Wednesday, April 16, 2008

The Reward For Dilligence

Very upset. Worked so hard as houseman only got 76 for my 2007 SKT. Wanna leave this stupid country.

That was the SMS I received from my colleague Dr. Bee, medical officer of Kinbatangan on my back from Kota Marudu today.

I was driving at 80km/hr along the treacherous Kota Marudu-Kota Belud ‘highway’ then, but could not help but feel angry over the news.

Dr. Bee like myself, graduated from UM and assumed housemanship in the state of Sabah by choice.

Doctors come to Sabah for many different reasons. The kiasu ones are here under the impression that a working stint in Sabah will earn them extra points in their pursuit of the local Masters specialty training. Some are here because they were told that the training and working experience here in Sabah are much better and wider compared to Peninsular Malaysia. I can’t comment on that, because I have never truly worked with the Ministry of Health in Peninsular Malaysia. My short attachments in the Klang, Banting and Tanjung Karang hospitals are not sufficient for me to make a proper comparison. Of course, there are always the jerk doctors who come to Sabah preying on the gullible local ladies. You can read my other posting for real-life stories.

Dr. Bee however, came to Sabah with nothing to gain and everything to lose – her spouse, her family, her friends, the comfort of home. I believe she came to serve the community of Sabah and verily I say, she has lived up to her personal pledges.

In the eighteen months of my working experience with Dr. Bee, I only have words of praise for her. She was among the top graduates in my class but unlike many other brainy doctors, Dr. Bee was competent and well-balanced in knowledge, work and character. She came to work early, examined patients thoroughly and demonstrated sincerity in her dealings with patients. She was so dilligent and motivated that other doctors took her for granted and pushed her around.

If I were to find any fault in her, it would be her uncanny fetish for all things afro. That's none of my business, though.

There have been a many emergencies and events whereby she was one of the few reliable hands around. There is no doubt in my mind that without her assistance and support during those times, a large number of patients would have had a very different and worse outcome.

She had had her share of frustrations and downcast while serving as a house officer. Sadly, this is the exactly the case with Malaysian healthcare. Lazy, moronic and irresponsible doctors get off scot-free while diligent, responsible and knowledgeable doctors like Dr. Bee get trashed. It’s a sickening system, to say the least. The hardworking doctors end up with more baggage and liability while doctors who go AWOL remain AWOL with no accountability.

Having studied real hard and basically smart to begin with, there were times where Dr. Bee just couldn’t reconcile with the occasional doubtful conclusions of some of the clinical specialists. In a feudalistic system like Malaysia’s, differing opinions are not tolerated well, much like the culture so rabid among our politicians.

Being pint-size and soft spoken, Dr. Bee was an easy target for the wicked bosses among us. It was really distressing to see her on the receiving end of verbal harassments from those racist, sexist, shit-full orthopaedic surgeons and NEP products.

While she was as frustrated with the system as I have been and still am, she remained ever enthusiastic and firmly focused on the big picture that is patient’s well-being and best interests.

We have gone separate ways and function independently as full-fledge medical officers now.

I have no doubt however, that Dr. Bee continues to maintain a self-imposed standard of excellence in her daily work in the interior of Sabah.

It was therefore remarkably upsetting that a doctor like her received a mere 76 marks for her annual work assessment called the Sasaran Kerja Tahunan (SKT).

Is this the reward for diligence in the civil service?

What the big deal about SKT, one might ask?


For non-bumiputera doctors like Dr. Bee and myself, the SKT points are very much a determining factor in our application for the local Masters program. The SKT points MUST NOT BE BELOW 88 FOR THREE CONSECUTIVE YEARS before we are eligible to APPLY for a specialty program.

Contrast the above criteria with the criteria set in place for Malay doctors who are accepted into the Skim Latihan Akademik Bumiputera (SLAB) program. Essentially, there are no specific criteria in place for the SLAB program. In fact, one may not even need to apply to join the SLAB program. I have had Malay colleagues who were simply offered to choose from a variety of SLAB specialty programs.

With an SKT of 76 points, the chances of Dr. Bee being eligible to apply for specialty training is practically nil.

Anyway, do we really seriously think that NEP products groomed in a racist system will be fair and considerate in their assessment of non-NEP products like Dr. Bee? Will they be able to empathize with the struggling non-Malay doctors striving for career advancement while juggling their daily work? Will they give a leg up and lend a helping hand the same way they were given crutches and wheelchairs to roll about?

To my dear friend Dr. Bee, take heart and don’t be discouraged. Study hard and kick their NEP asses. Above all, stay the same – a wonderful and dedicated clinician.

Now I wonder what my SKT is for 2007…..


CK Tan said...

i felt sorry for Dr. Bee and I was touched by her determination to leave her comfort zone and serve here.

so, this SLAB thing is like the matriculation course for the university entry.

so, u drive long distance too.

Product of the System said...

Being from West Malaysia, the long distance in sabah is really long. And the poor road conditions don't help at all.
It kinda explains why Sabahans despite being courteous drivers in general get involved in such terrible accidents.

koolgeek said...

i only can say thanks on behalf of the people who have benefited from the service of heroes such as yourself and dr. bee.

there must be a reason for things happening although we may not know what they are at present.

do not be discouraged.

take comfort in knowing that the poor and needy will always remember and have you guys in their prayer.

Anonymous said...

