Monday, May 31, 2010

Cervical Cancer Symposium at Shangri La hotel 29.5.2010

I have been looking forward for this Cervical Cancer symposium. Partly due to the fact unlike other symposium where the speaker would spill out medical jargon in the form of charts, diagrams, and graphs, this symposium would discuss the more practical method of approaching patients, which I feel is far more important than mere data and charts.
The speakers for this symposium are specialist from their respective backgrounds. First we have
Dr Anna Ong Lim-Pediatric Infectious Disease specialist from the Philippines,the renown gynaeoncologist  Dr Quek Swee Chong, from Singapore, Dr Maria Julieta Germar, who is a associate professor in obstetrics and gynaecologist university of Philippines, Manila, and Dr Cecelia Lavae, Clinical Gynae oncologist attached to Phillipines General Hospital.

Everything was so well organized that day. They printed name of participants of the symposium on files, and on the name tags along with the country of origin. .

Doctors from Vietnam, Thailand, Taiwan, and Indonesia attended this seminar.
One thing that is a little discouraging for me to attend CME or symposiums as such is the thought of being left out, as those who attends are mostly from mid age and above. Having said that, I don't mean to imply that I am young, don't get me wrong, it's just that our wavelength simply don't resonate with one another.
I wanted to ahem..ahem... cancel my attendance, however I got to know that GSK actually sponsored the attendees, which cost USD100 per head!

The facts are figures that was presented on that day was alarmingly worrying. Now, what do I mean by that?

Charts like this makes me worry.
There are doctors who thought cervical cancer is hereditary!... and due to bacterial infection??? Yikes!!! Now I know why 16% of doctors aren't particular about which brand among the 2 vaccine available in the market, and 8% are strongly against the idea of vaccinating young adolescent!.. ( I am sweating now!!)

A word of advice. Please ran away as  fast as you can if your doctor say this:-
1."Ini miny miny mo! Oh,ok... I think I shall use ******** today!!!"
2."Which one bettter,ahh?? Ok, now.. lets see.... you got a coin??"
3."Aiyah!! So obvious,lah! Those who cannot decide are simply blind or ignorant! One is bivalent, one is quadrivalent. You tell me.. Which one is worth it??? Count,lah!!"
4. Hmmm... you think good quality product BP lab can offer 3 doses for RM500,ah?

Indeed at the end of the day I've learned a lot of things,  especially on the practical side. This is what I've been hoping for in any symposium, where the practical issues are discussed in details rather than spurting out data in the form of charts and graphs which doesn't help me in my practice in creating an awareness at all!

I started to feel as if at any given time I will explode if the presenter continues to show graphs as such!This is the result of questionnaire given to doctor on their perception of those who are relatively more vulnerable to get cervical cancer. It's nauseating when you've been told 52% of doctors thinks only promiscuous women are prone to get it, a mind boggling 34% thinks it's related to personal hygiene,  and I almost fainted when 28% of doctors thinks it's hereditary!!!!
That goes to show how ignorant doctors in general are about cervical cancer.
It's a sin when a lifesaving and revolutionary vaccine that had changed the course of history in mankind is available, yet, they chose not to update their knowledge on this disease. If it's ranked 10-15th among reason for mortality, then I don't blame them for not paying much attention, but it's number 2!
I love the question and answer sessions, where the panel speakers had answered in detail, yet comprehensive manner to all the practical questions. I find the Phillipines and Indonesian doctors are inquisitive and more proactive in creating awareness about cervical cancer in their countries.
I am particularly impressed with Dr Cecelia from Phillipines who spearhead not 1 not 2, but a few NGOs and campaigns to create awareness among the public.
Cervical cancer vaccine has been in the market for 4 years now, yet, most Malaysians chose to ignore it, with the false sense of security that they aren't that unlucky to contract cervical cancer. Is that truly something you want to leave it to chance? 

These panel of experts seemed to answer the questions thrown at them so effortlessly. This is what i call knowledge at the tips of the finger. It doesn't matter how silly these questions were, but I realized only the Indonesian doctors asked questions. No Malaysians!

