Mismanagement, Mismanagement, Mismanagement!

....for twenty two years, Malaysia was under the stringent care of a medical doctor whose previous administrative experience was that of Klinik Maha in Alor Setar, Kedah.



Mismanagement, Mismanagement, Mismanagement!

An Ailing Malaysian
A graduate from Universiti Malaysia Sarawak (UNIMAS) shocked me recently with her pathetic knowledge in pharmacology. She was placed in charge of a patient with a fractured hip bone. The elderly man from Sandakan had been under her care for days already. I reviewed the patient and identified multiple acts of blatant neglect and implicit murder. The docile patient was simultaneously on three non-steroidal anti-inflammatory drugs – Celebrex, Arcoxia and Voltaren. As a result, his kidney function was deteriorating, a phenomena totally oblivious to the house officer concerned. He was probably having a slow upper gastrointestinal bleeding as well, for his red cell count was falling slowly but steadily.

As a house officer, she was to be in constant knowing of the patient’s latest condition and medications. She was not, obviously. In addition, a house officer is supposed to be working under the supervision of medical officers. This too, was not happening obviously. Her medical officers were either just as apathetic or equally unfamiliar with drugs and their adverse effects. The last question that begs an immediate answer will put to shame all ye pharmacist apologists. Drug charts are reviewed each day by the hospital pharmacists for approval and dispensing, so why did the wise and esteemed pharmacists dispense the medications knowing it is a case of overzealous polypharmacy? Perhaps they too, were as well-read as the house officer.

When confronted, the house officer became defensive and insisted that Arcoxia and Voltaren were not in the same group as Celebrex. In fact, she was even unable to provide me with the corresponding scientific names of all the drugs she was prescribing to the patient.

I can accept a doctor’s being fresh and uninformed. I can’t however, accept a doctor’s being clueless and arrogant. She incurred my wrath for more reasons than her outright ignorance. She downplayed my concerns and was unwilling to learn from her mistakes. In short, she was unteachable.

I ended up wasting thirty minutes of my youth trying to educate this young Malaysian Chinese lady in basic clinical pharmacology. I should have been paid by UNIMAS for doing the job of its lecturers.

I have acquired a notorious reputation of sorts among the junior doctors. They know they’re in for a fiery tongue lashing session when I discover a patient under their care is neglected and unacceptably mismanaged.

It’s really annoying when patients are mismanaged in the wards. It’s not as though I have never committed blunders of my own. Everyone screws up every once in a while but mostly inadvertently. Then there are those who are total screw-ups in life and are seemingly determined to make others meet the same fate.

From my own limited observation on which I have no evidence or random surveys to quote from, I find that patient mismanagement falls mostly into three categories: investigations, fluids and drugs. I can write endlessly about the mismanagement of patients but I don’t see how it can be edifying to anybody.

This is not to be another case write-up overflowing with incomprehensible verbose medical jargon.

An Ailing Malaysia
Rather, I wish to draw parallel of the daily bungling of an ill person to the half a century mismanagement of a nation. After all, for twenty two years, Malaysia was under the stringent care of a medical doctor whose previous administrative experience was that of Klinik Maha in Alor Setar, Kedah.

Malaysia is currently very, very ill. If the world had an Intensive Care Unit (ICU) for ailing nations, Malaysia is an ideal candidate for admission because despite being in a debilitated condition, there are chances that Malaysia can be restored to viability and stability. We can blame the Abdullah administration all we want but truth be told, he inherited a nation that was messed up by his predecessors for almost half a century.

Political analysts have write theses after theses about how Malaysia became as ill as she is today. The problem list is long but can be generally summarized to three main areas of mismanagement: Wealth, Human Resource and Time.

Wealth
At risk of sounding like an overplayed, outdated Vanilla Ice track, it really isn’t too far fetched to reiterate that Malaysia is a land blessed with abundant wealth.

Malaysia has almost everything mother earth has to offer except for real snow, chubby pandas and an intelligent deputy prime minister. Malaysia has the resources to provide almost anything for her citizens – delicious multicultural delicacies, natural places of interests and potent C4 explosives.

Had the richness of the nation been fully utilized prudently and honestly, Malaysia can today be more generous than Cuba, more flamboyant than Brunei and more peaceful than Switzerland.

Yet the solemn fact is that the fat of the land has been squandered and stashed away in the private Swiss bank accounts of those who call themselves ambassadors of the nation and defenders of race, religion and culture.

We have ended up therefore instead with trunk roads littered with potholes and hospital mortuaries stocked with fallen motorcyclists, even as our limestone mountains are indiscriminately chiseled away on a daily basis.

Our oil reserves have almost run out after decades of drilling with bountiful profits reaped in the process, but still we have districts without schools, schools without teachers, teachers without money and now, money without value.

