(Click on photo to enlarge)
Buongiorno !! Chao !!
These are two forms of greetings you will frequently hear when you visit Venice. Buongiorno means Good morning and Chao (pronounce Cha-o) means Hello. Chao also means Good bye, so people will say Chao when they meet and they will say the same thing when they leave.
My mission in Venice was to present on behalf of the Ministry of Health Primary Care Division, the “Teleprimary care - Casemix Project” at the 23rd Patient Classification System International Working Conference. In collaboration with the John Hopkins University (JHU) and jointly sponsored by the WHO this research project is the first Malaysian experience of analyzing the primary health care data using the casemix software. The project has been lead and managed by Dr Safurah Jaafar and the Teleprimary Care (TPC) team. Another team member includes Assoc Prof Awang Bulgiba from the Faculty of Medicine, University Malaya and Dr Rozita Harlina Hussein from the Institute of Health System Research, Bangsar. The three consultants from JHU were Prof. Dr. Barbara Starfield, Dr. Karen Kinder Siemens and Mr. Chad Abrams.
The conference was organized by the independent organization called Patient Classification System International (PCSI). It is an organisation that creates a network of researchers and users of the casemix concept from health administration, government agencies, and academia. From an initial focus on the Diagnosis Related Groups (DRG), the association’s goals have expanded to include a broader interest in clustering and grouping techniques of clinical and administrative data for health care management and financing. The association has stimulated the use and refinement of the science of "re-grouping patients" to create classes, which are relatively homogenous in respect of the resource used by taking into account severity of illnesses, patient age, co-morbidities and complication. This new group of patient database is extremely useful for risk adjustment, capitation, predictive modeling and resource distribution. And that is what ‘Casemix’ all about.
Traveling alone is less enjoyable especially when going to a place you never been. So few weeks before my journey, I sought information about Venice and Italy from books, internet, friends and patients. Safurah gave me a long list of stuff to take along. Prof Awang wrote a lengthy email describing “do and don’t” while in Venice. To ensure I would be always reachable and have no problem abroad, I activated the roaming service of my handphone as well as the maybank plus service to allow me withdrawing cash from any ATM abroad.
My flight to Venice would first make a transit in Paris, a twelve hours journey from KL. Traveling a long haul flight in a Malaysian Airline Business Class cabin allow you to relax and have a good rest. The seat is spacious, comfortable and can be transformed into a flat bed. It is also equipped with a ten minutes massager and a multi-channel in-flight entertainment. Even the food has so much varieties and course; one after another. The in-flight entertainment even has an interactive online fact of the popular travel destination all over the world together with a language lesson. I managed to learn a few basic Italian languages while on board.
It was 7am Malaysia time, almost 6h on board when I was awakened by the air steward. A view outside the window was still dark and the navigator on the small monitor in front of my seat showed that the plane was flying somewhere above a desert of Afghanistan. The air steward asked me whether I am a medical doctor and whether I could see a French boy who suffered from diarrhea and vomiting. I showed him my MMA card and agreed to see the boy.
‘Bonjour’ I greeted the boy and his parents in French. After introducing myself I took a brief history from them followed by a quick physical examination on the boy. It seemed that the boy had acute gastroenteritis and oral medication given earlier by the air steward seemed to be ineffective. I asked the steward whether they have any parenteral medication. He then led me to a medical container that only permitted to be opened by a certified medical professional. Fortunately I found a few ampoules of Stemetil and Oral Rehydration Salt inside it. After discussing with the boy and the parents they agreed for the injection. Every one felt relieved when the injection worked and that was one of the great moment where you really felt worthwhile being a family physician.
I reached the Charles De Gaulle International Airport, Paris at dawn (6 am local time). The chilling temperature outside was 5 degree Celsius. The airport buildings are scattered in one large area that you have to take shuttle bus and train to its various terminals. The congested tunnel shaped terminal seemed almost claustrophobic. I have to join half a mile queue to get my passport stamped. The immigration officer welcomed me with a grim, stern- faced and only let me go after I showed him the conference registration letter. Soon after, everyone had to go through a stringent safety screening before we were allowed to enter the departure gate.
I left for Venice with Air France and it took me two hours to reach the Marco Polo International Airport. The Aeroporto di Venezia Marco Polo as the Italian called it, is named in honor of its famous citizen. It is situated around 7 km north of Venice, on the edge of the lagoon. From there you have few options to enter Venice either by land or by sea. To give me the best possible introduction to the city, I decided to take a water bus.
