Saturday, July 18, 2009

SMRT fine for eating or drinking - ungracious SMRT?

The SMRT is embarking on a new campaign, fining all passengers caught eating or drinking.

As of now, it appears that the following falls under the definition of an offense:
1. Breastfeeding
2. Baby drinking from milk bottle
3. Sucking lozenges not from doctor - someone actually has been fined
4. Sipping a drink from your bottled water - someone actually has been fined

Now, the argument is that all kind of eating or drinking is an offense unless it is a medication. It is quite easy to define, isn't it? Unless you bring your MC or something labelled as prescriptive medicine, you'll be fined. What a convenient way.

I think with the new campaign, SMRT is being totally ungracious. Does it mean that they are suggesting someone with itchy throat or sore throat to tap out of the MRT, walk out to outside station to eat or drink before continuing the journey? That's absurd. I can understand the fine imposed to people eating bread, curry puff, nasi lemak, or drink from McDonald etc. However, fining a simple sweet eating and drinking from bottled water is bordering on over zealousy. The train is by itself not a bullet train. For me who takes 1.5 hours journey one way every morning and afternoon for work, I have experienced dry throat and sort. Demanding such a customer not to take a simple sip of water during that long journey is really too much. I wonder whether Health Promotion Board or Ministry of Health can even bother to put up comment on the health benefit of drinking water. Ha ha... No way.

For now, I suggest purchasing SMRT stocks. It is one of the company that won't fail and it's stock will always increase. What you earn from dividend and stock price is guaranteed. After all, everyone is bound to take MRT, the MRT price increases over time, more leasing of F&B outlet, and hey there are always ways to earn more money. Some time ago, after complaining of price not increased over some time, they are allowed to increase the price and hey, they posted a record profit after that. So much for "public" transportation.

Friday, July 17, 2009

The patient flight to Singapore

JW Mariott and Ritz Carlton hotel was bombed yesterday morning. Soon, the news report in Indonesia reported the flight of foreign patients, bomb victims, to Singapore to seek hospitalization and cure. The news highlighted the advance of skin grafting and burn victim care in Singapore. Salute to Singapore.

On the other hand, it exposes once again the perception (and I would think, the reality) of poor health care in Indonesia. Coming from Indonesia, I know clearly doctors are among those that make tonnes of money. Lots of smart doctors but the infrastructure and the investment are just not supportive of getting some good surgeons. Unless you are very nationalistic or very dedicated to human lives in Indonesia, there seems to be nothing that prevent the doctor leaving for a better place. Yet, I would tend to think that not many countries would recognize medicine degree from Indonesia. Then, if that is such, there is a slim chance of medicine graduate in Indonesia to work somewhere else. Perhaps it is the insufficient medicine education in Indonesia to produce good skin doctors that pulls down the quality care.

Considering the chance of more attacks in time to come, more disasters, it is imperative that the government or private institution to look at bettering the healthcare of the country. I would believe that a hospital that manages to pull themselves out beyond the average hospital and claims the best doctor would at the end be able to sell the value and serve the crowd more. It is quite unimaginable why no hospital has clearly done so. What has transpired recently is more like a wanna be 'international' hospital suing a patient who complains. Then, plenty of report how those 'international' hospital is not really 'international'. I can't comprehend the wish to be 'international'. There is in no way any international hospital standard. The standard of care between Africa and western countries are definitely beyond imagination. The fundamental issue is more on the line of perception and obtaining the instrument capable of helping doctors providing the best of care. And of course the medicine education must be reviewed to get them up to date from time to time.

Monday, July 13, 2009

SSO advertisement in MRT can be better

Saw Singapore Symphony Orchestra's new advertisement in MRT train. Impressive and educative. Lots of new musical terms to learn! Simple graphics and the message is that classical music is not that complicated. The advertisement is pasted in the exterior and interior's overhead advertisement board. In addition, it is also pasted on the panel at the end of the seating row. The ads on the panel could have been improved though. It seems that the ads pasted on that panel is with graphics on the top part and sentences on the lower part, which ends up at the side of the person sitting on the seat at the end of the row. Meaning.... noone can read the sentence at all. In other words, the poster on the panel is totally useless unless noone is sitting at the priority seat, which is always at the side of the poster. The graphics could have been at the lower part and the sentence at the top part? Or perhaps change the design?

Monday, July 6, 2009

Surgical mask and N95

It seems that there are quite a number of article perpetrating wrong information on the use of surgical mask to prevent from getting flu.

Referring to

It says that surgical mask is for ill people. The mask captures whatever expelled out from the nose and mouth during coughing and sneezing. It does not seal tightly so it only blocks large droplets. However, it is still useful for the ill people to prevent them from infecting others. They are not supposed to wear N95 because they are already with nose problem and wearing N95 may as well kill them due to additional breathing difficulty.

If you want to prevent yourself from catching flu, wear N95. N95 is supposedly fitting tightly to your face. In occupational setting, there is respiratory fit testing you are supposed to take to test how fitting N95 can be on your face. They will get you to breath lots of smell to test. On the other hand, in community testing, at least you have to cup your hand around the seals and inhale or exhale deeply to ensure that no flow is felt around the edge connecting the mask to your face. N95 then will protect you from breathing aerosols containing the virus. The big problem with N95 is that it won't fit in small face (e.g. children) since it's only produced in one size and it won't fit in people with facial hair (no way to create seal around the big mustache and beard.

So if you are the sick one, surgical mask is your choice. Ensure the flexible adjustment around the nose is pressed around your nose and check properly.

If you really feel you need to wear N95 since you are within 2 m of the sick all the time, wear N95 then, don't just wear surgical mask. In your household with flu infected person, just isolate that person and get him to wear mask when he is to common area. Stay away from him 2 m apart. You won't really need N95 or mask then.

