She is now 16 months old and has taught many of us useful lessons.
To her doctors, she taught them the virtues of not condemning their patients with hideous labels , such as 'cortically blind', 'spastic' and 'poor prognosis'. As she can now see, touch and wink naughtily, even from her squinting left eye. Lift both her arms in response to encouragements of " Who's Hannah?". Bears weight on both her 'spastic' legs and miserable-looking buttocks. She could , and by God she would!
To the nurses, she taught them that her unwillingness to swallow, wasn't from laziness. But that's the way she'd register her silent protest. Why pumped milk and nestum down her throat with big syringes when a simple finger feed would make her learn the art of chewing ?
To the other babies in the nursery,many of whom were recuperating from jaundice and hospital-acquired infections, she taught them that having good looks might make someone celebrate your birthday in hospital, but not enough to make them find you a home. For; as long as you cant control your own head or chew your own food, words spread that you are considered 'special' ( read 'spastic' ) and you can continue to bask under the phototherapy lights until state agents fetch you to welfare homes. Homes for the homeless.
She's nameless. As of the hospital tradition, even those with names are called " B/O - Baby of "someone".
That name lasts until the baby is discharged from hospital.
But for "Hannah" , she remained B/O for a long time. Dont know why mum could not think of a good name, as any mothers would. Hannah was a name through a popular vote; by nurses. And to this day, she remains Hannah.
I refuse to get to know minute details of her early life, for fear that this affects judgement.
But what i know is, at 14 months, she is the longest resident baby in the hospital.A close friend of her's, had been taken away not so long ago , so I was told. Gone, in the authoritative hand of welfare from this 1 nation of ours. Gone, as the nurses told me , to somewhere; a home, they would not place their stray cat into. Surely that's an unkind exaggeration.
Hannah turn for placement was next on the agenda and she patiently waited.
There were of course those with better luck and charm. Although nameless and a B/O, their looks make them attractive. Bookings are often made when they were even in their mother's womb. Documents made ready as they were born .A home not so long after. Different home to the owner of the womb that she'd lived for 9 months. Its OK . That was the deal.
Hannah was different.
By all counts and professional judgments, Hannah is considered abnormal. In as much as her sweet smile tries to compensate, there is no way it could hide her bad squint; or her spastic legs, or that awkward-looking ams;that head lag. Its a text book description that is really a short form of the dreaded word 'handicap'. To some, this means 'special'.
Special as she may seem to be, she is still doomed by hypocrisy of the day.
Wouldn't 'special' mean that she is entitled to at least a decent meal? After all, she does have some teeth!
Or to a loving cuddle?
Or being spoken to?
To rubber teats and bottles?
Nay; nothing of the sort. Sorry Hannah!. We call you special so that we be considered compassionate. We get into the good books of our 1nation- a caring society.
How could we give you things the authorities consider 'unfriendly'?
Bottles, teats, infant formula?. These are unfriendly objects Hannah! - dont you know that? These can never come near our beloved 'baby-friendly' place. We will lose our hard earned , world-certified accolade. "The Baby-Friendly Hospital"
It was November 2008 when I last visited Jordan to attend the first Reconciliation Summit, organized by Monash University and the RMIT Melbourne.
The Global Reconciliation Summit held in Dec 2009 was a follow up conference , but with a distinct difference
1) Almost 200 delegates participated, most of them were from various areas of conflict in the world- Sri Lanka, Serbia, Kosovo, Croatia, Turkey, Cyprus, Brazil,Palestine and Occupied Territories and Israel.
2) The delegates were from a variety of background - medical doctors, artists, playwrights, movie writers, journalists, and philosophers
3) Delegates shared their experience dealing with people traumatized by conflicts and their efforts on reconciliation
4) One clear message was, victims and perpetrators of violence and conflict each share similar suffering.The victim suffers from the obvious pain, while the perpetrators suffer from his undignified action of inflicting pain on his fellow human being. One common problem is that they dont share that mutual feeling as hatred is fanned , often by those with deeply vested interest in the continuing conflict.
