(function() { (function(){function b(g){this.t={};this.tick=function(h,m,f){var n=void 0!=f?f:(new Date).getTime();this.t[h]=[n,m];if(void 0==f)try{window.console.timeStamp("CSI/"+h)}catch(q){}};this.tick("start",null,g)}var a;if(window.performance)var e=(a=window.performance.timing)&&a.responseStart;var p=0=c&&(window.jstiming.srt=e-c)}if(a){var d=window.jstiming.load;0=c&&(d.tick("_wtsrt",void 0,c),d.tick("wtsrt_","_wtsrt", e),d.tick("tbsd_","wtsrt_"))}try{a=null,window.chrome&&window.chrome.csi&&(a=Math.floor(window.chrome.csi().pageT),d&&0=b&&window.jstiming.load.tick("aft")};var k=!1;function l(){k||(k=!0,window.jstiming.load.tick("firstScrollTime"))}window.addEventListener?window.addEventListener("scroll",l,!1):window.attachEvent("onscroll",l); })();

M. Bakri Musa

Seeing Malaysia My Way

My Photo
Location: Morgan Hill, California, United States

Malaysian-born Bakri Musa writes frequently on issues affecting his native land. His essays have appeared in the Far Eastern Economic Review, Asiaweek, International Herald Tribune, Education Quarterly, SIngapore's Straits Times, and The New Straits Times. His commentary has aired on National Public Radio's Marketplace. His regular column Seeing It My Way appears in Malaysiakini. Bakri is also a regular contributor to th eSun (Malaysia). He has previously written "The Malay Dilemma Revisited: Race Dynamics in Modern Malaysia" as well as "Malaysia in the Era of Globalization," "An Education System Worthy of Malaysia," "Seeing Malaysia My Way," and "With Love, From Malaysia." Bakri's day job (and frequently night time too!) is as a surgeon in private practice in Silicon Valley, California. He and his wife Karen live on a ranch in Morgan Hill. This website is updated twice a week on Sundays and Wednesdays at 5 PM California time.

Sunday, July 14, 2019

Excerpt #25: Unexpected Reminders of Canada

Excerpt  #25: Unexpected Reminders of Canada
M. Bakri Musa  (www.bakrimusa.com)

My work routine was now in place. Karen and the kids too had settled down well. We could now depend on Hapsah and leave our children with her for part of the day. They in turn had bonded well with her.

            Karen was committed to integrating into the local society and culture. She had volunteered answering the phones and doing general clerical work at the hospital. Those busy nurses sure appreciated that. At first it created quite a stir from patients and visitors, a white woman being “only a clerk.” I was sure that whoever phoned our nursing station when Karen was on would be startled and wondered at the strange “un-Malaysian” voice!

            That July 1st, Canada Day, Karen and I were invited to the Canadian Embassy for a reception. We went with Dr. Badri and his wife Karen, both PhDs and Professors of Chemistry at UPM. At the reception I was pleased but also surprised to meet so many Canadian experts seconded to the country, to universities and governmental agencies. They had nothing but praise for Malaysia. Their Malaysia was very different from what I was experiencing. I was beginning to wonder that maybe I should have stayed in Canada, worked there and then be seconded to Malaysia!

            The upshot from that reception was that my Karen was invited to a subsequent Canadian women’s group gathering. Badri’s Karen too was invited but based on her earlier experiences, she was not enthused with the group but nonetheless was willing to accompany my Karen and give it a second try.

            It was held at a house on Embassy Row, off Ampang Road. From the name of the hostess, she (or her husband) must not have been high up on the embassy staff hierarchy to have his or her name be officially listed, or that she had maintained her maiden name.

            What a different world at that private party! The house was gorgeous, centrally air-conditioned, and a with sparkling pool. This being Malaysia where the price of everything was displayed or discussed in the open, Karen soon found out that the rent was about RM5K a month, ten times our Bungsar home and over three times my salary!

            The only “native” she saw in that exclusive crowd was the Chinese maid. Karen was shocked to see the hostess being rude and curt with the maid. For a while Karen thought she was at a party in the antebellum south, except for the Chinese maid, or perhaps at one of Shanghai’s elegant colonial outposts pre-communist days.

            Decades later I was invited to a Hari Raya reception at a house in the same neighborhood belonging to a senior statesman. Yes, it was palatial too. However, having lived in Silicon Valley for the past 35 years I was not as awed as Karen was then. That was after all Malaysia of the 1970s when GHKL did not even have a CAT scan.

            Karen felt sorry for those Canadian ladies. They had missed a significant part of the Malaysian experience.

            We had always been impressed with Canadian diplomats. The first one I met, and who impressed me most, was Ivan Head. He was then just a junior diplomat (Third Secretary) involved with such mundane things as processing student visas when I first met him before leaving for Canada back in 1963. He returned to Edmonton soon after to be Professor of Law at my university, and faculty advisor to our Malaysian Students Association. I commented to him that the Canadian Foreign Service must be very competitive to have a Professor of Law be “only a Third Secretary.” He laughed. Later he left his academic position to be catapulted as Prime Minister Trudeau’s Special Adviser. Canada’s Kissinger, the press dubbed him.

