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Our philosophy of care is to normalize birth as far as is possible. Expecting mothers will be cared for by a team Midwives, Care Assistants, Consultant Obstetricians, Anaesthetists and Consultant Paediatricians, who are on-call 24 hours a day, should they be needed.

The labour suite has two well-equipped and comfortable rooms for labour and birth.

Our 24-hour clinical services include:

• – Epidural service
• – Emergency caesarean section service
• – Ventouse and forceps deliveries
• – Vaginal birth after caesarean (VBAC)

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Our Cardiac Catheterization Laboratory has the latest equipment with the modern technology. This facility is a special X-Ray equipment used to perform angiogram (specialist X-Rays of the arteries).
The following services are available:
– Coronary Angiogram to assess the severity of the coronary heart disease and suitability for bypass surgery or coronary angioplasty
– Right and Left heart catheterization to assess the disease of the heart valves, hole in the heart, etc
– Permanent pacemaker implantation to treat life threatening abnormal heartbeat.
– Coronary Angioplasty or PCI – Balloon dilation and stenting of the coronary arteries.
– Angiogram and Angioplasty of the kidney arteries

Electromyography (EMG) is an electrodiagnostic medicine technique for evaluating and recording the electrical activity produced by skeletal muscles. EMG is performed using an instrument called an electromyograph to produce a record called an electromyogram. An electromyograph detects the electric potential generated by muscle cells when these cells are electrically or neurologically activated. The signals can be analyzed to detect medical abnormalities, activation level, or recruitment order, or to analyze the biomechanics of human or animal movement.

Electroencephalogram (EEG) is an electrophysiological monitoring method to record the electrical activity of the brain. It is typically noninvasive with the electrodes placed along the scalp. EEG measures voltage fluctuations resulting from ionic current within the neurons of the brain. In clinical contexts, EEG refers to the recording of the brain’s spontaneous electrical activity over a period of time, as recorded from multiple electrodes placed on the scalp.

A nerve conduction study (NCS) is a medical diagnostic test commonly used to evaluate the function, especially the ability of electrical conduction, of the motor and sensory nerves of the human body. These tests is performed by neurologists.

Urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests can help explain symptoms such as:

•  incontinence
•  frequent urination
• sudden, strong urges to urinate but nothing comes out
• problems starting a urine stream
• painful urination
• problems emptying the bladder completely
• recurrent urinary tract infections

Urodynamics will provide the physician with the information necessary to diagnose the cause and nature of a patient’s incontinence, thus giving the best treatment options available. Urodynamics is typically conducted by urologists or urogynecologists.

A transesophageal echocardiogram is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient’s esophagus. This allows image and Doppler evaluation which can be recorded.

An echocardiogram (echo) is a graphic outline of the heart’s movement. During an echo test, ultrasound (high-frequency sound waves) from a hand-held wand placed on your chest provides pictures of the heart’s valves and chambers and helps the sonographer evaluate the pumping action of the heart. Echo is often combined with Doppler ultrasound and color Doppler to evaluate blood flow across the heart’s valves.

Ambulatory Blood Pressure Monitoring (ABPM) is when your blood pressure is being measured as you move around, living your normal daily life. It is normally carried over 24 hours. It uses a small digital blood pressure machine that is attached to a belt around your body and which is connected to a cuff around your upper arm. It small enough that you can go about your normal daily life and even sleep with it on.

Holter monitor (often simply Holter) is a type of ambulatory electrocardiography device, a portable device for heart monitoring (the monitoring of the electrical activity of the cardiovascular system) for at least 24 to 48 hours.
The Holter’s most common use is for monitoring ECG heart activity (electrocardiography or ECG). Its extended recording period is sometimes useful for observing occasional irregular rhythm of the heart which would be difficult to identify in a shorter period.
When used to study the heart, much like standard electrocardiography, the Holter monitor records electrical signals from the heart via a series of electrodes attached to the chest. Electrodes are placed over bones to minimize artifacts from muscular activity. These electrodes are connected to a small piece of equipment that is attached to the patient’s belt or hung around the neck, keeping a log of the heart’s electrical activity throughout the recording period.

A cardiac stress test is a cardiological test that measures the heart’s ability to respond to external stress in a controlled clinical environment. The stress response is induced by exercise or by drug stimulation.
Cardiac stress tests compare the coronary circulation while the patient is at rest with the same patient’s circulation during maximum physical exertion, showing any abnormal blood flow to the myocardium (heart muscle tissue). The results can be interpreted as a reflection on the general physical condition of the test patient. This test can be used to diagnose coronary artery disease (also known as ischemic heart disease) and assess patient prognosis after a myocardial infarction (heart attack).
The cardiac stress test is done with heart stimulation, by exercise on a treadmill with the patient connected to an electrocardiogram (ECG).
The level of mechanical stress is progressively increased by adjusting the difficulty (steepness of the slope) and speed. The test administrator or attending physician examines the symptoms and blood pressure response. With use of ECG, the test is most commonly called a cardiac stress test but is known by other names, such as exercise testing, stress testing treadmills, exercise tolerance test, stress test or stress test ECG.

