Malise of Public Hospial

When Dr Chua Soi Lek first came to office, he apparently called for a meeting of all senior officers and when asked about the priority of problems at the Ministry of Health, he reportedly was inundated with numerous comments about the dastardly troubles private hospitals had created and how they and their devious doctors were leeching the poor Malaysian public and something had to be done urgently.
The gullible Chua, ever willing to show off the political strongman that he conjured himself to be, wasted no time in implementing the shelved PHFSA and together with his DG, bamboozled it recklessly utilizing the BN’s brute but now mercifully clipped majority in Parliament, brushing off all objections against the Act just so he can show who’s boss.
Needless to say despite all of Chua’s and Merican’s big talk and assurances, the first victim who got thrown into jail was a registered doctor, a stark reminder of the previous government’s callous and appalling methods of governance. New health ministers are almost always a shoo in for our machiavellian Health Ministry officials who have become rather slick in cornering incoming, inexperienced and invariably unknowledgeable ministers into making silly decisions. All ministers are political animals and make distorted decisions essentially because the minister is fed only half the story or the story he generally likes to hear. And so it is with the new health minister Liow Tiong Lai. While Tanzanian President Jakaya Kikwete was going on an all out war against witchdoctors (read bomohs, sinsehs, etc) who were gorging out eyes of albinos and the Brazilians were calling in the army and possibly Cuban doctors to help battle the mortal incidence of dengue in that country, back in Malaysia, the hapless Liow had thrust upon him a meaningless business turf battle between pharmacists and doctors as his first task. The Brazilians must have wondered about the priority of the Malaysian health minister and cannot be faulted if they thought that Malaysians had indeed licked the dengue scourge and were actually moving on to bigger stuff. Far from it. The dengue fever outbreak in Brazil had infected 55,000 people, and killed 67 Brazilians so far this year with half of those killed by the mosquito-borne illness being under 13 years old. But Malaysia’s “Disease Control Director”, Hasan Abdul Rahman reported a proportionately higher mortality ratio of 9,889 people diagnosed, with 26 of them dead for the first three months from January to March alone of this year. Maybe we have something to learn from the Brazilians or more likely our stats are out of sync. But these problems will pale into comparison as the new and inexperienced health minister has made a second momentous decision. That of shipping unfortunate children with congenital heart disease to Devi Shetty’s “world famous” heart center 2000 miles away in Bangalore, the Narayana Hrudayalaya. Even Chua, known to be a brusque decision maker refused to take this decision. But the new health minister had no qualms sending these children off….or was he pushed into make this decision. When the NST published their under-researched cum marketing piece for the IJN on the lack of heart surgeons and the need for critical care for paediatric cardiac surgical patients in a center spread on 2/4/08, they didn’t quite delve into the factors as to why this country has not caught up with the rest of the world or at least India, despite the government spending millions to curb the rising incidence of heart disease.
Paradoxically, after 50 years of Merdeka, we are in fact sending off patients overseas for treatment just like the Mauritius, Ghana, Nigeria, Sierra Leone and Bangladesh to the Narayana Hrudayalaya Institute of Medical Sciences (NHIMS) Do we not have the expertise? Elementary. It is just poor management of our resources. Five gov't heart units
The government has five heart units. The unit in Penang was established in 1995 at a cost of RM30 million, followed by Johor Bahru in 1997 for RM40 million and Kuching in 2001 for RM55 million. A new unit was set up at Alor Star when the new Sultan Bahiyah Hospital was being constructed midway causing the hospital to have serious delays in its opening and another at Serdang Hospital which has been designated as the ministry’s heart center for the Klang Valley. Surprisingly despite the government spending millions on infrastructure, little attention was paid to manpower leaving many of its units underutilized or not operational. There are no paediatric cardiac surgical services at government hospitals save for a small number being attempted by an expatriate surgeon in Kuching. The Penang unit, although busy in the beginning, had its work slowed down when the initial surgeon resigned. It further attracted controversy when expensive and untested cardiac equipment bought for millions of ringgit ended up as a white elephant.
It was in the news again in 2005 when surgeons left the unit in droves when belligerent anesthetists there tried to take control of the cardiac surgical ICU which has always been the domain of cardiac surgeons throughout the world. The unit was then briefly run by an Indonesian born doctor who surprisingly was awarded a JPA scholarship to do his training. However patients complaining at the greatly lengthened waiting list reportedly as a result of the new surgeon being unable to do bypass surgery there saw the ministry moving some of its doctors from Johor Bahru to cover the unit. The Indonesian surgeon, in a bizarre move by the MOH, has been transferred to head the Serdang unit. The Unit at JB was initially run by a British trained Malaysian surgeon who left for Singapore leaving the unit now running only on a single theater at times. The Kuching Hospital unit is one of the better run units. One of the reasons for this is the high level of commitment of doctors there and the support financially by the local community.
Despite the lack of manpower, the ministry is planning to open more units in other areas such as Ipoh, Kuantan and Kota Kinabalu. In KK alone, the MOH announced last month that it will be spending RM70 million. Even planning administrators in the ministry have argued that that there should be a period of consolidation instead of splurging more capital until manpower problems are soughted out. But these reservations have apparently been over-ruled by the surgeons and anesthetists. It is always nice to splurge … if it is not your own money, especially if it brings you fringe benefits like more overseas trips for “lawatan sambil belajar”
There are in total 23 units doing cardiac surgery in the private sector. One in Alor Star, four in Penang, one in Ipoh (apparently now defunct), nine in the Klang Valley, three in Malacca, one in JB, one in KK and one in Kuching. Only the Adventist Hospital in Penang and Gleneagles in KL do paediatric cardiac surgical cases in significant numbers. The rest are essentially adult units. Most private units are solo run by individual surgeons. As a result they do small numbers. However the Penang and Malacca units cater for quite a number of foreign patients especially from Indonesia. National Heart Institute (IJN)
