Bangalore heart trip – self-inflicted malady of Malaysian healthcare


Letters
by GS

When Chua Soi Lek first came to office, he apparently called for a meeting of all senior officers and when asked about the priority of problems at the Ministry of Health, he reportedly was inundated with numerous comments about the dastardly troubles private hospitals had created and how they and their devious doctors were leeching the poor Malaysian public and something had to be done urgently. The gullible Chua, ever willing to show-off the political strongman that he conjured himself to be, wasted no time in implementing the shelved PHFSA and together with his DG, utilizing the BN’s brute but now mercifully clipped majority in parliament, brushing off all objections against the Act just so he can show who’s boss. Needless to say despite all of Chua’s and Merican’s big talk and assurances, the first victim who got thrown into jail was a registered doctor, a stark reminder of the previous government’s callous and appalling methods of governance.

New Health Ministers are almost always a shoo in for our health ministry officials who have become rather slick in cornering incoming, inexperienced and invariably unknowledgeable Ministers into making silly decisions. All Ministers are political animals and make distorted decisions essentially because the minister is fed only half the story or the story he generally likes to hear. And so it is with the new health minister Liow Tiong Lai.

While Tanzanian president, Jakaya Kikwete, was going on an all out war against witchdoctors (read bomohs, sinsehs, etc) who were gorging out eyes of albinos and the Brazilians were calling in the army and possibly Cuban doctors to help battle the mortal incidence of dengue in that country, back in Malaysia, the hapless Liow had thrust upon him a meaningless business turf battle between pharmacists and doctors as his first task. The Brazilians must have wondered about the priority of the Malaysian health minister and cannot be faulted if they thought that Malaysians had indeed licked the dengue scourge and were actually moving on to bigger stuff.

Far from it. The dengue fever outbreak in Brazil had infected 55,000 people, and killed 67 Brazilians so far this year with half of those killed by the mosquito-borne illness being under 13-years-old. But Malaysia’s “Disease Control Director”, Hasan Abdul Rahman reported a proportionately higher mortality ratio of 9,889 people diagnosed, with 26 of them dead for the first three months from January to March alone of this year. Maybe we may have something to learn from the Brazilians or more likely our stats are out of sync.

But these problems will pale into comparison as the new and inexperienced health minister has made a second momentous decision. That of shipping unfortunate children with congenital heart disease to Devi Shetty’s “world famous” heart center 2000 miles away in Bangalore, the Narayana Hrudayalaya. Even Chua, known to be a brusque decision maker refused to take this decision. But the new health minister had no qualms sending these children off….or was he pushed into make this decision.

When the NST published their under-researched cum marketing piece for the IJN on the lack of heart surgeons and the need for critical care for paediatric cardiac surgical patients in a center spread on 2/4/08, they didn’t quite delve into the factors as to why this country has not caught up with the rest of the world or at least India, despite the government spending millions to curb the rising incidence of heart disease. Paradoxically, after 50 years of Merdeka, we are in fact sending off patients overseas for treatment just like the Mauritius, Ghana, Nigeria, Sierra Leone and Bangladesh to the Narayana Hrudayalaya Institute of Medical Sciences (NHIMS) Do we not have the expertise? Elementary. It is just poor management of our resources.

PUBLIC HOSPITALS OFFERING CARDIAC SURGERY

The government has five heart units. The unit in Penang was established in 1995 at a cost of RM30 million, followed by Johor Bahru in 1997 for RM40 million and Kuching in 2001 for RM55 million. A new unit was set up at Alor Star when the new Sultan Bahiyah hospital was being constructed midway causing the hospital to have serious delays in its opening and another at Serdang Hospital which has been designated as the Ministry’s heart center for the Klang Valley. Surprisingly despite the government spending millions on infrastructure, little attention was paid to manpower leaving many of its units underutilized or not operational.

There are no paediatric cardiac surgical services at government hospitals save for a small number being attempted by an expatriate surgeon in Kuching. The Penang unit although busy in the beginning, had its work slowed down when the initial surgeon resigned. It further attracted controversy when expensive and untested cardiac equipment bought for millions of ringgit ended up as a white elephant. It was in the news again in 2005 when surgeons left the unit in droves when anesthetists there tried to take control of the cardiac surgical ICU which has always been the domain of cardiac surgeons throughout the world. The unit was then briefly run by an Indonesian-born doctor who surprisingly was awarded a JPA scholarship to do his training. However patients complaining at the greatly-lengthened waiting list reportedly as a result of the new surgeon being unable to do bypass surgery there saw the Ministry moving some of its doctors from Johor Bahru to cover the unit. The Indonesian surgeon, in a bizarre move by the MOH, has been transferred to head the Serdang unit.