Plastic surgery is a surgical specialty involving the restoration, reconstruction, or alteration of the human body. It can be divided into two categories. The first is reconstructive surgery which includes craniofacial surgery, hand surgery, microsurgery, and the treatment of burns. The other is cosmetic or aesthetic surgery. While reconstructive surgery aims to reconstruct a part of the body or improve its functioning, cosmetic surgery aims at improving the appearance of it.

Types of Plastic surgery available at KPJ Kuching:
1. Aesthetic
2. Reconstructive surgery

Our renowned spine surgeon performs procedures or surgeries to treat several spinal problems that the patient may face. He/she may have a spinal tumor, spinal disc degeneration, abnormal curve of the structure of the spine, some congenital spinal defect and others. For each problem, there are different techniques of surgery used for the treatment.

Minimally invasive spine surgery (MISS) uses advanced technology and innovative techniques to treat back pain and neck pain caused by a variety of spinal disorders.

Some of the spinal conditions MISS can treat are:
1. degenerative disc disease
2. herniated discs
3. scoliosis
4. spinal stenosis

Through computer-assisted technology and highly specialized tools, minimally invasive surgery is an attractive option for patients who want a quicker recovery after surgery, less post-operative pain, and smaller incisions.

Types of Spinal Surgery available at KPJ Kuching:
1. Endoscopic/Laminoscopic surgeries
2. Minimally invasive spine surgeries
3. Open surgeries

Neurosurgery is the surgical specialty that deals with the nervous system, including the brain, spinal cord, and nerves of the body.

Types of Neurosurgery available at KPJ Kuching:
1. Surgeries on brain diseases
2. Surgeries on trauma

Cardiothoracic surgery is a broad term encompassing almost all surgery that takes place in the chest and encompasses cardiac, thoracic, and congenital heart surgery.

Types of Cardiothoracic Surgery available at KPJ Kuching:
1. Open heart surgeries
2. Video Assisted Thoracoscopic surgeries

Urologic surgery is the integration of surgical activities for the pelvis—the colon, urogenital, and gynecological organs—primarily for the treatment of obstructions, dysfunction, malignancies, and inflammatory diseases. Common urologic operations include:
a) renal (kidney) surgery
b) kidney removal (nephrectomy)
c) surgery of the ureters, including ureterolithotomy or removal of calculus (stones) in the ureters
d) bladder surgery
e) pelvic lymph node dissection
f) prostatic surgery, removal of the prostate
g) testicular (scrotal) surgery
h) urethra surgery
i) surgery to the penis

Types of Urologic Surgery available at KPJ Kuching:
1. Open surgeries
2. Endoscopic and Laparoscopic surgeries

Obstetrics and gynecology are concerned with the care of pregnant woman, her unborn child and the management of diseases specific to women. The specialty combines medicine and surgery.

Gynecology is concerned with the well-being and health of the female reproductive organs and the ability to reproduce. It includes endocrinology, female urology, and pelvic malignancy. The specialty spans pediatric and adolescent gynecological problems through to later years.

In obstetrics most women, although pregnant, are otherwise fit and healthy. However, others will have acute or chronic medical problems that complicate their pregnancy and are under the specific care of an obstetrician.

Types of Obstetric and Gynecologic Surgery available at KPJ Kuching:
1. Open surgeries
2. Laparoscopic surgeries

Orthopedic surgery or orthopedics is the branch of surgery concerned with conditions involving the musculoskeletal (muscle and bone) system. Orthopedic surgeons use both surgical and non-surgical means to treat musculoskeletal trauma, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

Types of Orthopedic Surgery available at KPJ Kuching:
1. Sports and Reconstructive surgery
2. Arthroplasty
3. Arthroscopy
4. Trauma

ENT surgeons diagnose and treat conditions of the ears, nose, throat, head, and neck, and undertake some cosmetic procedures.

Types of ENT Surgery available at KPJ Kuching:
1. Endoscopic surgeries
2. Open surgeries

Ophthalmic surgery, also known as ocular surgery, is surgery performed on the eye or its adnexa, by our ophthalmologist. The eye is a fragile organ, and requires extreme care before, during, and after a surgical procedure. Common eye surgeries being performed are cataracts and pterygium excision surgeries as well as vitreo-retinal surgeries.

Types of Ocular Surgery available at KPJ Kuching:
1. Extraocular
2. Intraocular

KPJ Kuching provides comprehensive surgical services in general and surgical subspecialties including endovascular surgery, minimally invasive surgery, surgical endoscopy and trauma.

