“Sorry, we can’t allow you in, Sir.”
“I’ll have to ask you a few questions before we can proceed.”
“Would you kindly let me check you? Thanks.”
I served as school prefect throughout all my secondary school years in Sekolah Menengah Kebangsaan Taman S.E.A. (Taman S.E.A. Secondary School). Today in Malaysia, similar to other Commonwealth countries eg: Singapore and India, we still adopt the British education system of electing school prefects1. The word “prefect”, much like its Latin origin praefectus meaning “overseer”, “director”, or “one put in charge”2, indicates that a school prefect is assigned the role of maintaining discipline and order.
During those years spent as a school prefect, there were hours of patrolling under the hot sun in a uniform with blazer; I met countless uncooperative, cunning or even intimidating students, and received no salary.
After completing my secondary and pre-university education, I was accepted into medical school. Five years later, I graduated with an MBBS qualification (Bachelor of Medicine and Bachelor of Surgery), a proud alumni of Monash, one of the top eight universities in Australia.
As a junior doctor, I was posted to be houseman at Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM, better known by its former name of Hospital UKM, or HUKM) 3. During my first posting in Obstetrics and Gynaecology, there was a global outbreak of Covid-19 – an extremely contagious respiratory virus for which we are yet to find a vaccine or cure4. My colleagues who are senior doctors (medical officers and specialists) were sent to be frontliners. As a young houseman, I was among many called to perform screening duty – “Now you can tell your children you were once part of a pandemic control” a healthcare surveyor on site visit once told me.
During my Covid-19 screening shift, I was assigned duties similar to the ones I had during my teen years as school prefect – hours of working under the hot sun in stuffy layers of protective apparel to check temperatures and ask questions; I met uncooperative patients who deemed screening to be inconvenient and petty, but all with a salary – on contract, with risk of infection due to frequent exposure to patients and their relatives.
In order to be good at your job, you have to establish your role and job scope.
The main role of a screening doctor is to ensure the welfare of the people of this nation, and in this time, specifically, to control the transmission of “severe acute respiratory syndrome coronavirus 2”, the culprit that had claimed 37 lives in Malaysia by the time I am writing you this article5. We want to keep safe and healthy as many people as we can. Healthcare staff monitor those at high risk, and ensure that those who are outside this category do their part in restricting the contagion.
Today, as I check temperatures, ask questions and restrict entry at several locations in the hospital, I reminisce the five years I spent as a prefect during school days that prepared me for today’s call of duty. I can count up to four similar values shared between a good prefect and a good Covid-19 screening doctor:
- You know a liar when you meet one
- You put on humility to learn from others
- You know that people don’t care how much you know – until they know how much you care
- You were never perfect in the first place
1. You know a liar when you meet one
“Prefect, I am pretty certain that I did not bring my handphone to school today … oh … oops … okay ….”
Prefect: “We found this pack of cigarettes in the toilet next to your class. Would this happen to be yours?”
Student: “No, why do you think it’s mine?”
Screening Dr: “We noticed you were having some discomfort just now. Would you happen to have had this cough for a long time? Would it happen to be a dry cough, or a cough with phlegm?”
Patient: “Cough? No, no, I don’t have cough!”
When you are in the job long enough, you develop the intuition to detect when a student or patient is hiding something from you, or is making something up.
There are three types of people who tell half-truths and untruths: confabulators, people with factitious disorders, and liars.
Confabulators make up stories because they cannot really remember what happened, as a result of disorder of their memory6. People with factitious disorder act as if they have an illness out of an inner desire for attention and care7. Both categories of patients may sometimes be amusing and/or lovable despite the wrong information given. Doctors may be frustrated from getting a mismatched medical history, but we find these two categories of patients more easy to forgive compared to liars.
Liars, on the other hand, weave intricate tapestries of fabrication. They have set up something in hopes you will fall for it. They do so sometimes in effort of malingering – intentional production of false or exaggerated problems8. Their motivation is self-centeredness. One example during the Covid-19 outbreak are some people who tell the screening staff that they are living with someone who is of high risk for Covid-19 infection, when they in fact, do not9. They sometimes do so hoping to get a free nasal or throat swab that could cost up to RM700 if paid from their own pocket10.
The darting of gaze, the head hung low, the fidget, the adamant defense, the narrowing of eyebrows … watching a person can tell you more than the actual words spoken by the person11.
During my prefect days, people told untruths and half-truths to avoid my attention. Ironically, as a doctor, there are people who tell untruths and half-truths sometimes to divert, and sometimes to attract my attention9. A lying patient makes life difficult for not only the doctor, but also everyone else that the patient is in contact with.
The effectiveness of a Covid-19 screening session weighs heavily on the honesty of the patient. If you have symptoms or have had social contact, but are in denial, you may very well be passing on the virus to your loved ones unconsciously (or consciously).
