Precious Water

Precious Water
Water, essence of life

Saturday 1 December 2012

I dropped that tissue, so what!

Thanks to an educated driver, it gave me an opportunity to pen this piece. Usually at year’s end, I like to summarise the happy occasions, count our blessings in the year and to share the good stuff. This year, I am doing the opposite, share the ‘ugly’ and count on the silent majority to help turn things around to make for a happy year. The important work of moving the world forward does not wait to be done by perfect men (George Eliot).

Some weeks back late in the night, I was behind a car at traffic junction waiting for light to change in my favour. A hand popped out, low behold a piece of tissue gently sailed onto the road. Instinctively, I honked a few times. The Wife rolled her eyes, quite used to my upping the ante.

The car in front turned, and then stopped. I pulled alongside. The driver rolled down his side window and shouted: “what you want!” I took a breath then said calmly: “I saw you throw a piece of tissue paper back there”. This cool dude replied: “I did not throw. I dropped that piece of tissue” and then inch forward, scoot off. My wind screen almost misted instantly from that nonchalant respond. I revved up, kept my line of sight shouting to my navigator to“take it down, take it down”! I meant the car number.

So it is that this episode became the 9th incident for the year 2012 in which I reported to the National Environment Agency on littering by motorists. We pride ourselves as a First World Country. Unfortunately, we are still governed by Third World social behaviours. I take no pleasure in reporting such cases and I am no hammer looking for nails to pound!

I do not know about you but I am simply fed up with litter bugs, and as the new Chairman of Keep Singapore Clean Version 2, Liak (Group CEO for Alexandra Health System) puts it aptly: “We are not a clean city but rather a cleaned city because of an army of cleaners”.  Why can’t we take a little effort and responsibility to do what’s right by keeping clean in the first place? For years, we had this keep Singapore Clean and Green campaign. While we manage to be more green than clean, even frequented green places are usually not so clean; try East Coast park after a week-end. 

Recently, we revisited the issue of returning our utensils after a meal, starting at hawker centres. This is in line with keeping Singapore clean and cultivating a good habit in the interest of public health. Why is it so difficult to get people these days to return their utensils after a meal so it makes for a more pleasant eating experience? 

Even Cecilia reminded us in ST Forum of the good old days at Hewlett-Packard cafeteria. We were all required to return our utensils, meal trays after each meal onto a moving conveyor belt into the kitchen. It helps keep the place clean with minimal manpower. Likewise, all National Service blokes did the same years ago. You ate off a metal tray, then walk towards a collection point and deposit the empty tray on a tiered trolley. So why is it so difficult to return our trays after a meal?  

According to Keep Singapore Clean Movement V2,
Reality today is:
·         Singapore is a cleaned city, not a clean city
·         1st world infrastructure, 3rd world behaviour
·         Litters at HDB lift landings, neighbours quarrel over dirty corridors, dirty town centres
·         Beautiful parks, litters everywhere, piles of rubbish
·         Public toilets that we hesitate to use
·         Dirty tables in coffee shop, hawker centres, we share food with birds!
·         HFMD, dengue, food poisoning, SARS, Pandemic?
·         Army of 70,000 cleaners
·         2-3 rounds of cleaning a day

And the population can be classified into the good, the bad and the ugly:
The good (6 out of 10)
·         The majority
·         60% plus. Over 3 million
·         Considerate people. Never litter.
The bad (3-4 out of 10)
·         The minority 30% plus, nearly 2 million inconsiderate, poorly brought up.
·         Litter when convenient.  "Accidentally" drop litters
The ugly (3-4 out of 100), our nightmare
·         Tiny minority.
·         Litter wilfully. Create mess everywhere

And the solution should be:
·         Concerted effort by the good majority
·         People, private, public partnership
·         Make littering, dirty habits, as unacceptable as queue jumping.
·         The good to act, the bad to behave and the ugly to be punished.

In any good public policy, the following three pillars must work in tandem for it to be effective.
  • Education (an ongoing process)
  • Infrastructure (are there adequate rubbish bins)
  • Legislation (as last resort to bring offender to task)
As part of enforcement to address our pathetic situation, various penalties were changed recently by NEA. As an example, first time litter bug is fine $500 instead of $300.

Strangely, that prompted a Mr Chua to write in with the title: “Tougher laws work only if they are enforceable realistically” to ST Forum on 22Nov12. He questioned whether a foreign worker from a Third World country is familiar with our culture and whether he can afford to pay revised penalty of $500. He further questioned why the punitive fines instead of trying to craft more creative ways to promote clean public spaces and discourage bad health habits. Why should we mollycoddle litter bugs, especially recalcitrant ones, in the first place?

The bad will be addressed by ongoing education hopefully to modify behaviour. And as for the miniscule ugly, I am glad for more bites than barks (including compulsory work order and community service) because their uncouth behaviours are to the detriment of the silent majority.

Was it not Edmund Burke 1929-1797 (statesman, author, orator, political theorist and philosopher) who said: “All it takes for evil to triumph is for good men to do nothing.” So please help do the right thing when you see something amiss; act with a smile to make a difference.   


