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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, November 24, 2019

Excerpt # 44: A Royal Command To The Palace

Excerpt  # 44:  A Royal Command To The Palace

Midway through my first week at GHJB an ambulance drove up to the house. As in KL, getting a phone for our home was a monumental endeavor. Meaning, we did not have one at the time. Assuming that it was an emergency call from the hospital, I was ready to leave. The driver gestured for me to settle down as he handed me a note. It was from the Matron (Director of Nursing), Sister Chong.

            The Sultan wanted to see Karen and me the next morning. He had heard that there was a surgeon from Canada and asked Sr. Chong whether he was a Canadian. She, who I later discovered had an extracurricular role as the sultan’s personal nurse, had replied that I was a Malay.

             “Good!” he replied. “Ask him and his missus to see me!” How was that for a welcome?

            If not for Sr. Chong’s note, my mind would have wondered wild, speculating what royal protocol had I breached in my first few days in JB. My only experience with royalty was during my primary school prize-giving ceremony. I did not sembah (genuflect) to the Regent of Negri Sembilan when I was called on stage to receive my book prize from him. I was immediately taken off stage and made to practice the ritual before I could repeat the ceremony.

I had been down with chicken pox and thus could not take part in the rehearsal the previous week. As all the winners who had gone on stage before me had been non-Malays, I had no example to follow. They did not need to sembah, only Malays do.

            Back to the royal invitation, I rushed to the kitchen to tell Karen. She laughed, dismissing it as a bad joke. When I showed her the note, her immediate reaction was, “I have nothing to wear!”

            Later I discretely asked Yahya for some much-needed advice. He was from a long-time aristocratic Johor family and thus would be familiar with such feudal rituals and palace protocol. His immediate advice was, “Be careful!” I did not know what he meant. I wanted to know what attire to wear, traditional or formal business suit. He confessed his ignorance as he had never been to the palace.

            I then asked one of my Malay interns. Dr. Hashim was from Trengganu, a conservative state. He advised me to be traditional. You could not go wrong; otherwise I could appear biadab (uncouth). I asked Sr. Chong. Just be yourself, was her only advice. The sultan was quite modern, she assured me.

            I wore my maroon suit with a matching tie and black songkok. It was then that I realized that I was in a bad need of a haircut. A hippie in a suit! I did not remember what Karen wore. She couldn’t either.

            We were led in through the side door to find His Highness seated alone on his sofa in the parlor He was wearing a subdued Hawaiian shirt. He had both his hands on his walking cane in front of him. He looked cherubic, fair-skinned, his face with generous sprinkles of age spots. He was on the chubby side but his loose Hawaiian shirt camouflaged that.

            As we navigated in between the elaborate parlor furniture, I could not help but notice the absence of anything that would remind me that we were in a Malay house or palace. All the furniture was English-themed, Victorian specifically. It was as if we were in an English country castle except for the abundance of Chinese vases.

            He extended his right hand for a firm handshake.  “You are from Canada!” he greeted me, beaming.

I corrected him and that Karen was the one from there. That shifted the conversation to her.

            The sultan was knowledgeable about Canada, asking Karen about Vancouver, Ottawa (she had lived in both cities) and Toronto (she was born there). The conversations were now in Karen’s direction. He asked us whether we had trouble finding a house. When we replied that we did not, he went on to reassure us that should we encounter problems, to contact him. Wow, that would be quite an endorsement; a royal imprimatur. No one would dare say no to us then!

            He complimented us for what we had done to our yard. He noticed my hard work! He was pleased that we had planted the trees. As the conversation slowed down, he showed me his right elbow. There was a small lump and he wanted my professional opinion.

            There is nothing that would make a nervous young doctor ill at ease in a social situation feel confident than to be asked a medical question. I was now no longer an unsure peasant in front of his sultan but a surgeon being consulted by a patient, albeit a very important one. He kept rubbing the lump as I asked him some clinical questions, as with any pain or recent change in size. He had neither. Thinking that it might be a rheumatoid nodule, I asked him about joint pains and swelling; again, he had neither except for some neck pain and occasional knee stiffness. He spoke impeccable English with no trace of the distinctive Malaysian accent. No “lah” or “mon!”

            The lump was a lipoma, a benign fat tumor, an inch in diameter. To be thorough, I examined his axilla for nodes (I once had a patient with a rare malignant form of the disease), as well as his hands and wrists for any swelling or stiffness. There were none except for some mild degenerative arthritis expected of someone his age.

