Hoisted by the presidential petard

The petard was apparently a small bomb that the French used in the 16th century to blow up fortifications etc. The problem is that, like many such munitions, they can behave quite tempermentally and blow up at unexpected moments. Much like the situation of the terrorist who blows himself up accidentally in the comfort of his bomb factory. So one can easily be "hoisted by his own petard". Funnily, a related word to petard is 'peter' or 'petar' meaning 'to break wind', or fart. Seen in the light of this alternative meaning, one conjures up the comical imagery of someone being 'hoisted' by his own fart. For a guy, I suppose, it's like trying to pee against the wind.

Several years ago, the PAP, in a rare pique of insecurity, suddenly recognized that there could actually be a freak election result giving rise to an unintended opposition-led government. Quite an oxymoron here since all election results actually do reflect real decisions of the electorate, and if the opposition wins, it must be the decision of the electorate, and cannot be a freak result. Nevertheless, the PAP then petulantly declared that there should be second key to the national reserves that was to be held by an elected president; effectively the creation of a petard to be used against the opposition, should they be ever so freakish as to be voted into government. It was obviously never ever intended that the petard could be used against the PAP itself since any ruling party could easily engineer into position a pro-ruling party president.

How times have changed. Likewise the wind direction. Now, more than ever before, the possibility is very real that the opposition could swing enough votes to topple the PAP from its throne. Not only that, the sentiment among the electorate is very much in favour of a truly non-partisan elected president, who can actually serve as a check against the PAP itself. Under these conditions, there could be a very significant swing in support against any candidate viewed to be remotely linked to the PAP. In fact the support could likely swing in favour of any candidate who is capable of expressing some anti-PAP rhetoric.

So we see now the presidential petard dangerously being hoisted against the inventor of the petard. Will it actually detonate? We'll see. In any case, it is not a good time to be sitting downwind.

Black swans in Singapore?

The black swan metaphor was introduced to us by Naseem Nicholas Taleb to describe a high impact outlier phenomenon that no body expects and one that takes everyone by surprise. The recent global recession related to the collapse of Lehman Brothers was such a black swan event. And like all black swans it can be rationalized after the event, when everyone kicks themselves in the backside and wonders why they never recognized it coming.

Although not global in magnitude, there have been a number of black swans seen in Singapore recently. The GE2011 results for example, caught many people in the PAP by surprise. The flooding in Orchard Road was another such event. In retrospect however, these events could have been easily predicted, and now we have the unusual situation where many people in the gahment are kicking themselves wondering how they missed the picture.

Often therefore the black swans are not the result of extra-ordinary events but of a lack of foresight, and the reluctance to think outside of mainstream and traditional ideologies. The GE2011 black swanlette was I believe, very much a consequence the failure to really look at the signs, which in retrospect, was everywhere. There was much reluctance to listen to naysayers, and everyone was happy to fuel the emperor's vanity. The flooding story hasn't quite unfolded fully, but I believe the picture will emerge that the black swan really came about because of the reluctance to deal with changing weather patterns as a result of global warming. There was I believe, too much discomfort in wanting to move outside of traditional models looking at weather and flood patterns. After all, to do so would have been to abandon painstakingly collected historical rainfall and flooding data. Yet the world has changed, and these models need to change as well.

The increasingly recognized hospital "bed-crunch" is perhaps not unlike the flooding black swan. Caught everyone by surprise, did it? What absolute crock! The numbers were there for everyone to see. The population was growing at a phenomenal rate. People were aging. Medical tourism was being encouraged. But no one appeared to want to look seriously at the numbers. Either that or there was an absolutely wrong prioritization of healthcare resources to cater for medical tourism instead of community needs.

Singapore hospital bed crunch....again....and again and again

So Singapore is suffering from a hospital bed crunch? Again? Rightly it has been described as a perennial problem. Dr Jeremy Lim last year alluded to it being a 'systems problem'. Of course it is. Like the floods hitting us nowadays, it is a systems problem. When rainfall exceeds a certain rate, the drains must overflow. Likewise, if there are more patients needing beds than there a beds, there will be a crunch. And patients get to sleep in corridors.

When I was a houseofficer, this was a fairly common occurence during every admitting day.

The question is why has this problem not been solved? It is not as if the problem is unknown. Or cannot be predicted. At least for the flood problem we can always blame the vagaries of weather .... global warming etc. But patient bed demands are fairly predictable through the year. Population growth numbers are very well known...at least to government departments. Surely bed demands can be computed and modelled. To me, a bed crunch is a sad indictment of the lack of MoH resolve in tackling this problem.

There was once a model that promised to deliver at least 80% of capacity for local patients, and only 20% was to be for the servicing of medical tourists. Yet the current figures suggest that medical tourists now occupy 30% of bed capacity. Surely this discrepancy can be modelled and provided for. The problem did not spring up overnight!

Another problem relates to the unbalanced provision of beds. Bed occupancies differ in the different hospitals. SGH and NUH has much lower occupancies than TTSH and CGH, and the latter therefore suffer worse bed crunches. Has the MoH over provided for the premier hospitals and inadequately for those servicing residents.

I think MoH owes us an explanation.