B U D A K M E D I K

Al-Kindi Charity

2011-10-05T17:57:00.001+02:00

APPLY HERE!

For more info, visit: Al-Kindi-Charity.blogspot.com

Retroviruses

2011-09-14T16:43:00.001+02:00

Quiz (retroviruses)

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Obstetrics and Gynecology Oral Questions

2011-07-01T13:48:00.000+02:00

Post your Community Medicine oral questions here. If you do not have an account in Google, Blogger, LiveJournal, Wordpress etc., choose anonymous or Name/URL.

Arrange your questions according to these headings.

[Obstetrics]

1. Mention types of abortion

2. Clinical classification of pre-eclampsia

[Gynecology]

1. Clinical picture of acute salpingitis

2. Classification of CIN

Thank you.

WHO: Rate of donation in Malaysia among lowest in the world

2011-06-09T21:28:00.002+02:00

GEORGE TOWN: The rate of organ donation in the country, at 0.6 per million population, is among the lowest in the world, according to a 2010 World Health Organisation (WHO) report.

Deputy Health Minister Datuk Rosnah Abdul Rashid Shirlin said the rate showed that only 17 people in Malaysia’s population of 28 million had actually donated their organs or tissues in 2009.

She said the rate was a far cry in comparison with developed nations like Spain, Britain and Australia.

“Only 322 Malaysians have donated either their organs or tissues since 1975 after their deaths.

“There is a sharp contrast between us and other developed nations. Spain leads the list with 34.3 per million population being organ donors.

“We need to create awareness among Malaysians on the importance of donating organs,” she said during a press conference at a hotel in Batu Feringghi yesterday.

Rosnah had earlier flagged off a beach run held in conjunction with the 14th Scientific Meeting of Malaysian Society of Transplantation.

She said only 0.57%, or 165,438 Malaysians, had pledged to donate their organs and tissues.

“At the moment, there are 12,133 patients waiting for organ donations, with kidney patients topping the list at 12,100.”

Rosnah also said the number of Malaysians undergoing haemodialysis as a result of renal failure had increased threefold, from 7,837 in 2001 to 22,932 in 2010.

She cited religious and cultural subjects as the reasons why many still have the wrong perception on the issue.

“There is no issue in religion. We want to make it clear that nothing in the religion forbids organ donation. It is an act of benevolence,” she said.

The 6km run, themed “Race Against Time: Run For Life”, was meant to promote awareness on the importance of organ donation and to encourage healthy lifestyle in preventing end stage organ failures.

More than 700 participants took part in the run jointly organised by the ministry and the society at the beach near Shangri-La’s Rasa Sayang Resort and Spa.

Normal Labor

2011-05-01T12:28:00.003+02:00

GoAnimate.com: Normal labor by Yusri Arif

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Erythroblastosis fetalis

2011-04-22T18:54:00.006+02:00

GoAnimate.com: Rhesus incompatibility by Yusri Arif

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Clinical diagnosis of a scrotal swelling

2011-03-18T13:16:00.001+02:00

Scrotal Swelling

Nerve supply of the face & scalp

2011-01-23T22:42:00.000+02:00

Nerve Supply of Face

Nerve Supply of Scalp

Exam for docs won’t cause brain drain

2011-01-15T19:23:00.002+02:00

PETALING JAYA: A proposed amendment to the Medical Act to compel all overseas medical graduates to sit for a common licensing examination will not worsen the brain drain situation, Health Ministry director-general Tan Sri Dr Ismail Merican said.

“The Malaysian Medical Council examinations are not meant to make things difficult for them but to assess their core knowledge. They should not worry if they have passed their university examinations,” he said.

Dr Ismail, who is also Malaysian Medical Council president, said in view of the weakness in monitoring foreign institutions, the council had proposed to do away with the Second Schedule of the Medical Act, containing the list of recognised foreign medical schools.

“Students can choose any university they wish to attend abroad but they have to sit for and pass a common licensing examination before being accepted for registration,” he said, adding that this was practised in many developed countries.

The proposed examination, which would be different from the current Medical Qualifying Examination for students from unrecognised universities abroad, would ensure that doctors were “fit to practise” as safe and competent doctors, he said.

Recently, Health Minister Datuk Seri Liow Tiong Lai said the examination was one of the proposals it was looking into when amending the Act.

Although the Malaysian Medical Association and senior doctors had suggested that all medical graduates be made to sit for a common examination, Liow said it would only apply to overseas graduates.

It was not necessary for local graduates to sit for the examination as local institutions were easier to monitor, officials said.

However, senior doctors advocated otherwise, claiming that local schools could lower passing grades to make their universities look good.

Recently, The Star reported on the lack of training hospitals to meet the influx of housemen and a doctor had expressed concerns that some graduates lacked core knowledge and could jeopardise patient safety.

Asked where people could get advice on medical schools that met the country’s requirements if the Second Schedule was removed, Dr Ismail said they could get this from colleges and the council.

The Star Online

CVS History Taking in Pediatrics

2010-12-21T22:25:00.000+02:00

CVS History Taking in Pediatrics

Top 3 Health Threats for Men

2010-11-26T09:33:00.000+02:00

These are the worst of the worst -- the 3 most dangerous diseases for men. Every man needs to know what he's up against. The good news? They are preventable.

Heart Attack and Cardiac Arrest in Men

You've heard the terms a million times. But do you really know the difference between a heart attack and cardiac arrest? Here's what every guy needs to know.