            I assured him about the lump. He asked about surgery and I replied that would not be necessary unless the lump was causing him symptoms and discomfort, as rubbing against the surface of the desk when writing. He assured me that it did not.

            He inquired about my examination of his hands. I replied that occasionally the lump could be the sign of an underlying rare form of arthritis (rheumatoid) but I again assured him that he did not have that.

            I could not decipher whether his smile expressed satisfaction with my clinical thoroughness or concealed contempt for my physical intrusion upon his body.

Next:  Excerpt # 45:  A Museum Of Vintage Cars

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

Sunday, November 17, 2019

Excerpt $3: Dealing With Garbage Everywhere

Excerpt # 43  Dealing With Garbage Everywhere

            Our house in JB abutted Jalan Kolam Ayer with the side of the house facing the street. It was not the main street but busy enough. With the hospital at one end we often heard the ambulances as they sped by. At the other end was Bukit Serene palace. The sultan used to drive by on that road on his way to his other palace at Pasir Pelanggi on the eastern side.

            There was nothing but weeds and tall grasses, plus the ubiquitous strewn garbage between our fence and the street, a width of about twenty feet. People walking or driving by, and that included the sultan, could see right into our living room.

            The first thing I did was to plant some flowering trees. The hospital had plenty of Gliricidia trees they were pruning. I took some of the branches and stuck them into the ground outside our fence. Karen laughed when I told her that the sticks would sprout. Within a few days when she saw the light green shoots at the tip, she was not laughing at me anymore. She was amazed how fast they grew. Within a few months we had enough greenery to ensure our privacy.

            I hired a gardener, an old man with his ubiquitous gas lawnmower on the back carrier of his bicycle, which was how I deduced his vocation. I asked him to mow not only our lawn but also to clear up and maintain the stretch of land outside our fence. He told us that we did not need to do that as it was the responsibility of the Town Council; we would be wasting our money! We told him that the town was not doing its job, as was obvious. Only after we threatened to find another gardener did he agree to our terms. You would have thought that he would have welcomed the extra work and money!

            That was and is Malaysia; you do what you absolutely have to, nothing beyond. That would be someone else’s responsibility, like the Town Council or government, except that it did not, and still does not.

            Soon the area outside our fenced yard resembled a park, what with the trees I had planted now blooming with purplish white flowers, a striking contrast to the areas outside the other houses along the road. That notwithstanding, none of the other neighbors emulated us. They probably thought we were being stupid spending our money to do the Town Council’s job.

            My next major project was our stinking stagnant open drains that surrounded the house and emptied into the canal beyond our property. Those drains and canals were perfect breeding grounds for mosquitoes, their larva squiggling in the green slime. Clearing only the portion of the drain by my house would not do it. I had to clean the entire length, right down to the canal. None of the neighbors helped. It was beneath them to indulge in manual labor. Besides, that was the responsibility of the Town Council! One neighbor complained of the stench as I had disturbed the goo. He told me that the heavy rain would flush everything out. Malaysia has frequent heavy downpours yet its drains are still plugged! At the very least I destroyed the habitat for the zillions of mosquito larva.

            Our backyard abutted a large empty lot along Jalan Kolam Ayer. Any empty land in Malaysia is the neighborhood’s dumping ground. So it was with this empty property. We had rats from there rummaging in our yard. Karen was terrified of the huge critters. I was scared too but for a different reason. Those critters would attract snakes, in particular cobras.

            One hot afternoon I set the heap of rubbish on fire. I wanted to clear just the area near our house. It did not take long for that fire to spread and soon the whole lot was ablaze. There was so much garbage and debris hidden in the underbrush that the fire soon became huge. A few firetrucks came by but the firemen let the fire burn through.

            I was afraid that I would find some charred bodies among the ashes but thankfully, none, only metal and zinc debris. The fire scared us but we were rewarded with a clean lot beside our house. Now I became assertive. Whenever I saw someone bringing garbage I would intervene telling them that it was my land. It worked! I now had a vastly expanded clean area behind and beside the house to enjoy.

            Despite that we still had critters in the house, only this time the much smaller mice rather than the huge menacing wild rats. Their favorite safe retreat when chased was to get into the ground spouts of our gutters. One day I stuffed the outlet with some old newspapers and set it on fire. The smoke suffocated those mice. Those that tried to escape were met with instead beheading by me with a spade. Karen was horrified by my gruesome but quick and surgical method.

            We could now enjoy our yard in the cool of the evening, free from the stench of the stagnant drain and the invasion by swarms of mosquitos that it bred, as well as the prying eyes of the passengers in the cars and buses passing by.