As the water bus cruised through various stop point around Venice, my jet-lagged eyes suddenly got bedazzled by the spectacular view of this ‘floating’ city. Elusive and enigmatic, Venice is a dreamlike place that beggars description. Countless artists have tried with pen and brush to render the shimmering lagoon with its slender bell towers. World-famous for its canals, Venice was built on an archipelago of 118 islands formed by about 150 canals in a shallow lagoon. The islands on which the city is built are connected by about 400 bridges.
A brief rendezvous at
Piazza San Marco (St Mark Square) is all it takes for you to soak up with Venice’s diverse and rich heritage. Its history can be read in every monument and pallazo, in fact each and every stone bears witness to the period of splendor, decay and wars. The city could be described as a gigantic open air museum, visited each year by million of tourist from all over the world. Founded fifteen hundred years ago, Venice rose to become Europe’s main trading post between the West and the East, and at its height controlled an empire that spread north to the Dolomites and over the sea as far as Cyprus. Nowadays it’s no longer a living metropolis but rather the embodiment of a fabulous past, dependent for its survival on the people who come to marvel at its relic.
The two prominent buildings at the Piazza are the
Brasilica di San Marco and the
Pallazo Ducale. The
Brasilica di San Marco is the most mystical and exotic of Europe’s cathedral. Dan Brown, of
Da Vinci Code fame, would have had a field day here. The combination of ancient structure and later decorations is to a great extent what makes the cathedral so bewildering. In contrast, the adjacent building of
Pallazo Ducale is decorated with a geometric patterned stonework resembles an Islamic art. Perhaps this is one of the Islamic architecture that remains intact. Venice's economic and diplomatic relationship with the Islamic world from seven century onward is well documented. As Byzantium gradually gave way to Islamic caliphates from the eighth century onward, meeting its ultimate demise in 1453 at the hands of the
Ottoman Sultan Mehmet II, Venetians increasingly came into contact with Muslims and their ideas, culture, and way of life. As a result, Venice became Christian Europe's most important interface with the Muslim civilizations of the Near East. During my visit there was an exhibition entitled “
Venezia el Islam” that examines the relationship between Venice and the Islamic world over a thousand-year period, focusing on artistic and cultural ideas.
Walking north of the piazza would lead you to a labyrinth of medieval streets that been occupied by a variety of shops selling merchandise ranging from souvenirs, antiques, clothes, leather and the famous Murano glass. Many of the top-flight Italian designers and fashion houses are here; Gucci, Armani, MaxMara, Prada, Valentino, Benetton, Stefanel etc. For those with wallets as deep as oil wells this place is the most fruitful zone. If you are like me who always buy things at ‘pasar malam’ and during cheap sale carnival this place is only good for a window shopping.
As one of the most exorbitant city in Eastern Europe you would expect everything is expensive in Venice. A small hotel that I stayed cost me 140 Euros (RM670) per night. An hour of gondola ride through the canals will cost you 160 Euros (RM 768). You really need to have enough cash to enjoy Venice.
The conference itself was held in Lido Island, a southern island of Venice about 20 minutes by boat. The exact venue was at the Palazzo del Cinema where the annual Venice Film Festival (the world’s oldest and the most important film festival in Europe after Cannes) is usually held. In contrast with the bustling Venice, Lido is amazingly quiet, serene and peaceful to the point of pleasant somnolence.
With more than 300 participants from 36 countries all over the world, the conference was a great sharing forum. Every speaker presented their own project and enlightened their experience of using and implementing casemix system in their country. Safurah was right when she persuaded me to pursue into this area. Not everybody who involved in the casemix project has a degree in Public Health, there are pediatrician, psychiatrist, rehabilitation physician, nurses and even economist. To my surprise the person who presented the new version of German DRG is a surgeon!!!
As the last speaker that day my nervous eased a lot after seeing how the others performed. As you’d expect, you could hear a variety of English slang, dialect and intonation; Spanglish, Swedlish, Thailish etc. So I didn’t have to worry about my faulty English.
Generally the conference gave me a bird’s eye view on how casemix is implemented in different countries around the globe. While casemix system is quite established in evaluating hospital performance, the casemix in primary health care sector is relatively new. Some of the developed countries don’t even have one while others still experimenting. I hoped the knowledge I learned during the conference would be helpful in assisting the MOH Primary Care Division developing our own primary care casemix system.
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