Sunday, December 18, 2011

告别前夕

凌晨12点05分,从实验室懊恼地回家,又遇到不能理解的实验结果。

今晚,再度踏上这块土地。三年又十个月前,首次到珀斯,凌晨时分,夏天,宿舍办公处早已打烊。原本打算在机场宿一晚。

那一块土地

原来友人早已安排他们的屋主来接他们,多亏他们拔刀相助,才不至于在机场露宿。
第一晚宿

机场到大学宿舍途中,车辆寥寥无几,宽而直道路,英文路牌。到达目的地,下车,踏上了第一块土地。道路上,有几只勤劳的蚂蚁正在赶工。空气带有寒意,踏在离家乡5000km的那块土地,瞪着地上的那些蚂蚁,脑袋里有数不清的未知数;只是知道,人生的另一段已经开始。

三年又十个月的离别前夕,重踏着同样的那一块土地,怀着同样的心情-- 数不清的未知。

2011年12月18日; 凌晨00:18; 辛卯(2011)年,冬月廿四
Bentley, Western Australia





Friday, August 5, 2011

Series 5: The Translation of Stone Inscribed Warning Sign located outside of Xuan Tian Temple, Bukit Mertajam (Chinese Version)大山腳玄天廟外石刻告示牌之翻譯

2011农历新年前两个星期,我和小学同学,张玮琦一起吃午餐。之后,我邀他陪我到伯公埕一趟,以便我考察坐落在靠伯公埕奕记茶水摊旁的宝炉后边的一块刻有字的石碑。这一个毫不起眼且黝黑及肮脏的石碑(有45-55公分高,30-35扩),是我在吃馄饨面时,意外发现的。普通的路人及卖吃的小贩都没注意到它,那时因为它已经成为当地居民生活的一部分了;那是因为在他们没出世前,石碑已肃立在那儿了。

奕记老板谢先生表示:常有善男信女在这石碑插香。

我自问:难道是土地公?

好奇的我,当然是要查个清楚。所以,玮琦挨义气,陪我去查个究竟。
我俩花了一个小时蹲在那儿,像考古学家般的解读石碑上的字。由于,雕刻不是很深再加上百年来风吹雨打,石碑上的字模糊不清。须知道,伯公埕全大山脚最旺,人潮最多的地区,路过的人都很好奇我俩蹲在那里干些什么东西。或许,他们脑里想:“那俩神经的在那里干什么?”在一旁的奕记茶水摊主谢先生主动向我解释,有时有人会在石碑插香。结果,我认识了他及他的妻子。虽然当天只是解读到差不多是二十个字,总算是有收获。
帏全放假回大山脚当天我邀他到伯公埕吃早餐。用餐后,我要求他以他语文知识帮我看看石碑上的字。可是,很显然的,那不是会不会解读的问题,那时看不看得到石碑上刻字的问题。那天我们,待在那里有45分钟,也成功解读了五六个字。至此,我们以大概知道石碑的内容。
隔几天,福强终于回来了,我就约他做我的伴,第三次访伯公埕。第一个小时,没有什么收获。炒河粉摊主简况,建议我们用油漆,按着字形上色。我回答说:“Uncle,不行,石碑会坏的。”在绝望之际,一个老者出现。
老者说“用面粉抹上去就可以了”。

我俩半信半疑,可是却束手无策。我想:“既然面粉很便宜,不妨试一试,反正也没办法了”。于是就到伯公埕对面杂货店购买面粉。
“什么??!!面粉二十仙?”杂货店主问。
“是的,老板”,我回答。
“Okay,二十仙,谢谢”,说完,便把面粉交给我。

那杂货店主对购买20仙面粉的我感到无语。也许他想:“现在的年轻人到底干什么?!”

