Tales about My Father

My father fell into a coma hepatic encephalopathy since yesterday. Apart from the liver failure he also has severe arthritis and joint contractures due to ankylosing spondylitis. I felt it is better at this hour to treat him at home in familiar surroundings with drips and riles tube feeding with flagyl.Sister Yew kindly helped me to do all the necessary last night.

After a lifetime of calling this man papa, I finally got to know him in his final months and come to appreciate him for the man he is. Even in the deepest trouble of his illness going in and out of hospital I see a man slow to complain, always hopeful and seemed almost indifferent to his own pain. He concentrated on his concern his family and his following of the KLSE. He also seemed anxious to settle his will, financial matters and afterlife concerns. My mother said "he doesn't know how to feel sad." I don't know if his demeanour is peculiar to his generation or it is just him.

In Dec 2003 I took him together with my family to his ancestral village. He was very happy looking at the photos we took on that trip. At the age of 12 he walked with his mother 14 hours from Xianyou county to Xiamen to board a steamer to come to Malaysia circa 1945. Typical of my father's life he had very few options at every stage of his life. At an early age 6 or 7 he became the man in the house being the eldest son when his mother was widowed. After arriving here in Bukit Mertajam he was in primary school for 2 years 8 months before his uncle died and he had to go to the village at 15 years of age to be the kepala(estate conductor) of his uncle's rubber plantation.Lived by himself for the next 10 years cooking his own meals and living in the kampung in Mengkuang.

Typical of the man that I come to know he always made something good of whatever meagre options given to him. From the small salary he was able to send a considerable amount of money to his mother and brothers in China. He built a concrete house for them which still stands today. I believe he looked after his brothers very well.One of his brothers was the Secretary of the local Communist Party. When we visited in 2003 one of his cousins to whom he sent a Rado watch came to fetch us in a Mercedes to show his appreciation showed us hospitality and offered money to my father. To this day I am so proud of him.



Life was hard on a small salary and 3 children going to school in the town from the the village Sungai Lembu. Bas sekolah money came to quite a bit on top of everything else. Here again the man is in his element. He would trade in scrap rubber, soya sauce, plant papayas for sale and save every cent he could for the family. I remember many a night being told to go to sleep at 9pm. Lights out to save kerosene for the hurricane lamp. Despite being poor, my mother always dressed us very neatly and was givem ample pocket money so much so the teachers used to think I was a rich estate owner's son.

Scrounging and saving was not easy.I think he felt pressured a bit. But my father was always good at motivating himself. When my youngest brother was born 1970 he named him Khye Lock(pronounced Look) , meaning opening of happiness. You see despite everything he kept his hopes up. Khye Lock did bring us much happiness in our family.I am 10 years older than my youngest brother and having a small child in the family did bring much laughter.Later my fathers financial position improved somewhat. He was a many years the chairman of the Chinese school board of directors and the PIBG chairman. I remember one time he recieved a letter from the government appointing him to be the village headman -the chairman of the JKKK. But being the man that he was he turned it down because he felt he could n't do a good job.I showed him the letter and read it to him,he just chucked it out.That was it nobody else in the family knew about it.I found out later he was the compromise candidate acceptable to Gerakan and MCA who were fighting for the post.

I don't know how he did it but he managed on his RM300 salary to save RM15000 to send me to study in Australia in 1978. I did have to work to help put myself thru but my father gave me a leg up despite the disadvantages he faced. Eventually 4 of his children graduated from a University in Australia. This is a source of great pride to him. He visited Australia to see me graduate from University.

In 1991 he took a trip to China with my second brother. Unfortunately and fortunately he was able to see his mother to whom he has frequently written once more after a space of 46 years but she has become partially senile. She did intermittently recognise him. One month after coming back from China we received news from his bothers that his mother had died. I did not see any sign of grieve but thinking back it must have grieved him.

