Kuala Lumpur - miscellaneous photos

It's my last night in Kuala Lumpur. I've arranged for a taxi to pick me up in time to get to the Kuala Lumpur International Airport. 2 hours before an international flight. An hour to get the 45 minute drive from here to the airport.  Tomorrow I fly the 2 hours and some to Siem Reap.  Angkor Wat , the Buddhist temple complex, is there. I'm not sure where I'm going to stay. Some hotel with a safe and wifi.  That's upscale. I didn't mind where I stayed when I only had a wallet passport and camera.  That was years ago. Now I worry about laptops, iPads, iPhones and cameras.  I've also been encouraged to hire a driver for the day.  It's a big complex.
I thought to go out tonight but ,after the conference ended, I came back to the hotel, ordered room service dinner and haven't moved since.  I'm actually watching television.  I tried getting to a meeting last night but only ended up in a dangerous part of town with junkies lying  on the street.
There's an exotic bird park and a butterfly place here. I'd have liked to have got to either those. I felt the same about the night safari in Singapore zoo.  There's things I'd like to do but I'm touristed out tonight and looking forward to early bed. I've packed and have a couple of hand washed shirts and shorts drying.
I'm actually missing home.  I'm looking forward to the next couple of days, more sights, being a tourist, "free man in Paris", the hope for more spiritual experience in a place of spirituality.  But already I miss my own bed, Gilbert, my boat, the routine, friends, the known.  I feel alien a lot in my life without being an actual alien. There's a desire to be more with people who are more like me, whatever that is.
I remember an old man who joined my father in the assisted living home. He'd been a farmer and enjoyed that he could talk about farming with Dad who understood him.  They talked about the weather.  Yet our similarities are our core. I know that.  I liked meeting the Malaysia catholic doctor and talking about spirituality.
I've a book launch too.  It's an accomplishment. I look at the pages, I've a copy with me, and enjoy what I've written. Already looking forward to the next book.  I'm looking forward to visiting family too.  It's a good life.  Full and rich and blessed.
Thank you Jesus.  Thank you God of Gods.  Saints of all religions I bow to you too.
ISAM is meeting in Japan next year, then Scotland.  I hope to be in Scotland before that.  There's an English doctors meeting next fall I've been planning on attending for a couple of years.  The boat engine needs fixing though.  Africa is waiting too.  I like all the Australians and New Zealanders I know.  Just when I'm growing weary with living out of a suitcase I'm remembering places I'd like to go to.
I think my mind is a little overloaded by all the learning these last three days.  There's a stretch that occurs with all the intellectual learning coupled with the gestalt experience of being in a foreign place.
On the other hand, I don't feel guilty I'm not exploring any further. I usually get these lovely hotel rooms and then spend so little time in them when I'm at a conference. Right now I'm watching Captain America, the Avengers,  Thor and a whole bunch of superheros protect the earth from annihilation on tv. I've cream sauce spaghetti with garlic toast on the way. I love room service.  All that is missing is Gilbert.  He's a great companion when there's room service.
I have a group of pictures I've taken while here that I haven't included.  They'll fit in right here.  I liked the Convent with the Motorcycle.  I liked the motorcycle paths that are here and there. I liked the MacDonald's too.  Parents taking pictures of their little daughter.  The two rivers meeting here.  Now I'm going to watch Alex Cross on tv. I've read the books.  Thank you God for the wonders and sights of this trip, the education, the organizers and contributors, the Armada Hotel and staff, keeping me safe.  Kuala Lumpur is an amazing city with so much diversity.  The people have all been so friendly and helpful.

