My experience as a Medical Officer at Klinik Kesihatan Sundar

After I completed my Medical Officer floating period at Kluang hospital in May 2024, I got transferred to Sarawak. I flew to Kuching on 26 May 2024. I reported for duty at the Sarawak State Health Department in Kuching on 27 May 2024. After reporting for duty, I was told that I got allocated to Klinik Kesihatan Sundar (KK Sundar) in Lawas. I stayed in Kuching throughout that week, where I had the opportunity to explore the city and taste some good food. On 2 June 2024, I took a flight to Limbang. Limbang is a rather nice town that looks a bit like Kluang, but unfortunately I wouldn't be working there.

On 3 June 2024, the driver from KK Sundar came to Limbang to bring me to Sundar. I had to pass through the Temburong district of Brunei to get to Sundar and that was my first time entering Brunei. Sundar is a very isolated village, with the Lawas town located 30km away. The only accommodation available in Sundar is the quarters right next to KK Sundar. The quarters is a poorly maintained wooden house and it's a horrible place to live in. There are dust and spider webs everywhere and the facilities in it are in poor condition. I stayed there for 2 nights and I felt extremely uncomfortable. There are a few eateries and grocery stores in Sundar within walking distance from KK Sundar. The food tastes fairly good, although its variety is quite limited.

On 5 June 2024, I went to Lawas town and reported for duty at the Lawas District Health Office. Lawas is a rather nice town, it's smaller than Limbang but it looks newer. On that afternoon, I began working as a Medical Officer (MO) at Klinik Kesihatan Sundar. There was another MO as well as several Medical Assistants (MA) and Nurses at KK Sundar. There was no specialist here, instead we had to call the specialist at Klinik Kesihatan Lawas to seek his input if necessary. The standard working hours is from 8AM to 5PM every Monday to Friday, excluding public holidays. In addition, every MO has to take turns doing passive oncall. For the passive oncall, we have to stand by 24 hours every day including weekends and public holidays, to attend to patient referrals by the MAs. For less severe cases, we can just give the management plan over the phone, but for more severe cases requiring admission, we may have to escort the patient in the ambulance to Hospital Lawas. There's no active oncall.

The work at KK Sundar is quite relaxing. Every day, there's usually no more than 20 patients and most of the cases are quite simple. KK Sundar is fairly nice with fairly good facilities, despite its isolated location. It certainly is much more comfortable compared to the quarters. I decided that moving forward, I would stay at the MO room of KK Sundar instead of the quarters, and I would only use the quarters for keeping my luggage. On 8 June 2024, I, my MO colleague and the MAs went to Limbang to attend the Mesyuarat Penyelarasan Pengurusan Murid Berkeperluan Khas Pendidikan dan Kanak-Kanak Autism. On 9 June 2024, I registered for the August 2024 MRCP(UK) Part 1 exam. I began my full-scale revision for the MRCP(UK) Part 1 at that time. 

On the week starting from 10 June 2024, I had to undergo my 1st week of tagging at Klinik Kesihatan Lawas (KK Lawas) in Lawas town. KK Lawas has many more patients and a much greater variety of cases compared to KK Sundar, but the MOs at KK Lawas don't have to do passive oncall. An important new clinical skill I had to learn was antenatal ultrasound. I had never performed any ultrasound before that and it certainly was a challenge for me. However, I could pick it up with some practice under the specialist's guidance. Throughout that week, I stayed at Hotel Perdana in Lawas. It's a simple yet comfortable hotel. There's a variety of good food in Lawas and I really enjoyed them. My favourite restaurant is Hao Wei Seafood Restaurant which serves all kinds of dishes. There's a restaurant selling good bak kut teh and roasted pork next to Hotel Perdana. Everyday Chicken Rice is really good, in fact it's one of the best chicken rice I have tasted. As Lawas is a quite a small town, I could get around just by walking.

On that Wednesday, my colleagues told me that it's compulsory to wear batik shirt every Thursday at KK Lawas and KK Sundar. I didn't have a batik shirt and couldn't get one in time for that Thursday, then my specialist gently reminded me to get a batik shirt by the following week. As the specialist wouldn't be around on the following week, my 2nd week of tagging was postponed to the subsequent week. I would only begin doing passive oncall after completing the whole tagging period. I returned to Sundar on 17 June 2024 by taxi. Having experienced the nice Lawas town, having to return to Sundar felt so disappointing. To make matters worse, I forgot to take away some food from Lawas for my dinner, and all of the eateries in Sundar were closed on that day as it was a public holiday. I was looking forward to my 2nd week of tagging in Lawas so much and I booked Hotel Perdana for that week in advance.

