Existential questions

Questions, questions. Has child bearing become so utilitarian that the government has to compensate parents who have lost their only child?

*  *  *

Source: The Straits Times

BEIJING • Madam Cui Wenlan was devastated when she heard the news last month that China was scrapping its one-child policy. She is among more than a million grieving Chinese parents who have lost the only child the government allowed them to have.

Madam Cui's son was 30 when he died after an illness and she had been forced to abort her second baby in 1985. Now she and her husband are adrift in a country where parents traditionally rely on their children to look after them in old age.

"If, back then, we had been allowed to give birth again, I wouldn't be in so much trouble and wouldn't be so lonely," said Madam Cui, 53, from the northern city of Zhangjiakou.


Madam Cui's story underscores the punitive nature of China's family planning policy, beyond the more well-known stories of forced abortions and sterilisations, and highlights the plight of an estimated million "shidu" families, or those who have lost their only child.

China, the world's most populous country with nearly 1.4 billion people, says the one-child policy has averted 400 million births since 1980, saving scarce food resources and helping to pull families out of poverty .

ONUS ON GOVERNMENT

At that time, we complied with the government's arrangement and were forced to abide by the one-child policy. Now that we have ended up in this situation, the government should be held accountable.

MADAM A. LI , who lost her only son in 2009 in a traffic accident, and whose bid for compensation over the death was futile
The policy, however, will be eased when the ruling Communist Party last month said it will allow all couples to have two children. But the timeframe for implementation is yet to be known.

Madam Cui's husband, Mr Gao Zhao, said the government of Zhangjiakou gives the couple 680 yuan (S$150) a month in compensation, an amount that falls far short of what is needed in a country where there is little in the way of welfare or health benefits.

"We are rural people and don't have much education," Mr Gao said.

"The state told us what to do and we followed."

Madam Cui said she could not get surgery after being injured in a car accident because she did not have a child to sign the agreement for surgery.

Madam A. Li (not her real name), a mother who lost her only son in 2009 in a traffic accident, told Radio Free Asia she has made five trips to Beijing to petition the National Health and Family Planning Commission for compensation after the death of her child. But her efforts have been futile.

"At that time, we complied with the government's arrangement and were forced to abide by the one-child policy. Now that we have ended up in this situation, the government should be held accountable," said the 53-year-old woman from Hangzhou in the eastern province of Zhejiang.

Mr Fan Guohui, 56, has also petitioned the government to support "shidu" parents financially and emotionally. His son died in a car accident in 2012.

Mr Fan's wife, Madam Zheng Qing, said the couple was "emotionally ruined".

"One-child families are walking a tightrope," Mr Fan said.

"Once you lose your child, you lose all hope."

#ProudtobeSingaporean

Had heard much about this interview before, and never had the time to sit through all 45 minutes of it. Now that I have, mindblown at our DPM! #ProudtobeSingaporean

Popping panadols

Haven't taken a day of MC in the past 6 months of shiong postings, 3 months of Neurology, 2 months of back-to-back MICU and 1 month of ED. But alas, I am down with viral URTI and fever 1 week into my leave. I half blame the salted egg crab. Having said that though, with the time that I have on my hands, I went to read up on the pathophysiology of fever, hyperthermia and hyperpyrexia. I can feel my brain slowly rotting away....

There has been much ado about the fairly recent Supreme Court decision to allow same-sex marriages in all 50 states of the USA. Before I say something incriminating and land myself in some freedom-fight, I must say that reading the 103-page court judgement highlights an interesting facet of American culture that I knew, but never experienced first hand. The Majority had submitted 1 written argument (led by Kennedy) while the dissenting 4 each wrote their own judgements. It seemed peculiar to me that there was no response by the Majority to the objections raised by the dissenting, which was put forth with much sarcasm and verve. To be honest, the argument put forth by the Majority, while emotionally charged and persuasive in language, is weak in its legal basis when questioned at its fundamental level. I never thought I would have the patience to plough through such a wordy document, but I'm thankful for a husband who challenges me to look at the case and its facts and drawing my own conclusions instead of taking part in a popularity vote.

