An effective gloving or not

When I was in medical school, a microbiologist pointed out that the dirtiest part of a public toilet would be the door knob or door handle with the reason that the cleaner would clean commode and toilet floor in a particular time interval. But nobody would not bother to clean door knob that all toilet users need to touch it after their business. He claimed that million of germs could transmit from that source.

Based on above knowledge, I may be obsessed, I sometime see currency notes, which may have passed in the hands of hundreds of people before it comes to my pocket, as a kind of toilet door knob from the health point of view. I really don't know if there are harmful germs on £5 and £10 notes. But I believe that food handlers should not touch currency note while foods are being prepared.

I like Subway sandwich for many reasons. It is fresh. I can choose the type of bread and ingredients. I can order to toast it or not. I can select the salads and sauces (Mustard is my fav). It is also a good practice that food handlers are instructed to put gloves on while working.

Unfortunately, I came across a shop somewhere in Britain, which has been in sub-standard, in terms of hygiene although sale persons were on gloves.

When I got there, there were two sale persons in that Subway shop. I ordered BMT with Hearty Italian bread. The first person's job was cutting the bread and putting the meats inside, before toasting with cheese. After that, the second person put salads, which were cucumber, pepper, onion, iceberg as I chose, finishing by spreading with sauce. Then, it was packed. What was next!

The next step was that the sale assistant took the money with his semi-wet gloved hand, operating the machine and returning the change. When I got out of the shop, he had been dealing with next customers, repeating the same steps.

Any comment welcome.

If someone wants to know the actual place of this branch, I would be happy to tell for the sake of Subway customers. Just drop a comment.

Spreading sauce


finishing sandwich making


Holding the machine with food preparing hands, concentrating on digits


I was taking the change

Continuing medical education

A couple of years ago, my relative from Burma was visiting Britain, staying at home for a month. He noticed I was reading medical books and journals as my hobby or my task or whatever it was described.

"Work hard, Steve. Study harder to get a higher level"

His expression made me surprised. I was not preparing for any exam. I was doing a routine thing as a doctor. But in his eyes, I had to keep reading books because I still needed to learn a lot. He treated me as a student, patronising me a lot. I did not explain too much why I had to read books while working at hospital in Britain. I felt it was not worth doing so. He was just a visitor going back to Burma in a few weeks.

Basically, it is compulsory in Britain that all levels of doctors, from first year medics to consultants and professors, to do "continuing medical education" while practising. We need to keep updated with recent developments and advances in medicine while refreshing existing knowledge and skills. That is part of the duty of a good doctor. We are entitled with study days and leaves for that purpose. We need to attend education meetings and conferences .

I am wondering how a consultant physician from Burma seeing patients till late evening after working from 8Am to 4PM at hospital, would have a chance to update his or her knowledge. At the same time, I believe if patients and their families in Burma found out that their doctor keeps reading medical books, they would not trust him/her any more with the thought that our doctor had not got enough knowledge yet , but still studying. They might move to new doctors.

I still remember my early career when I ran a private clinic in Insein, northern part of former capital city, Yangon. I treated minor illness with pills and I did not request too much laboratory tests. There was a specialist clinic nearby. At that point, a funny thing was going on. The local people had been spreading words, saying that the specialist doctor from that clinic had no idea how to treat without blood tests and claiming that that young doctor, it was me, was much better. Every evening, there had been a long queue in my clinic.

Next, it is disappointing that there is a poor referral system in Burma. The doctors want to keep their patients with them for some reason, regardless of the conditions. My aunt has a sleeping difficulty and anxiety , and a cardiologist has been treating her with sleeping pill for many years, instead of referring to a psychiatrist or counselling service. Again, from the patient point of view, if they are advised to see other doctor for a different problem , they may think the referring doctor is not efficient. I heard several similar stories before. So we can't blame doctors' way of practice in Burma. But I believe general people would need to be educated. At the same time, the authorities concerned need to make sure the referral system in Burma running smoothly and effectively for the sake of our patients. Reinforcement may be required.



Friday afternoon Library at the hospital I am working


Evidence based Medicine corner


Reading a medical journal

Bournemouth and Brownsea Island

Previously, we intended to go to Isle of Wight in this weekend. But the plan was changed and today we headed towards Bournemouth which is a nearer place. Late summer saw the crowd of locals and visitors walking in the shopping centre and sea front of Dorset’s coastal resort town. As I expected, its town centre was not too much different from the counterparts of other English towns. There were usual shops and stores. I popped in to Borders book shop to buy Jamie Oliver’s Italian cook book as my colleague recommended. The interesting thing was that there were only pop, rock and some classic CDs on the music shelves. No R&B and Rap songs for some reason. Perhaps, it needs some more time to get updated to a world class cosmopolitan place.

It was within a walking distance from town to the sea front. After passing through a park, where there was a huge balloon, raising visitors 500 feet into the air to view the English Channel and Dorset countryside, we saw a rather small pier. Cloudy sky was not a perfect weather for beach lovers. But there were a few people swimming. Some were enjoying with surfing boards.





Brownsea island is the largest of the islands in Poole harbour with 500 acres. With £10.50 per head boat tickets, we had an opportunity to lean Bournemouth’s long sand beach and cliffs on our way to the island. Other boats and yachts were also around with different directions.



Now the island is under the control of the National Trust although it was private island in the past . It is naturally beautiful.



View Larger Map

The National Trust website said:

Peaceful island of woodland, wetland and heath with a rich diversity of wildlife

• Fine walks and spectacular views of Poole Harbour
• Home to the endangered red squirrel
• Famous for being the birthplace for Scouting and Guiding
• A haven for wildlife, including Sika deer and wading birds
• Trails and Tracker Packs for young smugglers and explorers
• Escape the noise and stress of modern life and discover nature in this unspoilt setting

I believe it is worth visiting there at last one time.

If you want to see the full set of photos, click here

Thank you