- Had breakfast by the road side today. American Breakfast at a small eatery called the Piggy's or something like that. Nice beef patty made from Australian beef - the owner seemed to stress the fact a lot. Rp24.000
- Went to the beach, got together with Meite's friends and AirAsia crews from the same hotel. Tumpanged their beach chair and umbrella - apparently beach chairs are for rent here on the beach - these people can find ways to make money out of anything - Rp saved.
- Got 2 Bintang Beer singlets for Rp80.000, didn't really felt lke haggling much so just let it be
- Went back to sleep at about noon - now the holiday mood has really kicked in...
- Dinner - Nasi Padang again, this time just around the corner of the hotel - Rp23.000
- After dinner treat - at a cafe called Local Cafe - quite upscale and serves illy coffee - had black, and latte - Rp36.300
- No drinking tonight, going to wake up early tomorrow, and rent a scooter to go around Denpasar
- Got home to shower after getting lost in Kuta chaotic streets for a bit
- Went out to hunt for authentic Indonesian dinner with Maite. The streets of Kuta is too Westernised, do they think all the Mat Sallehs paid all the money to get out of their country and have what they usually have anyway?
- Found a Nasi Padang restaurant which was decent, and more importantly, clean... paid Rp69.500 between the 2 of us - reasonably cheap for the feast we had
- Went around Legian area, then settled in a pub called Wild Catz for beer - the local beer here is called Bintang, Rp20.000 a bottle, had 3
- Wild Catz are ladies dressed in nurses costume that comes up to the bar to dance once in a while... damn, why our nurses back home never like that, heh...
- Went back around 1, totally spent for the day.
- Got up early this morning, watched the local Balinese pray.
- Came early to AirAsia at about 9am. Took the SkyNet bus like usual, costing RM9 per trip.
- Departed on time. at next to a domestic worker lady from Kupang, East Bali who wouldn't stop chatting - had to put on my earphone before she takes a break...
- Made friends with another German traveler, Maite, who works in Shah Alam, also traveling alone before joining his group in Bali. On arrival, decided to share a cab with him down town. Taxi ride from airport to Kuta - Rp50.000
- Looked for a place called Bali Manik - Rp80.ooo a night - quite decent for a place in the heart of Kuta, on Poppies Street
- Went to the beach but decided to do the street-shops first today.
- Meeting up with Maite and possibly friends later for dinner at 1930pm
- Started to think that 10 days may be stretching it a bit too long for this vacation, heh.
Though the World Health Organization (WHO) is referring to the situation as a "public-health emergency of international concern," the apparent emergence in several countries of an entirely new strain of H1N1 flu virus has led some scientists to believe that it is only a matter of time before the WHO declares pandemic status, a move that could prompt travel bans to infected countries. "We are clearly seeing wide spread," says Michael Osterholm, a pandemic risk expert who runs the University of Minnesota's Center for Infectious Disease Research and Policy. "There is no question."
Health officials in Washington were quick to point out Sunday that none of the 20 cases identified in the U.S. so far has been fatal; all but one of the victims has recovered without needing to be hospitalized. Officials also noted that only one American has been infected so far who had not recently traveled to Mexico - a woman in Kansas got sick after her husband returned from a business trip in that country, where he became ill - but that could change as more intensive disease surveillance begins. "As we continue to look for more cases, I expect we're going to find them," said acting Centers for Disease Control (CDC) director Richard Besser.
In the U.S., where cases have also been found in California, Texas, and New York City, the declaration of a public-health emergency is part of what federal officials termed an "aggressive response" to the outbreaks. In addition to releasing from the national stockpile some 12.5 million doses of the antiviral drugs Tamiflu and Relenza - which scientists say has so far been effective against the H1N1 swine flu virus - the Department of Homeland Security will begin "passive surveillance" to screen people entering the U.S. Any traveler coming from a country with a confirmed human swine flu infection will be questioned, checked for symptoms and potentially isolated if they are found ill. Though the CDC has issued public warnings about the more serious outbreak in Mexico, there are no recommendations from Washington against traveling to the neighboring country.
That is in contrast to the more extreme actions of some other governments, including Hong Kong, where officials on Sunday urged residents to avoid going to Mexico. Hong Kong officials also ordered the immediate detention in a hospital of anyone who arrives with a fever above 100.4 F, respiratory symptoms and a history of traveling over the past seven days to a city with a confirmed case of swine flu infection.
But Washington officials Sunday did their best not to overstate the situation and emphasized that their response wasn't out of the ordinary. "I wish we could call it declaration of emergency preparedness, because that's really what it is in this context," said Secretary of Homeland Security Janet Napolitano. "We're preparing in an environment where we really don't know ultimately what the size or seriousness of this outbreak is going to be."
Right now health officials around the world are trying to take precautions without inciting panic. Here are just a few of the questions facing them - and ultimately, us as well:
1. Is this a flu pandemic?
The influenza virus is constantly mutating. That's why we can't get full immunity to the flu, the way we can to diseases like chicken pox, because there are multiple strains of the flu virus and they change from year to year. However, even though the virus makes us sick, our immune systems can usually muster enough of a response so that the flu is rarely fatal for healthy people.