On the other hand, if you do not have symptoms but pretend to have them and lie about being in contact with a high risk individual, you have become an unnecessary target for medical attention, while the person who has truly developed symptoms and who truly has had contact may have their treatment delayed all because of you.
Always remember – the boy who cried “Wolf!” when there was no danger never received the help he needed when the real threat arrived.
2. You put on humility to learn from others
“You’ve got some gems of qualities there on yourself. Can I learn from you?”
While I was a prefect trainee and probate in Form 1 (13 years old), I learned leadership and effective management mainly by observation and imitation (or refrain of imitation).
I watched everyone around me – my prefect seniors, sports captains, presidents of various clubs and societies, people with rank and position in all the different uniform bodies, even the other leadership board with their own school uniform apart from prefects – the librarians.
I saw a commander instilling no-nonsense discipline in his squad, and how his tenure led them to win a trophy in our school’s marching competition. I saw the tender care and devotion of committee members towards their juniors during and after school hours, and the kindness that paid forward when those juniors became committee members themselves. I also witnessed how the self-interest and favoritism of a leader sowed discord among dismayed followers who had invested trust in someone who eventually let them down.
Covid-19 has caused only one of many outbreaks in history. In the past, there was the yellow fever, SARS, HIV, and the like. Some of these diseases are still prevalent till today, but the impeded course of spread was only possible because of the decisions and actions of great men and women – leaders who fulfilled their responsibilities in controlling the pandemic.
Hangzhou Health QR Codes for tracking Covid-19. The 8 words written at the bottom translate as “Everyone has a responsibility to prevent and control the epidemic” .Picture courtesy of World Economic forum: https://www.weforum.org/agenda/2020/03/coronavirus-covid-19-hangzhou-zhejiang-government-response/?fbclid=IwAR0fB2AaKMn4zO_E16_o8Vza2hSVE0dUCT-sTr1SarF5I7AWCeY1j2FoYAk
If Malaysia’s epidemiologists could take one city’s disease prevention system as a model for our own, they would choose Hangzhou. Hangzhou (杭州), in southeast China, is political and economic powerhouse as capital of the Zhejiang province, 100 miles away from Shanghai and more than 1000 miles away from Wuhan, the epicenter of Covid-19. Apart from a mystical landscape and tranquil aquatic scenery, Hangzhou has brains to match her beauty – this city houses the headquarters of Alibaba, a Chinese multinational company specializing in e-commerce, retail and technology12, 13, 14
While Covid-19 was just beginning to shroud Wuhan, Hangzhou had already raised its weapons in defense to the approaching enemy. Before they even had their first confirmed case, Hangzhou had already established a 24/7 tracking and response system to identify, isolate, monitor and treat positive cases. They named their approach “one map, one QR code, one index”.
In the city of Hangzhou, each of the 10 million people living in it is given a health QR code that comes in three colours – green, yellow and red. People who are marked with Green can go everywhere. Those with Yellow are on a 7-day quarantine. Those with Red are on a 14-day quarantine. The Yellow and Red can be turned Green after the quarantine time. This application of technology is used in most cities in Zhejiang Province.
The efficiency of Hangzhou’s healthcare system is as remarkable as their technology. Government officials in Hangzhou dispatched 204 public health physicians to investigate, perform contact tracing and survey close contacts with an eagle eye. In total, Zhejiang province has sent 1985 healthcare workers to Wuhan in response to disaster, and as of today, none of them is infected. The world’s first double-lung transplant surgery on a Covid-19 patient was performed in nowhere but Hangzhou13.
Here in my beloved home country of Malaysia, I pay much reverence to our Health Director-General – Datuk Dr Noor Hisham Abdullah, who made the daring move of imposing our country’s maiden Movement Control Order in effort to flatten the curve of the Covid-19 infection statistics. The order was originally intended from 18-31 March, but later extended to April 14. 15
Without the wise move of Datuk Dr Noor Hisham’s, along with necessary involvement from our police and military force, Malaysia might well have shown a steep gradient in the graph of newly diagnosed cases, as seen in the grievous case of “Patient 31”. In South Korea, the 31st case of Covid-19 was a woman who, while delaying her testing, traveled to both Daegu and Seoul, visited an Oriental treatment centre, attended two church services, and dined at one buffet with a friend. Korean Center for Disease Control reported that she had 1160 contacts before being tested positive, and is allegedly responsible for at least 60% of all Covid-19 cases in South Korea17.
Daymond John, CEO of hip hop apparel company FUBU, once said, “Life is a hard teacher – she gives you the test first, the lesson later”. China is so effective in disease control and prevention because she learned her fair share of history lessons – from the bubonic plague in the late nineteenth century, to HIV/AIDS in 1990s, to the more recent Severe Acute Respiratory Syndrome (SARS) outbreak in 200318. Would we prefer to take History tuition from others, or would we rather panic on exam day?
