Starting from her pre-university days in Pusat Asasi Sains Universiti Malaya, she remained in UM for a total of 9 years ie until completion of senior housemanship. 

Dr Zarina decided to venture into something different and new – although she did join the Masters programme in Internal Medicine in UM initially (briefly in 1994, for a month), she decided to have a different feel of things and left her alma mater and joined UKM in 1994 as a trainee lecturer. As she realised that Internal Medicine is ‘not her cup of tea’, she had no regrets in doing paediatrics as she enjoyed the experience of dealing with kids.

It is an evolution process going through life as a senior paediatric doctor in a university hospital till now. Her responsibilities as a paediatrician when she just passed her masters degree is absolutely different from her day-to-day work as a paediatric lecturer and when she stepped onto a higher level as a consultant.

As a clinical lecturer, there are 3 main pillars of the career including clinical work, teaching and also research. For example, as a new graduate in paediatrics, she was expected to shoulder a ‘different type’ of responsibility. Being the forefront liner, actively managing the child, supervising junior house officers and several medical officers, in addition to ward and clinic responsibilities. 

However, stepping into the academia world at a teaching hospital (UKMMC), she started to gradually shoulder some academic responsibilities. On top of clinical work, she started to have some teaching responsibilities. As she climbed the ladder from senior lecturer and slowly become a consultant, then senior consultant, the responsibilities evolved as she did more teaching and research at the same time. There was a time that Dr Zarina was the Head of Department of Paediatrics, UKMMC and also the Deputy Dean of postgraduate studies in the Faculty of Medicine. At that point of life, on top of her 3 pillars (academics, clinical and research), she had her administrative responsibility. To cope with that, she had to adjust her allocation of time to clinical work because administrative work is tremendous.

In the background, there is also community work like community outreach and advocacy of the public. Empowering the community is important so that the public can equip themselves better on how to manage health problems, recognize safety at home, identify emergency symptoms and so on. Community engagement is all about advocacy and prevention. For example, there was a time when Dr Zarina encountered a situation where the child had increased intracranial pressure where the child experienced headache, vomiting and feeling unwell. If the parents knew how to recognise these symptoms, they will be able to handle things better especially if the attending medical personnel did not take the appropriate action.

Dr Zarina did paediatric haemato-oncology for almost 10 years as a young specialist. However just like what she did 10 years back before stepping into paediatrics, she decided to venture into something different. Quoting what Professor Emeritus Tan Sri Dr Sharifah Hapsah shared, one can either take the path that is already well laid out or take a path which is not tracked by anybody yet (be a ‘trailblazer!’) Hence, she chose genetics as her choice of paediatric sub-specialty. Dr Zarina’s interest in this field is also a factor that drives her into genetics, wanting to do something different and venture into something that others have not done here yet in UKM. In Malaysia, to be trained as a clinical geneticist a doctor has to become a paediatrician first and then only sub-specialise.

There were no clinical geneticists in the UKMMC at that time. She saw this as an opportunity to also contribute to the genetic fraternity in UKM. In keeping with the needs of running an efficient clinical genetic service, genetic counsellors are much needed and there were only 2 accredited genetic counsellors in the early years of 2000 in Malaysia. In view of that, Dr Zarina developed the programme for Masters in Medical Science (MSc) in Genetic Counselling in UKM. UKM has pioneered this programme and till now remains to be the only local university that offers this programme. At that point of time, there were very few clinical genetics specialists. Even now there are only about 10 to 12 in the entire Malaysia; of these, there are only 4 clinical geneticists in the university set-up ie in UM, UKM and 2 in USM. The rest are all in the Ministry of Health because clinical genetics services is highly specialised and need sophisticated laboratory support which is largely regional. The clinical genetics services are centred in HKL and Penang general hospital under the Ministry of Health at present.

In the old days of doing child practices, doctors or nurses would just probably wrap up a child and then hold their hand out to set up a branula. A 2-3 year old certainly wouldn’t like that let alone any child! They will scream as a result of this and be traumatised thereafter. Hence, as a paediatrician, Dr Zarina was also given exposure on child-friendly and family centred care through collaborative works with Child Life Council USA. Following that, she and a group of passionate paediatric related doctors and healthcare personnel, developed the course on “Child and Family Friendly Healthcare Practices”. This course tells us how to understand the needs of the child before handling them in the best way possible. Child friendly practices should be tailored appropriate for the child’s developmental age. Doctors should use parents as their allies, warm up to the children, speak to them, acknowledge, interact and if need be, play with them first. In the ‘olden days’, parents used to stay outside of the treatment room when the branula was set up for the child. Now the child sits on the parents’ lap or doctors position them in a position of comfort/security when setting up the branula. Applying child-friendly practices, acknowledge the parents’ presence, learn to anticipate the potential stress source, and ‘come down to their (children) level’ are all helpful in making the situation better for the child and the family. It may be seen as ‘time consuming’ but Dr Zarina considers it as time well invested.

One of the things that will always make Dr Zarina smile is because she always work with children. During her younger lecturer days, paediatrics is a speciality where there are not enough specialists (even till now!!)

So as a young lecturer Dr Zarina was placed in a compulsory rotation (eg neonatal intensive care, NICU) or where there aren't enough specialists in that particular sub-specialty. At that time, haemato-oncology lacked specialists in UKMMC. Working with children may already seem challenging what more working with children who have cancer -it can be a devastating experience. Dr Zarina did her masters’ dissertation on paediatric oncology – thus she had to do the rotation longer but she was willing to stay back because she enjoyed the posting and found it fulfilling!

Dr Zarina continued to work in paediatric haemato-oncology for over 10 years. During those 10 years, whenever she managed a patient with the team in a cancer ward, the treatment can get very intense. She said the number 1 cancer in children is leukaemia. They can have very intense moments for the first 6 months of their treatment life and its ‘very bumpy’; sadly, some don't make it but for children up to over 95% can be cured, in general. So, providing parents and the community with the right facts are the type of things we must share because there are some people who say that cancer outcome is bleak and thus does not have to be treated. 

Throughout the treatment process when Dr Zarina deals with patients, she sees them in the clinic and wards for consultation, management and treatment processes. As up to a few years ago, she was still able to continue to see them even though they are already young adults. There is one patient of Dr Zarina where she started managing with the oncology team (she reminds us that team-work is very important) when the child was 3 years old. Now this little girl is in her 20s - she has already graduated and is still in contact with Dr Zarina. So when Dr Zarina keeps on seeing her from time to time growing up, in front of her eyes, its the most happy and rewarding thing for her, seeing her patients get cured with the help of the Al-Mighty, and seeing them being able to go back to a normal life. All with the help and care of the entire medical team – it’s a heartfelt warm feeling!

Aside from the clinical aspect, being an academician, some other lovely memories that Dr Zarina describes is seeing her students mature, graduate and become doctors (be it at undergraduate or postgraduate) just as how she sees her patients – that proud and happy moment of the student is certainly shared by her too!