Best precaution is still personal hygiene and get away from people displaying flu-like symptom (sneezing, coughing). But remembers, still help them if they need to. Just don't breathe in their direction if possible. The suggested steps if you see people sneezing or coughing near you is to exhale and then move away before inhaling and continuing with normal breathing cycle.

Get more information

If you can read Bahasa Indonesia, read

A representative from Indonesian embassy claimed that an Indonesian citizen paid 10k SGD as a treatment of his dengue fever although he went to doctor as a suspected H1N1 case. The report is written such that I interpret the representative being confused why the so-called suspected case has to pay for treatment. He also says that the change from having free treatment to having to pay is because there are more cases.

Strange reporting, as always from Indonesian news. The Singapore MOH said in the news that H1N1 screening is free while there are definitely charges of consultancy fee, etc. Now, the clear fact from the Indonesian news is that the patient is hospitalized because of dengue, not H1N1. It's not weird for him to be charged to cure his dengue!

Not a first time I read strange news from Antara.

Flu clinic and observance of PPE

I just came back from a Flu Clinic since I have fever and sore throat. So, I went to the flu clinic wearing a piece of surgical mask. I can testify that surgical mask is really posing breathing problem. My blocked nose went worse under the mask since I guess the nose detect higher breathing resistance which induces the production of more mucous!

Since I was without travel history, apparently was let go with just paracetamol and previous day's medication for sore throat.

What appalls me again is the observance of PPE by the front line staff in the clinic. I do realize that surgical mask is a problem, but the registration lady had her mask under her nose when she talked to the people who registered! Well, she did don it properly when talking to me. Perhaps she makes a judgement based on whether you wear a mask or not when you register. That should be problematic, isn't it? Not everyone has a mask at home! Well, the lady taking the temperature does wear gloves and N95. However, the same issue as the pervious clinic I went to, people are using the same pen. Hence, really, personal hygiene must be really implemented. Only if my eczema allows me to do so though.

So at the moment, extra days MC and hoping that the fever subsides tomorrow. Oh, quarantining yourself is a big problem. I am wondering about people who stays alone and never stocks up anything to cook. In that situation, is he going to wear mask to supermarket and buy things? I wonder...

Thursday, July 2, 2009

Temperature screening, mask and H1N1 in Singapore

Yesterday there is an article written by Dr. Lee Wei Ling, Director of National Neuroscience Institute in Singapore, daughter of Lee Kuan Yew. She called temperature screening as herd mentality. She argued that temperature screening is carried out since everyone else is doing it, not really because true belief that it will works. She is a knowledgeable person and quite right to quote research saying that asymptomatic person with H1N1 can be infectious. In fact, Singapore acknowledges that 1/3 of people infected with H1N1 can be infectious and this is a clear group of people which temperature screening will definitely miss.

Today I visited a clinic in CCK and notice first hand how I think temperature screening can really create more cases than prevent it. The clinic has employed a girl who is her teenage years. She wore a disposable blue gown, N95 mask and used ear thermometer. The N95 mask clearly looks too big for her, with the lower strap dangling loosely at the back of her neck. The N95 mask she wore is from 3M and it is actually for occupational use where respiratory fit testing is required and the mask must fit the face. The guidance document on mask clearly specify N95 mask is not designed for small faces.
Worse is the way she touched and adjusted the mask and then use the same finger to:
1. Touch her eyes
2. Play with her handphone which was on the table
3. Write using a pen which is also used by the multiple visitors + patients
4. She has no gloves. Not that it's wrong, but she has to perform personal hygiene to do it right.
And despite having a hand sanitizer on the desk, she never used it.

The girl is a clear example that putting PPE and temperature screening may create more havoc. The chance of cross infection from her action especially through the pen is enormous. The false sense of security by the patient and visitor that temperature screening will prevent H1N1 infection is something that should not be maintained. Inexperienced personnel handling supposedly first line defence like temperature screening is really an error that should be easily fixed.

Temperature screening is indeed helping to screen 2/3 of cases but the false sense of security and simple mistakes in screening activities may simply create more cases from the missed 1/3. The fact that a lady actually asked her daugther to wear surgical mask only because of fever is another example of wrong knowledge. Educating the population to be vigilant, appropirate use of PPE, keeping themselves away from people sneezing and coughing while being responsible to lock themselves up if they suspect themselves having flu will probably go a long way further than screening by inexperienced personnel.

Wednesday, July 1, 2009

Orange juice dangerous for your teeth

Scientists compare effect of orange juice and whitening agent to teeth and they found that orange juice is more dangerous than whitening agent! Read more at

This finding is distressing. So many people (including myself) are drinking orange juices and we all just see the bright side, that it is full of vitamin C. If orange juices are dangerous for teeth, it would also mean that orange by itself (not yet juiced) is also not so good for teeth. I wonder if this will provide the fuel needed by all the supplement manufacturer to promote the use of vitamin C tablet. To be very frank, they really should use this finding to boost their sales.

If indeed drinking orange juice is not good for our teeth, should there be any research on how to lessen the impact? Will there be such thing? Vitamin C is L-ascorbic acid anyway. Hence, it is indeed acidic by nature. But then again, if we as human has been eating orange all our lives, why should we care about the finding? I think the real perspective is that we drink and take too many substance that is not good for our teeth. Whitening agent is not uncommon in toothpaste. Sodas are also known to erode enamel. Therefore, the best and reasonable steps are to reduce those unnecessary sodas going down the teeth way and just enjoy our orange juices. Oh yeah, drink faster. Drinking longer = longer contact to teeth = bad for your teeth.