The Unit at JB was initially run by a British trained Malaysian surgeon who left for Singapore leaving the unit now running only on a single theater at times. The Kuching Hospital unit is one of the better run units at the Ministry. One of the reasons for this is the high level of commitment of doctors there and the support financially by the local community. Despite the lack of manpower, the Ministry is planning to open more units in other areas such as Ipoh, Kuantan and Kota Kinabalu. In KK alone, the MOH announced last month that it will be spending RM70 million. Even planning administrators in the Ministry have argued that that there should be a period of consolidation instead of splurging more capital until manpower problems are sorted out. But these reservations have apparently been over-ruled by the surgeons and anesthetists. It is always nice to splurge … if it is not your own money, especially if it brings you fringe benefits like more overseas trips for “lawatan sambil belajar”

PRIVATE HOSPITALS OFFERING CARDIAC SURGERY

There are in total 23 units doing cardiac surgery in the private sector. One in Alor Star, 4 in Penang, one in Ipoh (apparently now defunct), 9 in the Klang Valley, three in Malacca, one in JB, one in KK and one in Kucing. Only the Adventist Hospital in Penang and Gleneagles in KL do paediatric cardiac surgical cases in significant numbers. The rest are essentially adult units. Most private units are solo runs by individual surgeons. As a result they do small numbers. However the Penang and Malacca units cater for quite a number of foreign patients especially from Indonesia.

IJN

In the early eighties, the GHKL was the only heart unit the MOH had. It was controversially corporatised to IJN soon after Mahathir had his heart surgery. Many then thought that perhaps corporatisation of this service will soon see Malaysia self sufficient in this particular area but as always in the Malaysian scene, corporatisation comes with strings attached. IJN’s founders made a deal where all heart cases in the central region must be solely given to them. They didn’t want any competition.

But despite being a monopoly they couldn’t hold on to their surgeons. One paediatric cardiac surgeon resigned to go to Gleneagles while two more found cushy jobs in Saudi. So it has gone back to the same routine of trying to train more surgeons. Despite the high volume of cases it does, it apparently lacks space which may be resolved when its new building is commissioned. Interestingly IJN offered to run the Serdang Hospital Heart Unit for the Ministry but this deal was obstructed by the Ministry’s own surgeons. You sometimes wonder if everyone in this area is really working for the common good of patients..or for themselves…at the expense of the general public…with the Ministry and their political masters…the MCA doing nothing.

TRAINING PROGRAMS

So why are we not training enough heart doctors? There are three university heart units based at the UH, HUKM and HUSM in Kubang Kerian respectively. But the volume of surgery and procedures done are small, especially in Kubang Krian despite the disproportionately large incidence of coronary, valvular and congenital heart disease in Kelantan. The UIA in Kuantan apparently has been enthusiastic about setting up a heart unit there but again there was a problem regarding manpower and commitment by some of its specialists and of course the unending destructive rivalry between the MOH and the Universities. The price you pay if you don’t have your own hospital.

The first open heart unit this country ever had was the one established as early as 1969 at the University Hospital by NK Yong who took up the post of Foundation Professor in Surgery when the UM’s Medical Faculty was first set up. He had trained at Kentucky University and despite virtually no trained staff he performed Singapore’s first open heart surgery in 1965 after painstakingly assembling and training a cardiac team for two years following his return from the US in 1963.

His presence at the UH saw the emergence of new surgeons such as Saw Huat Seong and the late Razali Hashim. The unit was further strengthened by an expatriate surgeon from the Christian Medical College in Vellore, George Cherian. But all this came to an end when Razali passed away prematurely almost 20 yeas ago. Saw Huat Seong is in private practice in Singapore, George is in Kansas and NK Yong is of course retired and is now a famed wine connoisseur. The heart unit at the UH today is more renowned for fist fights and slapping incidents with no trainees forthcoming. While heart units around the world progressed by leaps and bounds, the UH unit stagnated and in fact regressed. The country’s pioneer unit fell victim to medical politics and to the tantrums of the remaining surgeon when heart disease was the pre-eminent killer with irresponsible University authorities just looking on, doing nothing or dabbling in trying to sell off university grounds.

