Thursday, August 31, 2006

National Day Wish



Selamat Hari Kemerdekaan Malaysia ke 49

Harapan Perdana Menteri Malaysia supaya masyarakat Malaysia yang majmuk memelihara semangat permuafakatan dan kerjasama tepat pada masanya. Pemeliharan beliau bahawa pembangunan negara yang dinikmati sekarang adalah hasil perpaduan yang terjalin antara rakyat pelbagai kaum dan agama selama ini tepat sekali. Kalaulah berlaku apa-apa kekacauan, pembangunan pesat yang di nikmati selama ini tentu akan hilang begitu sahaja. Ucapan beliau tentang perlunya perpaduan kaum dan agama tepat pada masanya kerana kini telah berlaku beberapa perkara perkauman and agama yang tidak begitu memuaskan.

Baru-baru ini dalam ucapan naib presiden Pemuda UMNO, Khairy Jamaluddin, beliau mengingatkan ahli-ahli UMNO mengapa mereka perlu bersatu kerana jika tidak kaum bukan bumiputra akan mengambil kesempatan jika UMNO lemah. Mengapakah ingatan Khairy begitu lemah? Dalam krisis UMNO tahun 1998, bila UMNO digugurkan, bukankah MCA sebagai parti sah yang terbesar dalam kerajaan mengambil balik UMNO (Baru) ke dalam Barisan Nasional? Jika MCA hendak mengambil kesempatan untuk merebut kuasa, bukankah itu masa yang paling baik? Siapakah yang mengambil kesempatan bila ada krisis dalam UMNO? Tentu sekali bukan MCA.

Di Hari Kemerdekaan ke 49 tahun ini, harapan saya adalah supaya Malaysia boleh mengujudkan sebuah parti politik and masyarakat dimana kaum dan agama tidak memainkan peranan yang penting di dalam politik and ekonomi. Bangsa Malaysia telah lama disebut, tetapi tetap menjadi impian. Entah sampai bila baru impian ini akan menjadi kenyataan.

Happy National Day Malaysia!

Wednesday, August 30, 2006

Why I am still a PR

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With the recent talks on making Singapore more open to foreigners with the hope of some of them taking up citizenship, I would like to share my experience on why I stay a Permanent Resident.

I came to Singapore about 20 years ago to study in the Junior College after obtaining a scholaship. There was no bond attached but the natural progression was to continue my studies in National University of Singapore. Since my graduation, I had been working here full time and successfully applied for PR a year after graduation.

The reasons why I came here to study in Singapore was 2-fold. Firstly there was a fear that I may not make it into a local Malaysian university for the subject of my choice. Then there was still the quota system and hence the more popular subjects like medicine, law and engineering were more difficult to enrol. Secondly, I was lucky enough to get a scholarship to study my pre-university level here. Coming from a not-too-well-to-do family, studying overseas was not an option. Hence at the tender age of 17, I left my hometown.

Now in my middle-age, having spent more than half my life here, why am I still a permanent resident? The most obvious is that my family is in Malaysia. My parents, siblings, uncles and aunties are all in Malaysia. Having grew up with all these people, it is difficult just to cut ties and 'forget' about them. This should come as no surprise because even for the Singaporeans who came back here after a sting overseas, most of them give family ties as one of the primary reasons for returning here. Apart from family ties, the memories of growing up in Malaysia, the childhood days and the experiences that I had gone through back home is something that cannot be easily forgotten. Every time I went home, every little events, structures and people, will bring back fond memories of my growing up. I guess this is what is meant by our roots.

Then there are those factors that cannot be explained. Although there are a lot of dissatisfaction with the Malaysian government and its affirmative policies, somehow when these are put aside, Malaysia does bring some pride to my heart. For example, when Malaysia did well in the Commonwealth Games, I felt proud. This was especially so when all the medals were won by native-born Malaysians and not through imported talents. When the Petronas Twin Towers was named the tallest building in the world, I felt proud. When Malaysia beat Singapore in football, I felt proud. When I speak Bahasa Malaysia to Malays I feel proud. When other people say bad things about Malaysia especially when unjustified, I became angry. Again I think this is not much different from most Singaporeans.

