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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……………….

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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……………

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** 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………………………………

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I have finally reached another milestone ……… as of 13/01/2020, my blog is 10 years old! Over the past 10 years, I have written hundreds of articles and even published 2 books from these articles! I probably achieved my wawasan by educating the public on what medical field is all about and how the world is changing.

My last article was written on 24/12/2019, just before the new year started. It has been almost 5 months now and the world has changed. In just a short period of time, our lives have gone upside down and we are still looking at months down the line before everything comes back to normal. 2020 suppose to be the year where Wawasan 2020 should have been achieved, transforming Malaysia into a developed nation, but unfortunately we are in a mess with recession coming soon, if not already. We have had 5 months of political drama and a brainless RNA virus terrorising the world. Let’s start with where I left you on 24/12/2019……

Critical Allowance

Based on JPA circular dated 20/12/2019, critical allowance for all new appointments into MOH will be removed. As I mentioned in my article, it is rather unfair when those who are already in the system will continue to receive the allowance but the new ones will be without the allowance. I said unfair because everyone is doing the same job and same amount of work. It does not make any logical sense, while I did predict and expected the allowance to go one day when we have more body than post. Following this announcement, there were huge outcries from various organisation and members of the public. Thus, on 9th January 2020, this proposal was postponed for further review, scheduled to be updated by end of this year. REMEMBER, it is only postponed and not cancelled!

U41 Contract Renewal

As I have written in several articles towards the end of last year, the number of permanent appointments given out following completion of housemanship has been dwindling down from about 500 for the first batch(December 2018 cohort) to almost 0 in subsequent batch(May 2019). This is again not unexpected. KKM simply do not have enough post to offer everyone. The slides below is self explanatory…..

It is very clear that KKM do not have any post to even offer permanent positions. Thus, almost everyone will be given an extended contract which will be the final contract before you say sayonara to KKM. The issue of being offered U41 post instead of U44 has not been resolved either, despite promising to do so in November 2019 by the cabinet, KKM and JPA. The new contracts are still renewed at U41 as of April 2020. On 29th October 2019, I wrote this :

The best is yet to come: those who receive extension of contract can remain at the same place where they were transferred as a floating officer! In another word (the way I interpret this), your life in civil service ends there within another year aka completing 4 years of compulsory service. It’s just a diplomatic way of putting it !

Interestingly, this is now proven true when the newer contract renewals categorically says that ” this will be the last contract!” ………

So, basically whoever received the U41 contract extension of 2 years, after their 3 year initial housemen contract, have to start planning their future. I believe this clause was added after the Sarawak doctors debacle that was publicised widely in newspapers in January 2020. These were doctors who returned from overseas in 2017 and was given a 2 year contract to complete their compulsory service. Unfortunately , they were told that their contract would not be renewed. To be frank, no contract is permanent. A contract is a contract and the employer can decide not to renew your contract once it expires. It is the same in any profession including the medical profession. Even in private hospitals, the hospital can decide not to renew your contract if they feel they do not need your service anymore or simply, if they don’t like your face!. It has happened before and there is nothing you can do about it. There is a clear difference between ” termination” and “non-renewal of contract”. While the Sarawak doctor’s contract were finally renewed, to avoid any such scenarios happening again, JPA has now clearly stated the above clause in the newer contracts. So, now no one can claim ignorance.

What about those who received a permanent post? Again, they were given a U41 post! However, they were told that this is due to technical reasons. The U41 permanent post will be backdated to the day they started housemanship and soon, they will receive their promotion to U44 backdated to the day they completed housemanship. Whether this has happened with all the chaos that is going on now, I do not know! We shall wait and see.

In a sudden turn of events in April 2020, about 102 permanent post were created in Sarawak. This could be part of about 1000 post that suppose to be created over the next few years as I wrote in December 2019. So, about 102 of them were sent an urgent email early April 2020 offering them this permanent post in Sarawak and NO appeal will be entertained……..

Whether there is a political reason for this, I got no idea. Based on the report by Codeblue, about 28 of them declined the offer and decided to stay on their final contract appointments. We just have to face the fact that the government will never be able to absorb all graduates. With the current economic situation, the scenario will only get worst. No job is guaranteed in this world. What is happening in Malaysia, is also happening in many developed countries but at-least, these countries have a better control over the number of graduates being produced, unlike Bolehland.

COVID-19

The world is yet again faced with another Pandemic. I would say that this is the 4th viral outbreak I am facing in my 23 years working as a doctor. It started with SARS in 2003 followed by H1N1, MesCOV and now COVID 19. Facing these viruses or any infectious diseases are part of our occupational hazard. I know many doctors who have contracted infectious diseases and some even succumbed to the illness. So, those who think that doctor’s job is sitting in a cozy room and earning big bucks, please think again. We are not only at risk of being infected with a disease but also high litigation rate and verbal insults.

We may be considered as a hero at the moment for tirelessly facing this pandemic. But trust me, once all this is over, we will be back to square one. No one will even remember what you did. That is the reality out there. But COVID 19 also thought us a lot of other lessons. The Earth is breathing better and animals seem to be enjoying their life. We must understand that the entire ecological system on Earth lives in a balance. It evolved over millions of years keeping everything in an absolute balance. The very fact that we produce CO2 and plants converts it back to O2 proves this balance. BUT humans are always greedy. We feel we can do anything to mother earth and get away with it. I had always said this to my children ” Never play with nature, take care of it. If not, nature will always get back to you!” COVID 19 just proves how nature can get back to you. A simple brainless RNA virus can shut down everything on EARTH! Viruses have been around before humans came about. So, never play with nature. Stop destroying nature and learn to live in harmony. As Sir David Attenborough said in one of his famous documentary “ If you kill a whale in the ocean, the entire ocean ecology changes!” If there are no animals which eat insects, the world will be overrun by insects, which by the way have the highest population number in the world.

