30 March 2008

Psychiatric Hospital

My next study of speciality was psychiatry: the branch of medicine dealing with the diagnosis and treatment of mental disorders.

Which meant that I had to go to a mental hospital.

Welcome to the Asylum of the Insane.

The psychiatric hospital which I traveled to was located at the furthest reach of town, at the village of Iskra. This village probably survived on the existance of that hospital alone. I guess they had a reason to build it that far.

Many people cringe at the idea of going to a mental hospital. You may think that that is a place where twisted minds and retards are condemned for life; those who do survive in there are either crazy or maliciously mad, and they behave like trapped monkeys which try to claw their way out at every given opportunity. And if you somehow ended up there, you'd turn into one of those zombies yourself.

If you think that way, you are probably right.

The block where patients lived and were treated.

However, that was just the tip of the iceberg. Psychiatric hospitals house many types of mentally challenged patients; from the insane to the ones born autistic. Patients could have become mentally unstable because of stressed due to the lost of love ones, or simply because they got involved in a traumatic accident which injured their brains. It could also be of disease origin, like Alzheimer's disease or toxic induced, like alcoholic syndrome.

Lesser known to the public about psychiatric hospitals are actually services that these places offer for treatment of milder mental disorders, such as counselling for those who are depressed or disturbed, those who has personality disorders like aneroxia nervosa or simply for those suffering from all kinds of phobias.

Patients of this hospital, like all other psychiatric hospitals, live in sad states of life. Unlike common diseases like pneumonia or hypertension, mental patients are harder to treat because there are no real cures to most of these diseases, diagnosis can sometimes be subjective, and patients are difficult to communicate with and very often they lose their abilities to care for themselves properly. It is because of this, they are sometimes neglected and uncared for emotionally.

Many a times, patients spend many long years here without making encouraging progress – as if they were given a life sentence they did not deserve.

The study and administration building.

Being a staff at the hospital can be challenging as well. Working in a place like this can be depressing at times; doctors and nurses treating these patients must not only conquer the psycho-emotional factor, but also need to tread interpersonal relationship carefully as well. One wrong remark or action can send the patient spiralling down the abyss of depression further, or turn a mild-mannered one aggressive and destructive. Facing those with mental retardation can be frustrating and patience bending.

As a student, I myself had a taste of interacting with mentally disabled patients. Some patients suffered from degenerative cerebral diseases due to old age, where making simplest of decisions and conclusions could be painfully difficult due to the affection of logical reasoning. An old lady thought that the hospital was actually a railway station because we students wore white lab coats, but she could not understand why she thought so.

The humble staff quarters.

Another patient was a adolescent boy whom I painstakingly interviewed for days, because he was mentally retarded with very low IQ. His reactions were slow, his answers uncertain, and he seemed reserved most of the time. A few days later, hospital staff barred me from seeing him again – his mental state had changed; he had become violent, unstable and dangerous.

The most interesting case that I've encounter far thus was an interview with a former army officer who had become schizophrenic due to work stress. He was educated and spoke excellent English, even to the point of discussing Shakespeare. Hallucination is commonly associated with schizophrenia. He spoke of grief about the accidental death of his daughter who mistakenly drank poison, and after her death appeared to him as an image to assure and console him. He was well aware of his ailment, and was open about being admitted into the hospital, because he could tolerate hallucination no longer. He was cooperative and receptive of his diagnosis.

The schizophrenic officer during the interview.

However, it struck me when I referred to his files. The story was deeper and more sinister than I thought: the man was never married, he never had any child. He was hallucinating a complicated mess all along.

Sometimes I feel sad for these people.

This guy had been here almost his entire life.

As we approached the end of our studies there, we left the ward for the last time. The kind warden opened the door for us and bid us a warm goodbye, and behind our backs the metal gates slams shut-tight, punctuated by the heavy clank of the large padlock. For the patients, life was no different than those of criminals in prisons, except with the inclusion of drugs like sedatives and antidepressants for the rest of their lives.

28 March 2008

Women Volleyball

Volleyball is the national sport of Russia, just as how baseball is to Japan, American football to the United States, and badminton to Malaysia.

Volleyball is an indoor sport where the game is played on a court, separated by a high net, and 2 opposing teams face off with 6 players on each side. Each team is required to send the ball over to the opponent's side, and score (within a certain set of rules) by volleying the ball over back and forth, hence the name volleyball.

