Showing posts with label health. Show all posts
Showing posts with label health. Show all posts

Saturday, December 19, 2015

Journal 5 - Life in Philadelphia

I always thought that off-campus program would be so much easier than regular school semester. Believe me, it is not! Working full time from 9 to 5 is pretty tiring, plus evening student worker shift and evening class. Some days, I would get home by 10 or 11 pm if I had to study at coffeeshop afterward. My two internships are good but I am not that excited anymore. My mood swings are like a roller coaster and currently, they are downward, maybe mainly because of my recent health problems.
In this Journal, I want to talk about how I recognized some of my privileges through my internship experience. Let me start off with my internship experience at PHMC care clinic which provides primary care for underserved population. My supervisor established Diabetes community including Diabetes Academy education program and community events  at PHMC care clinic. During my time at PHMC, I got an opportunity to plan and organize Diabetes Academy classes and its community events. I got a chance to meet people from different background with various health problems. My first impression on the patients was “Wow, they are really hard to deal with.” During the class, some of the patients would interrupt when someone’s talking, answered their phone loudly, got mad at the educator for not giving them the chance to ask questions ( they asked a lot of questions and there’s no time for all of the questions within one hour of class), so on and on. I was frustrated that patients did not pay respect to the educator and their classmates, so was my supervisor. One day, I and my supervisor talked about how they do not have basic manners and morality. And my supervisor said that some of the patients had mental issues and they are easily irritable because of their background and health issues. I did not think about their emotional instability due to what they went through in their life. I recognized some of my privileges by communicating with our patients at PHMC. Recognizing my privileges changed some of my perspectives on patients. I try to be more patient and flexible with some of the patients. I start listening to their voice and trying to get to know their life. They are very honest. That’s one thing I cannot find easily in this world. They tell me what they don’t like or what they like. There’s no pretentious attitude. They are ordinary people who have certain hatred, anger, jealousy and ego. They also have certain love kindness, and generosity. Working with underserved population is not easy. But, I feel pure joy and satisfaction when I am trying to help their life improve. I am very happy when our patients’ A1C ( average blood sugar measurement for the past two to three months) go down. During my internship at PHMC,  I took them to chinatown, showed them the cheapest grocery store that has fresh fruit and vegetable and showed them how to buy and eat healthy. We all had a great time. During the trip to chinatown, I remember when one of the patients asked me “ is this where your people are?” I gave her a big smile. There is no supremacy or prejudice between us. I am Burmese (who’s usually seen as Chinese), they are mostly black, some are spanish, some are white. We provide the service and they appreciate it. We share good things and bad things. We celebrate our imperfections and  differences. I wish the world will be that simple. But, it is not.
The field trip to chestnut hill gave me a lot thoughts about difference and inequality. I cannot imagine how I will survive long hours on bus to get education. However, compared to thousands of children in Myanmar who cannot go to school and are used as child laborers, the kids I have seen on the bus have their own privileges. And, I see the fluid concept of privilege.  


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  Chinatown field trip & Smoothie Day



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Our Diabetes Academy Graduation
                           

                           

Monday, February 3, 2014

G6PD ခၽြတ္ယြင္းၿခင္း အေၾကာင္းသိေကာင္းစရာ (EVERYBODY SHOULD READ THIS)

