A Day in Parliament

It was quite a remarkable experience to witness a live Parliamentary session recently.  The second meeting of the third session (13th Parliament, 2015) - Dewan Negara, is currently on. 

Getting to the Parliament
The public car park is now re-opened after a few months of renovation.

Apart from driving on your own, there is a RapidKL shuttle bus (bus no. S100) service that commutes from KL Sentral to the Parliament at only RM1.00.  As RapidKL buses these days use fully-mechanised ticketing system, it will thus be prudent to ensure you have RM1 note when taking the bus.  Alternatively, you may use the Touch n Go card.  From observation of a few times, there were very few passengers.

 As someone who usually does not drive to KL city, more so after the sale of my first car (currently having an old one inherited as 'harta pusaka'), this RapidKL service was a saviour indeed.  It was a 10 minutes ride.

The drop-off and pick-up point is around the vicinity of the police's guardhouse.

I notice a difference here though - if you were to drive on your own or being driven in a ministry/agency-owned car, you will be subject to a few questions on your purposse of going in, and will be required to obtain either a visitor's pass or a 'pas pegawai petugas'.

However, those coming via the shuttle bus are not subject to any questioning although the police will take a thorough look at all the passengers.  So to be safe, visitors (with official reason) or officers on Parliamentary duty for the day should obtain their passes at the guardhouse first, in order to avoid the hassle of going in and then to walk all the way back to the guardhouse to get the relevant passes, bearing in mind the wide area and long walking distance from one spot to another which may turn out to be unpleasant if the weather is very hot.  

Dewan Negara (the Senate) in session
The sitting time is officially from 10 am to 1pm, then 2.30 pm to 5.30 pm.  However, in reality, the Dewan usually ends past 5.30 pm, which may extend until late evening or sometimes even at night.  During the fasting month, it ends at around 6.30 pm.

The 2 Cafe
There main cafeteria located near the temporary block is closed throughout Ramadhan, while the canteen (that's what they call it) located next to the Dewan remains open.  The canteen somewhat reminds me of a school canteen, being an open area without walls.  The price of food there was reasonable, not expensive.

Oral Q&A and Debate
The morning session comprised mostly Q&A, while the late morning until evening sessions were solely debates on the 11th Malaysia Plan (RMK11).

Answers for the Q&A were prepared beforehand, so the ones who made the replies (Deputy Ministers) merely had to read it in Parliament.  However, it does not end there because the replies made were subject to additional questions (soalan tambahan) from the Hon.Senators.  There's where the task of 'petugas Parlimen' comes in - to take down the soalan tambahan and replies, if any, that are related to their respective ministries.

Among the areas brought up in yesterday's Q&A (this is not a complete list, as I was outside for a while) were:
- The move to allow UEC students to apply for public universities (reply: no, because at present, the UEC still does not fulfil the Malaysian requirement);
- Why has Malaysia become a destination for migrants from Bangladesh and Myanmar;
- The recovery plan for MAS;
- Efforts to make Malaysia an education hub in the region;
- The dealing of issues on intellectual property, competition policy, trade and distribution at  international level;
- Initiatives to monitor financial assistance to the target group (those who qualify to register with the Welfare Department) in order to ease the burden of those eligible for the assistance; and
- Issues and steps taken on red I/C holders (PR) with regard to enterring local public universities.

As for the RMK11 debates, one of the topics that had attracted my interest /likeness was when a YB Senator (a lady) highlighted the need of putting a greater focus on special education for children with special learning needs.  Accordingly, in the Scandivanian countries for instance, their special education syllabus is tailored to suit the different needs of special children of various conditions.  It was alleged that locally, many special needs pupils are made to spend most of their times drawing and colouring for the sake of keeping them in school.

I think it is good that the YB Sen. had brought up the suggestion to place more attention to special education in the effort to help and to maximise the potential of special learning needs children right from young, in order for more among them to grow up as independent as possible in adulthood.  The move for a greater accessibility to special education nationwide will be much-welcomed... or else the cost of providing for a child with special needs will be very high and become a financial stress for parents who are not well-to-do.

My humble 2 cents...
From what I briefly know so far, our country currently has a system in place, called the 'Program Pendidikan Khas Integrasi' (PPKI) and 'Program Pendidikan Inklusif' (PPI).  I shall try my best to make sure that what I have gathered so far is as accurate as possible, but in case if it isn't, please feel free to correct me. 