An update on Naltrexone and Flumazenil in Polydrug and Alcohol Abuse - George O'Neil - ISAM 2013 Kuala Lumpur

Endorphin tolerance develops quickly and needed more
Eg. 42 yo man who was unable to sleep through night having to get up and smoke several times.  Gave naltrexone - patient described increased anxiety - using very small doses of naltrexone - all of these people stopped smoking completing - using naltrexone and benzo - little doses in the pre use phase and on chronic user putting big does of both drugs under skin.  Very different ways of using drugs.
Mellanby showed that tolerance developed with first drug
PHREE program - pharmacology and overall care
Accelerated detox 48 hour, versus 7 days detox. accelerated had 89% versus 30%
Moving patients to long acting implant naltrexone
Medications are to get people in quickest possible time into community and back to family
Norway study RCT- Implant trial,  Russian RCT with implants too
Implant Naltrexone is 25 times more efficient than oral natrexone at preventing opiate overdose dates in the  first 120 days post detox
Perth Overview
 4000 opioid patients
- average 8-10 month
 500 amphetamine patietns
500 alcohol patients
Flumazenil implant  used for benzodiazpeine addiction, with alcohol and other detoxifications, anxiety and sleeping disorders, parkinson's disease
Nasal delivery systems and sublingual for naltrexone and flumazenil.
Treating cravings of nicotine with naltrexone and flumazinel.  250 ug naltrexone


(These are my rough notes. I apologize for any errors. George was one of the most interesting speakers and one of the most experienced. His questions  and discussion after presentations was always most interesting. He had a number of Perth colleagues present as well. I had the pleasure of talking to several of the individuals and was impressed with their medical knowledge and their compassion for their patients.  There is really a place for this type of work and these solutions to specific problems. There's a terrific sense that this is tailored to individuals and their wants and needs rather than the one shoe fits all approach.  I was most impressed and would encourage anyone who can give serious consideration to these options for treatment. I will be discussing these studies with colleagues. )

Managing as a whole person: the role of spirituality - Mohamad Hussain Habil, Malaysia

Began describing patient's he'd seen who had been jailed with chain to his leg for years to stop smoking.  With recommendation of Iman the beat an adolescent who smoked. This was the religious approach for addiction in the past, discipline, imprisonment, shame etc but now there is a new growing awareness.

Rational of the Mosque MT program
-to support the government mission for expansion and upscaling of MMT and greater impact on HIV/Aids prevalence
To provide platform for research opportunities, training program, etc


SEDAR (spiritual enhancement and drug rehabilitation)program
- pilot project, started in May 2009
- now have 40 patients
all male , 20-50
Majority are heroin dependent
BRI - brief religious intervention
Iman and religious expert deal with psycho spiritual counselling and health workers/doctor to help patient



Treatment Concept
positive addiction through 1 ritual (prayer and fasting ) to overcome craving and negative addiction
proses pembersihan diri (purification) "repent"
Overcoming selfish brain phenomena through spirituality
bring in concept of Bismilla to over come abstinence violation and efects
bring in mindfulness
Approach
work together with mosque officials
-BRI - individual and group activities, talk and discussions about religious ritual, Jemah - group work and group prayer in mosque

6500 mosques  
Most of the time they are not fully utilized

Views from ulamak, views from health practitioners, community participations (including police)
Medical intervention
BRI sessions - religious counselling
Individual sessin
Methadone taken in the mosque in front of the pharmacist
One year retention - 80%
Urine negative - nearly 100% in 6 month
Drug use reduction better in mosque than clinics
Sexual risk behaviour reduced more in mosque than in clinic
Quality of life indicators same for both groups
Spiritual Improvement scale - both had same results

Even smokers are stigmatized, so stigmatization with heroin addiction is truly major. Plan is to treat smoking in mosque now too.

Research to Reality (translational process)
-training oman/religious counsellor in addiction
upscale to 2500 mosques
waiting for grants from JAWI/JAKIM
mosque and bri for smoking and heroin but could also be used for behavioural addiction
New research tool for taqwa (THIM and the validity study being conducted in Iran and Malaysia
Heuristic to better research design


Conclusion
-possibilities of having addiction clinic in mosque
-spiritual religious program for treating addiction
early hopeful result which need to be supported by more systematic research

(These are my rough notes and slides photographed during the presentation. I provide this as an indication of the depth and breadth of study and apologize for any errors. I would recommend anyone interested go to the source for further clarity and information - W.HAY

Bintang Road, Kuala Lumpur

Friday Nov 22,13

Kuala Lumpur

I'm in the centre of this city's shopping district, the Bintang Walk.  I've been in Pavillion, the big upscale mall.  They are already marketting Christmas. I didn't last long.  I bought  a set of Henkyl scissors, just in case some one at the airport needs them. I'll try not to forget and leave them in m carry on luggage.

