What they don’t tell you in Biology class

I had the rare occasion of meeting a childhood friend after 25 years. Sylvia looked just the same as I have remembered her. Slim, fair, perhaps a little older as her pore-less facial skin no longer radiates that ridiculously pinkish glow it once used to.

At 39, she looks better than many women younger than her. Hell, she looks better than me.

As a child, I had always admired Sylvia. I wanted to be just like her. She had that quiet beauty about her and I honestly think she was completely obliviously of it, making her even more appealing. She had a gentle soul. She was smart, athletic and yet graceful. I thought she had it all. So when we reconnected recently, I was eager to find out how life had unfolded for her all these years.

When I saw how little she has changed physically, I imagined life is treating her well.

“I never thought I wanted one but now it’s kinda too late. I wish I had known earlier.”

I thought our dinner had gone splendidly despite my initial nerves. We ate, drank and talked for three hours but those were the words I took home with me that night, along with a bag of left-over barbecued spare ribs. She still eats like a bird.

When Sylvia told me she has been trying to have a baby through in vitro fertilisation for the past two years without much success, I was stunned for two reasons. First, there are not many women of her age whom I know who want a baby and second, the increasing number of women seeking fertility treatment in Malaysia.

According to Sylvia, it’s an emerging multi-million ringgit industry and it’s only the beginning because she pre-empts more fertility clinics infesting the city to feed the increasing demands of couples with reproductive health problems.

“If you don’t believe me, just visit any fertility clinic in the Klang Valley. The queues would make you think that Aphroditus has left town,” Sylvia laughed while I wondered why she mentioned Aphroditus instead of Aphrodite.

I’ve known Sylvia as the type who keeps things pretty much to herself. She listens more than she speaks and so the fact that she revealed something so intimate that night convinced me that she thought it was important for me to know.

“I hope I’m not stressing you out by telling you this. I don’t think women should suddenly readjust their lives because they think time is running out.” She said apologetically. I thought I saw that familiar pinkish hue on her cheeks for a split moment.

Throughout our conversation, I was conscious of the fact that Sylvia was trying hard not to appear desperate. For instance, when she talked about how empty she felt of her 10-year marriage, finally understanding her Mother’s wisdom that every couple eventually needs children in their lives, she would quickly followed the thought by reasserting how much she enjoys her career as an artistic director for an advertising company.

Like 70% of Belgian women who had their eggs frozen, Sylvia wished that she had done hers much earlier. A Belgian study carried out last year revealed that women who freeze their eggs in hope of improving their fertility in later years wish that they have done it at an earlier age. I had also read that American women feel the same way too. I wonder whether this holds true for Malaysian women as well.

Since I have no authority to speak on behalf of all Malaysian women, I shall share a brief history of my family’s fertility.

It was probably in their late teens when my Grandmothers had their firstborns. Both went on to have more than 10 children each, discounting those not carried to full term. The rate of miscarriage was quite high then but the lack of contraceptive awareness made reproductive rate even higher. So it wasn’t surprising for reproductively healthy women my Grandmothers’ generation to have an average of seven to ten children easily.

About half a century later, Mom gave birth to my brother at the age of 29. I was conceived two years later. We are only two but Mom’s siblings have an average of three children each. Dad’s have more.

I suppose it was considered late for a woman back in the 70s to give birth at the age of 29 but my parents had their reasons. Dad had just started his own business and Mom was there to support him every step of the way. Mom told me that it was one of the toughest time of their lives. The constant thought of failure and losing all their savings inevitably meant endless hours of hard work and sleepless nights. Mom said it was all worth it because what would be the use of hoping for a successful business if not to secure her children’s future?

I have just turned 38, married with no children. Both by choice. When I look at the circle of people I spend my time with, I am not an exception but rather the norm. Most of my friends are single and childless. I suspect they are happy just the way they are although I can’t be sure because these things can often be sensitive and private. So I try not to ask.

A survey by the National Population and Family Development Board revealed that the average age of marriage amongst Malaysians is 33. It could be higher now since the data is slightly outdated. Apparently, the number of those who are not married by the age of 30 has doubled since 2007. The common reasons given are that women are finding it harder to find men with equal or better educational qualifications and they have higher expectations in men than before. According to a local university associate professor, the fact that women are getting married later explained the rapid increase of infertility rate.

