Won't we give way to save lives?

I read yesterday's article in the Straits Times "Heart attack outside hospital: You have 2.7% chance to live" with surprise and disgust.

My Grandaunt who recently survived a massive heart attack can surely count her lucky stars because she was among the less than 3 people out of 100 who survived a heart attack at home.

What i was disgusted about are some of the reasons why paramedics were delayed getting to the heart attack victims. Not surprisingly, people who refused to give way to ambulance even under the full blare of the siren and flashing lights. What was even more disgusting are people who refused to get out of lifts so that paramedics could get in quickly with the stretchers to reach the victims quickly! What could be people be thinking about when they do so? Perhaps, "my time is more important than saving lives?"

What can be done to up the chance of survival? I personally support having more AEDs in more public places. Personally, I am motivated to refresh my knowledge in CPR so that I will be of use when the need arise. Also what Dr fatimah from SGH said in the Straits times is a simple and practical one, "hold open the lift door in anticipation of the arrival of the ambulance and paramedics", the few minutes saved can mean the difference between life and death.

Perhaps, the best chance of survival is avoid getting a heart attack in the first instance. It starts with our diet and watch stress in our lives.

Sighted again..."Madam Transparent" at Yio Chu Kang

Tonight was melody's (my 2nd Daughter) K1 graduation night performance at Yio Chu Kang Chapel. It was a night that I have looked forward to because Melody practiced really hard for her performances.

Again, my experience was marred by yet another inconsiderate parent/ grandmother. This time "Mrs Transparent". She decided to move herself to the "best spot" to view the performance with absolutely no regard whether she is blocking other's view or not. I went up to her to tell her that she was blocking the rest of us behind and she merely looked at me, slanted her body somewhat and carried on her ways.

Mrs Transparent's behavior and attitude certainly created other reciprocal behavior. Very soon, other parents whose view was blocked also got up to catch a glimpse of the performance. Within moments, the entire block of parents were standing up.

Thanks Mrs Transparent for leading the way... and generating bad behavior from the crowd. Which part of the principal's announcement "parents, in order for all parents to enjoy the performance, please do not stand up during the performances and remain in your seats" is so hard to understand?

If you recall, earlier my eldest daughter's performance at RGPS was similarly marred by "Mr Transparent."

We really more social grace and consideration for others... maybe we should empower a "Citizen Fine"...oops, did I say we are a "fine city?"

Hollywood is now Bollywood!!

For those of us familiar with the songs and drama of Bollywood will find all elements and more in the latest Disney's "High School Musical 3." Watch the trailer and you will know why. Better still go watch the movie, which I did, and you will be bowled over!!

White Tiger...A Source of power but a heap of bones and meat?

My visit to the zoo today yielded one of the most stunning sight of the White Tiger. Previous visits only allowed me to capture the tigers sleeping under the shades. As I watch the huge tiger pacing up and down the row of rocks, the sheer size and beauty of the the animal was a sight to behold.

At some point, I thought the white tiger must be caucasian of the cat world, because the animal seems to have gleaming blue eyes :-)

I later found out that the tiger is hunted for every part of the body. The tiger skin/ covering is a luxury item coveted by the rich. Her teeth a sought after ornament with properties to "ward off the evil". Her (of his) penis is among the first body part to be cut of from the hunted tiger - it is believed to have properties similar to viagra; her flesh is reputed to go well with spring onions and builds the body... Now, it is said that there are less than 500 tigers left in the wild and heading down the trial of extinction. When I contrast this against my image of the tiger that I just saw, I can't help imagining the animal in x-ray version, ie of her parts rather than her majesty.

Like Sharks and Sharks fin, I am still rather ambivalent about protecting the tiger. But, I know that the politically correct answer is that "we must do all we can to protect wildlife". In due time, I will educate myself and steer my point of views. What about yours?

When you expect the treatment to make you better, you feel better?

A placebo treatment is defined as a treatment whose benefits derive from positive patient expectations and not from the physiological mechanism of the treatment itself.

The 23 October 2008 BMJ's article "Prescribing placebo treatments: results of national survey of US internists and rheumatologists" shows that 50% of the US doctors surveyed routine prescribed placebo treatment. The placebo could come in the form of a sugar pill and in other cases headache pills or vitamins. Research has shown that placebo treatments do work in some clinical trials for depression, hypertension and pain.

So, the common phrase that "It is all in the mind" is true after all!

However there are deep concerns about placebo treatments, one of which is ethics. At the heart of this is that the trust between patients and doctors could be undermined.

With patient expections getting higher, and many expecting to at least swallow a pill after seeing a doctor even when they do not need it, placebo treatments could well keep all parties happy!

How things are Politicised?

I received a random email today, sharing it as it carries a good moral and lessons - applicable in many present day situations as well, if we are not careful...

Older Version:

The Ant works hard in the withering heat all summer, building its house and laying up supplies for the winter. The Grasshopper thinks the Ant is a fool, and laughs & dances & plays the summer away. Come winter, the Ant is warm and well fed. The Grasshopper has no food or shelter so he dies out in the cold.

Present Day Version (in imaginary country Y):

The Ant works hard in the withering heat all summer, building its house and laying up supplies for the winter.

The Grasshopper thinks the Ant's a fool, and laughs & dances & plays the summer away.

Come winter, the shivering Grasshopper calls a press conference and demands to know why the Ant should be warm and well fed while he is cold and starving.

TV1, TV2 & TV3 show up to provide pictures of the shivering Grasshopper next to a video of the Ant in his comfortable home with a table filled with food.

The majority of the Parliament are stunned by the sharp contrast. How can this poor Grasshopper be allowed to suffer?

One MP stages a demonstration in front of the Ant's house.

