Impressions from China - The Great Wall

We finally made our way to the Great Wall. Not that we didn't want to do so earlier, but with the cold wintry weather, if you factor in the wind chill factor, we would have frozen our buns off.

So we waited till Spring (i.e. now), when the weather is more favorable & flowers are blooming & birds are singing etc etc before we visited this, one of the Wonders of the World.

We went to the Mutianyu section of the wall which is north-east of Beijing, only about an hour away from where we live. Left at the ungodly hour of 7 am (ungodly for a Saturday morning, anyway) to avoid the heavy traffic that usually clogs up the roads heading to this tourist attraction.

Chinglish on the Great Wall

We took a cable car up to the wall. It was a hair-raising, ball-shrinking (the latter description straight from the mouths of my 3 guys) experience as we were pretty high up & the "cars" were basically just swings with a metal bar across. Our legs literally hung hundreds of feet above ground. Definitely not an experience for the acrophobic. A. had his eyes closed 80% of the time. Men.

View from the cable car (you can see my boys feet at the lower right corner- that's how precarious it was!)

From the wall, we could see miles & miles of mountainous vista, with the wall snaking up, over & through hill & dale. I tried to imagine how it must have been thousands of years ago when the wall was being built without the aid of modern machinery & technology. What a daunting task it must have been. But labor (& life) was cheap then (it still is, here in China), and whatever the Emperor said, went.

The white patches are blooms of white flowers (not sure what they're called)

The construction is still solid though the stones have been slightly worn by the elements. Mutianyu is a particularly well preserved part of the wall, & I believe that it will be one of the tourist attractions being promoted during next year's Olympics in Beijing.

It reaches far beyond the eye can see...

An overcast day...but an awesome view all the same

Definitely a site worth visiting.

Green Day

War.

Terrorism.

AIDS.

Cancer.

Unnatural selection, I call it. Much like Darwin’s theory of natural selection, it seems to be the modern day version of evolution.

Will we one day be a peaceful society, free of AIDS, cancer? Maybe. But new diseases will crop up. Global warming, which seems to be the political in thing now, seems to be slowly & surely creeping up on us. Mankind’s pollution of the Earth & exhaustion of our natural resources will one day prove to be our downfall. These seemingly insurmountable obstacles, which despite efforts of many trying to overcome with education & deeds, are uphill battles to fight.

A vast country like China, with the largest population in the world, wanting to keep up with the Jones’s, has its work cut out for itself when it comes to educating its people about the environment. Many just want to make money, by hook or by crook. Some resort to unethical practices, like the recently discovered melamine poisoning of certain rice protein & wheat gluten products used for making pet food; or the previous debacle involving tainted milk powder. Pollution of the environment by various industries remains a huge problem.

Extinction.

That’s my rather depressing forecast. It will not happen in my lifetime, or even in my children’s lifetime. But I think it will happen one day.

Despite my pessimism, I think we still need to try & beat the odds. So, I’m going to try to stick with Green Food as far as possible. And recycle. Those are my first small steps.

Ai-yai-yai-yai-yai

That was my initial reaction when I first read this article.

Gallbladder removed through the vagina.
Appendix removed through the mouth.

I wonder what's next.

I will reserve judgement on these very new & very experimental procedures until I know more about them & what advantages they may have over conventional laparoscopic procedures (apart from vanity reasons i.e. external scarring).

I'm a Field Spaniel

Take this quiz & find out what kind of dog you are!

Click the "GAME" button on the left side of the screen to start playing!

Another one

I have blogged about this before.

It's happened again, this time in Virginia Tech University.

"White House spokeswoman Dana Perino said while President Bush ``believes that there is a right for people to bear arms,'' all laws must be followed. "

Not a surprising statement, knowing the NRA/Republican stance on the gun control issue. In a perfect world, Ms Perino's words would be appropriate. But this is NOT a perfect world, & there WILL be people out there who WILL NOT follow the law while at the same time, have the right to bear arms.

How right is that?

How Much Is Too Much?

With the recent discussions that have arisen over the withdrawal of the Guideline of Fees for doctors, a couple of questions posed by this writer is certainly a valid one (emphasis mine).

April 16, 2007
How to decide if doc is overcharging?

THE Competition Commission of Singapore's (CCS) response to the recent withdrawal of the Singapore Medical Association's (SMA) guidelines on fees deserves more discussion.

CCS announced that it will work closely with the Consumers Association of Singapore (Case) to handle any complaints of overcharging by doctors.

This is good but it opens up two questions.

The first is will there be a charge levied?

The SMA never levied any charge on members of the public who filed complaints against doctors. But a visit to the Case website reveals that a complainant usually has to join Case as a member. Membership carries an annual subscription of $25 and filing a complaint incurs an administrative charge of $10.

The second question is more fundamental. How will CCS and Case decide on what constitutes overcharging?

The term 'overcharging' carries with it the notion of relativity. Overcharging can exist only if there is an understanding of what is 'normal charging'.

But without benchmarks and guidelines, it is practically impossible to define overcharging. Are CCS and Case going to draw up their own guidelines on what are acceptable and normal prices?

How will CCS and Case decide a doctor is not merely 'expensive' but has transgressed to the point of 'overcharging'?

Do they have the expertise or domain knowledge to know the intricacies and complexities of pricing in the whole spectrum of health care?

And will CCS and Case likewise step up to the plate to handle overcharging complaints when other professional groups withdraw their equivalents of price or fee guidelines?

These are questions that need to be answered clearly and soon.

Christine Chen Siew Mei (Ms)

In response to the first highlighted question, how indeed? What will CASE & CCS use as a benchmark when faced with a complaint from a "consumer" who alleges overcharging? They can't fall back on the now defunct GOF. Will they use results from MOH's planned survey of GPS fees?

More important in my mind is the 2nd question highlighted. Who will provide input to them in deciding whether a doctor has overcharged or not. And HOW would this person (or persons) decide? Can you even put a price on quality of care?

These are tough questions to answer. I am not even sure if doctors themselves would know how to answer them.

I am not even convinced that CCS nor CASE should be the ones handling such complaints in the first place. IMHO, it would "cheapen" healthcare, not literally in terms of dollars & cents, but qualitatively, as I don't think medical care should be considered a consumer product. But sad to say, it certainly looks like it's headed that way.

Addendum (April 17): angrydoc has also commented on this. I guess great minds think alike!

Impressions from China - Springtime

It is SO pleasant to see color after the grayness of the winter months here. With the warming temperatures, Mother Nature has awakened the buds & shoots, & we have started to see the beginnings of life.

Shoots of life

It started with the tiny shoots of leaves struggling to appear on the tree branches. Then the yellow buds of forsythia soon blossomed into a full blown riotous display of yellow, followed by the whites & pinks of the magnolia & peach blossoms. Now I am seeing the red sub-species of the peach blossoms flowering almost overnight after a week of temperatures above 15oC.

Forsythia

It’s amazing how the presence of color brings cheer & makes us feel better. I guess there may be something to be said about color therapy after all.

:)

Pink Peach Blossoms

Red Peach Blossoms

Dollars & Sense & Non-sense

And so it continues in today's ST Forum (April 9, 2007)...

First, a lone voice of reason...

Most GPs charge less than recommended fees

I REFER to the recent announcement that the Singapore Medical Association (SMA) had scrapped the medical fee guidelines and the resultant knee-jerk reactions.

