Wednesday, 29 February 2012

Budget 2012 debate: Day 1

Ease pain of economic makeover, urge MPs
Inclusive Budget lauded, but concerns raised about impact on SMEs
By Lydia Lim, The Straits Times, 29 Feb 2012

THE pace of economic restructuring and the pain it will inflict on local companies and low-skilled workers emerged as a key theme of the first day of Parliament's debate yesterday on the Government's Budget.

The 25 Members of Parliament (MPs) who spoke gave their support to the Government's broad push to raise productivity. While generally supporting the long-term gains that the Budget measures would bring, they voiced concerns about the short-term pain.


Seven MPs questioned the lack of measures to help small and medium-sized enterprises (SMEs) cope with rising costs, even as foreign worker inflows are further reduced.

Veteran People's Action Party (PAP) member Inderjit Singh (Ang Mo Kio GRC) was the most hard-hitting. He rapped the Government for expecting SMEs to become more productive overnight, and for allowing industrial rents to shoot up. He called on the Government to do a thorough review of ways to cut business costs.

Mr Liang Eng Hwa (Holland-Bukit Timah GRC) and Mr Zaqy Mohamad (Chua Chu Kang GRC) warned of the impact on workers if SMEs fail or are forced to relocate because of cost pressures and tight labour supply.

Hawker centres of the future

Future hawker centres: Keeping food cheap
Panel recommends that not-for-profit operators run centres
By Huang Lijie, The Straits Times, 28 Feb 2012

IN A move to keep hawker food prices affordable, a public panel has called on hawker centres of the future to be run and priced in a new way.

Instead of the Government tendering out stalls as is mostly the case now, a not-for-profit operator such as a social enterprise or cooperative should be in charge of running the centre.



It would have some autonomy to decide matters like tenant mix and use of space, but would defer to broad terms set out by the National Environment Agency (NEA), which will fund and own the centres, and regulate the licensing of stalls.

This hawker centre social enterprise would pre-determine the rental rates of the stalls, and invite 'operators with credentials' to run them.

Rentals would be lower than those usually offered by food courts and coffee shops, and hawkers could be made to offer at least one 'value meal' which would be cheaper than meals sold at nearby eateries.

To prevent profiteering by stallholders who do not intend to operate the stalls themselves, full-day sub-letting could be disallowed.

If hawkers do not wish to operate their stalls, they should return them, said the panel, which released its recommendations yesterday.

The current practice of allowing stallholders who enjoy subsidised rents to 'assign' their stalls to another hawker should also be abolished, it said.

Flood-prevention systems to be tightened at six MRT stations

By Royston Sim, The Straits Times, 28 Feb 2012

THE Land Transport Authority (LTA) is taking steps to beef up flood-prevention systems in six downtown MRT stations.

The stations are all sited in low-lying areas with track records of flash floods, but have themselves never been flooded.

They are Raffles Place, City Hall, Tanjong Pagar, Novena, Little India and Orchard.

A tender called this month said the works will include the installation of flood-barrier systems at the stations, the sealing of glass panels and other openings to make them watertight, and the raising of the height of vent shafts and firemen's staircases. The works are to be completed within a year.

Contractors are expected to design and install two types of flood-barrier system at several points in each station - a manual stackable type and a swing-type which stays open during normal times.

Both systems must be designed to be watertight when flood waters are below 1.5m - the height of the flood barriers.

The flood barriers should be made of lightweight aluminium panels, said the LTA in its tender documents.

The stackable barriers must also be made so user-friendly that they take two people no more than 15 minutes to set up.

When contacted, an LTA spokesman said: 'All MRT stations were designed so that the station entrances are high enough to accommodate potential flooding should it occur in lower-lying areas.'

But as a result of the ongoing monitoring of the MRT network, the LTA has decided to take additional measures for these stations, given their locations, he said.

No MRT station has ever been flooded, and the works are preventive in nature.

Associate Professor Susanto Teng of Nanyang Technological University's School of Civil and Environmental Engineering said that while MRT stations are flood-proof for now, there is no guarantee they will remain so in the future.

He said: 'It's good to be ahead of the problem. It's much cheaper to prevent something than to try and fix it when something happens. By then, it's too late.'

He noted that the systems of the kind being called for in the LTA tender are used in cities in the United States, where it is impractical to build permanent flood barriers.