In the early eighties, the HKL was the only heart unit the MOH had. It was controversially corporatised to IJN soon after Dr Mahathir Mohamad had his heart surgery. Many then thought that perhaps corporatisation of this service will soon see Malaysia self sufficient in this particular area but as always in the Malaysian scene, corporatisation comes with strings attached. IJN’s founders made a deal where all heart cases in the central region must be solely given to them. They didn’t want any competition. And if you believe a monopoly corrupts, then there must be some truth to this considering IJN’s phenomenal surgical costs. But despite being a monopoly they couldn’t hold on to their surgeons. One paediatric cardiac surgeon resigned to go to Gleneagles while two more found cushy jobs in Saudi. So it has gone back to the same routine of trying to train more surgeons. Despite the high volume of cases it does, it apparently lacks space which may be resolved when its new building is commissioned.
Interestingly, IJN offered to run the Serdang Hospital Heart Unit for the ministry but this deal was obstructed by the ministry’s own surgeons. You sometimes wonder if everyone in this area is really working for the common good of patients, or for themselves, at the expense of the general public. The ministry and their political masters, the MCA, are doing nothing.
Training programmes
So why are we not training enough heart doctors? There are three university heart units based at the UH, HUKM and HUSM in Kubang Kerian respectively. But the volume of surgeries and procedures done are small, especially in Kubang Krian despite the disproportionately large incidence of coronary, valvular and congenital heart disease in Kelantan. The UIA in Kuantan apparently has been enthusiastic about setting up a heart unit there but again there was a problem regarding manpower and commitment by some of its specialists and of course the unending destructive rivalry between the MOH and the universities. The price you pay if you don’t have your own hospital. The first open heart unit this country ever had was the one established as early as 1969 at the University Hospital by NK Yong who took up the post of Foundation Professor in Surgery when the UM’s Medical Faculty was first set up. He had trained at Kentucky University and despite virtually no trained staff he performed Singapore’s first open heart surgery in 1965 after painstakingly assembling and training a cardiac team for two years following his return from the US in 1963. His presence at the UH saw the emergence of new surgeons such as Saw Huat Seong and the late Razali Hashim. The unit was further strengthened by an expatriate surgeon from the Christian Medical College in Vellore, George Cherian. But all this came to an end when Razali passed away prematurely almost 20 yeas ago. Saw Huat Seong is in private practice in Singapore, George is in Kansas and NK Yong is of course retired and is now a famed wine connoisseur. The heart unit at the UH today is more renowned for fist fights and slapping incidents with no trainees forthcoming.
While heart units around the world progressed by leaps and bounds, the UH unit stagnated and in fact regressed. The country’s pioneer unit fell victim to medical politics and to the tantrums of the remaining surgeon when heart disease was the pre-eminent killer with irresponsible university authorities just looking on, doing nothing or dabbling in trying to sell off university grounds. UKM, which initially suffered a similar fate when it set up its unit a decade ago, has progressed much better and proposed a training programme for cardiac surgery last year to the ministry but it has yet to get off the ground. Again medical politics and unbridled, cumbersome, attritional professional jealousy has been the bane that threatens the progress of heart treatment in this country. The MOH and university authorities are in particular guilty of not dealing with these problems firmly, instead pandering to the whims and fancies of individual specialists against national interests leading Malaysian patients now possibly to that dusty road to Bangalore.
Malaise in our public hospitals Pt 2 Ahmad Sobri May 23, 08 12:23pm The Narayana Hrudayalaya center is primarily the brain child of Devi Shetty who initially trained at Guys Hospital in London where Philip Deverall, a British pioneering and innovative paediatric heart surgeon was based. He has no formal postgraduate cardiac qualifications unlike most Indian cardiac surgeons. However, apart from the thousands of cases he has carried out, he has conducted hundreds of seminars, wrote innumerable papers, created many training programs and of course built and managed quite a few heart hospitals.
MCPXDevi Shetty is living proof that clinical and operative skills may not necessarily be congruent to academic qualifications, something our local MMC (Malaysian Medical Council) should wake up to. Dedication and commitment could be far more valuable factors. In fact in all likelihood; Devi Shetty might not even get a job if he applies for one at the MOH as his qualifications would have been deemed by our “elite” council members as “not recognised” Shetty returned to India in 1989 to set up a hospital for the Birla group in Calcutta before ultimately moving onto Bangalore to found the Narayana in 2001. He is married to Shakunthala Shetty, the daughter of the wealthy construction magnate Sri Charmakki Narayana Shetty, who owned the land where the 800 bedded hospital is situated.
The Narayana Hrudayalaya is located in the Bommasandra Industrial Area on the outskirts of Bangalore on 25 acres of land, 30 km from the old Bangalore airport and 50km from the new one. The grimy road leading to the hospital where the pillars of Bangalore’s off/on Metro project stick out like sore thumbs may not really be palatable to Malaysian patients or parents used to our highways. But the hospital itself is a remarkable story. The hospital design is simple and furnishing is bare. It has 25 operating theaters for cardiac surgery alone of which half are currently operational. Shetty’s group which includes surgeons trained in India, Australia, Britain and Russia carry out an astonishing 20 to 30 open heart surgeries a day, clocking close to almost 6000 cases a year. Of these a third are congenital cases.
Maintain good results
Devi Shetty is one of India’s many rising entrepreneurial hospital pioneers who have contributed immensely to not only healthcare in India but also to its economy. They believe not only in bringing world class healthcare to India’s poor but are firm believers of strict financial prudence so that treatment remains extremely cost effective, a culture virtually absent in the Malaysian healthcare scene especially in government hospitals.
In a country where the incidence of congenital heart disease is 8 per 1000 births against a questionable 1 per 1000 in Malaysia, India has 180,000 children born with congenital heart defects every year with 90,000 requiring early intervention at the neonatal stage. Shetty’s strategy for success is simple. Focus on maintaining good results which are the accepted 2% mortality for adult cases and an incredible 5% mortality for congenital heart surgery considering that some very complex cases end up here. And an innovative packaged price for treatment. Heart hospitals are expensive. And if you are going to extend complex world class surgery to the poor, then, to make that buck, you need to operate a large volume of cases which is not a problem in India. Shetty maintains a fixed price of almost RM10,000 ringgit for each paediatric case no matter how complex the lesions are, making his money back through volume. He doesn’t compromise on equipment which is pretty similar to the ones Malaysian hospitals have. He further saves on costs especially on medication, equipment and consumables which are indigenously manufactured. But the most important asset he has is the great depth in staff required to look after patients. And this he does by having active academic programs which is headed completely by a dedicated academic dean.
