Saturday, April 30, 2011

The General Elections - die die also must say

These are interesting times. As some have already pointed out, this elections will prove to be a watershed one. A milestone. Whatever the outcome and no matter how much MM Lee wants to downplay it, I believe the consequences will be immense and the results will significantly shape the Singapore of tomorrow.

I am not a political commentator and generally have stayed away from directly commenting on political issues. Maybe indirectly shoot some arrows, but generally I have been quite content to just grumble from the sidelines. I am generally not a political person. Afterall am I not a happy-happy beneficiary of the stable gahment that has allowed me to be educated and trained to be able to provide for my family as a medical professional? I am comfortably ensconced in Singapore society. What is there to really complain about? When I am overseas, who do you think I root for, and defend when others criticize developments in Singapore?

So the recent outpouring of apparent wrath against the ruling party in this 2011 elections seems a bit of a mystery to me. Has not the gahment of Singapore, achieved wonders in bringing a resourceless Singapore into developed nation status? We are the envy of many around the world. The little red dot is only little on the map; we punch way above our weight in the world. By any measure, we have a fantastic gahment here in Singapore.

Yet people are unhappy. Why? Minister George Yeo, MP for Aljunied accused the opposition for imposing an emotional burden on the voters, yet paradoxically, here lies the true emotional burden - that the electorate must struggle between supporting an otherwise effective gahment, and the feeling of heaviness and dissatisfaction, that somehow things are not as good as the official statistics tell us.

People feel marginalized and neglected. It is not that Singaporeans are xenophobic or hate foreigners, even though the tone of comments expressed during hustings may suggest it. No, Singaporeans are not xenophobic. It is merely the feeling that their own gahment appears to value foreigners more than its own citizenry. This is probably not true, but the perception is very pervasive. This is where I believe, the gahment has failed. It has failed in managing public perceptions and expectations with respect to immigration, foreign labour and economic growth. It is fantastic that our economy and GDP continue to chug along at a healthy rate, but the perception on the ground is that the benefits appear to accrue mostly to the elites and the wealthy in Singapore. The gahment's reach out to the poor, the weak and the marginalized is often grudging and calculative. Paltry sums considering the size of our budget surpluses and national reserves. Can we do more? Of course we can..... and please don't tell me this is tantamount to raiding our national reserves. MM Lee's comments about the elderly working till 85 was supremely insensitive although I don't think he intended it. Choosing to work till you are 85, is really not the same as being compelled to work to survive until 85.

Being in power, unchallenged power, for such a long period of our history has bred a level of complacency so that leaders do not feel that the public needs to understand or seriously discuss issues. The most expedient way of going where you want to go is unfortunately via a top-down dictatorial approach. This approach has been over-used. Has there been enough planning and discussions?.... Not much apparently.

In the biomedical area, this lack of planning and discussions have wreaked real havoc in the system. Take for example, the hospital clusters. We have over a period of 20 years gone through various levels of clustering, and declustering, and now re-clustering. Each Minister that comes along pushes a hobby-horse position. Hardly evidence of long term planning. Medical manpower planning? Hardly any, apparently - because we have flipped-flopped from too many doctors, to the present situation of being desperately short of doctors. Suddenly we require 3 medical schools..... of 3 different educational systems? This is planning? Almost overnight, the US residency programme was foisted upon all and sundry. If there had been any long term planning, it was far from evident. Medical education is now in a mess. We have an undergraduate and a postgraduate system existing side by side. We have flirted with problem-based learning, then discarded it. We have integrated and disintegrated the curriculum. And we have the really bizarre situation where our medical students are not expected to have studied biology. Duh? And we are expected to believe there is someone somewhere who is responsible for planning all this?

No one discusses this publicly because everything is driven from the top. Very heavily driven.

Foreign talent is critically important for us to push towards excellence. But without appropriate signals that policy makers are concerned about protecting the interests of our home grown and local medical/biomedical professionals, one cannot avoid feeling that the economic pie is not really for local consumption. The mass of biomedical and life science graduates and postgraduates we produce annually find it hard to find jobs in the sectors they have trained for, despite the very rapid expansion of the biomedical sector.

Whatever the results of the elections, there is no doubt they will be important. I don't think the PAP will lose the right to govern. But I think it is vital for the ruling elite to recalibrate its way of doing things... to relearn how to communicate with the people it seeks to lead. If they truly believe they are servants of the people, they must make this evident. And stop being just rulers.

Thursday, April 28, 2011

gerrymander, salamander....

I was curious about the word gerrymander....thought it a bit strange and that somehow it had been derived from the salamander. True enough, it was.

According to my trusty reference for all things I would otherwise have been too lazy to go find out, Wikipedia, the word derives from a certain Gov Elbridge Gerry of the USA who, in 1812, redrew the district of Essex in Massachusetts to benefit the Democratic-Republican party in the elections. And as the shape of district was so bizarre, the press mis-characterized the cartoon creature as a salamander. Thus was born the word Gerrymander.

"First printed in March 1812, this political cartoon was drawn in reaction to the state senate electoral districts drawn by the Massachusetts legislature to favour the Democratic-Republican Party candidates of Governor Elbridge Gerry over the Federalists. The caricature satirises the bizarre shape of a district in Essex County, Massachusetts as a dragon. Federalist newspapers editors and others at the time likened the district shape to a salamander, and the word gerrymander was a blend of that word and Governor Gerry's last name."

Can you spot the salamander here?

Sunday, April 24, 2011

Top down? Or bottom up?

I think most organizations have a similar vertical structure.

