Oleh
Utz Zaharuddin Abd Rahman
Pada hemat saya, kita bolehlah mengatakan bahawa objektif atau sasaran yang perlu dicapai oleh Muslim di bulan Ramadhan ini kepada dua yang terutama. Iaitu taqwa dan keampunan. Perihal objektif taqwa telah disebut dengan jelas di dalam ayat 183 dari surah al-Baqarah.
Manakala objektif 'mendapatkan keampunan' ternyata dari hadith sohih tentang Sayyidatina Aisyah r.a yang bertanya kepada nabi doa yang perlu dibaca tatkala sedar sedang mendapat lailatul qadar.. Maka doa ringkas yang diajar oleh Nabi SAW adalah doa meminta keampunan Allah SWT.
Bagaimanapun, kemampuan untuk mendapatkan kesempurnaan pahala ramadhan kerap kali tergugat akibat kekurangan ilmu dan kekurang perihatinan umat Islam kini. Antara yang saya maksudkan adalah :-
1) Makan dan minum dengan bebas setelah batal puasa dengan sengaja (bukan kerana uzur yang diterima Islam). Perlu diketahui bahawa sesiapa yang batal puasanya dengan sengaja tanpa uzur seperti mengeluarkan mani secara sengaja, merokok, makan dan minum. Ia dilarang untuk makan dan minum lagi atau melakukan apa jua perkara yang membatalkan puasa yang lain sepanjang hari itu. (Fiqh as-Siyam, Al-Qaradawi, hlm 112).
Ia dikira denda yang pertama baginya selain kewajiban menggantikannya kemudiannya. Keadaan ini disebut di dalam sebuah hadith, Ertinya : "sesungguhnya sesiapa yang telah makan (batal puasa) hendaklah ia berpuasa baki waktu harinya itu" (Riwayat al-Bukhari)
2) Makan sahur di waktu tengah malam kerana malas bangun di akhir malam. Jelasnya, individu yang melakukan amalan ini terhalang dari mendapat keberkatan dan kelebihan yang ditawarkan oleh Nabi SAW malah bercanggah dengan sunnah baginda. "Sahur" itu sendiri dari sudut bahasanya adalah waktu terakhir di hujung malam. Para Ulama pula menyebut waktunya adalah 1/6 terakhir malam. (Awnul Ma'bud, 6/469). Imam Ibn Hajar menegaskan melewatkan sahur adalah lebih mampu mencapai objektif yang diletakkan oleh Nabi SAW. (Fath al-Bari, 4/138)
3) Bersahur dengan hanya makan & minum sahaja tanpa ibadah lain. Ini satu lagi kesilapan umat Islam kini, waktu tersebut pada hakikatnya adalah antara waktu terbaik untuk beristigfar dan menunaikan solat malam.
Firman Allah ketika memuji orang mukmin ertinya : " dan ketika waktu-waktu bersahur itu mereka meminta ampun dan beristighfar" (Az-Zariyyat : 18)
يارسولالله , أيالدعاءأسمع؟ : قال : جوفالليلالأخيرودبرالصلواتالمكتوبة
Ertinya : "Ditanya kepada Nabi (oleh seorang sahabat) : Wahai Rasulullah :" Waktu bilakah doa paling didengari (oleh Allah s.w.t) ; jawab Nabi : Pada hujung malam (waktu sahur) dan selepas solat fardhu" ( Riwayat At-Tirmidzi, no 3494 , Tirmidzi & Al-Qaradhawi : Hadis Hasan ; Lihat Al-Muntaqa , 1/477)
4) Menunaikan solat witir sejurus selepas terawih. Menurut dalil-dalil yang sohih, waktu yang terbaik bagi solat witir adalah penutup segala solat sunat di sesuatu hari itu berdasarkan hadith ertinya "Jadikanlah solat sunat witir sebagai solat kamu yang terakhir dalam satu malam". (Fath al-Bari, no 936). Sememangnya tidak salah untuk melakukan witir selepas terawih, cuma sekiranya seseorang itu yakin akan kemampuannya untuk bangun bersahur dan boleh melakukan solat sunat selepas itu, maka adalah lebih elok ia melewatkan witirnya di akhir malam.
5) Tidak menunaikan solat ketika berpuasa. Ia adalah satu kesilapan yang maha besar. Memang benar, solat bukanlah syarat sah puasa. Tetapi ia adalah rukun Islam yang menjadi tonggak kepada keislaman sesorang. Justeru, 'ponteng' solat dengan sengaja akan menyebabkan pahala puasa seseorang itu menjadi 'kurus kering' pastinya.
6) Tidak mengutamakan solat Subuh berjemaah sebagaimana Terawih. Ini jelas suatu kelompongan yang ada dalam masyarakat tatakala berpuasa. Ramai yang lupa dan tidak mengetahui kelebihan besar semua solat fardhu berbanding solat sunat, teruatamnya solat subuh berjemaah yang disebutkan oleh Nabi SAW bagi orang yang mendirikannya secara berjemaah, maka beroleh pahala menghidupkan seluruh malam.
