Wednesday, June 23, 2010

Is it all worth it?

 Listening to the story on how a patient of mine who's wife faced the ordeal of a downhill battle against cervical cancer, and experienced it myself seeing my aunt whom I attended to during her 9 months battle with pancreatic cancer, my heart tells me that nobody deserves to die from cancer.
I believed a person have died on the inside the moment they've been diagnosed to have cancer.
The memories of my aunt's weary stare each time she walked into my consultation room,the look on her face, her reluctant smile that greets each time she sees me, all those memories still lingers at the back of my head, still remain vivid as ever.

Though she isn't my mother, but her warmth, comfort, soft an genuine self was motherly. So much so that though I called her auntie, I held her hand and sat by her side while the drip was running. I was the one who administered the IV drip as she often gets dehydration. but it felt so naturally being more than just a nephew to her. Someone much closer. Someone that warms your heart. Her passing, till today remained unsettled within me. I can't believe she's no longer around.
From the bottom of my heart, I sincerely  do not wish anyone would have to go though what she went through from the day I told her of her diagnosis last June until her passing last March.
Out of sincerity, I hoped to create  a public awareness by going through all measures, by lowering the cost of vaccination, creating a blog purely for those who genuinely seeking out information regarding cervical cancer,  organizing awareness and prevention campaigns.
To be frank, I was feeling rather hopeful until reality hits me.
For the past 1 week has been, bad. I felt being taken advantage of, being made a fool of, being condemned, like for what purpose am I doing this if no is taking this seriously?
I had a middle age lady who came with her daughter last week for the vaccination and Thin prep Pap Smear, which both I have reduced the price. Yet, the mother was reluctant and tries to negotiate for a lower price! She claimed she didn't bring enough money, and that they are poor, all the crap she told me about blood investigation being so expensive, that I should charge her lower price, yet, when she flipped her wallet, i noticed she owns a gold credit card!

I felt cheated, and being taken advantage of.
Another lady who knew about the Cervical Cancer Prevention Weekend, were I purposely reduced the price of Thin Prep Pap Smear from RM90 to RM45. The price promotion lasted only during the week.

RM45 is  the cost price which the lab charges the doctor.

Not only am I not making any profit out of this, but i am bearing the cost of the disposable speculum used, the electricity to run the refrigerator where I store the vaccines,etc. Even after the campaign, i only kept the cost for Thin Prep at RM60 instead of RM90.
I don't think she can't afford to pay RM60! In fact, she claimed I agreed to charge her RM45 even after the campaign. I've checked through the mail and there wasn't any that i ever mentioned to her about RM45.
The the worst thing I got to know is that some other blogger who hold grudges against GSK blogged about my content, and totally twisted and turned the entire fact,mentioned my name, took photos from my blog despite the copyright as per written in the disclaimer.
To that particular blogger who claimed I advertised GSK's product within my clinic when I'm not supposed to, but I sincerely think he's making a fool out of himself for not getting his facts right about medical law in Malaysia. You CAN advertise anything within the vicinity of your clinic. To the blogger who condemned what I do,(google dr wan cervarix, it will lead to his blog) maybe you don't have a woman with cervical cancer, and I doubt you got the entire facts on Cervarix. What are the odds of you knowing more than world renown gynecologist in Asia Pacific region regarding this vaccine?
I got to know people who really wanted to get themselves protected, even at RM165, the price is still a little steep for them. They've had to save up to get themselves vaccinated. I've confided to one of my family members, that perhaps I could lower down the price for them, but the answer that i got was rather discouraging. "Perhaps if one day you're as rich as Bono or Bill Gates, then you can do charity." .... i think that is something I don't deserve to hear when I know I am not rich, nor have i even made my money yet, but that was the reason why I chose to be a doctor to begin with, not for the $.
I felt rather depressed over these incidences. There is a significant percentage of people who live within poverty standard. Why can't the government allot some funds towards them? Why are the politicians getting richer, driving RM1 million Cayenne, making a mockery in the Parliament, living a lifestyle way above their pay grades, yet they claim to represent the people, who's social and economic status hasn't changed for decades.
I am just mad. This is such an unjust world. I realized I cannot make a difference. Not at all. All the stories about about changes, or revolutions that begun with a single idea remained stories, something inspirational, only for idealist, not realist.
For those who intends to negotiate to lower the price, please don't bother coming at all.

Wednesday, June 16, 2010

Revised price for Thin Prep Pap Smear

While getting ready to work yesterday, i thought to myself what else can be done reach out to more people concerning Cervical Cancer awareness.
Recently I found out Tzu Chi Buddhist group foundation jabs their followers with Cervarix at RM130+. Wow!
There are only two way one could get such a good price. Someone must have purchased it in a large lot with the best bonus.Unfortunately, it's only for Tzu Chi members.
I am not running a charity clinic,yet I want to give something back to the society as I felt compelled to do so.
The price for Cervarix will remain competitively low.
Unless of course GSK is willing to further bring down the price. Then I will definitely reduce the price further.
Then it struck me, perhaps there are two other things which I can still try to do(irrespective of the result, more importantly is the attempt) to enable people of the lower income group to get themselves protected.
Out of the available methods of Pap Smear today, Thin Prep Pap Smear still be a choice for a more thorough and accurate sampling, hence accurate result.
I took some time and thought of several possibilities:-
1. to lower the price for Thin Prep Pap Smear from RM90 to RM60, and each test were done using sterile gloves and disposable speculum.
Normal price of Thin Prep Pap Smear will be reduced from RM90 to RM60.
Sample are collected using the prepacked sterile brush for Thin Prep Pap Smear.
For hygienic purposes, only once only disposable speculum are used.
Hence, the whole package will cost RM60 instead of RM90, which has just begun yesterday.
My sincere plea to all readers to inquire more knowledge on Cervical Cancer, as it is the one of two cancers that we are given a choice whether to be willfully protected, rather than leaving to chances. It would be a crying shame when this revolutionary vaccine that is available in the market, yet there are few hundreds of new cases and at 2 deaths everyday due to Cervical Cancer in Malaysia.
Ladies and gentlemen, is has never and will ever be a stigma to get yourselves or your daughter or wife examined.

