Heading East-Kuching Malaysia on Sarawak Island

We arrived into immigration in Kuching in eastern Malaysia and I found it strange that in the same country, you had to go through immigration just to travel to the other side of it. The island had a different climate and the people were mostly aboriginal and native Malays. I sense a more relaxed vibe here. I was impressed to meet a taxi driver who wears more jewelry than me :)We stopped at a batik factory and observed the way they make Batiks using steel dye presses which was nice.

In the morning, we set off to Sarawak general hospital and set up for another smaller patient group meeting. I was thoroughly amused from my public health point of view at the mural in the hospital to avoid overeating and to watch your weight.

The air conditioning was turned on full blast, so I would escape and take a few breaks outside in the sun. I met a junior resident and picked his brain a little about the health care access issues on the island.

Apparently, with global warming, most of the remote areas of the island are being flooded creating smaller islands which were the previous mountain tops. The Malaysian portion is very challenging to deliver health care because it is a long territory with a range of steep mountains in the middle. There are 27 tribes and a public hospital about every 1 1/2 hours from major cities. They have satellite clinics in place that are staffed by a nurse or paramedic. The satellite clinics are often very underutilized and used just in case of emergency. They have an issue of keeping enough stocks of medicines there. Once a month a boat comes to replenish, but since it is not used much, its hard to tell what they need or have.

Something I thought was very interesting is a helicopter service funded by private donations to the Ministry of Health physicians. It goes out pretty regularly to pre-scheduled locations and the populations come to meet them. They drop off a team, and continue on to do life flights and attend to other urgent situations. Apparently there have been an increased number of crashes, so now physicians are a little reluctant to go. Also, they have a floating boat medical clinic (similar to what I saw in Ecuador).

We then headed off to an impromptu patient group meeting at a fancy private clinic. The contrast was incredible! They had fish tanks built into the walls of the waiting rooms and flyers that looked like menus of services. You could purchase packages that included physical exams, ultrasounds, pap smears upto bone density scans. It was a little bit like a menu. Very strange. Most of the population was wealthier (but of course, not wealthy enough to afford some of the medicines) and spoke English. So, I had an easier time communicating.

For those of you who are into geography (eh hem, Biniam :) here is a little map of where I went