On 18 June 2024, my MO colleague told me that he wanted me to come back to KK Sundar to cover for him for 2 days during my 2nd week of tagging, as he would be away for a health screening programme at a school, adding that he had obtained the specialist's approval for that. I got quite upset considering that my MO colleague didn't discuss it with me beforehand and I had already booked the hotel in Lawas for the whole of that week, resulting in us having a minor argument. At that time, I found an eatery in Sundar selling good tomyam chicken. Later that week, I had a very bad diarrhoea. I bought 10 bottles of mineral water from a grocery store in Sundar so that I could replace my water loss.

I took a taxi to Lawas on 23 June 2024 and stayed there for a night. I managed to find a batik shirt at Lawas Supermarket. Lawas Supermarket is located right behind Hotel Perdana and it sells all kinds of food stuff and living appliances. After tagging at KK Lawas for a day on 24 June 2024, I returned to Sundar to cover for my colleague on 25 and 26 June 2024. I then resumed tagging at KK Lawas on 27 and 28 June 2024. To make up for the 2 days lost, my tagging at KK Lawas was extended for another week from 1 to 5 July 2024. Throughout the tagging period, I saw a good variety of cases managed under primary care and I became quite skilled at antenatal ultrasound. I also had the opportunity to learn implanon insertion.

I really hoped I could keep working at KK Lawas, as Lawas is a much better place to live in compared to Sundar. However, KK Lawas already had sufficient MOs while KK Sundar only had 1 MO excluding me, so I couldn't transfer to KK Lawas. After completing the tagging period, I began doing passive oncall on 6 July 2024. As my MO colleague had done passive oncall continuously for the past 1 month while I was tagging, I decided to do passive oncall continuously for the next 1 month. My car that was shipped from Kuala Lumpur finally arrived in Lawas on 6 July 2024. I stayed in Lawas for another night and then drove back to Sundar on 7 July 2024. I bought some food and living appliances in Lawas prior to returning to Sundar. I had been staying at Hotel Perdana for 10 days continuously from 27 June till 7 July 2024.

Power outages are very common in Sundar, affecting the whole village including KK Sundar. It would occur at least once in a week, lasting around 2 hours each time. Power outages at night can be quite scary. In contrast, I hadn't experienced a single power outage in Lawas town. The mobile network in Sundar is surprisingly strong and fast despite the isolated location. However, whenever there's a power outage, the mobile network will be totally lost immediately, and it can take up to several hours for the mobile network to recover after the power is restored. Sometimes, the mobile network may also be lost at random times even when there's no power outage. Power and mobile network outages are among the greatest annoyances in Sundar. At that time, I discovered a Ramly burger stall in Sundar. Its burgers are really tasty.

Majority of the patient cases at KK Sundar are follow ups for common medical conditions such as diabetes, hypertension, hyperlipidaemia and asthma. There are also maternal and child cases. Acute cases are less common but are more challenging to attend to. As working at KK Sundar was quite relaxing, I had a lot of free time every day to revise for the MRCP(UK) Part 1. In the middle of the night on 10 July 2024 when I was sleeping at KK Sundar, I suddenly got awakened by my MO colleague who told me that there's a pregnant patient in active labour. I got panicked as it had been more than 2 years since I last conducted a delivery. To make matters worse, the patient had a whole lot of antenatal issues and had defaulted follow up for some time. I quickly called Hospital Lawas to refer the case and then escorted the patient to Hospital Lawas. Thankfully, we reached Hospital Lawas in time before the baby was delivered.

On 13 July 2024, I went to Lawas and stayed a night at Hotel Perdana. With my car, getting between Sundar and Lawas is easy and it takes about 30 minutes. As I was doing passive oncall, I had to stay alert at all times for any phone calls from the MA referring cases. Early in the morning on 14 July 2024, the MA called me to refer a patient with STEMI. After giving the immediate management plan through the phone, I had to rush back to KK Sundar to escort the patient to Hospital Lawas for admission. On 19 July 2024, I found out that a Clinical Lecturer post was newly open for application and that I fulfilled all of the essential and desirable criteria for it. I quickly submitted my application on the next day and I was hopeful of getting a place. I told my colleagues at KK Sundar about it and even promised to give them a banquet before leaving KK Sundar to join the post.