Types of General Surgeries available at KPJ Kuching:
1. Open surgeries
2. Laparoscopic surgeries: 2D and 3D

Anesthesiologists provide care for patients in the operation theaters by helping them undergo procedures and operations without pain and distress. This specialty also provides relief from chronic pain. Anesthesia basically is a “reversible lack of awareness” whether this is a total lack of awareness (e.g. general anesthesia) or a lack of awareness of a part of the body such as a spinal anesthesia or a nerve block. Anesthesia is a pharmacologically induced reversible state of amnesia, analgesia, loss of responsiveness, loss of skeletal muscle reflexes and decreased stress response.

Types of Anesthesia available at KPJ Kuching:
1. General anesthesia.
2. Local or regional block anesthesia.
3. Spinal of epidural anesthesia.
4. Pain management

PEG is a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach. PEG allows nutrition, fluids and/or medications to be put directly into the stomach, bypassing the mouth and esophagus.

Patients generally receive an intravenous sedative and local anesthesia, and an antibiotic is given by vein prior to the procedure. Patients can usually go home the day of the procedure or the next day.

PEG tubes can last for months or years. However, because they can break down or become clogged over extended periods of time, they might need to be replaced. The doctor can easily remove or replace the PEG tube without sedatives or anesthesia, although he/she might opt to use sedation and endoscopy in some cases. The doctor will remove the tube using firm traction and will either insert a new tube or let the opening close if no replacement is needed. PEG sites close quickly once the tube is removed, so accidental dislodgment requires immediate attention.

ERCP is a diagnostic procedure used to examine diseases of the liver, bile ducts, and pancreas. It is usually performed under intravenous sedation rather than general anesthesia. Therapeutic measures can often be taken at the time of ERCP to remove stones in the bile ducts or to relieve obstructions of the bile ducts.

The procedure is performed by using a long, flexible duodenoscope. The duodenoscope can be directed and moved around the many bends of the stomach and duodenum. The duodenoscope is inserted through the mouth, through the back of the throat, down the esophagus much like gastroscopy except that it is with the aid of the fluoroscope.

Patient care: For the best possible examination, the stomach must be empty. The patient should not eat anything after midnight on the evening preceding the exam. In case the procedure is performed early in the morning, no liquids should be taken. In case the examination is performed at noon time, a cup of drink can be taken four hours earlier. Heart and blood pressure medications should always be taken with a small amount of water in the early morning. Since the procedure will require intravenous sedation, the patient needs to have a companion drive them home after the procedure.

Bronchoscopy allows the doctor to examine the inside of a person’s airway and lungs for any abnormality such as foreign bodies, bleeding, tumors, or inflammation using a flexible bronchoscope. The procedure can be performed easily and safely under mild anesthesia referred to as conscious sedation to help make the procedure comfortable. The doctor inserts the bronchoscope through either the nose or mouth. The patient can be either sitting or lying down. The specimen of lung tissue or bronchial washings may be obtained.

Nurses will monitor the patient closely for 2 to 4 hours following the procedure until the effects of sedative drugs wear off and the gag reflex has returned.

Colonoscopy is the examination of the large bowel and the distal part of the small bowel with a flexible colonoscope which is passed through the anus. It can provide a visual diagnosis (e.g. ulceration, polyps) and enable biopsy or removal of suspected lesions. A colonoscopy is generally recommended when the patient complains of rectal bleeding or has a change in bowel habits and other unexplained abdominal symptoms. Colonoscopy can remove polyps as small as one millimeter or less. Once polyps are removed, they can be studied with the aid of a microscope to determine if they are precancerous or not.

The patient is generally given a sedative and a pain-killer through the IV line. The procedure may take anywhere from 30 minutes to two hours depending on how easy it is to advance the scope through the colon. Colonoscopy can be a long and uncomfortable procedure, and the bowel cleaning preparation may be tiring and can produce diarrhea and cramping. During the colonoscopy, the sedative and the pain medication will keep the patient very drowsy and relaxed. Most patients complain of minor discomfort and pressure from the colonoscope moving inside. However, the procedure is not painful.

Packages:
OGDS and Colonoscopy package

OGDS is the inspection of the interior of the esophagus, stomach, and duodenum with a flexible fiber optic gastroscope which is passed through the mouth and esophagus. Various treatments can be performed by gastroscopy. The healing of ulcers can be confirmed by gastroscopy and bleeding ulcers can be treated by injection of adrenaline to constrict the blood vessels.

Patient Care: For 6-8 hours prior to the examination, the patient is not allowed to take any food or liquids by mouth. The stomach should be empty during the procedure to facilitate inspection of its lining and to avoid vomiting and aspiration of liquids into the lungs.