But every once in awhile, the virus shifts its genetic structure so much that our immune systems offer no protection whatsoever. (This usually happens when a flu virus found in animals - like the avian flu still circulating in Asia - swaps genes with other viruses in a process called reassortment, and jumps to human beings.) A flu pandemic occurs when a new flu virus emerges for which humans have little or no immunity and then spreads easily from person to person around the world. In the 20th century we had two mild flu pandemics, in 1968 and 1957, and the severe "Spanish flu" pandemic of 1918, which killed an estimated 40 to 50 million people worldwide.
The WHO has the responsibility of declaring when a new flu pandemic is underway, and to simplify the process, the U.N. body has established six pandemic phases. Thanks to H5N1 avian flu, which has killed 257 people since 2003 but doesn't spread very well from one human to another, we're currently at phase 3. If the WHO upgraded that status to phase 4, which is marked by a new virus that begins to pass easily enough from person to person that we can detect community-sized outbreaks, such a move would effectively mean that we've got a pandemic on our hands.
The H1N1 swine flu virus has already been identified as a new virus, with genes from human and avian flus as well as the swine variety. And since it is apparently causing large-scale outbreaks in Mexico, along with separate confirmed cases in the U.S. and Canada and suspected cases in other countries, it would seem that we've already met the criteria for phase 4. But though an emergency committee met on April 25 to evaluate the situation, the WHO hasn't made the pandemic declaration yet. Keiji Fukuda, the WHO's interim assistant director-general for health, security and environment, said on Sunday that its experts "would like a little bit more information and a little bit more time to consider this." The committee is set to meet again by April 28 at the latest.
As health officials have repeatedly emphasized, with good reason, the swine flu situation is evolving rapidly, and more lab tests are needed to ascertain exactly what is going on in Mexico and elsewhere. "We want to make sure we're on solid ground," said Fukuda, a highly respected former CDC official and flu expert.
2. What will happen if this outbreak gets classified as a pandemic?
Moving the world to pandemic phase 4 would be the signal for serious containment actions to be taken on the national and international level. Given that these actions would have major implications for the global economy, not to mention the effects of the public fear that would ensue, there is concern that the WHO may be considering politics along with science. "What the WHO did makes no sense," says Osterholm. "In a potential pandemic, you need to have the WHO be beyond question, and (April 25) was not a good day for them."
Of course, declaring a pandemic isn't a decision that should be taken lightly. For the WHO, phase 4 might trigger an attempt to keep the virus from spreading by instituting strict quarantines and blanketing infected areas with antivirals. But we appear to have missed the opportunity to contain the disease at its source since the virus is already crossing borders with ease. "We cannot stop this at the border," said Anne Schuchat, the CDC's interim director for science and public health. "We don't think that we can quench this in Mexico if it's in many communities now."
That would leave the WHO and individual countries to fall back on damage control, using antivirals and old-fashioned infection control - like closing schools, limiting public gatherings and even restricting travel - to slow the spread of the virus. But such efforts would likely inflict serious damage on an already faltering global economy - and the truth is, we don't know how well those methods will work.
3. Why have the U.S. cases been so much milder than the ones in Mexico?
This is the question that has health officials from Geneva to Washington puzzled. In Mexico, swine flu has caused severe respiratory disease in a number of patients - and even more worryingly, has killed the sort of young and healthy people who can normally shrug off the flu. (Fueling such concerns is the fact that similar age groups died in unusually high numbers during the 1918 pandemic.) Yet the cases in the U.S. have all been mild and likely wouldn't have even garnered much attention if doctors hadn't begun actively looking for swine flu in recent days. "What we're seeing in this country so far is not anywhere near the severity of what we're hearing about in Mexico," said the CDC's Besser. "We need to understand that."
Some of the difference may be due to the fact that Mexico has apparently been grappling with swine flu for weeks longer than the U.S. As doctors across the U.S. begin checking patients with respiratory symptoms for swine flu, CDC officials expect to see more severe cases in the U.S. as well - and as better epidemiological work is done in Mexico, we'll probably hear about more mild cases there too. Right now, however, the true severity of the H1N1 swine flu virus is still an open question, whose answer could change over time. The 1918 Spanish flu pandemic began with a fairly mild wave of infections in the spring, but the virus returned a few months later in a far more virulent form. That could happen with the current swine flu as well. "It's quite possible for this virus to evolve," said Fukuda. "When viruses evolve, clearly they can become more dangerous to people."
4. How ready is the U.S. - and the world - to respond to a flu pandemic?
In some ways, the world is better prepared for a flu pandemic today than it has ever been. Thanks to concerns over H5N1 avian flu, the WHO, the U.S. and countries around the world have stockpiled millions of doses of antivirals that can help fight swine flu as well as other strains of influenza. The U.S. has a detailed pandemic preparation plan that was drafted under former President George W. Bush. Many other countries have similar plans. SARS and bird flu have given international health officials useful practice runs for dealing with a real pandemic. We can identify new viruses faster than ever before, and we have life-saving technologies - like artificial respirators and antivirals - that weren't available back in 1918. "I believe that the world is much, much better prepared than we have ever been for dealing with this kind of situation," said Fukuda.
