Malaysia Travel Guide: Malaysia is a friendly, beautiful, culturally rich country and one that’s extremely good value for money to travel in. It’s modern enough to be comfortable yet full of natural beauty to be mesmerized.
Culture and Art: The mix of cultural influences in Malaysia is the result of centuries of immigration and trade with the outside world, particularly with Arab nations, China, and India, however each culture remained largely intact; that is, none have truly been homogenized. Traditional temples and churches exist side by side with mosques.
Special activities: Malaysia also offers some very special activities, and if you make room for one or two of them, they will enhance your trip immeasurably. You can choose to spelunk in the world’s largest single cave chamber in Sarawak’s extraordinary Gunung Mulu National Park, or a diving trip in the tropical waters off both Peninsular Malaysia and Borneo where you can find some of the world’s best scuba diving sites. A visit to the rain forest of Malaysia should be high on the list for anyone who has an affinity for nature, and it should be: the Malaysian rain forest is unique in the world, and the oldest on the planet.
Cuisine: Malaysia is a fabulous place to enjoy the art of eating and drinking. Malaysian Food is a multicultural fusion of Malay, Indians, Chinese and a bit of Peranakan, and this create a unique food that’s not only colorful, spicy and eclectic, but also downright tasty.
Come enjoy Malaysia with me, you can really see, feel, touch, smell and taste the hidden treasures of Malaysia. With so much to see and so much to do, one will never complain about feeling bored here. So, what are you waiting for? Come and visit Malaysia!
Friday, June 1, 2007
Vietnam Trip
Orientation
This was my third visit to the Center for Traumatology and Orthopaedics (CTO) with HVO. After arriving in HCMC on Friday, March 19th, I spent two and one half weeks teaching anesthesia and organizing a trauma course at CTO. As always, I appreciated the step-by-step description given in the HVO Orientation Packet for obtaining permission to enter Vietnam and work at CTO.
My advice (unsolicited as it is) to new volunteers, is to keep an open mind and be flexible in your expectations. No matter how you try to prepare yourself before arriving, there will be something that will be different than the way you thought it would be. Although I was last in Vietnam just two years ago, HCMC is undergoing changes at such a rapid rate that I experienced many surprises- both positive (mostly) and negative.
Activities
Monday I attended the morning staff meeting and was introduced to the physicians and nurses. It was interesting to see the emergency orthopedic cases of the previous evening being presented. Case after case of traumatic lower extremity fractures was presented with x-ray pictures. The emergency operative cases were presented first (usually 20-30 per day). This was followed by the closed reductions which are casted by technicians (usually 20 per day). Fractures which require casting but not reduction are not presented and there are often 100 per day of these.
Although CTO is a 500 bed hospital, there are often too many patients admitted to fit in the allotted beds. I saw many rooms with two patients in narrow beds meant for one and patients on stretchers overflowing into the corridors. It was evident that trauma is very prevalent in HCMC and is a burden on resources.
The approximately 100 surgeons at the hospital see about 1,250 outpatients per day. They do so very efficiently because by mid-afternoon the clinic waiting room, which is packed in the morning, is almost empty. The hospital has 9 physician anesthesiologists to cover the ICU and 11-12 operating rooms. They are aided by several nurse anesthetists.
During the rest of the week I gave lectures on regional anesthesia at 7 AM for the anesthesia department. CTO had managed to get a projector so that I was able to use my laptop to show the Power Point slides I had prepared. After each lecture I spent several hours in the operating room demonstrating and observing the regional anesthesia techniques that had been discussed. The department as a whole seemed much more interested in learning these techniques than they had been when I covered similar topics 6 years earlier.
Work in the operating room was often followed by lunch in the hospital cafeteria. Here we discussed topics ranging from medical care to popular culture while we ate typical and excellent Vietnamese food. In mid-afternoon I returned to my hotel and prepared for the next days lecture. The hospital activities in general start early and slow down significantly by 3PM.
I gave the traffic accident talk to surgeons and anesthesiologists at CTO on Monday and at Cho Ray Hospital on Tuesday. It was based largely on a study done by the Hanoi School of Public Health which was presented at the Road Traffic Injuries and Health Equity Conference held in Cambridge, Massachusetts in April 2002.
I was shown around one day at Cho Ray Hospital. At 1,000 beds, it is one of the largest in HCMC and is known primarily as a neurosurgical and trauma hospital. This was my second visit and it was nice to see that there have been improvements in equipment in the operating room and the recovery room. Despite its large size, the hospital has more cases than it was planned for. I saw two patients undergoing craniotomies side by side in the same room because of a lack of available operating rooms. Visits by AO can probably best be done in coordination with CTO in the future.