            Karen’s godmother, Elizabeth MacCallum, once served as Canada’s Ambassador to Turkey. My very pleasant memory was visiting her at her Ottawa home soon after she retired. We had just been married. She impressed me with her extensive knowledge of Islam and the Middle East, as well as her serving us Turkish coffee. It was the thickest, blackest and strongest brew I had ever tasted. And it was good! Suitably perked, I had no difficulty carrying on with the conversation.

            Karen was thus favorably disposed to her fellow countrymen and women who had served abroad. So was I.

            Seeing those Canadian ladies at the Embassy Row party however, Karen thanked her lucky star that her father had declined to accept a special assignment in Pakistan when she was young. Otherwise she would have grown up to be one of those ladies.

            I remarked that maybe those women (or their husbands) were not in the Foreign Service, rather the private sector. Canada was then a major investor in Malaysia with such companies as Electrolux and Bata Shoes. You don’t expect those corporate types to be too interested in local culture.

            A few months later Karen had a unexpected phone call. “Hi! I am a Canadian here on a visit. I used to go around with Ramli in Edmonton!”

The upshot of that brief call was that Karen invited her and her sister who accompanied her to our house. We remembered her and her boyfriend; they were frequent guests at our Edmonton home. They looked like they were in a serious relationship, hence their closeness to us.

            We did not inquire about her trip for fear of opening up a fresh wound. She was accompanied by her sister who was now on her way to New Zealand while she was stuck in Malaysia, alone. She had been to Kelantan to visit him and his family. We invited her to stay with us until her flight home. She accepted with no hesitation.

            Kelantan is more conservative and not as well developed as the west coast states. I remembered Badri’s Karen telling us of her experience there. They were already married then.

            So now we had at least five Canadian versions of Malaysia; that of this young girl, those ladies at Embassy Row, Ivan Head, Badri’s Karen, and my Karen. Which one is right or most accurate?

Next:  Excerpt # 26: Finding A Permanent Place

Excerpted from the author’s second memoir: The Son has Not Returned. A Surgeon In His Native Malaysia, 2018

Sunday, July 07, 2019

Excerpt # 24: A Near Tragedy

Excerpt # 24: A Near Tragedy
M. Bakri Musa (ww.bakrimusa.com)

Back to the clinical side, there was one memorable but very embarrassing and potentially tragic episode at GHKL during my brief association with UKM. The son of a “very, very important person” (VVIP) was having minor surgery. Circumcision is normally done as an outpatient and under local anesthesia, except in rare circumstances and with specific medical indications. The surgeon for this patient was my colleague Mahmud.

            A few days before the surgery, Mahmud confided in me his anxiety about the anesthesiologist who would be doing the case as it would be done under general anesthesia. That was unusual in itself. UKM had two academic anesthesiologists, one young and very competent whom I called with great fondness as Little Ahmad. He was not to be confused with another anesthesiologist, Dr. “Big” Ahmad, who was in the government service. The other UKM anesthesiologist was much older and by now consumed with his administrative chores at the dean’s office. He had been away from clinical medicine for some years. This senior academic anesthesiologist decided that he would do this case.

            Both Mahmud and I were aware of the ultra-sensitive nature of the dilemma. To be prepared, I arranged for young Ahmad to be on standby outside the operating room for that morning, ready to take over regardless of what feathers we would ruffle. Patient safety was our top and only priority.

            On that fateful morning, the young patient was wheeled in and the academic anesthesiologist took over with his usual elaborate ritual, making a big show of it. Mahmud was there and I entered the room on the pretext of making small talk with him on how to do the procedure the “right” or Muslim way.

            Then with the patient induced, sure enough, something happened. The anesthesiologist had difficulty intubating, and he started yelling at the nurses to get an endotracheal tube of a different size. Anytime someone yells, especially your superior and in a tense situation, everyone gets flustered. The nurses could not find the right-sized tube fast enough.

            Within seconds the orderliness and discipline of the operating suite degenerated into a scene resembling an oriental bazaar – chaotic. Except that at the bazaar, the activities were purposeful and productive. In our suite by contrast, the nurses were scurrying here and there, drawers drawn open and then slammed shut, likewise cupboard doors. The academic anesthesiologist’s eyes were darting in all directions, his voice rising with increasing desperation. He was doing everything except keeping his eye on the patient who was now motionless and not breathing.