The cause of a heart attack (or myocardial infarction) is pretty easy to understand. It's essentially a plumbing problem. As any schoolboy knows, the heart is really a pump that circulates the blood throughout your body. But like all pumps, it needs an energy supply to work -- in this case, a flow of blood with oxygen and nutrients.

Sometimes the arteries that feed the heart -- called the coronary arteries -- get clogged up with a combination of fats, clotted blood, and other nasty stuff. If a blood clot suddenly blocks off a clogged artery altogether, the heart stops getting the fuel it needs, the cells start starving and dying, and the pump can stop working.

Cardiac arrest is different. While a heart attack is a plumbing problem, cardiac arrest is electrical. Your heart is triggered to beat with regular electrical impulses. But if these electrical impulses become erratic -- causing an irregular heartbeat called an arrhythmia -- the pump may not work. When you see heroic TV doctors shouting "Clear!" and shocking a flat-lining patient with paddles, they're dealing with cardiac arrest. They're trying to electrically jolt the heart back into the correct rhythm. When it's fatal, cardiac arrest is known by the doleful name "sudden cardiac death."

While they're different problems, a heart attack can sometimes lead into cardiac arrest.

High Blood Pressure in Men

Many men have it for years and don't know it, while high blood pressure silently damages their arteries. Here's how to make sure you're not one of them.

Blood pumping through the circulatory system is under pressure, much like the water in the pipes of a house. And just as too much water pressure can damage pipes and faucets, high blood pressure can spell trouble. Hypertension occurs when the force exerted against artery walls is abnormally high.

Over time, the increased pressure can cause a wide range of problems. Small bulges, called aneurysms, may form in blood vessels. The heart can become enlarged, increasing the danger of heart failure. Damage to blood vessels in the kidneys can cause them to fail. Because tiny blood vessels in the eyes are especially vulnerable to damage, hypertension can lead to vision problems and even blindness.

Many factors can lead to high blood pressure. Clearly, diet plays a role. Too much salt, too little potassium, and heavy drinking have all been found to increase the risk of high blood pressure. Too much stress and too little physical activity both increase the danger of developing high blood pressure, as does being overweight or obese. And as with many chronic illnesses, high blood pressure also tends to run in families, suggesting that genes play a role.

In some patients, high blood pressure is related to other medical problems or to the use of certain medicines. This form of the disease is called secondary hypertension, because it is secondary to other medical conditions.

High blood pressure is usually diagnosed using the familiar blood pressure test that involves a cuff wrapped around the upper arm. The cuff is inflated and then sensors measure the pressure of blood beating against the arteries.

Blood pressure is measured using two numbers ― systolic and diastolic pressure. Systolic, the upper number, is the pressure when the heart is beating. Diastolic, the lower number, is the pressure between beats. Normal blood pressure is considered to be anything below 120/80. Prehypertension is defined as a systolic reading between 120 and 139 and a diastolic reading between 80 and 89. Hypertension is defined as blood pressure of 140/90 or higher. For people with diabetes or chronic kidney disease, hypertension is defined as 130/80.

High Cholesterol in Men

With the way men like to eat, the risk of high cholesterol begins as early as our 20s and keeps going up. Find out how to stay ahead of it.

Cholesterol, a fat-like substance, is an essential building block of cells. But if levels in the blood of certain forms of cholesterol climb too high, the substance builds up on the walls of arteries like rust on the inside of a pipe. This build-up eventually reduces blood flow to the heart. If levels of blood and oxygen to the heart drop far enough, the result can be severe chest pain. In the worst case, a chunk of cholesterol-laden plaque can break off and completely block blood flow to the heart, causing a heart attack. A blockage of blood vessels supplying the brain can cause a stroke. Cholesterol build-up can also disrupt the way the heart beats, increasing the risk that blood clots will form.

The artery-clogging form of cholesterol is called low-density lipoprotein, or LDL. Another form of cholesterol, called high-density lipoprotein, or HDL, is actually beneficial. It helps remove LDL from the blood and then from the body. The ideal for good health is to keep LDL levels down and HDL levels up. Cholesterol tests often include a ratio of these two forms of cholesterol. Desirable levels of LDL are less than 100 mg/dL. The ideal for HDL is 60 mg/dL or higher.

Your risk of having high cholesterol increases if:

Your diet is high in saturated fat. These fats, found in meat and full-fat dairy products, raise LDL cholesterol. Dietary cholesterol, found in eggs and organ meats, can also raise blood cholesterol levels.
You eat foods containing trans fats. These artificially made fats, found in partially hydrogenated oils, raise LDL cholesterol and lower HDL cholesterol — exactly the wrong combination.
You are overweight or obese. Excess weight increases LDL and lowers HDL.
You don’t get much exercise. Studies show that a bout of exercise can boost HDL, the good cholesterol. Lack of exercise can lead to weight gain.

There are two cholesterol tests. The simplest measures total cholesterol levels in the blood. However, most doctors now use a lipoprotein analysis, which includes:

total cholesterol level
LDL cholesterol level
HDL cholesterol level
triglycerides (another fat in your blood that raises the risk of heart disease)
ratio of LDL to HDL cholesterol

Good Morning Doctor! - Chapter 54 (Finale) - I Am Happy

2010-10-18T00:00:00.001+02:00

By: William A. Rohlf, MD

Here I shall end my story. As I look back I am happy to have lived in a most romantic and progressive age in medicine and surgery. A wonderful epoch!