If anyone is interested, the 103-page judgement is freely available here.

National Tragedy

Woke up today with tragedy plastered over the news and a nation with a heavy heart.

Source: Straits Times

Warning shots

Station 4 of the PACES examination is a Communications station. One of the most common clinical scenarios is that of "Breaking Bad News", of which one of the pillars of breaking bad new is giving multiple "warning shots". It essentially is making several statements related to the anticipated undesirable situation, to forewarn the receiver of what is to come.

Source: PMO Office

#ThankyouLKY

"Dear Papa, hope you get better": PM Lee pens a message for Lee Kuan Yew at Tanjong Pagar CC. (Photo: Kimberley Spykerman)

Aiyoh I feel so sad now. I just spent the last hour surfing articles about THE Lee and his life, the good, the bad and the ugly. Sending Mr Lee a virtual hug #hug.

Tampines accident

New of the tragic Tampines accident really hits hard. Young lives gone, just like that. 

He meets the love of his life for an hour each day

The Straits Times

17 September 2011

EVERY day at 3pm, a nurse pushes Mr Koombri Hasan, 77, in his wheelchair to a special meeting.

Tucked in the side of his wheelchair is a gift, usually a packet of biscuits, a packet drink or a portion of fruits he saved from lunch.

He is, after all, meeting the love of his life - his wife, Madam Ong Ah Chuan, 57.

They live in separate Resident Living Areas.

Today, the couple meet in the common area. On television, American personality Martha Stewart is demonstrating how to make creme brulee.

Mr Koombri pays no heed to her tips.

He is lovingly preparing a dish of his own; dipping a butter biscuit into water and softening it before feeding it to Madam Ong, who has difficulty swallowing.

Mr Koombri, a former air cargo handler, has provided care for his wife since meeting her in a Chai Chee kampung in her youth. She has been intellectually disabled since the age of five after a fever.

His memory is hazy and he does not remember when they got married.

But it was when Madam Ong was in her 20s, judging by a wedding photo that sits atop his bedside drawer in the room that he shares with five others at Peacehaven. He does, however, remember the dates they had in Orchard Road and fishing sessions at Bedok Jetty.

These days, their hour-long daily meetings are not as romantic. Sometimes, a nurse chaperones the couple, watching the feeding process closely to make sure that Madam Ong does not choke.

Many other residents share the common area, but today they pay little attention to the couple, preferring to watch Martha.

The couple converse in Hokkien. Madam Ong speaks with an almost incomprehensible slur but her husband understands every word.

Meet-ups like this were impossible two years ago.

From their one-room flat in Bedok, both were sent to different, far-apart nursing homes in 2009: Mr Koombri - wheelchair-bound after a fall in 2006, and suffering from a painful skin infection called cellulitis - to Peacehaven; and Madam Ong - who suffers from epilepsy and diabetes - to the Moral Welfare Home in Henderson Road.

Teary phone conversations were their only form of contact.

After hearing about their plight, social workers from both homes worked to reunite the couple.

Six months later, a vacancy in Peacehaven came up.

The devoted husband still remembers the day that she arrived in June 2009 and how he rushed to her bedside to embrace her.

He now finds pleasure in knowing that his wife is well during their daily meetings.

'As long as she speaks and manages to swallow the food I bring her, I am very happy.'

SAMUEL HE

Choosing Love

It started with me posting a news link about the new up and coming medical school to be set up as a collaboration between NTU and Imperial College. It was to be named the Lee Kong Chian School of Medicine. The papers reported lots and lots of money involved. 150 million dollars, matched 1-to-1.5 by the government (walau they only gave YLL 1-for-1). While there was some debate about how it appears as though some philanthropists give money for the sake of having monuments named after them, it made me wonder what I would do if I had 150 million dollars to give to the community. It came as a response to the many comments on the above-pictured Facebook thread. Strangely enough, I had some difficulty thinking of what cause was worthy enough to give to. Some things came quite intuitively - give to the homeless and destitute, or fund research to cancer. Others were a little bit less palatable - set up a swanky posh hospital for the high and mighty, and make even more money thereafter.