At the same time, the very nature of globalization puts us at greater risk. International air travel means that infections can spread very quickly. And while the WHO can prepare a new swine flu vaccine strain in fairly short order, we still use a laborious, decades-old process to manufacture vaccines, meaning it would take months before the pharmaceutical industry could produce its full capacity of doses - and even then, there wouldn't be enough for everyone on the planet. The U.S. could be particularly vulnerable; only one plant, in Stillwater, Penn., makes flu vaccine in America. In a pandemic, that could produce some ugly political debates. "Do you really think the E.U. is going to release pandemic vaccine to the U.S. when its own people need it?" asks Osterholm.
Indeed, the greatest risk from a pandemic might not turn out to be from the swine flu virus itself - especially if it ends up being relatively mild - but what Osterholm calls "collateral damage" if governments respond to the emergency by instituting border controls and disrupting world trade. Not only would the global recession worsen - a 2008 World Bank report estimated that a severe pandemic could reduce the world's GDP by 4.8% - but we depend on international trade now for countless necessities, from generic medicines to surgical gloves. The just-in-time production systems embraced by companies like Wal-Mart - where inventories are kept as low as possible to cut waste and boost profit - mean that we don't have stockpiles of most things. Supply chains for food, medicines and even the coal that generates half our electricity are easily disruptable, with potentially catastrophic results. Though we'll likely hear calls to close the border with Mexico, Osterholm points out that a key component used in artificial respirators comes from Mexico. "We are more vulnerable to a pandemic now than at any other time over the past 100 years," he says. "We can't depend on ourselves."
5. So how scared should we be?
That depends on whom you ask. Officials at the CDC and the WHO have emphasized that while the swine flu situation is serious, they're responding with an abundance of precautions. Even Osterholm, who has been highly critical of the U.S. government's long-term failures to better prepare for a pandemic, gives the CDC a 9 out of 10 for its response so far. Outside of Mexico, the swine flu hasn't looked too serious yet - unlike during the SARS outbreaks of 2003, when an entirely new virus with no obvious treatment took the world by surprise. In the U.S., the normal flu season is winding down, which should make it easier for public-health officials to pick out swine flu cases from run-of-the-mill respiratory disease. And there are simple things that people can do to protect themselves, like practicing better hygiene (wash hands frequently and cover mouth and nose when sneezing) and staying away from public places or traveling if they feel sick. "There's a role for everyone to play when an outbreak is ongoing," said Besser.
But the truth is that every outbreak is unpredictable, and there's a lot we don't know yet about the new swine flu. There hasn't been a flu pandemic for more than a generation, and there hasn't been a truly virulent pandemic since long before the arrival of mass air transit. We're in terra incognito here. Panic would be counterproductive - especially if it results in knee-jerk reactions like closing international borders, which would only complicate the public-health response. But neither should we downplay our very real vulnerabilities. As Napolitano put it: "This will be a marathon, not a sprint." Be prepared.
ATLANTA – As reports of a unique form of swine flu erupt around the world, the inevitable question arises: Is this the big one?
Is this the next big global flu epidemic that public health experts have long anticipated and worried about? Is this the novel virus that will kill millions around the world, as pandemics did in 1918, 1957 and 1968?
The short answer is it's too soon to tell.
"What makes this so difficult is we may be somewhere between an important but yet still uneventful public health occurrence here — with something that could literally die out over the next couple of weeks and never show up again — or this could be the opening act of a full-fledged influenza pandemic," said Michael Osterholm, a prominent expert on global flu outbreaks with the University of Minnesota.
"We have no clue right now where we are between those two extremes. That's the problem," he said.
Health officials want to take every step to prevent an outbreak from spiraling into mass casualties. Predicting influenza is a dicey endeavor, with the U.S. government famously guessing wrong in 1976 about a swine flu pandemic that never materialized.
"The first lesson is anyone who tries to predict influenza often goes down in flames," said Dr. Richard Wenzel, the immediate past president of the International Society for Infectious Diseases.
But health officials are being asked to make such predictions, as panic began to set in over the weekend.
The epicenter was Mexico, where the virus is blamed for 86 deaths and an estimated 1,400 cases in the country since April 13. Schools were closed, church services canceled and Mexican President Felipe Calderon assumed new powers to isolate people infected with the swine flu virus.
International concern magnified as health officials across the world on Sunday said they were investigating suspected cases in people who traveled to Mexico and come back with flu-like illnesses. Among the nations reporting confirmed cases or investigations were Canada, France, Israel and New Zealand.
Meanwhile, in the United States, there were no deaths and all patients had either recovered or were recovering. But the confirmed cases around the nation rose from eight on Saturday morning to 20 by Sunday afternoon, including eight high school kids in New York City — a national media center. The New York Post's front page headline on Sunday was "Pig Flu Panic."
The concern level rose even more when federal officials on Sunday declared a public health emergency — a procedural step, they said, to mobilize antiviral medicine and other resources and be ready if the U.S. situation gets worse.
U.S. Centers for Disease Control and Prevention officials say that so far swine flu cases in this country have been mild. But they also say more cases are likely to be reported, at least partly because doctors and health officials across the country are looking intensively for suspicious cases.