In the following weeks, I went to Lawas and stayed at Hotel Perdana every weekend. Even though staying at the MO room of KK Sundar is much more comfortable compared to the quarters, it's still far from perfect, so I wanted to enjoy staying at the hotel during the weekends. I was still doing passive oncall, but fortunately for me, there were no further cases requiring me to go back to Sundar to escort the patient. Throughout that period of time, I was busy revising for the MRCP(UK) Part 1, spending at least 3 hours on it every day. I discovered a really delicious chicken curry at an eatery in Sundar. It's one of the best chicken curry that I have tasted. Regularly, a staff at KK Sundar would sell fried rice. I really liked her fried rice, especially with fried chicken, fried egg and extra chilli.

At that time, I had gotten used to working at KK Sundar. While I appreciated how relaxing the work is, I still didn't like living in Sundar. I often got annoyed whenever the MAs or Nurses forgot to trace the patients' blood investigation results before handing the patients' notes to me, which would sometimes occur when they were very busy. On 3 August 2024, I finally completed my 4 weeks of continuous passive oncall. My MO colleague would be doing passive oncall for the next 2 weeks. On 8 August 2024, I was granted my Annual Practising Certificate for 2025. On 9 August 2024, there was a Continuing Medical Education session on Pain as 5th Vital Sign at KK Sundar. On 11 August 2024, I had lunch at Gaya Cafe in Hotel Seri Malaysia for the first time. It's the highest class restaurant in Lawas. The food tastes really good, but it's quite expensive and the portion is rather small.

On 12 August 2024, the Sister seek my help in blood taking for a neonate after multiple unsuccessful attempts. I gave it a try and managed to get the blood. On that afternoon, a pregnant patient in active labour came to KK Sundar. I immediately attended to the patient, feeling calmer this time after the previous experience. My MO colleague then escorted her to Hospital Lawas for delivery. I took 3 days of leave from 13 to 15 August 2024, during which I went to Bandar Seri Begawan, Brunei. There, I took the MRCP(UK) Part 1 online exam at Times Hotel on 14 August 2024. I also did some sightseeing and tasted the local food in Brunei. On 17 August 2024, I resumed doing passive oncall. On 18 August 2024, I attended the Ectopic Pregnancy Webinar. I didn't stay in Lawas on that weekend, having spent quite a lot of money in Brunei.

On the following week, there were several power outages in Sundar. Unlike previously where it would only occur about once a week, there were multiple power outages a day for 2 days, with one lasting longer than 4 hours! I got so upset that I telephoned Sarawak Energy to make a strong complaint. Around that time, Lawas Supermarket began selling mooncakes as the Mid-Autumn Festival was approaching. Only Kee Fui mooncake was available and I bought several of it. Later, my mother sent me some Oversea mooncakes by parcel. The postman couldn't deliver it to KK Sundar and instead told me to collect it at the Lawas post office. Starting from 24 August 2024, I once again went to stay at Hotel Perdana in Lawas every weekend. There weren't any patients requiring me to escort during the 2 weeks, and my passive oncall ended on 31 August 2024.

On 2 September 2024, a new MO was transferred to KK Sundar. With 3 MOs here, the work became even more relaxing. However, the new MO wouldn't be doing passive oncall until he had completed his tagging period. At that time, KK Sundar was undergoing some renovation, making it look nicer than before. On 9 September 2024, much to my disappointment, I was informed that my application for the Clinical Lecturer post was unsuccessful, without any reason given. I then quickly applied for a DU51P Trainee Medical Lecturer post. On 13 September 2024, a patient in cardiac arrest was suddenly brought to KK Sundar. We performed CPR for 30 minutes but couldn't revive the patient. That was the first cardiac arrest case I encountered in Sundar. Later that day, my MRCP(UK) Part 1 results were released and I successfully passed it with a great score.

