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1. Your name, matric number, date

Jeslynn Koh Hui Yi A182066 7/8/2023-13/8/2023

2. How is your progress?

I flew in to Singapore few days earlier from my exact elective posting date to settle down, get myself ready and familiarise with the surroundings and also to travel around with my sister. What a coincidence that the National Day of Singapore falls on that week as well! I was lucky enough to be able to witness their National Day Parade Fireworks show. My family and I went a few touristy spots such as Marina Bay Sand, Merlion and also Gardens by the Bay for picnic.

I went to meet up with my Singaporean friend that I got to know from an AMSA conference in Taiwan I attended a month ago. She brought me around the Lee Kong Chian School of Medicine NTU campus for a tour. I was truly captivated and amazed by the campus’s stunning and modern design, which seamlessly blends artistry. The facilities were all well-maintained making the overall environment very conducive for studying. They have a student lounge in the block and it has a gym, snooker table, ping pong set up and also rooms for houses where they can have a short nap or store their items in that room.

(14/8/2023)

On my first day of elective, Ms Fion (an admin from Education Development Office) who is in charge of clinical students affairs met me infant of the gantry at Tower E of Yishun Community Hospital located beside KTPH. She brought me to the conference room for a short briefing, passed me the access card and brought me around for a tour of the Hospital. I was then joined a group of NUS students for a scrubbing briefing in the main OT meeting room. We were asked to demonstrate how to wear the sterile gown and gloves one by one. After that, Ms Fion conducted a mask fitting session for me because the mask I was fitted back in UKM is not available in Singapore. At the same time, I contacted my supervisor , a HPB consultant Dr Wang Yi Liang for a meet up, and he told me to come over to the clinic at 2pm. I went to explore around the hospitals and had my lunch, then go over to the clinic at 2pm. Dr Wang have not arrive to the clinic at that time so I went to attach with one of the MOs which is Dr Sheryl for the entire afternoon clinic until around 5pm. Dr Wang came in between and we were just able to had a short conversation with each other.

(15/8/2023)

The next morning, I arrived to the Hospital around 6.30am to meet with the NUS students who was attached to the same team as me to go through the patient list before ward rounds. Eventually on that day, they had an hour talk on the update on the surgical education in UK through the ‘Improved Surgical Training’ Programme given by a consultant from Leeds University Hospital in UK. So the ward round on that day was slightly delayed until 9am. After the ward rounds, I followed the consultants and HOs for a coffee round at the cafe and there’s when I found out that they have a culture of ordering drinks after ward rounds which the consultant will belanja, then during coffee rounds they will go through the patient lists on the plans for the day or to discuss further plans. After that, the senior consultant Dr Tan Tzu-Jen offered me to follow him to the endoscopy room to observe OGDS. I met Dr Praj, the registrar of the team in the room and she taught me a few things during the scope. After that, I followed her to a Tumour board meeting where they discuss cancer cases through zoom meetings similar to our Radiology conference in UKM. I’m always very curious on how on call is like in the hospital, therefore I offered myself to attach to Dr Praj for on call that night. Right after the tumour board meeting, I shadowed Dr Praj for pm clinic and continued on call for the night and went back home at 12am. During the on call, I got the opportunity to observe an emergency laparoscopic cholecystectomy surgery and appendectomy surgery.

(16/8/2023)

It was so dead for me to wake up at 5am in the morning after a 3 hours sleep after the on call. Fortunately, I still managed to catch up with the rounds at 7.30am. After the coffee rounds, I was brought to the OT and join 3 Laparoscopic Cholecystectomy surgeries. They offered me the opportunity to scrub in however I quite afraid for it because I’m not very familiar with scrub in as this is my first time and I’m really afraid I might do silly mistakes in the OT which eventually I really did. >< for that day I scrubbed in and observed 2 OTs.

Around 5pm, although the 3rd surgery haven’t ended, but I can’t take it from the tiredness caused by sleep deprivation. I excused myself from the OT and go back home earlier to rest.

(17/8/2023)

Same routine as usual, morning ward rounds and coffee rounds at 7.30am. I had the opportunity to assist in Laparoscopic Cholecystectomy today due to lack of manpower in the Day Surgery OT. I was so so nervous at that time, but I’m so glad that a very kind and nice MO, Dr Yuki is willing to teach me subcuticular suture step by step and let me try it on the patient. So the OT ended early that day, and we had a lunch together outside and Dr Praj paid for the meal.

(18/8/2023)

It’s my last day in HPB team! As usual I followed Ward rounds in the morning and coffee round, then I asked to take a  picture together with everyone in the team. After ward rounds, I went to a tutorial class for HOs with the NUS students and we attended the session and eventually they provided us lunch as well. NGL the pizza is so good, really miss the taste now.

3. Points to remember from week 2!

Always be alert to your surroundings especially towards patient with the contact precaution sign and be prepared before going to ward rounds, at least have a basic idea on the patient that during rounds

Never be afraid to ask questions, towards consultant, doctors and even medical students. Ask for help whenever you need to

Knows your weakness and push yourself more to be a  knowledge equipped personnel and be attentive to your patient progression to practice as a safe doctor

4. Your feelings & thoughts

Being honest, I was really very afraid of the senior consultant for that whole week although he don’t really scold people and he always willing to teach, however sometimes his comment can be very sarcastic when he is unhappy with something. I realised myself being quite oblivious with sarcasm so it’s quite a culture shock for me.

5. ONE good thing from what you did that you can practice now!

I should start practicing my suturing skills from now, if one day I really decided to pursue my career to become a surgeon and also to equipped myself with knowledge (study harder)

6. Any difficulties/concerns? How did you cope?

Throughout my first week, especially right after the on call night, I felt super fatigue to wake up early morning to the hospital for rounds everyday. I was feeling a bit back out as well when I kept making silly mistakes in the wards which I was supposed to know but I have no idea what happen to me at a that point of time. For example, forgot to wear PPE before approaching contact precaution labelled patient. All these minor minor mistakes I made has created a barrier in me to approach the senior consultant or attach to anyone of them because I’m afraid I might trigger them or cause any inconvinience to them in someway. I became really self conscious on how others think of me, as I am indirectly carrying the reputation of UKM or maybe Malaysia, so will they be thinking the students from Malaysia are clumsy or not that smart as me. All these thoughts just came in to my mind and I was getting really stressed out. I told my concerns and problems to my friends that I was getting really depressed during this elective maybe due to the high expectation I set for myself. My friends comforted me that electives are not meant to be stressed out and I should be grabbing this opportunity to have fun instead. This sentence just clicks my mind and it calms me down a lot.

7. Your plan for next week (Week 3)

1. Entering new team which is Endocrine and Breast

2. Contact the NUS friend who attached to the EnB team and  study on ward round patient next Monday morning

3. Make new friends with people from different country who are doing electives in Singapore but in different hospitals

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Chapter 2: Launching My Elective at SNUH

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Chapter 2: Launching My Elective at SNUH

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1. Your name, matric number, date

Name: Tan Zi Yee

Matric number: A181429
Date: Week 2 (07.08.2023 - 13.08.2023)

2. How is your progress?

My first week of elective at Seoul National University Hospital (SNUH) has been a transformative experience. It was a week filled with both opportunities and unexpected challenges. I began with a mix of nervousness and excitement, uncertain about how I would navigate a foreign medical environment and overcome language barriers. The language barrier, while challenging, pushed me to adapt and utilize digital resources to access vital patient information.

Despite the challenges, I discovered the warmth of the SNUH community, formed meaningful friendships with fellow students from around the world, and gained cultural insights that enriched my journey. I am grateful for the trust and opportunities extended to me by my supervisor and colleagues at SNUH. This week has been a foundation for my elective journey, and I look forward to the weeks ahead.

07.08.2023 [Monday]

My first day at Seoul National University Hospital (SNUH) began with a 7 am surgery department meeting. I felt a mix of nerves and excitement as the only student present. To my surprise, I was called on stage for a prizing ceremony, where I felt welcomed. I met my supervisor, Prof. SeungBum Ryoo, and explored the colorectal office with Dr. Jae-Sung Park. Dr. Park Jae Hyun guided me through surgical preparations.

Much to my amazement, I was even given the chance to assist in a right hemicolectomy, my first taste of surgery with a 3D scope. After surgery, Dr. Park treated me to lunch in the operation theatre's cafeteria. Later, I observed a robotic surgery, a fascinating experience even though I didn't participate. It was a tiring but rewarding day, followed by dinner and laughter with fellow elective students from around the world.

08.08.2023 [Tuesday]

My second day of elective began at 8 am and was filled with opportunities to observe and assist in surgeries. While it may not have seemed extraordinary, I am grateful for the knowledge shared by Professors and Doctors. A highlight was watching exclusive teaching videos shared by Prof. Park Kyu Joo, the Chief of the colorectal surgery department.

I wrapped up my day early at 4.30pm, leaving me with the chance to explore the SNUH museum and delve into the hospital’s history. I also took a leisurely spin around the hospital compound, gaining a better understanding of its layout and facilities.

09.08.2023 [Wednesday]

Starting at 9:30 am, the day was dedicated to observing colonoscopy procedures. The doctors and nurses were not only skilled but also kind and friendly. They patiently explained their findings, detailed the procedure steps, and even taught me how to track the scope’s location.

I also met with Prof. Ryoo, my supervisor, who assigned me a case presentation task for my last day of elective. The next day, I was asked to join a surgery related to my presentation, which was both exciting and nerve-wracking due to language barriers and unfamiliar surroundings. Still, I trusted Prof. Ryoo's confidence in me and was prepared to tackle these challenges head-on.

10.08.2023 [Thursday]

Amidst the chaos of Typhoon Khanun, I embarked on what turned out to be an exceptionally long day at 7:30 am. Despite the relentless rain and strong winds, I was committed to my schedule, which included observing my supervisor's surgeries. One of these surgeries would serve as the basis for my upcoming case presentation.

I remained in the operation theatre from the beginning, observing two surgeries until around 1:00 pm. A quick 15-minute lunch break with my supervisor was graciously treated. The afternoon brought more surgeries until 6:00 pm, where I had the privilege of assisting. I also met my patient, Mr. Kim, during his surgery, scheduled for a left hemicolectomy due to distal descending colon cancer (T3N+). As the surgery concluded, I brought my day to a close. The strong winds of Typhoon Khanun prompted me to make a hasty retreat to my accommodation.

11.08.2023 [Friday]

My last day of the first week began at 7 am with two conferences that stretched until 9:30 am. Following this, I joined my supervisor for clinical attachments. I marveled at the efficiency as we attended to over 40 patients in just two hours. My supervisor patiently shared their treatment approaches and explained the best course of action for various cases.

During lunch, I seized the opportunity to log into the hospital system and meticulously retrieve and organize my patient’s crucial information since language constraints prevented physical clerking and examination.

I participated in a ward round. The day concluded at 5:00 pm, marking the end of a week filled with valuable learning and observation.

12.08.2023 & 13.08.2023 [Saturday&Sunday]

After an intense week at SNUH, I welcomed the weekend with Wen Jia. Our adventure began at the Hyundai department store, a shopper’s paradise where we indulged in fashion and beauty products. Next, we sought tranquility along the Han River’s picturesque banks. The serene promenade provided a peaceful contrast to the hospital’s fast-paced environment, allowing us to recharge our spirits.

The highlight of our weekend was Lotte World, an exhilarating amusement park. We laughed and cherished every moment. It was a joyful escape from the week’s challenges.  Our weekend in Seoul was a perfect blend of shopping, relaxation, and thrilling adventures. It was indeed an amazing weekend. While enjoying the weekend, I never forgot to allocate some time to work on my upcoming case presentation too!

3. Points to remember from week 2!

-Language

Overcoming the language barrier emerged as a significant challenge during my first week. To enhance communication with medical staff, I explored language apps and relied on non-verbal cues like gestures.

-Appreciate all opportunities given

Actively embracing challenges and learning from them. Recognizing the fact that each obstacle is a chance for growth. Paying attention to guidance from supervisor and colleagues is the key.

4. Your feelings & thoughts

In reflecting on my first week of elective, I found it to be quite challenging, primarily due to the unexpected case presentation that tested my adaptability. However, this challenge brought me excitement, as it pushed me to learn and grow. I am sincerely grateful for the hands-on opportunities I received in surgical procedures, which enriched my experience. As challenging as this week was, it left me eager for what lies ahead in my elective journey.

5. ONE good thing from what you did that you can practice now!

Adaptability. Facing unexpected challenges such as the sudden case presentation, forced me to think on my feet and adapt to unfamiliar situations, especially when all the information was presented in Korean. I had to translate it into English before starting to work on my case, which added to my workload. This newfound ability to adapt will serve me well in my medical career, as the healthcare field often presents dynamic and unpredictable scenarios that require quick thinking and flexibility.

6. Any difficulties/concerns? How did you cope?

The significant difficulty I encountered was the need to compare the colorectal cancer screening systems in Malaysia and Korea, a request made by my supervisor for my upcoming case presentation. This required me to dive into multiple Korean research papers to gain insights into Korea’s screening system. The difficulty arose from the fact that these research papers were solely in Korean, which meant I had to invest extra time and effort to translate them before commencing work on my presentation slides. This translation process was quite time-consuming, and I had to put in substantial effort. Given the limited timeframe, preparing the entire presentation was a formidable task. To cope with this challenge, I adopted strategy of careful time management and planning, allowing me to effectively balance my workload while ensuring I had some leisure time for myself.

7. Your plan for next week (Week 3)

I intend to continue seizing all the hands-on opportunities offered during surgeries. Additionally, I’m committed to being more proactive in asking questions and seeking guidance. Active engagement with my colleagues and supervisors will help deepen my understanding and knowledge. A significant part of my week will be dedicated to preparing my case presentation. I also plan to continue exploring the wonders of Seoul during my free time. This beautiful city has much to offer in terms of culture and history and I intend to make the most of my elective experience both inside and outside the hospital.

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Embracing Challenges and Learning Opportunities: The Second Week of Volunteering in Nepal

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Embracing Challenges and Learning Opportunities: The Second Week of Volunteering in Nepal

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Your name, matric number, date

Sarvisuwaran Ravi, A181777, 6/8-13/8

1.     What have you done.

My flight was scheduled at 8 pm and I reached a few hours earlier to get my luggage and immigration clearance sorted out smoothly. Flight took of at 8.00 pm and landed 5 hours later at Tribhuvan International airport, Nepal. We got our simcard and some money exchanged in the airport itself. We were greeted by the local IVHQ staff, and was transferred to our hotel. At the hotel, we were briefed with our schedule for the next day. Then, everyone went to their respective rooms to get some rest. Since it was my first day in Nepal, I went out to experience local night life and some local foods. I didn’t get to see much as it was close to midnight and most shops were closed,

The next day, we were briefed about our programme, our schedule for the next 2 weeks and our accommodation for the rest of the trip. After the orientation, we visited Swayambunath Stupa (Monkey Temple) in Kathmandu as part of our small tour session. End.

Next day, we woke up early at 6 and got ready to be transferred to Pokhara via bus. The hotel staff were kind enough to provide packed breakfast as it is too early to provide breakfast buffet for us. The bus departs exactly at 7 and the entire journey of approximately 250kms took us 14 hours to complete it. The road was bad with multiple constructions going on throughout the journey making the ride very bumpy throughout the journey. Sadly, we didn’t get to enjoy the beautiful landscape of Nepal during the journey as it was raining the whole day. The clouds covering the mountain range and dark sky disrupts our view. We reached Pokhara around 9 p.m. local time and were greeted by Mr Dharma, who will be hosting us for the next 2 weeks. Once we reached his home, we were shown our respective rooms, and he gave us some light dinner.

Our days starts at 7 in the morning with breakfast bring provided by the host. On our first day, we were briefed with our respective postings and and were guided on how to get to the hospital. Normally they journey from the homestay to the hospital takes approximately 30 mins but as days goes by the time reduces. On my first week, I was posted to the surgery department. I was shocked when I saw their operating rooms for the first time. It was completely different compared to Malaysia. Everything was so chaotic in that small space. Their rooms were only equipped with basic electronic equipments probably with no backups available.

For the past week, I watched different types of surgeries carried out by different departments. All the surgeries went smoothly with positive outcome. Their equipments might be different but their techniques were almost the same compared to our country. During the weekend , we planned some outdoor activites to create a memorable experience during this trip. Our first activity was ATV riding to the peak of a hill. It was fun as it started raining heavily halfway and it did really turn into an adventurous activity for us. Next day, we went for paragliding and It was definitely a memorable experience. Taking photos and videos while flying high above is definitely something that I might not in my country anytime soon

2.     Points to Remember

-        Try to step outside of our comfort zone and explore more activities. Nepal is vastly known for its nature and adrenaline seeking outdoor activities. Leaving Nepal without exploring these activites might be a sin.

-        Always be aware of your surrounding. Chaotic situations in operating theatre might cause some unnecesary things to happen. Always be aware of whats around you and do not touch all the surgical equipment without gloves as it might contaminate them

3.     Feelings and Thoughts

-        Happy, get to watch multiple surgeries which I might be able to watch only in Year 4 at my local Uni. Completed my bucket list on the adventurous things to do in Nepal.

-        Amazed with their hospitality. Majority of them gave us a warm welcome

4.     One good things you did that you can practice now

-        Namaste. Welcome in Nepali lannguage

5.     Any difficulties/concers? How did you cope

-        Long journey from homestay to hospital. Talk with friends througout the journey and the journey seems much more shorter and elss tiring

-        Language barrier with staff and patients. Approaced english speaking Drs mostly and those who can translate what the patient is telling

6.     Plan for next week ( Week 3 )

-        Next posting : EMED

-        More adventurous activites

-        Local sightings

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1. Your name, matric number and date

Name: Richard Sim Jian Cheng
Matric number: A179778
Date: 07/08/2023(Mon) - 13/08/2023 (Sun)

2. How is your progress?

07/08/2023 - 11/08/2023 (Mon- Friday):

I was attached to the hepatobiliary pancreatic surgery department for week 2 of my elective posting. On the first day, I attended the department's morning conference at 7:30am and introduced myself to my supervisor and surgeons in the department. I was given a briefing on my activities for the next 2 weeks before changing into scrubs and entering the operating theater. My schedule consists of morning conference, ward rounds and observing surgeries.

During my attachment here, I  was able to observe many pancreatic tumor cases as the hepatobiliary pancreatic surgery department is famous for it. I managed to observe pancreaticoduodenectomy or also known as Whipple procedure. I learnt that this procedure is mainly done for resectable pancreatic ductal adenocarcinoma. The surgery consists of removal of antrum of stomach, part of duodenum, head of pancreas, gallbladder and common bile duct. It was a complex procedure that took a very long time to complete as the surgeon also had to reconstruct and connect the remaining portions.

Other than that, I was also lucky enough to observed robotics surgery using the Da Vinci Surgical Systems for the first time. The surgery was done to remove a pancreatic cyst for further evaluation in a young female patient. I was told that Da Vinci surgery was done as it would cause very little scarring and would take a shorter time to heal. Also, it would help with her confidence as the scars are not big and obvious. It was amazing seeing the robotic arms move controlled by a surgeon using a computer. The electrosurgical knife is able to move 360 degrees compared to a normal electrosurgical knife which cannot move at all.

Besides that, I also had the opportunity to participate in the ward rounds. During ward rounds, the surgeons make sure that the post operative patients are feeling alright and will take note of any problems that the patients are having. One interesting thing I saw is that the surgeons will always take the time to explain everything about the surgery that the patient will undergo and take time to address each of the patient's concerns.

11/08/2023 - 13/08/2023 ( Fri - Sun):

During the weekend, I had the opportunity to meet up with the other participants of the program who are attached to different departments. I met some students from Germany, Paris, Hungary and Dublin. It was interesting as we shared the similarities and differences between the medical programs in different countries. I was surprised to learn that year 4 medical students in Paris are allowed to do suturing on real patients during their on calls. I also learnt that clinical year medical students in Dublin are expected to perform as well as  a houseman.

Besides that,  I  spent a lot of time exploring places that piqued my interest. such as the Tokyo National Museum, Tokyo Sea Life Aquarium, and the Imperial Palace East Gardens. I also had the opportunity to enjoy the fireworks festival in Sumida River. Though fun, it was also quite tiring as I walked almost everywhere.

3. Points to remember from week 2!

- Patience and empathy is very important to become a good doctor
- Having friends from different nationalities can help broaden ones perspective
- Don't have to always wait for someone to invite you out, you can also do the inviting
- A good work-life balance can ensure a healthy life and make sure you don't burnout

4. Your feelings & thoughts

I was feeling more confident as I gradually adapt to my new environment. As such, I more proactive and ask questions instead of waiting for someone to explain it to me when I do not understand certain things.

I also felt very excited as I saw Da Vinci surgery for the first time in my life. At the same time, I felt grateful for the doctors who patiently explained and made sure I understand the procedure even though their command of English is limited.

5. ONE good thing from what you did that you can practice now!

One good thing I did is become more proactive. I tend to ask more questions and  also invite my fellow participants of the program for dinner and to have fun together. I feel like being proactive is important as we cannot always wait for opportunity to come by and instead chase after it

6. Any difficulties/concerns? How did you cope?

The main difficulty I faced was still the language barrier. During morning conferences and ward rounds, the professors and doctors usually spoke in Japanese and though, I have a rough idea of what is happening, I do not understand it thoroughly. To cope with this, I would ask my supervisor about it after the ward round/conference.

7. Your plan for next week (Week 3)

- Continue to explore more interesting places in Tokyo
- Observe more surgeries next week
- Try and make some local friends

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Week 2: Beginning of my Visiting Clerkship in Breast Department 

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Week 2: Beginning of my Visiting Clerkship in Breast Department 

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1. Your name, matric number, date
Ng Wen Jia, A180860, 7/8/2023-13/8/2023

2. How is your progress?

7th August 2023 (Monday) - First Day at SNU

Dr. Beon Jin-Young, a first-year clinical fellow in the Breast department, guided me for the first week. We met at the hospital's main entrance, where I greeted her and introduced myself in Korean and that surprised her. She then took me to the conference hall where I attended two morning conferences. Although they were conducted in Korean, I could only grasp partial information. Dr. Beon noticed this and kindly explained everything, addressing my doubts. Later, Prof. Lee Han-Byoel welcomed me with an iced latte as a warm gesture. After the conferences, I concluded the day since Monday was primarily dedicated to doctors' research which did not involve me. Thus, I explored SNUH and visited its museum documenting the hospital's history and observed antique medical equipment. I also visited Naksan Park, the Ehwa Mural Village, Gangnam and Nonhyeon areas and met new friends from the orientation for dinner in the evening at Itaewon. We shared experiences and learned about healthcare and medical education systems in each other's countries.

8th August 2023 (Tuesday) - First time in SNUH's operation rooms

Excitement and nervousness filled me on my first day in the operation rooms. Before entering, everyone had to change into provided scrubs. A locker was assigned to me for the two weeks of my clerkship. The changing room resembled the one in HUKM. Dr. Jin-young guided me to the operation room complex, which was vast and easy to get lost in. The operation rooms and equipment appeared modern and new, resembling scenes from a medical drama. I observed five breast-conserving surgeries, involving wide excision with sentinel lymph node biopsy and total mastectomy. While one surgery was swift, taking about an hour on average, I spent the entire day observing. It was exhausting, but after class, I seized the chance to revisit the Naksan Park with my friend Zi Yee and we enjoyed the evening with a sunset view of Seoul and Namsan Tower from the hill's peak.