A standard volleyball court.

In Russia, the women's national team is particularly of interest as it ranks higher than its male counterpart. It is also one of the top teams in the world.

In the 2000 Sydney and 2004 Athens Olympics, the women's national team bagged the silver, while in the 2006 Japan World Championships, it claimed the gold.

At university level, superleagues are held among competing teams from states far and wide. Competition is intense, standards are set very highly. Winning teams usually get the priviledge for a shot at the national selection.

My university played host to this tournament recently, and I was fortunate enough to bear witness to one of its matches. A team from Tambov faced another from Smolensk in this game. Both teams came from the regions of south western Russia.

The team from Tambov poised for the match.

Both teams were highly seeded. Action began immediately as soon as the round commenced.

The spike and the block. The Tambov team executing a block.

The match was filled with fierce attacking, firm defensing, tactical deceptions and valiant saves. Rallies were long, thrilling and suspenseful. Both teams were aggressive, gritty and enduring.

Dive! And the point was saved.

At the end of the game, the girls from Tambov emerged victorious. The competition was exhausting but spirits were high.

Everybody needs good sportsmanship.

When the sports hall finally cleared, we resumed our training. A good few Russian players from the university team joined us for the practice.

Height is an clearly an advantage, as most Russian volleyball players stand above the 6 feet mark, even for their women's team.

A Russian girl in red beside one of my teammates, blue 11.

Unless Malaysians breed super tall citizens, there is no hope of us ever facing the Russians at the finals.

27 March 2008

Tagged: Improve Your Blog Stats

TINGhuongyew has tagged me.

I have randomly selected 5 of you below to be tagged and I hope that you will similarly publish this post in your blog. You have to tag 5 other bloggers and
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Now I'm tagging TINGhuongyew.

26 March 2008


Have you ever heard of medical cases where people talked about having stones, or specifically gallstones, extracted from their bodies?

Gallbladder opened to show numerous gallstones.

In medicine, gallstones are crystalline bodies formed in the gallbladder and the common bile duct by aggregation of bile components. Bile is the greenish-brown fluid secreted by your liver and is stored in the gallbladder. It is needed for emulsion and digestion of fat.

The green organ indicates the gallbladder in this schematic.

There are 2 major types of gallstone: cholesterol and pigment stones.

Cholesterol stones:
They are usually greenish-yellowish in colour, large and often solitary. They are made primarily of cholesterol. They account for 80% of gallstone cases.

Cholesterol stones

Pigment stones:
They are small, dark stones, usually friable and irregular. They are made of bilirubin and bile salts that are found in bile. They account for 20% of gallstone cases.

Pigment stones

Unlike infectious diseases like tuberculosis, you do not get gallstone disease from another person. This disease is caused within the person himself due to factors like lifestyle and habits. If you get this disease, it your fault.

Gallstones develop when bile contains imbalance amount of cholesterol and bile salts. Two other factors are important in causing gallstones. The first is how often and how poorly the gallbladder contracts to overconcentrate and contribute to gallstone formation. The second factor is the presence of proteins that either promote or inhibit cholesterol crystallization into gallstones.

Researchers believe that gallstones may be caused by inherited body chemistry, body weight, gallbladder motility (movement), and perhaps diet.

Risk factors:
Obesity, age, type IV hyperlipidaemia, cirrhosis, smoking, being female, and parity (having given birth).

8% of those over the age of 40, where 90% of these people remain asymptomatic.

Gallstone disease cause cholecystitis by obstructing bile flow, leading to concentration and stasis of bile, and promoting infection from intestinal microorganisms.

It results in cholecystitis, that is the inflammation of the gallbladder.

Cholecystitis is a painful disease!

Cholecystitis manifests itself in the following ways:

Severe and constant pain at the right upper quadrant (RUQ) of the abdomen, fever, vomitting, nausea and anorexia (loss of appetite); which may lead to jaundice and diarrhoea.

Pain at the right upper quadrant in cholecystitis.

What should you do?

Consult a physician immediately, unless you are fond of the severe and constant pain.

Always trust your doctors.

Your physician would then examine you physically. Special and specific signs are performed to confirm cholecystitis. Signs are diagnostic examinations founded by great physicians of the past and are named in their honour.