Another MP goes on a fast along with other Grasshoppers demanding that Grasshoppers be relocated to warmer climates during winter.

The Government immediately passes a law preventing Ants from working hard in the summer so as to bring about equality of poverty among Ants and Grasshoppers.

Yet another MP makes 'More Special Reservation' for Grasshoppers in Educational Institutions & in Government Services. The Ant is fined for failing to share 30% of his food with the Grasshopper.

The President of country Y announces that this is part of the NEP. Every ant must not question it.

Many years later... The Ant has migrated to the US and set up a multi-billion dollar company there. 100s of Grasshoppers still die of starvation despite the 'Special Reservation'.

Losing lots of hard working Ants and feeding the Grasshoppers, Country Y is still a developing country. All because the ANTS are just doing their work .............................

Rest and relax in Japan

I head to the land of Mt. Fuji in mid-november to unwind and spend time with family. The vacation will last 7 nights and I think we will have plenty of time.

Even though I have been to Japan twice, once to visit the famous Toyota factories to see how they efficienctly produce cars using LEAN processes, and the other to see how hospitals and companies run their supply chains; it almost appears to me that I will be visiting Japan for the first time. It is actually quite different when you visit a country or a city while on business trip.

What I can vividly remember about Japan are how everything is so organised, the sense of system and processes, the extremely punctual trains, the tastefully wrapped items that are too nice to even open and how polite and courteous the people are... One of my favourite so far has been the visit to the stationery shop, all 7 stories of it at the heart of Tokyo. This was certainly a dream come true for a stationery lover like yours truely!

The first 4 nights will be at Tokyo Disney. I figure 2 days at Disneyland and 2 days at Disney Sea. The beauty of this segment of the travel has to be that we are staying right smack within disneyland, where the magic will touch every aspects of what we do... see even the adults are excited. There is something about Disney that is able to create a new experience everytime one visit the resort.

On the 5th day, the plan is to head out to Hakone to take in the view of the famous Mt Fuji. Thinking of staying in a traditional japanese type hotel (i heard something like Ryokan) with the option to sleep on tatami, be served meals in traditional japanese settings and perhaps enjoy a hot spa (onsen?). Still seraching the web on the most exotic place to stay...suggestions welcomed.
Our 6th and 7th night will be spent in the heart of Tokyo. This is where we will see cosmopolitan Japan and take in Ginza, and do a couple of visits to shrines and perhaps shopping.

All of us need to make time to rest and relax. Even machines need to regular downtime for tuning and maintenance. I will do so, but this time with perhaps the blackberry at home. I am really looking forward to a proper vacation with my wife and 2 daughters and hope that it will be a great experience where we can remember for a long time to come.

Thanks for the Visits!

Green - Pageloads, Blue - Unique Visitors, Orange - Returning Visitors

(Statcounter on 25 October 2008)
Page Loads Unique Visitors First Time Visitors Returning Visitors
3,285 1,911 869 1,042

Over the last 39 weeks since I started my blog http://www.icansmell.blogspot.com/, I am humbled by the stats showing the number of hits that I've received.

In particular, for some unknown reasons, the last 5 weeks saw the highest number of unique visitors to my blog. Perhaps, it was because I have started to intensify my blog entries with at least one entry per day since end September 2008.

Thanks for visit and feel free to leave your comments!

Will the banking system fail?

Minister Mentor Lee Kuan Yew gave his projection that if the banking systems do NOT fail, the world economy will likely turn around in 3, 4 or 5 years; and the Asian economies under this optimistic scenario will likely come out ahead. However, if the banking systems do fail, the situation will be much more difficult.

The BIG question is whether the banking systems will come out ok after this financial turmoil?

The US Treasury has committed to US$700 Bil to buy toxic bank assets... BUT many say, "too little too late"

In Europe, UK banks were nationalised, even the biggies like RBS included to the tune of 80 Bil pounds... Is this enough?

Governments in ASIA have come together to set up a pool of $80 Bil to help with liquidity of banks if necessary?

Governments around the world, including Singapore, have guaranteed all bank deposits in full to restore consumer confidence and prevent capital flights

Alan greenspan, the long-time US Fed Chief admitted in court hearing that his fiscal policies are wrong...

... are all of these enough to prevent the banking system from failure, I would like to think so...

At this time, the stock markets are still tanking. Some labeled the downward spiral in asian and european stock markets on Friday the Black Friday... Watch out for the Black Monday when wall street opens. Singapore STI will have to wait till Tuesday as our market close for Deepavali holiday.

The general sentiment is that the stock market will be heading even lower... many analysts have advised to sit out this spiral and not commit new investments. When CEO Liew Mun leong was asked on ST what will he do with capitaland's cash hoard of $4 Bil he said he is no rush..."Just when you think something is cheap, it becomes even cheaper."

I will await MM's optimistic scenario to come true. For now, I will be sitting out like most people.

Shoot the Peacock and the Seagulls...

Capitaland CEO Liew Mun leong gave a rousing presentation during the Singapore Human Capital Summit 2008 that just ended yesterday.

He made the point that CEOs are responsible to teach values to the organisation. Mr Liew does this through many forums eg. Office of the President Meeting on Mondays, CEO Council meetings and of course his regular Sunday emails to all Capitaland staff. Reading his book "Building people - Sundays Emails from a CEO", one will really be convinced that when the boss speaks with passion, conviction and consistency, the tone, values and direction is set for the entire organisation.

During the summit, he made 2 memorable points, among others:

(1) "Shoot the Peacocks and the Seagulls" - The peacocks are the individual performers who are "showy" and who are not part of the team. The seagulls on the other hand, flies from one person to another dropping "shit" on others. Leadership needs to act decisively to drive the right values and create the right culture.

