Letters
by LTT

I refer to Dr. LMK’S letter “Eye specialist problem – another multiracial problem”, and sympathize with this ophthalmologist who wants to come home but is prevented as a result of bureaucracy pertaining to his postgraduate qualifications.

Some have commented that Dr. LMK should just go on to another country where his skills will be better appreciated, but this would be in essence giving in to racist policies that have now slithered into our professions. It would also mean that the change that all those Malaysians were yearning for when they took to the streets and turned up in massive numbers at all those ceramahs leading to the ruling party losing in five states and at the same time almost politically annihilating the previous government would have been for nothing. Further, all the efforts and sacrifices the DAP/PKR/PAS have made to seek a just Malaysia that practices equitable policies may come to naught. Malaysians must stand their ground and must unearth or hunt down the zealots and charlatans who prey on this country’s masses and in this case its medical institutions.

Dr. LMK should be commended that he wants to return home to make this country a better Malaysia. All right thinking Malaysians who have helped transform the political landscape should help him and other Malaysian doctors who plan to come home, by ensuring that the doctors who have hijacked this country’s healthcare system are flushed out once and for all. Dr. LMK should rest assured that there is nothing wrong with his Fellowship qualifications. The problems are all here with the so called “Master’s programs” and the muddled policies at the Academy of Medicine and the Ministry of Health which have been put in place by self-serving specialists who suffer a serious dose of inferiority complex.

As pointed out by a blogger, recently, specialists produced by our NEP factories at UKM, USM and UM are now policy makers for various specialties including ophthalmology. These specialists, in cahoots with the ones running the programs at the universities and at the Ministry of Health, have today proclaimed that overseas postgraduate qualifications are now inferior to the local postgraduate degrees that were handed to them on a golden platter rather then actually earned. Anyone who has been an examiner at these “Masters Program” examinations will attest to the fact that the standard of English of these “Masters Specialist graduates” not only borders on the atrocious, but the aptitude of the candidates is equally petrifying. Examiners however are instructed in no uncertain terms that the passing numbers must be closer to 100% rather then the 20 to 30% practiced by the royal colleges. If any of these “Masters” candidates “fail”, lo and behold , the concerned examiner will be called up for an explanation and if he is a foreign examiner, well, it may be his last paid holiday to Malaysia.

You may ask, “How do these pseudo rule makers thrive in the system?” An ignorant Health Minister helps, but it is usually all done under the guise of “standards” but in reality of course, it is systematic marginalization of any doctor seen as a threat to the positions of “specialists” who are entrenched in the system and have no where else to go as a result of their poor training and unrecognized local qualifications. If that particular hospital or university has a private wing, then prospective specialists or consultants are not encouraged to join for fear they will jeopardize the private wing cake.

Of course, in the case of USM/UKM/UPM only a Malay will do. Second choice will be an Indian/Pakistan/Middle Eastern specialist who will be put on a tight contractual leash. An expatriate who does not play ball by respecting Ketuanan Melayu or fails to give his boss good annual appraisals, will have to “balik negeri”. The usual entry made in the report is either he has poor communicative skills, late for work, patients are all dying under his knife or too many student complaints. If everything else fails, then the very last choice would be a non-Malay Malaysian, even if this Malaysian has all the training and qualifications from the Royal Colleges in the UK/Australia or the American Boards.

HOW DOES THE SYSTEM WORK?

1. Candidates are chosen according to the quota system to undergo “specialist training” at the various universities.

2. Some universities such as USM and UKM are popular because “passing” is assured by the same techniques made available during SPM/ PMR exams where examination questions are made available to candidates prior to actual examinations through various “tutorials”.

3. Universities generally market themselves for as many candidates as possible, both local and foreign from as far away as Mauritius and Ghana, because they need the labour, the cheap labour that is. Universities generally have problems recruiting medical officers to run their hospitals and the ego trip between the MOH and Universities is so bad that the former has stopped “seconding” medical officers to University Hospitals ages ago citing “shortage of staff. So candidates are usually working……“sambil belajar”.