The adverse feedback in the papers and on radio programmes seemed to be directed at the general practitioners (GPs). I think critics are pointing their arrows in the wrong direction.
The public should think about the family doctors who have been servicing them all these years. Think about the charges for simple medical ailments that did not need expensive medicine or investigations. Most of the time, the charges would range between $12 and $24 (inclusive of medicine).

Now look at the recommended charges that were recently scrapped by the SMA. It does not take a mathematics genius to calculate that if the consultation charges recommended were indeed followed, there would be no way that the total charges paid by patients could be within the range we have been accustomed to paying.

The conclusion must be that not many GPs follow the guidelines. They in fact charge much less than what was recommended.

One GP interviewed said that there was competition between the clinics. So it was unlikely that medical charges would increase.

It is not uncommon to see a number of clinics within a few blocks of HDB flats. Market forces would have ensured that none of the clinics would want to price itself out of the market.

Not too long ago, there was a report on the plight of some neighbourhood clinics which faced decreasing takings. Are we so illogical as to assume that these clinics would raise their charges overnight just because the guidelines were removed, when they have been undercharging all this while when the guidelines were around?

One chooses one's family doctor based on a number of factors, such as his medical competence, bedside manners, empathy and trustworthiness. Cost would be a factor, obviously, but if the charges were too high, the GP would not have been our family doctor in the first place.

As we have been told, we should stick with the same family doctor, who would be familiar with our medical conditions. Hence, it was with great surprise when I read that our Health Minister advised the public to vote with their feet when consultation charges are not displayed.

I am sure the issue of exorbitant increase in medical charges would not apply to the majority of clinics here.

Most of our humble family doctors slog hard to open their clinics. Please do not react adversely without first giving the issue a logical think-through.

Gabriel Koh Liat Choon

Not surprising, since I think Gabriel Koh is also a GP.


Then this one...

With no more fee guidelines, will 'bargain' clinics still match polyclinic rates?

I REFER to the editorial 'Beware spike in docs' fees' and the article 'Dropping of SMA's fee guidelines: Other professional groups relooking fee guidelines' (ST, April 5).

In April 2005, 22 clinics that were willing to charge the same $8 fee as polyclinics were told by the Singapore Medical Association (SMA) that they could not list this information on a medical services website, because it infringed the SMA's advertising guidelines ('Does' ads allowed, so why not discount scheme?'; ST, April 13, 2005, and 'Why stop doctors from charging polyclinic rate?'; ST, April 5, 2005). As a result, all 22 clinics stopped offering the $8 fee.

Now the fee guidelines have been withdrawn, will these 22 or more clinics offer the same fee as polyclinics again?

By the way, since polyclinic fees were increased last month to $8.80, it may soon be cheaper to go to a private clinic at $8.

Leong Sze Hian

I wonder if Mr Leong even realises that polyclinics are highly subsidised by the government while private GPs are not? These very pertinent facts seem to be conveniently forgotten. One would think that Singaporeans, in all their great wisdom (sarcasm meant), would take that into account when comparing polyclinic prices with private clinics.

And then there is this one who takes the cake (emphasis mine)...

SMA announcement sure to mean more overcharging

I AM uncomfortable with the latest announcement by the Singapore Medical Association (SMA) to deregulate fees charged by doctors ('Think doc has overcharged you? Turning to Case only recourse now' (ST, April 5).

Already with guidelines, general practitioners (GPs) have overcharged patients. Only recently, letters in the Forum page have reported cases of GPs overcharging patients seeking treatment, especially during the holiday season. Quoted fees of $60 to $100 were commonly seen.

I am sure not many GPs make their fees known to paying patients before they see them. This is unlikely to change now the SMA has withdrawn its guidelines as most GPs also see their profession as a business that needs to stay financially viable.

Many patients will not seek help from the Consumers Association of Singapore (Case) as the amount is not large enough to warrant the hassle of getting back tens of dollars.

Nevertheless, most GPs currently charge between $30 and $40 for general flu and fever cases. Some friends who have seen the same GP for many years say they are charged only $25 per session. Office workers tend to have medical coverage by group medical insurance and may not feel the impact of any fee increase.

More worrying, however, is the retirees group who have no proper income and no medical coverage. Their visits to the GP will also be more regular due to ageing medical issues. My mother was charged $60 last month for a consultation visit to a GP due to some skin problem. She was also not told how much she would be charged before consultation.

I dread to think of the time I was in Australia when each consultation session with the doctor for simple flu and fever was in the region of $150 to $180. No wonder most Australians self-medicate and visit the pharmacist for simple flu and cough.

This may be a viable consideration in Singapore if pharmacists can provide professional advice on common flu and cough illnesses. Nevertheless, as over-the-counter pharmacists cannot issue medical certificates for those who need to rest, the practice of seeing pharmacists may not work here.

Gilbert Goh Keow Wah

What's eating Gilbert Goh? He seems to have brushed off explanations on why consultation charges were higher during the holiday season. Apparently, Mr Goh thinks that doctors should not raise their charges come hell or high water.

He seems to be reasonably well-traveled, & a fairly intelligent fellow when he writes that GPs see their professions as a "business that needs to stay financially viable." I wonder how he thinks GPs are able to stay financially viable if they don't charge enough to cover cost...Oh! I get it now! GPs are supposed to earn just enough to cover cost. No need extra money for kid's education and maid salary (since doctors' spouses will probably need to also work in order to earn money for things like food in the house & utility bills) or car. Forget about luxuries like a TV or a PC at home too, or even the occasional holiday to Desaru.

He even knows that consultation charges in Australia are sky high compared to those in Singapore, and yet, $30 - $40 is still too high for him(although this is only about 20 - 30% of the Aussie charges).

He has the right idea about self-medicating for simple ailments. That's what many do in places like Australia & the USA. The issue about MC's is something that will have to be dealt with by the HR people.

Sigh...I have a feeling that many Singaporeans feel the same way as Mr Goh.

Teach Your Children Well

Teach Your Children by Crosby, Stills & Nash

You, who are on the road must have a code that you can live by.
And so become yourself because the past is just a good bye.
Teach your children well, their father's hell did slowly go by,
And feed them on your dreams, the one they fix, the one you'll know by.
Don't you ever ask them why, if they told you, you would cry,
So just look at them and sigh and know they love you.

And you, of the tender years can't know the fears that your elders grew by,
And so please help them with your youth, they seek the truth before they can die.
Teach your parents well, their children's hell will slowly go by,
And feed them on your dreams, the one they fix,the one you'll know by.
Don't you ever ask them why, if they told you, you would cry,
So just look at them and sigh and know they love you.


I agree with the author of this letter:

April 5, 2007, ST Forum
Wardrobe malfunction? Teach our kids proper values

I REFER to the letter, 'Models exposed too much, by design or otherwise' (ST, April 3), by Ms Wong Kam Fong.
I disagree with the writer's view and her suggestion of regulating fashion shows. If so, we will also have to regulate shows like music concerts, telling the superstar singers and dancers to be discreet with their clothing.

We have to restrict Jolin Tsai from revealing her cleavage, Alex To from taking off his top and Madonna from wearing her undergarments on stage because these shows have also a large number of children watching.

No, I am not suggesting that we should encourage indecency on public shows. I think the key is on education. We should teach our kids to be able to receive information of all kinds, analyse them and learn from it.

We should teach our kids to be able to identify the good and bad information, put them to good use in their life.

