Woodlands "not in my backyard" syndrome and how politicians should overcome this together

Dear Editor,

Introduction

I refer to the negative reactions of some HDB residents when they found out that eldercare centres were slated to be built in the void decks of 2 blocks in Woodlands Street 83.( Click here)

Among reasons to support their petition to their MP included concern that the flats will drop in value and that it would be inauspicious when there are more deaths in the estate!

Ugly examples of “not in my backyard" syndrome

This troubling phenomenon is the often mentioned “not in my backyard” syndrome where Singaporeans will publicly welcome community amenities such as hospitals unless it is to be located in their community.

We saw this in Serangoon Gardens when the government wanted to build proper dormitories for foreign workers only to face vociferous protests from residents there.

These Singaporeans recognize that foreign workers are needed for our economy and that the older generation had made significant contributions in Singapore’s success, but nonetheless, prefer that these groups of people be kept out of sight, hidden somewhere else.

Politicians should discard partisanship to support the common good

Sound community initiatives such as the eldercare centres would risk being shelved due to the parochial reactions of some Woodlands resident unless politicians from both sides of the political divide openly support them.

These protesting residents often use the threat of their vote as a lever (like a child who tries to play one parent against the other) but if all major political parties openly state their support for such initiatives, such essential facilities for our elderly will not be discarded.  

Skeptics will say that politics in Singapore would never allow non-partisanship and may (with some justification) point to instances when sound policies such as the WP’s Sylvia Lim’s attempt at introducing “Happiness Index” was shot down by PAP MP’s in a very partisan manner. I also sadly recall Ex-MP Chiam See Tong’s suggestion for smaller classes for more effective schooling being dismembered and ignored for the very same reason ( partisanship).

I am an optimist and hope for a new political norm where policies and initiatives are supported or rejected by politicians on their merits alone. And nothing else.

Dr Huang Shoou Chyuan

Singaporeans do not accept politicians' revised pay - blame it on PAP and Gini

Dear Editor,

Introduction
I feel some discomfort to see the government metaphorically pulling its hairs trying to understand why Singaporeans are still unhappy despite its offer to reduce ministers’ salaries to what it thought was by a significant percentage.

Parliament’s acceptance of this new pay package has not gained traction with the typical Singaporean who lives in the HDB heartlands as despite these cuts, Singapore’s ministers are still the world’s highest paid politicians by a wide margin.

I will just suggest two factors that account for this disconnect- the first one being created by the People’s Action Party (PAP) and the second due to how our world is structured.

1.PAP’s inability to attract the talented to its cause

The PAP as a political movement is not attractive to any idealistic Singaporean who views public service as an honor ala the concept of “Noblesse oblige”. (David Marshall on Noblesse oblige)

“Noblesse oblige” literally means nobility as an obligation and points to benevolent, honorable behavior considered to be the responsibility of persons of high birth or rank. In our context, it means our ablest must feel the privilege to serve. In any group, the ablest automatically steps forward to lead. It is expected. Period.

Unless the group has become dysfunctional with little sense of identity.

Hence PAP’s problem (and its solution with high salaries) has now become Singapore’s problem. Other political parties such as the Worker’s Party have little difficulty attracting talents even before it became fashionable to be associated with non-PAP parties. 


Expecting Singaporeans to accept PAP's logic is like trying to put square pegs into round holes!

2. Gini coefficient and the unfair world.

Bill Gates said in a speech at a high school that the first of 11 things they will not learn in school is 
“Life is not fair- get used to it!” (Bill Gates link)

The Gini coefficient is named after Italian statistician Corrado Gini, and measures the income distribution across a country and often used as gauge of the income gap. (Gini coefficient link)

The United Nation Development Program published an unflattering report that ranked us second only to Hong Kong in terms of income inequality ( see link here ) .

No matter if we blame globalization or our open economy, the fact remains our poorest and our richest might as well be living on different planets.

Unfortunately, the Committee to Review Ministerial Salaries has referenced the top 1000 highest paid Singaporeans (albeit with some discount) for our leaders’ salaries.

