INTERVIEW WITH DR. JULINA JOHAMI
Please tell us a little about yourself. Where do you practice and what are your primary clinical interests?
For the past 7 years, Hospital Tuanku Ja'afar Seremban has been my place of practice. It is a tertiary referral centre with 850 beds serving the state of Negri Sembilan, Malaysia, with a population of a million.
Currently in Malaysia most anaesthesiologists spread their time between providing anaesthesia and being part of the critical care team. I am no different. The bulk of my practice involves providing anaesthesia for the surgical specialties at the hospital which is also the referral centre for elective upper and lower gastrointestinal surgery, knee and hip arthroplasty and retinal surgery to name a few. Seremban is situated just south of the capital Kuala Lumpur and being close to the North-South highway sees its fair share of trauma cases due to motor vehicle/road traffic accidents.
I particularly enjoy regional anaesthesia and paediatric anaesthesia.
Dr. Johami (center) and Dr. Mafeitzeral (MSIGRA member) conducting a workshop at the recent Malaysian Society of Anaesthesiologists Annual Scientific Meeting 2012 Pre-Congress Workshop in US-guided Regional Anaesthesia in Kuantan, Pahang.
What do you feel is the value of regional anesthesia in pediatrics?
Regional anaesthesia in the paediatric population should be performed more regularly. In my opinion, the joy and satisfaction of seeing a pain-free child who is coherent and alert post-operatively is priceless. And that is one of the main reasons why I am a proponent of regional anaesthesia in children. The advent and increased use of ultrasound-guided regional anaesthesia has made a tremendous impact in the practice of regional anaesthesia not only in the adult population but also in paediatric age group. USGRA has improved the safety profile of block performance. This should prompt us to perform regional anaesthesia more frequently in children.
What is the state of pediatric regional anesthesia in Malaysia? Are there any obstacles to its practice?
Malaysia often follows the trends happening in the world of anaesthesia. Here there is a certain hesitance to performing regional anaesthesia in the paediatric population. That cannot be denied. Worry about nerve damage is real. Often this hesitance stems from a variety of reasons: lack of knowledge, a lack of interest in the performance of regional anaesthesia and also a shortage of equipment required to perform the blocks. Many smaller centres are not equipped with nerve stimulators or ultrasound machines. After all, the children are under general anaesthesia anyway...so why would they need a peripheral nerve block? Having said that there is a growing interest in regional anaesthesia and paediatric regional anaesthesia. Our workshops are often the most popular at local conferences so I'm hoping that as more anaesthesiologists are exposed to regional anaesthesia it can only result in regional anaesthesia being adopted into clinical practice more enthusiastically not only in the adult patients but also the children.
Your society, the Malaysian Society of Anaesthesiologists, created a special interest group in regional anesthesia. What were its objectives and what has been the result of its work?
The Malaysian Special Interest Group in Regional Anaesthesia (MSIGRA) started out small but we are an enthusiastic bunch and had big plans. It came about in 2008 after four friends threw ideas at each other over a coffee break during a small workshop on regional anaesthesia. We agreed that it would be a great idea to gather anaesthesiologists who shared the passion for regional anaesthesia into a cohesive group. And so these core members set out to recruit RA comrades and through various meetings resolved to set-up the SIG.
The main objective of our SIG was to establish a local, regional and international network connecting RA enthusiasts. Through the SIG, we would also be able to share resources and provide a forum for discussion. The bulk of our work has been in the dissemination of RA knowledge and information via the organising of workshops and teaching/training programs. This method has proven to be very popular and effective in achieving our objective of "spreading the word." The Ministry of Health Malaysia had also enlisted the help of the SIG in formulating the National Regional Anaesthesia Registry which was launched this year.
It was hard work and continues to be challenging. The future for our SIG is to encourage research at the local level and to set-up collaborative efforts with our friends in the RA field both regionally and internationally. We are also working towards formulating a training program in regional anaesthesia and setting-up a training centre in Regional Anaesthesia.
Dr. Hanapi Md Tahir (founding MSIGRA member), workshop facilitator at NYSORA Asia 2009 KL.
Do you plan on attending the NYSORA Asia meeting in 2013 in Manila? If so, what do you hope to learn and experience at these events?
I am looking forward to joining in the fun at NYSORA Asia in Manila next year along with other members of the MSIGRA. It would be a great opportunity to catch-up with friends from the region and those from further afar. I hope that the MSIGRA members will be able to contribute actively towards the meeting as speakers and also workshop facilitators after now running many workshops here in Malaysia. As always, the conference will provide updates on the most recent developments in the world of regional anaesthesia and pain management. It will be a chance for me to learn about the Filipino culture too as I have never visited Manila before.
Dr. Shahridan Fathil, MSIGRA Convener, currently attached to Alexandra Hospital, Singapore. Invited speaker and facilitator at loco-regional conferences in RA.
What are some of the unique aspects of practicing anesthesiology in Malaysia?
I am blessed as I work in a facility that is fully equipped with the most up-to-date tools to provide anaesthesia. However, this isn't the case in the more remote areas of Malaysia. Thus, there still exists the challenge of providing safe anaesthesia with more modest equipment.
We in Malaysia share the similar fate of tight healthcare resources that is common the world over. This makes providing the best of anaesthetic care to the public sometimes difficult. So we come up with innovative ways to make do with the resources that we have apportioned to us.
The multicultural population in Malaysia always provides for a colourful experience in the medical world. Communication is often tricky with the many languages that are spoken by our patient community. There also sensitivities peculiar to an ethnic group which we in the medical profession must be aware of. The multicultural population also provides us with the opportunity to compare and contrast the effects of anaesthesia in the different groups allowing for distinctive and unique research ideas.
The awareness of anaesthesiology among the general public is still poor. The pre-operative meeting with the anaesthesiologist is often also an education opportunity for the anaesthesiologist to introduce to the patients his/her role. There have also been many national programs in held in conjunction with World Anaesthesia Day to improve public awareness about anaesthesia.
Dr. Shahridan and Dr. Johami (with delegates from Thailand and Philipines) at NWAC Dubai 2010.
The NYSORA Asia meeting took place in Kuala Lumpur in 2009. What are some of your favorite memories from the meeting?
NYSORA Asia KL 2009 was truly memorable! It was the first time members of the MSIGRA participated in and contributed towards an international conference. It was nerve-wracking but totally enjoyable. The conference itself was a resounding success and that motivated us to organise more workshops. Being the host country, we also had the honour of taking our speakers and workshop facilitators out to tour Kuala Lumpur. I remember how some of our speakers like Admir Hadzic and Manoj Karmakar were willing to try Pewter decoration. They were great sports.
On a more personal note, the KL meeting was the beginning of me being part of the NYSORA Preceptorship program. This allowed me to be part of the associate faculty at the inaugural NWAC Dubai 2010 and the 4th Pan-Asian NYSORA Symposium 2010 in Bangkok, Thailand. The experience I garnered from these meets has helped me tremendously when I run workshops here in Malaysia. I now have many friends the world over connected through the common love of regional anaesthesia. Priceless!