            As per my earlier arrangement, I signaled behind my back to young Ahmad who was standing outside. He stepped in, bagged the patient, and with no difficulty slipped in a smaller tube that he had in the back pocket of his scrubs (together with a few other sizes anticipating this problem). By the time the attending anesthesiologist turned to his patient, everything was already settled and I continued with my casual conversation with Mahmud as if nothing had happened. Another day at the office! With everything now under control, young Ahmad slipped out and Mahmud started his surgery. The procedure ended with no further incident.

            The beginning and end are the two critical times during surgery. When I operate on children, I make it a practice to hold my breath once my patient is induced, and hold it until he is successfully intubated and ventilated. When I ran of breath, I know then that my patient has too. I would then tell the anesthesiologist to bag the patient (that is, breathe for him). Even today with special oxygen monitors I still hold on to that old practice, especially with my pediatric patients.

            Today’s operating rooms have a mandatory preoperative check-list adapted from long-established airline cockpit pre-flight routines. We call it “surgical pause” where we re-check the patient’s identity, procedure to be performed, laterality with respect to either left or right side, all to ensure that the wrong limb is not being operated on, or God forbid, the wrong patient. Prudent anesthesiologists carry endotracheal tubes one size smaller and one bigger than what they would anticipate using, like young Ahmad did forty years ago.

            The hazards of today’s modern operating rooms are of a different nature, of false signals, what with so many sensitive electronic monitors on the patient, each with its own warning peeps such that the beginning of an operation sometimes simulate the jungle at dusk with its cacophony of warning sounds from faulty connections. Those breed a new risk – the tendency to ignore them, “alarm fatigue.” I am reminded of an old morbid joke about a pilot’s last transmission from his doomed aircraft just before it crashed, “That damn alarm is acting up again!”

            I had another incident of a different and non-clinical nature, this time involving only a VIP. One day my secretary frantically gestured to me to answer the phone while I was busy in the out-patient clinic. I ignored her. She rushed to interrupt me with a note, “Tan Sri Hamzah on the line!”

            I had no idea who he was so I asked her to take the number so I could call him back. Later in the calm of my private office about to return the call, she stepped in and gingerly closed the door behind her. “Did you know who was that Tan Sri?” she whispered, not hiding her anxiety. She went on to illuminate me on this illustrious son of Malaysia. He was the brother-in-law of Tun Razak and a minister in his own right.

            I paused, to compose my profuse heartfelt apology before dialing. With her girlish grin, she then said how glad she was that I didn’t take the call. Otherwise I would have been inundated with all the big shots wanting their sons to be circumcised by me. When she left, I made my call. It was my luck that he was out. My unintended snub that morning was my savior.

Next:  Excerpt # 25: Unexpected Reminders of Canada
Excerpted from the author’s second memoir: The Son has Not Returned. A Surgeon In His Native Malaysia, 2018

Sunday, June 30, 2019

Excerpt #23: More Former UKM Faculty Members!

Excerpt # 23:  More FormerUKM Faculty Members!
M. Bakri Musa (www.bakrimusa.com)

While I did not have any formal academic appointment with UKM, and the non-too-pleasant encounter with its dean notwithstanding, I had plenty of interactions, planned as well as unplanned, with its faculty members, current as well as former. I was surprised that for a young institution, I met many more of its former faculty than current ones.

            One was Dr. Ariffin Marzuki, UKM’s formerVice-Chancellor. Note the emphasis. When I first met him in the surgical lounge at GHKL, I told him that I had heard of him during my secondary school days. His name was in the papers for designing a baby’s pram that was safe and comfortable. He was then doing his Ob-Gyn training in Britain. He brushed aside my compliment and went on to recount his “former VC” status without any prompting from me. I still do not know what I did or said to trigger his outburst on the topic.

            Prime Minister Tun Razak had tapped him from nowhere to head the new university following the resignation of its first head, Rashdan Baba. Rashdan, who previously headed the Universiti Pertanian (Agricultural University) Malaysia (now Universiti Putra Malaysia) with some distinction, had been with UKM for only two years. He must have had a very high opinion of himself to think that he needed only a very brief tenure to get the new institution on its feet. Why he took that crucial assignment in the first place and then quit shortly thereafter baffled me. He should have known that a new institution that was so dear to Malay hearts would need stable leadership. That was the height of arrogance if not irresponsibility on Rashdan’s part to resign so prematurely.

            Ariffin indicated that he had no clue as to why Tun Razak had picked him to replace Rashdan as he (Ariffin) had no academic experience. Perhaps it was because he was then one of the few Malays with a professional qualification beyond the first degree. Ariffin did not intimate why he was not a good fit. As was obvious to me, his first and perhaps only love was clinical medicine, being in the operating room was much more rewarding than discussing policy papers or grappling with prickly personnel issues.

            I also met another Malay Ob-Gyn at GHKL, Dr. Ahmad Adnan, a man of small stature and a humble demeanor to match. He introduced himself to me and then right away said that he was looking forward to his early optional retirement at the end of the year to start his private practice in Klang. He beamed when he said that, his excitement brimming over!