One that that came to mind and refused to budge though, was a fund for medical students to break their bonds. Of course, it was made in jest (yes, Mr Khaw please don't come after me) and I can already see many problems with how that would turn out. But it also became apparent to me that the liberty to choose one's own path in life is truly priceless. The system is not perfect, and the admission process of a portfolio and series of interviews is seriously not going to sieve out innocent young boys/girls (haven't even gone through army!) from pledging their lives to what they have not even begun to understand. In the course of 5 years, people realize, to their horror I'm sure, that medicine was not what they had signed up for. The study of medicine perhaps thrilled their senses, but the practice of which, maybe not. In most cases, it's easy to throw in the towel and say I QUIT!! ...but in medical school, it's not without a hefty price. A couple of hundreds of thousands of dollars before you're let off the hook. No money? Too bad.

Those of us in medical school will surely know at least one other who has had second thoughts about medicine as a career. Maybe they detest the working environment, or it might be the pressure-cooker healthcare system. Maybe it's just the fact that reality did not meet up with expectation. The story of Dr Allan Ooi may strike a cord in some of our hearts. Why then, should they be forced into 5 years of a pathetic existence that they so detest? An unwilling doctor may be a functional doctor, but will never be an excellent one. I have found, with anecdotal evidence, that things done out of my own accord are always done with a higher standard and a spirit of excellence as compared to things that I were coerced to do, even if both tasks were identical. People should not be forced into doing what they do not want to do.

Today is the 5th of January, and by truly by God's grace, marks four years of being together with SJ. Facebook couples' anniversaries are typically marked by fancy dinners, romantic strolls and extravagant presents (but you only see the good things on Facebook remember?). However, at the point of writing this post, SJ is completely unaware that today is our anniversary (he forgot last year too btw). We met up for a usual yummy Japanese dinner at Ichiban Boshi (the most awesome yet affordable Japanese food!), and went home. BUT, I'm not complaining. If it isn't in his mind to remember this date as something particularly significant, then so be it. (Actually I don't even know what it is that is significant, other than another excuse to eat expensive food. Anniversary also sounds like such a scary word, only for centenarians.) What would be really weird, would be me being upset at his forgetting, and making sure that he remembers to do fancy things and then he doing it unwillingly. Hmm, I sound like I'm consoling myself for the lack of a fancy date. But REALLY, I am not :p SJ if you're reading this don't worry, you're still my favouritest boyfriend :p

A couple months back, I wrote two lines on a whim.

Where free will is withheld, Love shall die;

But choice gives Love, a chance at life.

I was then inspired by God's decision to create the Tree of Knowledge of Good and Evil in the Garden of Eden (another debate for another day). So before I deviate any further from the point of writing this entry, my thought of the day is that if the system in which are function in as medical students aspires to uphold the value of having love for humanity, then we should be given all the liberty to either love with all our hearts, or a similar freedom leave.

Madam Kwa Geok Choo, 1921 - 2010

To love, to hold and to cherish,
in sickness and in health,

for better or for worse,

till death do us part.

(Photo Source: The Straits Times)

"One doctor told me, you may think that when she's gone you'll be relieved, but you'll be sad when she's gone. Because (now) there's still the human being here, there's still somebody you talk to and she knows what you're saying and you'll miss that. Well, I don't know, I haven't come to that, but I think I probably will because it's now been two years, two years and four months. It's become a part of my life.'"

MM Lee hospitalized

My mum told me last night that MM Lee was hospitalized in SGH for a chest infection, and my first reaction was an huge OH NO. I hope he doesn't suddenly become really ill. Singapore just won't the same without his brilliance. Most of us take credit for some things in this lifetime. We build our own families, companies and small successes. I always wonder what MM thinks when he looks out over Singapore from the top floor of MBS. Probably like, I built this country, man!

Get well soon!

haha!

In continuation from the previous post...