When my father was 69 the Lord Jesus remembered him and brought this exstudent leader Zhang Boli from China to share about his experiences as a refugee escaping from the Communist government after leading the Tiananmen uprising of June fourth 1989.It took another Chinaman to get to him. He accepted Jesus Christ. He insisted on completion of his term as the trustee of the local Tokong after he said proper goodbye to his past duties he was baptised in Pulau Pangkor by Pastor James Khoo.

I didn't enquire much about his faith but towards the end of his life I see great faith. He always hoped and expected to get well. He need help to move around the house since 2009 Chinese New Year when he fractured his spine. Even when his illness got worse he would have dreams where his "Father" rescued him from falling into a well and also had other dreams of hope and healing.He told my mother that there is a fragrance in his room in the evenings when Jesus visited him. I begin to spend more time but I must say not enough. There are many questions I want to ask him but I don't have the time now. I did remind him a few times how well he looked after me and my brothers and we are so grateful. 2 weeks before he fell into coma my sister came back from Australia to see him. He complained that she was spending thousands of ringgit just to see him, I reminded him that we loved him and he looked after us so well.

Even in his sickness his mind was very clear. He traded in shares and made a tidy profit up to 1 month before he fell into coma. 2 days before he dropped into the coma he had a few stock picks for me. He could always find something to keep himself happy.
My father didn't have many options in his life but he always saw each situation he was in as good and made the most of it. His childhood was spent as an adult with too many responsibilities. Most of his life he was happy to bring up his family unassuming quietly but what a blessing to me and my siblings! In his old age despite sickness he kept his spirits up by not complaining about his infirmities but by the things he enjoyed.

In many ways I am sad to be missing him and saying goodbye in another sense I am proud and happy that my father lived his life well.We need to celebrate his life. He run his race and completed what he was put here to do "a crown of glory" awaits him eternity.

P/s My father finally passed away in ICU in Metro Specialist Hospital with family by his side and singing a hokkien hymm to him on 29th Oct 2009 11pm.

How Come Doctors are Infallible?

Are doctors infallible? This is a joke right? Of course we know better after reports many incidences of medical mistakes, unfortunate incidences and outright malpractices in the press and huge malpractice awards. Should doctors be subject then to oversight like other professionals? Apparently not most doctors don't take kindly to regulation and patient safety standards and policing fearing it will infringe on autonomy, patient confidentiality and other reasons. While Malaysia was fomenting in anger over the death of Teoh Beng Hock here I was cooped up at the KL Convention Centre attending the APHM Healthcare Conference 2009- Applying Best Practises in Healthcare Delivery. Given the choice I would have like to attend Teoh Beng Hock's funeral to show my abhorrence at his treatment and death.

The conference about how to apply best practises in the delivery of health care and learning how other countries are doing it. The number one consensus statement of this conference is the fact that Doctors especially specialist are not interested and downright against this proposal. I am surprised or should I be surprised that doctors still live in the stone age compared to other professions.

The second message is that to get compliance there must be management commitment, communication and the signal to doctors that implementing best practise should be non punitive but information sharing. Doctors should be asked what they want to know more about their own practise in terms of outcomes and complications.This process is slow and laborious -it took 5 years to have a decent level of reporting form the KPJ group. In Taiwan incidence reporting is done online and a high profile person is in charge, even then reports from doctors as opposed to other staff only constitute 2%.

Another important aspect of improving standards is to communicate to staff how their functions integrate to the functioning of the hospital.

At lunch I was fortunate to meet the Quality Coordinators of Loh Guan Lye Specialist Centre and
learn from them concerning implementation of quality assurance. Their duties include reports and analysis of incidents reports, root cause audits on ISO, ISQ etc. They also shared that each department has more than 10 KPIs for each year with bonus tied in. So employees bonus are subject to Hospital KPI, departmental KPI and own performance.

