Dokter Blog: from the desk of Rahajeng Tunjungputri

Medicine et cetera by @ajengmd

“The Thinker: Science of Equality”, a column in The Jakarta Globe newspaper by Rahajeng N. Tunjungputri

Dear friends,

Today my writing about women in science is published in Jakarta Globe, a Jakarta-based English newspaper. I spent quite some time doing the research and editing for this piece. So indeed, I’m very pleased that the piece is finally published on paper.

The first time I read Jakarta Globe on holiday in Bali, I just thought, “Wouldn’t it be cool if I can have my writings in this newspaper…”.

It turned out to be cool indeed.

http://www.thejakartaglobe.com/columns/the-thinker-science-of-equality/394239

Best regards,

Rahajeng

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Investing in young Indonesian Researchers

Last week the article I submitted for The Jakarta Post was published on 22 August 2010. The issue was something dear to my life and work: that we need more young Indonesian researchers; and to accomplish that we need to invest in them.

The article was inspired by my experience with a mentor. He has always taken the time and energy to foster new generations of clinician-scientists. I recently realized, that to “produce” excellent scientists in Indonesia, a senior researcher has to be willing to make an investment. The mentor will have to invest his or her time, energy, patience and guidance, for years, in his or her students. There is no instant process of turning an average student into a leading scientist. Everyone must take part in investing in Indonesian young researchers.

http://www.thejakartapost.com/news/2010/08/22/investing-young-indonesian-researchers.html

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L’Oréal-UNESCO For Women in Science Interview with Rahajeng Tunjungputri

Dear Friends,

I was contacted few days ago by 4womeninscience (L’Oréal-UNESCO For Women in Science) saying that they’d like me to answer some questions for the blog. At that point I only thought the question were brilliant, and I’d like to answer them myself as I thought that putting the answers into writing will give me a better insight about my personal views as well.

I personally call them “important questions”, because the issue of the challenges that women face in science is real, and it’s something that is dear to my heart and highly relevant for me and my female peers in my science community.

Afterwards, they contacted me again and let me know that the interview is published on the website!

Share your thoughts about the issue raised in the interview…

Screenshot of the website with the interview at http://agora.forwomeninscience.com/index.php/2010/07/twitter-interview-2/#

The challenges women face in science are real, and while experiencing them we rarely discuss them openly. So thank you to The L’Oréal Foundation for bringing up this important issue!

Regards,

Rahajeng

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Beyond Borders with “doc2doc”

^

I enjoy writing, especially when I can interact with readers through my writings. While my writings here are only the ones more or less academically related, I know that my contemplative/narrative writing style is better appreciated at doc2doc.bmj.com.

I had problems before with some objections against my post in my old blog, thus the idea to build this blog, dokterblog.wordpress.com was born out of my desire to focus on academic medicine. But I miss writing critical and contemplative pieces, and “doc2doc” has been the perfect media for me. It’s a privilege to be able to blog there, I must say. And doc2doc has offered me the opportunity to interact with doctors from around the world.

It’s been amazing to get responses, ask questions, explore different answers and build friendship and networks because of my writing. And what astonishes me the most is to see that now my blog is being read by so many people in UK, Europe, US, Africa, and all across the world! My writings have gone beyond borders.

“A traffic report showing some of my doc2doc blog readers and their countries (for my latest post, “Empathy, or tea and sympathy?”)”

So, thank you doc2doc.bmj.com for enabling me to get more response, interaction and most of all, international readers.

For my fellow Indonesian medical bloggers, keep writing, be critical, and be true to yourself.

– Rahajeng, a.k.a. “AjengMD”

*Special thanks for David Isaacson, http://twitter.com/David_I, your an amazing community manager!

Thanks also to Prof. Cuello @CharlieNeck, Colleen Young @sharingstrength, and Zahid Raja @torydoc.

You can find doc2doc on http://twitter.com/doc2doc, and the website at http://doc2doc.bmj.com

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Empathy, or tea and sympathy?

^

Have you ever wondered about the difference between empathy and sympathy?

Jerome Groopman, MD put it in his book, “How Doctors Think”: “Patients and their loved ones swim together with physicians in a sea of feelings. Each need to keep an eye on a neutral shore where flags are planted to warn of perilous emotional currents”. We’re human, we feel. We just need to still be able to do our job with meticulous discipline in spite of our feelings.
Would you stop yourself and think whether it’s time for you to empathise or sympathise? Would it make any difference whether you’re in one mode or the other?