9th August 2023 (Wednesday)

Another busy day in the operation rooms began. I observed a total mastectomy, skin-sparing mastectomy, and more breast-conserving surgeries. I also briefly watched a plastic surgery procedure, where breast reconstruction followed skin-sparing mastectomy. I had the opportunity to meet Ju-hyun, a fifth-year student from SNU doing her first clinical rotation in surgery. Her presence was a stroke of luck as she helped bridge the language gaps. Afterward, I met Zi Yee, and we went to Myeongdong for dinner and shopping, ending the day on a high note.

10th August 2023 (Thursday) - Typhoon

I began to feel at home in Seoul and it was another day filled with surgeries. Dr. Ji-Jung, a second-year clinical fellow, guided me, and her fluency in English was a blessing. Unlike previous days, she allowed me to scrub in and assist Prof. Han Woo-Shik in the operation room. At first, I was taken aback and slightly panicked. Dr. Jung's encouragement and guidance, along with the assistance from the nurses, helped me overcome the initial confusion. I decided to embrace the challenge and took my place in the surgery. It was my first time scrubbing in and assisting, and though I held retractors, there was an art to it. Prof. Han and Dr. Jung patiently guided me throughout the surgery. This experience was unforgettable, allowing me to stand close to the patient, feel the real fat and muscle tissues, and assist in surgeries for the entire day. It was a memorable opportunity, and I was grateful for not giving up. Afterward, I headed straight home as a typhoon brought continuous and heavy rain to Seoul. I picked up some food from a convenience store for dinner, opting to rest early.

11th August 2023 - Last day in Breast Team

My final day observing breast surgeries began with a robotic surgery conducted by Prof. Lee. Interacting with Prof. Lee was enjoyable as he showed genuine concern, inquired about my experiences throughout the week and also asked questions about healthcare in Malaysia and the differences between South Korea and Malaysia. He also shared stories to me and demonstrated an easier and energy-saving way to hold retractors. This was also my first time observing a robotic surgery where the incision was small but to me, the procedures looked complex. Regrettably, I didn't take a photo with him to remember the moment. After class, Zi Yee and I visited Gwang-Jang Market for dinner and sightseeing, exploring the famous traditional market, which had been featured in numerous TV programs and offered a wide array of food, clothing, souvenirs, seafood, fresh produce, and more.

12th-13th August 2023 (Saturday and Sunday) - Shop, Eat, Play

On Saturday, we ventured to The Hyundai department store in Yeuido for some shopping and picked up souvenirs for our friends and family. Taking a cue from the local youth, we indulged in a quintessential Korean experience by purchasing ramen, fried chicken, and beer from the nearby 7-Eleven. We savored our dinner at Han-gang Park, relishing the cool breeze and picturesque views while indulging in our meal. It felt like stepping into a scene from a K-drama.

The following day, we embarked on a visit to Lotte World, a themed park in Seoul. We decided to embrace the experience fully by renting high school uniforms and adding cute hairbands to our attire. The park had elements of both Genting Theme Park and Disneyland, featuring a castle and unique, self-invented characters. While we did face long queues due to it being a weekend and the summer holidays, we managed to capture many memorable photos.

3. Points to remember from week 2!

Believe in Yourself: I've learned the importance of self-belief. Inner motivation has played a significant role in my journey. Embracing challenges without fear and believing in my capabilities has made a significant difference.

Confidence and Socializing: I've found joy in interacting with students from various countries. Learning about different cultures and educational systems within the medical field has been eye-opening. Building connections with them has added depth and happiness to my visiting clerkship .

4. Your feelings and thoughts
Entering the operating rooms and having the chance to observe and even assist in surgeries was exhilarating. Witnessing the speed, precision, and efficiency of the professors' surgical skills was awe-inspiring. While I initially considered this the norm, I now understand the level of dedication and practice required to achieve such perfection. This experience has deepened my interest in pursuing a career in surgery.

I'm grateful for the guidance and opportunities provided by the professors and clinical fellows. Being in close proximity to patients, assisting in surgeries, and touching patients for the first time left an indelible mark on me. It enhanced the meaning of my visiting clerkship and ignited my passion for becoming a surgeon in the future.

I'm also appreciative of the friendships I've forged with students from different countries. While we may not cross paths again, I cherish the connections we've made, enhancing the overall richness of my stay at SNUH.

5. ONE good thing from what you did that you can practice now!
My experience has made me more comfortable in operating rooms and observing surgeries. Initially, I found surgeries intimidating, but now I'm no longer hesitant to enter the operating room. This exposure has shown me that fear can be conquered through familiarity. In the future, I intend to be more proactive in operating theatres and will seek opportunities to assist in surgeries.

6. Any difficulties/concerns? How did you cope?
We faced a typhoon with heavy rain and strong winds during our stay. Initially concerned due to my lack of experience with typhoons, I found that the situation was somewhat similar to heavy rainfall in Malaysia. We received frequent public alerts from the government that advised us to be prepared. Seeking advice from doctors and friends who had experienced typhoons reassured me. Staying indoors and stocking up on food helped mitigate any potential risks.

Additionally, there were three stabbing incidents in late July and early August which involving random attacks on strangers. I followed local news closely, as there were online threats as well. Although I couldn't avoid going out entirely, I remained vigilant, avoided crowded areas, and paid attention to my surroundings. While it was a concerning time, observing locals continuing their routines offered some reassurance. Fortunately, the situation was brought under control as the perpetrators and those making online threats were apprehended. While I couldn't do much, being cautious was my primary response.

7. Your plan for next week (Week 3)
It would be my last week in SNUH and I would be rotating in endocrine department. I hope that I can gain more knowledge about endocrine and would be able to have more chances to assist in the surgeries!

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1. Your name, matric number, date

Nahgeshwarie A/P Ratha Manaalan
A182267
6/08/2023 - 13/08/2023

2. How is your progress?

We arrived at Tribhuvan International airport around 11.50pm. It took approximately 4 hours 45 minutes to reach Nepal. Nepal is 2 hours 15 mins behind Malaysia time. So personally I had jet lag. After arriving at the airport we exchanged money at the first money exchanger we saw at the airport with good exchange rates. We proceeded to buy sim cards and collected our luggage. Representative from IVHQ came to pick us up from the airport. As it was quite late, we went to our hotel and checked-in. After receiving our keys we went to our respective rooms and call it a night.

The next day we woke up around 8am for the briefing. During the briefing we were able to communicate with other volunteers from all over the world including United Kingdom, Japan, Norway, Australia and many more. I was fascinated all the programs everyone were involving such as elephant sanctuary, teaching kids and helping women in rural areas. After the short briefing on our medical elective we were given a short tour around Kathmandu. We went to Swayabunanth which is also known as monkey temple. We were able to withness the view of the city from the top. we were given masala chai as a sign of hospitality. We slept early that night because the next day we need to travel to Pokhara early in the morning.

The next day we took the early bus to Pokhara. It took approximately 14 hours to reach Pokhara from Kathmandu. The bus ride was extended to 14 hours because there were 2 landslides on our way which took quite sometime to clear everything. Furthermore the path to Pokhara was extremely bumpy. Upon reaching Pokhara bus station, our homestay person Mr. Dharma picked us up from there to his home. We were warmly welcomed by the host family. They applied tikka (a red powder) on our forehead as a sign of hospitality. There were 2 more people before us whom were named Martha and Mathew. Martha is a medical student while Mathew is a nursing student. They were very friendly and were kindly answering all our questions for the next day briefing at the hospital.

The next day we walked to Gandaki medical college as it was near to our homestay. The medical assistant conducted the orientation. We were introduced to the departments such as internal medicine department, surgical department, outpatient clinic, pharmacies and emergency department. We went to the wards and saw the patients and had a rough idea on how the medical system works there.

First I was posted in the emergency department. I got to do many hands-on basic procedures on patients. When I was inserting branula into a patient, the nurse in the ED guided us in each step. My first attempt in putting branula was not successful but when I was doing for the third and fourth time, I felt little more confident. Not only inserting branula, I have also take blood, perform ECG and insert catheter inside a patient. One of the days in the triage, Dr Tarun Patel, our superviser in Gandaki medical college was teaching us on what the procedures that we should learn before medical school ends and was asking a few medical related questions to help us gain knowledge. In addition, I took note of the medication they were giving patients in the triage. I was fascinated by that because there were some drugs that I did not hear before. There was an another medical officer in the triage called Dr Ashmitha. She was guiding us on how to interpret the case file, how to interpret bone scan and was very welcoming in teaching us. We also learned how to check manual blood pressure correctly, as the hospital do not blood pressure machine. The doctors were very kind and was teaching a few techniques that might sharpen our skills in taking blood pressure manually.

During our stay at Pokhara it was one of our friends birthday and we celebrated his birthday during dinner. As for the weekends, We indulge ourselves with some adventurous activities such as ATV rides and paragliding. Looking at ATV ride, when we were going up the hill which was part of our track, it started to rain. Everyone was drenched in the rain. Despite everything it was a very unique and exhilarating experience which I enjoyed throughout. As for paragliding, I was so thrilled to go on air. Some of my friends including me were very nervous about this. My guide named Shankar was a well trained and has 19 years experience in their field. Thereby, he was reassuring me that everything will be fine. Once I was on the air I enjoyed the view around me and was taking pictures. When we were involving ourselves in the adventurous activities I felt excited and enlighten.

3. Points to remember from week 2!

- I learned that I should not be hesitant to seek help from others. I realize that if I am hesitant, I cannot learn to many things. This does not only applies in Nepal but it can used throughout my life. Since I pulled myself out from my comfort zone I was able to accomplish lots of things

- I realized that adapting to new environment is quite important as it allows to learn more about the community and engage with many people.  As well as it allows us to appreciate more about the cultures and customs in different countries.
4. Your feelings & thoughts

It was dishearten to witness that there was shortage of medical equipment in the hospitals. The guardians of the patients must buy the equipment for their loved ones in order to any sort of procedures such as branula insertion, blood taking and donning gloves.

At the same time I was grateful for being able to do many hand-on procedure like branula insertion, blood taking, urinary catheter insertion, measuring manual blood pressure and interpretating x-rays. We were able to observe many different emergency cases in triage which were hyperemesis gravidarum, syphilis, bone fracture, acute myocardial infarction, urinary tract infection, dengue fever, pneumonia and many more. I was very grateful that Dr Asthmita was able to explain to us more about the management and investigation for each patient which is going to be a very valuable lesson in medical school learnings.

5. ONE good thing from what you did that you can practice now!

The one good thing that I can practice now is that I have learned that I should talk more with others and should not be afraid in seeking help. Before this I had this fear in myself that if I ask help people might judge me but it took me so much time to actually realize that there no point in overthinking about this case. The only thing that matters about this is what are you going to learn at the end of the day. I am truly very grateful that after coming Nepal I got to realize this in depth.

6. Any difficulties/concerns? How did you cope?

The main issue I found little challenging was the language barrier. Even if I learned a few words in Nepali and Hindi language, I was still quite blur when the patient converse with me in their native language. There were some very kind nurse who were translating what are the patient was saying to me in English. By the end of the emergency posting I was able to catch a few words in Nepali due to the frequent encounter in the triage.

7. Your plan for next week (Week 3)

I am excited to join the surgical department as my second posting as I heard my friends currently in surgical posting were mentioned about the surgical procedures that they get to observes. Not only that, my roommate Martha whom is doing her medical posting here for an month was showing all sort of interesting pictures in the OT which made me feel very excited to enter surgical department

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My First Week of Clinical Elective Posting in Japan

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My First Week of Clinical Elective Posting in Japan

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1. Your name, matric number, date

Name: Tan Xin Yee

Matric Number: A182195

Date: 24/7/2023 – 30/7/2023

2. How is your progress?

·         Monday 24.7.2023

I began my first day of the elective posting with a morning conference at 7:30 a.m. with Upper and Lower Gastrointestinal Surgery Department in Heptobiliary Pancreatic Surgery department.. After the conference, I had the opportunity to meet our supervisor, Prof. Saiura Akio. Following this, Josephine and I attended a Japanese class at the international center, which proved to be helpful and interesting. The Japanese class concluded with an orientation session during which we met new friends from the University of Malaya and Japan.

Mr. Ken provided us with nameplates, hospital access cards, international center access cards, and locker keys. We then shared lunch at a café and exchanged phone numbers. The hospital café was impressively modern, and the food offered was both delicious and reasonably priced. In the afternoon, Dr. Jun took us to the operation room and discussed the differences in surgical procedures between Japan and Malaysia. On this day, we observed the resection of a pancreatic neck tumor. The patient, previously treated with a Whipple surgery to remove the head of the pancreas, common bile duct, and duodenum due to pancreatic cancer, had returned for the resection of a pancreatic neck tumor as CA19.9 enzyme levels had risen again. This surgery lasted for four hours. Dr. Takeda Yoshinori explained the anatomical location of the spleen, the resection area, superior mesenteric artery, hepatic artery, stomach, and liver. He also detailed the procedure he performed for this patient.

·         Tuesday 25.7.2023

We attended the morning conference at 8:30 a.m. in the Hepatobiliary Pancreatic Surgery department. Following the conference, we entered the operation room and had the privilege of observing a surgery for a patient with hepatocellular cancer from start to finish. Dr. Mise Yoshihiro led this surgery, which involved the removal of segment III of the liver and other tumors in different segments of the liver after midline and right laparotomy.

·         Wednesday 26.7.2023

Our Wednesday morning conference began at 8:00 a.m. and concluded at 9:30 a.m. As per our routine, we proceeded to the operation room to observe the procedure. The patient of the day had an ampullary tumor. Typically, the Hepatobiliary Pancreas team performs an endoscopy to remove such tumors. However, in this particular case, the ampullary tumor was unusually large, exceeding 2 cm in size, necessitating a laparotomy. Prof. Saiura Akio connected a tube to the cystic duct and removed the common bile duct to preserve the pancreas. This operation proceeded smoothly. After lunch, we visited the stimulation lab on the 9th floor of the international center. I had the opportunity to perform laparoscopy and esophagogastroduodenoscopy (OGDS) there. The equipment provided was modern and functional, greatly exceeding my expectations. Ms. Mikida, in charge of the stimulation lab, was immensely helpful and friendly, making the experience thoroughly enjoyable.

·         Thursday 27.7.2023

The Hepatobiliary Pancreatic Surgery department had 54 patients across the 6th, 16th, and 19th floors of the ward. Following our morning conference, we joined Prof. Saiura Akio on his ward rounds. From the ward, we could admire the breathtaking Tokyo view. Juntendo University Hospital's wards are exceptionally modern, clean, spacious, offer privacy, and come with private toilets. There were also international patients in the ward.

One patient scheduled for surgery that day had been diagnosed with intraductal papillary mucinous neoplasms (IPMNs) during a medical checkup. To prevent the high likelihood of pancreatic cancer, the patient's tail of the pancreas and spleen needed removal. We were able to touch the mucinous tissue of the pancreas, allowing us to discern the difference from a normal pancreas post-operation. We also gained an appreciation for the lymph nodes and spleen. Dr. Ito Ryota explained the necessity of spleen removal due to its anatomical position and the removal of the gall bladder to reduce complications, such as cholecystitis.

In the afternoon, I had the opportunity to experience the Da Vinci simulation in the stimulation lab and gain insight into the challenges of robotic surgery.

·         Friday 28.07.2023

Our morning conference with the Hepatobiliary Pancreatic Surgery department took place at 8:30 a.m. During the conference, Dr. Kawano Fumihiro presented an operation involving cholangiocarcinoma in the liver, led by Prof. Saiura Akio. This was an exceptionally rare case as the right hepatic artery was positioned behind the pancreas. Accidentally severing the right hepatic artery could result in liver failure and hemorrhage. To mitigate this risk, Prof. Saiura used indocyanine green (ICG) dye to visualize the blood flow of the right hepatic artery. Fortunately, the common bile duct could be preserved as the tumor was benign.

3. Points to remember from week 2!

The healthcare environment in Japan is different compared to Malaysia. In Japan, medical students and healthcare workers can only contact each other using the phones supplied by the hospital. They don't use their personal phones during working hours, and they coordinate schedules using the calendar app on their hospital-issued phones. They have completely separated their work and personal life.

In the Japanese healthcare system, healthcare workers have their own access cards and elevators in the hospital. Patients and their families cannot enter other procedure rooms without permission because all access requires clearance from the cardholder.

Japanese hospitals provide clean, spacious, and modern settings for patients. Wards offer breathtaking views and are suitable for elderly patients. Each room has its own toilet, and laundry rooms are available on every floor.

4. Your feelings & thoughts

I am impressed by the students, patients, nurse staff, and doctors in Japan. Everyone is very polite and helpful. They are willing to assist and consistently demonstrate their professionalism. They refrain from casual conversations while working and are dedicated to providing the best healthcare to patients. Their attitudes inspire me to aspire to become a future doctor like them.

5. ONE good thing from what you did that you can practice now!

It's essential for us to be brave enough to ask questions. At the beginning of the elective posting, I had limited knowledge about surgical procedures and couldn't differentiate between organs during operations. Therefore, I didn't hesitate to ask questions. Professors and doctors explained things to me in great detail, contributing significantly to my learning during the elective posting. I hope to continue practicing this skill in the future.

6. Any difficulties/concerns? How did you cope?

Communication barrier: The main language in the Japanese healthcare setting is Japanese. I couldn't understand the discussions during the morning conference or what patients were complaining about during ward rounds. However, I'm grateful that all the doctors in the hepatobiliary and pancreatic surgery department were willing to help and made efforts to explain things to me in English and through drawings.

Limited knowledge: I realized that my knowledge was not strong during the elective posting. I wasn't very familiar with some of the cases I encountered in the hospital, and my understanding of the anatomy of blood vessels, pancreas, liver, gall bladder, and bile ducts was weak. To address this, I dedicated time to revise the hepatobiliary and pancreatic system when I returned to the hotel.

7. Your plan for next week (Week 3)

I'm eagerly looking forward to encountering more rare cases and observing additional procedures in the operation room during Week 3.

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Phase 2: First-week medical elective experience 

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Phase 2: First-week medical elective experience 

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1. Your name, matric number, date
Wong Yi Lyn, A179360, 14/8/23 -18/8/23

2. How is your progress?

After checking into the hospital’s dormitory, we met Dr Pan, the Director of Family Medicine, and also Dr Chew, Chief resident and they gave us an outline of the family medicine program. After that, on the orientation day, the resident, Dr. Hsiao, gave us a tour of the hospital and provided us with an update on the activities that were planned for us.

14/8 Monday - 15/8 Tuesday

For the first week of elective posting, I was given hospice care learning at the ward. The hospice ward is located on level 10 of this hospital and known as 10C.

In the morning I attended the meeting with the senior doctors and other medical staff members in the hospice ward to get an update on the patients' conditions. For instance, some of the patients experienced severe pain or shortness of breath at night, so the teams would try to understand the condition to decide whether or not to alter the medication's dosage in order to address the issue.

I also went to the ward round and observed how the doctors show concern for the patients or pay attention to their complaints. Besides observing the pre-dying state of the patients in the ward, I also learnt to communicate with them by using Hokkian language. However, most of the time they were unable to respond to my queries very well, hence I will also try to interact with their family in-depth.  Additionally, I had the opportunity to examine patients by performing digital rectal examinations under the senior doctors' supervision.

16/8 Wednesday

Other than that, I took part in the lectures offered in the ward's classes by Drs. Sun and Gao. From their teachings, I was able to gain a comprehension of the hospice care concept in the ward. There have also been moments when they have asked postgraduate juniors pertinent questions and provided in-depth explanations of the teaching that have benefited me greatly.

17/8 Thursday

In addition, I had actively participated in the conferences between the doctors and the families of the patients by assisting to record any decisions made by the patients or the advice given by the doctors after taking into account their conditions. Apart from that, I also learnt to inform the patient's family about the death with compassion. The following procedures, such as how to appropriately enter the patient's death time in their medical record and complete all necessary death-related paperwork, including the death certificate, were things I had seen done.

18/8 Friday

Under the guidance of Dr Chew, I came across the opportunity to do covid swab test on patients in an isolation ward. It was vital to take safety precautions, such as wearing protective equipment to prevent infections, and I also needed to exercise caution when administering the swab test to prevent any injury to the patients' nasal tissues and to obtain a reliable covid test result.  From his teaching, I was also able to explore some of the alternative forms of patient therapy can be applied in hospice ward such as massage therapy, aromatherapy, music therapy, guided meditation, and art therapy.

3. Points to remember:

The ways to assess the pre-dying or impending state of patients based on physical or psychological changes: For example, the physical changes include  loss of appetite, limb cyanosis, death rattle, irregular breathing, loss of pupil reflex, reduced urine, edema, and conscious disturbance. At the same time, most of the patients also may experience a range of emotions, including fear, anxiety, sadness, and acceptance of their impending death.

The importance of dyspnea management: As the patients may experience difficulty breathing in the pre-dying state, it is important to provide some interventions to alleviate respiratory distress, such as positioning the patient for comfort, administering oxygen if indicated, and using medications like opioids or benzodiazepines as appropriate.

Pain management which is a crucial aspect of end-of-life care: It is important to ensure that the patient is comfortable and pain-free. Hence, doctors should administer pain medication as needed and adjust it based on the patient's pain assessment.

Being compassionate and sensitive when delivering bad news: It is not only a moral and ethical imperative but also a fundamental aspect of providing quality, patient-centred care during one of life's most challenging moments. It acknowledges the depth of human emotions, fosters a supportive environment, and helps individuals and families navigate the grieving process with dignity and understanding.

4. Feelings and thought

I initially felt anxious about adapting to the ward since I assumed that doctors were preoccupied with the patients and I was embarrassed to ask them if I had any queries.

The doctors, however, were nice and even asked if I had any questions or needed any assistance. They were also willing to help when they saw that I was unable to understand the terminology they were using in the ward.

Hence, I felt incredibly appreciative and pleased with the assistance and guidance that I have received from the ward's doctors and seniors.

Besides, as I was also gaining new skills and adjusting well to a setting where everything is extremely unfamiliar to me, I felt more inspired to learn much from the doctors and other medical professionals.

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Phase 2: First-week medical elective experience

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Phase 2: First-week medical elective experience

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Wong Yi Lyn, A179360, 14/8/23 -18/8/23

5. One good things from what you did and you can practise now

Take greater initiative when learning and never be hesitant to ask questions when encountering any issues.

6. Difficulties, how to cope

The difficulty that I faced was the language barrier. As I was not familiar with the Hokkian language, so sometimes I was unable to understand the answers given by patients or their families. There was also some medical jargon in the Taiwan Chinese version I was unfamiliar with and initially I felt shy to ask the doctors and this has caused much trouble to me as I totally lost during the lecture. Hence, I changed my learning attitude by taking the initiative to ask bravely. Sometimes, if I felt the doctors were really busy after the lessons, I would try to search for a website by roughly pronunciation to understand the meaning. If I still failed to search, I would jotted down and asked seniors or nurses to solve my problems.

As the hospital is large and complex with the floor plan, the first few times, I was unfamiliar with the environment and hence I lost my direction to the specific ward.I was even once trapped in a hospital one evening and unable to leave.  I only realised I had entered the next paediatric hospital after finding a door leading out of this particular block. Therefore I learnt to identify a location from a map displayed on a noticeboard and also memorise the important landmarks in order to prevent the same issue from occurring. I ultimately succeeded in navigating the hospital well within a week.

