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It has been 8 months since I wrote my last article, the conclusion of my post-Wawasan 2020 series. The year 2022 started with relaxation of border rules in many countries. Being in Western Australia (WA), which had one of the toughest border rules in the world, we were happy that the border was going to open on 5th of February 2022. Unfortunately, 2 weeks before the date, the WA government decided to postpone the date indefinitely due to rise of Omicron cases all over the world and a new target was set for booster doses before the border opens. I had to postpone my flight that I had already booked for end of February 2022.

By mid-February 2022, the WA government announced that the border will open on 5th of March 2022. However, Malaysia still had a 5-day quarantine rule for those vaccinated. We decided to delay our first trip back to Malaysia in over 2 years, to May 2022, just in time to celebrate Raya in Malaysia. Thank fully, by then, not only the quarantine rule was removed for those vaccinated but also the pre departure PCR test. Thus, on 4th of May 2022, me and my wife stepped our feet onto Singapore Airlines Boeing 787 for the first time in more than 2 years!

It was a smooth flight to KL via transit in Changi airport. Changi airport will always be the best airport I have ever been. This is also the first time since 2014 that I am landing in KLIA. Since I lived in JB, I had always used Changi airport for my international flights. The “Malaysia Boleh” phenomenon hit my face the moment I landed in KLIA! Welcome to Malaysia! We walked towards the Aerotrain upon landing only to see the entire area was cordoned off without any signage to guide us where to go. There was a lady sitting inside the cordoned area but too busy looking at her handphone. All of us were wondering where to go till one of them “woke up” the phone lady and asked her! She pointed the direction to the bus terminal. It was a long walk from there with stairs going down, right at the end, after which you will see the bus waiting. Took the bus to the main terminal where our bags were waiting. The immigration clearance was the fastest as we used auto gate. Then came the custom screening.

1 scanning machine for the entire crowd! Everyone had to que up to scan our luggage, one by one. No green lane. As we finally exited out to the arrival hall, we were looking for the car rental booths. None to be seen! We had already booked the car online, but we could not see any booths or even any signage to direct us to the car rental area. My wife frantically went around asking people who were working at the arrival hall (money changers etc), none seem to be aware! Finally, I found a small signage on the right side of the arrival hall, you can only see it if you pay close attention on small wordings. It took us almost 10-15min of walk out of the terminal, sweating till my entire shirt was drenched like I just got wet in the rain! The efficiency of the car rental company was at another level. It took them almost 30-40min to give us the car. Of all the airports I have ever been (mostly developed countries), I have never seen the car rental booth being situated 10-15 mins walk from the arrival hall into another building. Most will be situated in the arrival hall, and you can collect the keys within 15 min.

Finally, we made it to the highway, heading north to my wife’s place. Cars speeding, motorbikes all over the place brought back my memories. No one follows the rule. Back to my Malaysia. Somehow, I felt the lawlessness has gotten worst. Grabfood and Foodpanda riders don’t seem to care about road rules. Even traffic lights can’t stop them. My 30 years’ experience driving in Malaysia was reactivated. As suggested by my friends, we bought a dashcam before coming to Malaysia. Getting a Touch N Go card was another nightmare. None seem to be in stock and thus we had to use our good old IC as our touch N Go card while we searched around. Finally, we got one from Watson in my wife’s hometown. Along the road, one thing was obvious to us. The maintenance culture has gotten worst. Maintenance of roads, buildings, public infrastructure etc was down the drain. I had always wondered how a tourist would feel when they arrive in Malaysia.

Overall, we had a wonderful time with our family and friends, whoever we had time to visit. From Perak to KL to Seremban to Melaka and finally to JB. Malaysia is always the best place for food! Something we always crave for when we return to Malaysia. Shopping and buying cloths that we are familiar with, is another heaven. Unfortunately, the politics in Malaysia never changes and has turned to the worst. I can clearly see that election is coming very soon. Whenever racial and religious rhetoric goes overdrive, we know election is coming. I can see more people have become poorer. Currency value is dropping day by day. The last I heard 1SGD is now RM 3.20. 1USD is about RM 4.50. The lower the currency falls, the poorer the people will become. After being in Australia for 3 years, I can see how the value of our currency is very important. The stronger the value of the dollar, the lower the cost of living. We left Malaysia after spending 24 days, on 27/05/2022.

I received many emails from young doctors asking for advice to migrate, especially after reading my last article. Unfortunately, as I had always said, medicine is the worst profession to be when it comes to migration/moving around. Unless your degree is recognised in the country you are intending to migrate, you need to sit and pass the entrance exam with no guarantee that you will get a job. It is an investment with a possibility of not getting any return. The border closure in Australia resulted in work force shortage in many fields. Covid pandemic also resulted in many states increasing their pool of doctors by creating more post. Unfortunately, they could not fill up this post as borders were closed. Not all local graduates like to work in hospital setting. Many IMG (International Medical Graduates) who were already in Australia manage to get these jobs if they had AMC Part 1. Most of them have been in Australia for years, some even citizens and PRs. Once the border opened, many IMGs with AMC Part 1 were also recruited from overseas. These are all mainly for MO and service registrar position.

My regional hospital advertised for 3 new senior registrar post. There were 15 applications, none from locals/Australia! All were from overseas and almost all of them only had AMC Part 1. They were senior doctors from their country of origin with at least more than 10-20 years of experience. Most of the applications were from India, Sri Lanka, Iran, Turkey and Egypt. It is a risk that you will need to take as the Limited registration will only be given for a maximum of 5 years. By then you must either pass the AMC Part 2 or complete the WBA (12 months ward-based assessment) program in an accredited hospital. Because of this, the hospital can only provide you with a yearly contract. Those who are recruited as GP with just AMC Part 1 have another option of completing your RACGP program to be awarded FRACGP within the 5 years period.

It is a tough life for many of them who come for greener pastures. Some of them were paediatricians, anaesthetist, psychiatrist, surgeons, neonatologist, gastroenterologist back in their home country but willing to sacrifice everything to start from scratch.  Even then, there is no guarantee that their contract will be renewed year after year. The more regional you are, the better the chance of getting a renewed contract.

Thus, this is what I advised those who intend to migrate with a medical degree which is not recognised in Australia. Be prepared to start from scratch with no certainty. You must take a gamble. Some may succeed and some don’t. That’s why you will hear some coming back home, not necessarily due to family reason, but they fail to get a job or training post to become a specialist. Be prepared to go to rural and remote areas to get a job.

With the increasing number of queries that I am receiving about migration, I can feel the pain the people on the ground are going through. The contract issue, while has been extended to about 10 years to complete your specialisation, it is very clear that the government will never be able to absorb everyone into permanent civil service. I had written about these many times before. Thus, it is not unusual for MMC to reduce the compulsory service to 1 year. So, now you can leave the service after a total of 3 years (2 years HO and 1 year MO). In fact, even before the announcement by the DG, for the past 3 years MMC has been approving exemption, usually if you have completed 18 months post housemanship. Even JPA has made an announcement that JPA scholars who are under contract since 2016 can break the bond and leave civil service. It is a way of saying “get lost”! But who created this mass in the first place! As for me, this is an inadequate training for any doctor to be able to practise medicine independently after 3 years. With no proper training system in place for GPs etc, we probably giving them a “license to kill”…………………

Oh Gosh, didn’t I predict all these were coming ………………………….

Continued……….

It’s been 6 months since I last wrote an article in this series. In between, I was interviewed by various organisation in relation to contract doctors etc. This will be my last article in this series. 

Despite all the hardship that I went through since my childhood of being a “non”, one thing that was guaranteed for me was a civil service job! This is simply because, there were only 3 medical schools producing about 450 graduates annually and some returning from overseas. There were plenty of post available for us to fill. Interviews by SPA and MOH were conducted in the universities even before we sat for our final year exams. The moment our results were out, we would receive our appointment letters within 2 weeks! I had written about this many times before and thus will not go into the details. I was asked to report to Hospital Ipoh within 30 days. While the salary was pathetic to say the least, we were grateful that we had a permanent job. Two months before we due to finish our housemanship, we need to apply for district posting and induction course (Kursus Induksi). At that time, district/rural posting after housemanship is mandatory. We must make our 3 choices. I was asked to go to Pontian Hospital in Johor for my district posting.