When a child is identified as one requiring special needs (e.g. sight, hearing, physical, learning), he/she will first have to be referred to a Govt hospital for evaluation and medical report, followed by registration at the Jabatan Kebajikan Masyarakat (JKM) in the district where the child lives, and then registration to study in a school with PPKI that suits the child.

PPKI classes are located within selected normal schools, with specially-trained teachers and facilities for special needs pupils, as well as trained personnels (teachers' assistants) to help in handling these pupils and classes.

Under the PPI, some special needs pupils may join other typical pupils for certain subjects, or may be included into the mainstream altogether, subject to being deemed fit to do so.

On the issue of special education system, I personally think that the issue is primarily in relation to access, while the issue of existence should be secondary.  While more and more schools, albeit still not many, are beginning to open up PPKI classes, the issues now are:

1) How many people know how to get help for their special needs children? 

2) Where to seek help?

3) For a child who finds it difficult to cope with learning in school, but otherwise appearing fine (no social or behavorial problem, can talk like any other children), are their parents/teachers aware that this child may have a learning problem that falls under the special needs category? 

Do we take an extra look into the matter, or do we just dismiss it and simply call the innocent child "stubborn", "hopeless" and so on?

End of session
The Dewan Negara was adjourned at about 6.30 pm, which was considered early because the breaking of fast was to start at around 7.30 pm.  If not, the Dewan would sometimes sit until night time. 

"The Premature Baby Book"

This is the first time I'm sharing about a book on this blog..  As I am not a serious reviewer of books, so please do expect a mishmash of other things alongside my so-called review.   ;)

Introduction
My first child Alvin is 3 now, but if we were to go by corrected age, he should be 2 years and 10 months.  Alvin is born at 29 weeks with a birth weight of 1.16 kg at Hospital Ampang, and was discharged from the NICU and subsequently Ward 4A on his 53 DOL, when he's almost 1.8 kg.  The cause of Alvin's premature arrival was finally known after my second pregnancy - it's due to cervical incompetence.  Thanks to an emergency cerclage done at HUKM during my second pregnancy, Alvin's brother, Aaron was born past the 36th week after the removal of cerclage. 

"The Premature Baby Book" is one of the books published under the Sears Parenting Library series, authored by the Sears family.  Dr William Sears is an American pediatrician who had appeared on numerous TV talkshows (known as Dr Bill), and had written many parenting books.  Dr Robert and Dr James, both pediatricians as well, are Dr Sears' sons.  Mrs Martha Sears is a registered nurse and lactation consultant.   Authored by a team of experts, you can be assured of accurate information and advices from this book.

Where did I buy the book?
As I seldom walk-in to bookstores in town, I am not sure which bookstore in Malaysia sells this book or whether it is available locally.  I bought the book online from Amazon, and was happy that the delivery was quick.  It took less than a week for the book to arrive via courier from the US.  

Timing factor
By the time I bought the book, Alvin was already close to a year old.  It was a late purchase, if only I knew about this book earlier.  Although there are plenty of information about premature babies available over the Internet, they are mostly very general.

The Premature Baby Book ("The Book") and some real experience
The book provides an overview of the NICU, the health issues and risks with regard to prem babies, how to introduce breastfeeding to a prem baby, tips on various latching and feeding techniques, exclusive pumping (very useful for moms with non-latching babies e.g. prem babies who receive EBM via tube-feeding in NICU),  preparations to bring a prem home, diet and when to introduce solid food to a prem, and so on.

Based on my personal experience, introducing a baby who's already used to tube-feeding requires extra work in the beginning, compared to a newborn who starts drinking milk either directly from the breast or bottle from day 1.  Starting off with syringe-feeding at first, followed by a bit of non-nutritive sucking, and then only serious direct latching.  Even then, many tiny babies (below 2 kg) are prone to get tired more easily when they only latch directly, resulting in slow weight gain, and even weight loss. 

At the time of writing out the review, I do not have the book in front of me.  Anyway, let me share what I can recall, have tried based on tips provided by the book (I have failed during the first time, but I tried applying some of them during the second time and it works). 