For those who reads my blog, I had previously mentioned that 10-15% of all Cervical cancers are adenocarcinoma. But Dr Quek's own data revealed a more alarming number... up to 25%!

I like the style of the presenter of this slide, she presented the meaning of lost in a more emotional, humane manner, rather than mere graphs and statistics, because each and our lives by any means is worth living to its' fullest, rather than just become a number, a part of statistics presented in conferences.
Another fact worth noting, that if in between doses, one found to be pregnant, she can actually delay the next dose until the termination of pregnancy before proceed with the subsequent dose.
And  Cervarix is safe to be given during breastfeeding.
i would like to congratulate GSK for arranging such a mind engaging symposium, which unfortunately, before the end of the session, half of the attendees were already missing. Strange.
Symposiums as such only happens once a while, and how often do you get to attend talks by a group of intellectuals who are experts in their respective field, and collectively constitute a whole and integrated lot. You need not surf the net, buy text books, or read journals. All you need is to have interest, the passion, and believe me, if you have that, understanding comes naturally as every details quenches the inquisitive mind.
It is not a task if you do it wholeheartedly. It's almost effortless to learn new things if you have genuine passion. Passion stemmed from the humanity expect, the desire not only to preservation of life, but improvement as well. Desire comes when we put a little bit of emotion to what we do, when we listen to pleas from patients, be genuine and exhibit a little emotion in responding to patient. It doesn't make you an emotional doctor, but instead, it makes you a healer, as 50% of patient's pain get alleviated simply by giving them a good listening ear.
As my previous unforgettable experience with Dr Christopher Lee that taught me it's ok to show a little emotion to what we do. Take a few step back when our response become mechanical, to enable us to see from a far, a clearer view of the entire forest, rather than standing inches away from the bark of the tree.
Being a doctor doesn't mean you're living in a higher society nor being any more important then anyone else. As a matter of fact, we are given more responsibility... as a servant to society.

"We've got to learn to kneel in order to reach out for the sky"
                                                             --Dr. Wan C Hung--

Thursday, May 27, 2010

Hope this will work.

I've created a blog, sending out flyers, organizing awareness campaigns, and the cost of vaccination that my clinic offers possibly be one of the lowest in the country, has yet to see much response from the public. Though the campaign held last week was a good start for many more campaigns to come, i sincerely hope the message that I am trying to convey gets across to the mind of the general public.
Prior to the first campaign, after we had sealed off the envelope that is sent to the people of Bandar Sri Damansara, I totally forgot to write the URL for the blog on Cervarix, it's indication, how it benefits women, why should women get themselves vaccinated, at .
No matter how hard I try to send out the message across, there is always room for improvement.
My sincere reason for being so proactive in promoting Cervarix stemmed from my experience with patients and my own family member who had died of cancer. There are certain parties who actually doubted whether the vaccine that I use is genuine or not.
Last year when BP lab organized a campaign where vaccination with Cervarix only cost RM500 for the total three doses. Due to the drastic drop below market price, there are a lot of doctors who actually complained as the move made by BP lab jeopardizes their market.
I am absolutely stunned upon knowing the reaction of the doctors. Is there a necessity for these doctors to react at such manner? Shouldn't they be happy that more people from all walks of life have better access to health care?
Even though the market price today may range between RM230-RM300 per dose, there are a significant number of population who belong to the lower income group who can't afford to get themselves protected against this deadly disease even if they want to.
The mere reaction of such doctors towards the price offered by BP lab is totally uncalled for and unjustified. This goes to show that these doctors prioritize monetary gains rather than providing proper health care which patients pay from their hard earned money.
But what shocked me the most was when the patients asked their doctor's how was it possible that BP lab charges so low compared to them. The doctor simply answered, "those are fake ones".. These doctors in my personal opinion do not possess the quality and character to be a medical practitioner. When you start to accused the competitor by telling the patients lies, they are nothing but scums.
Why can't these doctors who are already well established, would want to tell lies to the public?
These group of people should have their practice license revoked. When another doctor, or medical centre offers a lowered price, it is because they are community orientated. That's the essence of medicine. By simply telling the public that the vaccine they used were fake, all the effort in lowering the price with the noble intention to provide better access  to health care is ruined.
Just a few days ago, a friend of mine who came with his wife was curious as to why the price that I offered is SO MUCH LOWERED! They actually asked me to show them the vaccine that i use.
I am totally baffled with certain parties, who always have the impression that the quality of a product is always in direct proportion to the price.
Then why on earth would I want to write a post on how to know whether the product is genuine or not?(click here)
Has society today is so negative minded that when someone comes up with a noble idea, it is never accepted without skeptics?Or the public view him as having a hidden agenda behind the so called " too good to be true" offer?
To be frank, is RM165 per dose is so unbelievably low? To the extent where some international medical journalist actually send me this mail.

