Odysseys of George

I was shocked to see there were two unread sms on my iPhone this morning. In the hurry of getting to work, I forgot to check these messages and only had a look at them at about 10am. Gosh! Was I shocked and saddened.

In my carrier, I have met many people. My patients are all dear to me, they have all thought me something either directly or indirectly and not just about medicine, but the art of medicine and also life, this especially so with my elderly patients. However, some patients become closer than just patients and over the course of time, they almost are like family or a very close friend. This post is about one of them, a lady whose strength, determination and perseverance and above all her ability to smile and laugh in times of pain and suffering thought me a lot about life and love.

It was about 5 years ago. She was in her 40s and already on a wheelchair. I was a new specialist just a few months after graduation. She was wheeled in to my clinic by her sister. She smiled – a smile that was welcoming and yet cynical. I welcomed her with the usual greeting and proceeded to ask her as to why she came. Before we knew it, we were talking and she was telling me a story that I felt sorry for. A year before our first meeting, she had an emergency procedure which ended up with her having to carry a stoma bag to pass motion and an amputated right leg. She was diabetic and also hypertensive. She came to see if she could get her stoma reversed.I could understand why the stoma was a burden as it was sited poorly and she had difficulty taking care of it herself thus requiring her sister to help. She did not like the feeling of dependency. After 3-6 months of assessing her heart, her fitness level, her independent ability and seeing her determination, I agreed to reverse the stoma. She understood the high risk involved and bravely she signed the consent form. The surgery went well and she recovered well. She was able to attend functions and managed to built her self confidence all over again. She dressed better and the smile was a story of content happiness. She never fails to come for her follow up and she always wishes me via sms or calls on my birthday and on Christmas day. She would also remind me of all the important Malayalee celebration days for which I blogged before. She always kept in touch even after I have left that hospital for over two years. Early this year, she started to have problems again but this time it was more related to her female reproductive organs. A few days ago, she had difficulty in breathing and was admitted to a hospital. Yesterday night at about 1130pm, she took her last breath……………………….

“Ms Kana has passed away” was the sms that was staring at my face!!!!!

My heart felt heavy, my eyes started to tear. I called her sister and spoke to her. I decided to see her for the last time. She has always come to see me, now it is my turn. I wished it was not for this. I wished I saw her prior. I will miss her, her laughs and her smile. I will miss her wishes and her reminder of festivities. I saw her lying there on a table, they were doing their religious rituals for the departed. The ladies then dressed her up in her favorite dress. She looked contented. I hope she was. She was then placed in the coffin and was brought to the crematorium. I left. I wished I knew she was unwell. She would normally call me when she was unwell — maybe she was too weak to do so, maybe she knew and did not want to let me know. We did speak about death before — that was 5 years ago before the surgery — she looked at me, then looked at her sister and then looked down at the floor before looking back at me and said, “I’m ready. If it is my time, at least I would be no more a burden for my sister and siblings.Let God decide.”

As you showed me strength, I learned to be strong,
As you showed me determination, I learned to be determined too,
As you showed me love, I began to understand love too,
And with your smile, it made me smile even more.

Thank you for being my patient and a friend.

One of the highlights of our trip to Layang-layang Island was on the third day. We were heading to our dive sites in our quest to find the elusive Hammerheads when along the way, these wonderful friendly creatures came out to play with us. There were easily 20 of them swimming and playing with us. A few of us jumped into the deep blue sea to swim along these super fast and friendly these dolphins. A rarity but it made the trip so much more memorable. This edited video was taken by one of the divers, Lyla.

This is the first time I am incorporating music into the video and hope it is able to carve a smile as it did for all of us. Please comment!

Enjoy!!

I saw this in a good friend’s notes on facebook….. i thought of sharing as i believe in it…… Enjoy!

I thought I should put this in as I agree totally with him. The public should take up a more proactive role to ensure that Malaysia stays alive. The government and media continue to paint a different story afraid of losing popularity and votes.

JUNE 10 – What financial crisis?’

Readers following the great national debate initiated by Minister Datuk Seri Idris Jala in the Prime Minister’s Department on the possibility of the country going bankrupt must be thoroughly confused with the mixed messages from government. On the one hand, we are told that the country is more prosperous than ever before and that absolute poverty in the country, for example, is almost completely eradicated. We are also told that the country’s economy is in good hands and that the finances of the country are well-managed.

