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6/2/2017

Why do we get dressed?

There are quite a few Uniqlo clothing stores in Singapore. I saw this range of advertisements at the store. So here is my answer to the advertisement question.

Why do we get dressed is such a simple question that most people don’t ask. The striking ordinariness of the question is what makes it catch our attention. We think the answer is obvious, we dress because it is necessary, to protect us from the elements, comfort and fashion. Seldom so we think that we dress for modesty unless we see someone who is underdressed. Why are humans the only living species that need clothing?

Bible’s answer is so primitive that it dates to the first two humans on earth.  God created Adam and Eve naked.

Genesis 2:25
Adam and his wife were both naked, and they felt no shame.
And after they sinned, they felt naked and shame. They made clothes to hide their nakedness and shame. And they hid from God. Despite man being sinful, God still looked for them

Genesis 3:7-9
Then the eyes of both of them were opened, and they realized they were naked; so they sewed fig leaves together and made coverings for themselves. Then the man and his wife heard the sound of the Lord God as he was walking in the garden in the cool of the day, and they hid from the Lord God among the trees of the garden.  But the Lord God called to the man, “Where are you?”  
 
God still cared for man. The self made fig clothes were probably so bad that God made clothes of skin. The skin had to come from an animal who probably gave up its life as it gave up its skin. If so that would have been the first blood sacrifice for sin.

​Genesis 3:21
 The Lord God made garments of skin for Adam and his wife and clothed them.
 
Feeling shame about nakedness is a natural response in all humans.  In the last century, clothes have become more revealing but most people would still feel uncomfortable being completely naked in front of strangers. Only couples bare their nakedness to each other as a testament to their love for each other.
Therefore, the foremost answer to why we get dressed is we want to hide our sin. Getting dressed is only one modality to hide sin. Hiding, lying and blaming others were all techniques pioneered by Adam primarily to hide his sin from God.
 
Genesis 3 :10-12
He answered, “I heard you in the garden, and I was afraid because I was naked; so I hid.”  And he said, “Who told you that you were naked? Have you eaten from the tree that I commanded you not to eat from?” The man said, “The woman you put here with me—she gave me some fruit from the tree, and I ate it.”
 
I believe the story of Adam and Eve, it is not a myth. Putting on my clothes daily is a reminder of my sin.  

6/9/2016

Do unborn babies or infants who die go to heaven?

I attended a church camp in June 2016. That month a church member suffered a miscarriage and many church members came to know about it. So the above question was addressed to the invited speaker. The speaker said there was no direct answer from the bible but he pointed out a few verses that suggested that babies or children that were not yet conscious of their sinful nature would go to heaven. He said in this he supported the Westminster confession of Faith position.
 
Verses that were brought up
 
Psalms 139:13-16
For you created my inmost being;
    you knit me together in my mother’s womb.
I praise you because I am fearfully and wonderfully made;
    your works are wonderful,
    I know that full well.
 My frame was not hidden from you
    when I was made in the secret place,
    when I was woven together in the depths of the earth.

Psalms 51:5
Surely I was sinful at birth,
sinful from the time my mother conceived me.
 
2 Samuel 12:23
But now that he is dead, why should I go on fasting? Can I bring him back again? I will go to him, but he will not return to me.”
 
Psalms 23:6 A Psalm of David
Surely your goodness and love will follow me
    all the days of my life,
and I will dwell in the house of the Lord
    forever.
 
Luke 18:16
Jesus called the children to him and said, “Let the little children come to me, and do not hinder them, for the kingdom of God belongs to such as these.
 
From these verses we know that
  • The unborn baby is already considered a human by God
  • Babies are conceived in sin
  • David in 2 Samuel knew that his dead son’s spirit was going somewhere that he himself would go too when he died. And David was confident in Psalms 23 that he was going to heaven
  • In Luke 18:16 Jesus said God’s kingdom belongs to little children.
 
The Westminster Confession of Faith is a Reformed confession of faith. Drawn up by the 1646 Westminster Assembly as part of the Westminster Standards to be a confession of the Church of England, it became and remains the "subordinate standard" of doctrine in the Church of Scotland, and has been influential within Presbyterian churches worldwide.
 
Westminster Confession of Faith Chapter 10 “Of Effectual calling”
III. Elect infants, dying in infancy, are regenerated, and saved by Christ, through the Spirit, who works when, and where, and how He pleases: so also are all other elect persons who are incapable of being outwardly called by the ministry of the Word.
From the Westminster confession, only elect/predestined infants go to heaven. But only God knows who are elected. An additional point is that people who were mentally challenged and could not respond to the gospel were similarly elected.
Of course this is only one point of view among many others.