It is not too late for Malaysia to undo the wastages of her wealth on white elephant mega projects and salvage the residual assets of our land. UMNO has proven itself incapable of keeping its hands out of the cookie jar. Perhaps Anwar Ibrahim, Lim Kit Siang and PAS can do better job?

Human Resource
A Singapore-based hospital came to Sabah recently on a small-scaled roadshow. The institution is in the process of expanding its services and is thus somewhat short on manpower. The Human Resources team came on a recruiting tour, hoping to employ medical officers and registrars with the prospect of further training and sub-specialization. The employment terms and conditions were moderately attractive although the salary scheme will not make one rich in view of Singapore’s high living cost.

Yet the team of headhunters emphasized one crucial characteristic that has hitherto been sorely absent from our Malaysian civil service. It is none other than the factor of and emphasis on meritocracy in consideration for future remuneration and promotion. All this while, the Malaysian Ministry of Health proclaims that our doctors are leaving solely because of monetary reasons.

I must admit that I am extremely tempted to send in my curriculum vitae to a foreign institution. I am not alone, apparently.

What the Malaysian Ministry of Health is trying hard to oust and discard, their counterpart at the south of the peninsular border is waiting impatiently to receive.

In the Singaporean hospital’s own admission, up to 40% of doctors in the Lion City are Malaysians.

Some quarters estimate that between one to two million Malaysians are currently serving a foreign country. Every family I know seems to have a relative or a child working overseas. Therefore, a Malaysian diaspora in the scale of a million or two isn’t really incredulous.

Only God knows how many talented and skilled Malaysians have left the country since BN’s discriminative policies came into effect. It’ is not entirely an issue of race or ethnicity. It is very much the question of political affiliation and personal ideals as well. Great thinkers like Azly Rahman and M Bakri Musa are Malays by the most rigid definitions yet they have chosen to serve a foreign land in spite of the promises of a privileged life back here in Tanah Melayu. Enlightened individuals with enormous talent can never gel with an authoritarian regime that tolerates no dissenting view.

Indeed, we have lost doctors and engineers, economists and artists, thinkers and writers and even P. Waytha Moothy and Sufiah Yusof.

In short, the Malaysian government since 1957 has failed to safeguard our collective resources as well as resourceful individuals.

Only time will tell whether a Pakatan Rakyat administration will adopt a new stance in employment and promotion - the axiom that human resource is the greatest asset to any corporation. After all, such a working principle has worked well for our southern neighbours thus far.

Time
Time and tide waits for no man. Time and tide waits for no country too, especially one that doesn’t appreciate the value of time and the consequences of wasting time.

The Malaysian government and the civil servants it employs are experts in time wasting.

Our civil servants did not acquire their fame for unproductivity for nothing. On second thoughts, perhaps I’m contradicting myself. Maybe they did after all - by doing nothing.

Every half hour or so, is a protracted coffee break in the typical bureaucratic office. The culture of ‘minum teh’ is too entrenched in the system. In fact, the one who does not participate in this orgy of sluggishness might end up alienated and ostracized for being pretentiously diligent. The working ethics might have improved a little over the years but mostly, an administrative officer in civil service is more likely to have Solitaire on one’s computer screen than a window of backlogged records and documentation.

Every other day meanwhile, there seems to be a reason to organize a lunch function of sorts. It’s either the welcoming of a new department head or the farewell to a retiring director. It’s either the officiating of a Toilet Cleanliness week or the formal closing ceremony to the Service-with-a-Smile campaign. If 100 personnel attend these two-hour functions every other day of the week, it’s a loss of 100x2x3 = 600 working hours each week, or the loss of 2 months productivity per week.

Every other week or so thereof is an inescapably lame workshop or nonsensical seminar. These are programs that supposedly improve the skills, knowledge and public relations of our bureaucratic staff. More often than not however, they are delivered by untalented souls who would otherwise not find employment in the private sector. The mother of all these courses is none other than the Induksi and Biro Tatanegara Program (BTN) that serve only to brainwash any dissenting views and convert opposing voices into all-hail-UMNO-and-BN zombies. Each Induksi session lasts two and a half weeks.

Do the maths and one will arrive at a horrifying figure of unpardonably wasted time. Suddenly it all makes sense why our general hospitals never to seem to have enough nurses, medical assistants, dentists, pharmacists and doctors. They are all busy feasting away in a hotel ballroom listening to speakers spreading pro-UMNO propaganda.

Most people will welcome a paid holiday to while their lives away. I’d rather earn my keep and make the most of my time treating ill people just as I was trained to, so thank you very much.

A Priceless Trinity

Like the Father, Son and Holy Ghost unified in their Holy Trinity, Wealth, Human Resource and Time is essentially one and the same.

Time is money and human resource equals wealth.

Is that a concept too complex and beyond the understanding of our pea-brain politicians? Or are they as recalcitrant as the obstinate house officer from UNIMAS, the arcetypal of 'bodoh, sombong?