2009 and me

Basically, I do like evidence based practice which is a very scientific approach to solve the problems. . At the same time I am rather superstitious on numbers, days and some words. It happened after I experienced the same thing repeatedly. For example, I am likely to deal with death body at around 1PM at work in many occasions. Number one alone was not very good to me. But numbers such as 11, 29, 38, 47 were my lucky ones,. For instance, I was granted a settlement in Britain on the 11th of a month. Number 29 and 38 were good ones in my life as well.

When year 2009 was approached, I expected too much that it would be my golden year. In reality, the reverse is true.

During the first quarter of the year, I was so tired and very difficult to cope with enormous work loads due to an unexpected shortage of man power at work. I had to work at least extra 2 hours everyday for nothing. In the second quarter, it was getting worse. There was something went wrong in communication between human resource department and the deanery. It was learnt that my name disappeared from the list. The deanery had already employed someone for my place. It was a pain. I had to sort out that issue. I was nearly jobless. In the third quarter of this unlucky year, my family issue made me a misery. I encountered unnecessary expenses.

It can be said that the worst quarter is the last quarter. My BMW’s rear tyre blown out while driving at 70 mph (which is legal limit) on a notorious high way. I had my car serviced 2 months earlier. Car was swinging at first. After that, it spun off the road. Fortunately, nobody hurt. But the whole right side of car body was damaged. Now it has been written off and the insurance company sent me a cheque. Anyway, I am still alive.

This is my experience in 2009.

Awards Ceremony and Education in Britain

Ceremony starting

A few weeks ago, my sister attended the graduation ceremony of the university of East London held at the Barbican Centre for her BSC (Honour) in IT. In fact , it was a sort of celebration of the achievement of university students after 3 years of extensive reading, doing research works in given time frame, writing academic essays with thousands of words and attending seminars. I was proud of her. But that school event was little or nothing exciting to me as she is the 4th person among our relatives who took the UK degree. Yes, of course, I brought my camera and took some random photos.


queueing for a hand shake with chancellor. The degree certificate had been sent off by post in advance.

The following is some information about attending the university I was told.

Enrolment:

For International student : To join the UEL, student must achieve IELTS score 6.0 for undergraduate degree and 6.5 for post graduate. In some cases, they may accept score 5.5 or 5.0 for some subjects, such as history or geography. The university gives more chance to international students than home students in entry as it can earn oversea fees, which is around £7500 to £10000 per annum for foreign students while home rate is about £2000-3000.

For Home student: Entering university as home student could be challenging. The students aged under 25 must follow their UCAS (University college administration service) system. They have to apply 4 to 5 universities after finishing A level. Some Uni reject and some give offer to them, depending on the situation.

Those aged over 25 do not need A level and do not need to apply in UCAS. They can apply directly to universities but they have to take aptitude test in English, mathematics and language interview.

Modules:

As a student, 6 modules have to be taken in every single year. BSc (honour) degree is a 3 years course. So it needs to clear 18 modules to achieve the degree, including the dissertation paper which must be done in the final year. The dissertation is essential to complete the degree, which includes research proposal for 3000 words and dissertation itself for 12000 words in the final year.

Semesters:

There are 2 semesters in a year. 3 modules have to be completed in one semester. Every module has at least 2 course works, some have 3, including exam. One semester lasts 4 months, during which the student has to submit 6 to 9 course works with or without exam. That means not much leisure time, contrary to uni life in Yangon.

Marking system:

First year’s marks doesn’t count for final grading while the scores of 12 modules of The 2nd year and final year are important.

• The average marks over 75 is first class honour,
• over 65 is upper second class honour,
• over 55 is lower second class honour,
• over 45 is third class honour grade and
• 40 is just pass mark with no honour but an ordinary degree.

Achieving the first class honour means that he or she can do the Ph.D. directly, without having MSC or MA and it is also easy to secure a job, but it is rare. The commonest one is second class honour among the UK students, according to the research.

Any question about study in the UK, welcome!

A bad habbit

When I was in Burma, I overheard my mother advised a young woman, who was nurse, how to save money from food. I was only 12. But it was still a clear memory. My mother said "if you saved some money each time when you go shopping, you could have an emergency money when you need it for something in the future"

To be honest, I never appreciate that statement. But when I got to the UK, I a bit changed. Every time when I went to Tesco each week, I had to purchase at least £50 for my 7-10 days food quota. What I got back was a receipt and 5p off voucher (5P off for each litre of petrol).