ရည္ရြယ္ခ်က္

လူေတြအားလုံး  G6PD Deficiency အေၾကာင္း သိရွိသင့္သည္ ပာုယူဆ၍ ေရးရၿခင္းၿဖစ္ပါတယ္။

G6PD ဆုိတာဘာလဲ

G6PD အရွည္ေကာက္က Glucose-6-Phosphate Dehydrogenase ၿဖစ္ပါတယ္။ သူက မ်ိဳးရုိးလုိက္တတ္ၿပီး လူေတာ္ေတာ္မ်ားမ်ားက ကုိယ့္မွာ G6PD deficiency ရွိတယ္ဆုိတာမသိၾကပါဘူး။ ကၽြန္ေတာ္လဲ ငယ္ငယ္တုန္းက hepatitis B ၿဖစ္ေတာ့  sulfar ပါတဲ့ ေဆးတစ္မ်ိဳးေသာက္မိရာက ေသြးနီဥေတြကြဲကာ အေရးေပၚ ေဆးကုသမူခံရဖူးရာမွ ေဆးစစ္ၾကည့္တဲ့အခါ မွ G6PD deficiency ရွိေၾကာင္းသိသြားခဲ့တာပါ။ ကၽြန္ေတာ့္ အကုိလဲထိုနည္းတူစြာ ဆရာ၀န္ ေပးေသာေဆးကုိ ေသာက္ရာမွ hemolysis ၿဖစ္ရာမွ G6PD deficiencyရွိေၾကာင္းသိရပါတယ္။ မိ်ဳးရုိးဗီဇေၾကာင့္ ေယာက်ာ္းေလးမ်ားတြင္အၿဖစ္မ်ားတာေတြ႔ရပါတယ္။ ကမၻာေပၚတြင္ သန္း၄၀၀ ေက်ာ္ေသာ လူသားမ်ားတြင္ ရွိပါတယ္လုိ႔ data မ်ားက ေဖာ္ၿပပါတယ္။ အာဖရိက ႏွင့္ အေရွ႕၊အလယ္၊ ေတာင္ပုိင္းရွိ အာရွ လူမိ်ဳးမ်ားတြင္ အၿဖစ္မ်ားတာကုိ ေတြ႔ရပါတယ္။ မ်ိဳးရုိးအရလဲ G6PD deficiency ရွိၾကပါတယ္။
ငွက္ဖ်ားအၿဖစ္မ်ားတဲ့ ေနရာေဒသ နဲ႔ G6PD deficiency ၿဖစ္ေပၚမူႏွင့္ ဆက္စပ္ေနေၾကာင္းကုိလဲ ေတြ႔ရွိရပါတယ္။

G6PD deficiency က G6PD ဆုိတဲ့ enzyme မၿပည့္၀ၿခင္းတစ္မ်ိဳးပါ။ သူက ေသြးနီဥေတြကုိခုိင္ခံတည္ၿမဲ ေအာင္ ပံပုိးေပးပါတယ္။ G6PD deficiency က asymptomatic လကၡဏာလုံး၀မၿပသပါဘူး။ ဆုိလုိတာက လူေတြက G6PD deficiency ရွိေနမွန္းကုိ မသိဘဲ မတည့္တဲ့ ေဆး၊ အစားအေသာက္ စားမိကာမွ symptoms(လကၡဏာ) ေတြေပၚလာၿပီးမွ သိၾကရတာမ်ားပါတယ္။

ဘာေၾကာင့္ၿဖစ္တာလဲ၊ ဘယ္ေတြၿဖစ္မွာလဲ

ေဆး၀ါးမတည့္သာတုိ႔၊ ပရုတ္လုံး(သုိ႔)ပရုတ္လုံးပါတဲ့ အသုံးအေဆာင္ ေတြသုံးစြဲမိတဲ့အခါတုိ႔ ၊ အစားအေသာက္(အထူးသၿဖင့္ ပဲၾကားႏွင့္အလားတူပဲမိ်ဳး) စားမိတဲ့အခါမွာ ေသြးနီဥမ်ား ရုတ္ခ်ည္းကြဲသြားတဲ့ (hemolysis) ၿဖစ္စဥ္ၿဖစ္တယ္။