On Thursday and Friday I ran a two day Primary Trauma Care course for 22 participants. Five of the instructors were Vietnamese physicians from CTO who had participated in the first PTC course that was taught two years earlier. A general surgeon from Boston, and I were the only outside instructors. The course was taught using standard lectures, scenarios, skill stations, and discussion groups. My impression was that the students were quick to absorb and open to the concepts and knowledge of the PTC course. They seemed to especially enjoy the skill stations and discussion groups. This years students did not get into the scenarios as much as the participants of two years ago. My impression from previous visits, that Vietnamese physicians prefer to start their work early and finish early, was reinforced on this visit. Teaching after 3PM is pretty much not tolerated.
Assessment
I did feel that some of my lectures were more welcome than others. I believe the regional anesthesia lectures and demonstrations were appreciated as there were many questions and my colleagues seemed eager to try the techniques we discussed. Each time I visit CTO I see progress in equipment and anesthetic technique. As AO volunteers we contribute by supplementing teaching and by exchanging ideas and experiences.
Working with my colleagues at CTO is as rewarding as anything I do in medicine and as long as I can find the time, energy and finances, I will continue to visit. I am thankful that HVO makes the logistics of visiting so easy.
This was my third visit to the Center for Traumatology and Orthopaedics (CTO) with HVO. After arriving in HCMC on Friday, March 19th, I spent two and one half weeks teaching anesthesia and organizing a trauma course at CTO. As always, I appreciated the step-by-step description given in the HVO Orientation Packet for obtaining permission to enter Vietnam and work at CTO.
My advice (unsolicited as it is) to new volunteers, is to keep an open mind and be flexible in your expectations. No matter how you try to prepare yourself before arriving, there will be something that will be different than the way you thought it would be. Although I was last in Vietnam just two years ago, HCMC is undergoing changes at such a rapid rate that I experienced many surprises- both positive (mostly) and negative.
Activities
Monday I attended the morning staff meeting and was introduced to the physicians and nurses. It was interesting to see the emergency orthopedic cases of the previous evening being presented. Case after case of traumatic lower extremity fractures was presented with x-ray pictures. The emergency operative cases were presented first (usually 20-30 per day). This was followed by the closed reductions which are casted by technicians (usually 20 per day). Fractures which require casting but not reduction are not presented and there are often 100 per day of these.
Although CTO is a 500 bed hospital, there are often too many patients admitted to fit in the allotted beds. I saw many rooms with two patients in narrow beds meant for one and patients on stretchers overflowing into the corridors. It was evident that trauma is very prevalent in HCMC and is a burden on resources.
The approximately 100 surgeons at the hospital see about 1,250 outpatients per day. They do so very efficiently because by mid-afternoon the clinic waiting room, which is packed in the morning, is almost empty. The hospital has 9 physician anesthesiologists to cover the ICU and 11-12 operating rooms. They are aided by several nurse anesthetists.
During the rest of the week I gave lectures on regional anesthesia at 7 AM for the anesthesia department. CTO had managed to get a projector so that I was able to use my laptop to show the Power Point slides I had prepared. After each lecture I spent several hours in the operating room demonstrating and observing the regional anesthesia techniques that had been discussed. The department as a whole seemed much more interested in learning these techniques than they had been when I covered similar topics 6 years earlier.
Work in the operating room was often followed by lunch in the hospital cafeteria. Here we discussed topics ranging from medical care to popular culture while we ate typical and excellent Vietnamese food. In mid-afternoon I returned to my hotel and prepared for the next days lecture. The hospital activities in general start early and slow down significantly by 3PM.
I gave the traffic accident talk to surgeons and anesthesiologists at CTO on Monday and at Cho Ray Hospital on Tuesday. It was based largely on a study done by the Hanoi School of Public Health which was presented at the Road Traffic Injuries and Health Equity Conference held in Cambridge, Massachusetts in April 2002.
I was shown around one day at Cho Ray Hospital. At 1,000 beds, it is one of the largest in HCMC and is known primarily as a neurosurgical and trauma hospital. This was my second visit and it was nice to see that there have been improvements in equipment in the operating room and the recovery room. Despite its large size, the hospital has more cases than it was planned for. I saw two patients undergoing craniotomies side by side in the same room because of a lack of available operating rooms. Visits by AO can probably best be done in coordination with CTO in the future.
On Thursday and Friday I ran a two day Primary Trauma Care course for 22 participants. Five of the instructors were Vietnamese physicians from CTO who had participated in the first PTC course that was taught two years earlier. A general surgeon from Boston, and I were the only outside instructors. The course was taught using standard lectures, scenarios, skill stations, and discussion groups. My impression was that the students were quick to absorb and open to the concepts and knowledge of the PTC course. They seemed to especially enjoy the skill stations and discussion groups. This years students did not get into the scenarios as much as the participants of two years ago. My impression from previous visits, that Vietnamese physicians prefer to start their work early and finish early, was reinforced on this visit. Teaching after 3PM is pretty much not tolerated.
