Monday, December 2, 2013
“How to stop corruption like that?”
Saturday, October 12, 2013
Accidental lessons
The sickness of our private healthcare services
“If I keep this oath faithfully, may I enjoy my life and practise my art, respected by all humanity and in all times; but if I swerve from it or violate it, may the reverse be my life.”
– The Hippocratic Oath
Mary was entering her mid-thirties when it finally dawned on her that she is reproductively challenged. The thought of her own infertility did play in her mind when she was much younger but her suspicion was only confirmed recently when she was diagnosed for polycystic ovarian syndrome (POS). The strange thing was, the diagnosis did not come from her fertility doctor, who had then been too eager to start her and her husband on the notoriously expensive and invasive in vitro treatment, without first examining their health.
The diagnosis for POS had come up through her own initiative. Once she and her husband decided that they would try to conceive through artificial insemination, Mary thought it would be prudent to go through a full medical check-up, “just to make sure my body is ready for the baby, you know. We’ve read that in vitro is very stressful and we want to make sure that we’ve tried everything possible to make sure that the conditions are conducive,” she said.
When her blood work came back, her thyroid function tests were elevated. Later, it was her endocrinologist who told her that in addition to hypothyroidism, she might be suffering from POS too. He told her that the sudden and continuous weight gain, increased cholesterol level, development of fatty liver, irregular menstruation, and acne are some of the symptoms of POS.
Mary had initially thought that these symptoms were attributed to her bad eating habits and sedentary lifestyle but it now explains why these unflattering conditions remain unchanged even after her vigorous attempts to eat and exercise better.
“The funny thing is, no one told me about it. The GP (General Practitioner) at the hospital where I did the full medical check-up did not alert me to anything after he examined my test results. All he did was to make me feel bad about my weight and asked me to take another test in three months’ time to see whether there are any changes to my thyroid functions. All this while, I had been wondering why I’ve been battling bad skin and weight gain. If only I had known earlier, I would have been less depressed and feeling hopeless all the time,” Mary said.
“You have most of the POS symptoms. Go home and do a search online. Read up and learn as much as possible about POS and then go see a gynaecologist to seek treatment. You need to solve all this hormonal issue first before you even try to get pregnant. There are other options before you start considering in vitro. Let’s get you fixed up first, ok?”
That was the most honest and reassuring conversation Mary have had with a doctor so far.
After reading up on hypothyroidism and POS on the Internet, Mary discovered that the chances of having a problematic pregnancy would have been high if she had become pregnant either through natural or artificial means. She confessed that much to her disappointment and great horror, she felt that the renowned fertility specialist she saw at a highly recommended infertility clinic in Kuala Lumpur should have informed her of this vital piece of information.
Mary and her husband initially reasoned that the specialist would have alerted them to her condition if only he had bothered to look at their medical records, which they had brought along with them during their first consultation, having thought pre-emptively that the doctor would have asked for it.
“It was going to cost us about seventeen thousand ringgit for the whole procedure and that doesn’t even cover the cost of a second treatment if the first one doesn’t work. With hypothyroidism and POS, the chances of having a miscarriage would have been great.
"Can you imagine how devastating it would have been if we hadn’t known?” Mary asked and added dejectedly, “The thing is, the doctor didn’t even bother looking at our medical records, you know. They just wanted to make money out of us.”
Mary said that on hindsight now, she is not even sure whether the doctor would have warned them of the potential complications if he had known of her conditions. Mary insisted that her endocrinologist is the minority.
“There are definitely good doctors out there, but they are extremely rare,” she said. She revealed that she no longer trusts the medical service and would turn to her trusted online sites for all her medical diagnosis and query.
“You wonder why we should pay these useless doctors so much when we can find reliable answers online!” She laughed scornfully.
Mary is not alone when it comes to being at the receiving end of bad medical services and not trusting our medical practitioners. It would appear that more and more private hospitals are abandoning the Hippocratic Oath for personal gain.
A medical practitioner revealed that the price of medicine at a private hospital costs a lot more than an external pharmacy. He often advises his patients to buy their medicine from external pharmacies because it makes no sense for them to pay “cut-throat” prices for the same medicine. However, when Kelly tried to do precisely that, the doctor treating her apparently did not take it too well.
“Instead of giving me a prescription for six months as he had recommended, the bastard only prescribed me a month’s worth of medication. In other words, he was ‘forcing’ me to go back to him for a follow-up prescription and that would have meant paying him ninety ringgit for just a bloody piece of paper. Can you imagine that?!”