While there was subtle racism wherever I worked in MOH, it is hardly noticeable. This is simply because the staffs consist of mixed races. There were nurses, MAs (Medical Assistant), attendants from all different races. This reminded me of the time I was in school back in 1980s. While the schools were becoming monoethnic in composition of teachers by late 1990s, hospitals and klinik kesihatans were still consist of multiple races working together. In fact, most of the HODs were non-Malays in JB hospital. Unfortunately, things have changed since then. We hardly see any Chinese or Indian MAs working in MOH nowadays. Nurses are predominantly consisting of a single race and the composition of doctors are also becoming predominantly of a single race. I am not saying that these people are not doing their work or discriminating against non-Malay patients, but it is an unhealthy development in a multiracial and multireligious country. Many of the non-Malay consultants and HODs moved to private sector, mainly due to financial reasons. They have accepted the fact that their children will not receive any privileges in education or scholarship. Thus, they have no choice but to move to private sector to earn better revenue to support their children in the future. Nowadays we even have shariah compliant hospitals, whatever it means. An Ustaz or Imams are allowed officially into a hospital to say prayers, but similar permission are not given to other religious bodies. 

I used to say to my friends that the last government body that use to be multiracial will eventually come to an end, and it happened. Sometimes I should just keep my mouth shut! With the current contract issues and limited permanent position, I doubt the situation will get any better. This coupled with quota system in master’s recruitment and limited post graduate opportunities, will only make the situation worst. What really shocked me the most is when I found out that some of my Malay friends who I worked with as Medical Officers openly expressed their opinion that they would prefer all HODs to be Malays as this is a Malay country! When even highly educated people can think as such, what hope do I have? By mid 2000, I began to realise that this country is heading the wrong direction, the direction of destruction and no return.

The first 10 years of my medical life was a turbulent one. Getting married halfway through my 2nd year of working life (district posting), passing my Part 1 MRCP on 1st try and moving to JB Hospital to continue my training was the easy part. With a pathetic salary, busy work life (JB Hospital is one of the busiest hospitals in the country) and studying at the same time really pushes you to the limit. By the time I sat for my Part 2/3 in 2002, I had 2 child and got my 3rd in 2004. By this time, I was in debt! Looking into the future and where the country was heading, I had to make difficult choices. I quit MOH halfway through my Rheumatology training in Selayang Hospital and joined Monash University in 2006. My wife who sacrificed a lot with me, had to discontinue her Family Medicine Master’s program in 2002, as it was just too difficult for us to manage the whole family with both of us doing postgraduate education at the same time. We lived by ourselves. 

With the help of Professor Khalid Kadir, I was encouraged to complete my Rheumatology training in Singapore while I continue to teach in Monash which was based in Johor Bahru. I am forever grateful to Prof Khalid for this arrangement. This allowed me to complete my Rheumatology training by 2008. Working in Singapore gave me a different perspective of how such a small country could succeed! It is all based on meritocracy and knowledge-based economy. The way they encourage research and development and how they support you to develop new skills and new departments is fascinating. How they attract the best brains from all over the world and keeping their own best brains is something that Malaysia can learn from. Unfortunately, Malaysia is too engrossed with Malay nationalism with race and religion tearing the country apart. The best brains leave to be better received by another country.

Upon returning from Singapore, I encouraged my wife to continue her discontinued post graduate education. She was very eager to complete her post graduate training in Family medicine. She enrolled into the Academy of Family Physicians MAFP/FRACGP program which was a 4-year program. The advantage: you are eligible for FRACGP which is registrable in Australia. As an appreciation of her sacrifice taking care of the family while I was doing my post graduate education, I paid for her course. While Monash gave me a much better salary than MOH, with rising cost of living and higher tax that you must pay in private sector, it was still an uphill task to earn enough for my children’s education, especially tertiary education. As I had mentioned in my past articles, by 2010 I had to remove my children from national schools to private national schools (not international). The racial and religious issues that was happening in the national schools (despite being a missionary school) was not something that I could accept. I do not want my children to grow up with racial and religious dogmatism. It hurts you when your son who is just 10 years old asking you why the Ustaz in his school distributing free food to only Muslim students in the canteen!

Thus, by 2010 with my eldest already 10 years old, I need to save enough money for him to pursue his tertiary education in 7 years’ time. Again, I had to make a difficult decision in my life. While I loved academic life, publishing at least 5 papers in major international journals within 4 years and loved teaching, I had to give up and move to private sector. Columbia Asia Nusajaya invited me to join them as they opened their first hospital in Johor. After much deep thought, I accepted their offer. I was also the Chief of Medical Services for the hospital, for 7 years.

Life working as a consultant in private hospitals in not rosy either. Yes, you may earn much higher than public sector or universities, but it is no work, no money system. The more hours you work, the more money you get. The more patients you see the more money you get. After some time, you will realise that you are earning enough money, but you do not have a life! I have written about this in this blog as well as in my books. There is no work life balance. The unethical practices that happen in private hospitals is something that I could not accept either. In Malaysia, everything seems to be about money. As one of my friends who is a businessman said, Malaysia is the best place to make money! 

By 2015, my wife has cleared her FRACGP. By this time, the country was in turmoil. The 1MDB scandal and billions of dollars being swindled right in front of our eyes was sickening. Politically, the government has lost it’s 2/3 majority since 2008. Racial and religious politics went into overdrive. What more can politicians use other than race and religion, the well-known propaganda known time immemorial. The government started going after the citizens to collect more tax and penalties to patch up the loss. By 2016, the private specialist doctors became a fresh new target. GST was introduced. With just a single letter, LHDN decided that the private specialist can’t form a company and divert their income to the company (something that has been happening since 1980s and considered legal) and have to declare their income as personal income. They backdated these 5 years (2010-2015) with reduced penalty of 15%! After much discussion between MMA and LHDN, it was reduced to 3 years. We had to rush to settle this by end of December 2016 which was the due date for the penalty of 15%. This is when I realised that the government could screw you when they run out of money. LHDN is the most powerful organisation under the Ministry of Finance who can even charge you in court without going through the police/AG. The DG has absolute power to order any audit or change the rule and can deem anything as a form of tax evasion. 

By this time, I had no choice but to decide my next step. While I was doing well in private sector, it was a one man show. My wife was still a civil servant and my children’s education was totally dependent on me. My eldest son was going for SPM in 2017. We decided that it is best to send our children overseas for education. I wanted them to get a degree which would be more widely recognised all over the world. The world in shrinking and we can’t be living in a cocoon. Fortunately, my eldest was not interested in medicine. I let them do what they are interested rather than coercing them to do what the parents wanted them to do. To date, none of my children are interested in medicine. 

After my wife cleared her FRACGP in 2015, we started receiving calls from recruiting agencies in Australia, offering her a GP position. We rejected all the offers. But something happened in 2016. While I was talking to one my friend from KL, he suggested, why don’t you apply for Skilled Migration Visa (using my wife’s FRACGP) which would give you a PR status in Australia? I was baffled. Is there such thing as getting a PR status without even stepping your foot into a country? Surprisingly, there is such thing and he recommended me to have a chat with a migration agency in Subang. We met with the agent, and everything changed! We thought of giving it a try. It involved a lot of work, from getting the medical registration from Australia (including visits to Australia to confirm job contact), numerous amounts of documents, certification of degrees, English test, police clearance etc etc. It took us almost a year to get all these documents sorted, not to mention the money involved. Finally, by March 2017, we submitted.