Yes, all these can be done through parents teaching their kids proper Values. Shutting out such information from our kids through regulations is not going to help - we are not teaching them how to face the real world, instead, running away from it.

Our kids will grow up not being able to face reality but run away from it. Our kids should be able to look at the exposed breast of the model and say 'Oops! Okay, if I am the designer or the workers backstage in future, I will make sure this blunder does not happen and put the model in such an awkward situation'.

Our Government has so far done a lot in this aspect and constantly reviews its regulations to meet the standards of the ever changing world.

Even with such stringent regulations on our land, we still have problems with our kids. We have a nine-year-old child getting pregnant, teens having multiple sex partners and teens who think there is nothing wrong having pre-marital sex and no qualm filming themselves doing it.

We can stop pornographic materials on our land, we can stop Crazy Horse from advertising but we can't stop the Internet world from having pornographic materials, we can't stop the people on the streets from wearing revealing clothing, we can't stop accidents happening on fashion shows, showing off the wrong things.

Go to the news-stands and you will see that almost every issue of fashion, entertainment, women's and even car magazines have models in bikinis, lingerie or clothing that reveals lots of cleavage or legs on the cover.

Yes, Ms Wong has a valid concern. But I think the way to deal with it is to educate our kids with proper values and face it with the right attitude and not regulating and avoiding it.
Parents and schools play an equally important part in teaching our kids correct values of life and shaping their character to meet the challenges of the world.
Lim Soo Huat

It's hard to shíeld one's children from the "badness" of our world. Technology has made it so easy to access information through the Internet. There is Internet radio, video websites like YouTube, even Internet TV. Attempts at censorship by blocking websites can be bypassed using proxies (personal experience here!).

I know of parents who do not allow their children to watch "Power Rangers" or MTV because of violence in the former & promiscuity in dressing, explicit lyrics in the latter. It's easy to do so when the children are toddlers & preschoolers. But once they reach school-going age, & we let them out into the big, wide, scary world, they will start to pick up things from their friends.

So Mr Lim has it right when he says we need to teach our children well, starting from home. Having strong values & morals will allow our children to see for themselves what is right or wrong, what is inappropriate & what is not. Blocking out what we don't want them to see or hear is not going to work. Eventually, they will have to grow up & decide for themselves what is good or bad. We need to help them start building up a strong moral center, beginning when they are children, and continuing through their teen years so that when the time comes, they can make the right decisions in their own journey through life.

Dollars & Sense

HAHAHAHAHA!
HAHAHAHAHAHAHA!!
HAHAHAHAHAHAHAHAHA!!!

Oh dear..so sorry…*wiping tears of laughter of face*…

That was my response to the question posed to the Minister (highlighted below) taken from this article from channelnewsasia (emphasis mine):

Health Ministry to monitor fees charged by private doctors
By Hasnita A Majid, Channel NewsAsia Posted: 04 April 2007 0011 hrs

SINGAPORE:
Health Minister Khaw Boon Wan says his Ministry will monitor the charges levied by doctors on patients.

And it will gather information from private clinics and publish the data, like what it has done for hospital bill sizes and some clinical procedures.

This is possible as the Ministry is already gathering data from the Chronic Management Programme, where half of all GPs here are on board.

Mr Khaw says doctors should also display their fees as required under the Private Hospitals and Medical Clinics Act and Regulations, so patients know how much they have to pay before they decide to seek treatment.

He was responding to questions on what the Health Ministry will do to ensure doctors do not overcharge their patients, following the withdrawal of the Guideline on Fees by the Singapore Medical Association (SMA).

"Singaporeans are educated consumers, so they should demand all those. If you go to a clinic and find those things are missing, then I think vote with your feet, go to another clinic which does so. Why should you be blindly going to that clinic? So I think providers will react if consumers are demanding and discerning. And I think part of public education is to help them, that they have a right as a consumer to know how much the bill will be and so on." Mr Khaw said. - CNA/yy

Speaking from the POV of a GP, I had to laugh. Why? Because the problem with consultation fees in the GP sector (at least in recent history) is undercharging & not overcharging. And patients do not appreciate that. I have had a patient complain about a $5 co-payment under his company’s medical benefit scheme – Five Freaking Dollars. I don’t believe that patients even look at the GOF tents that are displayed in clinics.

On a more serious note, I see a few possibilities happening with the withdrawal of the GOF:

a) Patients realize that they need to be savvier about their healthcare, and in looking at fees charged by different doctors, learn to question why one doc may charge more than the other, and learn that quality of care is just as important as cost. A good thing, as it encourages transparency, & improved communication between patient & doctor, something that is very lacking at the moment.
b) And because they start to question, they hopefully learn that doctoring is not something as simple as “Say ‘Ah’” & “Take an aspirin and call me in the morning.” Perhaps patients may start to realize that they have “had it good” all this time.
c) With the MOH publishing data about GP bills, healthcare becomes nothing more than a consumer product, with the customers looking only for the most reasonably priced. A price war then starts among the already suffering GP’s, leading to more undercutting & further diminishing morale among them.

In a perfect world, most of us would hope that (a) & (b) become reality. For a skeptic like me, I think in Singapore, (c) is the most probable outcome.

Just take a look at this article from Today Online (again, emphasis mine):

Medical association says it had 'no choice' ; MOH to publish fee schedule online

Sheralyn Taysheralyn@mediacorp.com.sg

DESPITE the weighty ramifications of freeing up private doctors to set their own fees, few expected the Singapore Medical Association (SMA) to take that step so soon.
.
So the suddenness of the decision to withdraw its guideline of fees, taken at Sunday's annual general meeting after a year of bandying the possibility about, caught patients — and even some doctors and health officials — off-guard.
.
Yesterday, Health Minister Khaw Boon Wan expressed surprise that the SMA's fee guide, started 20 years ago to make transparent private medical charges, should be seen by lawyers as contravening the year-old Competition Act. The good news is that his ministry is now planning to publish doctors' fees online to help patients make comparisons.
.
But, as SMA president Wong Chiang Yin emphasised to this newspaper several times yesterday, the move to axe the guideline was made with "great reluctance". The SMA felt it had "no choice" in the matter.
.
It was, in effect, a choice of scrap the guideline now — or cough up $200,000 for a decision from the Competition Commission of Singapore that might simply lead to the same result.
.
Since the Competition Act was enacted last year, the SMA's consultations with its in-house legal counsel had indicated that the guideline was "probably" illegal.
.
But to get a definitive answer from the Competition Commission, the SMA would have had to foot a hefty bill, said Dr Wong.
.
Getting guidance alone from the Competition Commission to file paperwork would have cost $20,000, while getting a decision would have cost the non-profit organisation $30,000. In addition, the SMA would have had to cough up some $150,000 in legal fees.
.
"The penalty (for contravention of the Act) is 10 per cent of turnover for every year of infringement. That's quite a lot," said Dr Wong, who had written to the Competition Commission and requested to meet with them.
.
The commission did not take up the offer, he said, but merely responded to his four-page letter, noting that the SMA had "received legal advice that the guideline of fees may contravene Section 34(2)(a) of the Competition Act".
.
Said Dr Wong: "As the penalties are accrued on a daily basis, we had no choice but to withdraw the guideline of fees."
.
But the move was not taken lightly as it has "huge" ramifications on Singaporeans who typically see a doctor five to six times a year, said Dr Cheong Yeh Woei, first vice-president of the SMA.
.
Ripples will be felt in a wide range of medical services, such as surgical operations, consultations by specialists and doctors, emergency situations and house calls, as well as fees for court attendance and the retrieval of medical reports.
.
Apart from obvious concerns about overcharging, there is even the issue of undercutting, said Dr Cheong. Medical insurance claims may also be affected.
.
Dr Cheong said the association is telling members not to vary fees, keeping in mind that the Goods and Services Tax is also set to rise. Doctors and private medical groups this newspaper spoke to agreed that fees would not rise in the short term.
.
According to Mr Khaw, the Health Ministry intends to publish fee schedules online "before the end of this year", after it collates data on average bill sizes for general practitioners.
.
Patients will have to play their part — such as being aware if they are being "over-serviced" and ensuring that private clinics display their fees as required.
.
"If you go to a clinic and find those things are missing, then vote with your feet. Go to another clinic. Providers will react if consumers are demanding and discerning," he said.
.
One problem, however, is that there is now no clear recourse for victims of overcharging — under the guideline, they could complain to the SMA. The Consumer's Association of Singapore, or Case, might have to "pick up the slack", said Dr Cheong, "but they have not sufficient know-how".
.
Despite the medical community's misgivings, the Competition Commission said it welcomed the SMA's move. "This would permit greater flexibility for fees to be set by the medical practitioners in line with their business costs. Such a move is more in line with today's circumstances," it said.
.
"Consumers would therefore benefit from the greater transparency and competition of prices."
.
But GPs like Dr Clarence Yeo felt a reference was needed. Ultimately, he said, "we mustn't forget that healthcare is a basic necessity. The basic economics of things shouldn't be extrapolated to healthcare".
.
Look at what the rep from The Competition Commission (whose existence I was not aware of till I read the article this morning) says in the article above (highlighted). Greater transparency is great, but I wonder if the patients (note that I use the word patients & not consumers) would bother to find out more about their treatment and why it costs whatever the amount may be? Or would they just go to Dr A because he charges $5 less than Dr B?

