DISEASE THREATS IN SINGAPORE -- Unanswered Questions
- Date: 1 July 2005To: Editor, Singapore ReviewFrom: Mr See Leong KitSubject: DISEASE THREATS IN SINGAPORE --- Unanswered Questions.Note for Readers:-- For easier reading, print out hard copy of this detailed submission.-- Please circulate to other concerned parties, especially PART D (para 8) on the little-known health risks in the Chinese "sharing food" eating habit of dipping chopsticks/spoons into a common dish.-- My detailed feedback (full text below) was emailed on Mon 27 Jun 05. By the Wed 29 Jun 05 response deadline, there was no response at all from all four ministers. (See how a concerned citizen's honest feedback in supposedly "First World" Singapore is accorded such disrespectful TOTAL DEAD SILENCE by its supposedly "world class" million-dollar ministers.)To: PM Lee Hsien LoongMOE Minister-IN-CHARGE Tharman Shanmugaratnam(paras 1b, 9f)AVA Minister-IN-CHARGE Lim Swee Say(paras 1b, 9e)MEWR Minister-IN-CHARGE Dr Yaacob Ibrahim(paras 1b, 8g, 10d, 10e)MOH Minister-IN-CHARGE Khaw Boon Wan(paras 1b, 8g, 12d, 13c, 14g, 15b)From: Mr See Leong KitPART A: RESPONSES SOUGHT FROM MINISTERS-IN-CHARGE1 (a) Pertinent Quotations:
--- "DPM Lee promises a more open Singapore"; "I don't make promises I can't keep: DPM Lee" [ST 7 Jan 04]
--- "We are OPEN AND TRANSPARENT...WE CANNOT HIDE what goes on in Singapore" --- DPM-designate Wong Kan Seng [ST 18 May 03]
--- "People don't vote for a politician for what good things he has done IN THE PAST. People will support the man for what he can do for them GOING FORWARD." --- PAP MP Ong Kian Min [ST 20 May 05]
(b) In keeping with PM Lee's much-publicised promise of "openness and inclusiveness", responses (as indicated in the respective paras) from the four respective Ministers-in-charge are sought as follows:
(i) This email (together with the Ministers' responses by the stated deadline) will be downloaded on the Internet to keep fellow Singaporeans FULLY INFORMED on various important public health issues. ( Indeed, a golden opportunity [ahead of the General Elections] for the Ministers to demonstrate their political calibre --- being ANSWERABLE and ACCOUNTABLE to the people)
(ii) Deadline for responses: 5 pm WED 29 Jun 05 (as per PS21 3-working day Response Directive)
(iii) The Ministers' responses to refer to this email, the numbered questions and be copied to ALL addressees herein (in the spirit of "openness").PART B: FOR THE RECORD2 (a) As a 57-year old tertiary-educated Singaporean, I am amongst the growing breed of "thinking citizens" who have overcome Singapore's pervasive "social cancer" [ie Fear of Speaking Up].Over the past 30 years, I have contributed often in newspaper letters page (mostly on issues of public health, public safety as well as education/social issues).I may not be a doctor, but on health issues, I am well read, well researched and speak with a STRONG SOCIAL CONVICTION.Why HEALTH issues? Because HEALTH is certainly more important than WEALTH !!!Of what use is all our WEALTH if we do not have the HEALTH to enjoy it? Or if our dear children were to die from some infectious disease or else contract the deadly/incurable AIDS disease through pre-marital sex?[ Having gone through a harrowing experience with cancer, PM Lee would readily see this point.](b) Following our 2003 SARS encounter, I had expended considerable time/effort in providing extensive/detailed feedback to PM Lee (copied other ministers) on various public health issues as well as such issues of public concern:(i) "needless deaths" of OUR precious schoolchildren through suicides.[From 1997 - 2001, 20 primary pupils have jumped to their deaths](ii) "senseless deaths" of OUR precious NS sons in peacetime training.[From 1994 - 2003, 37 training deaths/ over 3,000 injured]Pathetic Outcome --- for my feedback efforts, I was met with mostly DEAD SILENCE and INACTON over the past two years!The only positive response was Minister Khaw's acknowledgement of the health risks in the Chinese "Sharing Food" eating habit (highlighted in PART D below)PART C: COMPELLING ARGUMENTS IN FIGHTING DISEASE THREATS3 Why must we take disease threats seriously?(a) THE REALITY --- Like it or not, WE and our CHILDREN/GRANDCHILDREN are now living in "An Age of DEADLY viruses and DRUG-RESISTANT bacteria".(b) Disease Threats are DEFINITELY NOT "sensitive" political issues to be "hushed up", but life-and-death issues TO BE TACKLED HEAD-ON !(c) In tiny Singapore without natural resources, OUR PEOPLE is our only valuable national resource. And with our "procreation problem", the death of ANY Singaporean from such diseases is certainly ONE DEATH TOO MANY!(d) Infectious viruses/bacteria will infect (and kill) ANYONE in their path --- they DO NOT CARE for geographical boundaries, nationalities, race, language,religion, age,sex, social standing, etc.... i.e. whether you are a politician, bureaucrat or ordinary citizen.[ Former South African President Nelson Mandela's only son had recently died of AIDS. In 2003, even PM Lee's own mother had a "close call" with SARS at Singapore General Hospital.](e) Besides killing human beings (such as US and OUR CHILDREN), an infectious disease epidemic can decimate a country's ECONOMY (particularly its TOURISM INDUSTRY providing many jobs for the people).(f) It is INCREDIBLY NAIVE of any Singaporean "to hope or pray" we will be spared the various disease threats!WHY SINGAPORE IS VERY VULNERABLE:(i) we are an international air/sea hub --- serving MANY business/tourist travellers, who could "import" various viruses/bacteria.(ii) our tiny, densely-populated island with warm climate makes it easy for viruses/bacteria to spread quickly [in crowded home/office lifts, buses/MRT trains, schools, army camps, shopping centres,etc ].(g) Infectious/deadly viruses and bacteria pose a FIRST-LINE risk to our Health Care Workers (doctors/nurses) and subsequently to the MANY patients under their care (if "infection control" procedures are not strictly complied with).Also, if more of our (already in short supply) doctors/nurses were infected or die from deadly diseases, WHO is going to look after the many other sick patients?