Odysseys of George

As life cruises along; vita non est vivere sed valere

Looking back there was another letter written by Alicia Au in 2006 a year before the Tioman Tragedy happened.

A Tioman disaster waiting to happen

On Saturday June 3, we boarded a ferry service at Mersing for the trip to Tioman island for our holiday.

Once the boat is fully packed; yes, you did read correctly, it is packed not loaded; because as always with Bluewater (the ferry operator), the boats are grossly overloaded, in this instance with 10 persons, including one baby in arms, standing in the aisle or precariously in the rear deck well of this small boat where they are at liberty to breath in the aromatic scent of engine exhaust fumes.

Off we go, finally leaving the jetty at around 7.10am, down the river we go to come to a grinding halt on the sandbank. After an hour, a smaller boat came along side and 75 percent of the passengers were asked to cross deck to the smaller boat, which then takes us clear of the sand bar, out to the open sea.

One point to note concerning cross-decking, according to Mersing Maritime police, is that whenever the ferry operators need to cross deck passengers, they are required to inform the police in advance, and a maritime police vessel must be in attendance. No sight of such here, or as you will see, on the next occasion.

The boats finally arrive in Tioman where for the next day or so, the fruits of the island are enjoyed by all, wonderful diving opportunities, very good food and accommodation, until finally it is time to depart on the 3pm boat to Mersing, once again with Bluewater services.

To start with, we arrive at the jetty in good time, generally for a 3pm boat, and with this particular operator, the boats are always a good 30 to 45 minutes late in arriving, however as always, we are on the jetty in good time, 15 minutes before the scheduled 3pm arrival.

At 5pm, there is no sign of the boat and after calls to Mersing and the Bluewater office, we are finally told that the delays and missing boat are because the Maritime police are stopping the Bluewater boats as they depart Mersing and issuing summons for being overloaded, having defective equipment, etc.

Finally at 6.15pm, a large Bluewater ferry, numbered 9, arrives and collects us from the jetty. We were accompanied by another Bluewater ferry, numbered 8. On ferry 9 there is a wide cross section of people, ranging from very young children, through to parents and elderly grandparents, and including one gentleman in a wheelchair. As we sit gazing out at the sunset, at around 7.10pm, ferry 9 suddenly slows down and pulls alongside ferry 8.

In this fading light, the doors are opened and without any warning, or even a polite request, the crew demands that passengers from ferry 9 cross deck to ferry 8.

Now consider this when the boats are in mid-water, at dusk with land was out of sight. The crew forced people across from one boat to another, despite protests being made that this was dangerous, illegal, and downright stupid. Women, children, the elderly and the wheelchair passenger were all forced across the widely moving gap between the two boats.

Protests to the captain of ferry 9 fell upon deaf ears. It was quite obvious, from the nature of this action, that this dangerous transfer at sea was premeditated for at any time during the early parts of the voyage, this transfer could have been effected in total safety whilst the boats were located at the same jetty.

Ferry 8 was by now grossly overcrowded, the forward emergency exit was blocked by the passenger in the wheelchair, the port and starboard exits were blocked by mountains of baggage and by people crammed into the small available space. People were standing in the rear deck well, sitting on the stairway to the upper deck, with even people squatting in the toilet because the boat was so overloaded, blocked the aft exit.

As the boat approaches Mersing, it again stops and it is the same old story – we are asked to cross deck into smaller boats for the journey to Mersing jetty. Again women, children, the elderly are forced to jump down from a high ferry to a much lower-lying speed boat, the jump was some four feet. No assistance from crew members as they are to busy holding onto the ropes. So everyone was forced to look after themselves in making this leap, literally into the dark.

We hear a mumble from a crew person that this is necessary because the tide is too low for the ferry. However, 15 minutes after disembarking at the jetty, the large ferry comes up river and also moors.