After all, consulting a doctor IS different from going to the supermarket to buy groceries. At least, it should be anyway.

(Look at angrydoc, Dr Oz & Dr Huang's blogs for more comments on this issue).

Hip & Happenin'

Apparently, I’m a “hip mom” – this from a friend/fellow doctor’s daughter who knows about the existence of this blog. I guess I am hip for being a blogger, when many others in my generation (man, that sounds so old) are still trying to figure out how to use email.

I’m glad I’m hip. I think it’s important for parents to keep up (or at least try to!) with the latest in technology or top of the chart hits or latest fashion or teen hottie etc. I think if your child sees you showing an interest in what he or she is into, it strengthens the relationship, and also helps parents understand the mysteries of their children’s minds a little bit better. Plus I also think it keeps you young at heart.

And it’s also great if your kid thinks you’re a cool mom.

:)

Pain in the ...

It looks (& feels) like I have a rotator cuff injury. I fell over some packing paper (only a klutz like me would trip over paper) back in December when the movers were packing our stuff. I
a) landed on my left knee,
b) inverted my right ankle, and
c) used my left outstretched arm to catch my fall so that I wouldn't land on my face.

The knee & ankle have since recovered. But I find myself wincing each time I take off my shirt or use my left arm to reach for something overhead - quite classical of rotator cuff injuries. Passive abduction is fine (I used my son to test this :)) but active abduction hurts. Even lying on my left side is not comfortable.

Am going to take Nsaid's for a few days (something I usually try to avoid) as 3 months is a bit long for this to go on. I took Celebrex a couple of times, but not at a stretch. Also tried traditional Chinese massage by a trained Chinese masseur (I'm in China after all!). The pressure he used felt good but the manipulation was not pleasant at all (although after the first session, the pain did lessen for a day), and I am not comfortable with all the joint stretching that he does (ouch!).

I've been using some light weights to try to strengthen the shoulder muscles, & doing some stretching to try to maintain/improve range of motion. I hope I don't need to go for physiotherapy. Being in a foreign country & looking for good healthcare is a bit daunting. On the other hand, I don't want to end up with Frozen Shoulder either.

Impressions from China - Old Beijing Hutongs

Riding through the narrow & uneven streets of old Beijing in a pedicab (or a trishaw), we were given a taste of life in the olden days, when extended families lived in the old courtyard style houses (siheyuan 四合院). Hutongs (胡同) refer to the streets that line these houses. “24 steps” was the width of the “main” streets, 12 steps for smaller streets & 6 steps for hutongs.

A typical hutong

Many of these homes have been demolished to make way for spanking new buildings to accommodate the fast growing population of Beijing. Fortunately, the Beijing government has designated certain areas to be preserved & protected from demolition. These occupants of these homes pay very low rentals (the one we visited pays only 85 yuan a month for living in a space consisting of a living room, bedroom, kitchen & bathroom). Drawback of living in these homes: no toilets! They share a communal toilet outside the home, or use a chamberpot. Ironically, most of these homes have Internet access, & both homes we visited had PC’s in their houses!

Depending on how prosperous the family was in the past, sizes of the homes differed. However, the basic layout of each home is pretty much the same. Entrance to the house is located at the SE corner (the good feng shui to allow luck in). No windows look out into the streets to ensure privacy & quiet. Each sub-building within the courtyard home has windows opening on to the courtyard which is the center of activity. Occupation each of these buildings is hierarchial, with the senior members of the family usually occupying the northernmost building, followed by the eastern building then western. The servants occupy the southernmost part of the home, & the toilets are placed in the SW part (worst feng shui).

Courtyard home, converted into daycare centre

A prosperous family may have more than one courtyard in their home. The first courtyard (closest to the entrance) is used as a “foyer”, a place where visitors wait while the servants announce their arrival to their masters. The second & even third courtyards are common areas for the family to entertain guests or to enjoy the fresh air (when Beijing used to have fresh air!). Wisteria vines crept on lattices built over the courtyards, fish were also commonplace pets, and apparently, it used to be a common past time to sit in the moonlight under the wisteria vines, enjoying the night air over a cup of tea. The rich folks would occasionally even invite an opera troupe to their homes for a private performance.

Aaahh…the simple life.

Blocked again

Sigh.

They did it again.

It's like a game.

On.

Off.

On.

Off.

And so on and so forth.

Id, Ego, Superego

Identity- The set of behavioral or personal characteristics by which an individual is recognizable as a member of a group

I had never before questioned my roots. Growing up in a multiracial/multicultural country where the concept of equality among races was indoctrinated into our young minds from an early age, I identified myself first & foremost as a Singaporean. The question of my “Chinese-ness” had never come up despite being “forced” to study Mandarin as a second language since being of Chinese origin, my mother tongue was considered Mandarin. I remember filling up a form which asked for Mother Tongue – I wrote there English…since that’s the language I think in, and dream in.

(Aside: Come to think of it, why do all the forms that we are asked to fill up in Singapore have the section on Race? If it is multicultural, how does that matter? I can understand that it is an important question when taking medical history. But when you apply for a phone line or club membership or housing loan or car loan etc, does it really matter?)

Now, being in the land from which my forefathers hailed, I find that I don’t feel any more Chinese than I did before. Maybe even less so, given my “foreign” tastes in food, clothing, music, books, etc and my inability to understand the local lingo if a native Chinese speaker starts rattling off at top speed. And I don’t feel bad about it.

I can appreciate the accomplishments of the Chinese- the richness of its culture, and the fact that some of the greatest inventions in history originated in China. I also realize that this country is home to cruel acts, sometimes of barbaric proportions, in history, both recent & not so recent.