Murphy's sign:
This is the standard sign of cholecystitis worldwide. Pain is felt during inhalation or coughing when the physician palpates your RUQ due to the inflammation of the gallbladder.

Murphy's sign: Pain during deep palpation.

However, as stated in my previous post, Russians emphasise greatly on the importance of practical skill. Therefore, Russian physicians test not one, but several other signs.

Boas' sign:
Increased sensitivity below the right scapula.

Kalk's sign:
Pain during percussion on area of gallbladder.

Ker's sign:
Pain during simultaneous inhalation and palpation on area of gallbladder.

Kurvuasie's sign:
Enlarged, distended gallbladder is felt during palpation.

Mussi-Georgievsky's sign:
Pain during palpation between pedicles of the sternocleidomastoid muscle of the right side.

Ortner's sign:
Pain during striking of the right costal arch by ulnar margin of the hand.

Razba's sign:
Pain during light punches of the right costal arch.

Shetkin-Bloomberg's sign:
Pain after sudden release of deep palpation of RUQ.

Vasilenko's sign:
Pain during percussion at peak of inhalation on area of gallbladder.

Zaharin's sign:
Pain during moderate stroking of gallbladder area.

Your physician would then perform several hi-tech diagnostic tests on you.

Blood taking to detect changes.
Ultrasonography to look for thickened gallbladder walls and gallstones.
Hepatobiliary scintigraphy to assess ability of gallbladder to expel bile.
Abdominal X-ray to look for gallstones.

Patients confirmed with gallstones are usually referred from your physician to surgeons.

Shiny scalpel. Gonna cut him up.

Recovery from this disease is possible with proper treatment, however, usually not without invasive intervention. Depending on the severity of the disease, patients are operated on with different surgical procedures.

Laparoscopic cholecystectomy as seen through laparoscope.

Antibiotics for preoperative preparation.
Oral ursodeoxycholic acid to dissolve gallstones.
Extracorporeal shock wave lithotripsy, to break up gallstones.
Laparoscopic cholecystectomy, using endoscope.
Traditional open surgical cholecystectomy.

X-ray during laparoscopic cholecystectomy

Surgery should be performed as soon as possible; delay in treatment will increase chances of morbidity, mortality and complications.

Remember, this disease is caused by unhealthy lifestyle and habits. So stay healthy, or suffer!

22 March 2008

Regional Hospital

This the the Regional Hospital of the state of Kursk.

Oblastnaya balnitsa, or Regional Hospital in English.

It is the largest hospital of the state, and perhaps the most modern of them all.

Inside its more modern operating theatres, dozens of surgeries are performed every moment.

A procedure of laparoscopic cholecystectomy.

There we were, observing our tutor as she assisted the head surgeon, who was meticulously dissecting the bilestone-filled gallbladder of an ill-stricken patient, with the help of the endoscopic video.

It was smooth sailing all the way, until the dissected gallbladder slipped from the remote forceps into the abdominal cavity.

"Uh oh!" we echoed in unison.

There was a short moment of silence.

"Oh, is that the way you express it in English? 'Uh oh'?" one of the surgeons asked. "In Russian we say 'Oi!'"

We chuckled lightly while the head surgeon picked the stapled-shut piece of useless appendage from the abdominal cavity and extracted it out from the still unconscious patient. "There, all is fine. Come, follow me and I'll show you the precious gemstones."

No matter how modern the operating theatres could be, there would always bound to be 1 or 2 Soviet-era pieces of equipment lying around. In this case, it was the ventilation machine.

As long as it works and gets the job done.

Sometimes the tools they use were so archaic, that the principle of that particular technology was unheard of in Malaysia. But they're happy as long as its still working.

As the operation completed successfully, we moved back to our classroom.

Hall of Fame: portraits of great Russian surgeons filled the walls of the hallway.

We continue the lesson with more practice of objective examination and diagnostic skills.

A mock patient, a student and our tutor.

For the Russians, skill is as important as knowledge itself, maybe more. As compared to the western world which is overly dependent on modern examination instruments, the Russians use their healing hands more often.

"A great physician uses not only his mind, but also his skillful hands. In times of war and difficulty, there would either be not enough instruments or simply no electricity for your MRI machines," a well-respected professor once told us.