When making a police report, we were advised that Bluewater had been receiving a large number of summonses during the day mainly for this practice of overloading and we were further advised that cross-decking of passengers is only allowed under the direct supervision of the maritime authorities. This operator shows a blatant disregard for passenger safety, their arrogance and the high-handed manner they deal with their clients has to be experienced to be believed.

At the very least, the captains of Bluewater ferries 8 and 9 should have their certification revoked, their comments and attitudes show them to be quite unfit to hold a position of any responsibility. One can only surmise, as on this occasion they were lucky. Should an accident have occurred, they would no doubt be running for cover and pointing the finger of blame everywhere except at the people it should be pointed at, themselves.

Issuing summonses against the operator is a joke. Any paltry fine likely as the outcome of this weekend’s shenanigans will be far outweighed by the collections from fare-paying clients they regard as so much cattle. Again at the very least, this company’s licence to operate should be revoked with immediate effect, and thus send a message to all ferry services that such downright dangerous practice and poor service attitudes will no longer be tolerated.

The real losers here are the Tourism Board of Malaysia, and the resorts and diving operators on Tioman, whose hard work has been wasted. We as a group will not return to this location, you can be certain that word-of-mouth from such a large group of people will dissuade even larger numbers of people to change their vacation locations to elsewhere.

How long can such poor service be tolerated? Or are the authorities simply waiting to react to a large-scale disaster involving one of these cowboy operators before wringing their hands and saying they were not aware of the situation?

At the very least, the captains of Bluewater ferries 8 and 9 should have their certification revoked, their comments and attitudes show them to be quite unfit to hold a position of any responsibility. One can only surmise, as on this occasion they were lucky. Should an accident have occurred, they would no doubt be running for cover and pointing the finger of blame everywhere except at the people it should be pointed at, themselves.

Issuing summonses against the operator is a joke. Any paltry fine likely as the outcome of this weekend’s shenanigans will be far outweighed by the collections from fare-paying clients they regard as so much cattle. Again at the very least, this company’s licence to operate should be revoked with immediate effect, and thus send a message to all ferry services that such downright dangerous practice and poor service attitudes will no longer be tolerated.

The real losers here are the Tourism Board of Malaysia, and the resorts and diving operators on Tioman, whose hard work has been wasted. We as a group will not return to this location, you can be certain that word-of-mouth from such a large group of people will dissuade even larger numbers of people to change their vacation locations to elsewhere.

How long can such poor service be tolerated? Or are the authorities simply waiting to react to a large-scale disaster involving one of these cowboy operators before wringing their hands and saying they were not aware of the situation?

Related Post:
Part 1

I have been to Tioman. Tioman is a great place to chill and relax though deteriorating by the year. The government and local councils just don’t seem to realize the problems as they are probably too brainless or too greedy because to change or solve the problem would translate to loss of monopoly and profit. One of the issues that have been ongoing for years now is the ferry services. It has been monopolized by one company and their services is far from acceptable. I personally had my own experiences the main issue is poor time management with frequent delays and also overcrowding. The letter below is well written and shows exactly the problems with the ferry system to Tioman and also many other major island destinations in Malaysia.

Disgraceful ferry service spoils Tioman trip
September 7, 2012

FMT LETTER: From Nirmala Arunaselam, via e-mail

Tioman has often been touted as a great tourist attraction, on par with overseas holiday destinations. Adverts peddling the appeal and lure of the island are aplenty. But for my family and I, what was supposed to be an enjoyable and relaxing Merdeka weekend getaway on the island turned out to be frustrating and traumatic on our trip home.

Mind you, Tioman island is a wonderful tourist destination and has its own quirky charm if you like a simple, laid-back relaxing-in-the-sun environment. It is also known as a divers’ paradise and tons of people come to dive and snorkel. However, the facilities and services were a complete and total letdown.

We were to return home on Sunday, Sept 2, 2012 after a nice, relaxing weekend on the island. The ferry (Bluewater Express company) pick-up was at 10.30am and it was expected to be jam-packed with people. We decided to go to the jetty half an hour early so that we could wait at the front of the line to ensure that we get a seat on the ferry. What we discovered was that there was no line, no queue system and basically no system whatsoever for boarding the ferry.

