Chinchards in Paprik Sauce

Instead of black tilapia we used fried chinchards (chencaru) instead, as my husband does not take fresh water fish. We fried the chinchards without removing its thick layer of outer skin. My niece Shazana helped prepare the Paprik Sauce, as normally found in Thai restaurants.

Method:

2 onions, 5 cloves garlic, 2.5 cm ginger, 2.5 cm galangal, 2.5 cm fresh turmeric root were pounded.
All pounded ingredients were lightly fried in a saucepan. When fragrant, 3 tabsp of chilli paste was added and the frying continued. A stalk of lemon grass was crushed and added with 5 sprigs of kaffir lime leaves. 700 ml water and 3 tabsp of Thai fish sauce were added. The juice of two big limes (limau nipis) was squeezed into the pan. 2 tabsp sugar was added. If the sauce is not thick enough you can a little chilli sauce to thicken it. Add more lime if the sauce is not sour enough.

Two tomatoes cut into 8, 1 sliced fresh chilli, half green capsicum sliced, were added to the sauce.
You may also add sprigs of Chinese celery (daun Sup) to add flavour to the sauce.

The cooked sauce is then poured over the fish and eaten with hot white rice.

Tonight, my brother from Alor Star and his family visited us.

We had the above, plus fried black tilapia in plum sauce as done in an earlier dinner with red tilapia. I think red tilapia tastes better. We also has grilled chicken and a kerabu of long beans and cucumber for dinner.

Only the rice remains as a leftover. It will be made into fried rice for breakfast.

Earlier today we all congregated at my cousin's house in Sunway Damansara. Efi had just moved into the townhouse and we had a little housewarming and "doa selamat"(prayer for safe passage ). Her parents and several aunts, uncles, greataunts and great uncle, cousins, and a nephew ( all from my side of the family from Alor Star) were there. Later some of Efi's friends turn up.

The menu for the housewarming was scrumptuous tomato rice with fried chicken, beef and mixed vegetable curry, chicken in tomato curry and mixed fruit rojak.

Red Tilapia in Sweet and Sour Plum Sauce

Tonight's dinner comprises of fried red Tilapia in sweet and sour plum sauce and "pecal" salad ( mixed vegetables in peanut sauce). (The bottom picture shows the pecal before it is mixed with the sauce)

Winter melon (kundur) was added with pieces of carrots to the plum sauce as recommended by the famous Malaysian chef, Chef Wan. Upon eating it, I thought putting slices of pineapple or unripe mangoes would also be as interesting and they would compliment the plum sauce. The vegetables in the pecal were boiled tapioca leaves ( from our backyard), long beans and bean sprouts added with cut cucumber. It was not a full pecal recipe as the salad was meant to be eaten with rice. Afif's orange drink added to the oomph of the meal.

Tomorrow we plan to prepare Thai paprik sauce with black Tilapia. We are having a freshwater fish feast as my husband is out of town. Freshwater fish is not in his cup of tea.

We bought the tilapia at Tesco's. They had removed the scales and gutted the fish. As with fresh water fish, we had to wash it in tamarind juice to remove any fishy smells, before adding salt and powdered turmeric. The Tilapia is then deep fried. I think Tilapia and catfish is best fried though I have eaten grilled Tilapia before with tamarind juice mixed with sliced fresh chillies, onions, lemon grass and kerisek (roasted coconut) and it tasted great.

To make the plum sauce, two onions, 2.5 cm ginger, 3 cloves garlic and some peppercorns are pounded before being lightly fried Some water is then added. The cubed winter melon is then dropped into the saucepan, followed by cubed carrots and a few dried Chinese plums. Half a bottle of plum sauce is then added.

When the vegetables are cooked, the plum sauce is poured onto the Tilapia in a dish. Some Chinese celery and fresh chillies are used to garnish the dish.

It is not a Bed of Roses

The debate on fresh doctors in government service had not ended. The letter sent by the Perak State Director of Health, reproduced below, adds fodder to the debate.