3. You know that people don’t care how much you know – until they know how much you care
“You’ve let me listen to your voice, now may I listen to your heart?”
From my prefect and doctor duties, I have not only learned to detect when someone is lying; more than that, I have learned to detect when someone is in need of help.
I practiced taking interest in others’ welfare by simply paying attention to them. When I was in Form 4, I noticed someone from the junior year getting anxious over her declining classroom test results. I approached her and offered to meet her after school in the library to discuss revision techniques and see if I could assist her in any way to improve her grades. More than that, I was concerned if there was something going on at home or in her social circle that was affecting her studies.
During this Movement Restriction Order, I understand why some people get fed up over the enforcement of rules by our healthcare system. Nobody likes to be restrained or subjected to inconvenience – not until they realise there is something important in it for themselves.
Prior to every screening session, I always let patients know that the purpose of the session is to ensure their safety and health, especially if it is a pregnant mother – considering that my posting is in Obstetrics and Gynaecology. “Ini untuk pastikan puan dan baby sihat ya…” (“We are doing this out of concern for both your health and also the health of your baby”). Always let a patient know that the inconvenience they are going through is to serve a greater purpose.
4. You were never perfect in the first place
Sanitizers, gloves and masks have mysteriously vanished from hospitals since the outbreak of Covid-19. Note: This photo was taken for illustration purposes only. The sanitizer used for this photo still remains in hospital till this very day
Since the outbreak of Covid-19, masks and sanitizers have rapidly gone out of stock from hospitals. Visitors and patients alike have conveniently staked claim over the items. In view of this shortage of supplies, my hospital PPUKM has started its own production of hand sanitizers19. We plead for all who access them to leave the bottles where they are found, so that another may benefit from using them.
Why do people take things for themselves … just because they can? Why do people do something when they know it is wrong?
Even during my prefect days, I have learned the gleeful possibility of taking advantage of a situation for one’s own interest – the times we stayed out of class longer allegedly for prefect duty when we didn’t like the lesson in class, the times we used the prefects’ room as our personal hangout suite when we would do better elsewhere …
When someone makes a grave mistake during the Covid-19 outbreak, such as stealing hospital belongings or going outstation with full knowledge of risk of infection before the quarantine was imposed – “Where did you get that thing from?”, “Why on earth did you go overseas for holiday even when you knew Covid-19 was on the rise??!!” – I remember that when I point one finger at others, I point the other four at myself.
When we reprimand the rule and law breaker, we remember that we ourselves have our faults. When we punish and criticize others, we see fit how we would like to be punished and criticized if we were in their shoes.
Wrapping it Up:
The school daze has led way to a stark reality of career in healthcare. As a young woman doctor, I still remember and apply all the lessons I learned as an even younger prefect schoolgirl.
I chuckle a little every time I recall that I was “beautiful in white” as a school prefect in my white prefect uniform. Today, I am “beautiful in white” as a doctor in my white coat. The healthcare surveyor was right – After I have become “beautiful in white” again on a blissful day in the future, I certainly would have many stories to tell my children about my prefect and doctor duties, but until then, there is so much to do now.
So I will continue to monitor temperatures, to restrict movement, to be gentle but firm, knowing that I cannot please everyone. I will continue to look out for persons of concern, to learn from good and bad decisions in the past, and to know that neither my patient nor I are clear of imperfections.
- Papa and Mama – who taught me that every task is an important duty, and that I should work at it with all my heart. Today, I give my best at everything because they taught me this since young.