7) Menunaikan solat terawih di masjid dengan niat inginkan meriah. Malanglah mereka kerana setiap amalan di kira dengan niat, jika niat utama seseorang itu ( samada lelaki atau wanita) hadir ke masjid adalah untuk meriah dan bukannya atas dasar keimanan dan mengharap ganjaran redha Allah sebagaimana yang ditetapkan oleh Nabi SAW di dalam hadith riwayat al-Bukhari. Maka, "Sesungguhnya sesuatu amalan itu dikira dengan niat". (Riwayat al-Bukhari)
8) Bermalasan dan tidak produktif dalam kerja-kerja di siang hari dengan alasan berpuasa. Sedangkan, kerja yang kita lakukan di pejabat dengan niat ibadat pastinya menambahkan lagi pahala. Justeru, umat Islam sewajarnya memperaktifkan produktiviti mereka dan bukan mengurangkannya di Ramadhan ini.
9) Memperbanyakkan tidur di siang hari dengan alasan ia adalah ibadat. Sedangkan Imam As-Sayuti menegaskan bahawa hadith yang menyebut berkenaan tidur orang berpuasa itu ibadat adalah amat lemah. (al-Jami' as-Soghir ; Faidhul Qadir, Al-Munawi, 6/291)
10) Menganggap waktu imsak sebagai 'lampu merah' bagi sahur. Ini adalah kerana waktu imsak sebenarnya tidak lain hanyalah 'lampu amaran oren' yang di cadangkan oleh beberapa ulama demi mengingatkan bahawa waktu sahur sudah hampir tamat. Ia bukanlah waktu tamat untuk makan sahur, tetapi waktu amaran sahaja. Lalu, janganlah ada yang memberi alasan lewat bangun dan sudah masuk imsak lalu tidak dapat berpuasa pada hari itu.. Waktu yang disepakti ulama merupakan waktu penamat sahur adalah sejurus masuk fajar sadiq (subuh). (As-Siyam, Dr Md 'Uqlah, hlm 278)
11) Wanita berterawih beramai-ramai di masjid tanpa menjaga aurat. Ini nyata apabila ramai antara wanita walaupun siap bertelekung ke masjid, malangnya kaki dan aurat mereka kerap terdedah da didedahkan berjalan dan naik tangga masjid di hadapan jemaah lelaki. Tatkala itu, fadhilat mereka solat di rumah adalah lebih tinggi dari mendatangkan fitnah buat lelaki ketika di masjid.
12) Memasuki Ramadhan dalam keadaan harta masih dipenuhi dengan harta haram, samada terlibat dengan pinjaman rumah, kad kredit, insuran, pelaburan dan kereta secara riba. Ini sudah tentu akan memberi kesan yang amat nyata kepada kualiti ibadah di bulan Ramadhan, kerana status orang terlibat dengan riba adalah sama dengan berperang dengan Allah dan RasulNya, tanpa azam dan usaha untuk mengubahnya dengan segera di bulan 'tanpa Syaitan' ini, bakal menyaksikan potensi besar untuk gagal terus untuk kembali ke pangkal jalan di bulan lain.
Nabi Muhammad menceritakan :-
ذَكَرَالرَّجُلَيُطِيلُالسَّفَرَأَشْعَثَأَغْبَرَيَمُدُّيَدَيْهِإلىالسَّمَاءِيارَبِّيارَبِّوَمَطْعَمُهُ
حَرَامٌوَمَشْرَبُهُحَرَامٌوَمَلْبَسُهُحَرَامٌوَغُذِيَبِالْحَرَامِفَأَنَّىيُسْتَجَابُلِذَلِكَ
Ertinya : menyebut tentang seorang pemuda yang bermusafir dalam perjalanan yang jauh, hal rambutnya kusut masai, mukanya berdebu di mana dia mengangkat tangan ke langit : Wahai Tuhanku...wahai Tuhanku... sedangkan makanannya haram, minumannya haram dan pakaiannya haram..Dan dia dibesarkan dengan memakan makanan haram maka bagaimana Kami mahu mengabulkan doanya. ( Riwayat Muslim, no 1015, 2/703 ; hadis sohih)
Justeru, bagaimana Allah mahu memakbulkan doa orang yang berpuasa sedangkan keretanya haram, rumahnya haram, kad kreditnya haram, insurannya haram, simpanan banknya haram, pendapatannya haram?. Benar, kita perlu bersangka baik dengan Allah, tetapi sangka baik tanpa meloloskan diri dari riba yang haram adalah penipuan kata Imam Hasan Al-Basri.
13) Tidak memperbanyakkan doa tatkala berpuasa dan berbuka. Ini satu lagi jenis kerugian yang kerap dilakukan oleh umat Islam. Nabi SAW telah menyebut :-
ثلاثةلاترددعوتهم , الإمامالعادل , والصائمحتىيفطرودعوةالمظلوم
Ertinya : "Tiga golongan yang tidak di tolak doa mereka, pemimpin yang adil, individu berpuasa sehingga berbuka dan doa orang yang di zalimi" ( Riwayat At-Tirmizi, 3595, Hasan menurut Tirmizi. Ahmad Syakir : Sohih )
Selain itu, doa menjadi bertambah maqbul tatkala ingin berbuka berdasarkan hadith.
إنللصائمعندفطرهدعوةلاترد
Ertinya : "Sesungguhnya bagi orang berpuasa itu ketika berbuka (atau hampir berbuka) doa yang tidak akan ditolak" ( Riwayat Ibn Majah, no 1753, Al-Busairi : Sanadnya sohih)
Sekian.
