• 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.

• to do history taking and physical examination on patient in the hospital
• to explore more places and the culture in Malta

• 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.

• 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.

• 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!

• 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

• 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.

• 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.

• 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.

• 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

• 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.

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

• 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.

• 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.

• 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.

• 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.

• 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 

• On 3^rd 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. 
  
  

• 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.
  
  

• 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. 
  
  

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

• 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.
  
  

• Preparing for presentation about Malaysia! (NFDP)
• Continue to assist in procedures and surgeries.
• Joining social programmes planned by the CPs.
• Sightseeing.
  
  

• 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.

• 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.

• 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.

• Patience and being kind to one another.

• 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.

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

•  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.

• 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.

• 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.

• 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.

• 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)

• 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. 

• 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. 

• 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!

• 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. 

• 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.

•  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.  

• 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. 

• 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.  

• Recap lecture notes before joining the respiratory department
• Practice Chinese medical term
• Participate in basic hands-on procedure

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

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

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

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

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

• 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. 
  
  

• 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.
  
  

• Entered the Internal Medicine respiratory department, requiring me to once again adapt to a new environment.
• Revisiting and refreshing my understanding of respiratory diseases.

• 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.

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

• 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.

• 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 

• 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.

• 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

10/8 -13/8

14/8 

15/8

16/8

• Small talk is an essential aspect of patient-centered care 

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

• Take the opportunity to interact with the locals while abroad. 

• I am impressed by Taiwan’s healthcare system

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

• I feel proud to be a Malaysian

• Some language barrier when dealing with local dialects and medical terminologies 

• 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.

• 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.

• 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. 

• 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 

• 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.

• 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.

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

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

9th August 2023 (Wednesday)

10th August 2023 (Thursday) - Typhoon

11th August 2023 - Last day in Breast Team

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

• 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 .

 
07.08.2023 [Monday]

08.08.2023 [Tuesday]

 09.08.2023 [Wednesday]

 10.08.2023 [Thursday]

11.08.2023 [Friday]

12.08.2023 & 13.08.2023 [Saturday&Sunday]

• 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 

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