            He was of the same vintage as Dr. Ariffin; they probably qualified at about the same time. Yet one was famous, his name in the papers, and being picked by the Prime Minister to lead a new university, while the other was an unknown. It was also obvious to me who was the happier one.

            UKM had its full complement of clinical departments, and I interacted often with their professors. Dr. Rahim Omar, an internist, once consulted me on a young girl with acute abdomen. He had just started her on steroids for lupus. I had to operate on her because of her deteriorating clinical condition and was horrified to find necrotizing lupoid pancreatitis, a severe and lethal condition. Such cases were also rare.

            Rahim too did not last long with UKM. He soon left to start his own private practice. Through him I met Dr. Amir Abbas, the inaugural dean of UKM’s medical school, at a clinical symposium. He remembered me through my earlier letter that I had written to the medical school from Canada. He apologized (rather late!) for not replying for his office then was in a turmoil. He did not elaborate on what that turmoil was and I did not pursue it. Nonetheless he encouraged me to pursue my interest in UKM and that I would be a positive addition. I did not bother to tell him of my earlier encounter with his successor.

            I met Dr. Amir a few more times, all at medical conferences. My impression of him was very different. I found him to be a solid clinician, an intellect with integrity, and he would have been an outstanding leader for UKM’s medical school. His being relieved of his duties reflected more on the poor judgment of then-Prime Minister Hussein Onn.

            Earlier, I related how Hussein Onn regretted very much his choice of Mahathir as his successor. Now with Dr. Amir, Hussein again demonstrated his poor judgement of character and talent. He probably hired and then fired this distinguished physician without ever meeting or personally evaluating him first, just like Hussein did with Mahathir.

            My encounters with such distinguished clinicians as Drs. Amir and Marzuki, men who emphasized their formerfaculty status, as well as my own very limited experience with UKM, convinced me that I should not hitch my future with that institution. My conviction was strengthened when I met a faculty member from the Physics Department. He joked that UKM meant Universiti Kuat Meeting (University obsessed with meetings).

Once I attended a reception hosted by Mahmud at his expansive house to honor a pair of visiting medical professors from the University of Texas, Austin. I was stunned that they were flown in first class all the way and were put up at the Hilton!

            My astonishment for that evening did not end there. During the social conversations, one of the local academic internists asked the visitors how big was their Department of Medicine. The visitors could not venture a guess; their own sub-divisions numbered over a dozen each. The whole department could very well be over a hundred.

            “Over a hundred!” exclaimed the astonished local academic. “What do they all do?” she continued much to my as well as the visitors’ embarrassment. It was obvious that the local academic could not keep herself busy enough.

            That reception stunned me for another reason. I saw what a luxurious government bungalow Mahmud lived in. It was in a wooded area up on the hills in a quiet, secluded part of KL, surrounded by lush expansive lawns. During the reception when showing Karen and me around, Mahmud complained that the government’s JKR (Malay initials for Public Works Department) people were unreliable workers. They had not mowed his lawn in days! I had to bite my tongue as I had to do my own lawn, quite apart from paying a hefty non-government-subsidized rent for our modest terrace house.

Next: Excerpt # 24  Still More UKM Matters – A Near Tragedy Avoided
From the author’s second memoir: The Son has Not Returned. A Surgeon In His Native Malaysia, 2018

Sunday, June 23, 2019

Excerpt #22: UKM's Misplaced, Expensive Priorities

Excerpt 22:  UKM’s Misplaced, Expensive Priorities
M. Bakri Musa (www.bakrimusa.com

            At about this time UKM’s medical faculty received a huge loan (gift?) from the Saudi government, with a substantial amount dedicated for surgical research. As Mahmud had no research experience, he sought my advice. I reviewed the blueprint prepared by the “experts” the Saudis had hired.

            One item struck me, an operating table for the proposed animal lab. Each cost about RM14,000 and they had ordered six. RM$84,000 may be small change in the context of RM50 million, but still the figure astounded me. I told Mahmud that I could design a set similar to the ones I had used in Edmonton for my research and then have the local Chinese metal sheet worker fabricate it for a fraction of the cost.

            Neither Mahmud nor the university was interested in my proposal. They just wanted to hear from me whether those tables were of suitable design. Of course, they were, at $14,000 a piece! They did not need to ask me that. However, if you were to ask the vets in town, they won’t buy any, not at that price. It would bankrupt them as there was no way they could recoup the costs.

            Here I was spending my limited personal funds to publish those papers of my trainees, all UKM appointees. UKM would not contribute a penny. Just the mechanical process of getting the papers published cost me a bundle. I had to rent a Selectric IBM typewriter and buy double-bond papers. Those cheap see-through rice papers, the staple at government offices, would not cut it. I had to use the commercial Xerox copiers downtown. Then there were the costs of making diagrams and slides. This was pre-Microsoft Office Suite days. Even airmailing those submissions cost me a bundle!