            As for garbage, which at times buried the country, Karen and her expatriate ladies decided to do something about it for the hospital. They bought wastepaper baskets for the wards so the patients could put their garbage into them instead of tossing it out of the windows and hitting those on the ground.

            They as well as the nurses decided to make a big fuss of the occasion, with cakes baked and balloons hung in the ward. The ladies made a ceremony of placing a basket at the end of each bed, as well as at the nurses’ station. Then the cakes were cut and Karen and the ladies make a big show of nicely folding the wrappers and then tossing them into the wastepaper baskets.

            One of the Chinese patients was about to throw his banana peel out of the window when he saw what those white ladies were doing. He caught himself. He leaned over his bed to drop the peel into the wastepaper basket at the end of his bed!

            The message had been delivered, and very effectively too, with no sermonizing lectures on the importance of cleanliness.

            The only folks unhappy were the cleaning crew. They were upset as they now had to empty all those baskets–more work! I pointed out those baskets saved them from having to clean up the pavements down below. That did not matter as those pavements were the responsibilities of the gardeners! The Jamaicans have an apt expression for that. “It’s not my job, mon!”

Next:  Excerpt # 44:  A Royal Command To The Palace

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

Monday, November 11, 2019

Excerpt # 42: Dealing With Garbage Everywhere

Excerpt # 42  Dealing With A Federal Medical Bureaucrat

            Soon we had a medical specialist from headquarters in KL on his annual tour to apprise our equipment and other needs. I put in my request for some basic journals and textbooks, as well as for a gastroscope. Nothing fancy or out of the ordinary. That was not enough, I was told. I had to justify them. So I added in the large comment section, “Desperately needed!” My pair of words looked like an isolated island in the vast ocean.

            He was not satisfied. He wanted me to specify how many people would be using the equipment and how often. For the books and journals, I put in “daily” and the number 50, the number of doctors in the hospital. For the gastroscope, I also put in daily, and 6, the number of medical officers in the two surgical units.

            Worse than a bureaucrat would be a failed clinician turned bureaucrat. That was this character. He called for a grand summation meeting with all the doctors in attendance to go over what we had requested, and also to impress upon us how important he was. Bhattal urged me to attend lest I risk my modest wish list not being fulfilled.

            We were taken away from our busy clinics that day to listen to this self-important doctor-turned-purchasing agent. Our requests would be reviewed and prioritized by a special committee at the ministry, he intoned, and then put out to bid to get the best prices. There would be no shady practices, he declared with great pomposity and put-on emphasis.

            I asked how long the process would take (over a year) and whether with respect to the journals he could get any better price than that advertised. He could not answer me except to revert to the bureaucrats’ old standby, “It’s SOP!” (Standard operating procedure.) As for the gastroscopes, the ministry would purchase from only one manufacturer so as to achieve maximal discounts with bulk purchases. Fair enough.

            He took great pride in disposing my queries with ease. Then I suggested that wouldn’t it be much easier and remove needless hassles if the ministry were to give each hospital a fixed allocation for books, journals and equipment every year and let the local doctors decide what to buy without going through all these hoops. His job would then become redundant and he could return to clinical practice.

            He ignored the snickering among my colleagues. It was to prevent corruption, was his curt reply. He was not amused!

            Sensing that I was now the alpha dog and he, the pariah, I piled on. “Let’s see,” I rebutted, “You trust us with the lives of our citizens but not with a few measly ringgit!?”

            He had no answer to that one and I did not press him. No, we did not get the books and journals we ordered. I had anticipated that and subscribed to the journals through my trainees using their discounted student rates. The ministry could never beat those prices!

            Malaysia would save more money by having that doctor work at its clinics and hospitals instead of wasting his time and talent being a bureaucrat taking purchasing orders.

            Karen and I were pleasantly surprised at how fast and smooth our transition to life in JB was, notwithstanding our (or at least my) initial disappointment in not being able to buy that house on the hill. I was still as busy in my work as when I was in KL but somehow I was not so exhausted at the end of the day. I still had the energy to take Karen and the kids out to the clubhouse once in a while. Those visits rejuvenated me.

            The short commute to the hospital had much to do with my not being so exhausted. Sometimes I would take the bus. That would always elicit stares from the other passengers; a doctor taking the bus instead of driving his own car or even being chauffeur-driven! It also helped that my car was now air-conditioned. My taking the bus freed the car for Karen. That greater mobility liberated her. We were however shocked every time we had to fill the tank, which was often. Despite the short commute, the car consumed more gasoline because of the air-conditioning.