Which came to my mind was that if I had to pay Tesco, I did need to pay myself something. That idea was a bit crazy and logically it was not right. In fact, foods I bought from Tesco was for myself. But anyway, whenever I went to Tesco, I put £10 or 20 notes beneath my mattress in last few years, trying to convince myself I earned from shopping.

The following pictures were the end result. I decided not to do like that any more in the future. It is not worth doing so. Mathematically, the figures of my money won't change. At the same time, we must not keep money at home for the security purpose. Banks are around.




Between mattress and base of the bed.


Interestingly, most were £20 notes


Counted before banking

Emergency contraception

I am not a GP, but yesterday someone from Singapore rang me, asking for an advice. It was about emergency contraception. Of course, it is well known as "morning after pill". In fact, this term is misleading. The pill works for up to 72 hours (three days) after unprotected sex. But it is advised that the earlier you take it, the better as it works best if taken within 12 hours of sex.

In Britain, it is the pill that people can buy from chemists without needing prescription. But the pharmacist will do a quick chat before issuing it, making sure everything is OK. According to the data, if the pill is taken within 24 hours after unprotected sex, about 95 in 100 pregnancies are prevented.

Of course, all drugs have side effects. Some people experience feeling sick after taking it. But the majority has no problem at all. At this point, I'd like to talk about something. Some people from far east thought that conventional western drugs have loads of side effects while herbal preparations have no or little side effects. That is absolutely wrong, I think . In fact, many of conventional drugs come from the purified extracts of herbal preparations. Lack of extensive scientific research dose not necessarily mean that herbal drug from some parts of world, such as Burma and Thailand, has no unwanted effect.

Obviously, morning after pill is not ideal for a long term plan and own doctor or GP is the best person to discuss about other options. At the same time, people should bear in mind that unprotected sex is one of the main mode of transmissions of viral illnesses, such as HIV, hepatitis B and C.

For the further information of emergency medication, please visit the following sites.

www.patient.co.uk

www.netdoctor.co.uk

Here is a related news you may be interested in

A pilot scheme allowing pharmacists to give women the contraceptive pill without a prescription has been given the go-ahead for next year.

Women and girls aged over 16 will be able to get the pill at two London primary care trusts, Southwark and Lewisham, Pulse magazine says.

If the pilots are successful, the pill could become available over the counter like the morning after pill. Full article on BBC

Update (22/11/2009)

This article is what I came across on The times weekend.

A The morning-after pill is effective only up to 72 hours after intercourse but the level of protection declines dramatically during that time. In the first 24 hours it prevents 95 per cent of pregnancies, but that figure drops to 85 per cent within the next 24 hours and only 58 per cent if taken after that......

Ann Furedi, of the British Pregnancy Advisory Service (BPAS), says that “for women who are not in a relationship, the morning-after pill is even safer than the contraceptive pill because it is only an occasional dose of hormones, although obviously it doesn’t protect against STIs”. The BPAS states that “there is no limit” to how many times you can use it.....

More....at The times Online

A reflection on staying online

More than half of office workers use sites like Twitter and Facebook for personal use during the working day, and admit wasting an average of 40 minutes a week each.

One in three of the 1,460 office workers surveyed also said they had seen sensitive company information posted on social networking sites, leading to fears about how workers use the internet.

Philip Wicks, consultant at Morse, the IT services and technology company who commissioned the survey, said the true cost to the economy could be substantially higher than the £1.38bn estimate.(Telegraph)

Above news article made me to think about my internet usage.

Discussion about advantages and disadvantages of the use of Internet is a sort of boring topic, commonly found in the study of foreign language schools. But I have to say that the emergence of social networks enables people to extend their contact list, discussing an issue in a wider scale and conducting a campaign for and against something up to a global level, at the expense of their private time, which can be used more effectively in other ways, in order to upgrade the working position and family welfare.

Probably, most individuals have their intended life time achievement. Obviously, I never think about myself to become a famous blogger or a great twitter user with a thousand of followers. If not, why have I been spending a colossal amount of time in front of computer, by clicking facebook and twitter links? At this point, my reflective practice came into an action to judge my next step. The verdict is that I need to change sooner rather than later.