What else has this pandemic thought us? Good hygiene and social distancing keep doctors away! Many would have realised that there has been 70-80% drop in the number of cases attending private hospitals and GP clinics. Some GP clinics have even decided to close their clinic as their income has dropped drastically. It is better to close than to continue to maintain the running of the clinic. Private consultant’s income has definitely taken a beating. With lock-down, there were hardly any accidents. People were afraid to go to hospitals as they were worried of getting infected in the hospital. Social distancing, stay at home and good hygiene has drastically dropped the rate of infectious diseases like URTI, respiratory infections and gastroenteritis which generally forms the bulk of private hospitals admissions. Elective cases has also been postponed. It just shows that any job can be affected if something like this happens. It happens in all outbreaks but COVID 19 has been the worst. The only job which will continue to be not affected are civil service jobs! The government has no choice but to keep civil service running and paid. While you may end up taking a pay cut eventually, you will still get paid. In fact you will even get Raya goodies!

BTW, KKM has also offered 6 months contract jobs for those who are interested to be the frontliners. Specialist will be paid RM 12K/month and MOs will be paid RM 6K/month. I understand the offer is not available anymore. I heard some GPs did take up the offer.

Democracy

On 9th May 2018, everyone thought that Malaysia has woken up. In my article titled ” Towards Malaysia Baru?” on 4th June 2018, I wrote this

With all the euphoria that we are having now, it is just too early to say how this new government will perform. Statistic shows that Pakatan only received 48% of the votes with BN & PAS taking 52% of the votes. Pakatan won in many areas due to split votes. PAS benefited from split votes in Kelantan and Terengganu. Personally, I feel that the Pakatan government is not really in a very stable situation. Tides can change by next election if they do not outperform the previous government by leaps and bounds.

Again my words have come through! One of my friends told me to stop predicting anything as everything I predict seem to be happening again and again. The Sheraton move on 27/02/2020 and subsequent fall of PH is something I expected to happen sooner or later. The politics in Malaysia is as such. Everything is tied to race and religion. Whoever plays the right card, will win. Who cares about corruption and good governance? Whatever said and whatever mockery that has happened to Malaysian democracy, the country seem to be going downhill. Years of brain drain and racial politics will only take this country to the dungeon. With COVID 19, fall in oil price and dry coffers, we are surely heading into a recession and disaster. Never in world history I have heard of a 1 day Parliament sitting with nothing more than the royal address! It is the joke of the century.

After 10 years of writing this blog, I hope readers would have learnt something. My predictions are all based on facts and statistics. It is not rocket science!

Have a blessed Ramadan and SELAMAT HARI RAYA………………………. a different Raya I must say………….

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It has been more than a month since I last wrote an article which caused a storm among the medical fraternity. My article prompted Codeblue to publish what I had written, in their portal, which was subsequently brought to the attention of the Minister. During the initial press conference , MOH officials claimed that the salary difference between U41 and U44/43 contract officers are merely RM100-200 which is definitely not correct. The total difference when allowances are included will be in the range of RM 1000. Subsequently MMA made several press statements and had several meetings with MOH and MOF. After much discussion, MOH/Cabinet sort of agreed that they will “discuss” with JPA to renew the contract under U43/44 for those who have completed housemanship and did not receive permanent position. Unfortunately, to my knowledge, till today no such change has been made. Probably they are still discussing.

Subsequently, the cabinet has agreed for approval of new posts for MOH which has been frozen since 2014. The new posts will be for the newer facilities that are in the pipeline for MOH. On 2/12/2019, JPA issued a circular that about 10 675 new posts will be created for MOH within the next couple of years. Before everyone get excited, please be informed that these posts include all category of staffs. I was informed that only about 1000 post are for doctors. With 5-6000 doctors graduating annually, it is once again very obvious that most of the graduates will not be receiving a permanent post in KKM. The Minister once again has reiterated this in the Parliament few weeks ago that MOH will not be able to provide jobs to all graduates. It is a fact and it is also the fact in many other countries.

Then, out of no where, the cabinet suddenly decided that doctor’s consultation fees (not procedure fee) will be deregulated. This caught everyone by surprise as the GPs have been fighting to increase their regulated fee for years. I have written  about this few months ago. Just before the decision, MMA was informed that the government did not agree to increase the fee. However, I feel this is just the tip of the iceberg that we are seeing. I feel something big is coming along the way. With doctors flooding the market by 2020, the government got nothing to loose. Doctors will be undercutting and fighting among themselves to survive. If doctors are not united (which has never been) the biggest beneficiary would be TPAs/Insurance companies. Now, these fellows will go around doctor shopping for the best rate in town. It is called market force. Let the market force decide! With the deregulation, all clinics must display their consultation charges clearly in their clinic for patients to decide whether they want to see the doctor or not. It will become an offence if you don’t do so. I smell something is coming………… the Sith lords are never without a bigger plan………

Over the last 10-15 years, many of my predictions have come true. Mushrooming of medical schools producing thousands of medical graduates with questionable quality flooding the market and eventual unemployment in civil sector was predicted by me almost 15 years ago. It is all based on simple mathematical calculation. I am not Nostradamus! Limited postgraduate pathways due to this has been mentioned many times by me. I also spoke about the increasing waiting time for internship and internship under contract in 2014 when the actual implementation came about in 2016. Almost everything eventually happened, just the timing varied. In my MMA article 2011 & 2012 and my blog posts as well as in my books (2016), I had said that there will come a time when the Critical allowance for doctors will be removed! Critical allowance is given when you have more post than body. It is reviewed every 5 years. It use to be 5% of your basic salary till 2001 when it was increased to RM 500 by the Finance Minister who was also the PM at that time , who is also our current PM! He is also responsible in introducing this allowance when SSB was announced in 1992. Subsequently, these amount was increased to RM 750 in 2007 when the last review was undertaken.

