Monday, January 8, 2018

of ethics

working here in this town beside the side, almost half (i think) of the residents are non locals.
so the big issues arise when they come to hospital to seek treatment.

this land below the wind has so many suku kaum which some, i only encounter few times and has so many ic color which i never see in west Malaysia. these people mostly are native people but somehow due to socio economic, logistic, non-legal marriage (kahwin kg), and too ignorant too i think they only have birth cert and dont hv ic.

mind you they have to pay a lot than local. for registration only it cost rm100. not include other investigations. they hv to pay every single of blood investigation and xray required.
but somehow, for us, the treating doctor, when look at the pt. see how they dress, and to the rest of the family members looks like, how low the socio economic they are, we just simply close one eye and send the necessary blood without payment.

more big issue when they need admission. for medical based they hv to pay deposit around rm1200 i think, and surgical based, rm2800. and it cost a lot more if admitted to icu.

so.
example if pt non local came in with mva (motor vehicle accident). for registration rm100. xray; cervical rm40, cxr rm40, pelvic rm40. if needed t&s rm300. if they dont hv money pt will stranded in dept for quite sometime, because we cannot discharge and cannot proceed with xray as xray need payment receipt before they will proceed.

chicken egg dilemma.
2pts impending respiratory distress. one local and another one not. and the non local one has worse condition. only one ventilator available. very limited bed available in ward and icu as level. and non local has financial issue as well. which one to intubate?

i lost count number of pts i extubate in the car as they couldnt afford admission after initial treatment given.

and  for peads cases too. somehow i think most of the non local rarely go to hospital unless they're seriously ill. we saw worse of the worse peads cases ever. peads pt with hb1, single digit hc03. and somehow they came with a chronic compensation. i dont know how they survived. thts y they said, these people hv 7 lives. their survival rate is very high.
we intubate peads pt almost every other day here. i kid you not.

just now i encounter one pt. young gentleman. alleged assaulted. sustained deep laceration wound on volar aspect near the wrist with tendon and vein cut. the wound was quite deep. funny thing, (not so funny) pt was assaulted by a cousin dt financial issue. they fought because of rm20. so pt came in afternoon around 4pm then refer to ortho team, medical advice given to admitted to repair in ot yada yada.. family members undecisive, try to find money 1st they said. untill midnight! only they give the decision. want aor discharge. the best ortho team can offer just for t&s under sedation in resus as they couldnt afford to be admitted. how much our PSA can last long, so ortho team just salvage whtver they could.
i feel bad to the pt. because of rm20. which i think is really meant a lot to him. made him fought for it. made him almost lost his hand because of it.

for some people kfc is like a normal meal, but for others it is a luxury food.
:'(

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