            Yet UKM was willing to pay $14,000 for an operating table for their planned surgical research animal lab that did not have any faculty member capable of undertaking the work!

            Today I read of Malaysia Airlines paying 40 percent more for its jets than its competitors, and that the proposed East Coast Railway would cost more per mile than the one built across the Swiss Alps. Those Malaysian wasteful ways have had a long genesis.

            That animal operating table was far from the only instance of misplaced expensive priorities. Soon after my arrival, Mahmud took me on a tour of the hospital, describing it as Asia’s most modern with its award-winning design, with wide corridors and expansive stairways.

            We were on the top floor when my eyes wandered onto the busy Circular Road towards its end where it intersected with the roundabout at Jalan Pahang, a busy section even at that time. There was a fender-bender that just happened.

            I turned to Mahmud and inquired, “Suppose that was more serious and the driver had busted his spleen. How would they get hold of us?”

            Mahmud was stumped. “Somehow the A&E (Accident and Emergency) docs will find us!” he stammered.

            To save him from further embarrassment, I broke the sequence into pieces, beginning with how the victim would get to the hospital, whether there was an emergency 911-equivalent number, and whether those manning the ambulances were trained or just a “scoop and go” team? Mahmud did not know those details either.

            We both decided to find out. We went to the A&E Department and were met by its Director, a Sikh fellow with a huge colorful turban, sitting at his desk reading a newspaper. Mahmud introduced me to him. He promptly excused himself as he had a sore back and delegated one of his medical officers to take us around. When I repeated my earlier queries to this young doctor, his immediate response was that indeed contacting the on-call surgeon was a perennial problem and consumed much of their valuable time.

            As for the ambulances, I was right. They were nothing more than a free government taxi-van service. The attendants were untrained, not even in basic first aid much less CPR.

            Later I suggested to the Deputy Medical Director to equip the on-call doctors, especially surgeons, with beepers. His response was the usual “No funds, lah!”

            I made some queries with the commercial operators of pagers in town and had a quote. I suggested to Mahmud to have the university pay for a couple, one for the surgeon on call and another for the medical officer. No funds for that either. I decided to get a personal one at my own expense only to find out that for individuals it would cost twice as much and would consume a major chunk of my pay!

            I wanted to discuss that with the Director of A&E. He was not interested in hearing me out. I was later told that he was just biding his time until retirement. He had earlier sought full, early retirement because of an injury but was denied – thus his petulance as the head of A&E. He was, to put it in my pathologist-colleague Kutty’s wise words, drawing haram(illicit) salary.

Next:  Excerpt # 23: More Former UKM Faculty Members
Excerpted from the author’s second memoir:  The Son has Not Returned. A Surgeon In His Native Malaysia, 2018

Sunday, June 16, 2019

Excerpt 21: Only Too Brief An Academic Association

Excerpt # 21:  Only Too Brief An Academic Association
M. Bakri Musa (www.bakrimusa.com)

It was not with much enthusiasm that I took my hospital’s Deputy Director’s suggestion to meet with the Dean of UKM’s medical school. My lack of enthusiasm was not without foundation. Years earlier while in Canada I had written to the then UKM’s Dean of Medicine, thinking that being a new medical school my prospects would be better there. No reply. I had also written to the University of Malaya. Similar results.

            The UKM Dean’s office was at the Malaysian Medical Association building across the street from GHKL. I entered a darkened office, the lights dimmed, and curtains fully drawn. Behind a huge desk that was remarkable for its bareness sat a stocky Malay man with dark glasses.

            “I am allergic to the sun!” he said when I could not help but stare at his wearing sunglasses in a darkened room. I suppressed my laughter with some success, managing only a detached smile. Allergic to the sun, in tropical Malaysia?

            He told me that he was called in from retirement to “run this place” because the inaugural dean had some trouble with corruption. I was surprised.

            I introduced myself. He was nonplussed and just continued staring at me. I was expecting some questions about my training and experience, but nothing was forthcoming. Only silence. I was getting uncomfortable.

            Then, “Why are you here?”

            I had interrupted the siesta of a slothful monk, and was taken aback. I thought my deputy director had spoken to him about me. More in desperation, I blurted out that I was looking for an academic job.

            “Was there an ad?”

            “I beg your pardon?” not believing what I had just heard.

            He repeated his question. I replied no.

            “Wait for the ad. Then apply!”

            Only a few months earlier I was told that the country did not need surgeons except in such places as Kuala Lipis. Now I was being told that its new medical school also did not need one.

            That was my briefest interview ever, if I could call it that. I should have been disappointed, but I wasn’t. It is not a disappointment when you expect it. It was more a relief. I concluded during our very brief encounter that I should not and would not trust my future to this nincompoop.

            The man, Dr. Wahab Ariff, was a former public health doctor. The last time he examined a patient was probably when he was an intern. As for academic experience, he had none. His mindset was civil service. His superior had not told him to recruit surgeons, so he did not. He was there only to keep the seat warm.

