Wednesday, July 1, 2015

2482. How to be an excellent vet in Myanmar - talk to final year students - draft for video production

Myanmar is rapidly developing with property prices increasing very high in 2015 . New veterinary clinics for pet dogs and cats are set up in Yangon just as in Singapore.



Comfort zone - work overseas









EMPLOYEE BEHAVIOUR
A sense of responsibility
Respect for elders, the boss
Respect for self
Strong work ethic

DESIRES OF SINGAPOREAN GENERATIONS

1-2-3-4   (1 wife, 2 children, 3-room apartment, 4 wheels). Generation born in the 1930s.
5 C's   (Cash, car, condominium, credit card and country club). Generation born in the 1950s after the second World War
Work-life balance and different desires. Generation born in the 1970s 

Is there hunger in your belly? No weekend work, no shift work, no evening work, more pay. 
Migrants work hard and long hours

Stress. Burnt-out. Take holidays. Appointment system.

Pro-active
Skills and experience - welfare cat and dog sterilisation
Continuing education, other skills like digital photography, case recording and research


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GIVING BACK TO SOCIETY
More animal welfare groups formed to advocate for the care of stray dogs, cats and wild animals. TRN - trap, neuter and spay in Yangon.  RABIES CONTROL in Yangon and Bali by vaccination of at least 70% of community dogs instead of culling them.

Giving back to society by Toa Payoh Vets - education of the pet owners. Be Kind To Pets project
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HOW TO BE AN EXCELLENT VET IN MYANMAR  LECTURE 2015
Lecture 2014 given in:

Part 1:  https://www.youtube.com/watch?v=Tco7lmAId3Y&feature=youtu.be

Part 2:  https://www.youtube.com/watch?v=IqzcEL2Tw6s&feature=youtu.be

Part 3:  https://www.youtube.com/watch?v=qxWrYm6FsCs&feature=youtu.be



1. PERSONALITY OF A VET
2. GIVING BACK TO THE COMMUNITY


Pl extract some footage from the following video:
https://www.youtube.com/watch?v=H0iuMV5vsxI
(About Dr Thein Tun Aung).






PERSONALITY OF A VET -  MOTIVATION  TO EXCEL          
1. 18:08 - 22:31   SACRIFICES AND HARD WORK TO ACHIEVE EXCELLENCE
                            GET OUT OF YOUR COMFORT ZONE (image).




                            GET OVERSEAS VETERINARY EXPERIENCE AFTER GRADUATION.
                            Insert subject  "About Dr Thein Tun Aung's 20 years of veterinary experience in Singapore".
                            Write subtitles for Naing to narrate in the Myanmar language as this was not done.



2.  8.27 - 11.50                             PASSION, HARD WORK, SACRIFICES AND PERSEVERANCE.
                           For example, Dr Aung used his day off to observe Dr Sing's case of a bone lodge between the dog's gullet and stomach.

Naing to narrate in Myanmese

3.  0.49 - 3.34
                           VOLUNTEER TO ACQUIRE MORE EXPERIENCE FROM A MENTOR. Dr Thein Tun Aung volunteered his time off to assist Dr Sing in a house-call



                           THE CASE OF THE FEARLESS VET - NEEDLE IN A CAT'S THROAT.
                           There are subtitles. Naing will narrate in Myanmar.




GIVING BACK TO SOCIETY by Dr Thein Tun Aung

                               GIVING BACK TO YOUR COMMUNITY AND UNIVERSITY
1.  11:56 - 14:05      TALK TO YEZIN FINAL YEAR STUDENTS IN AUG 2014










      15:25 - 16:55     DEMONSTRATING SURGERY TO YEZIN FINAL YEAR STUDENTS IN AUG 2014




2.      GIVING BACK TO THE VETERINARY COMMUNITY by Dr Sing Kong Yuen


2.1   TALK TO YEZIN VET UNIVERSITY FINAL YEAR STUDENTS IN AUG 2014
Organised by Myanmar Veterinary Association and sponsored by Royal Asia Veterinary Surgery.

