Prudence needed in use of public funds

Malaysians in general read with aghast the Auditor General’s Annual Report 2006.It was unbelievable that the various government departments have paid exorbitant prices for common items. Imagine paying RM224 for a RM32 set of screwdrivers, RM1,146 for a set of pens costing RM160, RM5,700 for a car jack worth RM50, the list is long and shocking. Besides over-spending other flaws included corruption, poor management of funds, incomplete and outdated data and lack of enforcement and manpower

What is distressing is that such mismanagement of funds does not seem to be isolated incidences but part of a generalized malaise that had inflicted almost the whole civil service. Nearly all the departments in all the states appear to be involved in some form of misuse of public money. There are set procedures and protocol for financial dealings, purchases and transactions, why are these being blatantly ignored?

These irresponsible actions are due to the lackadaisical attitude of many government officers. If they were to be spending their own money will they do such a thing? The money comes from taxes paid by the people. Money is not easy to come by these days and the people are overburdened with the escalating cost of goods, utilities, housing, education, healthcare and transportation.

Despite all these financial burdens, as law abiding citizens, people still continue to pay their taxes which come from their sweat and blood. If there is dishonesty and wastage of public funds, it would be greatest betrayal and injustice to the people by the very people who are employed to serve them.

This is not the first time that an audit report has revealed the inconsistencies and abuse in government departments. Year in and year out similar reports have brought out such discrepancies in financial management. Unfortunately no remedial actions were taken. Malaysians seem to have very short memories for such unpleasant incidences and the culprits are soon forgotten.

The Prime Minister has promised to look into the problem and we hope that action would be taken against those responsible so that these would not be repeated next year. We hope he will be able to strengthen the financial prudence, honesty and integrity of the officers at all levels of our government departments.

The Auditor-General Tan Sri Ambrin Buang and his team should be commended for the excellent job they have done to expose the weaknesses in the financial management of the various departments. We hope other department heads too can follow his example to stamp out this malaise that is threatening to take deep roots in our civil service. The ball is now in the court of our political leaders. Do they have the will to stop this misuse of public funds?

Dr.Chris Anthony

RTD responsible to the people

eKesihatan : Unhealthy health screening
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At first it was encouraging to learn that drivers of commercial vehicles will soon be subjected to a comprehensive medical check-up and certified fit before their driving licenses are renewed. These will include testing for drugs, alcoholism, cardiovascular and mental illnesses. The opinion changed on realizing the unhealthy developments that were taking place behind the medical screening scheme that is being implemented in a haste,“Unhealthy practice” (Sun,September 11).

The scheme, called eKesihatan, aims to ensure that only medically-fit drivers are behind the wheel of commercial vehicles. If implemented properly the scheme would definitely go a long way to improve the safety of public transport all over the country. The onus is on the Road Transport Department (RTD) to ensure the medical screening scheme is implemented effectively.

It is however unfortunate that that the project to improve the safety of our public transportation has been turned into a money-spinning one. The introduction of the middle agency,Supremme Systems Sdn.Bhd.is unnecessary and an waste of money.

Why can’t the RTD make arrangements with the government hospitals to screen drivers for illnesses? In fact the government hospitals are better equipped in every way to provide the service. If at all it needs the service of private clinics, why can’t they deal directly with the Malaysian Medical Association to make the arrangements?

Why should a third party be engaged and paid 41 % of the cost of each examination? It is ridiculous that the middle-man is paid more than the doctor who is solely responsible for carrying out the medical check up. More distressing is that the cost of such examinations have gone up from RM50 to RM 85,an additional burden on the drivers.

The RTD, a civil service department, is entrusted to safeguard the interest of the people by ensuring they enjoy a reasonably accepted level of safety of their public transportation. Why should that job be transferred to a third party, a private company in the form of Supremme System Sdn.Bhd.which will in no way be accountable to the rakyat?Is the RTD trying to abdicate its responsibility to the people who are paying them?

We are told that hundreds of panel clinics nationwide had been appointed under this programme to carry out the screening. There have been reservations expressed on the integrity of the clinics that are selected to do this important task. The RTD should bear this in mind and take great pains to select only those clinics with a good tract record to be granted these contracts. Merit alone should be only criteria in considering the appointment of the panel clinics.Favouritism in any form will be a sure cause of its failure.

Clinics must be responsible and ensure a high degree of competence and professionalism in conducting the medical examination. Medical laboratories undertaking to collect urine and blood samples should follow strict protocol to ensure accuracy and reliability of the tests conducted. Probably they should be done under the supervision of RTD officers to minimize the risk of cheating.