For me, being Chinese is not the be all and end all of my existence. There are those who will probably gasp in horror at my seeming indifference to my ethnic roots. And I don't begrudge those who feel strong ties to their "motherland". But I am an amalgamation of my life experiences; I am Singaporean Chinese with a some American thrown in.

I guess I could consider myself a third culture adult.

That is my identity.

Happy Birthday, aliendoc.

YES! Unblocked!

And blogspot is back in China!

For now, anyway...

For a while there, my new best friends were www.pkblogs.com and www.proxyhub.co.uk

Smile :)

I certainly hope none of my surgical colleagues have or will ever encounter this situation...

And if you ever feel that your job sucks...

Stirring up the Passion for Learning

I watched a debate about the pros & cons of a democracy vs. communism this morning. No, it wasn't a discussion among a group of adults about politics. It was by a bunch of 7th graders (13 & 14 year olds) in school as part of their year long class project called "City on the Sea".

The premise behind this project is for them to develop a whole new city from the "ground" up within the scenario of the polar ice caps melting & covering all the land on earth. They had to figure out how much space they would need for the population, how they would generate energy to run the city, what kind of government they would want for the city (hence today's debate) & so on & so forth. Math, Science, Social Studies are all covered in this project as well as public speaking skills (when they make their own presentations on different aspects of the project).

This is the kind of teaching in schools that will stimulate the students, & encourage their passion for learning. And it was passion I heard during the Q & A session at the debate as the students all voiced their questions & opinions about the kind of political system they would want to have in their city. Hands were shooting up left, right & center as so many wanted their voices to be heard. The teachers were there, not to criticise their opinions, but more as moderators to keep things moving along smoothly.

I think we can argue till the cows come home about which education system works best for whom & in what country...but end of the day, when I see the enthusiasm stirred up in these students & their eagerness to question what is placed before them, it's clear to me what works...and what doesn't.

Impressions from China - blocking blogs

Living here, one thing I've learnt to appreciate is freedom.

I realise that many websites are blocked by "the authorities" here in China...Big Brother is certainly watching. And many of these websites are blogsites which may or may not contain material deemed "unacceptable for viewing" by the local authorities.

I have been having problems accessing this very blog site. I can post entries but can't read them (or any entry on blogspot or wordpress or live journal or xanga for that matter). I am hoping that it is just a glitch in the system & that eventually I will be able to get into the blogs I regularly read.

For now, I will need to be careful about what I write here.

Paranoid? Maybe. But I don't want to chance anything. You never know who's watching.....

Impressions from China - Construction Conundrum

These are some of the problems I have encountered with our house since we moved in a month & a half ago:

1. Water condensation on some of the bedroom windows. I am not referring to the misty layer we see on glass when it meets cold air. This is water-droplets-rolling-down-the-window-on-to-the-floor condensation. Enough to cause the beginning of fungal growth on the curtains. Apparently this is not unique to our house. Others in the neighbourhood have been similarly affected. The contractor has tried replacing the double-glazed windows in vain. Those who have studied physics can probably surmise that the problem lies with poor insulation between the outer & inner surface of the exterior layer of glass resulting in the great temperature difference resulting in the water condensing on the warmer surface (i.e. inside surface of the window). But the contractor is waiting for warmer weather before commencing corrective work on this problem. Meantime, we live with towels perpetually placed on the window sills to absorb the water; otherwise we may end up with warped wooden floors.
2. One particular toilet that always gets blocked. The maintenence guys say that this particular model has narrow & curved pipes leading out. Problem with this explanation is that the other two toilets have the exact same model of toilet bowl, but do not get clogged at all. Solutions they have offered include a) use less paper b) use paper but don't throw it down the loo...throw it in the trash basket instead.....EEEEWWWWW!!!!!
3. Hot water (think sauna-steaming hot) that comes out the cold water faucet. We have to let it run for a few minutes before the water turns cold enough to not cook your flesh. Two contractors & two estate management guys were here yesterday trying to figure out the reason why. They held a long philosophical discussion on the workings of hot & cold water piping. After 2 hours, they were still at a loss as to what may be the problem. One guy suggested turning off the hot water supply for a day & see whether the same thing happens (duh). Next step: ask the boiler guy for his opinion.
4. Heat rises (at least that's what I was taught in Science in Primary school). We have floor heating; however the coldest part of the house is on the top level. I think that during construction, the contractor must have tried to save on insulation & neglected to include the roof when putting in the insulating layer.

Speaking with long time residents of Beijing (& probably this applies to the rest of China as well),many contractors take short cuts to save cost & time. On the exterior, everything may look fine & dandy. But over time, faults start to show due to poor quality of material used, or due to replacement of original imported parts by sub-standard ones (they can then sell off the originals for a profit).

Due to this lack of quality control & standards, the "Made In China" label will take some time to be recognised as world class...

Education

How will MOE or any of the local schools respond to this letter, I wonder?

March 17, 2007, ST Forum
Which school would students rather be in?

LET me contrast the approaches taken by an international school and an autonomous school in Singapore.
Guess which school offers customer-service orientation to parents and students (teachers respect students and do not scream at them); later-starting school hours; curriculum that allows learning to take place (teach less, learn more); good and motivated teachers; small class sizes; no pressure on students/staff to win accolades (the journey is more important than the destination); minimal homework and tests/exams; hiphop dancing exercise for PE and, best of all, cellphone and laptop usage.
Students and parents are welcome to see the teachers and the principal himself whenever possible - no bureaucratic system to block access, even the security is friendly.
The typical Singapore school's philosophy is that 'children should be seen and not heard'. The moment they arrive in school, they have to sit down quietly in the hall to read. During recess, there is no time to play. They are not allowed to talk in class (too noisy). Small wonder many do not grow up articulate and find school to be, at best, a forgettable experience.
Shoes, socks and hair pose no big issues in the international school (don't sweat the small stuff). Students are free to show individualism (and do they look good). But not the stern Singapore school - it wants the students to look like factory-produced robots. I do not think this is the only way to instil discipline. I recall the time I had to go out late at night to buy white school shoes with laces for my child (velcro not allowed).
Education should reflect changes in the workplace and society - including cellphone usage. Everyone is using cellphones everywhere, except in our conservative schools. How do you expect students to learn to use their phones properly in public if they are not allowed to do so in school? Education is also about teaching them responsible use of the phone during lessons.
Ultimately, it boils down to mindset and how a school manages the students. It is time for the local schools to loosen up.
By the way, ask the international school students if they are happy and the answer is an affirmative 'Yes'. The students also do reasonably well academically, in case you wonder.

Lam Mun Wai (Mdm)


Regular readers of my blog would know that one of my pet peeves is the Singapore educational system. Some of the issues have been highlighted by Mdm Lam: teachers’attitudes towards their students (perhaps not screaming at them, but stern all the same), expecting students to be “guai”& sit quietly listening to the teacher doing all the talking instead of an interactive learning environment, class sizes, the emphasis on results (i.e. exams/tests) instead of the learning process etc.

Will they cite cultural differences as an excuse for the different approach to education? The need for a strict dress/appearance code to instill discipline? Banning cellphones to avoid distractions?