7. Plan for next week

Prepare for clinic learning and case presentation

Follow the home visit to provide hospice care

Following a journey to the countryside to deliver medical services

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Phase 2: Exploring Healthcare and Culture in Taiwan

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Phase 2: Exploring Healthcare and Culture in Taiwan

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1. Your name, matric number, date
Ng Zhi Xuan, A182906, 10/8/23-16/8/23

2. How is your progress?

10/8 -13/8

Orientation

On August 10th, I and Yi Lyn met with Dr. Hsiao, the Chief Resident of the Family Medicine Department. He briefed us with detailed information about our schedules, placement sites, what to expect, and what we will be learning. He brought us to tour around the sites of Family Medicine Department in the hospital including the hospice ward, cancer screening center, physical examination clinic and outpatient clinic.

Explore the hospital surroundings

The hospital is enormous, consisting of 13 floors and one basement. We primarily explored the 2nd floor, where the Family Medicine Department is located, the 10th floor, where the Hospice Ward is situated. In the basement, there is a large food court, bakery, pharmacy, chapels, and convenience stores, among other amenities.

On the 2nd floor, near the outpatient clinic, I spotted a blind massage service station. Interestingly, their clients primarily consisted of hospital staff. Curious, I researched online and learned that 'blind massage' was introduced to Taiwan by the Japanese during the colonial era. Now, it has become an integral part of Taiwanese culture and healthcare due to its valuable therapeutic benefits, including stress relief, pain management, and relaxation.

I also discovered that being a blind masseur is a government-regulated profession in Taiwan. To practice legally, one must pass the national qualification exam for massage therapists and obtain a licensed massage therapist credential. This is the government initiatives to support the employment and integration of individuals with disabilities into the workforce. Consequently, the services of blind masseurs in Taiwan are widely popular and trusted.

14/8

Cancer Screening

Today marked the start of my elective posting in the Family Medicine Department. I was assigned to the cancer screening clinic, where my supervising doctor is Dr Hsiao. During this time, I had the opportunity to observe pap smears for cervical cancer screening and oral mucosal examinations for oral cancer screening.

Dr. Hsiao demonstrated to me the technique of holding and inserting the speculum to minimize patient discomfort during speculum placement. I also noticed that he inquired about the patient's method of child delivery before inserting the speculum, so I asked him about its significance.

He explained that the method of child delivery, whether it's vaginal or via cesarean section, can impact a woman's pelvic anatomy. For instance, a woman who previously had a vaginal delivery with a perineal tear may experience changes in her pelvic floor muscles and vaginal canal. Scar tissue from the tear could result in a slightly narrower or less flexible vaginal canal compared to before childbirth.

Therefore, understanding the patient's obstetric history can help us better navigate the speculum during insertion, possibly opting for a smaller size and taking precautions to avoid discomfort or trauma to scar tissue.

After the vaginal is dilated with a speculum, a cervical brush is used to gently scrape cells from the cervix. The cells obtained are then kept in a transport medium. He emphasized that the purpose that the purpose of the pap smear test is to detect precancerous changes and provide appropriate treatment to prevent the development of cancer.

In Taiwan, the Health Promotion Administration (HPA) subsidizes cervical smear screening for women aged 30 and older. It is recommended to undergo this screening once every three years, or individuals may choose HPV/Pap smear co-testing every five years. The government also provides free oral mucosal examinations every two years for individuals over 30 who engage in high-risk behaviors.

Regarding oral cancer screening, he told me that it is crucial to inquire about the patient's history of tobacco smoking, betel nut chewing and alcohol consumption, which are the primary risk factors for oral cancer. The oral examination primarily involves visually inspecting the oral cavity to identify any abnormalities, such as ulcers, white or red patches, lumps, or bumps.

I was impressed when the doctor shared with me the fact that Taiwan has been offering fully subsidized screenings for breast, cervical, colorectal, and oral cavity cancers since 2010. Additionally, as of July 2022, they have initiated biannual low-dose computed tomography (LDCT) lung screenings for high-risk groups. However, for lung cancer screening, candidates must meet strict criteria, including being heavy smokers or having a family history of lung cancer for better resource allocation and cost-effectiveness.

15/8

Employee Health Screening Clinic

On my second day in the Family Medicine Department, I joined an employee general health screening clinic led by Dr. Lin Yu-chien. All the patients in clinic were employees from corporations that had contracted with the hospital for health screening as part of their employee benefits. The process began with a quick review of the patient's health history and work record, followed by questions about medical history, lifestyle, and self-reported symptoms, ending with a comprehensive physical examination.

Dr. Lin explained that in Taiwan, the Labor Health Protection Regulation, based on the Occupational Safety and Health Act, mandates employers to conduct pre-employment health screenings. This regulation also outlines 12 categories of special health exams for jobs involving specific health hazards like radiation, noise, and lead exposure.

Employees aged 65 or older require yearly check-ups, those between 40 and under 65 should have a check-up every three years, and those under 40 should schedule one every five years. For workers in hazardous roles listed by the Regulation, yearly health exams are mandatory, with costs covered by the Bureau of Labor Insurance (BLI). Depend on the type of industry, different tests will be offered for the medical examinations, including blood and urine tests, EEG and chest x-ray. The purpose is to detect any abnormalities at an early stage and prevent occupational diseases. Today's session reminded me of what I learned from the Occupational Health Topic during my JKM posting.

16/8

Teaching clinic

Together with a postgraduate-year intern, I joined a teaching clinic supervised by Dr. Loke Song-seng, the Attending Physician at the Family Medicine Department. I had the opportunity to recall the topics of diabetes and hyperlipidemia, with a specific focus on lifestyle management and important considerations for drug prescriptions.

I observed Dr. Loke's interactions with patients, and I am impressed by his ability to recall almost every detail, both past and current complaints, from each patient without relying on records. This demonstrates his strong knowledge of his patients, which I believe is built upon the long-term relationships he has with them. This highlights the importance of continuity of care in family medicine.

He also takes the time to engage in small talk with his patients. I believe this habit provides him with valuable insights into his patients' overall well-being, which, in turn, contributes to a more holistic approach to his patient care.

Presentation

In the afternoon, me and Yi Lyn were assigned to give a presentation to audience consisting of doctors and postgraduate-year interns in the Family Medicine Department. My presentation covered 'A Brief Introduction to the Medical Education System in Malaysia,' followed by a presentation on 'Tourist Attractions in Penang and Malaysian Local Delicacies.'

To make it educational and promotes cultural exchange, historical sites in Georgetown such as Penang Hill, Kek Lok Si, Pinang Peranakan Mansion, and many more were mainly included in my presentation.

Throughout the presentation, I shared insights into the historical significance of each site, local delicacies, and the cultural aspects of Penang with our Taiwanese friends. I believe that by doing so, it promotes cultural exchange and foster a deeper understanding and appreciation of different cultures, at the same time encourage tourism to our country by highlighting the unique attractions and experiences Penang has to offer.

I think we both did a great job in our presentations because, in the end, our Taiwanese friends were very excited and enthusiastic, they even proposed us to organize a group tour to bring them to Malaysia!

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Phase 2: Exploring Healthcare and Culture in Taiwan

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Phase 2: Exploring Healthcare and Culture in Taiwan

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Ng Zhi Xuan, A182906, 10/8/23-16/8/23

3. Points to remember from week 2 (Phase 2)!

Small talk is an essential aspect of patient-centered care

Building rapport by engaging in friendly small talk can enhance the doctor-patient relationship and make patient feel more comfortable discussing their health concerns with the doctor.

In teaching clinic, I learnt Dr. Loke takes the time to engage in small talk with his patients which allow him to get to know their patients on a personal level, which can lead to a better understanding of their needs and preferences in patient care.

Don't be shy, just ask for help when you need it.

While navigating public transport, I often found myself confused about the locations of bus stops. I used to rely solely on Google Maps for directions, but I soon realized that asking locals for directions was often the fastest and most efficient solution.

Take the opportunity to interact with the locals while abroad.

Doing so has definitely made my journey more enjoyable, increased my cultural sensitivity, and boosted my confidence and adaptability.

4. Your feelings & thoughts

I am impressed by Taiwan’s healthcare system

Unlike many countries where healthcare access remains a privilege, Taiwan has ensured that nearly all of its residents have access to healthcare services. They do this with something called the National Health Insurance (NHI) system.

It is a comprehensive, universal healthcare program that provides medical coverage to all Taiwanese citizens and legal residents. It is funded through a combination of premiums, government subsidies, and payroll taxes.

The NHI system is awesome because it covers a lot of different healthcare services, including dental care, parturition, traditional Chinese medicine, Western medicine and preventative medicine, and patients only need to pay a small out-of-pocket expenses.

Interestingly, while the government runs the insurance scheme, Taiwan's healthcare market is predominantly driven by the private sector, and patients are free to seek medical care without restrictions.

Dr. Loke, during my clinic session, told me that there is a high level of health seeking behaviour in Taiwan, even for minor ailments. They can easily visit any clinic or hospital without needing a referral. As a result, there's a consistently high demand for hospital outpatient services, and the healthcare environment, much like what I experienced at Chang Gung Memorial Hospital every day, can be quite bustling. However, the upside is that healthcare services are usually delivered promptly, with minimal waiting times.

I feel touched by the warmth and genuine friendliness of the Taiwanese people.

In Taiwan, Mandarin is the most widely spoken, so I don't face significant issues in daily conversations. On several occasions, locals mistook me for a local and asked me for directions, only realizing I'm Malaysian when they heard my accent. Most of these encounters led to engaging small talk and cultural exchanges.

One memorable experience was meeting a middle-aged lady who asked me for directions at Weiwuying station. We happened to be heading to the same station. After some conversation, I discovered that she was a retired nurse who had previously worked at the Endocrine Department of Kaohsiung Chang Gung Memorial Hospital —the same hospital where I was doing my elective posting. She even recommended a medical-related K-drama on Netflix, which I found interesting.

Another cherished moment occurred when I met an elderly woman at a hypermarket who needed help checking the eligibility of her discount voucher. To my surprise, she generously gifted me one of her spare vouchers.

Through these experiences, I've come to appreciate the remarkable friendliness and 'human touch' of the Taiwanese people. Interacting with the locals has allowed me to deeply immerse myself in Taiwanese culture, traditions, and daily life which I found a sense of connection and meaning in my journey.

I feel proud to be a Malaysian

While I was in the cancer screening clinic, a lady, upon learning that I am Malaysian, enthusiastically expressed her admiration for Malaysians, noting that many of us are multilingual. She even shared that her boss, who runs a Traditional Chinese Medicine supplier business in Taiwan, is also Malaysian.

5. ONE good thing from what you did that you can practice now!

Step out of my comfort zone and try to interact with people around me by sharing stories and listening to theirs. I should also practice this while clerking patients in the ward, as engaging in friendly conversation can help patients feel relaxed, increase trust, and make them more open to sharing their medical concerns.

6. Any difficulties/concerns? How did you cope?

Some language barrier when dealing with local dialects and medical terminologies

While joining the clinic, most of the patients were elderly, and they only spoke and understood the Minnan dialect or Hokkien-Taiwanese Language.

Minnan is slightly similar to Penang Hokkien, which I speak, but there are significant differences in pronunciation and vocabulary. Therefore, I could understand some sentences and terms, but not all, while the doctors and patients were conversing in Minnan. To address this, I decided to learn some medical symptom terms in Minnan from my colleagues during lunchtime.

While medical education in Taiwan is conducted in Mandarin, I am not familiar with medical terminology in Mandarin. Consequently, I faced some challenges in understanding when the doctors explained medical concepts, especially when they used abbreviated terms. To overcome this, I asked them for the translated English terms. However, their English pronunciation was quite different, making it difficult for me to comprehend. As a result, I had to politely request them to spell out the characters, which was embarrassing at times.

Therefore, I decided to review their healthcare website and read some online medical articles that I believed would be relevant before attending the next class. This allowed me to become more familiar with the medical terms used in the local language, thereby minimizing language barriers during class.

7. Your plan for next week (Week 3/ Phase 3)

Next week, I am entering a hospice ward, so I decided to read about hospice and palliative care in Taiwan beforehand.

Clerk patients in the hospice ward.

Make friends with doctors and post-graduate year interns in the ward.

Explore more of Kaohsiung city.

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1. Your name, matric number, date

Lohith Selan Raja Selan, A182279, 6/8/2023-13/8/2023

2. How is your progress?

I took a grab with my friend to the airport and we reached at around 5:15 pm after rushing from college since we got our fresh haircut.As soon as we reached,I met up with all my friends and bid farewell to all the parents who had come all the way.Our flight was later that night so we checked in our luggages and we straight went looking for food as I was hungry and we ate at the gate itself.The trip to the airport in Kathmandu took about 4 hours and 30 minutes. The IVHQ organisers greeted us pleasantly and led us to our hotel after we arrived. We also enjoyed getting to know volunteers from different nations who were taking part in other programmes.

The journey was indeed a scary ride as there was turbulence along the way and thankfully we arrived safely and the first thing we did was collect our luggages and got our new SIM cards right after exchanging some money at the money changer.Once we checked in to the hotel my friend and I went to a nearby restaurant and had our first chicken momos and went to bed right after getting our tummies full.

We received orientation and an introduction to other volunteers the next day. Connecting with volunteers from different countries and learning about the programmes they had decided to take part in was really interesting. We received information about our posting and met our host family for the following three weeks during this session. We were brought to Swayambhunath, also known as the Monkey Temple, later that evening. This temple is significant in Buddhist history. Our tour guide gave us a brief overview of the temple's history and supplied us with information about Nepalese culture. We also indulged in their famous masala tea and dhal bhat, all of which were absolutely fantastic.We slept well that night because we had to get up early the next day as instructed as our bus was as early as 7 am.We asked the hotel to pack our breakfast earlier as we couldn't make it on time for their breakfast.

Our journey to Pokhara was an unexpected 14 hr journey arriving Kathmandu at around 9pm that night and we were all so famished as there wasn't any hygienic and proper food along the way.The journey was an absolute challenge with the bumpy roads and luggages falling on our heads on the bus.There were also three landslides along the journey which delayed the process even more.Finally,we reached the bus stop and our host family fetched us and welcomed us home.The host family offered us delicious Nepalese masala chai while we ate our first meal together, which served as the beginning of our introduction. . From our house, we could also see the stunning Annapurna Mountains. We had their traditional meal as our first meal which was Dhal Bhat.

The following morning, we went to the hospital's (Gandaki Medical College) orientation programme, where we were given an introduction to our various departments. A kind medical assistant showed us around the hospital and gave us useful advice on what to do and what not to do as medical volunteers.We were divided accordingly to respective departments and my first posting that I had chosen was surgical posting because I've always intended to be a surgeon one day.

Surgery department was indeed a whole different environment compared to what we see in Malaysia.The hygiene was definitely not as good but the success rates of surgery was high.The surgeons continuously would carry out surgeries back to back without a break and it was so inspiring to see all those.They also respected us as students and would teach us on what surgery is going on and whats the procedure called.We wore our own UKM scrubs proudly before entering the OT.A first year resident doctor guided us and showed us everything in the OT and we were allowed to watch any surgeries that are ongoing.

Since I always wanted to be a gynaecologist who is also a surgeon, watching my first C-Section was my biggest inspiration on how a new life is brought into the world and how the mother was handled before and after the surgery.The doctors also performed some reflexes on the baby such as the sucking reflexes and he was patiently teaching us everything.Other surgeries that I witnessed  were the laparoscopic cholecystectomy and hysterectomy,herniorraphy,open reduction and internal fixation and a hip replacement surgery.Standing and wearing the protective suits was indeed a challenge but the surgeries were too interesting to care about our legs that were getting hurt.

Afterward that end of the week, we chosen to lock in in a few gutsy exercises, counting riding ATVs and attempting paragliding. It was an completely extraordinary involvement, and I wholeheartedly prescribe it to anybody going by Nepal.

The ATV ride was very challenging, particularly since it was sprinkling intensely as we rose the mountain. We all finished up getting totally splashed, but it made for a important and interesting encounter.I got a certificate for driving the ATV and it was an experience to remember.Paragliding, on the other hand, was fantastically fun. Whereas up within the sky, I had the chance to appreciate the beautiful see of Nepal with its magnificent mountains.It was scary at first but in midair I was just enjoying Mother Nature.However by the end of it,I was nauseous but thankfully did not vomit and took some ginger honey lemon tea to make myself feel better.We also managed to celebrate my friend's birthday at the end of the week in a fancy submarine themed restaurant and enjoyed ourselves.

3. Points to remember from week 2!

-At whatever point you discover yourself misplaced or questionable around any perspective, never falter to look for help from the local people. Their direction can be vital in exploring new territory.

-Hygiene is of utmost priority and its very important to sanitise our hands at all times and mask up to prevent ourselves for getting infected.Food hygiene is also important on where to eat and avoid any roadside stalls.

-We should always respect our doctors and never hesitate to ask them anything as their our teachers who will guide us through becoming a better doctor.The field of medicine continually presents us to unused circumstances,guaranteeing that learning could be a ceaseless travel. In the event that there's ever something you do not get a handle on, do not falter to ask and look for clarification.

4. Your feelings & thoughts

I was very excited and in fact amazed by the way surgeries were carried out and how I gained so many new experiences which I never thought I would.I will forever be grateful to have been able to be part of Gandaki Medical College and be able to meet so many doctors who were so nice to me and only had intentions to teach us all the time.This 1 week in surgery made me realise my passion and what my future holds.I had a clearer picture of what I want to be and what is ahead of me in the future years to come.

5. ONE good thing from what you did that you can practise now!

Being able to blend with everybody permitted me to step out of my comfort zone.

6. Any difficulties/concerns? How did you cope?

-Not being able to understand what the doctors are talking among themselves as they would be using their native language was indeed difficult for us to thoroughly look into what was happening but we got a rough idea throughout.We would approach the doctors and ask them to explain to us in English and they would gladly do it.

-The travelling journey was very tiring and exhausting but all we did was rest well every night and sleep early in order to feel rejuvenated and fresh to start our day.

7. Your plan for next week (Week 3)

Another week, I'm energized to be joining both the Emergency Department . I'm truly looking forward to the chance to understand almost curiously cases, perform methods on patients, and witness procedures done on patients.

My friends and I are arranging to go shopping to purchase a few gifts.My friend and I have also thought of going for bungee jumping from the world's second highest spot also known as the Cliff.It's definitely going to be a week to remember doing one of my bucket list and trying out more adventurous activities with him.I will also read more on the procedures to be done on patients to be able to perform better.

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First Week : Venture into the Surgery Department of CMC

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First Week : Venture into the Surgery Department of CMC

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1. Your name, matric number, date

Noor Halinah Binti Mohamed Ali Jinnah, A181430, 14-20 August 2023

2. How is your progress?

14/9 (Mon) - It was the first day of elective posting. I woke up early because of the excitement to start the day. Had breakfast at the canteen which was just walking distance from the modale hostel. Then I head to the principal’s office in the Bagayam campus. Mr. Nantha Gopalan, the secretary of the principal's office, greeted us and guided us through the registration process. Prof Dr. Aby Charles, my posting coordinator briefed me about CMC. After the briefing, Mr Nantha handed me the ID card and posting order.

I arrived at the main hospital campus situated in a 19-acre Town campus in the heart of Vellore town, which is around 7 kilometers away from the Bagayam campus. The hospital was very huge and crowded with people. After paying the posting fee in the ISSCC building, I headed to the surgery department located in the Paul Brand Building. Finding these buildings was such a hassle but luckily the security guards were very helpful with directions. I was posted into Surgery Unit III  which specializes in General Surgery and Upper GI Surgery. The office secretary gave me the weekly schedule and  asked me to join the ward round in P3 ward to start off my posting. Unfortunately, by the time I arrived at the ward, the ward round ended and I had to wait for the registra. During my wait, I was approached by a medical student named Nicole. She told me that I will be joining her group for the rest of the day.

I joined them for suture practice in the Ethicon Surgical Skill Bus. The bus was equipped with  suture practice kits, surgical knot practice kits and advanced laparoscopic training boxes. Prof Myla and Dr Ajith along with some other surgeons taught us on different suture and knot tying techniques. They also played a video to enhance our understanding. I was very dumbfounded at first because I had only done basic sutures before and all the knot tying techniques seemed to be odd for me. It took me some time to get the right technique of the first step with the help of 2 surgeons! These are some of the things I learned: Granny knot, Reef knot, Squared and unsquared knots, simple and mattress suture. Later that day, I had class with Prof Myla. One of the medical students presented a vascular case on Chronic Venous Insufficiency. The discussion was extensive and focused more on the management part. The long day ended at 5.30 pm.

15/9 (Tuesday) -  It was India’s Independence Day. I took the opportunity to visit the town. The streets were lively with India’s flags hanging everywhere, school children were wearing costumes representing India’s freedom fighters and patriotic songs blasted on speakers.

16/9 (Wednesday) - In the morning I joined the medical students attached to the Outpatient Department. The clinic was so crowded, most of the patients were standing along the corridor barely having space to move or sit. We entered Prof Myla’s cubicle and observed the consultation. There were many hernia cases including inguinal hernia, incisional hernia and also umbilical hernia. Then, one of the students presented a case on the same topic. After lunch, there was a lecture on the topic burn in the lecture hall at Asha Building. The lecture was so engaging as the Dr demonstrated fluid movement in burn by asking med students to become models. Our last class of the day was conducted by Dr Dinakar. He taught us about indirect inguinal hernia by demonstrating how to examine a real patient in P3 ward. He also explained hernioplasty with drawing which helped us to visualize better. Although I don't really understand some of the terms in the management part, I still learnt a lott. I was very exhausted by the end of the day but all of it was fruitful.

17/9 (Thursday) - It was an OT day! Went to the main operation on the ground floor and changed into scrubs. The nurse in charge guided me into the OT 17 which was the room dedicated for surgery unit III. When I entered the OT, Prof Myla was conducting a laparoscopic cholecystectomy. When I was observing the surgery I met Dr Terefe, a doctor from Ethiopia currently doing fellowship in CMC. He was kind enough to explain about the surgery and cleared my doubts. The next surgery was Staging laparoscopy for Stomach Cancer and Inguinal Hernia Repair by TEP. The OR nurses were very friendly. I engaged in a conversation with them and I can see the love and dedication they have for their work as one of the nurses proudly said that she has been working for 14 years in CMC and she is very happy with it.

18/9 (Friday) - It was the last day of my posting in the surgery department. I headed straight to P3 ward as there will be a Grand ward round. The ward round started at 8 o'clock and many cases were discussed. The registra presented the case and I was quite overwhelmed with the medical terms they used mainly on the management part and types of surgery done. I managed to write down a few terms and Google it after. By the time the ward round finished, I was exhausted as the wards are located at different levels of different buildings and we need to walk long distances. Luckily, after the ward round they served us local snacks such as hot samosa and tea at the surgery office. It was indeed very refreshing after a long morning of walking around. In the meantime, the surgeons finalize the operation list for the following week. Then a registra presented on Laparoscopic Entry and Closure Technique. It was noon when the presentation ended. Dr. Terefe guided me to the library to find some study materials. For lunch, there was a small celebration in Surgery Unit III where one of the residents, Dr Feroz treated us biryani. The final activity of the day was the Multidisciplinary Tumor Board Meeting (MDT) which was held in the surgical skill lab. All the General Surgeons had a meeting with medical oncologists, radiologists and palliative care physicians through a Microsoft team Meet to discuss the treatment care for patients. To conclude the day, I took pictures and bid farewell to the team as it was my last day in surgery posting.

19/9 (Saturday) - Visited the nearest tourist attraction which is the Yelagiri Hill Station. It is  located just 2 hours from Vellore town. I visited the Punganoor Lake, a well-known man-made lake in Tamil Nadu which is almost 60 square meters in size. I enjoyed the boat ride and was pleased by the calm atmosphere and scenic beauty. Apart from that, there were also amusement rides such as bumper cars, haunted house and also a 7D theater. The next destination was the Cloud Forest Entertainment Park. It was like a mini petting zoo equipped with gardens, bamboo forest,  game spots and also a great treetop lookout. Overall, the weekend was well spent.