And, troublingly, more severe cases are also likely, said Dr. Richard Besser, the CDC's acting director, in a Sunday news conference.
"As we continue to look for cases, we are going to see a broader spectrum of disease," he predicted. "We're going to see more severe disease in this country."
Besser also repeated what health officials have said since the beginning — they don't understand why the illnesses in Mexico have been more numerous and severe than in the United States. In fact, it's not even certain that new infections are occurring. The numbers could be rising simply because everyone's on the lookout.
He also said comparison to past pandemics are difficult.
"Every outbreak is unique," Besser said.
The new virus is called a swine flu, though it contains genetic segments from humans and birds viruses as well as from pigs from North America, Europe and Asia. Health officials had seen combinations of bird, pig and human virus before — but never such an intercontinental mix, including more than one pig virus.
More disturbing, this virus seems to spread among people more easily than past swine flus that have sometimes jumped from pigs to people.
There's a historical cause for people to worry.
Flu pandemics have been occurring with some regularity since at least the 1500s, but the frame of reference for health officials is the catastrophe of 1918-19. That one killed an estimated 20 to 50 million people worldwide.
Disease testing and tracking were far less sophisticated then, but the virus appeared in humans and pigs at about the same time and it was known as both Spanish flu and swine flu. Experts since then have said the deadly germ actually originated in birds.
But pigs may have made it worse. That pandemic began with a wave of mild illness that hit in the spring of 1918, followed by a far deadlier wave in the fall which was most lethal to young, healthy adults. Scientists have speculated that something happened to the virus after the first wave — one theory held that it infected pigs or other animals and mutated there — before revisiting humans in a deadlier form.
Pigs are considered particularly susceptible to both bird and human viruses and a likely place where the kind of genetic reassortment can take place that might lead to a new form of deadly, easily spread flu, scientists believe.
Such concern triggered public health alarm in 1976, when soldiers at Fort Dix, N.J., became sick with an unusual form of swine flu.
Federal officials vaccinated 40 million Americans. The pandemic never materialized, but thousands who got the shots filed injury claims, saying they suffered a paralyzing condition and other side effects from the vaccinations.
To this day, health officials don't know why the 1976 virus petered out.
Flu shots have been offered in the United States since the 1940s, but new types of flu viruses have remained a threat. Global outbreaks occurred again in 1957 and 1968, though the main victims were the elderly and chronically ill.
In the last several years, experts have been focused on a form of bird flu that was first reported in Asia. It's a highly deadly strain that has killed more than 250 people worldwide since 2003. Health officials around the world have taken steps to prepare for the possibility of that becoming a global outbreak, but to date that virus has not gained the ability to spread easily from person to person.
A NEW flu feared to have killed up to 81 people in Mexico has "pandemic potential", the World Health Organisation has warned.
Suspected cases have been reported in New Zealand, Mexico, France and the US.
A school group has been quarantined in Auckland after returning from Mexico with flu-like symptoms.
Officials said three teachers and 22 senior students returned to New Zealand on Saturday after a three-week trip to Mexico. Test showed 10 of the students are likely to have contracted swine flu.
They tested positive for Influenza A and are being kept in isolation as a precaution.
The test results are to be sent to the World Health Organisation laboratory in Melbourne to ascertain whether it was the H1N1 swine influenza.
The US has declared a public health emergency after 20 people were diagnosed with the virus.
"At this point, a top priority is to ensure that communication is robust and that medical surveillance efforts are fully activated," said John Brennan, assistant to the president for Homeland Security.
Health and Homeland Security officials announced steps to release some of the country's stockpiles of anti-flu drugs, Tamiflu and Relenza.
They recommended that local authorities plan for possible school closures and called for people with flu-like symptoms to stay at home to reduce the possibility of transmission.
Homeland Security Secretary Janet Napolitano said the declaration of the public health emergency was necessary to free up federal, state and local agencies' resources and authorise the release of funds to buy more antivirals.
"This is standard operating procedure," she said, adding that similar declarations had been issued in the past to help states cope with flooding or to help them prepare for approaching hurricanes.
The acting director of the Centres for Disease Control and Prevention, Dr Richard Besser, said there were 20 confirmed cases of swine flu in the US. All patients had recovered and only one person had to be admitted to hospital.
It appeared to be the same strain as the virus that has killed scores in Mexico, he said, although it was not yet clear why it had not proven as deadly in the US.
Health officials from the United States and Canada were now in Mexico to try to answer this "critical question", he said.
"We expect to see more cases of swine flu. As we continue to look for cases, we expect that we will find them."
Dr Besser said the closure of two schools in New York City, where there had been a cluster of swine flu cases, and in Texas had been the right way to go.
"If there are other communities where we saw cases in a school, we would be recommending they take those actions as well," he said.
Ms Napolitano said the US would release 25 per cent of the 50 million anti-flu drugs from the strategic national stockpile.
The Department of Defence had also bought 7 million courses of Tamiflu for for defence personnel, she said.
French authorities have found two suspected cases of swine flu in travellers returning from Mexico. But tests showed a British Airways crew member being treated in a London hospital after arriving on a flight from Mexico did not have the deadly strain.