Many of the women I know are fiercely independent, professionally successful and generously kind. They love their jobs and enjoy their independence and why shouldn’t they? They’ve earned it by working hard and proving they can be as good as men in a society that is still patriarchal at large. Modern women make it clear to the world that they are not defined by their husbands or children. Marriage and parenting have become an option, rather than the norm.

I don’t think the single women I know are averse to marriage or children at all. In fact, I am sure many make good wives and mothers. Not wanting to settle for just anyone has been the common reason I’ve heard. The truth is, I think modern women are caught in two separate worlds – transitioning from a world that was intent on keeping them in supporting roles to one that suddenly expects them to be heroines. I believe somehow along the way, women begin to enjoy their newfound stardom but yet, they are unable to abandon their embedded biological code programmed since time immemorial to ensure the continuous survival of humankind.

I must admit that women have themselves as much to blame for making this transitional period very difficult. We can be very unkind to one another. For example, there are mothers who scorn at single women for living what they deem as irresponsible and selfish lifestyle while single women at the peak of their careers judge stay-at-home Moms as losers who cease to exist but for their children.

I spoke to my friend Siew Mei a couple of months ago and she said one of the most honest things I’ve heard in a long time.

“We’re so afraid of being judged that as women, we can’t even say out loud we want a baby for fear of being seen as a walking biological time bomb waiting to explode. It’s so not sexy anymore for women of our time to admit we want to be mothers, as if acknowledging our biological role is so shameful these days,” she said bitterly. “For the longest time I’ve lied to myself and my friends. I pretended not to have any interest in having a baby simply because I am not seeing someone. If I had a partner who wanted a baby with me, I would be the first one on that train to motherhood.”

Siew Mei is still waiting to find a suitable man who wants to be the father of her child. The last time I checked, she was still optimistic.

Now, here’s the thing I learned from Sylvia which I wish I had been told during Biology class many years ago. Many of us are aware that a woman’s fertility decreases with age. Biology says that each woman is born with a fixed number of eggs. Once a reproductively healthy woman hits puberty, an egg will be released from her ovary to her uterus every 28 days. If the egg is not fertilised by a sperm, it will shed as menstruation and this cycle repeats itself, provided the woman becomes pregnant. Therefore, a woman in her 40s would have less eggs than when she was 20 which then makes logical sense that her fertility would have reduced with age.

What was not told in Biology class is that our bodies release the best eggs first, saving the worst for last. This is also one of the reasons why the chances of delivering a healthy baby becomes lower with older women. It isn’t just because we have less eggs or our bodies are likely less fit or healthy, it’s also because we start “producing” F grade eggs.

“The doctor said I have less than 10% chance of pregnancy. Even if successful, I should have pre-natal testing to ensure my baby is normal. Apparently, if I had sought treatment before I was 35, I would have a greater chance of pregnancy but I didn’t think I wanted children then,” Sylvia said regretfully.

I asked her whether she would have reconsidered her choice if she had known this information earlier.

“Yes, definitely yes. When the doctor told us that we have the final option of fertilising another woman’s egg with my husband’s sperm, I nearly gagged. You can’t believe how humiliating it was for me to hear the doctor described the egg donors as ‘younger women in their 20s’. That their eggs are of ‘top quality’. I felt so shameful and inadequate.”

Sylvia later confessed that she had put her career and freedom above her marriage. Having a baby was on her list of things to do but it was right at the bottom, even after a trip to Bhutan. She thought she could put off motherhood as late as possible. After all, she has always maintained a healthy diet and lifestyle. She thought if Hollywood celebrities are popping babies in their 40s, why couldn’t she?

“By the way, smoking seriously reduces a woman’s fertility. It makes your eggs disappear. Seriously. I’m not kidding.” Sylvia cautioned although I had no idea why she thought I smoke.

I never thought my meeting with Sylvia could give me so much food for thought. For a start, I never thought someone as perfect as her could ever find herself stuck in this situation. I must confess that it also made me uncomfortable for the mere fact that it challenges my own choice.