There are other points of view.

​Here is a Christian article who explores the other views in more detail 


christianitytoday.com-do_all_children_go_to_heaven.pdf
File Size: 73 kb
File Type: pdf
Download File

And here is a reform article that expands on the Westminster Confession of Faith position
reformedanswers.org-when_an_infant_baby_dies.pdf
File Size: 48 kb
File Type: pdf
Download File

14/4/2016

Autism, Naughtiness & Sin

Below is a messaging chat between me and a Christian mother of twin boys. She became concern after researching on the internet that one of her twins, Son A, might have autism because he was different from his brother Son B. Her sons are dizygotic twins aged 2 year 4 months as of the conversation.
 
Ben: I understand you want to know more about autism
 
Mom: We note that our Son A current condition may be symptoms of autism, but we are not certain. Symptoms like not responding to name being called, echoing repeatedly what others have said, are typical. We didn't think much of it earlier, but as Son A grows up, the differences between Son A & Son B becomes more obvious.
 
Mom: Son A doesn't interact with his brother Son B in play. He is also not interested in other kids. Son B is very fast in telling us what he wants and pointing at the toys. Son A used to only scream and cry. Now we are teaching him to say what he wants. . He can echo sentences. I don't know if he's using them meaningfully or not. If we greet them both, Son A doesn't care. He doesn't look nor greet us. Son B does.
 
Mom: So I also wonder if it's just different personalities
 
Ben: How is Son A speech development? Monosyllable words, single words, 2 to 3 words or sentences?
 
Mom: Very good speech. Speaks in sentences Eg. alarm clock, Crescent moon, since below 18mths
 
Mom: On the other hand, Son B is very advanced in all areas of development
 
Mom: Though Son A picked up words fast and can sing tunes he hears; he doesn't seem to communicate much with us. He just cries and throws tantrums in frustration. Now he says "rabbit" for his favorite rabbit pillow. But he will still whine and cry first if his rabbit pillow falls onto the floor, instead of saying Rabbit. We kept teaching him to say what he wants.
 
Mom: He seems to be copying. Instead of saying something new
 
Ben: Can he communicate his needs to you in words? Eg I want to eat something?
 
Mom: Sometimes yes. He will say Eh eh. Then we say "Caleb wants to eat bread." Then he says the whole sentence
 
Ben: Immediate repetition or repeating old sentences?
 
Mom: Immediate as well as old sentences that he's heard before
 
Ben: Does he have any repetitive behavior that is odd or fixation on something for a long time - eg toy or object?
 
Mom: Fixation on wheels when young. Now fixated on rolling cars and trains on a ledge. Latest fixation is a large toy school bus. He can play with it for a very long time. But he will also snatch whatever Son B is playing with when he sees it
 
Ben: 1 car in particular or all cars/trains? How does he play with the car/train? Play with the wheels or push them up and down the ledge or some other part of the cars?
 
Mom: He does both. Play with wheels or rolls car back n forth on wheels. Then build a make believe mountain with a book n roll car over the mountain. As he does so, he says "over the mountain" He puts the book like an inverted V. He likes to stack 1 car on top of another object like a tissue box and move both along the ledge. Any ledge also can.
 
Mom: Son A doesn't seem able to read facial expressions. Son B can.
 
Ben: It is difficult to diagnose autism before 4 years old. though the symptoms appear after about 1.5 years old
 
Ben: But there is nothing in what you have written that suggest he has autism. Autism and personality are partially genetic. Twins especially dizygotic twins can be different
 
Mom: We tried an online assessment checklist and he got 10 out of 20. It says high risk for autism
 
Ben: I say so because 1. He has normal speech development. Already speaking in sentences.2. He has no fixated or repetitive activity
 
Ben: Playing with cars up and down a ledge is a normal play activity
 
Mom: He has terrible tantrums. We used to think he's just willful but looks like a complete and sudden meltdown. So we thought it was overload of sensory stimuli
 
Mom: But he can be pacified with pacifier n rabbit pillow. Quite quickly
 
Ben: What brings about the tantrums?
 
Ben: You scolding him? Sibling fighting? or toy is taken from him? or he is refused something?
 
Mom: Anything he can't get or there is a sudden switch of activity eg finishing shower and coming out of bathroom when he refuses to cause he wants to play with the water
 
Ben: That's normal for a child esp a boy
 
Mom: Or feed him 1 piece of bread. Once it's finished, he cries and screams
 
Ben: He wants a 2nd piece?
 
