Malaysian Chinese dissatisfied over national policies: survey

KUALA LUMPUR, April 18, 2008 (AFP) - Malaysia's ethnic Chinese are dissatisfied with the country's national and economic policies while youngsters are becoming racially polarised, a survey released on Friday said.

Racial and religious tensions, alarm over "Islamisation" and alienation of the country's minorities were reflected in the ruling coalition government's worst ever results in March 8 polls.

Voters swung in support of the opposition, depriving the ruling coalition of a two-thirds majority in parliament and handing over control of five states to the opposition, in protest against the Muslim Malay-majority government.

The Centre for Public Policy Studies said Malaysia's Chinese, who dominate the economy, feel that they have been unfairly treated by government policies favouring the Malays.

"The Chinese do feel the most dissatisfied and most unfairly treated. This is something that the government needs to look at urgently," the centre's managing director, Tricia Yeoh, said.

The survey found 75 percent of Malays say they have never been treated unfairly due to their race, compared to 45 percent of Chinese and 49 percent of Indians.

The Chinese also feel that they have significantly less ownership of the country compared to other races and gave "significantly negative responses" to economic policies, Yeoh said.

Only 42 percent of Chinese believed government policies fostered national unity, compared to 85 percent of Malays, the survey said.

The long-standing dissatisfaction and anger felt by Chinese and Indians culminated in the government's poor electoral results, Yeoh said.

"Now we have the numbers and statistics to confirm the perception that the Chinese and the Indians were feeling unfairly treated in the country," she said.

Malaysia's affirmative action programme was introduced in the early 1970s to bridge the wealth gap with ethnic Chinese who dominate business, by giving Malays advantages in education, housing and commerce.

It has been criticised for benefiting only an elite group of Malays, while many in the rural areas still live in poverty.

The survey interviewed 1,000 youths aged between 18 and 35 from both urban and rural areas across Peninsula Malaysia from July and August 2007.

Youngsters between the age of 18 and 24 in the country were also found to be more racially polarised, preferring to mix within groups of their own race, due to lack of interaction between the races in schools and universities.

Edmund Bon, from the National Young Lawyer's Committee which co-authored the report, said the government should change its "superficial" national unity campaigns, which merely scratch the surface.

"What we need to look at are the underlying problems... education policies, scholarship issues, quotas, both religious and racial policies, rather than the usual education campaigns and awareness programmes," Bon said.

Kestabilan Minda Melayu Penting – Nazrin

Written by Malaysiakini

Raja Muda Perak Raja Dr Nazrin Shah bertitah bahawa sebarang pandangan prejudis antara kaum di negara ini dapat dihilangkan jika minda masyarakat Melayu berada dalam keadaan stabil dan selesa, seterusnya hubungan harmoni akan terjalin.

Baginda bertitah kestabilan minda masyarakat Melayu amat penting dan ia adalah satu prasyarat kepada kestabilan negara.

"Agama Islam, kedaulatan Raja-Raja Melayu, Bahasa Melayu dan kedudukan istimewa orang Melayu adalah antara perkara yang tidak pernah lepas daripada perhatian Raja-Raja Melayu.

"Raja-Raja Melayu amat memahami bahawa kestabilan politik negara sangat bergantung kepada persediaan minda orang-orang Melayu menghadapi perubahan," titah baginda ketika menyampaikan titah sembah setia sempena sambutan Hari Keputeraan Ke-80 Sultan Perak Sultan Azlan Shah di Istana Iskandariah di Kuala Kangsar hari ini.

Turut berangkat di majlis tersebut ialah Raja Pemaisuri Perak Tuanku Bainun, Raja Dihilir Perak Raja Jaffar Raja Muda Musa, Raja Puan Muda Raja Normahani Raja Shahar Shah, kerabat diraja Perak, Menteri Besar Mohammad Nizar Jamaluddin, barisan exco kerajaan negeri, ketua-ketua jabatan dan agensi kerajaan.

Menurut laporan Bernama, Raja Dr Nazrin bertitahnya sejak Durbar pertama yang berlangsung di Kuala Kangsar pada 13 Julai 1897, Raja-Raja Melayu terbukti sentiasa memberi perhatian dan menyuarakan kepentingan orang Melayu dan agama Islam.

Oleh itu titah baginda, dengan perkenan Sultan Perak, baginda akan berusaha dan merintis langkah ke arah memastikan pemikiran serta persepsi orang-orang Melayu tidak akan membawa mereka berada dalam kegelisahan dan ketidakstabilan.

Keyakinan Terhadap Raja

Baginda bertitah Raja menjadi pilihan rakyat untuk bernaung ketika merasakan kedudukan diri mereka sebagai pribumi bagaikan tergugat dan ia merupakan satu penghormatan serta keyakinan terhadap Raja ketika rakyat cemas menghadapi krisis.

Raja Dr Nazrin mahu seluruh rakyat menerima realiti bahawa Malaysia mempunyai pelbagai kaum dan usaha memupuk perpaduan dan usaha mengikis sebarang prasanga negatif antara kaum adalah menjadi agenda penting serta satu prasyarat kepada kestabulan politik di samping menjadi keperluan untuk jaminan ketenteraman awam.

"Bumi Malaysia haruslah mengamalkan satu kesaksamaan yang tidak membenarkan berlaku diskriminasi atau tindakan negatif berunsur rasis. Semangat berpijak di bumi sama, dan menjunjung langit yang sama perlu dipupuk dan dihayati supaya terbina kekuatan warga yang teguh berpadu, cekal bersatu lalu sama-sama dapat membangunkan sebuah negara merdeka yang kekal berdaulat," titah baginda.