于是,我便把面粉抹上石碑。

“出来了,出来了,福强”,我极兴奋得说到。每个方块字清清楚楚地排列在我俩面前。
还等什么?我俩便开始拍照及抄写石碑上的字。


大山腳玄天廟外石刻告示牌 (满地都是面粉)


/////////////////////////////////////////////////////////////////

大山腳玄天廟外石刻告示牌之翻譯

众人协议后决定严加禁止: 从玄天庙前地坪左右烧金银纸用的宝炉直到戏棚是男女老少来往看大戏的地方,所以小贩不许在这范围内搭棚子、摆放货架及贩卖食物。每个人因该严格地遵守这项规则。倘若有人违反这条规则,此人将面对训斥及被申告至官府以追究处理。我等将传下这段言辞先前通知大家,也雕刻下这条规则在块石上,以保存下来,作为日后的凭证。

大山腳玄天廟外石刻告示牌(电子版)

问题在于:从宝炉到戏棚这个范围是指那里呢?其实, 本人还没有把这个疑问考察清楚。比如,宝炉及戏棚的位置,在百年以来,有改变吗?可是,值得一提的是,有两块注有“伯公界”的石块能仔细地表示出玄天庙的范围。这两个石块坐落在现今宝炉的一旁。高长宽大约为20cmx20cmx10cm。如果戏棚及宝炉从古至今未曾改变,此石碑之所禁止之事依然生效。

伯公界(打粉前)


伯公界(打粉后)


洪政阳译 (Translated by Zen Yang ANG)
辛卯年夏七月初八(大暑)丑时六刻 (7-8-2011, 2:30am)
宾利,西澳 (Bentley, Western Australia)

Series 2: Translation of the "Bukit Mertajam's Free School" Stone Inscription (Chinese Version)"大山脚义学堂"碑译

大山脚义学堂


我(们)私下思索,创造新事物的伟人难当,在事业上保持前人的成就的后人难道就很容易当吗?追溯当年的大山脚,大伯公理事会曾经设置(种植蔬菜、花果及树木的)园子。那园子是当地华人贸易及买卖货物用品的地方。于是,理事会便设置摊位给摆卖蔬果者来收取租金。这些年来,所获取租金大约数百元,足够于支付祭祀事务所需的费用。

这一直到现在,已经有三十多年了。三十多年以来,在这里监督及掌管祭祀的负责人不断地替换。然而,负责人的贤能与否因个人而有所不同;有的很有才智,有的则平庸,每个都不一样。有人把寺庙公祭活动视为牟利的工具,凭借担任职务/理事而谋求显达和富贵。或者是假借寺庙开销理由牟利,有人质问时,则以火灾后维修所需费用为理由。

等到己丑年(西历1889年)时,可以见到园子中空旷偏僻,冷落荒凉,仍旧是一片广阔的空地。考核历年来所积储的租金共有一千多元,随后经过我们商家们斟酌及商议、与别人贷款、筹备及策划,开始在寺庙后建筑店铺,随后继续建设(菜)市集所需的亭子。今年/今年的秋季则添加建设提供学子上课的教室。

在几年之间,可以发现现在和从前有迥然的不同。从前长满绿油油蔓草/野草的空旷,今时已建起了一栋栋重叠似的房屋/店铺了。从前的摊位租金只有几百元,如今新增店铺所带来的租金盈利有一千多元了。大伯公设立的义学/义塾(旧时一种免费学校,资金来源为地方公益金或私人筹资)以便培育才华杰出的人,使文化粗俗的大山脚/南洋(蛮夷=华夏中原民族以外少数民族的地方),最终可以成为有礼节、有正义(礼义=奴隶社会和封建社会的等级制度,以及与此相适应的一套礼节仪式即为礼,合于这些的做法即为义)的地方。

每逢神明诞辰就会上演梨园戏。梨园戏费都由大伯公承受及支付/补偿,使到全大山脚乡里的村民一同庆祝、一同欢乐(同欢共庆)。

怎么会是担任事务的负责人不一样?只是因为当地的风水/时运旺盛而已。虽然是当地的发展因为贤人展施有效策略的成果,但是其实是有赖于神明默默地鉴定/允许。只是希望继承这里基业的后人可以扩大并充实我们的基业,这就是我们所厚望的。于是,(我们)记载下这些话,以便永远地流传后世。就以这篇文章为序文。

现在(我们)把各项开销费用公开陈列及规矩条例写在左侧

第一议决每逢元天上帝,谭公伯及大伯公三位神明的诞辰时,都需要上演戏曲来庆祝。每一个庆典可向董事会索偿所需费用。董事会将会供给二百元作为聘请戏班及其他开销费用。如果有剩余的话,就将余银归还给董事会;如果不足够的话,不可以再向董事会索取。