Mom: Yes
 
 Mom: Son B is more calm. Can be reasoned with. Son A is more prone to angry tantrums. And will not listen once he erupts
 
Ben: Son A is like my son. Quick to anger, knows what he wants, impulsive, got his own mind.
 
Mom: Haha Son A is v v v challenging. Wants what he wants no matter what
 
Ben: My girl is soft and tends to give in but she has learnt to disturb my son back
 
Mom: Son B gives in 90% of the time. So we thought earlier that Son A is just spoilt. Cause he used to vomit all his milk after crying so adults scrambled to give him what he wants. But when we beat his thighs to punish him after warning him to stop screaming, he looks bewildered
 
Ben: What you have observed is the personality difference between your 2 sons.
 
Ben: You had observed a spiritual condition give root - sin expressing as a willful behavior.
 
Ben: He needs more discipline for the next 10 years compared to Son B
 
Mom: Yes. We are trying to strengthen that now
 
Ben: My son has now improved after 8 years. Medicine/psychology will tell parents to show more love and care but stick to the bible for discipline principles
 
Mom: It's because my parents give in to Son A every time in fear that he would vomit, so my dad even takes away Son B toys to give Son A.  Son A gets disciplined more often. We beat his hand if he beats people. So Son A knows how to toe the line. When he pushes the envelope, we go after him
 
Ben: Anyway Son A doesn’t fit in the DSM classification of autism. Autism children except savants have low IQ and the 1st symptom is speech delay / communication issues. Followed by unusual tantrums over nothing major and then unusual repetitive activity
 
Mom: Maybe he has Asperger's? Cos we also noticed his speech development is very fast. Atypical
 
Ben: Asperger is v difficult to diagnose. Not at this age. But the treatment for that is usually counselling and behavior modeling later in life if they cannot cope in school.
 
Mom: Smelling his rabbit pillow for long n sucking pacifier I would deem as usual, right?
 
Ben: Yeah that's normal even some adults still have their stuff toys. Your kids should stop using pacifier, bad for teeth
 
Mom: Yup. He refuses to. Wakes up at night crying for it when it drops out. Son B stopped 1 year already
 
Ben: Since your both kids have different genes, expect them to be different
 
Ben: our both kids need to be called many times before they respond too. They seemed to be lost in their own world
 
Ben: If a pediatrician were to see son A, the paeds will refer him to a paeds OT for further evaluation. The diagnosis is also based on your input to the pediatrician and the OT observation. But again difficult to diagnose before 4 years old. The end diagnosis will be nonspecific behavior needing OT + parent counselling
 
Ben: and that means more trips to the doctor and OT
 
Ben: Sin is not a medical diagnosis.
 
Mom: My husband has a question: what does this mean? "Followed by unusual tantrums over nothing major and then repetitive activity over unusual stuff"
 
Ben: Normal tantrums are in situations like kids are denied something or they are being punished. Kids tend to cry loudly with exaggerated contortions in their faces - which is actually normal and look really pitiful. That attracts attention especially grandparents. Some kids do cry softly or just sob like adults.
 
Ben: Abnormal situations are like kids cry over a bird chirping ( not dog growling ) or when the choo choo train move in reverse direction they are used to seeing
 
Ben: abnormal repetitive activity are meaningless activity like hands flapping, head banging on the wall or obsessions with objects that are not toys (age related). Autistic kids can get excited by the stimulus from head banging.
 
Ben: And you can print out the questionnaire and show me what you indicated as signs of autism.
 
Mom: We were alarmed that his tantrums mean he arches his back and doesn't care if he hits his head or not, loud n sudden outbursts made worse by the fact we don't know what he wants cos he won't say
 
Ben: A lot of these behaviors can be solved by discipline.  My son used to be like that and he used to have a couple of repetitive bad habits - which included head banging. Which all got better over time after sufficient scolding has been administered
 
My thoughts
 
Early childhood psychiatric disorder like autism and ADHD attention deficit hyperactivity disorder have been getting a lot of attention among young parents. Doctors and health information websites will emphasize the importance of picking up these conditions early so that intervention can take place. However, the symptoms are also often confused with the willful behavior and poor attention span in normal young children. These behaviors usually start around one and half years old (age of the terrible two). I belief all these are the manifestations of the sinful nature of children. The naughtiness, rebellious and psychiatric conditions are part of a spectrum. Those that result in dysfunction are categorized under the DSM V neurodevelopment disorders.
 