Funny is the man who turns up for his own funeral!
BBC: Brazil man appears at own funeral

More randomly, I suspect I did not dislike Surgery as much as I thought I did. I suspect it was an apparent dislike, and not a true dislike, and it was probably more associated with the place than the subject. Orthopedic surgery has been enjoyable thus far (: Then again, maybe it's the place too :p my 2 more major postings in medical student heaven - thank God! (:

1 in 700,000

Blessed is the man who gets struck by lightning.
The Straits Times: Lightning-hit golfer dies

Woe is he who falls to death immediately after wedding.
The Straits Times: New groom falls to death

Knee jerk reactions

Over reaction or not, this flu is here with us to stay. I secretly hope I get infected now, let my body react to the space invaders and create some strong IgMs and IgG, then pop in Tamiflu to combat the still sensitive strain. Maybe then will they let me back into the clinics. :( There ought to be some sense of proportion in the management of this outbreak-to-be. Here's some geek speak:

Go Die in JB

The Credit Crisis

The best animation I've seen yet.

The Crisis of Credit Visualized from Jonathan Jarvis on Vimeo.

Paracetamol: Pause to Reflect

After last Wednesday's COFM paper, reading this article and understanding the jargon made me oddly happy :) looks exactly like what would be in our tutorial - Identify the study design, discuss confounders and biases. :) enjoy. *too geeky* 8)

* * *

Source: Straits Times Interactive

PARACETAMOL is one of the world's most commonly used drugs. It is popularly sold as Panadol as well as other brands.

Paracetamol is the preferred medication for relieving fever and pain because of its safety profile. Ten years ago, it was hypothesised that its use may increase the risk of developing asthma.

Paracetamol is the preferred medication for relieving fever and pain. But it has been hypothesised that its use may increase the risk of developing asthma.It was suggested that a change from the use of aspirin to paracetamol among children in the US during the 1980s may have contributed to the increasing prevalence of childhood asthma noted during this period. Substitution of paracetamol for aspirin, researchers proposed, may have led to an enhanced allergic immune response, thereby increasing susceptibility to asthma and other allergic disorders.

Since then, a number of epidemiological studies have reported an association between asthma and exposure to paracetamol in the womb, childhood and adulthood. These studies led to the suggestion that the use of paracetamol may represent an important risk factor in the development of asthma.

The latest evidence to support this hypothesis comes from a large international epidemiological study of childhood asthma that was recently published in the medical journal The Lancet. This analysis, from the International Study of Asthma and Allergies in Childhood, involved more than 200,000 six- and seven- year-old children from 73 centres in 31 countries.

The children's parents or guardians completed written questionnaires about current symptoms of asthma, rhinitis (hayfever) and eczema, as well as about several risk factors, including the use of paracetamol for fever in the child's first year of life and frequency of paracetamol use in the past 12 months.

This study found that paracetamol use for fevers in the first year of life was associated with a 46 percent increase in risks of developing asthma in six- and seven-year-old children. Paracetamol use both in the first year of life and in children aged six to seven years was also associated with an increased risk of symptoms of rhinitis and eczema. This suggests that the potential effect of paracetamol is not restricted to the airways and may affect a number of organ systems.

Identifying the potential mechanisms that might underlie this association now noted between paracetamol and asthma (and other allergic disorders) was not part of this study. But other researchers have proposed a number of plausible mechanisms, primarily related to paracetamol's negative effect on the body's ability to withstand oxidant stress and this may lead to an exaggerated allergic immune response.

The authors emphasised that a retrospective study of this design cannot establish causality due to the numerous potential biases that may confound the association. For example, it is known that viral respiratory tract infections in infancy such as respiratory syncytial virus (RSV) are associated with an increased risk of asthma in later childhood and that paracetamol use for such episodes could have caused confounding in the study.

The study has contributed to the debate as to whether it is beneficial to treat fever in children, an issue comprehensively reviewed in a recent World Health Organisation article. The review concludes that the available scientific evidence suggests that fever is a universal, ancient and usually beneficial response to infection, and that its suppression under most circumstances has few if any demonstrable benefits.

On the contrary, it suggests, suppressing fever may occasionally produce harmful effects. Thus the widespread use of drugs to reduce fever should not be encouraged. It recommends that in children their use should be restricted to situations of high fever, obvious discomfort or conditions known to be painful.