- My siblings, for support from afar (literally) – Chow Ping, Chow Ern, Chow Yee, Chow Sern
- For support, providing information, advice, insight on Covid-19, and care: PJ, Anonymous, SP, THP and many more
- All my friends and colleagues who became my photographers or individuals in photographs who were willing to have their photos posted on this blog. Thank you to Liyana, Rachel, Jeanne, Isabelle and many more
- You, for flattening the curve by doing your part
- How did Covid-19 get its name? Visit https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it
- What does it mean to “flatten the curve”? Visit https://mobile.abc.net.au/news/2020-03-26/coronavirus-covid19-global-spread-data-explained/12089028?nw=0&pfmredir=sm&fbclid=IwAR2CkNs8jt3HCIab_2xptUhKdac9St-RzI50JQ0_DA90U-Ta1VHjgc_wTKE
- Walker AD. What are the Duties of a School Prefect? [Internet]. Unknown: The Classroom; Unknown [Updated 2018 June 27; cited 2020 March 29]. Available from: https://www.theclassroom.com/duties-school-prefect-6577111.html)
- Dictionary.com [Internet]. Unknown: HarperCollins; 2012. Prefects; [cited 2020 March 29]; [1 screen]. Available from: https://www.dictionary.com/browse/prefect
- Unknown. History of Establishment [Internet]. Kuala Lumpur: Hospital Canselor Tuanku Muhriz UKM; Unknown [Updated 2020 January 17; cited 2020 March 29]. Available from: http://www.hctm.ukm.my/sejarah-penubuhan/
- World Health Organization. Coronavirus [Internet]. Unknown: World Health Organization; 2020 [Updated Unknown; cited 2020 March 29]. Available from: https://www.who.int/health-topics/coronavirus#tab=tab_1
- Worldometer. Malaysia [Internet]. Unknown: Worldometer; Unkown [Updated 2020 March 31; cited 2020 March 31]. Available from: https://www.worldometers.info/coronavirus/country/malaysia/
- Nall R. Confabulation: What You Should Know [Internet]. Unknown: Healthline; 2017 [cited 2020 March 31]. Available from: https://www.healthline.com/health/confabulation#treatment
- Cleveland Clinic. An Overview of Factitious Disorders [Internet]. Ohio: Cleveland Clinic; Unknown [Updated 2017 March 28; cited 2020 March 31]. Available from: https://my.clevelandclinic.org/health/diseases/9832-an-overview-of-factitious-disorders)
- Bienenfeld D. Malingering [Internet]. Unknown: WebMD LLC; Unknown [Updated 2017 August 23; cited 2020 March 31]. Available from: https://emedicine.medscape.com/article/293206-overview)
- Shah A. Chen YW. Uncooperative M’sians Making Life Difficult for Medical Staff [Internet]. Unknown: Star Media Group Limited; 20 March 2020 [cited 2020 March 31]. Available from: https://www.thestar.com.my/news/nation/2020/03/20/uncooperative-m039sians-making-life-difficult-for-medical-staff)
- Unknown. Understanding Screening and Testing Criteria for Covid-19 [Internet]. Unknown: Star Media Group Limited; 2020 March 15 [cited 2020 March 31]. Available from: https://www.thestar.com.my/news/focus/2020/03/15/understanding-screening-and-testing-criteria-for-covid-19
- Jalili C. How to Tell If Someone Is Lying to You, According to Body Language Experts [Internet]. USA: Time USA; 2018 November 30 [Updated 2019 January 25; cited 2020 March 31]. Available from: https://time.com/5443204/signs-lying-body-language-experts/
- Travel China Guide. Hangzhou Travel Guide [Internet]. Unknown: Travel China Guide; Unknown [cited 2020 March 31]. Available from: https://www.travelchinaguide.com/cityguides/hangzhou.htm
- Wu XF, Xu XL, Wang XC. 6 Lessons From China’s Zhejiang Province and Hangzhou On How Countries Can Prevent and Rebound From An Epidemic Like Covid-19 [Internet]. Unknown: World Economic Forum; 2020 March 12 [cited 2020 March 31]. Available from: https://www.weforum.org/agenda/2020/03/coronavirus-covid-19-hangzhou-zhejiang-government-response/?fbclid=IwAR0fB2AaKMn4zO_E16_o8Vza2hSVE0dUCT-sTr1SarF5I7AWCeY1j2FoYAk
- Unknown. Company Overview [Internet]. Unknown: Alibaba Group Holding Limited; 2020 [cited 2020 March 31]. Available from: https://www.alibabagroup.com/en/about/overview
- Kanyakumari D. PM Muhyiddin Extends Movement Control Order In Malaysia Until April 14 [Internet]. Unknown: CNA; 2020 March 25 [cited 2020 March 31]. Available from: https://www.channelnewsasia.com/news/asia/malaysia-extends-movement-control-order-apr-14-muhyiddin-12574298
- Unknown. ‘Frontliners Doing Superb Job’ [Internet]. Unknown: Star Media Group Limited; 2020 March 25 [cited 2020 March 31]. Available from: https://www.thestar.com.my/news/nation/2020/03/25/frontliners-doing-superb-job
- Hernandez M, Scarr S, Sharma M. The Korean Clusters [Internet]. Unknown: Reuters.com; Unkown [Updated 2020 March 20; cited 2020 March 31]. Available from: https://graphics.reuters.com/CHINA-HEALTH-SOUTHKOREA-CLUSTERS/0100B5G33SB/index.html
- Peckham R. Past Pandemics Exposed China’s Weaknesses The Current One Highlights Its Strengths [Internet]. Unknown: Foreign Affairs; 2020 March 27 [cited 2020 March 31]. Available from: https://www.foreignaffairs.com/articles/china/2020-03-27/past-pandemics-exposed-chinas-weaknesses
- Unknown: UKM Makes Its Own Hand Sanitizers [Internet]. Unknown: Star Media Group Limited; 2020 March 24 [cited 2020 March 31]. Available from: https://www.thestar.com.my/news/nation/2020/03/24/ukm-makes-its-own-hand-sanitisers#cxrecs_s