第二议决在一整年里,义学堂将延聘两位教导读书先生(教师),他们每一位一整年的报酬可向董事会领取。

第三议决凡是遇见贫困的人在大伯公园子/范围去世,如果没有亲朋戚友或邻人认领尸骸,可向董事会领取一副棺材,以免他的尸骸在外头暴晒雨淋。

每个事项将雕刻在这石块上,以保存下来,作为日后的凭证。(希望以此)为祖先增光,为后代造福。

光绪二十一年(1895年)乙未年(1895)秋天月份(阳历8910`)董事会成员:黃陳慶、陳換、黃躍松、陳錦隆、陳成貴、張字、王媽賀、黃躍喜,共同立碑。


//////////////////////////////////////////////

洪政阳 (Translated by Zen Yang ANG)

辛卯年春三月廿五(谷雨)时一刻 27-04-2011 3.15pm 宾利,西澳(Bentley, Western Australia)


Original text of the stone inscription--原文

大山腳義學堂

窃思創始者難矣守成者豈易耳溯我大山脚 大伯公尝置园埔為我華人貿易市貨之所設秤以收其稅遍年約金数佰以充尝務迄今三十餘載董斯尝者前後迭更而賢否各殊智庸不一視公尝為奇貨以任事為榮華或托詞開銷則云歸囬祿迨至己丑覩园中荒烟蔓草仍一曠埔耳稽歴年所積計金仟餘嗣經余等商眾酌議移借筹谋始築宮后之店維营菜市之亭今秋添建書房数年之間今昔迥殊昔之蔓色青青今為屋宇叠叠矣昔之秤稅数佰今增店租盈仟矣設義學以育英才蠻夷之俗竟成禮義之邦矣值 神誕而演梨园費由尝給合港共慶歡樂矣豈任事之材不同亦地運之興則異雖因人展佈之效寔 神默鍳之功惟願後之人維斯事者曠而充之是余之而厚望爰誌斯言以垂永久是為序

玆將各欵使費開列規條于左
一議 元天上帝 譚公爺 大伯公 三位神誕演戲慶祝每次向董事尝給戲金使費銀弍佰元若有餘則歸還董事如不敷不得向董事添取
一議 義學遞年延教讀先生兩位其每位全年束修向董事領取
一議 遇貧困在大伯公园身故若無親鄰收殮者向董事領給棺材壹副免其屍骸暴露
各欵勒石存照光前 裕後。
光緒廿壹年乙未秋月董事
黃陳慶 陳換 黃躍 陳錦隆 陳成貴 張字 王媽賀 黃躍喜


Type written form of the "Bukit Mertajam's Free School" Stone Inscription


Original text after addition of punctuations--分句后的原文 Just want to highlight here that Chinese text before 20th century did not have punctuation.

大山腳義學堂

窃思創始者難矣守成者豈易耳?溯我大山脚 大伯公尝置园埔,為我華人貿易市貨之所,設秤以收其稅,遞年,約金数佰以充尝務,迄今三十餘載。董斯尝者前後迭(die2=更換)更,而賢否各殊,智庸不一。視公尝為奇貨,以任事為榮華,或托詞開銷,則云歸囬(hui2=回)祿。迨(dai4=等到)至己丑,覩(du3=睹)园中荒烟蔓草,仍一曠(kuang5=空而寬闊)埔耳。稽歴(li4)年所積計金仟餘,嗣(si4=承接)經余等商眾酌議,移借筹谋,始築宮后之店,維营菜市之亭,今秋添建書房。数年之間,今昔迥(jiong3 = 远/显然)殊。昔之蔓色青青,今為屋宇叠叠矣。昔之秤稅数佰,今增店租盈仟矣。設義學以育英才,蠻夷之俗,竟成禮義之邦矣。值 神誕而演梨园,費由尝給,合港共慶歡樂矣。豈任事之材不同,亦地運之興則異,雖因人展佈之效,寔(shi2)賴 神默鍳之功。惟願後之人維斯事者曠而充之,是余之而厚望。爰誌斯言,以垂永久。是為序。

玆將各欵(kuan3=款)使費開列規條于左∶

一議∶元天上帝 譚公爺 大伯公 三位神誕演戲慶祝,每次向董事尝給戲金、使費銀弍佰元。若有餘,則歸還董事,如不敷不得向董事添取。
一議∶義學遞年延教讀先生兩位,其每位全年束修向董事領取。
一議∶遇貧困在大伯公园身故,若無親鄰收殮者向董事領給棺材壹,免其屍骸暴露。

各欵勒石存照 光前 裕後

光緒廿(nian4=二十)壹年乙未秋月董事

黃陳慶 陳換 黃躍 陳錦隆 陳成貴 張字 王媽賀 黃躍喜

仝(tong2=同)立


Inside Xuan Tian Miao

Sunday, July 24, 2011

Health Interprofessional Education Conference

On 14th July 2011, I attended the Interprofessional Education Conference. The conference started at 12pm and ended at 5pm. Several experienced speakers were invited to give speech and discuss about interprofessional collaboration in clinical setting and the way to work interprofessionally. I took part in the Health Care Team Challenge Competition.