Reflective practice is a continuous process and involves the learner considering critical incidents in his or her life's experiences. It is also associated with learning from experience(Wiki)

A few months ago, I had to struggle tremendously to complete my tasks at work. It happened after wasting my time on-line uselessly. Learning from experience means less time on-line, planning to do mandatory jobs in a fixed time frame.

I like this quotation.

“Change will never happen when people lack the ability and courage to see themselves for who they are.” (Bryant H. McGill )

My opinion is that people should need to upgrade their social environment and working situation from time to time whenever possible as part of the quality of life improvement process. It is not the right way to stay in one community life long. I came across some people from far east who were confined in the group of same people, even after residing in Britain for years or decades. I am wondering what would be their point of living in Britain. It is very reasonable that the government introduced the Knowledge of life in the UK exam for settlement status applicants, encouraging them to learn briefly what the Britishness is.

We are social-beings. There are some people who enormously enjoy the virtual world for many reasons, one of which it would be a result of withdrawal from the community after not achieving any positive communication. That model is common among immigrants. For a temporary basis, involving with on-line community seems an effective for a loneliness. But what would be the long term effect? How much have I lost because of Facebook, Twitter and cbox?

Camera buying skill

The whole yesterday morning, I did on-line research on current digital SLRs, thinking to buy one. I also bought a couple of photo magazines to get some idea. I know many amateur photographers are crazy to buy Nikon D90 for some reason, even though it is one of the entry level cameras. It would be a copycat phenomenon among a group of people. To be honest, I am not the one who is keen to try a relatively expensive development, at the expense of my monthly investment.

I found out that Nikon D-3000 has acceptable specifications with a reasonable price to me. So I decided to get that one, which was introduced in July 2009 in Britain. I drove to the town centre. When I got to Jessops, I changed my mind to take Sony alfa 230 instead. Sony is rather new in digital camera world, I think. My friends normally prefer Nikon and Cannon. But I think Sony is attractive, extremely compact with a light weight. Moreover, the quality of image of Sony camera is excellent, according to several independent reviews. Next thing is that it is cheap. So I took it. I did also purchase 70-300mm zoom lens. It was nice to take test photos instantly at beach once I came out of the shop.

But I found out that there was no "live view" mode. The LCD screen was only for setting and viewing the photos taken. I must admit that I have a poor knowledge in Digital SLR camera although I used Nikon and Cannon SLRs since I was 18. I wrongly assumed that all dSLR had got a live view as its compact counterparts. In fact, my friend Vista mentioned about "live view" yesterday morning that Nikon 3000 had no such mode, but in Nikon 5000. I neglected her statement which was my mistake. The whole evening, I tried to take photos using view finder, leaving me with some eye ache.

This morning, I went back to Jessops and I did exchange with Sony A330. Now I am happy with new camera. It has got quick AF live view. That means that A330 can provide rapid camera performance without any delay for capture. Hopefully, photos will be available on my picasa web album shortly.



Updated 26.10.09

Please click : Some sample photos I took today

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

Holiday in Barcelona

Holiday means gong somewhere. I chose Barcelona. This Spanish city with UNESCO world heritage sites is decorated with a combination of ancient buildings and modern architecture. I stayed in the Front Air Congress Hotel which is 4 star with gym and spa. I must say £55 a night is relatively cheap, compared with the same grade hotels in England. The only drawback was that it was not in the down town. I had to take the bus 72 route from hotel to the centre of Barcelona. It was only Euro 1.35 per ride( one journey £2 in London). Saving money, I bought 2 days travel card, enabling me to take bus and metro as many as I wanted. Their underground network is rather smaller than London counterpart. Basically, no need to worry to lose the way for someone who has been familiar with London transport system.

During my stay, I made new friends. I met a couple from Toronto in hotel restaurant. Both of them were well over 60. They were in Paris before Barcelona. We chatted and later we enjoyed the dinner together. Spanish fine red wine boosted our conversation. Next morning, a young girl called Yumi from Japan asked me something in the hotel lounge. She was on her own. She visited her friends in Oxford for 7 days before coming to Spain. She was a sale assistant from Nagoya. We took sight seeing bus together. She was quite friendly. The only issue was her English with many pauses and stops. But it did not matter for that evening when we enjoyed Spanish foods and then went to spa.

