Excerpt #31: Mooting A Surgical Training Program

Excerpt #31:  Mooting A Surgical Training Program

M. Bakri Musa (www.bakrimusa.com)

Apart from getting more than my share of female doctors, my unit also had more of those who were not interested in surgery. Despite that I did not encounter many personnel issues. I can recall only two, and for very special reasons.

            One was an intern, a Taiwanese medical school graduate. At first I attributed his difficulties to language. However, I had no problem with the UKM students. Despite my intensive coaching, he was not making much progress. In the end I had to recommend that he repeat the rotation, a rare occurrence.

            A few days later I received a phone call from a senior hospital administrator about “a little problem, lah!” He wanted me to retract my earlier adverse recommendation. This intern (or rather his family) was well connected with the Minister of Health, my superior told me. When the implied threat did not work, it was made more explicit. Still, I resisted.

            True to form, a few days later I received a call from the Minister himself. In his half-English and half-Malay, interrupted by frequent “I say” and “Ayah!” he finally blurted out that my negative evaluation was unacceptable. Our ensuing conversation reminded me of the haggling at an oriental bazaar, except that it was not funny in any remote way. Unable to agree on a final term or price, I shifted tactic. I flattered him, by telling him that I was only a junior consultant and that surely he, as minister, could easily overrule my recommendation! That ended our very unpleasant conversation.

            A few weeks later the intern asked whether he could repeat his rotation with me! Either he was a masochist or that he agreed with my assessment. Obviously his family friend the Minister decided not overrule me.

            The other problem I had was with a medical officer. He was one of those not interested in surgery. I reprimanded him because he abandoned his patient in the emergency room while he was off for his Friday prayers. He retaliated by signing up to be a physician for the upcoming Hajj pilgrimage without first telling me, except at the last minute when he had to get my permission. I refused to grant him that. He was furious. For a while I thought he would become violent towards me. Instead he threatened to report me to the religious authorities. When that did not faze me, he warned me that I would rot in hell for preventing him to undertake his pilgrimage!

            The following day he made a formal request to withdraw from my service. I granted that right away even though that meant we would be short-staffed on an already overstrained service.

            That medical officer, and a few others like him in my unit, was a crying shame. It was also a significant lost opportunity. The rich resources (rich in terms of “clinical materials” or patients) of the hospital could be better used to train future surgeons instead of merely meeting the statutory requirements of new doctors. Those bureaucrats at the Ministry of Health and the UKM Dean of Medicine notwithstanding, Malaysia was desperate for surgeons.

            Earlier I had broached the idea of initiating a formal surgical residency training program with Mahmud, UKM’s Chief of Surgery. He was supportive. As he was busy with the undergraduate program, together with his lack of experience with such matters, he could not offer me much help. He was however, willing to pave my way to meet important players who could. One was Tan Sri Majid.

            So that August during Hari Raya, Mahmud and I went to Majid’s “Open House” to plead our case. We decided to go late as most visitors would come early when the food would be fresh, warm and plenty.

            When we arrived at his plush residence in the exclusive neighborhood of Bukit Tunku, the crowd was already thinning, as we had anticipated. The Tan Sri recognized Mahmud right away, and with more than a little bit of prompting on my part (“The surgeon from Canada; the one you mistook for the Egyptian Ambassador”), he remembered me.

            I reminded him of the country’s severe shortage of surgeons generally and of Malay surgeons specifically. That grabbed his attention; he guided us to a private corner of his house to continue the discussion.

            With the current set up at our unit, we could with minimal difficulty produce six surgeons annually, I told him. We could double or even triple that number in five years with the co-operation of the other units. He was skeptical that I could find that many qualified candidates, especially Malays. I assured him otherwise and that with my limited exposure thus far to young local doctors, I already had no fewer than a dozen excellent candidates who had expressed their interest to me. If I were to scour the countryside, I was sure to find many more. Then there were those now studying abroad like his son in Australia. He smiled at my reference to his son. I was also not so subtly reminding him of our earlier conversation not so many months ago.

            Tan Sri Majid was impressed. He was surprised that the bottleneck would not be in finding qualified candidates as he and many others had thought, rather in providing the opportunities. I was now into the nuts and bolts of my proposal when he had to excuse himself. He apologized profusely as he had a planned golf outing with a very important person. He asked that I pursue my project and apprise him of the progress.

            Buoyed by his endorsement I was a ready to charge, like a bull that had just been released out of its pen. The next day I went to the hospital’s deputy medical director for the list of incoming house staff. What list? “I would be lucky to get one when they arrived,” he smirked, “just like your arrival here!”

            I laughed even though the joke was on me. That was my introduction to the Malaysian bureaucracy at the nitty-gritty level. I already had intimations of that on my initial visit to the Ministry of Health, the search for my promised government quarters at Lake Gardens, and my encounter with the UKM dean. Nonetheless the import did not register on me then. After all my presence at GHKL proved that those bureaucratic hurdles and inertia were not insurmountable.

            Between my busy schedules and the runaround at the ministry, it took me weeks to secure my appointment with the appropriate officials, and that was only after I threatened to go over their heads directly to Tan Sri Majid. At first I was told that I could not get the list of medical students now abroad. I would have to ask the Public Service Commission (PSC). As for local students, I would have to go to the PSC too for them. I could bypass that by going to the dean’s office of the two local medical schools.

            If I could not get the list of those medical students, how about those interns and medical officers now outside of KL? I could not get them either. Only the ministry had the authority over where they would be assigned, not me. Once they were assigned to GHKL only then would they fall under the hospital’s authority and I could make the arrangements at that level.

            I protested that surely as a surgeon I would be a better judge who would be the most suitable candidates instead of passively waiting for them to be assigned to me. I could not persuade those civil servants. Those were the rules of the civil service, its “GO” or General Orders, its “Ten Commandments,” except that they ran into thousands of pages.

            Frustrated, I told them I would go directly to Tan Sri Majid. It was at that point that I was told that he had just retired. My hopes were deflated, my dream of a surgical residency program shattered. Only much later did I realize that even in retirement the man still carried much weight, and not just in healthcare.

            Although Tan Sri Majid’s successor, a certain Raja Ahmad Nordin, could not see me (he had just assumed office), nonetheless I would be able to meet with other top ministry officials. My hopes were again resurrected.

Next:  Excerpt # 32: Hitting A Bureaucratic Brick Wall

From the author’s second memoir, The Son Has Not Returned. A Surgeon In His Native Malaysia, 2018.