Whither medical excellence for Myanmar?

Burma‘s BSPP Ne Win‘s government had destroyed the Burmese Medical training with the almost freezing of the Post-graduate Medical Education. After every few years they would send one group of few (less than half dozen) post graduate training doctors abroad. That was dictated by not depending to the needs of the country but the cronies and children of the top leaders.

Even internal Post-graduate training was reduced to TWO persons per discipline or subject eg General Surgery, Medicine, Paediatrics, ENT, Ophthalmology etc. Yes, you are not wrong and I am writting the truth. Two persons only for the MSC entrance for the three Medical Institutes in the whole country. So if that two MSc students were sent to one Institute, they need to wait another three years to get another 2 trainees. For eg in Surgery or Medicine, there are dozens of well experienced Professors and Senior Lecturers but they usually got 2 Postgraduate intake in every three years.

In other reputable Medical training Universities they accepted at least few dozens as the Post graduate students but there would be strict Part 1 exam to choose the best amongst them. The common concept amongst the examiners is,”The Post-graduate student must prove themselves or earned the marks that they worth to be passed the exam.’ In the undergraduate exams there is some leeway for the students that the examiner must prove that the candidate should be failed. So it is somewhat easy to get enlisted as a Post graduate (or some times called as graduate course in other countries), as if entrance is easy but difficult to pass. But under Ne Win, it was difficult entry as cronies and Children of Military and Professors only could be accepted and they all must be passed at all costs. So it was reverse condition from the rest of the world. Because they were the “Royal family members” or related to the big shots or children of the Professors or who could bribed a lot (with money or rarely with sex) they would get their Post Graduate degrees.

After the mass exodus of specialists after Ne Win’s resignation, the brain drained Myanmar Medical authorities reversed the above method of manpower training. We need to praise the present Military Governments for their more opened minded, progressive approach of accepting back the Muslim doctors and others without any cable.

Under Ne Win’s Apartheid, open anti-Muslim policy we are labled as Kalas and discriminated but Chinese blooded doctors were accepted as many professors themselves had Chinese blood and they shamelessly give favours to Chinese blooded Medical Students and Post-graduate students.

Now I am away fro Myanmar and heard that because of the better mindset and openess of the present SPDC leaders many poor Burmese, Ethnic Minorities and Muslims got a chance to get further study chances. TQ Bo Gyoke Hmu Gyi U Than Shwe, Dr U Kyaw Myint, Dr U Pine Soe and all the leaders. May God bless all of you.

Please read the following good article I had read today. But even Malaysia, not only many Chinese, Indians, Christians, Hindus, Buddhists but a lot of foreigners around the world including Myanmar Buddhists could get a chance for Post Graduate training.

I still remember the words of Prof. Tan Sri Dato’ Dr. Syed Jalaludin Syed Salim, Ph.D University of London ex-VC of UPM and now the People’s Bank (Bank rakyat) Chairman:

“I had studied in India and got first degree, Post Graduate Degree in New Zealand and London.

Our Government’s policy is to accept Foreign Students at least 2% for the undergraduate and up to 10% for the graduate degree courses even in Government universities.

Some local Professors and Lecturers are jealous to give places to foreigners.

I had to tell them that if we do not accept the foreigners, there will be no competition, and locals would be lazy without any sparing rivals.

We forced the Foreign Graduated to do research for us, we gained a lot and our university would just lost just a paper printed with graduation certification only.”

He accepted our youngest sister, who graduated with MSc and PhD from his university.

I wish to write my experience in the MSc O&G exam interview in University Malaya. I had a gift of God to estimate what they would ask and could give the answers with surprising facts and figures which the examiners could not dispute. Almost at the end of the interview the Indian and Chinese Professors showed almost animosity to accept me and questioned me why I never go to UK for the training. I got the same feelings as in Burma under Ne Win’s system, I hit back at them pointing to all the examiners and told them off that they would not be able to become specialists nor consultants if other more developed countries like UK, US, Australia etc refused to train them. Now I came from Myanmar to the more developed country like Malaysia. According to the Medical Ethic they should not refuse training as I am here not for money or asking for a job as I already got the job in Malaysia and got the permission to stay here from Home Ministry even if I do not work anywhere. I asked them that if I went to UK and finished the MRCOG Part 2, whether they could accept me back or not. I told them that they are very protective and would refused me because I could not finished five year experience after the post graduate degree.

I told them that if I continue to stay then, I could easily get my Red IC and had choosen not to go to UK.

Although I thought I would be rejected, I was surprisingly accepted.

I do not know that my words had affected the Hearts and Minds of Malay Lady Doctor, who I did not know then, and at one Eid or Hari Raya, about 10 years later, we met at her house because her husband invited us.

At the time of interview she was the Professor/Head of the Department of O&G UKM, or National University of Malaysia and the Dean of UKM. Her husband is the Prof. Syed VC of UPM., I had mentioned above.

I never recognized her but she told my wife in front of many people that she liked my answers and courage and she was the one who strongly supported to choose me. The world seems to be so small, I was lucky that I did not have a bad history that others could point the fingers.