Quite a large part of the book touches on breastfeeding, an area which turns out to be a challenge for many mothers of prems.  What is a prem's mom to do in the absence of direct latching cum stimulation from a baby to ensure continuous lactation?  Preferably to look for a hospital grade pump, to express milk at short intervals, but short duration - once in every 2-3 hours, max 15 minutes for each side, bearing in mind that pumping for too long may cause soreness. 

The main aim of expressing milk here is not primarily to empty the breast, but to ensure that they are sufficiently stimulated, which is important to make sure that lactation does not cease. 

The book puts a heavy emphasis on a diet (when it comes to the solid food stage) rich in DHA e.g. oily fish, flaxseed oil, for prems.  As extreme/very prem babies tend to be born with immature brains, DHA helps in promoting brain development.

Based on ultrasound scan on the 4DOL, Alvin has no IVH.  But immature brain was noted and a repeat scan was scheduled to monitor its growth.  Imagine an immature brain as looking like a rugby ball, and a matured brain looking like cauliflower... The last result before discharge noted "grossly normal".  I am grateful that Alvin is physically like most of his full-term counterparts.  However, in relation to immature brain, it seems to have some effect upon him.  

E.g. hypersensitivity towards noises, as a baby he used to suddenly wake up screaming for no reason and his outbursts were very difficult to sooth, certain behavorial issues, and language delay (at the age of 3, his pre-verbal skills are still at a low level).  Those who are familiar with such problem may be able to guess what's probably plaguing us here without me sharing the further details.

Do I feed him with oily fish?  Yes I did put some salmon into his diet in the past, and he eats sushi sometimes (he loves salmon). Diet, to couple with suitable stimulatory activities.  The latter is easier said than done, given the limitation of time at home esp on weekdays.  Here, therapies come in crucial, and for the benefit of whoever in the same shoes, perhaps I should share about these one day.

The book provides a precise, comprehensive and useful information/reference for every parent of prem babies from newborn to 1 year of age.   It is written in plain English, yet explains the terms commonly used in the NICU, thus making it easy to read, understand, and to relate to what the doctors and nurses tell.

For the second pregnancy, the book again came into picture on my first day at HUKM.  My first ward-mate, had PPROM.  Her baby girl was 26 weeks when delivered, < 1 kg, and was admitted to the NICU.  She works in KL, while her husband, a British, was some 300 km away for work-related matter at the time of delivery, and the latter arrived a few hours later (that place, which I shall not reveal here, to KL is far, about 300 km away).   

Thought of giving the book to her, I thus called my husband to bring it to the ward on the next day.  But when the book finally came in, I suddenly had to be transferred to the HDU due to threatened preterm labour...   ouch, I did not manage in time to pass her the book.  From then on until my discharge 2 months later, the book had remained my companion in bed, where I went through it all over again.  I felt sorry, I wish I have given her the book, and deep inside I wish her family and her baby all the best.

Conclusion
If you were to ask me whether I would recommend anyone to read this book, I would say yes.  It is a good book to have, the earlier the better.  Besides parents of prem babies, this book will also be a good read for anyone who takes care of such baby.  From what I know so far, this book is available only in English.  Nurses in the public health sector, like my mom last time, may find this book of interest (perhaps...  but I never had the chance to show my mom this book). Lastly, if you're interested in the book, please feel free to ask and I shall be glad to share it. :)

Year of the Goat. Happy New Year.

Today is the last day of the Chinese New Year celebration, popularly known as chap goh meh which stands for 15th night in Hokkien.  Happy New Year of the Goat...

(1) What lies ahead for the festive season
Prior to the long break as CNY fell on a Thursday and Friday this year, among the FAQs received were "When will you be on leave?", "Only 2 days, such a short break, is that enough?", "Where's your hometown and when are you going back?", etc.

(a) Flashback to a year ago...
As any other ordinary person, I can only plan.  But what ultimately transpires is sometimes beyond contemplation.  Last year for instance, it was totally outside my imagination that I was to spend most of the CNY "celebration" at HUKM.  Ended up spending my entire third trimester at ward 2B for 2 months, which felt a lot like living in a dormitory, with shared bathrooms, makan ramai-ramai, the purple uniform, and a fixed daily routine.

Anyway, despite the dread and boredom at first, it was overall a pleasant experience after getting to know some new friends.   Lots of time to rest and sleep, but couldn't help missing the little guy at home.  While others enjoy yee sang and an array of festive dishes out there, I was only confined to bland hospital food.