Check out my new blog post on doc2doc.bmj.com, “Empathy, or tea and sympathy”, click here


Image from http://fuckyeahilovetea.tumblr.com/page/2


Regards,

Rahajeng



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2nd International Seminar and Workshop on Fragile X, Autism, and Related Disorders

Fragile-X syndrome (FXS) is the most common form of inherited intellectual disabilities (ID). The clinical signs are intellectual disabilities, hyperactive, autism, psychoneurologic disorders, and macroorchidism (testes enlargement) in male. The common affected is in males; however, carrier female could have a mild intellectual disability such as learning difficulties, without other symptoms. Some clinically normal males (Normal Transmitting Males) are known to carry and transmit the fragile X mutation to their daughter. In advance age, carriers of FXS could develop Fragile-X-Associated Tremor Ataxia (FXTAS), a neurodegenerative disorder.

Within the framework of long collaboration with the Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, UC Davis, USA; Faculty of Medicine Diponegoro University (FMDU) Semarang Indonesia will organize a 2nd International workshop on Fragile X Syndrome, Autism and Related Disorders. This workshop comprises also a talk show session, which will present some cases of autism and ID patients.
(Excerpt taken from the seminar’s leaflet)
The event will take place in Semarang, 7 August 2010. Please refer to the leaflet below (downloadable) and register for your ensured participation in the event.
Regards,
Rahajeng

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Announcement for Lectures of Prof. Cremers, 2010

Center for Biomedical Research (CEBIOR) Faculty of Medicine Diponegoro University, Semarang Indonesia in collaboration with Department of Human Genetics Radboud University Nijmegen Medical Centre, The Netherlands is announcing a lecture and presentation event by Prof. dr. Frans P.M. Cremers, PhD.
Below is short introduction of Prof. Frans Cremers:
In 1984, he finished his master Biology at the Radboud University Nijmegen (main subject: molecular biology). He performed his PhD study at the Department of Human Genetics, in the Radboud University Nijmegen Medical Centre and received a cum laude PhD in 1991 on the thesis entitled: ‘Positional cloning of a candidate gene for choroideremia’. In 2004 he was appointed full professor Molecular Biology of Inherited Eye Diseases, and in 2009, he was also appointed Adjunct Honorary Professor in Comsats Institute of Information Technology, Islamabad, Pakistan. In 2005 he was appointed Programme Director of the topmaster ‘Molecular Mechanisms of Disease’. From 1992 – 2010, he supervised 12 PhD students and numerous BSc and MSc students. He was awarded the ‘Internationalizations Award 2010 of the Radboud University Nijmegen’ for his continued efforts to facilitate MSc and PhD students to study in the Netherlands,and to foster international collaborations.
Lectures and presentation will be held 21-23 July 2010, from 08.30 a.m. in 3rd floor of Faculty building, Faculty of Medicine Diponegoro University Semarang.
(Please click image for full poster)

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Genetic Counselor and Ideas from Psychotherapy

I rarely post about genetic counseling, but to answer the basic questions, this is a clear explanation of what a genetic counselor is (ABGC, 2010):

A genetic counselor is a health care professional who is academically and clinically prepared to provide genetic counseling services to individuals and families seeking information about the occurrence, or risk of occurrence, of a genetic condition or birth defect.

The genetic counseling process involves the collection and interpretation of family, genetic, medical and psychosocial history information. Analysis of this information, together with an understanding of genetic principles and the knowledge of current technologies, provides clients and their families with information about risk, prognosis, medical management, and diagnostic and prevention options. Information is discussed in a client-centered manner while respecting the broad spectrum of beliefs and value systems that exist in our society. The genetic counseling process ultimately facilitates informed decision-making and promotes behaviors that reduce the risk of disease.


A very interesting book on genetic counseling provides a very useful insight. Below is my summary of the fourth chapter of the book, “Genetic Counselor and Ideas from Psychotherapy” (Evans, 2006):

Chapter 4: The role and skills of the counsellor and ideas from psychotherapy

(From Genetic Counselling by Christine Evans, page  61-82)

The role of the counsellor

There are different opinions on the role of counsellor. Some of these opinions are genetic counsellor as information provider or facilitator of decision-making. Another opinion stated that genetic counsellor play a role in assisting decision-making and helping to prepare clients for the result and to facilitate the client in accepting the meaning of a test result.