A rare opportunity for Dr Sing to meet a fisherman in Naypyitaw collecting his fish traps and to appreciate the pretty landscapes of Yezin Dam, near the University in August 2014.

 


 





2.  See "Corporate Social Responsibility" for video of BE KIND TO PETS and extract video footages

https://www.youtube.com/watch?v=wMlY4XcxHW0&feature=youtu.be

extract the following footage and combine

00 -- 2:52   How Dr Sing started the Be Kind To Pets project. Persevere to record case studies since 1991 when the world wide web was started to 2015. 

5:34 to 6:45  Writing case studies and making videos make you review your case and learn how to better deal with another similar case in future. This will make you a better vet.


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PATIENT SAFETY IS OF UTMOST IMPORTANCE AT TOA PAYOH VETS
Singapore pet owners worry much about anaesthetic deaths as they hear such stories from friends and read online articles.  Pets are family members all over the world and news of anaesthetic deaths may mean no more referrals to the practice, litigation and non-payment of fees.



For example,
1.  Dr Aung of RAVS uses the  Ap Alert  during an anaesthetic. It alerts him with a sound each time the patient takes a breath and also when the patient has not taken a breath.

2. Toa Payoh Vets use the Capnograph. This machine enables us to monitor an animals respiration rate, heart rate, blood oxygen levels, carbon dioxide levels, blood pressure and the amount of anaesthetic agent during an anaesthetic.







Image shows the veterinary operating table and anaesthetic machine of Toa Payoh Vets.

1. Isoflurane gas machine and oxygen are expensive but will be most important if the vet wants to get good outcomes from long surgeries such as Caesarean section (VIDEO)  and urinary stone removal.  (VIDEO). Every small animal veterinary practice is Singapore is mandated to possess such machines before they can be licensed.

This 2.5-hour perineal hernia surgery cannot be done with injectable anaesthesia without causing death. Gas anaesthesia was used.



Bilateral perineal hernias in a 10-year-old silkie terrier. The repair took 2.5  hours. With IV anaesthetics, the dog may die.  











Illustrate your complicated surgical cases for future references on "how the surgery was done" for old dogs and what anaesthetics were used.
Such records are made available on the company website for teaching of younger vets.
In this case  1 Maxon monofilament was used for the deep hernial repair. 3 layers of2/0 PDS were used.  A more expensive option will be to use the wire mesh.

(VIDEO).
Edit and shorten video with narrator's voice used  https://youtu.be/XjvYOjumAZw


2. An oxygen generator may be used instead of ordering oxygen cylinders.
3. An autoclave to sterilise instruments is important. (VIDEO)
4. Anaesthestic monitoring machines are useful for long surgeries. (VIDEO).
Edit and shorten video with narrator's voice used  https://youtu.be/XjvYOjumAZw

5. Injectable anaesthetics - IV and IM.


Edit and shorten this video
https://youtu.be/XjvYOjumAZw


For small practices without gaseous anaesthesia, IV anaesthestics like thiopentone may be used in Caesarean sections. The vet must top up the thiopentone and the dam and puppies may die as such surgeries take a long time. Therefore, such vets may not accept elective Caesarean section




5.1  In Toa Payoh Vets, I find that injectable anesthetics are safe for procedures like spay and neuter. I maintain with isoflurane gas + oxygen if necessary.

5.2 For young healthy cats less than 2-3 kg, I give xylazine 0.1 ml + ketamine 0.4 ml IM. For heavier cats of 3 - 4 kg, xylazine 0.15 + ketamine 0.6 ml IM. Heavier cats get xylazine 0.2 ml + ketamine 0.8 ml.


TABLE OF DRUG DOSAGE V. BODYWEIGHT

For young healthy dogs of 10 kg, my formula is domitor 0.4 ml + ketamine 0.5 ml IV. I find this formula very safe and effective in spaying of a young dog. However, the vet must be speedy in spaying by proper planning such as clipping the hairs of the surgical site before injection. Spaying should be completed within 20-30 minutes after injection.


