To cure sometimes, to treat often, and to comfort always. A known quote from the late Hippocrates states that we should always comfort our patients no matter what. In medicine, gaining diverse clinical experiences is a pivotal step to becoming an aspiring doctor. To fulfill these needs, the Faculty of Medicine, Universitas Airlangga, offers an innovative elective program that allows students to select clinical or non-clinical fields of interest, whether inside or abroad country. This year, I had the privilege of participating in the elective program at Universiti Kebangsaan Malaysia, where I explored two departments: Pediatrics and Emergency Medicine. These experiences enhanced my clinical skills and deepened my understanding of patient care across different specialties. Working in Pediatrics and Emergency Medicine presented unique challenges and opportunities to sharpen critical reasoning and problem-solving abilities. Each rotation offered invaluable insights from the delicate, patient-centered care in pediatrics to the fast-paced, high-stakes emergency medicine environment. Together, these experiences honed my ability to make informed decisions under pressure, adapt to diverse medical scenarios, and develop a well-rounded approach to patient management.
The first two weeks in Malaysia started with the Pediatrics Department. Located at Hospital Pakar Kanak-Kanak HCTM, Kuala Lumpur, it is a first-of-its-kind hospital in Malaysia specializing in and focusing on pediatric care. My rotation in this field allowed me to dive into children's healthcare, which emphasizes a holistic approach, family, and children-centered care. Pediatrics teaches how to accurately diagnose and approach with compassion and empathy, including the well-being of the child and their family, which became central to treatment. From understanding developmental milestones seen in children to managing acute illness, I gained a deeper understanding and appreciation for the unique challenges and joys of treating young patients.
On a routine basis, I would start my morning wards at 07.30 AM, observing and noting new cases, updates on old cases, and discussing with the doctors the differentials and plans for that patient. Our team will have clinic rotations at the Child Development Center (CDC) on Mondays, Wednesdays, and Thursdays. This CDC is the first CDC of its kind in Malaysia. The scope of the CDC is for the assessment, diagnosis, and intervention of children with special needs and neurodevelopmental issues. Subspecialty training for Developmental Pediatrics was initiated in this CDC, enabling the establishment of more CDCs nationwide. I observed and discussed various cases in the clinic with the attending doctors. We reviewed and took the patients' medical histories and discussed their symptoms, diagnoses, and treatment options in detail. It was mostly a rapport interaction between the children's parents and the doctor to learn more about the kid's issues. In the meantime, the nurses would conduct a schedule of growing skills II (SGS-II) assessment for the kid to note all four domains of development: gross motor, cognitive, speech and language, and social-emotional. Growth charts are also vital to ensure the baby is growing adequately. By interpreting growth charts during wellness visits, I understood how to identify subtle signs of malnutrition or developmental delays. This required correlating historical data with clinical findings, emphasizing the value of critical analysis. One unique healthcare system in Malaysia that differs in Indonesia is that you cannot see a specialist unless the medical doctor thinks you need to. If required, the case will be discussed with a specialist to determine further plans, or the specialist will see the children in person. I actively debated with other doctors and specialists when they were referred for each case. Other than that, I also participated in the SGS-II assessment with other nurses to assess the kids. I also interacted with the parents, listened to their concerns, and explained their children's condition. This experience enhanced my communication skills and deepened my understanding of approaching pediatric patients and their families.
Morning rounds by specialists involved going around pediatric wards to review, follow-up cases, and discuss treatment plans for each patient assigned to the specialist's team. Many common diseases involve wheezing, prolonged jaundice, and congenital or malignancy. I am lucky enough to be able to engage with the supervising pediatrician to discuss the diagnostic approach and mindset of "how to think like a pediatrician" to deepen my understanding of systematic, clinical reasoning. Balancing empathy with evidence-based care is crucial in pediatrics since the parents get involved. I witnessed doctors reassure parents about fever management in children, break the "bad news" of chronic illness, and educate the parents about disease management. It taught me the importance of merging compassion with evidence when counseling families.
