Its the same kurap again

Fungal infection of the skin is called kurap in Malay.

The kurap can appear like white patches or ring forms on the skin. It does not look good. To some, it is an indicator of a person's poor hygiene.

The bad part is, it may be difficult to remove. Especially when the offending factor is still persistent - dampness. Damp areas are seldom dried. It may be difficult to reach, or a person is too lazy to get a dry towel and wipe off the excess water.

That is why the kurap are always persistent at skin creases - armpits, the back, the nape, the groin and the foot. These are far flung places - so much like the jungle of Borneo.

Here, another form of kurap thrives. The kurap that has robbed the hard earned money of people who worked honestly. This kurap steals money. It also widens the gap between the poor and the rich. The richer gets richer while the poor remains.

This form of kurap operates in a clandestine manner. It needs to. Just as kurap does - thrives quietly under the protective layer of the epidermis. It is there, but not obvious. Only when you begin to itch and it looks unsightly, you will begin to look for the remedy.

Some times, it is too late. The roots of the kurap has gone beyond the depth of the skin. Topical medication is unable to penetrate deeply to reach the deep end of the roots.

At least it is getting treated - like the news clipping here:

The Malaysian Anti-Corruption Commission (MACC) has arrested 30 people in Johor and Sarawak for illegal logging activities and froze 30 bank accounts belonging to 10 companies worth RM18 million.- The Star 23/10/2014

That's a lot of money involved. Most people do not have RM 10 thousand in their bank accounts.

As for the kurap of the skin - the body is trying to rid it of. But this form of kurap reported in the paper, our own immune system is possibly committing an act of treason. They are turning autoimmune.

... they were also investigating several state Forestry officers for possible involvement in the illegal felling of trees which had put the forest reserve under threat of destruction.

The very people entrusted to take care of the forest were bribed by logging company managers. The amount ranged from a paltry RM300 to RM10000.

The same kurap probably cost our examination system dearly not too long ago. The rescheduling of the exam caused undue stress for many people, especially school children.

This disease seems controlled though. But, it could be just the tip of the iceberg phenomenon. There could be more integrity issues occurring subtly in our dealings, daily. The thing is, it is hard to obtain proofs. It is often concealed.

Whistle blowers can get harmed. And this is not helping at all.

Reading all these can be frustrating at times. People who work really hard and honestly are not paid accordingly. While those whose job is "sedentarily no-brainer" earns the big bucks.

Just how long should we keep quiet?

The many treatments of neonatal jaundice

All babies are bound to be yellow - or jaundiced. The treatment for these jaundiced babies depends on the cause. Most of the time, the cause is physiological - it comes within 2 days and goes off after about 2 weeks. Physiological jaundice is harmless.

The other 2 forms of harmless jaundice are breastfeeding jaundice and breast milk jaundice. These are diagnosed last if there are no other pathological cause that could be traced.

I would like to share some interesting perspective that locals have regarding jaundice - especially treatment. After talking to so many people who offered advice on how to reduce the "yellowness" in newborns, here are some interesting findings. Most of it needs some scientific explanation, which I was unable to do yet at the moment.

"Mother should avoid ginger"

from http://cancerbattlefield.com/functional-food/ginger/

This is the most common and prevailing. Almost all Chinese, Malay, Melanau and Iban individuals mentioned the same thing. However, there was no uniformity. Some individuals were surprised when ginger was blamed as one of the causes of jaundice. In the Chinese community, ginger is important to prevent the mother from being cold, which could cause premature soreness of the joints at old age. Taking ginger is believed to improve the "blood circulation" as a result of the dilated blood vessels. Among the Chinese, ginger is commonly added into a favourite post natal dish called "Kacang ma". Today, it is common for non Chinese Sarawakian to consume "kacang ma" as well. Wine, which is frequently added, is removed for those who do not consume it. As for the Malays and Melanaus, fried grated ginger or "serunding halia" is a favourite post natal dish.

"Grapes"

Amazingly, grapes, which is not a local fruit is believed to reduce the yellowness in newborns. From what I gather, grapes were belief to "absorb" the yellowness in the blood of the newborn. There was another version where grapes were believed to hasten the maturity of the liver, thus improve the serum bilirubin levels. Green grapes were noted to be more effective than the red ones.

"Glucose"

A granny in the clinic whom I met recommended "sugar water" or "air gula" to be given to the newborn. The mixture of water and sugar is guaranteed to bring down the yellowness in newborns. However, she did not offer any explanation of the possible physiology of the cure. 

"Plain water"

There was another section of the community who believed that plain water given to the newborn is the best treatment of jaundice. Their explanation is logical and simple. As the baby is dehydrated in the first few day of life - due to the adaptation process to breastfeeding - naturally the concentration of serum bilirubin is raised. To dilute the bilirubin, use water. 

"kurma" or dates

Dates: sidratul.com

There are some pregnant ladies who started consuming the dates in the belief that it could help with the maturity of the liver of the fetus. Mature liver in the newborn of the kurma eating mothers will prevent jaundice. In my opinion, this could be the result of the overzealous promotion of arabic dates as the prophet's sunnah, which could be mistakenly perceived as a form of cure. 

"Liver tonic"

Some clinics have started to promote a "liver tonic" given to newborns to "improve the health of the liver". Lay persons attending those clinics tend to accept it wholly without hesitation as it is given by a doctor. The scientific basis still elude me. If it was cheap and has the chance to improve the bilirubin levels from those newborns who do not take it, then it should be a standard treatment in hospitals nationwide - or worldwide.

"Bathing in coconut water"
Some locals believe that bathing the newborn in coconut water could reduce the "yellowness", Although there was no prescribed dosing or frequency the child should bath, it is recommended daily. The coconut water will absorb the "heaty" material from the newborn.

"Turmeric powder"
Turmeric is a part of the ginger family. This curcumin containing plant is known for its anti inflammatory and anti oxidant properties.  But, anti-bilirubinaemia? A few Malay elderly recommends rubbing some turmeric to the forehead of the newborn. Since it is yellow and belongs to the same yellow colouring of the newborn's skin, it will "attract" the yellowness and subsequently absorb it. Another version of applying turmeric to the newborn is by bathing the child in turmeric laced bath.

These are some really interesting beliefs in a multi racial society like Malaysia. Although most of it sounds absurd - at times too "magically" true, a proper study is needed. In fact, a few studies will be needed to prove or disprove the hypothesis. It is interesting to note that there are substantial beliefs that associate neonatal jaundice with the liver. There is also an idea that jaundice is caused by "something" in the blood -  that correctly points towards the high level of bilirubin.

It is interesting that exposing the baby to the early morning sun - the nature's equivalent to phototherapy - is regarded as a "hospital treatment" and not among the first few choices for treatment of neonatal jaundice. Exposing the newborn to the morning sun is currently not recommended due to the severe complications that it could have on the child when parents / caretakers lapse.

As for me, I would prefer the early morning sun exposure - with some modification to make it safer. At the same time, monitor the levels of bilirubin in the local clinic. God willing, all should be fine.