I began the study of medicine when bacteriology was revolutionizing the ideas of the causes of disease. The words of Pasteur, Lister, Koch, Behring and others have solved many problems in medical science and to them is due the honor of having made possible the marvelous progress in surgical achievement and preventive medicine.

Some of the reflections that crowd into my mind suggest sober realities, some awaken cheerful memories. I find renewed sources of continued contentment through my friends who share their companionship.

I cannot refrain from expressing my gratitude to my professional associates and to my efficient office force who have rendered such loyal service. I feel that I am leaving my work in hands more efficient than mine have ever been; for, in addition to Dr. Rathe, there is Dr. O. Hardwig, another Waverly boy, who in January of 1936 took over the surgical work of the firm. His natural ability and his training in a modern university and a large city hospital have fitted him eminently for his work.

And I cannot overestimate the contributions my wife has made to our life together, remembering her watchful waiting for my return from work day or night, and her unselfish devotion during the times of my past and present physical afflictions.

May the reader have garnered from these pages some memories of heroic yesterdays, of cheerful todays, and of hopeful tomorrows!

PM: Go for quality healthcare

2010-10-13T21:20:00.000+02:00

PUTRAJAYA: Nations must tackle the challenges posed by non-communicable diseases (NCD) by providing quality care that is co-ordinated and cost effective, Datuk Seri Najib Tun Razak said.

The Prime Minister said cardiovascular and chronic respiratory diseases as well as cancer and diabetes caused an estimated 35 million deaths each year or 60% of all deaths globally, with 80% occuring in low and middle-income countries.

He said it was necessary to “re-engineer” the healthcare delivery system to provide quality care.

“In order to do this, a formidable health workforce is needed.

“Individuals also need to play their part by embracing a healthy lifestyle and be responsible for their own health,” he said when addressing the 61st session of the World Health Organistion Regional Committee for the Western Pacific here yesterday.

Najib said the recent adoption of the United Nations General Assembly resolution on the prevention and control of NCDs was a manifestation of the global community’s political commitment to tackle the issue.

The Prime Minister also said this year’s WHO regional commitee meeting was significant as it provided an opportunity for experts to examine the response and effects of the A (H1N1) global pandemic which had been a “baptism of fire” for affected nations.

For better health: Najib placing the number 61 to mark the launching of the 61st session of the WHO Regional Committee for the Western Pacific at Putrajaya International Convention Centre yesterday. Looking on are (from left) Dr Shin, Health Minister Datuk Seri Liow Tiong Lai, deputy director-general of WHO Dr Anafi Asamoa-Baah and director of Health, Government of Hong Kong Special Administrative Region, and chairman of the 60th Session of Regional Committee for Western Pacific Dr Lam Ping-Yan.

Najib also said Malaysia wanted to transform its healthcare system to be more efficient and effective, adding a blueprint was being worked out to develop 1Care for 1Malaysia, a health system that would meet the needs of the population, provide quality healthcare and ensure universal coverage.

The Prime Minister said while Malaysia had been cited by international bodies as having a good model for health care, particularly in providing services to the rural population, it was necessary to change the structure to enable the Government to serve the people better.

Meanwhile, Najib said the Cabinet will only decide whether to go ahead with the Genetically Modified Mosquito Plan after assessing the outcome and effectiveness of the pilot project.

“The level of public consciousness on cleanliness is not that high, so we have to think of innovative ways to address the dengue problem,’’ he said.

The Star Online

Good Morning Doctor! - Chapter 53 - My Cup

2010-10-11T00:00:00.000+02:00

By: William A. Rohlf, MD

The telephone rang and my office girl answered. "Is Dr. Rohlf in?" the voice asked.

"No, he's at the hospital," she answered. To her surprise the person on the other end of the line asked, "Oh, is he sick?"

There have been two times in my career when that second question wouldn't have been foolish, for twice I have been at the other end of a surgeon's knife. Both times I learned a sympathy for the ills of others, something which is more important than even the gain in physical health.

In my first illness, an acute gall bladder infection, in 1913, I was attended by Dr. H. M. Richter who came out from Chicago to help me. After he removed the stones and drained the bladder, I made such good recovery that for ten years I was well.

When I did get sick I more or less made up for lost time. I was attending a meeting of the American College of Surgeons in Chicago, took sick at midnight, was in the hospital at one o'clock, and was operated on that morning, when my gall bladder was removed by Dr. Richter and Dr. Buchbinder. I had a stormy convalescence by severe phlebitis, but I came out all right and shall not soon forget the kindness of the doctors not only to me but also to Mrs. Rohlf.

I was finally able to come home, but as the winter wore on I knew that my birthday clinic would have to wait until another year. The disappointment of having to skip that year was made a little easier when my brother, Dr. Edward L. Rohlf of Waterloo, invited me to his home for a birthday dinner.

Arriving at the appointed time at his home, I was a little surprised to find no dinner ready; but he explained that he had decided to have the meal downtown at Black's Tea Room. So I accompanied him downtown, went to Black's, and stepped into the dinner room just as he flicked on the lights. There seated before me were all the doctors who would have been at my clinic! They cheered, they shouted, they clapped me on the back while the tears trickled down my cheeks unashamed and my mouth tried to find to find words for the emotions I couldn't express.

During the dinner I got hold of myself a little and heard how this great banquet happened to be. Dr. John Brinkman of Waterloo had written my office girl for my clinic list and had sent out invitations to everyone. This was the response.