The following is the link of my presentation for the Health Care Team Challenge Competition:


The following image is my certificate of participation:

Sunday, July 17, 2011

Health Care Team Challenge Treatment Plan/Report

1.0 Introduction

An inter-professional team approach to health care improves the overall quality of care received by patients. Below is the assessment and managed plan for Mr Turner in the rehabilitation ward, 6 weeks following his discharge and long-term. This report is written by an inter-professional team consisting of an occupational therapist (OT), nurse, two pharmacists and a dietitian.

2.0 Body structures and functions

Mental health

Mental health is important for immediate recovery and ongoing issues after rehabilitation due to the large impact an amputation has on lifestyle and family. This includes maximising comfort and addressing any issues regarding body image or psychological stress that have resulted from the amputation1. To accomplish these goals the psychologist, nurse and OT need to assess emotional function, apply a strengths-based approach and trial coping strategies. Post-discharge, Mr Turner can continue receiving support through phone counselling, diabetes support groups and the Mount Magnet Medical Centre.

Pain

Post-operative pain is another key issue. After assessing his current level of pain and impact on activities, interventions include education regarding possible phantom sensation, drug therapy, desensitisation and exercise. Drug therapy ranges from Paracetamol, Panadeine Forte® or Panadeine® to morphine conventional oral liquid depending on the pain assessment2. Key professionals involved in this pain assessment and management include the nurse, OT, physiotherapist, pharmacist and doctor.

Diabetes management

Mr Turner is showing signs of poor diabetes management. Testing his glycated haemoglobin levels will help to confirm this. All diabetics need to be treated like they have had their first heart attack, because of high causation, so all parameters that indicate heart failure need to be tested e.g. albumin, c-peptide and pulmonary function test3. A diet assessment and management plan will be written up before discharge. In addition his insulin regime will be checked and cholesterol lowering treatment (eg statin) can be started. Key professionals involved include the pharmacist, doctor, radiologist, nurse and dietitian.

Post-discharge, Mr Turner will require yearly visits to the ophthalmologist (Refer to Mt magnet ophthalmology service), diet and insulin regime support from the Dietitian and Diabetes Educator, monitoring of nervous and muscle tone issues with the physiotherapist, frequent health examinations by the local GP, yearly visits to the podiatrist and medication review by the pharmacist.

Nutritional intake

During a stressed state, malnutrition is a huge risk factor and increases recovery time3. Energy requirements need to be met to ensure optimal wound healing, immune function and a faster recovery. If nutrition requirements cannot be met orally during this time of increased energy demands, enteral feeding may be needed. Lack of fibre and fluid intake, decreased bowel motion from autonomic neuropathy and medications may cause constipation for which diet and drug therapy would be effective. Fluid and bowel open charts can monitor this. Key practitioners include the dietician, pharmacist, GP, nurse and speech pathologist.

Wound care

Mr Turner will need intensive management of dressings, healing, moisture of the site, and protection from infection4. Precautions to prevent deep vein thrombosis, development of pressure ulcers and flexion contracture of the right knee will be continued. Drug therapy including Prophylaxis antibiotic may help to reduce infection and improve healing. Key professionals involved include the physiotherapist, nurse, OT, pharmacist and doctor.

3.0 Activity and participation

Fatigue

Fatigue limits activity and participation. Sleep apnoea is a contributing factor to his daytime fatigue. This can be reduced by keeping his bed slightly upright or using a mandibular advancement splint. OT intervention would include education about activity pacing, energy conservation & work simplification techniques. This should be practiced during the hospital stay to maximise transfer of skills to home environment. Referral to the physiotherapist will be made for cardiopulmonary rehabilitation and strengthening.