The Department of Pharmaceutical Services at the Ministry of Health informed that there is currently no law to control the prices of medication at private hospitals. However, it is encouraging when the Head of the Medicine Pricing Unit wrote, “As a patient, you have the right to obtain a prescription from your doctor to buy your medicine from any pharmacy even though it displeases the doctor. I believe that empowered patients can change the current bad habits practised by medical professions so that we can all guarantee affordable medication for the people.”
Vikram, another unhappy patient, shared the experience he had with his doctor when he was undergoing treatment for Hepatitis C. He said that he was mortified when the nurse asked about his treatment in front of other patients while he was waiting for his doctor in a clinic. He understood that the nurse probably asked out of customary politeness but he did not appreciate the fact that in the course of her doing so, other people had learned about his medical condition.
He said that patient information management is lacking in many healthcare facilities and was shocked that this clinic is part of a hospital that has received an accreditation from the Malaysian Society for Quality in Health (MSQH), the national accrediting body for healthcare facilities and services.
“On top of that, my doctor failed to inform me of all the side effects of the antiviral medication I was taking. There was no counselling or support for me and my spouse. The repercussions of the medication was so great that I felt as if the treatment had ruined an important part of our lives.
"For each visit, I paid ninety ringgit for a five-minute consultation where the doctor did practically nothing. Thankfully I had a good insurance coverage because the medication cost an arm and a leg. To be honest, I wish I had not undergone this treatment if only I had known of the repercussions. I wasn’t informed properly,” Vikram said regretfully.
As of June this year, 75 percent of public hospitals have received the MSQH accreditation while only 25 percent of private hospitals have. At the international level, only eight hospitals have received the Joint Commission International (JCI)’s accreditation.
The JCI is created by the Joint Commission on Accreditation of Healthcare Organisations, a US government agency, aimed to improve the safety and quality of care in the international community through the provision of education and advisory services, and international accreditation and certification.
The assessment criteria used by the MSQH is quite similar to the one used by the JCI, except the latter provides additional components such as patient and family education, staff qualifications and education, medication management and use, and the assessment and care of patients; elements which seem to be sorely lacking in our own private healthcare services.
Previously, the government has made several attempts to make it mandatory for all public and private hospitals to obtain MSQH accreditation but these attempts have been put on hold thus far. Although having some sort of national or international accreditation by a recognised and credible agency does boost public confidence, alongside minimising and mitigating clinical and safety related risks, these accreditations do not take into account public rating. The application submission for accreditation is done by the hospital in question and the assessment is then carried out by a panel of surveyors appointed by the accreditation agency.
There is no consideration for public opinion on how the hospital has fared.
“As a patient, I would like us to have some sort of a scorecard for all the hospital in Malaysia. Something simple for a start and it can be done by civil society, someone independent and done from the patient’s perspectives.
"What we need is someone who will disguise as a patient to test out the hospitals. So you have this person who goes to several hospitals and says he’s got liver problem, for instance, and then he assesses how the hospitals handle him based on selected key criteria. The problem has to be the same though, so you can compare apple for apple,” Vikram suggested thoughtfully.
Kelly said the hospital’s ability to deal with complaints is something left to be desired.
“No point. I’ve written to a hospital before to express my dissatisfaction over their service. I haven’t received any response from them. This was last year. It’s like as if the hospital doesn’t really care if you’re unhappy with them. They have patients lined up anyway. So why should they care?”
Sumitra, who is married to a doctor, revealed that medical practitioners often tend to close an eye when their colleagues commit a medical error. This culture is deeply rooted on the notion of solidarity akin to the “I have your back now so that when I need you, you’ll have mine” philosophy.
This makes it virtually impossible to have a doctor testifies against the other, even when a grave error occurs at the expense of a patient’s life.
Perhaps what Malaysia needs is a patients association such as the one in the United Kingdom. The UK’s Patients Association provides a platform for the people to rate their National Health Service (NHS). The association also runs educational campaigns such as the Speaking Up Complaints Project which encourages patients to speak up against poor medical services and the NHS to improve the way it deals with patients’ complaints. The NHS is ranked as one of the top 20 best healthcare services in the world by the World Health Organisation.
Not all is lost. Malaysia seems to be doing remarkably well in the area of medical tourism. A private hospital in Kuala Lumpur is recently recognised by the Medical Travel Quality Alliance as one of the world’s top ten best hospitals for medical tourists. By taking advantage of the weaker Malaysian currency, foreigners from the Middle East, Europe and Japan are flocking to Malaysia to enjoy better medical treatment.