5) Successful reconciliation efforts are often facilitated by readiness of common people on either side to accept and share mutual feelings of respect. This takes time and requires perseverance
6) I was asked to give some thoughts on the situation in Malaysia
7) I presented a paper entitled "Community-Engagement Projects as a Tool for Teaching Ethics in Medical School - Our Experience "
8) My arguments were as follows : That we in Malaysia must strive to preserve racial harmony especially among professionals by designing a training program that specifically adresseses ethical issues. Failure to do this might enhance highly polarized professional doctors as their primary academic background were not necessarily similar. Promotion of mutual understanding and respect among students can be developed through specific community engagement projects .
9) We in the Medical School Universiti Sains Malaysia regularly conduct the Community and Family Case Studies (CFCS) - a community-engagement project led by medical students of mixed ethnicity. CFCS is an essential component of our training of doctors and involve medical students being 'adopted' by members of the community for a period of 5 weeks during the 2nd and 3 rd year of the medical study.
10) Students identify medical and health -related problems in the community that they are adopted and implement intervention programs that deal with the problems identified
11) They work in groups with mixed ethnic groups and naturally getting engaged with fellow students from other cultures in a highly close setting. They also, at the same time understand the community they live in and appreciate the ethical issues at the most micro level
12) I came to realize that being a medical doctor, we are in the position to appreciate that the differences we notice between individuals are merely 'skin deep'. Having operated and opening up the abdomen of people from colours and creed across the globe, one does not fail to realize that as the outer skin is retracted, everything else is the same inside : the colour, function , smell and suffering! Understanding that , may just slightly facilitate reconciliation!
The world academia is akin to the vast forest where various types of species thrive
An academic institution is full of such potentials. Highly intellectual individuals ,each with his own pursuit, people in love with acquisition of knowledge and dissemination of the same
Should they be managed? and if so ; What are the qualities of their managers?
Managers who act as mere administrators, reading loudly from a list of 'do's and dont's' often make poor academic leaders. These are the same type of leaders who are so cautious to make an intellectual decision, have an obsessive fear of the 'unknown' and resort to the safest rule of administration. "If in doubt- dont do it"
Academics who approach such administrators will often be given expected, run- of -the- mill answers to their questions
There is little room for innovation in this sort of leadership sphere. "Out-of-the box" thinking requires new rules to be throught of and be eventually written. Administrators work from rules already written. They often love saying "no" as it represents renewed insignia of 'authority'. Sometimes responding with a "no" answer even before the question is well understood!
Such leadership stiffles academic progress.
Leaders should perhaps be like a lion. He's gentle and caring, eats only when hungry, and always comforting to the young. He only roars when necessary, as frequently roaring diminishes ones voice and makes people think that 'He always shouts- so take no notice!'. He does not wait for food to be delivered , but takes initiative to go out and hunt. Leaders frequently seek and reach out and not to be merely victims of fate, or wait to be attacked like a sitting duck.
He attacks sometimes, but after careful consideration or repeated provocation.He takes pride in being in a team.
He's respected even after his demise. Even his skin is displayed proudly on the wall after his death - a symbol to remind about power and authority.
Professor of Paediatrics Universiti Sains Malaysia
and Former Council Member of Malaysian Medical Council
(This article is part of an invited lecture delivered by the author in the “National Ethics Seminar” organized by the Academy of MedicineMalaysiaon 2nd Dec 2006)
Research fraud, misconduct and misrepresentation are not new phenomena. Various forms of misconducts have occurred throughout history of medicine. One may recall the well publicized Nuremberg Trial when numerous forms of misconducts and human experimentations were exposed purportedly committed by Nazis. The cases of unethical research on stem cell by Dr Hwang Woo-Suk and 6 Korean professors are the more recent examples of misconduct in the 21st century, citing their ‘blinded desire for achievements’ and work as their reason for misconduct. This reflects many more unspoken reasons for similar conducts by other researchers throughout the scientific world. As a consequence, legislations have been formulated over the past 50 years to safeguard the general population against possible unethical researches. However as new demand for research become necessary, newer forms of misconducts became known, requiring a complete revisit of the subject.
