KKIA Kuchai (Klinik Kesihatan Ibu dan Anak)

These are my experience and opinion of KKIA Kuchai which serves Sri Petaling and Bukit Jalil:-

The contact number for KKIA Kuchai is 03-79801178. The number listed in the website is wrong.

1) the clinic is NOT on the ground floor. You press for your number on the ground floor but you will need to go one floor up to wait for your turn.

2) be there early because it covers a wide area therefore there's a crowd by 10am. I arrived at 8:06am and got number 35.

3) for new cases, it's best to go on Wednesdays as the nurse takes blood every Wednesday. Also note that they handle new cases from 8am to 10am only.

UPDATE:-
They handle new cases on Tuesday and Wednesday but they require you to make an appointment through phone before going.

4) the best time to go is when you are 12 to 13 weeks into your pregnancy.

5) as with all government clinics, expect to wait. Then again even with good private gynae, the wait is the same.

6) do not be alarmed if the numbers being called jumped from 20 to 50. This is because in this clinic, every patient is automatically assigned a nurse. This will be the same nurse that will attend to you from Day 1 until you deliver (unless she is on leave that day).

So the numbering progresses according to that particular nurse's list of patients and the tests (blood, urine, blood pressure etc) which the patients have to take.

7) the clinic is very organized with rooms assigned for taking blood, checking heart beat, opening account and explaining the do's and don't of pregnancy (but I personally think that by filling in your highest education in the pink book, the nurse know the level of information they need to impart).

Anyhow many important information can be found from the pink book itself.

8) lastly, there are a lot of foreign nationals moms to be there.. possibly from the influx of foreign workers in Kuala Lumpur, thus adding to the crowd but all the nurses are very patient even when they have to write the same information twice (once in your pink book and then another time in the clinic's pink book which they keep as a record).

9) there is NO ultrascan machine in KKIA Kuchai :(
That is why you are requested to bring your own ultrascan printout at the time of registration.

Not many KKIA have the machine but I know KKIA Puchong has one.

So basically in this KKIA the nurse will feel for the baby with their bare hands and use the doppler to listen for the heart beat.

I commented to the nurse on this and she recommends that I write to Kementerian Kesihatan to complain, which I did.

The Kementerian was very efficient in replying through an acknowledgment email and a phone call follow by an official reply:-

Basically they are saying that since March 2013 they have requested for the machines but reiterates that for every acquisition by the government will take time and there's a process which they have to follow.

So let's see if my baby will enjoy this machine and if not, I hope other moms to be will not have to wait too long for this one important piece of equipment.

UPDATE @ 4 December 2014:
Yahoo!! KKIA Kuchai just received their spanking new ultrasound machine last week!! Yeah.. but it's not up and running yet as the doctors need to go for training first on how to use it.

Still it's great news! :D

Audio test for baby with high jaundice (BSER)

Since my baby had jaundice of 361, the doctor in HUKM prescribed an audio test, Brain Stem Evoked Responds (BSER) to be taken when he is 3 months old.

Imagine the anxiety of having to wait that long before you can breath a sigh of relief that the jaundice ordeal is completely over.

At HUKM government hospital we had to book the date when baby was one month plus and the hospital gave a set of instructions to ensure that the test can be carried out without any hitch.

Because for the test to be successful, baby must be sleeping. So it is suggested that we wake the baby earlier and not let him sleep during the journey to the hospital.

Otherwise if the baby is awake, they will give medicine in syrup form that will cause baby to sleep. If the medicine does not work, then the last option will be to fix another date where the baby will be admitted one day before the test and then in the morning, they will apply anaesthesia.

Gulp! So scary..

So I was sleepless and up early at 5am plus on the day of appointment

For the test, the attendant attached 4 wires to his head, 2 in the center and 2 behind both his ears.

Initially she will apply a type of abrasive gel with a paper to remove dead skin to ensure strong adhesion.

Then she will scoop another type of adhesive gel with the cup shape connecting point to be attached to the head.

It was not easy to mount these things plus there is also an ear piece (the blue wire) which play the sound. Left ear first and then the right ear.