The rest is history. UM or University Malaya started to accept a lot of Myanmars for the graduate training.

Although I withdraw from the course I left a good reputation that first few Myanmar Doctors just accepted by the Professors with my introduction only.

I never charge any agent fees nor even get any presents and after helping five doctors (Buddhists/Muslims/Rohingyas) Allah rewarded our family with the Red IC we wanted.

When the others need to search and spend for connections, I just got with the one letter written to the Prime Minister! Yes, up to now he never seen me and had never give a single present. Actually all happens according to Allah’s will and our good unselfish deeds or help to other fellow humans in need.

Dr. Soe Aung wrote on my FB Wall: “Dr Ko Ko Gyi is the first Burmese Medical Officer worked at University Malaya. Before him, non of Malaysian University wanted to to appoint Burmese MOs. Due to his strong knowledge in Medicine ( I really don’t know how he remember everything) , dedicate in his work (he still can work 365 days  a year), excellent clinical skills ( worked at Mandalay GH)  , University Hospital started to accept Burmese doctor and later,  followed by HUKM.  I was the first one benefit from his excellent work and subsequently my brother. I  thanks and fully appreciate his jobs on introducing NG and Lee Locum, loan me money for a day to do MPH (at that time,  I need to show bank account to do MPH), introducing AE UH Medical officer and etc. JUST TO LET new Medical Officers FROM UH and HUKM know. In fact, I learned medical ethic and professionalism from my mother, our lecturers from Burma and later from Dr Ko Ko Gyi in Malaysia. I learnt the most important one from him  is telling patients what I believe the best for them without fears and favors.”

Now let us read the following good article I had read today. 

Time magazine’s March 23, 2009 issue carried four striking pages of frontispiece advertorial from Singapore Medicine. In short, it captures the essence of what Singapore usually touts itself, i.e. that Singapore is “the ultimate healthcare destination – one destination that’s done them all.”

Four simple steps are articulated:

1. First, collect really good doctors

2. Then, put them into slick healthcare facilities,

3. Third, connect the above two to a wonderful healthcare system, and

4. After that, put them all into an accessible, convenient and safe country.

It goes on to say that “putting them all together takes some skill but even trickier is making it sustainable and not just on paper. Prices must not escalate, the public sector must continue to serve the local population, the quality of healthcare must not fall, and the commitment of putting patients first must not waver. Keeping all things in balance is where many stumble. There… 4 easy steps to create a world class medical destination. Not many actually get there, but some do…”

medical doctorsThere is much that can be admired with such a simplistic take on marketing and self-assurance. But we in Malaysia already know that Singapore and its proud citizens appear to have buckets of such self-belief and its carefully-nurtured culture of excellence and meritocracy.

Its government of PAP-leadership and dominance for 44 years, has never pretended otherwise, and has always exhorted its citizens to be world-beaters, the best in the world that they can ever be, and has striven relentless toward this goal.

Founding patriarch and much admired (and criticised) Minister Mentor Lee Kuan Yew brooks no nonsense when he plainly tells his wards that unless Singapore invests in its people and services par excellence, Singapore will not survive.

Especially so, when seen in the context of it being surrounded by a sea of potentially hostile neighbours. None of these are not in fulsome praise with Singapore’s stupendous progress. Notwithstanding its much acclaimed if disgruntled “pulling-up-its-own-bootstraps” performance and efforts, there is more begrudged resentment than genuine approbation. More than one piqued regional leader had even labelled Singapore, an inconsequential “tiny red dot” in Asia, a denigrating snot even, as decried by one exasperated Taiwanese legislator.

Singapore has excelled

But let’s be brutally honest, it is an extremely bright red spot! One that has put many lesser or even greater nations to shame! Why? Because its dogged pursuit of nearly incorruptible and flawless administrative and socially-directed economic policies, has made this tiny island city-state into one of the wealthiest nations in the world.

Economically and administratively, Singapore has excelled. It has become one of the richest nations (albeit for a small population of around 6 million). It has also been recognised as one of the least corrupt, most efficient, unabashedly meritocratic, cleanest countries in the world.

Yes, it has done so with uncompromising suppression of its still fledgling if dismembered hapless opposition. Anyone who dares to challenge its superlative vision, who dares breathe and preach too much unfettered democratisation, who dares criticise without the full facts and arguments of any semblance of brilliance and superlative stance, would be challenged vigorously to the point of utter defeat, even destruction.

Thus for a long time, the people of Singapore has had to stifle their creative juices or any seeming inconsequential aspirations for greater freedom of expression – why rock the boat, why derail the gravy train that has provided so much, so well…? What’s the beef about having your individual say when you can’t provide a better alternative?

Singapore still believes in a unique form of rigidly-guided democracy, one where a paternalistic neo-Confucianist mindset oversees its top-down system of highly-virtuous mandarin-like governance, where state interests supersede individual freedoms – which, to be fair have been loosening recently.

It is also one of the most autocratic which has relentless bankrupted many an opposition politician because of their less than stellar pursuit of the truth, where defamation is seriously regarded as its checks and balances against any perceived slight on the Singaporean government’s honour and jealously guarded ‘morality’.