So there we were waiting for the ferry from 10am. 10.30 passed, then 11am, 11.30am and still no ferry in sight. It finally arrived at 1pm. You can just imagine the crowd pushing to get on board. I had to board the ferry first with my two young children while my husband went to the back of the ferry to load the bags. Here I was with two small kids – holding onto one and carrying the other – and people were pushing me from the back, left and right. My temper started to rise and I had to tell them to stop pushing.

After boarding the ferry (Bestari 2), I noticed that there were people already on board – obviously picked up from the earlier stops. Usually this is not the case as Salang is usually the first pick-up point, but due to the delay I guess that they must have picked up passengers from the other stops while dropping others off.

I hastily tried to find four seats but was unsuccessful. I found two seats and left my seven-year-old there while I went to look for another two. I finally found one other empty seat. Suddenly I realised that the ferry was moving. I looked out the window and saw my husband still waiting at the jetty, after not succeeding in loading our bags as the boatmen would not take any more bags on board. He called my handphone and told me that they were not letting anymore people on the ferry as it was overloaded already.

I quickly ran to those in charge and asked them to stop and go back for him. I spoke to two people, one of whom told me that my husband had to wait for the next ferry which might come in about another hour (not guaranteed). After I raised my voice, the other person finally agreed to radio the skipper and ask him to stop the ferry.

Imagine how I had to frantically negotiate with the boatmen to turn back for my husband while handling two girls aged four and seven who were sitting in different sections of the ferry. Initially I thought they were going back for my husband but that was not the case. My husband called and said that the ferry was not turning back.

I flipped out and almost yelled at the person in charge. I told them there was no way I was going to travel on the ferry for three hours with two small kids while my husband was left behind at the jetty. I insisted, “Let him on or let me off”. I believe most of the passengers were staring at me but I was so furious I could not care less if I was upsetting anyone.

Well, the ferry finally turned around and my husband came on board. All this took quite a few minutes. For your information, out of nearly 80-100 people who were waiting for the ferry, more than half were not allowed on board and were thus left behind. We later overheard the boatman saying that this was the last ferry out for now. What was the fate of those left waiting at the jetty? I shudder to think if I was one of those left behind.

That the ferry was overcrowded is an understatement. There were people standing, sitting on the steps, squatting near the toilets as well as bags and stuff everywhere on the floor, steps and compartments. I saw only a few life jackets, and I wonder how many rules and regulations were broken that day.

Remember the Tioman ferry tragedy in 2007 where seven people died? Ref: Ferry tragedy trials postponed – Nation/The Star Online

Five years have passed and I wonder if the authorities are waiting for another tragedy to occur before any action is taken to enforce the regulations meant to safeguard passengers. Or has integrity been thrown out at sea with authorities closing one eye so that the ferry company can rake in more money at the expense of passengers’ safety.

Back to my story, when reaching what we thought was Mersing jetty, we were told that it was instead heading towards Tanjung Gemuk as it was low tide at Mersing and the ferry could not go there. Buses were supposed to be waiting at Tanjung Gemuk to transfer passengers to Mersing.

The question here is, if they already knew that it would be low tide at Mersing after 2pm (as was told to us), why did the ferry not come on time at 10.30am to fetch passengers and make it back on time to Mersing by 1.30pm? And what about all the other passengers left stranded at Salang jetty?

The obvious answer could be that the ferry company was making sure that profits were maximised by overloading the ferry and cramming in as many people as possible (we paid for four tickets but only got three seats).

This is not my first time to Tioman and each time I board the ferry from Mersing, I pray for a smooth and safe trip to the island and back. On almost every trip, the ferry is overloaded and waiting for a disaster to happen. Ref: A Tioman disaster waiting to happen – Malaysiakini

What is it going to take for the authorities to wake up from their slumber and do their jobs? Are they waiting for another seven people to die, or maybe 15 or 20 people this time? Malaysian authorities are known for acting only after a tragedy happens.

