Lesson from Singapore

Morning Talk by Prof Ho from Singapore NUS, originally uploaded by Haris Abdul Rahman.

We wouldn't like to admit it, but there are things we could learn from our Southern neighbour. And we are not just talking about how to make a sitcom here.

This morning, the Faculty received a visit from a Professor from NUS in Singapore. He basically told us the story of how the healthcare system in Singapore been undergoing a major revamp since the turn of the millenium. And it all started from a realisation of something very obvious.

First, Doctors were leaving for Private practice in droves and that needed stopping. Second, the only real advancement can only be made if backed by R&D. In short, there are investment needed to be made into the health system, and it is not to build the biggest hospital with no specialist, or to purchase a CT machine to be hidden in a basement. The money should be channeled directly at the target. Increase the Faculty members pay packet, spend the money for research opportunity for these Faculty members and spend the money on proper human resource development, not on just some 'modal insan' mambo jumbo.

It all started with a simple questionnaire distributed to all doctors at one of the main hospital, asking what they detest most about their job and what it the main reason why they are still at it. The main reason why they want to leave is 1) the pay is a lot better outside, 2) limited career prospect for advancement. The next thing they do was realign the services, and change the hospital demography of the island down into 4 'district' hospital and 2 University Hospitals, the '4 plus 2' plan.

At the hospital, to promote career development, the Faculty Members were introduced into 4 career tracks, ranging from pure Clinicians to mainly Researchers. The promotion criteria will be aligned to each career tracks and everyone knows exactly what is required of them. At least what it sounded on paper. In en updated survey, they seems to be looking at early success. The staff retention rate looked good and their research output is also on the rise. The feedback from the Medical Students and patients also seems better than before, but Prof Ho himself felt that it is too early to paint any conclusions.

I find the talk fascinating and Prof Ho has plenty of insight to offer us. Realistically however, with a more intellectual population (and politicians) and smaller, and more compact geography, these major rethinking is much easier to implement in Singapore. The fact that the Minister of Health also tended to be medical doctors does help! The fact that they realised that something was wrong in the first place, quickly proposed a solution and implemented it is something that I admire. If only we can have similar strive for a goal, any goals, than there is hope for my beloved 1Malaysia.

Me and Specks

Me and Specks, originally uploaded by Haris Abdul Rahman.

Spent the whole day yesterday sorting things out for the audit in the afternoon. The auditors came and went, and they are pretty pleased with things, which is great. I am sure those of you who had to endure an audit before would testify that it can be an ordeal. This particular one was for an anticoagulant study I have been conducting for the past couple of years. The auditors were from France, Korea and Taiwan. The lady from Taiwan was particularly menacing, but her boss, the Parisian guy was pretty steady and complementary. It may be just a French thing I think.

Lanyau and the othersPavillion in the evening!Anyhow, in the evening after work, I had dinner with Specks, one of my old buddy from school. He is now working for a Pharmaceutical company in London and is just back for a couple of weeks. He brought with him a couple of friends, an actor from Bristol and his girlfriend, a Medical Microbiologist from Cardiff. We had dinner at Madam Kwan in Pavillion, and we were graced by the presence of Madam Kwan herself! They had some Char Koey Teow, and so did I. Another old Terendakian also came with us, Lanyau. They are off to Cherating tomorrow morning having just got back from a weekend in Langkawi. I can see that they were all sporting a tan!

Idlan and his Assessment

Idlan practicing his sumsAnita has been up all night last night thinking of Idlan's assessment this morning. Bear in mind he is only 5, and it is for kindergarden. I think she is a tad over-reacting. Anyhow. She got him up and early and ready to go by 7.30. As usual, our driver was late, and Anita had to do the driving herself.

I used the new DUKE highway today and left the house at 7.30. Traffic was cool on the highway with only a minor hick-up at Jalan Duta exit. Reached the Faculty by 8, and already up and running in my room at 8.15. Quick check on the feeds and email. This is when I learned that Ida Nerina is in the ward after taken a tumble the night before. She had spinal injury but the details about what happened was rather sketchy.

