Wednesday, January 31, 2007

Foreign Doctors- Should we err on side of caution?

1.More foreign docs, but 'no lowering of standards'
By K. C. Vijayan Jan 29, 2007 The Straits Times

SINGAPORE needs more doctors, and the Government will let in those from the top two to five overseas medical schools from Asian countries like India.

But Health Minister Khaw Boon Wan made it clear there would be 'absolutely no'' lowering of standards in the move to get more foreign doctors to make up the numbers.

Singapore's goal is to have enough doctors in the public sector, which will translate into a ratio of one doctor per patient in public hospitals, up from the current ratio of 1:2.

Speaking on the sidelines of an Emergency Preparedness Day event at Sembawang yesterday, Mr Khaw said between 250 and 300 doctors are trained locally every year but this is not enough.

There is a need for 400 to 'even 600'' doctors per year, he said.

It was unrealistic and undesirable to produce such numbers locally, as it would mean bright students who wanted to go into areas like engineering and economics switching to medicine.

Yet, the pressure for more doctors would grow as patient numbers increased.

The Health Minister had spoken about this issue when he addressed undergraduates at the Singapore Management University on Friday.

He mentioned increasing the list of medical schools from which foreign doctors will be recognised, with a shortened probation period for such doctors, accompanied by a good supervision and assessment system.

Since 2003, the number of foreign medical schools on the list has gone up from 20 to 120.

Two years ago, there were 130 foreign doctors but last year it rose to 160. Mr Khaw said yesterday he was 'reasonably happy'' with this. 'If the ground feedback is positive, it would give us reason to open up even more,'' he added.

Even if the numbers trained locally were increased, it would still be not enough, given the country's population growth of about 40,000 babies a year, Mr Khaw said yesterday.

One answer: increase the numbers trained here but at the same time accept doctors from foreign medical schools, without lowering standards.

The Government is already looking to broaden the recruitment base to include European countries like Sweden, Germany and France. To this end, it sought doctors from the top medical schools there.

He said the experience has been that other countries will have at least one or two top medical schools, followed by a bunching of others that would be harder to differentiate.

'If you pick the top one or two, usually you will not be too far wrong,'' he noted.

But while identifying the top two in European countries was easy, the problem was different for schools in Asian countries like India and China, which the Government was looking at.

'In India, there must be hundreds of medical schools, if not thousands, and you can't say that we accept everyone and then come in and let's see if they mess themselves up,' he said, stressing that patients' health care was of foremost importance.

'So we start with the top two and very soon we'll get the top five,'' he said, adding that recognition of more medical schools can then 'progress step by step''.

He said it would take time to monitor this. If the foreign doctors did good work, that would generate confidence but if the opposite happened, then the authorities would have to 'tighten up''.

'My key point is: don't lower standards.''

A Straits Times check found, from the annual surveys in India, that it might be difficult to keep track of the top 10 medical schools there.

An Indian media report last year said that while the All India Institute of Medical Sciences topped the survey of India's top medical schools for four consecutive years, the number two spot varied. In different years, the Christian Medical College (CMC) from Vellore and the Armed Forces Medical College, Pune, took second spot.

But the CMC ranked sixth in 2005.

2.A comment from a Singaporean doctor now practising in the USA (travailingdoc)

Hi allI too read about the flood gates being opened and doctors with 5 years following their specialist's qualifications are allowed straight access into the private sector.

With the added recognition of 150 medical schools, Singapore is practically letting in sundry and all.

They have obviously forgotten about the renegrade neurosurgeon of German training who was performing unethical procedures with very questionable skills.We know of many others with very unscrupulous practices and dubious backgrounds.

These doctors are very easy to let in but difficult to eliminate, like a Trojan virus.

As a foreign graduate, to practice in the USA requires many more tough years in training programs and testy examinations before one can even begin the arduous task of getting a license.

This ease of getting into Singapore to practice Medicine will remove safeguards and any supervisory opportunities to vet these doctors before they are allowed to treat Singapore patients.