UKM, which initially suffered a similar fate when it set up its unit a decade ago, has progressed much better and proposed a training program for cardiac surgery last year to the Ministry but it has yet to get off the ground. Again medical politics and unbridled, cumbersome, attritional professional jealousy has been the bane that threatens the progress of heart treatment in this country. The MOH and university authorities are in particular guilty of not dealing with these problems firmly, instead pandering to the whims and fancies of individual specialists against national interests leading Malaysian patients now possibly to that dusty road to Bangalore.

THE NARAYANA HRUDAYALAYA

The center is primarily the brain child of Devi Shetty who initially trained at Guys Hospital in London where Philip Deverall, a British pioneering and innovative paediatric heart surgeon was based. He has no formal postgraduate cardiac qualifications unlike most Indian cardiac surgeons. However, apart from the thousands of cases he has carried out, he has conducted hundreds of seminars, wrote innumerable papers, created many training programs and of course built and managed quite a few heart hospitals. Devi Shetty is living proof that clinical and operative skills may not necessarily be congruent to academic qualifications, something our local MMC (Malaysian Medical Council) should wake up to. Dedication and commitment could be far more valuable factors. In fact in all likelihood; Devi Shetty might not even get a job if he applies for one at the MOH as his qualifications would have been deemed by our “elite” council members as “not recognized”

Shetty returned to India in 1989 to set up a hospital for the Birla group in Calcutta before ultimately moving onto Bangalore to found the Narayana in 2001. He is married to Shakunthala Shetty, the daughter of the wealthy construction magnate Sri Charmakki Narayana Shetty, who owned the land where the 800 bedded hospital is situated. The Narayana Hrudayalaya is located in the Bommasandra Industrial Area on the outskirts of Bangalore on 25 acres of land, 30 km from the old Bangalore airport and 50km from the new one. The grimy road leading to the hospital where the pillars of Bangalore’s off/on Metro project stick out like sore thumbs may not really be palatable to Malaysian patients or parents used to our highways. But the hospital itself is a remarkable story.

The hospital design is simple and furnishing is bare. It has 25 operating theaters for cardiac surgery alone of which half are currently operational. Shetty’s group which includes surgeons trained in India, Australia, Britain and Russia carry out an astonishing 20 to 30 open heart surgeries a day, clocking close to almost 6000 cases a year. Of these a third are congenital cases.

Devi Shetty is one of India’s many rising entrepreneurial hospital pioneers who have contributed immensely to not only healthcare in India but also to its economy. They believe not only in bringing world class healthcare to India’s poor but are firm believers of strict financial prudence so that treatment remains extremely cost effective, a culture virtually absent in the Malaysian healthcare scene especially in government hospitals. In a country where the incidence of congenital heart disease is 8 per 1000 births against a questionable 1 per 1000 in Malaysia, India has 180,000 children born with congenital heart defects every year with 90,000 requiring early intervention at the neonatal stage.

Shetty’s strategy for success is simple. Focus on maintaining good results which are the accepted 2% mortality for adult cases and an incredible 5% mortality for congenital heart surgery considering that some very complex cases end up here. And an innovative packaged price for treatment. Heart hospitals are expensive. And if you are going to extend complex world class surgery to the poor, then, to make that buck, you need to operate a large volume of cases which is not a problem in India. Shetty maintains a fixed price of almost RM10,000 ringgit for each paediatric case no matter how complex the lesions are, making his money back through volume.

He doesn’t compromise on equipment which is pretty similar to the ones Malaysian hospitals have. He further saves on costs especially on medication, equipment and consumables which are indigenously manufactured. But the most important asset he has is the great depth in staff required to look after patients. And this he does by having active academic programs which is headed completely by a dedicated academic dean. No one is actually sure why Chua was attracted to this hospital. Perhaps he was impressed by the shear numbers of the assembly like care patients received in diagnostics, theater and especially the ICU. Or maybe he was influenced by an ex-senior health ministry official who is the Dean of a local private medical school which has a twinning program with a medical school in Bangalore where Shetty maintains a branch.