(2) "Discriminate boldly between star performers and the rest". Mr Liew said that star performers in capitaland get significantly more bonus than the average performer in order to send the right signal. Promotion, rewards and other benefits for various levels of performance are made transparent to set the performance culture. For example, it is made plain that staff who makes $100 Mil for Capitaland gets to attend the Harvard's Advanced management programme! I know this is true because the Capitaland participant at Harvard AMP 172 told me while we were at the programme together before I heard it from Mr Liew. All these seem commonsense, BUT many organisations do not have the courage to do the same - no wonder many just bumble along with mediocre staff making average impact...

The boss sets the tone and the culture for the entire organisation. We need to lead with clarity, courage and conviction because what we do help to direct the energy of all staff within the organisation either towards success or failure.

Let's load up and fire...

Quotable quote...

"I embrace the values of a family business... that's why I don't fire people in my company", a successful local entrepreneur took pains to explain at a forum about creating a strong corporate culture at the Singapore Human Resource Summit 2008 at Shangri-La...

"BUT, that does not mean people do not leave the company!", he added, much to the laughter of the audience.

Corporate culture can make or break a company's ability to hire and retain talents. Companies with strong culture is palpable. Those who can identify with it stays and thrive, while those who don't, will find out quickly, stick out like a sore thumb and leave!

In a sense, through the corporate culture of a company, staff can identify (or not) with a cause that is in alignment with their own beliefs. This will increasingly be an important attraction for talents beyond compensation.

Will patients cut back on medication in the wake of economic recession?

The New york times reported that for the first time in a decade, Americans are cutting back in their medication in favour of spending on food and gas.

Could this happen in Singapore? I certainly hope not, but for patients suffering from illnesses that generic drugs are not yet available and the cost of branded drugs is still steep, this could be a real possibility.

The longer term impact could well mean that patients allow their "illness to cook" until they are really ill before they are conveyed to the accident and emergency department and receive intensive interventions that could be much more costlier - both for the patients and the nation.

Singapore Healthcare system has safety net that Singaporeans could depend on. Basic and affordable healthcare is available through the polyclinics and the public hospitals. We should not let this happen.

Should I hold my savings in cold hard cash?

Over dinner tonight, my mom told me "I have asked papa to withdraw our savings from the banks to keep at home, I heard it is not safe to keep money in the banks anymore...".

It suddenly dawned upon me that there could be lots more people who may not be as informed about all that is happening amidst the financial turmoil. The Singapore government has over the last week announced that they are putting out $150 Bil to guarantee all bank deposits in full. This is a major contrast to the earlier policy of a minimum guarantee of $20,000 per individual per account.

The coffee shop chatters have intensified. Lots of people have lost faith in the Singapore banks particularly in the wake of the savings of many retirees and other members of public who have seen their hard earned savings wiped out through the collapse of Lehman Brothers Mini Bonds. For many elderly who cannot understand the news (or those whose children are too busy to explain things to them - like me!), they take their cue from the coffee shop chatters. To many Singaporeans, how can big strong banks like DBS, Standard Chartered Bank possibly collapse? They should not, but have we not seen major financial institutions disappear overnight in US?

I am wondering how we could better communicate what members of public need to take note of in this financial crisis? Perhaps, we should target the coffee shops :-)

For me, my parents are now convinced that it is now safe to leave money in the banks. Maybe my father will be an important source of input to his friends at the Ang Mo Kio Coffee shop meeting tomorrow morning.

I dropped my finger!

... No, I actually have a dropped finger or mallet finger!

While trying to remove a microSD card from my wife's mobile phone last night, I used my last finger (pinky) to exert pressure on the tiny little slot. The next I know, I heard a loud "snap" (similar to the sound of a piece of dried branch snapping under pressure) with a sharp sensation on my pinky. The last joint of my finger holding my nail was bent downwards, and could not be straightened on its own ie a "dropped finger". The feeling while having a dropped finger is rather strange - slightly numbish and lack of control.

This morning I went to the occupational therapist. He told me that I had snapped the tendon propping up the joints to my pinky. Putting on a splint for 6 weeks will align the two ends of the snapped tendon together and allow them to fuse together over time. Most times, this is all that I will need but I have to remember to keep the splint on. He proceeded to cut out a piece of material that look very much like plastic with holes and put it into hot water to soften it. He then used the softened plastic and mould it around my pinky. With a few snips, the splint was done.

Dropped finger is actually quite a common injury. It can be quite alarming to the uninitiated but with simple treatment, the finger could be straightened - althought not back to original form.

So, when i have finger sticking out at you - I am trying to insult you, but rather have compassion on me :-)

Inspirational Message from Steve Jobs, CEO Apple

Steve Jobs addressed the graduating class at Stanford University in 2005.

His message: "Follow your heart, never settle...", "stay hungry, stay foolish"...

His quotes:

"I was rejected but still in love"

"sometimes life is going to hit you on your head with a brick, but don't lose faith"

"the only way to do great work is to love what you do"

"you got to find what you love, and as with all matters of the heart you know when you find it"

"I ask myself, "if today is the last day of my life, will i still do what I am about to do today? If the answer is No for a few days in a row, I know I have to change""

"in the face of dead, fear of failure, fear of embarrassment of doing something, all fade away..."

"there is no reason not to follow your heart...you are already naked, you have nothing to lose"

"no one wants to die - even people who wants to go to heaven don't want to die to get there"

"your time is limited don't be trapped living someone else life"

"don't let other's opinion drown out your own"

"stay hungry, stay foolish"

I hope that others will be inspired too...

Be Fearful when Others are greedy, Be greedy when others are fearful

These are the words of the world's greatest investor, Warren Buffet.