My elective clinical rotation in the Emergency Department has been an inspiring and eye-opening experience for first-hand exposure to hospital life. This experience brought my understanding of the theories I studied in my pre-clinical years to be applied and tested my critical thinking skills when facing the real deal. Each day brought new challenges, allowing me to immerse myself in daily clinical and life-threatening situations to deepen my understanding of emergency medicine. My mornings always started around 8 AM, and I would finish mostly at 3--4 PM, even a few times I finished at 8 PM. One of the first skills I practiced extensively after learning the theories deeply was interpreting electrocardiograms (ECGs). Under supervision, I conducted ECGs for multiple patients, including one with palpitations and chest pain and another with an irregular heart rhythm. Analyzing the results from the sinus until finding abnormalities in the QRS and coronary artery allowed me to identify critical features like atrial fibrillation, ST-elevation myocardial infarction (STEMI), bundle branch blocks, and many other ECG findings. Each case provided a deeper understanding of how immediate clinical decisions hinge on these findings.
Trauma patient management was another pivotal aspect of my learning. I was directly involved in assessing and stabilizing a patient involved in a motorcycle accident. My tasks included assisting with a log roll to check for spinal injuries and performing a physical examination to identify fractures and internal bleeding. Additionally, I observed the use of imaging modalities like focused assessment with sonography for trauma (FAST) to detect free fluid in the abdomen, enhancing my understanding of diagnostic adjuncts in trauma care. Another case involved a 25-year-old construction worker who sustained a crush injury to his foot, where I assisted in wound cleaning and dressing while discussing compartment syndrome risks with the attending physician.
One of the most challenging yet rewarding experiences was managing critically ill patients. During my time in the ED, I observed and participated in several cardiopulmonary resuscitations (CPRs). In one notable case, a 58-year-old patient presented with hemoptysis and type 2 respiratory distress and was placed on BiPAP, later progressing to tachycardia, ventricular tachycardia (VT), ventricular fibrillation (VFib), and asystole. I performed CPR for the first time during the resuscitation effort and witnessed the importance of teamwork and adherence to protocols. Despite the outcome, the case reinforced the need for emotional resilience and precise execution in life-threatening situations.
Medical cases also presented opportunities for thorough history-taking and differential diagnosis formulation. For instance, I took a detailed history from a hypertensive emergency patient with a blood pressure of 190/100. I observed their treatment, which included discussing the IV antihypertensives that will be used and close monitoring for end-organ damage. Another case involved a 60-year-old with chronic hepatitis B and hepatocellular carcinoma presenting with severe anemia (hemoglobin 3.7). I contributed to discussions on the management plan, which included transfusions, antibiotics for suspected peritonitis, and diuretic adjustments for ascites. These cases emphasized the complexity of managing chronic diseases in acute settings.
Furthermore, I gained hands-on experience with venipuncture, administering intravenous fluids, peritoneal tapping, and managing fluid therapy. In one case, I calculated fluid requirements for a dehydrated child with gastroenteritis, ensuring appropriate maintenance and resuscitation fluid rates. For an elderly patient with septic shock, I observed the administration of crystalloids and discussed the rationale for transitioning to vasopressors when fluid resuscitation alone was insufficient. Such cases highlighted the critical balance between addressing immediate needs and monitoring for complications like fluid overload. I have done many venipunctures to take blood samples to be sent to the lab and run for arterial blood gas (ABG) analysis and be able to interpret the acid-base results and whether there is compensation or not. In peritoneal tapping, I assisted twice in inserting the catheter needle to release the fluid, performing antiseptic procedures, and fixing the needle in place.
I encountered a variety of respiratory cases, from chronic obstructive pulmonary disease (COPD) exacerbations to asthma attacks. These cases made me understand more about the management of each of the types of respiratory distress and also management in cases of acute, subacute, and chronic compensation of each acid-base disorder. I learned to perform a cranial nerve examination on a suspected stroke patient and observed non-invasive ventilation setups, distinguishing between CPAP and BiPAP based on clinical scenarios. Another memorable case involved a young female adult with suspected tuberculosis (TB), where I discussed differential diagnoses with the doctor specialist, including malignancy, and observed the initiation of empirical treatment while awaiting biopsy results.