Every few days or so, we are reminded of how fortunate we are to be living in Malaysia and how much foreign investors love us. Just a short while ago, it was trumpeted that our competitiveness had shot up this past year so that we are now ranked number 10 in the world — ahead of many advanced economies.

We regularly receive a barrage of statistics and data on not only how well the economy is performing but also how, thanks to the outstanding economic management of the government, we will soon reach dizzier heights of prosperity and affluence.

The New Economic Model, it is claimed, will transform the Malaysian economy to become one with a high income and high quality growth.

Presently, per capita annual income in Malaysia stands at RM23,100; under the NEM plan, that figure would more than double to RM49,500 by the year 2020.

Lucky Malaysians — according to the government’s plan — to be able to live in a land of milk and honey with fistfuls of ringgit to throw around and to be standing side by side with the developed countries in the foreseeable future.

We have been fed with this optimistic and glowing picture of the country’s economic prospects for so long that many of us can be forgiven for believing that we stand on the threshold of unprecedented economic prosperity if not greatness. Never mind that doubt — in the way of the impoverished in our slums, squatter and ulu areas — is often just around the corner, many Malaysians prefer to close their eyes to this reality.

Idris Jala’s wake-up call

Fortunately or unfortunately, thanks to Minister Idris, we have now received a dose of reality that our economic situation is more complicated and a lot worse than what earlier leaders and the government-controlled media would like us to believe.

Although a few recalcitrant leaders are still living in denial and claiming that the minister has misled Malaysians on the true state of the country’s financial health, a closer look at Idris’s speech during the open house on ‘subsidy reduction’ shows that his concern and warning on the country becoming bankrupt (in the same way as Greece is) was absolutely correct and spot on.

Idris’s warning is based on a number of economic projections including:

* the country’s GDP would grow at 3 per cent annually

* government debt continues to grow at 12 per cent annually

Both assumptions are not unreasonable.

Average GDP growth has been slowing down in the past two decades. Prior to the Asian financial crisis of 1997-98, the country’s growth rate averaged 9 per cent from 1990-1997. Between 2000 and 2008, growth rates fell to an average of 5.5 per cent. If the trend of slowing growth continues, then the assumption of 3 per cent GDP annual growth for 2011-2020 may well prove correct.

If there is no quick recovery in the global economy and we have a prolonged double-dip recession which seems more likely now following the ongoing financial crisis in the Euro zone, then even 3 per cent annual growth in the GDP may seem optimistic.

As for the country’s debt, government debt in 1997 was RM90 billion. This has grown at a rate of 12 per cent per annum to RM362 billion today. Based on a similar annual increase of 12 per cent over the next nine years, the country’s debt will balloon to RM1.16 trillion by 2019.

The government’s own Performance Management and Delivery Unit’s calculations show that by the year 2019, the following economic scenario will be faced by the Malaysian government:

* The country’s projected debt will be 103 per cent of GDP

* The fiscal deficit will reach RM449 billion or 38 per cent of GDP

At that point, what will happen is that government revenue will not be enough to service its debt and to operate the hospitals, schools and other government services. In other words, the country will go into sovereign debt crisis, which is a polite way of saying that the country will become bankrupt.

The bigger subsidies are …

Where Idris went wrong is not in his assumptions and projections but in his focus on subsidies as the main culprit in the country’s perilous financial state. Addressing a public audience and as a member of the Barisan Nasional government, however, he was not in a position to finger the colossal wastage, inefficiency and corruption that has characterised Barisan rule and economic management of the country.

Yes, subsidies are part of the cause of our potential financial downfall but it is not subsidies to the poor that are to be blamed — in fact, the entire food subsidy bill in 2009 was only RM3.4 billion or less than the cost of the two recently purchased low-quality diesel submarines that cannot even dive properly! What is being spent on tolls, sugar, flour, cooking oil, school books, etc. is only a tiny fraction of what goes into the country’s black hole of defence expenditure.

Instead of being fixated on subsidies to the poor, let us open the books on the subsidies that have gone to the ruling political elite and its business allies — the cronies, middlemen, consultants, and agents that are key to the massive binge of irresponsible government procurement in all sectors, especially defence.

Finally, it is also the subsidy of a huge, bloated and unsustainable civil service that is swallowing much of public revenue and helping to pile up our debt. Subsidies that have kept the cost of living down for the average Malaysian are only a small part of the larger subsidy equation.