No one is actually sure why Dr Chua Soi Lek was attracted to this hospital. Perhaps he was impressed by the shear numbers of the assembly like care patients received in diagnostics, theater and especially the ICU. Or maybe he was influenced by an ex-senior health ministry official who is the Dean of a local private medical school which has a twinning program with a medical school in Bangalore where Shetty maintains a branch. Whatever it is, Shetty has done remarkably well. And this he managed to achieve through sheer hard work and perseverance. To operate such a large volume of cases with a low mortality he would have had to climb that agonizing learning curve and cross a lot of dead bodies, something Malaysian surgeons are anathema to, focusing rather on safe, less complex cases. To be successful in paediatric cardiac surgery you will have to run through that deadly gauntlet that ended the careers of Professor James Wisheart and Janardan Dhasmana at the Bristol Royal Infirmary in 1999. Both found out to their costs that taking the risky gamble of operating on paediatric cardiac surgical patients with iffy paediatric cardiologists, anesthetists and ICU staff can not only end your career but may get you profoundly vilified for the rest of your life. But certainly Shetty’s hospital is not the only one doing similar surgery at these prices. There are almost 200 centers in India that offer heart surgery in India. In South India alone, the level of work that is carried out at the Narayana is done in 11 other paediatric cardiac surgical centers with the total number of paediatric cardiac surgical units throughout India numbering about 20. Some of these centers like the Amrita Heart Institute, Cherian Heat Foundation, Madras Medical Mission, Ramachandra Medical College, CMC Vellore, MIOT and the Asian Heart Institute in Bombay produce very good results but do not match Shetty’s costs.
On average, the cost of treating a congenital heart defect can cost between RM20-30,000 per case. Surprisingly only a single government hospital, the All India Institute of Medical Sciences (AIIMS) in Delhi, does any neotatal cardiac surgery of note. And every heart surgeon in the private sector in India will swear that the price of similar surgery at the government funded AIIMS is far costlier then the ones done in private centers, a testimony that accountability in subsidized healthcare is almost always never accountable to anyone, anywhere around the world including Malaysia. Solutions
The MOH stated that an agreement had been reached to operate on 200 children at a cost of RM10,000 for each child over a period of one year excluding incidental costs. These costs would be probably flight fares, food, accommodation, etc which may put the cost at about RM15,000 or more, provided there are no complications. Paediatric cardiac surgical cases are generally divided into cyanotic and acyanotic babies, meaning blue and non-blue babies. It is the blue babies that are difficult to manage, are costlier to operate on and generally would require complex surgery including initial palliative surgery if expertise for complete correction is not available in the first instance. The ministry could outsource non-blue baby and palliative surgery for blue babies to local private hospitals at a competitive price as this will be logistically more suitable for the family. Blue babies that will require complex staged surgery could perhaps be flown to Bangalore although there will be risks involved for the three-hour flight and that perilous road journey to the Narayana itself. Alternatively it could ask local surgeons or their surgical teams in “not so busy” private hospitals to operate in the Ministry’s government units so that there are savings in consumables and theater time. Since the ministry has the infrastructure but not the staff, perioperative care could also be contracted out. Or it could invite foreign surgical teams or surgeons to operate at its heart units on a regular basis to do surgery. Cases that don’t require urgent surgery could be accumulated and be done on a regular monthly basis with our local surgeons and hospital staff looking after them. It would be a good learning experience for them although cases need to be carefully chosen. Or allow private hospitals to employ these foreign surgeons or teams directly and the ministry outsources the work to these hospitals. Foreign medical staff, especially surgeons, anesthetists and cardiologists could be offered incentives like PR and citizenship etc so that they stay back in this country. And importantly, the universities and the MOH have to revise their training programs to ensure that Malaysia’s expertise in this area rises to match the number of patients in this country. Whoever did this marketing for the Bangalore team may have done Shetty a large favour and a disservice to cardiac care in this country. But this story is the natural end result of a poorly managed service that saw no proper audit in cost production ratios. It is sad refection of the state of services in this country where for far too long the focus has been on constructing sophisticated infrastructure without paying attention to human development in direct contrast to India where the reverse has taken place. Before the minister dives into the uncharted National Health Financing Scheme, he should perhaps ponder if outsourcing healthcare to private hospitals that offer competitive pricing is a better option. The Ministry should refrain from reinventing the wheel all the time by building more heart units that only make contractors and suppliers rich, and instead save its financial resources and perhaps outsource its work to hospitals that provide a service at very cost effective prices. You can save a whole lot of money in places like Kota Kinabalu where instead of blowing 70 million ringgit, you can buy services from the Sabah Medical Center where its cardiac operating theater and 12 ICU beds are almost always lying idle. Competition and innovation is the key to lower prices and better services. If the Malaysian public is to be saved, the confrontational policies of the previous former minister and DG must end. There must be greater cooperation between the large numbers of private doctors and the public service. Failure by the new minister, Liow Tiong Lai, to handle this impasse effectively will ultimately see not only cardiac going India way but a whole lot more of other specialties.
form malaysia kini 23 mei 2008--------------------------------------------------------------------------------AHMAD SOBRI is a surgeon who has served in both the public and private sectors in Malaysia for 20 years. He is currently based in South England and his interests include resuscitative techniques including reanimation. His work also includes health policies, planning and finance.
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Tak Mau Bercakap Sampai Mati Pun Tak Aper