It was the 9th day of CNY when threatened preterm labour occured (also at 29 weeks) and I was transferred to the HDU for tocolysis before undergoing the emergency cerclage.  Thankfully everything turned out well and Ken-ken did not come out during the CNY period.  "Be patient baby... the angpows can wait until next year..." I thought. 

(b) Cuti-cuti New Year
I only took a day off on CNY eve and another a day off post-CNY weekend.  After skipping Ipoh last year, we went there on the 3rd day this year to the home of my cousins+aunts in Bercham.

Scene along the PLUS highway.  

(This is an old picture taken a few years earlier... not during the recent trip)

Alvin was in a rebellious mood.  The rebellion was probably further aggravated by a previously-unknown fact that he's car sick, as he had never puked in car prior to this.  Puking can be traumatising to a young child, and worse when it occurs in a strange place.

Speaking of Alvin and some of his behavorial/sensory issues...  It's NOT TRUE that Alvin's rebellion is due to seldom going out, as what a few concerned relatives said to my parents-in-laws.  He was seldom exposed to crowds before he turned one due to low immunity as a very preterm baby... but after that, he started going out, unless he's having flu or something like that.  I swear that he had been to more places than me at the age of 1+ compared to when I was 5 (i.e. visits to local attractions, not overseas). But then this is my fear... how to bring him to people's house without his  resistence?  Tak bawak kang unfair to him...

Maybe this is related to prematurity as very preterm babies are born with immature brains.  Or maybe it's not.  If by God's will, things works out successfully, I shall try to share them here for the benefit of those under the same shoe.   Issues may not end upon discharge from the NICU, no matter how positive things appear to be at first.  The longer your baby stays inside your womb, the better it is... even by a week.  I don't know whether to be happy or otherwise, but I have probably been chosen to walk a path that differs from the majority... and parenting an ex-prem baby may or may not be the same as for other children.

Despite being a brief, simple and impromptu one, the one-day trip to Ipoh was memorable indeed.  From meeting up with family members whom I've not seen for a long time to passing through places that was once a part of me, I cherished them a lot despite already not feeling well a few days earlier... oh my sorethroat!

(2) The voiceless CNY
On 1st day of CNY, swallowing felt painful to me.  Body temperature was up at 38 deg C by evening.  All clinics around my place, including non-Chinese doctors, were closed for public holiday.  The only safe home remedy available?  PCM and Difflam lozenges.  Tahanlah dulu....

The same thing persisted on the following few days, coupled with cough later on.  I lost my voice completely on Sunday (Day 4), a day after the visit to Ipoh.

On Day 5, when the panel clinic resumed operation, I went to see my regular dr.  I had no voice at all, thus wrote everything on a piece of paper and showed it to the dr.  Fever was still on after so many days... although just very mild.  A medical leave of 2 days after the CNY break was a lil against conscience, as if taking advantage to sambung cuti.  But, commit no fault and hence fear nothing...

Remaining silent, especially when in front of the kids was very odd esp when they are too young to understand why you're suddenly all-quiet with them.  Then they'd frown in front of you, as if wondering why, when they hear your strange voice.

(3) Conclusion
Today, on the 15th day of CNY, my voice still has not fully-recovered although improvement is starting to be more visible now.   :p

Fortunately the voice came back early this week or else I might have to miss the sponsored CNY luncheon again at my workplace.   It's very thoughtful of the management to organise such an event for its (minority) Chinese employees, so how could I have the heart to skip it... unless I genuinely couldn't be present, as in last year?

The Breastfeeding Story: A Renewed Course

Introduction

Driven by the random discovery of this old key chain while I was looking around what's in the drawer at home (being a busybody when it comes to "treasure-hunting" at home since I was a kid, a habit that dear Alvin has inherited), I am reminded of a topic that I have long wanted to share about but somehow didn't have enough motivation to do so due to more limited time nowadays.  It belonged to my mother, obtained during the times when she's still at work before her retirement in 2004.

Here's sharing something on breastfeeding, or breast milk feeding experience with whoever happen to drop by.

I am not an advocator as to what milk is superior or inferior.  As someone who had gone through 2 different routes with 2 children i.e. formula-feeding and breastfeeding, I respect and understand the various reasons cited by mothers with regard to formula vs breastfeeding.  Please don't outwardly condemn a formula-feeding mother without first knowing the reason behind it.