Got a shock when I turned up when I saw that there are 8 Medical Officers now attached to my ward. This is what I call total care for the patient. The ratio is around 1 doctor every other patient when you count out the 5 lecturers as well. So we were practically tripping on each other during Grand Ward Round yesterday. Myself and Bee gave up during Day Care where there were no seat for us. We ended up trouble-shooting then left early to start the Transplant Clinic.

We then had a discussion about our future plan for the Unit over tea. Then head home and looking forward for the usual badminton session. I must confess that I was rather tired and all. I left after 3 games and already ready for bed soon. Guess I am getting old.

Happy Father's Day

The 5 grandchildren, originally uploaded by Haris Abdul Rahman.

As mentioned, we took my Dad (Dada) for lunch today. As he liked steaks, we brought him to Marche at The Curve. All his five grandchildren were on tow and as expected they created havoc. The good news is there was a 20% discount on meals for Father's Day!

We spend a couple of hours there with the children occupied at the playground. Next, we headed across to the Sunday Market. According to my sister, Julia, the stalls were pretty disappointing today compared to last. That didn't stop here from getting a brand new pair of shoes. Next, we walked across to IKANO. Julia wanted to get her children Crocs shoes.

It took us nearly an hour trying shoes out to keep everyone happy. They then headed for the play area back at The Curve causing more havoc there!

Finally we drove home around 4. It was a long afternoon. Both Idlan and Irfan went to sleep at 8 tonight. Idlan has his school assessment tomorrow, and Anita was up awake worried. Imagine if he was taking A levels or something. I'll probably need to get Anita a pacemaker!

Happy Birthday to my Dad

090620 KL Butterfly Park 07, originally uploaded by Haris Abdul Rahman.

Today happens to be my Dad's 63rd. However, we thought we will take him out for dinner tomorrow for a 2 in 1 thing with Father's Day. First thing, I drove to PJ Hilton for a Haematology Study Group Meeting. We spent the whole morning discussing protocols and I must say, compared to the sessions in the years past, this has been the most fruitful.

We actually touched almost every aspect of Haematology, but the gist of it is the the plan to standardise the trefatment for adult Acute Lymphoblastic Leukaemia. Looking back, the treatment response has been rather disappointing and it is about time that we be more aggressive in terms of chemo regimes. It will take a few more sissions though to get things rolling although from the looks of things, Hospital Ampang will be going ahead as early as July with the new plan.

Lunch came next, after a good chit-chat, I decided to take my camera out in the afternoon. Last year, I went to the Butterfly Park in Tasik Perdana, KL with my gear and was disappointed. Most of my snaps turned out blurry or out of focus. I think the problem was the aperture I was using was too wide, narrowing the depth of field. As a result the focal plane become very small. So in English, aperture (assigned a an f number) is the diameter of the opening on the lens to let light in. The smaller the f number, the wider the aperture, the more light gets in. The maximum aperture is usually indicated at the name of the lens. The main advantage of wide aperture is the ability to increase the shutter speed. The higher the shutter speed, the less like the image become blurred.

However, there is a price to pay for wide aperture. The wider, ie, the smaller the f number, the narrower the plane of focus become. Image falling before or after the plane will become out of focus.

The mistake I made was thinking with the smaller f number and the higher possible shutter speed, I hope the image will be sharp. Unfortunately the focusing on my camera can be tricky sometime. As a result, around 75% came back unsatisfactory. This time around, I increase the ISO - sensitivity of the camera to light, and shot at f8 to 11. I think the results this time around is much better.

Later in the evening, I attended the Medical Department Annual Dinner. This year it was held at Holiday Villa Subang. The highlight was definitely Sanjiv's rendition of "Sound of the Falling Rain" as a tribute to KL Goh. It was hilarious. Iqbal's 15 minutes of stand-up wasn't that bad either. I got to also go on stage to pick up my Badminton's winners medal.