Selain itu Raja Dr Nazrin bertitah baginda akan memastikan bahawa institusi agama yang berada di bawah bidang kuasa Sultan Perak seperti masjid, surau dan institusi pendidikan Islam akan dijadikan alat penyatuan dan tidak dibenarkan menjadi pentas politik yang boleh membawa perpecahan.

Baginda bertitah masyarakat Islam akan rugi jika terus bertelagah dan berselisih hingga akhirnya "yang menang menjadi arang dan yang kalah menjadi abu" kerana Islam menyeru kepada perpaduan dan amat menekan aspek perdamaian serta mengajak umat untuk membina semangat ukhuwah di samping menjalinkan silaturrahim.

"Umat Islam hari ini bukan umat yang kuat, baik di dunia begitu juga di negara ini. Umat Islam tidak boleh berpecah kepada kumpulan-kumpulan kecil hingga akhirnya menjadi umat yang lebih lemah. Umat Islam jangan terlalu taksub berselisih hingga ke peringkat `berkerat rotan, berpatah arang'. Umat Islam haruslah arif lagi bijaksana memastikan antara permata dan kaca," titah baginda.

Raja Dr Nazrin bertitah umat Islam perlu berpegang kepada 'semangat kiambang yang akan kembali bertaut sebaik biduk berlalu' kerana mampu menjadi tenaga yang kuat jika mengamalkan semangat bermaaf-maafan, memberi dan menerima, semangat musyawarah dan persaudaraan yang akan membawa penemuan kata sepakat.

Kuasa Memerintah

Menteri Besar dalam ucapan persembahan tahniah dan setianya, berkata kerajaan negeri sedang merangka pelan strategik yang berteraskan prinsip-prinsip amanah, adil, telus dan berkebajikan di samping meneruskan agenda pembangunan yang telah dirancang oleh kerajaan terdahulu.

"Keutamaan yang akan patik dan kerajaan lakukan hari ini ialah program-program yang memberi kebajikan dan kesejahteraan rakyat...kerajaan negeri berazam meneruskan dan memperkukuhkan dasar pembangunan negeri berpaksikan prinsip dan nilai sejagat," kata Mohammad Nizar yang mengangkat sumpah sebagai Menteri Besar pada 17 Mac lalu.

Sebuah kerajaan yang diberi kuasa memerintah dan mentadbir negeri serta rakyatnya adalah amanah besar daripada Allah s.w.t, katanya.

"Menyedari hakikat...maka sayugialah kerajaan itu melaksanakan tanggungjawab selari dengan ketetapan Allah S.W.T. yakni menegakkan yang makruf dan mencegah kemungkaran serta menjadi 'negara berkebajikan dan mendapat keampunan'," katanya.

Mohammad Nizar juga berkata kerajaan negeri akan sentiasa memelihara dan meningkatkan kestabilan sosioekonomi dan politik, kedaulatan institusi Raja, adat istiadat dan juga agama.

"Kerajaan negeri di bawah bimbingan patik sangat mengharapkan bimbingan dan teguran Paduka Seri Tuanku yang adil lagi bijaksana agar pemerintahan hari ini akan lebih maju, aman, makmur, amanah dan berkebajikan...Insyallah kerajaan yang ada sekarang tidak akan mensia-siakan hasrat rakyat Perak yang telah membuat perubahan.

"Patik akan sentiasa mendukung institusi Raja Berperlembagaan di negeri ini yang sentiasa merupakan sebahagian sejarah dan sistem berkerajaan di bumi Melayu. Patik akur dan menyedari bahawa institusi Raja Berpelembagaan akan kekal relevan dan memenuhi peranan besar pada sepanjang masa seiring dengan undang-undang tubuh negeri yang menyatakan bahawa kuasa pemerintah negeri hendaklah terletak hak kepada Duli Yang Maha Mulia Tuanku," katanya. -- (Global Media Channel)

Mesyuarat Exco jadi Mesyuarat UMNO ?

Written by Buletin online

Menteri Besar, Dato' Mad Said, ketika ditemui pemberita selepas mempengerusikan Mesyuarat Ke­rajaan Negeri di WDI, menyatakan beliau dan 10 Ahli Mesyuarat Kerajaan Negeri memberikan sokongan padu mereka kepada Abdullah Ahmad Badawi.

Demikian dilaporkan oleh sebuah akhbar perdana tempatan yang sebelum ini juga melaporkan Mad Said disifatkan sebagai masih dalam keadaan yang terhoyong hayang, merujuk kepada pentadbiran negeri yang masih goyang.

Keputusan menyokong Presiden UMNO sepatutnya dibuat didalam mesyuarat perhubungan negeri.

Desakan kepada Abdullah supaya berundur yang sedang hangat kini adalah urusan dalaman UMNO, setelah UMNO/BN kalah terus dalam pilihanraya yang lalu.

Oleh kerana Mad Said yang tidak memegang jawatan Pengerusi Perhubungan UMNO Negeri, beliau menggunakan Mesyuarat Kerajaan Negeri Majlis untuk tujuan urusan parti.

Mesyuarat Kerajaan Negeri Terengganu adalah membincang hal ehwan dan urusan rakyat Terengganu dan bukan urusan parti UMNO.