He wrote an editorial on the NewYork Times on October 17 2008 basically saying that he is seeing tremendous value in great companies whose stocks are battered badly and he is converting his personal portfolio into stocks. Previously, his personal portfolios comprise only government bonds. He is greedy now when others are fearful.

His view is that in the short term, no one can predict the direction the market will head, but in the long term, we will look back to today and marvel at the value that is available.

This is afterall Buffetology... the man who can afford to lose but kept winning.

Singapore Nursing Role Model - A/ Prof Lim Swee Hia

SingHealth Group Nursing Director and SGH Director Nursing Lim Swee Hia was conferred the position of Adjunct Professor with the Curtin University's School of Midwifery and Nursing last week. This is the first international appointment by the school and a significant honour. Concurrently, Swee Hia was also conferred a similar adjunct professor position by the National University of Singapore's School of Nursing. Swee Hia... Oops A/ Prof Lim Swee Hia has done herself and nursing profession proud with such distinguished honours!

Aspiring nurses can now follow her footsteps to a bright future in Singapore Healthcare!

Congratulations Swee Hia, my friend! I am very proud of your achievements.

A Birthday card from Community Chest

Dear Hee Jug

Happy Birthday!

From all of us at Community Chest

This is the first time that I received a Birthday card from the Community Chest. I am surprised and happy that I am not a digit among the donors to the SHARE programme.

Well done, Comm Chest for making this effort to connect with donors!

New Infection Control Guidelines - How will the hospitals respond?

I received this on email today. Digesting the article as I post it. How will hospitals respond? Is it practical?
--------------------
October 9, 2008
Infection Control Guidelines Issued

By KEVIN SACK

Hoping to improve infection control in hospitals, the nation’s topepidemiological societies joined Wednesday with the American HospitalAssociation and the Joint Commission, which accredits hospitals, to issue acompendium of guidelines for preventing six lethal conditions.The unified backing of the hospital association and the accrediting agencyshould give the recommendations some teeth. The Joint Commission’s vicepresident, Dr. Robert A. Wise, said his agency would spend the next yearstudying which guidelines it would add to its accrediting standards in 2010.

The recommended practices, like vigorous hand-washing before the insertionof catheters and warnings against using razors to remove hair beforesurgery, do not vary in significant ways from the encyclopedic guidelinesissued and revised over the last two decades by a government advisorypanel.But their authors said they had been written more clearly and concisely,with advice not only on what hospitals should do, but also on what theyshould not, and on secondary approaches to try if first-line measures donot lower infection rates.The president of the 5,000-member hospital association, Richard J.Umbdenstock, said the guidelines, which were two years in the making,represented the first “professional consensus” on strategies to minimizeinfections. “As of today, the nation’s infection control team has a commonplaybook,” Mr. Umbdenstock said at a news conference in Washington.

The other groups that produced the guidelines are the Infectious DiseasesSociety of America, the Society for Healthcare Epidemiology of America, andthe Association for Professionals in Infection Control and Epidemiology. Epidemiologists contend that the challenge in reducing hospital infections,which are said to attack one of every 22 patients, has not been a dearth ofguidelines but a lack of adherence.A survey of hospitals last year by The Leapfrog Group, which advocates forhealth-care quality, found that 87 percent did not consistently followinfection-control guidelines. Studies have found that half of hospitalworkers do not follow hand-washing protocols. And epidemiologists inhospitals around the country have found that an intense focus on cleanliness and prevention can lead to significant reductions in infectionrates.“Too often where we fail is not in the knowledge but in the execution,”said Dr. Patrick J. Brennan, chairman of the federal Healthcare Infection Control Practices Advisory Committee, which supports the effort.Dr. Wise said his accrediting agency found large variations in hospitals’practices to control infections.“The same hospital which does great at inserting a central line and maintaining that central line might do poorly in the way it handles urinarycatheters,” he said, adding, “All hospitals are partially effective. Few hospitals are completely effective.”The federal Centers for Disease Control and Prevention, which also endorsesthe new guidelines, estimates that there are 1.7 million infection cases ayear in hospitals, and that 99,000 patients die after contracting them(although the infection alone may not be the cause).

It projects the costof treating hospital infections at $20 billion a year.With new research making a compelling case that infections are oftenpreventable, many hospitals have become more aggressive. They have alsobeen prodded by new policies by Medicare and other insurers to not pay forthe added cost of treating patients who develop certain infections. But a persistent problem, hospital officials say, has been the difficultyof translating guidelines into practice.“One of the reasons hospitals are having difficulty now is that when theylook at guidelines they are drinking from a fire hose,” Dr. Wise said.“There are thousands of these things, and they don’t quite know what to dowith them.”The six conditions covered in the guidelines, which run 6 to 16 pages, arecentral-line-associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections, surgical siteinfections, Methicillin-resistant Staphylococcus aureus, or MRSA, andClostridium difficile, an intestinal bacteria.Dr. David C. Classen, an epidemiologist at the University of Utah and alead author, said his team surveyed existing recommendations and researchbefore deciding which practices were based in solid science.

Some of the existing guidelines had not been updated in years, Dr. Classen said.Among the additions were recommendations that patients with ventilators bekept in raised hospital beds and that they receive regular antiseptic oralcare.The group did not change standard practices for controlling MRSA, avirulent drug-resistant bacteria that may contribute to 19,000 deaths ayear. It recommends universal testing of patients for MRSA on admission ­so that infected patients might be isolated and treated with specialprecautions ­ only if less burdensome efforts fail to reduce infectionrates.Some hospitals have had great success with prevention programs that includeuniversal screening. But other researchers argue that vigilant hand-washingand other precautions can be just as effective and less expensive whilebetter caring for infected patients.

The guidelines’ authors said the science remained inconclusive.

