 

Whatever it was, its one full circle completed. 

So what did i encounter on my hiatus journey?

Many, many things that made me perhaps better and stronger..

The system has a way of beating the crap of ones individuality, 

Silencing the thoughts and voices, 

Yet its always there and it was not lost.

It just needs some time and courage to let it out. 

Am i a little wiser? 

Perhaps.. but im also alittle naiive

Yet here i am today, thankful for where ive been and what ive seen.

Truly, our subconcious minds are a powerful place. 

Updates

Fastforward from where i left off it seems like time hasnt been moving so fast afterall. 

2 years plus with alot speedbumps,ive finally earned myself the permanent registration number. From that point onwards, i stalled awhile uncertain of the many roads i couldve undertaken.. a reflection of the past, a kind soul and a buddy was all it took for me to end up here. I was quite certain my life events were leading me to where i am now. After all these years, with depersonalisation i managed to move on yet at times i still go back wishing i couldve fix what still felt like a heavy unfinished business. 

What ive learnt from all these years is that the journey is the most important instead of the destination. 

Funny isnt it that after all these years my writing voice hasnt come back. Seems that what ive been repressing for so long has affected the writing part of me. 

Adieu.