There were so many things that went through our mind. Are we really going to leave a country where we were born and grew up? Will our children be able to adapt to the new environment? Would we be able to adapt to a new environment and culture? The worst part, what about me? I am not registrable in Australia as I do not have a registrable degree. It is another long process and money to even apply for assessment. While we were considering all these, and my son was going to sit for his SPM (November 2017), we received another shocking news! In June 2017, my wife’s application for Skilled Migration Visa was accepted and we need to do some final document submission such as medical check-up, police report etc within 60 days. We did it in 30 days and submitted all necessary final documents. Woolah, within 3 weeks, our Visa was approved, and we are officially an Australian permanent resident! This visa is for the whole family, not just for my wife! My children will now be able to enrol into Australian university as domestic students with heavily subsidised fee. 

Why am I talking about this? A country which does not even know who we are, gave us permanent residency without even the need for us to step our foot into the country (except I have been to Gold Coast as a tourist). There were NOT a single question of what race or religion we belong to. Those who know me knows that my wife is not an Indian, she is a Malay! What mattered most was your skill and documents! And despite my wife being the main applicant, the entire family received residency status. This is how a country valued your talent and invites you to be part of their country. We are considered equal to their citizens except in voting rights. This is how they attract the best brains. Where are we Malaysia? Race, religion, and nationalism chased away the best brains, only for us to be proud of saying “Malaysian Born so and so……….” Foreign professionals married to Malaysians have to wait close to 10 years to receive their residency status, not to mention the various insults they receive at immigration office. We have a long way to go……

I moved my family to Perth, Australia in December 2017. My wife started working as a GP in January 2018. My eldest son started his university in February 2018 and my other 2 children started their schooling. What happened to me? Well, I had to start my ball rolling. With an unrecognised degree in Australia, I am not registrable in Australia. But as a senior physician I can apply to be recognised (not guaranteed) via the College of Physician. Another long process of degree verification, document collection, English test, interviews etc was conducted by the college (RACP). I submitted my documents in April 2018, called for an interview in Melbourne in May 2018 and finally in July 2018, I received their verdict. I received a “substantially comparable” status which would allow me to work as a consultant with 12 months of peer review before receiving specialist registration. This verdict is only valid for 2 years, which means I must find a job for the 12 months peer review within that timeframe. 

Based on RACP report, there were 145 applications in 2018 from all over the world for specialist assessment. 112 were considered “substantially comparable”, majority of these were from countries where specialist training is recognised by Australia such as UK, Ireland, USA etc. Out of 11 applications from Malaysia, only 4 were deemed substantially comparable and I am one of them. The other 2 options are partially comparable and non-comparable. Partially comparable means you need to do top up training of about 1-2 years as a registrar and may or may not need to sit for Part 2 exams. Non-comparable means, case closed. Once again, as my wife’s visa application, I was extremely lucky to receive the substantially comparable status. This, together with my status as a resident in Australia, I was able to look for a job. This was the next hurdle that I had to endure.

While I was going through all these processes, I was travelling between JB and Perth quite frequently. Then came the 2018 General Election. Everyone was euphoric after the historic result. Many wanted me to stay since a new Malaysia has emerged aka Malaysia Baru. Yet again, based on evidence and sentiments on the ground, I knew this excitement is going to be short lived. I wrote an article in this blog dated 4th June 2018 with the title Towards Malaysia Baru? I predicted that if the new government do not perform at a supernatural speed, either the government will fall before the next election or at the next election. My friends laughed at me and said it is unlikely due to overwhelming majority. Nowadays, they asked me to keep my mouth shut as everything that I predicted seem to be happening!

It was only in January 2019 I was invited for a job interview (after trying for 7 months). Again, I was lucky to be given a full-time consultant job in a regional hospital in Western Australia. Hopefully this would be my last leap of faith. I decided to take it and left Malaysia in May 2019. ……. I received my FRACP in 2020. It saddens me to see what is happening to Malaysia since I left. The vision of Wawasan 2020 remains an elusive dream. The country is more divided than the time I grew up in 1980s and 1990s. Racial and religious rhetoric is tearing the country apart. When even a vegetarian food prepared by Gurdwara Sahib can be questioned on halalness and cleaning a temple by Muslims can be haram, where are we heading? 

I can go on writing and ranting but I will stop here. It has been a tough 2 years for most of us. I hope and pray that 2022 will be a better year with disappearance of Covid.

I wish everyone a very Happy New Year 2022………………………

PART 1

PART 2

PART 3

PART 4

I was invited to give a talk at the UKM Career progression workshop which was held on 17/04/2021. I did mention this in my blog on 29/06/2021 where I showed some of the slides from the talk. Many have emailed me and asked me whether I can upload the talk that I gave. It took some time for me to get the recorded video from the organiser and I also had to do some editing to make it shorter.

So, here is the video of my talk and it is almost an hour long……… Some of the documents might not be clear but those documents are available in my blog.

It has been 4 weeks since my last post on the Black Monday campaign by SCHOMOS and the hartal that is being organised by a separate group of junior doctors. I had received a lot of feedbacks for my previous post personally and via my blog. In the background, SCHOMOS/MMA has been working with MOH and finally had a direct meeting with PM on 23/07/2021. On the very same day, the PM’s office issued the following circular:

As I mentioned in my previous post, absorbing all graduates into a permanent position is NOT a long term solution. I had explained the reasons for this very clearly. It is almost impossible for the government to do this looking at the number of graduates being produced. My recommendation is for all doctors who are into post graduate training should have their contract renewed till they complete their training and get gazetted. The postgraduate training should be standardised. I also said that the permanent government positions is not sustainable anymore and all positions should be changed to contract from now onwards but they need equal opportunities etc, similar to other developed countries.

The circular above basically agrees to what I have been saying all this while. The government has guaranteed that they will provide a minimum of 6 years contract (4+2), increase from 5 years (3+2) currently. During the last 2 years extension, if you are enrolled into a post graduate training program, the contract will be extended to a maximum of 4 years. I presume this 4 years comes about due to the 4 years Master’s program. Those who are already in parallel pathway, they should be in their specialist training by the time the 6 years is done, especially for MRCP, MRCPCH and MRCOG. This 4 years extension hopefully will support their subspeciality training programme. So, overall, if you are in specialist training program, you will be guaranteed a job and training for at least 10 years. The government has also agreed to provide Cuti Belajar Bergaji Penuh and HLP if you are enrolled into the Master’s program. The only problem I foresee are for those who are dependent on local Master’s program which predominantly will be the surgical fields.

With large number of graduates applying for local Master’s program, the waiting period is going to get longer. I did mention this many years ago. The number of slots for Masters program is only about 1000 per year for all speciality included. My question is whether these doctors would even be able to get into the Master’s program within 4 years after housemanship. If they don’t , would their contract be not extended? What if they do not complete the training within 4 years, like they get extended etc? What if they do complete their training but wants to do subspeciality training? Would the contract be extended further? There are many unanswered questions but at least this circular clarifies some of the urgent matters and hopefully, further improvement could be made in the future.

However I noticed that the letter did mention about amending the Medical Act which I find it puzzling. The medical act has nothing to do with employment EXCEPT in regards to the compulsory service. Are we looking at an official reduction in the compulsory service in the future? Currently MMC (since Oct 2020) do allow junior doctors to leave the service 18 months after completing housemanship, pending Minister’s approval individually. Would this be lowered further, permanently? Or are we looking at a common licensing exam applicable for all graduates? It will be interesting to watch but again, it is all a political ball game!

Unfortunately, the above circular and reassurance did not seem to satisfy the group of doctors who were organising the Hartal. Yesterday, they issued the following circular, insisting that the hartal will go ahead today:

I also understood that many warnings have been issued to the junior doctors by the hospital Pengarahs and DG himself has issued a reminder on his FB post as below:

Interestingly, the DG has said that the Pension Act will be amended. This again goes back to my last post where I said, permanent post with pension is not sustainable anymore and all government positions should be changed to contract basis with continuous extension as long as the post is needed and for post graduate training. The hospital should be given the right to choose their own doctors based on need. I feel this is how this scenario is heading into the future. In fact, if the pension act is going to be amended, it may affect all other civil service jobs as well.