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3. Points to remember from week 2!

- Always be proactive and don't be afraid to ask questions in class, ward rounds and study sessions. One thing that I realized is that I get better answers and learn more when I ask. The surgeons explained things thoroughly when the students showed interest in learning.

- Treatment or Proper Medical Care which we take for granted  is a luxury for some. Why? It's because patients in CMC came from all over India. Some need to travel for days to reach the hospital in a hope for recovery. Lack of enough secondary and tertiary care facilities with unmanageable patient-load (India’s population: 1.4 billion) leads to this condition.

4. Your feelings & thoughts

- At first I felt a bit uneasy walking around the hospital because CMC is a Christian community - run hospital and medical school . As a hijabi, I often feel eyes upon me and get stopped in front of the wards by the security guards. They only let me in after seeing my temporary student ID card. But soon I got used to it and so were the guards.

- I was very happy that I was received well by the fellow doctors and surgeons. They were always ready to help, happy to share the knowledge and teach valuable skills.

5. ONE good thing from what you did that you can practice now!

- Being confident. I realized that I am more willing to learn when I don't worry about what others might think of me or whether I can blend in or not. I was able to fully benefit from my first week of surgery posting with it and I will definitely try to be more confident in my future endeavors.

6. Any difficulties/concerns? How did you cope?

- As a hijabi, I realized that I always stand out from the crowd and be scrutinized by people around me in the hospital. Although I found it inconvenient at first, soon I got used to it.

- Language is one of my biggest concerns because patients who come from different parts of India speak in different languages. Other than the Indian language that I am fluent in, which is Tamil, most of them speak in Hindi and Urdu. So, whenever I don't understand the conversation between the consultant and patients or when clerking patients, I often ask for help from the medical students. They were more than happy to translate it to me and I really appreciate their help.

7. Your plan for next week (Week 3)

-Get acquainted with the internal medicine team of CMC.

-Learn as much as i can. Clerk and workup cases in the ward.

# data[].attributes.headline
Week 2 Adventures: Learning Through Observation and Discovering Hong Kong's Beauty"

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Week 2 Adventures: Learning Through Observation and Discovering Hong Kong's Beauty"

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1. Your name, matric number, date

Name             : Oon Men Joo
Matric number: A179804
Date                : 07/08/23 (Mon) – 13/08/23 (Sun)

2. How is your progress?

07/08/23 – 11/08/23 (Mon – Fri): My schedule was mainly centered around HBP and LT procedures, which followed a similar routine throughout the week. During this time, I had the opportunity to observe more than 10 OGDS. The doctor in charge of these procedures was often busy due to the high number of patients. Therefore, I tried to understand the patient’s condition by looking at the patient’s files and doctors’ comments on the computer.

In the ODGS room, I met a surgeon from mainland China who was on a three-month exchange program. His application to perform procedures at Queen Mary Hospital was pending, so he was observing procedures as well. I took advantage of this opportunity to ask questions and gain insights, although some topics required a deep surgical background to fully understand.

I also had the chance to wear a lead apron and closely observe several ERCP procedures. With the doctor's explanations, I witnessed the removal of CBD stones and the insertion of stents. This week of observing OGDS and ERCP procedures significantly enhanced my knowledge in these areas.

I attended a department grand ward round meeting on a Tuesday morning, where random questions were posed to specialty year 6 students and doctors. I initially felt apprehensive as the discussion exceeded my current knowledge level.

Afterwards, I visited Tung Wah Hospital, the first hospital in Hong Kong, to observe a few laparoscopic cholecystectomies. While waiting for the next operation, I engaged in a conversation about becoming a surgeon with an overseas medical elective student from the University of Glasgow. He mentioned that Malaysia used to send doctors to Hong Kong for Liver Transplantation training before the COVID-19 pandemic.

In the following days, I attended clinics related to LT, HCC and HBP. I was given access to informative booklets on “Information for Patients (and their families) waiting for liver transplantation” and “Information to Living Donor” and asked doctors question to clear my doubts. I attached myself to different doctors each time, learning from their expertise.

I also observed a lap segment V hepatectomy and a lap + open segment VIII hepatectomy. It was my first experience wearing 3D glasses to watch a surgical screen. The procedure was amazing and interesting which captivated my attention for the whole OT, although it eventually transitioned from laparoscopic to open surgery after several hours.

In addition to my clinical experiences, I participated in the LT evening ward rounds, although I found them somewhat less beneficial due to difficulties in hearing their discussions clearly. Nonetheless, I followed the ward rounds, jotting down any aspects that I found unclear for later research.

I met numerous local secondary school students who were spending their summer holidays participating in a summer exposure program. Many of these students expressed a keen interest in the field of medicine and would often pose questions during our sessions to me. I did my best to provide answers to their questions. I attended most of the sessions with a secondary school student named Shania. We always had lunch together and we chat about some cultural and educational difference between Malaysia and Hong Kong.

12/08/23 – 13/08/23 (Sat – Sun): I spent time exploring various Hong Kong attractions with Yee Xin. Our activities included visits to the Avenue of Stars, Victoria Harbour, Mang Kok, You Matai and Braemar hill along with capturing memories through photographs. During the Braemar Hill hikes, we encountered several tourists from Malaysia and China. Meeting fellow Malaysians in a foreign country brought me a profound sense of happiness and connection. This adventure, while enjoyable, also involved a considerable amount of walking.

3. Points to remember from week 2!

·       Meticulous observation and patients’ files study are very important for medical students, especially when the supervising doctor is busy.

·       By asking questions and seeking clarification from doctors, it deepened my understanding. By explaining the answers to secondary school students, it further enhanced my understanding.

·       Cross-cultural friendships and discussion help to broaden one's perspective.

·       It is important take breaks and enjoy leisure activities to maintain a healthy work-life balance.

4. Your feelings & thoughts

I gradually adapted to the environment and felt less anxious. This was partly due to the company of a local secondary school student who spoke both Cantonese and English fluently, which helped me seek clarification when doctors spoke Cantonese too rapidly. I was proud of myself because I was able to independently carry out the daily activities and effectively manage my time.

I was allowed to choose any session based on my preference and not having to sign any attendance. Therefore, it was depending on my discipline to arrange my schedule. At times, I considered skipping sessions due to fatigue or boredom, but I didn't want to miss out on valuable opportunities, so I made the most of the time from 7.30 a.m. to 5 p.m.

I noticed that most doctors explained things in a well-structured manner, making it easier for me to understand, even when encountering new knowledge for the first time. During clinic sessions, they primarily explain patient’s condition to students rather than asking us.

5. ONE good thing from what you did that you can practice now!

One good thing I did was continuous and self-directed learning. I embraced every opportunity to acquire new knowledge about medical procedures and diverse cultures. Even when I was merely an observer, possibly overlooked by busy doctors, I attended sessions with the belief that every exposure had something to learn. In instances where doctors were occupied, I made use of patient files and computer comments to learn. This dedication to lifelong learning is a mindset that will benefit me in any field.

6. Any difficulties/concerns? How did you cope?

My initial challenge was the language barrier. Some doctors, local students, and overseas students spoke English fluently, sometimes with various slangs or pronunciations that I found challenging to fully understand due to my limited English vocabulary. However, I managed to grasp most of the knowledge being shared. I tackled this issue by actively seeking clarification from doctors and fellow students. To address this communication challenge in the long run, I recognise the need to enhance my English-speaking skills and express my thoughts in a more organised manner.

Another challenge I encountered was a lack of confidence in communication, making it difficult to establish strong doctor-student relationships. I noticed that some of my fellow overseas medical elective students were highly sociable and adept at initiating conversations. To address this, I made an effort to attend most sessions and actively asked questions, hoping to become more recognisable. However, at times, I hesitated to approach nurses with inquiries, fearing I might disrupt their busy routines. To manage this, I began asking concise and focused questions, minimising interruption and ensuring that I wouldn't inconvenience them.

7. Your plan for next week (Week 3)

·       Continue to explore the healthcare system in Hong Kong

·       Observe different surgeries and try to explore other potential medical activities

·       Make more Hong Kong friends

·       Visit Macau and Lantau Island

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1. Your name, matric number, date

LIM YEE XIN, A179999, 5/8/2023-11/8/2023

2. How is your progress?

I believe I have gradually adapted to this new and ‘stranger’ posting environment! As I delved deeper into Obstetrics and Gynaecology through reading and study, I found that I could better grasp the previously unfamiliar topics discussed during teaching sessions and rounds. I am particularly grateful for the opportunity to work alongside my favourite and, I must say, the most approachable doctor, Dr. Lorraine Chan, in the gynaecology new case clinic. She not only provided thorough explanations for each case but also demonstrated the endometrial sampling procedure using a pipelle. During the clinic sessions, I had the privilege of sharing the experience with a final-year HKU student, and our attachment proved to be immensely valuable due to the insightful discussions we engaged in.

I am genuinely thrilled about this week because I had the opportunity to access the labor ward and witness deliveries. I had the privilege of observing a complete normal vaginal delivery from 10:30 am to 6:30 pm. Although it was physically demanding, with me nearly standing throughout the entire session, I consider myself fortunate to have witnessed the entire process – from the leaking of amniotic fluid, cervical dilation, uterine contractions, the actual childbirth, to the delivery of the placenta.

Furthermore, during this time, I gained insight into how the nurses monitor the progress of labor, and they even provided me with a basic understanding of interpreting cardiotocography (CTG). I was also delighted to contribute by assisting both the nurses and the pregnant woman. It was impressive to note that the entire normal vaginal delivery was skillfully managed by just three nurses.

Moreover, I had the rare opportunity to witness a twin vaginal delivery, which is quite uncommon in a labor room. On the following day, I observed a Cesarean section (C-section) delivery, and to my surprise, the entire process was significantly quicker compared to a normal vaginal delivery, taking only about one hour.

During the obstetric teaching round, the doctor provided us with instruction on basic CTG interpretation and led a discussion on antenatal bleeding cases. Additionally, I had the opportunity to participate in the pre-admission clinic with Dr. Flora, where we discussed sterilization procedures in both Hong Kong and the UK. In Hong Kong, when a woman wishes to undergo sterilization, her husband must accompany her to sign the consent form for the operation. In contrast, sterilization for women in the UK is an entirely autonomous decision and does not require the husband's consent. Furthermore, contraception in the UK is provided free of charge.

Additionally, there was an oncology teaching session held on Friday that centered around ovarian cancer, a condition that is relatively prevalent in Hong Kong. Regrettably, patients diagnosed with ovarian cancer frequently come forward in later stages when seeking medical care, as the signs and symptoms tend to manifest later compared to endometrial cancer, which is more likely to be detected in its early stages.

3. Points to remember from week 2!

·        Actively participate and engage in learning sessions.

·        Cultivate gratitude for being born safely into this world and cherish the role of a mother.

4. Your feelings & thoughts

I truly appreciate the opportunity to have encountered a compassionate and instructive doctor who was willing to teach me, even though I had limited knowledge in obstetrics and gynecology. I am also grateful for the chance to work in the clinic alongside a friendly local student who patiently addressed my questions and offered assistance. This past week has been remarkably exciting and rewarding compared to the previous one, and I'm delighted to note that my initial nervousness has significantly diminished.

5. ONE good thing from what you did that you can practice now!

I've gained increased confidence and courage in my ability to communicate and seek assistance from others. I've come to understand that speaking Cantonese more fluently requires less overthinking and more direct expression of my thoughts and needs. I've pushed myself beyond my comfort zone, where I've had to rely solely on my own abilities without the support of colleagues, as I did at UKM. I've realized that opportunities present themselves when I'm willing to speak up and take initiative.

6. Any difficulties/concerns? How did you cope?

The people in Hong Kong exhibit remarkable efficiency and discipline in their daily lives. Their pace is notably faster, and adherence to rules is of utmost importance. Living here has made me feel more emotionally constrained and stressed compared to my life in Malaysia. However, I've found solace in exploring various places in Hong Kong during the weekends, which helps me unwind and alleviate my stress.

Given that Hong Kong is renowned for its high cost of living, I've become quite conscientious about my expenditures, as it's easy to run out of cash quickly. Consequently, I diligently record every single expense using a money management app on my phone and make financial predictions for the upcoming weeks.

7. Your plan for next week (Week 3)

·        Deepen my knowledges and try to do obstetric physical examination!

# data[].attributes.body
1. Your name, matric number, date

Prissha Siveraj , A184223, 6/8/2023-13/8/2023

2. How is your progress?

The journey to Kathmandu airport took around 4 hours and 30 minutes. Upon arrival, the IVHQ organisers welcomed us warmly and escorted us to our hotel.

The following day we had orientation and an ice-breaking session with fellow volunteers. It was incredibly intriguing to connect with volunteers from around the world and learn about the programs they had chosen to be a part of.
Later in the evening, we were taken to a temple called Swayambhunath, known as the Monkey Temple, which holds significance in the Buddhist tradition. Our tour guide provided a concise history of the temple and shared insights into Nepalese culture. As an additional treat, we tried their signature masala tea and dhal bhat, both of which were incredibly delicious.

The next day, we embarked on a roughly 14-hour bus journey to reach Pokhara. Upon our arrival, our host family extended a warm welcome, adorning us with traditional scarves and applying tika, a red powder, on our foreheads as a symbol of their hospitality. Our introduction began as we shared our first meal together, during which the host family served us delightful Nepalese masala tea. We also had the pleasure of participating in a lively welcoming dance session with our host family, known as 'drink and dance.' We were also able to see the beautiful Annapurna mountains from our home.

The next morning, we attended an orientation session at the hospital (Gandaki Medical College), during which we were introduced to our respective departments. A medical assistant kindly guided us through the hospital facilities and provided valuable insights into the dos and don'ts for medical volunteers.

My first posting was Internal Medicine. Our mornings were filled with participation in the ward rounds alongside the doctors. This provided an invaluable learning opportunity as the doctors would engage with us by asking questions and elaborating on the cases present in the ward. One of the specialists taught us to interpret CT of a patient with bronchiectasis with the positive finding of a signet ring sign.

We even had the opportunity to celebrate one of our friend's birthdays during that week. Later that weekend, we decided to engage in some adventurous activities, including riding ATVs and trying paragliding. It was an absolutely phenomenal experience, and I wholeheartedly recommend it to anyone visiting Nepal.

The ATV ride proved to be quite challenging, especially since it was raining heavily as we ascended the mountain. We all ended up getting completely drenched, but it made for a memorable and unique experience. Paragliding, on the other hand, was incredibly fun. While up in the sky, I had the chance to appreciate the picturesque view of Nepal with its majestic mountains.

3. Points to remember from week 2!

It's crucial to remember that there's no need to hesitate when seeking guidance from doctors, especially when you find yourself unsure.

Expand your social circle and don't hesitate to mingle with new acquaintances. Forge new friendships and delve into the culture and beliefs of the country you're visiting.

4. Your feelings & thoughts

I was genuinely excited about the opportunity to learn from the Internal Medicine department. During my time there, I encountered a wide range of cases, many of which were quite common in our country. However, the majority of cases I came across were respiratory diseases, including pneumonia, chronic obstructive pulmonary disease, bronchiectasis, pleural effusion, and others. Even though we weren't always given the chance to conduct a full physical examination, I was grateful that the doctors allowed us to perform percussion and auscultation when we identified a positive finding in a patient.

It was disheartening to witness the shortage of medical equipment in their hospital. They frequently ran out of essential medical supplies. I recall one instance where a patient had pleural effusion, and the hospital had run out of underwater seal drainage systems for fluid removal from the lungs. Instead, they had to resort to using a mineral water bottle for the procedure. This experience made me appreciate the advanced healthcare system in our country, where hospitals are well-equipped with all the necessary medical facilities to meet the needs of patients.

5. ONE good thing from what you did that you can practice now!

Being able to mingle with everyone allowed me to step out of my comfort zone.

6. Any difficulties/concerns? How did you cope?

Travelling for almost 14 hours was really tiring. All those bumpy roads gave me motion sickness and leg pain. Luckily I brought along motion sickness medicines and compression stockings.

Obtaining medical histories from the patients was difficult since most of them had limited English proficiency, primarily speaking Nepalese and Hindi. Communicating with them was quite challenging.

7. Your plan for next week (Week 3)

Next week, I'm excited to be joining both the Emergency Department and the Surgical Department.

My friends and I are planning to go shopping to buy some souvenirs and explore new restaurants in Pokhara.

# data[].attributes.headline
Paeds FKUGM: Week 2 (Orientation day, Poliklinik Tumbuh Kembang, PICU) 

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Paeds FKUGM: Week 2 (Orientation day, Poliklinik Tumbuh Kembang, PICU) 

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1. Name, Matricular Number, Date

Farah Dina Khansa

A177347

31/7 - 4/8 2023

2. How is your progress?

Monday 31st July was the day my EP journey officially began. I had a briefing at the faculty of medicine with the other participants from Germany and the Netherlands before the staff brought us to the hospital and sent us according to the department we had applied for earlier. The first day was only orientation day with my 2 supervisors, both of them brought me exploring the pediatric department. The department was scattered throughout the 4 buildings of the hospital, it was indeed very confusing. They showed me the pediatric clinic which was located at the very first building. There were so many people and it was very crowded. Our second stop was the neonatal intensive care unit, located at the second building and the third stop was the pediatric intensive care unit at the third building. Even Though all the buildings had a connecting bridge it was still very confusing since the hospital was very huge. After my orientation both my supervisors allowed me to go home early and my first attachment would start on tuesday. I had my first attachment at clinic tumbuh kembang instalasi kesehatan anak for 2 days. At the clinic I had the opportunity to observe immunization, attach with my registrar sv at the clinic and also visited TPA thunggadewi (tempat penitipan anak) on day 2 which was exclusively made for the staff of the hospital. I accompanied one of the clinical students of UGM and one registrar. We went there to do growth screening for all the babies and children. It was very heartwarming to be able to see all the cute and healthy babies and children at the TPA, we all performed the screening test while also playing with all of them. My second attachment was at the pediatric intensive care unit (PICU) for 2 days also. I needed to join ward rounds twice a day with all the registrar and the specialist. I did not get the opportunity to do much actually, since all the patients were critically ill and the diagnosis was also very complicated. On day 2 my registrar sv teached me regarding shock in newborns and the assessment. I directly learned how to assess shock on the patient at the ICU. I did not really enjoy my attachment at PICU to be honest, the continuous monitoring sound was very stressful to hear and also the vibes there were just very gloomy. For 2 days I witnessed many parents crying beside their children’s bed or outside the ward and it affected me somehow but thanks to all the registrar there for making my 2 days attachment at PICU more enjoyable. Eventhough all of them were busy to the point I got abandoned sometimes ahahah but they still welcome me nicely bought snacks and lunch for me and especially my supervisor she still made time to teach me eventhough she had a very tight schedule. All in all it was still enjoyable.

3. Points to remember from week 2!

It is important to have a sense of direction since the hospital was huge

Never be afraid to approach strangers to ask for help if you got lost since i did twice got lost in the hospital

4. Your feelings and thoughts

I have mixed feelings for my 1st week of EP, since I did not really enjoy my days at ICU but overall it was still nice and pretty much enjoyable. Everything was new and I kinda got lost but all the clinical students, the nurses and all the registrar treated me warmly and welcomed me very nicely and made me feel less scared and much more relaxed and for that I was very grateful. I also gained many experiences and knowledge from my first 2 attachments, all in all everything went just fine.

5. ONE good thing from what you did that you can practice now!

Never hesitating in asking questions to the dr or supervisor for anything that I did not understand or not uncertain.

6. Any difficulties/concerns? How did you cope?

I did have difficulties in locating the location of my attachment place within the hospital therefore I got lost so many times. In order to be more familiar with the hospital I tried to explore more during lunch break or before I went back to the dorm and if I got lost just ask any registrar, security or random people that I encountered for any direction.

7. Your plan for week 3

Looking forward for my next 2 attachment and also making new friends with the clinical students at my next attachment

Tried to explore more canteen option within the hospital area since the one i used to go was very crowded

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1. Your name, matric number, date

Parvin A/P Thirumurugananthajiva
A180823
6/8/2023 - 13/8/2023

2. How is your progress?

I arrived at KLIA 1 at approximately 5:30 pm, where I met up with my friends and said farewell to my parents. Our flight, scheduled for 8 pm, took us on a 4-hour and 30-minute journey to Tribhuvan Airport in Kathmandu. The flight was quite turbulent, but we arrived safely. Upon landing, we exchanged currency and purchased SIM cards. Despite our late-night arrival, the IVHQ organizer warmly welcomed us. We then checked into our hotel, and since everyone was exhausted, we enjoyed a restful night's sleep.

The following day, at around 10 am, we attended an orientation session. Alongside this orientation, we participated in an ice-breaking activity with fellow volunteers from all corners of the world. This was a fun way to get acquainted with our fellow volunteers and learn about their objectives. During the session, they provided us with an overview of the program and introduced us to our host families. Since we were a group of ten, we were split into two groups, with four of us placed under one host family and the remaining members with another. After the session, we had lunch at a nearby restaurant. In the evening, we were taken to Swayabhunath Temple, also known as the Monkey Temple due to the presence of monkeys along the way. This Buddhist temple emphasizes the path to nirvana, their concept of heaven. We also had our first taste of masala tea and dhall bhatt, traditional Nepali cuisine. The temple featured Chinese paintings called "thanka", which were intricate and beautiful.

The next day proved to be quite challenging as we embarked on a 14-hour journey from Kathmandu to Pokhara, departing at around 7:30 am and arriving at 8 pm. The journey was rough, with bumpy roads causing constant shaking. We encountered three landslides, which further prolonged the trip. After a tiring day, we reached the bus stop, where our host family welcomed us with scarves and red tikka on our foreheads. They also served us our first traditional meal, chow mein.

On the following day, we had a 20-minute walk to the hospital, where we received a brief tour. I was astonished by the hospital's bustling atmosphere. I chose internal medicine for my first rotation because I was eager to learn about the most common medical cases in Nepal. Among these were cases of heart failure and pulmonary conditions like COPD and bronchiectasis, even in younger patients. COPD cases were prevalent due to Nepalese individuals' exposure to tobacco and soot from burning wood. During my internal medicine rotation, I learned a great deal from medical officers who translated cases into English for us. I also studied patient files to gain deeper insights into various cases and accompanied doctors on ward rounds. One doctor even allowed us to perform a respiratory examination on a pleural effusion patient. We were extremely grateful for these new experiences.

Later in the weekend, we planned adventurous activities. My favorite was riding ATVs on a bumpy hillside. The most exciting part was when it started raining as we ascended the hill, creating a memorable experience. The following day, I had a thrilling experience as I went paragliding for the first time, enjoying breathtaking views from above. It was a lot of fun.

3. Points to remember from week 2!

- It's essential to reach out for assistance when we have doubts, as regretting not asking important questions and clearing doubts on the spot can be far worse. I felt appreciative of the doctors for patiently addressing all our inquiries regarding the patients without causing any discomfort.

- Cultivating a strong doctor-patient relationship is vital. I was particularly attentive to showing respect by giving patients their personal space, even when we faced language barriers. In cases where patients approached us seeking help, we guided them to other doctors using hand gestures.

- It's crucial to prioritize hygiene by consistently sanitizing our hands.

4. Your feelings & thoughts

I found the pleural tapping procedure to be incredibly intriguing. Due to limited resources, they improvised by using a branula and an empty mineral bottle for the procedure. Although it was time-consuming, with a doctor carefully holding the branula in place without any movement, they displayed remarkable patience throughout the process.