Anonymous said...

I couldn’t help myself but wept into a state of exhaustion after reading your story last night. It was encouraging and heart warming. I cherish all the moments working with you during our housemanship. I definitely do not deserve praises you gave. I fail to practise medicine according to Declaration of Geneva but I do hold firmly on the basic principle in medicine i.e. no malfeasance. There have been many sleepless nights filled with indignation and regret for myself and my dedicated colleagues as well as sorrow and guilt for my helpless patients and their caretakers. It needs courage and patience to go through these and of utmost importance, to have supportive friends like you.
I thank you with all my heart, my dear friend.

p/s: Timorese kids have most wonderful and artistic Afros among the rest.

Anonymous said...


This post is yet another piteous tale documenting the travails, injustice and despair of a doctor amidst dismal troughs of her career.

Dispirited, disappointed, despondent, disillusioned, disenchanted, disgruntled, demoralised, defeated, disparaged, denigrated and downtrodden. These are but some of the adjectives that were floating in my mind as I was going through this post.

Who wouldn’t be? I know I would if my future is hanging on balance, knowing very well that my future hinges on my superiors’ appraisal of my performance and we all know this means one is at their mercy because appraisals are purely subjective and not readily measurable nor easily disputed (incidentally how is the key performance index measured in the case of a public healthcare practioner?).

Needless to say, it must be like hell on earth to have to work in a highly toxic environment day in day out, reporting to people with a paucity of goodwill without any respite in sight. As if it isn’t bad enough that one’s efforts are neither recognised, appreciated nor validated, to add insult to injury one is constantly being put down.


This message is for Dr Bee

Commiserations over your plight.

Pat, pat and a big bear hug. Poor you! Fighting a solitary battle against the forces of injustice.

Chin up! **Our thoughts are with you as you struggle. **We’re also sending you good vibes. We feel for you. We chafe at the abuse and the undeserved tongue-lashings you’ve been receiving for no rhyme or reason. We think it’s absolutely disgraceful of them to push you around and to try to wreck your future. Your superiors sound like disagreeable, domineering, overbearing and irascible gits.

Yours is undoubtedly a real Gordian knot. We feel sorry that yet another ethnic Chinese is in this all too familiar predicament. Short of advising you to cut the Gordian knot by throwing in the towel there isn’t much we can do other than to give you moral support.

While you courageously soldier on, know that we are behind you every step of the way. Cheering you on from a distance. This is just a minor setback, one of the numerous hiccups on the way to bigger, better things. Think of it as deferred success. Don’t loose sight of your goals. Don’t let this snag impede your progress. We’re sure that your indomitable spirit, dogged determination and persistence will enable you achieve everything you set your heart on. Show these insufferable twits you’re no pushover, not someone they can trifle with. Proof to them that you’re made of sterner stuff. We’re certain you can shake off the shackles of injustice to hold your own in the medical world.

You’re the Malaysian Chinese’s ehime daruma (princess daruma). A daruma is a Japanese self righting doll (similar to the weebles) which invariably returns to the upright position no matter how one tries to knock it down. Hence it is the symbol of optimism, persistence, perseverance and strong determination.

By the way, it was very noble of you to leave your loved ones and your comfort zone to work in the backwater of Malaysia (to Sabahans who are offended and take exception to how I have described your state, I mean no disrespect and I do apologise if I have ruffled your feathers). If this post is anything to go by, you’re an accomplished, personable, dedicated and conscientious doctor. Definitely an asset to the medical community. Our good doctor/blogger holds you in high esteem, a testament to your skill, devotion and hard work. This is why we’re sanguine about your success.

Cheers Dr Bee.

** Readers of this blog who are sympathetic and commiserate with you.

I think it’s best to qualify all that I have articulated. I said what I said based purely on a)what I’ve read/interpreted with b)loads of reading between the lines as well c)my understanding of the ugly side of human nature embodied by unreasonable, demanding and totally odious bosses. Such people delight in running others down. I do apologise if I am wrong, have misread/misunderstood or made assumptions that are way off the mark.

Q 8-) vexed kindred spirit

jj said...

i'm a malay dr ( a product of NEP) currently working in sandakan.
SKT of 76 was still ok. most of the MO here dint get SKT more than 80. our hospital director is very strict in marking the SKT. in order to get SKT of 85, apart from beeing competence in our work, we must contribute to the society eg health campaign, organizing donations run etc.. , publish a scientific papers, representing hospital/ministry eg in sports and many others.
its not that simple!

Jimbo said...

My firm belief is that the SKT should be abolished as it is liable for abuse. In my younger years, I felt the same kind of frustration that Dr. Bee felt. You slog like hell and they give u peanuts. And then when I was an MO, I had to work under this sadistic pengarah hospital who only gives high SKT marks to those who would lick his gluteal region and actually mark down the marks of others (one of my colleague had his marked down from 95 which would have qualified him for a 'cemerlang award' to a mere 85! He left 2 months later).
And I also left. No point working for a system where they reward laziness and sloth the same as diligence.
Anyway, there are other avenues to achieve your dream. You only have to look harder. :)

nckeat88 said...

What she can do is to complaint to KKM or DG with a written letter stating that why you should not get 76 only. Some of my MO did that and the DG usually wrote a letter to the specialist requeting them to state the reason why little mark was given. Usually the specialist will redo the SKT and give higher mark.