Friday 2 November 2012

Change we can, timing matters


In the past 46 years, the dress code of the ruling party has been white-on-white on National Day. Thanks to a gentleman by the name of Ronald Seow who wrote in to the ST forum page last August 2011 suggesting “One people, one dress code, please”, this year’s National Day is a refreshing combination of red and white. One rotund politician came in light red (almost pink) chequered shape, prompting my son to exclaim: “dad, that looks like a walking picnic mat”. That was rude, I barked. Some appeared off-white. A handful stayed on well-tested white-on-white code.

Our national mascot, in a complete red T-shirt, received the loudest applause, beaming ear to ear, gunning two thumbs up. His presence was a sigh of relief to many despite rumblings from multitude of ill chatters in cyberspace leading up to National Day.
I was asked the same question multiple times prior to 9Aug. Has he passed on? I guess humans love gossips. My standard response is simply: "our practice has always been never to flinch or hide from any news". Someday, it will come to pass and we will know as sure as the sun will rise. 

We were watching the parade on TV and I witnessed the joy of my guests, especially the older ones, when LKY told measured steps toward his seat. They cheered, clapped as if on parade. A family friend sheepishly told me she cancelled her overseas trip just to ‘see for herself’ that LKY appears. All said, I guess he can only be as well as can be for a man almost 90 yrs.

When PM appeared in a stunning short-sleeve shirt of more red than white, it signals change is possible. It is a celebratory shirt, chic and suitable for any happy occasion.

Several years back, I wrote (in capacity as private citizen) to then President Nathan to consider wearing something ‘more comfortable’ and in line with the festivity of our National Day Parade. Furthermore, why not have his wife seated next to him to enjoy the proceedings. Everyone attending the national day parade is seated next to somebody and the President is all on his own!  

For those of us who have been around a bit, you may have recalled the late President Ong Teng Cheong and his many batik shirts. Back then, these were ostentatiously worn on special occasions and some considered ‘national costumes’ standing.
Gradually, these disappeared completely and we are back to wearing Western based suit. Having to wear a suit in our hot, humid climate with a silly tie is close to walking into a bikram yoga class fully clothed.

Apparently, my request to the President was referred to MINDEF. Some weeks later, an officer wrote back with a terse no. As parade organiser, they had the final say. So to this day, the President continues to suffer in that suit whilst the whole of Singapore celebrate in mostly red and white short sleeves. Looks like this practice is fossilized. 

Let me jump into another story of change. This must have been more than six years ago. There were these distasteful ‘$1,000 fine’ signs at five underpasses along Singapore river. You are not supposed to cycle through these thoroughfares, each wide enough to take one MRT train and more. Often times, cyclists would simply cycle through, never mind the signs. Because of such explicit signs, pedestrians are more inclined to glare and reprimand cyclists resulting in tense situations.

 I wrote to one agency thinking they were in charge. Instead, it ricocheted twice before another Government agency grudgingly replied. They said no flatly to remove these ‘fines signs’. As it was not exactly a life threatening matter, I did not want to sweat the small stuff and let the matter rest.

Earlier this year, I was invited to the opening of Bishun-AMK park by NParks. During the break, I was cajoled forward to engage PM in small talk. Somehow, the conversation drifted to my peeve of six years ago. PM, I said: "the most scenic tourist route today along the Singapore river on a bicycle can set you back by $10,000". Why so, he asked? I related the details, he gave a suggestion and we all had a good laugh. I subsequently wrote “Humourously Serious” on my blog.

The relevant agency picked up this story and contacted me. We dialogued. They remain adamant in not explicitly allowing cycle through. However, after several months of huff-and-puff, those ‘$1,000 fine signs’ were finally removed. But the ‘cross out’ cycling signs remain. So I would argue that change is possible, timing matters.

Onto my final story on change, two weeks back, I was in the Old Parliament house listening to Quek Leng Joo, MD for CDL, presentation on his photo exhibition entitled “Flora Exotica”. He donated 18 photos for sale and raised $150,000 for charity.

The rare treat was his “black-and-white” photos of The Malaysian railway network (Keretapi Tanah Melayu) which ceased operation in Singapore on 30 June 2011 after 80 years service. It took him all of 8 months and was nearly run down by a train.

I was first seated at the fourth row and as usual the first row was empty. The organizer waved to us to move forward so the place does not look sparse. Several of us rumbled forward and to my right was an audit partner in one of the big 4. There was an empty seat to my left followed by Professor Karpal Singh.  

Towards the end of the presentation, I turned to the empty seat on my left and notice a small plaque. Under dim light conditions, I could still make up the name “Lee Kuan Yew”. Instinctively, I shifted my butt, turn around to read whose seat I took. It read Toh Chin Chye. So I turned to this gentleman on my right and said “LKY seat is empty”. He shot back readily: “why do you think it’s empty?” Trust an auditor to ask you a question when you needed an answer.

As we were about to leave, I jumped into LKY empty seat, stretched out, enjoyed the leather and muttered: “thank goodness for change”, our new Parliament house is now next door. It was momentarily surreal. 