Tak mau bercakap sampai mati pun tak aper.Tetapi, dengan satu syarat, jalan marah dan dendam kalau I pun tak mahu bercakap.Dua tida hari lepas, pasal Rosmah ni, I ingat dah settle, sebab I hanya berhubungan sebagai kawan, iaitu kawan baik U.tetapi, nampaknya tak habis-habis lagi nak di korek dan dicari pasal.kalau berlaku macam ini, I tahu, ada sesuatu yg ingin dilindungi.Tak payah.Tak payah nak berlindung disebalek alasan ini.pergilah dan buat lah apa yang U suka.

Tak jawab makna Tak Sayang

Ina tak jawab telefon I, mengisyaratkan bahawa U dah menolak segala kebaikan I selama ini.Tak per.Jangan risau. I pun tahu, sebab sebenar Ina tak mahu I mengenali kawan-kawan U, bukanlah kerana cemburu.Tetapi, adalah kerana ketakutan U.Takut kalau semua RAHSIA U dan perbuatan U disana terbongkar. I tak kisah lagi.jangan cari alasan kecil.I pun dah tahu OK?

2170 hari

Kalau Ina tak mau bercakap dan menjwb telefon I pun Tak aper. tak kisah. Sebab I ni buat salah besar kerana berhubungan dengan kawan U sebagai sahabat.Tak payah lah nak cari pasai.Sehingga saat ini, dah 2170 hari dan 15 jam Ina menjadi Isteri I.Dan selama itulah U duduk dalam keadaan yang mencurigai I.Sekarang dah jelas I ni lelaki yang Ina tak boleh percayai langsung.I reda apapun yang akan berlaku.Dan I tetap mencintai U.Hanya U dan KT Isteri I.Kalau U balek nanti, Tak mahu jumpa I lagi dan tak mahu ke Tapah pun tak apa.3 tahun U tinggalkan I . I dah biasa hidup mencintai U tanpa kehadiran U.Jadi buat, kata dan fikirlah mengikut kemahuan dan kepuasan U.Apapun yang berlaku I tak menyesal lagi, sebab semuanya berpunca SALAH dan SILAP I.

Kata-kata Mengores Kalbu

Ina TQ dengan penuh sinis kerana I tak dpt pick-up phone. Sungguh sinis dan berpsangka buruk tanpa sedikitpun untuk berfikir yang baik. Tanpa befikir mungkin pada masa itu ada sesuatu berlaku, kalaupun tidak bergelut dengan maut.
Kemudian sms dengan tuduhan yang berat utuk di terima dengar.Apa tujuan? Hanya Allah dan Ina sendirilah yang tahu.
Segala kata-kata kesat dan tuduhan melulu yang ditujukan kepada seorang suami pastinya bukannya datang dari rasa kasihsayang dan cinta melainkan rasa kebencian yang membuak-buak. Siapakah lagi yang sanggup hidup dengan linangan airmata dan bersedih kerana digores dengan kata-kata yang menghina, yang mengertak dan mengancam? Dan kata-kata itu datangnya dari orang yang mendakwa mencintainya malahan pula bergelar isteri dan tidak pula pernah menunjukkan kekesalan kerana perbuatan itu?

Jangan cari Alasan

Kenapa U selalu cakap Tak mau balek malaysia? dan selalu menyalahkan I?
ini mungkin jawapannya:


Date: Sun, 8 Jul 2007 02:02:58 -0700 (PDT) From: shahrina26@yahoo.com Yahoo! DomainKeys has confirmed that this message was sent by yahoo.com. Learn more Subject: i miss you To: "OSAMA AHMED" <superior_man56@yahoo.com> Add to Address Book Add Mobile Alert thank u for the photo my mother is waiting for, and thank u for calling me from Saudi to tell me about your number, and your love to me. thank u for every thing especialy your hug and kiss the other day.

Date: Wed, 27 Jun 2007 05:13:05 -0700 (PDT) From: "shahrina hashim" <shahrina26@yahoo.com> Add to Address Book Add Mobile Alert Subject: BROKEN HEART To: "OSAMA AHMED" <superior_man56@yahoo.com>
Note: forwarded message attached.
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Date: Fri, 8 Jun 2007 06:42:53 -0700 (PDT) From: Subject: SONG ARABIC To: shahrina26@yahoo.com HTML Attachment [ Scan and Save to Computer ]
hi darling i love you so much. i attach to you a song mixed of ROMANIAN and ARABIC languages, hear it it is veryyyyyyyyyyyyyyy nice, i love it so much, as i love you too..and it is a gift from me to you to express my emotions to you, when you hear it, tell me about your opinion. i loveeeeeeeeeeeee you i wish to see you i misssssssssssss your lovely kiss so much my handsome man.ALI NASER

This evidence taken from web site. Web site dont lie!

Doa

Kalau dia memang bukan lagi suamiku, Alhamdulillah,Jodohkan aku dengan yang lain segera.
Jauhkankanlah dengan dia ..

Tapi kalau jodohku, Jauhkanlah. …Jika dia berjodoh denganku, maka jadikanlah kami tidak berjodoh..dan bermusoh dan berbenci selalu atau tidak megingati satu sama lain, tidak merindui satu sama lain,

Kalau dia jodohku juga , jangan sampai dia berjodoh denganku lama-lama , atau menjadi suamiku lama-lama, Jodohkan aku dengan orang lain, selain dia.Seperti yang aku mahu.

Kalau aku tidak bisa di jodohkan dengan orang lain, seperti yang aku minta, jangan sampai dia dapat jodoh denganku, baiklah aku menjanda, atau berilah yang lain yang aku hargai, yang aku cinta, yang aku mahu, yang aku akan hormati sehingga mati, biarkan aku tidak berjodoh orang jahat seperti diri dia...

Dan pada saat aku telah tidak memiliki jodoh, jodohkanlah aku dengan orang yang aku cinta dan mahu, tetapi bukan dia.. bukan orang seperti dia..Kalau dia jodoh orang lain, kekalkanlah! Jodohkanlah bersama dengan dia itu... selamanya...tetapi bukan aku, Biar aku tetap menjadi jodoh orang lain, dan berbahagia, biarlah aku ketemu jodoh tetapi bukan dengan yang, seperti dia ,
dan kemudian Jodohkan kembali aku dengan si DIA dan dengan dia selamanya....“Amin…”.

Mencari Alasan

Hanya kerana satu gambar Kad kpd kawan U sanggup bersumpah tak mahu balek lagi?
Hanya kerana itu U sangup menuduh dengan penuh rasa benci bahawa I lelaki jahat?
Hanya kerana gambar itu u sanggup menghemburkan kata-kata yang menghina kasihsayang I selama ini? dan menyesal kerana nak balek Malaysia? Menyesal kerana tak dapat sambung kontrak?
Terpulanglah pada U. Tak perlulah mengunakan alasan yang sekecil itu untuk lari. I pun dah tahu dan merasakan, dah lama U bukannya ingin hidup dengan I. Sebenarnya U ingin yang lain. U suka I kununnya kerana I cerdik. Bukannya kerana Cinta. U akan temui banyak orang cerdik nanti. Mungkin sudah lama U temui, cuma menunggu masa sesuai saja. Buatlah apa yang U suka. Selama ini pun I tak ada kuasa membantah dan melarang.
Bertahun-tahun u membuat bakti kepada sekeliling orang dan kawan u disana. Macam-macam.
I apa dapat dari semua itu? Apa yang I dapat dari pengorbanan(?) itu?
Buatlah apa yang U suka. Selama ini pun I tak ada kuasa membantah dan melarang.
I tahu apa yang berlaku disana. Kita tenguk nanti siapa yang benar. U selalu mahu menang, Dan U akan sentiasa MENANG! dengan I.
Sehingga akhirnya tiada apa lagi yang U boleh mencari alasan! barulah puas hati U. Baharulah U akan merasa U cerdik. Biarlah I menjadi Bodoh.
I merasa bahagia sekarang mendengar sendiri apa yang terhambur dari mulut manis u.
U pun sudah bersumpah. I tak harap apa-apa lagi dari U. Get Lost!