Ini adalah satu kepincangan yang berlaku apabila seorang Menteri Besar bukan ketua sebuah parti yang memerintah.

Walaupun apabila ditanya pemberita, mengenai persoalan jawatan Pengerusi UMNO negeri beliau menjawab tugasnya sebagai Menteri Besar tidak langsung tergugat, namun kenyataan sokongan kepada Presiden UMNO hari ini menunjukkan ada kejanggalan dalam urusan kepimpinan UMNO Terengganu.

Kenyataan sokongan oleh Majlis Mesyuarat Kerajaan Negeri Terengganu itu juga merupakan 'isyarat yang jelas' dari Mad Said kepada Pak Lah supaya mengambil sesuatu tindakan membetulkan kejanggalan itu.

Sebelum dari ini, Mad Said pernah disifatkan sebagai masih dalam keadaan yang terhoyong hayang oleh akhbar Sinar Harian yang merujuk kepada pentadbiran negeri yang masih goyang.

Selepas Idris ditolak oleh pihak istana dari menjadi Menteri Besar untuk kali yang kedua, Idris telah diminta oleh beberapa phak untuk melepaskan jawatan Pengerusi Perhubungan UMNO.

Gelombang perpecahan kepimpinan UMNO akan berlaku berlaku sekali lagi dalam menghadapi isu Pengerusi Perhubungan UMNO Negeri.

Sebelum ini, kepimpinan UMNO berpecah apabila menghadapi kemelut perlantikan Menteris Besar Terengganu. -- (Global Media Channel)

Bodoh Jika Desak PM Berundur – Nazri

Written by Malaysiakini

Menteri di Jabatan Perdana Menteri, Datuk Seri Mohamed Nazri Abdul Aziz berkata, perbuatan setengah ahli Umno yang meminta Perdana Menteri Datuk Seri Abdullah Ahmad Badawi untuk meletakkan jawatan, adalah tindakan yang bodoh.

Sambil menyatakan mereka sebenarnya tidak faham makna demokrasi, beliau berkata, adalah tidak wajar bagi pemimpin Umno untuk mendesak Abdullah melepaskan jawatannya sebagai Perdana Menteri dan Presiden Umno kerana ia bermakna menafikan hak rakyat yang telah mengundi Barisan Nasional (BN) untuk memerintah negara.

"Dalam pilihanraya umum bulan lepas, rakyat telah memilih BN sebagai wakil majoriti dalam Parlimen dengan 140 kerusi yang melayakkan pemimpin BN menjadi Perdana Menteri.

"Ini bermakna rakyat, yang mengetahui bahawa BN bertanding dalam pilihanraya dengan Pak Lah sebagai pemimpin BN, sedar bahawa jika BN menangi kerusi terbanyak, dengan itu Pak Lah akan menjadi Perdana Menteri.

"Dengan meminta Pak Lah mengundurkan diri, dengan itu mereka sebenarnya memberitahu pengundi bahawa mereka tidak boleh menjadikan Pak Lah sebagai Perdana Menteri. Apakah hak mereka untuk berkata begitu," katanya kepada pemberita di sini hari ini.

'Bukan semua menteri cerdik'

Sambil menggesa ahli Umno untuk berhenti mendesak Abdullah meletakkan jawatan, Bernama memetik Nazri sebagai berkata adalah salah untuk berbuat demikian.

Katanya, Umno sepatutnya menumpukan untuk mentadbir negara ini dan menunaikan janji yang dibuat kepada rakyat sebelum mereka kehilangan sokongan orang ramai.

"Saya fikir apa yang rakyat mahukan sekarang ialah bagi kami untuk mula mentadbir negara. Mereka sudah bosan diberitahu mengenai apa yang nak dibuat, kini mereka mahu kami mentadbir, bukan Umno memberitahu mereka yang Pak Lah tidak layak menjadi perdana menteri," katanya.

Ditanya pendapatnya mengenai beberapa menteri yang turut meminta Abdullah meletakkan jawatan, Nazri berkata: "Hanya kerana mereka adalah menteri, ia tidak bermakna yang mereka tahu segalanya. Bukan semua menteri cerdik.

"Tetapi kenapa anda terkejut mengenai apa yang menteri berkenaan katakan. Bekas perdana menteri juga berbuat perkara yang sama. Ini mungkin menyebabkan saya tidak popular tetapi saya fikir apa yang saya katakan adalah betul," katanya. -- (Global Media Channel)

Lompat parti: Ali Rustam ingatkan PKR jangan bongkak

(Bernama) - Parti Keadilan Rakyat (PKR) sedang menggunakan perang psikologi politik dalam usahanya untuk menidakkan kesetiaan wakil rakyat Barisan Nasional (BN) terhadap BN, kata Naib Presiden Umno Datuk Seri Mohd Ali Rustam.

Generasi muda hari ini mungkin tidak kenal wajah-wajah 11 orang ahli UMNO itu yang mempertikaikan kesahihan Perhimpunan Agung UMNO tahun 1987 yang menyaksikan pertandingan antara Team A Tun Dr Mahathir Mohamad dengan Team B Tengku Razaleigh Hamzah.

Dalam pertandingan bersejarah pada 24 April 1987 itu Dr Mahathir menewaskan Tengku Razaleigh dengan majoriti cuma 43 undi.