The second day of this conference 22nd July was mainly devoted to teaching undergraduates what about patient safety. WHO has started a World Health Alliance for Patient Safety and one of the aims is to insert this very important subject into the undergraduate curriculum of medical schools. It is very difficulty to teach new tricks to old docs so the only hope is the new future docs?

Ismail Merican the DG for Health ( yes the one who stood by the government report on Kugan's post mortem and Anwar's sodomy report) spoke that in 2010 online reporting will be required of public hospitals on safety issues. This should improve safety issues as it will then be compulsory. But the implementation of this aim may or may not be efficient as it is always a question of delivery of the public service will come to question.

The third day the conference was divided into 4 tracks I attended the one concerning Hospital Financial Management for non Financial Manager: 1.Lower Staff Cost through Labour Management Models 2.Reducing Non Labour Cost through Cost Management and Supply Chain Management 3.Recognizing and Understanding the Revenue Cycle. Labour cost needs to be studied and a unit labour cost and total volume correlated. The supply chain is well managed already but there are perhaps still some opportunities here for management. Lastly in the revenue cycle the overarching theme is this: The more effort you put into precertification the less problem you have everywhere else. 70% of our business is from insurance now, it follows that preadmission vetting and communication is of extreme importance to patient satisfaction and future collection. More effort needs to be expanded here.

The application of best practises is already a fact in some countries and in many hospitals eg in Korea they have yearly survey of hospitals and in Taiwan the infrastructure of a universal accreditation is in place. It follows that our hospital has to be ahead of this curve.

The "UMNO-isation" of PAS

This morning I couldn't sleep, I mourned the loss of a historic opportunity for Malaysia to become more inclusive and forward looking. It could have been a watershed muktamar ushering in a new Pakatan government in the 13th GE but PAS leadership and members missed this opportunity. Instead the party elected more ulama and turned conservative, defending and offering a unity government with UMNO for the sake of race and religion. This rallying cry is almost indistinguishable from UMNO's ketuanan Melayu. It suddenly came to me, somehow and thru' some mysterious method the "UMNO-isation of PAS" is taking place. Despite the massive support of non Malays to put PAS reps in racially mixed seats, PAS leaders are ignoring this reality and trying to outUMNO UMNO in racial bigotry. Calling for Unity government, reserving no1 and 2 postions for Ulama without contests,the flip flop position on the NEP, calling for alcohol ban in Selangor etc etc , all these reek of UMNO. PAS leaders do not understand the urban and suburban electorate, Malay and non Malay, labouring under heavy tolls, taxes and high cost of living are sick to death of UMNO and can see thru' the Ketuanan rethoric as cynical bigoted attempt to get votes without really heeding the electorates feedback to reform.

Under these circumstance I ask myself why wont PAS project a more inclusive and confident face to capture Federal Government in the 13th GE. Are they trying to lose the newly gained support of the non Malays? The only possible explanation perhaps is that PAS even though they are the biggest party in the PR coalition in terms of membership and commitment, they have the least number of MPs. While PKR and DAP are deriving the most benefit from the awakening of the urban and suburban electorate to the abuse and corruption of the present government, PAS is allocated mostly rural seats where the rallying cry of Ketuanan Melayu still carry some weight. PAS cannot be seen to deviate too far from this if it were to be competitive in Malay predominant rural seats. I was made to understand that over 90 seats in Peninsular Malaysia has 30% or more non Malay voters. Based on current trend BN looks like they will lose in every on of them. It will be interesting to see how many of this type of seats is allocated for PAS to contest.

It may well be that with this direction PAS has taken we will not see a PR federal government by 2013 but more likely Malaysia has to suffer another 5 years until 2018. The UMNOisation of PAS will in one stroke of the pen undone all the good work of the last 12 months when Malays and non Malays stood side by side to defeat BN. Non UMNO BN parties have been left for dead because they are not able to mitigate the abuse and arrogance of UMNO. With the UMNOisation of PAS these parties are now given a lifeline. I would think they will be celebrating the direction PAS has taken. It may well be just as well for this to happen as going on the uneven and suspect quality of PKR and DAP reps eg Jelapang and Penanti, PR may not be ready to govern despite the experience of Anwar. Best left unsaid.