4. Lop sided churning out of 100% passes at USM and UKM were getting so obvious that “Conjoint Boards” between the three universities had to be set-up to reduce bias. However this has not gone down well with certain universities who claim, “Chinese examiner fails Malay candidate. Therefore Malay candidate must be examined only by Malay examiner with “friendly” external examiner from India. Otherwise, Malay examiner will start failing Chinese candidate”. This nonsense has gotten so bad that candidates who wise up usually will spend a little more and sit for the postgraduate examinations held by the Royal Colleges simultaneously.

5. Candidates who pass and are posted to various hospitals eventually climb up the ladder and some day become heads of departments or lecturers and eventually policy makers. They make certain they are surrounded by fellow Masters graduates or Indian expatriates so that deficiencies on their part are not questioned. So mediocrity, like money politics, becomes entrenched.

6. Of course, there are candidates who, given the opportunity, quit these programs and train under Australian, British or American programs. But opportunities are scarce and returning home will be difficult unless they opt out for the private sector which primarily recognizes only foreign postgraduate qualifications from the Royal Colleges or the US Boards.

WHO PERPETUATES THE SYSTEM?

The MCA. These guys have been running this ministry for almost 40 years and still remain clueless. Perhaps that’s another reason why the MOH is in trouble. The rot as usual starts right at the top. The Health Minister, who usually is a technically ignorant lackey of the MCA (the latest addition being a MCA youth leader who, God forbid, has vowed to consult the previous Chua Soi Lek in bettering the MOH), will have as usual no inkling what the hell is going on. By the time he generally learns how to spell some of the terminology; it is time for the next election.

Most times he will depend on his “advisors” which primarily include the DG of Health and a Division called Amalan Perubatan and the Malaysian Medical Council. He is usually oblivious to the fact that 60% or more of all doctors in the country are in the private sector and he is being fed only half the story. Of course, as in the instance of the previous Minister who was very busy taking on private clinics and visiting every health facility and one particular hotel in this country, the minister, soon realizes that it would be wise to leave these technically challenging headaches to the DG who effectively becomes the de facto Minister in these matters.

WHO ARE THE REAL CULPRITS?

Perhaps a brief look into the medical hegemony of policy makers at the MOH who claim to know better may help untangle this quandary.

1. The Academy of Medicine, Jalan Folly Barat, Kuala Lumpur

The Academy consists of the various specialty colleges, subcommittees and its own court of examiners. Some have sterling qualifications. Some sadly do not. Many are from the private sector. The Academy, besides its educational programs, is basically trying to establish and upkeep a specialist register, the criteria of which not all doctors are agreeable to. The Academy’s unseen aspirations in having the register, apart from letting the public know who actually are specialists, appears to be money.

The Academy collects hefty fees from specialists who want their names to be in the register. Perhaps the money is required badly for it’s building fund. The Academy, otherwise plays a benign role in the career of a specialist and questions still linger as to why they are trying to usurp the task of certification that has already been handled by the Royal Colleges and Universities. Some have put this down to outright politics although the Academy does not have legislative powers. In which case, prospective employers should just ignore their eccentrics.

There are, of course, runaway elements in the Academy who have a chip on their shoulder and think they are God’s gift to humanity and medicine. But these charlatans can easily be exposed as most doctors know who they are. With our courts hopefully liberated, some of these demigods ought to be sued for malafide and misuse of authority.

2. Malaysian Medical Council, Block E1, Putrajaya

The obstacles are here. There are four components to this council:

? The DG of Health, who wears his second hat here as Chairman of the council despite the MMC supposedly being an independent body, much like the Bar Council

? The MMC Secretary, who is a seconded officer of the Ministry of Health, obviously adding bias to a supposedly independent body.

? The MMC Secretariat who comprise almost all seconded staff from the Ministry of Health, again adding further bias to this supposedly independent body.

? And 21 council members, of whom only eleven are elected despite the majority of all doctors being from the private sector. The rest comprise of deans of the respective medical schools and more health ministry appointees.

As was demonstrated in the previous cabinet where the MCA Minister watched while his MIC colleague, Sothinathan, got chopped up trying to defend students who were caught in the CSMU crossfire, the MMC currently is a patsy for Ketuanan Melayu which the MCA and Chua Soi Lek knew but did nothing about. The MCA’s frying at the recent elections is no accident and truly well deserved. Those in the driving seat at the MMC are Ismail Merican and Wan Mazlan Bin Md. Woojdy.