Patients waiting for their chance at the healing hands.

And so that was class at the Regional Hospital, all in a day's work.

17 March 2008

Sudden Snow

Russia is known for its cold, bleak and harsh winter. When one mentions about the country of Russia, it is very often stereotypical for people to associate with Siberia, where winter never seems to end – knee-deep snow in the background of a pounding blizzard.

Cliché as it seemed, this assumption is true. Not only is the winter harsh, but also unpredictable. And when it does snow, it comes blitzkrieg-styled. A sudden snowfall today precisely demonstrated this.

Be reminded that, as stated in my previous posts, winter has passed and spring has arrived.

It was supposed to be a fine sunny afternoon as I was preparing to return home from the hospital after class.

Snowflakes are falling on my head.

As I turned around, the building roof was already completely covered with snow.

People scurrying for cover.

As I reached the main road to take the bus, road vehicles were already partially topped with snow.

Vehicles usually don't get affected by snow. Their hot running engines thaw snow quicker than snow can accumulate.

I'd like icing sugar on my cheesecake, please.

As I alighted, I couldn't help but stare in awe of the beauty of the landscape, yet felt disturbed by the result of just one day's worth of snowfall.

Boulevard beauty.

The wind was howling mad, but wasn't strong enough to shake off so much snow from the tree branches.

It was just yesterday that I hoped to see the spring flowers bloom today.

Snowfall got heavier as the day progressed.

Before I retreated into the refuge of my hostel, I took one last glance over my shoulder.

It's all white again.

As the entrance door slammed behind me, I found myself drenched wet. But at least I survived the onslaught and lived to tell the tale.


10 March 2008

Morning Fog

Ever wondered what are the differences between fog, mist and haze?

Synonymous to a cloud except that it touches the ground. Limits visibility to less than 1 km.

Limits visibility to less than 2 km, looks bluish from a distance.

Looks brownish from a distance.

Fog forms when the difference between temperature and dewpoint is 3°C or less, at relative air humidity of 100%. It is because of this total humidity that the air becomes supersaturated, and this moisture condenses into water vapour of fine droplets.

Fog happens very rarely at this part of the world due to its geographical location, altitude and low humidity.

Inland cities don't get much humidity from the sea.

However, it was a foggy morning today.

A window shot showing thick fog in the distance.

No one knows the mysterious doings of mother nature, and today was one of those days.

The experience of seeing your residence shrouded in a blanket of fog was simply surreal.

Visibility beyond the yellow van was close to zero.

The time was about 9 a.m. in the morning, yet, no sign of the sun.

Standing by the main street, one could barely see the end of the road through the thick fog.

Life as usual despite the fog.

Further away from the town center, the fog persisted still.

Fog at the countryside.

This reminded of the time when I was much younger, when my family would travel up to Genting Highlands at weekends and spend the cool afternoon in the clouds.

Genting Highlands theme park, Malaysia.

09 March 2008

Spring Cleaning

A couple of days back the hostel administration decided to do away with the old wiring system that has been around since Soviet times.

We were given a few days of prior notice before renovation began, and we were to be evicted by all means. Old wiring was to be replaced so wall-drilling was to be done, and it would be really messy.

Some of us, however, were not given an alternative place to stay for the few nights.

My roommates and I weren't pleased, as we went about ranting for a while. But considering the fact that hostel accommodation was partly sponsored by the Russian government, we did shut up a little.

We pay MYR600 (approximately USD188) per year in hostel fees. Water and electricity bills are subsidised by the state government.

That means we pay only MYR2 (USD0.63) per night for our whole 10 months here!

It couldn't get any better than this, unless you enrol yourself in your local town prison.

Renovation started with us moving out our belongings and furnitures.

Rubbish, furnitures and tools littered the hallway.

Furniture that was too large to be removed had to be moved away to from the walls to the center of the room.

Beds were made to stand upright.

Renovation took 2 days. My wallpaper was ripped apart, walls carved into for new wiring and worst of all, they replaced my bright flourescent lamps for incandescent tungsten lightbulbs!

Apparently, Russians love lightbulbs. Its poor lighting hides furniture defects and unsightly uncleanliness of the room, just as the rest of the world is about to phase out lightbulbs.