Let’s see what they say…

United 93

I just watched on DVD the docu-drama “United 93” which just won a BAFTA award (British version of the Oscars) for Best Direction. I

It was gut-wrenching to watch the re-enactment of the events that happened on 9/11. Emotions which I thought had already faded with time resurfaced. I felt chills & goose bumps watching the collision of the two planes smash into the two towers of the World Trade Center. I couldn’t stop the tears from forming. Despite knowing how it all ends, I couldn’t help but feel the devastation as it happened.

In addition to relating the story of what happened on flight UA93, the movie also shows a gripping view of what went on in the air traffic control towers on the East Coast & the military air command post when these events were unfolding. Two words: Utter Confusion. No one knew what was happening till it was too late. Even the military had no rules of engagement for such an occasion. No one ever thought that something like that could or would happen.

At one point, the director shot a close-up view of the radar screen showing all the air traffic that was in flying in American air space. Imagine each of those blips as a potential weapon. A terrifying thought. And not as outrageous as it may seem. Five years ago, if someone were to tell me that large commercial planes would be used by terrorists to inflict horror upon the world, I would have laughed & pooh-poohed it off as rubbish. Then look what happened.

I cannot imagine how the passengers on flight United 93 must have felt when they realized what was happening. How do you face your impending doom? What do you say in that last phone call to your loved ones?

And would you have the courage to do what those few did, trying to disarm the terrorists, knowing full well that whatever they did, the end result would likely be death?

What would you have done?

What would I have done?

I hope I will never have to find out for myself.

Impressions from China - Mandarin

Had my first Chinese lesson today. (note: last time I had a Chinese lesson was in 198_!) I admit was a bit nervous waiting for the teacher to come. Maybe it was my subconscious dragging up the horrible time I had trying to "scrape through" my Chinese exams in JC...I barely made it by the skin of my teeth...one grade worse & I wouldn't have made it into University/Med school. I never learned to love the language in school, thanks (or no thanks) to the teachers I had. It was just a matter of trying to make the grade in order to progress up the academic ladder.

So today, I didn't know what to expect. The teacher is a very pleasant lady, used to teaching "wai guo ren" (foreigners). She first assessed what level of Mandarin I'm at. I am glad to say that as far as sentence structure & "grammar" are concerned (I put grammar in parentheses because there really isn't grammar in the true sense of the word in Mandarin; more like knowing how the verbs & the nouns & the adjectives & adverbs etc are used in a sentence, & in what sequence), she thinks that I am OK. My main problem area is vocabulary (or the lack thereof). And I totally agree with her. That's why I can't understand responses when waiters & salespeople answer my questions & also why I literally am lost for words while in the middle of giving instructions to the driver or the ayi.

The rest of the lesson was spent with her trying to encourage me to dig up whatever Chinese vocab I had by my describing (in Mandarin) pictures she showed me, translating English text into Chinese (with her help of course!) & with her asking me questions about Singapore to which I had to reply in Mandarin (very much like how it would be in a real life situation speaking to a local). Along the way, she would prompt me, & write down words which I didn't know into a note book, so as to help me build up my vocabulary.

The rest of my lessons are going to comprise of similar situational "conversations" with my teacher. Eg. at the market, or shopping for furniture, or instruction the ayi etc. Things which will be helpful in everyday life.

My kids (who both have very rudimentary knowledge of Mandarin) also had their first lesson today. I didn't sit in on their lesson, as I wanted to teacher to have free rein in assessing their standard. But I could hear them actually making the attempt at speaking to her in Mandarin (albeit with a very American accent!), learning the names of fruits (there happened to be a bowl of fruit on the table), figuring out how to verbalise different amounts of money (using real currency). They were laughing along with the teacher possibly over mistakes they made...whatever it was, they were laughing! They had NEVER associated Chinese lessons with anything remotely humorous before in Singapore...NEVER!!!

What a difference the teaching methods make. If only they could have taught us this way in the Singapore schools...maybe we would have developed a love & interest for the language.

P.S. My teacher used the word "han yu" (汉语) to describe Mandarin, not "hua yu" (华语) which is what is used in Singapore.

The Doctor-Patient Relationship - A New Paradigm?

Dr Bard-Parker's latest entry talks very succinctly about this new (& evolving) relationship. Check out this article from the Boston Globe penned by Dr Marcia Angell , lecturer from Harvard Medical School.

I am not sure if the doctor-patient relationship in Singapore has reached this level in general. I believe that it has to a certain point, especially among the better-educated & usually younger patients.

In any case, I agree with Dr Bard-Parker that this is great advice from Dr Angell :

"As patients, your best bet is to ask your doctors what they would do in your place, and persist until you get a straight answer. If nothing else, that forces doctors to imagine being in your shoes, at least for a moment, and it may cause them to think more deeply about what you should do."

Impressions from China - Pollution

The rain & snow did some good. At least the pollution index has gone down to a good level of 34 today & 28 yesterday. Amazing.

It's scary looking at all the 3 digit numbers which signify how polluted this city usually is. No wonder everything is grey most of the time.

I'm glad we have our air filters at home.

Impressions from China - Freaky weather

Apart from a snowfall the day after we arrived, it had been absolutely moisture-less.

Till 2 days ago is started to drizzle.

Then to rain yesterday.

Then this morning, we woke up to a layer of white!

The trees must be confused. I've been noticing shoots of new growth sprouting from the branches, then now this.

Freaky weather as a result of El Nino? Global warning?

Good for a laugh

Inspired by angrydoc's latest blog entry (or rather, blog link), I figured these might be worth a laugh. It's one of those email jokes forwarded from various friends every so often - this is a keeper though...

NEW DRUGS FOR WOMEN

DAMNITOL
Take 2 and the rest of the world can go to hell for up to 8 full hours.


EMPTYNESTROGEN
Suppository that eliminates melancholy and loneliness by reminding you of how awful they were as teenagers and how you couldn't wait till they moved out.


ST. MOMMA'S WORT
Plant extract that treats mom's depression by rendering preschoolers unconscious for up to two days.


PEPTOBIMBO
Liquid silicone drink for single women. Two full cups swallowed before an evening out increases breast size, decreases intelligence, and prevents conception.


DUMBEROL
When taken with Peptobimbo, can cause dangerously low IQ, resulting in enjoyment of country music and pickup trucks.


FLIPITOR
Increases life expectancy of commuters by controlling road rage and the urge to flip off other drivers.


MENICILLIN
Potent anti-boy-otic for older women. Increases resistance to such lethal lines as, "You make me want to be a better person. "


BUYAGRA
Injectable stimulant taken prior to shopping. Increases potency, duration, and credit limit of spending spree.


JACKASSPIRIN
Relieves headache caused by a man who can't remember your birthday, anniversary, phone number, or to lift the toilet seat.


ANTI-TALKSIDENT
A spray carried in a purse or wallet to be used on anyone too eager to share their life stories with total strangers in elevators.


NAGAMENT
When administered to a boyfriend or husband, provides the same irritation level as nagging him.

Impressions from China - Finding the 'qi' in me

Took my first Chinese painting class today. It's harder than it looks! My bamboo plants look pretty pathetic...more like a bunch of measly black colored bananas.

The art teacher says we have to use the 'qi' in our body to control the brush - how much pressure one uses while painting & how we hold the brush will determine what the end result will look like.

Hmm...I wonder if George Lucas was inspired by the Chinese concept of 'qi' when he created the Star Wars saga.

I have signed up for a package of 10 classes. Hopefully I will improve.

In the words of Obi-wan Kenobi: Use the Force, aliendoc.