Pertubuhan Jaringan Komuniti Islam Kuala Lumpur atau JARINGAN ialah sebuah "NGO" yang ditubuhkan untuk mengeratkan lagi siratulrahim diantara penduduk Islam di Bandar Sri Damansara (BSD) khususnya dan penduduk dipersekitaran kawasan BSD am nya.
Announcement | Pengumuman
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Friday, August 28, 2009
Tuesday, August 18, 2009
Thursday, August 13, 2009
Bengkel Pengurusan Jenazah Muslimin
PADA HARI AHAD 16hb OGOS 2009,
JAM 8 PAGI - 5 PETANG
TEMPAT DEWAN MUSLIMAH, MASJID ALMUKARRAMAH
YURAN PENYERTAAN RM10 SHJ
ANJURAN BIRO KEBAJIKAN DAN JAIS
JAM 8 PAGI - 5 PETANG
TEMPAT DEWAN MUSLIMAH, MASJID ALMUKARRAMAH
YURAN PENYERTAAN RM10 SHJ
ANJURAN BIRO KEBAJIKAN DAN JAIS
Gotong Royong Membersih Masjid
PADA HARI SABTU 15hb OGOS 2009
BERMULA JAM 9 PAGI
SEMUA JEMAAH DIJEMPUT HADIR
Tolong bawa "tools" yang berkaitan.
BERMULA JAM 9 PAGI
SEMUA JEMAAH DIJEMPUT HADIR
Tolong bawa "tools" yang berkaitan.
Malaysia SME Congress
The MALAYSIA SME™ Congress is the first congress in Malaysia for SMEs to network. It will be a perfect annual platform for SMEs to learn, share, network, exchange information and strengthen the fellowship within the SME community. This congress will feature speakers from successful Malaysian SMEs of various background and industries to share their success stories, experiences and business skills. The congress is an initiative by MALAYSIA SME and the congress is supported by MITI, SMIDEC, MICCI, SME International and KLMCC. Thus, this will be the great opportunity for the SME companies to gather and develop their own businesses through this special networking event.
To register for the Congress, please fill in the e-form and submit back to us. An invitation card will be sent to you as confirmation once we have received your e-form. Should you have any inquiries, please do not hesitate to contact us at 1-300-88-6763.
Once again, welcome to the “Largest SME Networking Event Of The Year”.
Details of the congress:
Date : 18th August 2009
Venue : Sunway Pyramid Convention Centre
Time : 8.30am - 6pm
Admission is “FREE”
Tuesday, August 11, 2009
CIP Catalyst Informational Talk
“How Cradle Can Help Fund Your Innovative Ideas”
Warm greetings from Cradle Investment Programme (CIP) & MCA ICT Resource Centre (MIRC)!
Cradle Investment Programme in collaboration with MIRC, will be organizing a talk entitled “How Cradle can help fund your Innovative Ideas” to further explore many innovative ideas by talented individuals like you!
HOW WILL YOU GAIN FROM THIS TALK?
The objective of this talk is to provide valuable information and tips on how you can get CIP Catalyst funding of up to RM150,000 to help you develop your innovative ideas into commercially viable products.
Come and find out how Cradle Investment Programme (CIP) and its CIP Catalyst grants can help you on your way.
Date : 26th August 2009 (Wednesday)
Time : 9.00 am – 12.00 pm
Venue : Seminar Hall, Level 12, Wisma MCA, Jalan Ampang, 50450 KL
Programme:
8.30 am Registration
9.15 am ‘Introduction to Cradle Investment Programme (CIP)’
by Encik Rizal Alwani, Manager – Competency Building Unit, Cradle Fund Sdn Bhd
10.20 am Break
10.30 am ‘How to Apply for CIP Catalyst’ by Encik Rizal Alwani
11.30 am Q&A Session
12.00 pm END
*Note: While every effort has been made to ensure that the programme outlined above is accurate at the time of printing, CIP reserves the right to alter the programme depending on unforeseen circumstances.
Admission is FREE, but there are only sixty (60) seats available, so please register your attendance by emailing your interest to: enquiries@cradle.com.my
Warm greetings from Cradle Investment Programme (CIP) & MCA ICT Resource Centre (MIRC)!
Cradle Investment Programme in collaboration with MIRC, will be organizing a talk entitled “How Cradle can help fund your Innovative Ideas” to further explore many innovative ideas by talented individuals like you!
HOW WILL YOU GAIN FROM THIS TALK?
The objective of this talk is to provide valuable information and tips on how you can get CIP Catalyst funding of up to RM150,000 to help you develop your innovative ideas into commercially viable products.
Come and find out how Cradle Investment Programme (CIP) and its CIP Catalyst grants can help you on your way.
Date : 26th August 2009 (Wednesday)
Time : 9.00 am – 12.00 pm
Venue : Seminar Hall, Level 12, Wisma MCA, Jalan Ampang, 50450 KL
Programme:
8.30 am Registration
9.15 am ‘Introduction to Cradle Investment Programme (CIP)’
by Encik Rizal Alwani, Manager – Competency Building Unit, Cradle Fund Sdn Bhd
10.20 am Break
10.30 am ‘How to Apply for CIP Catalyst’ by Encik Rizal Alwani
11.30 am Q&A Session
12.00 pm END
*Note: While every effort has been made to ensure that the programme outlined above is accurate at the time of printing, CIP reserves the right to alter the programme depending on unforeseen circumstances.