Thank God, baby was very cooperative and to help him to sleep, I breastfed him during the test.

The readings are captured by the computer which comes out in a graph form. For each ear, there were 3 graphs.

The results came back good! Praise God!

But the doctor did asked if I have other babies and when I said this is my first child, he mentioned that since there is no other siblings to compare with, he would recommend self monitoring.

Meaning babies will usually talk between 12 months to 18 months.

So if baby still do not know how to make 2 syllable sounds by then, I will need to make another appointment for audio test.

But for now, I'll leave it as that cos the results showed that my baby can hear so I am ecstatic that the jaundice did not affect him physically. Woo HOo!!

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But the funny thing was, a few days AFTER the test, I almost wet the baby's ear during bath... so me being overly concerned that water may have seeped into his ear, used babies cotton buds to "dry" his ear.

I was surprised to find on the cotton bud very strong dark coloured earwax.. Motivated by this "find", I proceeded to clean the next ear with cotton bud.

Having cleaned both his ears, I felt a niggling feeling that perhaps it is not safe to clean his ears... so I googled on it.

Lo and behold... to my horror!! We are NOT supposed to use cotton buds on babies ear.. Those earwax will somehow make it's way out and you just clean the outer part of the ear http://www.babycenter.com!!

And to think that we have just done the audio test a few days earlier to confirm baby's hearing is ok and here am I causing potential damage to his hearing... GULP!!

My only saving grace was that I did not dig real deep plus I was using cotton buds for babies with large tips. Phew!

So mothers out there.. Know what you can and cannot do! Google first before you do it and not like me.. do then check.. Hehe..

So cotton buds on ears are a definite no no.. no matter how "dirty" the ear may look inside.

Post delivery care for your vagina wound

If you deliver by natural birth and if there is tear or the doctor made incision or cut for you, then the doctor will also made stitches for you.

Since there are stitches then you have to take care of the wound so that it will heal properly.

FIRST IS TO PREVENT FURTHER DAMAGE

Take stool softening medication like Duphalac (from Abbott) or Lactul (from Y.S.P.) because you would not want any further damage whenever you pass motion.

Personally I prefer Duphalac because Lactul is sweeter than Duphalac.

Also bear in mind if you plan to breastfeed that your body tends to be more dehydrated which translate to "harder"stools :(

So Dupholac is a must. In fact I consume a total of 3 plus bottles for about 3 months because during my confinement, I did not consume much fruit thus aggravating the situation.

Note the different prices. Cheapest @ AA Pharmacy RM17.80

Also during post delivery, you may be prone to having piles or hermorrhoids because of the dehydration. So to prevent, try passing motion frequently like twice a day (ideally) and drink more fluids.

One symptoms I had of hermorrhoids is itchiness in the bottom after passing motion. Really an annoying post delivery symptom.

Plus there were numerous times where I suffered "cuts" from passing hard motions where it bled momentarily as well.

TREATMENT
So to prevent major cut to the anus, I read that to help pass out hard stool, use a finger and apply pressure near the opening of the anus.

And if you suffer from piles or hermorrhoids, do Kegel Exercise throughout the day and even night.

When taking hot showers, use a finger to GENTLY push the protruding part into the anus. It also helps to do Kegel exercise simultaneously as you push the part in as it help to suck that part in.

APART FROM STOOL SOFTENING

Initially I was afraid to take a mirror to look at my "bottom" because of the stitches and all but when I finally found the courage to do so, I noticed I had "yellow" spots in certain parts.

Yellow spots (enlarged) in the vagina area

My KKIA nurse and  my gynae nurse said these are normal. I just need to keep the vagina area:-

1) clean 

2) dry

3) aired

4) sizt bath

5) kegel exercise

How to do this?

Clean is obviously with water.

Dry means tissue follow by blow drying with hair dryer with cool air

Aired means do not use thick sanitary pads. Use panty liners if there's no more blood discharge etc. And if possible do not use even panty liners.

Sizt bath for me means soaking with hot salt water for 15 minutes. Initially 2 times a day but increased to 3 times a day when I saw the yellow spots.

Use "garam halus" as it is easier to dissolve and I used about 3 handful each time. That's a lot of salt.