It would have cost the local patients an arm and a leg to receive treatment in these hospitals but Mary said, “If the service is compatible with the amount I pay for, why not? The problem with the private hospitals here is that I’m not even getting the value for my money.”
While our private hospitals continue to nurse tourists with top notch care, in order to stay competitive alongside South Korea, Thailand and Turkey, have they forgotten our own illnesses along the way?
This article was first published at The Malaysian Insider on 9 October 2013.
Thursday, October 10, 2013
“Don’t let your friend come. Don’t want her to go through all this.”
It seems that a few days before they were to depart to Australia, they were told that their working visas were not ready and they would have to leave on a tourist visa while their agent would continue to work on getting them the correct paperwork.
Wednesday, October 9, 2013
In search of the right one
Saturday, June 1, 2013
A 1Malaysia: 2Standard story
As I go through a rare spring cleaning exercise on my personal laptop, I discovered this unfinished script which I would like to share here. As mentioned, it’s unfinished and hopefully I’ll find the courage and discipline to expand the story before the year ends.
As the file indicated, I first attempted to write this in April 2012 (more than a year ago!) and it was meant to be a screenplay. Hence, the odd-looking format and font.
Oh and if you feel like helping me finish this story, please feel free to share the direction you think this story should go to.
*****************************************************************************************************************
INT. BASEMENT PARKING IN A MEDIUM-COST HIGH-RISE CONDOMINIUM – EVENING
Ah Lian arrives home after a long and hard day at work. As she pulls into her parking bay, she hears a thunderous roar coming from her neighbour’s silver Proton Waja with dark tinted windows.
Ahmad, the neighbour, is testing his car’s engine by pressing the accelerator repeatedly. Since the car’s engine has been modified to resemble a turbo racing monster machine, the noise becomes unbearable for the human ears.
INT. AH LIAN’S APARTMENT – SHORTLY AFTER ARRIVING FROM WORK ON THE SAME EVENING
Ah Lian walks into her apartment with a look that could easily make Darth Maul purrs in coy submission. She is greeted by her housemate, Meenachi.
MEENACHI
Eh, Ah Lian. Are you ok? Why you look so garang?
AH LIAN
(sighs)
You know that fucker who has that silver Waja
parked near our parking bay?
(without waiting for Meenachi to respond)
I swear to God, I’m going to kill him one day.
I mean who the fuck does he think he is?
Making all those damn noise!
MEENACHI
Whoa! Sabarlah, Ah Lian. What can you do?
These people have no idea how ridiculous and stupid they are. Biarkanlah aje.
No point getting all upset over something you can’t change. Let it go.
Jom! Let’s go and makan?
In the next few weeks, Ah Lian is greeted by the same annoyingly loud noise coming from the silver Waja. Sometimes, she tries to convey her annoyance to Ahmad by sending him daggered looks across the parking bays. All Ahmad does is to double up the volume of his engine and smiles at her slyly, as if he needs to prove to Ah Lian how much he’s enjoying every second of her misery.
One day, she decides to take matters into her own hands.
INT. THE SAME BASEMENT PARKING – ONE MONTH LATER
Ah Lian and Meenachi are seen lurking behind Meenachi’s grey Perodua MyVi. They look around the basement several times to make sure that nobody else is around.
MEENACHI
(whispers)
Pssst! Ah Lian, I’m scared. Are you sure you want to do this?
AH LIAN
(irritated)
Aiyoh! Don’t be such a scardy cat, can ah? No time to chicken out now, ok?
I’m going in. Watch my back.
A few hours later that same day.
INT. THE SAME BASEMENT PARKING WHERE THIS STORY FIRST STARTED
AHMAD
What the fuck?!!
(He proceeds to tears off a picture of a pig with the word “BABI!!” written diagonally across the picture in capital letters from his Waja’s tinted window shield)
Ah Lian and Meenachi walk into the parking basement and are confronted by a seething Ahmad.
AHMAD
(points at Ah Lian)
You! It’s you, bukan? You did this!
AH LIAN
Hello?!!! Excuse me? What are you talking about?
Kenapa marah-marah ni?
Gambar apa tu? Eh, so cute this babi.
AHMAD
Eh, you ni bodoh ke apa? Saya Muslim, tau?
Apa yang you buat ni berdosa tau? Dahlah kafir,
makan babi,tak cuci buntut, tapi nak kurang ajar!
Tak tau ke apa ertinya respect?