It is reported that about 500,000 licenses will be involved in this scheme. With each paying RM85, it would amount to RM42.5 million per year. This is a very large sum of money which calls for very stringent control or risk being mismanaged. Strict adherence to rules and regulations must be enforced at every stage and at all times. Anyone flouting the rules must be made to face the music regardless of his status or political alignment.

The RTD should be embarrassed for the Bukit Gantang tragedy and the high number of similar accidents. It should be embarrassed for allowing buses that are not roadworthy and unfit drivers to ply our highways. Instead of learning a lesson from the recent tragedy and resolving to serve the rakyat better, the RTD has used it to embark on another business venture with a corporate body with questionable credentials to carry out medical check-ups on drivers of commercial vehicles.

It is time the government departments take seriously the rights and welfare of the people at large. It is their duty to protect and safeguard our rights at all times. It would be morally wrong for them to run away from their responsibility to the rakyat by passing their job to private companies whose primary motive is profits.

The Sun was criticized for being an opposition paper but in fact it should be praised as a people’s paper for bringing issues like “Unhealthy practice” which affect the ordinary man on the street.

Dr.Chris Anthony

Declining passion for the job

Commercialization of Medicine to blame

Health Minister Datuk Seri Dr Chua Soi Lek’s warning to doctors to resign if they do not want to attend to patients when called to do so is timely. The ministry should take a serious view of this issue of doctors refusing to attend to patients, even those critically ill.

I agree with Dr Chua that doctors are burdened with more work due to the increasing number of patients at government hospitals but this is no excuse for failing to be present when needed. We must understand that while the number of patients may have increased drastically but the number of doctors and specialists have also increased proportionately over the years. Patients’ expectations are also much greater these days.

We have now reached a stage where medical officers and specialists should be made stay-in when on call, especially in urban areas, where traffic congestion makes it impossible and dangerous for them to rush back in time for emergencies. Comfortably equipped rooms and proper food should be provided for those on call.

In the seventies and eighties we had very much fewer doctors and specialists. Major clinical departments then were run by 1 or 2 specialists and a couple of medical officers and housemen. The specialists were on call daily, seven days a week. There was no such thing as public holidays or weekends for them. Moreover no overtime or call allowance of any sort was paid at all.

Despite these shortcomings and frustrations, work went on reasonably well. The driving force behind was the commitment of doctors to their patients. All patients admitted were seen by the respective specialists daily without fail, sometimes more frequently as the needs dictate. Work went on irrespective of whether it was a weekend or public holiday.

Today the scenario is very much different. These clinical units are now staffed with 5 to 10 times more specialists and medical officers. There are also the super-specialists in the various subspecialties. I am made to understand a specialist these days just goes on call 3 or 4 times a month. Furthermore they are given time off on the day after the call (post-call).They are also paid handsome overtime allowance (call allowance).

Despite having more doctors in the public hospitals we still frequently get complains that specialists do not see their patients, even the critically ill ones, for days at a stretch. The patients, especially after office hours and on weekends and public holidays, are left to be managed by junior doctors with minimal clinical experience.

Why are our doctors and specialists adopting such uncaring attitude towards the welfare of their patients? Why are they indifferent to the plight of the sick and dying? The Health Ministry should seriously look into the reasons behind this lack of passion among our doctors and specialists.

The underlying cause of this malaise is the commercialization of the medical profession in general. Medical training and treatment have become lucrative industries that are quickly tapped by big business corporations. Like in all industries, there is no place for medical ethics and compassion for the patients. It is strictly “you pay, I treat” relationship.

This has indirectly been reflected onto potential doctors early in their training days. It has become necessary for doctors to quickly obtain the necessary paper qualifications and leave the public sector to join one of these corporate institutions or risk being left out. Compassion and dedication to for the patients are lowest priority in this pursuit.

In this medical industry, patients may continue to receive treatment but for the wrong reasons. The final loser in this “you pay, I treat” medical business will be the poor penniless rakyat. Privitisation and commercialization of our heathcare may be unavoidable to a certain extent but the government must decide how far it is going to allow these to undermine the nobility of the medical profession.


Dr.Chris Anthony

Comments

The Malaysian Medical Service probably scored a first when doctors from the Klang General Hospital phoned or handphoned a specialist to ask how or what to do in that emergency when the arm of an infant eventually needed to be amputated.Another MALAYSIA BOLEH case that was not publicised to attract mothers to be to give birth in this country?Malaysia is breaking new grounds!