The bible answer is for parents to love and discipline their children. Although it seems cruel to discipline a child, yet the bible recommends discipline as necessary ingredient to train up a child. It may seem illogical to associate discipline as vital for growth but I have witnessed it happen to my children. Their willful & impulsive nature had been tempered over the years through teaching of proper manners, scolding and sometimes caning. There is also a role of discipline too in managing children with autism and ADHD especially the willfulness and impulsivity side.  
 
Through proper discipline by parents, children are taught to 
  • recognize bad behavior (outward sin)
  • curb their own willful desires (sinful thinking)
  • learn that bad behavior deserves punishment
  • the need for repentance
  • it is done out of parents’ love
 
 
Supporting bible verses
 
Proverbs 13:24
Whoever spares the rod hates their children,
but the one who loves their children is careful to discipline them
 

Proverbs 22:6
Start children off on the way they should go,
and even when they are old they will not turn from it
 

Proverbs 22:15
Folly is bound up in the heart of a child,
but the rod of discipline will drive it far away
 

Proverbs 23:13-15
Do not withhold discipline from a child;
if you punish them with the rod, they will not die.
Punish them with the rod
and save them from death

 
Proverbs 29:15
A rod and a reprimand impart wisdom,
but a child left undisciplined disgraces its mother
 

Hebrews 12:11
 No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it
 

19/4/2015

Being ADL dependant

The following was a case study by my colleague in the family medicine fellowship course we attended. We would post our case studies via email and then our colleagues would provide feedback.  My colleague case is colored re while my comments are in black

Background and Past Medical History
Mdm A is a 74-year-old  lady with hypertension, hyperlipidaemia, ischaemic heart disease and a left middle cerebral artery (MCA) infarct , after which she was home bound but able to furniture walk at home and be independent in her basic activities of daily living (ADLs). She then suffered a new catastrophic left MCA infarct secondary to new onset atrial fibrillation, which unfortunately left her chair to bed bound, and requiring moderate to maximal assistance in all her ADLs and requiring a nasogastric tube (NGT) for artificial nutrition and hydration. As she had previously indicated not to go to a nursing home, the family respected her preferences and caregiving duties rested with her eldest daughter Ms B who was single. Mdm A was referred to rehabilitation hospital for a period of slow stream rehabilitation and caregiver training. During the admission, she was also started on fluoxetine 10mg OM for depressed mood. By discharge, she was able to sit out on a geriatric chair and stand for a short period with 1 person assistance and a walking frame.

  • This looks like a case of Ms B being dumped with Mdm A by her family
  • Being a single female is a risk factor for being dumped with unwanted parents by uncaring families.
  • If Mdm A was wealthy was willing to will her wealth to whoever takes care of her during her last days.  I am sure she won’t be dumped. 
  • It would be good to list Mdm A diagnosis. Although you mentioned she is taking fluoxetine, was she diagnosed with major depression? SSRI can sometimes be given for sedation too.

Progress of Case
My first encounter with Mdm A was to review her at my outpatient clinic two weeks post-discharge. Mdm A was a thin, frail-looking elderly lady wheeled into the consultation room by her tired-looking daughter Ms B. I realized my first challenge was communication with the patient. She had documented mixed aphasia (expressive > receptive) secondary to her cerebrovascular accidents. Although she appeared to understand what I was trying to tell her, most of the times she did not respond or would only nod her head after a long pause. Despite my best efforts to speak louder, slower and use gestures to improve communication, progress during the consultation remained slow. Aware that she must be equally frustrated at not being able to expressing herself, I reassured her that “it was ok”.

I completed the rest of the medical history and physical examination with input from Ms B. Cognizant of possible caregiver stress; I interviewed Ms B on how she and the patient were coping at home. She was not coping well and felt stressed . There was much frustration caused by communication barriers and physical challenges in care. Mdm A had become more irritable and easily agitated when she couldn’t communicate what she wanted and would have temper tantrums and threw things. Mdm A did not want to participate in day care, and would spend most of her time sleeping or watching television. Ms B was also physically exhausted from managing the household chores and felt socially isolated as there was minimal help from other family members who have their own families and would only visit for short periods over the weekend. She had much difficulties preparing Mdm. A for her medical appointment today but decided to come because she needed help. Ms A’s plea to me was “Please apply a nursing home for my mother, she would be better taken care of”.

  • Is Ms B depressed?
  • What are Ms B resources to take of Mdm A? Eg maid, money, home care nursing. 
  • What are Ms B barriers to caring for Mdm A? Eg, work schedules, physical illness.