In practice, there change between the role of information provider and facilitator is a dynamic process. When a patient gives emotional response after information is given, then the role of the counsellor is more as a facilitator than information provider. The elements of genetic counselling are review of the family history, present and past relationships and attitudes, self-reflection, decision-making and coping. There is also a need to process emotions and contain anxiety. Skills repertoire of genetic counsellor may be expanded with additional ideas taken from general theory of psychotherapy.

Principles from psychotherapy

Winnicott (1971) and Bion (1959) emphasise the attitude and skill needed in professional relationship. There is also a need to understand the link between emotion and thinking in genetic counselling.

The structure of the interview

The interview takes place within a physical space, a time space and a psychological

space.

The physical space

The physical space of genetic counselling may be anywhere as long as the purpose is clear and there’s an agreed agenda for both patient and genetic counsellors. The space is more of an interactional space of discussion between the counsellor and patients or also with the family. The genetic counsellor is responsible for the time, focus, and approach.

The time space

A consultation may be similar to a music piece with a beginning that then builds up in the middle and ends with a conclusion. Within a time space patients can bring what is relevant about their condition to the genetic counselling process. Ending the meeting session may be difficult for the genetic counsellors or the patient, and the counsellor has to be able to let go and allow the patient to find their own way or manage their situation with the support of friends or family or alone.

The psychological space

The professional relationship between patients and genetic counsellors is also a psychological space where there is a potential for sharing feelings, developing thinking and decision-making. During the consultation, the counsellor needs to be aware and consider of how the patient is registering the experience.

The elements of a therapeutic professional relationship

The ‘facilitating environment’ and ‘potential space’

Winnicott (1971) and Bion (1959) developed understanding of the conditions needed for building a therapeutic encounter. Winnicott’s stated that genetic counsellors must have particular qualities – an attitude of being emotionally available, supportive, aware and understanding of the patients’ vulnerability. That relationship could then facilitate emotional growth and development in professional consultation. Bion (1959) stated that in the professional relationship there needs to be an ability of the counsellor to tolerate negative emotions, to be able to internally process them and transform them into positive feelings of empathy, concern and compassion. The counsellor is not disturbed by the patient’s high anxiety, but understands the fear, is able to tolerate it and gently and compassionately conveys that sentiment. In a more contractual language the counsellor and patient have to set up a working alliance.

The working alliance

This term refers to the necessity for the counsellor and patient to work together to complete the agreed tasks.

Bordin (1982) considers that there are three components to the working alliance: a consensus between the counsellor and patient on the goals of the encounter; an agreement on the topics and number of meetings to address how the goal is achieved; and, most importantly, the development of a strong affective bond between the professional and patient.

The co-construction of purpose of an interview with the definition of roles

A natural corollary to the working alliance is the idea of the co-construction of the purpose of the interview where the counsellor and patient jointly agree on the purpose of the interview. The counsellor must allow considerable space for the patient to tell their story, but also to keep the focus of the discussion. Sometimes, it may be difficult to interrupt a patient who is telling a personally significant and painful story but with skill and experience the counsellor will be able to balance listening to the story and focusing on the genetic task.

Empathy

Empathy is a ‘feeling state’ of being able to understand someone else’s subjective experience and is the essential skill in human interaction. It is the ingredient the counsellor needs to establish the secure base of relationship with patients. To achieve this special form of communication, the counsellor has to suspend personal ideas and views to be receptive, linked and attuned to the patient in order to understand the other person’s mindset.

Facilitating thinking

Genetic counsellors must aid decision-making and facilitate patients to process the effects of a result. The patient then must be able to self-reflect, which means not only experiencing, but also thinking about the experience. The ability to self-reflect results in thinking aloud, reflecting, integrating and also assessing one’s present position and comparing it to one’s former self. This self-reflection gives an overview and a deeper understanding.

Communicative competence and listening skills of integrating meaning

The counsellor should identify key words used by the patient and follows the train of thought, joins with the thinking process. The counsellor must also read the non-verbal behaviour and consider the level of intelligence. For example, the counsellor revealed a more complete understanding by pausing and summarising the story of the patient.

The use of metaphor

Metaphor language can facilitate an understanding where logical thought, clarification or explanation has failed. The use of metaphor allow the patient and counsellor away from the direct problem to look at it in another way, which is not personal but capture the similar problem of the patient.

Summary points

  • The genetic counselling process involve creating a physical and psychological space which facilitates the patient.
  • Anxiety of the patient may be contained when the genetic counsellor is empathetic and understand the patient’s experience.
  • Metaphors, listening and communication skills of the counsellor may facilitate the patient better.
  • Further on, the genetic counsellor must develop the patient’s ability to self-reflect, make decisions, and deal with the emotions and frustrations.