3. Bahagian Amalan Perubatan, Block E1, Putrajaya
This particular division generally will claim that it is a screening division for all medical and postgraduate degrees before employment to the Ministry of Health. Of course, like the MMC, it is also a front for Ketuanan Melayu. Which is why CSMU, MRCP and LMK are stuck. This unit is hopelessly politicized and to even think that this Ministry is under the MCA is beyond belief. Until two years ago it came under a level headed chap called Datuk Abdul Gani who was no push-over and was well versed with the connivery of specialists and professional boards who were always willing to throw a spanner in the career of another specialist. Yes, professional jealousy in the Ministry is a rising problem and Ghani used to have his hands full.

The problems worsened and magnified when Merican came into the picture and Ghani retired. He was replaced by Noorimi Morad who was helped by the infamous Khairy Yaakub of the PHFSA and Basmullah Yusom disaster. These were the faces of Ketuanan Melayu. She has since been replaced, ominously by Noor Hisham Abdullah, a locally trained endocrine surgeon, who could further spell disaster for doctors like LMK. The position of Deputy DG (Medical) if held by clinicians have generally proved catastrophic for the Ministry. The rest of this department is staffed by retired matrons who have no business being there and junior doctors from local and Indonesian universities who prefer a 9 to 5 job in Putrajaya instead of the grueling clinical work out on the wards or in the A&E Department in Tawau.

WHAT CAN THE MCA DO?

They should first call up their erstwhile DG, Ismail Merican and ask him to explain all this nonsense. They should query, how is it that the country needs so many eye specialists but established qualifications such as the one from Glasgow are not recognized while an Indian expatriate with an MD ophthalmology gets to run a whole department in their hospitals.. Merican should be further asked to toe the line and clean up the mess that has partly brought the BN to ruin or the MCA should just request from Sidek another DG. If the MCA cannot sort out this problem, it would be confirmatory evidence of their lame duck status in Badawi’s government. It would further mean that the only way to solve the headaches at this Ministry would be to vote in a new government.

WHAT SHOULD THE OPPOSITION DO?

1. It is high time the opposition placed an astute shadow health minister/committee as its watchdog who is technically competent. The MOH generally gets away with whatever it wants including the notorious PHFSA, etc because of the technical ignorance of both its MCA Minister and the Opposition.

2. In parliament, Merican or his Minister should be called up to explain why the discrepancies in the various postgraduate qualifications including why the PHFSA amendments have yet to be ratified and the continuance of Basmullah’s incarceration.

3. Merican and the new Health Minister should be further queried why an independent body such as the MMC is being chaired by the DG when it should be held by someone completely independent of government.

4. Merican and Noor Hisham must be asked why are there multiple deeming authorities such as Universities, Royal Colleges, Academy of Medicine, MMC, JPA and Amalan Perubatan for our medical degrees.

5. And of course, Merican must answer why doctors like LMK who choose to come home cannot be accommodated but are marginalized.

6. He should be further admonished for repeatedly using patient care and standards as his favourite bogeyman to cow his ignorant Minister into passing idiotic legislations.

Dr. LMK’s problem is minor. Outright non-recognition of such a prestigious degree is nothing but sour grapes on the part of the MOH and Academy. Dr. LMK may require some exposure at the local level if he has not completed his CCST which is not applicable to local circumstances. This can easily be sorted out by him working as a Junior Consultant under someone senior. During this time his services will benefit this nation greatly and in time his presence will not only help patients but future doctors as well.

Perhaps it is Nik Aziz who said it best when he was told by party officials that PAS repeatedly lost in elections because the BN cheated. His answer was plain. “They cheat and win only because you let them” Which is why PAS is very meticulous with every elective procedure wherever they choose to contest especially when it comes to phantom voters and Borang 14.

Cases such as Dr. LMK’s plight will stop arising if the opposition knows the regulations and pins the right questions in parliament. With its new found electoral strength and mandate, it is the hope of many Malaysians that the DAP/PKR/PAS will usher in long awaited reforms that have hindered this country from achieving its true potential.