5. ONE good thing from what you did that you can practice now!

I've acquired the knowledge to use medical items like gloves and syringes judiciously, employing them only when necessary, and avoiding unnecessary wastage. This practice is rooted in the understanding that medical supplies are both costly and precious resources.

6. Any difficulties/concerns? How did you cope?

Initially, the language barrier posed a challenge during the ward rounds, as specialists would communicate with patients and discuss matters with other doctors in Nepalese, leaving us completely in the dark. However, we developed a workaround by reviewing the patient files beforehand and directing important questions to the medical officers, which helped us navigate the situation.

7. Your plan for next week (Week 3)

-I was excited about the switch to the emergency medicine and surgery department.
-After completing my hospital session, I had plans to go shopping.

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1. Your name, matric number, date

Josephine Tan, A184112, 24th July - 30th July

2. How is your progress?

Monday 24/7

I attended morning conference of HPB surgery department, they had a conference call with multiple departments. However, it was conducted fully in Japanese and I couldn’t understood most of it. After the conference, I attended the Japanese class by professor Yuki. She gave us a lecture on a brief history of Japan. She also taught us some basic Japanese and some commonly used phrases in the hospital. After the Japanese class, the person in charge of the international students affair, Mr Ken gave us an orientation and we got our ID card and access card to the hospital. After that, I went to the operation room to observe operation. It was a procedure to resect the pancreatic neck tumour, preserving the pancreatic tail. The doctor also told us to stand next to the operation theatre and showed us the anatomical location of the spleen, superior mesenteric artery, splenic artery, hepatic artery, common bile duct, stomach, and liver.

Tuesday 25/7

I attended morning conference of HPB surgery department, they discussed on the progress of their research papers. Next, I went to the operation room to observe procedure. Today’s patient has hepatocellular carcinoma and therefore requires partial liver resection via open laparotomy.

Wednesday 26/7

I attended the morning conference of HPB surgery department, they continued to discuss their progress on their research papers. After the conference, as usual, I went to the operation room. Today’s patient has ampullary tumour which is larger than 2cm. Professor explained to us, for smaller size tumour, it is usually done by endoscopic, but in this case the tumour size is larger than 2cm which is why operation is done on this patient. for this patient, the pancreatic duct, common bile duct and the second part of duodenum was resected, and a tube was connected to the cystic duct.

After that, I went to the simulation lab & tried equipments like da Vinci, laparoscopic suturing and OGDS simulator. It was a fun and exciting experience.

Thursday 27/7

I attended the morning conference of HPB surgery department. After the conference, I followed ward round with HPB team. Under HPB surgery department, there are 52 patients in the ward. I finally get to step foot into Juntendo hospital, it was spacious and clean. The ward round was surprisingly quick, the professor asked questions like: how are you, do you still feel pain, how is your appetite. It was a quick process compared to the ward rounds I’ve followed in HUKM. After ward round, I entered the operation room. Today’s patient has intra-pancreatic mutinous neoplasm. It was an incidental finding from ultrasound. The location of the neoplasm is located at the tail of pancreas. In the operation room, the surgeon took specimen at the head of pancreas & immediately send to pathology lab. the result was sent back immediately & confirmed to be benign, therefore the head of pancreas was preserved. After the surgery ended, the doctor let us felt the mucinous tumour of pancreas. We were able to appreciate the difference between mutinous and normal parenchyma of the pancreas.

Friday 28/7

As usual, I joined the morning conference and operation room procedure. Today’s patient has cholangiocarcinoma. One of the doctors explained to us that this patient has a rare type of anomaly where the right hepatic artery arises from the left hepatic artery. We were clueless, and fortunately enough, the doctor drew out the anatomy of the arterial system of bile duct to give us a clearer picture. We were able to appreciate to difference between normal bile duct arterial anatomy and anomaly type.

3. Points to remember from week 2!

Be puncture. I will usually arrive 10 minutes earlier before the morning conference starts and what I noticed was most of the doctors are already there. The work ethic of Japanese is admirable.

4. Your feelings & thoughts

Doctors here in Japan are not so familiar with specific medical terms in English because they have gone through medical school fully in Japanese. Despite that, they still tried their best to explain to us. They could have just leave us their blur but they didn’t, and for that, I’m very grateful of.

5. ONE good thing from what you did that you can practice now!

I am more bold to ask questions, I hope I can keep this habit when I’m back in HUKM.

6. Any difficulties/concerns? How did you cope?

I realised the foundation of my anatomy knowledge is too weak. In the operation room, if it weren’t for the professors, I wouldn’t have been able to identify each blood vessel and their functions. To overcome this, I did a revision on anatomy of hepatobilliary system and focus on the arterial supply.

7. Your plan for next week (Week 3)

Observe operation room procedures & enjoy my time in Tokyo.

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1. Your name, matric number, date

Name: Haritha Subba Rau

Matric number: A181806

Date: 6/8/2023-13/8/2023

2. How is your progress?

I reached KLIA1 around 5pm and I gathered there with my other friends. We all arrived early at the airport and as soon as everyone was there we checked in our luggage, printed our boarding passes and we boarded the plane to Kathmandu which was around 8 pm and the journey took around 4 hours 30 minutes. We landed in Tribhuvan International Airport, Kathmandu around 11.30pm Nepal time. Since we have already told the person in charge about our arrival details, so all the arrangements were made and we were brought to Hotel Arts Kathmandu .The person in charge briefed us a little about the agenda for the orientation next day.

Next day the orientation was held at a meeting room in the hotel where we sat with around 20 other volunteers from different countries and we had an ice-breaking session with them. Mr Bijen was very friendly and welcoming and he hosted the session and it went smoothly. We were also briefed about our medical elective and the details of our host families. In the evening we went to the Swayambhunath Stupa in Kathmandu also known as the Monkey Temple. We climbed 365 stairs up to the temple and the view from the top was breathtaking. Once we reached the top, Mr Bijen gave us a tour around the temple and he also briefly explained to us about the history of the monkey temple. We also had some masala tea and then went to see some beautiful paintings called Thanka in the temple.

The next day was very challenging as we took a bus to Pokhara and it was a very bumpy ride. We departed from our hotel around 7.30 am and the journey was 14 hours and we reached our homestay very late at night. My host family was so kind as they helped us to settle in and showed us to our rooms and provided us with delicious Chow Mein which is Nepali staple dish. We took a good rest that night and prepared for our medical elective the next day.

Our first day in Gandaki Medical College and my first rotation will be in the surgery department. Mr Dharma who is also a healthcare assistant gave us a tour around the hospital and introduced us to our respective departments. During the whole week in surgery department I was able to meet so many kind doctors who were explaining to us about each surgery and were always attending to our requests. We also saw patients in the surgical ward every morning during the ward rounds. We had to wear own surgical scrubs before entering the OT and were briefed by a kind doctor who is a first year surgical resident. I was able to observe many surgeries throughout the week such as C-Section, Bilateral tubal ligation (BTL), Hernioplasty, laparoscopic cholecystectomy and many more. The ward rounds for us was not so fruitful because of the language barrier we were not able to understand the discussion that was going on among the doctors. However, the experience in the OT was amazing as I got the see the stark difference in surgical department between this hospital and HUKM.

During the weekend we did ATV ride. The ride was very adventurous and it started raining heavily in the middle of the ride and it was very challenging however it was once in a lifetime kind of experience and I really enjoyed it.Then we also did paragliding at Pokhara. It was something I never expected I would challenge myself to do since I have fear of heights but in the end it was so worth it. The view of mountains from the top was breathtaking. These are something I never thought I would have the chance to and I am so glad I did. We also did a surprise birthday celebration for our friend in a restaurant with a live band.

3. Points to remember from week 2!

·       To take risks and challenge ourselves to push beyond boundaries otherwise we might regret it later. Initially  I was so afraid to go for paragliding because I was also sick on that day but in the end I am so glad I did because it was a wonderful experience.

·       To always maintain a good hygiene everywhere you go especially in the hospital setting. Always sanitize your hands before and after touching patients.

4. Your feelings & thoughts

I felt grateful since I was able to observe so many interesting surgeries in OT and also very happy that I was able to do some adventurous activities during the weekend. I was also sad and disappointed to see the healthcare in a third world country like Nepal with no enough medical facilities and poor hygiene.

5. ONE good thing from what you did that you can practice now!

Learning Nepali language helped us to communicate with the local people such as when we want to bargain or take ride.

6. Any difficulties/concerns? How did you cope?

During the time of our volunteering, it was Monsoon season, so it was raining heavily almost every day. It was a bit challenging for us to travel to places so we always have to get a car ride.

Another challenge we faced was the language barrier and because of that we were unable to clerk patients in the ward.

7. Your plan for next week (Week 3)

I am excited to go for the next posting which is the Emergency Medicine department.

# data[].attributes.headline
Week 2 in China: Navigating Challenges and Exploring Opportunities

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Week 2 in China: Navigating Challenges and Exploring Opportunities

# data[].attributes.body
1. Your name, matric number, date

Goh Xin Qi, A184017, 10/7/2023 – 16/7/2023

2. How is your progress?

[10/7/2023, Monday: Nothing out of the ordinary]

I joined the ward round every morning, and I did electrocardiograms on six patients today.

[12/7/2023, Wednesday: Clerked a Patients with Chronic Headache]

In the morning, there was an article-sharing session discussing the "Phase 2 trial of Baxdrostat for Treatment Resistant Hypertension," as cited from the New England Journal of Medicine. Thankfully, the presenter conducted the session in English, and I was finally able to understand all the details.

I perform electrocardiograms on six patients.

In the afternoon, Yuxin and I were assigned the task of clerking a 19-year-old patient who had been experiencing chronic headaches for 3 years. We were required to gather the important information from the history-taking session and input it into the computer system. It was not just me, my teammate Yuxin also found it challenging to convey the patient’s history using Mandarin. Without the assistance of seniors, we grappled with this task, dedicating the entire afternoon to completing the patient’s case summary.

[13/7/2023, Thursday: Just the Usual Routine]

In the morning, I participated in an article sharing session that centered on the topic of “microvascular resistance reserve: diagnostic and prognostic performance in the ILIAS registry” as cited in the European Heart Journal. The presentation was delivered in Mandarin.

I did electrocardiograms on four patients.

[14/7/2023, Friday: Last Day at Cardiology Department]

In the morning, Dr. Shen Yuqing conducted an article-sharing session that centered on the topic of “sodium-glucose cotransporter 2 inhibitors vs sitagliptin in heart failure and type 2 diabetes: an observational cohort study” as cited in European Heart Journal.

I did electrocardiograms on two patients.

During the ward round discussion, Dr. Gao Danchen emphasized the approach that doctors should take when interacting with patients. One patient had complained about a doctor’s impolite attitude when inquiring about the timing of their surgery.

This was the final day of my clinical elective at the Internal Medicine Cardiology department. After completing all the tasks, I approached Dr. Ting Chen to inquire about my performance and feedback.

[15/7/2023 – 16/7/2023, Saturday – Sunday: Two Days and One Night at Ningbo]

With careful planning and anticipation, I arranged a solo adventure to Ningbo, another city in Zhejiang, for a span of two days and one night. I booked my train ticket and hotel well in advance to ensure a smooth and stress-free journey.

3. Points to remember from week 2!

A doctor-patient relationship: Mutual respect is a fundamental element in developing a doctor-patient relationship. I am grateful to UKM for comprehensive three-year Personal Professional Advancement (PPA), which has instilled in me the concept that we must consistently uphold respect for patient and seek their permission every time before proceeding with any action. This practice is universally applicable, regardless of the country.

Daily article-sharing sessions at FAHZU: Almost every morning, there are article-sharing sessions in the cardiology department at FAHZU. The physician take turns to conduct this session right after the hand-over shift. I am consistently impressed by these sessions and appreciate the opportunity to acquire new knowledge from them. While most presentations are in Mandarin, I can easily find the original articles in English on the Internet. This has allowed me to gain a wealth of knowledge through these sessions.

Harmonising traditional Chinese and modern medicine: At FAHZU, uses of traditional Chinese medicine are integrated into their treatment approach. There are two commonly used Chinese medicines for cardiovascular diseases. The first one is "麝香保心丸" which can be translated to “musk cardiotonic pill” in English and is available over the counter. It offers benefits for patients with cardiovascular diseases such as angina, heart failure and myocardial infarction without conflicting with Western medicine. The second one is “速效救心丸” which translates as “quick-acting heart-saving pill” in English and can only be obtained with a doctor’s prescription. This medicine is often used to alleviate chest discomfort or other cardiovascular symptoms.

4. Your feelings & thoughts

In the second week of my clinical elective in the cardiology department, I came to the realisation that my involvement might be limited. After a briefing from my teammate Yuxin, I understood that in China, medical students are primarily observing procedures and are not required to clerk patients unless they are in Year 5. Consequently, my main role is to perform electrocardiograms on patients. Although it is a simple procedure, I find enjoyment in it each time, as it allows me to interact with patients. Sometimes, I engage in conversation with friendly patients, which gives me insights into their culture and helps me understand them better. Even though I am not responsible for clerking patients, I will use their computer to review the details of every patient under my group to learn more about their diseases. This approach offers another way of learning and spending my time effectively.

Regarding my solo trip to Ningbo, I am the type of person who enjoys planning my trips in advance and sticking to my itinerary. I take pride in the fact that everything went according to my plan, and I managed to visit all the places I had intended to explore. Initially, I had some concerns, as it was my first time staying alone in a hotel, especially in a foreign country without knowing anyone. Therefore, I carefully selected a hotel that prioritized safety, followed by a convenient location and reasonable pricing. This thoughtful selection ensured my peace of mind during the trip.

5. ONE good thing from what you did that you can practice now!
Taking initiative and volunteering for tasks within my capabilities.

6. Any difficulties/concerns? How did you cope?

Difficulty for foreigners in using mobile payment: I discovered the advantages and convenience of using Alipay for various transactions, including purchasing food at lower costs, and utilising public transportation. However, I encountered an issue when I was unable to top up my Alipay account without a China bank account. After discussing the matter with my new friend, she kindly offered to help by allowing me to deposit the cash I had brought to China into her bank account and then transferring it to my Alipay account.

Restriction of social media in China: The China government has implemented restrictions on the use of platforms like WhatsApp and Google, which has resulted in my inability to access important information from UKM while I was in China. Consequently, I missed the deadline for my college application. Fortunately, I am grateful to have my friends who were able to contact me using WeChat, a China social media platform. They consistently forwarded important messages from WhatsApp to WeChat to ensure I stayed informed. However, the inability to access Google was really inconvenience for me and this issue was  solved when I finally bought virtual private networks (VPNs) that allowed me to access all platforms and receive the WhatsApp messages on time.

7. Your plan for next week (Week 3)

Entered the Internal Medicine respiratory department, requiring me to once again adapt to a new environment.

Revisiting and refreshing my understanding of respiratory diseases.

# data[].attributes.headline
Week 2: Posting in the endocrinology department 

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Week 2: Posting in the endocrinology department 

# data[].attributes.body
Name: Chee Jun Kai

Matric number: A181855

Date: 31/07/2023 -  04/08/2023

2. How is your progress?

Monday: People in charge of international students bring me to look around the Hospital. The hospital consists of 12 blocks with different departments and 1 emergency department. After that, I met my supervisor in the endocrinology department - Dr. Pan Jie. We had a simple ice-breaking with the doctors and students there. Following, I joined their afternoon ward round and learned some basics of their medical system on the computer to look for patients’ information and medical history.

Tuesday - Thursday: Follow morning ward rounds with supervisor and head of department. After the ward round, Sr Pan assigned me to write a medical report of a patient with type 2 diabetes mellitus with a Year 5 medical student. In addition to that, I also did clerking on patients with pituitary tumors. The methods were different compared with us which before the clerking they already knew most of the details of the patient from the clinical report.

Friday: Joined grand ward round and discussed management for a patient with diabetic ketoacidosis. Following this, we had a meet-up with all the diabetes patients in the ward. Nurses gave a talk titled How and the importance of having a good diet for diabetes patients. Besides that, they also teach the patients how to calculate nutrient intake based on their own condition.

3. Points to remember from week 2!

Always listen to what nurses say in the ward

Build a good doctor-patient relationship and treat the patient as a friend

Keep patient when communicating with patients when you don’t understand their spoken language

Always ask questions when you don’t understand Chinese medical terms.

4. Your feelings & thoughts

Overall during the week, I learned a lot of new Chinese medical terms that I never heard it in Malaysia, and very grateful can join the ward round with the head of the department. The medical system in China is mostly different compared with Malaysia. For instance, all the patient information was digitized and can get any information about the patient with just one click of the mouse button. Another difference is, that the syllabus that was learned by the student there was different. They are focused on clerking patients and hands-on procedures but not physical examination of patients. So, for the first week of elective posting, I never saw and tried physical examination on any patient.

5. ONE good thing from what you did that you can practice now!

Practice to build a good doctor-patient relationship. Based on my observation throughout the whole first week, I noticed that there are no barriers between doctor and patient. Somehow, it is a good thing that we can practice, and is very beneficial for us when we become a doctor. Patients have trust in us, we can get any information from patients easily and even if we give advice to patients, they will more easily comply with it.

6. Any difficulties/concerns? How did you cope?

Communication with China’s patients is very difficult. Our knowledge and medical term that we learned is all in English version but they just can understand Chinese. Basic communication with them for me is not a problem because I am Chinese also but if related to the medical field my brain will be blank and need help from doctors. To solve this problem, I learned the basic terms from my colleague and practiced more by chit-chatting with patients whom I had clerked before.

7. Your plan for next week (Week 3)

Recap lecture notes before joining the respiratory department

Practice Chinese medical term

Participate in basic hands-on procedure

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1. Your name, matrics number, date
Azizah Zafira (A179285), 10th August - 24 August 2023

2. How is your progress
In week 2, is where the actual fun begins.

On my first day, I was introduced to all the hospital staffs by the PIC from human resource department. Everyone was so welcoming and they even invited me to lunch with the boards of directors. We talked about my background, why choosing this hospital as my elective posting, what is my expectations, and what can they help to maximise my time there. They welcomed me like a new family member. After taking a tour for about 4 hours (the hospital was huge!!) I was assigned my first posting to be in the MRI room. There, I met the most kind radiology operator I have ever encountered. She taught me how the MRI works from the patient preparation, consent signing, how to operate the MRI machine, do's and dont's in the MRI area, how to adjust the image and send to the doctors to be interpreted. There were so many patients doing MRI at that time, at least 15 within 3 hrs. The machine was different from the common one I see in HUKM, it was more like a CT-scan machine, where the patient does not need to enter a big circular machine, the machine is open, it is more beneficial for people with claustrophobia. The machine was so effective, the whole process took only 30-35 minutes. I also witnessed how they print out the images.

Day 2 was the day I have decided and confirmed what I want to be in the future. I was invited to observe an operation on a middle aged lady with Right tibia and fibula fracture due to recent fall. The operation lasted for 2.30 hours and not a single second of it I did not feel amazed by what the surgeons did. Entering the OT for the first time was intimidating, but there was an anaesthesiologist who called me and asked me to be near him, as he wanted to ask me several questions as well as teaching me the procedure. He asked me basic anatomy of the lower limb, starting from the skin, nerve, muscles and the bones. He also demonstrated to me how to do spinal anaesthesia. Throughout the operation, I stood beside him and jotted down every questions he asked, as I could not answer all of them, so he told me to make them as a homework and make sure the next time I met him, I sure know the answer. One thing he told me that sparks my will to study more "It is okay to not know everything for now. as a future doctor, it is not possible to know everything. This is the time for you to learn and be better the next time, so that you will remember and does not repeat the same mistake. Learning from what you don't know is the way to study. You are a good student. Don't forget that. If you don't know, be honest, we won't get mad. I was also like you last time." From that point onwards, I promised myself that I will do better each day. After the operation, I finished my day by attaching to one of the surgeon on his clinic, learned so many new cases, such as recurrent hip fracture, osteoarthritis and many more!

Day 3, I was assigned to attached to an emergency doctor as we started the day with ward rounds, follow-up cases on 3 post-operative patients. Followed by chatting with the nurses in the nurse station together with the doctor, talking about the healthcare system in Indonesia and also had some discussion with doctor regarding the patient we saw before and other common cases in orthopaedics. On this day as well, I was fortunate enough to be given a chance to give a presentation regarding "basics of epidemiology" to a year 1 physiotherapy students via online by a request of one of the director of the hospital who is my mother's close friend.

On the 4th day, the first half of the day I was assigned to a physiotherapy department where I studied the difference machines they have, how to operate them and also assist the physiotherapist to do some quadriceps exercise on a post-operative patient. Continued my day to review some MRI cases. As I was about to finish my day there, one of the director asked me a favour to be a model for their MRI machine promotional video. I agreed and there I was, experiencing how the MRI machine works right on the spot ;)

Day 5, I started my morning as before by attaching with the emergency doctor followed by a session with the pharmacists. There, I observe how the medical dispensal work, how to make a "combined" medicine as well as how to check the drugs from dr's prescription before giving them to the patients. I finished my week by a clinic attachment with an orthopaedic surgeon, managed to see 4 patients, first a frozen shoulder in diabetic patient, followed by lower back muscle strain, osteoarthritis in elderly and periprosthetic fracture of Right pelvis in an elderly lady following a recent fall at the hip area. In between the patients, the doctor I was attached to was so excited to have me, as he was enthusiastically asked me non-medical questions, especially about my medical degree in UKM. And he even given me his white coat so that the patient did not mistaken me to be someone not in a medical field. I remember saying "Dr, is it really fine if I wore this, I'm not a doctor yet". "Of course it is okay, Azizah. You are a future doctor, I want you to grasp the feeling first, so that you know how it feels later". It was touching and giving me another motivation to strive in achieving my dream.

3. Points to remember from phase 2
- Body language and proper communication is crucial
- Don't be afraid to ask questions, even when I think the questions were to simple to be asked. They will appreciate your curiosity
- Your competition is yourself. Be the better version of your from yesterday

4. Your feelings and thoughts
I felt so grateful to meet so many wonderful doctors and staff in the hospital, they not just pushed me in term of knowledge, but also outside of medical field. To be a better, a wholesome doctor in general. As I mentioned earlier, it made me certain of what I want to be in the future. I was certain that I want to be a surgeon, and orthopaedics is definitely one of the option

5. ONE good thing from what you did that you can practice now
Words are a powerful things that can both uplift and downgrade people. Always be thoughtful of what you are about to say.

6. Any difficulties/concerns? How did you cope?
Knowledge gap that I had was my main concern, especially during my clinic attachment, as I had zero knowledge on orthopaedics. I overcome it by being honest and communicate my lack of knowledge so that the experts can help me to guide where I should focus more on my level, since medical field is wide.

7. Your plan for next week (Week 3)
Read more a day before, ask more questions, attached to more clinics, read more radiological images, both from plain Xray to MRI.

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1. Your name, matrics number , date

Name : Kaviyarasi A/P Manoharan
Matrics Number : A182834
Date : 7/8/2023-11/8/2023

2. How is your progress?

My flight to Nepal was on 7/8 at 8.00 p.m. I reached KLIA 1 a few hours earlier and gathered with my friends. As we have checked in earlier, there was not much hassle and we were able to depart on time. We reached Nepal around 11.30 p.m. Since I had already updated our flight details to the coordinator a few months ago, all the arrangements were made and they fetched us from the airport and dropped us at the hotel. The assistant briefed us on the next day's schedule and we were done for the day.