(h) MISPLACED PRIORITIES of Singapore politicians/bureaucrats:SO MUCH TALK about fighting TERRORISM.SIMILAR TALK on protecting/saving the ENVIRONMENT.BUT WHERE IS THE "OWNERSHIP & POLITICAL WILL" on "educating/preparing" the people to deal with disease threats [viruses/bacteria being very tiny/unseen "terrorists"] and possible "bio-terrorism" ???4 Our Worst Enemy in the fight against disease threats.It is SMUG INDIFFERENCE/ COMPLACENCY/ OVER-CONFIDENCE found in the following mindsets:(a) We know best (ie not taking feedback of concerned citizens seriously). We are First World, world-class, first-class, etc......It WON'T HAPPEN in Singapore. It WON'T HAPPEN to ME or MY CHILDREN.(b) At the political level, NATO (No Action,Talk Only) approach.At the bureaucratic level, SBDN (Sit Back,Do Nothing) approach --- being REACTIVE instead of PROACTIVE i.e. wait for "the sky to fall down" or for "tragedies to happen".(c) The "Hush Up" approach, using the misguided/lame excuse of "not wanting to cause public alarm".[ This is a well-entrenched pervasive mindset amongst MOH officials (ENV officials too) ]It is a MISGUIDED approach because if you keep the public in the dark, would not the UNINFORMED public panic even more???Our MOH, NEA, AVA officials certainly have much to learn from these enlightened words of an Australian doctor:"...... Governments have a DUTY & RESPONSIBILITY to FULLY and FRANKLY inform/educate the people about diseases, how they are spread and so on.An INFORMED people can then take the necessary preventive measures to protect THEMSELVES and their LOVED ONES....."[ Invaluable Lessons from the 2004 Tsunami Tragedy:(i) Expect the Unexpected. Be Prepared for the Worst.(ii) Practise "Worst-Case Scenario" Contingency Planning. ]5 JUSTIFIED PUBLIC ANGER and JUST RETRIBUTION for politicians/bureaucrats who "monkey around" with precious human lives in disease threats.Important Lessons --- HUMAN LIFE MUST ALWAYS COME FIRST. Human lives count more than balance sheets or national interests.(a) 2004 Thai Government Bird Flu Hush-Up/Cover-Up Scandal.The Nation editorial --- "....the government has been caught red-handed in lying to the people..."The Bangkok Post editorial --- ".... the government's efforts to SWEEP THE PROBLEM UNDER THE CARPET have EXPLODED IN ITS FACE, leaving the poultry industry in tatters and the very SAFETY OF THE PUBLIC in jeopardy..."The parents of the first Thai (a 6-year old boy) to die from Bird Flu VOWED TO SUE the government [with PM Thaksin as first plaintiff and his Cabinet the second plaintiff.]Mr Thaksin had admitted he had suspected "for a couple of weeks" that the disease had appeared in the kingom but kept it quiet for "fear of sparking mass panic".Boy's angry Father: "If the government had told us about the spread of bird flu, we would have protected our son."Boy's angry Mother: "I REGRET VOTING for Thaksin. I will NEVER FORGIVE them (the government) for this pain."(b) 1985 French Government AIDS Blood Hush-Up/Cover-Up Scandal.1,200 haemophiliac patients were infected (of which 300 have died) from Aids-tainted blood transfusions.It took one of the victims seven years to unravel a shocking account of OFFICIAL NEGLIGENCE and BUREAUCRATIC COVER-UP.In 1992, four officials in its Health Ministry were convicted in the scandal.The justifiably angry public was not satisfied.In 1994, former PRIME MINISTER Laurent Fabius and former HEALTH MINISTER Edmond Herve were next charged in court.6 Pertinent Quotations from Singapore's politicians/bureaucrats.(a) ".....we can always do BETTER if we try HARDER. We ALWAYS MUST try HARDER. Don't just do NATO (No Action,Talk Only)....." PM Lee Hsien Loong [5 May 05 CNA "Up Close" programme](b) "The Four Monkeys of Unresponsiveness --- SEE Nothing, HEAR Nothing, SAY Nothing, DO Nothing" [title of 2002 "pep-talk" speech by former Head of Civil Service Lim Siong Guan](c) PAP MP Lim Hwee Hua once rightly lamented civil servants' reluctance "to accept OWNERSHIP of problem situations" --- a polite reference to highly-paid senior bureacrats who shirk managerial responsibility and in unfairly "passing-the-buck" to lower-paid junior officials.".....So I see it more as a PUBLIC HEALTH issue, not a personal privacy issue. And THE GOVERNMENT IS ULTIMATELY RESPONSIBLE FOR PUBLIC HEALTH....." --- Minister-of-State Lim Hwee Hua [TNP 10 Apr 05](d) "....It is better to be a bit kiasu and over-react rather than under-react, because you never know what surprises await you --- a lesson learnt from the SARS outbreak.The other lesson is that it is better to be OPEN AND TRANSPARENT, and TELL PEOPLE WHAT'S GOING ON , whether good or bad, so that they will be BETTER PREPARED...." --- MND Minister Mah Bow Tan [ST 2 Feb 04](e) "In disease control, we CANNOT afford to have HALF-MEASURES" --- AVA CEO Dr Ngiam Tong Tau [ST 4 Jun 05]7 A Million-Dollar Question.As the popular saying goes, " TALK IS CHEAP ! So politicans/bureaucrats must WALK THE TALK to earn public credibility and respect."From the following revelations, will Singaporeans have faith/trust/confidence in their Government's ability to tackle disease threats???(a) 2003 EHI Laboratory SARS case Fiasco.Singapore became the "laughing stock" of the international medical community (first country in the whole world to have a SARS case contracted in a laboratory!).Former NEA Public Health Commissioner Wang Nan Chee displayed a deplorably "smug over-confidence" in his persistent denials that the SARS-infected NUS researcher could have picked up the infection at its "world-class" laboratory.He was proven wrong by the International Expert Panel, which also provided these very shocking findings. These VERY BASIC laboratory procedures (for a lab dealing in "live" viruses!) were ABSENT --- restricted access to the lab; proper records; wearing appropriate protective gear; using properly-sterilised equipment. [ Even a secondary school Chemistry teacher would be shocked!]At the televised Press Conference on the findings, both ENV Minister-in-charge Lim Swee Say and Wang were conspicuously absent.When interviewed by reporters the next day, Minister Lim finally offered his belated apology (one day late).This incident is certainly no small nor laughing matter.POSSIBLE DIRE CONSEQUENCES --- WHAT IF the SARS-infected NUS researcher is a "super-spreader" who then wander around the university campus to start new clusters of SARS infection amongst NUS students???[ Note: PM Lee's one precious daughter was then an NUS student.](b) 2004 Nicoll Highway Collapse Fiasco.Are these two incidents that were "WAITING TO HAPPEN"?