A sedative is given before the examination. The patient is awake during the procedure, which is not painful but is uncomfortable and exhausting. The sedative help relieve apprehension and fear so that the patient can be more cooperative during the examination.

A local anesthetic is sprayed on the posterior pharynx (throat) to depress the gag reflex and reduce local reaction to the passage of the gastroscope. The patient is monitored closely during the procedure which usually lasts about 5 minutes. A routine biopsy of the stomach lining is usually performed.

After the procedure, the patient is allowed to rest while being monitored at the Recovery Room.

Packages:
OGDS package

PACS is a medical imaging technology which provides economical storage and convenient access to images from multiple x-ray modalities. Electronic images and reports are transmitted digitally via PACS (on line), making all images available to the healthcare provider that require the images and reports anytime within the hospital boundary. A secured network for transmission of patient information, workstations for interpreting and reviewing images and archives for the storage and retrieval of images and reports are made available in PACS.

A bone densitometry test is using to diagnose osteoporosis, a disease that weakens bones and makes them more likely to break. The system is used to measure the bone density known as Bone Mineral Density (BMD). These measurements are compare to the normal norms in various age groups. Thus the likelihood of possible future fracture. The sites usually used for assessment of BMD include Lumbar Spine, Hip and Forearm. Bone densitometry test is a quick and painless procedure with very low dose of radiation.

We are using 1.5 Tesla Magnetic Resonance Imaging (MRI) to perform a non-radiation test that creates detailed pictures of organs and tissues such as cysts, brain aneurysms, stroke, tumors and cancer throughout the body.

1.5 Tesla Magnetic Resonance Imaging (MRI) studies:
1. Blockages or enlargement of blood vessels and certain heart and aorta problems.
2. Diseases of the liver, gallbladder, pancreas and other abdominal organs.
3. Abnormalities and diseases of the reproductive organs, including the causes of infertility, in both women and men.
4. Spine injuries, disorders or inflammation of the spine. Neurosurgeons also can be evaluating the integrity of the spinal cord after trauma. It is also used when considering problems associated with the vertebrae or intervertebral discs of the spine.
5. Diagnose or evaluate for any extremities such as:
6. Degenerative joint disorders such as arthritis and meniscus tears (knee) or labral tears (shoulder and hip)
7. Fractures (in selected patients)
8. Joint abnormalities due to trauma (such as tears of ligaments and tendons)
9. Spinal disk abnormalities (such as a herniated disk)
10. The integrity of the spinal cord after trauma
11. Sports-related injuries and work-related disorders caused by repeated strain, vibration or forceful impact
12. Infections (such as osteomyelitis)
13. Tumors (primary tumors and metastases) involving bones and joints
14. Pain, swelling or bleeding in the tissues in and around the joints and extremities

Mammography is a specific type of breast imaging that uses low-dose x-rays to detect cancer early – before women experience symptoms – when it is most treatable. Screening mammograms usually are not recommended for women under age 40 who have no special risk factors and a normal physical breast examination.

CT scan is special X-ray tests that produce cross-sectional images of the body using X-rays and computer. This type of special X-ray takes ‘pictures’ of slices of the body so specialists/ consultants can look right at the area of interest.

Multi Slide CT Scan studies:
1. Brain
2. Heart and blood vessels
3. Head, face, including sinuses and neck
4. Chest, abdomen and pelvic areas
5. Spine, bones, and joints
6. Upper extremities and lower extremities.
7. CT Angiography (CTA)
8. Mammography (Mammogram)
9. Magnetic Resonance Imaging (MRI)
10. Bone Densitometry
11. Picture Archiving and Communication System (PACS)

Ultrasound imaging uses sound waves to produce pictures of the internal structures of the body. It is used to assist in diagnosing the causes of pain, swelling, and infection in the body’s internal organs and to examine the baby in pregnant women. Ultrasound is safe, non-invasive and does not use radiation.

Ultrasound Studies:
1. Determine the source and location of pain, swelling and/or infection
2. Examine internal organs for disease and abnormalities
3. Track the development of a fetus while in the mother’s womb
4. Guide minimally invasive surgical procedures and needle biopsies that extract tissue samples for the purpose of diagnosing cancer and other diseases
5. Diagnose a variety of heart conditions and assess damage after a heart attack

Fluoroscopy is an imaging technique commonly used by specialists/ consultants to obtain real-time moving images of internal structures of the patient. A fluoroscope consists of an X-ray source and fluorescent screen between which a patient is placed.

Fluoroscope Studies:
1. Barium enema
2. Barium swallow
3. Upper gastrointestinal series
4. Small bowel series
5. ERCP (Endoscopic Retrograde Cholangio-Pancreatography)
6. MCU (Micturating cystourethrogram)
7. HSG (Hysterosalpingogram)
8. Arthrography