As a student over thirty six years ago, I visited Stonehenge, a prehistoric monument located in the English county of Wiltshire. All these huge towering blocks of stone were accessible and visitors were even allowed to touch them. Today, the site is rightly cordoned off to minimise damage. So, I guess it is a matter of time before our historic front bench in Old Parliament house will be cordoned off as well. So what are you waiting for? 

Friday 5 October 2012

A new migrant may well appear


Some years ago, while working in a hospital, I was informed by a nursing staff that a Ms Juliana asked to see me in the ward. Visiting patients (friends and relatives) comes with the turf. When I walked into the 4 bedder ward, I saw a familiar face, a lady with long hair in bed.

She looked gaunt with exhaustion, a face turned ashen. From her livid lips, she appeared next to death’s door. I was shocked. She whispered and said she was down with dengue fever. There is no medicine for dengue and while most victims recover, some do succumb to dengue haemorrhagic fever which can be fatal. Fortunately, she recovered although it took months to get back to her usual self.

Dengue fever is an illness caused by infection with a virus transmitted by the Aedes mosquito. There are four types of this virus (serotypes 1 to 4) which can infect you.
Dengue fever and dengue haemorrhagic fever (a more severe form) are the most common mosquito-borne viral diseases in the world. In Singapore, dengue fever has been endemic since the 1960s.

In 2005/06, my daughter visited Kerala, India twice as part of school community involvement programme. Back then, I first learn of chikungunya virus, also carried by mosquitoes. The symptoms are similar to dengue although in some serious cases, complication of encephalitis (swelling, inflammation of the brain) sets in, a dangerous situation. Chikungunya is fairly common in parts of India. As parents, you can imagine our anxiety.

The first outbreak of chikungunya in Asia occurred in Bangkok, Thailand, in 1958. Since then, outbreaks have been reported in Cambodia, Vietnam, Laos, Myanmar, Malaysia, the Philippines, and Indonesia. In 2007, 10 imported cases were reported to Singapore’s Ministry of Health.

On January 14, 2008, a local case of chikungunya infection was detected through the general practitioners’ laboratory-based surveillance system. A total of 2,626 people who resided or worked within a 150-m radius of the index case-patient’s address were screened for chikungunya infection. The consequences of chikungunya are equally dreadful as is dengue.

Last month, the US experience the highest resurgence of West Nile disease, another virus passed on to humans from mosquitoes.

Originally from Africa, West Nile virus first appeared in Queens, New York in 1999. Crows were dying in large numbers. It took weeks before officials found out the culprit.  This virus lives in birds. Mosquitoes biting infected birds are themselves infected. This virus is then passed on to humans when these pesky mosquitoes draw blood.

As of September 4, 2012, 48 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 1,993 cases of West Nile virus disease in people, including 87 deaths, have been reported to CDC. That’s a high mortality rate of 4.3%, much higher than dengue or chikungunya.

Like dengue fever or chikungunya, there is also no drug or vaccine to counter West Nile virus. The best we can do is to prevent mosquitoes from infecting us in the first place; never mind what kind of mosquitoes. This calls for vigilance especially in minimising breeding sites, be it in flower pots, pails and all vessels containing stagnant water. For the privileged few living on landed properties, your roof gulleys are the usual culprits for mosquito breeding.

In the case of the West Nile, the key culprits were infected birds in the first place. It begs the question whether West Nile will eventually find its way to Singapore. After all, we are a natural refueling stop-over for many migratory birds. Furthermore, we are a city state with a history of imported chikungunya and deadly SARS before.  Who knows? An unwanted migrant may well surface.


Meanwhile, it is the stupid culex mosquito that is keeping me awake; better known as the common house mosquito. While not considered as much of a threat to our health as the Aedes mosquitoes, it is still an irritant we can do without.  

Side Notes:
No thanks to the Indons, the current haze makes it impossible to sleep without air-con. So while it is mosquito-free nights on air-con, their haze creates another set of hazards; respiratory associated problems. So now I am tearing from the haze and high electricity bill.

By Larry Greenemeier | October 1, 2012 |  Comments1

The emergence of international air travel in the 20th century enabled an unprecedented spread of ideas, cultures and communication. Unfortunately, modern aviation has also proved an effective means of spreading diseases. Air travel didn’t introduce worldwide pandemics, of course, but with tens of millions of scheduled international flights annually and hundreds of millions of passengers en route from high-risk areas, health officials are often hard pressed to pinpoint the source and cause of an international outbreak……

The first step when using the VBD-AIR tool is to input the name of the airport to be investigated, the month in question and the disease to be tracked—current choices are all mosquito-borne and include denguemalariayellow fever and chikungunya. …….

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Saturday 1 September 2012

The bicycle that rocked Singapore


On December 7, 1941 the Japanese landed on the North Eastern coast of Kota Bahru, Malaysia. Within two months, Peninsular Malaysia fell. On February 8, 1942, they crossed the causeway and seven days later, Singapore surrendered.

Bicycles played a critical role in the Japanese advance down the Malayan Peninsula. Japanese Army planners adopted the bicycle as their main mode of transport. Most Japanese soldiers were issued bicycles. Strapped to the bicycle would be the soldier's personal equipment and food rations.