In 1993, at the Clementi Station, an MRT train crashed into a stationary train (156 people injured, some with severe "whip-lash" neck injuries).
DAMNING INDICTMENT of then Inquiry Panel --- ".....The seeds of the collision were actually sown FIVE YEARS AGO in 1988. The crash COULD HAVE BEEN AVOIDED but for a series of "errors of judgement, omissions of communication, lack of initiative, over-confidence in the automatic train protection system and a LACK OF A SENSE OF DANGER by groups and individuals prior to the collision........."
ELEVEN YEARS LATER, the past lessons have clearly not been learnt !!!
SAME DAMNING INDICTMENT in the 13 May 05 Final Report (Committee of Inquiry into the Nicoll Highway Collapse) --- the collapse of the section of MRT Circle Line and subsequent collapse of 100m of Nicoll Highway was a MAN-MADE DISASTER that COULD HAVE BEEN AVOIDED.
ST 14 May 05 front-page headline --- "Panel slams safety at worksite: RECKLESS, SLOPPY, INDIFFERENT"
TNP 14 May 05 report "So many warning signs, but....." --- FOUR lives could have been saved. FOUR families would not be grieving. IF ONLY the WARNING SIGNS had been taken more SERIOUSLY. But they went UNHEEDED. Only simple patch-ups were done.
Again, this incident is no small nor laughing matter.
POSSIBLE HORRENDOUS CONSEQUENCES --- WHAT IF the design/construction faults manifest themselves only AFTER the project was completed? Say, during peak hour traffic, the collapse occur. ABOVE GROUND, many cars and crowded buses plunge into a big gaping hole along Nicoll Highway. BELOW GROUND, many MRT commuters suffer the terrible fate of being "entombed" to death. Total Death Toll in the hundreds, thousands???PART D: THE "SHARING FOOD" ISSUE8(a) "Sharing Food" --- refers to the traditional Chinese eating habit of dipping chopsticks and spoons into a common dish.Because it is such an ingrained habit, VERY FEW Chinese Singaporeans are "aware/conscious" of the "associated health risks" ( IN THIS AGE of emerging/re-emerging infectious diseases).(b) Way back in 1994 (10 YEARS AGO! ), in its little-known Health Educator publication, our Health Ministry had:(i) CONFIRMED that through sharing food, "we are likely to share SALIVA as well, with any bacteria or viruses in it".(ii) RECOMMENDED the use of serving spoons, separate soup bowls and sauce dishes --- in both the HOME SETTING and in PUBLIC EATING PLACES (eg restaurants, hawker centres).MOST REGRETTABLY, this very important public health message was NEVER communicated nor publicised to the GENERAL PUBLIC!IN FACT, 5 years earlier (since 1989), myself and a few other concerned S'poreans have highlighted the health risks in STForum pages.Indeed, I had persisted over the past 15 LONG YEARS pursuing this issue publicly MANY TIMES --- BUT EACH TIME, the laid-back MOH/ENV officials would use all sorts of lame excuses to "dodge the issue" [even despite my mentioning (b) above!](c) There is actually a LONG LIST of viruses/bacteria that can be transmitted by SALIVA (ie saliva-borne). TO NAME JUST A FEW:VIRUSES --- common cold*, human influenza*, SARS*, HFMD*,Hepatitis B (liver cancer), Epstein-Barr (nose cancer)BACTERIA --- Tuberculosis*, Meningitis*, H.Pylori (stomach cancer)[ *also spread through sneeze/cough droplets ]This is a possible "chain of transmission" in the spread of infectious diseases:Mr X unknowingly picks up (say, a flu virus*) through sharing food at a business lunch.At home, during dinner, he unknowingly pass on the flu virus (again through sharing food) to his wife and child.Next day, his wife pass on the flu virus (through sneezing or sharing food) to her office colleagues and his child do the same (through sneezing) to other school children.[ *Ditto for the VARIOUS OTHER saliva-borne viruses/bacteria mentioned above.](d) LONG BEFORE the emergence of various "exotic" viruses/bacteria, Asian mothers would feed their babies "like birds" i.e. first chew the food in her mouth till soft, then regurgitate into spoon to feed her baby.BUT NOW, any mother would be utterly stupid to follow this "tradition" because if she has a sore throat or cold or flu, she could pass on the relevant bacteria/viruses through her saliva --- which could then kill her very own baby right before her very eyes!(e) NOTABLE FACT: Some 80% (or 240 million) of the world's over 300 million Hepatitis B carriers are Chinese --- an attributed cause being the Chinese "sharing food" eating habit [as Hepatitis B can be spread through saliva].(f) Although "sharing food" is a mainly Chinese eating habit, this issue concerns ALL SINGAPOREANS.WHY? SIMPLE ANSWER --- Consider the various diseases that can be transmitted by coughing/sneezing and by saliva (eg common cold, human flu, SARS, HFMD, Tuberculosis, Meningitis )If more Chinese Singaporeans were to contract the above diseases [through either coughing/sneezing or sharing food], this will certainly pose a higher risk [through coughing/sneezing in crowded situations] for fellow Malay/Indian/Eurasian Singaporeans.(g) SIMPLE TWO-PRONG APPROACH to fight VARIOUS "saliva-borne" infectious diseases:(i) Health Promotion Board (HPB) to carry out an aggressive/effective TV/press campaign to EDUCATE S'poreans to "EAT THE HYGIENIC WAY" with serving spoons/separate crockery.(ii) National Environment Agency (NEA) [ through using its licensing clout ] to immediately issue a COMPULSORY DIRECTIVE to hawkers/restaurants to provide serving spoons/separate crockery as a ROUTINE HYGIENIC PRACTICE (i.e. automatically [without being asked by patrons], as practised by Chinese restaurants in Australia,Canada,US,UK. Currently, in MOST Singapore restaurants, it is a "constant hassle" asking sulky staff to provide serving spoons for each common dish!!!)