Not easy being a doc

I would like to refer to the recent letters about housemen and sick doctors. The job of a medical officer is very demanding and carries a heavy responsibility, especially now, as patients are more aware of their rights, have high expectations, are medically more knowledgeable and more litigation conscious. Housemen, their parents and those who aspire to be doctors should realise this.
Housemanship requires psychological and physical endurance. If one is unable to cope with the demands during this period, then one may succumb to stress, and the possibility of making medical errors is higher.
Many want to be doctors without realising that they have to make a lot of sacrifices.
A medical student is responsible only for himself, but once he graduates and becomes a doctor, he is responsible for the life of his patients.
The medical profession is rather unique in that although a doctor may have obtained a medical degree, he still cannot practise because he still has a lot to learn especially the practical skills of medical management.
In fact, the medical degree is just a licence for them to start learning how to practise medicine. Medical doctors will not be given full registration unless they pass their housemanship training. Housemanship is the time when newly-graduated doctors are trained not only to manage and administer the medical management under supervision to patients but to withstand the endurance of working long hours, day and night, weekdays and weekend.
There was an incident when a new doctor entered the ward for the first time, and a paediatric patient collapsed in front of her. She was stunned and unable to respond whereas the nurses tried to revive the child. Unfortunately, the child died.
The doctor did not come to work for three days. On the fourth day, she came to see me and said that she had chosen the wrong profession, and subsequently left the hospital. As mentioned in your papers, there are doctors who get “sick”.
A doctor can be held liable in an action of negligence if he fails to exercise that degree of care and skill which is expected of him. Medical errors do happen when doctors misdiagnose, delay treatment or administer the wrong dosage.
As such, a houseman who examines more patients, spends longer hours in the wards and handles more procedures will become a better and more confident doctor.
Housemen should not complain about the long working hours and being scolded by their seniors and specialists. Teachers and lectures have been scolding students since ages because they want their students to succeed and be better than them.
As part of their training, housemen have to report for work long before the official hours and work through lunch and dinner if need be, and know every detail of their patients.
They should love their work and enjoy the satisfaction of seeing patients under their care recover. No patient should die because of a houseman’s incompetence. Inexperience is not a defence.

So housemen should go to work with the right attitude and acquire knowledge, skills, stamina and patience so that they can be confident of working alone anywhere in the country.

DATUK DR AHMAD RAZIN MAHIR,
Pengarah Kesihatan Negeri, Perak.

Well said, Dr Razin

Tonight we had this delicious simple to prepare meal.I made the mushroom soup ( with low fat milk and mushrooms and a sprinkle of oregano and pepper) and the grilled chicken in barbeque sauce. Nurul, my eldest daughter who is back for a holiday, prepared the salad while Zaty my youngest daughter and faithful helper made her favorite garlic bread. Except for the barbeque sauce which was bought from the hypermarket, the rest was made ourselves from basic ingredients

Afif who came home starving after his futsal outing, ate all the above with rice and soya sauce. That's fusion menu of which Malaysians are familiar with.

Learning to Cook

Picture above is the meal cooked by Zaty entirely by herself a few days ago. She managed to cook a complete meal comprising of white rice, Ayam Masak Merah based on my instructions, and mixed vegetables.

The other caption is Afif taking his turn to fry some fish.Suddenly he has acquired an interest in cooking? Cannot be... Maybe my comment earlier stirred him on.

A Little Spice to Make Food Nice

I don't know when Afif will be interested to learn to cook. I just hope he can live on sandwiches, cornflakes and Maggi noodles when he goes to Sheffield next year.Right now he is busy playing the XBox. Cooking is the last thing on his mind. Hopefully when he is on his own he will learn to cook simple meals from recipes in this blog when the time comes. Actually, we learn best when we are in need. Just like taking on another language in a foreign country. The Bangladeshi workers can speak good Malay now. They have to . If not how to survive? Now they can even flirt with the local Malay girls and get the latter's parents worried.

I found a few good tips in a recent newsletter. It is from Nestle Nutrition reproduced from Maggi's website. It is about adding a little spice to make food nice.

It says a pinch of cinnamon powder, a few bay leaves and a pip of garlic will enhance the taste and aroma of the dish. Of course, I agree with this statement. I use the sweet cinnamon and jintan manis (fennel seeds- top left picture) to add sweetness and avoid using sugar.I have yet to learn to use bay leaves which I bought sometime ago. But using kaffir lime ( daun limau purut) leaves and turmeric leaves (daun kunyit) and torch ginger flowers ( bunga kantan- centre picture) is no stranger to me as I love the flavour they add to a particular dish.

For best results the article on spices suggests these little "secrets:

• Buy spices in small amounts as aging robs their flavour and aroma.


• To test the freshness, rub a bit of spice between thumb and index finger and breathe in the aroma. If it is not present, discard it as it is no longer fresh.

• Store spices in airtight containers in a cool, dry place, away from sunlight.

• Less is best. Start with a small amount of spices and add more if insufficient. To much makes the food bitter instead of enhancing its flavour.

• Cooking releases the aroma and flavour of spices. So if you stew, add spices in the last hour. However, if using in cold dishes, you need time for the spices to release their flavour.