The next day, our orientation was held. They briefed us on the department we would be in and regarding our homestay. I was posted in the Emergency Medicine department. I was very excited as this will be my first time being in this posting. Later in the evening, we visited Swayambunath Stupa in Kathmandu. Swayambhunath stupa is also called the `Monkey Temple' because of the many hundreds of monkeys who scamper about the temple at night after the pilgrims and priests have departed. The temple is dedicated to Harati, the goddess of all children. It is said that she was an ogress before Lord Buddha converted her to be the caretaker of all children. The area surrounding the stupa is filled with chaityas, temples, painted images of deities, and numerous other religious objects. The next day, we took the tourist bus for the journey to Pokhara which took 14 hours. We reached Pokhara late at night and prepared everything for our posting the next day.

My first day in the hospital started off with a tour around it. I went to the hospital around 8:30 a.m. and it was super crowded, especially near the pharmacy and laboratory. I wondered why. Apparently, patients there have to pay first before doing any test and treatment. It is a big hassle for the patients and their caretakers but the only way to cope with the economic status. To add on, most of the patients are covered by insurance. Our coordinator gave a short briefing about the rules and regulations of the hospital. Then, our supervisor, Prof Tarun Padel introduced us to the doctors in the Emergency Medicine department. The doctors were so welcoming and assured us that we would be learning a lot in the emergency room.

For the past week, there were many patients in the morning and evening, who came in with various problems. I volunteered to perform the procedures such as ECG and branula insertion on them. The nurses were so nice and guided me in performing those procedures patiently. I did learn about some of the ongoing diseases such as viral conjunctivitis. Currently, this disease is very prevalent and all you have to do is stay at home if get infected.

3. Points to remember from week 2!

-Viral conjunctivitis is a contagious disease and I needed to remind myself before examining the patient to check for the symptoms to avoid getting infected.

-I should be more outgoing. This week, I met a medical student from India who has been doing elective here for the past 6 months. She helped a lot in terms of clerking the patients. The patients here mostly speak Nepali and Hindi language. The language barrier made it quite hard when deal with them. By approaching more people, I believe my posting here would be more interesting.

-I realised that I need to volunteer if I want to learn new skills. Having the chance to do all the simple procedures every day has brushed up my skills a lot. I used to be so nervous when inserting branula but nowadays I do it confidently as I am already familiar with it.

-Don’t be afraid to approach people when you need help. This is really the key to survival. I would definitely not be able to enjoy my posting here if I were scared to approach people. I have utilized this opportunity given by the university to get out of my comfort zone and challenge myself by mingling with people from different backgrounds.

4. Your feelings & thoughts

Based on the first week, I would say that deciding on doing my elective posting in Nepal is totally worth it. The people here are so kind and always let me to clerk and examine them. Although the hospital is quite far, I chose to walk every day. I hope I can do it when I start working in Malaysia as well. I am so grateful that my parents allowed me to explore the medical system in another country and provided all the support they could.

5. ONE good thing from what you did that you can practice now!

Getting out of my comfort zone

6. Any difficulties/concerns? How did you cope?

For the past week, I had communication problems due to the language barrier. I tried to learn more common words for better interaction. Besides, the doctors helped me to translate. Surprisingly I met many Nepalis, who were able to speak in Malay as they have worked in Malaysia before.

7. Your plan for next week (Week 3)

I hope I can learn and practice more next week. I am eager to find out more about common diseases in Nepal. I am planning to explore Pokhara more during the weekends and next week.

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Visiting places with other volunteers, OT setting, celebrated friend's birthday, Observing OT, eating 'dal bhat' at homestay, went for paragliding & ATV, tikka 

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1. Your name, matrics number, date

Name: Shuithadevi Ganaraj (A184032)
Date: 06.08.23 - 13.08.23

2. How is your progress

We landed in Kathmandu, Nepal at night on the 6th and we were straight taken to the hotel where we will be staying for 2 nights for our orientation programme. We rested and the next morning we started our orientation by meeting many other volunteers from all over the world doing other volunteering programmes under IVHQ. It was a great ice breaking session and we got to know more about our new friends from there. Later we had a briefing about our programme by the manager Mr Bijen and he also gave us more details regarding our homestay and that is when I got to know where I will be staying throughout my whole programme.  After that we did a brief sight seeing with the whole group to Swayambhunath temple and climbed up 365 stairs while seeing lots and lots of monkeys!

The next day, we got up early and left at 7am to Pokhara where our hospital was posted. It was a very long and bumpy bus journey of nearly 15 hours. Furthermore, it was raining that day and the weather was definitely not in our favour. Throughout the journey, we experienced two landslides and traffic was just standstill. It was a scary bus journey and probably my longest journey on road but nevertheless I got to admire the beauty of Nepal along the way even when the weather was cloudy and misty. Great job to the bus driver for bringing us to Pokhara safely. Upon reaching Pokhara, we were picked up by Mr Dharma (who was the homestay owner). We got onto his jeep and it was a 15 minutes journey to his house. Once we reached his house, we were greeted with tikka (a red dot placed on our forehead) that was put by his wife Mrs Shanti. Since, we reached quite late, we just talked briefly, had dinner, freshened up and straight went to bed. Dinner was dal bhat which is Nepal's local dish. They had the moto of "Dal Bhat, 24 hour power"

The next few days were when we actually started our hospital posting. Mr Dharma was the healthcare assistant in Gandaki Medical College (GMC) and he gave us briefing and a short hospital tour. We were split into Emergency Department and Surgery Department. I started with Surgery first. Surgery Department over there was just so different compared to what I see and experience in HUKM. We had to wear our own scrubs before entering the OT and once we entered there, we were briefed by a first year resident doctor. He was kind enough to show us everything in the OT and we were free to choose what operations we wanted to observe everday.

I got to see my first C-section and it was so wonderful to see a new life brought into this world. After the baby was born, I even got to see the doctor performing some reflexes on the baby and he was so dedicated in teaching me and told me to even read up more about it. Other than that, I  got to stand very close to the surgeon who was operating and it was a whole different experience of seeing it close up. Other operations that I observed were laproscopic cholecystectomy, vaginal hysterectomy, herniorrhaphy, open reduction and internal fixation (ORIF) and a few more. Although I stood for many hours to observe all these operations but I didn't feel the tiredness kicking in as it was that interesting. However, I didn't go to the surgery ward much because I couldn't understand what they were speaking and patients there are not very fluent in English.

During the weekend, I did go for some activities with my friends like riding ATV and that too in the rain. It suddenly started raining heavily when we were on the hills but it was something fun and challenging I guess. We also celebrated our friends birthday that night. Furthermore, I went for paragliding which was definitely worth all the experience and screams. Those activities were so extreme and I couldn't believe myself that I went for all of these. Probably my friends were the biggest motivation to get me up on all these rides. It was so fun and I would definitely treasure all these dearly.

3. Points to remember from Phase 2

- Maintaining good hygiene is a must for us. Its important to always wear mask and sanitise our hands everywhere in the hospital to prevent us from contracting any sort of diseases from a foreign country.

- Do not force patients to speak if they are not in the mood to do so. It was difficult for me to communicate with patients there but nevertheless that did not disappoint me and I respected their boundaries because language barrier is not something that can be easily overcome.

4. Your feelings and thoughts

Throughout the whole week, I definitely had mixed feelings but I can proudly say that I got more and more excited as each day passed because I was so keen to know what I was going to see and learn the next day. Meeting with doctors, nurses and patients from another country was so overwhelming at first but they were all so nice and made me feel comfortable in the hospital setting. It was no doubt tiring because everything was always walking there as we wanted to save money whenever we could but this experience is something I wouldn't regret. Also, I for sure became more adventurous after going there because certain things even my parents would be shocked to see what I have done especially paragliding. I was so happy with how the first week went and was already waiting for the second.

5. One good thing from what you did that you can practise now

It is their language. I learnt a few basic nepali words that could be used when we speak to patients, ordering food, hailing a taxi and even when bargaining. It definitely helped me get through those weeks. I also had a basic language of Hindi which most Nepali people speak and that too helped me and my friends to avoid miscommunication here and there.

6. Any difficulties/concerns? How did you cope?

First was indeed the monsoon season. It was raining nearly everyday in Pokhara which made life so hard. It was difficult to walk anywhere because definitely we would come back with our shoes soaked wet and also muddy. I even fell sick because I got wet in the rain the previous days although I was with an umbrella. the hospital however weren't very strict with our attire and this was definitely a bonus as we could wear sandals during this monsoon season. Our shoes and clothes took such a long time to dry up and even if its dry, there's no point becasue the next day rain happens again.

Secondly was the language barrier. As mentioned earlier, most of the patients do not speak English and it was hard to understand and communicate with them nut since I knew a little bit of Hindi so it was bit easier for me to get some information from them. If I really couldn't understand, then I would just ask the nurses to help me out.

7. Your plan for next week (Phase 3)

- Ask my other friends who were in Emergency department on what I should learn prior as that would be my posting next week.

- Find out more on good restaurants and sight seeing places that I can go and try with my friends.

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1(One with IVHQ Nepal volunteers); 2(landslide ahead!); 3(One with Dr Tarun); 4(ECG); 5(One with Dr Aasmita&Jyothi); 5(branula insertion) 6(ATV); 7(Paragliding)

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1. Your name, matric number, date

Name: Keshrina Subramaniam

Matrics number: A182868

Date: 6.8.2023 - 13.8.2023

2. How is your progress?

We began our medical elective journey by having a day of orientation with other volunteers on Day 1. It is incredible how surprisingly, we managed to meet other volunteers from all over the world too like Singapore, the United Kingdom, France and many more! Meeting and getting to know them further excites me to know what awaits me during my stay in Nepal.

On Day 2, we had a 14-hour long bumpy bus ride across the country to Pokhara (where we will be doing our elective). Although the road and environmental conditions did not favour us by having multiple landslides along the way, I managed to witness the beauty of nature with preserved greenery, soothing to the eyes. Upon reaching, we were greeted by our very friendly host, Mr Dharma. He welcomed us with ‘Tika’ (a red dot placed on the forehead) as part of the tradition. He was also kind enough to serve us dinner although it was almost midnight. We had homemade Dal-bhat which is a local dish that is delish and packed with protein!

The following days were when the real excitement began! We had a brief tour around the hospital and learned a bit about how things worked in hospitals in Nepal. A few of my friends and I started with attachment to the Emergency Room (ER- similar to the Emergency Department (ED) in Malaysia. We were greeted by Dr. Tarun Paudel, who is the Head of ER Department and also a Teaching Professor. He introduced us to Dr. Aasmita Pandit, a Registered Doctor who will be guiding us during our time in the ER. She was very sweet and was kind enough to explain to us how things work here in Nepal.

Throughout our time in the ER, I managed to insert a few branules, did a few ECGs, practised manual blood pressure measurement and observed a few intravenous medicine administrations. Since I enjoy practising my clinical skills, this experience was indeed very fun and at the end of the day, I definitely learnt something. Apart from that, we also managed to get hold of a few patients’ radiograph findings which we tried to interpret. Each time we turned on the radiology view box, there were indeed doctors nearby who approached us to help us out. This is definitely something that is not common in Malaysia. Immediately, we felt at ease as we were being held under supervision and we could confirm our findings with the doctor. Besides, Dr Aasmita also brought us to review a few patients while she described the patient’s condition and the acute management given. Since there were not as many drugs used in the ER, she informed us that we could memorize them quickly. Not only that, she also gave a brief idea on how to determine the amount of fluids to be given and how it differs between a child and an adult. Besides that, we also had Dr Tarun, occasionally checking up on us and throwing us a few questions about the theory behind our practicals. This makes things far more interesting since we are given the opportunity to recall our pre-clinical knowledge and use this to our applied skills.

Over the weekend, we also did a few adventurous activities together as a group. We went on ATV and paragliding up from the Mountains of Madero, Pokhara. It was definitely very fun and since these were extreme activities, a lot of fast thinking was required to make quick decisions, especially for the ATV ride since it also unexpectedly started to rain during the ride. Simple decisions like a suitable track line and the speed of the vehicle really challenged my fast-thinking ability. Nevertheless, this experience will definitely be something that I will treasure for the rest of my life.

3. Points to remember from phase 2!

In Nepal, first-time patients or patients without appointments are admitted to the ER. However, before the doctor meets the patient, the guardian must buy medical equipment from the pharmacy. For example, patients are required to get syringes, vacutainers for blood investigation, branula, plaster and even gloves. This is due to the short supply of medical equipment in the hospital. After taking blood for investigation and receiving the results, only then the patient is referred to specific departments by the ER Doctors.

Antibiotic skin testing- Contrary to broad-spectrum antibiotics being prescribed to patients upon admission and taking specimens for culture and sensitivity, In Nepal, patients are required to take the Antibiotic Skin Testing (AST) prior to any antibiotics administration.

Some Nepali words and its translation

Simple greetings

Namaste (Hello)

Dhanyavaad (Thank you)

Subra prabhat (Good morning)

Subha raatri (Good night)

Hospital setting

Ma photo lina subsu? (May I take a picture?)

Nepali bujhina (I dont understand Nepali language)

To bargain

Bhai, ali-ali sastoma dinus (Brother, please reduce the price)

4. Your feelings & thoughts

During this week, I was pretty excited about new things to anticipate each day! Loved how our schedule was we started our day with breakfast provided by our host family, proceeded to walk to the hospital and then stimulated our brain cells and hand skills, and then after lunch, we were free to play our tourist responsibility. Despite constantly having something to do until night, it was very enjoyable and never tiring. Apart from that, being able to go paragliding and an extreme ATV adventure is definitely something that I never thought of. Growing up, I always thought that I was a timid girl when it came to going up on thrilling rides. However, now, I have discovered the adventurous side of me. In addition to all this excitement, since I was together with another 9 of my friends, this made my Medical Elective Abroad even more hyped.

However, an issue that I would like to put here that disappoints me is the hygienic practice of this hospital. It is sad to see that most procedures are being done without wearing gloves. This is definitely a practice that could induce a lot of nosocomial infections.  When we tried asking the nurses the reason for them not wearing it, they replied that it was a hassle to wear and change gloves each time. In my opinion, this should never be normalised, especially if it is in the ER of receiving new patients each time.

5. ONE good thing from what you did that you can practice now!

Learning their language

Simple words to communicate while taking a cab for sightseeing when bargaining can really help to further reduce the price of souvenirs to its lowest.

6. Any difficulties/concerns? How did you cope?

Monsoon season

Since our volunteering project was scheduled during the monsoon season, it was rainy and gloomy at the beginning of the stay. So, most of our closed shoes got wet and soaked. It was also hard for it to dry. However, the hospital was quite linear with our attire and we were allowed to wear sandals to the hospital. This is definitely a relief since we won't be getting the hospital floor wet with our soaked-up shoes.

Language barrier

Since most speak their native language in the hospital setting, it was pretty hard to communicate with patients especially when we were placing in branulas. However, there are also some patients who are able to speak in Hindi. Thus, I was able to communicate with them minimally.

7. Your plan for next week (Phase 3)

Get a briefing before I begin my second attachment at Surgery

Find a nearby laundry to wash our clothes! (Since it has been raining all along, it was hard for clothes to dry, and yes! It was a mini struggle;/)

Ask our new friends and host family for recommendations and suggestions for good restaurants and more things to do!

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1.     Your name, matric number, date

Salinee A/P R Arasu (A184222) >> 06/08/2023 to 13/08/2023

2.     How is your progress?

Let’s begin with a fun fact about Nepal : It is currently year 2080 in Nepal. When we first learned about this we were utterly shocked and amazed. All of their medical reports were recorded based on Nepalese date together with our western date. In the beginning we were confused with their dates. As time goes by, we adapted to their culture and environment quickly.

My friends and I embarked on this beautiful journey on the 6th of August. Our flight was at 8pm. After five long hours, we finally reached Tribhuvan International airport where we were welcomed warmly by the IVHQ team. They picked us up from the airport to Hotel Arts Kathmandu, our accommodation for the next two days. Once we reached the hotel, all of us feel into deep slumber as we were all tired.

The next day, 7th of August, we had breakfast in the hotel together with many other volunteers from all around the world. All of us introduced and had a small chat. Then, we attended the orientation by Mr Bijen, Nepal representative of the IVHQ program, at the rooftop. He gave an amazing overview on Nepal and the whole programme. Later that day, we went for lunch at a café nearby where we had delicious nepali dish, Dhal Bhat. Each bite was filled with rich flavours. At the same time, we also mingled around with other volunteers, listening to their stories and adventures. After lunch, Mr Bijen brought all of us to Swayambhunath Temple alias monkey temple. An amazing fact about this temple is it is one of the oldest (2000 years) religious architecture which houses several shrines and temples that boasts both Buddhism and Hinduism. We climbed 365 steps to reach the top of the stupa where we could see the whole Kathmandu city which was breathtakingly beautiful.  Later on that day, we head to dinner at the same café, then back to the hotel.

On the 8th of August, in my personal experience, this was one of the most challenging days in my life. At 6am, we left the hotel in Kathmandu and headed to Pokhara where we were posted to volunteer. On a normal day, it would take about 6 to 7 hours to reach Pokhara. Unfortunately, on the day we departed it was raining cats and dogs. Due to the geographical features of the land, we encountered 3 landslides on our way to Pokhara. This has caused a major delay in our arrival time. We were stranded in the middle of the highway with a lack of food and no toilets. After 14 dreading hours, we reached Pokhara around 8 pm. Our host family welcomed us warmly to their homes. We introduced each other and had a light dinner together.

On the 9th of August, Mr Krishna, a medical assistant who is working at Gandaki Medical College showed us the way to the hospital. We were all posted to Gandaki Medical College which is a private teaching hospital which is 20 minutes away from our homestays. The hospital was painted in white and green. Mr Krishna gave us a tour around the hospital. We went to each and every department in the hospital, including the surgical, medicine O&G and emergency departments. After the tour, he explained how the healthcare system is managed in Nepal. It was different from how it works in Malaysia. For example, if a patient needs medication, the family member of the patient needs to buy it from the pharmacy which is located outside of the hospital. The treatment will only begin after the medication has been bought or after the payment for the treatment has been made.

On the 10th of August, all of us segregated into a smaller group and decided which department to volunteer in. We decided we would rotate each department after the week was over. We divided into internal medicine, surgical and emergency departments. I was first posted into the internal medicine department. Our shift begins at 10 in the morning and ends at 4 in the evening. We have a lunch break from 12-2 pm. Our first day was relaxing as we were just introducing ourselves to the doctors and interns in the internal medicine department. On the first day, we were briefed on how the internal medicine department works and how they handle each case. It was a short day. At the end of the day, we meet with our friends and discuss on what were the cases we encountered during the day.

On the 11th of August, it was another relaxing day where we followed the doctor for ward rounds and read the patients’ files. It was another short day as we were just adapting to the system there. Also, the year 5 medical students were having their OSCE exams in the ward. Hence, we couldn’t encounter many cases that week. Later on, my friends and I visited a few tourist spots and famous cafes.

From the first week, we noticed that most of the internal medicine cases in Nepal arise from infectious causes such as pneumonia, syphilis, hepatitis and dengue. So many patients with textbook findings were discovered. The case that caught my attention the most was the left-sided pleural effusion. Usually in Malaysia, we use underwater seal drainage to collect the pleural fluid during thoracentesis. In Nepal, unfortunately, they use empty mineral bottles to collect pleural fluid due to resource limitations. This action really moved me.  We were able to clerk a few patients who spoke fluent English. One of the specialists was even so kind as to teach us how to interpret chest CT.

Apart from the hospital, we also had some fun outdoor activities. That week, we had a karaoke dinner party to send off one of our housemates from the UK, we went for ATV rides, we explored the local theatre to watch a movie without subtitles (we were clueless as to what was happening) and we celebrated one of our friend’s birthday.

There is a tradition upheld by my host family every weekend called The DND, Drink and Dance. It’s a party where all of us gather to have a drink together and dance to our favourite songs. It was a cute and fun activity which brought all of us closer as a family.

3. Points to remember from week 2!

Always remember that things are different in a different country. The healthcare system was very different from the one in Malaysia. Always be more open to accepting and embrace the differences.

Don’t be shy to ask questions and be more social. Getting to know so many people from all around the world can be a little overwhelming but in the end, it’s going to be worth it.

Be grateful for what you have and enjoy the little surprises that life throws at you.

4.  Your feelings & thoughts

According to Buddhism, comparing is sin. I can’t help but to compare Malaysia and Nepal. I understand that why Nepal’s healthcare system is the way it is but I feel utterly grateful for the healthcare system in Malaysia. Watching how thoracentesis is being done without proper equipment was an eye-opener to me. Another thing I’ve noticed in Nepal is their hand sanitiser which was kept in a shampoo bottle. These differences shocked me.

My friends have been amazing throughout the whole journey. Spending my holidays with them has been a pleasure. Creating memories with them has been the best thing in my university years.

5. ONE good thing from what you did that you can practice now.

·       Interpreting chest CT.

6. Any difficulties/concerns? How did you cope?

The only difficulty I faced was when clerking the patients. I was able to clerk very few patients as most of the patients speak Nepali or Hindi. However, I was attached to a very kind intern who helped us to translate everything the patient said. He even helped us during ward rounds when doctors would interact in their own language. I’m very much grateful to him.

7. Your plan for next week (Week 3)

Next week I’m entering the surgery and emergency department.

To watch as many surgical procedures and help to assist in surgeries.

Perform basic procedures in ED.

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 1st (me wearing the yukata), 2nd (tea ceremony making), 3rd (maggots sample taken to breed them into 🪰), 4th (mini lectures), 5th (autopsy #ootd), 6th (band!)

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1. Your name, matric number, date

Maisarah binti Junaidi, A173345, 31/7 - 4/8/2023

2. How is your progress?

We did autopsies back to back from Monday to Thursday. We encountered cases involving drowning, suicide/homicide, dementia patients and decomposed bodies. We also attended a few mini lectures regarding cause of deaths and the autopsy system in Japan by our teachers and friends. We were also given a task to interpret a few histology slides from an autopsy case done by Hitosugi sensei that will be presented on the following week.

Besides being involved in autopsies we also experienced a bit of Japanese culture by wearing a Yukata that was brought by Nakamura sensei. She was kind enough to bring 3 sets (including a special suitcase!) of her personal Yukata for us to try on and take pictures with everyone in the department. They also helped us put on the outfit. The Yukatas were soooo beautiful and the material felt very expensive.

Besides trying on the traditional Japanese Yukata, we also got to experience a traditional Japanese tea ceremony. One of our Japanese friends, Hitomi, borrowed her senior's tea ceremony kit and brought it for us to try. She showed how it was performed first and let us try afterwards. The matcha taste was very different from what I had tasted previously in Malaysia. It had that authentic and thick taste making it delicious without adding any sugar or other additional flavours.

We learned from our Japanese friends that SUMS had many clubs that medical and nursing students could participate in such as music and dancing. They offered us to watch a band practice after class and even requested them to sing me a happy birthday song! I felt so honoured and touched that they were willing to go through those lengths for me. We also visited the dance studio and practiced a dance together.

3. Points to remember from week 2!

During the summer, the death rate in Japan increases due to a lot people play in the water and many outdoor activities are done.

There are only a small number of forensic specialists in Japan.

When dealing with decomposed bodies that has maggots, taking a few maggots as samples is important to determine how long the body has died. Keeping them and waiting for them to become an adult is also important to determine what type of maggot it is.

During the autopsy, urine will be taken as a sample for drug tests to be performed afterwards. This is helpful in determining the cause of death by detecting any drug ingestion by the person before death.

4. Your feelings & thoughts

I feel like I am widening my knowledge on forensics as I have encountered various causes of death and what to take note of during the autopsy procedure.

Japanese people are too nice to us, once we mention something we are curious about they will straight away try their best to fulfil our needs.

The cafeteria food is really cheap, very kind to my pocket.