National reconciliation or retaliation?
There was no cry of jubilation. Neither were there tears of joy.
If you had been in a coma during the past few weeks and were suddenly awakened to the image of the Barisan Nasional’s victory speech on television, you would have thought that someone important had died and the whole nation had gone into mourning mode. Why wouldn’t you when Datuk Seri Najib Razak and his sidekicks looked as if the apocalypse was upon them?
Before you could even make out the hazy details that had preceded such collective sombreness, you found yourself being hit by a train of confusion. “Chinese tsunami” quickly followed by “national reconciliation” — two terms coined together only mere minutes after the announcement of the election results were enough to make me want to crawl back into that coma. Ignorance is after all bliss during moments like this.
As I begin to hear comments pouring in from different public figures and the public, of what they thought of the proposed national reconciliation, I felt sheepishly stupid. Am I the only one who doesn’t understand what it means or what it’s for?
The coma must have impaired my intellectual capacity. Full stop.
A few days ago, someone asked me what I understood about Najib’s notion of national reconciliation. Instead of giving that person a straightforward answer, I went on a crooked tangent. If you were as confused as I was, you would probably understand why.
This was my answer: “You know what? It took me two years to learn how to reconcile my accounts. Why did it take me so long? Well, honestly, I had no clue how to do it! Accounting is like a useless foreign language to me. Neither do I understand it, nor do I have the desire to learn it. So it took me two years to finally nail it down. Anyway, to answer your question, I think national reconciliation is a bit like me trying to reconcile my accounts. The federal government has no clue what it’s about and most likely has no desire to learn what it really is about.”
Horrified at my analogy, the person finally said: “If what you said is true, let’s hope they’ll at least nail it down in the end.”
Of course, hope is a good thing and one can always hope.
Anyway, Najib had come out in public and said that national reconciliation is needed to heal racial and political divide. Never mind what he said because since then, I’ve had more opportunities to hear what other people thought about this notion in person and, unsurprisingly, different people seem to hold very different opinions of it. Although some agreed wholeheartedly that it’s all about reconciling racial divide, others said it’s more about the urban-rural divide. A few said that there’s really no racial divide and it was the politicians who have spun it to instil hate and fear because the real issue here is economic divide. A few vehemently claimed that it’s all about political party divide, much to the chagrin of those who quickly rebutted that political party division is a good thing and the pillar of a robust democracy. Listening to these opinions reminded me of the story of the elephant and the three blind men. (Scary or what? But anyway, Malaysia boleh!)
Without turning this article into something unnecessarily lengthy, I shall cut to the chase. Let’s just suppose that the prime minister is honest about his intention, how should he and his Cabinet go about developing the framework of this national reconciliation?
Here’s my take as a layperson. (I realise I’m running the risk of oversimplifying the issue but I think simplification is exactly what we need now.) I believe in order for a national reconciliation to be successful, it must first fulfil three criteria — it must 1) command the public’s confidence, 2) be a meaningful exercise, and 3) result in action. At the same time, it must be guided by these core principles — 1) truth, 2) repentance, and 3) justice.
In order to achieve the first criterion, the government owes it to the public to provide a clear and truthful explanation of what this national reconciliation is all about. As it is, the public’s confidence of the new government is already at an all-time low, it is now up to the latter to convince the public of the true purpose of this process. Without the public’s confidence and faith in this, it is likely going to suffer the same fate as the 1 Malaysia slogan, one that reeks of a political rather than human agenda. To curb this, the government must secure the public’s participation in developing its framework; not just their supporters but also dissenters. As such, it is imperative for the government to listen to both sides and this necessitates freeing up media space to allow opinions from both sides to be heard.
Secondly, for this exercise to be truly meaningful, the government must understand the true meaning of reconciliation. In order for reconciliation to work, all party must be willing to admit their wrongdoing, repent and agree to move forward together. The closing of one chapter so that a fresh one can begin, so to speak. As the initiator of this agenda, the government must first admit that it has played a role in allowing racism to manifest and, as such, resulted in this divide. By initiating this process, the government must be willing to admit that the 1 Malaysia campaign, the National Service Training and the National Economic Programme have in a way failed or contributed towards perpetuating racial-based politics because otherwise, why on earth do we need national reconciliation? By doing this, the government shows repentance and sincerity and this will help to restore the public’s confidence in the process.