Admission is FREE, but there are only sixty (60) seats available, so please register your attendance by emailing your interest to: enquiries@cradle.com.my
BSDRA | Saga Security Meeting
Attention all Jaringan members living in Saga area. BSDRA is calling for a Security Meeting (details below). Your attendance is highly appreciated.
Date: Saturday, August 15, 2009
Time: 4:00pm - 6:00pm
Location: Saga Room, Bandar Sri Damansara Club
Street: Persiaran Perdana
City/Town: Kuala Lumpur, Malaysia
All Saga residents are invited to a meeting to discuss about SNS.
Meeting Agenda:
1. Appointment of new working commitees for Saga sector;
2. Proposed SNS program by pro-term Saga Volunteer WC;
3. Proposed SNS collection fees;
4. Speech by BSDRA president 2009-2010;
5. Speech by Ketua Polis Bdr Sri D'sara &
6. Presentation by CEO of security company.
Attendance is COMPULSORY as SNS program will be implemented according to the majority during the meeting.
Thank you for your support.
Date: Saturday, August 15, 2009
Time: 4:00pm - 6:00pm
Location: Saga Room, Bandar Sri Damansara Club
Street: Persiaran Perdana
City/Town: Kuala Lumpur, Malaysia
All Saga residents are invited to a meeting to discuss about SNS.
Meeting Agenda:
1. Appointment of new working commitees for Saga sector;
2. Proposed SNS program by pro-term Saga Volunteer WC;
3. Proposed SNS collection fees;
4. Speech by BSDRA president 2009-2010;
5. Speech by Ketua Polis Bdr Sri D'sara &
6. Presentation by CEO of security company.
Attendance is COMPULSORY as SNS program will be implemented according to the majority during the meeting.
Thank you for your support.
Sunday, August 9, 2009
A(H1N1) flu: Updates on 10 FAQs
AUG 06, 2009
1) Can we distinguish between regular and H1N1 flu, without a lab test?
No, the flu is the flu, but there are variations in presentation. Some symptoms such as cough, runny nose, fever, body aches, fatigue, vomiting, diarrhoea occur more or less in every flu patient, but may present differently by different people. Some infected people have very mild symptoms, some in between, and a small minority, probably less than 10 per cent, have severe features including the dangerous pneumonia.
However, from sentinel testing and surveillance by the Ministry of Health the last few weeks have shown that almost 95 per cent of all flu-like illness are now caused by the H1N1 virus. Earlier some months ago, seasonal flu variants caused by the B and other A virus were the main causes, the bug causing most flu these few days is the A(H1N1). This appears to be the case also in neighbouring countries, meaning that the new virus is causing more havoc and symptomatic illness than previous types of flu (which are still in the community).
Because almost every flu-like illness (influenza-like illness or ILI) is due to H1N1, the MOH is now recommending that no testing to confirm this H1N1 will now be offered.
Treat as if this is H1N1 for ILI — symptom relief for mild symptoms (paracetamol, hydration, cough medicines, etc) and self-quarantine, social distancing, be alert for complications.
Most (70 per cent) do not need any anti-viral medications such as Tamiflu or Relenza. Only severe cases need to be referred to hospital for further treatment.
2) How should doctors decide if a person be given further specific treatment for H1N1?
If after 2-3 days, fever and cough symptoms do not improve, a recheck with the doctor is recommended, especially if there are features of difficulty breathing, severe weakness and giddiness, or, if the following risk factors are present:
1. obesity (fatter patients seem to have poorer outcome and more complications)
2. those with underlying diabetes, heart disease
3. those with asthma, or chronic lung disease
4. pregnant women
5. those with reduced immunity, cancer patients, etc
6. those with obvious pneumonia features
3) Many anxious people with flu-like symptoms want to be tested or treated for suspected H1N1, but are kept waiting or sent home, without being tested. Is this practice right?
There is no right or wrong practice as this outbreak is extensive and is stretching our resources to the limit. This is also the case not just here in Malaysia, but also elsewhere around the entire world!
The recommendation is now not to spend too much time and effort trying to get tested at designated hospitals or clinics — there is probably no need to do so. I have been informed that as many as 1,000 patients queue anxiously at Sungai Buloh Hospital for testing, due to fear of the H1N1 flu.
So the message must be made clear: Most flu illness do not require confirmatory testing, and are mild and self-limiting. More than 90 per cent will get better on their own, with symptomatic treatment — just watch out for possible complications, and risk factors as mentioned above.
Our resources are limited especially for testing. This is not just for Malaysia, but globally as well. The global demand for test kits and reagents for the H1N1 (PCR) is overextended and are rationed due to this extreme demand.
Some 200 million test kits have been deployed worldwide, but this supply is critically short because of excessive demand, so most countries have to ration testing to confirm only the worst cases, so as to monitor the pandemic better.
4) Are doctors confused as to what to do in this outbreak, especially when they do not have ready access to confirmatory lab tests?
Not really. Earlier on there was some confusion as to what to do next and who to test or who to refer for further testing and admission. Now the rules are clearer.
There is no need to do any testing to confirm the H1N1 virus for any ILI — just assume that this is the case in the majority of cases. Treat symptomatically when symptoms are mild, reassure the patients and ensure that these infected patients practice good personal hygiene, impose self-quarantine and social distancing, wear masks if their coughing or sneezing become troublesome, and keep a watchful eye on whether the infection is getting better or worse.