            One day when she was hanging the clothes outside to dry, an Australian lady who was driving by stopped and introduced herself. She was married to a Malaysian. Through her Karen was introduced to the local expatriate community.

            Karen was at first reluctant to join them, remembering her earlier experience with the Canadian Universities Women’s Club in KL. She thought they were a bunch of women with too much money and time on their hands. Karen had neither. She remembered how sorry she felt for them for missing out on the local life and culture. This JB crowd turned out to be very different.

            Our daily routine was set. After work, I would grab some pisang goreng (fried banana) at the hawker stall by the hospital (being hot allayed my reservations of the otherwise atrocious food hygiene) and Karen would be ready with our afternoon tea. Then some days we would drive up to the golf club for our swim. That swim was not only relaxing but also therapeutic for my back. The prolonged standing and stooping over in the operating room are killers to your back and neck. On Friday evenings, we would stay for dinner and take in the movie at the clubhouse. On other days we would have dinner at home. If Karen did not feel like cooking, we would hail the satay man on his motorbike and he would grill right there on our front lawn. Very cheap too, and no cleaning up!

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

Next:  Excerpt # 43  Dealing With Garbage Everywhere

Sunday, November 03, 2019

Excerpt # 41: An Easy Transition

Excerpt #41:  An Easy Transition

I had a warm welcome from everyone at GHJB[1], in particular my senior colleague and fellow surgeon, Mr. A R Bhattal. He had a more practical reason for welcoming me; he was tired of covering two busy surgical units!
            He assured me that I should have no problem transiting to the local scene. “Unlike KL, we don’t have big egos here!”
            He added that I was lucky to have an excellent team of interns and medical officers. He mentioned Yahya Awang and Suraya Hussein, medical officer and intern respectively. I knew Yahya’s older brother, Hussein Awang, a urologist at GHKL. He had wanted me to join his kidney transplant team after he had heard about my research experience in Canada. I was tempted to, but considering that I already had so much on my plate, declined it. I could not justify joining his team when we had so many patients with incarcerated hernias, bowel obstructions, and ruptured appendicitis to take care.
            Suraya was Prime Minister Hussein Onn’s daughter. You would not know that from her demeanor on the wards. One morning during our usual robust rounds early during my tenure there, I came down hard on her over what I thought were her shoddy clinical notes. She tried to correct me a couple of times as I read them to the group, but I ignored her. Likewise her fellow interns who tried to rescue her.
At the end after my very pontificating–and condescending–“I don’t want ever again to see that caliber of clinical notes . . .” comment, she responded in a cool, calm voice and a winning smile, “I wanted to tell you that I forgot to remove my page of scribbles. My actual notes are behind that.”
I read her finished notes, taking my time.
“Yes, this is what I want on all my patients!” I did not know whether I succeeded in hiding my utter stupidity and embarrassment. It was a good thing that the ward floor did not have a hole, or I would have crawled into it and stayed there!
            Earlier, Bhattal must have sensed my lack of reaction to his introduction, for he added, “They are nice kids, really, unlike children of other big shots!”
            He alluded to my teaching program in KL and expressed his hope that I would continue with it. He would give me his full cooperation. GHJB used to have a national reputation for its post-graduate medical training program under Dr. Lim Kee Jin, an internist. With his retirement a few years earlier, that program fell apart. Bhattal hoped that I would resurrect it, this time focusing on surgery. I took that to be a compliment; I was comforted by his confidence in me.
            My transition to GHJB indeed went without a hitch. The hospital director was extra effusive in welcoming me. He complimented me on my publications. “Unprecedented in the history of our hospital for a staff member to have papers published! Not even Datuk Lim had any!” he gushed. He expressed his hope that one day while he was still there to read in the medical journals, “From the Department of Surgery, General Hospital Johor Baru.” Well, at least he was different from that medical director at GHKL. Bhattal was right; they did not have big egos at JB.
            My next courtesy visit was to the head of medicine. He had just taken over from the legendary Lim Kee Jin. Lim’s replacement wanted everyone, especially me, to know that he was more than capable of filling in that big shoe, and then some. That visit was pleasant enough but l was fortunate that he did not pick up on my lack of enthusiasm to his frequent name-dropping.
            Bhattal next introduced me to the head of anesthesia, but not before giving me some editorial commentaries. The man was very competent and ran a very tight ship, he told me. If I were not to interfere with his domain, I should be fine. Fair enough; that applies to most individuals.