Rohlf Loving Cup

After the dinner there was a toast program. Knowing that I would probably be called upon, I steeled myself; yet when the time came I was lost for I hadn't known the rest of this banquet story. The toastmaster produced a magnificent loving cup filled with folded pieces of paper. He explained: "When the invitations to this dinner were sent out, there was included in them the suggestion that we buy something for you, a token of esteem to give you tonight. That token is this cup. In it you will notice many pieces of paper. Those are the letters which came back in answer to the invitations. We had had no notion of keeping these letters, but as they arrived it became more and more apparent that in each was something which really belonged to you: a sincere personal tribute to you. We felt you would enjoy reading them. It is my privilege to present them to you in this silver loving cup."

My trembling hands closed over the cool, smooth handles of the cup, gripping them as if for support. I tried in vain to choke back the tears, my throat was tight; yet somehow I heard my own voice, as if it were miles away and belonging to some other person, thanking my friends for the cup; I heard myself telling a silly story about Ole and Katrina, in which Katrina hurried Ole with his proposal for "she had had the answer ready a long time"; I heard myself saying that I wished I, too, had an answer.

I couldn't see my friends' they were a blur in front of me; my heart pounded and my voice seemed far, far away.

But within me my soul cried out in exaltation, "My cup runneth over with joy."

Inscription: Presented to our esteemed and loveable colleague Dr. W. A. Rohlf on the anniversary of his fifty-seventh birth-day, January Fifth - 1924, by fellows of his former birth-day parties and clinics. Photograph from the Rathe Family Archive.

Good Morning Doctor! - Chapter 52 - The Birthday Cake

2010-10-04T00:00:00.000+02:00

By: William A. Rohlf, MD

No birthday party, even though it be part of a clinic, is complete without a birthday cake. And mine was no exception. Yet I believe the story of my birthday cake is a little out of the ordinary.

It began more than twenty years ago when I answered a telephone call at midnight. Dr. McDanell was calling from his home in Nashua: his little daughter was sick and would I take the train over in the morning to see what I could do? I asked the symptoms. He told me.

"Acute appendicitis?" I asked.

I wasn't waiting for any train if that was the trouble. I got my driver and together we went the twenty miles to Nashua, facing a blizzard from the northwest with the thermometer at eighteen below zero. Arriving, I found that the little girl did have acute appendicitis, and I thanked God that I had made the trip when I did instead of waiting until morning.

I suggested to the doctor that we operate immediately; so we got ready. And with a colleague of the doctor to give the anaesthetic and the colleague's wife to assist, I removed the children's appendix which was very acutely inflamed. We were all done by five o'clock. The child rallied nicely and made a fine recovery.

Both Dr. and Mrs. McDannell thanked me again and again, and in the years that have followed they have shown their gratitude in countless ways. But to me the most touching is Mrs. McDannell's remembrance for each birthday. An excellent cook, and truly an artist in frosting and decorating food, she bakes for me each January fifth a birthday cake. At first, when my clinics were smaller, the cake was more of a family-size creation. As the clinics grew so did the cakes, until in later years they have become culinary masterpieces of design as well as of taste. Sometimes they have been tiered, sometimes a number of smaller cakes artistically grouped, always beautifully frosted in color, often enhanced by living flowers wreathed at the base. Always there have been candles, and the right number; always there was enough for everyone even though in the later years more than one hundred guests were served.

After we got the Boy Scout Troop established here, it was the happy privilege of a group of those boys to present the birthday cake at the clinic dinner.

These years, when my health has made it unwise to hold a clinic, Mrs. McDannell hasn't forgotten me. Each year the cake comes, clinic or no clinic. This year she quite outdid herself, making me a little Hansel and Gretel cookie house, an enchanting creation which served as the centerpiece of the children's table at my family birthday party.

Good Morning Doctor! - Chapter 51 - Happy Birthday!

2010-09-27T00:00:00.000+03:00

By: William A. Rohlf, MD

I was a member of the Iowa Clinical Surgical Society as long ago as the first decade after the turn of the century and at that time we used to meet with various members, the host each time giving a clinic. When it came my turn I gave my clinic and, after the discussion period, invited my friends of the society to the house for dinner.

Mrs. Rohlf had gotten up a tasty home-cooked meal, and after a hard day's work we were quite in the mood to relax and enjoy it. After we had finished eating we had some after-dinner speeches. In one of thee a friend, rising gallantly at his place, said that he had had such a good time that he, for one, would be back. "I'll see you on your birthday!" he added.

His jest was of course all in the spirit of fun, and merely his way of telling me he had had a good time. But it set me to thinking. Why wasn't his idea a good one? After all, I would be having a birthday soon and what better way would there be for me to celebrate it than to give a real clinic and devote that day to charity. There were so many sick people, worthy and in need, who would be benefitted.

So when January fifth came around, a couple of months later, my first birthday clinic was a reality. It was a success from many points of view. In the first place, I did charity work for many good people, people of my own and people who were sent by doctors who were in the habit of referring surgery to me. Then, in addition to the satisfaction of knowing that we had been of service to these unfortunates, in addition to feeling that happiness and humility which accompany such giving of self, we had the pleasure, after our work was done, of renewing friendships and recalling other happy times. And in a doctor's life, as in the life of most professional men, such contact with colleagues gives satisfaction and inspiration.

The next year and the next I cerebrated my birthday with a clinic. Mrs. Rohlf each time prepared a fine meal, and our home on January fifth rang with the hearty laughter of our guests. The clinics grew; even the dinners were better if that were possible. We had nine-course meals. We had wines and champagne. Once we had a whole roast pig.