You can see some photos I took.



the view from Montjuïc ( 'Hill of the Jews')


Cruises. Barcelona has a major port in Europe


A women statue who I don't know.


Columbus monument


Date trees


Casa Mila' or La Pedrera (built between 1906-1912)

More photos, click here


+++++++++++++++++++++++++++++++++

The most annoying things

The most annoying things

I came across an article on the telegraph. “The most 100 annoying things in Britain: Poll.”

The followings are top 3 out of 100.
1. Chavs
2. People driving close behind you
3. People who smell

Full list at Telegraph

I totally agree that chav is in number one position.

Chav (pronounced /ˈtʃæv/ Charver or Scally (In northern England), CHAV) is a derogatory term applied to certain young people in the United Kingdom. The stereotypical "chav" is an aggressive teenager or young adult who often engages in anti-social behaviour, such as street drinking, drug abuse and rowdy behaviour. They are often assumed to be unemployed or in a low paid job, although it is incorrect to assume that all chavs are working class, as chavs belong to no distinct social class. Chavs typically wear tracksuits and hoodies made by sporting brands such as Nike and Adidas and listen to mainly MC and some have been known to listen to Rap, R'n'B, Hip Hop and Techno. (Source: wiki)

(This is for someone who is not familiar with the meaning of chav.)



An example appearance of chavs (source: telegraph.co.uk)

Basically, once I see a group of teenagers with above appearance on my way, I would walk on the other side of the street. That is what my experience taught me. It was near the royal infirmary in west Yorkshire where I lived. A group of teenagers asked for a cigarette. I said I did not smoke. They shouted “F....... Chinese”. What a coincident. Next day, a girl from that group was visiting on the ward to see her sick grandmother who was under my care. She disappeared in a minute once she found out who I was.

Another time, a group of teenagers threw at my car with stone at near Prince Regent Station in east London while driving at about 8PM. I pulled over. They ran away. I rang 999. Police patrol arrived in 2 minutes (Police must be very aware of the situation in that area). Police man checked my car if any damage. Nothing found. They did not take any action. I think teenagers’ behaviour depends on the many factors, such as social class, parental guidance, environment they grow and many more. In fact it is a wide social science topic, I believe.

“People driving close behind you” and “People who smell” ranked number 2 and 3 respectively in above public poll.

To be honest, I do not bother tailgaters too much. Once I have a chance, I let high speeders to take over.

Am I annoyed with smelly people? Absolutely not. Of course. It is my job seeing sick people who have various smells. In fact, some particular smells help establishing a diagnosis in certain conditions.

This is my list of annoyance.

1 Chavs (as above)

2. Noisy self-closing fire door. Because of poor manufacturers or brainless builders, in most NHS buildings I lived previously, the doors shut with a bang, making walls vibrating. Unable to sleep at day time during night on-calls, risking care of patient.

The old closers with above appearance still being used in many places are really bad. The Geze brand fixed in doctor's room at work is the worst one. It shuts the door slowly until about 4 inches away to close completely. After that, it bangs the door, making a loud noice and vibrating walls. No easy way to adjust the door to close gently. (Photo credit to : http://www.locksearch.com )

3. Windows Operating system. I have no choice. But it needs update all the time. In the middle of an important task, it has been asking to restart. Loading and shutting time are ridiculously long. I frequently need to switch the power off.

4. USB memory stick. Very useful. But every time, I need to be careful to put in a right way after one USB socket has already torn.

5. Patriotism/Nationalism

6. Road work. Now it is road work season, I believe. Everywhere, road works. In most sites, workers start their jobs in morning rash hours and finish after evening peak time.

7. Accidents and motor break-downs during rash hours. I sympathise the innocent victims. But I think it is a sort of lengthy investigation in each incident. I feel police and emergency services should have a better tools and system to get job done quickly.

8. People who asked me “Where did you originally come from?” I believe I have to answer that question as long as I am alive and living in Britain, regardless of my nationality.

9. Gordon Brown. Until a few months before this economic slow-down, I remember that he kept saying British economy was still going strong while manufacturing industry has been shrinking year after year with many factories and firms moving out to eastern Europe and China. Of course, Britain mainly depends on service sector. Until when? Who knows?

10. Putting feet on the table. Unfortunately, I start having this practice.

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