On bicycles, the Japanese troops moved rapidly down the main roads of the Malay Peninsula and outflanked the Allied Forces defending the main roads by riding through rubber estate roads and tracks to surprise them from the rear. On their bicycles the Japanese were also able to move faster than the withdrawing Allied Forces. (http://www.s1942.org.sg/s1942/bukit_chandu/directory_bicycles.htm)

Mr Rajoo recalls bicycles being widely used as mode of transport during the Japanese reign. So much so that even after the Japanese surrender, Rajoo and the other villagers working in the Sembawang Shipyard used bicycles as means of transport to travel to work. (Title of essay : Reminiscences of the Japanese Occupation ). Today, the humble bicycle is still the preferred mode of transport for shipyard workers at Sembawang.

70 years on, it is again the humble bicycle that comes back to haunt us! Never has so much being achieved (in terms of publicity) by 26 bicycles. The story was first picked up by Zaobao. Then after, cyberspace and netizens brought this matter to a standstill and all bicycles are now cold-storaged.   

Shortly following the Zaobao news, a friend who works in China went ballistic, sent me a brilliant CSI investigative piece by a SG netizen posted on forums.hardwarezone.com.sg.  It has since been removed.

https://encrypted-tbn1.google.com/images?q=tbn:ANd9GcTPQn0IH4f9f_GXN419mhi2Yoz5619lbX3WdmGIKLUk7LBC1vTQk0E60AHardwarezone Forum, 18 Jul 2012
This is abit irritating. The story is not about me, that why i tell them to focus on the actual story instead. EXTRA CSI Attempt -nParks Brompton procurement process ended up with a dodgy winning bidder? [Extra]
Also, i were got so stupid... give them everything now, then next time how i going to continue do any future undercover CSI works to expose other sagas and keep check on the authorities?

It purported argued there could be wrong doing in the bicycles being awarded to a specific supplier. He/she painstakingly piece together relationships of officer-in-charge of project to various parties associated with supplier. It was an intriguing detective work, piece together from Facebook threads.

While I understand that the rules of engagement in this tender were followed, details surfaced cause much unhappiness to Singaporeans. For example, why was tender opened only for 4 work days? Why award when there was only 1 bidder with 2 options? Why did agency not extend the deadline to encourage more bids? And yes, why are civil servants spending $2,200 for a bicycle? Minister Khaw wrote on his blog to assert that while equipment is appropriate for the type of work, he expressed displeasure that the procurement process could have been better executed. After all, value for money is always an important consideration when it comes to spending tax payers’ money.

Meanwhile, it was a field day with netizens running on two tracks. One questioning the Government’s procurement process, the other questioning why such an expensive bicycle?

Overnight, it appeared most Singaporeans seem to have an opinion on this matter. For days, the radio, TV, Internet and all newspapers went into over drive. One vendor even took advantage as Singaporeans learn a new word: “foldable bicycle”.

There was a conspicuous advertisement on a Saturday for a military specification full foldable bicycle, listed at $2099, going for $630. I checked the website and the specs were impressive. I alerted my cycling buddies. One was game and we visited what looked like a “hole in the wall” unit in an industrial estate, 2 hours passed opening time. It was frenzy feed on site; many lugged away big boxes on cash-and-carry. I was surprised to find my elder brother there too, eyeing this good buy. I examined the assembled bike like a hawk and listened in on a conversation between a silver fox and his companion. While parts appeared original, I was not comfortable with the quality and finishing. I backed off. My friend, a lady rider, decided to buy. So it was with my brother.

That same afternoon, my brother, after assembling the bike, called to inform me he is returning the bike immediately and prayed for a full refund. The invoice looked dubious. The more he assembled, the more disillusioned he became. Parts don’t fit well, quality was suspect. I alerted my friend whose poor husband, in the process of assembling, felt likewise. She called the vendor. No one picked up her call!

She marched down to location the following day with her husband and after some hassle, vendor reluctantly refunded her fully. So it is that what is cheap is not necessarily good or genuine and what is good is not necessarily cheap.

Khaw took an extra step, walked the talk by taking a field trip to satisfy himself that such an equipment is indeed necessary. He again concluded that the foldable bicycle is the right choice. Meanwhile internal scrutiny uncovered “some form of bias” and the officer-in-charge is suspended from duty. Khaw blogged for the 2nd time and as we all know it, the case is now in the hands of CPIB.

Only time will tell if there was any wrong doing on the part of the officer. Some one’s livelihood and future is put on hold. We must be fair to the officer to assume he is innocent unless proven otherwise.

Shortly after this incident, DPM in Parliament, raise the bigger picture of government procurement in the light of audit lapses in multiple agencies. While he proclaimed the present system as sound, he suggested fine-tuning as well. So now we have another few agencies belly-aching over Auditor-General Office audit results on procurement of Herman Miller chairs. Soon, we may run the risk of the civil service not buying anything for months!  

As a cyclist in the past 6 years on a foldie and knowing most actors in this unfortunate episode, I feel sorry for NParks. I interact with their officers across a spectrum of “green related matters”, park connectors included. Most have fire-in-their-belly in their professional domain. They are courteous, no air, working like beavers in the background to transform and upkeep our limited green space.