By sentosa007, 11-Sep-2007


Agree with your initial statements. Doctors owe a care of duty to their patients. There can be no justification for death through neglect of patients. This is an issue that the profession must deal with through the local medical registraton authority and leaders of the profession.However, one must not paint all doctors with the same brush just because of the inecusable behaviour of some in the same profession.

I have personnaly known doctors who are dedicated to their patient care and who choose to continue working in the government sector despite the temptation of huge financial rewards in the private sector. We must remember that doctors are also human and subjected to the same needs and weaknesses as anyone else. Doctors pay the same price for everything in life, may that be food, housing, clothes, education for their children or even healthcare for their own family. This is just to put things in perspective.

The fact of the matter is that the commercialisation of healthcare is one of the major challenges in this century for all govenments in the world. In the developed nations, the problem is now even more acute with 40 million americans without health cover while the rest of the population have over the top health care through health care insurance. I have met doctors working in the public run hospitals that cover those 40 million without health cover and have been told that they are worst than hospitals in Africa despite being only a stone throw away from the private hospitals on the same road.There are no easy answers to problem. The govenment have taken the right step by demanding accountability from the medical profession.

They should not expect any less from themselves.Efforts are needed to make the govenment hospitals centres of excellence, so that the people that work in them, may they be doctors, nurses or porters, can feel proud of the good work that they do and commit 110% of themselves depite being paid comparably less than in the private sector.This would be much more effective than having any govenment legislation or any other form of enforcement.

Put our hands on our hearts and we know that the public contributes to this problem by having a negative outlook on our general hospitals and the staff working there. It then becomes a self-fulfilling prophecy with no end in sight.This solution is already in practise in the UK. ALthough the private health care sector is thriving, no one would willingly go to a private hospital if they have a life threathening illness, as they know that the most experienced and skilled physicians are in the National Health Service. That is also why the majority of UK doctors remains in the public sector, where they can devote themselves to good patient care, research and the education of future generations of young doctors.

This is the way forward...

Here's an interesting article on the same issue in America..only that it happened many years ago..Scholars, Investigators, and Entrepreneurs: The Metamorphosis of American Medicine. Perspectives in Biology and Medicine - Volume 46, Number 2, Spring 2003, pp. 234-253


The introduction of the article is as follows: "WHEN I ENTERED MEDICAL SCHOOL in 1948, specialization and group practice were developing rapidly, but most physicians were still solo practitioners, often maintaining their office in their home. As proprietors of this cottage industry, physicians were usually financially comfortable, but not rich. They were respected, often revered members of their community, making useful contributions to the health and lives of their patients.

For most patients, the relationship with their doctor was mutually trusting and gratifying. Five decades later, the medical profession has undergone changes much more drastic than the social transformation that raised physicians' incomes from relative poverty in the 19th century to modest affluence in the first half of the 20th (Starr 1982).

The changes of the past 50 years can be quickly summarized with the following three vignettes of conversation that might occur when someone met a doctor on a social occasion.

In 1957, the statement might be, "So you're a doctor. Hey doc, what do you think about this rash on my arm?" In 1977, the speaker might say, "So you're a doctor. Where's your Porsche?" In 1997, the comment might be, "So you're a doctor. Let me tell you what some damned doctor and health care plan did to my sister." [End Page 234]

Why has this change occurred? How did medicine evolve from a caring profession to a business? And how and why did doctors trade their professionalism for commerce? I shall try to answer those questions as an internist whose career allowed direct observation of the cited events. First

Half of the..."Here's the weblink to the article.(http://muse.jhu.edu/login?uri=/journals/perspectives_in_biology_and_medicine/v046/46.2feinstein.html)The late author, Alvan R. Feinstein, was the Professor of Medicine and Epidemiology at Yale University. (http://www.yale.edu/opa/v30.n9/story12.html)