[ COMPELLING ARGUMENT: Besides protecting PUBLIC HEALTH, such a simple directive will also boost our TOURISM INDUSTRY in promoting Singapore as a "Food Paradise".From ST 14.7.03 "Post-SARS Asia to give tourism a booster shot" --- At a Beijing conference, delegates from China, Hong Kong, Macau, South Korea, Malaysia, Philippines, Thailand and SINGAPORE (STB rep Edmund Chua) agreed that serving spoons/chopsticks and cutlery MUST be provided at EVERY table (to boost tourist confidence).From ST 16.2.04 --- Acting Health Minister Khaw Boon Wan said "There is nothing wrong with COMMUNAL EATING.... But I think we can make it HYGIENIC just by using serving spoons", adding that RESTAURANTS and HAWKERS should make it a "standard operating procedure" to provide diners with serving spoons.]>>> Comments & Question 1/5 (for Minister Khaw):-- In healthcare, PREVENTION is definitely better (and cheaper) than CURE! The "sharing food" issue is about "preventive medicine" i.e. how to avoid contracting deadly viruses/bacteria through sharing food and passing on same to loved ones AND ALSO to other fellow S'poreans.-- Following my 15.10.03 letter to PM Lee (copied you) on this issue, you replied to formally "re-confirm" para 8(b) above and "directed" the HPB CEO to follow up on the press/TV education campaign.20 MONTHS have since passed with the HPB featuring only a couple of "sedate" newspaper adverts (but no "eye-catching/effective" TV adverts -- WHICH IS WHY some 98% of Chinese S'poreans are STILL "uneducated/ignorant" of the sharing food health risks!)[ So much for the HPB's "half-hearted/ineffective" efforts! Yet, in 19.4.05 Parliament Debate on Integrated Resorts, you have urged the Institute of Mental Health not to be "half-hearted" about treating gambling addicts. Gambling addiction concerns only a small group of people, BUT the sharing food issue concerns ALL S'poreans as per para 8(f) above.]-- As Minister-IN-CHARGE of our Health Ministry, you certainly have the OVERALL/ OVERRIDING AUTHORITY to "direct" the new HPB CEO Lam Pin Woon to proceed RIGHTAWAY (Be Prepared/No Time To Lose in fighting potential disease threats!) with a "full-hearted/effective" press-cum-TV advert campaign (as was done for the Depression/Breast Cancer/Healthy Teeth campaigns).Minister Khaw, will you be doing so? If not, please explain fully WHY NOT?>>> Question 1/3 (for Minister Yaacob):Likewise, will you be "directing" NEA Director-General of Public Health Khoo Seow Poh to issue RIGHTAWAY the SIMPLE/COMPULSORY DIRECTIVE in para 8(g)(ii) above? If not, please explain fully WHY NOT? (especially when such a move will help boost tourism in creating tourism-related jobs for our people!).[ Note: To keep our public fully informed (so that they can subsequently help the NEA in enforcement ), the directive should be publicised in the media and be posted on the NEA website (as per AVA's commendable practice of posting all its public circulars on the AVA website) ]PART E: DISEASES OF CONCERN TO SINGAPORE9 SARS AND BIRD FLU(a) WHY should we be concerned? SARS, Bird Flu and the normal Human Flu are all "respiratory diseases" --- which can lead to severe breathing problems and pneumonia.[ A human being can live without food or water for several days. BUT if he cannot breathe i.e.no oxygen going to his brain, HE JUST DIE! ]NOTE: Being respiratory diseases, all three can be transmitted by sneezing/coughing and also by SALIVA ("sharing food').(b) See how, in 2003, the SARS virus emerged from China and QUICKLY SPREAD (via rapid air travel) to 30 countries [total 8,400 infected/ 800 dead].(c) Has SARS completely vanished? UNLIKELY --- it may be lurking somewhere. So Singapore CANNOT and MUST NOT let its guard down! SARS MAY YET RETURN.(d) Our 2003 SARS Outbreak [ 238 infected/ 33 deaths]:(i) We were DAMN LUCKY in that, THIS FIRST TIME, the disease was largely confined to the healthcare setting --- so most victims were HCWs (healthcare workers ie nurses/doctors).THE NEXT TIME, if the virus spreads to the WIDER COMMUNITY through a combination of Coughing/Sneezing AND Sharing Food, it would be "near impossible" to contain the disease!(ii) Beneath the seemingly calm exterior, there was underlying panic and under-estimation of the threat:01.03.03 Victim No 1 hospitalised at TTSH.12.03.03 WHO global alert on "atypical pneumonia".15.03.03 WHO named new disease as SARS. 16 infected to-date.18.03.03 21 infected (still early days)Amazingly, an over-confident Health Minister Lim Hng Khiang told Parliament: "It will require us another 10-14 days, before we can declare 'all clear' if all things go well". He also said there was NO CAUSE FOR ALARM (when this was just the BEGINNING of the outbreak !!!)30.05.03 Singapore taken off WHO SARS list. [Final tally 238 infected/ 33 deaths](iii) On extending the closure of schools, I had to send then Education Minister Teo Chee Hean my 3 Apr 03 email to remind him thus --- "The LIVES OF OUR CHILDREN are DEFINITELY MORE IMPORTANT than the unavoidable disruption to curriculum, examinations and holiday plans. With this new and little-known killer SARS virus, it is DOWNRIGHT SENSIBLE to err on the side of caution."(iv) A 40-something SARS victim in S'pore went into a lengthy coma, almost died, then survived (but alas, with 20% of her lungs permanently damaged. In time to come, she may feel increasingly breathless doing simple housework or climbing a few stairs).Several SARS survivors in Hong Kong went on to develop a form of bone disease --- said to be a side-effect of the steroid medication used to treat SARS.(e) BIRD FLU (70% fatality rate) is even deadlier than SARS (30% fatality rate).Big Worry: the H5N1 bird flu virus has (since Dec 2003) infected 97 HUMAN BEINGS in IndoChina, with 54 deaths [ 38 Vietnam,12 Thailand,4 Cambodia] indicating:(i) the virus is already endemic (entrenched) in IndoChina.(ii) it is killing more human beings.(iii) all signs point to greater human-to-human transmission.Even Bigger Worry: the bird flu virus will most likely be also endemic in the large/populous country of China (with many large areas frequented by migratory birds carrying the virus). [Recent reports of birds infected with H5N1: more than 1,000 migratory birds dead in Qinghai; in nearby Xinjiang, 1,042 geese at a farm infected, with 460 dead.]Yet another potential Bird Flu "hot spot" --- OUR NEIGHBOUR Indonesia.