This is not to say that foreign graduates are not good doctors. On the contrary, I have met many from very diverse countries and schools with excellent clinical skills and knowledge, and impeccable morals.But they have mostly come through a very tough and stringent screening process in the USA.

I just read from the American Medical Association newsletter that J1 doctors ( those with a temporary visa to train in the US) and who must return back to their home countries on completion of their training, are now less likely to remain to apply for US PR status because the pay is better in Europe, India and Singapore.....yes Singapore was specically mentioned. So even AMA had caught on to MOH's sell in America.

The Singapore medical scene will change certainly but significantly the character of it will be drastically different from what it is now. There will be enclaves of foreign doctors from similar origins who will monopolize certain geographic localities or specialty leading to in group referrals and controlThe Singaporean doctors with their rather go it alone mentality will be pushed out of the competition.

After visiting Toronto and London after a good 2 decades I have appreciated a change of character in these two cities. I used to love these cities for their charm, history and culture. But my recent visits were marred by rude and haughty residents of foreign extraction and " FTs" who had a ubiquitous presence in the cities.

People were not as warm and hospitable, and it does not feel the same.Many visitors travelling with us shared the same sentiments.

I reckon that when I visit Singapore in year 2009, I will not be able to identify with the citizens anymore.

Looking at Lucky Plaza and its weekend residents will give an idea of what I mean..10 years down the line when all the damage had been inflicted, no decision maker will be held accountable.By then, Singaporeans had again paid the price for another disastrous half baked concoction.

ViVa Singapore

3.My comments:

Hi friends,

After Minister Khaw's pronouncement-which is not new, as he had been hinting on this for many months now, I was expecting some response from the Singapore Medical Association or senior members of the fraternity.

However, it looks like there will be none.

Hence I wrote a letter to the forum page to voice my concerns.

Bewarned that it is very subtle ( too subtle for most "ranter" I think), but the forum editors are unlikely to print "rants".

As the letter has not appeared after 2 days, I am posting it here for your perusal.

Letter to the Editor of The Straits Times

January 29, 2007

Increased supply of doctors- Let us err on side of caution

Dear Editor,

I understand Minster Khaw’s concern that in view of the impending increased demand for healthcare due to the ageing and increased population, increasing the supply of doctors would avert inflation of healthcare cost as per the classic supply/demand equilibrium that any Economics student would be familiar with.

The Minister is also aware of concerns that increasing the inflow might compromise the standards of medical practice as he had taken pains to reassure the public recently that measures would be in place to ensure that this indeed would not happen.

The good reputation of Singapore’s medical practice had taken decades to build. Patients from the region and even from very developed countries usually have nothing but accolades for us. I personally vouch for this.

I hope that the Ministry of Health would err on the side of caution and do its utmost to ensure that only the most qualified doctors are allowed in and only after close scrutiny and vetting.

Most advanced countries require tough and stringent screening process and examinations before alien doctors are allowed access to their patients. This ensures safeguards and ample supervisory opportunities for vetting out unsuitable applicants.

To allow easy entry –almost “carte blanche”, may seem like a good short-term solution but may instead turn out to be a longer term complication.

Singapore Medicine’s reputation, if damaged, may not be restored as easily.

I look forward to learning from these new colleagues.

Dr.Huang Shoou Chyuan

Friday, January 26, 2007

Singapore too conservative to have unbridled horseplay?

Poor turnout closes Singapore Crazy Horse

Channelnewsasia: 25 January 2007 1851 hrs

SINGAPORE : Little more than a year after making its Asian debut in Singapore, the famous Crazy Horse Paris cabaret will close its doors this month because of poor audience turnout.

"This is a business decision. The attendance is lower than expected, that's why we have decided to close it," Goh Min Yen of entertainment firm Eng Wah Organisation, which brought the show here, said Thursday.

Goh said the decision was made after months of consultations with Crazy Horse Paris when the Singapore show failed to achieve its target of filling 65 percent of the 400-seat theatre.

She declined to give specific figures but said the theatre was less than half filled on most nights.

The Singapore show, like the original in Paris, features a scantily-clad, all-female troupe.