The supervisor, under suspension, is someone passionate about cycling as an alternative mode of transport, walks the talk by cycling to/from work. To have to inspect 200km of park connectors and more distance in the pipeline, including remote nooks and corners, a foldable bicycle is a good choice augmented by public transport of MRT and buses. This is a much greener option compared to the past and cheaper in the long run.

So now onto why spend $2,200 for a foldable bicycle? Here’s my take. Price range for foldable bicycles vary a lot, much like full bikes. You can buy one low-end for $200 and a top-end model can set you back $8,000. There is even a Youtube video that teaches you how to assemble a US$20,000 road bicycle. Ultimately, specifications and requirements drive the price. From what I know of the specifications cum requirements for NParks project, paying $2,200 is not unreasonable.

I do not agree to thumb down others with a “poorer thy neighbour” mindset.  That is, since I do not own a $2,000 bike, how dare you spend $2,000 of tax payers’ money? There is no one answer that will satisfy everybody. Hopefully, in going back to fundamentals, we stand a better chance of a more satisfactory answer.

Buying a reliable bicycle is not simply picking off-the-shelf, cash-and-carry. It is also about service and other related considerations. For example, warranty period, availability and price of spare parts, servicing cost, weight, portability and track record. I requested my bike shop for some pointers (I moderated these), and I hope the following will serve you well.

I do not know what’s going to happen to those quarantined foldable bicycles. If these are up for auction eventually, I hope for a good buy. It shall be my first British bicycle and you should know that brand. 

Declaration: I possess two pre-owned foldable bicycles. One (Dahon Hammerhead S$2,200) for park connectors, minor roads and pavements (when necessary to stay alive!). I am retro-fitting the second (Dahon Jetstream S$1600) to handle dirt track and rough terrain. The 26 km of contiguous distance of the Rail Corridor, after rail tracks are removed, is calling me!  

Six steps you want to consider before committing to a foldable bike:
STEP 1: DECIDE HOW YOU RIDE
The first step in choosing your folding bicycle is to decide what type of riding you’ll be doing. How often and where you plan to ride. Look at various brands and model that fit your purpose:  recreational, commuting, urban riding, trekking, weekend centuries, touring … Is having a good ride more important or the ability to push your folded bikes? Is that suspension worth that extra money if  your ride is just at PCNs and pavements? 

 STEP 2: CHOOSE YOUR WHEEL SIZE
Today folding bikes come with different wheel diameters: 14″, 16″, 20″, 22″,  24″, 26″.  Wheel size will affect the ride characteristics and portability of your bike.
Another very important question you want to ask will be availability of inner tubes and tire replacement. Sure that 17 inch or 18 inch or 24 inch wheel size may look cool BUT if you cannot get hold of spares or replacements, you are going to pay lot more in down time and costs to get spares. 
Also confirm that the rims used have the correct ETRTO numbers that fit available tire. Wrong fittings can mean your tire may come off while you are attempting a sharp cornering. Any wheel too small (Smaller than 14 inch) goes against sound bicycle geometry and this can mean the bike is unstable or tends to topple over. You do not want to be carried off on a stretcher after a ride.

STEP 3: CHOOSE YOUR COMPONENTS & FRAME DESIGN
Aluminum,  Cromoly steel or Hi Tensile steel.
No rust  -> Rust when metal is exposed -> will rust
Carrying 11kg is equivalent to 2 bags of rice. Anything above that weight category is not great for commuting especially if it involves going up/down overhead bridges and intermodal transport.
If humidity is high and bicycle is going to be knocked about - opt for Aluminum to overcome the issue of rust. A simple multi-speed Derailier system with folding joints that come with manufacturer track record and guarantee makes sense. 
Folding joints must be easy to fold and unfold, made of durable design for repetitive locking and unlocking
An important factor that affects the price considerably: consider what level of performance you’ll need from your components. The better the components, the better your bike will ride. And better components also mean improved durability and lighter weight but will cost more.

STEP 4: CHECK OUT THE EXPERIENCE AND TRACK RECORD OF YOUR BIKE DEALER AND THE BIKE MODEL 
Operating a bicycle needs ongoing maintenance, servicing and support! Derailiers need servicing from time to time, hubs and bottom brackets need greasing and damage components will require experienced mechanics, proper tools and chemicals to ensure that your bicycle is safe and serviceable to ride. Many bikeshops open and close within 2 years due to unrenewed lease  or being unsustainable. Are they opened on days and have operating hours that allows you to get spares, timely support and also stock good range of accessories? You are not just buying a bike, you are buying a service too! 

STEP 5: WARRANTY SUPPORT
Recalls can occur with bicycles (same as cars). Does the brand have a reputation of being responsible? What is the number of years the brand offers? Is the bike shop you are buying the bike from has been around for a period? What is the scope of coverage?  Buy with peace of mind

STEP 6: RESEARCH, VISIT SHOPS
Do your homework and check out neutral websites and reviews rather than forums hosted by shops or manufacturers as they will tend to be biased for their own brand. There is no need to hurry, a reputable shop should have a good range of bicycles for you to test-ride.   

So Ride Safe – Buy Safe!