Whatever it is, Shetty has done remarkably well. And this he managed to achieve through sheer hard work and perseverance. To operate such a large volume of cases with a low mortality he would have had to climb that agonizing learning curve and cross a lot of dead bodies, something Malaysian surgeons are anathema to, focusing rather on safe, less complex cases. To be successful in paediatric cardiac surgery you will have to run through that deadly gauntlet that ended the careers of Professor James Wisheart and Janardan Dhasmana at the Bristol Royal Infirmary in 1999. Both found out to their costs that taking the risky gamble of operating on paediatric cardiac surgical patients with iffy paediatric cardiologists, anesthetists and ICU staff can not only end your career but may get you profoundly vilified for the rest of your life.

But certainly Shetty’s hospital is not the only one doing similar surgery at these prices. There are almost 200 centers in India that offer heart surgery in India. In South India alone, the level of work that is carried out at the Narayana is done in 11 other paediatric cardiac surgical centers with the total number of paediatric cardiac surgical units throughout India numbering about 20. Some of these centers like the Amrita Heart Institute, Cherian Heat Foundation, Madras Medical Mission, Ramachandra Medical College, CMC Vellore, MIOT and the Asian Heart Institute in Bombay produce very good results but do not match Shetty’s costs. On average, the cost of treating a congenital heart defect can cost between RM20-30,000 per case. Surprisingly only a single government hospital, the All India Institute of Medical Sciences (AIIMS) in Delhi, does any neotatal cardiac surgery of note. And every heart surgeon in the private sector in India will swear that the price of similar surgery at the government funded AIIMS is far costlier then the ones done in private centers, a testimony that accountability in subsidized healthcare is almost always never accountable to anyone, anywhere around the world including Malaysia.

SOLUTIONS

The MOH stated that an agreement had been reached to operate on 200 children at a cost of RM10,000 for each child over a period of one year excluding incidental costs. These costs would be probably flight fares, food, accommodation, etc which may put the cost at about RM15,000 or more, provided there are no complications. Paediatric cardiac surgical cases are generally divided into cyanotic and acyanotic babies, meaning blue and non-blue babies. It is the blue babies that are difficult to manage, are costlier to operate on and generally would require complex surgery including initial palliative surgery if expertise for complete correction is not available in the first instance.

The Ministry could:

1. Outsource non-blue baby and palliative surgery for blue babies to local private hospitals at a competitive price as this will be logistically more suitable for the family. Blue babies that will require complex staged surgery could perhaps be flown to Bangalore although there will be risks involved for the 3 hour flight and that perilous road journey to the Narayana itself.

2. Alternatively it could ask local surgeons or their surgical teams in “not so busy” private hospitals to operate in the Ministry’s government units so that there are savings in consumables and theater time. Since the Ministry has the infrastructure but not the staff, perioperative care could also be contracted out.

3. Or it could invite foreign surgical teams or surgeons to operate at its heart units on a regular basis to do surgery. Cases that don’t require urgent surgery could be accumulated and be done on a regular monthly basis with our local surgeons and hospital staff looking after them. It would be a good learning experience for them although cases need to be carefully chosen.

4. Or allow private hospitals to employ these foreign surgeons or teams directly and the Ministry outsources the work to these hospitals. Foreign medical staff, especially surgeons, anesthetists and cardiologists could be offered incentives like PR and citizenship etc so that they stay back in this country.

5. And importantly, the Universities and the MOH have to revise their training programs to ensure that Malaysia’s expertise in this area rises to match the number of patients in this country.

Whoever did this marketing for the Bangalore team may have done Shetty a large favour and a disservice to cardiac care in this country. But this story is the natural end result of a poorly managed service that saw no proper audit in cost production ratios. It is sad refection of the state of services in this country where for far too long the focus has been on constructing sophisticated infrastructure without paying attention to human development in direct contrast to India where the reverse has taken place.

Before the Minister dives into the uncharted National Health Financing Scheme, he should perhaps ponder if outsourcing healthcare to private hospitals that offer competitive pricing is a better option. The Ministry should refrain from reinventing the wheel all the time by building more heart units that only make contractors and suppliers rich, and instead save its financial resources and perhaps outsource its work to hospitals that provide a service at very cost effective prices. You can save a whole lot of money in places like Kota Kinabalu where instead of blowing 70 million ringgit, you can buy services from the Sabah Medical Center where its cardiac operating theater and 12 ICU beds are almost always lying idle.