The clinics kept on growing. Finally we outgrew our home and had to have the dinner at the hotel.

From the standpoint of renewing acquaintances and honoring our eminent colleagues I believe the 1921 clinic still is the memorable one. That was the time that I invited many of the pioneer doctors from around Waverly to be special guests; most of them came, others sent greetings.

"Most of all, I hope that progress will be made in recognizing medicine as a great social preserving and preventing force and that the day will come when the doctor will be regularly paid and chiefly engaged in keeping people well, not in curing them after they are impoverished and wasted by sickness."

There was Dr. D. F. Ford, of Plainfield, a man who was a seasoned practitioner when Queen Victoria died and who remembered the introduction of ether as an anaesthetic. The concluding thought in his speech was an inspiration to us all. He said, "I have seen great changes. When I began, Lister had just started to practice and teach antisepsis in surgery. In the next fifty years still greater progress will be made. Most of all, I hope that progress will be made in recognizing medicine as a great social preserving and preventing force and that the day will come when the doctor will be regularly paid and chiefly engaged in keeping people well, not in curing them after they are impoverished and wasted by sickness."

Dr. Amos Babcock, of New Hampton, confined to his home by illness, sent his greetings. Rather than bemoaning the fact that he had been suffering with eczema for a year, he sent us a chuckle as he wrote: "God will reward that man who discovers a specific for itching."

Another honored guest was Dr. D. S. Bradford, of Janesville, then over eighty years old, of whom it was truthfully said that there was never a road so bad, never a night so dark, never a storm so severe, but that when a call came--regardless of whether the patient had money or not--he answered it. In fact, there never was an occasion, except when he was sock with pneumonia and had a temperature of 104, that his wife was able to keep him from going night and day in the fifty-five years of his practice on any sick call he ever got. And Dr. Bradford, a twinkle in his eye, concluded his remarks with a very sober "Thank you, Doctor, and all the doctors for the courtesy they have sown me, even though a youth; they have treated me very nicely, as if I had had age and experience behind me."

Dr. H. T. Walker, who was to Riceville what Dr. Bradford was to Janesville, responded briefly to his welcome: "Gentlemen, I am better at practicing than preaching. I came to Riceville thirty-two years ago and raised ten children, giving them a fair education. (He put them all through college.) I am honored to be here tonight and I want to thank you one and all for this occasion.

Dr. C. S. Chase, another honored guest who then occupied the chair of pharmacology at the State University of Iowa and was known to many of his younger colleagues as Dad Chase, turned the tables on me and told about my life story instead of his own, ending with a touching tribute. In the course of his talk he gave us a quotation which I have carried with me since:

True worth is in being, not seeming,--
In doing each day that goes by
Some little good--not in dreaming
Of great things to do by and by.
For good lieth not in pursuing,
Nor gaining of great nor of small,
But just in the doing, and doing
As we would be done by, is all.

We had other special guests: Dr. Ely of Des Moines, Dr. Brinkman of Waterloo, Dr. Kennefick of Algona. It was Dr. Kennefick who recalled that he was in Iowa City when I arrived there to enter the University in 1889, and it was he who gave us a review of medical history in the years since. He said he could remember when Des Moines, a city of 50,000 had no hospital; that was in the day that the whole state of Iowa had only two hospitals, one at Davenport and one at Dubuque. At that same time Minnesota had no hospitals outside the Twin Cities and Winona.

"Fellows of the age of Dr. Rohlf and myself," he said, "have seen the evolution of this whole surgical game. It was really a joke, the surgical things we had at Iowa City when we entered. And to think of the handicap of Dr. Rohlf going up without any special training in surgery, without any opportunity to attend clinics anywhere, to evolve and bring about this work himself...A little hospital like this (Waverly's) is doing a remarkable thing. The work you do here is great."

Dr. Buchbinder of Chicago was present and so was Dr. Bierring of Des Moines, the man who preceded me a few years as president of the Iowa State Medical Society and who has since served as president of the American Medical Association. Dr. Bierring, who was a medical student with me, made me very happy when he complimented the idea of group medicine as we had it in Waverly, of "grouping together for the best possible work, and I think when the history of this town is written, it will be of that inspiration which Rohlf and these men about him have given in the way of a stimulus to real medical progress that will be his greatest moment."

Then Dr. Call of Greene spoke, and Dr. F. A. Osincup of Waverly paid tribute to the late Dr. Jungblut of Tripoli.

The end of the party was at hand when Dr. Chase asked if I would repeat Dr. Guthrie's eulogy to the medical profession, the eulogy which I had heard as a student at Iowa City. My pulse quickened as I gave again those thrilling words.

As the last guest departed I began looking forward to the next January fifth. And as it approached I realized anew each year what a beautiful task my mother had set for me, how pregnant with meaning were those words of hers that day long ago on the farm when she had taken my hands in hers and had patted them saying, "They are the hands of a helper, son. I hope they will be--always."