Segalanya bermula bila kumpulan yang asalnya dianggotai oleh 12 orang itu merayu kepada ibupejabat UMNO supaya siasatan dibuat kerana mendakwa ada beberapa kes dimana ada mesyuarat UMNO cawangan dan bahagian tidak sah .

Selepas ia tidak dilaya baru mereka membawanya ke mahkamah.

Jika mesyuarat cawangan dan bahagian itu tidak sah maka dengan sendirinya perwakilan mereka yang menghadiri Perhimpunan Agung UMNO itu juga tidak sah.

Ini yang akhirnya membawa kepada Hakim Harun Hashim memutuskan UMNO haram.

Pagi Sabtu salah seorang anggota Kumpulan 11 itu,Rahim Abdul Rahman mengadakan satu sidang akhbar di sebuah hotel di Kuala Lumpur untuk menuntut agar diperbetulkan fakta sejarah tentang fiasco pengharaman UMNO itu.

Bekas Setiausaha Sulit Kanan kepada bekas Timbalan Menteri Pengangkutan,Datuk Seri Tengku Azlan Sultan Abu Bakar ini tidak mahu lagi kumpulan itu terus menerus dipandang sebagai ‘ budak jahat’.

Rahim tampil ke depan setelah melihat Perdana Menteri Datuk Seri Abdullah Ahmad Badawi menunjukkan kesungguhan beliau untuk memulihkan kepercayaan orang ramai terhadap badan kehakiman negara.

Khamis malam Perdana Menteri menghadiri jamuan makan malam Majlis Peguam yang turut dihadiri oleh bekas Ketua Hakm Negara Tun Salleh Abas dan tiga lagi bekas hakim yang dipecat dari jawatan mereka oleh sebuah tribunal hakim 20 tahun lampau atas alasan melakukan salahlaku kehakiman.

Pemecatan Salleh dan lima lagi hakim dikaitkan dengan keputusan mahkamah mengharamkan UMNO ekoran pemilihan jawatan Presiden UMNO antara Dr Mahathir dan Tengku Razaleigh Hamzah pada tahun1987.

Rahim yang kata beliau mewakili rakan-rakan lain dalam kumpulan itu ( ada yang sudah meninggal dunia) mendakwa bahawa UMNO haram kerana tindak tanduk Dr Mahathir yang tidak mahu melihat UMNO pulih sebab bimbang pemilihan UMNO perlu diadakan semula waktu itu.

Katanya tindakan mereka membawa kes mesyuarat cawangan dan bahagian yang tidak sah itu semata-mata bertujuan agar Perhimpunan Agung UMNO diadakan semula dan bukan hendak melihat UMNO haram.

Dakwa Rahim semasa mereka merayu kepada ibupejabat UMNO supaya siasatan dibuat Dr Mahathir dan Setiausaha Agung UMNO masa itu Tan Sri Sanusi Junid bersikap tidak demokratik tidak melayan dan menjawabnya dengan betul.

“Sebelum ini tidak seorang pun berani mempertikaikan tingkah laku Tun Dr Mahathir dan Tan Sri Sanusi Junid yang dengan sewenang-wenangnya mentabir parti mengikut acuan dan citarasa mereka,”katanya.

Beliau mendakwa Dr Mahathir tidak mahu Perhimpunan Agung UMNO diadakan semula kerana tidak yakin keputusan akan menyebelahi beliau jika pemilihan diadakan semula.

Dakwannya sebab itu bekas Perdana Menteri itu lebih suka melihat UMNO haram.

“Di situlah bermulanya episod The Grand Design of Mahathir ,”dakwa Rahim yang turut melibatkan pemecatan para hakim itu.

Katanya beliau sedia disaman oleh Dr Mahathir dan berdepan dengannya di mahkamah kerana membuat dakwaan ini.

Beliau juga kesal dengan cara bekas Perdana Menteri itu membangkitkan banyak isu berhubung dengan kepimpinan Abdullah iaitu orang yang beliau tunjuk mengantikannya.

“Soalnya apakah beliau merupakan the saints yang tidak terlepas daripada kesalahan dan dosa? Soalnya apakah beliau lupa bahawa banyak kesalahan dan dosa beliau terhadap ahli-ahli UMNO dan rakyat masih belum tertebus?

“Pada hemat saya beliau sengaja melemparkan kritikan-kritikan pedas serta memperkecilkan YAB Perdana Menteri kerana tergugat oleh ketelusan YAB Perdana Menteri serta didorong oleh rasa takut bahawa kesalahan-kesalahan beliau akan terdedah satu demi satu,” dakwa Rahim.

Let us get one thing very clear

Barisan Nasional did not lose these five states. Pakatan Rakyat did not win these five states. It was the people who decided that they wanted to get back control of these fives states.

NO HOLDS BARRED

Raja Petra Kamarudin

When the opposition went around campaigning in the run-up to the recent general election, the message that was sent to the voters was:

Let the people kick out Barisan Nasional and take back this country. Let the people sack the government and claim back this country. Let the people show Barisan Nasional the potency of People’s Power, Makhal Sakhti, Kuasa Rakyat. Let the people grab control of this country and send Barisan Nasional into retirement. It is time the people show the government who owns this country. The people are the boss, the government works for the people. The people should not be afraid of the government, the government should be afraid of the people.

Yes, that and more was the message the people wanted to send to Barisan Nasional. And the people did send Barisan Nasional this message. Today, Barisan Nasional has lost control of five states. It has also, in theory, lost control of Kuala Lumpur if not for the fact that Kuala Lumpur comes directly under the control of the Federal Government through the Federal Territory Minister. And, of course, Barisan Nasional has also lost its two-thirds majority in Parliament.