What do the Ministry of Transport and Ministry of Tourism have to say about this? Why all the hype about local tourist destinations when they can’t even enforce basic rules to ensure the safety of passengers on ferries? Ministry officials should experience first-hand waiting for delayed ferries and suffering the congestion of overloaded ferries.

They should also try using the public toilets, especially at Mersing jetty. There was only one female toilet and one male toilet catering to around 120-150 people. To make matters worse the lights were not working. Imagine the stench! I’m sure foreigners who visit Tioman will go home and discourage others from visiting the place.

Does the ferry company, Bluewater Express, have a conscience? What they did that day smacks of greed, recklessness and unprofessionalism. They are willing to put so many lives at risk, just to make a few extra bucks. Aren’t human lives more precious than dollars and cents?

I don’t expect miracles overnight, but I do hope that more people come forward and voice out their views and opinions, especially where safety and health issues are concerned. Only then will we see a change for the better in the tourism and other public sectors.

I urge the authorities to take action and be proactive instead of reactive. Safety should not be taken lightly. Ensure that ferry operators act professionally and enforce safety regulations before another disaster happens!

Related Post:
Part 2

The Beautiful World ……

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I started scuba diving in 2003 and that was out of an intense love for the sea and the unknown attraction and unseen bond that I always felt whenever I am near sea. I could always feel the sea calling out to me asking me to venture into its depth. I never realized what was to see until I decided to get my license and take the plunge. I quickly realized that I had no difficulty to adapt to the life under the sea but what I saw made me not only feel at home but brought about me to tears as I took in the beauty that the seas kept a secret. I felt like a secret door unlatched and I was allowed to see the wonderful world, a totally different and mesmerizing world……the Marine life.

I had so much difficulty trying to tell and share what I saw because words just cannot do justice to this secret beauty that lies beneath the ocean. Thus, I decided to be an underwater photographer and my first few shots did not do justice to show the beauty as mostly turned out blue or green. As time went by, I learned to take better photos and with time also the ocean became my secret retreat. Being able to share this with the one I love, makes even more meaningful as my wife also loves to scuba dive.

Today, I came across a TED talk by a lady who describes her experience almost like mine but only she concentrates on another aspect of this beautiful marine life… their bioluminescence….. and she rightfully ends by giving a warning, ” But i warn you…. its addictive!”

The weird, wonderful world of bioluminescence by Edith Widder

Then as I made more dives, I learnt the wonderful behavior of these marine creatures and its magnificence was just jaw dropping awesomeness…

David Gallo: Underwater astonishments

Taken from Discover Magazine written by Louis F. Janeira
From the July-August special issue; published online August 27, 2012

A doctor is baffled: Why did a ?giant man walk into the ER holding ?a tiny woman by her feet?

My mind raced through the possibilities. Mary could have something obstructing the blood flow from her heart to her brain that was overcome when her head was down. Or her blood pressure could be so low that blood reached the brain only when she was upside down. Blood pressure that low could have been triggered by an allergic reaction, anaphylactic shock, or severe dehydration.

Another possibility was that Mary was suffering from cardiac tamponade, a compression of the heart caused by a buildup of blood in the sac covering the organ. If her heart had been perforated during the pacemaker implantation and blood had seeped out into the sac around it, it might be that her ventricles were now being squeezed by this accumulating blood, lowering her cardiac output. That condition could improve when she was upside down by increasing blood flow to the brain.

The first thing to do was to check Mary’s vital signs. “Bring her into a room,” I said. “Let’s get her on a monitor.”

I pointed the way, and Jason carried her into the cardiac room, an entourage of curious ER personnel trailing behind us.

Even once in the cardiac room, Jason was unconvinced that he should let go of her ankles and put her on the bed. “When I put her down, she’ll go out on us,” he said.