The poor turnout was partially due to Singapore's tight guidelines on where the show could be advertised, said Goh.

She added the show may have succeeded had it been introduced to Singapore later, since the city-state's two integrated resorts (IRs), which will include casinos, are expected to be fully operational by 2010.

"I guess we need a bit more like the new developments like the IRs," said Goh. "On hindsight, maybe I think that would be a better time to bring in Crazy Horse."

The company invested S$7m (US$4.57m) to bring the show here and has lost $3.8m, she said. Crazy Horse Paris opened in the city-state in December 2005.

Singapore, a tiny island nation lacking natural wonders, is striving to boost its appeal to tourists by building man-made attractions to augment its reputation for efficiency, cleanliness and safety.

The city-state lifted a 40-year ban on casinos in 2005 and issued gaming licences last year to two foreign companies, Las Vegas Sands and Malaysia's Genting International.

The two firms have promised to invest a total of over 10 billion dollars to build the integrated resorts, which will also include entertainment and convention facilities.

Singapore's long-term target is to attract 17 million visitors generating, who could generate $30b in revenues by 2015. - AFP /dt

My comments:

Hi friends,

I have great admiration for risk-takers and entrepreneurs.

Hence it is with a tinge of sadness that I hear of the premature demise of the Crazy Horse.

From a cursory straw poll in the doctors’ tea-room, none of my colleagues had gone to watch it. Even if they had, they would not have openly admitted to patronizing it, perhaps for fear of spousal complications.And I am not even talking of "porn"!

Crazy Horse’s target consumers are definitely not people like “us”- “Us” being the conservative and mostly professional-types.

The target groups are the millions of tourists that pass through our shores annually. Also ...not just any tourists but the high-end sort.

The average tourist stays for ?2 or 3 days? It would have taken smart marketing to tempt our tourists to commit big bucks and precious time to the show instead of going to the “almost mandatory” visits of Sentosa; the Night Safari, and of course shopping at Orchard Road!

Eng Wah’s marketing strategy was hampered right from the start. As there was nudity, Crazy Horse was classified as “adult” entertainment and hence the show could not be publicized properly in the mass media.

This was like going into battle with hands tied behind the back! Defeat was inevitable.

Shareholders (of which I am not) would be interested to know if the management had known how prudish Singapore’s government agencies were about advertising or did the strict criteria for advertisements land like a ton of bricks on the management’s heads after Crazy Horse's contract was secured?

It seems more like the latter as Ms Goh said, “. “For the first eight months, we could advertise only in the newspapers’ movie listings. No images. No pictorials. Even famous brands like Prada or Louis Vuitton have to continuously advertise. Also, on hindsight, I guess we came in a bit too early. Crazy Horse is a premium product that needs time to nurture.”

It is now water under the bridge for Eng Wah. I hope that the lessons learnt will spur them to succeed in the future.

"Today" newspaper reported, “After the topless revue arrived at Clarke Quay, Minister Mentor Lee Kuan Yew saw it as a centrepiece to help Singapore shed its squeaky clean image and become “the Paris of South-east Asia”.

I guess we can safely say that unless we morph away from the top-down micro-management style that our rulers ( and the ruled) are so used to, Singapore cannot expect to be Paris or New York. Singapore will only ever remain Singapore.

Loosen up lah!


Dr.Huang Shoou Chyuan

Friday, January 19, 2007

Organ trading? What next?! Is there nothing sacrosanct?

Ban on organ trading entirely irrational
ST Forum 16 Jan 07

IN THE Review article, 'To receive, S'poreans must learn to give' (ST, Jan 11), Ms Salma Khalik argued that the Human Organ Transplant Act, which states that specified organs taken from deceased persons can be given only to Singaporeans or permanent residents, is selfish.

This is because if no Singapore citizen or permanent resident is waiting for an organ, it cannot be harvested, even if there are foreigners who need it urgently.

A Ministry of Health (MOH) spokesman responded by saying that 'We don't want to be seen as doing a tourist trade in organs. We don't want to see a waiting list of foreign patients.'