Wednesday 8 August 2012

Medicine needs healing


Staying alive is expensive with modern medicine. Post Japan Disaster Charity ride in April11, my friend Francis called to tell me he is treating the major sponsors to dinner. He already donated 50 grand. What more do I deserve? When asked why, he said: "so that it may make future charity events a little easier on you". So 12 of us were treated to a sumptuous dinner of Thai food. 

Post charity ride, I was lethargic. A mild, lingering fever and a little soreness on my right ear bothered me for a few days.

With the impending long week end of Labour Day, I took no chances, paid a visit to my company's doctor. There was no fever and he concluded I may have a slight ear infection. So I was put on erythromycin, a standard antibiotic, and paracetamol for suspected ear infection. This is medicine 101 type prescription.

Despite medication, I felt lousy, slept a lot with a lingering roller-coaster fever. Come 2May11, the wife cooked a sumptuous abalone wanton mee for my son's 21st. We celebrated together with his twin sister in UK, via Skype. By 4pm, I threw up everything; prescribed antibiotic acted up.  

The following day, I consulted a doc friend. He did base line checks, drew blood, to rule out dengue or any parasitic disease. Nothing showed and that was good. Two days on, I still felt at sea and again visited the company doc, a different person. Another type of antibiotic was prescribed. While my fever was kept at bay, I was still not my usual self. My doc friend subsequently fast tracked me to an ENT specialist in private practice.
 
Latter took a close examination, said it's an inner ear viral infection (nothing changed) and immediately put me on acyclovir, a powerful antiviral drug. In the next 2 weeks, I felt my ear eaten up by creepy-crawly insects; crusted skin, flaking and then finally drying up. My hearing was impaired and my balance compromised.

My dizziness persisted. At each visit, the specialist would nudge me, ever so gently, to consider undergoing an MRI on the ear to rule out any remote chance of a tumour. I finally yielded. An MRI experience is most daunting. I rather draw blood a 100 times. Visualise your head strapped still, push into a washing machine (without water), no movement allowed, and clicking sounds torment you all over in this claustrophobic capsule. A few millions gray cells must have died.

The results, according to my radiologist, look normal except for a one liner observation. When I asked the ENT specialist on that remark, he promptly suggested consulting a neurologist. Though not my money, I said no. 

While recuperating at home, vertigo kicked in, the world went into a tail spin just a day before my driving holiday up to Penang. It was so bad I eventually checked into hospital; slept through 2 days on drip. The specialist suggested staying another day which I turn down flatly; not over my dead body. A foreign talent nurse inflicted some much unnecessary pain when changing drips (that's another story).

I waddled out of hospital with vestibular (the inner ear organ responsible for balance and spatial perception) imbalance from nerve damage. My lingering fever was gone, so was the pain in my right ear but spatial disorientation took over. I would knock off objects. My judgement of depth and distance was poor. I tried driving and it was hopeless. Eye, brain, movement coordination suffered a lag and judging speed was difficult. So, I hang up my number plate, took the MRT and bus to and from work for one month. It was all good before Christmas arrived early for SMRT with 2 massive break downs.

To put myself at ease over MRI observation, my public service network recommended a neurologist. I eventually consulted the head of neurology in a large public hospital. I showed him my written summary and MRI result. He asked a couple of questions, viewed some images, examined my ear and then pronounced: “you just recovered from shingles” (you must google in case it hits you!). It’s unfortunate some nerves in the ear were damaged, causing hearing impairment and imbalance. Lucky you, he said. If shingles hit your eye socket, going blind is conceivable. So I guess I am better off hearing less, seeing more!

He went on to comment that the negative one liner is not even something he would document or discussed, given my age.  The profile of my brain is no cause for alarm.  He stopped short of criticizing the MRI procedure as unnecessary. To him, it is game's over, nerve damaged and hearing belongs to another discipline. So, he referred me to the ENT specialist, a few doors away.

From hearing test, it was confirmed by the ENT specialist that there was a slight damage. There is nothing more to add, good luck. So I ask the doc if acupuncture is useful. He was non committal. What about my imbalance I ask the doc? Oh, it will go away through time. Damn it, it's far from going away, I mumbled to myself. Is there anything I can do to take away the dizziness (this term vestibular was not even in my vocabulary then)? Instead, he gave an open appointment to see him anytime I feel something is amiss.

With each passing day, I felt a little better. I force myself back to cycling, crashed into pedestrian barrier once but persisted. On the suggestion of Cecilia who works for KTPH, I visited the geriatric rehabilitation centre, ahead of schedule!  It was good education to learn that imbalance is a common problem with the not so young.

In rehabilitation, the promise is: no practice, no gain. I was taught a regime of exercises, if you like, to retrain the eye-brain and skeletal coordination. My physiotherapist was horrified to learn I cycle despite my condition. As it turns out, she is an avid cyclist. So she added gently: “cycle with care and please do more!”. Apparently, cycling (because one needs to balance) is excellent exercise for imbalance. If you can tolerate roller-coaster rides, better still.

According to my therapist, old people are more prone to be inflicted with vertigo or other forms of vestibular imbalance. Most adopt a sedentary lifestyle, lapse into depression, never to recover.