So with my roots in Malaysia and the feelings I have for Malaysia, how can I just change my citizenship? If I renounced my Malaysian citizenship, would I be truthful to myself? Am I being fair to Singapore? No doubt, the situation in Singapore may be much better than Malaysia, but the truth is, with all the mess that she has, she still has some intangibles to offer; intangibles that cannot be explained. Maybe it is just the emotional ties that I have.

Sometimes I wonder why the Singapore government is so keen to make foreigners take up their citizenships. Is having the passport so important that it does not matter whether they have any feelings toward Singapore? I have a friend who is a medical specialist. He was born in Singapore but hold a Hong Kong citizenship, left for Hong Kong at the age of 3, studied his Medical degree in Australia and later worked there for about 10 years. He later came to Singapore to work. When he tried to apply for permanent residence here, he was told by the immigration department that because he was born in Singapore, he has no option to apply for PR; he's only options were work permit or citizenship. His query was how can one just take up citizenship just like that? My exact sentiments.

Recently in the forum page, a writer wrote that in times of war, how many of the 'imported' Singaporeans will stay and fight for the country. She wondered whether there is a way to test this. I think an indirect way to gauge is to see who the person supports when their ex-home country compete with Singapore in a sport event. If he does not support Singapore, then I think it is safe to say that having the Singapore passport is just another item in his possession.

I may sound like a sentimental freak. I may sound too idealistic. But I feel that I am just an average Joe, and hence my feeling should not be too different from the next average person. Call me what you like, for pride of citizenship is a matter of the heart. With matter of the heart there is no logic.

So, will I ever become a Singaporean? The answer is ..................

Sunday, August 27, 2006

The way forward...

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The recent suspension of 2 Chinese sinsehs by the Traditional Chinese Medicine Board sheds some lights on the practice of Traditional Chinese Medicine (TCM) in Singapore. In the cases reported by The Straits Times August 26 2006 edition, both were fined and suspended for "illegally dispensing prescription and banned drugs and the other for importing prescription drugs without a license."

The drugs in the case of illegal imports are antibiotics and contraceptives pills brought in from a neighbouring country. This may seem trivial until one consider the risk of getting counterfeit drugs or contaminated drugs from unlicensed sources. There were many cases of liver disease after taking slimming pills that was either tainted or contained fenfluramine. The most well-known must be that of Singapore actress Andrea De Cruz who developed liver failure in 2003 after taking Slim 10 which contained fenfluramine. Fenfluramine had been banned by the FDA since 1997. The drug was able to be imported legally because it was classified as a supplements and not a prescription drug and hence need not go through the mandatory testing. Little was known that it was "spiked" with the banned drug. Thankfully this sad story had a good ending when her fiance, fellow actor Pierre Png donated half his liver for her, enabling her to survive the crisis; and in the process probably redefined the definition of love!

The case involving the illegal dispensing is more dangerous. In this case, the TCM practitioner "prescribed the herbal product called BGT to control blood sugar and obesity." However it was found to contain glibenclamide and phenformin. Both these drugs are used in the treatment of diabetes in Western medicine. Hence these medication should only be prescribed to a diabetic and not just for the sake of controlling blood sugar, which has little to do with obesity. Improper use of the medications can lower a person's blood sugar so much so that the person may lose consciousness and going into coma and death! On top of that phenformin had been banned for at least the last 25 years. This followed the findings that the drug was found to cause the blood to be too acidic, resulting in fits and death.

These were the very reasons why the Ministry of Health (MOH) sets up the TCM Practitioner Board in 2000. Through the years TCM has gained popularity with the population and the practice was not regulated. Anyone can open a shop and claim to be TCM-trained. This may create a situation where unscrupulous and unsafe practice being carried out by fly-by-night self-proclaimed TCM practitioners. The result will be exposure of the population to potential mishaps from such practices with no recourse to any protection in the form of law suits. With the set up of the TCM board, only qualified practitioners are licenced; with the Board empowered to mete out any punishment for treatment that is unscrupulous, unethical or detrimental to the patient.