• Spices like bay leaves, lemon grass, ginger and peppercorns can do with a bit of crushing to release their flavour. That is why they are crushed with the pestle before being thrown into the pot.

• Spices like mustard seeds, aniseed, curry leaves, cumin and fenugreek needs to be fried lightly to release their aroma and flavour

• One can experiment with the different spices to see their suitability.For example, fenugreek (halba- top right picture) is great at masking the fishy smell of seafood, while nutmeg is usually used in baked foods,beverages and puddings.

• To keep soups clear, bag up the spices in a small muslin pouch (bunjut) before adding to the soup before boiling.

Now we understand why our grandmother's freshly ground spices in curries, korma and the like tasted so good, unlike the spices we buy from the Mamak store and keep it for months before using.

No Room For Ignorance

I am reproducing a letter published in the Star on 19th Dec 2008 from a senior doctor in Seremban who felt that he/she has to response to the houseman issue and give the senior officer's side of the story.

No room for ignorance in hospital wards

I AM a senior doctor who works in a government hospital with house officers. Having read letters and comments by these house officers and their parents regarding the harassment by their senior colleagues, let me share some of my experiences.

> A middle-aged man, admitted to ward for severe diarrhoea, died due to hypovolemic shock (life-threatening fluid loss). The reason: The house officer on call did not check the patient’s vital signs documented in the record chart.

> A house officer during his morning rounds continued serving potassium supplement even though the patient has hyperkalemia. The reason: He did not review the patient’s drug chart during rounds. He did not trace results of blood tests taken two days ago.

> A young man was transferred from a district hospital for chest pain. The doctor who first saw him had missed the ECG findings of acute myocardial infarction (severe heart attack).

As a result, the man received delayed treatment, and ended up with heart failure. The doctor was a house officer from my hospital, sent out to the district hospital after having completed two years of house officer training.

> A man who collapsed in the ward at 7am was left unattended. The house officer who was on call the night before had left the ward to take a bath, even though he had been informed that the patient was unstable. The patient died due to a delay in administration of CPR.

These are some of the scenarios where the house officers got a shelling from me, not only because of their severe deficiency in knowledge, but due to their attitude and half-hearted manner when dealing with patients.

Then there are house officers who habitually come late to work, even later than their senior colleagues. And there are house officers who don’t take blood investigations on time for patients with dengue fever and never bother to trace the results on time, putting patients at risk.

There are also house officers who smoke in the doctor’s room and house officers who go out drinking late into the night, and are unable to come in to work the next morning due to a severe hangover.

These are the house officers that I have scolded. They grew up, finished their two years’ training and became my colleagues.

Some of them became my good friends, and appreciated what I had taught them. Yet, some will not even look at me when me meet and keep on making silly mistakes when treating patients.

I do not scold house officers for no reason. I don’t get paid for that. I don’t expect them to be superb in knowledge, but the basic knowledge that was acquired from medical schools must be there when they start working.

How do you call yourself a doctor when you do not even know how to perform CPR? Most importantly, one must work with a conscience. Yes, they are allowed to make mistakes, but never at the expense of the patient’s life due to their lousy attitude or severe deficiency in knowledge.

To the parents of these young doctors, have you heard the other side of the story before defending your children? Did they tell you why they got scolded at work?

And if you find out that your child caused a patient’s death, simply due to his poor knowledge and lousy working attitude, will you be able to sleep well at night?

To the house officers who complain a lot, if you can’t even handle negative comments from your senior colleagues, how can you survive when you face demanding patients and family members?

It’s disheartening to see that the public is trying to sensationalise this issue without hearing the other side of the story.

As for myself, I will still scold them if I need to. Of course, I will praise my house officers if they have done well. I don’t mind being unpopular, because it’s not a popularity contest, and my conscience is clear.

A DOCTOR,

Seremban.

So, all housemen and would be medical graduates, please be well equipped with the right mindset before you start your national health service. Be ready to be humble and have an open mind.Most important of all, be ready to LEARN.

This Year's Korban

I am very happy with our korban this year. The bull was a strong one with little fat. Before the slaughter, it was already pacified and everything went without much drama unlike last year when the bull did not give up and tried to escape its fate.

See Zaty's blog for the photos.

Since the Eidul Adha, we have been having beef every now and then. Not every day, as I think it is too heaty.We had fried beef slices on the second day and for today's lunch we had fried rice with beef slices from last night 's dinner. Tonight we had rice vermicelli soup made from the ribs. Zaty's fried shallots complimented the soup really well.

I promised Ikmal to post my fried beef slices recipe and here it is:


Fried Beef Slices made from fresh korban meat.