The Lehman Mini-bond fiasco...it is true that many fall prey to bank's tactics

The picture of the elderly lady that appeared on the front page of Straits times in tears, because she lost her life savings of $100k because of the collapse of the lehman mini-bond "guaranteed" savings plan, is stuck in my mind.

Do banks target retirees and customers who are unsuspecting and unprepared with offers too good to be true, my anecdotal observations seem to point to the affirmative?

My father who went to the bank about a year ago to renew his fix deposit was gently ushered to a relationship manager to offer him a capital guaranteed product. The same happened to my mother-in-law in another bank. A friend from one of the local banks told me that all relationship managers are given targets to cross-sell and their performance was strongly tied to this key performance indicator, possibly giving rise to perverse incentives. My wife was targeted the same when she went to the bank to withdraw our savings to put into another savings account with higher interest. Personally, it also happened to me. It all sounded so convincing - "no risk" and all upside! Moreover, they are our BIG local banks - very easy to trust unconditionally, especially the elderly and put their life savings there.

Even though customers are supposed to read the fine prints but how many people can understand. many times, even the very people selling the product will have difficulties themselves. When that happens, they throw in the blanket statement "very safe one, nothing to lose, even if you don't trust me, you can trust the bank... Singapore bank you know".

Buyers beware - I know the standard line, but I guess this is what we need to learn to expect as Singapore turns more capitalistic...sigh!

PS: As I am writing this, I received an sms from Channelnewsasia that MAS has officially initiated investigation into possible poor practices of banks. Hope some justice will be done.

Nice picture reflecting the financial turmoil...

A picture tells a thousand words...

Is this the time to do the opposite?

The herd mentality drives the stock market.

When the market goes up, people arrive at the market in droves buying frantically as prices escalate. In the end most end up buying high.

When the market is way down (like now), most investors would stay on the side line, thinking that the market will tank further. Most are afraid and there isn't lots of others to follow. Most then miss the chance to buy low.

The logic of buy low, sell high seems to be hard to execute but theoretically easy to understand.

Warren Buffet in his books has often advice that a great company is worth the buy when it is cheap. His experience has been one where most will stay out of the market, he goes out hunting for value.

Here is an interesting article from the Investor Edge newsletter is giving the same advice...

Maybe this time, I will stay away from the herd mentality?

My Grandaunt Survived the Heart Attack!

Last week, my grandaunt had a heart attack and was conveyed to Changi General Hospital just in time for her to be rescued after an emergency angioplasty (PCI).

Recalling her condition at the accident and emergency department, it is hard to imagine that she is now well enough to be discharged from the hospital after 3 days at the medical ICU followed by another 2 days at the general ward.

She is chatty now, relieved that she is well. The chinese believes that if one manages to overcome a major huddle (eg heart attack) and survives, then one will have many years more to live. For my grandaunt, this cannot be better news as she is already 79 years young! She kept thanking me but I told her that the real heroes are the nurses and doctors at Changi General Hospital.

Her attack is an instructive lesson for her loved ones. You know how hard is it to tell even my parents not to take our health for granted. Somehow the older generation of folks would ignore signs and symptoms of a medical condition until they become too late. That was exactly the story told by my grandaunt. She started to experience pain on her chest at about 11am. Thinking that it must have been heartburn, she ignored it. By 3pm, my aunt called her, she complained that she has been experiencing chest pain and had just taken 2 extra strong panadol and found some relief. Right after the call, she started to vomit and fortunately for my grandaunt, her son was at home and called the ambulance. Only when she arrived at CGH that they found out that she had a massive heart attack. When this tale was related to my relatives, the message sank in. Don't ignore our body, take action. It is unfortunate that we need such an event for the lesson to be learnt.

It is also enlightening to discuss my grandaunt's medical episode with doctors around me since I work in a hospital. I realised that there are differing opinions about what my grandaunt needs. Almost instinctively, the response seem to be that we should not do too much given the age of my grandaunt. When I asked if stretokynase is the correct intervention in the first instance, the reaction include this may cause a stroke. When I asked if angioplasty should be done, some said it depends. When I asked what would have been best practice for a patient as old as my grandaunt, the views differed widely. But to be fair, I did not speak to any cardiologist and actually none of them has seen my grandaunt. Maybe, the perception is that my grandaunt at 79 years is frail and confined to the bed but she is not - at her age she is independent and very active. That's why medicine is an Art even though it is grounded in science.

This is not just a lesson about survival but what should one do to survive...

The bright spark amidst the grey sky of financial turmoil

View of Shanghai architecture from the Bund

The financial turmoil that has gripped the world during the last 2 weeks cast a shadow on the future of many economies.

Until the major powers in Europe decided on a concerted action to take stakes in major banks (aka nationalise) and guarantee interbank loans over the weekend, and the indication that the US Treasury will follow suit, did the market respond with a vote of confidence on tuesday with biggest ever gains in Wall Street and Nikkei.

While all of these were happening, I was attending a health policy summit at Shanghai, China. I witnessed for myself the exuberant growth that has taken place and continuing to take place there. Compared to the mental image that I held in my mind only 2 years ago when I last visited Shanghai, major progress has been made. Even with financial turmoil, the Chinese economy is expected to grow some 9.4% this year, down from 11+% - but still 9.4%! China has also made a mark for itself holding the best ever olympics and recently put her own people in space. With domestic consumption growing (or shall we say exploding), the economy will no doubt be expanding consumption in oil to meet the ever increasing energy needs. I wonder why people say that the days of rising oil prices are over?!

China is the bright spark that is clearly visible in this storm. I suspect, much of the rich chinese money would have gone to take stakes in great companies battered by the financial meltdown in the western world. No doubt, the new era of global companies will soon emerge in China and the east.

There are opportunities of a lifetime (my lifetime :-) that need to be mined and I will certainly be looking out for them.