The punishments meted out by the TCM Board is indeed timely and the right way to go because now patients' rights are protected and at the same time the practice of TCM can be elevated to a higher level. As a practicing doctor, the rise of TCM is not seen as a threat but more as a complimentary practice to Western medicine. However this can only be achieved if TCM practice is regulated so that there is enough confidence in accepting their diagnosis and treatment. This is clearly proven by the overwhelming response by Western-trained doctors to the first TCM series of lectures leading to a diploma certification. With the interactions between TCM and Western medicine, the patients will stand to benefit.

With the practice of TCM regulated, maybe the next sector to look into is that of beauty salon. Beauty salons had been known to prescribed antibiotics for their patients with acne. Some beauty salons also proudly advertised their laser skin treatment. Unfortunately, antibiotics use and laser treatment can only be carried by a trained-doctor. Not all skin condition is treatable with laser; some condition may actually worsen with the use of laser. When such unfortunate incident happens, there is nothing much anyone can do short of plastic surgery. Hence, in the same vein as TCM practice, maybe the beauty industry should set up a board to regulate themselves so that a few bogus ones will not affect the image of the beauty industry sector.

Friday, August 18, 2006

Managed Health Care scheme - the sad truth

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Today newspaper highlighted the Managed Health Care scheme in Singapore in today's edition. In the report, it highlighted the danger of unprofessional conduct by general practitioners under the scheme and the need to regulate the industry. The main concerned highlighted is that doctors may compromise on the medication prescribed for maximum profit.

To the uninitiated, Managed Health Care is a scheme akin to an insurance policy taken out by employers for their employees. Employees either do not have to pay for their consult and medication when they see their doctor or pay a minimum sum of usually S$5 in the co-pay scheme. In return the employees are restricted to see only a panel of doctors covered by the scheme in order to enjoy this privilege. For the doctors, they have a ready potential pool of patients from the scheme. The downside being a cap on the charges that the doctor can charged. Sometimes, certain scheme even place restrictions on the type of medication that can be prescribed for the purposes of reimbursement. In short the company that carry out the Managed Health Care (MHC) scheme acts a middleman between the employer and the doctor.

Do employees benefit from the scheme? Yes and no. If the employee is seeing the doctor for simple everyday cough and cold, then he does benefit from the scheme. This is because the medication prescribed are rather standard and the cost of such medications are manageable for the doctor. Hence his medical care is not compromised as similar medication would be prescribed whether a patient is under the scheme or not. The only downside in this instance is the trouble of having to seek out the doctor under the scheme.

If a problem is more complicated, then the problem may arise depending on the MHC scheme. Some MHC does not limit the type of medication that can be prescribed. Others restrict to a certain approved list, some give leeway but only if given prior approval. In practice, many MHC restrict the type of medication to an approved list. As a result a more prolonged sickness which may need for a change of medication maybe compromised by the restriction placed on the doctor; or a better medication but one not approved by the MHC scheme may not be able to be prescribed by the doctor without the patient paying it himself. In such instances medical care is necessarily compromised.

To the doctors, MHC schemes also presented with a double-edged sword. On one hand it gives a potential ready pool of patient. On the other hand, he does not have a free hand to manage the patient in the best possible ways because of the restriction imposed by the scheme.

To the companies, MHC is a boon for them. Where previously they have to bear the cost of medical care, now they can 'outsource' to another company. In this way they may be able to save on the healthcare cost as they can shop around for the cheapest MHC. In addition to that, estimates of running cost for the company becomes easier as healthcare cost is now fix yearly.