She was however right by saying, “I don’t think women should suddenly readjust their lives just because they know time is running out but at least such information would allow us to make informed choices. I regret not knowing because I think I would have done what I could possibly can to ensure that I have the possibility of delivering a healthy baby.”

“If I am financially able, I would even consider freezing my eggs because if I have no problem spending thousands of ringgit traveling, why not preserving something which one day could become life?” She added.

In vitro fertilisation is an extremely costly procedure. It averages between RM10,000 to RM18,000 per cycle of fertilisation. A couple can easily spend up to RM50,000 for a small chance of getting a baby. What hope does it leave for those who have no financial means?

I think in the midst of trying to educate children on safe sex, we have forgotten the importance of reproductive health. We are so concerned about not getting pregnant that somewhere along the line, we’ve forgotten how to.

The original article was first published here on 3 May 2014.

 

Technorati Tags: Fertility,reproductive health,in vitro fertilisation

Is freedom of expression a problem?

French comedian Dieudonné M’bala M’bala became an instant household name in France when he was banned from performing his anti-Semitic stand-up comedy routine. He is notoriously known for implying that a renowned Jewish journalist belonged in a gas chamber. 

Dieudonné may have become one of the most hateful personalities in France but many of his haters still believe that he should not be banned from performing.

It is not very often that the French court decides to restrict freedom of expression, a sacred institution in France. The other time it was done was when it prohibited the wearing of all religious headgear in public school, and more recently the wearing of a full-face veil in public spaces.

I found it interesting that France, a country that gave birth to Voltaire – known for his “I may disagree with what you say but I will defend to my death your right to say it” quote – appear  more willing to use court power to silent offensive speech and curtail the expression of religious identity.

I was told that the majority of the French disagree with the court’s ban on Dieudonné’s comedy show despite many who think he’s a hateful bigot and found his jokes extremely offensive and borderline violent.

I also learned that many French people believe that while the ban against hate speech is wrong, religious headgear isn’t (and other symbols for that matter) because they are two separate matters.

“Dieudonné’s jokes are more than just racist comedy. If you watch his videos online, you’ll see that he’s inciting violence and hatred against the Jew. What he does is criminal. But you [the court] cannot ban his show because that’s against freedom of expression. We cannot allow that to happen in France. It’s much too sacred,” Philippe, a French expatriate said when asked what he thought of the ban on Dieudonné.

“What the court should have done was to give him a prison sentence or a huge fine. There is sufficient evidence to charge him for inciting violence. But to ban his show, that’s just ridiculous.”

Philippe’s concern obviously lies in the protection of freedom of expression, something he considers sacred and cannot be violated.

I was told that the majority of the French are outraged by Dieudonné’s anti-Semitic jokes but like Philippe, they are more concerned that the judiciary may fall into a slippery slope.

“We couldn’t care less about Dieudonné M’bala M’bala. Who the hell is this guy anyway? If civil liberty groups are upset about the ban, it’s definitely not to defend what he did. It’s to defend our right to freedom of expression. We cannot allow the ban to happen because who knows what else will be banned in the future?” Philippe insisted.

“People need to understand this. Objecting the ban does not equate to defending racist behaviour. They are two separate issues,” he added.

Guillaume, another French expat, agreed with Philippe. Although he disagrees with Dieudonné’s racist behaviour, he wished people would stop giving him so much attention.

“I don’t really care about him. He did not exist in my life before but now because of this fracas, everybody knows him and they are giving him way too much importance.  He’s become so popular. Why? There are other more important things that deserve my attention,” said Guillaume.

What is true for Philip seems to hold true for Guillaume as well. According to both, freedom of expression must not be restricted. But what I find even more intriguing is that the duo feel that the French court’s consistent upholding of the ban on religious headgear (more prominently the face-veil worn by Muslim women) in the public sphere is completely justified.

What’s the difference?

“Well, for centuries we’ve suffered the imposition of the Catholic Church. France is a secular country now. There’s no room for people who want to impose their religion on others. You go to school to learn, not to practise your faith. We did not say you can’t have a religion. All we’re saying is religion has no place in the public sphere. You can do what you want in private. That’s your business,” Philippe asserted.