Competition and innovation is the key to lower prices and better services. If the Malaysian public is to be saved, the confrontational policies of the previous Minister and DG must end. There must be greater cooperation between the large numbers of private doctors and the public service. Failure by Liow to handle this impasse effectively will ultimately see not only cardiac going India way but a whole lot more of other specialties.

  1. #1 by k1980 on Monday, 14 April 2008 - 1:24 pm

    How the hell can a non-medical grad such as LTL ever be entrusted to head the MOH? [deleted]

  2. #2 by lakilompat on Monday, 14 April 2008 - 2:00 pm

    Singapore’s economy is governed by professional, Malaysia’s economy is governed by the politicians.

  3. #3 by helpless on Monday, 14 April 2008 - 2:00 pm

    The health minister position shall possess inborned kindness to feel the pain suffered by the people. Every cents save from corruption can help to save people’s life.

    If he/she to observe normal Malaysian queing up for treatment were leave to dead instead, the Minister must have shouted at the Government for inability to take care the welfare of the people.
    Sickness is equal to every human as popular say among the insurance company. ” Nothing is certain except dead ”

    Just wonder if the minister has the conscious mind in carrying the duties.

  4. #4 by Mr Smith on Monday, 14 April 2008 - 2:22 pm

    One reason why the MOH is given to MCA is because it is a “problem ministry” and no UMNO many is fit to handle it.
    With a Malay administrators who have no qualms showing ther middle finger to a Chinese Minister, there is very little he can do except to agree to the policies they want implemented.
    Its the same with Transport. Chinese Ministers fumble when confronted by Malay civil servants.

  5. #5 by lakilompat on Monday, 14 April 2008 - 2:25 pm

    Dear helpless, if there are 2 group of ppl? will you picket for the rich (pharmacist) or poor (general public)?

  6. #6 by fade2grey on Monday, 14 April 2008 - 4:22 pm

    MOH has no professionalism nor vision to do anything. This statement is no directed to the healthcare practitioners but rather the administration. How can they hold on to their doctors if a fresh applicant is told this in their first briefing “…don’t come crying to us for a transfer if you don’t like where you are going. We will not listen…” (translated from BM). Go ahead and ask any medical graduates applying to join the ministry as a doctor.

    After being treated like beggars during application, they are then subjected to working conditions only slightly better than a worker at McDonald’s; 36 hours of non-stop work (including on-calls). There are even cases where some housemen have been working for 60 hours straight (2 nights of on-call in a row). With this in mind, I have no doubts that many will jump ship to the private sector or even to another country as soon as the opportunity arises.

    They cannot achieve anything without an overhaul of the administration, human resources and the ministry itself starting right at the top; the DG himself.

  7. #7 by baoqingtian on Monday, 14 April 2008 - 6:20 pm

    Congenital heart disease and its problem is already a difficult topic to grasp for an ordinary doctor. Please don’t expect Liow Tiong Lai who is a lay man to understand anything related to medicine. In the first place, the health portfolio should be held by a doctor who is in a better position to understand the health problem. I ‘m not saying Chua Soi Lek has done a good job but at least he is a doctor.

    There are so many MPs who are doctor themselves. Why not choose one of them instaed of choosing a nutritionist.

  8. #8 by allasstra on Monday, 14 April 2008 - 6:32 pm

    quote :

    “# lakilompat Says:

    Singapore’s economy is governed by professional, Malaysia’s economy is governed by the politicians.”

    —not really true,…rumour has it that M1,starhub and singtel all belong to LKY’s chins…

  9. #9 by allasstra on Monday, 14 April 2008 - 6:36 pm

    suggestion :

    ministry of health be made a independent entity,..
    with no strings attached to political entities,…

    afterall,…yan-meng-kwan-tien…[life comes first]

  10. #10 by cemerlang on Monday, 14 April 2008 - 9:42 pm

    Please make me understand why Kementerian Kesihatan Malaysia has to be under the Malaysian Chinese Association aka MCA. Don’t tell me please but the Prime Ministership has to be under the United Malay National Organization aka UMNO. So which ministry is under the Malaysian Indian Congress aka MIC ? What is all that Malaysia Boleh when in fact Malaysia tidak boleh in giving all the health services to her own people and having to send them to faraway places ? Please do away with all the propaganda slogans that mean nothing. Please do not air them over Radio Television Malaysia.