At the clinic in 1930, Dr. Leonard West, who had worked with me in Waverly and who was then practicing in Des Moines, by some strange coincidence gave another expression of my mother's words when he said in his after-dinner speech: "...And intimately connected with his life have been his hands. There is something distinctive, individualistic, characteristic in Dr. Rohlf's hands. I have looked at them and watched them many times. Mrs. West painted a portrait of the doctor, and the thing that pleased me more than anything else about the portrait was the doctor's hands. There is something about them that reflects the personality of a surgeon. Ida Norton Munson has written a little verse called 'The Surgeon's Hands' to which I have added a little for your birthday":

YOUR HANDS AT SIXTY-THREE
(with apologies to Ida North Munson)
Your face? I know not whether it be fair,
Or lined or grayed to mark the slipping years.
Your eyes? I do not glimpse the pity there,
Or try to probe their depths for hopes or fears.
Only upon your wondrous hands I gaze,
And search my memory through so fittingly
To voice their loveliness. In still amaze
I bow before their quite dignity.
They make the crooked straight and heal old sores;
The blind to see, the war-torn clean and whole.
Throughout the suffering world they touch the doors
That open wide to life. The bitter bowl
Of pain they sweeten till the weary rest,
As though the hands of Christ had served and blest. 'Your hands I clasp each birthday morning,
And then, all sorrows flee,
May your hands work on, each day at dawning,
I honor them at sixty-three!

Good Morning Doctor! - Chapter 50 - The Stoic

2010-09-20T00:00:00.000+03:00

By: William A. Rohlf, MD

Accidents do terrible things to the body, but more often than not they bring out a courage and pluck in the character of the injured which is almost beyond belief.

In comparatively recent years I was called to take care of a little boy, about seven, who had fallen into a ditch-digging machine. The sharp shovels and grinding chains had mangled his small body and broken both legs and one arm.

I got into the reception room of the hospital a very short time after the child arrived, and was just in time to see one of the most touching incidents of my whole life.

The boy was half sitting, half lying on the davenport and by him sat his father, sobbing as though his heart would break. "Don't cry, Dad," the child said in a shaking voice. "It might have been worse."

In the long weeks of the losing battle that followed, the lad kept that attitude. When infection developed in those ugly cuts which had been ground full of dirt, and shock and internal hurts finally took his life, that little boy left for all of us a precious legacy: the great bravery of a tiny heart, a stoicism which had prompted him to reach over and pat his Dad's arm and say, "Don't cry, Dad."

New test gives one-hour TB diagnosis

2010-09-16T18:42:00.000+03:00

LONDON (AFP) - – Scientists have developed a new test which can diagnose tuberculosis in one hour, potentially helping to curb the spread of the disease, a British health agency said in a study Wednesday.

The "ultra-rapid" test is far quicker than traditional methods, which can take up to eight weeks and mean that patients, who are often from transient populations, move on untreated, said the Health Protection Agency (HPA).

"Were excited to have developed this new test because it means we can potentially diagnose someone at a TB clinic within an hour and start them immediately on the treatment they need," said Cath Arnold of the HPA, who led the study.

"This new test could really have an impact where it is most needed."

The new, highly sensitive test works by identifying a single molecule of DNA in the TB bacterium.

Current tests involve taking mucus from sufferers and growing a bacterial culture in the laboratory, which can take weeks.

"It will be a lot more effective," HPA spokeswoman Emma Gilgunn-Jones told AFP.

"Up to 75 percent of people with TB are transient and it is difficult if they are not treated straightaway because they can move on and infect people."

But it could be at least two years before the test appears on the market as it must now undergo extensive clinical trials which are starting in Britain soon, she added.

The agency's findings are due to be presented at a conference at the University of Warwick in central England on Wednesday.

The announcement comes less than two weeks after US researchers said they had developed a new test also using genetic markers that could diagnose drug-resistant TB in two hours.

Tuberculosis killed an estimated 1.8 million people worldwide in 2008, according to the World Health Organisation, with the disease spreading fastest in South East Asia.

Drug-resistant TB is becoming a serious threat to global health, especially as only a small proportion of cases are diagnosed, the WHO warned. Almost half the drug-resistant cases were estimated to have occurred in China and India.

Good Morning Doctor! - Chapter 49 - When the Bridge Went Down

2010-09-13T00:00:00.000+03:00

By: William A. Rohlf, MD

A passenger train left the Great Western station in Waverly. When it was passing over the bridge across the Cedar, something gave way and the last cars were thrown into the river. As the accident happened a young man and an older one were standing on the rear platform and both of them went down with the car into the water.

The younger one was thrown against the bridge piling; the older one was dumped right into the water. Being unable to swim, he struggled helplessly. The younger man, hearing his companion's cries, swam to him, grasped him, and towed him to shore. Once there they both got out on the river bank.

The older man paled as he look at the youth, "My God, man, your arm!"

Blood was streaming from an empty torn sleeve; the youth's arm was sheared off just below the elbow, and yet he had not known of the injury until that moment. He had not even missed his arm as he saved his companion.

They brought him to the hospital where his injury was dressed--not a hard job since the member was amputated neatly. He made a good recovery. As if to render his convalescence the more enjoyable, a romance budded between him and one of the nurses before he left the hospital.

Good Morning Doctor! - Chapter 48 - The Expert Witness

2010-09-05T23:00:00.000+02:00

By: William A. Rohlf, MD

Most doctors, at some time in their careers, have been called in as expert witnesses in court trials. I remember very vividly two such incidents: one in a friend's experience, one in my own.

This friend was an expert witness in a case in which a doctor was being sued for not operating. The expert was asked how many times he had had cases of the kind in question. He answered, "Three times. I operated on two.":

"And," said the attorney, did they recover?"

"Yes," my friend answered.

"Then why," continued the attorney who was trying to show that operation was the proper treatment, "didn't you operate on the third?"

"Because," my friend answered dryly, "at that time in the progression of the malady, the patient changed doctors."