On 20/12/2019, once again my prediction has come true. JPA issued a circular dated 20/12/2019 stating that the Critical allowance will be removed for all new appointments effective 1/01/2020. WAWASAN 2020 has been achieved! We have enough doctors to serve, we have enough civil servants, no category is considered critical anymore as we have more bodies than post. Unfortunately, we are not a developed nation yet! Interestingly, the PM who initiated Wawasan 2020 lived long enough to see himself becoming the PM again in 2020, not achieving what he envisioned. What is rather amusing is the fact that those who are already in service will continue to receive the RM750 critical allowance till they retire or resign. So, the newcomers will be doing the same amount of work but receiving a lower pay. But then, “you tak suka, you boleh keluar bukak klinik lor…………” it is called market force……….. supply and demand, more supply than demand, employer calls the shot! You have to thank your lucky stars to be even given a job!

Hit me with all your anger, use your lightsaber and I shall become stronger and the most powerful resurrected Sith of all time………

Welcome to the Rise of Palpatine …………………. where the dark lord rules………………once and for all…………..

 

Merry Christmas and a very Happy New Year 2020…………………..

 

 

 

 

 

 

 

 

 

 

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11th of June 2019 was supposedly a uniting day for all our GP friends in Malaysia. It was the day when our new Minister had a town hall meeting with almost 1000 GPs from all over Malaysia. It all started when the Minister made a statement about a month ago that the Cabinet has approved drug price control and currently under review for implementation. This triggered an uproar among the GPs whose consultation fee is already regulated and capped under Private Healthcare Facilities and Services Act (PHFSA) 1998. Schedule 7 which controls consultation fee for GPs has capped the maximum price at Rm 35! This has been as such since 1998 but the act came into force in 2006. The hospital doctors on the other hand had a review in 2013 and Schedule 13th was amended with roughly 15% increment, starting 2014.

What are my views and take on these issues? Well, my comments, even in the past, had created a lot of negative feedbacks from fellow doctors. But as I had always said, I call a spade , a spade! Just look at the public feedback in Facebook etc when the above town hall meeting was reported. Videos of our GP colleagues venting their frustration was shown live and recorded by various media. Did you really expect the public to show sympathy? The answer is a BIG NO! For the public, doctors are sitting in a cozy air-conditioned room and earning tonnes of money! Only when their own kid ventures into becoming a doctor, hoping to live a glamorous life, they realise the actual life as a doctor! The hours of work, training, exams, risk taken, litigation etc before you can even think of earning a decent living.

Having said that, generally a doctor can still earn a living as long as they can get an internship post and complete their training. However, the era of earning tonnes of money and being “rich” is gone and going…….Our income will be similar to any other profession, allowing us to live a life. If you are still thinking that spending RM 500 000 to RM 1 million to be a doctor is going to give you a luxury life, think again! Jobless scenario is already happening in many countries.

Now, coming back to GPs. The day you open a private clinic, it is a business, period!Same goes to private specialist. In any business, there are gains and there are loss. Some businesses closes down and some businesses thrive and even become global players. Business is a business, nothing differentiates you than anyone else. Unfortunately , health is an essential service. Health and Education are 2 components in any country which should be the government’s responsibility. I have said and maintained this statement since I started this blog. Many may not know that the PHFSA 1998 was actually tabled and passed in the Parliament in anticipation of corporatisation of health care in this country. The corporatisation of healthcare aka National Health Financing Scheme was suppose to be implemented in 1999 as the last corporatisation exercise of Dr M! Everything was ready on paper.Unfortunately, the sacking of Anwar Ibrahim and subsequent reformasi etc totally shut down the plan till today.

Frankly I don’t agree with controlling of consultation fee. Let the market force decide. BUT healthcare is an essential service and thus the government need to be responsible. Thus, in Malaysia, they control it via the Malaysia Boleh way! Same goes in any other country as well. You may think that in other countries, the government do not control the consultation fee. On paper , yes but they do control it in another voluntary way. Their National Health Financing Scheme(NHFS) that pays for all the consultation/procedure fee do have a limit and standardised payment system. Anything more than that, the patient has to pay out of their own pocket. Public being public, obviously they will choose a doctor that only bills what the NHFS pays. NO one will ever want to pay out of their own pocket! In some countries, the doctors can only accept what the NHFS pays which is basically a fee control mechanism where everyone technically is a civil servant. Even in Australia, many patients prefer to visit the “bulk-billing” doctors (accepting Medicare fee) rather than cash billing doctors.

The GPs were arguing that they are only allowed to charge a maximum of RM35 for the last 21 years. Now, just look at the comments from the public in FB etc. You, me and all members of the public knows that a simple consultation and medication by a GP will cost RM 50-70 and in some cities, can even reach RM 100! Patients are smarter nowadays. Even my patients will go to a pharmacy and ask for the cost of the medications. Similarly, many cash paying patients would do that and will know the actual cost of the meds given by the GP. So, do you think they believe that you are charging only maximum of RM 35? You may argue all you want about the cost of running the clinic etc, but a business is a business! NO one cares whether you are running at a lost or not. No one believes the notion that you are providing a service to public. Didn’t you become a doctor to help man-kind and provide service (aka free service)?

I found that one of the main issue that was discussed the other day was about TPA (Third Party Administrators). Many were arguing that TPAs are only paying RM 10-15 per consultation and wants the government to make sure that they pay RM35 per consultation. Now, let’s go back to my statement above. It is a business! TPA goes around to negotiate the best deal in town. So, the person who is WILLING to take the offer will sign an agreement with the TPA. A business deal! So why are we complaining? You signed it and agreed to it but complain later? We all know that many GPs are dependent on TPAs. Almost 60-70% of a GP’s income comes from TPAs. Without TPA, many more GPs will close shop. This is similar to private hospitals. 95% of hospital admissions are medical card holders. If insurance companies go bankrupt, all private specialist will be out of jobs! That is the fact. So, TPAs can “tarik-harga” . Unless the GPs can unite and state their demands, no TPA is going to entertain your request. By 2021, the market is going to be flooded by GPs when 50-60% of doctors(roughly about 2000-3000 per year) completing their compulsory service not going to be absorbed into civil service. You think the TPA is going to symphatise you? They will be having a jolly good time of GP shopping! And don’t forget the “uberisation” of healthcare where even those who are waiting for housemanship seem to be giving “online” or phone advise!