Research demands creation of new knowledge, and requires ‘careful, patience, systematic and diligent inquiry’ into a problem in order to establish the truth. As many of these attributes are subject to human fallacies, the temptation for a lesser and easier option frequently arise, leading to the various forms of misconducts.
Among the forms of misconducts are:
Misappropriation of ideas, or funds
Not complying with International Guidelines and Principles on Research Ethics
Not respecting guidelines on publication and authorship, double submission, false declaration
Denial of publication of rightful articles
Misleading the Ethics Committee- methodology, sample size, budget allocation, honorarium payment to subjects and to researchers, conflictof interest of members of committee
Breach of research protocol- recruitment of subjects, randomization, blinding,
Recent developments among the scientific community in Malaysia may also contribute to the tendency of research misconduct. Among these are:
Intense competition for Research Institution/University status and the ‘reward’ such status brings
Personal gain and glory and a possible overcompensation for research achievements either in the forms of monetary rewards or research exhibition medals
Corporateintrusion into research and academic freedom undermining foundations of scientific inquiry
‘Publish or perish culture’ cultivated in universities and research institutions to encourage healthy research competitions among researchers
Intense desire to patent and commercialize research achievements and researchfindings
In order to safeguard possible opportunities for research fraud and misconduct, the following measures may be considered appropriate and necessary:
Revisit the purpose of research, revival of altruisms in research objectives and minimizing unhealthy corporate intrusion in academia
Strengthen Ethical Research Guidelines and upgrade the guidelines into Acts of Law wherever appropriate
Laws and legislations (Copyright Laws, Breach of Trust. Fraud ,Medical Act etc) ought to be revised to include research issues
Institutional Review Boards to be made more transparent and accountable for their decisions
Composition ofReview Boards ought to be carefully chosen to maintain independence in decision-making with greater participation of the general public
Role of Medical Council to be expanded and be made explicit to include research misconduct
Public Auditing of Research with ‘Annual Reports on Research Approval’ be made accessible to the general public
Independent research auditors and ombudsman to receive complaints related to medical research. Research frauds are currently underreported worldwide
Research findings to be made public and not only confined to medical fraternity. This is important for research scrutiny
Establishment of an independent body called Medical Research Monitoring Committee – multisectorial representation where research annual reports are highlighted to safeguard public interest
Facilitate publication of research findings especially by young researchers through increasing use of ‘Open-Access’ electronic journals. Unnecessary difficulties imposed by editors of reputable journals through whatever forms on newer, young researchers may encourage unethical research behaviour by some unscrupulous medical researchers
Strengthening the number of medical personnel and improving the support system in any particular academic institution so that medical researches are done by personnel who are not too heavily burdened by teaching or provision of clinical service. A system where the same, small number of staff are expected to perform ‘miracles’ by being able to undertake good research in the background of multitude of other commitments ( teaching, clinical service or administrative duties) may inadvertently encourage a medical researcher to be fraudulent for his academic ‘survival’
In the final analysis, the motive for research fraud and misconduct stems from a multitude of factors; from a faulty system to a ‘faulty’ person. Reexaminations of each of these factors will be necessary to eliminate the possibility of fraud and misconduct.
This article was published in ‘Berita Akademi” the Official Newsletter of the MalaysianAcademy of Medicine March 2007. It was also presented in the National Ethics Seminar organized by the Academy of Medicine , Malaysia
1)The first day was pretty relaxing. Found a mosque adjacent to the Al Khozaymah Hotel. Quite convenient for congregation prayers
2) Second day was spent examining final year medical students at the Department of Paediatrics, King Saud University. It was OSCE station for abdominal xamination
3) Students spoke good English and typical for OSCE, they were irritatingly well rehearsed almost to the level of a pre-programmed performance.
4) Most did well, except one or two who almost swore that he felt a big spleen when there was none. A few digged well into the abdomen, claiming to elicit tenderness.
5) The next day was a debate on results.Presented my analysis of events and trying to make hosts as comfortable as I could. One dared asked " Are our students as good as any in the world?".Difficult to say on OSCE alone.There were generally safe. I thought
6) Then the formalities with Deputy Dean, Dean, Cheif of Clinical Services. Cordial and diplomatic
7) They made me deliver a talk. I choose " Research- For Whose Sake;Really?.Someone thought the talk was 'dangerous' !