The employees unfortunately have no say in the MHC scheme. The doctors have a choice, and if the MHC scheme is so restrictive, why do they want to join the scheme in the first place? The choice is very limited, especially for those stand-alone practice. In this day where the big will eat the small, if they do not take up such scheme, how are they going to compete with the big players - company that runs a chain of clinics. Because their chain of clinics are dispersed around the island, they are at an advantage because employees do not have to travel far to see an approved doctor. However once they signed up the scheme, their hands are tied. They cannot practise the same way their are accustomed to. Medication given has to be limited in duration, the type of medication has to be limited to an approved list.

The call by the Singapore Medical Association for the Ministry of Health to regulate the MHC industry is therefore timely. A benchmark and guideline should be set up so that health care received by members of such scheme do not get short-changed; even as the MHC companies try to tweak the price they charge to employers and give the doctors unrealistic reimbursements in their quests to improve their business. The benchmark is the most important because it will serve as a guide for the minimum acceptable level of care expected by the patient. As the members of the scheme has no choice or say in these scheme, only the benchmark will be able to protect their interest. And as doctors, we should "vote with our feet" and shun those schemes that give unrealistics reimbursements, so that our conscience can be clear when we treat our patients and so that our patients can have the best treatment with the given restricted conditions.

I would like to share my own experience. I was running a high fever of 40 degrees. Unfortunately, the nearest clinic that covers my MHC scheme was in the next township. In order to save the trouble and time I decided to see a doctor in my neighbourhood whose fee have to be borne by myself. I was given a medical leave but unfortunately the medical leave was not accepted by my company because "it was not part of the panel doctors". In frustrations, I told the HR to convert the medical leave to my annual leave instead! To the cynical, that was my first medical leave in two years.

So who benefits from the MHC scheme? Of course the MHC companies themselves!


P/S: Read the novel Unmanaged Care by K E Schields which touch on this issue in the US. A movie by the same name was recently shown on HBO.

Tuesday, August 15, 2006

Who won the Israeli/Hizbollah war?

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Finally the Israeli/Hizbollah cease fire had been put in place after a month of war. Now both sides is claiming victory in this unfortunate war. Who has actually won this war?

I usually have much sympathy for the Arabs in the Middle East when it comes with dealings with Israel. Israel, like its backer, the US, had been pretty much into bullying and intimidation. However in this instance, the blame should be shouldered by Hizbollah directly and the Lebanese government indirectly. It is no secret that the Israeli had been uneasy with the Hizbollah bases in south Lebanon. Hizbollah had been armed and possibly trained by its backers Syria and Iran. This has made the Israeli uncomfortable because Israeli's cities are within striking distance from these bases. However it has no excuse to attack these bases without incurring the wrath from the rest of the world with the possible exception of US. However the Hizbollah has nicely created just such an excuse for the Israelis when they kidnapped 2 Israeli soldiers. In normal circumstances, such innocuous actions would not have triggered off a full-blown war but in this instance the kidnapping had given the Israelis the very excuse they are seeking to invade Lebanon with the aim of destroying the Hizbollah bases. So the blame should be borne by the Hizbollah group.

However the Hizbollah should not be solely to blame. The Lebanese government had not been trying to disarm the Hizbollah group since the Syrians were expelled from Lebanon. How can a country have two groups of arm forces? Who will the arm forces answer to? Therefore this has created a state-within-a-state situation. Hence, although the war takes place in south Lebanon, it is actually a war between Israelis and Hizbollah forces. So far the Lebanese army had not even entered the fray. This is as if the Hizbollah-controlled is an autonomous one. However the people killed are Lebanese; people who voted the current Lebanese government. What has the government do for these civilians?

The war will not be so protracted if external powers do not come into play. If the US do not supply arms to the Israelis and the Syrians/Iranians did not do likewise, where are the two opposing sides going to get their ammunitions? Apart from that the US also had given their tacit approval for the attack against Hizbollah bases when there rejected the call for a simple cease fire citing cease fire is only temporary and will not solve the Hizbollah attack on the Israelis.

So why the 'sudden' change of heart? I think the civilians toll is getting too high for the US comfort level. This coupled with the apparent stalemate with the Israeli army incursion into Lebanon and the dogged resistance from the Hizbollah, means that if the war is to be prolonged, then both sides will suffer more casualties risking the loss of support from general public.