Discussion
I was faced with the dilemma posed by Ms B request for a nursing home application. Although Mdm A had aphasia and depressed mood, I could not assume that she lacked mental capacity. All practical steps should be taken to help Mdm A adequately make an informed and voluntary decision. I assessed that she seemed to understand information but would require input from a speech and language therapist on her capacity to remember and weigh the information. If she lacked mental capacity, then her substitute decision maker Ms B should decide based on Mdm A likely preference or best interests, with consensus from her other siblings.

  • Mental capacity is not an issue to begin with. Because all patients are assumed to have capacity and you did not mentioned she was diagnosed with dementia.
  • Maybe adding a AMT score to Mdm A history would be good
  • This is case of mismatch expectations and resources, not mental capacity

Is the nursing home option in Mdm OT’s best interests?
On one hand, applying nursing home seemed the “easy option out” and would ensure medical and nursing care for Mdm A and relieve Ms B of her caregiver stress. However, considering her previous preference, admission to a nursing home would seem like abandonment to the old lady and devastate her psychologically. I also had the responsibility to be the gatekeeper of limited resources. Aware that Mdm A may be upset by further discussion about nursing home; I distracted her by getting my nurse to do her blood tests in the treatment room while I could have a private discussion with Ms B on other alternative options.

  • This is case is of 2 people. Mdm A and Ms B. 
  • Let’s turn the question around.
  • Is nursing home in Ms B best interest?
  • Is Mdm A selfish in demanding home care? Does she know her daughter is stressed out in taking care of her and other kids don't want her?
  • Are Mdm A children uncaring? Why don’t they care for her mother? Don’t they think Mdm A request to stay at home important?
  • Have you spoken to Mdm A’s other children?
  • Who is more important? Mdm A or Ms B? The carer or the dependant? 

Mustering community and family resources to alleviate caregiver stress and avoid premature institutionalization
In a rapidly ageing population like Singapore and with limited long term care facilities, informal caregiving by family members remained the major source of care for older patients with functional dependence. This heavy burden of caring fell onto the shoulders of Ms B, who also left her day job as a cashier. Without adequate support, many caregivers suffer from depression and poor health themselves. Although the plan on discharge was for Mdm A to attend the day care centre to improve her participation in social activities and relieve caregiver burden, she was reluctant to go after the first session as they could not understand her needs. I encouraged them to attend a few more sessions to get Mdm A accustomed to the routine and for Ms B to accompany her mother to observe the activities at the centre. The day care would also provide much needed respite for her. I organized senior home care to assist with the household chores and showering of Mdm A on non day-care days. On encouragement, Ms B agreed that she should request for her siblings’ assistance in caring for Mdm A. We made a shared decision to try out this new plan for the next two weeks to see if Ms B would be coping better.

Improving communication with aphasia patients and involving the speech therapist in the care
Communication with aphasic patients can be difficult; and physicians often neglect the patient and turn to their caregivers for information. My communication with Mdm A during the first consultation could have been better. I did a literature search and approached my speech and language therapist to discuss the case and learn strategies to communicate more effectively with an aphasic patient. By doing a simple exercising in guessing what my speech therapist was trying to tell me using gestures, I appreciated the difficulties and frustrations aphasic patients faced in communications. Some useful strategies are:

·        Acknowledging patient’s competence to understand & communicate
·        Using simple sentences, reducing rate of speech and using active voice, reducing distraction, using gestures, emphasizing key words, writing main topic on big font, using pictures, real objects and resources, asking yes/no questions, speak and write /gesture to patient naturally and concurrently, encourage pointing / showing/ gesturing, placing objects within reach (e.g. calendar, map), give patient time to respond, and use yes/no card for patient to point to.
·        Verifying answers

During my next consultation with Mdm A, I employed these strategies and also used the resources and aids , including picture diagrams to illustrate common questions in the history taking and answers. To assist Mdm A to respond, I gave her written choices to point to Yes/No or point to what she wanted. Lastly, I verified each of her answers to ensure that I did not misunderstand her.
Gradually, Mdm A’s mood improved and she was able to attend day care sessions three times per week and group language rehabilitation sessions. The improvement gave Ms B much needed respite and avoided premature institutionalization.