I argued that wearing a headscarf does not mean a person is imposing her religion on others. It is well within one’s right to express one’s religious identity and to practise one’s religious teaching.

“I really doubt that these people are merely expressing their religious identity. I think they are trying to Islamise the country. They are deliberately provoking the public with their religious attire,” Philippe said.

I looked at Guillaume to hear what he had to say about this. He remained silent and appeared to be in deep thought. Perhaps he may disagree with Philippe this time.

Philippe meanwhile continued to express strong feelings against the wearing of religious headscarf in public. He said that those who insist on practising their religion openly should live elsewhere. France is not a country for them.

As I am familiar with such sentiment, often expressed by those who think we (the Malaysian minority) are complaining too much and should leave the country, it dawned on me that freedom of expression wasn’t really the issue here. It was the fear of France losing its secular identity and Islamaphobia that had prompted such different opinion.

I had an epiphany - there are people who are equally as afraid of the threat of converting into Islam as much as the threat of converting out of Islam. I begin to see some sort of a resemblance between religious and anti-religious fanatics.

When I pointed this out to Philippe, he argued vehemently that it wasn’t just the Islamic headscarf that he has an issue with, but all religious headgear and symbol.

“Do you know that Muslims are now demanding public schools in France to serve halal food? I mean, what next?” Guillaume finally broke his silence and that was sufficient for me to deduce that he shared the same sentiment as Philippe.

The French courts may try their best to apply restrictions on constitutional rights as consistently as possible, the French public are quite split on the two issues. This is precisely what makes freedom of expression an extremely grey area. No matter how it is being applied, there will always be someone who is unhappy somehow, somewhere.

To me, freedom of expression is not the problem. What becomes problematic is the hypocrisy of human being – “I will defend my right but not yours”.  

Freedom of expression must be for everyone which is why, it should only be restricted when it is absolutely necessary and within the law. There is no fast rule on what entails necessity. It must always be judged contextually and from both sides of the perspectives.

What could potentially be a solution to address polarity is the emphasis on critical thinking by our society, a faculty so lacking these days.

For many centuries, the Socratic Method or what is commonly known as critical thinking has been the pillar of the finest teaching institutions in the world. Famous for his quote “an unexamined life is not worth living”, Socrates distinguished intellectual and free minds from ignorant fools although he was sentenced to death for making a mockery out of the ancient Greek Gods and the Athenian ruling elite.

His student, Plato, created the first institution of higher learning in the Western world and wrote Dialogues, a book where characters argue a topic by asking each other questions.

The Socratic Method further inspired Plato to expound on his theory of dualism, separating perception from idealism. He illustrated this theory using the cave metaphor – people living in a cave can only see the light within the parameter it is projected upon, hence depriving them from seeing the big picture or external realism as he would call it. Here lies another reason why freedom of expression must not be restricted to allow peripheral points of view.

Plato’s Academia and Dialogues are both famous for promoting critical thinking. The presiding philosophy was that all school of thought must be given equal opportunity for discourse so that students and readers can make their own judgment after careful analysis.

The American Association of University Professor agrees with Plato’s philosophy and thus adopted a Freedom of Expression and Campus Speech Code which says:

“Freedom of thought and expression is essential to any institution of higher learning. Universities and colleges exist not only to transmit knowledge. Equally, they interpret, explore, and expand that knowledge by testing the old and proposing the new. This mission guides learning outside the classroom quite as much as in class, and often inspires vigorous debate on those social, economic, and political issues that arouse the strongest passions. In the process, views will be expressed that may seem to many wrong, distasteful, or offensive. Such is the nature of freedom to sift and winnow ideas.

On a campus that is free and open, no idea can be banned or forbidden. No viewpoint or message may be deemed so hateful or disturbing that it may not be expressed.”

The code went on to prescribe measures that can be taken to address incivility, intolerance, offensive and harassing behaviour, all short of banning free speech. Click here for the full code.

Freedom of expression can be both empowering and disempowering at the same time. To me, it should not be restricted whenever possible because it can be used to empower more than it can disempower.