I was called to a neighboring county to testify in a case of insanity. The facts presented were that the defendant, a man past middle life, a farmer who had always taken great pride in doing his work well, who was kind to his family, who was economical and frugal, had within the last number of weeks lost interest in his farm and in the manner in which his work was conducted, and was unreasonable with his family. His whole disposition was shown to have changed. Also, instead of being agreeable with his neighbors he was so unreasonable that he was having difficulty with them.

With that situation to consider, I was asked if the circumstances would indicate that the man was abnormal. I answered that I thought he was.

The attorney then said, "You base your opinion on the facts that this man changed in his attitude to his neighbors and his family and changed from being a man of good economical practice to one careless in financial matters?" I answered that I did.

He then said, "Well, doctor, following that line of reasoning, consider the case of a gentleman, well dressed and dignified in appearance and demeanor, walking along quietly, then suddenly dashing down the sidewalk and out into the middle of the street among moving vehicles, apparently heedless of what might happen to him. Because of that change in his conduct would you say that he was insane?"

"Quite the contrary," I answered. "The gentleman was probably chasing a new hat."

The cross questioning ceased at this point.

It just happened that the attorney who was cross questioning me was a friend of mine who had told me that very story himself only a few weeks before.

Good Morning Doctor! - Chapter 47 - Sleep

2010-08-29T23:00:00.000+02:00

By: William A. Rohlf, MD

Sleep! That is one of the things a doctor often has to get along without.

During the influenza epidemic in 1918, when doctors worked day and night, one of my colleagues was called to see a patient. He knelt down by the bed and put his ear on the lady's chest to listen to her breathing. Utterly exhausted, that attitude of relaxation was too much for him and he actually fell asleep.

After some little time the patient stirred, startling the doctor out of his slumbers. "I'm sorry, Doctor," said she, "for I know you're worn out, but I'll have to ask you to move. I just must change my position."

I am happy to report that both the doctor and the patient recovered.

But all patients aren't that thoughtful. I remember one who visited me on a bitter cold night in the middle of winter. I hopped out of bed to answer the knock on my door, shuffling into my bedroom slippers and putting on my dressing gown. Opening the door, I saw a man wrapped up like an Eskimo in fur coat, felt boots, fur cap, heavy shawl, and bit mittens. "My wife's going to have a baby," he said, standing there. "Can you come out?"

It was only eighteen below that night and the wind whipped through that door chilling me to the marrow. "Won't you come in?" I shivered. At least I could get the directions to his place without freezing to death if I could shut the door. But with the most innocent and slightly startled look he replied in a slow drawl, "Never mind, I ain't cold."

And many times our sleep is broken needlessly. Take this case, for instance. I had seen a child one morning, had diagnosed his trouble as bowel complaint, and had suggested that he should not be nursed until the mother reported to me again.

About one o'clock that night the mother telephoned, saying that the child was crying and that she could do nothing to stop him. Learning that his temperature was normal, that the vomiting had ceased, and that the bowel had quieted down, I said that the child's trouble was probably only hunger and that he should be fed. Then I went back to bed.

An hour later again the telephone rang, jolting me out of a sound sleep. It was the same mother. "You were right, Doctor," she said sweetly. "He was hungry. He's asleep now."

I wonder if she thought I had been sitting there by the telephone waiting to find out if the baby was hungry or not!

Good Morning Doctor! - Chapter 46 - Behold Your Child

2010-08-22T23:00:00.003+02:00

By: William A. Rohlf, MD

A young woman was dying. Tuberculosis was eating away her larynx slowly, a little more each day, until now she could talk only in a whisper. Inevitably it would soon choke her to death. And so that she might be nearer her home folks in those last horrible days, she was bought to the Waverly hospital from one farther distant and I was called in to see her.

She was a pretty little thing with a strangely beautiful smile. A happiness was hers; although she knew that death was clutching at her body, she knew also that within her was life. She was with child.

She whispered something to me and I leaned down to catch the words. "I am going to die, Doctor, soon. I don't mind that. I have only one request before I go. May I see my baby? Is there any way?"

I hesitated. What was there for me to say?

"Please, Doctor, I won't mind being hurt. I wouldn't mind anything if I could only see my baby." Her frail hand clutched my sleeve feebly, frantically.

"I will try," I said and with that I left the room, shaken, realizing the enormity of my problem. But that little white face, that whispering voice would not let me say no. What could I do! I went to my colleagues and talked it over with them. They agreed that we had no precedent to follow, that any operation was virtually out of the question. But we finally decided on an unusual thing--our only chance--a Caesarian operation under a local anaesthetic.

I told my patient and her family, explaining the hazards of such procedure. But the little patient would hear of nothing but that we try; her happiness was touching. And her family, realizing that the operation was the only way of giving her one desire, consented.

So the next day, assisted by Dr. Kern, and with Dr. Graening to watch the condition of the patient and care for the child, I began the operation. I injected the anaesthetic and made the incision without any special difficulty, taking from the dying mother a fine, healthy baby girl.

The mother rallied nicely. When they brought the child to her, great tears welled up in her eyes, trickled down her hollow cheeks. "Oh, my baby! My little girl!" she whispered with joy and pain so intermixed in her words that they cut us to our hearts. She looked up at me. "Thank you, Doctor. God bless you. I can die now and be happy. I have seen my child. She's a lovely baby, isn't she?" and she patted the little rosebud fists of the sleeping child.

As we had expected, scarcely forty-eight hours after the operation the mother died, choking her life out.

And the baby? She thrived and few under Dr. Graening's care. She is now a woman and a mother.