Here is a pool of medical knowledge with no medication, no cuts, no removal, nothing glamorous; only sheer discipline to practice, practice and then practice to recover. Rehabilitation centre is managed by physiotherapists, not doctors. There is barely any skin in this game; a 45 min therapy cost under $40.  

So as is often the case with the elderly, especially hypochondriac, it is “lokun bo yao, bay ho”! (roughly translated from Hokkien ‘doctor, without medicine, how to recover?’).

Are you then surprised to learn that private sector healthcare cost 2 to 2.5 times of public healthcare cost for similar procedures including up-selling? As medicine gets more sub-specialised, every square inch of our body is potentially attended to by a different specialist. Combined that with a more enlighten and litigious society, it’s gun powder in kegs in the years to come.

To maintain healthcare cost, medicine has to get back to basics, take a holistic view by having well-rounded GPs as family physicians. I was unfortunate to have 2 different GPs diagnose my condition. If it had been the same GP doctor, I stood a better chance of an accurate diagnosis.

When it came to the ENT specialist, my condition was already full-blown shingles and reflecting back, the MRI procedure, I guess, is part of the circus of modern medicine. An experienced family GP would have detected my early stage shingles, prescribed acyclovir and spared me the agony of a long and debilitating post recovery. Now my kids are screaming: "dad, why is the TV so loud!"

Think about this:
“With every additional medical procedure or test ordered, there lies a fresh possibility of error” so said the associate chief of neurosurgery at Grady Memorial Hospital Sanjay Gupta.

Friday 6 July 2012

In search of happiness in the land of the thunder dragon

I made a promise to my daughter that we would go trekking in India or somewhere remote since she was 15 years. She was charmed with India after having served twice in her school’s CIP programme.
Now that she completed university, it is opportune time. Then, Tiger mum (aka The Wife) appeared and asked: “Don’t you folks want to learn how to live happy?” So our 7 day trek in Nepal was torpedoed. We compromised, settled for several treks in search of happiness in the land of the thunder dragon.
As many of you may know, Bhutan takes pride in this Gross Happiness Index formula to measure happiness of its people. According to this index, they are supposedly the happiest people on earth.
Here in Singapore, every other person seems to be testy, ever ready with an opinion on just about anything. The latest include whether to cull or caress our wild boars. I remembered years ago, Priscilla, a tamed sow boar, resides at Chew Jawa, Pulau Ubin. She simply enjoys being tickled on its belly! But these are WILD. NParks have gone that extra mile to explain the rationale to cull. We need to act before someone gets seriously hurt.
Bhutan physical size is 350 km by 150km. It’s 70% forest with 8% arable land. The terrain is hilly and mountainous with some peaks over 7,500 metres. The population is 700,000 and literacy is under 60%. Hydropower contributes about 60% revenue (sold to India), 25% tourism and a mixed bag of small inconsequential sectors. Life expectancy is below 66 years. In tourism, their emphasis is low volume, high value. The local currency is in Bhutanese Ngultrum and is interchangeable at par with the Indian Rupee. English is widely spoken and our guide Dorji speaks perfect English; thanks to many overseas teachers from India and Canada during his schooling years.
There is no direct flight to Bhutan from Singapore (akan datang, September 2012). As such, we overnighted in Bangkok, crawled out of bed at 3:00am, chauffeured to the airport and arrived 3 hrs ahead of flight time. Talk about kiasuism on the part of the agent.
There is only 1 international airport located at Paro and Bhutan’s capital, Thimphu, is 50 km away. The only operating airline is Druk Air, state owned with a few A319 Airbus, powered by A320 engines. In the words of my guide, Druk Air pilots are well trained to sneak in and out without radar assist; all things visual.
Our flight was delayed 2 hours because of massive clouds. We circled twice before landing. We took pictures of the plane, runway and, of course, with the lovely poster of the 5th King and Queen. Her Highness is stunningly pretty with mesmerizing eyes, 10 years his junior. My spirit was momentarily uplifted, good start to have a pretty Queen and an educated, happy King. (they were wedded last Oct11).
Immigration was a breeze. We took over an hour of meandering about to get to Thimphu followed by some sightseeing. By the time I turned in bed past 10pm; I was totally concussed for the day. Just before blissful sleep set in, Tiger mum shook me vigorously and said: “honey, the lights went off”. Can you blah, blah, blah... Whilst my spirit was willing, my flesh was dead and I mumbled that she should just go sleep.
Apparently, she had not showered and the ensuing ruckus must have awakened all the dogs in the neighbourhood. Mercifully, the lights came back 40 minutes later. Otherwise, I would have been eaten in comatose state. Thank God, the day ended on a happy note.    
On the second day, I notice vehicular traffic was sparse. Apparently, private vehicles are taken “off road” every Tuesday leaving all to depend on public transport of buses and taxis. Taxis also have to take a day off once a week based on even or odd number plate.
Smoking is not allowed anywhere except in private homes. There is no “over the counter” tobacco sales and the natural substitute is “doma”; beetle nut chewed with a piece of leaf and mixture of gooey lime. Bhutanese loves to chew this all day long. Not so long ago, we too chewed “doma”, especially with the elderly. Marijuana (considered wild weed) is everywhere. I collected some, crushed it, but there is no aroma of any sort. I was told by Dorji it has to be roasted for efficacy.
Without tobacco, we would have 16% of more unhappy 18-29 years in Singapore. Without private vehicles for a day, we would be screaming murder! So, why are they happier than us when more affairs are regulated?
Theirs is probably a state of “resilient poor”. Most of them have roofs over their heads, plant vegetables for sustenance living. Some better off own fowls and animals. But life is very hard. Getting to school may require walking 1.5 hrs from one ridge to another and then another 1.5 hrs to get home. Planting rice is back breaking and climate dependent; at best, two crops a year. Produce, commodities are barely enough for domestic consumption.   
In urban Singapore, our very poor are likely “unhappy poor”. All our edible items are imported. Without money as exchange tokens, one simply cannot bring food to the table. We don’t have the land to rear chickens or tend to cows. At best, we grow some vegetables along the corridor or balcony. While therapeutic, the yield is never enough to feed the family (I experimented). So our poor generally have to depend on state hand outs and from well-wishers.  Over time, our very poor may be conditioned as “handout happy”, trapped in a vicious cycle.