ထိုသုိ႔ေသြးနီဥေတြ ကြဲသြားၿခင္းၿဖင့္ အသား၀ါၿခင္း၊ ေသြးအားနည္းၿခင္း၊ ေသြးလုိအပ္ၿခင္းတုိ႔ ၿဖစ္ေစႏုိင္ပါတယ္။
အဆုိးရြားဆုံး အေၿခအေနၿဖင့္  ရုတ္တရက္ ၄၈ နာရီအတြင္း ဖြံၿဖိဳးတဲ့ ေက်ာက္ကပ္ လုပ္ငန္းစဥ္ ကုိ ပ်က္သုဥ္းသြားေစႏုိင္ပါတယ္။ Severe hemolitic (ၿပင္းထန္တဲ့ ေသြးနီဥ ပ်က္ဆီးဆုံးရွုံးမူ) ေၾကာင့္ ေက်ာင္ကပ္ ပ်က္စီးၿခင္းအၿပင္ အသက္ပါဆုံးရွုံးၿခင္းကုိ ၿဖစ္ေပၚေစႏုိင္တာေပ့ါ။

ဘာေတြနဲ႔မတည္႔တာလဲ၊ ဘယ္လုိေရွာင္ရွားမလဲ။

  • Antimalarial drugs
  • Aspirin
  • Nitrofurantoin
  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Quinidine
  • Quinine
  • Sulfa drugs
  • mothballs( ပရုတ္လုံး)
  • ပဲၾကား စားၿခင္းမွလဲေရွာင္ၾကည္သင့္ပါတယ္။ Broad beans အမ်ိဳးအစား ကုိလဲ မစားသင့္ပါဘူး
  • အထူးသၿဖင့္ ေသြးနီဥဆုံးရွုံးၿခင္းကုိ ၿဖစ္ေပၚေစတဲ့ ေဆးမ်ား western ေဆးေတြဆုိရင္ antibiodic, antimalaria,  antipyretics ေတြကုိ အထူးေရွာင္ရမယ္၊ eastern ေဆး မသိတဲ့ေဆးေတြကုိလဲ မေသာက္သင့္ပါဘုူး၊  တစ္ခ်ိဳ႔ေသာ ငွက္ဖ်ားေဆးမ်ားကုိ အထူးၿပဳ၍ ေရွာင္ၾကည္ပါ။
ေသြးနီဥကြဲၿခင္း(hemolysis)၏ လကၡဏာမ်ား

ၿဖစ္တဲ့အခ်ိန္မွာ အဓိက အားအင္မ်ားကုန္ဆုန္းမယ္၊ေသြးအားနည္းမယ္၊ ႏွလုံးခုန္ၿမန္လာတတ္ၿပီး အသက္ရွုမ၀ၿဖစ္တတ္တယ္။ လူကၿဖဴဖတ္ၿဖဴေရာ္ၿဖစ္မယ္။ တစ္ခါတစ္ခါ ဗုိက္အေပၚဘက္က ေအာင့္တတ္ တယ္။ အဖ်ားလဲရွိတတ္ ၿပီး ေသြးအေရးေပၚလုိအပ္ပါတယ္။ ဆီးသြားတဲ့အခါမွာ ဆီးအေရာင္က ညစ္ေနတတ္ပါတယ္။ အသားလဲ၀ါတတ္တယ္ ဆုိတာ သိထားရမယ္။

ယခုလုိ လကၡဏာေတြ ၿဖစ္ေပၚလာပါက တတ္ကၽြမ္းတဲ့ ဆရာ၀န္ မ်ားဆီ ကုိ ခ်က္ခ်င္းသြားေရာက္ ၿပသရပါမယ္။