            My surprise was that the authorities had given him the awesome responsibilities of setting up a new medical school. I wondered who was the greater fool, he or the one who appointed him?

            That distracting minor detour aside, my routine at the hospital remained unchanged. Take care of patients, teach medical students assigned to my unit from both UKM and UM, and guide the interns as well as medical officers. As for the third leg of the three-legged stool of modern medicine that I was trying to create at GHKL – research – I had introduced the rudiments of clinical inquiry to my trainees by assigning them each some small clinical projects. There was no shortage of clinical materials at GHKL, including the rare birds.

            Once I did a stomach biopsy and the results came back as “eosinophilic gastritis.” I asked one of my senior trainees about the condition and she replied, “Oh yes, we see quite a few such cases!”

            Good, I replied, and then asked her to expound on it. She could not. I told her to look up the literature and report back. To her surprise there was not much written about it either. I assigned her to follow that and similar cases and document in full the clinical history and presentations, as well as perform further necessary diagnostic tests.

            That case served many useful lessons for my trainees. Seemingly common cases may not be so, nor have been adequately studied and documented. We must remain inquisitive and not be so ready to accept pat answers or the conventional wisdom.

            Every one of my trainees had a little project or two. By the end of the year, three of them had published scientific papers. Freda Meah wrote on traumatic small bowel injuries in blunt trauma; Yusha’ Wahab on a sub-variety of injuries associated with wearing seat belts, and another series with ventral hernias. Those were case reports rather than true clinical research. Nonetheless they provided a good exercise in reviewing the literature as well as scientific writing.

Zulkifli Laidin’s clinical research was on the effect of prophylactic (preventive) preoperative topical antibiotic infiltration on surgical wound infections in acute appendicitis. As our unit was a busy one, it did not take us long to acquire a respectable publishable series. Zul showed that the technique did indeed reduce wound infections. This was at the time when the use of prophylactic antibiotics was frowned upon. Today it is standard practice; not to use one would be considered substandard if not negligent.

I too had started on my own research project, on the immunology of parasitic infections, in particular amebiasis. In the short few months I was GHKL, I saw more than a few cases and was intrigued by their myriad manifestations, from self-limiting diarrhea to severe enterocolitis and from self-healing “tumors” (ameboma) to fulminating liver abscesses. I was also certain that none of the major research centers in the West were engaged in this study. So I had this wide new field open to myself.

            The beaming smiles of my trainees when they saw their names in print for the first time made all their hard work worthwhile. I had the same elation with mine and assured them that the joy did not diminish with subsequent papers. Each was an accomplishment in its own unique way.

Next:  Excerpt 22: More UKM Matters – Misplaced Expensive Priorities

Excerpted from the author’s second memoir:  The Son has Not Returned. A Surgeon In His Native Malaysia, 2018

Sunday, June 09, 2019

Excerpt #20: Obsession With Pay And Perks

Excerpt #20:  Obsession With Pay And Perks
M. Bakri Musa (www.bakrimusa.com)

A preoccupation of Malaysian civil servants, including the professional staff such as doctors, was with their pay and perks. No surprise there as doctors were poorly paid and received far meager benefits as compared to their administrative colleagues. When compared to doctors in the private sector, the gap was even wider. Still is, only much more so today.

            I decided very early on not to be too bothered with my compensation details. I had accepted the harsh fact that my returning to Malaysia meant a significant reduction in my pay, and with that a corresponding lowering of my living standards, at least as compared to what I had enjoyed in Canada. Even if I were to be made Director-General, I would still earn less than what I did in private practice in Canada. Karen too had also accepted that.

            A few years earlier while in Canada, my in-laws referred me to a magazine article of a Canadian parent whose daughter had married an Indonesian student and the couple had returned to Indonesia with their young family, just like I would be doing in a few years’ time to Malaysia. Later her parents visited them. They were heartbroken to see their daughter and grandchildren living in such desperate conditions. I assured Karen and her parents that Malaysia was far ahead of Indonesia and that, God willing, we would not face such a fate. We may not have a nice suburban home and a lakeside cottage, nonetheless we would be comfortable. After all, I would be returning as a surgeon, not a lowly intern.

            Thus whenever conversations in the hospital cafeteria turned to pay and allowances, which were often, I tuned them out. Now that reality had struck, I could not ignore those details.

            My old high school classmate, Ramli, was well tuned into those sort of things. He told me not to expect much regardless of the sweet promises of the bureaucrats. I would never qualify for “Superscale” until I had served at least five years. My alternative would be to quit government service after the mandatory two years or join the university, which was not much better, he assured me. He was with UKM.

            At my parents’ home too, the conversations were often with income. Salaries, pay grades, the car your drive, and how much was your dowry were very much everyday topics among Malaysians of all classes and at all times. As Karen found out much to her discomfit, they would even ask her how much her dress or wedding ring cost!