Finally and perhaps most importantly, all this must in the end result in the government taking real action towards reconciliation. There has been far too many projects and agenda that ended up being nothing but mere politically rhetoric with no real benefit or meaning for the people. I’ve listened to various people giving recommendations of what should be done to achieve this goal — from establishing a parliamentary select committee to unifying our education curriculum. All noble solutions which will take a long time to implement and before you know it, the public loses interest and nobody remembers why the process was proposed in the first place. For a quick start just to get things rolling, in order for the government to prove its sincerity and will, why not get rid of those boxes that seek to verify our races in all government-related forms once and for all? Punish ministers who incite racial hatred and make an example out of them. Justice must be blind and not just for the powerful.
In conclusion, after all that is said and done, the secret ingredient that will eventually create a Malaysian culture that abhors racism is really quite simple. All it takes really is for the government to first set an exemplary role in eradicating racial sentiments and once that is accomplished, I am quite confident that the rest will follow. Not unlike reconciling your accounts, the two sides must be in tandem with each other. Otherwise, let’s not fool ourselves by calling it reconciliation but retaliation instead. If I were an avid conspiracy theorist, I would have concluded that “Chinese tsunami” and “national reconciliation” were part of a national retaliation strategy to divert the people’s attention from what’s really to come.
So Mr Prime Minister, which one is it going to be?
This article was first published on The Malaysian Insider on 27 May 2013.
Tuesday, March 5, 2013
“To sign or not to sign?”
That was a decision I was forced to make one early morning at a private hospital in Kuala Lumpur.
“I’m not signing. The hospital can go fuck itself!” My husband’s mind was made up even before I could blink my sleepy eyes twice.
For a brief second, I almost dismissed my husband’s reaction as a tad too melodramatic and was very close to signing what had already begun to threaten the tranquility of our rare morning together. But I didn’t.
I let out a big sigh and told the young woman at the front desk, “Sorry, I can’t sign this. We won’t consent to this.”
Once I had said it out loud, the look on her face told me that things were not going to be smooth for my husband and I that day. The wide eyes behind her glasses looked shocked, confused and uncomfortable. I might be biased but I thought she also reeked of judgment.
“I’m sorry but this is a hospital policy. You have to sign this if you want to get tested,” she said a bit too timidly. I don’t know how, but she seemed to sense that this would not go down well on us.
I looked at my husband, not as an attempt to persuade but for an affirmation of our decisions.
“Nope. I’m not going to sign.” He walked away to signal his unwillingness to waste any more time on this matter.
I let out another big sigh as I found myself losing patience too.
“Look, we have no problem signing a consent form for HIV testing but we do have a problem with this clause here. See? It says, if tested positive, you guys will be notifying the Government Authorities,” I explained.
“But this is the law,” she tried to convince me.
So if the law requires you to jump off the Penang Bridge, you would?
I rolled my eyes and sighed again.
“I know but we don’t agree with this law. So we’re not going to consent as a sign of our protest,” I said instead.
We were then told to wait at the lounge while she consulted her manager.
After ten minutes, an older woman came and asked to speak to me privately. She ushered me to the corner of the room and said to me in a low voice, “M’am, your medical package includes HIV screening. We’re not sure whether it is possible for us to exclude this testing.”
I stared her. It was my turn to look shocked, confused, uncomfortable and judgmental. By then my patience had hit a record low and I couldn’t help myself but to retaliate in full force.
I can’t remember what I had told her precisely but I surprised myself that day for being eloquent as I made my case. The conviction and anger inside me helped me to articulate my argument to her and in summary, I told her that nobody could force my husband and I to test for HIV/AIDS.
“Of course, of course. You’re right. Let me go and check with the company who offered you the package to confirm that it’s OK for you to go through the check-up today without the test.”
My husband looked defeated. He was convinced that we were not going to have our routine medical check-up that day. In a determined voice, I said to him, “If she comes back and tells us no, I swear I’m going to give them hell.”
After waiting for another 15 minutes, hell remained mine.
For close to ten years, my husband and I had gone through routine HIV tests annually. In fact, before we had our first sexual intercourse, we had ourselves tested. This is how strongly we feel about protecting each other from HIV/AIDS. The episode above was the first time that we had actually skipped a HIV test.
Many of you may wonder why we had made such a ruckus over this.
I had recently learned from a friend that testicular cancer is apparently rather common amongst Canadian adolescents. According to her, because most adolescents are embarrassed to talk about their private parts, many choose to remain silent when they feel an abnormal growth on their testicles. By the time they decide to seek treatment, the cancer has already advanced considerably.