In Mexico, 13 new suspect cases were reported in the past 24 hours, and 1324 patients with flu symptoms were under investigation.
Mexican Health Minister Jose Angel Cordova yesterday raised the probable death toll from the new multi-strain swine flu in Mexico to 81, including 20 already confirmed.
Mexican President Felipe Calderon published an order giving his government extraordinary powers to tackle the deadly outbreak. Hundreds of public events have been cancelled and schools in Mexico City have been closed for millions of students.
"This virus has clearly a pandemic potential," World Health Organisation director general, Margaret Chan, said.
The UN agency branded the outbreak "a public health emergency of international concern", following a meeting of its emergency committee.
It recommended all nations "intensify surveillance for unusual outbreaks of influenza-like illness and severe pneumonia".
Dave Daigle, of the US Centres for Disease Control and Prevention, said a bird flu strain, two swine flu strains and a human strain had combined for the first time.
These features, along with the fact that healthy adults have fallen victim in Mexico - not the very old or very young - have given rise to fears of an epidemic or even a pandemic.
Many Mexico City residents wore surgical masks on the streets, after authorities urged people to avoid contact.
No travel restrictions had been placed on Mexico but medical teams are on stand-by at the city's airport.
- Make race car noises when anyone gets on or off.
- Blow your nose and offer to show the contents of your kleenex to other passengers.
- Grimace painfully while smacking your forehead and muttering: Shut up, dammit, all of you just shut UP!
- Whistle the first seven notes of It's a Small World incessantly.
- Sell Girl Scout cookies.
- On a long ride, sway side to side at the natural frequency of the elevator.
- Crack open your briefcase or purse, and while peering inside ask: Got enough air in there?
- Offer name tags to everyone getting on the elevator. Wear yours upside-down.
- Stand silent and motionless in the corner, facing the wall, without getting off.
- When arriving at your floor, grunt and strain to yank the doors open, then act embarrassed when they open by themselves.
- Lean over to another passenger and whisper: Noogie patrol coming!
- Greet everyone getting on the elevator with a warm handshake and ask them to call you Admiral.
- Censored by your son.
- On the highest floor, hold the door open and demand that it stay open until you hear the penny you dropped down the shaft go plink at the bottom.
- Do Tai Chi exercises.
- Stare, grinning, at another passenger for a while, and then announce: I've got new socks on!
- When at least 8 people have boarded, moan from the back: Oh, not now, damn motion sickness!
- Give religious tracts to each passenger.
- Meow occassionally.
- Bet the other passengers you can fit a quarter in your nose.
- Frown and mutter gotta go, gotta go then sigh and say oops!
- Show other passengers a wound and ask if it looks infected.
- Sing Mary had a little lamb while continually pushing buttons.
- Holler Chutes away! whenever the elevator descends.
- Walk on with a cooler that says human head on the side.
- Stare at another passenger for a while, then announce You're one of THEM! and move to the far corner of the elevator.
- Burp, and then say mmmm...tasty!
- Leave a box between the doors.
- Ask each passenger getting on if you can push the button for them.
- Wear a puppet on your hand and talk to other passengers through it.
- Start a sing-along.
- When the elevator is silent, look around and ask is that your beeper?
- Play the harmonica.
- Shadow box.
- Say Ding! at each floor.
- Lean against the button panel.
- Say I wonder what all these do and push the red buttons.
- Listen to the elevator walls with a stethoscope.
- Draw a little square on the floor with chalk and announce to the other passengers that this is your personal space.
- Bring a chair along.
- Take a bite of a sandwich and ask another passenger: Wanna see wha in muh mouf?
- Blow spit bubbles.
- Pull your gum out of your mouth in long strings.
- Announce in a demonic voice: I must find a more suitable host body.
- Carry a blanket and clutch it protectively.
- Make explosion noises when anyone presses a button.
- Wear X-Ray Specs and leer suggestively at other passengers.
- Stare at your thumb and say I think it's getting larger.
- If anyone brushes against you, recoil and holler Bad touch!
- Arrived at Singapore at approximately 2pm today.
- Had a bit of glitch with Singaporean authority when they caught me snapping pictures of the passages I went through to get from Johore to Singapore. He demanded that I delete all the pictures associated with immigration building, cilaka betul... if I know I would have hidden the camera, I literally took a shot of the Woodlands singage and including him in the pic some more... my fault... never mind, second attempt tomorrow...
- Got a bit confused with the Singaporean MRT system. Good thing I'm not the type that keeps his ego and stay lost. Got my way around town and arrived at Chinatown.
- Got a cheap backpackers style logding with single room the size of a big wardrobe, and common toilet. Cannot expect much for S$58 I guess...
- Went jalan-jalan along Orchard road, my first assignment - to get a Starbucks Green-Apron Bearista... not available, so got the type with a stupid cap and a t-shirt - S$24.50
- Had KFC for dinner - S$8.50
- Thought long about getting something from Bodum on sales - finally succumbed to 2, a travelling tumbler S$16.50 and a mug that says Coffee Lover - S$8.80
- Men's Health magazine that comes with a large tube of hairgel for free - S$6.00
- Bought 2 litres of guava juice on offer - S$2.00
- Reloaded A.Ng's ez-link card - S$10.00
- Got myself cafe latte at Starbucks - as usual - S$can't remember how much...
