10th Batch MBBS IIUM Blog

Being in Instalasi Gawat & Darurat (IGD) of Rumah Sakit Umum Daerah (RSUD) Pembina Kesejahteraan Umat (PKU) Muhammadiyah for one week was an eye-opening experience for me. The fact that the space is quite small, about half the size of observation ward in Emergency Department of Hospital Tengku Ampuan Afzan (HTAA), never defeats its purpose as the first area to receive patients, whether it is an emergency, life-threatening case or merely a patient with low grade fever and mild cough. Located in the heart of Yogyakarta city, the hospital is exclusively owned by an Islamic non-governmental organization named Muhammadiyah. Since its establishment in 1912, the organization has devoted itself to educational and social activities in Indonesia.

The IGD is situated at the north part of the hospital, just next to the main entrance, where more than 100 patients are treated daily. The systems in IGD were a bit different from what is practiced in Malaysia, from the administration, management as well as facilities. It is mainly run by two dokter umum (general practitioners), a few perawat-perawat (nurses) and medical attendants. The nurses were in smart green uniform while medical attendants wear white clothes. A bunch of nursing students doing practical plus three of us (me, Farhi and Wan) made the room smaller than usual. As you walk in, you can see a large wood carved with verse from the holy Quran, hang on the wall, which means, “And when I am sick, He who cures me” (Surah Asy-Syu’ara, verse 80), a rare sight in Malaysia’s hospital indeed. In fact, there are abundant quotes from al-Hadith and al-Quran pasted on the walls and boards in various places in the hospital to motivate patients and staff and remind them of the Almighty.

Even though the sign triage was hanging near the entrance, the system was not carried out as it should be, probably due to lack of space and personnel. There were no partitions or separate areas for patients of different colour codes and no specific resuscitation or observation rooms. In fact, the patient was not even tagged and there was no triage officer around. The walk-in, non-critical patient (green-coded) will be seen by dokter umum while the semi-critical and critical will be first attended by perawat, whose job is to take patient’s history, doing simple physical examinations and interventions like setting intravenous line, withdrawing blood, giving oxygen and others along with medical attendants, all happening in one area. Subsequently, the same doctor will see the patient to prescribe medication. The situation may become slightly chaotic if the room is packed with patients especially when there is only one doctor available. It could also prolong the waiting hour. Obviously, the amount of medical staff was insufficient to cater for the increasing number of patients as day goes by. This is different in HTAA where the A&E department is headed by a specialist followed by several medical officers, houseman officers, nurses and lastly medical attendants. The triage is also efficiently practiced here with separated areas for different colour codes and triage officers placed on the main entrance. It is undeniable that even in HTAA, the waiting hour in green zone can be extremely long, again, due to lack of doctors and plentiful patients.

From my observation, to my surprise, most of the procedures done on patients like setting intravenous line and blood taking were conducted without observing the safety precautions. For instance, they did not wear gloves and sometimes the same branula or needles were used repeatedly after the initial trials failed. This could certainly introduce nosocomial infections as well as needle-stick injury. I recalled in many occasions of toilet and suture procedure done on patients with laceration wound at the IGD, despite wearing the sterile gloves, the nurse touched and held everything around him including the patient’s clothes and the unsterile instruments, not long before he continued suturing the wound. I would not blame them as this most likely occurs as a result of ignorance and lack of supervision. A few talks or workshop should be organized to educate and enlighten these medical front liners.

In terms of facilities available, there are not much different from HTAA, except the quantity is lesser. They do have electrocardiogram, cardiac monitor, nebulizer therapy and other important emergency instruments and medications. The algorithm for acute management of certain diseases slightly differs but I believe that does not alter the consequences. Minor surgery can also be performed in the IGD. There was a patient with profuse bleeding at the right forearm as he suffered from deep laceration wound and arterial cut, in which a surgeon was immediately called to repair the cut. The surgeon had to use magnifying glass, minute suture and needle as the arteries were small. Fortunately this time, the sterility of the procedure was properly observed.

Perhaps, it is not thoroughly fair for us to compare the IGD of RSUD PKU Muhammadiyah and A&E Department of HTAA as they stand on a different category; RSUD is a district hospital while the later is a tertiary healthcare centre. Believe it or not, unlike district hospitals in Malaysia, where specialist can hardly be found, and most of them have none; there are a lot of specialists in rumah sakit umum daerah in Indonesia. But one thing I like most about this hospital is that, it has its own mosque located on the second floor and when the azan was heard, everybody made a beeline for the mosque and get ready to pray. And after every prayers, there will be a short, inspiring tazkirah delivered by the staff on various topics every day while all of jemaah were listening attentively. This is something that should be implemented in Malaysia, as an Islamic country.

All in all, I have gained valuable knowledge and experience throughout my stay in IGD. We would like to express our gratitude to all of the staff who have guided and assist us along the way.