As a woman, I may be offended by a disempowering video objectifying women as sex symbols but as a human rights activist, freedom of expression is an inviolable right that must be defended at a reasonable cost. It is because of freedom of expression that human rights values are imparted and upheld all over the world on a daily basis. Finding a balance between these competing interests is not easy and requires time and wisdom to understand. 

To me, it is easier to correct a harm caused by an expression than to correct one that is caused by a ban on expression. For example, the public can challenge an offensive expression through criticism and counter argument when there is space which allows freedom of expression but it becomes extremely difficult to expose and correct wrongdoing in an environment where freedom of expression is being curtailed.

Plato’s theory of dualism explains the inevitability of two opposing views which makes it difficult to judge an issue as simply black or white. As such, the solution should never be to restrict the expression of these two opposing views, but to encourage the audience to think about the views as critically as possible and come to their own conclusion.

Shielding an adult from distasteful or offensive form of expression is not a heroic act. In fact, it can be disempowering and it can perpetuate ignorance. Not only are you treating the adult like a child, you’re saying that you know better. This is an offence many Malaysian politicians are committing on a daily basis. 

Fighting injustices and human stereotypes is not about restricting offensive or distasteful content. It’s about educating and empowering men, women and children on a daily basis to think critically about such content so that they can learn to make informed judgment on their own.
Freedom of expression is not the problem. The lack of it is.

This article was first published here on 13 February 2014.

Technorati Tags: Dieudonné M’bala M’bala,Voltaire,Socrates,Plato,Socratic Method,Academia,Dialogues,dualism,American Association of University Professor,Freedom of Expression and Campus Speech Code

Stop feeling happier

If one of your New Year’s resolutions is to feel happier about the world, I have got news for you, buddy. It is not happening.

Misery is here to stay and unfortunately, you are part of it.

The truth is, I have been unhappy for a while. There you go, I finally said it.

If you think I’m another self-indulgent writer who is taking advantage of the media to whine about how unhappy I am, you’re absolutely right. But I will tell you now that I take no pleasure in doing so because I would rather be the bearer of good news on this New Year if I could.

Well, it began to dawn on me how unhappy I have been when the media recently reported that a French company has successfully produced the world’s first self-regulating artificial heart transplant. Instead of being thrilled with the technological marvel, I scorned at it.

I scorned at it because seriously, do we really need human beings to live longer?

Here are some words to describe human beings – capitalist, authoritarian, hypocrite, sadist, fanatic, xenophobe and racist.  I mean, look around you. Misery is everywhere and we, the human beings, are responsible for it.

For those who truly know me, I usually have a sarcastic or cynical comeback for most things. People who constantly post positive things on their Facebook or say only positive things about the world make me feel uncomfortable. Do not get me wrong, it is not that I do not want to share their positivity, I just do not buy it. I wish they would just cut the crap and stop pretending that everything is okay.

I had a conversation with a colleague about what it means to save the planet. This is what he said, “The term saving the planet is so deceitful because the planet does not really need saving. It has the ability to heal itself. If we are really concern about saving the planet, then we must be rid it of ourselves because our mere existence is harming the planet. So people should stop using the term ‘save the planet’ because what they really mean is to save human beings, not the planet.”

I appreciated him for cutting the crap.

I have been unhappy for a while because I know the world is not getting better and I do not have to look far to see this. Just look at what we’re doing to each other in Malaysia and how our government is intent on making us unhappy.

You see, the general rule is that many of us have to slog away at least five days a week for many years before we can live the lifestyle we want, unless we are born on a silver platter, win the lottery or steal.

On top of paying our home loan, car loan, electricity bill, water bill, sewerage bill, service and maintenance fee, tuition fee, legal fee, sinking fund, pension fund, insurance, road toll, road tax, assessment tax, service tax, and income tax, a part of our hard-earned income will eventually be stolen to benefit a few people while we pinch here and there just to save up for the things that will make us happy. So let me tell you now that as a taxpayer, I am extremely unhappy but what can I do?

If I refuse to pay my taxes in protest, I will be punished by the very same government whom I’m protesting against.

When things look bleak and if I want to turn to God for wisdom, I am told by people who simply have no business in my personal life that I cannot address God the way I want to.

If I want to express my unhappiness out loud, I am reminded to leave the country.