People at the top, stern countenance notwithstanding, tend to see life as being rather rosy, and the view below them as being populated by trouble-making, poo-heads. The view from the bottom, is really quite different. When they get to see anything through the droppings, all they see are contracting orifices.

The situation is clearly made worse by group-think at the top, and the propagation of a monolithic logic down the ranks.

Selling off our heritage

Some 5-10 years ago, as if at a given signal we started all this nonsense about naming buildings and institutions after dignitaries and philanthropic donors. Now, I don't really care if they name new (or even old) buildings after people who give lots of money. Nor do I particularly care if they want to name institutions and buildings after local 'heroes' and prominent figures who have contributed much to our nation building. But naming established institutions after people who just give money is, I think, way over the top.

I beilieve the NUS was one of the first to lead the charge. The School of Medicine particularly. I for one, was aghast when heard they named the grand old School of Medicine after a Yong Loo Lin. 'Yong who?' was my first response. How could they? Here was my old alma mater, 100 years old, with a proud heritage.....gone overnight. Morphing unceremoniously into the Yong Loo Lin of Medicine. "Yong-who? School of Medicine?" . No consulation with staff.....or alumni. Talk about a top down approach. Many of my contemporaries had been equally appalled. A heritage sold. No matter how the School of Medicine insists on the continued heritage, there is no doubt it had all been destroyed by the stroke of a pen.

How much was the heritage worth? One hundred million bucks. Sounds big doesn't it? Until you realize how big the annual operating budget for the school is. Let me tell you one hundred million dollars doesn't really go very far. Consider for example, that the NUS operating expenditure is in the range of $1.5 billion.

And so we sold the hundred year heritage for a hundred million dollars. One million for each year. How callous, and tragic (not to even mention that the old original building of the medical school, the female asylum, had much earlier on, been bulldozed over to build a carpark!).

This was most certainly one of the straws that led to the final one for Dr Tan Cheng Bock. He finally resigned in exasperation from the board of Jurong Hospital when they decided to name the hospital after Ng Teng Fong, whose family had also donated some money.... some $125 million of it. Again while the sum may appear big, it is also small compared to the $1 billion the government is spending on the hospital.

So what gives....?

Seems to me that our idea of Total Defence includes the protection our heritage, because it is our heritage that holds us together and gives Singaporeans a sense of that common history and vision for the future. Seems to me that the selling off of our heritage for a paltry 30 pieces of silver is not working in our favour, and undermines all the effort in the building our total defence.

It is time to take stock.

Tuesday, April 19, 2011

Death of Physiology....and of medical education?

Hot on the heels of my preceding 'rant' on groupthinks and health/education, here is an article by a leading physiologist and Emeritus Professor in King's College, London, Prof RJ Naftalin. Needless to say our medical educational system is pretty much hurtling down this road to disaster.

I reproduce an abstract here, and the full article can be read at The Scientist

Opinion: The decline of physiology
Medical schools in the UK are teaching physiology courses primarily focused on clinical applications with much curtailed practical laboratory training to the detriment of medical education. Prof RJ Naftalin.

Clinicians now take a leading role in pre-clinical teaching, largely displacing pre-clinical scientists who are more in touch with basic physiological processes. Scientific content taught in the context of clinical problems omits much basic science, which is regarded as inessential digression from the clinical problems upon which the course is centred.

Another factor contributing to the decline of physiology courses has been the loss of physiology departments as a result of their merging with schools of biological, life, health, or medical sciences. Only one or two discrete academic physiology departments remain in the United Kingdom. Resource allocation within the preclinical schools, formerly controlled by academics working at the pre-clinical faculty or departmental level, is now centralized and controlled by senior administrators and clinicians. The financial and man power resources are redirected towards the more highly prioritized needs of the medical school rather than to science departments.

Election fever!

So the long awaited election date has been announced, and the main stream media has predictably been insufferably carpet bombed with stories of huffing and puffing politicians doing their rounds and making promises.

Cynically, I must say the so far the most interesting stories have been about Tin Pei Ling's feet stomping on YouTube, and Mr Lim Boon Heng being moved to tears on the suggestion that the political leadership suffered from a 'groupthink'.

Made me wonder what the definition of groupthink actually was.

According to my most reliable source of knowledge, Wikipedia, "Groupthink is a type of thought within a deeply cohesive in-group whose members try to minimize conflict and reach consensus without critically testing, analyzing, and evaluating ideas. "

Is the political leaderhip at the highest government level deeply cohesive? I believe so. Are they trying to minimize conflict and develop consensus? No reason to doubt that. So what is the problem? Really, it is about whether the consensus are reached without critically testing, analyzing and evaluating ideas. Herein lies the the difficulty. Can ideas be fully tested and evaluated behind closed doors within a small in-group, especially where there are strong ideological positions? I am not so sure. Even when discussions are taken beyond the inner sanctum, as long as they operate within party constraints, can truly critical evaluations be made? I seriously doubt it.

So while Mr Lim Boon Heng insisted and believed there was no groupthink, I am not so convinced. I for one believe that Singapore will be a much stronger and cohesive society if the political leadership could trust civil society a bit more, and would allow for more and broader public debate on critical issues.

Having said that I must qualify that I don't believe that the problems we have on the ground are fundamentally a result of any groupthink occuring at the top. In my opinion, the problems we see all over the place are largely related to the middle managers implementing extreme forms of a 'monolithic logic' derived from otherwise 'sensible' policies generated at the top. And by middle managers, I refer to that thick layer between the top echelons of political leadership and the workers.

What have these to do with Gigamole? I think health and education have been badly affected by this. Lots of giraffes.

What have giraffes got to do with this discussion? Read here.