Ms Khalik had earlier pointed out that Singaporeans have no qualms getting organs from abroad. I would go further.

The MOH spokesman's explanation is politically correct. Organ trading is frowned upon and usually not allowed in countries where political correctness reigns. However, it is entirely irrational and medically incorrect.

No one is harmed by harvesting an organ for transplant into a foreigner needing it desperately when there is no potential local recipient.

On the contrary, a life is likely to be saved. Whether money changes hands is irrelevant. If a person needing an organ transplant is willing to pay for it, what is wrong in us allowing this, so long as Singaporeans and permanent residents take priority over foreigners?

To go further, our law which prohibits live-donor organ transplant whenever there is a contract or arrangement is irrational.

Healthy people can live with one kidney or after having part of their liver removed. If monetary incentive makes a potential living donor more willing to save another life, what is wrong in allowing that?
(read on)

My comments:

Dear friends,

Medical ethics is increasingly cloudy and in muddy waters.

It seems that anything and everything is possible now in the name of modernity!

In the name of advancement, keep Ashley as a baby with hormones and surgery.

What's an organ?

After all, what’s an organ? Just some combination of proteins and connective tissues, performing various biochemical and physiological functions. Just like so many pipes and gadgets that you see under the hood of a car.

The brain- just so many zillion cells passing thoughts and emotions in the form of neuro-transmitters. Perhaps, “Love” is just some imbalance of one of these neat equations, as is anger, loneliness and what-not.

So if man is just a lump of meat strung together by so many hinges, then go ahead. Having two kidneys is a waste of good space, some say. Even more unforgivable than being redundant, it is a depreciating asset that could have been turned into cold hard cash. The extra bean-shaped commodity in the loins is the poor man’s stairways to heaven.

Or is it?

Insatiable demand

The demand for organs is insatiable. The demand for kidneys is the aggregate sum of patients with end-stage renal failure in the whole wide world. Think “globalised” world , factor in Singapore’s reputation as a centre of medical excellence, the benefit for tourism and healthcare dollars must be astronomical. But is this what this is all about? Dollars and cents? But of course the patient benefits too.

In the short-run, it may seem common-sensical, even noble.

In the long-run, what happens?

Long-run effects of demand

As demand is insatiable, or infinite, suppliers will find a way to meet this demand ala Adam Smith’s supply-demand “invisible hand” equilibrium ( yadda, yadda, yiddi).

Supplies initially come from well-meaning people who donate for free (LOL), followed by desperate poor folks who want the good life that the recipient has. Since normal supply is unlikely to meet this insatiable demand, what will likely happen next?

Strange bedfellows

Crooked doctors (yes there are such despicable creatures, but not in Singapore), corrupt prison wardens and executioners working in collusion with officials (like in some ahem.. North Asian country), and the black market with all those colourful “mafia” characters get into the act. Don’t blame them, they are just as inevitable as flies around rubbish.. they serve a function, fill a void.

Before we know it, horror stories (which I still find hard to believe) will surface, of people waking up after a night out at a Mohamed Sultan pub with a long scar in the sides? Far fetched?

The good professor

I agree with Professor Alistair Campbell, head of the Centre for Biomedical Ethics at the National University of Singapore ( I wonder where he is going next?) who said that the ban on organ trading must stay as:

Such trade inevitably involves exploitation of the worse-off in society”

“Every operation carries a risk. Since the poor will be the main sellers, their compromised health will be further jeopardized”

“Treating the body as a saleable asset is regarded by many people as morally wrong in principle”

Hear! Hear! Prof!


Dr.Huang Shoou Chyuan

Link:1 Another forum letter on organ trading
2. and Another letter

Monday, January 15, 2007

Malaysian floods: C’mon Singapore, let’s be good neighbors




NB: So far these charities do not have specific donation drives for the flood victims. I will keep you updated if there is.

Malaysia floods test aid efforts (BBC News 15th Jan 07)

Relief centres in southern Malaysia are reported to be bursting at the seams with more than 100,000 people evacuated from their homes after heavy flooding.