Assessment
I did feel that some of my lectures were more welcome than others. I believe the regional anesthesia lectures and demonstrations were appreciated as there were many questions and my colleagues seemed eager to try the techniques we discussed. Each time I visit CTO I see progress in equipment and anesthetic technique. As AO volunteers we contribute by supplementing teaching and by exchanging ideas and experiences.
Working with my colleagues at CTO is as rewarding as anything I do in medicine and as long as I can find the time, energy and finances, I will continue to visit. I am thankful that HVO makes the logistics of visiting so easy.
Vietnam Trip
Overview:
This was my fourth visit with HVO to the Hospital for Traumatology and Orthopaedics, HTO. I keep thinking that I should try some of the other HVO sites for variety but Vietnam has a magic all its own and it's hard to imagine a place that would be more gratifying or more interesting.
Activities and Assessment:
On Monday through Friday I lectured at the 7 AM meeting to the anesthesia staff. The first three days I used my laptop and a projector they were borrowing from B-Braun to give talks on regional anesthesia. On Thursday and Friday I tried running a more interactive session by doing a "Problem-Based" discussion. This worked reasonably well in trying to get everyone talking but because of the translation back and forth slowing things down we didn't cover much territory. We discussed hypotension, the treatment, differential and the management of the airway in a patient with hypotension and a full stomach. The system is more geared towards lectures but I believe interactive discussion is helpful in getting an idea of how much is being absorbed by the staff and students.
After the morning lecture, I spent time in the holding area observing and doing some blocks and also going into the operating rooms to observe. There have been changes since I was there last. They now use a CO2 absorber in circuit in the OR where the scoliosis and other back cases are done with low flows. In one case I was observing the ETCO2 was measured and was quite high (60s and 70s) on a young child and I did not ask but am now wondering whether they change the absorbent often enough. The anesthesiologist also are not mixing the lidocaine and bupivacaine in the same syringe but are giving them in separate syringes at my suggestion the last time I was there. During my last visit I discussed femoral nerve blocks and I was told that the department is regularly doing these blocks now for both intraoperative procedures and postoperative analgesia. On this visit I discussed the use of suprascapular nerve blocks and superficial cervical plexus blocks as rescue blocks for failed interscalene blocks or for analgesia after shoulder surgery. The staff seemed very interested and tried it on several patients while I was there with good results. They have insulated regional needles which they use for select patients. I emphasized the importance of blocking the musculocutaneous nerve separately from the axillary nerve block.
You asked if there was "one person who really touched you during your trip" and the answer is yes. I was attempting to demonstrate an infraclavicular nerve block using a nerve stimulator on a young man scheduled for forearm surgery. The patient seemed very stoic as I kept introducing the needle without any success at finding the brachial plexus. I have to add that this is a technique I have done successfully hundreds of times and feel very comfortable doing. I finally decided to desist ("first do no harm") and do the easier and safer axillary approach to the brachial plexus. I always first block the musculocutaeous nerve separately and then the rest of the brachial plexus. To my embarrassment I had great difficulty finding the musculocutaeous as well- this was in front of about ten eager young trainees. I felt terrible. Finally I found the right spot and as soon as I injected the last drop of local anesthetic the patient was immediately wheeled to the operating room. As the patient entered the OR he looked up at me with tears in his eyes and said "help me" (to my surprise he knew those few words in English). I worried that perhaps the block wasn't working and he was frightened that he would have surgery without anesthesia.
After a successful surgery under a good block (whew!) I went to see the patient in the recovery room and he started crying again when he saw me. I asked one of the anesthesia staff what was wrong and I was told that the patient was so thankful that an "expert" from the US had taken care of him that he was overcome with relief and gratitude. I have to say that this was one of the most pleasant outcomes of a cultural misunderstanding that I have experienced and one that I will probably never see in the US.
Living Conditions and Suggestions:
I stayed in the Spring Hotel. This is the hotel I have stayed in every visit and it is still very comfortable and gives a safe feeling while being close to everything (except the hospital which is a 15 to 25 minute ride away). The most recent addition which I truly appreciated is that if your laptop has wireless access equipment, you can access the internet in your room for free. Otherwise you can still log on to one of the two computers in the lobby for free but there is sometimes a wait. I think there are many new hotels being built in HCMC as more and more tourists come and there are certainly other good hotels to stay in if you wanted to take the time to look. Prices are starting to go up but are still very reasonable compared to the US and Europe. I recommend e-mailing ahead to book a room, especially during peak tourist times.
I recommend taking one of the boats from the city to the Mekong Delta or one of the nearby beaches. If you have time and money there are many wonderful exotic and interesting places to visit. On my way to Hanoi to the Congress, I spent three days seeing Hoi An and Hue, both charming and very interesting historically.