Consequences of mismanagement

So what happens when the country becomes bankrupt?

When ordinary citizens or businesses become bankrupt, they can hide behind a court order and return to some kind of normal life thereafter. Those who have borrowed from Ah Longs, of course, cannot throw themselves at the mercy of the courts. They are more likely to be forced to rely on family members or friends to help them reach some kind of settlement or have to flee their aggressive creditors by changing their residence or even identity.

Countries that are in default do not have the luxury of changing their identity or getting a court to provide some measure of protection. In Argentina which defaulted on sovereign borrowings and debt repayment in 2001, the consequences were horrendous. The country experienced a brutal spiral of inflation followed by hyperinflation, soaring unemployment soared and a collapse in the currency.

The economy imploded, shrinking by 13 per cent in a year and the government was forced to cut public sector wages, slash the state pension and other social benefits. Unable to pay for goods with cash and with banks rationing withdrawals, citizens had to resort to bartering. Imported goods became unattainable.

Economic shock was followed by social trauma and political crisis. The quality of life of the average Argentinian was lowered drastically and many businesses closed or went bankrupt. Argentinian society has still to recover fully from the mismanagement of the country’s economy during the late 90s.

Let us pray – but prayer is not enough — let us make sure that the government never mismanages the Malaysian economy to the stage when we have to go through what the people of Argentina have had to suffer. — cpiasia.net

* Dr Lim Teck Ghee is Executive Director of the Centre for Policy Initiatives.

* This is the personal opinion of the writer or the newspaper.

Today in the newspaper, the Director General of Health spoke on a few issues namely:
1. The exorbitant fees in private practice
2. The failure of medical curriculum
3. The loss of human touch
4. Mushrooming of medical schools
5. Quality of Housemans

Lets look at the issues which actually has been around for ages and yet the typical Malaysian attitude prevails that is to make noise and then forget about it as fast as it was brought up.

The issue of exorbitant private fees have been brought many times but what most of us fail to understand is that while the doctors charges are regulated by the MMA, the private hospital charges aren’t. Well, then again there are many aspects that this matter can be looked at. The doctors who do their job and charges according to the MMA schedule, well I guess that should not be an issue. However, there will always be the ugly ducking, where charges are made unethically, though bounding to the schedule – that is to say there are abusers of the schedule — people who will make multiple charges for a 10 minute procedure for instance. From the hospitals standpoint, medications, technology and utility charges are rising and therefore the need to increase the charges gradually but saying this some hospital managements are equal to that of hotels. I suppose that it is difficult to regulate the hospitals as many sitting on the top of these hospital managements are linked politically or another and thus are indispensable. So the best way – squeeze the doctors!

The failure of the medical curriculum and the mushrooming of medical faculties are issues that have been voiced for many years. The problem is that those who now enter universities are not mentally prepared to undertake the real university education which for the failure of our secondary education, the tertiary education has been modified. Many lectures and professors have been heard saying that students that enter universities nowadays are not mentally matured as what it was before. The students are less resilient and the need to “hold hand and guide” is so high that if the past system maintains there would be many more failures and mental breakdowns. This I believe is the failure of the primary and secondary education. Then we have the major migration of brains to overseas especially to our neighboring Singapore. Then we have so many medical schools that blooms faster than mushrooms that dilutes the brains further. This has caused many major medical faculties to fall to the support of younger inexperienced staff to teach. Many of these new medical faculties do not have enough staff to teach their medical students and are dependent on the support of government specialist to assist the teaching of their students. The remunerations in pay and the acknowledgment of the work of those who did this country proud has been forgotten and left unattended to the extent frustration would be the natural response. Now, in government service everybody is sitting on the same scale as long as you are a specialist regardless of seniority and experience which is paramount in medical fraternity. I regress. The curriculum has been modified over time to make medical education more fun and attractive at the price of the quality of education. The so called US-based system is adopted without taking into consideration the local health system. There are more assignments and projects which has overtaken the need of medical students to spend time with patients. So, one wonders why the loss of human touch? Medical students nowadays hardly spend anytime with patients unlike my time. I have seen this happening in UMMC,UITM and also USIM. I am sure it is across the board.

