"I believe in a country where hard work and merit, not privilege or background, determines success."
Tony Blair 2005

Sunday, September 30, 2007

Doctors with borders

A recent report of an Australian doctor requesting for a reward in return for treatment rendered to a fellow passenger is a revelation on the true mindset of doctors today. Even the Australian Medical Association(AMA) agrees that doctors should be compensated by airlines for services rendered. How greedy and calculative can one get?

Being a doctor is unique in a sense that we are bound to bump into a medical emergency in the least expected of places. It is not about being on call round the clock as was argued but rather a sense of duty, as a doctor. A sense of satisfaction when we are available at another's time of need, will usually suffice.

When a doctor decides to treat another, for example in an airline, it would be considered volunteering. One could decline to act but then it would only bear down on one's conscience. It is such conscience that makes doctors unique. It should be a reaction rather than a conscious decision.

I am ashamed that the AMA has defended a fellow doctor when all it has done is to reveal a decaying moral value of doctors today. Are we blood thirsty vampires out for more blood? Do we no longer accept a simple thank you as a sufficient gesture? Or are we becoming like lawyers, forever deceiving a gullible public?

Perhaps we should include in the Hippocratic Oath that one should treat without any pre conditions. But which doctor actually remembers the full content of the Hippocratic Oath anyway!!

Saturday, September 29, 2007

Burmese tragedy

The military junta remains defiant and today continues to quash pro-democracy demonstrations in the capital Yangon. It's military rulers appear immune to international prosecution when it comes to crimes against humanity. Despite decades of political pressure, the military junta appears firmly in control of the country.

Despite being part of ASEAN, other ASEAN nations are notoriously silent, preferring not to break a spirit of non-interference in internal affairs of another member country. In addition, countries like China and India continue to focus on economic gains through their investments, throwing a lifeline to the Burmese rulers.

Malaysia is seeing an influx of Burmese workers which on most occasions is a blessing as they are renowned for being hardworking. Nevertheless, it will no doubt worsen the refugee crisis in neighbouring countries including Malaysia. A nation of 54 million Burmese, a paucity of jobs and a hardline ruler are warnings for an impending refugee crisis.

Malaysia and similarly ASEAN nations should be more aggressive in their stance against the military junta in Myanmar. ASEAN nations should be based on democracy despite a non interfering role amongst member countries. Admitting a country like Myanmar into ASEAN is hypocritical and defies a logical political move. Arguments that ASEAN does not wish to seclude Myanmar to enable subtle political negotiations, is baseless and proven ineffective. If the military junta feels that they are immune to international opinions and rule of law, then the time for talk is over.

Delaying economic sanctions and political isolation will only fuel delusional beliefs of the military junta. Malaysia is paralysed into inaction when it's record too is hardly pristine, lest they be termed hypocrites.

Monday, September 24, 2007

TB on the rise in KL

From a recent news report indicating an alarming rise of tuberculosis and HFMD infections in an affluent area of Malaysia.

What is worrying is the actual incidence rate of MultiDrug Resistant TB infections in Malaysia. MDR TB is a problem in surrounding countries in South East Asia and has not yet been a major problem in Malaysia.

Tuberculosis has always been thought to affect lower socio-economic groups. Thus much blame has been put on migrant workers. The new style of living in high rise buildings could also have a role in this air borne infection where families are now living in closer proximity to each other.

It is however still of paramount importance to beef up the health screening of migrant workers and identifying illegal immigrants which is thought to be in the region of a few hundred thousands in Malaysia. Citizens of Malaysia will have play an important role here. Solely relying on the police and the immigration authorities may not be sufficient if we are to plug the holes in our borders.

At the same time, doctors should be thorough when examining immigrants during their compulsory health screenings. Being pressured to pass off an unhealthy individual should not occur and is tantamount to medical negligence.

Strengthening our DOTS program is important to ensure completion of treatment and thus reduce the likelihood of MDR TB. Complacency in this aspect will be catastrophic.

Ultimately, TB is a treatable condition. What is more ideal would be a more effective drug requiring a much shorter course of treatment. Many new compounds are currently being tested and still remains far from reaching clinical practice. There is a Tuberculosis Antimicrobial Acquisition and Coordinating Facility (TAACF) which accepts new compounds for testing against TB.

Perhaps a Nobel Prize is in store for the discoverer of a new more potent anti-TB drug which will revolutionise TB treatment and save millions of lives.

Sunday, September 23, 2007

Crime on Innocence

Alas, DNA evidence has put pen to paper with regards to the true identity of a young girl, brutally murdered by a sadistic pedophile still at large. An entire nation is no doubt enraged by such viciousness and driving most parents to paranoia.

The scramble for answers has begun. Can parents actually be vigilant round the clock? How can the society spot the danger before it arrives?

Not unlike the Cho shootings at Virginia Tech, many such cases tend to reveal startling warning signs, glaringly clear in retrospect. Perhaps a previous crime of passion or rape, or maybe a mind filled with sadistic delusions.

A sick mind is as real as a sick heart. Psychiatry, often viewed as the pariah of medicine, should be equally recognised and researched. In a nation where the paucity of psychiatrists and psychologists alike is evident, many sick minds go untreated, much to the peril of the defenseless.

Even in schools, educators must be taught the warning signs of psychiatric disturbances and thus refer for much needed professional help. Unfortunately, such competence is sorely lacking. What hope is there when deaths at national service camps are never taken seriously or thoroughly investigated.

Improving our skills in forensic medicine is paramount if we are to solve cases. Much is needed to beef up our current CSI teams.

Traditional or faith healers, to me, is a scheme of deceit. The latest drive by the government to approve traditional medicine where evidence is scarce, is disappointing and does not display the quality of a progressive nation. Outlawing such practices should not be delayed if we are to put to an end countless unscrupulous medical practices.

Catching the perpetrator of Nurin's death is only the beginning of a journey in our understanding of such heinous crimes. Let not her death be in vain.

Saturday, September 08, 2007

Washing dirty linen in public

There is an increasing spate of doctors penning their thoughts in our local dailies. Contents range from advice to discontentment. A recent letter stood out like a sore thumb. What is the point of writing this letter in the press?

Docs must be more open to referrals

HEALTH Minister Datuk Dr Chua Soi Lek recently brought up the matter of the responsibility of doctors who are on call; namely that they should be ready to work during their call hours as they are being paid. continuing story

This doctor laments on the attitudes of doctors taking referrals from primary care teams. However, there are always two sides to a coin. I do agree that it is important for doctors, be it those that refer or the ones that receive them, to carry out their duties with decorum.

Unfortunately, it has to be understood that on call doctors taking referrals would have been working for the entire day, as opposed to most referring doctors , especially those manning the emergency units, who work by shifts. Primary care doctors should not take it to heart if the doctors at the other end of the line appears edgy or "difficult to deal with".

Calling for help should not go unheeded and should be taken seriously. However, there are many instances where primary teams are lackadaisical and careless. For example, a referral for jaundice made to a medical team without a proper history, examination and initial investigation, displays incompetence.

There are many variables at stake here. Perhaps the author of the letter should bring the matter up with his respective hospital administration before showing such angst in a public domain.

Perhaps, what medical educators should stress upon, in addition to doctor-patient relationship, is doctor-doctor relationship. A department where even senior doctors would trip carelessly.
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