The world is changing. Jobs are changing as well. Unemployment of doctors is also a norm in many countries. Consultant without full time job is also common in developed countries but at least they get to complete their training. We need to change. We can’t keep on harping on the same benefits and perks as the baby boomers generation where the world population was a third of what it is now!

I will stick to what I have said in my previous blog post. The era of guaranteed job and permanent pensionable job in civil service is over. Every job is the same and will be treated as the same based on need. Doctors are not an exemption. Everything should be based on merit. I hope the selection of doctors into postgraduate training will be done on merit and be transparent. I also hope that a single post graduate training system will be implemented rather than 2 separate system. I might be dreaming but it is the only way forward. A total revamp of the healthcare system will be needed. A National Health financing scheme is needed to sustain at least the GP practise. A Restructured healthcare system is needed to move away from tertiary health care to primary based healthcare!

The question is , are the politicians ready to make this unpopular decisions? Looking at the current scenario, I don’t see it coming anytime soon!

At the time of me writing this piece, this is happening :

Frankly , you don’t need to be a rocket scientist to predict what I had predicted since 2006. It’s just simple mathematics and statistics. When I first started writing about the future of doctors in Malaysia in the MMA Magazine, I was brushed aside by MMA itself. No one took it seriously. In July and November 2006, just before I left the civil service, I wrote my last 2 articles about the civil service doctor’s future. I started my blog in 2010 where I spent the most amount of time writing about the mushrooming of medical schools, quality of medical schools and the very likely scenario of future doctors: unemployment! I was again called by all kind of names by parents and students themselves. Well, all those are history now. My blog posts since 2010 are still available in this blog. I had never removed any of it and even the books I published in 2016 are still available.

Let’s come to the topic. There are various social media and news agencies highlighting the upcoming “Hartal” by contract doctors which is being scheduled on 26th July 2021. Meanwhile SCHOMOS is starting the “Code Black” campaign from 1st-12th July 2021 which will end on 12th July 2021 with Black Monday event. Many have asked for my comment. In August 2020, I had a discussion about contract doctors in DOBBS which was posted in this blog. On 17th April 2021, I gave a talk via Zoom to a group of medical students in UKM for the Career Progression workshop where I spoke about the current situation, how we reached this stage and what are the options for graduates, concentrating on foreign countries’ opportunities. It was an interesting discussion. Some of the slides I will reproduce below.

We must face the fact that we are producing just too many doctors. Poor planning and knee jerk reaction is the reason for this. You can read all these information from my blog post dating back to 2010. We have one of the highest number of medical schools per capita population in the world. Have a look at the slides below ……..

With our typical Malaysia Boleh style, we lead the world, on how to start a medical school in the shortest time possible. Quality? Who cares, we just need the numbers! It is just too fast too soon. Our government is always obsessed with numbers. Let’s look at the doctor’s figures below……

These figures are from our government’s statistics (MMC and MOH). As of 2019, we had achieved the ratio that the government always wanted (1: 400). Almost 50% of the 31 medical schools started to produce their graduates between 2011 and 2018. Fifty percent of that 50% only started to produce their graduates between 2014 and 2018. Basically, we have not even reached the peak yet! This is what I call planning human resource with your butt! We are producing close to 5000 graduates annually since the past 3 years and these figures will continue to increase till about 2023 before it stabilises. But look at the number of new health facilities built since 2010? On paper, we have enough doctors, the issue is maldistribution ( I have written about this many times before) and the healthcare system.

Now, did the government ever promised you a job? The answer is NO. No government in the world promises you a job. These goes to all other profession as well. Do the government stop producing engineers just because engineers are jobless? Obviously NO. However, Malaysia is a unique country. Instead of investing in public universities , we started private universities since 1996. Once education is made into a business, 3 scenarios will happen: mushrooming of poor quality education centres, low quality graduates and mass production. These universities do not give a damn whether there are job markets for their graduates. They are just degree mills and profit driven. The government can only control the public universities intake(which is hardly done) but private universities are driven by market force. Few years ago, MOE did reduce the intake of medical students into public universities which I feel is the dumbest thing to do. It should be the opposite but hey, who do you think are the board of directors of these private universities?

Almost in all developed countries, doctors work on contract basis. Malaysians are just not used to it. The main problem is the fact that we are still stuck in a civil service system which was left behind by the British. Most countries have already restructured their civil service into a contract based system, including Britain. The old permanent civil service system and pension system is not sustainable. It is a huge burden to the financial coffers of a country. Remember, for every permanent post created, the burden is not just the salary you are guaranteed of receiving till the age of 60 (aka 35 years with increment and promotion) but also the life long pension that you will get after that, which your spouse will continue to receive after your passing. If you have a 2nd wife , she will also continue to receive 70% of your pension till she gets remarried or dies! Imagine if your wife or second wife is 20 years younger than you! Thus, it is a huge financial burden to the country which may even bankrupt a nation, similar to what happened to Greece few years ago.

Basically, what I am saying is that the government will never be able to create 5000 post annually. It is simply not possible. Based on what the Minister had said, out of about 23 000 contract doctors since December 2016(when it was first introduced) only 789 received permanent post after completing their 1st 3 year contract. Even if against all odds, the government agrees to create 22000 post to absorb all these contract doctors into permanent position, it will be, as usual a knee jerk reaction to satisfy the masses due to COVID. The next question will be on where these posts will be located and whether these doctors will be willing to go there.

Unfortunately, medicine is once again a unique profession. Our training and education does not stop after graduation. It goes on and on with various laws and regulation governing us. I am very sure not all of those 23 000 contract doctors planned to stay in civil service after completing their compulsory service. I have already heard many who had resigned after the 3 year contract and MMC even allowed them to be released before they completed their 4 years compulsory service (less than 1 year short).Some did not even take up the extended 2 years contract. Some left to overseas whenever possible (not to say it is greener out there). The problem with our healthcare system is the fact that specialisation can only be done in KKM hospitals and the local Master’s program. Parallel pathways are available but the training can only be done in KKM hospitals till you are gazetted as a specialist. Private hospitals are simply not suitable for this except for some big tertiary private hospitals but, would the patients allow trainees to treat them?This training process will easily take about 5-10 years depending on whether you want to pursue the subspeciality program. As for our local Master’s program, at the moment, this is only open for KKM staffs who are holding a permanent post (as HLP is only for permanent staffs). Of course you can still enroll as a private candidate and pay the full fee which may be in the range of RM50K/year. While the number of slots for private candidates may be small currently, if the contract system continues, it will likely increase.

I believe the contract system is here to stay. We just have to get used to it. At least you are given the opportunity to complete your housemanship, receive your full registration and complete your compulsory service. You would still have a job for at least the first 5 years. I understand that the 1st batch of contract doctors who started in December 2016 and did not receive permanent post, who are scheduled to complete their extended contract in December 2021 are being promised that their contract will be extended another year. The real problem is for those who want to continue to specialise. Other options are university hospitals and military hospitals.

The entire healthcare system has to be revamped. We have to move on to a more sustainable system. Like many other countries, I believe eventually all doctors will be hired on contract basis. This means that the government employs based on need except for the guaranteed first 3 year contract. Nothing is permanent. You need to reapply for a new contract whenever the previous contract comes to an end (this is how it is done in other countries). However, the way a person is recruited and trained to become a specialist has to change. Both Master’s system and the parallel pathway have to be merged into a single training system under a single body (academic colleges?). Those who wants to do any basic specialist training have to apply directly to this body before their 1st 3 year contract ends. If you are accepted into the training program then your chances of extending the contract till you graduate is almost certain. However, you need to pay whatever training and exam fees needed, by yourself.

