March 18, 2016 160
GetDoc: Hello Doctor, thank you very much for this interview. Could you start by telling us what you specialize in?
Dr Melanie: I am a general paediatrician. I treat a variety of illnesses in children at the primary care level , as well as , on an in-patient basis.
GetDoc: Could you tell our readers what paediatrics is in once sentence?
Dr Melanie: Paediatrics is a specific branch of medicine that deals with a group of patients ranging from newborn to adolescence, generally until they are 18 years old. It involves treating common and uncommon illnesses in this age range as well as monitoring their development and growth throughout this period.
GetDoc: Since when have you been practicing in the field of paediatrics?
Dr Melanie: I actually started my medical career as a house officer in Hospital Tengku Ampuan Rahimah, Klang . Subsequently, I continued my training as a medical officer in Hospital Kuala Lumpur. Initially, I was posted to the department of rehabilitation medicine . During that period , I started to manage some paediatric rehabilitation patients and developed an interest for paediatrics. Eventually I decided to change fields, switching to paediatrics department, spending a total of 8 years in paediatrics so far.
GetDoc: What aspects of paediatrics interested you the most, that you shifted departments?
Dr Melanie: I think paediatrics is not just a science, it is also an art. Seeing children brings joy to me. Paediatrics is a branch of medicine that involves the care of the newborn child till the age of 18 years old, even extending up to 21 years old in the United States. In this branch of medicine, paediatricians deal with the common and uncommon illnesses encountered in children. It also involves monitoring these children throughout their growth and development. When parents are concerned about their child’s development, for example, whether their child is hyperactive or has learning problems, these concerns need to be addressed to determine if their child’s development is normal or needs extra attention. Hence, paediatricians tend to build a long term relationship with the parents as well.
GetDoc: You mentioned that in American till the age of 21 paediatricians are involved in treatment and not a GP. Could you tell us more about this?
Dr Melanie: In Malaysia, technically if you’re 18 you still fall under the care of paediatrics. But in government clinics, anyone falling in the category of 12 years old and above and possess an Identity Card tend to be treated in an adult medical ward. However, sometimes, in the case of a small-sized 12 years old , they would be directed to us when they are worried about calculating the medication dosage.
Some patients may have special conditions diagnosed when they were younger, such as asthma, thalassaemia or heart problems and would continue to be under our follow-up until they are 18 years old. Sometimes when these children are transferred to an adult physician, they will initially feel a little shocked since they are now responsible for their own care with nobody to constantly remind them to take their medications .
GetDoc: In comparison to other specialists, you need to put a lot of care to your patients. Isn’t it very challenging and taxing?
Dr Melanie: Oh yes! The real challenge is that in children, the history is usually provided by parents/caregivers, so, it is from a third party perspective. Even at times when the children are able to talk, they may not be able to verbalise their precise symptoms. Sometimes they will say they don’t know, or they just say ‘yes’ to everything!
So in paediatrics, the challenge is having to pick which information is important and relevant for the diagnosis before administering the treatment. Paediatricians also generally need to be more flexible because children usually do not sit still during check-ups and you will need to be opportunistic, be patient and learn to distract and play with the child. Parents are naturally anxious when their child is unwell, so communication is important as you need to constantly reassure them and to include the parents in all decision-making concerning the child’s treatment.
GetDoc: What are the common/uncommon cases you’ve seen in Malaysia?
Dr Melanie: The common cases encountered are the ones related to upper respiratory problems such as sore throat or runny nose , asthma, pneumonia (lung infection) acute diarrhoea and other viral infections such as Dengue Fever which is increasingly common .
During my government practise, I encountered many serious cases like cardiac problems, very bad pneumonias , thalassemia , HIV patients and kidney problems
GetDoc: So more uncommon cases happen in government hospitals?
Dr Melanie: I think it is not because private centres can’t handle the challenging cases, but rather these cases usually require more investigation and a longer stay . This may not be feas
ible cost-wise for patients, thus, landing them in government hospitals instead.
GetDoc: You mentioned something about HIV cases earlier; could you elaborate more about it?