Self-care

Self-care includes activities of daily living (ADLs). A baseline assessment for performance in ADLs can be conducted. OT intervention includes education and retraining in modified techniques, and prescription of assistive devices so as to maximise independence. Liaison between OT and nursing should be implemented to maximise skill development and practice. Referral will be made to HACC services available at Mt Magnet Health Centre for 1 hour daily self-care assistance for Mr Turner post-discharge.

Mobility and access / Transfers

Amputations affects mobility and therefore impacts participation in life activities1. The doctor, physiotherapist, prosthetist and OT will discuss possible mobility options together with Mr Turner and his wife with consideration of his health status and desired lifestyle. The short-term priority will be on wheelchair mobility and ADLs with the use of a manual wheelchair. OT intervention includes wheelchair fitting with residual limb support and pressure cushion. Referral to the physiotherapist and prosthetist will be made for strengthening, standing and ambulation. In the longer term, return to driving can be made with the help of an OT driving specialist.

To transfer to and from the wheelchair, a joint assessment and intervention from OT and physiotherapy is appropriate. These transfers will be practiced with graded difficulty. Education will be given to Mr Turner and his wife about technique and safety precautions.

Safety awareness and falls prevention

Mr Turner faces risk of falls and further injury due to the amputation, orthostatic hypotension and retinopathy. The OT will educate Mr Turner and his wife about identifying hazards in the home and safety precautions to prevent falls, while the nurse will educate about precautions to prevent further injury which could lead to future amputations. Post-discharge, a referral to the OT at Mt Magnet will be made to conduct functional home safety assessment and home modifications.

Instrumental activities of daily living, occupation and leisure

Assessment includes discussion with Mr Turner and wife about the level of importance and need for assistance in these activities. He will practice the appropriate and relevant activities with modified techniques as required, with input from the OT.

Referral will be made to the OT at Mt Magnet to assess and recommend appropriate farming tasks for Mr Turner, recommendation to employ more farming assistants.

OT can also assess and provide appropriate interventions (environmental modifications for access, modified techniques and assistive devices) to enable Mr Turner to return to valued leisure activities such as wood-turning and bowling.

4.0 Contextual Factors: Environmental and personal factors

Relationship with wife

Mr Turner’s main carer is his wife, who would face significant stress with undertaking this new role. Counselling and education will be provided to her about caring and coping strategies. Information about carer support groups and respite services available at Mt Magnet will be provided. Key professionals include the OT, nurse, and social worker. In addition, the psychologist might counsel the couple about potential issues related to intimacy and sexual relations.

Financial situation

A referral will be made to the social worker for eligibility of disability support, carer payment and allowances, and financial assistance schemes.

Smoking habit

Mr Turner’s smoking habit would delay wound healing, worsen the issue of fatigue and exacerbate diabetes symptoms. Counselling and education about smoking cessation, prescription of nicotine replacement patches if necessary will be done during the rehabilitation phase with the pharmacist and nurse5.

Access to health and medical services

This is a major issue that impacts upon time and finances for Mr Turner and his wife, as Mr Turner is presently required for appointments in Geraldton. Referral will be made to the Mt Magnet Health Service for medical, nursing and allied health services post-discharge, transportation services for specialised medical treatment required at Geraldton, and delivery of medications6.

5.0 Ethics

Health care professionals are governed by a code of ethics that cover the four main areas of autonomy, non-maleficence, beneficence and justice4. In the case of Mr Turner we have taken into account these criteria to ensure best practice. Autonomy - We respect Mr Turner's right to informed choice, even if they do not concur with professionals view. Non-maleficence versus beneficence - our interventions are carefully considered to avoid harm or stress. We were wary of not imposing any unnecessary intervention or testing procedures to ensure the management plan focuses on healing and does not cause harm. Justice - We have taken into account Mr Turner's financial and social situation to ensure he receives eligible benefits and can remain in his own home.

6.0 Conclusion

Inter-professional care is imperative for any client. In this report it is clear that Nurses and doctors have responsibilities throughout all areas of the clients’ care and they are the leading health professions for his assessment and management. Dietitians, physiotherapists, pharmacists and OTs contribute to client care with support from the social worker, podiatrist, prosthetist and ophthalmologist. Many health professionals not mentioned are also influential in Mr Turner’s care, e.g. speech pathologist and dentist. An inter-professional approach towards Mr Tuner’s care, rehabilitation and management will ensure best quality care possible.