I paused for a moment. “We’ll do an assessment of the vital signs first while Mary is upside down. Then we’ll put her in bed and see if and how things change, OK?”

Jason nodded. Mary’s long black hair waved back and forth, which I took for agreement from her, too. Ellie then placed heart monitor electrodes on her chest.

“Normal-paced rhythm,” I said, watching the monitor. “The pacemaker is working perfectly fine right now.”

“And I feel perfectly fine,” said Mary. “Well, except that I’m upside down and have been for about 30 minutes now.”

Ellie wrapped a blood pressure cuff around her arm. “It’s 120 over 66,” said Ellie. “Pretty good.”

“OK, slowly get her on her back,” I said. Jason walked closer to the bed and Ellie and I eased Mary down onto it. The only sound came from the heart monitor: beep, beep, beep, steady at 60 times a minute. We all held our breath.

Then the cardiac monitor showed a sudden change. The alarm began screaming.

“Here I go,” said Mary. “It’s happeni…” Her words dissolved into nothingness.

“No heart rhythm,” Ellie called out. “Pacemaker failure.”

“Get me epinephrine,” I yelled. Also known as adrenaline, epinephrine is a hormone that can constrict blood vessels and get a stalled heart beating again.

“But we don’t have an iv in yet,” said Ellie.

“Out of my way,” said Jason, pushing us aside to get to Mary’s feet. “I told you this would happen.” The big man grabbed Mary’s ankles and pulled them up in the air. Moments after Mary was upside down again, the heart monitor resumed steadily beeping.

“I’m back,” said Mary.

Something must have gone wrong with her operation yesterday, I thought. Then suddenly it hit me. “The pacemaker lead, the wire going from the pacemaker generator to your right ventricle, must have disconnected. Your coughing spell could have done it,” I said. “Somehow, the lead reconnects when you are upside down and continues to stimulate the heart.”

Pacemakers are made up of two main components, a generator and a lead that carries electrical impulses to the heart. Often the lead tip is screwed directly into the heart muscle, but in rare cases it can dislodge and cease to stimulate the heart. Data from St. Jude Medical, one of the largest pacemaker manufacturers, show that out of about 220,000 implants of the company’s most popular lead attached directly to the heart, only 97 dislodged within 30 days of implantation. Apparently, Mary was one of the rare cases.

Getting The Patient Upright

“How are we going to fix this, doc?” Jason wanted to know.

“You’ll need to go back to surgery to reattach the lead,” I said to Mary. “Let’s page your electrophysiologist stat.” I looked at Jason and sighed. “Meanwhile, keep her upside down.”

We inserted an iv in Mary’s arm and hooked her up to an external pacing device. But pacing her heart through her chest wall gave her severe discomfort and was not a good option, even in the short term. Moreover, it turned out that Mary’s slow beat did not respond at all to medications, including intravenous epinephrine. So she was quickly transported to the electrophysiology laboratory, dangling by her ankles, carried by the only man around with enough strength to do it. And my ER shift continued.

The next day I was back on duty. As I came out of a room after examining a small child with a fever, I heard a familiar voice behind me.

“Dr. Janeira, it’s me, Mary. I’m all fixed up.”

I turned and smiled at Mary and nodded at Jason, who towered massively behind her. “You were right. The pacemaker’s ventricular lead had to be re-screwed in my heart,” she said. “I’ll be having the pacemaker checked in a few days and then every three months.”

“How do you feel now?” I asked.

“Back to normal,” she said. “Thanks for your help!”

And with that, she left my ER walking upright and hand-in-hand with her giant.

Colour Coded Surgery

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or see it here

http://youtu.be/-j2XrT0QN5

A moving talk – something for patients and doctors alike…..something we doctors have forgotten .. the human touch.

As written on the TED, “Modern medicine is in danger of losing a powerful, old-fashioned tool: human touch. Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.”

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