[ Stark Warning from WHO --- Within a few months of an H5N1 bird flu pandemic, 30 MILLION people could be hospitalised [of which 7 MILLION expected to die], with BILLIONS of dollars in economic damage.]>>> Question 1/1 (for Minister Lim Swee Say):(i) What contingency "worst-case scenario" action plans does the AVA have in place to deal with a Bird Flu outbreak in Singapore?(ii) Why such a "half-measure" --- "Ban on all live poultry in Ubin" (TODAY 4.6.05) but "...chickens on mainland Singapore still run free" (TODAY 6.6.05) eg East Coast seafood centre, Adelphi Park off Upper Thomson Rd?(f) From my 16/3/05 TODAY published letter "Unwise to put pupils at risk":In 2004, 69 Singapore schools did "community work" overseas.In Nov 2004, 6 teachers and 10 students from Choa Chu Kang Primary School spent a week helping out in an orphanage in Vietnam (around that time, Vietnam was having its major bird flu outbreak!)Whatever the good intentions, the trip was "an incredibly stupid idea"!The teachers/students were putting themselves at risk of contracting bird flu AND PASSING ON THE INFECTION to fellow citizens/teachers/students upon returning to Singapore.[ In my 28/3/05 email to MOE Perm Sec Lieutenant-General Lim Chuan Poh, I had specifically asked him to furnish a public reply to "assure concerned parents", but he did not bother to do so and chose to maintain a DEAD SILENCE.]>>> Question 1/1 (for Minister Tharman) --- What measures do the Education Ministry have in place to prevent a recurrence of such "incredibly foolhardy" overseas school trips?[ THINK (IBM slogan) --- Would YOU send your own precious children on such a trip?If any teacher/student in that trip were to contract and die of Bird Flu, how are YOU going to answer to the grief-stricken family members? ]10 DENGUE(a) Two types --- Dengue Fever (with 4 strains of virus) and the more deadly Dengue Haemorrhagic Fever (internal organs bleed/potentially fatal).(b) FEW S'poreans know these FACTS:--- Since 2003, 10 people here have died from Dengue.--- HDB/private flats are just as prone to dengue outbreaks as landed homes.--- Severe cases may require blood transfusions (with an attendant AIDS risk, which can NEVER BE ZERO -- see para 16(f) below)--- Both young and old people are vulnerable [ In one Yishun outbreak, a 2-year old infant and a 68-year old woman were both hospitalised]--- The year-end mosquito breeding season coincides with important year-end school/university exams. [An 18-year old DHF victim had to sit for his important A-level exams in a hospital, with his performance naturally affected by the ordeal](c) DO NOT EVER ASSUME these large-scale dengue outbreaks CANNOT happen in tiny densely-populated Singapore:(i) Mar 2003 Indonesia Dengue Outbreak[ over 50,000 infected/ over 500 dead (mostly children)](ii) May 2005 Thailand Dengue Outbreak[ 7,000 infected(mostly children under 9 years), 16 dead so far](d) Feb 2004 --- NEA announced its Mozzie Buster programme to get primary students (initial target: 2,000 students) to seek out "potential mosquito breeding sites"!!!Yet another "incredibly stupid idea" ---coming from former NEA Public Health Commissioner Wang Nan Chee --- as this would expose the students to the risk of being bitten by mosquitoes and contracting DF/DHF.Interesting Question: WHY didn't ANYBODY in both NEA and MOE (who allowed the scheme to be introduced in schools) EVER GIVE A THOUGHT to such risks for the students?[ Some years ago, an 8-year old schoolgirl had died of dengue. Recently, a 10-year old schoolboy also died of dengue.]>>> Question 2/3 (for Minister Yaacob) --- I had previously written extensively to your predecessor Lim Swee Say (who did not respond) to have the scheme scrapped rightaway to safeguard the health of our school children.I now seek the following answers from you: Has the Mozzie Buster scheme for students been scrapped? If so, indicate when it was scrapped. If not, please explain fully WHY NOT?[ THINK (IBM slogan) --- If your own children were in primary school, would YOU allow them to participate in such a stupid/foolhardy scheme?](e) There are still many older HDB/private flats installed with sloping bamboo-pole holders which can harbour stagnant rain water --- and so breed mosquitoes (VERY FEW S'poreans know this).NEA's Dengue public education programme SHOULD thus be:(i) PRIMARY Objective --- Make use of TELEVISION to EDUCATE as MANY people as possible (to QUICKLY "prepare" the people to handle a possible large-scale outbreak).Show on TELEVISION a homeowner or maid carrying out ALL the various simple measures to prevent mosquito-breeding in homes eg covering up bamboo pole holders, overturning pails,etc,etc ["monkey see, monkey do"](ii) SECONDARY Objective --- Next, carry on with its "grassroots approach" to "reinforce" the messages in the TV education programme. If NEA just do this "time-consuming" approach (as currently), by the time it finish going around the numerous grassroot bodies, many S'poreans (including possibly our politicians/bureaucrats!) may have already died of Dengue!!!>>> Question 3/3 (for Minister Yaacob) --- Are you going to direct current NEA Public Health Commissioner Khoo Seow Poh to undertake approach (i) RIGHTAWAY (no time to lose, as we had big spike in dengue cases early this year)? If not, please explain fully WHY NOT?11 HAND,FOOT & MOUTH DISEASE (HFMD)(a) HFMD is caused by various members of the Enteroviruses group, commonest being the "milder" Coxsackie virus (CA 16) and the "deadlier" Enterovirus 71 (EV 71).While HFMD is usually mild and self-limiting, SERIOUS COMPLICATIONS (involving the lung/brain/heart/nervous system) CAN OCCUR. Each year, about 180 children with HFMD have to be hospitalised.NOTE: HFMD can be transmitted by respiratory droplets(sneezing/coughing) and saliva("Sharing Food").Children (under 10-years, mostly pre-school) have the highest risk.BUT few people know this --- ADULTS can also contract HFMD, and pass on to their children (through close contact and "sharing food").