You need 1/2 kg beef, cut across the grain in thin slices and marinate with the following spices for at least one hour.( You must remove all fat and membranes so that the meat is tender. In case of korban meat, I bury whatever part that is not cooked or eaten so that the sacrifice is accepted by God and the sacrifice is not a futile exercise.)

You may add a little liver or spleen if you like. I find fresh organ meats taste okay if it is lean.

Spices:

1 tsp fennel seeds (jintan manis)
1 tbsp coriander seeds (ketumbar)
2 candlenuts ( buah keras)
1 tsp cinnamon powder
1/2 cube beef stock
1 tbsp vinegar ( Putting a little vinegar helps tenderize the meat)
The dry spices in red font are grinded in a grinder without any water and added to the rest of the ingredients.

Heat a kuali or deep frier and add 2 ladles of oil. Fry some sweet potato slices, remove and set aside.Fry the beef slices in medium heat and stir continuously until the meat is cooked.When meat is cooked you may remove excess oil. Add in 2 sliced big onions and 5 sliced fresh chillies and continue to cook. Finally, add in the fried sweet potatoes and 2 tbsp of soya sauce. Stir for a minute and serve with hot white rice.

Note that no water is added in the cooking. The dish is served together with the oil used in the frying.

This dish is not idle for weight watchers but I guess it is better than preparing beef rendang which is even more "fatal"

More on Training of Young Doctors in Malaysia

Further to my previous post, two opinions in subsequent editions of the Star are given below:

Docs in Good Hands

I WOULD like to refer to comments and SMS messages in response to the report “Sick doctors” (Sunday Star, Nov 30) and the letter by Dr T. K. Khoo from Iowa, US “Housemanship can drive you crazy” (The Star, Dec 1).
The writer’s comments on the working conditions in Malaysia were very unfair. The working system here is totally different from that of the US or any other western country.
In most places in this country, we are still very short of doctors and other health professionals; still lack modern health infrastructure and facilities and have to deal with overcrowding
Therefore, we cannot avoid working long hours. In order to practise the shift system, we need a very large number of doctors from housemen right up to specialists and consultants. The public hospitals and health centres just cannot cope with that.
Despite the working conditions, many improvements have been made to ease the burden of doctors. These include increased renumeration for junior doctors; more allowances; sponsoring of registration to conferences and call allowances etc.
Now, about the “public yelling, abuses and dressing down”. Just because you saw it once, it does not reflect the situation in the whole country.
The working conditions for housemen are now far, far better than what it was 10 to 20 years ago. This so-called inhumane treatment by seniors is mostly a thing of the past.
The majority of housemen receive good guidance and supervision, and now with the new system in which a specialist is specifically assigned to a group of housemen as supervisor/mentor, they will be even better treated and trained.
Of course I do not deny that there are a few bad apples amongst us who treat juniors very badly. But please look at the other side of the coin.
The quality of medical graduates now is definitely on the decline. Nowadays, we have to deal with discipline and attitude-related problems. Some of the housemen have poor work ethics; they come in late, go off early, are very choosy about postings and refuse to do what is expected of them.
We can thus expect them to respond pretty badly like breaking down and crying; there are also those who call in their parents to confront the consultants for giving them a bad time. Some go into depression, even to the level of becoming neurotic.
Those who do well during housemanship rarely have problems with the seniors. Even if they are reprimanded, they can take it in their stride.
Let’s face it; working as a doctor in a public hospital, especially at junior level, is definitely tough and demanding.
I do not advocate training junior doctors in an inhumane manner. But do not tell me that a yell, like a parent reprimanding their kids for making mistakes, is also out of the question.
How else would you train these junior doctors, especially when a patient’s life is in their hands? I would rather yell and rattle them a bit to toughen them up so that they remember their mistakes for life.
GOVERNMENT DOCTOR,
Kuala Lumpur.
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Be aware of challenges facing medical students