- Ice-cream on bread S$1
- Gave S$3.00 to 3 different street buskers on Orchard Road......
The luxurious short coach-bus that shuttled us to various locations for our observational assignment. We were segregated into 4 teams and my group was assigned to observe the management of a pulmonary tuberculosis case, from diagnosis till notification, contact tracing and treatment.
I was really upset with myself for forgetting my camera back at home. Restless at best. A friend actually suggested I buy a disposable camera, but I actually carry 2 partial cameras attached to my 2 handphones already. So the shots today were taken with my HTC rather than Sony Ericsson because SE died on me yesterday morning.
So if anyone tried to contact me using my 013 number, it might be diverted to the other phone. But now it's all okay, I got myself a RM8 ciplak charger that does the work and resuscitated my connectivity! Yay!
The Out Patient Department of Johore Bahru Health Clinic
Look at this... this is what I call Information Technology... impressive!
And being a type 2 Clinic set-up, they have elevators in their building!
Well, some scientist may argue that the Earth is much much older than that, but as far as I am concerned, it has been only 30 years ;-P
Now as a special treat to the dear Earth, I would take these 10 steps to help make it a better place to stay. Honest, I'll try my best...
- I WILL TRY MY BEST TO carry my reusable shopping bags whenever I go grocery shopping.
- I WILL TRY MY BEST TO put a mug in every Starbucks chain that I frequent to reduce the use of disposable plastic and paper cups.
- I WILL TRY MY BEST TO decline plastic bags for small puchases.
- I WILL TRY MY BEST TO walk more and drive less... and carry a towel because inevitably I'll be drenched.
- I WILL TRY MY BEST TO buy recycled products whenever possible.
- I WILL TRY MY BEST TO reuse my plate when I dine in hotels to reduce need to wash more plates and utencils.
- I WILL TRY MY BEST TO bring more live plants into my workspace and encourage my office-mates to do the same.
- I WILL TRY MY BEST TO bring my own container whenever I tapao food to reduce the usage of styrofoam containers.
- I WILL TRY MY BEST TO switch off the airconditioning during daytime when I am not in the room.
- I WILL TRY MY BEST TO organise a recycling project before Earth's 31st Birthday
Took a walk along Jalan Tebrau towards MetroJaya at Plaza Pelangi.
There seems to be quite a number of these fertility clinics along this road alone...
The view from a pedestrian bridge.
Shopping at Cold Storage before rushing off to the first session that night.
The official duty actually is in Johor Bahru, where I'll be attending a course on Outbreak Management (yes, again) for MOHs, and if all goes well, maybe some time to sneak into Singapore and visit the Merlion. The weekend is to attend a birthday party of a friend.
Something that I notice happening every time I plan to go on vacation - especially long ones - that things aropund me will go wrong. It's like Murphy's Law on hyperdrive! Thinking back, yeah, each and every one of my trips away after started working, something somewhere would just get screwed -- the Hong Kong trip, the Jakarta trip, the Philippines trip... sigh... It is almost like, if I take leave, my cosmic balance will be tipped off, being on leave would start off a karmic consequences for this workaholic...
Okay lah, I admit there's a bit of drama there...
A run down of what-could-go-wrong-would-go-wrong, and I do hope it stops here... please...
- My driver in Telupid got involved in a car accident and has a fractured femur
- One of my staffs contracted Tuberculosis and has to go on compulsory leave for 2 months
- Lost my Identification Card and had to have a new one done just before the day I travel
- Being rushed to board the flight and had to leave my half-full glass of Starbucks Dark Berry Mocha Frappucino to the bin... and worst of all...
- Forgot to bring my camera for this trip!!! Shit!
Now, I am not so good with such liberty!!
Actually AirAsia has canceled their BKI - DPS sector and gave me the option of flying through KL at an open date - whenever I feel like going as long as there is seat available - now that is quite a bargain - to have an open ticket, since the original was on super economy deal at zero fare!
So I've made up my kind to connect my trip to KL for a course with Bali, to save on the fare to KL. And finally I've got the confirmation. Yay!
But somehow, I still have hesitation to leave the office unattended for about 3 weeks... well, yes, I am a workaholic - and there'd better be easily available internet connection in Bali for me to check my e-mail!
Materiality. Material Force. Material temptation; sometimes obsession
The Devil is often a great card for business success; hard work and ambition.
Perhaps the most misunderstood of all the major arcana, the Devil is not really "Satan" at all, but Pan the half-goat nature god and/or Dionysius. These are gods of pleasure and abandon, of wild behavior and unbridled desires. This is a card about ambitions; it is also synonymous with temptation and addiction. On the flip side, however, the card can be a warning to someone who is too restrained, someone who never allows themselves to get passionate or messy or wild - or ambitious. This, too, is a form of enslavement. As a person, the Devil can stand for a man of money or erotic power, aggressive, controlling, or just persuasive. This is not to say a bad man, but certainly a powerful man who is hard to resist. The important thing is to remember that any chain is freely worn. In most cases, you are enslaved only because you allow it.