What is the purpose for this Hartal? If it is to ask the government to absorb everyone into permanent post, than I feel it is NOT going to happen. It is not the long term solution. If it is to threaten the government, then it is also not going to work as the government never promised you a job anyway. If you think the public is going to support you, rest assured it will not happen (except your family members)! The public will only consider you as a selfish group of people. There are many people out there who have lost their jobs during this pandemic (commiting suicide) and here we have a group of doctors who are earning monthly salary and demanding to be absorbed into permanent jobs and endangering public’s life, if it is really going to be a proper strike. The public will never treat you as someone special. Trust me!

My opinion is to have a complete restructuring of the healthcare system to enable doctors who are interested in specialisation to remain on contract till they complete their training and gazetted as a specialist and continue till they decide to leave. I believe the way forward is to abolish permanent system and only go by contract system with full transparency in selection. Individual hospitals should be given full right to recruit the contract doctors and also determine their workforce numbers. Unfortunately, the word “transparency” do not exist in our government dictionary as you would have noticed from our controversial Minister’s reply letter. As I have said many times before since 2010, the days of guaranteed job for medical graduates is all OVER. Doctors, like any other profession have to find their own way. In Australia, there are consultants who do not have a full time job and ALL medical jobs are given on contract basis, between 3-5 years duration. No one complains as they are simply, used to it!

Stay Safe…………………..

Continued………..

In 1989, I sat for my SPM examination. As I mentioned earlier, there were 3 science stream classes in my school, out of which there was only 1 Malay student. The rest have all disappeared to MARA colleges, Boarding schools, military college, agama schools etc. I took the maximum of 9 subjects and received 7A1,1A2 and 1C3(in BM). I applied for JPA scholarship but decided not to attend the interview as I was told beforehand that medicine is only for Bumiputera. Some of my friends who attended the interview were told point blank that medicine is only for Bumiputera but they can request for other fields. For those who are from the 21st century, scoring 8As in those days were less than 10 students per state, unlike now where we have 10K students scoring straight As in the country!

Thus, I had to bite the bullet and go on to do STPM which is a 2-year program run by national schools (not all but selected national schools). It is considered as the toughest pre university exam in the world. Two years of knowledge tested by 1 exam at the end of the 2 years. We are allowed to choose 5 subjects. It was the only way for us to attempt to enter the public universities. There were only 3 universities offering medical program. Matriculation/Asasi science were reserved for Bumiputeras till 2003 when 10% of seats, in some programs were given to non-Bumiputeras.  Most Asasi programs in major universities are still reserved for Bumiputeras, till today. By God’s grace, I scored 5As in my STPM science examination, the only Indian student to do so in Malaysia. There were 72 students who scored 5As in the country, in 1991 STPM.

As I had mentioned in my earlier articles, our universities work on a quota system. While the Bumiputeras enter via an exclusive matriculation pathway, all non-Bumiputeras must use the STPM pathway. Two different system with 2 different standards. Further to this, we had the quota system. There were hardly any private colleges except for some which were running twinning law programs. Otherwise, you need to go overseas under your own parent’s sponsorship. As far as the medical faculty is concerned, 60% is given to the Bumiputeras, 30% to the Chinese and 10% to the Indians. The total intake for the 1992 UM medical faculty was 180 students. The ratio is the same for all other faculties. It supposed to follow the population ratio of the country. The number of intakes were fewer in UKM (150) and USM (110). Chinese students will need at least 5As or 4As in their STPM while the Indians can get away with 3As, to enter the medical faculty. Well, we had to accept the fact that we are treated differently. It became part and parcel of our life. It made us a better person and a fighter as we need to fight for entry into local public universities for 40% of the seats that are allocated to the non-Bumiputeras. BUT we were all Malaysians and I only had Malaysia as my country.

It was in the university that we yet again see all the 3 major races coming together. It is also here that I realised what “educational segregation” at primary and secondary school levels has done to our social integration. Many of the Malays were totally isolated for at least 7 years before they start to see non-Malays again. Many of them were from boarding schools, MARA colleges and agama schools, before entering matriculation. All these schools were reserved for the Malays. For some, even their primary schools were predominantly Malays as they were from rural schools where there were hardly any non-Malays. Some did do up to SPM in a national schools before entering matriculation/Asasi. As a non-Malay, I could clearly see the difference among these people. The ones that mingle around without any issues are those who were in the national schools up to SPM or from a major city where they are used to non-Malays. Many seem to have a culture shock looking at the non-Malays, not to mention the inferiority complex, being brought up in a non-competitive environment. They don’t mix around much and tend to keep to themselves. They did improve along the way especially when we started our clinical years. But I must say that there were some excellent Malay students as well, who had now achieved successful career in their respective field. It is sad that the society may still look down upon them just because of the different entry pathway and the quota system. Society’s perception cannot be changed unless everyone is at a level playing field.

Similar issue could also be said about some of the Chinese students. Many were from Chinese vernacular schools up to Form 5 or even STPM. I could clearly see how they prefer to be among themselves and speak their own dialect even when they are among the non-Chinese, because they are so used to do so. They don’t realise how rude it is, to the others. While the national school educated Chinese were able to mingle around more freely and more proficient in English, the vernacular school educated prefer to stick to themselves. As they enter the clinical years, some of them do improve and mingle around more with the other races.

As for the Indians, all of us are from national schools. If I can remember, there was only 1 among us who was from a Tamil primary school. As there are no secondary Tamil language vernacular school, even if they do go to Tamil primary schools, they will end up in a secondary national school. We were among the students who can get along with anyone in the university. Almost always we speak in English as even many among us are not Tamilians. We were a rojak group.

Did religion affect us in any way? Yes, it did. When I was in the 1st year, the Malays will form their own study group and the Chinese will form the own study group. The Indians usually play around. We don’t form any study group. We only play football together. So does the national school educated Chinese. We are happy go lucky kind of people. There were also some Malay boys who are in the same category. In my batch there were 2 Indian Muslims who entered the medical school under the Indian quota, via STPM. They used to mingle around more with the Indian students at first. Both were approached by the so called “dakwah people” who are usually students from the religious faculties. They were told openly that they should not be with the non-Muslims. They should only help the Muslims. They were told that they should avoid being close friends with the non-Muslims but spend more time with the Muslim students. One of these Indian Muslim student heeded their advice and moved away from the other Indian students. He eventually came closer to us when we started our clinical years. The other student remained close to the Indian students and became one of my best friends. We were roommates from Year 2 to Year 4. He now heads one of the top cardiothoracic unit in KKM.

Every residential college in UM use to organise respective religious festival celebrations. We had Malam Raya, Chinese New Year celebration, Deepavali Night and even Chrismast night. Everyone in the college will participate as it is considered as a cultural event. I was the Director of Deepavali night in 1996 for my 6th residential college. I even worn the best director award for the college. Deepavali night is considered the biggest event of the college every year. Unfortunately, I was informed that 2 years after I graduated, UM banned any other religious celebration in individual residential college. I am not sure what is the current status.

It is also in the university days I realise that many of these Malay students do not know what is happening out there. The more you talk to them, the more you understand that they are totally unaware of the racial policies in education and scholarships. While they understand that the Malays are given privileges in boarding schools, MARA colleges and Matriculation, they felt that the “others” are also given equal opportunities. They felt that the special opportunities given to them were because they are from rural /poor areas. Some are not even aware of the quota system and lack of scholarship for poor non-Bumiputeras. Many do empathise with us as they learn about the situation.

Five years of my medical school came to an end in May 1997. What appeared to be a long journey at the beginning, appeared rather short when I completed the course. It was a fun filled journey. I made new friends and learned a lot. Our lecturers were excellent. It was the days when Professors teach undergraduate students. I could still remember those great names like the late Prof John Bosco, Prof CT Chua, Prof Siva, Prof Raman, Prof Deva, Prof Fatimah, Prof Annuar Zaini, Prof Alan Teh and many more great teachers who thought us at the time. Many of them had retired but many did resign when I was about to graduate. As the private hospitals began to mushroom from late 1990s, many of our great lecturers left for greener pastures. It was a great loss to the faculty.