Is there always a hidden agenda whenever a person wants to be a good samaritan?
Anyway, I went to a local bookstore located within my housing area to get a stamp made.

I collected the stamp just a few hours ago.

Yup, to use it to stamp the URL of the blog specially designed for those who are reluctant to check out this vaccine simply because the doctor in charge is a male.

 Now, you don't a reason not to be ignorant with all the various ways to create awareness.

Monday, May 24, 2010

Today is a good day...

Today was the day of the presentation for the Cervical Cancer prevention weekend.

Though the crowd wasn't large, nevertheless, it was worthwhile as it has the personal touch.
In a way, its good to have a small crowd as the interaction would be more personal. I started off the presentation by telling the crowd not to consider this as a talk, but rather a talk, and they are allowed to stop and question me at any time. 

I forgot to shave that particular morning, as I just completed the slides for the presentation at 6.30am, which gave me hardly 3 hours to sleep before the presentation. I tried not making this presentation too "medically orientated", hence making it more public orientated. No graphs, no dates, no charts in my presentation which is typical of any medical forum which bores not only the general public, but to me as well..
I didn't have time to practice my presentation, so everything that i presented was spontaneous.
When you are telling your genuine experience, as to why I developed the desire to educate the public, I told them my personal account with with cancer, it sounds genuine, because it is!

One of the featured slide was this, a true photo of my aunt while receiving her drips during her last visit to my clinic before being admitted to the hospital for the very last time. The computer screen was the true file on her during her visit on 16th June 2009, the time when she came with jaundice.
I guess what captured the audiences attention was the true life account that I've experienced, hence making the presentation more heartfelt and genuine.
For a while, while describing the last few hours of my aunt's ordeal, i started to stammer a little, as I felt a little emotional while recollecting those memories that will always stay at the back of my mind. I've emphasized that I sincerely do not want anyone else to experience the same ordeal as my aunt and uncle did. There in fact, isn't a reason to as Cervarix offers women the choice, the option to decide whether or not you want to be protected, rather than merely leading a healthy lifestyle, and hope you would be have cancer.

The most appealing part was I got to know there are people out there who are aware of such vaccine, and willing to step forward to get themselves protected from this deadly disease.
Perhaps, getting oneself vaccinated with this revolutionary vaccine would probably be one of the most important decision you've made in your life.

No one else can decide on the course of our lives. The discovery of a vaccine that protects us from Cervical Cancer has got to be one of the most highlighted and monumental significance in the history of medicine and mankind.

I ended the presentation is a short poem.

At the end of the day, with the amount of specimens  collected by Thin Prep Pap Smear is the most rewarding result that I hoped for, though I don't earn anything at the end.
I am already looking forward for the next campaign.

Wednesday, May 19, 2010

Thin Prep Pap Smear

Designed and patented since 1996, Thin Prep Pap Smear is the answer to the flaws in Conventional Pap Smear. Today, over 90% of Pap Smear done in US is by Thin Prep Pap Smear.
It has it's advantages over conventional Pap Smear in many ways.

In Thin Prep Pap Smear, it's advantage begin with the use of a specially designed sampling brush, to enable a more thorough collection of both ecto and endo cervix.

The central longer bristles and the shorter adjacent ones fits snugly onto the ectocervix, and samples are collected by rotatory movements while in contact with the surface of the cervix.

Compared to Conventional Pap Smear that was designed back in WWII, no doubt it has saved thousands if not millions of lives.