In addition to patient interactions, I actively participated in continuing medical education (CME) sessions, which deepened my theoretical understanding. A session on diabetic ketoacidosis (DKA) explained its pathophysiology and reinforced the importance of managing electrolyte imbalances and acidosis. Another session is about stroke ischemia and also acute abdomen. The department also prepared an introduction from pre-hospital care that introduced me to ambulance transfer protocols, portable monitors, and effective communication between paramedics and ED Staff.
Through these varied cases and experiences, I have developed clinical skills and an appreciation for the intricate balance of critical thinking, teamwork, and adaptability required in emergency medicine. Each patient interaction and procedure reinforced the significance of evidence-based practice and the human element of care, inspiring me to continue pursuing growth in this challenging and rewarding field.
As I explored Malaysia, I gained a deeper appreciation and understanding of how cultural diversity shapes healthcare practices, the country, the culture, and the people. Working in the hospital has allowed me to witness the various patients from different backgrounds and how each doctor adapts to specify the patient's needs based on their cultural and religious background, which is needed as a doctor to provide holistic care. Additionally, the seamless collaboration within the teams in the emergency department emphasized the value of teamwork, communication, managing patients, and many more, all while in a high-pressure environment. I mostly like to speak in English, so communicating between doctors and some of the patients is relatively easy, especially English, which is studied as a second language in Malaysia. I navigated conversations between the patients in Bahasa Melayu and English since Bahasa Melayu can be similar to Bahasa Indonesia. This enhanced my communication skills and helped me build a rapport with people of different backgrounds.
Outside of the hospital, exploring the beauty of Malaysia's vibrant city refreshed my mind every time I finished a shift or two at the hospital. Visiting Bukit Bintang was a once-in-a-lifetime experience; the busy streets and the lively atmosphere are unforgettable. Sometimes, I go for a morning walk around my street, walk in the park at Taman Botani, and use the MRT and LRT to travel around Kuala Lumpur to visit KLCC and the Sirau Mall to buy groceries for my parents and siblings. The National Art Gallery reflects Malaysia's finest arts and visualization, representing Malaysia's past, present, and future. At the TRX Tower, I was captivated by the breathtaking cityscape and the futuristic design of this financial hub, which reflected Malaysia's aspirations for development. These experiences deepened my understanding of how tradition and modernity coexist harmoniously in Malaysian society.
A memorable aspect of Malaysia was the culinary experience. I relished dishes like nasi lemak, char kway teow, laksa, and many other traditional Malaysian cuisines that burst with flavor and showcased the rich heritage of Malaysian cuisine. Village Park restaurant and nasi lemak burung hantu is a very recommended try for nasi lemak. Dishes like Penang Char Kway Teow, a smoky stir-fried flat noodle dish with prawns, egg, and bean sprouts, were outstanding. The creamy, rich Penang Laksa, tangy tamarind-based fish broth, and herbs offered a unique taste reflecting Penang's blend of Malay, Chinese, and Peranakan influences. Another highlight was indulging in Nasi Kandar, where I chose a variety of spiced curries and accompaniments to pair with fragrant steamed rice, one of the first foods I tried in Malaysia.
Although I didn't visit Genting Highlands, this missed opportunity has only fueled my curiosity to return and explore more of Malaysia's natural beauty. Instead of focusing solely on tourist landmarks, I prioritized immersing myself in the daily life of Kuala Lumpur and building deeper connections with the people I met. The next time I visit Malaysia, I will embark on long journeys to Genting, Johor, and Penang to fulfill my experience in Malaysia. From the warm hospitality of the hospital Staff to the friendly locals who offered helpful recommendations, every interaction made me feel welcome and valued.
Looking back, my time in Malaysia has been a personal and professional growth journey. Adapting to a new environment has taught me resilience and adaptability while experiencing Malaysia's rich culture, which has broadened my perspective on global healthcare and society. I am deeply grateful for the kindness and support of everyone who made this journey unforgettable, from the doctors and the paramedics who guided me in the hospital to the locals who made me feel at home. This experience has not only enriched my medical training but has also left me with lifelong memories and a newfound appreciation for cultural diversity.
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