If there is difficulty breathing and gross weakness, then patients should quickly present themselves for admission. Understandably this phase of worsening is not always clear or easily understood by everyone... But there is not much more that we can do — otherwise we will be admitting too many patients and this will totally overwhelm our health services.
But prudent caution would help to determine which seriously ill patients need more attention and more intensive care. Unfortunately however, there will be that odd patient who will progress unusually quickly and collapse even before anything can be planned — hopefully these will be few and far between.
A more important note is that all doctors and nursing personnel should be very aware that they too have to take precautions, and employ barrier contact practices, if there are patients with cough and cold during this period of H1N1 outbreak, which is expected to last a year or two. Carelessness can result in the physician or nurse or nurse-aide becoming infected!
5) Are there sufficient guidelines from the Ministry of Health to address this situation?
I think there are sufficient guidelines from the MOH. Although some politicians have blamed the MOH and the minister for being inept at handling this pandemic — in truth this is not the case.
It is useful to remember that this is an entirely new or novel virus, which no one previously had encountered before — thus its infectivity and contagiousness is quite high and almost no one is immune to this virus.
Perhaps, there will come a time when all the resources from both public and private sectors can be put to more efficient use. Some logistic problems will invariably occur, because human beings differ in their capacity to understand or follow directives, whatever the source or authority.
Also patient demands have been extraordinarily high and at times very difficult to meet — every patient necessarily feels that his flu is potentially the worst possible type and therefore requires the most stringent measures and testing...
Doctors are also unsure as to the seriousness or severity of this new ailment — and we are only now beginning to understand this better — so our less than reassuring style when encountering this new H1N1 flu is sometimes detected by an equally anxious patient and/or their relatives.
But there is only so much that we can do under such a pressure cooker of an outbreak which is spreading like wildfire! But nevertheless we should not panic, and remember that most (more than 90 per cent) of infected people will recover with very little after-effects. Possibly only one in 10 patients develop more serious problems which necessitate hospitalisation.
6) Is limiting H1N1 testing only to those who have been admitted to hospital justifiable?
I have explained the worldwide shortage of such testing kits and reagents. Also it is near impossible to test everyone, the world over. Besides, knowing now that almost all the flu-like illness in the country is due to H1N1 makes it a moot point to want to test for this, especially when most are mild.
The rationale for testing only those who need hospitalisation is to ensure that we are dealing with the true virus, and also help to isolate possible changes or mutations to this viral strain. The MOH is also constantly doing sentinel surveillance (random spot-testing at various sites around the country to determine more accurately the various virus types and spread that are causing ILI).
7) Are we short of anti-virul drugs (Tamiflu, Relenza)? Should I take Tamiflu?
These antiviral drugs were available to most doctors during the earlier scare of the bird flu virus, but now are severely restricted, although some orders are still entertained from individual doctors, clinics or hospitals. Remember that these have been block-booked by more than 167 countries which have been shown to have been penetrated by the H1N1 flu bug.
Our MOH has actually stockpiled some two million doses of the Tamiflu or its generic form. In the last inter-ministerial pandemic influenza task force meeting, this stockpile will be bumped up to 5.5 million doses to cover some possible 20 per cent of the population.
Right now there is no shortage in the country. It is just that it is not readily available on demand for anyone just yet. The MOH is still of the opinion that this antiviral drug be used prudently and would like to register every patient given this drug.
The private sector on the other hand would like to have a looser control over the use of this drug — but we acknowledge that we should be meticulously prudent in its use. There is a genuine fear that resistant strains to this drug may develop with indiscriminate and unnecessary use — then we will all be in trouble with a drug-resistant H1N1 virus run amok!
Drug-resistant strains have been detected in Mexico, border-towns in the US, Vietnam, Britain, Australia even. So we have to be vigilant and closely monitor the situation. Right now, the very limited usage of Tamiflu gives us good reason to be optimistic.
However, because of some unusual patterns of seemingly well people dying or having very critical infections, some people and doctors are wondering if these new strains have already reached our shores... or have we been too late in instituting proper treatment...?
The rising number of deaths to 14 now is quite worrisome, but our health authorities are watching this development very closely and are also checking the virus strain to see if this has mutated. We can only hope that this is not the case, for now.
8) What are some of the problems faced by doctors in dealing with the H1N1 problem?
It would be good if every medical practitioner keeps a close tab on the H1N1 pandemic, and remain fully aware of the developments and changes, which are evolving daily. Every doctor has to be learning on the trot, so to speak, to keep up with the progress of this outbreak and its management, so that we can serve our patients better.
Logging in to the Internet regularly for more updated information will certainly help, instead of lamenting that not enough is being disseminated via the media thus far... Every doctor has to be more proactive and practice more responsible and cautious medicine during this trying period which is expected to run into at least one to two years. Importantly, look out for lung complications, and the above stated higher risk profiles, and refer these patients quickly for further care.
Easier access to antiviral drugs and their responsible use and monitoring would help allay public fears of delay in treatment, but this should be tempered with care and not over-exuberance to dish out to one and all, the precious antiviral drug, just for prevention — this may be a very bad move which can inadvertently create a worse outcome of drug-resistant bugs.
