From The Land Below The Wind – Why You Should Consider A Radiological Posting in Sabah?
By Dr Damian Kissey, Radiologist, Kota Kinabalu
North Borneo or its more familiar name, Sabah, is also known as “The land below the wind” because it lies just outside of the typhoon belt of South East Asia. Kota Kinabalu , the state capital and location of Queen Elizabeth Hospital , is about 3 hours flight (or about RM 700 return ticket before the 50% discount rate for domestic flight was introduced) from Kuala Lumpur . More than 20 different ethnic groups with diverse lingual and sociocultural habits live in Sabah which has a total area larger then half of Semenanjung Malaysia and a projected population of 3 million in 2003 (excluding the repatriated immigrants of course).
Sabah boasts the highest peak, Mount Kinabalu , in South East Asia , the largest flower , Rafflesia species , in the world , one of the world’s unique center for orang utan and white rhinoceros rehabilitation , world famous scuba-diving atoll of Sipadan and quite some publicity in the media for a range of political news . On the other hand, we cannot say the same for Radiology because there are only 3 Radiologists (ratio of 1: 1,000,000 Sabahans ) in the government hospital and one colleague in the private sector. The same situation is prevalent for the medical officer, radiographer and paramedical side. The doctor workforce is largely dependant on our countryman (and women) from the peninsular.
The oft quoted reasons for appealing against a posting to Borneo are:
(1) Far away from home and family
(2) Concern about adequacy of public utilities
(3) Safety and security concerns
(4) No social life or activity etc.
Fortunately there is a paradigm shift in the last few years with more young doctors and specialists coming over because of favourable personal testimonials from friends who came earlier to Sabah.
As a local and medical person for more then 10 years, I can assure you that with Information and Communications Technology (e-mail, chat and teleradiology), cheaper domestic flights, family and peninsular colleagues are virtually a dial away.
Hospital staff and the locals are friendly people. Quite a number of House Officers and Medical Officers even told me that the supervising consultants here are more approachable than and not as intimidating as the ones at the ivory towers “back home”. Perhaps big cities and big varsities make people more sombre and stressed.
Utilities are adequate except for some very remote Klinik Kesihatan that may still depend on generators for power (radiologists definitely need not worry because you will be posted to the big hospitals). Special housing allowances are given to peninsular civil servants and rest assured that you do not have to live in primitive tree-top houses with proboscis monkeys as companions.
The tribal warfare practice of headhunting is extinct and outlawed since the British was around in the late 1800s and the odds of a doctor being kidnapped by Abu Sayyaf pirates is as remote as the risk of developing breast cancer after a mammogram. So do not let your ignorant friends or your timid self hold you back from a trip to Borneo because of the above reasons.
The range of leisure activity, whether for the outgoing adventure person or family with children, are staggering - tropical islet resorts, scuba diving or snorkelling spots, white water rafting /canoeing, agrotourism parks, Mount Kinabalu National Park, unique local cuisines, relatively cheap seafood restaurants, local clubs and golf courses, modern shopping complexes or a quiet weekend watching Astro at home – all are within driving distance from the major towns.
A Glimpse of the Radiological Scene in Borneo
It would be interesting to share some news on the professional front with you. These are perhaps geographically peculiar to this region. Ever heard about “susuk” and “PUO or Pellets of Unknown Origin”? It is not uncommon to incidentally find needles and pellet-like foreign bodies (FB) of metallic density in radiographs of local patients done for an unrelated indication. The first thought that comes to mind is whether these foreign bodies are due to accidents or deliberately placed in situ. Sometimes one has to consider calcification foci as a differential if the FB is not so dense. I do not know much about the etymology of the word “susuk” but it is usually meant to imply charm needles, which are inserted by bomohs into the bodies of persons for the intended purposes ranging from beauty enhancement to protection against evil spirits.
The radiologist has to report in such as way so has not to further confuse the referring clinician. Having scrutinised the film, one should do some history taking from the patient such as any accidents previously with splinters from glass or metal? Any shooting incident with the police or the Abu Sayyaf pirates or guerilla experience during the Japanese occupation? Any previous surgery with any sort of implants?
Some male members of our species are known to frequent backstreet “surgeons” to insert metallic implements of various sizes and shapes into their genitalia to enhance sexual performance. Perhaps somebody should conduct a double-blind crossover trial to compare the efficacy of these metallic implants with Viagra.
We have also seen a case of bilateral breasts parenchymal silicone injection with multiple charm needles which could be mistaken for linear microcalcifications. Any psychiatric or eccentric history or personality? Everyone has heard of the foreign body deliberately inserted into various body orifices. These can sometimes occur accidentally in children. One of the local “causes” for pellets noted on the abdominal radiograph is that of villagers who ate wild fauna (wildlife meat) that were killed with shotgun pellets.
In summary, when you see a metallic foreign body on the Xray film in Borneo, consider some of the above differential diagnoses. Do be tactful with your questioning as some subjects are sensitive and taboo to the patients.
Well, these are just glimpses on the general and radiological scenarios in Sabah. Maybe not as exciting as the ventures of Scully and Mulder but certainly real and worthwhile to explore.