Now that new governments have been formed in these five states, Pakatan Rakyat appears to be overlooking one fundamental issue. Barisan Nasional did not lose these five states. Pakatan Rakyat did not win these five states. It was the people who decided that they wanted to get back control of these fives states. And the people did this by appointing Pakatan Rakyat as their trustee to run these fives states.

That’s right. Pakatan Rakyat is not the government in these five states. The people are. But the people can’t all be running these five states so they entrusted these states to the care of Pakatan Rakyat. So Pakatan Rakyat, the trustee, has to go back to the people to find out how they would like these states run.

Pakatan Rakyat must perish the thought that the people gave them a mandate on 8 March 2008 and now that they have that mandate they can do what they like. Pakatan Rakyat must erase from their mind that now that they are in power they need no longer talk to the people until the next election five years or so from now. Pakatan Rakyat must not harbour the fallacy that now that they are in charge they can decide how they would like to run the five states.

No, do not accuse the people of interfering in how the states are being run. Do not think that you are the government so it is your job to run the states the way you would like them run. Do not imagine that the people have done their job on 8 March 2008 so now the people should just sit back and allow Pakatan Rakyat to take over and get down to the business of running the states. The people are the stakeholders and Pakatan Rakyat is merely the manager, paid to do a job from money that comes out of the pockets of the people.

Malaysia is owned the people, the stakeholders. The five states are also owned by these stakeholders. The stakeholders sacked the old managers and employed new managers to replace them. And the stakeholders will decide how these new managers will conduct themselves.

The stakeholders have spoken. The stakeholders have made their decision. The stakeholders were not happy with the old management. The stakeholders have changed the management. The stakeholders want the new management to do better and to do things differently. But has the new management asked the stakeholders what it is about the old management that they were not happy with? Has the new management called the stakeholders for a meeting to ask the stakeholders what it is that they want?

There are thousands of people waiting; Malays, Chinese, Indians and ‘lain-lain’. They are waiting to be called to come forward to serve their country. They are waiting to be summoned for national service. They are ready to fulfil their national duty. All they need is for the word to be given. Then thousands of people, the Rakyat, the voters, the stakeholders, will come forward to provide the best brains to help run the states they grabbed back from Barisan Nasional.

Bangalore heart trip: self-inflicted malady of Malaysian healthcare

When Chua Soi Lek first came to office, he apparently called for a meeting of all senior officers and when asked about the priority of problems at the Ministry of Health, he reportedly was inundated with numerous comments about the dastardly troubles private hospitals had created and how they and their devious doctors were leeching the poor Malaysian public and something had to be done urgently.

The gullible Chua, ever willing to show-off the political strongman that he conjured himself to be, wasted no time in implementing the shelved PHFSA and together with his DG, bamboozled it recklessly utilizing the BN’s brute but now mercifully clipped majority in parliament, brushing off all objections against the Act just so he can show who’s boss. Needless to say despite all of Chua’s and Merican’s big talk and assurances, the first victim who got thrown into jail was a registered doctor, a stark reminder of the previous government’s callous and appalling methods of governance.

New Health Ministers are almost always a shoo in for our Machiavellian health ministry officials who have become rather slick in cornering incoming, inexperienced and invariably unknowledgeable Ministers into making silly decisions. All Ministers are political animals and make distorted decisions essentially because the minister is fed only half the story or the story he generally likes to hear. And so it is with the new health minister Liow Tiong Lai.

While Tanzanian president, Jakaya Kikwete, was going on an all out war against witchdoctors (read bomohs, sinsehs, etc) who were gorging out eyes of albinos and the Brazilians were calling in the army and possibly Cuban doctors to help battle the mortal incidence of dengue in that country, back in Malaysia, the hapless Liow had thrust upon him a meaningless business turf battle between pharmacists and doctors as his first task. The Brazilians must have wondered about the priority of the Malaysian health minister and cannot be faulted if they thought that Malaysians had indeed licked the dengue scourge and were actually moving on to bigger stuff.

Far from it. The dengue fever outbreak in Brazil had infected 55,000 people, and killed 67 Brazilians so far this year with half of those killed by the mosquito-borne illness being under 13-years-old. But Malaysia’s “Disease Control Director”, Hasan Abdul Rahman reported a proportionately higher mortality ratio of 9,889 people diagnosed, with 26 of them dead for the first three months from January to March alone of this year. Maybe we may have something to learn from the Brazilians or more likely our stats are out of sync.

But these problems will pale into comparison as the new and inexperienced health minister has made a second momentous decision. That of shipping unfortunate children with congenital heart disease to Devi Shetty’s “world famous” heart center 2000 miles away in Bangalore, the Narayana Hrudayalaya. Even Chua, known to be a brusque decision maker refused to take this decision. But the new health minister had no qualms sending these children off….or was he pushed into make this decision.

When the NST published their under-researched cum marketing piece for the IJN on the lack of heart surgeons and the need for critical care for paediatric cardiac surgical patients in a center spread on 2/4/08, they didn’t quite delve into the factors as to why this country has not caught up with the rest of the world or at least India, despite the government spending millions to curb the rising incidence of heart disease. Paradoxically, after 50 years of Merdeka, we are in fact sending off patients overseas for treatment just like the Mauritius, Ghana, Nigeria, Sierra Leone and Bangladesh to the Narayana Hrudayalaya Institute of Medical Sciences (NHIMS) Do we not have the expertise? Elementary. It is just poor management of our resources.