Money in motion creates more money.

span How does money in motion produce additional wealth? This is possible only when each of the other nine principles are applied to your financial situation, coming together like a crescendo behind Principle 10. The appli- cation of all the principles builds momentum and creates opportunities to put your money to work in a variety of ways. Applying each of the 10 prin- ciples at the same time has exponential power to transform your life, creat- ing a multiplier effect. Systematically building from one Money Mastery prin- ciple to the next and applying each principle on top of the other is like multiplying two times two times two times two: The end result is much greater than if those numbers are simply added together. That’s because each prin- ciple builds on the power and potency of the one that came before.
2 x 2 x 2 x 2 = 16
On the other hand, applying some of the principles part of the time is much like adding two plus two plus two plus two. You will see some results, but the overall effectiveness will be much less potent.
2 + 2 + 2 + 2 = 8
When you apply all of the principles all of the time by controlling yourspending, eliminating debt, planning for the future, and reducing your taxes, you are in a position to put your money to work for you so that it can do more than one thing at the same time, creating opportunities to maximize your wealth to its fullest; this is what Principle 10’s “money in motion” is all about.
The basic concept behind Principle 10 is learning how to get your dollar to do more than one thing at the same time. class="fullpost"> So how can money be put in motion to create more money? Let’s take a look at banks as a prime example of Principle 10. Suppose you deposit $1,000 ina bank. The bank pays you, in turn, 4 percent interest on that amount. What does the bank then do with that $1,000? Under the rules of the banking system,it can go to the Federal Reserve and get an additional amount to go with it,$10,000 for example. It now has $11,000 it can lend out at a much higher rate of interest than it pays you. Of course this is a simplified example of a very complex system, but it gives you an idea of how money in motion creates more money. Banks follow the very strict federal regulations that govern the banking indus- try, along with their own operating protocols to get your dollars to do more than one thing for them at a time. Take a closer look at how banks put money in motion, continually turning your money over and over to make a profit.If the bank lends out your money as part of a car loan and gets 10 percent interest on the loan, it will make 6 percent profit (af- ter paying you 4 percent in- terest ) on that car loan, right? Now when the car dealer gets the loan pro- ceeds, he puts that money into his bank. While the car dealer lets the money sit until needed, that bank loans his money out on a home construction loan at a rate of 9 percent. Then, the contractor for that con- struction job puts the
money in his bank and before he makes payroll or buys lumber, his bank has already loaned that money for a computer at 14 percent. When the com- puter dealer puts the loan proceeds into the bank, the bank turns around and loans it out on a boat for 10 percent. The boat dealer then deposits that money in his bank, and that bank loans it out on a Visa card at 18 percent.From this example you can see that $1,000 will typically multiply within the banking system eight to 10 times; often this will occur very quickly, within hours or days. The banks benefit every time that money turns over, no mat- ter what the rate—18, 6, 10, 8, and even 4 percent. If you add up all the turns on that original $1,000 in a year, the banking system will have earned between 38 to 42 percent while you only earn 4. Who’s winning this game? The point is, that if like the bank, you can get your money to do more than one thing at a time, you can look forward to both safety for your money and higher rates of return. This idea is worth repeating:
If you can get your money to turn over, or in other words, do more than one thing at the same time, you can makea constant and higher rate of return on that money.
In the prior bank example, we showed how these institutions literally turn money over and over again. In this next example, we’ll demonstrate how more than just money can be put in motion to build more income and wealth. Take for instance a large public company that sells shares of stock. Let’s say this company builds roads and bridges and takes the money from the sold shares to buy road-graders and other machinery. It then uses this equipment over and over again on many jobs, “turning” it many times to make a profit. The equipment only needed to be purchased once, but is used many times over to create additional wealth. This company, rather than getting a set “rate of return” on their money like its share holders, actually uses its equipment to turn over a greater and more continual profit.“Okay,” you might be thinking, “that’s fine for banks and large public com- panies, but what about me?” Let’s apply this concept of “money in motion” on a more personal level through the following account of one of our clients.

My Vital health stat?

Today 12.05.2008 i have a helth check up. Done by somebody but not in medical line.

Weight: 58.5 Kg
Age: 49-59
Ages 52
Height: 158 cm
Gender :Male
Body fat: 21.7. Female should be 50%-55% Male should be 60%-65%
Viceral fat:11 bad [1-6 healthy, 7-8 alert, 9-12 bad, over 13 Alarming]
Muscle mass 43.4 so i got 6 standard [ 1-Hidden Obesse, 2-Obese,3-Solidly build, 4-Under exercise,5-Standard, 6-Standard mascular, 7-Thin, 8-Thin and nascular, 9-Very mascular
Physic rating: 5
Bone Mass: 2.4
Kcal: 1239
BMR:41

Serabut yang tak dapat di urai oleh suara Suami.

Mungkin sudah bangun. Maaf kerana ganggu sekejap. Harap Ina banyak bersabar. I faham kalau I tak mau bercakap dlm keadaan serabut perut. I pun sebih suka begitu. I can imagine what U feel right now. Dalam keadaan serabut perut kita akan tension dan kekadang bercakap tidak mengikut otak.Dan boleh mencetuskan ketegangan.Boleh bergaduh tak tentu pasal. Sedih jugak kalau difikirkan dan di kenang-kenangkan suara I ni tak boleh membantu menguraikan serabut Ina. Tapi, I kena terimalah hakikat ini. Soon when u dah OK dan Tak serabut kita boleh bersembang lagi.Harap relax.Tabah. Berdoa. Kalau tidak bercakap dengan i membuatkan Ina rasa lebih selesa dan atau sekurang-kurangnya tidak menambahkan lagi serabut, Well it ok.