Oh crystalballs of light, tell me when will the Russians ever modernise.

We took the entire evening sweeping, vacuuming and moping the floor, and rearranging our furniture.

A good spring cleaning for the room.

Lastly, it was time to lay the carpet.

The last hurdle.

Maybe I should have laid it before moving the furniture.

What should I do now? I'm already so tired!


I give up.


Have you ever thought of the possibility of contracting tuberculosis?

Do you even know what tuberculosis is?

Tuberculosis (TB) is one of the leading infectious cause of death worldwide, with 2 billion infected people and causing 3 million deaths a year.

Worldwide cases per 100k; red >300, orange 200-300, yellow 100-200, green 50-100, gray <50.

With that figure in mind, shouldn't you be concerned about this disease?

Getting infected:
It is very easy to contract TB. Simply by sharing the same environment with a person who suffers from TB is a risk factor, and talking to that person almost guarantees that you will contract it. This is because TB is an airborne disease.

The Sneeze of Death: sprinkle pepper at face for instant effect.

So, what causes TB?

TB is primarily caused by the organism of Mycobacterium tuberculosis, and less commonly by Mycobacterium bovis by drinking unpasteurised milk.

Mycobacterium tuberculosis under the electron microscope.

Up to 80% of cases of tuberculosis are confined to the lungs, or pulmonary TB, and the rest of the cases being extra-pulmonary TB. Pulmonary TB is further divided into primary TB and post-primary TB (ie, reactivation of TB).

Chest X-ray showing TB of lungs.

How would you know if you have TB? If you have fulfilled some of the criteria below, you are at risk.

Risk factors:
You had unprotected contact or interaction with a TB patient.
You suffer from a serious disease like AIDS.
You require chemotherapy which suppresses your immune system.

Wearing protective face masks can prevent infection and spreading of TB.

When you're infected, you might exhibit symptoms characteristic of TB.

Fever, general weakness, sweats, anorexia (poor appetite), cough, sputum, erythema nodusum (painful nodes on legs), or phlyctenular conjunctivitis (red nodes on cunjunctiva).

What should you do?

Always trust your doctor.

Consult a physician immediately. Not only are you sick, you could be a health hazard to others.

Your physician would then perform several hi-tech diagnostic tests on you.

Sample taking, which includes blood, urine, sputum, pus and pleural fluid.
Chest X-ray, to search of visual signs in your lungs.
Bronchoscopy, to look into your lungs with an endoscope.
Biopsy, to confirm TB lesions in your lungs.
Immunologic tests, specifically the Mantoux-Tuberculin test, which requires patients to be injected with TB antigen under the skin, in which a diagnostic skin induration would form a few days later.

The Mantoux-Tuberculin test.

Malaysians usually get their first Bacillus Calmette-Guérin (BCG) vaccine shot at 12 years old. However, this form of immunisation lasts about 5 years. Further immunisation would be required.

Skin induration of less that 4 mm is considered a negative reaction. New BCG shot is required.

Luckily, due to the advent of modern science, survival from this disease is possible with proper treatment, which is in the form of medical therapy. Depending on the severity of the disease, patients are prescribed drugs in different regimes and doses, and treatment for the most common form is as below.

Rifampicin - 600 mg PO, thrice a week.
Isoniazid - 900 mg PO, thrice a week.
Pyrazinamide - 2.5 g PO, thrice a week.
Ethambutol - 30 mg/kg PO, thrice a week.
Streptomycin - 1 g IM, once a day.

Treatment of tuberculosis is of long duration up to 9 months. Any breach of compliance of treatment may result in reactivation of the disease, or post-primary TB.

However, taking drugs of any kind are almost never without adverse effects, just as these ones.

Drugs and its adverse effects:
Rifampicin - Hepatitis, orange discolouration of urine and tears
Isoniazid - Hepatitis, neuropathy
Pyrazinamide - Hepatitis, arthralgia
Ethambutol - Optic neuritis
Streptomycin - Ototoxicity

Anti-TB chemotherapy drugs.

Therefore, to counter the negative effects of these drugs, it is advisable to take adequate vitamin B, particularly B6 (pyridoxine) throughout the entire treatment.

Take adequate vitamin B6 during treatment.

At the end of this post, I hope you're enlightened! Stay healthy!

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