Well done Changi General Hospital!!

It has been a somewhat tiring night for me. At 6.15pm, I was informed by my wife that the only (and favourite) grandaunt has suffered a massive heart attack and was in critical condition at the A&E of Changi General Hospital.

I rushed to CGH and along the way managed to speak to Dr Mohan and found out about a rough prognosis of my grandaunt. She was put on streptokynase (a clot dissolving medication to reduce damage to the heart muscle after a heart attack) and being monitored for the need for PCI (Percutaneous Coronary Intervention - also known as angioplasty).

Finally, my grandaunt had to undergo an emergency PCI and the procedure was a success! The doctor told me that her right arteries were 70% block and were totally cleared with the insertion of a stent. After the procedure, her chest pain was largely relieved and she is currently under observation at MICU.

It was heartwarming to see a dedicated group of doctors and nurses working in concert in rescue of my grandaunt both at the A&E and the medical ICU. The professionalism and care that they showed to my grandaunt was truly remarkable. The staff kept the family members informed every step of the way and have a way in managing anxious NOKs.

Singapore healthcare system while not perfect is truly one where Singaporeans can be proud of. The care that my grandaunt just received at CGH is an example. To staff at CGH A&E, MICU and Cath Lab, I thank you from the bottom of my heart!

I am glad I could help through my blog...

I am actually quite surprised at the "Hits" that my blog (www.icansmell.blogspot.com) is beginning to attract!

About a month ago, when I was interviewed by Shin Min newspaper regarding my blog entry on "How do we give way to ambulance?" and my motivation for blogging, my "Hit Counter" at the end of my blog registered some 1200 hits. Today, the number of hits has since exceeded 2400 - modest by most measures, but still significant because this is a personal blogsite.

Lately, I also received a comments regarding my blog - all of which were directed to me via email instead of a direct comment against my blog entry. I am encouraged by all the comments. I am glad that some of my entries were found to be encouraging and motivational to some readers; and I am also happy to note that my "spur of the moment" Mosquito Art was quite widely shared as well. Today, I received an email from a colleague complimenting me for my diligence in updating my blog and at the same time reminding me of an essential typo in my "Means Testing" entry yesterday.

What have learnt so far since I started blogging?

1. It is actually quite fun!

2. When I take time to record my significant thoughts and experience, I sealed them into my long term memory...

3. Writing helps me with my thinking

4. I have become more aware of my daily activities and experience as i am constantly thinking about what to share

5. My experience can be a source of help and inspiration for others...and if they are not helpful, people can immediately decide not to tune in

6. I read more and more widely as it helps to generate ideas for blogging as it relates to what i do and how I live

7. When i share, I decompress :-)

For those of you who has been reading my blog, thanks for the visits and feel free to comment. Also feel free to share my blog...

Means Testing for Healthcare...US may be have no choice but to implement

Come 1 Jan 2009, Singapore public hospitals will implement means testing for admission into subsidised wards class B2 and C. The idea behind much an implementation is to better target limited government funding to the more needy, i.e. the more needy will get higher government subsidy and the better financially endowed will get less. Part of the motivation is also because the subsidised wards have improved significantly over the years, and even the rich find that it is value for quality to select them during hospitalisation - competing with needy for govt subsidy.

Well, this is not just a Singapore phenonmenon. The US Medicare which reimburses elderly over 65 years for their healthcare expenses is widely expected to run into financial difficulty over the next 15 years. To sustain the programme in its current form will necessarily bring tax to an exhorbitant rate, according the an article in the NYTimes.

Perhaps, after the November 2008 US Presidential election, will see the gradual implementation of means testing for Medicare. This will be a political hot potatoe and it is expected that neither Obama nor McCain will touch it with a 20-foot pole.

It will be interesting to see how means testing may be pulled off in the US and contrast it with how it is done in Singapore.

Slow medicine and the guilt of not doing enough for our loved ones...

My Mother, Your Mother Embracing "Slow Medicine," the Compassionate Approach to Caring for Your Aging Loved Ones is a book written by Dennis McCullough, M.D.

The book describes using the author's own experience how in the edge of ultra high tech medical technology, the promise of blockbuster drugs where both medical professionals and patients are conditioned to "fast medicine", ie quick diagnosis, early interventions and high doses of drugs should SLOW DOWN - particularly for the elderly.

According to Dr McCullough, "This medicine is specifically not intended to save lives or to restore youthful vigor, but to ease the inevitable irreversible decline of the very old."

In a sense, slow medicine can be quite commonsense in general. For example, if we have a headache, we can opt for a few options with varying degree of success and "fastness" and cost:

Option A: We can take a nap and sleep the headache off. Most often this will be enough and it is FREE.

Option B: We can decide to take paracetamol or aspirin. This will likely work most of the time and will cost less than $0.20.

Option C: We can panic and decide that our headache could be due to brain tumour, rush out to the hospital and ask for a CT of the brain. Usually, the CT will show all is normal and we end up going home to sleep off our headache but $700 poorer.

In a sense Option A is "slow medicine" but just as good.

Sometimes, slow medicine will take on an emotional paradigm, particularly when our loved ones are involved. The question we may carry when asked to consider slow medicine is "are we doing enough for our loved ones?"

My friend's elderly mom had brain tumour. Several doctors did not offer a good prognosis and the advice was to keep her "comfortable" - Slow Medicine. His love and gratitude for his mom could not be reconciled with slow medicine. For him, he needed to know that he has done all that is medically possible and no cost will be spared. Subsequently, major head and neck surgery was performed that was deemed "medically successful" but left his mom immobile, unable to speak and depressed. Maybe this would have been the natural outcome of the disease in any case, but maybe keeping her "comfortable" and spending her last days of her lives fully functional could have been better. But, who are we to judge? The emotional roller-coaster of such decisions are perfectly understandable.