I suppose the same principle applies here, except multiplied by ten because of the stigma HIV/AIDS carries. Because of our strong fear of stigmatisation, we would rather not get ourselves tested. Because of the lack of information, we are not sure what the Government Authorities would do with our medical record. In the meantime, the hospital did nothing to help us understand the procedure of HIV disclosure. If anything, the hospital did everything wrong that day to gain our trust. This problem could have been potentially solved by sound public relations and communications practices but instead, the hospital staff made us felt like we were the enemy.
When I first saw that young woman’s reaction when we declined to sign the consent form, and her subsequent looks after that, I knew that I had made the right choice not to sign the paper. She carried a look that spelled, “They have AIDS. That’s why they’re not signing the paper.” She was very awkward with us. She would tense up whenever we appeared before her. When we went to collect our test results a week later, we felt unwelcomed. The doctor who went through our report dismissed me when I told him that I thought I felt a lump on my neck. He did not even feel my neck. He behaved as if he couldn’t wait to get rid of us.
Act 342, Section 10 (2) is the clause that compels every medical practitioner to notify the government authorities if he/she is aware of the existence of any infectious disease. Under the same section, it also compels anyone, other than a medical practitioner, to do the same. This means, if I know my work colleague has HIV/AIDS, I must report this to the authorities.
In the United Kingdom, the General Medical Council states that a disclosure of HIV positive patient to anyone other than a healthcare professional is unlawful. Their Data Protection Act provides legal redress to people living with HIV/AIDS if their confidentiality rights have been breached. In Malaysia, there is no such law yet unless the personal data is used for commercial purposes.
In the United States of America, hospitals do report to the US Centres for Disease Control and Prevention, but only after they have removed all personal information from the patient’s record. This is mainly because the federal and state funding for HIV/AIDS is often targeted at areas where the epidemic is strongest.
An American survey revealed that one-third of 20,000 respondents knew at least one person who is afraid to take HIV test for fear of prosecution if they are tested positive. More than 60% of Americans do not know whether their state has a HIV specific disclosure law. Accordingly, many people at risk may prefer not to get tested for HIV rather than risk being accused of or criminally charged for non-disclosure if they are tested positive. In a similar survey, when asked what motivated people to disclose their condition, majority of them cited moral or ethical reasons; honesty, love, desire to protect their loved ones. Less than 1% said that the law is the primary motivation.
All these studies point to the understanding that having a disclosure law such as the Act 342, Section 10, does not help to reduce the risk of HIV/AIDS. On the contrary, it has significant repercussions because it stops people like my husband and I from getting tested and seeking appropriate treatment once diagnosed.
Driven by curiosity, I called two organisations* relevant to this subject matter for more information. I could not get through one but the other told me that I could get an anonymous HIV test for free.
“Total anonymity? How come the law doesn’t apply to you guys?”
“That’s because we’re an NGO. There are a couple of NGOs around that do anonymous testing. Do drop by and get yourself tested. It’s important.”
Free anonymous testing with an NGO versus a private hospital that doesn’t seem to give a toss, it’s a no brainer really who will have a more successful campaign against the spread of HIV/AIDS.
* The identities of the organisations have been deliberately kept confidential to avoid getting them into trouble with the authorities.
This article was first published on The Malaysian Insider on 5 March 2013.
It generated quite a bit of discussion on a friend’s Facebook. According to this friend, the local NGOs are not exempted from reporting to the Government Authorities if you’re tested positive for HIV. He also left a comment on my Facebook and here’s what he said:
“Also, at the NGO, you are testing live with a person, who then gives you the result. You are no longer anonymous to him. Some people don't go to such NGOs because they may know people from the community who are volunteers at the NGO. So actually, this creates a different problem. People who would go for such testing in spite of the social barriers (being recognised, reporting, etc) are already monitoring their sexual health -- even if some do test positive eventually. The problem is getting people for whom the lack of anonymity prove a deterrent. Some people also have to overcome the guilt of being judged for being irresponsible at such an NGO as these NGOs have been aggressive in promoting Safe Sex messages with moralistic overtones (you are irresponsible if you don't use condom, you are a slut if you have multiple sexual partners, etc). It is a lot to overcome for most people. In Taiwan, their anonymous testing works like this: you get your blood taken for testing and you are given a code and a phone number to call; you call the number and tell them your code and you get your result without needing to reveal your name at all.”
Another person left a comment on this article:
“As a matter of fact[ly], both Malaysian and Singaporean law requires medical practitioners to report patients tested positive for HIV. Both deport and ban entry to foreigners if tested positive while in the country.”