10 facts on health workforce crisis

2010-08-20T03:34:00.000+02:00

WHO estimates the global health worker shortfall to be over 4.2 million. That shortage is impairing provision of essential, life-saving interventions such as childhood immunizations, safe pregnancy and childbirth services for mothers, and access to treatment for AIDS, tuberculosis and malaria. As a result, people are suffering and dying needlessly.

Without prompt action, the shortage will worsen and health systems will be weakened further. As populations continue to grow in developing countries and grow older in the developed countries, health demand is on the rise virtually everywhere.

The Global Health Workforce Alliance, which is housed and administered by WHO, is a partnership dedicated to identifying and implementing solutions to the health workforce crisis. Since its launch in 2006, the Alliance has convened experts, political leaders, civil society and health workers to grapple with complex workforce challenges, including employee migration from developing to more developed countries, educational obstacles to a trained workforce, financing to invest in human resources for health, and advocacy and research for long-term problem-solving.

Fact 1

Health workers are people whose main activities enhance health. They include health care providers and people who manage and support delivery systems. Worldwide, there are 59.8 million health workers. Without them, prevention and treatment of disease and advances in health care would not reach those in need.

Fact 2

In 2006, WHO stated that a country with less than 2.3 doctors, nurses and midwives per 100 000 people is undergoing a critical health worker shortage. This is the case in 57 countries (36 of which are in sub-Saharan Africa).

Fact 3

The global health worker shortfall is over 4.2 million, with 1 million health workers needed for Africa alone.

Fact 4

Sub-Saharan Africa faces the greatest challenges. It has 11% of the world's population and carries 25% of the global disease burden. Yet the region has only 3% of the global health workforce and accounts for less than 1% of health expenditures worldwide.

Fact 5

In comparison, North America and South America, which together have 14% of the world's population but only 10% of the global disease burden, employ 37% of the global health workforce and are responsible for over 50% of the global health expenditure.

Fact 6

Many factors have led to the health workforce crisis, including growing economic disparities between countries and upsurges in new and old pandemics. Such pandemics pose special challenges to workers; for example, HIV/AIDS is a 'triple threat' to health workers, causing far bigger workloads, psychological stress, and the daily risk of HIV infection.

Fact 7

Training a nurse takes at least three years; training a doctor can take more than six. If action to expand the health workforce is taken now, effects will only begin to be felt years later. Innovative methods (distance learning, task shifting or community health worker programmes) can shorten this delay effect, but there is no "quick fix" to this problem.

Fact 8

Health worker migration is increasing due to disparities in working conditions, wages and career opportunities. One in four doctors and one in 20 nurses trained in Africa later migrate to work in more developed countries. In Africa and some Asian countries, a public sector physician's monthly wage can be less than US$ 100; in higher resource countries, monthly salaries can exceed US$ 14 000.

Fact 9

WHO estimates that a rapid health workforce scale-up by 2015 would cost US$ 447 million on average per country per year. WHO advocates for 25% of the US$ 12 billion (2004 figure) devoted to international health aid to be spent on the health workforce.

Fact 10

The health workforce issue crosses many sectors – no single entity can successfully address it on its own. The Global Health Workforce Alliance has brought together a coalition of health leaders, civil society and workers to explore solutions to this crisis at the first Global Forum on Human Resources for Health in Kampala, Uganda in March 2008.

Good Morning Doctor! - Chapter 45 - Mud!

2010-08-15T23:00:00.000+02:00

By: William A. Rohlf, MD

It was before Iowa got out of the mud, before there was much paving, that I made what I still consider my prize trip.

About seven o'clock in the morning I started out by automobile with my chauffeur and two nurses to perform an emergency abdominal operation.

We found the roads were worse than we had thought. When we had gone about sixteen miles, the car mired down hub deep in the mud. Calling on a farmer for aid, we were driven in his lumber wagon over four miles of almost impassable roads to a stretch of pavement. From here we telephoned to the county seat for an automobile to take us the six miles into town.

At the garage in town we found that a man had made the trip ahead of us the day before and that he would help us, for he knew where we would have to have help getting through. On his advice we telephoned farmers at these points along the route to have their teams ready to pull us out. We needed every one of them, and with their help we finally arrived at our destination.

After the operation, so that we might get home in time for work at the hospital the next morning, we flagged a train in the small town where we had done the operating. And the train, remarkable as it seemed to us that night, got us home without trouble.

By the end of the trip we had used eleven different conveyances and twenty hours of time--at the slight cost of forty-two dollars!

Good Morning Doctor! - Chapter 44 - A New Kind

2010-08-09T00:00:00.003+03:00

By: William A. Rohlf, MD

Dr. Bradford's story reminds me of one in my own experience. A widow with seven children to support, but without funds, was my patient. So I took care of the whole family without any compensation save a head of cabbage, a few tomatoes, or a chicken occasionally. I knew this pay was the best she could do; therefore I cheerfully answered all calls.

She succeeded in rearing her children to more or less useful lives. As the children grew up and had families, there was a natural increase in the calls and responsibilities which I had as their family physician; but I made no charge, having grown accustomed by now to expect no remuneration from them.

One of the widow's sons died not long after his return from the World War, leaving his mother a substantial life insurance policy which the government paid in monthly installments.

Shortly after this I happened to meet the widow in another physician's waiting room. She spoke to me but seemed a little fussed. Apologetically she explained to me that she was visiting this other doctor because she thought she would try a "pay doctor" once.