Odysseys of George

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.

I actually blogged about this a few days ago only to realise that the page went missing 48 hours later! So here it is again!

Manta rays next on restaurant menus as shark populations plummet

Conservationists fear a falling shark population is prompting Asian chefs to look for manta and devil rays to help meet the voracious demand for shark fin soup.

Found in coastal waters throughout the world, rays present an easy target as they swim slowly near the surface with their huge wings. So far, they have escaped commercial exploitation and have been hunted only by small numbers of subsistence fishermen, who traditionally catch them using harpoons.

But the growing demand for the manta ray (Manta birostris) and its close cousin the devil ray (of the Mobula genus) is turning ray fishing into an export operation. In the eastern Indonesian port of Lamakera, catches of manta have rocketed from a few hundred to about 1,500 a year.

“Mantas and mobulas are being used as shark fin soup filler,” said Tim Clark, a marine biologist at the University of Hawaii. He said the cartilage was being mixed with low-grade shark fins in cheap versions of the soup. “The life history of manta rays makes them highly susceptible to overfishing,” he added.

With a life span thought to be well over 50 years, the fish reach sexual maturity only in their teens, at which time they produce one pup every one to three years.

While the rays, which are distantly related to sharks, are ending up in Hong Kong’s restaurants, their gills are also being used in traditional Chinese medicines. “The big market is for the gill elements,” Mr Clark added. “They are dried, ground to a powder and used in traditional Asian medicines.”

Reaching sizes of up to 7m (23ft) from wing tip to wing tip, the manta’s branchial gill plates, which filter plankton from seawater, constitute a tiny portion of a body that can weigh up to 2½ tonnes. The plates can fetch up to £200 on the street in China. Practitioners of traditional Chinese medicine claim that gill rakers — called peng yu sai — reduce toxins in the body by purifying the blood.

Eli Michael, of the Manta Pacific Research Foundation, said Hawaii is poised to outlaw catching or killing mantas. Until now, getting caught in nets intended for other fish has been the biggest threat to rays, listed as “near threatened” on the International Union for Conservation of Nature (IUCN) Red List.

Overfishing is also a problem in Britain and Europe. Ali Hood, of the Shark Trust, said: “In European waters, particularly the Mediterranean, the giant devil ray is classified by the IUCN Red List as ‘endangered’. The large skate, found in UK waters, has been exploited for decades, leading to alarming declines, and species such as the common skate are now critically endangered.”

The market for shark fin soup is growing at about 5 per cent a year, while shark populations are crashing: 80 per cent of Atlantic sharks have been lost in the past 15 years, according to the trust. Britain is one of only five EU member states that still allows the removal of shark fins at sea. More than 80 tonnes of fins are landed in Britain every year.

So, where do we go from here? Not only is our fight against shark fin has yet to see its effects, now they go for those lovely Manta’s! Greed will lead to fall of mankind!

Also to read:
Controversial Delicacy!

Is this really necessary?

If you had to choose to let go of a particular sense, which would it be?

It all started when a friend of mine related a true story. There was this girl who was having problems with her nose — so much so that there was no relieve despite anything or any treatment she took. So, eventually the ENT surgeon told her of a particular procedure that may settle her problem at the cost of her losing her sense of smell. She agreed. The procedure was a success but she is now unable to smell anything.

My friend was sad to hear this story and it got me thinking. We have five sense – smell, sight, taste, touch and hearing. Medically, sight is probably the most developed sense in humans, followed closely by hearing. We use these senses without giving a thought of its individual importance until we lose them. But if you were asked to which of these sense was most important to you and which is the least or willing to give up, what would it be?

For me, I would put them in these order — sight, hearing, touch, taste and smell, with sight being the most valuable. What would yours be?

I am so pissed off. It all started with a cheque I received. It was a Maybank cheque and thinking that it would clear faster than me crediting it into my CIMB account, I credited it to my Maybank account via the cheque deposit machine.

After 2 days, as I was busy with work I thought I would get the bank to help me check if the cheque has been cleared. So I called the customer service number and a lady with an irritating tone took the line. My question was, can you please help check if my cheque has been credited into my account? Sounds relative easy question to answer isn’t it! No the lady decided to break the bad news that in Maybank it takes three days to clear — and that if I wanted to find out I can check the ATM machine the coming morning! STUPID!!!
I told her that if I had the convenience to check the ATM I would not bother calling an idiot like her to help me.

Next day, I, trying to help my mom, I came to realize that Maybank 2U only allows transactions to a maximum of RM5000 per day! So fine I take a walk to the Maybank and realized that I could not do a thing without a cheque book. To transfer money, I need to issue a cheque because the bank cannot do that transaction over the counter even with me in their presence!! I somehow managed to do the transfer using ATM machine.

Next, I wanted to make a bank draft and even for that I needed a cheque to get a bank draft. Otherwise, I need to withdraw cash from the ATM and give them the cash to give me a bank draft. How silly is that!!
I am in the bank and I am the account holder but yet I cannot get a bank draft because ….. it takes a cheque to withdraw money!!!!!!!!

Stupid and so useless. In these day and age, work process like this should be made easy and without hassle. I am so pissed!

I came across this while surfing through MMR blogpost. Even before reading it, I had sensed that this would be something that would move me.

As I read the first paragraph of the post, I immediately realized that this was something long due and very appropriate – A tribute to the late Tan Sri T.J.Danaraj, the founder of the medical faculty University Malaya. A visionary man who had managed to have an impact on me even though he never thought me.

We stand on the shoulders of Giants is a teaching blog dedicated to the late Emeritus Professor T J Danaraj, the foundation Dean of the University of Malaya Medical Centre. The blog is moderated by Dr. Wong Yin Onn.

I remember presenting about this great man, during my batch Deepavali Festival as a tribute to him. We felt that little was done to honour this man, so much so that many present UMMC medical students hardly even know him.

I end this with a letter he once wrote which I copied from that very blog. An encouraging note to all……….

Dear …….,

T.J. Danaraj

TJ Danaraj