8) I then took the postgrads for 1 hour. Fun, assertive lady docs fully clad in burkhas. Very intelligent tho. The men folks were typically quiet
9) Visited ENAYAH - an organization to help the poor - impressive efforts
10) Madinah was a far cry from the bustle of Riyadh.Serene, wise,cold and very friendly from the start. A Syrian University student gave me a lift from airport to hotel. Most hotels were empty as the Haj season had just ended. As usual, emotional scene near the Prophet's tomb, with people queing up to say 'salam' to prophet, and his 2 beloved companions, buried next to him. Always a moving scene.You could almost hear murmurs of confession " Yes, we failed to do as you said, and now people are killing your children and grand children ;in brutal murder"
11) Met a Malaysian studying at the Madinah Islamic University.A confident young man whose knowledge of history of Madinah was a pleasure to listen to. He'll be organizing my zam zam water delivery in few days. Gave me a lift to the airport
12) Back in Riyadh the same evening, I attended a sumptous wedding reception. Almost 40 tables,; the main table had 10 large plates. In each saw a roasted lamb resting on a bed of rice; the torso was savoured and shared by a company of 4. Impossible to finish the rice and the lamb. although everyone made sure that the torso lost its resembelance to a sheep at the end of the feast. A pure act of sharing. I was told that what remains of the uneaten food will be handed to a company specializes in handling leftover food to be repackaged and distributed to the poor.
130 The next day was time to pack things up. Had to buy 2 extra bags to place the 30 kg dates that were given as gifts. Lovely , memorable visit, but alas, it could have been more enjoyable had the killing of children by adults whom they have never met and hated, happening in the north hadnt taken place!!
1)Its my second visit to the Middle East this year.Coming too close to the first , it caused a bit of anxiety to my family. Nonetheless, as usual, my wife and family unanimously gave their blessings.
2) This visit is to the King Saud University (KSU)and I'll be examining the medical students who are in their final year. KSU is the first University in the Saudi Kngdom and has a long history to its credit
3) My immediate host is Dr Ebrahim ElAyed, formerly from Newcastle upon Tyne. He is in his 50's but you can recognize his charm from afar, despite not having met from 1987
4) We sat in an old style Arabian restaurant in central Riyadh, recalling the good old days in Newcastle. Names like Aynsley-Green, Parkin, Lawson, Heather, Lamb,Eastham, Watson,Craft,Nelson,Wariyar, were among the few that came to mind when the warmth of Arabian tea took it's desired effects. We recoiled with laughters as he recalled his inability to drive in snow and tested his car against a Newcastle double decker bus!
5) Theres an invasion in Gaza at this time, with kids bearing the main brunt of war and its consequences.Its quite difficult to be too happy during this occasion, as both of us are Paediatricians.Our life centres on making kids better and free from pain.Yet we could only watch and listen from far the cries from these children,amplified many times over and repeatedly done as though to challenge us sitting comfortably in our rooms.
6) Geographical borders ensure that we remain isolated to those suffering from this unjust war and can only pray that someone can stop the brutalities of it.Perhaps no one could , as killing one soul leads to the killing of another in reciprocity.Hence the praying is to God who has power over man's heart and intention. May He makes human have mercy on his fellow.Man share the same pangs of hunger and pains from injuries, whichever side he is on.
Universiti Sains Malaysia Kota Bharu, Kelantan, Malaysia
This blog represents my views relating to various issues relating to medical education, professionalism of medical practitioners,religion ,culture and politics.My early experience being brought up in relative poverty in rural Malaysia for 12 years followed by rewarding experience as a high school student in Wales,a medical student in the University of Newcastle upon Tyne UK ,my job as a doctor dealing with sick children in Northern England in the 80's serve as an important background that shapes my thinking. Working in Malaysia in Universiti Sains Malaysia's Medical Faculty for the past 17 years gives me another dimension to life.It is the contrast of this two important period of my life that my views are largely based on...