Aid workers have appealed for help as they try to feed and shelter victims in the worst-affected state of Johor.

Major rivers burst their banks, cutting off a number of towns.

The floods came as many were returning home from shelters following the first round of flooding in December that killed at least 17 people.

More than 300 relief centres have been set up on higher ground to shelter the huge number of displaced people.

But relief workers say some centres have been overwhelmed and cannot take in any more evacuees. At least one centre has reportedly run out of rice.

"We need donations of food. Some [relief] centres have no more space already," one official was quoted by the Associated Press as saying.

"Blankets and warm clothing are also needed."

Health officials are also concerned about the risk of water- and mosquito-borne diseases.

Heavy rains deluged Johor, the state that borders Singapore, over the weekend.

One town was almost submerged, with only rooftops standing above water in some areas, local media reported.

More than 1,000 police are reportedly being drafted in to assist with relief efforts and to prevent looting.

Prime Minister Abdullah Ahmad Badawi has said a state of emergency may be declared if the floods worsen.

My comments:

Hi Friends,

I was tempted to plunge into the debate about Tom Plate’s write-up about Singapore or even about PM Lee’s pronouncement that Temasek should be held accountable if Shin Corp turns out to be a disaster ( as if it isn’t already), but the news about the deluge affecting our northern neighbors takes precedence over all that.

Does anybody know how we can help these Malaysians in a practical way? Any contacts of the Red Cross or Mercy Relief ? I will source for these and post them in this blog soon.

Let’s not forget that Singapore and Malaysia was one entity before the acrimonious split in 1965.

Even if previous political association does not cut any ice with you, perhaps we should remember an old saying that says, “ A friend in need, is a friend indeed”.

Then in a selfish and convoluted way, perhaps our Malaysian friends may extend a hand to us in the future when we get into difficulties.

But of course the best reason to help would be to help without expecting anything in return.

Just because... we are human beings. Not animals.

Best wishes to Malaysians!

Dr.Huang Shoou Chyuan

Links: ThinkHappiness (Yadav): Nice article about how to be a good neighbor in our region.

Tuesday, January 09, 2007

More Bangkok bad news: Shin Corp an unmitigated disaster for Singapore!

Thailand imposes limits on foreign investment

Posted: 09 January 2007 1534 hrs

BANGKOK : Thailand's military-appointed government Tuesday approved new limits on foreign investment, despite concerns about the potentially disastrous economic fallout.

The cabinet approved changes to the Foreign Business Act after a nearly five-hour meeting, agreeing to limit foreign investors to holding no more than 50 percent of the shares or the voting rights in companies.

The cap will only apply to companies that deal with areas considered important to national security, or that have an impact on natural resources or Thai culture, Finance Minister Pridiyathorn Devakula said.

Foreign investors in violation of the new limits will have a year to reduce their stakes, and two years to reduce their voting rights, he said.

Prime Minister Surayud Chulanont said the changes would not take effect for "some time", as a panel of legal experts reviews the changes and the government tries to reassure nervous investors.

"We think that it needs to be worked out in detail for the law to be more transparent, and to make investors more confident," Surayud said.

"If we explain clearly and allow investors to participate, they will agree that the law is open and transparent at a certain level."

But that failed to console the stock market, which tumbled 2.69 percent on the news, with the Stock Exchange of Thailand (SET) composite index losing 17.07 points to close at 616.75.

Companies have traditionally set up their operations in Thailand so that the local subsidiaries are nominally owned by Thais, but controlled by foreigners.

The practice became controversial last year after investors led by Temasek Holdings bought 96 percent of telecom giant Shin Corp for 3.8 billion dollars, giving it key stakes in Thailand's biggest mobile operator, a satellite company, a television station and an airline.

The investment firm bought half of those shares from the family of former prime minister Thaksin Shinawatra, sparking public outrage that eventually led to the military coup that ousted the billionaire premier in September.

After the coup, the commerce ministry ruled that the takeover violated foreign ownership requirements, casting doubt on the legality of the operations of thousands of local subsidiaries of foreign companies.