Even if the government removes the fee schedule, how much do you think you can charge a patient? How much a patient is willing to pay out of his/her pocket? Under-cutting and bad-mouthing is going to be rampant and again TPAs will have the same modus operandi. They will continue to negotiate a deal for the cheapest possible GP. That is business and everyone wants to make the maximum profit.So, if you agreed and signed for it, you have no basis to complain. The government is not going to interfere with that.

I really felt that most of the arguments that were forwarded during the town hall meeting were emotional in nature. I was watching it live on FB and was putting myself as a member of the public. What I saw was just doctors arguing to make more money! And that was exactly how the public felt as seen in many comments on FB etc. Bringing politics into the picture made it even worst! Whatever political ideology we have, we should keep it among ourselves and should not display it publicly, as we are dealing with members of the public who may have different political ideology. Even more shocking and surprising for me was when one of the speakers rejected Universal Health Care! Lucky the MMA president came with a statement 2 days ago that MMA and all medical associations had signed Declaration Titiwangsa in support of Universal Health Care.

When 1Care was mooted in 2012, the GPs went against it as well, mainly because of dispensing separation. It was scheduled to be implemented in 2014 but the 2013 election results made it to be shelved indefinitely. We have to admit that it is the dispensing rights that the GPs have which is giving them the survival. With limited consultation fee, they make profit from dispensing medications. IF this is removed, more GPs will close shop and become unemployed. This was the reason why GPs were shocked and reacted when the Minister announced last month that drug price control mechanism will be implemented. To me, I support the drug price control mechanism. We have to look at the public and see what benefits them. Working in a private hospital, I very well know how the hospital mark-up the medication prices. Some are up to 100% mark-up, especially for inpatients. That’s the reason I don’t like to give generic medications to patients as the organisation that makes the most profit will be the hospital. The cheaper the drug, the higher the mark-up. I rather ask the patient to buy from a pharmacy via a prescription slip from me. As for a GP, having a price written at the box may reduce their overall charge.

Now, let’s come to the solution! WE have to change and move forward. We can’t be harping on the same model that we have been doing since the 1960s! The world is changing and many countries have moved on to new models. Whether these new models are better or worst is something to be decided later. We have to move to a win-win situation, for the GPs, doctors in general, government and the public. Our healthcare system is not sustainable. I have said this many times before. Two parallel system running concurrently, competing against each other for an essential service is doomed to fail. We have a public system totally funded by tax payers and a private system almost 80% funded by insurance (aka out of pocket). The insurance companies are also bleeding in billions and the only reason they are still providing medical cards is because it is mandatory under Bank Negara rules. If not, which company wants to continue a loss making business?

The way forward for a GP to have a lifeline is to have a National Health Financing Scheme which will integrate  public and private healthcare system. This is the only way you are going to survive and have a decent living. You may not make tonnes of money but at least you can earn a living. With the NHFS, GPs will be paid by the scheme with an agreed fee. GPs can charge extra with removal of fee capping but how many patients will be willing to pay out of pocket is something we need wait and see. Eventually, most GPs will do bulk billing! It will come with a price. Dispensing separation will become inevitable with NHFS, where subsidised or fully funded medications by the NHFS will have to go through a dedicated pharmacy. But the overall cost of running a clinic will drop as you do not need to employ staffs to dispense or to run an in-house pharmacy. GPs have to form group practices like in many other countries. The NHFS may have to pay higher fees for a specialist GP which will make more GPs to upgrade themselves. Sometimes I feel very sad when I attend CME talks to see the same GP’s faces all the time! And guess what, most of them are senior GPs! The younger ones are hardly seen as they are busy trying to run their clinic.

With the NHFS paying the consultation, procedure fee and medications, there are bound to be audits. Again, this is nothing new as most countries with NHFS do such audits. You will have feedback audits, prescription practise audits and even average consultation fee audits. The number of patients you can see a day may be limited in the context of quality care. Prescription of certain drugs like opiates, steroids , antibiotics etc will be monitored. At the moment, these are never audited and the GPs can do whatever they want. Do we even have the data of total usage of antibiotics by GPs in Malaysia? We do have data from KKM and private hospitals but not from GPs as there are no laws to mandate GPs to be audited for such usage. IN any system there should be check and balance and doctors are not or should not be exempted. Unethical practices will rise if these issues are not kept in check, as what is happening increasingly in private hospitals.

There is no point arguing with the government when it comes to essential services. A government’s duty is to provide such service to public. Just see what happened when education was privatised! We made someone rich by making the public to go into debts!While the NHFS will have to get the money from the public in the form of premiums plus funding from the government, at least it will distribute the health service to a united system. Patients can go anywhere without paying anything and the GPs will be able to get the load with lower overhead cost, enough to have a job to survive.

Either we change to live a reasonable decent life or we die a slow death……. it’s our choice.

 

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Towards Malaysian Baru ?

It has been almost 3 months since I last updated my blog. I had to travel a lot during these 3 months and a lot of personal issues to settle. But one thing I never forget or miss, is to vote! I have voted in every election since 1995 except in 1999 where I could not go back as I was on-call(at that time my voting station was in Seremban before I changed to Johor for 2008 election). This year’s election was the mother of all elections and the verdict was something I had never expected. I never expected BN to fall in my life time! The most I expected was to give BN a close simple majority to win. I also never expected Johor to fall and close to winning 2/3 majority by Pakatan. While I stood awake till 4am in the morning of 10/05/2018, i could not resist the tears that flowed through my eyes when I saw the people of Malaysia waking up and voting out a government that has been in power for 61 years.

