DIARY OF ELECTIVE

27 MAY 2013
A week after our 2nd professional exam the five of us made our way to the Yayasan Orang
Kurang Upaya Kelantan (YOKUK) centre. It took us around 20 minutes to get from Kubang
Kerian to Padang Tembak, merely a few kilometres away, mostly due to the infamous Kota
Bharu traffic. As we arrive at YOKUK, a small yellow building next to a driving school we
were welcomed by the receptionist, a cheery, wheelchair-bounded man. He entertained us as
we wait for the nurse in charge, Nurse Nurul Adila.
Our group had contacted Nurse Adila a few days before; we were given her contact
information by Dr Fahisham who was our group supervisor and one of the minds behind
YOKUK palliative care programme. We had a meeting with Nurse Adila, during which we
discussed YOKUK, palliative care, what we will be doing and the prospect of us becoming
volunteers under YOKUK. She also took time to answer our questions. The meeting lasted
about 2 hours.
We helped the volunteers load rice onto a car which we were told would be distributed to
those under YOKUKs care. We were dismissed soon after and made our way back to our
hostel. We regrouped soon after to discuss and distribute jobs. We decided that it will not be
prudent for all of us to go in one session as it might overwhelm and tire the patients. We
chose to divide into 2 groups, consisting of 3 and 2 members.

28 MAY 2013
We left USM at 9 am sharp after a hasty breakfast. We arrived at YOKUK a short while later.
We were briefed by Nurse Adila on the houses she intended to visit on that day. We were

given their files and were asked to try remember as much detail as possible, this is especially
important as it helos the patient to be comfortable with us. Our jobs were to help carry the
equipment and rice to be distributed, interview and chat with the patients and perform simple
examination.
We set out with Nurse Adila and a driver, who is a volunteer at YOKUK. During the entire
car ride, Nurse Adila talked passionately about palliative care and the need to raise awareness
among both the public and the medical practitioners. No one answered the door at the first
home. The protocol was to call and confirm with the patient first. But as the patient has not
been in touch with YOKUK, Nurse Adila insisted on trying anyway.
We met a bed ridden stroke patient and his daughter who took care of him, in the second
house. We divided tasks between us, one of us took the patients blood pressure and talk to
him while I was told to talk to the caregiver and gave the rice. We talked about the health,
social, financial and emotional condition of the patient and the caregiver and tried our best to
give her an encouraging word. We also interviewed her, and she told us that palliative care
had indeed helped her family.
The third house was on the river bank of Sungai Kelantan it was amazing to imagine that
literally behind the towering skyscrapers that is the modern Kota Bharu there would be a
small, wanting set of house, Kota Bharu is a city of contrast. We met an acute disseminated
encephalomyelitis patient and his brother. A few years ago, he was involved in an accident
and was given vaccination as a precaution; unfortunately he had a reaction to the medication
which left him homebound. Nurse Adilla checked his urine bag and we talked to him about
his life, he confided in us that he wanted to work. Nurse Adila had frantically thought of a
few ideas to help him. He was interested in business and wanted to start his own and Nurse
Adila gave him some pointers. He was very happy to receive palliative care as he often felt

frustrated and lonely, having someone who came to check up on him and who sincerely cared
for his wellbeing brought him great relief.
Next we headed to Kok Lanas where we met with the mother of an infant who had been
diagnosed with testicular cancer. The mother noted that after receiving treatment her child
had shown progress such being more active and talkative. Unfortunately they live far away
from any medical facilities that are equipped to treat her son. We inform her that YOKUK
provides transportation when necessary.
Our last house was in Bachok, near Pantai Irama, unfortunately we could not stop to enjoy
the beach and were merely able to marvel its beauty behind the window of our car. After a
quick lunch and prayer, we headed for our last house. The patient was a young boy suffering
from neuroblastoma. His mother complained of their familys financial restriction and we
gave them 2 bags of rice to help them, even though it was not much.
Lastly, we headed back to YOKUK. Nurse Adila asked us about our experience. It sounds
clich but it was a truly memorable day. If nothing else, we went home understanding a bit
more about empathy.
18 JUNE 2013
I arrived at Pudu Raya bus station at around 5 am. We had decided to meet at Hospis
Malaysia, to understand the finer points of palliative care. I showered and prayed at Masjid
Negara, before hailing a taxi to take me to Cheras. We all met at a nasi lemak stall and had
our breakfast.
Hospis Malaysia was nothing like YOKUK. This is a formal institution specifically meant for
palliative care, with staff members consisting of fulltime doctors, nurses, administrative staff

and numerous volunteers. Of course we were excited, but we were also overwhelmed by awe
at the sight of the building. It was a beautiful building, roughly the size of a small hospital.
We were welcomed by the receptionist who introduced us to Nurse Wong. Nurse Wong
guided us to 2 meeting rooms. Again we were divided, a group of 3 and 2 members. The first
thing we did that morning was called the handover. The handover is where doctors and
nurses discussed their patients. In my room there were 1 doctor, 1 master of medicine student
from Universiti Kebangsaan Malaysia (UKM) and 3 nurses.
This discussion was nothing like any medical discussion I had previously followed. Nothing
only was symptoms, signs and diagnosis discuss but great emphasis is also placed on the
patient and caretakers need. They did not see their patient as a sick person but as a human
being in need of assistance. It was also great honour for us, who were merely students, to be
counselled on our thoughts on certain issues.
We were dismissed an hour and a half later. While waiting we were asked to help with some
clerical and office errands, which we did gladly. Finally, we were of some use. At about 10
am we left Hospis Malaysia to go for home visits. I was asked to contact the patients and set
up a meeting between us and them. The nurse told us her view on palliative care as holistic
treatment and the shortcomings of many medical practitioner who lack empathy for their
patient.
The first patient lived in an old folks home. She was recently diagnosed with cancer and had
since been depressed. Her family members had tried to comfort her and encouraged her to
follow through her treatment with little success. We talked and chatted with her for a while,
after which she calm down a bit. Unfortunately, we were not able to convince her to follow
her treatment; she even refused any medication to relief her symptoms. When we asked her
about any unfinished business, she said that she merely wanted her family to be happy. We

took her details and told her family about palliative care. We also assured them that we will
come again to try to convince her to follow her treatment.
The second patient was an old woman who has breast cancer and is taken care of by her
daughter. She is bedridden and is often tired. We were asked to take her blood pressure;
unfortunately she was alarmed by our presence but was calmed down by the nurse. The
daughter complained that she might be unable to take care of her mother fulltime in the
future, as she has to attend to her business. The nurse assured her that it was fine and gave a
few advices that might be useful for her situation, such as asking family members to take part
in taking care of the patient. The nurse also informed the daughter that Hospis Malaysia is
able to lend her a hospital bed for free if necessary. She agreed and the nurse helped make the
necessary arrangements.
The next house belonged to a blind couple who lives with their children. We only did a few
medical examinations and asked them about their lives. As there were no issue we did not
stay long but the couple was grateful to have been visited.
The last house we visited was in Pandan. The patient, an ex-intravenous drug user have been
diagnosed with lung cancer. He had been unable to work despite have small children to feed.
We did a few medical examinations, check up on his medications and listen to his worries.
The nurse gave him a few advices and name of organization that may be able to help him.
The nurse drop us of at an LRT station in Pandan, where we made our way to our friends
home, where we would spend the night. We returned with renewed ambition to serve and
strive.