Then we have the new houseman. As it is with students entering universities, we now have fresh doctors who are not ready to work and fail to realize that they are in a job that deals with life. Our government has spent billions to send some “brains” to many ambiguous medical universities overseas where the curriculum is worse than that of our very own — where they hardly have exams and that these fresh doctors hardly know what the thyroid gland is or what hernia is all about. It irritates me that the DG says that the onus are on the specialist to train these fresh graduates when at the same moment protects these bunch of fresh doctors with various rules and regulations. These new doctors are so not ready for the job that in recent years, as the DG says, “There have been many instances where housemen experienced mental anguish, depression, anxiety, stress and suicidal tendencies while undergoing training and this is no laughing matter.” But the truth to the matter is not to then blame the specialist but to then go back to the crux of the issue – stop sending these students to such places. As a patient, would you be happy to be treated by somebody who know not where the thyroid gland is or know not how to ascertain your diagnosis because he has no clue what your complaint is about? Is it fair for the public to be treated by these generation of fresh doctors even though there are specialist supposedly overlooking their work? There are people you can train and teach and there are the ones you just can’t! To make things worse, the DG decides to enforce a promotion exercise where part of the assessment is from the housemen– “As such, he advocated a two-way assessment system where not only the specialist and doctors provide feedback, but the houseman would also be given an opportunity to provide feedback on their trainers. On the criteria for promotion of public service doctors, Ismail said it was based on five main aspects, namely service, training, research, one’s standing in the eyes of peers and the 360 degree perception” — ridiculous — it only encourages the system to get worse then any better as now those specialist who really care and are strict would be judged badly and those who have no regards for the future of the medical system would be promoted quickly – Bullocks!

This is just part of the matter but I have said enough for now!

I have always wanted to watch a stage show – a theater, a musical etc. Recently, I managed and I was left in awe of the show – so much so that it still seem like it was just yesterday I watched it. Maybe, I could relate to it at many levels – and thus this musical really did touch my heart and I found myself crying. This show that I speak of is non other than our very own, “Adam, the Musical” .

The show started on the 12th May 2010 and will be the first ever to run for over a month and ending on the 20th June. The show written by Mark Beau De Silva and directed by Joe Hasham, is based on issues pertaining to HIV/AIDS. The crew was excellent and delivered the musical so very well. The music was good and I especially liked the song,” Here, Here’s a Lollipop” and “I dont need a wheelchair anymore”. The actors and actresses was all very very good with the likes of Dato Faridah Merican, Malik Taufiq, Tabitha Kong and also who could forget the role played by Tria Aziz.

This musical brought many thoughts to my mind. As a doctor, I have come across many HIV/AIDS patients and have taken time to listen and care for them.I have also seen how the community and also the medical institution treated these group of patients. Many would say, “They deserve what they get for the way they behaved!” I never agreed with these remarks as I feel nobody deserves to be sick of any disease what ever your character or conduct is like. Furthermore, who am I to judge them, as I myself have my own shortcomings. Then again how would that remark above fit for those born of mothers of HIV/AIDS or those who got it from blood transfusion. It made me remember of this one particular patient I took care of in my early years of service. A young Chinese man diagnosed with AIDS and then at that time AIDS was new to the world. His family deserted him. He had no visitors. He understood why but was feeling very alone without anyone to confide in. He had many things to say but to no one. Nobody was interested enough to listen. He did not want advice, he did not want empathy but just a ear to hear him. I was that ear ………. and he as my patient has somehow become my unofficial teacher and thought me that my duties as a doctor had a wider definition. For that, I owe him for being who I am today. I watched him deteriorate every day and breathing his final breathe, brought tears welling in my eyes then… I still remember his face.

The other part of this musical that touched me was the emotional dynamics that was going on between the couple and their respective family. The musical depicts the lady, Sylvia and her sister and the gentleman, Adam and his Auntie, who took care of him as her own after the death of Adam’s mother. It also touches a little on the fact that both are of differing religion. It also the addresses the emotional and realistic issue of loving a person who has AIDS/HIV from birth. What or how would you react if your spouse or loved one was found to have HIV/AIDS? I had recently had a friend who was diagnosed to have HIV and he expressed to me his fear of telling his girlfriend of his condition. We had the same discussion over tea a few times and despite my medical advice which I have given him, I understand the fear and worry he harbors.

Watch it before it finishes, I assure you, you would not be disappointed.