Spoilt

Someone complained of being overcharged by a GP during the Chinese New Year:

Clinic charged $42 for consultation over CNY


DURING the long weekend to celebrate Chinese New Year, an incident occurred which I feel I have to clear my doubts about.

It happened that my grandmother had gastric flu and had to consult a doctor. As it was a public holiday, we had to go to Tampines Central where there was a 24-hour family clinic.

It is actually quite heartening to know there is still a clinic nearby when you need one, even on a public holiday.

When we reached the clinic, we found out it charged $42 for consultation alone. This charge applied from Feb 17 to 20, from 7am to midnight. It did not include any medicine or anything else.

I find it disturbing that patients are charged such a high amount just for consultation. Are the doctors different? Is the service provided different?

Just because the clinic is open 24 hours and has to stay open during public holidays, it does not have the right to raise consultation fees so high.

It is true that staff may have to be paid more during public holidays, but there were three staff members at the dispensary when two would have been more than sufficient.

I would like to know if there are rules or guidelines which private clinics have to follow regarding the charging of consultation fees during public holidays. I do not think it is right that patients who fall ill during this period are charged so much more.

It may be reasonable to charge $20, but $42 is far too much. On a normal day, $42 would be more than enough to pay for the consultation and medicine.

Andrew Chia Teck Fatt

ST Forum, Feb 23, 2007

Then today more letters appeared in the papers in response to this. But I wanted to give a standing ovation to this particular person:

Thank docs who make themselves available


I REFER to the letter, 'Clinic charged $42 for consultation over CNY' by Mr Andrew Chia Teck Fatt (ST, Feb 23).

I do sympathise with Mr Chia, but I honestly feel he should not begrudge the fact that his grandmother was charged $42. In fact, he should be grateful to the doctor who made himself available on a public holiday when most clinics are closed.

If he had taken his grandmother to a public hospital, he would have had to pay a higher fee. Public hospitals charge no less than $70 per consultation. In addition, he would have had to wait at least a couple of hours to see a doctor.

I called a plumber recently to fix a leaking tap. He charged me $400 without batting an eyelid.

I called an electrician to fix a fuse box, and he charged me $600 without hesitation.

I called a roof contractor to fix a leaking roof. He sent a worker up to the roof with a pail of cement. The worker came down within five minutes and I had a $500 bill. I paid because it was after office hours and a public holiday.

Why do we complain when we pay $42 to the hardworking doctor who makes himself available on a public holiday? It's a pittance to say the least.

I believe the good doctor should have charged Mr Chia $100 for a consultation on a public holiday. And that, I feel, is still very modest.

Amy Ng Siok Im (Ms)

ST Forum Feb 26, 2007

I have said it before & I will say it again. Singaporeans do not realise how good they have it. The very fact that GP clinics stay open on public holidays/weekends/24 hours a day is not appreciated. $42 for a consultation is extremely reasonable under the circumstances. But unfortunately, in Singapore, priorities are all screwed up. It's OK to pay $2,000 for a Tod's handbag or thousands of dollars to the beautician for a facial spa package. But when it comes to your health, $42 is WAAYYYY too much.

Sigh.

Impressions from China - Shanghai

My first impression of Shanghai as we headed to our service apartment from the airport, was that it didn't feel as "foreign"as Beijing. Things looked familiar - the roads were better maintained, the buildings looked more modern, even the people looked different (northern Chinese faces seem to be broader, & their complexion seems to be darker), closer to the southern Chinese faces that I have been so used to seeing in Singapore. More signs were bilingual (Chinese + English) so that I didn't feel so lost.

Traffic was just as bad (if not worse) than in Beijing. People seemed more aggressive, especially when we were in crowded situations like at the Bund or Yuyuan, which during the holiday season, was thronged, and I mean THRONGED, with visitors. It was literally push-and-shove in order to make ones way through to ones destination.

The crowd at Yuyuan

ATTRACTIONS

The city definitely looked more developed than BJ. Walking along the Bund, we noticed that one side of the Huang Pu River had architecture reminiscent of its colonial days, while across the river, modern buildings were the norm.

The "old"side of the Huangpu River

The modern side of the Huangpu river

The Shanghai maglev train is another example of modernization. We did a round trip on this train for the sake of our kids...after all, how often does one get to ride in a train at 430 km/h?!

Shanghai Maglev train

FOOD!

One does not visit Shanghai & not rave about the food! From fine Italian cuisine (read: expensive) at Cucina on the 56th floor of the Grand Hyatt in Pudong, to different varieties of buns at a Mantou restaurant in Yuyuan, to delicious (& greasy!) shenjian mantou costing us only 70 yuan for 72 buns which the 9 of us devoured, one can find an amazing variety of food available in the city. The pig's elbows ("tipang") is a must. Don't be turned off by the layer of wobbly fat & skin that you see on the surface. Underneath all that, you find the tasty lean braised pork meat...mmm...yummy...

"Souper" buns at Yuyuan

Shenjian mantou - delicious & cheap!

Braised pig elbows "tipang"

Impressions from China - New Year

(Written 12 MN, Feb 17/18,2007)

I gaze out of the bedroom window of our service apartment overlooking downtown Shanghai. The cityscape is covered in a haze created by a combination of fog and smoke from burning fireworks & firecrackers.

Right, left and centre, we seem to be surrounded by rainbow-colored shooting stars exploding to an incessant continuous cacophony of snaps, crackles & booms - explosive retorts from exploding fireworks. It seems neverending, this noise & light show that is welcoming in the Lunar New Year.

I am fascinated by this city, a seemingly foreign & Western Hub in an ancient Oriental country. It reminds meof Hong Kong & Malacca & Penang & Singapore all rolled into one. I look forward to exploring more.

The fireworks are still going off as I write this...and it looks like the city is not going to sleep...not tonight anyway...

Gung Hei Fatt Choy

I dreamt of my dearly departed grandmothers last night. The images are vague, as dreams tend to be. I remember snatches of the dream, images of my maternal grandma, my mom & I shopping along Orchard Road, taking shelter from the drizzling rain along the five-foot way near Peranakan Place just outside the Taka jewelry store. What we were shopping for, I don’t know.

Then the dream shifted to my paternal grandmother, urging me to make the booking for a cruise or a hotel or some kind of holiday online before it became all sold out! This is totally radical as my Ah Mah never had an inkling of how to use a computer!

Since time immemorial, people have wondered about dreams & their meanings. I won’t even begin to go into that. What the dream did for me was to evoke memories of Chinese New Year shared with those who are no longer with us, New Year celebrations when extended families were actually in the same country. New Year’s Eve would see us having dinner together: grandparents, uncles, aunts, cousins. We would pre-arrange the sequence of ‘visitations’ (actually, my beloved but dictatorial maternal grandpa would be the logistician), & even co-ordinate what kind of food we would have at each house so that there would be no overlap!

The morning of New Year’s Day would dawn with my siblings & I waking up, wishing our parents “gung hei fatt choi” & eagerly receiving hong baos from them. We would then dress in our new clothes & head out to the first stop, usually my maternal grandparent’s home. That would mark the start of a whole day of stuffing ourselves silly, mahjong, & for the kids, totaling up the hong bao takings (not necessarily in that order).

I know many people complain about the monotony & tedium of having to visit all their relatives year after year after year. To those people I say: Appreciate what you have when you have it because one day, you’ll wake up missing & wishing for those days.

I know I do.