PUBLIC HOSPITALS OFFERING CARDIAC SURGERY

The government has five heart units. The unit in Penang was established in 1995 at a cost of RM30 million, followed by Johor Bahru in 1997 for RM40 million and Kucing in 2001 for RM55 million. A new unit was set up at Alor Star when the new Sultan Bahiyah hospital was being constructed midway causing the hospital to have serious delays in its opening and another at Serdang Hospital which has been designated as the Ministry’s heart center for the Klang Valley. Surprisingly despite the government spending millions on infrastructure, little attention was paid to manpower leaving many of its units underutilized or not operational.

There are no paediatric cardiac surgical services at government hospitals save for a small number being attempted by an expatriate surgeon in Kucing. The Penang unit although busy in the beginning, had its work slowed down when the initial surgeon resigned. It further attracted controversy when expensive and untested cardiac equipment bought for millions of ringgit ended up as a white elephant. It was in the news again in 2005 when surgeons left the unit in droves when belligerent anesthetists there tried to take control of the cardiac surgical ICU which has always been the domain of cardiac surgeons throughout the world. The unit was then briefly run by an Indonesian born doctor who surprisingly was awarded a JPA scholarship to do his training. However patients complaining at the greatly lengthened waiting list reportedly as a result of the new surgeon being unable to do bypass surgery there saw the Ministry moving some of its doctors from Johor Bahru to cover the unit. The Indonesian surgeon, in a bizarre move by the MOH, has been transferred to head the Serdang unit.

The Unit at JB was initially run by a British trained Malaysian surgeon who left for Singapore leaving the unit now running only on a single theater at times. The Kucing Hospital unit is one of the better run units at the Ministry. One of the reasons for this is the high level of commitment of doctors there and the support financially by the local community. Despite the lack of manpower, the Ministry is planning to open more units in other areas such as Ipoh, Kuantan and Kota Kinabalu. In KK alone, the MOH announced last month that it will be spending RM70 million. Even planning administrators in the Ministry have argued that that there should be a period of consolidation instead of splurging more capital until manpower problems are soughted out. But these reservations have apparently been over-ruled by the surgeons and anesthetists. It is always nice to splurge … if it is not your own money, especially if it brings you fringe benefits like more overseas trips for “lawatan sambil belajar”

PRIVATE HOSPITALS OFFERING CARDIAC SURGERY

There are in total 23 units doing cardiac surgery in the private sector. One in Alor Star, 4 in Penang, one in Ipoh (apparently now defunct), 9 in the Klang Valley, three in Malacca, one in JB, one in KK and one in Kucing. Only the Adventist Hospital in Penang and Gleneagles in KL do paediatric cardiac surgical cases in significant numbers. The rest are essentially adult units. Most private units are solo runs by individual surgeons. As a result they do small numbers. However the Penang and Malacca units cater for quite a number of foreign patients especially from Indonesia.

IJN

In the early eighties, the GHKL was the only heart unit the MOH had. It was controversially corporatised to IJN soon after Mahathir had his heart surgery. Many then thought that perhaps corporatisation of this service will soon see Malaysia self sufficient in this particular area but as always in the Malaysian scene, corporatisation comes with strings attached. IJN’s founders made a deal where all heart cases in the central region must be solely given to them. They didn’t want any competition. And if you believe a monopoly corrupts, then there must be some truth to this considering IJN’s phenomenal surgical costs.

But despite being a monopoly they couldn’t hold on to their surgeons. One paediatric cardiac surgeon resigned to go to Gleneagles while two more found cushy jobs in Saudi. So it has gone back to the same routine of trying to train more surgeons. Despite the high volume of cases it does, it apparently lacks space which may be resolved when its new building is commissioned. Interestingly IJN offered to run the Serdang Hospital Heart Unit for the Ministry but this deal was obstructed by the Ministry’s own surgeons. You sometimes wonder if everyone in this area is really working for the common good of patients..or for themselves…at the expense of the general public…with the Ministry and their political masters…the MCA doing nothing.

TRAINING PROGRAMS

So why are we not training enough heart doctors? There are three university heart units based at the UH, HUKM and HUSM in Kubang Kerian respectively. But the volume of surgery and procedures done are small, especially in Kubang Krian despite the disproportionately large incidence of coronary, valvular and congenital heart disease in Kelantan. The UIA in Kuantan apparently has been enthusiastic about setting up a heart unit there but again there was a problem regarding manpower and commitment by some of its specialists and of course the unending destructive rivalry between the MOH and the Universities. The price you pay if you don’t have your own hospital.

The first open heart unit this country ever had was the one established as early as 1969 at the University Hospital by NK Yong who took up the post of Foundation Professor in Surgery when the UM’s Medical Faculty was first set up. He had trained at Kentucky University and despite virtually no trained staff he performed Singapore’s first open heart surgery in 1965 after painstakingly assembling and training a cardiac team for two years following his return from the US in 1963.