It was when I was about to start my Final year that I met my wife, who apparently is in the same batch! Since we had 180 students, sometimes we only knew those who are in our group or partner group. It was very difficult to get to know everyone in our batch by name. Sometimes we can recognise that they are part of our batch but do not know the name. How ironic! My wife was in my partner group starting Year 4. We first got to know that we exist somewhere towards the end of Year 4 and became friends when we started Year 5. By the time we sat for our final exams, we had confessions to be made! The rest is history…..

To Be Continued …………

Continued ……….

Education should never be politicised. Unfortunately, in Malaysia everything is politics unless stated otherwise. When I started my Standard 1 in 1979, the education system had already been converted from English to Bahasa Malaysia. If I am not mistaken, I was the 2nd batch of Standard 1 which was conducted in BM. English was thought as a second language. However, we were still a lucky batch of students as the books were still Cambridge books translated into Malay. Our teachers, almost all of them had excellent English language proficiency as they were educated in English medium. My school was a missionary school which is technically a semi-aided school. I did not see any racial or religious issues within my school. The Malays, Indians and Chinese were all playing, studying and eating together. Our canteen was run by a Chinese family till I completed my Form 6 in 1991. There was no such rule as only Muslims owners can run public canteens. They don’t sell pork or beef to respect everyone’s religious requirements. The vernacular schools on the other end were dying a slow death. Many non-Malays wanted to enrol themselves into national schools as they expected to be treated equally. My father, who was once a Tamil school Headmaster before becoming a national schoolteacher (after doing a degree), decided to send all of us to a national school albeit a missionary school (the top schools at that time). He still says that the reason he did so is to make us Malaysians. Many small Chinese and Tamil schools were on the verge of closing down by late 1980s due to lack of enrolment.

Unfortunately, after 1981 everything changed. The quota system of universities was in full force. MARA colleges and boarding schools were raised everywhere since 1970s to cater for a single race. Scholarships were limited to non-Bumiputras. Civil servants were reserved for a single race. As more and more non-Malay teachers began to retire, the pool of teachers were predominantly Malays by early 2000. Worst still, unemployed graduates were recruited as teachers under KPLI (Kursus Perguruan Lepasan Ijazah) program. When my daughter went to Convent JB in 2011, there was only 1 non-Malay teacher in the entire afternoon session!

As I said earlier, the government must lead by example. On one end, you claim vernacular schools are causing disunity but on the other end, you do the same. I remember very clearly how most of my Malay friends disappeared after Standard 5 (before UPSR, lower school exams were held when you were in Standard 5) to MARA colleges, Agama schools, boarding schools and royal military college. Another batch of my remaining Malay friends disappeared after Form 3 SRP exams (PTK equivalent), also to MARA colleges, Agama schools and boarding schools. By the time I reach Form 4, the entire science stream only had 1 Malay student. By Form 6, all my classes were filled with only non-Malays. The remaining Malays who use to come from other schools to my school for Form 6 Science classes disappeared within 2 months, as they enrolled into university run matriculation system. Mind you, my school (St Paul’s Institution) was one of the premier top schools in Negeri Sembilan. By removing the Malay students to agama schools, boarding schools, MARA colleges and Matriculation, the government was basically doing the same. Lee Kuan Yew of Singapore took 20 years to abolish the vernacular schools in Singapore. Did he do it overnight by just banning the schools? Nope. He created a merit-based system, a common language of English with mother tongue language as mandatory 2nd language, offered scholarship to Chinese school top scorers to move to national schools which is valid till they reach university, no religious elements in school curriculum etc. The vernacular schools died a natural death. You can read this in his book “My Lifelong Challenge: Singapore’s Bilingual Journey”.

By mid 1990s, many non-Malay parents were moving their children back to vernacular schools. A new national education system was introduced in 1983 known as KBSR and KBSM. Religious education was made a mandatory subject for Muslims and as part of the national curriculum. Prior to this, it was not part of the national education curriculum. We had a period, if I can remember, once or twice a week known as POL (People’s own language) classes. The Muslims will go to Pengajian Agama Islam class whereas the Indians will go to Tamil classes and Chinese to Chinese classes. I grew up in this system and KBSR and KBSM did not affect me as it only affected those who started their Standard 1 in 1983 onwards. When KBSR and KBSM was introduced, these POL classes were abolished and replaced with Pendidikan Moral for the non-Muslims. The mother tongue language classes were abolished for good under the new national education policy known as KBSR and KBSM. Some schools still continued with these as an optional out of ordinary classes. These were done after school hours. Language is an asset to a country but we decided to do the opposite.

With the formal introduction of religious education into our education system from 1983 onwards, the national schools slowly but surely were moving towards a monoethnic and mono religious centric schools. The Ustaz and Ustazah became very influential. MOE barred any other religious events or celebration in schools by 1990s. Openly telling the Muslims students that non-Muslims are kafirs who only deserve to go to hell were a norm. Islamic religious activities were held openly including saying daily prayers during assembly. The non-Muslims became very anxious, uneasy and started to move their kids out of the national schools. Religion should never be part of any official education system. It only serves to divide people. By 2000s, these phenomena had become toxic enough that many decided not to even send their children to national schools.

What options does these parents had? The cheapest option is to send to vernacular schools. Vernacular schools were becoming very popular and some schools did not even have enough classes to accommodate everyone. Schools that were on the verge of shutting down by early 1990s got a new lifeline. Many non-Chinese, including the Malays began to send their children to Chinese medium schools. If I am not mistaken, the current statistics shows that close to 20% of students in Chinese schools are non-Chinese.

By 2004 under the leadership of our new PM Abdullah Badawi, another new “education policy” started to take place. International schools which were once only available for expats or to students who had at least 1 parent being a foreigner, were allowed to take Malaysian citizens. It started with 30% quota but by 2008, almost 100% of the students can be Malaysians. These created another mess in our education system. Mushrooming of private and international schools started. It’s all about making money, I guess. Now, we not only have racially and religiously divided nation by education but also a class divide. The “Bangsa Malaysia” of Wawasan 2020 were just going down the drain. So, whoever who claim that the vernacular schools are the cause of disunity, think again. Digest what had happened and look at yourself. Assimilation will NEVER occur if everyone is not treated equally. That’s the reality.

To be continued……………….

continued.……….

While many countries in the world were attracting the best brains, we were happily removing them. The biggest beneficiary of our best brains was Singapore. Singapore, a country without any natural resources has to depend on its best brains to become a regional business, financial and research centre. They knew the only way to survive and develop is via knowledge-based economy or k-economy. They started their Asean scholarship program in the 80s to attract the best brains of the region to come and study in their university and be bonded to work in Singapore for at least 7-10 years (no one leaves after that). Those who enrol into their university by merit were also given scholarship with a bond. These not only attracted the best brains to study, work and remain in Singapore but also made their universities, one of the best in the world. Across the causeway, we were doing the opposite. We chased away the best brains using race factor. We sent our best students of certain race to overseas countries to study via MARA and JPA scholarship, instead of retaining them in the country. Many never returned back to serve the country. MARA loans/scholarship never had any bond with the government. I have seen many Malays who were under MARA and JPA scholarship happily working in Australia, UK, Ireland and New Zealand till today. As far as I know, neither MARA nor JPA had ever released the figures of how many remained overseas upon completing their education. It was only in 2016 when JPA decided to stop sending students overseas (except for those courses that are not available locally and the top 50 students) but indeed sponsored them locally in private universities. MARA was still sending students overseas but gradually reduced those who were sent to western developed countries due to cost.

