Pulau Aman 安曼島的馬來風光

If you're longing for a not too crowded, not too quiet place for a retreat, you may consider going to the "Island of Peace" -- Pulau Aman.

"Pulau Aman" -- the name that was planted in my mind since my teenage years. I used to cross Penang-Butterworth by ferry. When the ferry was departing, the captain would announce "Pulau XXX akan bertolak sekarang". The ferries were named after some of the famous islands in Malaysia, like "Pulau Tioman", "Pulau Redang", "Pulau Langkawi", "Pulau Talang-talang", "Pulau Kapas" and one of them was "Pulau Aman".

Kok Sheng, Hatta and myself made a trip to Pulau Aman last Saturday. We headed there off Batu Kawan by passenger boat at Batu Musang Jetty about 11.30am. The fair for a return trip is RM 6. The journey takes only about 10 minutes. Our sole purpose was to satisfy ourselves with the famous "Mee Udang" (Prawn Noodles).

Pulau Aman is an idyllic Malay fishing village with population of about 250, mostly elderly folks and children. You won't see a single car on this island. There are only 3 motorcycles! Ha! No worry for the traffic pollution. One thing worth a mention, this island is the only area with 0% criminal rate in the state of Penang. It's said to be the most simple and safest island in Malaysia.

There is a school providing education to the pupils with great convenience. Other than the beautiful traditional Malay houses, there is a government clinic, a sundry shop, a community hall, a mosque that takes care of the needs of the islanders. There are also few chalets available for renting to the tourists.

We wandered around the island and taking photos for about one and a hour hours and decided to have the must-try delicacy - Mee Udang. We had been recommended to have it in "Restauran Terapung" (Floating Restaurant) by the villager. Not bad, we satiated our stomach with Mee Udang and the coconut milk which cost RM6 and RM4 respectively.

In addition, you can buy the freshly harvested Udang Lipas (Mantis Prawn) and other fresh catches from the fishermen near the restaurant & get the restaurant cook/steam them for you. I didn't do that as I thought it was a less merciful thing to make some living creatures become a dish on the table.-

There are some local entrepreneurs promoting and selling the locally made products like “Kerepek Sukun” that made from "Buah Sukun" (Breadfruit), Pisang goreng, homemade Belacan and body lotion.

We departed the island in the late afternoon and moved ahead for other activities in the evening -- "A date with Nyonya Kuih" and D'Home Charity Dinner cum PCK performance. This marked the much enjoyable and fulfilled day for me. Thanks pals!

生產災難 ─ 羊水栓塞 (Amniotic Fluid Embolism)

我朋友她今年33歲，初为人母。八月十五临盆，真如她所愿，可以在中秋月圆日添个丁。因为这天，也是她嫁为人妇的一周年喜庆。原本喜氣洋洋，但卻在生產下小孩子后，一聲不響的離開了。就連守護在她身邊的先生，一句道別的話也來不及說。在ICU里依靠life support生存的小孩也在她出殯那天，牽著媽媽的手走了。 正當大家在厲聲苛責院方疏忽的時候，剖解報告出來了，是一種罕見的婦科急疹，把她們兩母女給帶走。除了祝愿她們得到永遠的安息，也想把一些關于此重症的資料，給大家了解一下：

羊水栓塞 (Amniotic Fluid Embolism)

羊水栓塞是一种在分娩过程中因羊水物质进入母体血液循环，引起出现肺栓塞、休克等一系列严重并发症的产科危重症，也会造成心肺的衰竭，死亡率是SARS的十二至十五倍。虽然医疗进步，但碰到羊水栓塞这个产科的急症，戏剧性的病程变化，前一分鐘還好好的談笑風生，下一分鐘就好像吸不到空氣般呼吸困難，一下子就抽慉、心肺衰竭，在数分钟内即夺走宝贵的生命，也令人措手不及。让原本的喜事变成丧事，往往将医病双方卷入冲突的漩涡。

究竟羊水栓塞是什么？大甲光田医院妇产科廖修德医师表示，这是一种非常少见的产科急症，起因于羊水、胎儿细胞、胎发、胎脂或其他碎片进入母体的血液循环中，引起严重的类似过敏反应，产生血液栓塞，造成心肺衰竭或大量出血。羊水栓塞的发病率低但病死率高，發生率約在八千分之一左右。

廖修德医师进一步指出，羊水在子宫内围绕在胎儿的周围，完整的保护在羊膜内，但如果羊膜和胎盘破裂后，子宫或子宫颈的血管有了破损，羊水就有机会大量进入母体的血液循环；当到达肺部后，会诱发肺动脉血管收缩，产生高血压和右心室血压上升，进而引起缺氧、心肌和肺部微血管的伤害；另外有一半的病人，会产生消耗性的凝血功能病变，造成产妇突然大出血而休克死亡。

羊水栓塞一旦发生，母体死亡率高达80%，因为突然的心跳停止或是随后的呼吸困难和多重器官衰竭，有时甚至连抢救都来不及。羊水栓塞不但死亡率很高，幸存者往往会留下永久性的神经伤害，例如中风或植物人的可能。至于胎儿端视处理的时间长短，如果在母体发生症状后，能及时将胎儿产出，那么宝宝还有多一些存活的机会，然而不幸的是，约有一半的宝宝仍可能因缺氧而留下永久性的神经后遗症。

現在認為可能羊水進入的多寡並不是很重要，而是媽媽對胎兒羊水的反應，因為有百分之四十以上的媽媽有過敏体質，而且整個病程跟藥物過敏休克反應很像──進展迅速且無法預測。所以現在有一種趨勢將「羊水栓塞」改稱為「羊水過敏症候群」。

老一辈常以“生得过，鸡酒香，生不过，四块板”用来形容生产过程的凶险。医学技术再进步，仍然有它无法克服的难题。廖修德医师强调，面对羊水栓塞这种危险的产科急症，除了让民众能对它多点了解外，生产过程中亦要随时注意蛛丝马迹，因为每个产妇都有可能是羊水栓塞的候选人，当然急救的速度和医术一定是必要的。

那麼知道原因後，是不是可以有效預防呢？很可惜的是以前認為很重要的因素──催生，現在反而認為在子宮收縮愈強時，羊水反倒不容易進入媽媽血液中造成反應，所以目前沒有任何可以預測會導致羊水栓塞的指標來做預防。

既然無法發現導致羊水栓塞的危險因子，那麼早期診斷、早期治療是不是有幫助呢？接近九成的媽媽只來得及做心肺復甦術。若急救成功，還得面臨缺氧、心臟無力、全身性血液無法凝固等問題。六成的媽媽因此失去生命，存活的媽媽只有不到百分之八腦部沒有受損。可見媽媽為了一個新生命的誕生是冒著多大的生命危險。這也是要對母親永懷感恩之心的原因之一。