What is agreed is the need for randomised controlled trials of the long-term effects of repeated use of paracetamol in children. Only then will it be possible to develop evidence-based guidelines for recommending its use.

Pending the results of such research, paracetamol remains the preferred drug to relieve pain and fever in childhood. Current WHO guidelines recommend that it be reserved for children with a high fever (of 38.5 deg C or above).

Aspirin is not used in young children owing to the risk of Reye's syndrome, a rare but serious complication. So paracetamol still remains the preferred drug of choice to relieve pain or fever in children or adults with asthma, because aspirin (or other medications like it called non-steroidal anti-inflammatory drugs) may also provoke attacks of asthma in susceptible people with this condition too.

The writer is a respiratory physician at Wellington Hospital, director of the Medical Research Institute of New Zealand and a consultant to the World Health Organisation Global Initiative on Asthma.

These Days

a rising trend in the recent news-

1) Mr Nordin bin Mondong had guts of steel.

Photo from Straits Times Online. Full story here.

2) The controversy on euthanasia, and a feature on Eluana Englaro and her Dad on her right to die (Full story here).

3) The 13 year old Hannah Jones, suffering from leukemia, who refused a heart transplant. (Full story here).

* * *

seems like everyone wants to die these days.

$3

my mom told me about this piece of news earlier this week, but i brushed it off, thinking nothing much of it. until i saw for myself in the papers today, the photograph of a beautiful 11 year old girl, now dead. she felt her life wasn't worth $3. it left me speechless for a while.

perhaps the reality is this - that we are all equally poor.

...

Her death focuses national attention on widening rich-poor gap despite booming economy
By Alastair McIndoe, PHILIPPINES CORRESPONDENT

MANILA - THE apparent suicide of an 11-year-old girl out of despair that her family would never rise above a hand-to-mouth existence has put a tragically human face on the often anonymous poverty blighting the Philippines.

The death of Mariannet Amper in the southern city of Davao has shocked the nation and focused attention on the country's stubbornly high levels of poverty, despite its brightening economy.

Details of the girl's harrowing death on Nov 2 were reported earlier this week by national newspapers.

Before she hanged herself with a nylon cord, Mariannet wrote to a television show asking for a school bag, a bicycle and jobs for her parents.

The letter was never sent and found under her pillow, along with her diary telling of her family's money problems.

The night before her death, Mariannet asked her parents for 100 pesos (S$3) to finish a school project. But her 49-year-old father Isabelo Amper, an unemployed construction worker, could not raise the money.

'I suspect she did it because of our situation,' he was quoted as saying in the Philippine Daily Inquirer.

A few days before Mariannet's death , President Gloria Arroyo ordered an additional allocation of 1 billion pesos to finance more projects to help eradicate poverty.

The World Bank estimates that 40 per cent of the country's population of 87 million live on less than US$2 (S$3) a day.

Though most leading social indicators are in fact improving, Mariannet's death will likely harden perceptions among poor Filipinos that gains in the economy are not trickling far enough down.
The economy is certainly on a roll: The gross domestic product rose 7.2 per cent in the second quarter, its highest in two decades, inflation is at its lowest level in several years and the peso is rallying against the US dollar.

But political analyst Ramon Casiple said the drivers of growth are not creating desperately needed jobs for the poor, especially in rural areas.

'The sectors doing well, like information technology, do not benefit the poor. The economy is growing, but the gap between rich and poor is also widening,' he said.

The country's unbridled population growth, which is one of the highest in the developing world, continues to badly hobble efforts to eradicate extreme poverty.

The conservative Catholic church in this mainly Christian country vehemently opposes artificial forms of contraception. And successive governments - including the current administration - have been reluctant to cross the bishops on this sensitive issue.

This has meant countless unwanted pregnancies for poor women living in areas where public health clinics refuse to dispense or recommend artificial forms of contraception.

The Straits Times recently spoke to one such mother, a careworn 35-year-old with eight children living in one of Manila's most crowded slum districts.