In addition I keep a pot of warm to hot water nearby to add when the bath water (I used normal heater water set to highest temperature) is not longer hot.

Apparently when the water is not hot, the bacteria which came out can go in again. So it's important to keep the water temperature hot during the 15 mins.

Normally by 10 mins the water in no longer hot, so I'll add hot and salty water.

I will use a timer and during the 15 mins, I do some simple arm exercises (for sample click tracy-anderson-arms-exercise) as well as Kegel exercise because Kegel along with Sitz Bath can really speed up the healing process.

Also getting a bigger pail is great if you have bigger hips like me.

Initially I used the blue official Sitz Bath pail but later I changed to the red pail cos I find the water level in the blue pot too low to reach those yellow spots.

So now after 4 months of delivery, I am glad to say that proper care, Kegel exercise and Sitz bath, there were no permanent damage and I have complete healing from the initial cut and tear as well as post delivery cuts from passing motion.

Also thankfully whatever piles or hermorrhoids which I suffered during the first 2 months are also gone! :D

Baby jaundice emergency - what to do in Malaysia

If you have read my previous entry you would have known that my newborn baby was admitted to hospital on Day 6.

I would like to share on the chain of events in the hope that it would prevent others from making the same mistakes as me.

First you must understand that if you are breastfeeding, then do not consume any herbal medication. Read my post breastfeeding-and-eu-yang-sang-products-jaundice.

Secondly to check for jaundice, press on baby skin with your finger. It should NOT be yellow after you release the finger. The most yellow part would start from the head, follow by the chest, arm and getting less at the feet.

Also jaundiced baby are very lethargic. Will only sleep and not wake even for milk.

Medically there are a few ways to check jaundice level but the most accurate method is by blood test.

And by Malaysian standard, the type of treatment is determined by the level of jaundice.
Above 400 - blood exchange
399 - 300 - phototherapy with 2 lights
Below 200 - phototherapy with 1 light

For my case on Day 6 at night, when I went to a pediatric for checkup, the doctor using a light sensor obtained a reading of 28mg/dL approximately 490umol/l.

He immediately recommended hospital admission but did mentioned that with high jaundice level, the light sensor's reading may not be accurate. I requested for a letter. My 1st mistake.

Referral letter from the pediatric to Pantai Cheras

With the letter, I rushed to Pantai Cheras because I delivered there.

I thought with the letter, baby can be admitted immediately. I was wrong!

I was told to wait for my turn to see a general doctor before he can direct me to the proper department.

I was shocked because there were a lot of patients waiting.

The right thing I did was:-
I stood in front of the nurse and refused to take a seat even though she kept telling me to sit.

The 2nd thing I did right was IMMEDIATELY ask if there are any phototherapy light available.

The answer was None!

Imagine if I had waited!!

Having learned this, I then googled for hospitals contact and called the hospitals first to know which have available light.

Results:-
Pantai Ampang and Sunway have but Sunway will only accept the baby and not me as there's no bed for adult available. Plus priorities are given to those who delivered at Sunway.

So I rushed to Pantai Ampang. Again I have to wait at the emergency room.. And it's no surprise that there's a crowd. But the nurses fast tracked me and I got to see a doctor soon.

When she saw the report and the high reading of 490, she gave us 2 options.

First - get a blood test to confirm the level.

a) If the reading is confirmed higher than 400 then baby will need blood exchange which Pantai Ampang does not have facility.

b) If the reading is lower than 400 then we can be admitted.

It is really not an option because it takes time to do the blood test and we would have wasted precious time if the reading is indeed more than 400.

So we chose to go to a government hospital in case the reading is really that high.

Again we made a MISTAKE of asking for Pantai Ampang doctor's referral letter.

Anyway with the letter we went to HUKM as only government hospitals have the proper facility for blood exchange.

AT HUKM

Once in HUKM we waited, yes waited to see the medical officer to take the blood, then wait even more (total of 5 long hours to be exact) in HUKM for the blood test.

The level was confirmed as 361.

Good news that baby don't need blood exchange.

Bad news - HUKM do not have bed available for us.