However, in the light of the very quick deterioration of some young patients who have died, it might be prudent to use antiviral treatment earlier and more aggressively.
We look forward to the specific H1N1 vaccine, when it does come our way, probably towards the end of the year. In the meantime, encouraging those in the front-line, heart or lung patients and frequent travellers to have the seasonal flu vaccination is a useful adjunct to help stem the usual problems from other flu types.
9) Are we doing everything that should or needs to be done?
Yes, if you check what other nations are doing, we are doing relatively well. We are not overstating the dangers and we have been quite transparent on the possibilities of this pandemic. Earlier, many agencies and even the public and doctors have accused us of exaggerating the pandemic, and our response was dismissed as being too much, even over the top! Unfortunately, it was only when some deaths occur that many are now decrying that we have done too little!
Also if you are quite honest about it, just compare with the countries globally, and you will notice that no one health or government authority has got this right, spot on.
We are all learning about this novel flu pandemic, and each country's response is coloured by its past experiences. In Hong Kong, China, Vietnam, Singapore and Malaysia we have had the SARS outbreak, so we are necessarily more paranoid! Also here the experience is that flu does not usually cause death in our community, unlike the west where seasonal flu kills some hundreds of thousands every year!
So the fear factor for this H1N1 flu is not nearly as great in the West, although it is slowly sinking in that its contagiousness and infectivity is far greater, and fears of its reassortment to a more virulent mutant form are growing, into the so-called second and/or third wave of this pandemic, but we will not know until a year or so down the line.
10) Is the public in general doing enough to help in controlling the outbreak?
I think the public is now reasonably well-informed as to this H1N1 pandemic. Perhaps, they are too well-informed, that they have a fearful approach to this virus. But the proper thing is not too over-react and to panic, although I know this does sound easier said than done.
It is almost a certainty that this flu will spread within the community — in schools, universities, academies, factories, work places, offices, etc. WHO has projected that possibly some 20-30 per cent of the population worldwide will become infected by this novel flu bug, after studying various models of spread of past infections — the huge and very rapid spread worldwide is mainly due to air travel. While older flu pandemics took six months to extend to so many countries, this H1N1 flu did so in less than six weeks!
In the worst-case scenarios of course, this outbreak will be alarming — hospitalisations may be required for 100,000 up to 500,000 Malaysians, with perhaps as many as 5,000 to 27,000 infected patients (depending on the case fatality rate or either 0.1 to 0.5 per cent) succumbing to this illness.
But because we have been monitoring closely and containing the outbreak thus far, with heightened awareness and greater social responsibility, it is possible to ameliorate the infectivity, spread and fatality that will unfortunately accompany this pandemic... Just how successful we will be in limiting these adverse outcomes remains to be seen, but we can be hopeful.
How can the public help? First learn and acquire good personal hygiene. If sick, please be responsible and stay at home, even in your own room where possible, wear a face mask (a cheap three-ply surgical mask will do, because large droplet spread is the main danger). Do not go out, practice what is now known as social distancing (about three metres from anyone), and be socially responsible, don't go to public places and infect others — for young people this would be hard, but absolutely necessary — the spread is most rampant in this age group between 16 and 25 years.
When the illness does not go away after a few days or when you are deteriorating, get to the nearest hospital. Most importantly, be very aware and responsible!
Finally, keep abreast of all new developments, because these are evolving all the time. With keen awareness, prudent care, early detection and social responsibility, correct and prompt use of antiviral and other support medical care, and later mass specific vaccination, we can overcome this novel H1N1 flu! But it will take time, patience, public cooperation, much concerted effort and consume great resources.
Article from Dr David KL Quek who is president the Malaysian Medical Association.
1) Can we distinguish between regular and H1N1 flu, without a lab test?
No, the flu is the flu, but there are variations in presentation. Some symptoms such as cough, runny nose, fever, body aches, fatigue, vomiting, diarrhoea occur more or less in every flu patient, but may present differently by different people. Some infected people have very mild symptoms, some in between, and a small minority, probably less than 10 per cent, have severe features including the dangerous pneumonia.
However, from sentinel testing and surveillance by the Ministry of Health the last few weeks have shown that almost 95 per cent of all flu-like illness are now caused by the H1N1 virus. Earlier some months ago, seasonal flu variants caused by the B and other A virus were the main causes, the bug causing most flu these few days is the A(H1N1). This appears to be the case also in neighbouring countries, meaning that the new virus is causing more havoc and symptomatic illness than previous types of flu (which are still in the community).
Because almost every flu-like illness (influenza-like illness or ILI) is due to H1N1, the MOH is now recommending that no testing to confirm this H1N1 will now be offered.
Treat as if this is H1N1 for ILI — symptom relief for mild symptoms (paracetamol, hydration, cough medicines, etc) and self-quarantine, social distancing, be alert for complications.
Most (70 per cent) do not need any anti-viral medications such as Tamiflu or Relenza. Only severe cases need to be referred to hospital for further treatment.
2) How should doctors decide if a person be given further specific treatment for H1N1?
If after 2-3 days, fever and cough symptoms do not improve, a recheck with the doctor is recommended, especially if there are features of difficulty breathing, severe weakness and giddiness, or, if the following risk factors are present:
1. obesity (fatter patients seem to have poorer outcome and more complications)
2. those with underlying diabetes, heart disease
3. those with asthma, or chronic lung disease
4. pregnant women
5. those with reduced immunity, cancer patients, etc
6. those with obvious pneumonia features
3) Many anxious people with flu-like symptoms want to be tested or treated for suspected H1N1, but are kept waiting or sent home, without being tested. Is this practice right?