Australia removed their all-white policy in 1973 and started their planned migration policy. The motto was “either you populate or perish”. They started one of the best migration policies in the world, attracting skilled workers into the country. Skilled workers, especially of young age were automatically given residency status even before they sat foot into the country. They were given the same benefit as the citizens, minus eligibility to vote. Racial Discrimination Act was passed in 1976. In 2001, they allowed dual citizenship. For those who are working in Australia under other visas, they were given residency status (PR) in 2 years. Due to some abuse of the system, it has now been extended to 3 years since 2018. And after 4 years of residency in total (including the 3 years of stay for PR), you are eligible to apply for citizenship. In Malaysia, we were too proud of our nationalism. I had foreign friends who were married to Malaysians who received their PR status after more than 10 years, going up and down the immigration office multiple times and being insulted several times. Till then they had to renew their social visa yearly which do not allow them to work unless you are granted a work permit.  These were skilled professionals. We were going into negative balance. The best leaving the country, none coming into the country. I have seen some comments saying, who said people are not rushing to Malaysia to work, look at the number of foreign workers in Malaysia! They forgot one thing for sure, these are unskilled labour force! They don’t contribute anything to the country except building structures. Do they pay tax? Do they provide any intellectual ideas? Nope. They are lowly paid untrained labourers, and they send their money back to their homeland, outflow of money.

By mid 1990s, Malaysia was a rich country. We had all the natural resources that was giving us all the money we wanted. We had industries coming and investing in Malaysia. Our surrounding neighbours except Singapore and Thailand were in turmoil. Indonesia was facing dictatorship of Suharto (till 1998), Philippines was being swindled by Marcos and family till late 1980s (still suffering from its aftermath for past 30 years), Vietnam recovering from war, Cambodia was recovering from civil war, Burma was under military rule and China was just starting its open market policy in early 1980s. We were plain lucky to be able to attract investment with a good english speaking professionals, good infrastructure etc. Unfortunately, we did not have skilled workers or even the labour force as the time went by (people refuse to work in these sectors due to low pay). The investors had no choice but to import foreign workers which resulted in more money than expected being spent. Corruption in the civil service increased the cost further. We did not have minimum wage policy till 2018. We were in the middle-income trap. Instead of investing in k-economy, we were more interested in keeping cost low so that investors will come into the country. We were more interested in having grandiose and delusional ideas of building the tallest, biggest, longest this and that when other countries have moved way beyond that philosophy. Buildings do not make you a developed country, knowledge does. Cronyism became rampant and millions were lost. Unfinished projects were a norm, but the money was gone. All in the name of supporting Bumiputera entrepreneurs. That’s why it is known as “piratisation”! By 1999, when the Asian Financial crisis happened, we were doomed. We never actually recovered since.

Within the country, we were more interested in privatisation, or shall I say “piratisation”. Education and Health should be government’s responsibility. Instead of building more hospitals and recruiting more brains, we were more interested in allowing private hospitals to mushroom. Almost all private hospitals in Malaysia are GLC owned aka government owned, basically government’s left pocket! The public health system was stretched to the maximum with minimum number of staffs to run it, the effect of which can be seen now during the COVID outbreak. “You tak suka, you boleh keluar” motto prevails. Many of the best brains again left to the private sector and overseas. Doctors demanding higher pay? we shall flood the market with doctors! Then came the mushrooming of private medical colleges, which can even run in a shop lot complexes (the first in the world). We currently have the highest number of medical schools’ per capita population in the world. I had written enough about this for the past 10 years. Whatever I predicted since 2006 has come true. I shall not repeat those over here. We are in total mess. The dire need of our healthcare system was exposed by a virus. We are like an emperor with no cloths!

To Be Continued……………

** a word of caution : this blog post is a general statement /opinion of mine based on facts, looking at what is happening in Malaysia, the country where I grew up. There are sensitive issues discussed, which people may or may not agree. Just keep an open mind and think deeply. It will be in several parts, ending with my story………….***

I was 19 years old when I was sitting in the Parliament on 17/06/1991 listening to our then Prime Minister Dr Mahathir Mohamad launching the Dasar Pembangunan Nasional (DPN). It was the replacement for Dasar Ekonomi Baru(DEB) which was a 20-year plan introduced in 1971. I was in Upper Six at St Paul’s Institution, Seremban and this was our educational tour as part of our “Pengajian Am” subject. DPN supposed to be part of Wawasan 2020 (1991-2020) to elevate us from a developing country to a developed country. Wawasan 2020 was just introduced 5 months prior on 28/02/1991.

At that young age, listening to the word “Bangsa Malaysia” and becoming a high-income nation was mesmerising. As a student, I wasn’t very much interested in politics then, except to accept the fact that we have something known as Bumiputera and non-Bumiputera terminology. I know that we need to fight to enter local public universities just among the non-Bumiputeras, due to quota system. Among the 3 of my school’s Form 6 Science classes there was only 1 Malay student. Every Malay science student was accepted into matriculation after completing SPM. We accepted the fact that we have to fight for whatever we need as we will never be treated the same. But Wawasan 2020 gave us some hope.

Along the way, the country took the wrong direction. Instead of uniting the people as a single race, we decided to divide it further. Instead of building more public universities to cater for all citizens, we decided to keep the quota system and different entry system into the public universities. We decided to privatise education in 1997 to make more money and to make every single citizen of the country to become a debtor, by making someone else rich. PTPTN was established for both private and public university students. Generally public university fees are heavily subsidised and most do not need to take any loans. Civil service, which forms the backbone of a nation was pre-determined to be run by a single race. From a 40% non-Bumiputera containing civil service in 1970s, we became almost 95% (some say 98%) consisting of a single race. To provide more jobs to people, we became one of the largest civil service in the world, based on population ratio. The financial burden to the country was and is exorbitant.

Malaysia was considered as one of the most successful post-independence countries in the world. Within 30 years after our independence in 1957, we were the most progressive and industrialised country in SEA. We discovered oil in 1970s and formed Petronas in 1974. By the 1980s, we were an oil producing nation. This, together with rubber and oil palm were already making Malaysia a rich country. With industrialisation and investment from Japan etc, we were going in the right direction. We were known as the Tiger of Asia! BUT we have forgotten an important part of our history! Migrants!

One of the reasons I always ask my kids to read about history (not for exams but for knowledge) is because through history you will learn how not to repeat a history. History teaches us a lesson so that we do not do the same thing again. Unfortunately, history nowadays is thought in school as just a “point form” text to pass exams. During my time in 1980s, history books are like story books, not in “point forms”. If anyone bother to read history, you will know that the most successful countries in this world are countries who embraced migrants. They made migrants as part of their country and equal citizens. Every country that chased away migrants after independence has collapsed. Look at the African countries which did this after their independence from colonial power. Every one of them went downhill. Zimbabwe chased away all the whites who were doing farming. It was the biggest agricultural producing nation in Africa at that time. See where they are now. All these farming lands were taken over by cronies of Robert Mugabe and successfully destroyed it for money. Sounds familiar?

Malaysia was gifted with almost 40-45% migrant population at independence. These were migrants who were brought by the British to work at mining sites, roads, railways, plantation etc. They worked hard for pea nut money, many died of infectious diseases but without these migrants, Malaysia would not have been where it was 30 years ago. My grandparents worked in rubber plantations, roads and railways. When they were given citizenship, they were happy and continued to dedicate their life serving the country in whatever capacity they could. The Chinese even helped the military and police to defeat the communist. Who worked as spies for the Malaysian police and military? Without the Chinese help in Malaysia, it would have been impossible to defeat the communist. Malaysia was one of the most successful country in the world to defeat communism. Who thought the children in schools? It was the missionaries and Indians. Most of our teachers in 1970s and 1980s were non-Malays. My Headmaster was an Irish missionary guy, Bro James Macken. Did they not teach our children without any prejudice etc? Racial and religious matters were never an issue. What happened?

In 1981, someone took over the reign of our country. He was a smart doctor and a cunning politician. His motto is very simple. Malaysia belongs to the Malays. Thus, everything that represent Malaysia should be by the Malays (please read his autobiography). These includes the civil service, military, police and sports. Have you ever wondered why we were once a football powerhouse of Asia in 1970s up to mid 1980s, after which we just went downhill? Politics! Many politicians were appointed to sporting agencies. Their duty is to make sure that majority of those who represent Malaysia in sports must come from a single race. Token of appreciation can be given to a few non-Malays. The non-Malays can do whatever they want in the private sector and the government will collect their taxes. Malaysia is the only country in the world that I know which has a different tax structure for civil servants and the rest of the population. Civil servants do not pay any tax for their allowances, which most of the time can be higher than their basic pay (which is the taxable income). But this blame does not go to Dr M. It was by his successor Abdullah Badawi. The government should always set an example as being fair to everyone. Unfortunately, in Malaysia that is not the case.