References

1. Keenan DD, Glover JS. Amputations and Prosthetics. In: Pendleton HM, Schultz-Krohn W, editors. Pedretti's Occupational Therapy Practice Skills for Physical Dysfunction. St Louis, MI: Mosby Elsevier; 2001. p. 1095-1138.

2. Pharmaceutical Society of Australia, Australasian College of General Practitioners, Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists. Australian Medicines Handbook 2010. South Australia: Australian Medicines Handbook Pty. Limited; 2010.

3. Mahan LK, Escott-Stump S. Krause's Food and Nutrition Therapy. 12 ed. St Louis, MI: Elsevier Saunders; 2009.

4. Crisp J, Taylor C. Fundamentals of Nursing. Sydney: Mosby Elsevier; 2005.

5. Pharmaceutical Society of Australia. Smoking Self Care Card. 2011 [cited 2011 July 7].

6. Mount Magnet Medical Centre. Mount Magnet Medical Centre Brochure. 2011 [cited 2011 July 7].

Health Care Team Challenge Client Profile

Health Care Team Challenge 2011 - Client

***(NOTE: the Health Care Team TREATMENT PLAN/REPORT can be found at the following link)
http://expfiles.blogspot.com/2011/07/health-care-team-challenge-treatment.html


Medical & Social History

Mr Turner is a 67-year-old male who resides with his wife on a ten thousand acre property in the shire of Mt Magnet. He and his father-in-law built their present two-storey home with the first floor fully wheelchair accessible to accommodate his mother-in-law, who used a wheelchair prior to her death two years ago. Mr Turner and his wife live on the ground floor and use the top floor of the home for visitors when their 3 children and 7 grandchildren visit.

Mr Turner has a 20-year history of type 2 diabetes mellitus, complicated by retinopathy, peripheral and autonomic neuropathy, coronary artery disease and peripheral vascular disease. He has had progressive amputations of his toes and right forefoot. In addition, he has had a four-vessel coronary artery bypass. Five years ago, because of chronic renal failure he received a kidney transplant, with the kidney being donated by his son. Four years ago he had a cholecystectomy. Prior to his kidney transplant he had been hypertensive. Following the transplant he has had orthostatic hypotension which is controlled by making postural changes slowly, sleeping with the head of the bed raised, and a high salt diet. Also, because of the kidney transplant he takes immunosuppressive drugs. His prescriptions are very expensive.

Two years ago Mr Turner quit his 1 pack of cigarettes per day smoking habit of 30 years but he has resumed smoking a “few” cigarettes per day in the past three months. He denies chest pain or shortness of breath but he does have a persistent cough. His wife states that he snores at night and is often restless. He sleeps best propped up with two pillows. He describes his feet as “pretty numb.” He has not reported any falls but recognizes a fall could be a problem.

Prior to his kidney transplant, Mr Turner was an active farmer and his wife volunteered part time at the local Meals on Wheels. Since the transplant, Mr Turner can no longer manage the farm and his wife has had to take on many of the farm chores with the help of casual farm labourers. She finds it difficult to assist him during the day and to transport him to and from his frequent medical appointments which at times require a long drive to Geraldton.

Hospital Treatment

Ten days ago Mr Turner was admitted to the Geraldton Hospital for a non-healing foot ulcer. He had driven 800 miles to attend his sister's funeral. When he returned home, his right foot was badly swollen and erythematous. A large blister was evident over the metatarsal plantar aspect of the foot. Upon arrival at the hospital, his temperature was 39.4° and the ulcer was draining green purulent material. He was immediately admitted to the hospital for evaluation and treatment.

Upon admission he was started on antibiotics. In the operating room the infected area of the plantar space of the right foot was incised and drained. Purulent material was collected and submitted for culture.

Culture results: Staph. aureus, Strep. intermedius and Strep. constellatus.

Antibiotic treatment was changed to IV only.

Mr Turner and his wife were presented with two treatment options:

1. Aggressive debridement, infection control and surgical revascularization

2.Amputation of the right leg.

They decided to have his right foot removed. He felt he would be better off without the problem. It was recommended that he have the amputation above the knee but he insisted that it be below.