With the conventional Pap Smear, early non malignant changes can be detected early for intervention before it turns malignant.
Though 85% of cervical cancers are squamous cell carcinoma, the other 15% are adenocarcinoma, which most of the time arises from the endocervix, the inner part of cervix that faces the uterus.Due to the design of the wooden spatula, though it is able to collect a good sample from the ectocervix, but not the endocervix.

The flaw of the conventional Pap Smear arises from the sampling as well as the deposition of the samples collected onto the slides.

Smearing of the sample collected onto the glass.

Fixing the sample onto the slide with a cytofix chemical. Unfortunately, the possibilities of a false negative(early signs of pre-malignant changes has occurred but unable to be detected) is as high as 50%.This is due to as the deposition of smear takes place, only 20% of the sample actually gets deposited onto the slide, while 80% of sample remained on the wooden spatula.

of which often gets tossed into the bin...

Besides the poor sampling method, Thin Prep Pap Smear goes through two level of screening, where the samples are initially screened by an imaging device. Upon detection of abnormal cells, the samples  is then reconfirmed by a pathologist.
While conventional Pap Smear is normally screened by a pathologist, where the report is based upon the experience of the person doing the screening.
Upon detection of abnormal cells, the existing sample collected through Thin Prep Pap Smear can be sent for HPV DNA, while another separate sample is needed for conventional Pap Smear.

So, ladies, insist upon Thin Prep Pap Smear from your doctor. Unfortunately, not many general practitioner are aware of the availability of such test.

During the Cervical Cancer Prevention Week, Klinik Wan & Keluarga will be conducting Thin Prep Pap Smear at a lowered price at RM45. Normal price for this price is RM90.
You need not worry about hygiene as the speculum used to collect samples are disposable ones.

Protect yourself against cancer today.
A note that i feel compelled to say. With the availability of this vaccine today, in addition to the campaign which is regularly held, it would be a crying shame if you procrastinate upon getting vaccinated, and unlucky enough on day to be diagnosed to have cervical cancer.
Cervical cancer is not limited to those who have multiple partners,but to you as well. There is always a possibility of contracting cancer in every woman. The possibility wouldn't be as remote as you thought to be considering it being ranked number 2 among mortality secondary to cancer.

Preparation for Cervical Cancer Prevention Weekend

This post is written based upon the author's own initiative, and not being influenced in any way, nor being given any form of remuneration by the pharmaceutical company of which the product is highlighted. 
The much anticipated Cervical Cancer Prevention week begun yesterday. Over 700+ flyers were mailed, however yet to receive any response. I am optimistic this campaign, being the first of many more to come throughout the year will reach the public. I don't expect many to turn up for the talk this coming Saturday, but for every project, initiation by taking the first step irrespective on the size of the crowd is what counts. It's easy for any medical practitioner to routinely come to clinic, treat the sick, then go home once the clinical hours is up.
However, deep down, I sincerely believe the nature of the medical profession goes beyond treating the sick, but to reach out to create an awareness among the public.
Cervical cancer is merely a word to many, but to those who was diagnosed to have it, their life revolves around it.
Unless a celebrity, an icon, a personality known to many who is diagnosed with this deadly disease is made public, otherwise, it's most disheartening to know most people are still ignorant about this disease.
This is the reason why it's important to reach out to the public, to educate the masses that such a diseases is now avoidable by choice. I guess one wouldn't realize the degree of trauma one has to go through upon being diagnosed by this disease, getting test done to know the stage, whether are they salvageable or be told that their days would be numbered, the morale that has died the moment being told their treatment is purely palliative. Why? Why would anyone in the right frame of mind would want to risk all that when a revolutionary vaccine is available today to avoid all those inconveniences?
For those who follows this blog would understand why am I being so driven in creating an awareness.
First of all, on behalf of Klinik Wan & Keluarga, we would like to personally thank Miss Wendy from GSK who has been so helpful in furnishing me with updates concerning this vaccine. Her help in providing materials in this campaign has been monumental and instrumental. If it isn't for her help, the campaign wouldn't have materialized.