I've just had Thai grilled fish with steamed rice. It was good.  Now I'm drinking coffee enjoying being in an outdoor cafe.  There is an NA meeting tonight. I have the address for that.  A pretty girl invited me for a massage.  I walked by La Sensa and realized that I wouldn't be buying lingerie gifts here. They even have women only cars on the LTR.  I'm tall here.  I'm very white.  The advantage I have is a bit of grey hair.  That is respected here.  I wonder if that girl offering a massage was selling more than a massage.  I could certainly use a foot massage.  My feet have hurt this last year since my injury and all the redistribution and permutations. The orthotics are working and I feel my foot is healing.  I'm thankful I've been able to walk aswell and as far as I have this fall.  Travelling and hunting I've had my fair share of exercise.

The conference is going well.  I see these academics getting their vacations paid for.  Theres clearly some serious long term thought that has gone into these conferences, not all altruism.  I appreciated the Canadian doctor raising the issue of the cost of training as educators were scheming for longer and longer fellowships.  I mentioned later that Id made the most money ever as a family physician my firstt year and now where I am the family physicians make more and many claim to be specialists. Indeed I know one who says he is a psychiatrist.  I mentioned that to another doctor who knew the man I was referring to and he laughed saying he calls himself and addiction medicine specialist now too. He has no further certification or training than I did as a gp. 

I liked the Thailand presentation with it's discussion of the combination of public health and police involvement in addressing the methamphetamine epidemic.  

I`m reading the Renegade, historic fiction about Robert Bruce.  I think life would be easier in some ways if I had a sword. When Bruce got knighted the author had his grandfather as what does it feel like to be an earl,  Bruce says he doesn`t know. The grandfather answers, humilty comes first, the arrogance comes later. 

Arrogance is an interesting word tied to the sin of pride.  I find it ironic that today in the pride of secular society that the word has arisen again in a different context, referring to subservience to money and secular power.  Yet it once referred to the inner relationship of self with God.  I must love my enemy and recognise that that which I dislike, in terms of character traits is so often what I don't see in myself.  My threat is that I dont want to be around them and want to go off alone again at sea or into the wilderness.  

Coming here I see sailing here would be possible.  I would like to sail again but I've an engine to get fixed and I need to win a lottery to have the money to repair my boat should any break downs occur and they do.  Though I've come along way to restoring my boat to offfshore capability.  All the major work except the engine are done.  There in is my escape.  Sailing across oceans.  Sailing alone to Hawaii in winter was a true feat. I'd be crossing more oceans to get here.

I feel claustrophobic inside the mall with all the people and the closed spaces. Even this city would probably get to me though right now I am enjoying the sense of being a part of without feeling closed in.  There's a gentleness here ,  I don't feel the pressure of ego that has haunted me in the past.  Maybe its the anonymity. I also dont have the sense that Im unwelcome sitting here.  I feel that sense of third space welcome in the cafes that I feel in Europe as well.  I dont feel it at home.  People watching me and wanting me to move along.  I had a young woman shadowing me in a store. I felt like she though I was a thief and left quickly.  Maybe she thought she was being available.  I expect I look affluent enough,  I wonder where the term loitering came from.It must have an interesting history.  

Move along I heard when I was a kid, It must stick with me.  It is growing dark so Im going to walk some more before night

At my hotel before I left I noticed a sign for the Miss Borneo pageant. I'd noticed all these beautiful young women in Armada Hotel these last couple of days.  At one point I was on the elevator surrounded by a half dozen in their gowns with their banners across their shoulders. I commented, "I"m a very lucky man." They all giggled, asked me where I was from, then encouraged me to come to the pageant.  They all had that high energy pre performance excitement.

I took photographs from the taxi getting here and then more walking about.