My reflections on being ADL dependant
  • I had long ago told my wife if I am old and incapacitated and if she can’t take care of me, just put me in a nursing home. At least I am cared for. She can visit me frequently. I can’t expect too much out of my kids. And I don’t want to burden them. I want to be remembered as a caring father not as a father being cared for.
  • If I am severely incapacitated to point of being useless ie lying on a bed 24 hours. I will pray to die. After all I am assured of heaven so I am going to a better place. 
  • God told Adam( the 1st man on earth) , he would have to work hard till he died. Nothing about Adam  suffering or enjoying in his retirement years. See Genesis 3:17-19. So he worked from the day he was created and he lived for 930 years. Retirement is not a bible concept.  

 

 

13/11/2014 0 Comments

Medical support for a overseas mission trip

This email request is from a fellow nurse

Dear Benjamin


I will be going on a mission trip organized by my church to Sibu Sarawak. As I am the only one among those going for the trip who has first aid training, I have volunteered to be their safety coordinator. We will not be going into the jungle.  We may pay a visit to local orphanage or old folks home and long house while we are there.

      Objectives of this trip
·       To support training for women from the Iban Women’s Ministry in a West Malaysian Church,
·       To develop missions awareness and participation through bible studies,
·       To participate in a Spiritual Retreat.
 
 My duties would include:
·       Discuss team safety and necessary medical precautions.
·       Provide a written itinerary with contact phone numbers.
·       Gather Health and Safety Information such as Emergency Numbers, Medical facilities, First Aid Kit etc…
·       In the event of a serious illness or fatality, to be able to act promptly and with great care.
·       Be familiar with the arrangements for medical assistance, evacuation in case of severe weather, social upheaval etc…

I have already advised the team members to buy traveler insurance and those with chronic condition to bring their own medication. 
As this will be my first mission trip cum first time been safety coordinator thus I am quite unsure about what I should prepare and what I need to know. Thus I wish to seek your kind advice.


                   
My reply

Here are my recommendations for your Sibu trip

I found 2 Sibu hospitals with A&E facilities

1. Sibu Hospital - Government
Address: KM 5 1/2, Jalan Ulu Oya, 96000 Sibu, Sarawak, Malaysia
Phone: +60 84-343 333

Sibu Hospital is the second largest hospital in the state of Sarawak, Malaysia. It is the main tertiary and referral hospital for the Central Region of Sarawak, Malaysia. The emergency and trauma Department (A & E) provides emergency treatment of trauma or non-trauma patients. It operates for 24/7. It is also a center of integrated services ( one-stop crisis centers ) provide emergency treatment and stabilization of patients.

2.KPJ Sibu Specialist Medical Centre - Private centre
No 52A-G, Brooke Drive 96000 Sibu, 
Sarawak, East Malaysia,.
Malaysia. 
Tel: 084 - 329900 

Operates 24/7 and has 24-hours ambulance services. Is is equipped with a minor operation theatre for minor surgeries and other emergency procedures. 

 There are 2 Guardian stores @ Sibu where you can top up OTC medicines
1. Address
LOT F16, GIANT HYPERMARKET SIBU, LOT 1304, BLOCK 3, SG. MERAH TOWN, JALAN LING KAI CHENG,
Postal Code:96000
City/Town:SIBU
State:Sarawak
Tel No:084- 314718
Operating Hour:10:00 hrs - 22:00 hrs

2.Address LEVEL 1 WISMA SANYAN LOT 6999 BLOCK 5 JALAN CAUSEWAY
Postal Code:96000
City/Town:SIBU
State:Sarawak
Tel No:084-347 859
Operating Hour:9:30 hrs - 22:00 hrs

I am recommending these following medicines which you can dispense comfortably at your training level.  You can get these medicines from the polyclinic doctor. Keep the medicines in their original packages with your name pasted on them because medicines need to be properly labeled to get through Malaysian customs. Otherwise the immigration officer might suspect you are bringing in illegal medicine.

Useful medications

Panadol
Loratidine
Dextrometorphan
Stemetil - motion sickness and nauseau
Lomotil
Antacid
ketoprofen plaster - for muscle pains
Betnovate cream 


Useful bandages
Handiplast
Big plaster for bigger wounds
gauze
crepe bandage

Other equipment
Torch
Scissors
Gloves
Thermometer

A resus mask is not necessary. Just do your chest compression first and activate the ambulance service. I am assuming no one else in your team is CPR trained. I had trained nurses in my church trip.

For emergency evacuation back to Singapore, you need to have the travel insurance company telephone number at hand and you need a liasing person /friend in Singapore to help you with the arrangements. Just send the sick person to the hospital first and contact the insurance company and friend. God willing this doesn't happen

Ben

0 Comments

20/9/2013

Edible Insects

Hi Ben

Insects have 6 legs... But Lev 11:20-23 seems to suggest differently... I can buy the argument that locusts have 2 hopping legs on top of 4 legs.... But i cannot reconcile verse 23, because NIV says "insects that have four legs".....

