Saturday, November 21, 2015

Antibiotic Apocalypse: Rebooting the Earth System

I would eagerly like to talk about how nice my trip with my family to the beach today, or talk about how wonderful my morning waking up on a sandy beach with the sound of the wave from the ocean. No, I have to highlight this topic because it seem that we are going to face it real soon.

Antibiotic apocalypse, is what they called it. Since this week was the antibiotic awareness week through out many region in this world, I sense a little bit of responsibility to inform everyone about the 'doomsday' that will start very soon.

As a medical officer myself, having my fair share of experience working in district posting, I have to admit that once in a while we did prescribe antibiotic to those who does not need it.  We were thought in medical school about the usage of antibiotic, about the harm it will cause if you freely prescribe it to anyone, yet we did the same mistake once in a while. Once in a while is dangerous no matter how innocent that statement was. Yes, some patient did. While in the ward, don't lie to me, even a consultant would start a high end antibiotic to a patient, always giving a statement "we should hit them hard" referring them to the bacteria that cause the infection.

Now, what we did, came back to us. We are running out of antibiotics.

Prescribing to those who does not need it.

Using the antibiotic for a very long time.

Using antibiotic in animal farm

These are all the causes for antibiotic resistant. Almost all of our antibiotic today were somehow overcome by the superbug which are resistant to them. By 2050, we may not able to treat a simple chest infection because we don't have antibiotic to do so.

By that time, humanity will eventually being wipe off from the surface of the earth. For thousand of years, we were fighting bacteria and infection and by the last few decade, we were winning the war, however we became greedy, we want to kill every antibiotic, but we forgot Darwin's theory on Struggle for existence. Now the bacteria that struggle to survive, evolve and became resistant to our 'weapon' now we can't fight them back. We were heading towards that apocalypse era.

I would not describe in details on the theoretical part of antibiotic resistant, just to make you all understand that by using antibiotic, you kill all the bacteria but a few of them were actually resistant to that antibiotic. This group of bacteria will lost their competition to live as all their other bacteria were already dead by the antibiotic. They multiply, colonise, became the new infection that you could not fight anymore.

This mechanism is pretty simple yet even those who graduate from medical school seem to forget about it.

Who are the one who need to be blame? Well, doctors, patients, just admit it, its humanity fault. We do not need to blame anyone. We should focus on how can we fix this mess.

Well, we just can't. We are at the end of the war, just realising our strategy actually did not work, plus it was a wrong way after all. We will not fix this mess.

But what we can do is, we should, as usual, to admit that this problem is real. Then, guidelines and law should be implemented on antibiotic usage. Restriction should be made. A team should be created in every hospital to monitor antibiotic use. There were a hundreds thing that hospital are doing right now to reduce the damage from what we will face later when the time has come.

For the public, all the people out there, first of all, we should stop thinking that antibiotic is everything. We should not think that only antibiotic can cure us. A common cough and cold usually cause by virus do not need to be treated with antibiotics. Stop buying antibiotic and use them like candy. Pharmacy store should not sell antibiotic without doctors prescription.

We can do a hundred thing in our hospital, health ministry and agency, but if public still have the antibiotic mentality, then our effort will become such a waste.

Prevention is the better than cure.

Take the above statement seriously. I mean really seriously. That statement translated into - please get vaccinated. Yes, anti-vaccination group were directly causing this antibiotic resistant as more infection occur without vaccination equals to more antibiotic use to treat them. More antibiotic use, the faster we will go down to apocalypse.

As said by an ID physician in my hospital, we (the humanity) will eventually survive this apocalypse, but most of us will not. The one who survive will be those who evolved to become immune to the infection. Well from 10 000, maybe one will survived.

I imagine that era as a rebooting phase of the earth system. Less human, but with that painful incident, they who survive, would eventually realise the mistake and maybe will win the battle again in the future. Are we among them who will survive? Most likely not. Well most of us will not. Earth would be a better place then.

Saturday, November 14, 2015

Win Cafe @ Financial Park Labuan: Variety of Food, Less in Taste.

So I was back in Labuan last week to celebrate my daughter birthday party along with aqiqah and 'Cukur Jambul" ceremony for my second daughter. This time, I was determined to taste some of the newly open restaurant in Labuan.