Arab Saudi

Arab Saudi di Kuasai oleh keluarga diraja Saud.Kerabat mereka ini bertanggungjawab menghalau sharif Husin dari hijaz dengan bantuan inggeris. Mereka berpegangkuat kepada aliran wahabi yang kununnya sangat membenci Bidaah. Sikap mereka adalah suka meminta-minta bantuan kuasa asing untuk menghapuskan mnusuh-musuhnya.Inilah sikap tradisi mereka. Kalau dulu mereka meminta bantuan kafir inggeris, diakhir-akhir ini mereka suka meminta bantuan kafir Amerika.Kah! Kah! nampaknya mereka si arab-arab ini lupa nak menghukum apakah perbuatan mereka itu bidaah atau tidak.
Dan kalau diberi peluang lah mana kota yang nak di Bom dulu antara Tabuk dengan Israel, mana yang dipileh? Hah ha Tabuk duluu yang patut di Bom kerana disitu ramai laknat yang berperut busuk! Read here:
Newsbreaking and controversial -- an award-winning investigative journalist uncovers the thirty-year relationship between the Bush family and the House of Saud and explains its impact on American foreign policy, business, and national security.

House of Bush, House of Saud begins with a politically explosive question: How is it that two days after 9/11, when U.S. air traffic was tightly restricted, 140 Saudis, many immediate kin to Osama Bin Laden, were permitted to leave the country without being questioned by U.S. intelligence?

The answer lies in a hidden relationship that began in the 1970s, when the oil-rich House of Saud began courting American politicians in a bid for military protection, influence, and investment opportunity. With the Bush family, the Saudis hit a gusher -- direct access to presidents Reagan, George H.W. Bush, and George W. Bush. To trace the amazing weave of Saud-Bush connections, Unger interviewed three former directors of the CIA, top Saudi and Israeli intelligence officials, and more than one hundred other sources.His access to major players is unparalleled and often exclusive -- including executives at the Carlyle Group, the giant investment firm where the House of Bush and the House of Saud each has a major stake.

Like Bob Woodward's The Veil, Unger's House of Bush, House of Saud features unprecedented reportage; like Michael Moore's Dude, Where's My Country? Unger's book offers a political counter-narrative to official explanations; this deeply sourced account has already been cited by Senators Hillary Rodham Clinton and Charles Schumer, and sets 9/11, the two Gulf Wars, and the ongoing Middle East crisis in a new context: What really happened when America's most powerful political family became seduced by its Saudi counterparts?
-From muttawa blogspot

Here My Home!

126 Question For NWAFH but you need to answered.

Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Quality dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya?

• Demonstrates accuracy and thoroughness
  Tunjukkan ketelitian dan saksama
• Displays commitment to excellence
  Tampilkan kesanggupan untuk keunggulan
• Looks for ways to improve and promote quality
  Mencari jalan dan cara untuk memperbaiki dan meningkatkan mutu
• Applies feedback to improve performance
  Mempergunkan maklumbals bagi memperbaiki kerja
• Monitors own work to ensure quality
  memonitor cara kerja untuk memastikan mutu

Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Quantity dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya?

• Meets productivity standards
  menepati piawai produktivi
• Completes work in timely manner
  Melengkapkan atau menyelesaikan tugasan dan kerja tepat pada waktunya
• Strives to increase productivity
  Gigih dan Bekerja keras untuk meningkatkan produktiviti
• Works quickly
  Bekerja dengan cepat dan tangkas
• Achieves established goals
  Mencapai sasaran yang ditetap dengan mapan

Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Planning & Organization dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya

• Prioritizes and plans work activities
  Memberi Prioritas dalam rencana , pekhidmatan dan aktiviti
• Uses time efficiently
  Gunakan waktu secara efisien
• Plans for additional resources
  Rencanakan untuk mendapat daya-sumber tambahan
• Integrates changes smoothly
  Integrasikan perubahan-perubahan dengan lancar
• Sets goals and objectives
  Objektif dan sasaran hasil di-set atau di tetapkan
• Works in an organized manner
  Bekerja dengan satu cara yang diorganisir dan tersusun kemas

Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Management dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya.

• Develops project plans
  Mekembangkan dan membangun perencanaan projek
• Coordinates projects
  Koordinir dan menyelaras projek-projek
• Communicates changes and progress
  Menghebah serta Komunikasikan perubahan-perubahan dan kemajuan
• Completes projects on time and budget
  Mensiapkan proyek-proyek tepat waktu dan sesuai dengan anggaran
• Manages project team activities
  Atur-urus aktivitas projek berkumpulan

Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Job Knowledge dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya.

• Competent in required job skills and knowledge
  Berkompetensi di dalam melaksanakan pekerjaan yang diperlukan berpengetahuan dan mahir
• Exhibits ability to learn and apply new skills
  Menunjukkan kebolehan utuk belajar dan mengunakan kemahiran baru
  
• Keeps abreast of current developments
  Mengambil tahu mengenai perkembangan semasa
  
• Displays understanding of how job relates to others
  Menunjukan kefahaman bagaimana kerja berkaitan dengan yang lain-lain
  
• Uses resources effectively
  Mengunakan sumber dengan berkesan

You as worker must be deem as cumtomer by Hospital management. And you as Nurses must be deem your patient as customer. Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Customer Service dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya.

• Displays courtesy and sensitivity
  Memperlihatkan sensiviti dan keramahan
  
• Manages difficult or emotional situations
  Mengurus masaalah dan situsi emosional
  
• Meets commitments
  Memenuhi komitmen
  
• Responds promptly to customer needs
  Berindakbalas sewajarnya terhadap kehendak pengguna
  
• Solicits customer feedback to improve service
  mempergunakan teguran dan aduan pelanggan bagi memperbaiki perkhidmatan

Note: I heards a lot of ramblings from you especialy about Gaji related. please be precise when you answred this question. Dont feel sorry. You are paids according to job you have done. You are not social worker.You sacrife a lots for this gaji.

You are salesperson to the patients and your Hospital are salesperson to you as employee. Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Sales Skills dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya.

• Achieves sales goals
  Mencapai sasaran jualan
  
• Overcomes objections with persuasion and persistence
  mengatasi bantahan dengan perundingan dan kerjasama
  
• Initiates new contacts
  Memulakan hubungan baru
  
• Maintains customer satisfaction
  Menjaga kepuasan pelanggan
  
• Maintains records and promptly submits information
  Menyimpan rekod dan melaporkan dalam waktu yang wajar

NWAFH terutama ER Adalah sebuah organisasi.Apakah yang berlaku di ER /Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Organization Support dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya.

• Follows policies and procedures
  Mematuhi polisi dan peraturan
  
• Completes administrative tasks correctly and on time
  Menyelesaikan tugasan pentadbiran dengan betul dan tepat
  
• Supports organizations goals and values
  Menyokong matlamat dan nilai-nilai organisasi
  
• Benefits organization through outside activities
  Mengharumkan nama jabatan melalui kegiatan luar
  
• Supports affirmative action and respects diversity
  Menyokong tindakan yang diputus bersama dan menghormati kepelbagaian

Sebagai Nurse atau doktor kemahiran anlitikal adalah amat penting. Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Analytical Skills dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Adakah superior anda mempunyai analytical skill?Apa yang mereka sudah lakukan?