TABLE OF DRUG DOSAGE V. BODYWEIGHT

For dogs older than 3 years, I give 50% of the formula and top up with isoflurane gas + oxygen, if necessary. (VIDEO. 8-year-old Husky X - ear irrigation, back area ringworm clipping and dental scaling).

5.3  Veterinary University's teachings. When I studied veterinary anaesthesia in 1973 (4th year of Glasgow University), the professor recommended sedation with acetylpromazine IM first, then thiopentone IV induction followed by halothane gas maintenance. Atropine is given to prevent bradycardia. In 2015, I note that the same procedures are taught. (VIDEO  Yesin Vet University)




5.4  Zoletil 100 anaesthesia. I find this drug very effective and safe for tumour removal surgeries in dwarf hamsters and the rat.  Dosage for dwarf hamsters is 0.01 ml IM and for the pet rat, 50mg-70mg/kg IM. Maintenance with isoflurane gas + oxygen is needed. (VIDEO of hamster anesthesia and rat mastectomy pre-op, op and post op using Zoletil 100 + gas mask).










Conclusion
Safe and effective anaesthesia usually lead to good anaesthetic outcomes.  You get more referrals and retain your clients in the intensively competitive field. In 2015, there are more than 70 vet clinics in Singapore. Singapore pet owners are better educated and have high expectations.



Without a gas machine, you lose out on growing your revenue as your client needing elective Caesarean sections has to go to the competitor with the machine!

Some competitors will tell your client not to use your services as they are better equipped!






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INFORMED CONSENT


SOP
Systematic  in treatment

Meticulous anaesthetic and surgical records - litigation


FINANCIAL MANAGEMENT
Without rich parents' investment, the following tips may be useful for small practices;

1.  Outsourcing the x-rays and blood tests are advised. However, some clients who prefer a fully equipped practice will not come anymore.

Account management
net profits   savings  SARS  MERS











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PERSONAL CHOICES - Homeless








A single person may be more useful to the company's bottom line if he has strong work ethic and a sense of responsibility. 








SUPPORT THE ARTS
Various art forms - performing, visual, literary, contemporary and traditional

Value the arts and culture in your society. You need to support it as artists need an audience.

1.gives you a better understanding of people from different backgrounds
2. helps you to express your thoughts, feelings and ideas
3. inspire you to be more creative in your work or studies
4. nurturing creativity and innovation




STRESS
Anxiety, Depression
FIC in a cat.


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  Standard Operating Procedures (SOP)
Speedy, Accuracy, Completeness
in Veterinary Surgery.  This requires a SOP so that there is a systematic process in anaesthesia, surgery. E.g Electro-cautery pad and machine ready

Hamster with leg wart video - Edit it, try put in some narrator's voice
Credit: Operating surgeon : Dr Daniel Sing


Evidence-based medicine






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Narrate as follows:

The police looks for evidence to solve a crime. In this case, a tourist coach was locked and parked in the hotel car park overnight. The next morning, the coach driver discovered the doors were unlocked and his sunglasses and some water bottles were stolen.  The police came to investigate (Images of police car and police woman)  




The packaged tourists left the hotel, thinking that the burglar must have used duplicate keys to enter the coach. After a few minutes of driving, the safety vent on the roof of the coach flew off!



The tourists scanned the expressway for the safety vent. The coach driver retrieved the vent from the road. This was the "evidence" for the crime scene investigation.

 In veterinary diagnosis, evidence must be gathered to help in solving the problem of the pet. This evidence includes blood and urine tests, X-rays, ultrasound as illustrated in the following case of a cat having difficulty passing urine (dysuria). In Ascites, you need to gather evidence as to the cause of ascites.