The right leg was amputated approximately 8 inches (20.3 cm) distal to the knee joint. Large vessels were tied off with silk suture material and a posterior myofascial flap was used to cover the stump. Skin edges were joined with staples. Fluff was used to pad the end of the stump, which was then wrapped with a Kerlix® roll and an Ace® wrap. No intra-operative or post-operative complications were noted.

During his hospitalization, he received acute care services from OT and physio. Initially, he required a maximum assist of 2 persons for transfers postoperatively. But within 3 days he was able to transfer to wheelchair with minimal assistance. He was independent in sink activities such as oral care and hair care and washing his upper body. He fed himself independently. He was able to dress his upper body independently but required moderate assistance to dress his lower body due to fatigue from exertion and trunk instability.

He required maximum assistance with all other lower body care, e.g. bathing, toileting, and changing the wound dressing. The operation site remained clean and dry and slightly edematous, with the skin pink and cool to the touch. He reported feeling tired following very little exertion such as sitting up on the edge of the bed.

Rehabilitation Treatment

Ten days after his operation, Mr Turner was admitted to the rehabilitation unit with the following: Immunosuppressants, enteric-coated Aspirin, Multi-vitamin, Fludrocortisone, Proton pump inhibitor, stool softener, Magnesium oxide and Insulin, 2400-calorie ADA diet with 3 gm sodium, 3 meals/3 snacks per day.

You are the interprofessional team tasked with Mr Turner’s rehabilitation and his return to the community including risk management and ongoing support.

Describe your priorities within the rehabilitation unit and then for the first 6 weeks post discharge, justify who would be the lead professions during Mr Turner’s journey and how they would be supported by the remainder of your team. Also consider which other health professionals outside of your team you might want to involve.

You are required to develop an integrated care plan for Mr Turner and his family

Tuesday, June 14, 2011

Series 4: The History of Bukit Mertajam's Xuan Tian Temple and its development (Chinese Version) 大山腳玄天廟歷史及建設發展--伍百恰PJM

廟歷史及建設發展--伍百恰PJM

溯自一百多年前,大山腳北面頭以種植豆蔻、丁香及其他水果為生的惠邑客家人,把產品有山頂挑下來擺在目前福德正神廟址所在地售賣。由於該處有一深潭,對擺賣工作諸多不便,且亦恐危及人命,因此他們便發起每天從山頂肩挑豆蔻一筐來此擺賣時,亦須順便挑一筐石頭來填平該深潭。經過長年累月的努力不懈,數年后,終于將深潭填平,因而填出一塊空地,以利擺賣水果等產品。大約在光緒八年左右,遂倡議在該地建廟,所需費用,則由每擔豆蔻抽佣所得,再加上園主的捐獻,集資所成。於是建廟工作即行展開。費時數年始將廟宇建竣,並于光緒十二年(一八八六年)出征信錄,以昭大信,並揚仁風。

爲了紀念山頂人挑石填潭建廟的功績,凡山頂人在本廟伯公埕前擺賣山頂水果者,概不收費,以示優待其他人士及各地產品如黃梨、甘蔗等,則仍須交佣金。然後利用該佣金于光緒廿一年(一八九四年)興辦義學,供本埠學子就讀,以啓迪民智,而教以孝悌忠信之義,明人倫之大本,俾所以立身處世之道,以揚我中華傳統文化。當時由惠邑客家人成立理事會,掌管廟務及辦理義學諸事宜。民囯七年(一九一八年)為適應潮流,遂接納閱書報社諸君子的建議,將原有的私塾義學改制為正式學,而以“日新”二字為校名。至于每年廟收盈餘累積,購買店屋多閒以爲廟產。

一九四一年,日軍南侵,英軍敗退,馬來亞失陷,廟務被逼停頓。迨一九四五年日軍投降,馬來亞光復,本廟會議記錄等文件全部散失無存,致廟務無從展開。

一九四九年五月十五日,在當地法官及檳城社團註冊官諭令下,由大山腳四大鄉團--廣惠肇會館、福建會館、韓江公會、瓊崖同鄉會召集華商埠眾大會,討論組織福德正神理事會,俾恢復廟務活動,會議由陳時吉主持,何克柔記錄。大會並推選陳時吉,吳志發及鄭石三負責草擬本廟規章。

一九四九年十月廿日,四鄉團派出的代表,在華裔埠眾大會復選下誕生,王譚清衆望所歸,當選戰後第一屆福德正神廟理事會會長,副會長吳志發,正財政鄭石三,副財政沈清楚,正產業林于利,副產業林泰南,正建設葉萬尚,副建設陳囯興,正調查梁英龍,副調查陳時吉,正福利黎榮昌,副福利朱亞文。