(b) Our 2000 HFMD Outbreak Fiasco.[ some 4,000 infected/ 7 young children dead ]The 1997 Sarawak and 1998 Taiwan HFMD epidemics showed this contagious disease could spread quickly to large numbers of young children. (But, alas, our ENV/MOH officials didn't pick up the lessons.)ENV Public Health Commissioner Wang Nan Chee was then Chairman of the HFMD Task Force. He was caught napping, slow to react and his deplorable "smug complacency" were revealed through these burning questions:(i) WHY did he not adopt the PRO-ACTIVE APPROACH of making the disease LEGALLY NOTIFIABLE when the Task Force was set up in 1998?[ Doing so would have enabled it to track cases, anticipate an impending epidemic with more time to alert parents/childcare operators.](ii) WHY WAIT until the death of a 2-year old toddler on Sep 10 to annouce making it notifiable as from Oct 1, and not rightaway?[ Anyway, for the 20 days after this was done, some 2,200 cases were notified --- confirming that an epidemic was ALREADY AT HAND!!! ](iii) WHY WAIT until the deaths of two siblings* on Sep 30 to HASTILY announce the SUDDEN closure of childcare centres in a BELATED bid to halt the growing epidemic?[ *All three children in one family came down with HFMD, with a 2-year old brother and 14-month old sister dying within hours of each other. Altogether, 7 young children died in this outbreak.][ Note: In the above 2000 HFMD fiasco, senior civil servant Wang Nan Chee had demonstrated a deplorable "smug complacency". In the 2003 EHI laboratory SARS case fiasco (para 7(a) above), he demonstrated an equally deplorable "smug over-confidence". And in 2004, he was behind the incredibly stupid NEA Mozzie Buster scheme for primary students (para 10(d)above).](c) Our 2005 HFMD Epidemic Hush-Up.[7,500 children infected over first five months](i) What actually transpired:By 12 March 2005, MOH had recorded a surge of 2,532 HFMD cases (vs 6,411 and 5,457 cases for the whole of 2004 and 2003 respectively).[ Unity Primary School had 27 cases, affecting all levels from Pri 1 to Pri 6.]MOH officials in the know had "kept quiet" about this (typical excuse: fear of causing public alarm).BECAUSE OF THIS SILENCE, many unaware/uninformed young S'pore couples [first-time parents] were worried sick when their young children came down with HFMD --- thinking it could be the return of SARS.(HOW PATHETIC --- left hand don't know what right hand is doing! MCYS exhorting young couples to have more children, but MOH not doing its part to help allay the worries/fears of these young couples with HFMD-infected children!)Following numerous calls to the MediaCorp Hotline from worried parents, it was a TODAY reporter who took the initiative to approach a "nameless/faceless" MOH junior official (from the Corporate Communications dept) --- the latter then tried to "downplay" the matter saying the current strain of HFMD virus as mild, unlike the virulent 2000 outbreak! ( HOW COMPLACENT --- what if the more deadly strain were to appear next???)And HOW IRONIC --- it was only AFTER the epidemic had died down, that another "nameless MOH spokesman" spoke at length about the epidemic, indicating that for the first five months of 2005, more than 7,500 children contracted HFMD, surpassing the 2004 total of 6,411. ["Hand, foot and mouth epidemic ending:MOH" ST 4.6.05](ii) How MOH officials can do better in handling such outbreaks (to earn public trust/confidence):--- DON'T JUST KEEP QUIET! (which is as IRRESPONSIBLE as what China did when SARS first appeared there). As soon as the surge in cases is detected, MOH to issue a press release to "alert" and "educate" parents on what is HFMD, what symptoms to look for [show pictures on TV or MOH website], when to hospitalise children (to prevent possible complications), etc,etc.--- MOH's Communicable Diseases Division has at least 5 "manager-level" doctors (the addressees indicated at end of this email). For public credibility/confidence, the press release should be issued in the name of any of these doctors i.e. no passing-of-the-buck to Corp Comm junior officials! (News reporters can then approach the doctor DIRECTLY for any clarifications or more information. Going through a third party can lead to "confusion/misinformation"!)This is the true meaning behind "HELPING/SERVING" THE PEOPLE!!!12 TUBERCULOSIS(a) Tuberculosis (TB) is caused by the bacteria "mycobacterium tuberculosis". It is a highly-contagious "air-borne" disease (i.e. spread through the air).NOTE: This disease is spread through airborne droplets (sneezing/coughing) and through saliva ("sharing food").FEW PEOPLE KNOW THIS --- While TB mostly affect the lungs, it can spread to many other parts of the body (eg brain, heart, bones and even the WOMB [reproductive organ of female victims])Once thought eradicated (the "forgotten disease"), TB has ALREADY made a COMEBACK WORLD-WIDE (incl Singapore) due to two factors:(i) the emergence of drug-resistant strains (i.e MDRTB for Multiple Drug Resistant Tuberculosis )(ii) the growing world-wide AIDS epidemic (most AIDS victims go on to develop TB)[ Note: (i) Increasing AIDS cases in our surrounding large/populous neighbours China/India/Indonesia will lead to increasing TB cases --- which means likely more "imported" TB cases for Singapore (leisure/business travel hub) despite our declining "local" TB cases.(ii) While AIDS is contracted mostly through sex, TB is a highly-contagious airborne disease that is easily spread in TINY DENSELY-POPULATED Singapore.So, NO ROOM FOR COMPLACENCY by MOH officials, who MUST take TB cases VERY SERIOUSLY! ](b) Previously, TB affected mostly elderly people. BUT NOW, TB is afflicting more younger Singaporeans, as in these victims:--- 21-year old NSman (risk to fellow NSmen in crowded army camp)--- 30-year old teacher (risk to fellow teachers/students in crowded school)--- 40-year old Managing Director (risk to workplace colleagues)(c) Two types of Tuberculosis-infected victims:(i) "active" TB --- where the TB germs are actively multiplying/spreading and damaging organs or other parts of the body. People with "active" TB are capable of spreading the disease to others.