Something that appreciate the most is how Japanese people make the effort to give us lectures in English despite not being fluent in the language.

5. ONE good thing from what you did that you can practice now!

Patience and being kind to one another.

6. Any difficulties/concerns? How did you cope?

Again, the one difficulties is language barrier. During the mini lecture sessions, some of the presenters had a hard time trying to present in English, however it was easily overcome as we had a Japanese friend who was fluent in English and helped translate it for us.

The task of interpreting the histology slides were most challenging for us, we almost spent an hour by ourselves trying to figure out which organ was cut in the slides. However, our friends and one of our sensei saw is struggling and came to the rescue. We figured how to complete the task together successfully.

Decomposed bodies tend to have a really strong smell that can be detected from miles away. Since we all wore a headscarf it was impossible to wear it during the autopsy as the smell will linger on the clothing. So they gave us an alternative to wear a fully covered hat with an apron that covered our necks.

Finding directions to places we wanted to go to was challenging for us. However, we asked around and even asked our senior, Kak Aslina to teach us since she has been staying in Japan for 5 years already.

7. Your plan for next week (Week 3)

Do better in helping our sensei in performing the autopsies and prepare for our big presentation at the end of the week.

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Step into the extremely CROWDED hospital: SAHZU! 

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Step into the extremely CROWDED hospital: SAHZU! 

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1. Ng Yueh Chee, A182958, 31-7-2023 to 4-8-2023

2. How is your progress?
Monday, 31-7-23
It was the first day we step into The Second Affiliated Hospital of Zhejiang University. I finally had the chance to meet the person in charged who had been contacting and communicating with us since 6 months ago. She briefly introduced to us the history and background of SAHZU. Then, she brought us to have a tour around SAHZU. It was really huge and crowded! She then brought us to the hospital laundry, which is the place to take and return our white coat. Then, we had our lunch in the hospital using student card. They used AI as cashier to calculate the price of meal. It is really advanced!
After lunch, another PIC from Teaching Department brought us to meet our supervisor, Dr Liang Wei Wei. She is an attending physician in Endocrinology Department. Then, my elective posting journey started with the first ward rounds in SAHZU. As expected, I did not manage to pick up the progress as I did not understand the medical terms in Chinese during their discussion. My first day ended with following a fellow doctor to clerk a new patient. It is very challenging as I had to use pure Chinese to clerk her. Before leaving the wards, a doctor from another team brought us some deserts. When we opened it, I realized it is DURIAN CREPE CAKE!

Tuesday, 1-8-23
I arrived in the ward at 8am, preparing myself for the ward round. It was the first day of the month, so the rotation of the doctors in the ward changed. All the doctors that I met yesterday already went to other departments. So, Dr Liang took some times to brief all of us including fellow doctor and medical students of SAHZU about all the cases in the wards. She explained to us one by one from the symptoms of the patient, investigations that had to be done and the management. I slowly picked up the medical terms in Chinese and used BAIDU to search if I did no understand them. I managed to saw a few patients with pituitary gland tumour and Dr taught us how to appreciate the tumour in MRI.
I also saw a patient with Cushing Syndrome. He had hyperpigmentation skin and a lot of bruises especially at area with brannula. Although it is not that obvious, we still able to observe his buffalo hump.

Wednesday, 2-8-23
As routine, I attended the daily ward rounds at 8am. Most of the cases in the wards are pre-ops patients who need to undergo a series of check up before their operation. That day, I saw a young girl with hyperthyroidism with very typical symptoms which are tremor and sweating.

Thursday, 3-8-23
We attended an educational talk in the demonstration room for diabetic patients in the ward. It was given by the diabetic nurse. They brought props like food that are commonly consumed by China people to explain. The nurse also made the patient to calculate the calories need to be consumed daily. It was really a very comprehensive and easily understand talk.

Friday. 4-8-23
Last day in Endocrinology Department.
I attended the teaching rounds in the ward. There are around 30 doctors from other hospital visiting our department to attend the teaching rounds given by my supervisor, Dr Liang. The case discussed in this session is DKA. We were brought to the patient and educated him about prevention of diabetes.

3. Points to remember from week 2
- Be more outgoing to talk to others! Building connections with healthcare professionals and peers during the elective could lead to future collaborative opportunities and mentorship.

- Be calm and patience! China hospital is very crowded! As a doctor in SAHZU, we have to very calm and make sure our brain is always clear to our decision.

4. Your feelings and thoughts.
The populations in China is very big, hence the healthcare facilities is always not sufficient to support all the people in China. Somehow, I felt blessed when I saw some patients had to sleep overnight where their bed is placed at the corridor of the ward.

5. One good thing from what you did that you can practice now!
Wake up 6am everyday to get ready myself and head to the hospital.

6. Any difficulties/concerns? How did you cope?
- Cultural Differences: Adapting to a new culture, both in terms of medical practices and everyday interactions, can be daunting. Different cultural norms and patient expectations might require a period of adjustment. The patient in China is very different in Malaysia, they will ask a lot of questions to the doctor and their family members are very irritable. They want everything to be fast.
- Having lunch in the hospital canteen is also a very challenging part for us because during the lunch time, it is very crowded and did not have enough place for us to take our lunch. So, we need to be fast and reach the canteen earlier to be able to have our lunch.

7. Your plan for next phase
- Revise back my knowledge about cardiology to prepare my posting for next week.
- Follow my own pace in the very fast-paced country. Relax and enjoy the learning process in hospital.

# data[].attributes.headline
Blending in As a Local Medical Student in Szeged, Hungary!

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Blending in As a Local Medical Student in Szeged, Hungary!

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Name: Siw Ming Huey

Matric Number: A181220

Date: 3rd July 2023 – 28th July 2023 (Phase 2)

How is your progress?

On 3rd July, I woke up early to get ready for my first day in general surgery department! I met up with Ines from Spain, who will also be in surgery department with me for the rest of the exchange. Flora is one of the CPs who will also be spending a month in surgery department as part of her summer program. We met up at 7:30 a.m. and departed to the hospital together – which is just across the street from the dormitory – the whole journey took less than a minute. Flora showed us where we could leave our bags, change our shoes, and grab a lab coat (we don’t have to bring our own!). Then, we went for a briefing about our assigned team, attendance, operation theatre etc. After the briefing, we were dismissed. Flora introduced us to our supervisors respectively and we are off on our own! After that, we went to the operation room and observed a few surgeries before we ended our day at 13:00.

For the rest of the month, Ines and I joined the hepatic team under Dr Geczi for our 4-week long clerkship in the hospital. We usually attend Dr Geczi’s operations since he was very patient to explain the cases to us and kind enough to teach us related information. Our schedule in the hospital is mostly dependent on Dr Geczi’s schedule since he was the supervisor. We would have days in the OR and days in the ambulance (which is the outpatient clinic). However, there would be an off-day for him if he was on-call the day before. On these kinds of occasions, we would have our own choice to observe other surgeries or attach to other doctors in the ambulance. It was always interesting for us to see different types of surgeries. Moreover, we can always get the chance to practise different skills especially wound care if we are willing to volunteer ourselves to help.

During the first time I got to scrub in and assist in a surgery, I was so clueless and nervous. Dr Geczi taught me the pre-scrub wash and the scrubbing procedure. Basically, after the pre-scrub wash, I need to use the cleansing solution to wash my hands, forearm and up to the elbow very thoroughly. This process has to be repeated five times, each scrub covering all areas and should take approximately a minute. I also learnt the proper way of gowning and keeping myself sterile with the guidance of Dr Geczi and the scrub nurse. After the first experience, I am much better at scrubbing in on my own.

The most memorable operation to me is on a 94-year-old female patient who has a carotid artery stenosis. In the carotid endarterectomy, they removed the atherosclerotic plaque with the patient still conscious throughout the whole operation! They did a transverse arteriotomy and stopped the blood flow in the left carotid artery. Once the blood flow has been stopped, there will be a 3-minute window period to observe the patient’s vitals. During this period, the nurse will talk to the patient, and she will have to squeeze a squeaky toy as her response. Seeing the patient was fine, they proceeded with the operation from there.

Points to remember from week 2!

We are reminded that we should bring a pair of shoes specifically for wearing in the hospital. It doesn’t have to be professional hospital clogs, but it has to be a clean pair of shoes to keep the hospital area as sterile as possible. This pair of shoes shouldn’t be worn outside of the hospital. Therefore, we carry our clogs to the hospital and change into them in the lobby; before leaving the hospital, we will change into our own shoes again.

On my first day, I woke up at 04:00 in the morning because the sunrise was so early there. I was so startled that it was already daylight when I opened my eyes. It felt like 09:00 in Malaysia and I thought I woke up late, ON THE FIRST DAY OF CLINCIAL CLERKSHIP! I was relieved when I saw that it was only four in the morning. My conclusion was, “Daybreak is early, if you don’t hear your alarm, sleep on!”

“Sebészet” means surgery in Hungarian. If you’re lost and want to ask for directions, say “sebészet”. If surgeons start asking you questions as soon as you enter the operation room, they’re most likely asking about which department you’re under, so answer “sebészet”. If you really don’t understand something, say “nem értem” which means I do not understand.

Your feelings & thoughts

I feel so fulfilled whenever I finish a day at the hospital. There are always so much to learn, and the surgeons are always patient to explain what they’re doing in the operation. Although there might be some language barrier, the local students who are also observing the operation always try their best to translate to us. In the ambulance, the doctors usually converse with the patient in Hungarian. At times like this, one of my teammates, Akos, also tries to explain what is happening as much as he can. I am honestly so grateful to my teammates for being so helpful and kind all the time.

I was amazed to see how Dr Geczi and my teammates got along with each other. Different from my experience of students being afraid of making mistakes in front of doctors, they talked to each other like friends discussing about a patient’s case. Dr Geczi was always straightforward to point out any mistakes we made; however, it was never a harsh attack that made us doubt ourselves or diminished our self-esteem. It made me more confident to voice out my opinions to his questions, knowing my wrong answers wouldn’t be responded with a terrible scolding.

From the most memorable operation mentioned above, somehow, I learnt to view from a patient’s view. If I put myself in the patient’s position, I think I would be so nervous and afraid myself, let alone an old lady aging over 90 years old. It led me to think that, we can never fully understand the suffering of the person experiencing it, so it is always important to learn about the patient’s concern or worries, and proceed to reassure them the best we can.

ONE good thing from what you did that you could practice now!

Speaking up or stepping up to volunteer myself is always an opportunity for me to learn, no matter what settings I am in.

Any difficulties/concerns? How did you cope?

My supervisor is originally another surgeon instead of Dr Geczi. However, it has been quite difficult to get into contact with or talk to my initial supervisor since the first day. He was always in a rush when I see him in the wards and dismisses me away. I realised then that if I could not reach my own supervisor, I would have to find my own way to learn during my exchange here. Therefore, I found Dr Geczi and tagged along with the team whenever he has discussions or teachings.

Language barrier is the main problem I faced throughout the exchange, especially since I could not directly converse with patients. Most of the elderly only speak Hungarian, but it was a relief that most of the younger generations can speak both Hungarian and English. I also asked for help whenever I need translation.

Your plan for next week (Week 3)

Preparing for presentation about Malaysia! (NFDP)

Continue to assist in procedures and surgeries.

Joining social programmes planned by the CPs.

Sightseeing.

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1. Your name, matric number, date
Nurul Nabihah bt Zahanordin, A173349, 31/7/23 - 4/8/23

2. How is your progress?

Monday - Thursday:

Hands-on doing autopsy every morning at 9.30am until 12pm. Very interesting and different cases this week and we learned a lot.

Mini lecture everyday in the evening from 2.30pm until 4pm

Friday morning:

Observe histology using microscope and determine the type of organs and abnormalities

Prepare for our grand presentation that will be held next week

Tuesday:

Japan culture - trying kimono

Wednesday:

Tour and visit the club activities - went to their dance club

Thursday:

Tour and visit the club activities - went to their band club. They even performed some songs for us

Friday:

Japan culture - experience tea ceremony

3. Points to remember from week 2!
One of the cases involved an elderly person who passed away due to suicide and was later found after 5 days. A lot of maggots surrounded the body, and we learned that to estimate the time of death is by measuring the size of the maggots and to know the gender of the body is by measuring the size of the pelvic and check if there’s any prostate in male. We also learned signs to know if the cause of death is due to drowning such as measuring the composition of stomach content and fluid in stomach and also if theres any bubbles found in the trachea of the lungs.

4. Your feelings & thoughts
I am always grateful for their kindness towards us. They were always patience and attentive in providing us the best experience throughout our attachment in their department.

5. ONE good thing from what you did that you can practice now!
The value of being patience gives the most beautiful outcome. For instance, during tea-ceremony we should be patience on following the rituals and handling the tea. As we sipped the tea that was given to us, it was very delicious and meaningful.

6. Any difficulties/concerns? How did you cope?
difficulties handling my emotions during the autopsy. I put aside my mixed feelings and focused on doing my tasks during the autopsy to prevent mistakes that could affect the investigation. Forensic specialists should have a very strong mindset when conducting this work, as they will experience various forms of bodies in various conditions. I pay my respects to doctors who work in this field.

7. Your plan for next week (Week 3)
To enjoy my experience doing autopsy and focus on finishing my presentation slides.

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1.     Your name, matric number, date

Muhammad Azim Bin Jawhardeen,
A182374,
25/7/23-1/8/23

2. How is your progress?

• On July 25th, I had a great time at the Tenjin Matsuri festival, which is one of Japan's famous summer festivals. I had an amazing time watching the parade and the amazing fireworks.

• For the next few days, I went to famous places in Osaka ,like Den-Den Town (which is like an Anime Town) and Dotonbori. There, I had my first-ever bowl of halal ramen.

• On Saturday, after my regular Arabic class in the morning, we got ready for our Sunday event in the evening. We went to the store to get things we needed, helped with the food preparations, and also folded brochures for our guests.

• The event was all about showing Japanese people different cultures. I had to show the men how to wear ‘kain pelikat’, which was fun. At the same time, we had a special area where Japanese women could try out henna, and they liked it a lot. It showed they were really interested in learning about different cultures.

3. Points to remember from week 2!

·      Japanese people are interested in learning about different cultures, and JDC has organised many events to help with that.

·      I got to experience one of the biggest summer festival in Japan, saw lots of people wearing their traditional yukata outfits to enjoy the festival.

·      Getting ready for the event was tiring since we had to do everything the day before. But doing it with my friends actually made the whole preparation enjoyable for me.

4. Your feelings & thoughts

• The week was enjoyable and memorable, but a little sad because my friends returned to Malaysia on August 1st since their internship had finished.

5. ONE good thing from what you did that you can practice now!

Being able to start a conversation with a stranger

6. Any difficulties/concerns? How did you cope?

·      Language difficulty but it can be managed using google translate

·      Taking the train in Osaka was a bit tricky at first because there were lots of platforms and different lines, but the officers there are always ready to help us.

7. Your plan for next week (Week 3)

·      Visit Kyoto

·      Trip to Nagoya to give out brochures with my supervisor

·      Explore Osaka

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1. Your name, matric number, date
Nur Emilia Ellina Binti Mohd Imran
A183604
31/7/2023-6/8/2023

2. How is your progress?

Every morning, we joined autopsy cases at 9 a.m., followed by mini-lectures that were prepared by the forensic department team. And in the evening, we hang out with our Japanese friends and tour around their campus. They invited us to see some of their club activities, such as the band club and dance club.
Monday: We exchanged origami with several of our Japanese friends.
Tuesday: We tried on kimonos that our sensei had provided, and we were each given a traditional hand fan called a "sentsu" to go with our kimonos.
Wednesday: we visited the dance club hall where members typically practice for competitions.
Thursday: we visited the student creative hall to watch the band club in practice.
Friday : our Japanese friends organized a traditional tea ceremony for us, and we participated.

3. Points to remember from week 2!

On the second week, we joined another four autopsy cases, which included suicide and drowning cases. There are a lot of new things we learned, such as important signs of drowning that can be found in a certain organ.
During our tea ceremony, we learned that each cup that was served to us has a different symbol and needs to be drunk at a certain part that needs to be connected to its vessel.

4. Your feelings & thoughts

The forensic department greeted me with open arms, and the students and sensei were both quite friendly. I am really grateful to have made new friends. We also shared ID lines so that we could stay in touch. It was a special occasion for me because I had never participated in a tea ceremony or worn a kimono before, which has made me more familiar with their customs. Moreover, throughout our stay, all of our friends there kept giving us gifts and delicious Japanese foods on occasion. I hope I can treat them with the same courtesy if they visit our nation.

5. ONE good thing from what you did that you can practice now!

There is a lot of waiting involved in the tea ceremony.  I'm not the kind of person who can sit still for long periods of time. But sitting and reflecting while attentively observing their rituals does help me throughout the tea ceremony.

6. Any difficulties/concerns? How did you cope?
Even though I studied Japanese in high school, it wasn't enough for me to get by in Japan on a daily basis. I wish I could have done more planning so that I wouldn't bother anyone there. I continue to study Japanese at night so that I can expand my vocabulary.

7. Your plan for next week (Week 3)
My plan would be to prepare for our presentation regarding our tasks that were told to us by our sensei and finish our pathology slides.

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1. Your name, matric number, date

Adliana binti Abdul Samad, A181052, 23/07/2023-31/07/2023

2. How is your progress?

On Sunday, I arrived safely at Kansai International Airport (KIX). A fellow Malaysian post-graduate student, generously accompanied me and four other UKM students to Shiga University of Medical Science (SUMS) and then to the International House (IH), where I'll be residing for the next 3 weeks. Here are a few updates after my first week of living in Japan

·      Adaptation to living in Japan

Navigating public transportation: Getting used to the train system, especially at big stations like Kyoto Station was initially quite confusing. However, I quickly learned about the three main categories of transportation in Japan: the Shinkansen for long-distance travel, subway lines for getting around within cities, and JR lines for comprehensive rail coverage throughout the country. On my first day, I was extremely grateful for the senior’s guidance which helped me to avoid getting lost. We took the Haruka express from Kansai International Airport (KIX) to Kyoto Station.

I had also taken care of grocery shopping without relying on the resources of the house. Being responsible for managing my own needs and making decisions about what I eat has truly made me feel like ‘I’ve grown up’. Planning meals, making shopping lists, and navigating the supermarket have all contributed to my self-reliance and personal growth. It feels fulfilling to see how far I've come in becoming more independent.

On Monday, I toured the hospital, basic science building and library. We then visited Professor Katsuyama's neuroanatomy laboratory where I met Mongolian post-graduate students on the first day. On the second day, I met Professor Katsuyama, who had just returned from a conference. They all warmly welcomed and were kind to us.

·      Adaptation to laboratory life

The first day in laboratory, I have observed on (1) cell passage. Cell passage is a technique to ensure the cells are alive by changing the medium, Dulbecco's Modified Eagle Medium (DMEM) that provides nutrient to the cells [N2A from mouse and Human Embryonic Kidney (HEK) cells]. However, it was unclear that what experiment that she was conducting at first but she explained roughly and printed her daily plan for the experiment.

During our second meeting with Prof. Katsuyama, he discussed previous research related to the ongoing experiment now. The research focused on the deficiency of the Sbno1 gene, which was observed in autism patients. Sbno1, a member of the helicase superfamily, plays a crucial role in brain development and is believed to contribute to the development of psychiatric disorders. To understand the effects of Sbno1 deficiency, previous research was conducted using mice as experimental subjects.Previous studies have demonstrated that mice with Sbno1 deficiency exhibit a thinner cerebral cortex with reduced dendrite branching and length, but no significant decrease in the number of neurons. Prof. Katsuyama explained that Sunjee's experiment aimed to investigate the molecular functionality of Sbno1, specifically its potential as a protective mechanism against x-ray treatment. As a reference, Prof. Katsuyama provided both of us with a research paper summarizing previous studies on Sbno1.

Throughout the week, I learned about (2) cell transfection where foreign nucleic acids are introduced into cells to create genetically modified cells. Neuro2A (N2A) and HEK cells were used in this case. The transfection solution included Opti-mem to reduce serum requirements for cell cultivation, Polyethylenimine (PEI) to deliver DNA into cells, and Green Fluorescent Protein (GFP) to label specific proteins in live cells.

3. Points to remember from week 2!

·      Pay attention to the signs while using public transportation, as they provides valuable guides throughout the journey.

·      Signs can be a bit misleading occasionally, don't hesitate to ask for assistance from locals or seek help from the friendly staff at the Tourist Information counter when in doubt of which direction to take.

·      It's important to handle neuron cells with great care as they are sensitive cells. In order to maintain a clean and safe environment, disinfects the surrounding area with alcohol.

·      Fully immerse and engage the task on hand. For instance, stay focus and remember to change the tip of the pipette or aspirate before handling a different type of cells, such as N2A (mouse) and HEK (human) to ensure accurate and reliable results.

·      Each medium has its own unique purpose and benefits in supporting the growth and study of cells. For example, trypsin is used to separate clumpy cells. On the other hand, high glucose medium serves as a rich source of nutrition.

4. Your feelings & thoughts

·      I felt a mix of excitement and curiosity for the experiment, wondering where it would take me. Being a medical student, this was a new opportunity to learn about laboratory procedures for future use and I was eager to explore and gain more knowledge in this area.

·      At first, I had concerns about living with a roommate since I was used to living alone. However, this experience has helped me develop the ability to tolerate and understand each other. We both contribute to completing shared tasks and responsibilities such as household chores.

·      On my way to Kyoto station from airport, I couldn't help but notice the peaceful and quiet streets on Sunday. The lack of people has intrigued me and sparked my curiosity about the reasons behind this uncommon (or possibly common) sight. It motivated me to explore further and uncover the local customs and daily activities of the locals that contribute to this phenomenon.

5. ONE good thing from what you did that you can practice now!

·      Handling rubbish in Japan has been an eye-opening experience. The Japanese have a strong emphasis on proper rubbish classification distinguishing between plastic, plastic containers, burnable, and non-burnable items. This approach has made me more mindful and discerning when it comes to disposing of waste. Nowadays, whenever I need to throw something away, I find myself taking a moment to carefully consider its correct category. It's a good practice that encourages environmental consciousness and responsible waste management. This process also fosters the practice of reduce, reuse, and recycle, enhancing my commitment to sustainability.

6. Any difficulties/concerns? How did you cope?

•      Unfamiliar laboratory procedure: As I started to observe some experiments, I found myself facing the challenge of unfamiliar laboratory procedures. However, I approached it with a positive mindset and ready to gain the valuable experience in the laboratory. The good thing was that some procedures in the experiment were repetitive which allowed me to gradually become familiar and remember them effortlessly.

•      Difficult terms on research paper given: The research paper that I received was filled with complex terms, which initially was the barrier to my understanding. However, I took this as an opportunity to enhance my analytical abilities. I took the time to carefully grasp on the meaning of each term, seeking additional resources from the other research paper and guidance from sensei when needed. This process not only expanded my vocabulary but also comprehension skills.

•      Insufficient/Forgotten knowledge on biochemistry and cell cycle: I realized that my knowledge on biochemistry and the cell cycle was insufficient. I had coped it by reading on research paper and notes from human genetic module. This extra effort allowed me to fill the gaps in my knowledge and gain a more comprehensive understanding of the subject.

•      Exploring halal food options: Most convenience store food options are not vegetarian-friendly, as they often contain pork or chicken. However, I discovered that there are some fish-based dishes available, such as mackerel or salmon in tempura, steamed with soy sauce, sushi, and sweet pastries. The SUMS cafeteria also offers fish on their menu. Additionally, I've been using Google Translate to scan ingredient lists and ensure that the food I consume is free from mirin, meat, and gelatin. It has been a great help in navigating dietary restrictions.