Dr Melanie: HIV is a hugely taboo subject. In my previous practice , there were about 20 HIV patients under my care who were co-managed with the paediatric infectious disease unit from Hospital Kuala Lumpur . The treatment for HIV is completely free for Malaysian children in the government hospitals.
Medication will be life-long and needs to be taken at precise times (e.g 8am and 8pm) to prevent viral resistance . The patients under my care usually came from a lower social economic background because I noticed the higher income groups would go to private hospitals/institutions for confidentiality. Usually these patients from the lower social economic come from broken families or are orphans. They are usually taken care of by their relatives with poor supervision. The thing is if you take the medication properly, you are able to suppress the virus and lead a fairly normal life – you can have a normal social life, get married and go to college .
However, it is very difficult to get a child to take medication. So what we want to do is to prevent the child from contracting HIV in the first place. More than 90% of children contract the virus from their mother, during pregnancy, delivery and breastfeeding. However, there are ways to bring down the transmission rate to less than 3% . If the mother is diagnosed with HIV earlier, we can begin treatment for the mother and take necessary preventive steps such as to deliver via caesarean section, as well as to completely disallow breastfeeding. The baby would also be monitored and administered with medication for the first 6 week or so to prevent transmission. If you don’t do anything, there’s a 30-40% chance that the baby will contract the virus. The problem is sometimes there are mothers who do not even know they have HIV, hence they miss the boat. Therefore it is very important for early diagnosis in the mother.
GetDoc: So what are the consequences?
Dr Melanie: If treatment is not commenced in a timely manner, the virus will multiply continuously and the child will gradually succumb to the illness. Fatality is bound to happen. The sad part is that it is actually something you can control with strict adherence to the treatment regime.
GetDoc: What would be your advice to the public in regard to this issue?
Dr Melanie: Currently all pregnant mothers who are under proper antenatal follow-up are usually screened for several infections - HIV is one of them . In certain quarters, pre-marital testing is also implemented . I think the most important thing is a self-awareness of your own risk factors and taking the responsibility to screen yourself if necessary.
GetDoc: You’ve mentioned common cases like upper respiratory infections , do you have any advice to the parents to prevent their children from being infected?
Dr Melanie: Developing these infections is part of the body’s way to build the immune system. During early childhood, the child is usually at home . Once they attend school they are exposed to other children, hence, it is normal for them to get upper respiratory infections up to once a month during the first year of the schooling period. I think one of the most important preventive measure is basic hygiene. Hand wash is the best way to prevent infections since these infections are usually through respiratory droplets and can spread through touch, as well as airborne. If the child is unwell, it is a civic responsibility to keep them home till the infection resolves, as far as possible. Having said that, not all infections will be preventable as it is all a part of growing up and developing their immune system.
GetDoc: What is the most satisfying case you have worked on?
Dr Melanie: I think every case does give some form of satisfaction. Children usually don’t lie. If they are not well they will cry and feel irritated and look generally unwell. Once they are well, they will run about, bounce around and chat happily with their parents. These are the things that make me satisfied- seeing them back to their normal self.
GetDoc: There are common diseases like Zika spreading recently; is there any big impact on a child’s growth?
Dr Melanie: At the moment there is no commercial tests available as only specific labs are able to test for the virus . Hence, you may be infected with Zika virus without even realising it. If a mother is infected with the Zika virus, she may spread the infection to her baby and there is possibility that this baby would be born with microcephaly. In microcephaly, the size of the baby’s head is smaller as a result of a smaller underdeveloped brain. This can lead to a huge impact on these children – development may be affected to varying degrees and they may need long term help and special education.
GetDoc: Well said doctor, last question which is not related to work: how do you unwind yourself from the stress at work?
Dr Melanie: I usually read materials which do not require much effort, basically something light to relax my mind. I spend a lot of time with my two boys, who are 8 and 10 years old respectively. I am with them during their activities such as football classes. It is all about balance, you need to work but also spend time with your family because they are important to us.
To know more about Dr Melanie Majaham, kindly check here
Do you have any further questions regarding breastfeeding and paediatrics? Feel free to ask your questions in the comments section.
Qian's interest in healthcare industry came about after her father was diagnosed with bladder cancer. This experience has led her to become a strong believer in empowering individuals to take charge of their own health. View all articles by Qian.