• Synthesizes complex or diverse information
  Mempermudahkan maklumat yang sukar dan komplek
  
• Collects and researches data
  Mengumpul dan menyelidik data-data
  
• Uses intuition and experience to complement data
  Mengunakan ilham dan pengalaman bagi menyokong data
  
• Identifies data relationships and dependencies
  Megenal pasti perkaitan data-data dan dependencies
  
• Designs work flows and procedures
  Mereka bentuk peraturan dan aliran kerja

During your work in ER you meet a lot of problems. From anybodys. Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini adalah berkaitan dengan Problem Solving dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya. Bagaimana dengan cara mereka menyelesaikan masaalah?

• Indentifies problems in a timely manner
  Mengenalpasti masalah dalam watu yang singkat dan sesuai
  
• Gathers and analyzes information skillfully
  Mengumpul maklumat dan menganalisa maklumat dengan mahir
  
• Develops alternative solutions
  Membangunkan penyelesaian alternatif
  
• Resolves problems in early stages
  Menyelesaikan masalah diperingkat awal
  
• Works well in group problem solving situations
  Bekerja dengan baik dalam situasi kumpulan bagi menyelesai masalah

Pengurusan kos adalah amat penting dalam segala pekerjaan. Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini adalah berkaitan dengan Cost Consciousness dan berkaitan dengan kerja. Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya. Bagaimana dengan cara mereka menyelesaikan masaalah?

• Works within approved bujet
  Bekerja dalam lingkungan buget yang diluluskan
  
• Conserves organizational resources
  Menjimatkan sumber organisasi
  
• Develops and implements cost saving measures
  Membangunkan dan melaksanakan langkah penjimatan kos
  
• Contributes to profits and revenue
  Menyumbang kepada keuntungan dan pendapatan

Kepimpinan adalah segalanya dalam sebuah Hospital. Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Leadership dan berkaitan dengan interpersonal . Siapa terlibat? bagaimana contoh buruk dan baik mereka? Bila? Apa cadangan bagi mencapainya?

• Exhibits confidence in self & others
  Menunjukkan keyakinan pada diri dan orang lain
  
• Inspires respect & trust
  Mencetus rasa hormat dan kepercayaan
  
• Reacts well under pressure
  Bertindaj dengan baik semasa dalam tekanan
  
• Shows courage to take action
  Menunjukan galakan untuk bertindak
  
• Motivates others to perform well
  Memotivasi orang lain untuk bekerja cemerlang

Semangat kerjasama adalah penting dalam tugas. Adakah Pengurusan, Doktor, Nurses, Incharge, dan jabatan-jabatan lain mempunyai atau tidak mempunyai perkara dibawah ini? soalan ini berkaitan dengan Cooperation dan berkaitan dengan inter personal . Siapa terlibat? bagaimana contoh? Bila? Apa cadangan bagi mencapainya.

• Establishes and maintains effective relations
  Memelihara dan membibitkan hubungan berkesan
  
• Exhibits tact and consideration
  Mempamirkan konsiderasi dan ketegasan
  
• Displays positive outlook and pleasant manner
  Menunjukan pandangan positif dan budi yang luhur
  
• Offers assistance and support to co-workers
  Menawarkan bantuan dan sokongan pada rakan setugas
  
• Works cooperatively in group situations
  Berjasama dalam situasi berkumpulan
  
• Works actively to resolve conflicts
  Bekerja kuat untuk menyelesaikan konflik

Job Related in NAWF: Nurse Stress?

Sources of stress in nursing The role of nursing is associated with multiple and conflicting demands imposed by nurse supervisors and managers, and by medical and administrative staff. Such a situation appears to lead to work overload and possible to role conflict. One form of such conflict often mentioned in surveys of nurses relates to the conflict inherent in the instrumental and goal-oriented demands of "getting the patient better" and those related to providing emotional support and relieving patient stress. Role conflict of this kind may be most obvious when dealing with patients who are critically ill and dying. Indeed, one of the areas of nursing that has attracted particular attention has been critical or intensive care nursing. Health care is also a sector which suffers a high rate of violent behaviour (see our pages on violence at work).
Many studies on stress in nursing have attempted to measure, or have speculated on, the effects of such stress on nurses’ health and well-being. There appears to be general agreement that the experience of work-related stress generally detracts from the quality of nurses’ working lives, increases minor psychiatric morbidity, and may contribute to some forms of physical illness, with particular reference to musculoskeletal problems, stress and depression.

So What NWAFH do about stress prevention for nurses?

your guess as good as me!

Read more here:ILO and tell the managements what should they done.Give your feedback to the Director of Hospital.

Nurse creative thinking note

CREATIVE THINKING STRUCTURE
A Amass info
F Four way Thinking
D Definition
A Alternative
N Narrow down
C Choose/consequences
E Effect/act Upside Down esp people Problem Start with solution i.e. tsetse fly
AFARCE
A Alternatives
F Four way Thinking
R Recombine
C Choose which meet createria?
E Effect/Act
BRAINSTORM/FORCE QUANTITY
C cut Out A Add?
S Subtract
P Put To Other Use E Adapt?
R Rearrange
ADD CONDITIONS FOR SPARK RULES
no initial label
no rule except new perspective
ANALYTICALTHINKING PROBLEM SOLVING
DANCED
Definition question are tool for truth the 5 why system thinking
A Alternative
N Narrow down
C Choose/consequences
E Effect/act
DECIDING
A Assumption?
F For?
A Against?
N Now What?
MENTAL MODEL Form early persist tree
ATTIUDES
Persevere admit doubt fight for reason
checklist
A-assumption
B-big idea
C-calarity
D-depth
E-eyes ponit of view bias
F- fact or opinion or evidence
G- goal
I-implication / conssequences