If I am serious enough and decide to lobby for mass support, I will be accused of overthrowing the government.

If I decide to seek legislative change through the ballot, I may never see change because the politicians who share my sentiment will not have fair access to the media and resources to reach out to the majority of the people.

I had dinner with an NGO partner this week and we talked about how to run successful awareness campaigns. I could tell he was not impressed with street protests and thought the original Occupy movement failed to maintain the momentum it garnered from the beginning. He was convinced that public satire will pressure the authority into respecting human rights and democracy.

The sad truth is, shaming does not work in this country. Believe me, many people have tried.  Satire has no place in this country. It is like those offending drivers who stick their middle fingers at you just because you honk at them for cutting into your lane without signaling. That is who we are. We reward the bad guys and punish the good ones. 

I have been unhappy because this government has never lifted a finger to help NGOs that promote human rights, democracy and good governance. For years, these NGOs are made the enemy of the state while groups propagating racial hatred are allowed to flourish.

The Auditor General’s report will tell us that the wastage generated by our civil servants year after year would have secured the funding of many NGOs for many years. As I often say, their spare change would have made these NGOs millionaires. Instead, many are forced to depend on irregular sources of funding through the goodwill of people other than this government.

So my fellow Malaysians, we cannot afford to be happy now. If anything, we need to be extra unhappy and continue to express that unhappiness because I know what the top people are doing. Do not think I have been fooled for a second. Creating religious and racial polarity among us is a classic example of trying to distract us from focusing on how they have led this country and its people into ruin.

My fellow Malaysians, please do not be fooled by the people who tell you that you should be happy, that things are not that bad. To these people, I will tell them to wake up and smell the rotting flesh before they are turned into carcasses.

Here is an Unhappy New Year message to all – stop trying to feel happier about the world. Instead, make it happier.

This article was first published in The Malaysian Insider on 9 January 2014.

“How to stop corruption like that?”

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Accidental lessons

This article was first posted on The Malaysian Insider on 21 November 2012 and LoyarBurok on 11 December 2012.

It was 1991. My classmates and I were punished for being noisy in class. We were told to stand up and remain silent for the rest of the lesson. The silence was deafening until Cikgu stormed towards the back of the classroom and barked, “Why are you smiling?! Is this supposed to be funny?”

Alarmed, we all turned around to find out who had the misfortune of inciting Cikgu’s sudden outburst. It was Lee, the boy who hardly spoke during lessons. If anything could be said about Lee, he stayed away from trouble and wore a pleasant demeanour on his face.

Cikgu repeated her question. This time with greater force. Puzzled, Lee had no choice but to answer, “Err… no. But, but, but is it a crime to smile?”

I was stunned because I didn’t know Lee had it in him to speak up against a figure of authority.

“Ohhhhh… you think you’re so smart, is it? Stand on your chair now!” Cikgu decided to play the power card. They always did when they had no answers to smart questions.

Lee did as he was told and the smile disappeared from his face.

Many of us still remember this incident and Lee will always be remembered as the guy who got punished simply because he smiled.

Recently, when my husband got into a minor fender-bender with a taxi driver, I was reminded of this story. As the article unfolds, I hope it will serve as a cautionary tale for all.

It’ll serve you well to know that if your car has been hit by a vehicle used for carriage of passengers for hire or reward (or what is commonly known as a taxi, rental car, public bus, school bus and factory bus) to be referred to as “public vehicle” hereafter, you are not entitled to make a No-Fault Own Damage (ODN) or Knock-For-Knock (K-F-K) claims, even if you have a police investigation report proving that the other party is at fault.

The only claims you can make are of your own insurance, which will then affect your No Claim Bonus (NCB) or to claim directly from the perpetrator’s insurance, which can be an insurmountable task if the latter is not co-operative.

Now, this is alarming news to me because I did not know, as I suspect many of you don’t either, about this. It got my husband and I very concerned. How and where can we find out more information? Could this be an explanation why taxi and bus drivers drive as recklessly as they do here?

Dissatisfied with my motor insurance company’s response, I’ve since then made multiple enquiries to different insurance companies, the Road Transport Department, the General Insurance Association of Malaysia (PIAM), Bank Negara and even three motor workshops.