Leviticus 11:20-23
“‘All flying insects that walk on all fours are to be regarded as unclean by you.There are, however, some flying insects that walk on all fours that you may eat: those that have jointed legs for hopping on the ground. Of these you may eat any kind of locust, katydid, cricket or grasshopper. But all other flying insects that have four legs you are to regard as unclean.

My reply
Bible is a religious document so you got to read it in its context.

In Leviticus , Moses was discussing  foods that the Israelites were allowed to eat and foods that were forbidden.  The topic of edible insects has to be discussed in this religious context. So Moses gave  simple instructions. Edible insects  must have wings, walk with 4 legs and have 2 more jointed legs for hopping. And then Moses gave specific examples. locust, katydid, cricket or grasshopper.

 Moses was writing a practical guide for a layman rather than writing a scientific paper.

A good discussion on this topic can be found at
http://creation.com/are-praying-mantises-kosher


Hi Ben

Your response is helpful, It answered the question of "What is edible?" And I am fully convinced that the Bible is right in its description of insects that fly and have 4 walking legs and 2 jumping legs.
However, it also seems that both questions are avoiding the question of "Why did Moses say 'But all other flying insects that have 4 legs you are to regard as unclean'?" Because that verse raises the following questions:
Why say "all other ..."
Was Moses referring to the mosquito/butterfly/winged-ant in any of what he was saying?
Was Moses omitting non-flying insects like ants?


My reply
Yes all other flying insects like mosquito, butterfly , winged ant and non flying insects are omitted. I think Moses gave the example of  locust , katydid, cricket or grasshopper because the prior instructions may still be vague in its interpretation.

I have attached Food and Agriculture Organisation of the United Nations  on edible insects. It describes the culture of insect eating among many nations. Many of these practices started from ancient times. Clearly the law of Moses was to restrict the range of insects the Israelites were allowed to eat.

edible_insects.pdf
File Size: 5922 kb
File Type: pdf
Download File

Paper on Eible Insects by Food and Agriculture Organisation of the UN
Grasshoppers and locust are rich in protein. Both these insects are herbivores so there is less chance that eating them will transmit diseases. Imagine eating dung beetles that is not properly prepared for human consumption. An example is Dung beetles is a delicacy in some part so Thailand.  Dung beetle is an insect that feeds on dung - literally . 
Here is an advertisement on dung beetle. http://www.thailandunique.com/edible-dung-beetles

These food laws and ceremonial laws were given by God to the Israelites so that they are a people set apart for God and easily identifiable.It is the same concept that God wants to set Christians apart from other people groups.. 

The 10 commandments , the civil laws, ceremonies , festivals , clean & unclean food , circumcision is primarily for this purpose.Because of these laws the Israelites could not mix with other races. The differentiation of clean and unclean food  was that the Israelites would not be able to join the dinner table other peoples. God also said they could not marry other races.

But with scientific progress we can find the wisdom of God instruction. That God’s choice of ceremonies and food was not random. For example before modern farming,   sheep was the healthier source of meat.  Ancient farming of pigs poses serious health issues

From wiki http://en.wikipedia.org/wiki/Pig
Pigs can harbour a range of parasites and diseases that can be transmitted to humans. These include trichinosis, Taenia solium, cysticercosis, and brucellosis. Pigs are also known to host large concentrations of parasitic ascarid worms in their digestive tract. The presence of these diseases and parasites is one reason pork meat should always be well cooked or cured before eating. Today trichinellosis infections from eating undercooked pork are rare in more technologically developed countries due to refrigeration, health laws, and public awareness. Some religious groups have dietary laws that make pork an "unclean" meat, and adherents sometimes interpret these health issues as validation of their views.
Pigs have health issues of their own, of course. Pigs have small lungs in relation to their body size and are thus more susceptible than other domesticated animals to fatal bronchitis and pneumonia.Some strains of influenza are endemic in pigs (see swine influenza). Pigs also can acquire human influenza. Pigs can be aggressive in defending themselves and their young. Pig-induced injuries are thus not unusual in areas where pigs are raised or where they form part of the wild or feral fauna.


