I refer to the letter Last days of my aunt . I am shocked at the way Lim Han Syn's aunt was managed at the USM hospital. Before I comment on that, I believe that the Kota Baru Medical Centre's reason of being less equipped does not hold any water unless they did not have an ICU bed.

For the aunt to be admitted after 5 to 6 hours (that is what I assume half a day is) shows a very poor triaging system at the hospital emergency unit unless, of course, the aunt was admitted via a normal outpatient clinic of the hospital. Having said that, half a day is way too long when the honourable health minister is talking about a less than 90 minutes waiting period.

If she had intestinal block due to hernia, she most probably had what is known as a strangulated hernia where the intestines come out of the abdomen into the hernia and get twisted and then blocked (strangulated). There are two ways of managing her depending on the severity of the strangulated intestines.

One is to manage her conservatively which is by not allowing anything orally but at the same time putting a naso-gastric tube to suck out any excess intestinal material which cannot pass beyond the strangulation. They would also put her on a intravenous drip to keep her well hydrated and make sure her electrolytes are balanced.

She has to be closely monitored and this can be done in the ward with at least a daily blood investigation of her electrolytes and renal function and X-rays of the abdomen and chest to pick up improvement or deterioration. This other than at least a twice daily examination by a doctor.

If her condition improved , they would continue with this conservative treatment and try to reduce the hernia manually later when the strangulated part is less swollen. If it worsens, then they have no choice but to do surgery to prevent further deterioration and save the patient's life

For her doctor to say that the doctors were 'not confident' was very unprofessional The next thing for this doctor to do should have been to immediately call for the specialist to come and see the patient. If that was not possible then the next right thing for them to do was to refer her to a doctor that was 'confident'. The specialist should have checked on her at least within 24 hours of her admission if not much earlier if her condition warranted it. The enema rightfully should have been administered by the nurses of the ward.

The procedure of inserting the naso-gastric tube can be made less uncomfortable by using a nasal spray and throat sprays to partially anesthetise the nose and throat before inserting the tube. The doctor could have been impatient (and overworked) or/and was not sensitive to the patient's discomfort, and last but not least did not explain the necessity of the procedure to the patient.