Breastfeeding vs breast milk feeding... The former means direct latching (DL) while the latter is to pump-and-feed.  DL is the most ideal of course, but in the event where the baby doesn't suck, whether due to baby's downward refusal, baby's inability to do so, or having to be away from baby due to work, moms nowadays are fortunate with the availability of various good breastpumps.  If you're passionate about breastfeeding but you're unable to help your baby latch correctly, it's a good idea to see a lactation consultant before committing to EP (exclusive pumping). EP is very tough-going because you must pump consistently in order to maintain milk production... but nevertheless a viable method to ensure that your baby gets your breast milk. 

I shall organise my note as follows:  learning from past mistake, my new journey, and the challenges I have encountered so far.

Lesson from Past Mistake
During the second pregnancy, I was still a little affected by my failure to breastfeed my eldest for longer (it stopped on exactly the 53rd day).   That was back in 2012 and I ended up ranting about it on this blog.  The regret was aggravated primarily because he is a very preterm baby, and secondly because he became constipated when on various formula milk.

So what did I do wrong that caused the sudden cessation of breastfeeding back then when I was initially into the "minimum 12 months target"?

As Alvin was separated from me because he was admitted into the NICU, DL thus could not take place.  When I finally roomed in with him, I made a mistake of listening to one of the personnel at the NICU who told me to only pump and feed with syringe since Alvin lost weight when given DL.

When I think of it now, I should have ignored that advice and continue to let him latch for at least twice a day, on top of pumping.  So what if Alvin's weight gain is slower and thus we had to stay in ward for longer?  Maybe the instruction was given due to the fact that places are very limited at the NICU. 

Had I been adamant, I might have continuous stimulation.  The routine of pumping and feeding every 3 hours was physically too taxing on me.  Mind you, at 1.4 kg when I roomed in with Alvin, he took close to 1 hour to finish 30 ml of milk.  I ended up with a sharp decline in milk production, from 120 ml per session to just 30 ml.

Worst, I did not have a good pump back then and only relied on the sole unit of Spectra 7 at the NICU and subsequently at ward 4A to express milk.  The queue to use the breast pump at the NICU can be long at times esp day time, so imagine how hard it is to adhere to the once-in-three-hours pumping schedule.

Renewed resolution: To turn over a new leaf
My past mistakes coupled with the useful info gained from The Breastfeeding Advocates Network, or TBAN on Facebook,  I have made a resolution to try again this time.   But with an open mind, prepared for all possibilities.  I am grateful to my long-time friend Mei Mei for introducing me to TBAN.

The Spectra M1.   It's a middle range pump (price-wise), but has excellent performance - good suction, compact, light-weight and  low noise level.  It comes with rechargeable built-in lithium  ion battery and very few parts, so cleaning is easy.  Ideal for those who pump part of the day. (NB: A hospital grade pump such as Spectra S1 will be better for EP mommies because the S1 is more durable, and is super quiet too)

The Second Journey - It's not what I thought it to be
Contrary to my initially-innocent impression that breastfeeding would be easier because the baby's right in front this time, it was all dreadful for the first few days.

Unlike previously when I started having drops of colostrum on the night Alvin was delivered, even in the absence of stimulation from latching, for this time, colostrum only came in on Day 4.  It's no joke, for reason unknown, this time, there's no secretion whatsoever and (.)(.) felt very soft as if I was back in my early teenage years.  Ken-ken would latch but within seconds, he would scream in hunger again.  It would happen every hour even with correct latching.  So stressful.

So what's for a hungry newborn to drink while waiting for mom's milk to arrive? 

There was no choice but to sparingly seek the kind nurses to top up with formula.   Before anyone starts to condemn me for resorting to formula while waiting for my own milk to come in, below are the reasons why I did it:
i) I had no colostrum until Day 4;
ii) More than half a day after birth, Ken-ken still had not passed meconium (newborn's first stool); 
iii) There is an increased risk for jaundice when the passing of meconium is delayed.  In this case, although I foresaw jaundice to occur, I would not wish it to go too high. Sufficient hydration = normal BO frequency = getting rid of bilirubin faster.

As for other times when I forced him to do "empty" DL, I ended up with a screaming baby.  I was thinking, "A baby-friendly hospital is only friendly when mom has milk... otherwise it's not".