Human cysticercosis especially neurocysticercosis as a cause of epilepsy is still a major health problem in modern India and Latin America. I have attached the following reference

human_cysticercosis.pdf
File Size: 725 kb
File Type: pdf
Download File

http://www.ias.ac.in/jbiosci/nov2008/571.pdf

The ceremonies of washing hands, maintaining cleanliness , proper disposal of corpses saved a lot of Jews during the Black Death. All these was before the germ theory in the 19th century.

God is the creator of all things. He gave the Israelites these laws and they do not conflict with the laws of nature ( biology , medicine, physics).  Neither do Moses 600+ laws conflict with each other. From this oneness, we can see that God is real. This is so unlike national laws that change over time or contradict with one another. Lawyers and accountants are paid lots of money to find loopholes to exploit. And so unlike me as a father, sometimes I set contradictory house rules for my kids.

Anyway we are no longer under the law of Moses. We as Christians are better off with God’s law written in our hearts. See Hebrews 10:16-18. In Matthew 5, Jesus was describing the law that will be written in men’s heart vs Moses laws. We are not to be angry with a brother or sister; we are not to lust, not to divorce, not to take revenge and we are to love our enemies. In this we have fulfilled Moses law and much more.

Coming back to food, Jesus has declared all food as clean
Mark 7:18-19
 “Are you so dull?” he asked. “Don’t you see that nothing that enters a person from the outside can defile them?  For it doesn’t go into their heart but into their stomach, and then out of the body.” (In saying this, Jesus declared all foods clean.)

I love pork. And I am willing to try eating insects if I can convinced the preparation is clean



Ben
with inputs from Yap Wei Hua

6/6/2013

Infection control in church

Hi Ben


We observed that a number of our children in church falling ill (fever, flu, respiratory problems) & we thought we should encourage church members to be socially responsible.

We've already asked the cleaning lady to use dettol when cleaning the rooms and also thinking of placing face-mask & alcohol hand-rub at the entrance. We'll also ventilate the fellowship hall often. Are there anything else we can do? Posters, advisory?

Thanks.




Hi


Answers from http://www.cdc.gov/flu/school/qa.htm are quotes in blue

How does the flu spread?

Flu viruses spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick. That means that you may be able to pass on the flu to someone else before you know you are sick, as well as while you are sick.

Flu spreads mainly person to person via air particles from coughing and running nose. So the most important is someone with fever + cough + running nose should avoid contact with others. Just fever alone should not be highly contagious.

Having face mask + alcohol hand rub is useful. But only if the sick knows how to use the mask and hand rub.

If someone is having fever + cough + running nose & still wants to come to church, he should put on a mask, sit outside alone in the fellowship hall during service. He can listen to the service on the TV. After service, probably after the message is over,  he should clean the table & then go home before everyone else comes out.

Studies have shown that human influenza viruses generally can survive on surfaces between 2 and 8 hours.

Cleaning tables before service is useless. Any virus from last week or from Sat fellowship service are  already dead on the table. Cleaning after everyone has left home is also useless in the same context.

How long is a person with flu virus contagious?The period when an infected person is contagious depends on the age and health of the person. Studies show that most healthy adults may be able to infect others from 1 day prior to becoming sick and for 5 days after they first develop symptoms. Some young children with weakened immune systems may be contagious for longer than a week.

People with fever + cough + running nose should be isolated or not come to church / work / school. If it is only fever or just cough + running nose, the change of a highly infectious flu or the flu infectivity is much less but not 0%. Therefore for practical reasons drs tend to give mc only for the fever period. If dr gave 5 day mc for every flu attack or every cough or running nose,  our sick leave wont' be enough, and students will miss too many days of school. 

Occasionaly getting infected is good for the immune system. Like going some trials is good for the Christian soul. But saying this in public is politically incorrect.

--------------------------------------------------------------------------------------------------------
In my opinion


The best measure is education

1. Occasional announcements for people who are having fever + cough + running nose that they can stay outside in the fellowship hall for service. And don't mix around.

2. Forget the posters. They are distracting. Keep posters to the minimal like church camps posters, evangelism event posters. Too many posters are like too many advertisements.

3. Have face mask on demand or readily available. Don't enforce use

4. Have alcohol rubs readily available. Don't enforce use

5. Don't need extra cleaning. Dont' stress the cleaning lady unless she needs OT money.

6. With 300+ people every sunday, there will be at least 1 person who is having flu, or going to have flu. And it could be you or me. Don't go witch hunting or finger pointing. Keeping sick people out of church is incorrect. Jesus has a healing ministry. He is constantly surrounded by sick people. Most people don't understand disease processes. It is not their fault they are sick, it is not their desire to spread the virus.



Ben





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