There is no right or wrong practice as this outbreak is extensive and is stretching our resources to the limit. This is also the case not just here in Malaysia, but also elsewhere around the entire world!
The recommendation is now not to spend too much time and effort trying to get tested at designated hospitals or clinics — there is probably no need to do so. I have been informed that as many as 1,000 patients queue anxiously at Sungai Buloh Hospital for testing, due to fear of the H1N1 flu.
So the message must be made clear: Most flu illness do not require confirmatory testing, and are mild and self-limiting. More than 90 per cent will get better on their own, with symptomatic treatment — just watch out for possible complications, and risk factors as mentioned above.
Our resources are limited especially for testing. This is not just for Malaysia, but globally as well. The global demand for test kits and reagents for the H1N1 (PCR) is overextended and are rationed due to this extreme demand.
Some 200 million test kits have been deployed worldwide, but this supply is critically short because of excessive demand, so most countries have to ration testing to confirm only the worst cases, so as to monitor the pandemic better.
4) Are doctors confused as to what to do in this outbreak, especially when they do not have ready access to confirmatory lab tests?
Not really. Earlier on there was some confusion as to what to do next and who to test or who to refer for further testing and admission. Now the rules are clearer.
There is no need to do any testing to confirm the H1N1 virus for any ILI — just assume that this is the case in the majority of cases. Treat symptomatically when symptoms are mild, reassure the patients and ensure that these infected patients practice good personal hygiene, impose self-quarantine and social distancing, wear masks if their coughing or sneezing become troublesome, and keep a watchful eye on whether the infection is getting better or worse.
If there is difficulty breathing and gross weakness, then patients should quickly present themselves for admission. Understandably this phase of worsening is not always clear or easily understood by everyone... But there is not much more that we can do — otherwise we will be admitting too many patients and this will totally overwhelm our health services.
But prudent caution would help to determine which seriously ill patients need more attention and more intensive care. Unfortunately however, there will be that odd patient who will progress unusually quickly and collapse even before anything can be planned — hopefully these will be few and far between.
A more important note is that all doctors and nursing personnel should be very aware that they too have to take precautions, and employ barrier contact practices, if there are patients with cough and cold during this period of H1N1 outbreak, which is expected to last a year or two. Carelessness can result in the physician or nurse or nurse-aide becoming infected!
5) Are there sufficient guidelines from the Ministry of Health to address this situation?
I think there are sufficient guidelines from the MOH. Although some politicians have blamed the MOH and the minister for being inept at handling this pandemic — in truth this is not the case.
It is useful to remember that this is an entirely new or novel virus, which no one previously had encountered before — thus its infectivity and contagiousness is quite high and almost no one is immune to this virus.
Perhaps, there will come a time when all the resources from both public and private sectors can be put to more efficient use. Some logistic problems will invariably occur, because human beings differ in their capacity to understand or follow directives, whatever the source or authority.
Also patient demands have been extraordinarily high and at times very difficult to meet — every patient necessarily feels that his flu is potentially the worst possible type and therefore requires the most stringent measures and testing...
Doctors are also unsure as to the seriousness or severity of this new ailment — and we are only now beginning to understand this better — so our less than reassuring style when encountering this new H1N1 flu is sometimes detected by an equally anxious patient and/or their relatives.
But there is only so much that we can do under such a pressure cooker of an outbreak which is spreading like wildfire! But nevertheless we should not panic, and remember that most (more than 90 per cent) of infected people will recover with very little after-effects. Possibly only one in 10 patients develop more serious problems which necessitate hospitalisation.
6) Is limiting H1N1 testing only to those who have been admitted to hospital justifiable?
I have explained the worldwide shortage of such testing kits and reagents. Also it is near impossible to test everyone, the world over. Besides, knowing now that almost all the flu-like illness in the country is due to H1N1 makes it a moot point to want to test for this, especially when most are mild.
The rationale for testing only those who need hospitalisation is to ensure that we are dealing with the true virus, and also help to isolate possible changes or mutations to this viral strain. The MOH is also constantly doing sentinel surveillance (random spot-testing at various sites around the country to determine more accurately the various virus types and spread that are causing ILI).
7) Are we short of anti-virul drugs (Tamiflu, Relenza)? Should I take Tamiflu?
These antiviral drugs were available to most doctors during the earlier scare of the bird flu virus, but now are severely restricted, although some orders are still entertained from individual doctors, clinics or hospitals. Remember that these have been block-booked by more than 167 countries which have been shown to have been penetrated by the H1N1 flu bug.
Our MOH has actually stockpiled some two million doses of the Tamiflu or its generic form. In the last inter-ministerial pandemic influenza task force meeting, this stockpile will be bumped up to 5.5 million doses to cover some possible 20 per cent of the population.
Right now there is no shortage in the country. It is just that it is not readily available on demand for anyone just yet. The MOH is still of the opinion that this antiviral drug be used prudently and would like to register every patient given this drug.