            It was during one of those discussions that my parents discovered how much less I was being paid as compared to my much younger brother Adzman. Not only that, he had a beautiful government-issued bungalow on a spacious lot in a secluded part of Kuala Lumpur, and with a rent a fraction of what I was paying. Even my parents realized that I was getting a raw deal.

            My parents of course could not do anything about my pay. Theirs when they were Malay school teachers was much lower yet they managed to save, made good investments, and had a comfortable retirement. So comfortable money-wise were my parents such that my older brother Sharif’s main duties on his frequent visits home were to deposit our parents’ pension checks. They would just let them accumulate as their income from their rubber plantations was more than enough.

            As I was showing my parents my monthly budget to justify my overall bitching about the government, my paymaster, my parents offered me their pension checks so I would not have to dip into my savings. I was horrified. So was Karen when I later related to her their kind offer.

            My parents knew of our lifestyle in Canada; they had seen pictures of it. They did not want us especially Karen to have a standard of living much lower to what we had been used to, and they were willing to contribute to that. Bless them, they meant well!

            My parents were also haunted by something else. The son of their colleague back in the old village had also married a foreigner. This fellow had left his wife and young family in the village to live with his parents while he was off abroad on an extended study leave. His parents spoke no English and I assumed she, no Malay. Within a few weeks her parents in Australia mailed her their airline tickets. She and her two children were gone, never to return.

            When my parents related that episode to me during my 1969 trip home and before I married Karen, no doubt part of their parental dutiful cautionary advice to me, my immediate reaction was to blame the son and sympathize with the daughter-in-law. He should have sent his family back to live with her parents in Australia, not in a Malay kampung among strangers. At first my parents were horrified by my reaction. After much reflection, they agreed with me.

            In the back of their minds my parents thought that unless I maintained a standard of living that Karen was used to in Canada, a similar fate would await their daughter-in-law; hence their offering their pension checks. I had to reassure my parents many times that their new daughter-in-law was not a spoiled white brat.

            That still did not resolve the issue of how to refuse my parents’ kind offer without sounding impudent or ungrateful. One evening with Karen by my side, I told them that we were committed to each other, “for richer, for poorer, in sickness and in health.” I told them that I could live, and Karen would accept and so would my children, even if my paycheck were to be halved and we lived in a wooden house on stilts back in the kampung. I did not know whether that convinced them or not, but the issue of my pay never cropped up again.

There were not many instances of mixed marriages with foreigners in my parents’ small world. When I married Karen, my parents had only that unfortunate example.

            Bless my mother, she saw that not as a problem but an opportunity, and a very splendid one. She was not one to miss using it to her advantage.

            When I visited them back in May 1969 it was in part to tell them of their potential daughter-in-law. At that time my parents were building their dream home in Ampangan, a suburb of Seremban. It was a modern brick bungalow, with electricity, piped water, and indoor plumbing. It bordered on an elegant golf club, and a universe away from their village home back in Kampung Tengah. It was unfortunate that halfway through, the builder went bankrupt. With that, my parents’ dream house collapsed, though not literally. The nearby British army base had closed, and with that a significant part of the builder’s business.

            The house was nearly completed with only the cosmetic interior to be done. I suggested that they could recoup their investments by borrowing more and getting another builder to complete it. We secured one and my parents’ dream was again rekindled. At the last minute however, my father balked. What if this second builder too were to file for bankruptcy, and my father would then be stuck again, this time with two loans. He was ready to write off his losses. My mother was devastated again as my father would not budge.

            In desperation, my mother warned my father that if they did not build that house, it would mean that Karen had to come visit them in the kampong – no electricity, no piped water, and no indoor plumbing. How would your Canadian daughter-in-law react to that, my mother taunted him. Remembering what had happened to that young Australian mother and her two kids earlier, my father relented.

            I felt guilty that my mother had used Karen as a battering rod against my father. However, as my mother rationalized, if that was what it took to make my stubborn father change his mind, then so be it! That was Karen’s contribution to her in-laws’ (specifically my mother’s) realization of their dream house and comfort in their old age.

Next:  Excerpt # 21 Only Too Brief An Academic Association
From the author’s book, The Son Has Not Returned: A Surgeon In His Native Malaysia, 2018

Sunday, June 02, 2019

A Rookie In The Bureaucracy

Excerpt #19:  A Rookie In The Bureaucracy
M. Bakri Musa (www.bakrimusa.com)

During my second week at GHKL the entire specialist staff was summoned–yes, summoned–to meet the Minister of Health at the ministry, some miles away from the hospital. Mr. Lee Siok Yew’s reappointment had just been announced by new Prime Minister Hussein Onn only weeks earlier. Thinking that as a new hire and a very junior one at that, my absence would not be missed, I thought of skipping it. Datuk Menon advised me not to.