I know one person who would be really interested in this questionnaire - my sister Emme!
Click here to find out
Beginning early this year, KKM has launched an all out war against dengue, seeing the rise of dengue cases all over the country. In BM, it's called Perang Habis-habisan Menentang Denggi, and through the 10-Minutes Campaign, we are asked to promote self-inspection at home and work-place once a week for aedes mosquito breeding places.
Awareness on dengue fever and its transmission is rather good (knowledge-wise) but practices of seek-and-destroy breeding grounds is still low. Last year for the whole state there were only 2 dengue deaths, and the horrifying thing about it is that boh occured in Beluran. I guess it's about time to buck up our effort and do something about this situation.
Beluran Health Office has officially started this campaign today, with the District Office as our launch site.
Today, most work is still done on my Pavilion and my blog is getting listed for ancient heritage. Dang.
Okay, to rectify the whole failure, let me fill you people - my dearest blaudiences - with what has been happening for the past week or so.
Last week, as usual, I had a relatively short workweek at Beluran, ending up with me having to have a few meetings in a string so that I am able to cover them all. Last Tuesday was especially hectic because my big Boss - the State Director of Health Department decided to pay Beluran Hospital a visit - a decision he has made a week in advance but somehow the hospital side overseen the importance of telling us of the news. It was only on Monday evening that I was told about it, and there was no way I could reschedule the 2 staffs meetings I planned for that day.
So in trying to squeeze everything into one day, I ended up having 3 official functions on, and luckily the Boss decided not to come to my office for a spot inspection - the first thing on my mind was - shoot, how am I going to hide my very personal drip coffee machine in my office table which was strategically parked just next to the fax and copy machine?
Then on Thursday, 4 vehicles from Beluran Head Office convoyed to Lahad Datu, to visit Klinik Kesihatan Tungku to see and learn their implementation of Father Friendly Workshop, a programme that had a humble beginning when I was still a clinical officer for that clinic.
True to the tradition of KK Tungku even since the time I was there, we were happily welcomed with food, food and more food. To any visitors, KK Tungku hospitality is almost synonymous with constant feeding.
On Saturday I went to fix my vacation date to Bali - and although it took me quite some time to decide on how long I want to be away - weighing the factor that I feel a little hesitation to leave the district and go enjoy myself - I finally put my feet down and decide on 10 days. That should give m ample time to go around the island. Furthermore, if I were to get into a post graduate programme next year, this could very well be my last easy vacation.
The holy weekend was not a free weekend for me, DrN has asked me to join his team as a secretariat for an Introductory Course for new Medical and Health Officers. It was actually a nice weekend, catching up with DrP and his family, and just like any other government sponsored programmes run in a hotel, we had 2 hourly feeding throughout the whole weekend.
Later this week, there's going to be a meeting with the Boss in Tawau. Back to back to the meeting, a course on Outbreak Management (again!) in Johore and since I get to go KL for free, I decided to just connect my Bali trip at one go.
So if my calculation is right, I will be away from KK for about 3 weeks and the next time I come back here would be almost mid May.
This clip is capable of squeezing out some tears, so be warned.
Okay, the mushy sentimentalism and impression on family value aside, the script for this production (by the Singaporean Ministry of Community Development, Youth and Sports) sounds suspiciously familiar - I should know, I watched the movie like a kazimazibazillion times.
Read on, the script of Good Will Hunting (Matt Damon, Ben Affleck, Robin Williams) 1997.
Yeah, I went on a date last week.
How’d it go?
Well, are you going out again?
I don’t know.
Haven’t called her.
Jesus Christ, you are an amateur.
I know what I’m doing. She’s different
from the other girls I met. We have a
really good time. She’s smart,
beautiful, funny. she’s different from
most of the girls I’ve been with.
So Christ, call her up, Romeo.
Why? So I can realize she’s not so
smart. That she’s f..ckin boring? You don’t
get it. This girl is like f..ckin perfect
right now, I don’t want to ruin that.
Maybe you’re perfect right now. Maybe you
don’t want to ruin that.Well, I think that’s
a super philosophy Will, that way you can go
through your entire life without ever having to
really know anybody.
Sean looks directly at Will, who looks away. A beat.
My wife used to fart when she’s nervous. She
had all sorts of idiosyncrasies. You know what?
She used to fart in her sleep. Sorry I shared
that with you, one night it was so loud it woke
the dog up. She woke up and gone like,
"Is that you?" I’d say, "Yeah" I don’t have
the heart to tell her, O, God. (laughs)
My wife’s been dead two years, Will.
And when I think about 0ther, those are
the things I think about most. Little
idiosyncrasies that only I knew about.
Those made her my wife. And she had
the goods on me too. She know all my
little peccadilloes. People call these
things imperfections Will, aww, but
they’re not, that’s the good stuff. It’s
just who we are. And we get to choose who
we’re going to let into out weird
You’re not perfect, sport.
And let me save you the suspense, this
girl you met isn’t either. The question
is, whether or not you’re perfect for
each other. That’s the whole deal. That’s
what intimacy is all about.