            I had an instant rapport with this anesthesiologist, Dr. Poopathy. He apologized that he had just retired and was holding the fort until the new chief arrived. Whatever rules he had in place could become inoperative with the new head. Perhaps his retirement and now being called back to work but minus all the administrative and other headaches had mellowed him. He could now focus on his clinical work.
            Dr. Poopathy was more than just any anesthesiologist. He was one of the country’s pioneer formally-trained ones. Prior to him, Malaysian anesthesiologists were the products of “quickie” British training, sporting the Diploma of Anesthesia. Dr. Poopathy was a Fellow of the Faculty of Anesthetists of the Royal College of Surgeons (FFARCS).
            Later I met the radiologist, another Dr. Lim. I went to his department to check on a patient’s films. We introduced ourselves and exchanged pleasantries.
            “I’m embarrassed to show you these shitty films,” as he put them up, his earthy language matching his casual attire. His machines were so ancient, he said, that by the time he could demonstrate the pathology I could have figured it out clinically. He was right about the quality of the films, nonetheless he went over them with me.
Then, focusing on me, “Let’s see, you graduated from Canada, trained there, and have practiced there. Now you’re here!” He leaned back in his chair. “What madness brought you here?” he laughed.
            He said that he had submitted numerous proposals to upgrade the department under the various Malaysia Development Plans but to date nothing had been done. Only promises.
            I was glad if not relieved to discover that I was not the only one bitching about the government. That was reassuring.
            Looking back, I was pleased that Bhattal had taken his time to introduce me all around. That was what I missed in KL. I didn’t blame Datuk Menon, the surgery chief, for he was in the ICU when I reported to work there.
            Bhattal went beyond and apprised me of the local social scene. An avid golfer, he told me about the Tasek Utara Golf Club and its many wonderful non-golf activities such as its Friday-night movies, swimming pool, and fantastic dining. Good for the family, he assured me. As a civil servant I was entitled to a vastly discounted membership, subsidized by the government. He encouraged me to join, and I did. He was right about the facilities. The club was my as well as my family’s savior while in JB.
            I had minimal difficulty duplicating what I did in KL. My trainees in JB were just as smart, diligent, and enthusiastic. Unlike in KL, this time I paced myself in part because we did not have as many young trainee doctors as there. I had only one weekly seminar, alternating the combined basic science and clinical surgery. The pathologist declined to participate in my conferences. He was already swamped with his regular responsibilities, was his excuse. I was fortunate that Yahya would be sitting for his FRACS (Australian surgical board), so he and Hew, another trainee contemplating his FRACS, were the major impetus behind my teaching program.
            We had our seminars on the top floor, the site of the now defunct Post Graduate Medical Institute. It still had a functioning staff, the sole medical librarian. She willingly accepted the new responsibility. With her old mailing list, she helped spread the word around about my surgical seminars. At least I now had some clerical help, unlike in KL.
            GHJB may be a large hospital but it did not have a cafeteria. There were many makeshift hawker stalls of doubtful hygienic standards along the adjacent streets. As the seminar would be at lunch time (to accommodate everyone time-wise), we would have to provide lunch, otherwise we would waste precious time with everyone trying to grab their own meals. How to fund that?
At first I wanted to have the drug companies sponsor the meetings, but that meant I would have to scramble every week to find a sponsor. Besides, it did not seem right. In the end, I decided to have everyone chip in RM10 at a time. When the funds got low we would chip in again. Since we always had an influx of new interns throughout the year, we had a constant inflow of fresh money. There were no free loaders. During the year we all had to chip in no more than two or three times.
            Our JB seminars soon developed a local following. The presence of the other specialists as well as the town’s practitioners enhanced the quality and appeal. My expanding the topics beyond the purely surgical gave it wider appeal.
            One of my medical officers presented a topic on surgical immunology, the same one Zul presented in KL a year earlier. At the end of the seminar one of the consultants, Dr. Ravi, an ENT specialist, came up to compliment me. He had just returned from Britain to take his FRCS examination and had enrolled in its basic science course there. He gushed that my presentation was far superior. I corrected him that it was not mine but my medical officer’s.
            “Come on lah, Bakri,” he teased in disbelief and then went ahead to ask me a question on the presentation. I pretended not to be sure of the answer and turned to my medical officer. He gave an impromptu full dissertation on the topic. That convinced my colleague!

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

Next:  Excerpt # 42  Dealing With A Federal Medical Bureaucrat

[1] Now the Sultanah Tun Aminah Hospital