I had always supported a 2 party system. It is a system that is in place in most western countries or matured democracies. The people have the power to decide which coalition party will rule the country. In any such countries, you will see that the people will change the government every 5-10 years. This will keep the ruling party on their toes and never to underestimate the power of the people. Once they fall, their dirt will be washed in public as what you can see happening right now in Malaysia. So, in the future no party can hide anything for long. It will benefit the people in long run.

So, what are we to expect from this new government. To be frank, I don’t expect much in 5 years. There are a lot of things that need to be corrected over a short period of time. First and foremost, I feel the new government should put a system in place that will prevent any form of power abuse. AG, MACC, EC chairman etc should be elected by Parliament and made answerable to the Parliament. MACC should be given power to prosecute. These people should face the Parliament to answer questions from both side. Prime Minister’s term should be limited and Finance Minister should never be the Prime Minister.

WE should not forget that the mess that this country is in now, and abused to the maximum by the previous PM was created by our current 7th Prime MInister! I had written enough about this in my earlier articles way back in 2010. I had mentioned how DR M’s social engineering and Malay nationalist ideas destroyed the future of this country. However, he did develop this country into an economic power house which benefited many people. Unfortunately, as smart as he is, he never expected or foresee that his very own people will misuse the system that he created. I just hope that in his last few years of life, he had realised his mistakes and do what is necessary. I had always said to many people that GOD will make sure that DR M will live long enough to see the damage that he has done to this country. GOD is great!

Many people asked me whether anything will change to the medical field. Firstly, I don’t think the long waiting period of medical graduates for employment will change anytime soon. With the current financial situation of the country, it is unlikely that the new government can create more post or even build more hospitals. With increasing number of graduates from this year( where all medical schools will be producing graduates), the waiting period will only get longer. However, one thing that the new Education Minister can do is to tighten the entry qualification into the medical program. By doing this and making the accreditation process tougher, many medical schools (especially the smaller “shop-lot” ones) will undergo slow death due to lack of enrolment. Over the last 2 -3 years, many medical schools already struggling to meet the required number of students.Imagine increasing the entry criteria to 5A’s in SPM with higher CGPA in Pre-U courses. Hopefully, this measure will slowly reverse the current situation over the next 5-10 years. Remember, the mess that we are in now was created almost 14 years ago!

If even the Ministers’ have to take pay-cuts, I don’t expect any pay rise to civil servants in near future. Probably once the country’s economic status is better, we can expect some pay rise. What I would like to see is a complete restructuring of the Malaysian Healthcare System. The current system of having public and private healthcare system running parallel to each other is not sustainable in long run. The government would not be able to sustain the increasing healthcare cost and maintaining an almost free healthcare system. On the other hand, the private health insurance companies would not be able to sustain the private health sector. Our private health sector is almost 90% funded by the private health insurance. I use to tell my friends that if the private health insurance collapses, I will become jobless!

I would really like to see a proper integration of public and private healthcare sector via a National Health Financing Scheme. This should include the GPs, private hospitals, KKs and public hospitals. WE have enough doctors but maldistribution is the issue. BY having such a system, maldistribution between private and public sector can be reduced. Eventually, this will also reduce the maldistribution between urban and rural areas.

With all the euphoria that we are having now, it is just too early to say how this new government will perform. Statistic shows that Pakatan only received 48% of the votes with BN & PAS taking 52% of the votes. Pakatan won in many areas due to split votes. PAS benefited from split votes in Kelantan and Terengganu. Personally, I feel that the Pakatan government is not really in a very stable situation. Tides can change by next election if they do not outperform the previous government by leaps and bounds.

Whatever said, politics in Malaysia will NEVER be the same anymore………

 

SELAMAT HARI RAYA 2018 TO EVERYONE………

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The world of medicine is changing rapidly. For those who are aware what is happening around the world, we know how the perception of public towards medical profession has changed. Unfortunately, there are many out there who are living in cocoons, do not even know that sooner or later they can be charged for manslaughter!. The recent case in UK involving Dr Bawa Garba has sent shock waves around the world. A senior trainee paediatricians were given suspended jail sentence of 2 years for gross negligence amounting to manslaughter. GMC ( the guardian of medical profession) appealed to High Court to struck off her registration despite Medical tribunal giving only 12 months suspension. Two weeks ago, the court allowed GMC to struck off DR Bawa Garba from medical registry. A detail reading of her case will remind us that what has happened to her, happens on a daily basis everywhere in this world! Unfortunately , the world is changing.

Many still believe that medical indemnity will cover their butt if and when they make any mistake. Unfortunately, any negligence leading to death can now be charged under manslaughter and no more a civil negligence case. IN Malaysia, similar case is currently ongoing involving our very own DPM’s son in law’s death. The doctor who gave sedation is now being charged for manslaughter which can carry a prison sentence of up to 10 years. If he is convicted, it will set a precedence for any other such cases in the future. Similarly, another doctor was charged in December 2017 for circumcision gone wrong. He is being charged under Section 338 of Penal code for causing grievous hurt which can give you 2 years of imprisonment.

IN the US, just 2 months ago, an anaesthetist was charged for murder, “killing” a patient undergoing plastic surgery procedure by giving overdose of an anaesthetic agent. In fact, the first time a doctor was charged for second degree murder in US was in 2015.

Doctors around the world are rallying behind DR Bawa Garba. The fact is , the case just portrays how the healthcare system has failed. She was overworked, just came back from maternity leave and covering 2 person’s job without a supervising consultant. Sounds familiar? Unfortunately, the court do not take into consideration of all those shortfalls. It just concentrates on the negligence part and sentenced her accordingly. Any gross negligence leading to death is now considered a manslaughter! Is anyone still living in dreamland thinking that doctors are “gods” in the eyes of public? You are treated similar to anyone else when you cause a death due to negligence. Nothing special.