After a bit of discussion (basically just randomly picked), we chose Win Cafe which is located at Ground Floor Financial Park. This place previously was occupied by..some shops ( I forgot what shop). Located in front of Aifa Electrical shops.

Environment wise, this place provide a good old rustic but classy looking eating place. Calm, clean, and all the worker looked professional. When you walk in, you feel like you are going into a high class fancy restaurant.

Nevertheless, the restaurant provide affordable and variety of food. Ranging from western to local cuisine. Food prices almost all, are below RM20. The steak was priced based on how many gram of beef do you want. That was cool.

There were buffet lunch promotion where you pay RM12 to eat as much as you can from their limited chicken and fish dishes with unlimited rice and plain soup. Did not try that though.

We, instead, choose to eat ala carte menu.

My wife ordered Char Kueh Teow with Clam. The odd thing was, there were no clam inside it. Only prawn, my wife said that to me after she finished eating. The taste was so so. No special thing to brag about. 

My sister in the other hand went for an Oblong beef burger. The beef was hand made. The thing about this burger was the patty taste. It taste sweet, vinegary sour, smell like old pickles. It was Worchestershire sauce that make it taste like that, I guess. My sister did not like it. But I think it's okay for those who are used to that kind of taste. 

I ordered Maryland chicken chop. The chicken was big (but actually the crusted flour make it look big). Nothing special about it. It was served with a kind of sauce which I think also taste like Worchestershire or Hp sauce. Sour, black pepper taste sauce. 

Our desert turn out well. Nothing goes wrong with ice cream, chocolate, caramel, and peanuts. 

In conclusion, this place was ambitious. I praised that. It tries to bring an affordable western and asian cuisine in one place. The environment was nice, the waiter and waitress were polite. Variety of menu. Good proportion of food. However, I think they need to enhance their flavour in every meal. It was not enough, serving a chicken chop, for example, that look like one but does not taste like one. I am a fan of chicken chop and I can tell that there were a lot of better chicken chop than this place. I think they need to turn down a bit on their Worchestershire or Hp sauce and just try to make it as simple as possible but taste great. 

I give this place 2.5/5 in rating. For their effort, I would still recommend this place to others and perhaps will went there again when I am in Labuan. 

Sunday, November 01, 2015

Vaping is safer than smoking: Incomplete story.

Vape is becoming a hot topic today to be discussed. Since its introduction a few years ago, it has been quite a common thing to nowadays, everywhere. The heat of the debate fueled by politics and social media creating a perfect pathway for some to start a fight, and to start a group or community of vaper. Do we have a community of smoker? Or a society of drug addict? Community of vaper are creating a reason to avoid themselves from becoming another therapy group like smoker, drug addict or even alcoholic. They were fighting a battle they should not be in, in the first place.

E-ciggarettes in its introduction era was a promising stop smoking method. With this new method of inhaling nicotine, smokers can avoid from getting more harmful chemicals to cause health problems. It was promising in the beginning. 

Day by day, more research produce what all have expected. Vaping is not ultimately safe. It does contain cancer producing agent. Worse, researcher have not yet found the complete list of chemicals like what they have found in normal ciggarettes. 

With little evidence, reseacher, and even us the medical practitioner are in a state where we can't say yes or no. We need more evidence. We need time. Time will tell it all. However, some people are playing with this issue like they know it all. Like they have a concrete evidence on it. Vaper community start saying they were right all along promoting vaper as safe, and the politicians start trying to banned and demolished this new thing. 

Assumption is the most dangerous act to do no matter in what situation you are. Without concrete evidence, we can't say much about this. 

What we know, however, is that vaping is less harmful than smoking, however, not vaping or smoking is 100% no harm to your health. Thus, by the current evidence, we can say that vaping is not safe anyway no matter how less the risk it bring. Clean air is always the best thing. For heavy smokers, e-ciggarettes maybe a good choice to reduce that 'very likely' risk of cancer. But for non smoker, vaping definitely not a way of reducing that risk, it does increase the risk of getting cancer compare to those who do not. 

I hope that Malaysian can be clear about this and for those who are very pro in vaping, please remember that you are no difference with those people who told young generation to smoke. For those who are trying hard to banned this, please step back one step and think about it. This maybe a way of reducing the risk of cancer for heavy smoker. 

Ultimately, no smoking and no vaping still the best way to live.