15 Sep to 20 Oct 2002
Dr Lim Yeow Wai
I had the privilege of representing Singapore in the 20th Asean Orthopaedic Association Junior Travelling Fellowship programme last year. For 5 weeks, I travelled to Malaysia, Thailand, the Philippines, Indonesia and finally ending up at the AOA meeting in Singapore.
Every year, each of these Asean countries will select a representative to participate in this programme. The fact that it has been running for 20 years is a testimony of its immense success and popularity.
The first day of the trip was however an anticlimax. I arrived in the hotel at Kuala Lumpur only to find that there was no room reservation under my name. Of course it did not help being a Sunday where the tour agency arranging the reservation located in KL was closed. After making several calls and convincing the hotel staff to allow me to look through the reservation records, I managed to get a room. Coincidentally, that week was also where the taxi drivers of KL went on strike; so travelling around became restricted to pre-arranged transport. Nonetheless, meeting my fellow companions that night more than make up for the inconveniences encountered on the first day. They were a very interesting and diverse group of orthopaedic surgeons.
There was Dr Alvin Amador, who is an orthopaedic surgeon in private practice from the Philippines. He just completed his orthopaedic residency in the Philippines Orthopaedic Centre as the 2nd top graduate. As an incentive he was awarded this fellowship from POA. Alvin is 31 years old and is an expectant father. He is remarkably enterprising so much so that I suspect orthopaedic surgery may just be his pastime. He has three other thriving businesses under his belt, which fetches more income for him than his practice.
Dr Bambang Kisworo is also another orthopaedic surgeon in private practice from Surabaya, Indonesia. He too was the top graduate from his cohort of orthopaedic trainees. Interestingly he trained under a new programme in Indonesia whereby you have to pay the hospital to be in the orthopaedic residency programme. The advantage is that you can leave for private practice immediately after graduating. He is 36 years old and had only been married for a few months before embarking on this fellowship. He too has a general practitioner partnership outside his orthopaedic practice.
Then there is Dr Wan Faisham Nu’man bin Wan Ismail an associated consultant from University Science of Malaysia in Kota Bahru. He has been a practicing orthopaedic surgeon for about 2 years and has a keen interest in orthopaedic oncology. Faisham is a very diligent surgeon and according to his contemporaries in University Sains Malaysia, a thoroughbred workaholic. He is 33 years old and is married with 3 lovely kids.
Finally the "godfather" of the group was Mr. Montien Sirisuntornlak. Montein is 39 years old and has been a practicing orthopaedic surgeon for more than 9 years. He works in a lovely town called Cholburi. (in case you are wondering where this is … it is next to Pattaya). He practices both in the public hospital as well as in private. A system very much like ours here. However unlike most orthopaedic surgeon he has both a private general practitioner clinic and a private orthopaedic clinic in Cholburi. He even has his own Xray machine and physiotherapist working for him.
On the same night we arrived, the Malaysian Orthopaedic Association welcomed us at Angkasar Restaurant located on top of the KL tower. Prof S Sengupta, A/Prof Jamal Azmi and others from the executive committee hosted the dinner. The ensuing days were however less relaxing. Adorning our well-pressed shirt, pants, tie and cameras we started on our tour of duty. The first day saw us through University of Malaya and University Kabamsan. University Kabamsan is a spanking new hospital (only 5 years old) boasting 900 beds with the full complements of sub-specialty as well as instructing some 280 medical undergraduates each year. From the spanking new we proceeded to visit the first general hospital built in KL. Hospital Kuala Lumpur is an extensive low-rise hospital with 2400 beds of which 280 are devoted to orthopaedic surgery. The hospital is so huge that it has to provide doctors with bicycles in order for them to get around. But the most impressive must be the famous paperless hospital called Seleryang Hospital. This 540 million ringgit ultramodern hospital boasts 960 beds with 52 of them meant for orthopaedic. There are about 5 laptops mounted on a trolley in each ward and everything from morning rounds to prescription is all done through them. I was however a bit disappointed when I visited the toilet only to find that toilet paper was still being used.
We flew to Kota Bahru later that week to visit the hospital Faisham is working - University Sains Malaysia. (Sains means Science). Kota Bahru belongs to the state of Kelantan, which of course is run by the opposition party. In the airport this fact was subliminally instilled in us, as we had to walk through rows and rows of empty gateway before reaching the one that flys to Kelantan. We were told it is to allow the Kelantanians a chance to reflect before the next election.