DR David Sellu’s case in 2013 is another good example. A well renowned colorectal surgeon of 66 years old was sentenced to 2 and a half years imprisonment for causing death of a bowel perforation case. A patient who developed bowel perforation following a knee surgery, deteriorated while waiting for surgery and subsequently succumb to sepsis. This happened in a private hospital with limited facility for emergency anaesthetist and OT. Thankfully, after 15 months spending in jail, the court of appeal reversed the decision when new evidences emerged regarding the lack of facility and why he could not do the surgery immediately. Unfortunately, damage is done and he had spent 15 months in jail together with other criminals convicted of rape, murder etc! After saving lives for 40 years, at the age of 66 he was treated as a criminal and even labelled as Dr Death! He was also subsequently subjected to GMC’s suspension. This is a good article to read as well : https://health.spectator.co.uk/david-sellu-a-surgeon-wrongly-jailed/

These cases have created a new term : ” Medical Manslaughter“! The list of such cases in UK till 2014 are listed in this article and attached below.

 

Looking at those cases above, we will wonder that these are nothing unusual in day-to-day medical practice. It happens on daily basis. Sometimes complications can never be predicted. Errors do occur and it is not entirely due to the doctor’s fault but the system as a whole. There are many factors that can cause such negligence to happen or how the complications are treated. Unfortunately, the court only considers the healthcare professional’s mistake. This applies to paramedics as well. Nurses have also been charged for manslaughter. This WEBSITE has some information of other health professionals who have been charged similarly.

 

The above video made last year is worth watching. Doctors are humans and do make mistakes. However, the society is not willing to accept these mistakes anymore. I had written much about civil litigation that is increasing day by day. Criminal charges are now increasing day by day as well. As long as you are proven to make gross negligence leading to death, you can be convicted for manslaughter. This can be as simple as giving a medication !  For example, if you give IV Pethidine for pain and the patient stopped breathing and dies, you can be charged for “murder”! And subsequently, the medical council will struck you off the register!

As I had always said, the world of medicine is changing. Modern medicine is infected by virus of mistrust as written over HERE. Commercialisation of medicine is one of the reason behind these issues. A profession which started during ancient times as a science to help people has been systematically and gradually converted into a multi billion dollar business. A business to suck people’s money in many developing countries. Generally, countries which have a universal healthcare system will have lesser number of negligence and complains, as patients do not pay much. Unfortunately, NHS in UK is dying day by day due to lack of funds and overcrowding.

If criminal charges against doctors left unchecked, we may be seeing many doctors behind bars despite saving many lives! I wonder whether AI will come to the rescue? Can AI be charged in court for making a mistake? These are the reasons why many doctors are feeling the overwhelming stress at work(burnt out) all over the world. After years of training and money spent, a simple mistake will land you in court. What use to be civil has now become criminal offence. I can only see more and more doctors retiring early and leaving medical practice. Many do not even encourage their offsprings to do medicine.

What I foresee is that the society will dig their own grave. More and more people would not do medicine. Many doctors would not take high risk cases. Consent forms will become as thick as “Harrison’s Book of Medicine”. Finally, mistakes will be hidden and notes will be fabricated!  The art of medicine is already dying due to CBM (Cover backside medicine) but eventually medicine itself will undergo a silent death………..

Gong Xi Fa Chai everyone………

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3 years ago, i wrote an article about a pharmacy which was treating patients like a doctor‘s clinic. In fact that was the 2nd time I wrote about the same pharmacy. For the first, I sent an official complain to Jabatan Kesihatan/KKM and for the 2nd I sent the letter to JKN. However, I never received any further feedback from any one of them. Typical of any government agencies which never provide any feedback. Wonder whether it is under Official Secret Act!

While over the last few years, I do see patients being prescribed medications by pharmacist which they should not be prescribing in the first place, I just kept quiet as I felt it is worthless complaining. I have seen Prednisolone being given by pharmacist without prescription and even NSAIDS being given continuously without even knowing the patient’s renal status. Worst still, I have even patients buying Methotrexate from pharmacy without even my prescription.

Last week, yet again I saw the VERY SAME pharmacy/pharmacist prescribing the following 2 medications to a patient with poly arthritis of 1 year duration!

IMG_20160624_1122025

 

According to the patient, she was not even examined by the pharmacist. He just listened to her complains and gave her the medications above. One is a steroid(Betamethasone) and another is Sulphasalazine! Patient developed allergic reaction to Sulphasalazine and THANKFULLY, she stopped the medications. Sulphasalazine contains sulphur and allergic advise should always be given as it can cause Steven Johnson Syndrome and Toxic Epidermal Necrolysis. I will always advise patients about allergic reaction whenever I prescribe Sulphasalazine. Furthermore, this is a generic Sulphasalazine! Finally, one fine GP referred this patient to me.

So, what action has the JKN taken to this pharmacy? How in the world they can continue to prescribe these type of medications to the general public? I forwarded yet again this picture to a colleague of mine in JKN for further action. While I don’t expect anything much but at least I have done my job to protect the public.

ON another note, why did this patient even landed up with a pharmacist? Sometimes, we are to be blamed for all these issues. Patient had seeked multiple consultations from various GPs and Klinik Kesihatans but was only given NSAIDS. Patient has clear-cut Rheumatoid Arthritis. Her RT wrist is almost fused now.

Then we have TCM practitioners who are happily treating patients with “so-called” herbal medications which obviously contains steroids. The moment the patient walks into my clinic, I will give them a spot diagnosis and most of them will be shocked! An obvious Cushing’s syndrome. Serum Cortisol levels will be < 16 in almost all these cases. I do this just to prove to the patient that they have been taking exogenous steroids. Interestingly, recently I came across a patient who was given intravenous infusion by a TCM practitioner over the last 2 months. It was given periodically with tapering dose durations. The patient has Rheumatoid Arthritis. The patient definitely looked Cushingoid. Was he giving steroid infusions? “ Hari ini masuk ubat, besok boleh lari lor“, exactly what the patient told me! Obviously it is steroids! I wonder whether the person giving it knows that these are all steroids and nothing miracle! Or are they giving western medicine in the name of herbal medicine?