So that morning the entire GHKL was in suspended animation as all the specialists were called away. Nobody had suggested that logistically it would have been much easier and less disruptive if the minister and his staff were to come to the hospital. As for the specialists, they lapped up at the invitation, a chance to escape their busy schedules and hectic workplace.

            There were over thirty of us seated around the huge oval conference table. You could tell the seniority of the specialists from how far away they were seated from the minister. As expected, I was the furthest away but as fate would have it, directly in front of the minister right across the huge conference table.

            Preambles at Malaysian gatherings regardless of size or formality are long drawn-out. This one was no exception. The minister expressed his gratitude and humility at having so many distinguished medical specialists around him that morning. He went on and on mentioning specific names. Those named would of course beam. I kept thinking that the minister (or anyone else for that matter) better not have any loved ones with a medical emergency condition that morning. He or she would be left unattended as all the specialists were away.

            The minister humbly apologized for the many shortcomings of his ministry. He was committed to improving things, he assured us over and over. That done, he went around the table asking each specialist to tell him what needed to be done. He was ready, an eager novice waiter waiting for his first customers’ special orders.

            This meeting was called for on very short notice. I was sure that nobody had prepared their presentations. It did not take long for the meeting to degenerate into a long venting session, no different from the cafeteria bitching my house staff engaged at in the cafeteria. With over thirty of us at that meeting with the minister, it consumed the whole morning and then some.

            My otherwise intelligent and distinguished colleagues were now all acting up, like little boys (they were all males) complaining to their favorite uncle of not getting their expected Christmas toys, or since this was Malaysia, generous enough duit rayaor ang pow. Everyone was pouring out their wish list. I did not know what else transpired for I quickly tuned out the discussions.

Then suddenly I became aware of my colleague beside me tapping my elbow to warn me that my turn was coming up. Way sooner than I had expected; either that or I had been dozing off.

            Datuk Menon, who was seated beside the minister, interrupted him to introduce me just before the minister was to recognize me. Menon was very warm and generous in his remarks such that I was put off track from the ‘spontaneous’ speech that I had been practicing silently earlier. Suitably primed, I should now say something profound but I could not.

            “I have nothing to add, Yang Berhormat,” the carefully-memorized response that I had earlier by now vaporized, “I agree to everything my distinguished colleagues have said.”

            The minister was not satisfied. I had underestimated him. “You have worked in a big hospital in an advanced country. How do we compare?”

            Now was stuck! All I could blurt out in desperation was that I shared the frustrations of my more experienced colleagues. Then like a cobra that had earlier recoiled in defense but now was ready to strike out, I added that if he could correct just ten percent of the problems, then I would be satisfied.

            “Satisfied enough that you won’t leave us then?” he teased. Earlier in his presentation he had alluded to the rash of resignations from dissatisfied medical specialists.

            I replied that I would not leave if he could attend to just fivepercent of the problems. Then as he and his staff nodded with smug satisfaction, I added that I saw no one taking notes.

            There was an immediate and embarrassing scramble among his staff looking for papers to write on! The meeting ended on that downbeat observation of mine.

            As we were leaving, a colleague came up to me. “You have guts, Bakri. I wouldn’t dare say what you just said!”

            A few weeks after my interview at the Public Services Commission, I received a formal letter of my appointment in the Ministry of Health of His Majesty’s Government of Malaysia. There were other details on that missive but I could not make them out as they were worded in dense bureaucratic mumbo jumbo. The one information that I desperately needed to plan my daily life – how much I would be paid – was not mentioned.

            I would know of that a few paychecks later. I received a few thousand dollars more in back pay, which helped replenish some of my savings, but still, I was disappointed with the amount. I still had to dip into my savings. I was told earlier that as a specialist I was entitled to be on the “Superscale” status, with the lowest “G” pay of around RM2,000 per month. Mine was way short of that.

            I sought the deputy medical director for clarification. He expounded on the government’s remunerations scheme as only a bureaucrat could. I was lost, or more correctly, uninterested. All I wanted to know was the bottom figure. He did clarify matters, up to a point. As I was a new hire I was treated, at least pay-wise, as all the new hires such as an intern. However, because of my specialist qualification I had a slight increment, but still hired and paid as a rookie. If he had meant to mollify me, he failed.

            He tried to mollify me by adding that the pay was only part of the total package. I should also consider the assorted benefits and allowances, like for a car, house and entertainment. Those would be substantial, he assured me.

            What allowances? I had none. He checked over my files and was puzzled. Then he beamed like an alchemist who had discovered the secret formula to eternal youth. I was not entitled to any as I was a new hire.

            Sensing my disgust, he suggested the university. Being a statutory body, the pay would be higher and the bureaucratic requirements less demanding, he enlightened me. He also knew the dean of UKM well and would put in a good word for me. With that he referred me to the dean.

Next Excerpt # 20  Obsession With Pay And Perks
From the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.