The eye catching posters being provided for by GSK. One should note that no clinic is allowed to advertise the products available, however, this poster did not mention the world Cervarix, merely an eye opener for the public.
One is placed inside the clinic, while another being placed outside,along the walkway outside the clinic.

Noticed the multiple posters pasted on the glass, indicating Klinik Wan & Keluarga's commitment in creating an awareness for the public. The counseling conducted is free. Anyone irrespective of age and sex can walk in to inquire about cervical cancer and vaccine available. For those who is planning to get themselves vaccinated, please note that you need not do a Pap Smear prior to vaccination, nor the need to feel obliged to be followed by Klinik Wan & Keluarga.
In preparation for the Cervical Cancer prevention week, GSK has furnished us with several goodies, which includes:-

Word puzzles or patients while waiting for their turn for counseling or vaccination.

Leaflets as such in all four corners of the clinic for patients to read, and ask the doctors if unsure of what is written or for a more thorough explanation if needed.

The campaign shouldn't be something to be taken so "seriously".. Hence balloons to create a more "light hearted or happier" ambient.

A questionnaire to determine whether do you fall within the high risk group that warrants vaccination.

A button tag for the staff...
A goody bag for attendees for Saturday's talk on "How to prevent cervical cancer".. which contains
A leaflet, tissue, questionnaire, and a pen, courtesy of GSK...
In fact, i was given a door notice to inform the public of my presence, unfortunately...
It can't be used in my clinic as there isn't a door knob on the door into my consultation room.
GSK has gone all the way to support medical practitioners like me to create awareness among the patients and public by providing tissues with messages printed on the cover.
Even they have printed plastic bags with messages on it. As you are aware, this isn't a advertising ploy, as they don't mention anything on their product, but merely emphasizing on the disease per say.
Even though cervical cancer vaccine was first introduced to the public since 2006 in the form of Gardasil, it is still considered new, as a considerable number of people aren't aware of the availability of such vaccine.Even if the public knew about the presence of such vaccine, how many actually know the the extent of problem cervical  cancer has on us? 
With the availability of different vaccines, now the public has a choice. Which is the better 
vaccine? Which is superior compared to the other? How to decide when one doesn't have knowledge on the properties of the vaccine? 
Hence, it's important to educate the public on it, and it takes times. But cervical cancer don't wait for the "ideal" time to strike. 
Cervical cancer do not recognize race, religion, social status, and age. We've come across patient as young as early 30s who was diagnosed to have cervical cancer. 
One thing that i like about GSK is their commitment towards providing medical practitioners up to date knowledge with diseases and findings of ongoing medical studies by providing medical journals.
...and regularly organizing CME(Continuous medical education) and symposiums by inviting world renowned doctors and scientist from their respective fields of expertise.
The next CME will be on the 29th May in Shangri-La, with Dr Quek from Singapore, who is a renowned Gynecologist who came for a symposium held last year. 
In conjuction to Mother's Day celebration, we took this opportunity to kick start our all year long campaign, and personally, I am excited about it. 
The clinic before this was "normal".... 
How plain the clinic was previously compared to .......NOW!
This is the "Pink Corner" where chart, pamphlets, and leaflets are placed for the patient to read and explore while waiting for their consultation.
That's Miss Wendy, a gentle and petite lady, who blew most of these balloons.
Whoever miss seeing the notice hung from the chandelier must be blind or simply ignorant.
Would I simply hang a notice tied to thousand dollars chandelier if it's not important?
That's Miss Wendy hanging the balloons...
Ta...dah!!!!! But wait!!!
More balloons!!....
Now the clinic look more "cheerful and a happier" place, even to those who come to seek treatment for cough and cold, hopefully coming to Klinik Wan dan Keluarga wouldn't be a glum experience, as normally clinics are associated with. 
It ain't no Disneyland either,though..
Just do not want coming to Klinik Wan & Keluarga to be an ordeal, but rather, an experience..
Klinik Wan & Keluarga isn't just a clinic for the sick, but rather a health centre.
Forward the URL to your love ones, friends, wife,sisters,mother,cousin,colleagues,etc...