Dr McCullough suggest that we should start slow medicine early. Start showing up for our parents' medical appointment, start questions around should they continue to drive, start watching for their bad health habits and advocate a better lifestyle, resist highly interventional procedures even when recommended by doctors...

This is a good reminder for me. I love my parents dearly and the time is now...

Do we all have 2 jobs?

Dr Lim Suet Wun the CEO of Tan Tock Seng hospital told staff at the Quality Day Launch today that all of us need to see ourselves with 2 jobs. One is our regular job and the second, just as important is improving on our regular job.

The trouble that when we have two jobs, we tend to focus on one and forget the other. More often than not, it is usually the second. Maybe it is better to just have one job and one can say that is the second.

We all can get caught in the tide of busyness and settle to be contented with just doing our jobs. But human beings are not created to do the same thing over and over again. We get bored... uncreative...dissatisfied... and wonder why things don't improve. In short we get into the rut!

My pastor once told us, "to do the same thing over and over again and expect a different outcome is FOOLISHNESS!" If we want a different outcome, what we do must change.

But, I am already so busy, how do I get time to make improvements. The beauty is that when we do make improvements, our jobs become easier to do, much more satisfying and we will get less busy! Go ahead, make a difference...make a change for the better!

Hospitals in US won't get paid for care that causes harm

Starting october 2008, Medicare (The US government payment for care of citizens 65 years and above) will not longer reimburse hospitals for the additional cost of care that causes harm. This was reported in the NYtimes Editorial on October 4, 2008.

The objective of this change is really not the savings (estimated at $21 Mil per year compared to the over $1 Trillion in health care expenditure in the US) but hopefully this will encourage hospitals to do more to reduce errors and protect patients.

The new rules will start with just 10 "preventable errors" such incompatible blood transfusion, patient falls, bed sores but it is expected that over time more conditions will be added and hence the impetus for US hospitals to get ready now.

The key question is will this work as it should?

In a way, I respect this man for the way he fought for his rights...

Mr fernandez spent $12,000 of his own money to stand up for his own innocence.

When I read about his story in the Straits Times today, I was first baffled but as his story unfolded, I ended up respecting this man.

To go through 12 court appearances, $12,000 out-of-pocket, and now taking his case to the high court and won his appeal leading to a discharge amounting to acquittal for what would otherwise been a penalty of $130 fine and 6 demerit points takes commitment and guts. From the news, what kept him going was the fact that he was not prepared to sacrifice his innocence for convenience. This I respect!

How many of us have this fighting spirit? How many of us are prepared to live our lifes with sufficient intensity and stand up for what we consider to be right?

Mr fernandez, I salute you!

Do you think you are transparent??

Mr Transparent at RGPS

This was the sight at a recent performance by primary 4 pupils at Raffles Girls Primary School (RGPS) open to parents.

Several rows of chairs were lined up behind the students for the parents in the school hall. I arrived early with my wife inorder to get a good view of my daughter's performance.

We thought we were fortunate to get front row seats until this GUY came up and positioned himself right smack in the middle of the hall with his video camera, totally oblivious or cannot quite care-less of how his position would affect the view by every one else. My wife went up to him and told him that he was blocking the view of all his parents and all his did was to mumble a few words that he cannot understand and continued his ways.

An otherwise great experience for parents watching their kids performed was marred by such inconsiderate behavior. How could one bring themselves to be so inconsiderate?

Plus, his rear view is not exactly the best sight!

Mind over Body...a Personal Revelation

You may be aware that I recently experienced a "Fitness Awakening" when I had my one week break. It started last saturday morning when I was aimlessly looking at my facebook when I chanced upon the status of one of my friend Ivan. He posted "just cycled another 40km and ran 4km...".

It started me thinking. The question I asked myself was "why was I lazing away and others could get themselves so disciplined with fitness". Even though I was still feeling lazy at that time, my mental state brought me into action. I changed into my sports gear and headed straight down to east coast park with the aim to cycle a significant distance.

By 1230pm, I was on a bike and cycled all the way close to changi point and made my way back. I covered some 24km to and fro, got a little sun burnt and felt really good with myself after that.

On Sunday, I got into my regular gym at Serangoon garden Country Club and this time I got on the treadmill. To tell the truth, after my national service I had developed an adversion to running but I know I need the cardiovascular exercise perhaps more than the weights and static exercises. Within 10 minutes, I was ready to stop. My mind was sending very strong signal to my body that I am tired and I should quit. My mind was also telling me that it was alright because I had already put in the distance the previous day through cycling. At the same time was telling me the "Ivan Status on facebook" and that I should be disciplined if I want to stay fit.

By the time I won the mental "war", I was able to concentrate on my breathing, listen to the rhythm of my pace and before I knew it, I completed 30 full minutes on the treadmill each time upping the speed at regular interval. My body was covered with sweat after the run but it was really satisfying. It was even more amazing for me that once my mind was decided, my body was able to take it.

Next, I was at the benchpress and loaded on 40kg. before I started the first set, I developed a mental picture that I would complete 8 repetitions. True enough, by the time I completed my 8th rep, my body was telling me that I should rest. I decided that in the next set I should completed 10 reps instead. Amazingly, even by the time I reached the 8th rep, my body was still able to go on and eventually complete 2 more reps. I am convinced that within limits, our mind has the capability to programme our body to do what we can imagine. Many of us had our first revelation when we were serving our national service but my "fitness awakening" is a reminder. This has tremendous applications even in our daily personal and worklife.

Mind over body, its is true. We can do wonders when we can imagine it!