I call a spade, a spade all the time. Many do not like me because of this but I have my principles. Patient safety comes first in all instances. Sometimes, we doctors are to be blamed for all these distrust going on out there. While I have said that patients are becoming more and more naturalistic, claiming we are giving chemical to destroy their kidneys etc, doctors are also venturing into unethical medicines. Unethical practices are NOT uncommon nowadays. I have seen enough steroids being given by doctors themselves. Just saw a 76 year old man with OA knees given betamethasone daily for the last 3-4 years. The daughter is asking me why is his skin becoming thin with easy bruising! How am I suppose to answer that when I know exactly what’s the answer.  I saw a patient with generalised body-ache being given Prednisolone 5mg tds! Am I outdated or something? Many doctors out there still do NOT label their medications despite the law mandating it. Eventually business and profit takes over you, either consciously or unconsciously!

It’s called “Prostitution of Medicine“, a word described by the late Prof TJ Danaraj, the founding Dean of University Malaya medical faculty. Commercialisation of medical education and medical practise will eventually lead to this. Medicine is used to make money. It’s not a noble profession anymore.

The world on the other hand is going mad, especially in Malaysia where race and religion is used for business. WE have doctors promoting anti-vaccination (circulating in Facebook) and home birth. In fact, my wife just saw a HO who refuse to vaccinate her child! She is still doing her Housemanship. Interestingly, her husband who is not a doctor is not against it !We have doctors promoting supplementary products claiming can cure every illness in the body. We have an apex University promoting miracle water, suppose to cure 150 illness. We have syariah compliant dental clinics , whatever it means! What’s next ? Halal and Non-Halal clinics/hospitals? Trust me, we will be seeing more and more of these type of issues creeping into this country.

The practise of medicine is never the same anymore. I enjoyed practising medicine during the first 10 years of my service when patients listens to you and unethical practices were almost unheard of. Now, it saddens me when I see patients refusing medical treatment, refusing vaccines, unethical doctors, lost of clinical medicine and the rise of investigative medicine(make money for corporate guys). The rise of vaccine preventable infections like Diphteria and Measles are part of the consequences of our society’s ignorance. Wondered why our medical forefathers created medical councils run by medical practitioners to control the ethical practise of doctors? They had predicted few centuries ago that medical practise can be misused for profit and the world of medicine will eventually undergo slow death.

Many youngsters will realise all this when they start their practise. With more and more doctors being produced with huge debts behind them, medical business will only get worst! While my books will hit the stores within the next 2-3 months, I am now preparing for my 3rd book which hopefully will be released next year.

Selamat Hari Raya 2016 to everyone……………

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Finally, the government aka JPA has announced the new scheme for scholarship. As expected, the numbers has gone down and overseas scholarship is being reduced. When the bursary program was announced in 2012/2013, it was an election goody. Somehow I knew it may not last long. Those who benefited are the lucky ones. Personally I feel we should stop giving scholarship based on SPM results. SPM is never a pre-university course. WE should standardised our Pre-University courses and use that as the University entry and scholarship requirement. Unfortunately, in the name of education hub, there are simply too many pre-university courses being conducted in Malaysia. This has resulted in agencies, including MMC to use SPM results as the main university entry requirement.

I had always felt that the best students should be retained within the country. However, it should be in public universities. Unfortunately, selection of students into public universities are always biased based on certain constitutional rights. Education should never be commercialised. WE can see the outcome of this commercialisation with the quality of graduates being produced nowadays. This in turn will also affect the public universities’ quality as it is never based on merit. We have just too many higher institution of learning with too few academics. We have more medical schools than what UK has for double the population.

Well, for this year, only 250 students will be selected for bursary. None from next year. Only top 20 students will be given overseas scholarship which I think is fair enough. They must return to serve the civil service. 200 special scholarship for engineering courses are still maintained. The local undergraduate scholarship will be given as loans. Graduates are required to repay 25 per cent of the loan amount if they work with government-linked companies; graduates are required to repay 50 per cent of the loan amount if they work in local private companies; and graduates are required to repay the entire loan amount if they choose to work abroad. For those who join the public service sector, they should serve within a certain period of time according to their field of work, for example within six to seven years for engineering and over 10 years for the medical field. 

Personally I feel it is a fair criteria but does the same rule apply for scholarship offered by other bodies such as MARA, State governments, Majlis Agama etc?

*** update 9/04/2016: as expected, the government announced that all 2015 top SPM students will receive bursary to study locally****

Fewer overseas scholarships

BY CHELSEA L.Y. NG

PUTRAJAYA: The bulk of SPM top scorers who apply for Public Service Department (PSD) scholarships can forget about studying in top universities around the world.

They will have to make do in local universities.

The privilege of choice overseas study will be reserved only for the best 20, according to the Public Service Department (PSD) which is the country’s largest provider of scholarships and bursaries for post-secondary education.

In a media briefing here yesterday, a PSD senior spokesman said only 20 of the “creme de la creme” would be allowed to study in top ranking universities abroad and return to join the civil service.

“It is part of the long term plan to inject the civil service with quality graduates who will in turn be quality civil servants.

“They will be groomed to be our civil service’s next generation of leaders,’’ the spokesman said.

He said an additional 200 top students would have places under the Special Engineering Programme but would only be allowed to study in Japan, Korea, Germany and France.

On the new funding regulations, the spokesman said that studies in local public and private universities will be given priority.

“We cannot be having all our finest and brightest study outside the country as it does not reflect the aim of having outstanding students in our local institutions,” he said.

The spokesman also announced that there will be no more Bursary Graduate Programme from next year onwards.

For this year only 250 SPM leavers with 9A+ from 2015 will be offered funds through the bursary programme to study locally.

As for some 744 students, who qualified for the bursary programme in 2013 and 2014 and were hoping to study abroad, they will now have to do their degrees in local public and private universities.

The spokesman advised the 744 students not to be disheartened.