Pimonwan Mahujchariyavong, head of macro-economic research at Kasikorn Research Centre, said the legal review period would do little to reassure investors who felt the law was approved without consultation.
(read the rest...)

My comments:

Hi friends,

The Thai government has today driven yet another nail into the coffin that is Shin Corp(se)!

The cabinet’s approval of changes to the Foreign Business Act forces Temasek to reduce its stakes in Shin Corp to no more than 50 percent within one year!

Lelong! Lelong! ( Singlish for Fire Sale!)

This means a fire sale! This will be a buyer’s market and the potential buyers (assuming there are some Thais who might not mind being seen to be our bed-fellows!) will be driving a very hard bargain.

Admit it, these same buyers have got us by our b*lls and they know it.

Yet to this day, our authorities continue to put on a brave front and defend this purchase as one based purely on a commercial decision.

If it were a purely commercial decision, did someone in Temasek actually do some due diligence?

What did the Due Diligence Committee think ? ( if there was such a committee and if such a committee could indeed think)

Let's suppose this "Due Diligence Committee" having been satisfied with the Shin Corp's financial ratios, SWOT (strength-weakness-opportunity-threats) analysis or P.E.S.T analysis etc and what-not,did anyone there then consider that the friendly ever-smiling Thais may not take too kindly to us taking their jewel in the crown?

Did we ever expect that they may not be as benevolent as we when we allowed foreigners to come into our city-centre and whisk away our grand Dame, the Raffles Hotel?

Could it be possible that the Thais had much more national pride and resolve than we thought possible?

Some window dressing needed at home

Now Temasek’s accountants will just have to find a nice and tidy way to write off this investment from their books and then their frontman ( or woman) can boast that (yadda yadda yadda) not withstanding this or that event, they still managed a Return On Investments of XX% ( whatever the figure is)!

I am encouraging my kids to do accountancy. Their work is.. how shall I say, eh like MAGIC!


Dr.Huang Shoou Chyuan
( who refuses to be cheery after Singapore’s loss of billions in this escapade of folly)

Other links: BBC:Thai revises business rules
CNN: No plans to lift Thai controls
FT:Getting Singapore to drastically reduce Shin appears to
be Thailand’s main purpose (10 Jan 07)

Sunday, January 07, 2007

Air Asia X’s budget flight to London is a wake-up call to SIA and good for competition

Long-haul budget airline unveiled
(BBC News) 5 Jan 07

Malaysian aviation tycoon Tony Fernandes has unveiled a new no-frills long-haul airline, Air Asia X.

The venture - a tie-up between Air Asia and Fly Asian Express (FAX) - will launch in July and fly to destinations in India, China and Europe.

The new airline aims to carry half a million passengers in its first year, Mr Fernandes said. (read on...)

My comments:

Hi friends,

Air Asia is proving to be the Ryanair of the East!

I will be anxiously waiting for the launching out of its new service to Europe and other new destinations.

Although budget travel is seldom suitable to professionals like us, it is still worth considering if one can plan one’s schedule way ahead.

Cheaper air travel does wonders for the whole world’s tourism trade and contributes significantly to many countries’ economy.

Singapore has benefited from many first time tourists who would never have stepped onto our shores if not for cheap fares. Many of my clients ( or patients) admit to bringing their whole family for a weekend of shopping at Orchard Rd on account of this.Of course they also drop in to see me at the same time.

Days of prohibitive air fares are almost over
SIA ( Singapore Airlines) have seen the trend and has already hedged it by setting up its own budget subsidiary, Tiger Airways. “If you can’t beat 'em, join 'em” is its philosophy and I am sure that budget travel will not cause more than a temporary setback in its bottomline.

I heard somewhere that the money earners for airlines are the business and first class passengers and that a full coach cabin ( economy class) causes each flight to merely break even.

How do LCC's make money?( without jeopardising safety)

The business model for Low Cost Carriers (LCC) is a mystery to me. How is it possible to be profitable by just flying budget passengers without compromising on safety? How much costs can be reduced and how efficient can one get?