Summary:
Vietnam is a spectacular country. It is beautiful, exotic and friendly. The people I have met are intelligent, interested in education and quick learners. After visiting I feel optimistic about the future of both the medical profession in Vietnam and the country itself. Still, there is much that a volunteer can do to help. It is remains very rewarding to teach in HTO and I certainly plan to return when time permits.
This was my fourth visit with HVO to the Hospital for Traumatology and Orthopaedics, HTO. I keep thinking that I should try some of the other HVO sites for variety but Vietnam has a magic all its own and it's hard to imagine a place that would be more gratifying or more interesting.
Activities and Assessment:
On Monday through Friday I lectured at the 7 AM meeting to the anesthesia staff. The first three days I used my laptop and a projector they were borrowing from B-Braun to give talks on regional anesthesia. On Thursday and Friday I tried running a more interactive session by doing a "Problem-Based" discussion. This worked reasonably well in trying to get everyone talking but because of the translation back and forth slowing things down we didn't cover much territory. We discussed hypotension, the treatment, differential and the management of the airway in a patient with hypotension and a full stomach. The system is more geared towards lectures but I believe interactive discussion is helpful in getting an idea of how much is being absorbed by the staff and students.
After the morning lecture, I spent time in the holding area observing and doing some blocks and also going into the operating rooms to observe. There have been changes since I was there last. They now use a CO2 absorber in circuit in the OR where the scoliosis and other back cases are done with low flows. In one case I was observing the ETCO2 was measured and was quite high (60s and 70s) on a young child and I did not ask but am now wondering whether they change the absorbent often enough. The anesthesiologist also are not mixing the lidocaine and bupivacaine in the same syringe but are giving them in separate syringes at my suggestion the last time I was there. During my last visit I discussed femoral nerve blocks and I was told that the department is regularly doing these blocks now for both intraoperative procedures and postoperative analgesia. On this visit I discussed the use of suprascapular nerve blocks and superficial cervical plexus blocks as rescue blocks for failed interscalene blocks or for analgesia after shoulder surgery. The staff seemed very interested and tried it on several patients while I was there with good results. They have insulated regional needles which they use for select patients. I emphasized the importance of blocking the musculocutaneous nerve separately from the axillary nerve block.
You asked if there was "one person who really touched you during your trip" and the answer is yes. I was attempting to demonstrate an infraclavicular nerve block using a nerve stimulator on a young man scheduled for forearm surgery. The patient seemed very stoic as I kept introducing the needle without any success at finding the brachial plexus. I have to add that this is a technique I have done successfully hundreds of times and feel very comfortable doing. I finally decided to desist ("first do no harm") and do the easier and safer axillary approach to the brachial plexus. I always first block the musculocutaeous nerve separately and then the rest of the brachial plexus. To my embarrassment I had great difficulty finding the musculocutaeous as well- this was in front of about ten eager young trainees. I felt terrible. Finally I found the right spot and as soon as I injected the last drop of local anesthetic the patient was immediately wheeled to the operating room. As the patient entered the OR he looked up at me with tears in his eyes and said "help me" (to my surprise he knew those few words in English). I worried that perhaps the block wasn't working and he was frightened that he would have surgery without anesthesia.
After a successful surgery under a good block (whew!) I went to see the patient in the recovery room and he started crying again when he saw me. I asked one of the anesthesia staff what was wrong and I was told that the patient was so thankful that an "expert" from the US had taken care of him that he was overcome with relief and gratitude. I have to say that this was one of the most pleasant outcomes of a cultural misunderstanding that I have experienced and one that I will probably never see in the US.
Living Conditions and Suggestions:
I stayed in the Spring Hotel. This is the hotel I have stayed in every visit and it is still very comfortable and gives a safe feeling while being close to everything (except the hospital which is a 15 to 25 minute ride away). The most recent addition which I truly appreciated is that if your laptop has wireless access equipment, you can access the internet in your room for free. Otherwise you can still log on to one of the two computers in the lobby for free but there is sometimes a wait. I think there are many new hotels being built in HCMC as more and more tourists come and there are certainly other good hotels to stay in if you wanted to take the time to look. Prices are starting to go up but are still very reasonable compared to the US and Europe. I recommend e-mailing ahead to book a room, especially during peak tourist times.
I recommend taking one of the boats from the city to the Mekong Delta or one of the nearby beaches. If you have time and money there are many wonderful exotic and interesting places to visit. On my way to Hanoi to the Congress, I spent three days seeing Hoi An and Hue, both charming and very interesting historically.
Summary:
Vietnam is a spectacular country. It is beautiful, exotic and friendly. The people I have met are intelligent, interested in education and quick learners. After visiting I feel optimistic about the future of both the medical profession in Vietnam and the country itself. Still, there is much that a volunteer can do to help. It is remains very rewarding to teach in HTO and I certainly plan to return when time permits.
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