[ Note: From HPB website, the risk of developing active TB disease is higher in certain groups of people, such as CHILDREN.](ii) "latent" TB --- where the TB germs lie "dormant" in the lungs, so the infection does not progress (to be passed on to others).HOWEVER, the TB germs can be "reactivated" AT ANY LATER TIME (ie cannot be predicted) if the victim's immunity is reduced/weakened (by, say, stress [exam-related/work-related]; some other illness; old age; etc). When this happens, he can then infect others.(d) Two recent incidents of TB cases in our schools (Hush-Up approach by MOH/MOE officials):(i) Case 1 --- [ No press release from MOH or MOE. Hence, not reported by ST, TODAY, CNA TV. Thus, most S'poreans not aware! Was only reported in afternoon tabloid 20.4.05 New Paper.]Right after Chinese New Year (Feb 2005), a teacher in (unnamed) PRIMARY SCHOOL had persistent cough and was diagnosed with TB.Principal sent 38 students/ 12 teachers to TB Control Unit for testing.Outcome: TB germs were passed on to 5 students/ 3 teachers (tested positive for "latent" TB infection. The 3 teachers were placed on preventive medication.)(ii) Case 2 --- [Again, no press release from MOH or MOE. Not reported by ST and TODAY newspapers, but mentioned in passing by CNA TV on 25.4.05. Once again, most S'poreans not aware!]A secondary 3 student from an (unnamed) SECONDARY SCHOOL found to have TB. [ An "imported TB case" -- this student, a Chinese national, joined the school this year. He has since returned to China.]Some 70 students/ 10 teachers, who have been in contact with the boy, sent for screening. 5 persons (no breakdown given between students/teachers) found to be infected with "latent" TB.[ Commentary: MOH/MOE officials MUST put an IMMEDIATE STOP to such "hush-up" mentality/approaches and henceforth be "open/transparent" in the fight against deadly/infectious diseases!Learn from how Anglo-Chinese School handled the May 2005 case of a male teacher accused of molesting several students.Instead of a "hush-up" approach, ACS Board of Governors Chairman Tan Wah Tong issued a PRESS STATEMENT (to "assure" concerned parents and to "pre-empt" wild rumours) explaining the Education Ministry had been informed and the teacher would be on leave pending outcome of detailed investigations.]>>> Comments & Question 2/5 (for Minister Khaw):-- THINK (IBM slogan). WHAT IF one of your daughters is in the "affected" class of one of the schools mentioned above. WHAT steps/measures would you introduce to protect your precious daughter (as well as the equally-precious children of other S'poreans!) from the "highly-contagious" TB infection.-- TB is certainly no laughing matter, considering the "multiplier effect" in its transmission i.e just ONE infected teacher/student can quickly pass on the airborne TB germs to MANY other teachers/students, who then go home to pass on the infection to OTHER family members.-- The above two cases are likely just the "tip of the iceberg". In our economy-boosting move to encourage more foreign students to study here, MOH had better gear itself for possible more "imported" TB cases (as in Case 2).If foreign domestic maids are screened for AIDS/TB infections, will MOH follow suit for foreign students?-- These are cases of an infectious disease (TB) found in a school setting. So, MOH has the PRIMARY RESPONSIBILITY in "taking charge and advising" the clueless Education Ministry officials on what to do, the Standard Operating Procedure for future cases, etc,etc. to "break the chain of disease transmission as quickly as possible".So, WHAT is the MOH doing in ENSURING TB-infected (both active and latent) teachers/students are given the necessary drug medication [ under Directly Observed Therapy] to completely kill off the TB germs (so as not to pose ANY FURTHER RISK to other students/teachers?13 MENINGOCOCCAL DISEASE (MENINGITIS)(a) Caused by the meningococcus bacteria "Neisseria meningitidis" (various strains: A,B,C,W135,Y).The infection can affect the membranes of the brain ("meningococcal meningitis") or lead to blood poisoning ("meningococcal septicaemia").NOTE: The bacteria is transmitted from person to person through close contact via droplets from nose/throat secretions i.e. sneezing/coughing and by saliva ("sharing food").NO FOOLING AROUND with this potentially fatal disease (high fatality rate) --- death can OCCUR QUICKLY WITHIN 48 HOURS of infection!So, outbreak control strategy lies in EARLY DIAGNOSIS and PROMPT TREATMENT (with antibiotics).(b) Meningitis used to be "rare" in Singapore in the past, but more cases are surfacing in recent years. Some reported cases involving S'poreans both at home and [abroad]:--- 1996 [London]. Dr Linda Hoon (39, married with one 3-year old son), administrator of SGH Medical Board died from meningitis. She had just graduated with a Master's degree in hospital administration.--- 1999 & 2002. Two NSmen died from meninigitis (risks to fellow NSmen in crowded army camps). Possible delayed diagnosis/treatment by army doctors?--- 2000 [Melbourne]. S'porean Indian teenager studying there contracted meningitis (caused by tuberculosis bacteria). Didn't die but ended up a comatose "bed-ridden vegetable".--- 2001. In separate cases, two kindergarten teachers died of meningitis (risks to the many young children under their care).Two-year old only son of a young couple here was hospitalised for some 3 months with meningitis. Didn't die but suffered permanent brain damage.Two S'poreans (who came into contact with Haj pilgrims returning from Saudi Arabia) were infected with meningitis --- one died, the other recovered.(c) May 2005 New Delhi Meningitis Outbreak (in NEARBY India).--- Outbreak started in beginning of May 2005. By mid-June, some 405 infected with 48 deaths (mostly under age 30). [ 20 years ago, a meningitis outbreak in India had claimed 800 lives.][ In early 2005, in China, bacterial meningitis claimed 16 lives among 258 people infected.]