I would have thought the one thing PR should do is the behind the scenes work in the rural areas to explain its position, discuss current issues and massive voter registration exercise to recruit young voters. At the same time showing good governance in the present PR states. This kind of hack work is tough but PAS is normally known for doing it. I wonder if Hadi has lost his appetite for this kind of tough grind, having once tasted power as single term MB in Trengganu, and is in a hurry to enjoy the perks of government even if in a unity government with UMNO.

Hidup Melayu, Hidup UMNO don't know about PAS hidup or ...........................

Hip Operation In India

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9th April 2009



It is 23 days since my Hip Replacement in Coimbatore, Tamil Nadu, India on 18th Mar 2009 at http://www.hipresurfacingcenter.com/. I can feel the recovering strength in my Left thigh muscles. I walked around the park with elbow crutch on my right side today. I am delighted after 3 years limping around with the last 12 months worse after I took my son James to visit prospective colleges in US in March 2008.

When I graduated in medicine in 1984, during the stone age, one of my professors said " I can assure you half of what we taught you will be wrong in the next 10 years. Unfortunate I don't know which half will be false." Until the late 1990's conventional wisdom was that the under 60's who suffer from hip arthritis were treated conservatively because Total Hip Replacement operation done will need a revision- repeat surgery after 10-15 years. This is no longer true the methods of operation has improved and Hip Resurfacing invented by Derek McMinn( designed the Birmingham Hip Resurfacing in Birmingham, Great Britain and released it for use in the UK in July 1997 ).This method preserves more bone and even if another operation required is not so troublesome.



I did some research after consulting my orthopaedic surgeon Dr Ng Khai Oon from Metro Specialist Hospital http://www.hospitalmetro.com. He joined my hospital after being in Australia for Fellowship in Joint Reconstruction. A good site to go to research this topic is http://www.surfacehippyinfo.com/ put up by a patient volunteer advocate Vicky Marlow, very informative and helpful.

I emailed various doctors in India and Bangkok and settled on Dr G Bala at Coimbatore http://www.hipresurfacingcenter.com because he was quick to answer his emails and seem like a straightforward guy when I talked to him. On 15 Mar 2009 I flew to Coimbatore. After reading the testimonials of so many patients who had successfully recovered from hip operations, I was just relieved to be finally going to have one myself rather than scared. I was just so sick and tired of hobbling around and not being very mobile for past 3 years.

I prayed to God seeing that my children are still in college and school but God gave me peace about taking this step. The few days before I left for India I was very touch the many friends and relatives that visited me and emailed me. I learnt how much people's concern and care mean to the sick person.

Arriving in an Indian Trust Hospital is an education in itself-I was concerned about the dustiness and basic conditions of the hospital on arrival at midnight. The next day I met an Indian national in the next room, who was brought by his cousin,a medical person all the way from New Delhi for this operation. The felt Dr Bala was the best guy to do this operation. This brought back my confidence.







My operation on 18th Mar 2009, Dr Bala was unable to do hip resurfacing so a total hip replacement was done with a metal on metal prostheses inserted. I was alerted by all the doctors I had corresponded with , I may not be able to have hip resurfacing due to the bone cyst formation and weakness due prolonged limping and non weight bearing.Anyway the new prosthesis is supposed to last a lifetime so Okay. The operation and recovery was mainly uneventful, that is for another blog. I just want to add the Indian nurses and the people whom my wife and I came into contact with were very professional and very caring. The physiotherapist Saravanan helping me 2 day post op with a walking frame.

Dr Bala treated Sanjay from Delhi, my wife and me to a buffet dinner at the Residency Hotel, the biggest hotel in Coimbatore.Dr Bala is the handsome man with the orange shirt.