大山腳玄天廟

至此,廟務才納入正軌,而穩健地逐年發展。一九六二年十二月卅日,本廟在召開埠眾大會中順利通過修改章程,其中包括:(甲)本廟以崇奉神教及辦理社會慈善為宗旨;(乙)本廟承先賢舊例,訂農曆二月初二日為伯公誕,三月初三日為玄天帝爺公誕,四月初八為譚公爺誕;八月初二為伯公誕。

一九六四年,廟宇進行修葺,面貌煥然一新,香火日益旺盛。

當年創廟的宗旨原為崇奉神明,而後隨着時代的變遷與社會環境的需求。戰後數十年來,本廟理事會除了繼續保持崇奉神明的宗旨外,亦發展成爲一個贊助教育福利,慈善公益事業的機構。尤對日新中小學及幼稚園五校的建設、維持與發展,全力贊助與支持。一九五五年,本廟理事會購下愛士頓律地皮一塊供日新中學建校之用。一九六一年,另購武拉必地段,供日新小學建校。當年由于本廟存款不夠付還購地費用,而銀行又規定社團不准透支,在無法可施之下,結果由鄭石三,王譚清、朱亞文、葉萬尚、黃成國與黃耀南六位以私人名義向合眾銀行透支用以塾付地主(透支利息由廟支付)這樣才解決了購買日新小學校地款項不敷的難題。

日新獨立中學的辦公樓及鐘樓(舊時,日新囯中及日新獨中用同個校舍)


日新獨立中學懷德堂

一九六二年八月,本廟理事會通過檳城葉玉力會計師向當局申請豁免繳交所得稅,因鑒于本廟之產業收入盡用于社會教育福利,慈善公益事業,檳州所得稅當局于一九六五年批准本廟豁免繳交所得稅。

一九六三年七月,本廟理事會接獲廣惠肇會館建議購買武拉必樹膠園地為新塚山的來函,經從討論后,僉認高吧三萬舊山墳地已先爆滿,為應付埠眾之需,遂議決接受購買新塚山之建議。其後,由廣惠肇會館借出一萬元,福建會館伍千元,韓江公會伍千元,瓊崖同鄉會四千元,連同本廟所存款項,于一九六九年七月成功購下武拉必五十七依格膠園地段闢為塚山用途,一九七三年九月獲有關當局正式批准啓用。在此之前,即一九七二年為發展武拉必新塚山,一條直通嶺頂的大路,一座伯公廟及兩座涼亭,先後由建設股策劃下開闢及興建,美化工作尚在進行中。

此外,日新中小學食堂及日新中學校門,皆由本廟撥款興建。

一九七九年,日新中學興建新辦公樓及教堂,本廟捐獻十萬元,而一九八〇年亦曾以五萬元購買地皮一塊,供蔗芭僑光小學建校。同年,本廟理事會通過在武拉必塚山興建火葬場及骨灰停,一九八二年七月有關當局及市議會已正式批准本廟理事會提出之兩項圖測。招標及興建工作,料將在不久進行及推動之。

由以上贊助教育及各項建設措施,顯示出本廟理事會已充分發揮了“取諸社會,用諸社會”的崇高信念,對地方上的教育,慈善,福利事業,莫不遺餘力,鼎力贊助。

一九八一年,本廟理事會爲了響應威中社團聯合檳州華人大會堂籌募興建大廈建築基金,慨然捐獻三萬元,另捐華人大會堂活動基金五千,以示支持。

在四大鄉團諸理事會同心協力,共同策劃之下,本廟會務蒸蒸日上,原設于日新中學内的辦事處,已不敷應用,因此乃決定興建新會所大廈,一九八五年九月十五日,大廈工程完成,欣逢本廟百週年紀念,除舉行隆重紀念慶祝儀式外,復將各界收購禮券,悉數撥充日新國中建校基金。

本廟理事會同仁希望能繼續獲得埠眾的擁戴與支持,俾本廟會務能辦得更有聲有色,而為地方上的繁榮與進步作出更大的努力與貢獻。

伍百恰

一九八六年

洪政陽 謄寫

二〇一一年六月十五日上午一時十分