Commercialization of Medicine to blame

Commercialization of Medicine to blame Health Minister Datuk Seri Dr Chua Soi Lek’s warning to doctors to resign if they do not want to attend to patients when called to do so is timely. The ministry should take a serious view of this issue of doctors refusing to attend to patients, even those critically ill. I agree with Dr Chua that doctors are burdened with more work due to the increasing number of patients at government hospitals but this is no excuse for failing to be present when needed. We must understand that while the number of patients may have increased drastically but the number of doctors and specialists have also increased proportionately over the years. Patients’ expectations are also much greater these days. We have now reached a stage where medical officers and specialists should be made stay-in when on call, especially in urban areas, where traffic congestion makes it impossible and dangerous for them to rush back in time for emergencies. Comfortably equipped rooms and proper food should be provided for those on call. In the seventies and eighties we had very much fewer doctors and specialists. Major clinical departments then were run by 1 or 2 specialists and a couple of medical officers and housemen. The specialists were on call daily, seven days a week. There was no such thing as public holidays or weekends for them. Moreover no overtime or call allowance of any sort was paid at all. Despite these shortcomings and frustrations, work went on reasonably well. The driving force behind was the commitment of doctors to their patients. All patients admitted were seen by the respective specialists daily without fail, sometimes more frequently as the needs dictate. Work went on irrespective of whether it was a weekend or public holiday. Today the scenario is very much different. These clinical units are now staffed with 5 to 10 times more specialists and medical officers. There are also the super-specialists in the various subspecialties. I am made to understand a specialist these days just goes on call 3 or 4 times a month. Furthermore they are given time off on the day after the call (post-call).They are also paid handsome overtime allowance (call allowance). Despite having more doctors in the public hospitals we still frequently get complains that specialists do not see their patients, even the critically ill ones, for days at a stretch. The patients, especially after office hours and on weekends and public holidays, are left to be managed by junior doctors with minimal clinical experience. Why are our doctors and specialists adopting such uncaring attitude towards the welfare of their patients? Why are they indifferent to the plight of the sick and dying? The Health Ministry should seriously look into the reasons behind this lack of dedication among our doctors and specialists. The underlying cause of this malaise is the commercialization of the medical profession in general. Medical training and treatment have become lucrative industries that are quickly tapped by big business corporations. Like in all industries, there is no place for medical ethics and compassion for the patients. It is strictly “you pay, I treat” relationship. This has indirectly been reflected onto potential doctors early in their training days. It has become necessary for doctors to quickly obtain the necessary paper qualifications and leave the public sector to join one of these corporate institutions.There is no place for dedication to their profession as that will not take them far in today’s materialistic and consumerist society. If this commercialization of the medical profession is allowed to continue, the care of patients will continue to deteriorate. Patients may continue to receive treatment but for the wrong reasons. The final loser in this “you pay, I treat” medical business will be the poor penniless rakyat. The government, instead of promoting this commercialization of medicine, should take steps to bring back the nobility of this age old profession. Dr.Chris Anthony

NS death toll reaches 20

NS death unacceptable

It is with deep regret that we read of the death of the tragic death of Mohd Rafi Ameer, a National Service (NS) trainee at the Cheneh Cemerlang camp.This brings the total number of deaths to 20. The untimely death of the 18-year old lad is really terrible loss to the family and the nation.

Mohd.Rafi was first treated at the Cheneh Cemerlang camp’s clinic on Monday,27 August 2007 for fever, cough and flu. He came back the next day with more symptoms and again given treatment at the same clinic. Five days after his initial treatment, his condition worsened and he was sent to the Kemaman Hospital. The following day (Saturday,1 September 2007) he was rushed to the Tengku Ampuan Afzan Hospital in Kuantan,more than a hundred kilometers away, but unfortunately he died on the way to the hospital.

Looking at the circumstances of the death reveals 2 major contributing factors :

1. Exposure to some deadly pathogen
2. Inadequate medical expertise and facilities to diagnose and treat the patient.

From the chronology of the events as reported above, it is quite obvious that Mohd.Rafi was not well from the start. He must have been harbouring some serious illness even on the first day he reported at the clinic. Whoever treated him at that time did not recognize the gravity of his ailment thereby leaving him neglected in the camp for 5 days within which time his conditioned worsened and he died on the 6th day.

We are not sure who really attended to him in the camp’s clinic. Was he examined by an experienced doctor? However it is reasonably clear the boy’s illness was not taken seriously and therefore invaluable time was lost in administering early treatment for his ailment. Any disease will continue to run its natural course unless we detect it and intervene at an early stage using all the expertise and facilities at our disposal. The onus is on us for timely intervention not on the disease to wait for us.

The unfortunate death of Mohd.Rafi warrants a thorough investigation into the set up of the health environment and medical facilities at our NS camps all over the country
It is unacceptable to subject our children to the high risks of the present format of NS. The NS camps are located in remote areas with unsatisfactory arrangements for basic amenities and health and medical care. They are unnecessarily exposed to various pathogens of unknown virulence to which the children are not immune.

Imagine the torment and anguish of the parents in losing a child after 11 years of upbringing. It is an emotional wreck for the whole family. No amount of monetary compensation will ever be able to erase the misery for the rest of their lives.