"Say it Like Obama - The power of speaking with Vision and Purpose" a sure read for me over the next 2 weeks

I was driving home from work together and as usual I was tuned to 938Live - the most happening station!

After headline news, the radio DJs were discussing the merits of the US Vice-Presidential debate today between Palin and Biden. The conclusion was that Palin came across as "shallow" and kept going back to canned answers whereas Biden was "at least answering the questions". The verdict seemed to be that Biden won but does it matter?

One of the DJ said that Palin could actually take a leaf off Obama in public speaking and she referred to a new book "Say it Like Obama" and that piqued my interest.

I did a search on the book and found review of the book. The review certainly made the book worth the read. On occasions I have enjoyed public speaking - like the experience that I had today addressing a group of Johnson & Johnson executives from their group of companies from all over the world. There was a sense of connection and I felt I was speaking from my heart. My guess is that I made the connection with the audience and the feeling was great! There were other times, however, when I felt awful about public speaking and wished I could have done better - much better. This book seems filled with practical example that I could learn a thing or two. During the few times that I saw Obama in action on TV, I too marvel at how he was able to hold the audience.

I look set to head down to the Kunikuniya bookstore tomorrow and pick up the book. Let's see if it is really worth the read...

A Touching Story of How Donations through SHARE programme helped this girl

Presenting a bouquet to Minister Balakrishnan

Sharing her story on Stage

Today I attended the annual SHARE award ceremony at the Grand Hyatt. This event is held every year to honour companies and individuals who have contributed significantly to the Community Chest SHARE programme.



This girl (shown on picture above) has celebral palsy, a medical condition that gradually weakens her legs. She shared her story of how her medical condition resulted in the need to go through regular multiple treatments including physiotherapy, which have not been affordable if not for the help through the Community Chest SHARE programme. Through the help that she has been getting, she is determined not to let her medical condition get the better of her. She is currently taking up a degree/ diploma in mass communication and one day would like to be a social worker, so that she can give back to the very society who is caring enough to help her.



Her voice trembled as she shared her story and i dare say that many among us were moved close to tears. Her sharing brought back meaning to why we are still involved in fund raising in an environment that can be quite difficult after NKF... Her story is one of courage and determination to rise above with the help of tides of donations that comes true from compassionate donors.



I think many of us who are contributors to the SHARE programme need such occasional stories to remind us of the reason we gave. For those who have yet to give, this could be the reason.

Take 2 on JAMA article on "Single-patient Rooms for Safe Patient centred Hospital

It has been some time since I last introduced this article from 27 Aug 08 JAMA, but it has only been a few days ago that I finally got hold of the full article.

Author Dr Michael Detsky and Dr Edward Etchells from University of Toronto, Canada advocated single-patient rooms using reasons that studies have shown that reduction in airborne-related and contact related nosocomial infections. However, the authors acknowledged that the evidence is less compelling when it comes to reducing MRSA (methicillin-resistant staphylococus aureus) colonisation.

Here are the reasons put forward by the authors to support single-patient rooms:

1. Single rooms are easier to clean and decontaminate

2. Health care professionals may be more likely to perform hand-hygiene between rooms than between beds

3. Single rooms can reduce the need for patient transfer - the point made is that patient transfers within hospital can be potentially harmful because of missed treatment, reduced monitoring, increased psychological stress, higher chance of medication error

4. Single rooms can enhance patient flow - the authors quoted a study that 85 beds in single rooms can offer the same capacity as 100 beds in multi-bed patient rooms. It is not hard to see that for example when you a 4-bedded room and one male patient is put in there, the other 3 neds cannot be occupied by female patients.

5. Single rooms offer better privacy, rest and family support. Family members can visit single rooms more freely to offer support and share information with healthcare team.

6. Noise level in single room is lower and hence lower stress level - noise levels have been shown to be associated with increased blood pressure, heart rates etc.

7. patients in single rooms have their own toilet and bathroom. According to the authors, toilets are important sources of nosocomial infection.

According to the authors, there are disadvantages for single rooms as well:

1. additional walking and time needed to move from room to room.

2. loss of room-mates who can potentially help summon help

3. increased construction cost for single rooms - but can better utilisation of single rooms offset the higher capital costs?

This not withstanding, the authors said that it is easier to build single rooms once than to teach thousand of individuals to be attentive to patient privacy when patient care is provided in multi-bed room.

What are the practices overseas? According to authors,

a. France has adopted single rooms for all new hospitals built for the past 20 years

b. British, dutch and Nowegian hospitals are moving more towards single rooms.

c. According to 2006 American Institute of Architects guidelines - single patient rooms are a minimum requirement for new medical and surgical wards.

There is a "Ward of the 21st century" in Calgary, Canada where single room is a cornerstone feature of a multi-faceted research initiative in hospital design (http://www.w21c.org/). this will be good piece to watch!

Personally, I think most of the points raised about the benefits of single-rooms for patients are valid, however, we have to be careful to note that it is not a panacea for patient safety and hospital infection.

If the society decide to move into only single-room hospital, the impact of increased cost cannot be denied and this naturally translates into higher burden for the patient, the insurers, the employers and the government. The magnitude of this burden needs to be better understood.

Of course, human behavior and good habits must continue to be inculcated for the heath care professionals, the public and patients. Hand hygiene, cough etiquette, consciousness for patient privacy and better visitor control will always continue to be key ingredients in basic patient safety in hospitals.

Will Singapore move from its multi-bed class system in her public hospitals to one where there will only be single rooms remain to be seen. The fact that single rooms will lead to better bed utilisation than multi-bed rooms is perhaps true, especially so in Singapore where gender, bed class and medical condition segregation is a consistent practice. I was speaking to be a senior clinician recently and he told me that while we are pondering this question, some of the more progressive hospitals in China have already started to adopted this practice.