The private sector on the other hand would like to have a looser control over the use of this drug — but we acknowledge that we should be meticulously prudent in its use. There is a genuine fear that resistant strains to this drug may develop with indiscriminate and unnecessary use — then we will all be in trouble with a drug-resistant H1N1 virus run amok!
Drug-resistant strains have been detected in Mexico, border-towns in the US, Vietnam, Britain, Australia even. So we have to be vigilant and closely monitor the situation. Right now, the very limited usage of Tamiflu gives us good reason to be optimistic.
However, because of some unusual patterns of seemingly well people dying or having very critical infections, some people and doctors are wondering if these new strains have already reached our shores... or have we been too late in instituting proper treatment...?
The rising number of deaths to 14 now is quite worrisome, but our health authorities are watching this development very closely and are also checking the virus strain to see if this has mutated. We can only hope that this is not the case, for now.
8) What are some of the problems faced by doctors in dealing with the H1N1 problem?
It would be good if every medical practitioner keeps a close tab on the H1N1 pandemic, and remain fully aware of the developments and changes, which are evolving daily. Every doctor has to be learning on the trot, so to speak, to keep up with the progress of this outbreak and its management, so that we can serve our patients better.
Logging in to the Internet regularly for more updated information will certainly help, instead of lamenting that not enough is being disseminated via the media thus far... Every doctor has to be more proactive and practice more responsible and cautious medicine during this trying period which is expected to run into at least one to two years. Importantly, look out for lung complications, and the above stated higher risk profiles, and refer these patients quickly for further care.
Easier access to antiviral drugs and their responsible use and monitoring would help allay public fears of delay in treatment, but this should be tempered with care and not over-exuberance to dish out to one and all, the precious antiviral drug, just for prevention — this may be a very bad move which can inadvertently create a worse outcome of drug-resistant bugs.
However, in the light of the very quick deterioration of some young patients who have died, it might be prudent to use antiviral treatment earlier and more aggressively.
We look forward to the specific H1N1 vaccine, when it does come our way, probably towards the end of the year. In the meantime, encouraging those in the front-line, heart or lung patients and frequent travellers to have the seasonal flu vaccination is a useful adjunct to help stem the usual problems from other flu types.
9) Are we doing everything that should or needs to be done?
Yes, if you check what other nations are doing, we are doing relatively well. We are not overstating the dangers and we have been quite transparent on the possibilities of this pandemic. Earlier, many agencies and even the public and doctors have accused us of exaggerating the pandemic, and our response was dismissed as being too much, even over the top! Unfortunately, it was only when some deaths occur that many are now decrying that we have done too little!
Also if you are quite honest about it, just compare with the countries globally, and you will notice that no one health or government authority has got this right, spot on.
We are all learning about this novel flu pandemic, and each country's response is coloured by its past experiences. In Hong Kong, China, Vietnam, Singapore and Malaysia we have had the SARS outbreak, so we are necessarily more paranoid! Also here the experience is that flu does not usually cause death in our community, unlike the west where seasonal flu kills some hundreds of thousands every year!
So the fear factor for this H1N1 flu is not nearly as great in the West, although it is slowly sinking in that its contagiousness and infectivity is far greater, and fears of its reassortment to a more virulent mutant form are growing, into the so-called second and/or third wave of this pandemic, but we will not know until a year or so down the line.
10) Is the public in general doing enough to help in controlling the outbreak?
I think the public is now reasonably well-informed as to this H1N1 pandemic. Perhaps, they are too well-informed, that they have a fearful approach to this virus. But the proper thing is not too over-react and to panic, although I know this does sound easier said than done.
It is almost a certainty that this flu will spread within the community — in schools, universities, academies, factories, work places, offices, etc. WHO has projected that possibly some 20-30 per cent of the population worldwide will become infected by this novel flu bug, after studying various models of spread of past infections — the huge and very rapid spread worldwide is mainly due to air travel. While older flu pandemics took six months to extend to so many countries, this H1N1 flu did so in less than six weeks!
In the worst-case scenarios of course, this outbreak will be alarming — hospitalisations may be required for 100,000 up to 500,000 Malaysians, with perhaps as many as 5,000 to 27,000 infected patients (depending on the case fatality rate or either 0.1 to 0.5 per cent) succumbing to this illness.
But because we have been monitoring closely and containing the outbreak thus far, with heightened awareness and greater social responsibility, it is possible to ameliorate the infectivity, spread and fatality that will unfortunately accompany this pandemic... Just how successful we will be in limiting these adverse outcomes remains to be seen, but we can be hopeful.
How can the public help? First learn and acquire good personal hygiene. If sick, please be responsible and stay at home, even in your own room where possible, wear a face mask (a cheap three-ply surgical mask will do, because large droplet spread is the main danger). Do not go out, practice what is now known as social distancing (about three metres from anyone), and be socially responsible, don't go to public places and infect others — for young people this would be hard, but absolutely necessary — the spread is most rampant in this age group between 16 and 25 years.
When the illness does not go away after a few days or when you are deteriorating, get to the nearest hospital. Most importantly, be very aware and responsible!
Finally, keep abreast of all new developments, because these are evolving all the time. With keen awareness, prudent care, early detection and social responsibility, correct and prompt use of antiviral and other support medical care, and later mass specific vaccination, we can overcome this novel H1N1 flu! But it will take time, patience, public cooperation, much concerted effort and consume great resources.
Article from Dr David KL Quek who is president the Malaysian Medical Association.
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