  11. #11 by pjboy on Monday, 14 April 2008 - 11:49 pm

    Health Ministry should run along with NGOs. Problem with all our past HMs is very simple…all politicians to BN, regardless of background.

  12. #12 by LT on Tuesday, 15 April 2008 - 1:04 am

    Very well said. GS.

  13. #13 by passerby on Tuesday, 15 April 2008 - 1:18 am

    # lakilompat Says:
    Yesterday at 14: 00.04

    Singapore’s economy is governed by professional, Malaysia’s economy is governed by the politicians.

    Wrong. Should be “by the crooks”!

  14. #14 by kingandcountry on Tuesday, 15 April 2008 - 6:35 am

    Well lets think in terms of incentives. Say if the mother of Chua Soi Lek or Liow Tiong Lai, were to fall sick with heart disease, where do you think they would send her to… most likely singapore, or europe or the states, depending on the amount of corruption… cause they can afford it with the money they got by illegal means.

    Is there any incentive for them to improve the public healthcare that you and me are so dependent on? Well, its well and fine to stay in malaysia if you are young and healthy, but once you get one of those chronic diseases, man you’re f**cked.

  15. #15 by ktteokt on Tuesday, 15 April 2008 - 8:26 am

    Another case of putting a round peg into a square hole! Malaysia Bolehlah! Like I have said in other blogs, we will soon find ministers in the wrong ministeries when the Minister of Defence does not know to handle amunition, the Minister of Finance does not know accounts, the Minister of the Media does not know how to read papers, the Minister of Transport does not know how to drive, etc.

  16. #16 by lakilompat on Tuesday, 15 April 2008 - 9:12 am

    My mum is a Malaysian, but everytime she has symptoms like constant headaches she will prefer to seek treatment in Singapore rather the local specialist.

    My nanny, admitted to Malacca hospital for heart bypass, but the earlier 2 operations are done in Singapore hospitals.

    Well the thing is, Malaysian would prefer to seek overseas specialist rather than local if you all can afford.

    Even Pak Lah late wife also seek treatment overseas.

    —not really true,…rumour has it that M1,starhub and singtel all belong to LKY’s chins… You should also include the law firm (Lee & Lee) owned by LKY family. Do they deserved it? after what they did to Singapore. I’ve interviewed a few expatriates from overseas, their wives loves Singapore because it’s fabulous, nice shopping good foods with varieties of choice. Here in Malaysia, we are not trendy, less choices, most boutique are expensive owned by cronies, and we have good food but not so clean environment e.g. the multi hawker food court.

    Singapore community are organized and clean. I really love to go Singapore for shopping, and teaching my childrens look how responsible is their government compare to what we have here.

    Our leader listen to their pocket rather than the people.

  17. #17 by lakilompat on Tuesday, 15 April 2008 - 9:22 am

    I would prefer our politicians and govt. servants to earn more rather than hide all on corruptions.

    If the govt. salary is peg so low, do you think they will be at ease to help the Rakyat, because day in and day out their name has been cursed, tarnish, polluted, and much more. How much it cost your name to be used for scolding? Billionth. They deserved to receive billionth just becos their name are in authority list.

    Whereas in Singapore, all the ministers earn pretty good bonus when the country is doing great, they even have salary cut when Singapore is in recession. This is called national unity which Malaysia unable to chase.

    UMNO tried to break loose from Islam (PAS) disunity. MCA, Gerakan vs DAP disunity (MCA & Gerakan has been talk but no action for too long as a result GE12 Gerakan lost all contested seat in Penang) MIC vs PKR (Sammy Vellu reign failed to free Hindraf leaders). We have 26 millions of people Singapore have 4 millions. If each state is govern with unity sure we can chase Singapore in another few years to come.

  18. #18 by sonJa_iNC on Tuesday, 15 April 2008 - 9:24 am

    To lakilompat :

    ‘Dear helpless, if there are 2 group of ppl? will you picket for the rich (pharmacist) or poor (general public)?’