The authorities responsible must place themselves in the position of the parents of Mohd.Rafi and the parents of other NS victims. They must search their conscience to see whether the NS programme is really necessary. Egoism and monetary considerations should not be allowed to cloud their minds in their decision.

The aim of the NS may be noble - to forge closer unity among the youth of various races but I cannot understand how this can be achieved in just 3 months when it could not be done after 11 years of schooling together.

Dr.Chris Anthony

Don't all religions lead to one same God?

Love,not convert one another

The nineteen South Korean Christian volunteers held hostage by the Taliban in Afghanistan for six weeks were finally freed. It brought great relief not only to the hostages but to the whole international community. It is deeply distressing that two people lost their lives in the ordeal.

According to the Taliban, they were paid $20 million for the release of the hostages, a claim which the South Korean government denies vehemently.

Encouraged by the “reward”, the Taliban have wowed to continue their struggle with more such kidnappings and ransom. Meanwhile the Christian workers say that they went to spread God's love and carry out his wishes and their Afghan ordeal had only strengthened their resolve to send more missionaries. According to some of the hostages they had been tortured for refusing to embrace Islam.

We have a strange situation where the Christian workers went to Afghanistan to “convert” people there but in the process they were kidnapped and tortured to embrace Islam instead. In the process some lost their lives. Where does all these going to lead – where one religious group is trying to convert another to its own faith?

While both groups claim to be out to do God’s work, it is ironical that, in the final outcome, only money could free both of them from their predicament.

In a world plagued with so much hate and violence for fellow humans, we need religion to direct mankind to peace, love and harmony. It is sad that the very religions that were instituted to serve such a noble purpose are being hijacked for reasons contrary to its aims.

Instead of trying to convert others to our own religion, it would be a great service to mankind if we can convert them, by our examples, to become better humans in their own faith, as finally all religions lead to the same God, whom we call by different names.

Dr.Chris Anthony


Comments

drchris,

I wouldn't be so politically right or ignorant to share your titled opinion. As much as people want to highlight on the "conversion" part of the South Koreans, do we forget that they are there for humanitarian purposes also?

I'm speaking from a Christian faith that I believe they did it out of love. Whenever there are disasters around the world, who sets the precedence to relieve those unfortunate victims. I don't deny that there are other groups who contributes but if we look back at statistics, who kicks off such aids and also the amount put into it? I'm not here to glorify these people but rather to just highlight a fact.

Also if we have laws (be it gravitational law, mathematical law) to guard us in this world, why are we so certain that there aren't any laws guarding the heavenly realms? Can we regard ourselves dogmatic when 1+1=2? So will it be dogmatic to claim there is only one way to God?

By klyong2502, 5-Sep-2007

Ensure safety of passengers at all costs

No compromise on safety for any reason

The Road Transport Department (JPJ), police, Commercial Vehicles Licensing Board (CLVB), Puspakom and Immigration Department should be commended for swinging into action under Ops Bersih to check on buses and drivers at major stations and along highways following the Bukit Gantang bus crash recently.

This has created fear among errant bus drivers and owners of such buses causing many of them to flee or cease operation. There is now a worry that this could affect the coming balik kampung rushes for Hari Raya because there might not be enough drivers and buses to meet the surge in demand during the festive period.

The authorities have no choice but to keep up the pressure to ensure errant drivers and buses that are not roadworthy are kept off the roads permanently. The festive season may be around the corner but that shouldn’t be an excuse to let down on stringent enforcement of the laws governing public transport. The safety of the commuters is of paramount importance and that should never be compromised for whatever reasons.

While Ops Bersih and others like it are important and necessary, they are just short term measures to ensure the safety of public transport. While they are underway, long term measures should also be introduced to maintain an acceptable level of safety all times.

Renewal of driving licenses of bus drivers, road tax for buses and permits for bus operators should more stringent and must strictly based on the provisions of the rules governing them. Complacency and irresponsibility on the part of officers tasked with the job must be severely dealt with without fear or favour. Those who flout the laws must be made to face the music and that will also act as a deterrent for others intending to commit the same offense.

The existence of corruption in these areas of enforcement should be checked and top priority given to stamp out this enemy of the nation that, if allowed to continue, will ruin our aspirations to become a developed state in the near future.

Dr.Chris Anthony


Comments

It takes death to make the local machinery moving. What a sad joke. After all these years, they tell us they can do nothing as they have no jurisdiction over each other deparment. 50 years of progress, 50 years of preparation, 50 years of planning , all boiled down to this. TAK TAU and TAK BOLEH. Sad.

By Dr_Aoi, 3-Sep-2007