Hence the remunerations, even after the review, remain unfathomable to many middle and lower income Singaporeans. Why does any Singaporean require so much before he can be coerced to serve his fellow citizens?

A colleague has very succinctly summarized our political reality-

“The government’s moral authority is inversely proportional to the ministers’ salaries.”

Conclusion:
The dice has been cast, and the PAP dominated parliament has accepted the review, we should just leave it to the political parties to win over our hearts and minds.

Dr Huang Shoou Chyuan

Health Sciences Authority's high cost of registering medical devices needs urgent review

Dear Friends,

I was ( and still am) extremely concerned that certain of HSA’s (Health Sciences Authority) regulations can potentially cause great harm to Singapore’s healthcare industry directly and the welfare of our patients indirectly.

Distributors of medical devices are finding that it is not economically viable to bring in much needed medical devices. These distributors are not just from my specialty but from all medical and surgical disciplines.

I felt that if something were not done quickly to rectify this, this might signal the start of our decline as a Regional Centre of Medical Excellence.

Hence, being the good citizen that I am, I wrote to a person of very high standing in the Ministry of Health and to the press. However, I did not even get an acknowledgement much less a response from the MOH. I don’t think the forum editors feel this issue of enough mass appeal for publication either.

Just in case the powers-that-be think I am a rabble-rouser ( or shit-stirrer), I am not. 

Whoever has the ear of the powerful, please feel free to forward this to the relevant authorities.

Cheers,

Dr Huang Shoou Chyuan

The letter:

Health Sciences Authority’s (HSA) registration procedure for Medical devices needs urgent review

Introduction

I did not take seriously the complaints by vendors of medical devices, who claim that new regulations by Health Sciences Authority (HSA) have added significant cost to doing business as well as threaten our status as a regional centre of medical excellence, until it affected me personally.

My ENT clinic’s audiometric equipment for ear assessment became spoilt beyond repair and when the distributor revealed that although there is a newer version in the market, they are not importing it due to high costs and risks involved in getting these devices registered and evaluated by HSA.

HSA’s website states that any medical device (whose broad definition means almost everything one sees in any typical medical clinic and range from the mundane eg suction pump, to the complex eg heart valve) needs to be registered and evaluated before sale to end-users. Click here. 

HSA’s high fees (click here)

Registration for Class B ( low-moderate risk eg suction pump) to Class D (high risk eg heart valves) devices include a one time application fee of $500 followed by an “abridged” evaluation fee ranging from $1800 to $5700 if these had already been approved by competent overseas regulatory agencies such as USA’s FDA (Food Drug Authority) or European Union etc.

If not previously approved by any agency,higher evaluation fees ranging from $3500 to $11400 apply.

No device is exempt (not even if these had already been evaluated and approved by America's FDA which has a reputation of being very stringent). In fact, I was told that sponges ( which come in various sizes) used for packing after nose surgery have to be individually registered!

The higher costs and our small market (there are less than 40 ENT clinics plus 5 ENT departments in the restructed hospitals) have caused many vendors to give up product lines. Those that do register the products would inevitably pass on the additional cost to the end-users. In both scenarios, the patients will be the losers as either they will not be getting the newest technologies or if they do, it costs them much more.

Proper regulation of medical devices is crucial for “safeguard(ing) public health” but the cost for this should not “unduly restrict consumer choice and their access to new technologies”- ironically mentioned on HSA’s website as something it wants to avoid.

Suggestions

I suggest that HSA operates on a cost-recovery basis. Application fees should be lowered to $50 and those devices that had prior approval by other competent agencies should not need re-evaluation and hence fees should be lowered to reflect the paperwork done to verify documents which should cost no more than $200.

Those not approved by any agencies would of course need evaluation by our competent local agencies but fees should be applied in a transparent manner reflecting actual work done.

Fee reduction will mean a win-win for all. Patients will feel assured that our medical devices have been properly certified and vendors can source for devices that their doctors need without worrying unduly about losing money if after paying huge fees for evaluation find that our small market disadvantaged them. 

Dr Huang Shoou Chyuan

(NB: Dr Huang holds several offices in various medical committees at different levels but writes this in his personal capacity. He does not have any financial interest in any medical device companies. )