His presence at the UH saw the emergence of new surgeons such as Saw Huat Seong and the late Razali Hashim. The unit was further strengthened by an expatriate surgeon from the Christian Medical College in Vellore, George Cherian. But all this came to an end when Razali passed away prematurely almost 20 yeas ago. Saw Huat Seong is in private practice in Singapore, George is in Kansas and NK Yong is of course retired and is now a famed wine connoisseur. The heart unit at the UH today is more renowned for fist fights and slapping incidents with no trainees forthcoming. While heart units around the world progressed by leaps and bounds, the UH unit stagnated and in fact regressed. The country’s pioneer unit fell victim to medical politics and to the tantrums of the remaining surgeon when heart disease was the pre-eminent killer with irresponsible University authorities just looking on, doing nothing or dabbling in trying to sell off university grounds.

UKM, which initially suffered a similar fate when it set up its unit a decade ago, has progressed much better and proposed a training program for cardiac surgery last year to the Ministry but it has yet to get off the ground. Again medical politics and unbridled, cumbersome, attritional professional jealousy has been the bane that threatens the progress of heart treatment in this country. The MOH and university authorities are in particular guilty of not dealing with these problems firmly, instead pandering to the whims and fancies of individual specialists against national interests leading Malaysian patients now possibly to that dusty road to Bangalore.

THE NARAYANA HRUDAYALAYA

The center is primarily the brain child of Devi Shetty who initially trained at Guys Hospital in London where Philip Deverall, a British pioneering and innovative paediatric heart surgeon was based. He has no formal postgraduate cardiac qualifications unlike most Indian cardiac surgeons. However, apart from the thousands of cases he has carried out, he has conducted hundreds of seminars, wrote innumerable papers, created many training programs and of course built and managed quite a few heart hospitals. Devi Shetty is living proof that clinical and operative skills may not necessarily be congruent to academic qualifications, something our local MMC (Malaysian Medical Council) should wake up to. Dedication and commitment could be far more valuable factors. In fact in all likelihood; Devi Shetty might not even get a job if he applies for one at the MOH as his qualifications would have been deemed by our “elite” council members as “not recognized”

Shetty returned to India in 1989 to set up a hospital for the Birla group in Calcutta before ultimately moving onto Bangalore to found the Narayana in 2001. He is married to Shakunthala Shetty, the daughter of the wealthy construction magnate Sri Charmakki Narayana Shetty, who owned the land where the 800 bedded hospital is situated. The Narayana Hrudayalaya is located in the Bommasandra Industrial Area on the outskirts of Bangalore on 25 acres of land, 30 km from the old Bangalore airport and 50km from the new one. The grimy road leading to the hospital where the pillars of Bangalore’s off/on Metro project stick out like sore thumbs may not really be palatable to Malaysian patients or parents used to our highways. But the hospital itself is a remarkable story.

The hospital design is simple and furnishing is bare. It has 25 operating theaters for cardiac surgery alone of which half are currently operational. Shetty’s group which includes surgeons trained in India, Australia, Britain and Russia carry out an astonishing 20 to 30 open heart surgeries a day, clocking close to almost 6000 cases a year. Of these a third are congenital cases.

Devi Shetty is one of India’s many rising entrepreneurial hospital pioneers who have contributed immensely to not only healthcare in India but also to its economy. They believe not only in bringing world class healthcare to India’s poor but are firm believers of strict financial prudence so that treatment remains extremely cost effective, a culture virtually absent in the Malaysian healthcare scene especially in government hospitals. In a country where the incidence of congenital heart disease is 8 per 1000 births against a questionable 1 per 1000 in Malaysia, India has 180,000 children born with congenital heart defects every year with 90,000 requiring early intervention at the neonatal stage.

Shetty’s strategy for success is simple. Focus on maintaining good results which are the accepted 2% mortality for adult cases and an incredible 5% mortality for congenital heart surgery considering that some very complex cases end up here. And an innovative packaged price for treatment. Heart hospitals are expensive. And if you are going to extend complex world class surgery to the poor, then, to make that buck, you need to operate a large volume of cases which is not a problem in India. Shetty maintains a fixed price of almost RM10,000 ringgit for each paediatric case no matter how complex the lesions are, making his money back through volume.

He doesn’t compromise on equipment which is pretty similar to the ones Malaysian hospitals have. He further saves on costs especially on medication, equipment and consumables which are indigenously manufactured. But the most important asset he has is the great depth in staff required to look after patients. And this he does by having active academic programs which is headed completely by a dedicated academic dean. No one is actually sure why Chua was attracted to this hospital. Perhaps he was impressed by the shear numbers of the assembly like care patients received in diagnostics, theater and especially the ICU. Or maybe he was influenced by an ex-senior health ministry official who is the Dean of a local private medical school which has a twinning program with a medical school in Bangalore where Shetty maintains a branch.

Whatever it is, Shetty has done remarkably well. And this he managed to achieve through sheer hard work and perseverance. To operate such a large volume of cases with a low mortality he would have had to climb that agonizing learning curve and cross a lot of dead bodies, something Malaysian surgeons are anathema to, focusing rather on safe, less complex cases. To be successful in paediatric cardiac surgery you will have to run through that deadly gauntlet that ended the careers of Professor James Wisheart and Janardan Dhasmana at the Bristol Royal Infirmary in 1999. Both found out to their costs that taking the risky gamble of operating on paediatric cardiac surgical patients with iffy paediatric cardiologists, anesthetists and ICU staff can not only end your career but may get you profoundly vilified for the rest of your life.