Prof Zulmi Wan and the staff from Hospital Kota Bahru and USM greeted us with a bountiful seafood dinner by the river on the same night. Kota Bahru was a stark contrast from KL. It is comprised mainly of low-rise buildings with the tallest being a 20-storey commercial building in the city center. Although a small town, it boasts to have the largest hospital in the East Coast of the Peninsula and the only hospital in the East Coast accredited with ISO 9002.
The next day we went on long road trip, seven hours to be exact from Kota Bahru to Kuantan. There we participated in the morning conference and shared our country experiences in managing common orthopaedic fractures.
On 22 Sep we arrived in Thailand. The warm hospitality of the Thai was immediately apparent. The entire executive committee hosted a dinner to welcome our arrival on the same night and this was followed by sumptuous dinner every night by the respective hospital that we visited. We visited the Ramathibodi Hospital that was affiliated to the Mahidol University. (Their hospitals are often named after their kings). Over there A/Prof Pornchai Mulpruek greeted us. This is a 30 years old hospital with 1000 beds. Although a relatively small hospital it sees about 60,000 outpatients a year with 6000 day surgery cases and 2500 major operations a year. We had a tour of the Bhumipoh Hospital by the head of department Dr Amnuoy. This hospital is a reputable hand / microsurgery and trauma center for the nation. The other major hospitals we visited included Siriraj, Vajira and Cholburi Hospital.
We stayed in Sasa International House during our stay in Bangkok. This is within the premises of Chulalongkorn University. (Named after King Chulalongkorn that Chow Yuan Fatt portrayed in the Anna and the King). Interestingly we were told that the building is haunted. Apparently a gynecologist killed his wife several years ago and hid her body somewhere in the building. Till today the body has not been found. Unfortunately we did not stumble on the body.
We arrived in the Philippines on 29 Sep. The strong American presence was apparent immediately upon getting into the car. The vehicles in the Philippines unlike other Asian countries are right hand drive. There is also strong security presence in the airport and malls. I was told that most Filipinos have some form of firearms at home. We visited both public and private hospitals including Makati medical center where Dr Gustilo practices. The center director Dr Antonio Riveria showed us around and chaired a conference showcasing some interesting cases. Philippines Orthopaedic Centre where Alvin graduated from is an entire hospital devoted to ortho. Dr Jesus Duenos, head of the department informed us that they have 6 operating rooms devoted to orthopaedic everyday and with 700 beds it is clearly one of the largest orthopaedic centers in South East Asia. Besides hospitals, we also visited the oldest university in South East Asia, University of Santos Tomas that was established in 1611. On the fourth week, we arrived in Surabaya. We visited Dr Soetomo Hospital (In Indonesia most of the hospital are named after army generals) and Arilanga University. We were welcomed by Dr. Djoko Roeshadi and Prof. Bambang Prijombodo who showed us an interesting study on the use of Kuntscher nail as semi rigid segmental Spine Instrumentation. The University was actually started by the Dutch some 90 years ago and it is now one of only four medical faculties in Indonesia. That could explain also why the orthopaedic surgeons to patients ratio is only 1 to 700,000. We when on to visit Malang and Bali. There is a general hospital in Bali called Hospital Sanglah where there are four orthopaedic consultants. Dr Iketut Siki Kawiyana heads the service. We were quite fortunate to have changed our original schedule of visiting Bali on 12 Sep to 9 Sep, as the Bali tragedy that killed 180 people happened on the original day. In fact during our trip we were jesting about possible terrorist attack in the island. Well it was a startling reminder to all about how vulnerable we can be.
On the final week we arrived in Singapore for the Combined Meeting. Each of us presented our paper during the meeting. My freinds were particularly delighted with Sentosa and the Night Safari. Bambang and Montien loved our local laksa, Alvin liked the chilli crab and Faisham cannot have enough of the crispy prata. They were also amazed by the freely available use of implants, plates and nails in Singapore. These are often too expensive in their country even the locally made implants.
This trip was rewarding for me in many ways. Not only did it allowed me to observe the practice of orthopaedic surgery in our neighbouring countries but more importantly also in establishing the friendship and camaraderie between our countries. Once again I would like to thank the Asean Orthopaedic Association and the Singapore Orthopaedic Association for giving me this opportunity to be part of the Orthopaedic fraternity in ASEAN.