Nothing was based on merit. Quota system was introduced in the universities in late 1970s (guess who was the education minister?). Matriculation was introduced as a short cut pathway into university for certain race (he himself had admitted this in 2018!). We even have a race-based University, funded by the government via tax payers money! Talent and merits were thrown into the drain, not only in civil service, sports, university intellectuals, graduates but in almost everything that made Malaysia great once. All in the pretext that Malays can do it if given the opportunity (from his autobiography) aka short-cuts. He undermined the very capability of the Malays to succeed on merit. Crony businessmen cropped up overnight with directly negotiated contracts. Open tender became a dirty word. Many instant millionaires of a particular race were created, all in the name of creating Malay entrepreneurs to compete with the Chinese. Did these people help the rest? History would have given you the answer by now. He was a man in a hurry.

In the process, he wasn’t interested on what the non-Bumiputeras wanted. You want to go to university; I give you private university. Sorry, overseas scholarship is not for you except for a few tokens of appreciation. Overseas JPA scholarship to do Medicine and Dentistry was only reserved for Bumiputera till late 1990s. Lower merit individual from certain race were given priority. Obviously, migrants will always find a way around. They will work hard and sell whatever they have to educate their children. They will send their children overseas and ask them not to come back etc. The exodus started in 1980s and still ongoing. Many best brains left the country gradually, not that they want to, but forced to. Our failure is another country’s gain. I wonder why our newspapers keep reporting of “Malaysian born” so and so is a Hollywood director, international star etc. They have left Malaysia and are not even a Malaysian citizen anymore. If at all, we should be ashamed that they did not achieve this for Malaysia. Why did we chase them to be somewhere else achieving their glory?

TO BE CONTINUED………………………………

Five years ago I wrote an article in my blog ” Patient’s Confidentiality and Autonomy” . It was about an article in the Malay Mail discussing on the issue of doctors posting confidential informations of patients being treated in hospital and using it to make remarks against certain group of people on Facebook etc. I wrote in detail my opinions on these matters and did warn the doctors that every patient has the right to choose what they want. Our job is to educate and advise, period. I wrote this same article in my books that was published in June 2016 (Chapter 9, page 185). Along the way I had written numerous articles on issues of doctors and social media. Interestingly, the exact issue that I spoke about in 2015 has taken a centre stage again, over the past 1 week.

We as doctors should learn to control our emotions. The public look at us as a highly educated person and we should not tarnish our names by making mocking or defamatory statement to any particular individuals, especially if we do not know the exact details of a case or never involved in it etc. Making general statements are fine. The issue that has been circulating around over the past 1 week started in early 2018, almost 3 years after i wrote my article. The court has decided that the said doctor has made defamatory statement against an individual and was asked to pay RM 230K in total, as damages and legal cost. I do not want to discuss in detail about this court case unless I have the detail judgement, which may only be released at a much later date.

What I want to talk about are comments made by many medical practitioners claiming that doctors have now lost the ability to advise people on quack practitioners, medical notes are neglected as evidence in courts etc. Some even gone to the extend of saying that doctors should be protected from being sued by member of the public for trying to protect the public from quack practitioners.

Firstly, let me explain that a defamation case is NOT a medico-legal case. In a medico-legal case, your case notes becomes a hardcore evidence against a negligent suit. Medico-legal cases/notes are only applicable from the time the patient seeks your treatment till the time the so-called negligence happens and so forth. The court will take the medical notes as evidence. So, if the patient has lied to you, they cannot turn the case against you as our management plan depends on what patient informs you. The legal test used to determine negligence is way different than a defamatory case.

In a defamation case, you need to proof that the accusation you have levelled against an individual is, on a balance of probabilities, true and proven. The legal test used is totally different than a medico-legal suit. So, when a doctor accuses a member of public of something serious, like causing death of a baby etc, she need to proof this statement in court. Can the medical note be used as an evidence?

My answer is NO, especially if you are not even involved personally in this case. Anything that happened outside a hospital/medical facility is hearsay. That’s the reason when a patient comes to emergency department and says that she/he met with an accident, we say ” Alleged MVA”. This is because we don’t know whether what the patient tells you is the truth and nothing but the truth, as proclaimed in court of law. No such proclamation is made when a patient comes to hospital. That’s also the reason why we always say ” claimed by patient” in our history taking. I hope the medical schools are still teaching this, as I learned it when I was a medical student.

Now, let’s go back to this particular case in general. The case revolves around a doctor who supposedly made remarks on FB against another “complimentary medicine” practitioner, accusing that the said practitioner caused the death of a child. I can vaguely remember the hot issue that was circulating at that time in regards to this case. The doctor made direct accusation and thus, it can definitely be deemed defamatory. No two way about it. If it was a general advisory statement without pointing to any particular person directly or indirectly, then it is not an issue and cannot be deemed defamatory.

Anything that happens outside of an hospital have to be reported to the relevant authorities to investigate. For example, if we suspect child abuse, we need to report to the police and social welfare department. It is up to these departments to take further actions. Just because the child said that she has been abused to you, it does not mean she is telling the truth and we should not depend on that story to throw accusation to anyone. Our job is to report. If we accuse so and so as responsible based on what the child said but subsequent investigations by police showed otherwise, you are liable for defamation and you can never win. Similarly, if any patients makes public accusation against a doctor in social media etc, you have every right to sue them. However, if the patient makes a report to MMC and MMC finds you not guilty, you can’t sue the patient, as she has made the right move. This is similar of us making a police report when we suspect something. The person cannot sue you for making the report.

In this particular case, police reports were made by both MOH and the person being accused of killing the child (directly or indirectly), who is the plaintiff in this case. Unfortunately, police investigations found no evidence that the plaintiff was responsible for the death of the child. This alone is enough to proof that the statement made by the doctor is defamatory. Some said that the mother lied in court and changed her statement, comparing to what was recorded in medical notes. Again, what the mother told the doctor is considered hearsay as it happened outside the hospital. In my 24 years of medical practise, I have seen countless number of patients not telling the truth. Many at times, they make up stories so that you don’t scold them or find them stupid. In the court of law, it is up to the defence lawyers to proof that the person is a liar and to expunge the entire witness statement. Till the judgement details are out, we would not know what happened in the court. I understand the said plaintiff in this case has also won another case in Shah Alam against a doctor as well, who supposedly did not turn up in court to defend himself.

Many young doctors out there do not understand the field of medicine. Defamation and medical negligent cases are 2 different entity. Medical notes evidence is only valid for something that happened within the medical facility, aka from the time the patient come to you. It is only applicable for treatment related issues. Secondly, what patient tells you is confidential and cannot be made public. A doctor who accuses someone publicly of wrongdoing by using this case notes has technically breached patient confidentiality. He or she can be reported to MMC. So, be very careful when you make emotional post on social media on certain issues when it involves specific patient etc. I have written an article on this in 2018.

Some doctors have said that they will stop advising the public against going to traditional practitioners to prevent being sued. Again, many don’t understand the scenario. You can always advise and educate the public in general terms. But what you can’t do is directly accusing someone of doing something. That is defamatory unless you have solid proof. Please do not forget that despite all the advise and education, it is every patient’s right to follow or not to follow. You can’t push your ideas into anyone even if it is based on solid evidence. Always remember your medical ethics: patient’s autonomy. My article in 2015 had explained this in detail.

Our country is in a mess right now and the world is in recession. I know this year’s Deepavali would be uneventful to many. However, I would still like to wish ” Happy Deepavali” for all those who are celebrating at home.