“You can’t get what you want all the time, just like everyone wants to be a CEO but that is impossible,’’ he said.

“The focus is on funding more people to get into the varsities here. The quality of our varsities have improved,” he added.

Stressing that the Government was trying its best to offer as many scholarships as possible from the RM1.65bil pool announced in Parliament recently, the spokesman said there was also the additional allocation of RM160mil approved under the recalibrated Budget 2016 to fund this year’s batch of students.

This amount, which came following the Budget 2016 revision announced in January, is meant to support 49,060 students, with 41,324 (84%) of them studying here, and the remaining 7,736 overseas.

He said among the criteria that will guide the PSD in its selection process were merit and the socioeconomic background of the applicant, besides grades and co-curricular achievements.

The spokesman said the department will also focus on those categorised in the B40 and M40 groupings, with attention on technical & vocational education and training (TVET).

(B40 refers to the bottom 40% of households in the country who typically live on a monthly household income of under RM3,860, while M40 refers to those from households with monthly incomes of up to RM8,319)

A thousand students from B40 families will be offered the Dermasiswa B40 to pursue diplomas in polytechnics and public universities, including Universiti Tenaga Nasional and Multimedia University, he said.

Seven thousand university students, who are currently pursuing their studies in local public and private institutions of higher learning, will continue to benefit from PSD funding.

The spokesman added that a special briefing for 2013/2014/2015 Bursary candidates will be held soon, although no specific date was mentioned. More information can be found at esilav2.jpa.gov.my or by calling 03-88853603/3777/3398.

PSD introduces new sponsorship model

Tuesday April 5, 2016
10:32 PM GMT+8

PUTRAJAYA, April 5 — The Public Service Department (PSD) has implemented a new student sponsorship model this year, including the introduction of a sponsorship programme for 1,000 students from the B40 families.

(B40 relates to bottom 40 per cent household income) Besides the B40 Dermasiswa programme and five other sponsorship schemes, the new model also requires students to sit for the Cambridge Online Test (COT), to evaluate the applicant’s personality and tendencies.

A senior PSD officer said overall, the new PSD sponsorship model was drafted based on four key thrusts, namely merit and inclusivity; focus on the B40 group, M40 and the Technical and Vocational Education Training(TVET); development of Malaysia as an education hub; and, return on investment (ROI).

“The new model focuses on the sponsorship of students to local higher learning institutions to retain the brightest students in the country, thus supporting efforts to make Malaysia a regional education hub,” he said.

Five other sponsorship programmes are the National Scholarship Programme; the Special Engineering Programme to Japan, Korea, France and Germany; the Local Undergraduate Programme; the Post-Bursary Programme; and the Bursary Programme.

He said to ensure commensurate returns, starting this year, sponsorship would be implemented in the form of variable rate loans except for the Dermasiswa B40 programme.

The sponsorship agreement will be subjected to four conditions, namely loans can be converted into full scholarships and are exempted from repayment if graduates serve in the public service.

Graduates are required to repay 25 per cent of the loan amount if they work with government-linked companies; graduates are required to repay 50 per cent of the loan amount if they work in local private companies; and graduates are required to repay the entire loan amount if they choose to work abroad.

“For those who join the public service sector, they should serve within a certain period of time according to their field of work, for example within six to seven years for engineering and over 10 years for the medical field,” he said.

The PSD officer said for the Dermasiswa B40 programme, sponsorship would be given to 1,000 students to pursue diploma studies in polytechnics, public universities, Universiti Tenaga Nasional (UNITEN) and the Multimedia University (MMU) in the TVET field.

“It is estimated they will receive a minimum sponsorship of RM25,000 for a duration of three years,” he added.

He said the selection of students for the B40 Dermasiswa Programme was made, among others, through the National Poverty Data Bank or eKasih list, students from households with monthly income of RM3,690 and below and consideration on household income based on states and localities.

“This is part of the government efforts towards realising the highly-skilled talent development to meet the needs for skilled workers in the future.” On the National Scholarship Programme, he said 20 best Sijil Pelajaran Malaysia (SPM) 2015 holders would be sponsored to study at top universities worldwide.

He said the sponsorship would cover the preparatory courses in the country, that were limited to certain fields, designated by the government.

For the Special Engineering Programme to Japan, Korea, France and Germany, the PSD officer said it would be given to 200 SPM 2015 holders, who were interested to take up a diploma or bachelor’s degree programme in engineering in the three countries.

The sponsorship would also include preparatory courses taken in the country, he added.

He said under the Local Undergraduate Programme, sponsorship would be given to 7,000 students to pursue their studies in public universities, UNITEN, MMU and Universiti Teknologi Petronas (UTP).

PSD will continue the Post-Bursary Sponsorship Programme for 744 Bursary Programme 2013/2014 (SPM 2012/2013) students, in order for them to pursue their first degree at local universities set by the government.

Under the Bursary Programme, he said sponsorship would be given to those who obtained 9As+ and above in SPM 2015, with the selection of recipients based on merit and inclusivity.

According to the PSD officer, the sponsorship is focused on the fields of clinical and health, engineering and technology, and science and social science.

“The Bursary Programme that was previously handled by the Education Ministry will be implemented by PSD on a one-off basis and for 2016 alone. This programme will not be continued, beginning 2017,” he said.

Meanwhile, he said a special briefing session with the Bursary Programme 2013, 2014 and 2015 students would be held in the near future.

Students involved can refer to the PSD’s portal at http://esilav2.jpa.gov.my or contact 03-88853603/ 3777/ 3398 for more information regarding the briefing.

Overall, he said the JPA was continuing its sponsorship programme with an allocation of RM1.65 billion for 49,060 students comprising 41,324 students locally and 7,736 students abroad.

An additional allocation of RM160 million has been approved under Budget 2016 to finance the sponsorship of new students in 2016. — Bernama 

– See more at: http://www.themalaymailonline.com/malaysia/article/psd-introduces-new-sponsorship-model#sthash.QyEIwPS1.dpuf

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