'We only wanted three children,' she said, asking not to be named. 'I have been to the health centre to be put on the pill, but they told me it was banned.'

The family lives in a single room no bigger than a prison cell. Her husband sells coconut juice, making around $7 a day.

'It is not enough to feed us,' she said, surrounded by her children. 'When I look at them, I feel like crying, but try not to show it.'

A comment by one official that Mariannet's death was an isolated case sparked a small protest in the Philippine capital on Thursday.

But such suicides are indeed rare here, and government social workers in Davao are still investigating the girl's death.

parenting - the ultimate saigang

ST Online Forum letter: In home schooling, the child misses out on human interaction best experienced in schools

I AM impressed by the home schooling practices featured in the article, 'Some kids are right at home with their studies' (ST, March 8). Indeed, home schooling does open a wider range of opportunities for the child to venture into aspects that are not experienced as a mainstream student, granting him an edge over his or her peers in their mental and creative capacities.

However, one major lacking point in home schooling is that the child misses out on the human interaction that is (in my opinion) best experienced in schools.

By being home schooled, the child may become overly comfortable with learning as an individual worker or learning only under the guidance of the parents. He or she may eventually find difficulty relating to his or her peers when being educated at higher level institutions in future.

In mainstream schools, students participate in group work, outdoor activities and camps, learning to accept different personalities and forging precious bonds that often extend to adulthood. A lacking in this aspect changes a child's perception of society, and may create an unrealistic expectation of the real world.

School is a platform for children to pick up both academic abilities and social skills. The 'teach less learn more' method should pick up tips from effective home schooling practices and the amalgam of both would be most advantageous.

Different subjects should not be mutually exclusive while activities should encourage experimenting and arouse curiosity. Invest time in mixing food colourings, simple investment games, making instruments from empty bottles filled with various levels of water or even just maintaining the school geographical station.

Only then can mainstream education be considered versatile and not stifling.

Glorijoy Tan Shi En (Miss)

i wrote this letter after i saw the home schooling article in ST, during which i was constantly thinking of the very cool things that Mrs Goh does with her kids over in the US. using bubble wrap to do painting, playing with cookie cutters, having a ball with water guns during bath time with self made targets. it's brilliant, and deserves respect. parents who take up the challenge of home schooling are people i really really really admire. to me, parenting is just about the hardest thing that the people will face during adulthood. it's not just taxing but very very dangerous for one adult to play so many roles to one child - a parent, a PE/Science/Math/Language teacher, a disciplinarian, a classmate, a care giver and the list goes on. and the scariest part is that if you fail, you cannot complain to MOE or scold poor teaching curriculum. it'd only be your fault.

i think one of my greatest fears is to be a poor parent to my child. a life so precious in your care. no longer are we dealing in inanimate objects, doing sai gang or teaching pure academic subjects. we're talking about a human here, whose mind, character, value system and maybe even personality is moulded by each and every word you speak, action you take. and after years and years of investing time, effort and even your prime nurturing these irritants, they grow up to be rebellious, disobedient and just about anything else that you want them to be. there is no guaranteed reward in it. newspaper reports of professionals abandoning old parents to live on their owns, to wait for death in hospices, refusing to acknowledge their disease-stricken parents...parenting is just about the worst sai gang anyone can do.

children who grow up with with unhappiness blame their parents, vowing not to make the same "mistakes" their parents did. but like a chip off the old block, they couldn't differ much in style. it has to work that way isn't it, just like in the movie Jasmine Women. children were never made to understand parents, and perhaps parents never to understand children. how unfortunate.

my mum is the only person in the entire world who would come have lunch with me for an hour and then go home. my dad is the only person in the entire world who would scrape some ram's horn thing to boil some (gross) tonic for me to drink when i'm sick. my mum is the only person in the entire world who would drive me to school and back when my school is just 200m away for 18 years straight. my dad is the only person in the entire world who would make me open my windows to ventilate it so i don't breathe in bad air. and in spite of all that, i complain they nag too much, ask that they send me around more often, demand that they do stupid things like drive to collect the wallet i've left in the bus because i want to study for my tests.

parenting, the ultimate saigang.