My insufficient lactation during the initial days is very obvious, as evident from Ken-ken's significant loss of weight ( 12%) for the first one week.   Normally, a newborn would lose at most just 10% of his/her birth weight in the early days before re-gaining weight later.

Beneath what's good, lies many untold stories
People will usually only tell you what's good, and breastfeeding is certainly not an exception.  "My daughter-in-law has abundant milk... my grandson is gaining weight very well...", said one aunty.  "So-and-so exclusively breastfed her baby for 1 year, that's why the baby has Michelin-looking arms", said another. 

Very rarely would anyone come around to tell you the "pains" involved in ensuring successful breastfeeding, unless that person is someone close.

Here's sharing some of the challenges that I faced in my attempt at breastfeeding:

"Alone on an island"
I shall not put a blame on anyone for not having sufficient understanding with my needs when I decide to go for breastfeeding, as no one in my close family circle had breastfed before.

According to sources, in my infancy, all that I'd ever had was colostrum for the first 3 days before being forcibly weaned off as my mother's doctor told her she needed to resume her thyroid medication soon, which was said to be contraindicated in breastfeeding.  Both my husband and I grew up with the same formula milk - S26.

E.g. of familiar remarks:
(a) "Do you have to be so extreme...pump every "x" hours... that you even wake up in the middle of the night?"
Answer: To ensure continuous stimulation when baby is not sucking/when you're away from baby, which in turn ensures steady prolactin level.  Milk production correlates to demand.

My faithful companion wherever I go...

(b) "This can't go on you know... it has to stop one day" 
Answer:  True, lactation cannot go on forever.  It's important to strike a balance between loving your baby and taking care of yourself by having enough rest.  But the making of such a statement at an early stage before baby is even 6 months old sounds very discouraging.

(c) "Never seem full... "
Answer:  Human breast milk is easily digested, which is why breastfed infants get hungry faster.  Cow's milk based formula takes longer to digest, and thus a baby who consumes formula feels full for longer.

Conclusion
In view of the routine of waking up at least once past midnight to express/feed, I do feel physically drained out.

On the statement made by many that breastfeeding moms slim down quickly, here's my scenario - While I've lost a few kg by now, I don't look slim.  Flabby tummy seems so stubborn that with the right type of clothing, I may still pass as a pregnant woman... perhaps in late first trimester.

Appetite-wise, I get hungry almost all the time that I cannot imagine how I can look as slim as last time.  If I eat a bit less, it affects milk production.   If I eat a bit more, then I have enough.  But just enough because I am not a high-yield mom. I used to have a little frozen stock when Ken-ken used to consume very little last time, which I have fed to Alvin and also given to a few other babies.  Ken-ken rejects frozen milk after thawing+heating up.

The Famous and Infamous Kacang Parang

The popular bean is known by a few names, among them kacang parang, fava bean, broad bean, sword bean, field bean, bell bean and 蚕豆 (chan dou in Mandarin)".    Today, I would like to share something about this famous as well as infamous bean.

Common local snack.  Satay-flavoured kacang parang sold at the 'kedai koperasi' of my workplace.

This picture gives a better idea as to what the bean looks like.  Kacang parang with shell... In its original state, the beans are contained in pods similar to "petai"/
Source: http://ms.wikipedia.org/wiki/Fail:YosriKacangParang.jpg

Almost wherever I go, I frequently come across them being sold as snacks at various shops as well as "kacang putih" stalls, be it at supermarkets, sundry shops, bus stops, as well as the shop at my workplace.  There must be a high number of kacang parang lovers around or else what explains its sale at large scale throughout the country...

Kacang parang and I...
I used to buy 'kacang putih' - an assorted crispy snack with comprising various "kacang", and it contains kacang parang.  The snack is famously sold around Ipoh by Indian peddlars on motorcycles. 

For strange reasons, I would automatically pick out and get rid of all kacang parang before I settle to eat.  This had been the phenomena since I was very young.  Perhaps I found the shells a nuisance, perhaps I disliked its appearance.  It wasn't in my wildest imagination I'd one day discover that I am related to G6PD deficiency, suspectedly from my mother's side of family... oh God, why am I created as a carrier of two X-linked conditions from both parents....  Either way, I am doomed especially when I only have sons, looks like it's either this or that and there's NWO (no way out).