--- Yet again, in typical "hush-up" fashion, our MOH officials sat quietly on the sidelines (although the Indian capital New Delhi is a popular destination for MANY Singapore visitors/businessmen).Taking the "hush up" cue from MOH, our two pro-PAP main newspapers (ST and TODAY) did not bother to report the outbreak until mid-May. So, most S'poreans were unaware of this Indian outbreak.--- How MOH officials can do better (to earn public trust/confidence):DON'T JUST KEEP QUIET but issue a formal press release on the outbreak to "alert" potential S'pore travellers to New Delhi (explaining what is meningitis,its symptoms and why this disease can cause QUICK DEATHS).This way, our pro-PAP media will be "obligated" to publish the contents of the press release.And S'poreans can then make an INFORMED DECISION to postpone "non-essential" travel to New Delhi (hence avoid contracting the deadly bacteria and bringing same back to S'pore and INFECTING OTHERS, right???)>>> Question 3/5 (for Minister Khaw): Will you be getting MOH officials to henceforth adopt the above "serving/helping the people" mindset as a Standard Operating Procedure for deadly/infectious diseases?14 DRUG-RESISTANT BACTERIA ("SUPERBUGS") --- MRSA & VRE.(a) MRSA (Methicillin-Resistant Staphylococcus Aureus) refers to the Staphylococcus Aureus bacteria which has become resistant to the powerful antibiotic Methicillin.VRE (Vancomycin-Resistant Enterococci) refers to the Enterococci bacteria which has become resistant to the very powerful/expensive antibiotic Vancomycin [a "last line of defence" antibiotic].(b) In Britain, MRSA is a major problem (and even became an "election issue") in their hospitals [causing some 5,000 deaths every year].In the United States, MRSA has already spread BEYOND HOSPITALS to the WIDER COMMUNITY [e.g. kindergarten children, school athletes, military recruits]. Hence the distinction "hospital-acquired MRSA" and "community-acquired MRSA".(c) MRSA and VRE are normally hospital-acquired infections that are both WORRYING and IRONIC --- because a sick person enters a hospital to be cured of his sickness and certainly NOT to pick up another (secondary/hospital-based) infection, that could well kill him [due to his already weakened immunity from the original sickness!].(d) ST 13.4.05 report "Saved from cancer, almost killed by bug":Madam Huang,70, went to a public hospital in Dec 2001 to have a cancerous tumour removed.Her single operation turned into a six-month ordeal (four months in intensive care) after she contracted MRSA at the hospital.The bacteria spread to her lungs/liver/kidney. She developed pneumonia and bedsores --- placed on ventilator; undergone kidney dialysis.At one point, almost didn't make it. But recovered/discharged in Jun 2002.Total hospital bill came to $80,000 (of which $70,000 was due to the MRSA infection!!!)(e) 1992 MRSA Outbreak in Toa Payoh Hospital (over 100 infected/ 12 dead)An attempted cover-up --- there was no MOH press release on such an important public health concern [ Don't S'poreans have the RIGHT TO KNOW???].The public FINALLY found out from a 22 Feb 93 ST report by a "journalist whistle-blower with a social conscience".(f) 2005 VRE Outbreak at Singapore General Hospital.01.04.05 Prior to this date, numerous calls by the public to MediaCorp Hotline regarding "circulating rumours" about SARS re-emerging or some kind of flesh-eating bug surfacing in SGH. When FINALLY confronted by the media, SGH revealed 15 patients had been found with VRE since March 9 (ie THREE WEEKS AGO). SGH will be postponing surgeries, adding there is "little cause for alarm".03.04.05 MOH Minister Khaw said VRE is not a "major problem" in Singapore, BUT has the potential to be "very serious" if it becomes entrenched in hospitals, as has happened in the U.S.04.04.05 SGH now said 42 patients had VRE (nearly three times the number the hospital announced on April 1)18.04.05 Minister Khaw told Parliament that altogether 93* SGH patients have so far been identified to have VRE (with three found to be infected).[ * Final Tally 141 carriers(4 infected). This high number points to "sloppy" infection control practices by SGH staff (who seem to have forgotten our SARS encounter!). ST 25.6.05 report "Tough bug that hit SGH shows up at 2 other hospitals" (ie NUH and TTSH).][ For the layman --- "Infection Control" refers to procedures/practices to prevent "cross-infection" between patients/doctors/nurses eg proper handwashing, use of disposable gloves and other disposable items, etc](g) A MAIN CAUSE behind the emergence of "superbugs" --- mis-use/over-use of antibiotics.Ways to fight "superbugs":(i) STRICT COMPLIANCE by HealthCare Workers (doctors/nurses) of INFECTION CONTROL procedures.(ii) WIDESPREAD USE of disposable "one-time use" items (wherever available). [ IMPORTANT ADVICE for our hospitals --- for affordable healthcare, "cut costs" in other areas BUT NEVER NEVER on disposable items !!! (penny wise, pound foolish)]>>> Question 4/5 (for Minister Khaw):(i) VRSA (an even deadlier cousin of MRSA) have surfaced in Hong Kong, Taiwan, Japan, Australia. What about Singapore?(ii) MOST doctors here don't seem to bother (too busy or no time?) reminding patients to "complete the full course of antibiotics". The FEW who do so often leave out the important part of explaining WHY to the patient.What is the MOH going to do about this "sorry state of affairs"?(iii) In a hospital's "fast-pace environment", sloppy infection control can easily become widespread. What measures/penalties/disincentives will MOH be implementing (for BOTH public/private hospitals) to inculcate STRICT COMPLIANCE WITH INFECTION CONTROL PROCEDURES by HCWs?15 POLIO(a) Once thought heading for total eradication, Polio is a highly infectious disease caused by the poliovirus (which invades the nervous system and causes paralysis).(b) Re-emergence of polio in Indonesia (our neighbour). In May 2005, see how an African strain of the po
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