That weekend was busy for everyone at KK Sundar. On 14 September 2024, we organised a community health screening event at Dewan Masyarakat Sundar. It was fun yet tiring. On 15 September 2024, the Deputy Premier of Sarawak visited KK Sundar and we were involved in the reception. We then had a free lunch at Dewan Masyarakat Sundar. After the busy weekend, I was glad to have a holiday for Malaysia Day on 16 September 2024. I resumed passive oncall on 17 September 2024. After updating my MRCP(UK) Part 1 results, I was informed that I had been shortlisted for an interview for the DU51P Trainee Medical Lecturer post. The interview was held online on 19 September 2024, and it included a 10-minute teaching presentation. I did the interview at Hotel Perdana in Lawas and I felt that I performed fairy well. But much to my disappointment, I was informed on 24 September 2024 that I was unsuccessful in the interview. On 30 September 2024, I tried nasi bungkus for the first time. A staff at KK Sundar made it and it was quite good.

On 2 October 2024, the Deputy Minister of Health visited KK Sundar. I had the opportunity to speak to him. On 4 October 2024, I had to go to Wisma Persekutuan Lawas to reset my MyDigitalID after I forgot the password. On that afternoon, there was a steamboat party at KK Sundar. The steamboat tasted quite good. My passive oncall ended on 5 October 2024. At that time, I applied for another DU51P Trainee Medical Lecturer post. On 7 October 2024, I was unexpectedly told that I would be transferred to Klinik Kesihatan Ibu dan Anak (KKIA) Limbang in the coming weeks, as KKIA Limbang was lacking MOs while 2 MOs would be sufficient for KK Sundar. Considering that I never liked staying in Sundar and I would very much prefer to live in Lawas or Limbang, I happily agreed to transfer to KKIA Limbang. On 9 October 2024, I stayed at All Are Welcome Inn in Lawas for the first time. It's nicer than Hotel Perdana, but also significantly more expensive.

At that time, my colleagues at KK Sundar introduced me to an eatery in Kampung Baru Sundar. The food there is very good and it's unfortunate that I never discovered the eatery earlier. On 11 October 2024, a patient who collapsed was brought to KK Sundar. We found him to be in cardiac arrest and we performed CPR, but we failed to revive him. On that afternoon, the Sister held a farewell party for me and another staff who would be transferred to KK Lawas soon. There was a barbeque which was really fun. At the end of the party, the Sister gave me a simple trophy as recognition for my contributions to KK Sundar. Knowing that I would be leaving Sundar and Lawas soon, I made sure to go eat at every single one of my favourite restaurants in Sundar and Lawas. I decided to honour my previous promise of giving my colleagues at KK Sundar a banquet before leaving. The Sister helped me organise the banquet while I paid for all the costs. My banquet was held on 17 October 2024, during which I gave a heartfelt speech to my colleagues. They appreciated the banquet very much. 

On 18 October 2024, I went to the Lawas District Health Office to submit the documents for my new MO contract. After returning to KK Sundar at noon, I suddenly heard through the WhatsApp group that there had been a bad accident nearby where a car fell into the river. I was alone in KK Sundar at that time as the MAs and Nurses were having lunch. Then out of sudden, several victims who drowned in the river were brought to KK Sundar by their family members, all in cardiac arrest! I got panicked as I couldn't possibly perform CPR for all of them all by myself. I could only perform CPR for one of the victims while telling the family members to try to do the same for the others. Luckily, my MO colleague and the MAs arrived soon enough to help with the CPRs. Each of us then escorted a victim to Hospital Lawas. MOs from all over the Lawas district had been called to stand by at the ED of Hospital Lawas to attend to this mass casualty event. We then had to wait for quite some time at Hospital Lawas for a debriefing before we could leave. 

On 19 October 2024, I resumed passive oncall for the final week. On 23 October 2024, there was a 2-hour power outage at noon, followed by another 7-hour power outage at night. Even the emergency lights went off due to the extended duration and I was in complete darkness. That was the worst ever power outage in Sundar I had ever experienced. There was a planned power outage on 24 October 2024, but it was cancelled following the terrible power outage on the previous day. 24 October 2024 was my last day in Sundar and I said goodbye to all of my colleagues. On that night, I stayed at Hotel Perdana in Lawas for the last time. Early in the morning on 25 October 2024, I drove to Limbang and attended the Approach To Unwell Children Under 5 Years (ATUCU-5) Course. After the course, I just stayed in Limbang without returning to Sundar. My passive oncall ended on 26 October 2024, marking the end of my work at KK Sundar. I began working at KKIA Limbang on 28 October 2024. After this, I will surely miss Lawas a lot but I will only miss Sundar a little. I will also miss my colleagues at KK Sundar.

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