With the cease fire now in place, who won? Before this question is answered, lets see who has lost. Of course, civilians are the biggest losers. They have their lives messed up because of misjudment of a few. Next is the Hizbollah because they are driven further up north, away from their traditional power bases, away from striking distance to their sworn enemy. The Israelis also lost because of the destruction of their cities, their economy, their armies and their reputation as an invincible army in the Middle East.

So if both sides lost in this war, who won? The answer is the arm suppliers to both sides, who make millions from the sale, from the destruction of people's livelihood, and from the unnecessary death of civilians and the army personnel alike.

Wednesday, August 09, 2006

The irony of blogging

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The Net is full of blogs. Most of them have two things in common. Firstly, most of them are by anonymous writers. This is especially so for personal blogs. Secondly, most blogs present a point of view, discussions on current events or just simply telling the world about encounters one has in his/her daily life. So what is so ironical about blogging?

To see the irony, one must understand why people blog in the first place. People blog because they want to share something with the world at large. This can be the everyday encounter as one goes through the passage of life, sharing of experiences, of opinions regarding politics, current affairs or just to rant about any frustrations one encounters. Bloggers may just want to keep a record of the life just like writing in a diary. No matter what the reasons for blogging, one thing is certain - the blogger wishes to share something with anyone who cares to read the blog. They wanted to be heard, to be counted and hopefully make a difference. They hope to change opinions if not move the world.

How is this different from the coffeeshop talk, so popular in our part of the world? In coffeeshop talk, generally the people involved are known to each other. The audience is therefore small. Opinions generally do not change with the few participants. In the world of blog however, the audience is potentially large, directed at nobody and anybody at the same time. With such a large potential audience, opinions are necessarily varied. Here is where the irony of blogging comes in.

The blogger wanted to be heard. He wanted to be counted. He wanted to make a difference. However he wanted to remain anonymous! If you wanted to be heard, why hide under the cloak of anonymity? Why spend hours preparing and writing the blogs and not recognised? Why tell the whole world your life story and yet not prepared to tell the world who you are? Does writing anonymously any different from writing your thoughts in a diary, the sacred and private personal space? Why feel anxious and frustrated when that site counter does not move? Why get disillusioned when nobody leave any comments to a blog which you think will create a controversy?

So how useful can a blog be? Despite its anonymity, blogs can still be useful if the contents do make a difference to someone's life. This is because the writer is not important, but the content is. This is especially true for those blogs which discusses current affairs, life experiences and those touching on special interest. If the content is relevent and useful, whether the writer is young or old, male or female is irrelevant. The exchange of ideas is what counts, and precisely because of such exchanges of ideas, the society progresses. Each builds on the others ideas. On the other hand, blogs that chronicles ones life story maybe lost its usefulness and relevance if it is anonymous. This is because if no face is attached to such life experiences, the impact and the authenticity may be lost, making such experiences akin to the work fiction.

The spread of blogs and discussion groups on the Net has been partly attributed to its anonymity. Hence should the lively discussions that blogs bring about be removed of such anonymity? I think not. Anonymity had been present for a long time under the guise of pen-name. Authors had been using pen names for their books. Nobody had question why authors do not use their given name. Some authors even have a few pen names for different genre of novels. If authors can remain anonymous, shouldn't bloggers be granted the same choice? After all, there is no such thing as true anonymity as there are always ways to find out the real identity of a blogger if one is committed enough. And just like novels, the true identity of the blogger is secondary to the ideas presented. The identity just act as an address so that the site can be identified and revisited.

So where does that leave me? I think I will remain Wormie for the time being. Hopefully people read my blogs because of the content and not because who I am. However, at the back of my mind, I wish to enjoy the recognition that my blogs may bring. What an irony!

Thursday, August 03, 2006

New toy

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Succumbed to temptation. Got myself a new toy. Will be very distracted for the next few days.