The medical officer told us to try HKL. I immediately broke down and cried.

By God's grace the medical officer took pity on us and helped us to get a place in the maternity ward instead of the NICU (Neonatal ICU).

By 3am, Baby was finally admitted and had to go through phototherapy with 2 lights and blood test every 6 hours (taken from the wrist) to monitor the jaundice level.

So my ordeal to get him admitted began 7pm and ended at 3am (8hours) that night and through all these hours all I did was keep feeding him breast milk.

In the ward, I set alarm every 2 hours and even carried him on my chest as he sleep under the light.

Thanks to all the prayers, breast milk and the fact that both me and baby are of same blood group, the level drop from 361 on admission date on to 273 in 43 hours.

Also a big thank you to all the doctors, nurses and staffs at HUKM for saving my baby's life!!

In addition, upon discharge, HUKM recommended a follow up audio test because high jaundice besides affecting the brain could also damage a baby hearing. Will blog on this experience in the future.

UPDATES:- click audio-test-for-baby to know more about this test.

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So what have I learnt:-

1) Always know which hospitals are the nearest to you and which have the best emergency service.

Knowing your options will save you time.

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2) If you decide to go to emergency government hospital, never ask for referral letters from other hospitals.

Having letters gave the impression that government hospitals are your last minute options. You only went to them because the private hospital rejected you or do not have the facility to treat you.

If you just go there with any medical emergency, like for my case, baby high jaundice, you have better chance of being accepted without any letters.

That is because throughout the conversation between the medical officer (MO) and the pediatric doctor in HUKM on the phone, I kept hearing the MO saying that we went to KPJ (which is govt staff lingo for private hospital) and they did not accept our case for a good 3 minutes before the doctor on the other end rejected us by saying there is no bed available.

This is my personal opinion because I feel that if they are really full, they would have rejected us outright instead of having that long conversation.

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3) Referral letters cost money $$. My bill at the pediatric was RM70 and RM102.15 at Pantai Ampang.

RM102.15 for medical advice only. There were no medical tests done at all except taking of body temperature. I suspect the amount is for the referral letter which is now in HUKM's record.

RM70 bill from the pediatric

RM102.15 bill from Pantai Ampang

Breastmilk storage bottles - Autumnz or Bumble Bee

For breastmilk storage bottles - even though Bumble Bee's are slightly more expensive than Autumnz, they are worth your money because of just one point.

Yes ONE point!

Autumnz sealing cap always comes off by itself because it does not fit properly!

And when it does, it somehow manages to land on the sink's dirtiest spot :( humph.... and you will have to wash it again  ヽ(ಠ_ಠ)ノ 

I have used Bumble Bee's many times and not once do they come off by itself because the fit is perfect and you need to use force to remove it from the cover.

Comparison chart:-

IMPORTANT NOTE:

I never use the electric sterilizer for these bottles because PP bottles are BPA free. So they tend to have a cloudy look and can withstand heat until 120 degree celcius.

Water boils at 100 degree but steam can be more than 120.. Anyway Bumble Bee's staff also wrote this on their page:-

Therefore it is not recommended to use electric sterilizer SO for me, I just use tap water and liquid cleanser to wash and then dry. So far baby's stomach is ok with this method :D

Breast pumps - manual or electric?

Since I have tried both, my verdict are as follow:-

Manual pump
Pro
1) Less parts to wash and assemble (depending on model)
2) Cheaper
3) Total control on speed and suction

4) More natural suction like babies'

Con
1) Tiring for the hand
2) Might not be able to empty breast cos your hands are tired from the pumping

Electric pump
Pro
1) Not tiring. With practice, you can even be hands free without using the hands free bra
2) Can empty the breasts

3) Adjustable speed and suction power (depending on model)

Con
1) Price price price.. With Medela Freestyle going for RM1,499 (this is the cheapest price for this model in the market), it's no wonder people think twice before buying an electric double pump.

But fret not as there are many cheaper and affordable brands out there.

2) More parts to wash and there are more parts to be carried - the pump, tube and power adaptor.

VERDICT
The choice of pump will depend on how often you intend to pump.