 



Digital X-ray machine



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WORK-LIFE BALANCE


 IMAGE -- YEZIN UNIVERSITY OF VET SCIENCE 2014 FINAL YEAR STUDENTS



IMAGE OF NEW GRADUATES  SINGAPORE




Family responsibility. The father needs to work to support the family.



IMAGE - Mother goes on holiday with child and parents.

After you graduate, you will find that career, family and society take up a lot of time. Families usually do not have the time of the workacholic who wants to be successful in his profession or business.






If you cannot balance these three demands, you will suffer burn-out, divorce (if married), depression, chronic diseases and early death. Some commit suicide as they cannot cope with the stresses of living.







Some solutions are:


1. Focus on the most important aspects of your work and do it well. Write a priority list of what you have to do for the day.

2. Let your employer know if you cannot cope with the caseload or find a better employer. Most employees prefer high pay and less work so as to spend time with the family and friends.  Be realistic as the company needs to make money to survive in a very competitive world.

3. For self-employed vets, have an appointment system to prevent over-work and str Gess in yourself and the staff. More than 40 small animal cases per vet per day may be considered too many.  The quality and standard of care will be poor if everyone has no

time to rest, eat well and exercise.  Staff will resign and new staff need to be trained.

4. Take at least 30 minutes/day to exercise or meditate.  Make new friends rather than just hang around with your group. Enjoy your hobbies like photography.



5. Eat healthy foods to prevent high blood pressure and dying from diabetes and kidney diseases.    




6. Be interested in how other professionals become successful. For example, in my tour, I met a  French artist selling his paintings at the market. He works around 6 months per year, so that he has time for his family. He told me how he markets his paintings through his website and got buyers from China.  I bought a small painting from him.





7.  Have a hobby and learn how to be good at this hobby. My hobby is digital photography. I met this fisherman near a Naypyitaw police station. This police signboard looks like a framed painting. I have not seen such a pretty signboard in Singapore. 





Here are some intesting photographs I took in Myanmar. A rice-field fisherman wearing similar shirt pattern as me. Another interesting photograpoh of a smoking woman in Yangon.  The pretty landscape of the Yezin Dam and 2 boats near the Vet University in August 2014.





 





Support the Arts. For example, appreciate paintings and support the artists.











Friendship, romance, marriage, motherhood and career - It is very difficult to balance it all. You have to decide on what goals you want to achieve in your life after graduation. Be a stay-at-hoe mother or father if that is what you want.


Conclusion

To be successful in being a very good vet - sacrifices are needed as you focus on acquiring skills and expertise in your profession. It is hard to acheive a work-life balance if you want to be the best veterinary surgeon in your field. 

The image shows a car accident from Naypyitaw to Yangon in August 2014. I was fortunate that it was not a serious accident for me and my friends. On the road from Naypyitaw to Yangon, there is a road side signboard in English. It says: "Life is a Journey. Complete It."

Your life after graduation to retirement is like a journey. Have a strong work ethic and a sense of responsiblility. Be honest. Do not get involved in drugs and cheating people. Or you will end up in a police station. De-stress with a hobby like travel photography. You will enjoy more of life and learn more about other culture. My digital image of of Myanmar police station is shown. It must be the prettiest police station signboard in Myanmar.






Be humble. Respect your seniors. Know how to communicate with your clients.  You will be able to complete your journey as a good veterinarian.   





CREDITS

Follow the same as in 2014 Talk. See the Part 2 of the 3 videos.


This is the 2nd Talk to Final Year Yezin Vet Students
Video of tThe 2014 Talk is at:
https://www.youtube.com/watch?v=Tco7lmAId3Y&feature=youtu.be  - Part 1


https://www.youtube.com/watch?v=IqzcEL2Tw6s&feature=youtu.be  - Part 2


https://www.youtube.com/watch?v=qxWrYm6FsCs&feature=youtu.be   - Part 3





MORE VETERINARY EDUCATION VIDEOS AT:
toapayohvets.com/videos.htm



2014 TALK TO FINAL YEAR STUDENTS

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