The calls and Internet searches I made generated a lot of frustration and failed to answer satisfactorily why public vehicles are exempted from ODN and K-F-K claims. Only one person came up with a direct response (although not necessarily plausible or reliable) in an online public forum.

According to this person, the measure was taken to discourage people from driving private cars. See it as some form of vice tax, if you like. I’m not entirely sure whether this is indeed the rationale behind this ridiculous policy but at least someone offered an opinion other than just re-iterating what has suddenly become an obvious policy.

The Road Transport Department said that they are not responsible for insurance regulation and referred me to the Ministry of Finance. I did not pursue with the latter.

I had to make four telephone calls to obtain a written policy stating the exemption from AXA Affin Malaysia. The first call was answered by someone whose standard response seemed to be “cannot.” Period. My husband and I have taken to calling these people Ms/Mr Cannot and they seem to dominate the service industry in Malaysia. Before you can even explain what you’re asking for, they’ll tell you with great certainty and conviction that you cannot.

Kurnia Insurans Malaysia and Etiqa Insurance have the same policy on their websites. AIA Malaysia’s telephone operator said that this should not be true but was unable to confirm. She also said that all motor insurance policy should apply across the board because they are being regulated by Bank Negara. When I called Bank Negara, there was no one who could answer my query. They promised to call me back but they haven’t.

Zurich Insurance Malaysia Berhad informed me that they, too, practise the same policy. According to their officer, the policy is a result of an agreement made by all the insurance companies. Although I was disappointed by the answer, I was pleased that they were helpful enough to explain what I could do instead.

“You can claim third party insurance directly from the taxi. If you don’t want to go through the hassle of doing this, some workshops will help you. You just need to obtain the police investigation reports,” she said.

“How do you make a claim directly from the taxi? I don’t have his insurance details?”

The taxi driver had conveniently claimed ignorance when I asked for his insurance details. He said he had to call his company to find out and until today, I haven’t managed to get an answer from him. I was told by several people that this is to be expected.

“I hope you have his registration number. As long as you have it, you can find out from JPJ.”

“Does the workshop charge a fee for this service and if yes, how much?” I asked.

“Yes, I think they charge a fee but I really don’t know how much. What I can do is to give you a contact. You can call them and enquire.”

I called the number and to my great surprise, the lady who answered the phone said they don’t charge anything if I can furnish them with all the relevant documents. If I am unable to do so, they will charge a runner fee of RM150.

I’ve also talked to another workshop recommended by someone else and according to the workshop, as long as I send my car to my insurance panel workshop, I can make a KFK claim.

My insurance panel workshop offered us two solutions: 1) submit a ODN claim but our NCB will be forfeited and our insurance will cover the cost of repair, or 2) submit a third party claim but we’ll have to pay for the NCB adjuster fee and cost of repair first. We may be able to get it reimbursed by the taxi’s insurance later but it is entirely up to the latter’s discretion.

My husband and I haven’t quite decided yet what to do with our car. Although no injuries were inflicted (albeit a huge bruise to our morale), the simple principle of justice remains that we shouldn’t be paying for other people’s mistake. It isn’t just about the cost of repair but the time spent on dealing with it.

In my attempt to find answers, I’ve remained utterly confused and defeated. My French husband has cheekily asked me, “Why didn’t I marry a Swede? Why do you have to be Malaysian? It’s the first time I’ve heard of such stupid policies.”

Just like my friend, Lee, who shouldn’t have smiled, we shouldn’t have rejoiced so quickly with the knowledge that it was someone else’s fault when the accident happened. Just like Lee who asked the question “Is it a crime to smile?” and was then punished without any clear reason whatsoever, we are being punished in a similar fashion.

How safe can you be on the road if the rules do not punish those who inflict damage and injury to others? I can be a responsible and safe driver but it doesn’t protect me against those who aren’t. Something’s clearly wrong and how do we get to the bottom of this?

If you ever encounter an accident with a public vehicle (which I sincerely hope you won’t), it’ll be wise to obtain the vehicle’s insurance information immediately.

Meanwhile, do stay safe on the road.

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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.

 

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