If occasional pumping (once or twice a day), then manual will do. But if you are full time working mother, then do yourself a favour and get double electric pump!

See the guideline chart below on choosing the type of Medela's range of breast pump:-

Disposable breast pad comparison

This is a comparison among 3 brands of disposable breast pads - Pigeon, Autumnz and Lacte.

My CONCLUSION is unless Pigeon is on offer (RM30 for 72pcs), Lacte deluxe pads are just as good (RM16.90 for 36pcs).

But I definitely WILL NOT buy again Autumnz (RM15.90 for 30pcs) because not only is the material coarser, the adhesive left a sticky feeling on the fingers. A definite no-no for me.

PACKING
Both Autumnz and Lacte come in plastic wrapping. Pigeon's wrapped with thin cotton sheet.

SHAPE
Both Pigeon and Lacte are almost flat.

Autumnz is contoured like alphabet C which is shaped like the breast - Which is supposed to be fantastic but somehow it made the pad more uncomfortable especially when your breasts are engorged.

Possibly due to the fact that this design made the pad rigid and not soft to gently cup / cover the breast.

ALTERNATIVES to disposable breast pads:-
Using disposable breast pads are not cheap considering a normal Pigeon price will cost rm1 a piece - thus rm2 for both sides.

Even babies diapers which have more features and are bigger in size only cost maximum rm0.70 apiece.

So I read somewhere in the internet that a person tried to take panty liners and cut it in half.

I actually went and tried it but I have to make sure to seal the open end with tape. It did worked (especially if you dont leak a lot) but you might get some cotton on the breast if you did not seal off the cut end properly :p

But recently I found out the reason for the high price when I accidentally soaked the breast pad - the pad became jelly like inside and expanded - meaning the pad is filled with special gel like diapers and not just cotton or fiber like panty liners! Ta-DAA!

So for convenience and the fact that Lacte disposable breast pads are reasonably priced, I will just stick to using disposable breast pads and leave the panty liners alone :D

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ADDITIONAL PHOTOS OF THE BOXES

Pigeon

Pigeon

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Autumnz

Autumnz

Autumnz

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Lacte

Saving Trend

Just a thought:- Is it possible to find coin boxes nowadays?

Do children save money in coin boxes nowadays? Or does the parent even teach their children to save money?

Or have coin boxes become obsolete and suffered the same fate as cassette tapes and camera films?

How many people can remember the old clay coin boxes which does not have a bottom opening as the only way to get the money out is to break it?

These used to come in designs of chicken.. perhaps it is synonym to chicken storing and laying eggs :D but for the westerners, they prefer the piggy bank design.

Do share your experiences if your children does save and how do you encourage them to save.

Bail Procedure in Malaysia

Recently I had to attend criminal court because a friend was unwittingly implicated in a voluntarily causing hurt case or better known as a s323 case because the offence is punishable under section 323 of the Penal Code.

So I went for the remand order [RO] hearing. Because for the police to detain him for more than 48 hours, there must be an order from the Magistrates.

But of course we would like to bail him out because if not he will be sent to the Sungai Buloh prison.

Apparently:-

- an accused are not allowed any visitation rights during their first week.

- convicted are not allowed visitation during their first month there.

HOW TO POST BAIL

But in order to post bail, you MUST make sure you have sufficient money with you or in the bank as there are ATM machines in the court premise.

Basically once bail is allow by the court, you have to go downstairs to the bail counter which will issue a letter to you.

With this letter, you can then open a special savings account in any bank and a savings account book [savings book] will be issued.

You will then deposit the savings book with the court.

So you do not actually pay cash or cheque to the court, which is quite dangerous. Also with this method, the court can ensure that you cannot withdraw the money.

Each bail will have its own specific instructions. For example, the accused must:-

a) report himself every month to a police station specified by the accused
b) surrender his passport
c) not to go near the complainant or complainant's families

And most importantly, both the accused and the bailor attend court on any given future court hearing or mention dates. Failure to attend court will result the bail money being forfeited.

Even with medical reasons, the bailor must attend court and inform the court with valid proof and all these record of attendance must happen before the court starts hearing at 9am.