As a matter of fact, it is probably be one of the most important decision you've made in your life.
To demonstrate to you how rampant Cervical Cancer is in Malaysia, recently I've conducted a Cervical Cancer Prevention week, where I performed Thin Prep Pap Smear only on 4 individuals, out of which one of the four's test result came back as such.
...and when I proceeded with HPV DNA test where the samples are sent to Australia to identify presence of HPV virus and it's subtype.... it reads,
HPV subtype 16,18,31,33,45 are ranked top five that causes Cervical Cancer.
I sincerely ask the public please take care of your health.Please make use of the available "tools" today to detect and prevent this deadly disease before it fully develops.
This reaffirms my belief that one shouldn't have the attitude where disease as such won't happened to them.
It happened to my aunt, it happened to my mother in law. Do you think if ever given a choice, would they want it???
2.Income base/age base
Based upon the income of an individual, where patient would require to bring their pay slip. Monthly income below a certain amount would be charged much lower than proposed price. This will be implemented soon, but yet to ascertain the cut off income point and the price offered.
3.Organize outreach program
90-95% of individuals who have heard of cervical cancer vaccine are urbanite, yet those who stepped forward for the vaccine is rather discouraging and insignificant. Perhaps to organize a talk in the rural area would be a good idea. It has never been tried for this vaccine, which doesn't mean it won't be receptive.
Ladies,please approach your doctor and ask regarding Cervical Cancer.With the availability of this vaccine, there is no one else to blame if one day your doctor informs that you've got cervical cancer.

Monday, June 7, 2010

Eh?? Excuse me?

Last Saturday, I had a lady who came along with her friends to my clinic to inquire on Cervarix. From a question and answer session it slowly turned into a dialogue.
I've explained I was perpetually surprised to know that many women are still hesitant about getting themselves vaccinated despite the lowered price. One of the factor was that these women have the impression that prior to vaccination, they need to get a Pap Smear performed. Naturally, being  male doctor, it's natural to feel shy from being examined by a male doctor. Hey, if I've got a "male" problem, I'll think twice about seeing a female doctor.
But what I found from the conversation got me stunned. For a fleeting moment, I was left speechless. Honestly, my mind went blank from the question that was thrown at me.  I tend not to be judgmental, not at all. But this time, I simply can't help it.
I've accepted the fact that most people are ignorant about Cervical Cancer Vaccination. I've even accepted the fact that not all doctors are offering accurate counselling on Cervical Cancer. Some women actually stated their rationale for not getting vaccinated was that they've experienced intercourse before, and since the vaccine don't render 100% protection, why would they bother getting vaccinated? The saying "common sense isn't very common doesn't apply in this situation as there are people who genuinely unaware of the availability of these vaccines in the market.
I sincerely do not mind have to repeat myself over and over again like a broken record just to get the right message across, because more than anything else within the spectrum of priority, education should be listed right on the top. With knowledge, an inquisitive minds follows, and that would lead to the right information,counselling, and ultimately decision making. To have the will for self preservation and health care is essential, which unfortunately many of us take it for granted. It's almost disheartening to know that most of us would never realize the extent of damage, emotionally, psychologically, and mentally, for any cancer patients bears. One would never realize the fact that non of us are naturally immune to cancer. "What are the chances to get cancer?" often the thought that pops in the mind of an average Joe. The answer would simply be, "More often than you think. You could be next."

That's the main reason why this blog is created in the first place. For those who feels uncomfortable to meet a doctor face to face, this would be a perfect platform for finding out the facts. You can write to me, and stay anonymous, or even perhaps want me to write a post on a given topic (I am more than happy to answer your questions in a post)with your identity remained anonymous.
Ok, back to the question that caught me off guard... this lady and her friends came over the moment they sat down, they actually told me they just wanted to ask, and not come for the injection itself.. I told them it's absolutely fine. I don't charge a single cent for counselling on Cervical Cancer.The first lady broke the silence by introducing herself."Doctor, before taking the injection, no need to do Pap Smear one,hor?" Of course!
I added that in fact, I told them that need not feel obliged to be followed under me simply because they got vaccinated by me.
" that.." That's why, no need to feel shy, you can just come alone only for the injection."...
"then coming for the injection also shy,mah?"
I was surprised! Injection.Just an injection. What's so shy about that. I almost fell off my chair when I was asked,"Doctor, you mean this cccCervaarix is not injected into the private part,ah?
NO!!! Of course not! It is injected in the muscle either through the deltoids or the thigh.

Boy! I found out something new today. No wonder these ladies were hesitant about the injection, first has to do with me being a man, and second, I felt like I  was in the Twilight Zone when she asked me whether wasn't the injection meant to be given at the "private part"I forgot to ask her how did she come with such funny conclusion?