    I’d like to re-phrase your sentence. Pharmacists in Malaysia are paid peanuts when compared to their counterparts in other countries. The rich are the general practitioners (GP’s) who ply their trades in clinics. They’re the ones who are selling generic drugs at branded prices, but does anyone knows? No, since everything’s in a ‘package’, consultation fees and all.

    Tell me, how many of you have ever paid less for your visits to the clinic before? Everytime you go, it either goes up again, or you’ll feel relieved that the price hasn’t changed. But alas, as the public is still uneducated on the importance of taking control of their medications, the clinical doctors will continue to run rampant in this country.

  19. #19 by megaman on Tuesday, 15 April 2008 - 10:09 am

    It would preferably and more cost effective to get a good team of heart specialists from India to fly into our country and operate at IJN at a regular basis.

    Post-operative care can be handled by our local doctors and nurses further cutting the costs and also the risks involved in transporting patients over a large distance.

    Second, the local heart surgeons may also learn and participate in these operations thus gaining the necessary knowledge and skills.

    Unfortunately, we do not have the right leaders that think in the right way. The current batch ministers got their positions mostly by political maneuvering and Machiavellian methods. How do you expect them to be doing what’s necessary when all they know is how to get the cushy job and how to retain it using ‘dirty’ methods ?

    As for low wages as mentioned by lakilompat, I disagree. First of all, our ministers and gov servants are well paid compared to their productivity. Second, if they are really professionals and take pride in their work. It doesn’t matter whether the pay is low or high, the true pros will still produce good results and take their work seriously. However, do not expect to keep these people for long because they are valuable assets and will deservedly be poached for better positions elsewhere.

    This is exactly why I support Pakatan Rakyat. The current batch of opposition leaders comprise more of educated professionals and social activists where politics is just the means to their noble agenda not the ends. It is about time we dump the current politicians who has really lost their way when climbing up the ladder to where they are today.

  20. #20 by megaman on Tuesday, 15 April 2008 - 10:14 am

    Hi ktteokt,

    Whether or not our Minister of Defence knows how to handle ammunition is not important. But what is important is, does he has a personal adviser who understands the business of security and defence ?

    If you study the different effective leaders of the world and Sun Tzu’s art of war. It is only important if the leader knows how to evaluate talent and use them in the correct positions. And second, how to retain these talents and motivate them. Unfortunately, I don’t see this in our current leaders at least they are not retaining the kind of people that would benefit the country at large.

  21. #21 by lakilompat on Tuesday, 15 April 2008 - 10:48 am

    Dear megaman,

    It does matter when govt. servant pay are low.
    In Police, they will go for bribe or 2nd source. Cases of Rahim
    In order to approve certain permit or license e.g. JPJ needless to say i think most of you will know what happen there when you apply Driving License.
    There’s this PUSPAKOM, but you will see many heavy vehicles or buses emitting black smoke everywhere.
    MITI issuing thousand of APs to benefit specific individual who is related to politician in the previous cabinet.

    Low wages breed croynism, favoritism and corruptions.

    If you go for massage normally RM 40 per hour there will be special or extra service you will want to add so that you can be treated like the king, am i wrong?

    likewise in every govt. department, low wages allowed them to do so.

  22. #22 by waterfrontcoolie on Tuesday, 15 April 2008 - 11:49 pm

    It looks like many of us like to associate ppl through their training or ‘profession’. We don’t need a doctor to be the Minister of Health. We certainly need an honest and sincere Minister. After we have witnessed so many doctors in the private sector who are no less ‘corrupted’ in their profession. Doing unprofessional cats with money the sole aim in their decision making. Yes. we can say. don’t generalize! that is what we are doing just then.
    Some doctors seem to think the ‘western’ medical cures are the only way out of all medical problems. If that is the case, then China and India would never have the current population sizes. I believe the CREATOR has provided the human race with natural cures if the human race did not poison their body with so much toxin in their bodies with all the artificial drugs!!

  23. #23 by ktteokt on Monday, 21 April 2008 - 8:50 pm

    Megaman, the problem is they cannot or rather will not recognize talents in front of their eyes. They only recognize “skin colours”!!!!

  24. #24 by lakilompat on Tuesday, 22 April 2008 - 12:21 pm

    “honest and sincere Minister”

    How many of them survived, those who are honest and sincere will stay in monastries.

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