But it has delivered its promises of an enviable, high quality of life, if not socially, at least materially, within the constraints of its tiny footprint in terms of land area, natural resources and influence.

Thus, it is not surprising that it has always had aspirations to grow to its self-realised larger-than-life potential of being an economic giant which can teach the world a thing or two, about what constitutes good governance and administration. This is a neo-Confucian-Asian model of philosophy-king benevolence, where the majority of its citizens thrive and are taken care of, to the point of placid contentment, and indeed docile acceptance of its pampered lot, and its puissant godlike leaders.

World class service centre

It probably is unfair to label its citizens as subservient, but many of my emigrated friends are quite content and happy with the status quo, which has bred a less critical mindset, but who remain seriously competitive and very intolerant of inefficiency and corruption.

It has developed into a world-class services centre, which vies with and competes unyieldingly with the best in the world. In this context, are we surprised that Singapore would have tried to do their stuff any differently? No, that is why in many ways and on many an occasion, that is their modus operandi. It has not been afraid of attracting foreigners to beef up its intellectual genetic pool.

It so happens that healthcare is just one of its core centres of excellence – and Singapore has undoubtedly projected its strength and its capability by showcasing more than a few of its superlative talents and expertise.

Thus, our neighbouring city state has been constantly and consistently selling its excellence, and not unashamedly touting its own superduper facilities and expertise. This, Singapore and its supremely confident physicians and surgeons have always positioned and marketed its supremacy, its capacity for the best that modern healthcare can offer and then some more.

Sometimes, these promotional exercises can be very overbearing and over the top. Although mostly uninvited in neighbouring Asean countries, Singaporean healthcare companies have brazenly advertised in naked marketing activities which appear to infringe upon the codes of conduct of local or regional medical practice. Such excesses, even if pursued with ignorance, smacks of arrogance, which rightly peeve many local physicians–they are viewed as being too brash, too deprecating of local/regional standards, or lack thereof.

Many Malaysian doctors feel piqued and somewhat angered that they have been unfairly compared with, even slighted; our egos busted. Often our shortcomings become glaring and we get irritated that for some reason of other, we appear second-rated and not nearly as good as we should be.

Deep down perhaps, there is that little bit of green-eyed envy that for some inexplicable reason, Malaysian healthcare cannot really be considered at par with many aspects of that of Singapore.

What piques us is that many of our own locally-trained doctors are now practising in Singapore, our own colleagues of yesteryears who have found the climate of challenge and excellence to their liking and choice. At least half a dozen of my own class of 1979 University of Malaya’s medical school are now deeply ensconced in the Singapore health care system. Many more of my school friends from the 1970s are also thriving and serving in the Singapore Medicine system.

But I suppose this is true of any community – we are now so globalised, so mobile, that we can be wherever or whoever we wish to be. It is sad but not altogether surprising that so many of our talents have found the Singaporean experience to their taste. There have also been others in other countries, who have chosen not to return to serve in our Malaysian system.

Because, Singapore has always touted its unapologetic culture of excellence and meritocracy, many talented people especially those from nearby Malaysia, are attracted to and would naturally gravitate towards such a city state. The attraction is due to possibly sociocultural similarities and even ethnically-proximate comfort zones. Malaysia’s loss, as they say, is Singapore’s gain.

Are our standards below par?

More seriously, we have to ask ourselves, Malaysian doctors, where we are in the scheme of things? Are we truly comfortable with where and who we are?

Are we necessarily inferior in delivering healthcare? Are our standards below par, when compared with Singapore and the rest of the world? If this is so, is this perception unfair and unrealistic, or is it the unvarnished truth?

Why is there this divergence in health care delivery and standards when not too long ago we were so close as even one single country and people in the 1960s? Clearly, because any if not every doctor in Malaysia can possibly work and function well in Singapore, there should not be any reason, why the general perception is so divergent, that superb consistent competent care can more often than not be obtained from Singapore rather than in Malaysia.

Why this possibly preferred pilgrimage across the Causeway for many a second or third opinion or tertiary specialised medical care, remains an ultimate choice for many a patient who can afford to choose. The reasons are not hard to fathom.

Until and unless Malaysia get beyond its own parochial and ethnically-sensitive constraints, it will be hard for us to compete for such true excellence. We can gripe and show all our angst and outrage, but we will have to do more to show that we can be truly world-beaters.

It is no shame to look over our nearby shoulder across to Singapore, and see how they have done so well, so fast and so consistently. I believe we do have the human capital, which we have shared from a common stock for so long.

It is just the will and the determination to want to be the best, to maintain that excellence of service, that is lacking or missing.

Whither medical excellence for M’sia? by Dr David KL Quek in Malaysiakini

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One Response to “Whither medical excellence for Myanmar?”

  1. Rebuttal to the Racist Bama Buddhist attacking my fellow Muslim doctor cum Human Rights Activist | Dr. Abdul Rahman Zafrudin @ Ko Ko Gyi Says:

    […] Whither medical excellence for Myanmar? […]

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