Yet Ryanair has succeeded whilst the pioneer Sir Freddie Laker’s Laker Airways had gone bust in 1982. Maybe Laker was ahead of his time.

Cost cutting is the buzzword now as in a recent flight to/from the USA on Northwest Airways, I was asked to pay US $5 if I wanted alcoholic beverages. Service ranged from good to average. But there was a very polite and chatty stewardess named Michelle (in Minneapolis-Narita leg) who made flying a pleasure for many passengers!

Online ticket booking sites like are also forcing "brick and mortar" travel agencies to be lean and mean. No more fat commisions like in the past. Even SIA is doing a raving business through direct online booking.


Dr.Huang Shoou Chyuan
7 Jan 07

Friday, January 05, 2007

The Ashley Treatment: Medical Ethics at the Docks

Treatment keeps girl child-sized
BBC News 4th Jan 2007

Parents of a severely disabled girl in the US have revealed that they are keeping her child-sized in order to give her a better life.
The nine-year-old, named Ashley, has the mental ability of a three-month-old baby and cannot walk or talk.
Along with hormone doses to limit her growth, Ashley's parents also opted for surgery to block breast growth and had her uterus and appendix removed.
They say the treatment will help to improve her quality of life. (read on...)

The “Ashley Treatment”,
Towards a Better Quality of Life for “Pillow Angels”
January 3rd, 2007
By Ashley’s Mom and Dad

Ashley’s Story

Our daughter Ashley had a normal birth, but her mental and motor faculties did not develop. Over the years, neurologists, geneticists, and other specialists conducted every known traditional and experimental test, but still could not determine a diagnosis or a cause. Doctor’s call her condition “static encephalopathy of unknown etiology”, which means an insult to the brain of unknown origin or cause, and one that will not improve.

Now nine years old, Ashley cannot keep her head up, roll or change her sleeping position, hold a toy, or sit up by herself, let alone walk or talk. She is tube fed and depends on her caregivers in every way. We call her our “Pillow Angel” since she is so sweet and stays right where we place her—usually on a pillow.

Ashley is a beautiful girl whose body is developing normally with no external deformities; see photos. She is expected to live a full life and was expected to attain a normal adult height and weight. Ashley being in a stable condition is a blessing because many kids with similarly severe disabilities tend to deteriorate and not survive beyond five years of age.
(read on...)

My comments:

Hi Friends,

I am certain that Ashley’s parents love her and what they have done on her was not out of selfishness.

However, I am uncomfortable that so much of Ashley’s normal anatomy and physiology were altered in order to ensure that she can have as “normal a life” as possible.

It is a truism that most cases like Ashley's would not have survived beyond early childhood (as mentioned correctly in their blog). So if the parents had not been meticulous in their caring, Ashley would have died sooner rather than later.

The real world out there is seldom in clear-cut “black or white” but mostly in shades of gray.

Ashley’s parents were faced with doing something drastic to endeavour that Ashley’s future was more predictable and her daily care more manageable. Hence they altered her hormonal secretions and removed her uterus and breast buds.

Before we become judgmental, do we realize that many medical decisions that we take for granted now would have raised many eyebrows in the not so distant past:

1.Taking medications to cure illnesses. If God had wanted one to live, He would not have let you be sick in the first place? Are we distorting the Almighty’s plan? ( but someone else would argue that since God allowed Fleming to discover penicillin, it must also been His will that diseases be wiped out? Comprehended?)

2. Non-essential lifestyle surgery- a double eyelid here- a repaired hymen there.

Society dictates what is acceptable . If you want it (whatever it is), who are doctors to deny your wish?

3. Organ transplantation- from whom? Patients go to China and within a week, perfect matching donors are found!

Where are these kidneys/organs from? Should we care that they are from Chinese prisoners ( who probably would have been spared if their blood/tissue-type were incompatible ) ?

Is it none of our business who gets chosen to be executed? ( oh yes, and the condemned prisoner's family gets billed for the bullet!)