What's it about the bean?
Favism refers to reaction towards fava bean - hemolysis.  Or simply-called, the breakdown of red cells.  Of course not everyone who eats kacang parang will get it, but individuals with G6PD deficiency have to be careful not to consume the bean.

The philosopher Pythagoras used to forbid his followers from eating fava beans, in fact also all other beans.  Relating this to our knowledge today, this probably has something to do with the occurrence of favism upon its consumption. 

Which in turn brings us to the following topic:

G6PD Deficiency (or 蚕豆症 in Chinese)
The infographic below illustrates what is G6PD deficiency:

 Source: http://www.medcomic.com/050414.html

I am not a medical doctor but merely a layperson whose life is related to the condition.  So the purpose of my writing here is to share my humble knowledge on this topic, and *hopefully* also to increase our awareness on the condition.  Among my sources of information are the handout I took from hospital, the website of the G6PD Deficiency Association at www.g6pd.org as well as my good cousin who is a hematologist.  Ultimately, please consult an expert for advice / clarification.

Here we go...

1) G6PD stands for Glucose-6-Phosphate Dehydrogenase.  It is a type of enzyme in our red blood cells.  G6PD protects red cells from breaking down. 

2) G6PD deficiency is more prevalent among people from the Mediterranean, Africa, and South East Asia.  These areas also happen to be malaria-prone places.  G6PD deficiency itself offers a degree of protection against malaria.

World map distribution of G6PD deficiency.  Source: The Lancet

3) In our country nowadays, the screening for G6PD deficiency is performed upon newborns on their respective cord blood.  I am not sure when did this practice start, but I am sure that during the era when my brother and I were born, the screening wasn't a routine.  Over here, G6PD deficient newborns will have to remain in ward for observation for 5 days.

4) G6PD deficiency is X-linked i.e. carried via the X chromosome. 

5) Among the signs and symptoms of hemolysis are anemia (paleness, exhaustion, dizziness), rapid heartbeat, chest / back pain, jaundice, dark/tea-coloured urine.

6) G6PD deficiency is lifelong.  But G6PD deficient persons should be able to live healthily just like any other normal persons provided they take care and not expose themselves to factors/substances that may trigger hemolysis, as shown in the following table:

The list is subject to revision from time to time, so it is not exhaustive. 

7) More dos-and don't:

- The consumption of fava bean / broad bean / kacang parang is strictly prohibited for a G6PD deficient person;
- Please beware of the hidden content of kacang parang / fava beans in popular dishes, e.g. ful medames (an Egyptian breakfast dish) or kacang pool in Malaysia (most famous in Johor), dou ban jiang (豆瓣酱)  - a famous spicy and salty paste from Sichuan, China - common ingredient in the famous "ma po dou fu" (麻婆豆腐)dish and a spicy sauce called ma la jiang (麻辣酱) from Sichuan, and zha jiang mian (炸酱面) from northern China.  Since it's impossible to know the recipe of all dishes from around the world, caution is thus advised before consuming dishes containing beans;
- Contact through ingestion, touching or inhalation of moth balls ("ubat gegat") shall be avoided due to the content of Naphthalene in most of them;
- Medication-wise, to avoid using those stated in the list above;
- Certain traditional medicines are unsafe for G6PD deficient people, so to be safe, please refrain from consuming them on your own.  A reputable local Chinese traditional medicine manufacturer even print warnings on some of its products like bao ying dan and pearl powder, that are known/believed to be unsuitable for G6PD deficient persons;
- Some suggest that it may be a good idea to wear a Medic Alert pendant/wristband which states "G6PD deficient" so that medical personnel who treat such person in an emergency will be aware of the condition.  

Conclusion
Sometimes I am just a little concerned when I see kacang parang being sold abundantly at so many places, when so many of us (e.g. my generation and earlier) have never had our G6PD status tested.

If someone, be it adult or child, were to come over and I were to serve them snacks,  I'll serve almost anything except kacang parang.  I am afraid what if someone who is unknowingly G6PD deficient termakan the forbidden bean.  At ward 2B HUKM - my home for 2 months, the nursing sister told that one of her nephews was admitted to ICU and had to be given blood transfusion after unknowingly consumed a dish that contained kacang parang at his friend's house.