ဘယ္လုိကာကြယ္မလဲ။

လူေတာ္ေတာ္ မ်ားမ်ားက ကုိယ့္မွာ G6PD deficiency ရွိတယ္ဆုိတာကုိ မသိၾကပါဘူး၊ ဒါေပမယ့္ ေဆးရုံေဆးခန္းေတြမွာ စစ္ေဆးလုိ႔ရပါတယ္။ အဓိက G6PD deficiency ရွိေနၿပီ ဆုိကတည္း က ေဆးေသာက္တဲ့ အခါ မွာ အထူးသတိထား ေသာက္သုံးသင့္ ၍ ကာကြယ္လုိ႕ရပါတယ္။ အခုလုိ ပဲၾကားေတြ ဘာေတြ မစားရဘူးဆုိတာ သိသြားေရာေပါ့၊ naphthalene ပါတဲ႔ပစၥည္း ( ပရုတ္လုံး)တုိ႕ ကုိ လဲ မသုံးဘဲ ေရွာင္ၾကည္သင့္ပါတယ္။ ဆရာ၀န္မ်ား ႏွင့္လည္း တုိင္ပင္ ကုထုံး မ်ား၊ ေဆာင္ရန္ ေရွာင္ရန္မ်ား သိထား ၿခင္းၿဖင့္လည္း ကာကြယ္ႏုိင္ပါတယ္ေနာ္။

၀န္ခံခ်က္

ကၽြန္ေတာ္ကုိ္ယ္တုိင္ က G6PD deficiency  ဆုိေတာ့ ကေလးအထူးကုဆရာ၀န္ ၾကီး ေဆးမွား on ရာမွ အသည္းအသန္ ၂ ၾကိမ္ၿဖစ္ခဲ့ပါတယ္။ အထူးသၿဖင့္ ငွက္ဖ်ားေဆးေတြဆုိ ေသခ်ာ ေမးၿမန္း ၿပီးမွ ေသာက္သင့္ပါတယ္။ ၿဖစ္တဲ့အခ်ိန္မွာ ေသြးအားၿပန္ၿပည့္ ဖုိ႔ ေသြးအားတုိးေစတဲ့ အစားအစာ ေတြကုိ စားသုံးၿပီး ဆရာ၀န္ဆီမွာစနစ္တက်ၿပသ သင့္ပါတယ္။ G6PD ခိ်ဳ႔တဲ့ ေနတဲ့လူေတြက သာမန္ လူေတြနဲ႔ တူတူပါပဲ၊ ေဆးေသာက္သုံး တဲ့အခါ မွာသာ သတိေလး နဲ႔ ေသာက္သုံးရုံပါပဲ။

အားလုံး ဗပာုသုတ ရရွိေစရန္ ရည္ရြယ္၍ ေ၀မွ်ၿခင္းၿဖစ္ပါသည္။ အမွားမ်ားပါခဲ႔ရင္၊ လုိတာမ်ားရွိခဲ႔ရင္ အားမနာပဲ ေထာက္ၿပ ေစလုိပါသည္။


က်န္းမာသုခ ဥာဏသုခ ႏွင့္ ၿပည့္စုံပါေစလုိ႔

စုိးယုႏုိင္

ေဖေဖာ္၀ါရီ ၃ရက္ ၂၀၁၄


ေအာက္ေဖာ္ၿပပါ website မ်ားတြင္သြားေရာက္ဖတ္ရွုႏုိင္ပါသည္။ မွီၿငမ္းခ်က္ အခ်ိဳ႔မွာ စာစဥ္မ်ားမွ၊ website မ်ားမွ ၿဖစ္ပါသည္။

 http://www.g6pd.org/en/g6pddeficiency/researchpapers/meloni_03.aspx

အေပၚက link က Research ပါ။  စိ္တ္၀င္စားရင္ သြားေရာက္ဖတ္ၾကည့္သင့္ပါတယ္။ data ေတြရယ္ distribution ေတြပါ ပါ၀င္ပါတယ္။

http://www.nlm.nih.gov/medlineplus/ency/article/000528.htm

http://g6pddeficiency.org/wp/living-with-g6pd-deficiency/drugs-to-avoid-list/#.UvBo8YWQnp5

http://www.aafp.org/afp/2005/1001/p1277.html

http://g6pddeficiency.org/wp/living-with-g6pd-deficiency/drugs-to-avoid-list/#.UvBo8YWQnp5

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