I REFER to two recent reports in The Star, in particular the Sunday Star front page headline “Sick doctors – at least five found to suffer from mental woes every month.”
The report may sound alarming, but nevertheless it is a reality that mental health problems affect all strata of society and doctors are no exception.
The sad truth is there is still so much stig­ma attached to mental disorders, resulting in people delaying or not seeking help and getting the appropriate treatment.
The National Mental Health Registry report on schizophrenia for the period 2003-2005 showed that on average, it took a period of 28 months for people suffering from schizophrenia to seek treatment from the onset of first symptoms.
It is believed that many people who suffer from depression, anxiety or other disorders suffer in silence while people around them pretend that there is no problem.
Undetected or untreated, people with mental disorders live with limitations in their mental and social functioning, besides suffering distress in their daily lives.
Schizophrenia, one of the more severe forms of mental disorder, is a chronic dysfunction of the brain which is the result of a combination of psycho-biological and socio-environmental factors.
It is not due to the fault of anyone, just like other chronic diseases such as diabetes mellitus, hypertension or bronchial asthma.
Many mental disorders are often triggered by stress or adaptation difficulties in new environment. Early diagnosis and treatment is essential to limit mental and social dysfunction associated with the disorder.
Medical students are subjected to tremendous stress during their studies, what more in a foreign country and having to learn a foreign language as well as adapting to a new culture.
They are subjected to further stress during housemanship training. Therefore, it is desirable that parents and students themselves be aware of the challenges of a medical course and medical career, and weigh their readiness before embarking on it.
The Malaysian Mental Health Association would also like to urge the public to be aware of, and be supportive of people with mental health problems.
For those who suffer from mental disorders, do not fear or feel ashamed of your problem. Seek help from a counsellor or a doctor, and get early treatment.
DATIN DR ANG KIM TENG,
President,
Malaysian Mental Health Association.

The second opinion should be treated with caution as not all people with depression end up as mental patients.To be depressed for one to two days may be normal but if a person is depressed for longer than 2 months, then there is a problem.

There are other ways to soothe depression before you seek professional help. Maybe you can seek God's help (through Zikir and Quran recitation for Muslims), or have slow talk with close friends and family and people in similar situations. Family and peer support is a great help. After all housemanship does not last forever. Even in the US, interns face the same problems of having to work 30 hours in a stretch.

Doctors have to have passion to help and keep up with the antics of ill people. They must keep the reason and objective to be doctors at the back of their minds and see the challenges as a means for them to be groomed to be great doctors of the future. Anyway, the training of doctors is not like other professions. Life itself is a non tradeable and irreplaceable commodity. Doctors cannot afford to risk making mistakes. That's why we must understand the harsh training they have to go through sometimes.

A tip for young doctors... If you have done well in your training, (in theory and in clinical practice) and you are sincere to serve and learn, you can take all this in your stride. Those with discipline and ethical problems are not cut to be doctors anyway.

POSER FOR MEDICAL STUDENTS TRAINED OUTSIDE MALAYSIA

The following news articles appeared on the December 1st issue of the Star.

It should be of interest to Ikmal and his friends who are pursuing medical studies abroad.

Students being trained locally are aware of the conditions in the hospitals during their housemanship period. Personally, I think the government should do something to remedy the difficulties due to the long working hours imposed on fresh housemen when they start working after graduation. Sometimes I think the senior doctors purposely like to bully the new interns instead of giving them a friendly helping hand.

On the students' part, they should come back to serve in our hospitals with an open mind. There is no need to compare with the advanced or otherwise poor conditions they experienced during their training overseas.Even locally trained students get a culture shock when they start their medical career in Malaysian hospitals.

Students should concentrate on mastering the clinical skills and knowledge during their medical training and be prepared to adapt and learn some more when they return. They must remember that the housemanship does not last forever. Nowadays it is even easier to pursue further postgaduate qualifications after the housemanship. So , there is definitely a better life after the houseman period. There is no need to feel depressed and regret you became a doctor.

Many medical students suffer from depression

By M. KRISHNAMOORTHY, THE STAR

KUALA LUMPUR: Many Malaysian medical students overseas who take examinations in a foreign language suffer from depression when they return.
Physicians for Peace and Social Responsibility (PPSR) vice-president Datuk Dr Abdul Hamid Abdul Kadir said that large numbers of young Malaysians were being trained in foreign medical schools in Indonesia, Russia, India, Poland, Britain and the Republic of Ireland.
At a forum on Saturday organised by the PPSR, it was highlighted that at least five such houseman are found to suffer from mental illnesses every month.
“These countries have varied systems of medical training and different types of patient care, based on the emphasis of the country. As a result, many of the students who go there undergo a culture shock,” said Dr Abdul Ha­­mid.
“Coming from different universities, backgrounds and experiences, they have difficulty relating and working, especially the weaker students,” he said, adding that there had been a sudden sprouting of many public and private medical schools.
While the schools have increased, however, the number of teaching hospitals have not.
Dr Abdul Hamid said that although there was an increasing demand for doctors, the standards and quality of patient care should not be compromised.
“These are the major concerns which the country’s healthcare and medical educational planners have to constantly bear in mind so that the value systems governing the training of our doctors are never lost sight of in the short term and the long term.”