Gung Hei Fatt Choi/Gong Xi Fa Cai/Happy Chinese New Year everyone!

Impressions from China - This & That

Been here over a month. Can't say I totally feel at home yet, but things are slowly & surely falling into place.

Our immune systems have been challenged. In total, the 4 of us have suffered from 5 bouts of URTI, & 4 bouts of GI-related illnesses in the short time that we've been here. Not fun, but I guess our resistance against new bugs has to be built up.

Chinese New Year is coming up & we're off to Shanghai to visit with some friends. People here get a whole week off for the "chun jie"(Spring Festival), as they call it here. Many return to their home towns & villages, & apparently bus & train tickets are impossible to get this week.

The tid bits I see being sold in supermarkets are not much different from those sold in Singapore. One big difference is that fireworks are allowed to be sold here for the weeks around CNY. We have already started hearing the booms of firecrackers being lit at night; I think this will escalate & peak on New year's Eve & the first few days of the New Year.

Another difference I see is that there is no "yusheng" here. Shouldn't be surprised though, since I think that is a Singaporean "invention".

Gong Xi Fa Cai everyone!

Numbers

Disclaimer: The opinion expressed in this entry is solely that of aliendoc’s, based on experience in both public & private sector. It in no way reflects policies or opinions of the Powers That Be.

There has been much discussion the last few weeks about MOH making it “easier” for foreign doctors to practise in Singapore. This is supposed to address the shortage of doctors in the country.

There have been arguments & questions raised on why & whether there is actually a shortage at all, especially in the private sector. No, I don’t believe that there is a shortage; it’s a dog eat dog world out there especially in GP-land*. (*I exclude aesthetic practitioners in this group, as I believe they are a different species from what one would perceive as a typical GP…but then, that is whole different kettle of fish altogether ☺. I also exclude doctors who are employees of a larger medical group – this will be expounded upon later.)

Doctors are not businessmen. We were not taught a module on business strategies & economics in medical school. Hence, GP’s end up “killing” each other trying to get a “market share” of patients. They undercut, sign on with HMO’s & MHC’s (whatever you may call it, these 3rd party administrators exist for the sole purpose of making money) just to make ends meet. Business consultants would probably cringe if they saw the kind of decisions that have been made by some of these doctors.

As for the larger medical groups, it’s a different story altogether. Speak to any of their operations managers or HR manager & you would probably discover that recruiting & retaining doctors is a difficult task. Many have a high turnover rate; take a look at the SMA newsletter & you’ll see what I mean - ads repeated issue after issue, seeking doctors to join them.

On the flip side, you have the government polyclinics – obviously overcrowded & evidently understaffed. Junior doctors in hospitals are also lacking (although this may have improved the last few years with increasing medical school intake).

So why the shortage in the government sector? Simple: doctors leave after they complete their obligatory bond. And why do they leave? Perhaps they seek the almighty $. Or they want some autonomy in how they practise. Or they are just sick of the bureaucracy. Like it or not, there is still a strongly hierarchical structure (not to mention the politics!) in the government departments (call it NHG or Singhealth, call it what you like, but in the end, it works the same way ☺). It is hard to be heard unless you go through the proper channels (i.e. somewhat of an obstacle course where you have to clear a few obstacles before reaching the finish line, if at all).

And how would you explain the medical groups’ dilemma of finding & keeping doctors? My take is that doctors working for these groups have very little say (if at all) in how certain patients (read: those under very restrictive HMO/MHC contracts) are managed. After all, these groups have to answer to their shareholders & clients (note: I use the word "clients", not "patients") & the bottom line is VERY important after all (sarcasm intended). So, see as many patients as possible, get as many contracts as possible, & save money for the clients (the companies who contract with them to look after their employees). End result is that doctors will use this as a stepping-stone, a temporary job before they venture out on their own to compete with their colleagues for patients, and the vicious cycle continues.

So will letting in more foreigners in do the job of resolving the numbers problem? Probably partially & temporarily, especially in the government sector & in the medical groups. But it won’t help the GP’s out there who will still be struggling to stay afloat, competing with each other, & forced to charge miniscule amounts for consultation fees.

So if the big wigs want to look at the long term problem of shortage (I prefer to use the word, skewed distribution) of doctors, they will need to examine the causative problems first. Otherwise this will just be another fire-fighting scheme, which does not prevent another fire from starting.

Impressions from China - Aliens

As an alien in China, you begin to appreciate the difficulties that foreign workers meet with when they leave the comfort (not neccesarily just physical, but psychological & emotional as well) of home. A strange new language, different transportation systems, electricity voltages/sockets, customs & culture...when one is inundated by a shock wave of all things new & unfamiliar, it can be extremely daunting. The simple task of shopping for groceries or neccesities in a store takes twice as long when one is trying to interpret the labels on a can/bottle/package.

I have met with many foreigners in the last month that we've been here, hailing from the various continents. It is weirdly comforting to know that no matter where we're from or what our mother tongue, we all share the same stories of fumbling & learning our way around an alien country. I guess being in a foreign land makes our differences seem insignificant in the greater scheme of things.

We have the advantage of accessibilty to information & resources like the Internet & guide books to help us settle in. But most of the manual foreign workers who travel thousands of miles from home searching for a better life do not have that. They rely on sometimes unscrupulous agents & employers to "help" them in their expatriation. And yes, by definition, they are expats too.

So the next time you see a foreign worker ,who labours to help us build those skyscrapers & condos, or who helps you to look after your home, take care of your children/parents, spare them a kind thought & put yourself in their place. After all, once upon a time, most of our ancestors were expatriates too.

Battlestar Galactica

I’ve been glued to the sci-fi series “Battlestar Galactica”. Not the old series from the 70’s, but the revamped one that has been playing on the SciFi channel in the USA since 2003. I bought Season 1, 2 & 2.5 & brought all 3 sets here, in expectation of a relatively barren TV listing in China (which I am now happy to report is not that bad after all ☺).

I was a huge fan of the original series (probably, in great part, due to my crush on Dirk Benedict who played brash, cigar-chomping ace pilot, Starbuck). Star Wars: A New Hope started off my fascination with the scifi genre. When BG came along, it became a favorite of mine. Looking back, I suppose that during my adolescent years was also when my mind started to question if there was something out there in the Universe; after all, statistically speaking, in our humongous universe, there has to be other worlds with intelligent life-forms apart from our big blue marble.

The new series is definitely different from the old. A lot darker for one, & despite its setting, delves into current day issues - war, terrorism, abortion, racism, torture of prisoners (season 2, rated NC-16, addresses the latter & had me cringing at some of the scenes).

With brilliantly written scripts & great acting by veterans Edward James Olmos (Commander Adama) & Mary McDonnell (President Laura Roslin), & relative newcomers Jamie Bamber (Capt Lee “Apollo” Adama), Katee Sackhoff (Lt. Kara “Starbuck” Thrace), Grace Park (Cylon sleeper agent Lt. Sharon “Boomer” Valerii) & Tricia Helfer (as the babelicious Cylon No. 6/Gina), I have been watching episodes from the series avidly in the last week, going through season 1 & now seasons 2 & 2.5 (don’t ask me why they divided season 2 up). Grace Park especially deserves special mention in season 2 with all the heart-wrenching emotions she must have had to drag up from the depths of her soul in order to portray her character’s situation so adeptly.

Season 3 is being broadcast now in the USA. I can’t wait for the DVD set to be released (or at least for the series to start showing on Cinemax).