Good, bad and ugly of Selayang Hospital

I PEN this account to inform all those concerned of some major flaws in our public hospitals which must be corrected.
Let me declare, at the outset, that this is not a complaint. My intention of going public with this matter should be seen as a genuine attempt at assisting the Ministry of Health (MOH) to correct some nagging problems that have been plaguing our public hospitals.
This is a personal experience which took place in Selayang Hospital, a new hospital located 15km north of Kuala Lumpur. I will not mention the names of the surgeons involved out of respect for them here but will refer to them as Mr B and Mr A, as surgeons are professionally addressed as 'Mr'. (However, I must respectfully inform them that their names will be mentioned in my official report to Tan Sri Dr Ismail Merican, Director-General of Medical Services, Malaysia, who had requested me to furnish him details of what actually happened.)
This is my story.
My Aunt Lucy (my late father's youngest sister) was referred to Selayang Hospital by the Sarawak General Hospital in Kuching. She is 63 years old and was diagnosed with pancreatic cancer on June 26 this year. It has been a long, agonising three-month wait for her to undergo an operation (a hepatobiliary procedure).
When she was finally informed by the Kuching Hospital in mid-September that an operation date has been scheduled for her in Selayang Hospital on Oct 3, she was elated but sadly, her joy was short-lived.
SEPT 30 (Sunday): She followed the Kuching hospital's instructions to the letter, flew to Kuala Lumpur on Sept 30 and was duly warded in Selayang Hospital the same evening. She was accompanied by my cousin, Alice, from Kuching.
In passing, let me mention some minor hiccups. The ambulance from Selayang Hospital which was supposed to turn up at the KLIA on Sept 30 to pick up my aunt never came. So, Alice called a cab instead. Arriving in Selayang Hospital at about 2.30pm, Alice later informed me that she was 'pushed here and there' for more than three hours before she finally managed to get our aunt warded at 6.00pm. I later learnt that this mismatch was due more to the fault of the Kuching side rather than Selayang's.
OCT 1 (Monday): The next day was a smooth, happy and stress-free one. My aunt was seen by the doctors and was duly taken for a CT scan. After that, she was specifically informed that the operation would be performed on Oct 3 (as scheduled). That night, my aunt was jovial and slept well. She felt very comfortable in the hospital - the second-class ward was air-cond with two attached bathrooms. She only had praises for this comfort provided by the hospital. I was also profoundly impressed with this ultra-modern Selayang Hospital and the facilities there. This was also my first visit to the hospital although I have been living in Kuala Lumpur for many years.
Read more here

"woman of the house". Saudi Arabia?

...Husband will open the door and welcome you. There may well be an incense burner in the doorway, as a mark of greeting. Waft the smoke over your hair and clothes. Remove your shoes (best to come in sandals).
Husband will lead your wife to a back room. That is all you are going to see of her, all evening.
Coffee or tea, and dates, will be ready on a table. You sit down (better on the floor), drink, eat, talk "guy talk". You may hear sounds of movement and rustlings from the next room.At a certain point, husband will lead you thru to the next room where, miraculously, food will be laid out. The dishes are probably set out on a plastic sheet on the carpet. Nothing, and I am being absolutely serious here, beats eating in a reclining position, perhaps leaning on a decorative camel saddle, with the food at floor level, and using your hand (right, not left, but don't ask why) to eat.
There will be enough to feed a small army. Arab hospitality demands that guests should never leave hungry. When you see all those dishes for just the two of you, including one with several small roast chickens, do not make the foolish assumption that this is the main course. PACE YOURSELF.
When you have assured your host that you have eaten all that you can manage from what is before you, he will remove many dishes. However he will return and replace them with an even larger selection of larger dishes. Carry on eating. Aren't you glad you are lying down? (It allows the stomach to distend more easily).
When you have eventually finished (NB If you are the "BellyBuster" champion at your local restaurant's "All you can eat Prime Rib Night", don't try and eat everything, they will only bring out more, so that you won't leave hungry) , you get up as best you can, and repair to the room you originally started out in, where miraculously fresh coffee will have appeared. Resume the horizontal once more. More "guy talk". There will be more sounds of rustling from next door.
As the evening draws to a close, husband will leave you and return from the back room with your wife. Say your farewells, put your shoes on, waft the incense, and out you go. Your wife will then inform you that your host also has a wife, who did all the cooking, and laid out and removed plates for the menfolk, not to mention coffee, as well as doing the same for herself and your wife. And you thought it was just a miracle.
[There is a slight variation to this routine, if the guests are male relatives of the husband. In that case the wife may emerge to pour coffee, but she will have a cloth draped over her head (rather like the cloth you would cover your parrot cage with, to shut it up) . Not that she's going to say anything, of course, she will just pour the coffee; the cloth is thin enough to allow her to see the spout and the cups, without curious male relatives being able to see her face].
The main point of that etiquette guide was just to show how little the typical Saudi wife is able to get out and about in her own house when the men are around, never mind get out and about in society at large. If you're going to be confined to a backroom or under a parrot-cloth, how the hell are you going to go out and organize a social revolution?
I wish to God I knew the answer, apart from collectively battering the men of Saudi Arabia over the head with a blunt instrument. First, the womenfolk need to get their attention. As every woman knows, there are two ways to get a man's attention:
1. Switch off the TV when his favorite sport is on.
2. Deny him his conjugal "rights".
from muttawa.blogspot

Antara mitos dan fakta berkerja di Saudi Arabia

Jangan terperangkap dalam dilemma. Lebih baik bertanya daripada rasa teraniaya.
Some Myths & Truths about working and living in Saudi Arabia.
Many are interested in working in Saudi Arabia for a variety of reasons; however, most have one thing in common TO SAVE MONEY. The fact that there are NO taxes deducted from a pay cheque, no rent at the end of each month, no hydro bill, no telephone line rental bill, no insurance bill etc ... allows you to do exactly that. In addition to saving money, there can be a multiple opportunities to enrich one's life. Read more here

Mewarnakan Rambut

Soalan: Suami saya meminta agar saya mewarnakan rambut. Dia sukakan warna berambut perang, sedangkan saya berambut hitam. Boleh saya mewarnakan rambut dengan pewarna yang ada di pasaran bagi memenuhi hasratnya?.Faridah, Shah Alam.
Jawapan:
Mewarna adalah diizinkan dalam Islam, bahkan RasuluLah pernah menggalakkannya bagi menyanggahi iktikad Yahudi dan Kristian pada zaman tersebut yang menganggap mewarna rambut yang beruban sesuatu yang salah dalam agama...baca jawapan selanjutnya disini: fatwa .

Ministry wants Local Women Going Abroad Alone to Get Family Consent

Gila! Apa pendapat ina? Ministry wants Local Women Going Abroad Alone to Get Family Consent. marina Mahathir have are arguments. Read more here