You can know everything in the world,
but the only way you’re findin’ that one
out is by giving it a shot.
You certainly won’t get the answer
from an old f..ker like me. And even
if I did know, I wouldn’t tell a piss ant
Why not? You told me every other
f..kin’ thing. You f..ckin talk more than any
shrink I ever seen in my life!
I teach this shit, I didn’t say I knew how to
Did you catch it?
Fortunately a new system has been introduced and for big chunk of my assessment points are contributed by my (active) participation in continuous professional development throughout the year, and this exam is meant only to evaluate my ability to carry out professional tasks such as running a meeting, setting up a cunducive environment for effective discussion, and ability to come to and summarise a conclusion from the meeting. This part is rather new, and most of us came without as much as an idea of what was going to happen. So here I lay down some tips to survive the new Part One of PTK Exam under KKM.
ARTEo's 5 POINTS TO REMEMBER WHEN SITTING FOR PART 1 PTK UMUM FOR UD41 OFFICERS (KKM)
Before anything, it would help to remember that everything is part of a theatrical act, just like the Physical ExaminaAtion during final MBBS - so it helps to take a few moments to yourself, and get in the role.
- First things first. Come with the idea that you don't know each other, even though the chap next to you is your best mate and you're on farting-freely kind of kamchengness with each other. Be the one to suggest that you should introduce yourselves before you start, and be heard doing so.
- Ask questions. This should be easy to do. After reading out the scenario given, develop more questions, ask hypothetical what-ifs, rephrase the question in as many ways you can think of - the point here is to not stop talking - and make sure you're seen talking when the invigilator's around.
- Mind your body language. Fling your arms to be seen, raise your voice a little higher to show conviction, but not too high that the next group is jotting points from your drama. And when the times calls for you to shut a while (usually when other people are talking), you should scratch your chin in deep thoughts (like you're digesting what they're saying) or let out a small giggle here and there (make sure it is done appropriately - to show that you have a sense of humour). Waking around during groupwork can also show you off as an involved leader. Move around, get that bum off the chair!
- Keep some problem solving techniques under your sleeves. Usually the exam scenario will present itself as a problem to be solved - so arm yourself with one of the problem solving techniques such as SWOT analysis, or bubble charting etc. Your discussion will appear more complicated and that itself earns points.
- Give examples. This would help if you read a lot, or watch a lot of Macam Macam Ada on Astro. Quote people: Einstein, Presidents, Ghandi, politicians, musicians, anybody. During my last written paper I quoted Abraham Maslow - just because I researched hijm for an article I wrote in p-a-t-c-h before. See, nothing goes to waste.
Talking about going to the gym, I have been (trying to be faithful in) attending one that does not need a membership fee of RM1600 a year like what I had last year. In fact, I have the liberty to pay per visit. And it's only RM4 a trip to the adonis-land, though the smell could be very unsuggestive of anything adonic at all. The gym I am talking about - Likas Sports Stadium Community Gym. And how I miss the shiny glistening non-rusty, near wholly digital, state-of-the-art muscle building contraptions they have in the gym at Shangri-La Tg Aru Resort.
Now, the gym can be a very intimidating place to be in. Don't even start about how a lardbag like me would feel among the Misters Sabah (champions, runner-ups, and apperentices), those people make me feel like a pig visiting buffalo land. Okay enough about that. Self-consciousness apart, there are few other put-offs that can derail me from my strong-willed intention to keep a discipline on going to the gym and make myself buff. There are some common etiquette regarding the accepted behaviors to be observed in the gym, and here are some that I rate as top five.
ARTEo's TOP 5 GYM ETIQUETTE
- Bring a towel. Or an old t-shirt. It is irritating, not to mention disgusting, to have to wipe off the excrements of the butch that was there before you. It's only good manners to wipe the instruments after every use, especially if you're wearing stringy singlets to show off your hard-earned cleavages. (Plus: cleavages can be a very good thing on women, but on guys - a tad weird)
- Shut up. First - the screamers - those who carry the weight of the world on their shoulders, or the weight of 12 plates on the shoulder press machine. We know you're strong, we can see you hog that machine for the whole night. We need not an audible reminder of the fact that you're still there since one and half hour ago. Secondly, the chatters - some just love to make small talks, and often initiates them when we are in mid-set concentrating on our reps.
- Return apparatus to normal position after use. Or don't leave your towels / bottles / personal belongings hanging around machines after you're done with it. We just don't know if you're done and we don't want to break rule number 2.
- Kids stay out. We appreciate the fact that you're ably feccund and higly reproductive but the gym is not the place to show-off your procreating capabilities. Off-springs in the category of young teenagers, primary school children, toddlers and babies all have their places in the world, but the gym is not one of them. Keep them guarded at the parks, playgrounds or McD PlayCorners.
- Mind your social manners. Often we meet old friends or colleagues at the gym and its only natural to shake-hands. In doing so, take off your damp gym-gloves. And don't decline hand-shake saying you have a dirty glove on when the other chap already extends his hand. That's just plain rude. And smile. We know how painful it gets when you push yourself to the limit, but there's no need to be vivid with facial expression. What a woos!