Now that I have stirred sh*t ( again), let me say that I fully understand why some are for or against all the above issues. ( I sit very nicely and politely on the fence)

As I grow old(er), I become more tolerant, less judgmental. Life is too short to get uptight about everything!

Notwithstanding my open-mindedness, I will continue to stand on the proverbial pedestal and shout to whoever is willing to listen. Just like the “crazies” in Hyde Park,London condemning this government figure or that. In my days, Thatcher was a favourite target.

In fact (to digress), I remember vividly the day Thatcher was forced to resign in a kitchen coup, as that was the same day I passed my Edinburgh surgical fellowship exams. The Glasgow one I passed 2 weeks later.

The winter of 1990- How time flies.

Good luck to Ashley.

Dr.Huang Shoou Chyuan

Wednesday, January 03, 2007

I am ready for 2007!

Hi Friends,

A short break from Singapore and blogging has given me a fresh perspective and new impetus for the coming 12 months.

New Year-Fresh Perspectives

Leaving the little red dot for the land of the Free, let me realize that although there is much more that Singapore can strive for, we should not throw the baby out with the bath water.

Before I go on, let me admit that I am prone to wearing blinkers and at looking at other countries through “rose-tinted” glasses ( and I am not completely coherent on account of jet-lag).

Singapore- still one of places I like but…

Singapore has come very far. It still remains one of my favourite places to live and raise kids in.

Efficiency and safety are under-rated qualities that all of us take for granted.

Education has been one achievement that we can be rightly proud of. One of the secrets (which the government would surely want to keep from us) is that the average 17-year old with the “O” levels ( not “A” level) , would be able to get admitted into many excellent colleges/universities in the West. Of course,they would need advice on SAT/admission essays etc.

We are so cosmopolitan that any average Singaporean would be able to fit “hand in glove” into any 1st world city.

Before detractors start to sharpen their knives to castigate me, let me also say here, that all these had been bought at a high price.

Our achievements don’t come cheap

Social engineering, through the schools and national service, aided in great measure by the mass media monopoly of the Singapore Press Holdings, has made us one of the most docile peoples in the world. We have learnt to look to the government ( or PAP- some say it is the same entity) for everything.

How long to wear one’s hair, how many children to have etc are just some of the levers of micro-management that my generation had to live through. My parents and uncles had to live through worse.

More than one generation had learnt that taking individual initiatives is not expected and sometimes not rewarded.

More good things to come?

A new year brings with it fresh opportunities for change. The government of PM Lee Hsien Loong, has shown itself adept to change.

2006 might well be remembered for Mr.Brown’s sacking as columnist from Today newspaper, but to me what is even more significant was that the authorities showed great tolerance for the “Mee Siam Mai Hum” podcast and follow-on skit at the Indignation 2006.

Don’t get me wrong, if I were LHL, I would have been just as tolerant.But can you imagine the reaction if the subject was not LHL but his relative? ( I can!)

I am cautiously optimistic that we are heading in the right direction and that we are slowly reclaiming the freedoms and liberties which were ours in the first place ( anyway, better than not having these).

I know that bloggers would be keeping their eyes wide open to ensure that the process of "reclaiming our freedom" continues unabated.

So what’s the break done for me?

America has never claimed to be perfect nor without blemish. The endless TV adverts for anything from "ambulance chasing" lawyers to health insurance that promises you get the "benefit you deserve" made “Law and Order” almost the only program worth watching ( and we watched both the "Special Victims Unit" and "Criminal Intent" versions-marathon sessions of them).

Americans treasure personal freedom and liberty. No one is expected to conform to any given template and most don't. Patriotism is innate and palpable. One can be a Bush-hater and yet not be accused of anti-Americanism or lack of loyalty.

Driving (even in Chicago) is a pleasure due to courtesy that drivers show each other.

After-Christmas “sales” is out of the world at Gurnee Mills and Prime Outlets. I won’t mention the prices of the items I bought, lest I be accused of lying and exaggeration.

And, spending time with my kids is even better than blogging!

Happy New Year Singapore and America!

Dr.Huang Shoou Chyuan
No Fear Singapore