From Thimphu, we travelled to Punakha, our second stop. On the way, we visited Chimi Lhakhang – The Temple of Fertility, dedicated to Lama Drukpa Kuenley, the Divine Madman. Getting there was quite an adventure as we criss-crossed over paddy fields. Couples who visit the temple are blessed by a replication of the iron bow and arrows of Drukpa Kuenley, his scriptures and the phallus, which is the symbolic representation of fertility. It’s rather an unusual place with phallic symbols all over. Wife and I were tickled pink, happy to redirect all good intended blessings to our daughter.

Besides the temple of fertility, we visited the Queen’s Village at Talo. It’s was a winding, uphill climb of over an hour. The village is essentially a monastery of sort for boys entering monkhood. There must have been more than a hundred of them of various ages; each holding a piece of paper (a few lines of script) and scribbling repeatedly in a huge garden in the sun. Some of them were blowing their “long horns”, similar to those in Switzerland.  Some gawked as we obviously looked alien. I cannot say they looked happy or otherwise. Most looked beyond their age, exposed to the harsh elements. What would become of them as they grow up? What would they do for a living? There are no easy answers.
We walked down the village, came across a farmer no more than 5 feet, hunched, carrying a huge basket on his back and holding an old fashion ‘changkol’ in one hand. We bowed, and my guide exchanged a few words. As he proceeded downhill, my guide turned to us and asked if we mind giving the old man a lift down to Punakha. Of course not, we said.
In our exchange in the van, we learn the farmer’s home is next to the Queen’s village. He grows some vegetables and fruits. He owns another small plot of land near valley of Punakha for growing rice. He was on his way to the market in Punakha to sell his basket of peaches. For him, it would have been a 3 hr walk downhill. On the van, it took 45 mins.

Upon arrival at our hotel, we bought some peaches from him. He was insistent in not charging us. We flatly refused and paid him fully. After pushing to and fro, he reluctantly accepted our payment. Recently, I read Michael Lewis Princeton University's 2012 Baccalaureate Remarks and the issue of “luck” popped up. Extract reads:
"But you must sense its arbitrary aspect: you are the lucky few. Lucky in your parents, lucky in your country, lucky that a place like Princeton exists that can take in lucky people, introduce them to other lucky people, and increase their chances of becoming even luckier.”
It begs the question? Are we the lucky people in Singapore or are they the lucky ShangriLa, the size of Switzerland?
On the penultimate day, we made our way to Tiger’s Nest (a prominent Himalayan Buddhist sacred site and temple complex, located in the cliff side of the upper Paro valley, Bhutan. A temple complex was first built in 1692, around the Taktsang Senge Samdup cave where Guru Padmasambhava is said to have meditated for three months in the 8th century. Padmasambhava is credited with introducing Buddhism to Bhutan), a must visit place.
A return journey to the peak at 3,120 m takes 5 hrs. It sure makes Pengkang Hill, SAFTI a walk in the park. Tiger mum, smiling ear to ear, outsourced a horse to take her to the top (one way only). We minions, including Dorji, soldiered on stoically on foot. She was initially terrified with the horse but soon got into rhythm as the animal trotted uphill. Half way through, another party with a few horses overtook us. One disgruntled horse, overtook us, kicked Tiger mum in the shin as if telling her to get off the horse. We could only snigger as we were so out of breath!
I left Bhutan 1.5 kilo lighter after all the hard trekking, feeling satisfied to tick off another item in my bucket list. When the wife consolidated all travel bills, I felt only half happy. And she is less happy too, having to nurse a bruise.       

Side note


I replayed backwards to reflect on my formative years. Poor as I was, somehow I remembered more “happy than unhappy days” and asked why? I suspect my surroundings played a major part in keeping me upbeat. I had nature’s 3Ss on my side…the sun, sea and sand. Then again, maybe mum’s reminder that in the school of hard knocks, the harder you work, the luckier you get. Supposedly good luck makes for a happier person.


My fantastic guide Dorji is likely to visit SG in Sep/Oct. He is superb and understands good service after having worked in high-end Aman for over 10 years. I intend to get him to give a presentation.