Further reading:

American Board of Genetic Counseling (ABGC), 2010. Genetic Counseling As A Career. [Online] American Board of Genetic Counseling. Available at http://www.abgc.net/english/View.asp?x=1484 [Accessed 26 June 2010].

Evans C., Biesecker B., 2006. Genetic Counselling, A Psychological Conversation. Cambridge: Cambridge University Press.

***

26 June 2010. Rahajeng. https://dokterblog.wordpress.com

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The Tobacco Epidemic: Problems, Conflicts, Solutions

Dear all,

I mentioned before that I was asked to speak about tobacco for a group of medical students few weeks ago. I wrote a more comprehensive review of the tobacco epidemic in Indonesia into my blog in doc2doc, “The Cure of The Tobacco Epidemic”.

At the event I brought up the issue of the tobacco epidemic; the problems, conflicts and solutions. This presentation is aimed to highlight the importance of consumer perception, the tobacco and anti-tobacco campaign “wars”, the socio-economic context of the tobacco epidemic in Indonesia and how physicians can contribute in curing this epidemic.

I have uploaded the presentation from that event to Slideshare.

For further reading, please do check the last slide with a list of great reference sites.

Regards,

Rahajeng

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Blog safely ^^

I’m in academics, so in the spirit of critical thinking and freedom of speech, I’d like to introduce you to this very useful site that give information about how to blog safely.

This is a very useful website which explains everything about how to blog safely. Being critical is exciting and inevitable, especially when you actually do have a critical mind. So this is a preliminary warning of the possible adverse consequences and how to avoid them.

Dr. Isis, a famous science blogger once wrote

“I consider blogging to be no different than buying advertising space on a billboard – thousands of people or more are going to see it and (unless you use password-protected entries) you have no control over who is reading it.  You also have no control over how people will use your information.”

And for me this has been my rule-of-thumb, that yes, indeed blogging is similar to having a huge personal billboard with whatever we have expressed on that given (very) public space. So please remember that. I have found that the best strategy is to keep in mind that everybody reads what you’re writing, whether you’re on facebook, twitter, or blogs.

Finally, my take home message is: You have the right to blog, and you have a right to blog safely.

Rahajeng

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Identification PPT for Parasitology Students

For students,

The following is now available on slideshare:

http://www.slideshare.net/rntunjung/identification-june-2010

And a very informative video on Schistosomiasis, this is the last of 3 videos:

Wish you all the best for your exams!

-Rahajeng

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Latest post on doc2doc.bmj.com

If smoking is bad, why do people still smoke? What does it take to successfully overcome the tobacco epidemic in Indonesia? Indonesia has been in the spotlight for not signing The World Health Organization Framework Convention on Tobacco Control (FCTC), but is it really just a matter of not having a political commitment and a failure of implementing health policy on tobacco?

Read more about “The Cure of Tobacco Epidemic” on my latest writing at http://doc2doc.bmj.com (or click here)

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Trematodes presentation

The short version of the powerpoint presentation of trematodes we use for response discussion was just uploaded. This only consists selected (and most important) slides.

You can click the pic below (or click here) to see the presentation on slideshare.

There is an interesting case report on trematode infection on NEJM:

Do Hyun Park, M.D., Ph.D.
Hyun-Young Son, M.D.
University of Ulsan College of Medicine
138-736, Seoul, South Korea
dhpark@amc.seoul.kr

A 62-year-old man reported having had fatigue, fever, and cramping abdominal pain for 7 days. He also reported that he had recently eaten raw pond smelt (Hypomesus olidus). The results of liver-function tests were abnormal, showing elevated levels of aspartate aminotransferase (350 IU per liter), alanine aminotransferase (352 IU per liter), alkaline phosphatase (204 IU per liter), {gamma}-glutamyltransferase (434 IU per liter), total bilirubin (6.4 mg per deciliter [109 µmol per liter]), and conjugated bilirubin (3.9 mg per deciliter [67 µmol per liter]). The white-cell count was also elevated (13,000 per cubic millimeter), and there was eosinophilia (27%). A computed tomographic scan of the abdomen showed dilatation of the common bile duct without definite filling defects. Given our concern that the patient might have acute cholangitis, a duodenoscopy was performed, and a prominent major papilla was discovered. After cannulation of the common bile duct, numerous leaf-shaped worms popped out (see video) and were subsequently identified as Clonorchis sinensis (also called Opisthorchis sinensis). The patient was given praziquantel and had a quick and uneventful recovery. The clinical manifestations of clonorchiasis tend to reflect the worm burden and the duration of infection. Clonorchis may persist in the biliary tree for decades, and prolonged infestation is associated with the development of cholangiocarcinoma. Acute cholangitis and pancreatitis are rare but important complications of C. sinensis infestation.