7. Your plan for next week (Week 3)

·      I plan to observe the immunocytochemistry and immunohistochemistry conducted by the post-graduate student.

·      Give my full attention to observe the dissection of mice brain, genotyping of each mice by using the tip of the tail and using the electrophoresis technique.

·      Start to plan for weekend trips to explore on beautiful cities of Japan including Kyoto, Osaka and Nagoya.

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1. Your name, matriculation number, date
Farah Alysha binti Mohd Farid Ridzwan Lee, A181270, 22/7/2023 - 31/7/2023

2. How is your progress?
It was the beginning of my exciting journey. I finally flew to Japan and settled down in the accommodation provided by the university. Though the journey was long and tiring, it was worth it. On the orientation day, we had a campus tour and also a short briefing on the rules and regulations of the university. After that, we were introduced to the neuroanatomy department and met all the professors and students there. They gave us a very warm welcome. They were conducting an ongoing research on the SBNO1 gene which is hypothesised to be involved in the pathogenesis of neurodevelopmental and neurodegenerative diseases such as autism, schizophrenia and dementia when mutated. Their previous research focused on the histological and anatomical changes of the brain but this time they’re focusing more on the molecular changes when there’s a mutation of SBNO1. Hence, we were at the laboratory everyday to observe how they perform cell passaging, cell transfection, electrophoresis, immunocytochemistry, immunohistochemistry and so on. They were very meticulous with each step that was carried out because every step contributes to the outcome of the research. Even the slightest mistake such as not changing the pipette tip after each step might cause the cells to die and affect the experiment outcome. To think that all the small efforts that go into the experiments are going to contribute to a greater cause when the paper is published give me chills every time. Putting the laboratory life aside, I’ve become more independent after coming to Japan. I planned and cooked my meals, managed my finances, got groceries on my own, travelled around with my friend and did all the house chores together. I honestly liked the sense of discipline I’ve gotten out of it, it made me feel like I’m in charge of my life.

3. Points to remember!

Stepping out of one’s comfort zone is the key to growth. I’ve never been this far away from home because I fear change and new beginnings. I learned that progress is impossible without change. Hence, instead of fearing it, I’m learning how to embrace changes and make the most out of it.

Patience is the best remedy to all trouble. I’ve learned to be more patient when I’m faced with challenges because all things are difficult before they become easy.

Respect and kindness go both ways. If you’re polite and nice to people, they’ll reciprocate the energy. Hence, we should always treat people with kindness.

4. Your feelings & thoughts

My first thought upon arriving in Japan was how incredibly clean the country is. There was no garbage in sight and I was fascinated.

I was so tired on the day of arrival because there were a few bumps along the journey, making it long and exhausting. However, I couldn’t contain my excitement to begin my exploration.

I admire the work ethics of the Japanese people because they put in so much dedication into their work. They get their work done very efficiently and it’s amazing. I’ve lodged a complaint about our toilet’s light bulb once and the next thing I knew, the problem was already fixed. The professors there also don’t go home until it’s late at night to conduct their research and it made me wonder where do they get their energy from.

5. ONE good thing from what you did that you can practice now!
In Japan, they have their own way of disposing garbage. On our orientation day, we were given a guide on how to sort out our garbage at home. They have a few categories but the ones we most commonly come across are burnable waste, plastic containers and packaging, recyclable plastic bottles, glass bottles and cans. I personally think that this idea is brilliant. It’s not only effective in reducing waste, it also helps in reducing pollution. I will start implementing this idea when I’m back home to improve my environmental wellness.

6. Any difficulties/concerns? How did you cope?

On the day of arrival, Shiga University has sent one of their staffs to pick us up but she was late. As we arrived at the crack of dawn, no stores were opened yet so we had to wait mindlessly for 4 hours. I did all sorts of things, I walked around the airport, I read a book and I even took multiple naps to kill time.

After the person in charge arrived, she took us to buy train tickets. Unfortunately, there were some problems with the train tracks, causing all the trains to be delayed. We had to wait for an additional 2 hours on top of the 4 hours just now. It was so challenging that I couldn’t even describe it in words. I was so worn out from the long flight and all the waiting, not to mention having to drag a 30kg luggage along the whole journey too. Thankfully, I went through all the unfortunate circumstances with a friend, making it slightly endurable.

At first, I found it quite difficult to communicate with the people in the neuroanatomy department because of our language barrier. The PHD students were Mongolian and we had a hard time understanding each other. However, I tried using simple English and some hand gestures to convey my messages and with time, it got easier to understand each other. Sometimes, they drew out their explanation and I found that to be very helpful.

7. Your plan for next week

I plan on observing different kinds of experiments and request to do some hands on as well.

I intend on asking my professor for some published articles that are related to the ongoing research. This way, I can get a better grasp of what goes on in the laboratory.

I plan on visiting a few tourist attractions and also do some sightseeing around Shiga and other prefectures in Japan.

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1st & 2nd row: Tourist things I did in Warsaw after hospital and weekends! | 3rd row: Things I did in the hospital that week :D

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Week 2 in Poland: Part time internal medicine student, part time professional tourist !

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Week 2 in Poland: Part time internal medicine student, part time professional tourist !

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1. Your name, matric number, date
Yasmein binti Yuhaimi, A181933, 5/8/2023-11/8/2023

2. How is your progress?
I am so proud to reflect on this week as I have come so far when compared to my first week in Warsaw. I am more confident when taking the public transport with minimal mistakes. Not only am I more well-versed in the public transportation apps, I also now know how to read the manual bus/tram schedule at each station and commute to a few frequent locations without the use of the app. Other than that, I have made new connections with other exchange students whom just entered a week after I did. Progress in the wards are well on track as well! Our supervising doctor of course, continues to be as dedicated and enthusiastic in teaching us as much as we can learn in the wards. I can now grip the surface of the healthcare system here in Poland and am able to compare certain crucial disparities with the healthcare system in Malaysia. Since hospital ends around 12 to 12.30 pm, I was also able to accomplished my goal to visit as many free museums/exhibitions/events in Warsaw as I can.

[Saturday, 5/8] My roommate and I decided to pay the rooftop gardens of the University of Warsaw Library a visit. We continued our stroll along the Vistula river and ended the day walking around the Old Town. Fruitfully on that day, we were able to witness the Międzynarodowy Plenerowy Festiwal Jazz na Starówce, an international jazz music performance in the middle of the Old Town.

[Sunday, 6/8] A Polish student had suggested an activity to which my roommate, an exchange student from Kenya and I decided to go to. It was the Koncerty Chopinowskie 2023, a free classical music performance of Friedrich Chopin's pieces at the Lazienki Royal Park. Later that day, the polish student introduced us to some classic Warsaw treats during summer as well as treated us to a bicycle ride around the city. We ended this day with a spectacular view of the city of Warsaw from the top of a viewpoint.

[Monday-Friday, 7/8-11/8] It was the start of the new week in hospital. I very much enjoy and anticipate my next visit to the hospital. Dr. Marlena Kwiatkowska has made sure she has something for us to do everytime we greet her in her office. I also enjoy watching her work, although I do not understand the conversations she has with her colleagues, she manages to keep calm and professional at all times. After hospital on Monday, I visited the Warsaw Uprising Museum with the other exchange student where we learnt about the historic event of Warsaw's Uprising during the war. After hospital on Tuesday, I visited the National Museum. On Wednesday, we had an off-day thus I took the chance to visit the Royal Castle in the morning and the Friedrich Chopin Museum in the evening. On Thursday, I had the opputunity to attend the evening shifts where I was allowed to trail along their evening ward rounds. The doctors of course communicated with the patients in Polish, but there have been so kind to translate everything said in English so that we are included in the discussion and understand the patient's concerns. We also did our rounds in the hemodialysis stations. Not only were we able to talk with the patients doing the hemodialysis, Dr. Marlena also explained to us the procedures and protocols of the operation. Our discussions with Dr. Marlena and the rest of the nephrology team has also grew. Now, we are able to also ask questions outside of the case topics we have seen in the wards. For example, the topic of kidney transplants in Poland, the different drugs used when managing the patient in an acute setting and encountering cases which are rare in Malaysia, but common in Poland.

3. Points to remember from week 2!

Kidney transplants in Poland is very common - everyday I would meet a newly admitted patient who had just received a kidney transplant and had came in for complications or a normal follow up. When compared to Malaysia, out of 50,000 dialysis patients only 180 received kidney transplants.

There is no such thing of "registering to be an organ donor" in Poland. Once declared dead and donor's organs are suitable/viable for harvest they are immediately done so. However in Poland, only a special letter has to be made if the person wishes to NOT be an organ donor. This then has to be taken into consideration when deceased before harvesting the organ.

Similarly in Malaysia, pubic healthcare is accessible to those with health insurances and covers most of their medical needs. Private clinics also do operate on those specific medical care where the patient is not insured.

Primary health knowledge amongst the Polish citizens is also not well introduced. The Dr. had explained that many had come to the hospital once the modifiable risk factor of the patient had led to the deterioration of their disease.

I have developed such high tolerance for walking and waiting in lines here! I realize that already being in a foreign country and maximizing my time and energy is so worth the 15,000 steps I average at every week. It is also good to appreciate how efficient the pavements, bicycle lanes and public transport system in Europe.

4. Your feelings & thoughts
I am so grateful and satisfied with how the doctors in ward have been treating and teaching me. It has been 2 weeks and my enthusiasm and determination to learn has not faded. I am learning more things I did not have the opportunity to during my internal medicine posting in HUKM and HTI, as well adapting well into an environment where everything is very foreign. I have also been feeling so contempt with the itinerary I have set for myself. Although the other exchange students don't always follow along with plans we try to make together, I have never been happy exploring the places alone.

5. ONE good thing from what you did that you can practice now!
Being able to use my Polish language knowledge in basic conversations - I was even complimented by a Polish speaker on my efforts!

6. Any difficulties/concerns? How did you cope?
I was quite bothered over the fact that whenever I had suggested an activity to go to a free museum in WhatsApp group with the other exchange students, they would dismiss it or ignore the message. I had a feeling that they have formed another WhatsApp group where the ones from Morocco, Jordan, Lebanon and Oman had been in and separately communicating within themselves there. - and it was true! I still struggle to find common grounds whenever I meet or bump into them as they tend to speak in Arabic amongst themselves and I become quiet fast. Though, I have been improving in bringing myself forward into greeting them from a far, invite them over to events although they wouldn't reply or constantly try to spark an interesting conversation. Our relationship was never bad though I feel it could be better and stronger even! Fortunately I do have a friend living in Warsaw whom I can rant to and discuss communication problems. Though I do not want to be bothered by them, and continue on with my plans as well as inviting them to join whether they do or not.

7. Your plan for next week (Week 3)

1. Plan and participate more activities with the other exchange students

2. Finish editing clips of the town and my travels

3. Participate in more nature themed activities such as hiking, visiting the lake and beaches

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Week 2: The fast-paced team ft poor direction me 

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Week 2: The fast-paced team ft poor direction me 

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1. Your name, matric number, date
Chia Xin Yi, A181188, 19/6/23-25/6/23

2. How is your progress?
Monday, 19/6
The journey began on this day. After checking in and receiving a briefing from Miss Marguerite, who oversees medical electives, I was assigned to work with Miss Angela Sultana for the next two weeks. She is a consultant general surgeon with a special focus on colorectal and emergency surgery. It took me some time to locate her, and unfortunately, by the time I did, the ward round had already concluded. As a result, I headed home earlier than anticipated and took the opportunity to visit Valletta and Mosta Rotunda.

Tuesday, 20/6
I arrived in the ward at 7 am, ready for the start of the round. To my surprise, there were numerous junior doctors working under my supervisor's guidance, more than on other teams. I later learned that among these seven individuals, two were final year medical students from Germany. How exciting! During the round, we discussed each case in detail and had the chance to observe several surgeries performed by our supervisor. They also kindly invited me to join them for a coffee break while waiting for the next surgery.

Wednesday-Friday, 21/6-23/6
Throughout these days, I attended the daily ward rounds at 7 am. Most of the cases were follow-ups or referrals. I also participated in online meetings such as Continuing Medical Education (CME) sessions and handovers. The majority of these meetings centered around colorectal and hepatobiliary patients. Additionally, I had the opportunity to learn about the ABCDE approach when I encountered an emergency resuscitation situation involving a man who had been injured by a truck while unloading goods. As the week progressed, I also accompanied my supervisor during her clinic sessions, preceded by another coffee break with my two German colleagues.

3. Points to remember from week 2!

About Maltese: uġigħ fl- istonku means stomach pain!

Being punctual holds great significance, as the rounds consistently commence promptly without any delays.

Sense of direction is way, MUCH MORE important than I expected! and it is not limited to travelling around the city but also in hospital itself because it is extremely HUGE!

Paying attention to the team members who move quickly, is crucial, as diverting my focus elsewhere could result in easily losing track of them in any area of the hospital.

Always ask for assistance or reach out for help, particularly when you're dealing with something completely unfamiliar. It's nothing to be ashamed of.

4. Your feelings & thoughts

I was taken aback by the number of students, approximately 30 in total, arriving from various corners of the globe to apply here, including countries like Germany, the United Kingdom, Ireland, and more. Interestingly, Casey and I are the sole Asian students in this diverse group.

I initially felt hesitant about approaching my German colleague due to the perception that Germans might be reserved and unresponsive. However, I quickly realized my misconception as they turned out to be incredibly friendly. We shared several coffee sessions during which we discussed our respective home countries' working cultures and personal interests.

5. ONE good thing from what you did that you can practice now!
Actively engaged in conversation with my colleagues and whoever I encountered.

6. Any difficulties/concerns? How did you cope?

Initially, I found myself quite disoriented due to the limited information provided despite the briefing from Miss Marguerite. After all the ups and downs I have been through, it has prompted me to step out of my comfort zone and approach the German students, who had been part of the team for the past six weeks, to inquire about the weekly schedule. Their assistance helped clarify my uncertainties, and I am truly thankful for their guidance.

Navigating the hospital posed significant challenges due to its immense size, and I often struggled to locate wards and find my way out. The hospital's division into separate color-coded blocks added to the confusion, as they were not interconnected. Being new to the environment, I had to rely on asking the hospital staff for directions to ensure I reached the wards on schedule and managed to exit the premises. To address this, I started memorizing a few key landmarks and familiarizing myself with signboards. While it was undoubtedly a difficult process, I gradually improved and became more adept at navigating the hospital.

I also faced challenges during rounds and clinics due to the majority of patients conversing in Maltese, a language I am not proficient in. Nevertheless, both my supervisors and the junior doctors were considerate enough to provide explanations about each case's management plan after attending to every patient. They also encouraged us to ask questions whenever uncertainties arose.

7. Your plan for next week (Week 3)

to be more proactive by volunteering assistance to the doctors

participate in basic procedures and join the pre-operative consultations, compensating for the missed session this week

delve deeper into different working cultures prevalent in various countries

explore more of the other islands in Malta

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A Week Into General Surgery Dept. at the Teaching Hospital of Wrocław (A hijabist in the OT?!)

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A Week Into General Surgery Dept. at the Teaching Hospital of Wrocław (A hijabist in the OT?!)

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1. Your name, matric number, date

Anis Nazira binti Razali, A180856, 31/7/23-6/8/23

2. How is your progress?

It has been a week into August as an exchange student in Wrocław and it couldn’t get any better! Alhamdulillah everything has been sailing smoothly ever since I got here especially due to the warmth of the surrounding people here. Befriending with other international students was more fun that I thought it would be.

This week, I have been going to the operation theater to observe surgeries done by my supervisor, Dr. Sebastian along with another 2 male students, Anas from Morocco and Alisher from Kazakhstan. We were informed to join operations that were scheduled from 8am to 2pm everyday and after that, it was free & easy hour for us. I still remember clearly my first operation I saw was regarding the reconstruction of the a,nal canal due to this elderly male had an a,nal fistula. Up until this week, I have witnessed almost 10 surgeries ranging from 15 minutes to 5 hours. The medical system of ward rounds in the department I was assigned to was definitely different than in Malaysia that I witness. Other surgeries were laparotomy, stoma bag removal and sternotomy which I did not have the chance to observe in Malaysia. There are not much difference in terms of technology used in the operation room compared to Malaysia but their daily operating schedule did differ a bit from ours as mentioned earlier.

Here, everytime we go to the hospital, we should wear casual clothing, anything appropriate such as sweater, jeans etc. but as soon as we reach the hospital, we need to straight away head to the changing room in the -1 floor (referred as Lower Ground in Malaysia) and change into our scrubs/white coat and hospital shoes if we want to enter the wards or clinical departments. In comparison to Malaysia, we would directly wear scrubs from our rooms/home and when arrive in the wards, we should then put on the disposable apron, n95 masks and face shield if necessary upon entering wards. They no longer compulsorize face masks here. This I find very interesting concept of sterility in attire. There was also access to lockers in the changing room that were taken care by 2 staffs that will give us the locker keys in exchange with our student’s ID just to make sure that the locker keys in the changing room were returned. There’s also another space which had toilets & curtains in the changing room if any students do not feel comfortable changing in the common area.

Everyday, in the surgery department, they medical staffs & doctors start their day as early as 6 am. They will then have a meeting with all specialist, head of nurse, residence and medical officers at 8am regarding patient’s progress pre-operatively and post-operatively to plan for the most optimum and recommended plans beneficial for the patient. This meeting lasts for at maximum 30 minutes and they’ll dismiss. Afterwards, the specialists will go for ward rounds along with all medical officer, residence, nurse & internships (houseman). Surprisingly, when i asked their internship experience regarding their jobs, they told me that they dont do much in the wards except for observing and just minimally helping out when needed but apart from that they are free to rest. Their salary is almost the same as a medical officer there with remarkably less jobscope.

3. Points to remember from week 2!

Be punctual! The morning meetings start and end on time without any delay. Regardless of positions, be it specialist to the interns they all could make it on time to ensure every medical members of the surgical department are on the same page.

It takes 53 minutes to get to the hospital, get up early so you won’t miss the tram!

Surgery related: one of the reasons that determine the duration of a laparotomy is the amount of bowel adhesions present in the patient. The patient I watched during this week took 4 hours to finish the procedure.

4. Your feelings & thoughts

I enjoyed very much learning holistically being here. Not only I learnt about surgery-related but also the culture of Polish people & also others from my incoming friends. However, thru talking with them, I realised how much I have been lacking in terms of general knowledge as a lot of terms and information introduced by them sounded very new to me.

I was quite mesmerized initially with the differences in medical system when I found out some countries actually have medical school up to 7 years and vice versa, some students from other countries were surprised knowing Malaysia’s medical school is only for 5 years which is the shortest among all the students there. This is because our housemanship period is for 2 years whereby theirs is only for 1 year.

5. ONE good thing from what you did that you can practice now!

Ride public transports & walking more often to different places. It is actually convenient if you are used to the maps & road. It even feels healthier everyday getting to indirectly exercise.

6. Any difficulties/concerns? How did you cope?

One incident that significantly affected me during this week at the hospital was when I was turned down from assisting in the operation theatre due to clothing regulations. Normally in HUKM, they provide surgeons scrubbing in with their own sterilised hijab however here, there was only a headcap. My hijab & inner sleeves were actually not permissible if I were to scrub in. When my surgeon told me that morning that I was going to assist, I didnt know I was to suppose to change into the desired attire as he did not mention to me regarding any clothings so I just waited for him to give me the instructions to scrub in. But in the end, he chose Alisher which is a male student from Kazakhstan instead. I was very frustrated I remembered walking out of the operation theatre and called my parents to rant about the incident with tears running down because I was anticipating the moment to scrub in and assist him very much! It was worrying to me because both my comrades were able to assist but I still haven’t gotten my turn yet.  I got hold of myself and tried talking with my supervisor in personal, proposing alternatives and he agreed to let me help assisting next week. I am looking forward for that moment!

7. Your plan for next week (Week 3)

Watch more interesting operations that have not been watched. If possible, assist more operations.

Start editing and compiling videos for the vlog report

Explore more of Wrocław city

Make more memories with other incomings by traveling with them

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First week of Elective Posting in Mater Dei Hospital

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First week of Elective Posting in Mater Dei Hospital

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1. Your name, matric number, date

Casey Lau, A181338, 14/6/2023 - 1/7/2023

2. How is your progress?

Monday: Today was our first day of the medical elective in Malta. Miss Marguerita from the University of Malta's Medical Elective Office introduced us to the hospital and gave us an overview of the hospital rules. I met some students from different countries who will be joining different teams. Each of us received a map of the hospital and had to find our own supervisors. It took me a while to find my supervisor, Mr Charles Cini, because the hospital is huge. After getting settled, my friend Xinyi and I visited the famous Mosta Rotunda, a 158-year-old church in Malta.

Tuesday: I arrived at the ward at 7:30am for the ward rounds. I met my colleague Leah, a fifth-year medical student from Germany. I realized that the ward rounds covered various wards, not just one. After the rounds, we were dismissed early because my supervisor had to go to a private hospital for a clinic session.

Wednesday: I continued to follow the ward rounds in the morning. After lunch, I had the opportunity to observe colonoscopy procedures and even witness a polyp excision.

Thursday: Another day of following the ward rounds in the morning. In the afternoon, I shadowed my supervisor's house officer and observed procedures like venepuncture. Although I wanted to try it myself, I felt unprepared, so I decided to observe first and plan to try it next week.

Friday: I joined the ward round in the morning and attended an outpatient clinic session in the afternoon.

Saturday: Today, I visited the National Aquarium of Malta.

Sunday: I took a trip to Gozo Island.

3. Points to remember from week 2!

I learnt some basic greetings in Maltese. For example, "bongu" is good morning in Maltese, you can pronounce it as "bonjour" which is also a greeting used in the daytime in French. "Ciao" which is goodbye in Maltese. Pain in Maltese is uġigħ. So if patient wanted to express they had stomachache they will say "uġigħ fl-istonku"

It is utterly important to overcome the fear of approaching individuals and seeking information, despite the possibility of rejection or discrimination. Stepping out of your comfort zone is acceptable as it is never a mistake and sometimes will make a lot of things easier.

I had read in textbook before that pancreatitis can be caused by scorpion bites which I thought is quite rare but my supervisor before he really encountered a patient who had pancreatitis due to scorpion bites. Therefore, maybe next time when I encounter a patient who had similar condition, I should be more aware and not to miss out scorpion bite as one of the causes.

4. Your feelings & thoughts
To lay bare, I am quite nervous as I was learning in a new environment with a different language, but I'm glad that the language they used there during teaching is still English. However, I am happy that I got to know some students from different countries such as Germany, India, England and Ireland and we did talked about life as a medical student in our own universities. It's nice meeting all of them.

5. ONE good thing from what you did that you can practice now!
As an ambivert myself, I might find it difficult to initiate conversations with people I am not familiar with. However, during the ice-breaking session, I did approach some of the students who joined the elective programme in the same period and understood more about their countries' culture.

6. Any difficulties/concerns? How did you cope?

I will say the difficulty I faced during this week is language barrier. Although my supervisor spoke English to me and my colleague, but the main language used during ward rounds and clinic sessions was still Maltese. Sometimes, I would ask the nurse or house officers about the patient's history and I am grateful that they were very kind and willing to explain to me. Sometimes I would use the Google Translate app. I will try learn more about this language so I can understand at least the patient's complaint.

As a person with horrible sense of direction, I still struggled to find the wards in the hospital. I will walk around in the hospital after I was dismissed by my supervisor.

7. Your plan for next week (Week 3)

to do history taking and physical examination on patient in the hospital

to explore more places and the culture in Malta