But certainly Shetty’s hospital is not the only one doing similar surgery at these prices. There are almost 200 centers in India that offer heart surgery in India. In South India alone, the level of work that is carried out at the Narayana is done in 11 other paediatric cardiac surgical centers with the total number of paediatric cardiac surgical units throughout India numbering about 20. Some of these centers like the Amrita Heart Institute, Cherian Heat Foundation, Madras Medical Mission, Ramachandra Medical College, CMC Vellore, MIOT and the Asian Heart Institute in Bombay produce very good results but do not match Shetty’s costs. On average, the cost of treating a congenital heart defect can cost between RM20-30,000 per case. Surprisingly only a single government hospital, the All India Institute of Medical Sciences (AIIMS) in Delhi, does any neotatal cardiac surgery of note. And every heart surgeon in the private sector in India will swear that the price of similar surgery at the government funded AIIMS is far costlier then the ones done in private centers, a testimony that accountability in subsidized healthcare is almost always never accountable to anyone, anywhere around the world including Malaysia.

SOLUTIONS

The MOH stated that an agreement had been reached to operate on 200 children at a cost of RM10,000 for each child over a period of one year excluding incidental costs. These costs would be probably flight fares, food, accommodation, etc which may put the cost at about RM15,000 or more, provided there are no complications. Paediatric cardiac surgical cases are generally divided into cyanotic and acyanotic babies, meaning blue and non-blue babies. It is the blue babies that are difficult to manage, are costlier to operate on and generally would require complex surgery including initial palliative surgery if expertise for complete correction is not available in the first instance.

The Ministry could:

1. Outsource non-blue baby and palliative surgery for blue babies to local private hospitals at a competitive price as this will be logistically more suitable for the family. Blue babies that will require complex staged surgery could perhaps be flown to Bangalore although there will be risks involved for the 3 hour flight and that perilous road journey to the Narayana itself.

2. Alternatively it could ask local surgeons or their surgical teams in “not so busy” private hospitals to operate in the Ministry’s government units so that there are savings in consumables and theater time. Since the Ministry has the infrastructure but not the staff, perioperative care could also be contracted out.

3. Or it could invite foreign surgical teams or surgeons to operate at its heart units on a regular basis to do surgery. Cases that don’t require urgent surgery could be accumulated and be done on a regular monthly basis with our local surgeons and hospital staff looking after them. It would be a good learning experience for them although cases need to be carefully chosen.

4. Or allow private hospitals to employ these foreign surgeons or teams directly and the Ministry outsources the work to these hospitals. Foreign medical staff, especially surgeons, anesthetists and cardiologists could be offered incentives like PR and citizenship etc so that they stay back in this country.

5. And importantly, the Universities and the MOH have to revise their training programs to ensure that Malaysia’s expertise in this area rises to match the number of patients in this country.

Whoever did this marketing for the Bangalore team may have done Shetty a large favour and a disservice to cardiac care in this country. But this story is the natural end result of a poorly managed service that saw no proper audit in cost production ratios. It is sad refection of the state of services in this country where for far too long the focus has been on constructing sophisticated infrastructure without paying attention to human development in direct contrast to India where the reverse has taken place.

Before the Minister dives into the uncharted National Health Financing Scheme, he should perhaps ponder if outsourcing healthcare to private hospitals that offer competitive pricing is a better option. The Ministry should refrain from reinventing the wheel all the time by building more heart units that only make contractors and suppliers rich, and instead save its financial resources and perhaps outsource its work to hospitals that provide a service at very cost effective prices. You can save a whole lot of money in places like Kota Kinabalu where instead of blowing 70 million ringgit, you can buy services from the Sabah Medical Center where its cardiac operating theater and 12 ICU beds are almost always lying idle.

Competition and innovation is the key to lower prices and better services. If the Malaysian public is to be saved, the confrontational policies of the previous Minister and DG must end. There must be greater cooperation between the large numbers of private doctors and the public service. Failure by Liow to handle this impasse effectively will ultimately see not only cardiac going India way but a whole lot more of other specialties.

GS

Government Welcomes Proposal For Engineers To Serve As Councillors

PETALING JAYA, April 19 (Bernama) -- The Government welcomes a proposal to appoint engineers as councillors as it wants to see more professionals serving in local authorities, said Deputy Prime Minister Datuk Seri Najib Tun Abdul Razak said.

He said although the appointment of councillors was under the purview of the respective state governments, nevertheless he would support engineers to be appointed to the position.

"I on my part have no reservations for engineers to fill such posts," he said in his speech at the 49th Annual Dinner and Award Night of the Institution of Engineers Malaysia (IEM) at a hotel in Subang Jaya here Saturday night.

He said engineers are more often "seen but not heard" and they are the unsung heroes of infrastructure development and major contributors to the nation's economy.

"I agree that it is perhaps timely that engineers shed their low profile image and participate more proactively in the affairs of the country, particularly in areas where the profession has a distinct advantage" he said.

IEM President Datuk Paduka Ir Keizrul Abdullah in his speech earlier said the engineers were more than willing to volunteer their services as councillors in the various local authorities in the country.

Keizrul said IEM had put forward their offer to serve as councillors to all the state administrations and was looking forward to their positive replies.

"We look forward to the opportunity of engaging more fully with the government, to contribute to the development of engineering and to the process of nation building," he said.

During the dinner, Dr Law Chung Lim was accorded IEM's Young Engineer Award while its Outstanding Engineering Achievement Award was given to T and T Konsult Sdn Bhd.

Both awards were presented by Najib.

-- BERNAMA