Good luck for your exams!
-Rahajeng-
*
Images used in the presentations are not mine, no copyright infringement intended.

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Semester Exam of Genetic Counseling

I had the semester exam this week in my Master Programme of Genetic Counseling FMDU. I really had to focus on these exams, because as you can see, within 6 days I had 19 different exam subjects, and not much time, energy nor interest in anything else other than preparing myself for these exams.

And the menu for those 6 long days were:

  1. Psychiatry – Grief and bad news, Counseling in children with congenital or genetic abnormalities
  2. Psychology – Helping theory, Development of helping relationship, Genetic Counseling
  3. Obgyn – Psychosocial aspect of fetomaternal cases, Prenatal diagnosis
  4. Endocrinology – Genetics of Diabetes Melitus
  5. Neurology – Myotonic dystrophy, Parkinson Disease, Spinal Muscular Atrophy, Ataxia
  6. Mitochondrial medicine
  7. Immunogenetics – Blood group and HLA
  8. Molecular biology – Gonadal development, Molecular basic, Sexual development disorder
  9. Medical ethics – Bioethics, Professional ethics
  10. Pediatric endocrinology – Basic physical measurement, Cytogenetics, Genetic screening, Genetic disorders
  11. Endocrinology – Genetics of thyroid diseases (congenital hypothyroidism, autoimmune disease, malignancy)
  12. Pediatric urology – Congenital adrenal hypertrophy, Androgen insensitivity syndrome
  13. Pediatric neurology – Epilepsy, Myasthenia gravis, Muscular dystrophy
  14. Embryology – Genetics of embryology, teratology
  15. Immunogenetics – Immunodeficiency, Genetics of immune system
  16. Cancer genetics
  17. Biomolecular aspect of thalassemia
  18. Inborn error of metabolism

*Reenactment of my exam preparation by a model (image is not mine)

And the exam week was particularly challenging because I had what looked almost identical to this (WARNING: This is NOT my picture), the cause I presumed was psychological stress which leads to immune dysregulation (due to exam and several other things… such as my passport issues -Not to be discussed here):

*Reenactment of my canker sores (image is not mine)

Note that it was a large and deep ulcer, heavily inflammed and located on the side of the tongue. When I talk the tongue (and ulcer) is hitting my lips and my teeth, when I sleep the tongue dried and sticked to my palate, and OUCH!!! Basically, the ulcer made eating, drinking, speaking, studying, answering my exam, sleeping, and living, in general, very difficult and extremely painful, each and every minute.

I guess we’ll see the result of the exam in the next few weeks, but generally I’m content and satisfied realizing how broad my studies were in the past 6 months. Considering that my main interest is infectious disease, the opportunity of learning genetics and psychology has been a privilege. I explored the subjects I never really thought about learning before (psychology, counseling, embryology) and I even enjoy them!

And what I truly love from the master programme is: you have this whole new world of knowledge and science opening up, and you are free to explore it for yourself!

*

– Rahajeng

https://dokterblog.wordpress.com

PS: And YES, as the exam finishes, my stomatitis is healing.

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How could you be so heartless?

Gosh this is so NOT what I had intended when starting this blog (I have another 2 FYI), but, this is too good to pass.

I had 2 psychology exams and another 5 clinical exams tomorrow and about 100 other exams within this week (OK, not 100, but still, a lot…)

But there’s always a room for music within my 24 hours/day. The Fray has been one of my favorites since early 2007. Their “How to save a life” was my theme song in Nijmegen, so the band and their honest lyrics have been a constant companion of mine.

When I heard this one, I just have to share it with the world, and you all of course. Besides the amazing video with the fresh and creative (cute) graphic idea, I love the lyrics. Plus, it’s a bit medical if you see the (cute) little animated heart walking and stumbling on the numbers… Enjoy Heartless…

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Disclaimer

Medicine is a growing field, and information presented here is reflective of the time of posting. Please refer to your physician for direct medical consultation. My views do not reflect those of my employers. --
Regards, Rahajeng

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