Commuter Chua Wei Yang agreed that it was a good move to make MRT stations such as Orchard more flood-proof.

The 25-year-old associate engineer said: 'The station is underground and there could be a lot of damage if it is flooded.'

Big push to fight colorectal cancer as cases continue to rise

By Poon Chian Hui, The Straits Times, 28 Feb 2012

THE health authorities are stepping up efforts to fight colorectal cancer, the most common cancer here.

All Singaporeans and permanent residents aged 50 and above are being invited to go for screenings as the number of cases continues to rise.

By next month, nearly 100,000 people would have received letters from the Health Promotion Board (HPB) inviting them to visit family doctors to discuss screenings.

The campaign started last July.

The doctors will advise them on how to do the screening at home and where to send the completed kits for processing. Any abnormal results are followed up on, and patients are sent to a specialist if necessary.

Those with lower incomes who are eligible for subsidies have to pay only the doctor's consultation fee and not the $30 for the kit.

In total, 900,000 people aged 50 and above will receive the letters in the next three years, said the HPB.

Next month and in April, anyone aged 50 and above can pick up a free test kit at the 71 Guardian pharmacy outlets islandwide.

Kits are also available at any of the 18 polyclinics from March 5 to 9.

These kits are funded by the Singapore Cancer Society to mark Colorectal Cancer Awareness Month next month.


The number of cases of the disease is increasing, going by figures released by the Singapore Cancer Registry yesterday.

About 8,200 new cases were diagnosed between 2006 and 2010, compared with about 7,900 cases from 2005 to 2009.

Associate Professor Tang Choong Leong, who heads the colorectal surgery department at Singapore General Hospital, pointed out that the number of deaths has also increased slightly.

Some 3,435 people succumbed to the disease from 2006 to 2010, a rise from the 3,373 in the five-year period starting from 2005.

'It's possible that the cancer is still being detected too late,' Prof Tang said.

One way of identifying the cancer early is to make use of the faecal occult blood test, which checks for blood in stools and can detect the disease even at an early stage.

The Singapore Cancer Society has been giving out free test kits since 2003. Last year, 34,069 kits were given out, with 66 per cent of recipients sending in their stool samples for testing.

The year before, 71 per cent of the 32,416 kits given out were returned. Of these, 28 people were found to have colorectal cancer.

Despite the wider reach, Associate Professor Lim Soon Thye, a council member of the Singapore Cancer Society, said the figure is but a fraction of the number of people aged 50 and above in Singapore, which stands at more than one million.

'There is significant room for improvement,' said the medical oncologist from the National Cancer Centre Singapore.

But he noted that the return rate for the free test kits is quite good compared with that in other countries.

People who receive the letters from the HPB have a pick of 700 private general practitioners whom they can make appointments with.

Test results will be ready in one month.

Retiree Ronald Lee, 72, has benefited from regular screenings.

The former sales and marketing officer has done the test every year for six years. Last year, it helped him detect the cancer at an early stage. He required surgery to remove 15cm of his colon but did not have to go for chemotherapy.

Mr Lee encourages others to take the step to protect their health.

'The test is a simple thing. It is also free of charge, what more do you want?' he said.

'If you have cancer, isn't it better to have it taken out early?'

Tuesday, 28 February 2012

Green Mark hits 1,000th landmark

Pasir Ris sports centre is latest to be certified for eco-friendly features
By Lin Zhaowei, The Straits Times, 27 Feb 2012

THE sun louvres on the facade of the recently opened Pasir Ris Sports and Recreation Centre look brand-new, but they were actually made from timber benches from the old National Stadium.

The use of the recycled materials and other environmentally friendly features has won the complex the Building and Construction Authority's (BCA) green certification, known as the Green Mark.

The sports complex is also the 1,000th building here to attain the Green Mark, a milestone for the scheme that started with just 17 buildings in 2005.

Deputy Prime Minister Teo Chee Hean, who went on a morning walk with 500 residents yesterday to mark the occasion, described the recycling of the National Stadium benches as a 'nice touch'.



The old stadium held many fond memories for him, said Mr Teo, who is an MP for Pasir Ris-Punggol GRC. He cited the National Day Parades, football matches and South-east Asian Games events that used to be held there.

The Green Mark scheme, he said, is an integral part of national efforts to reduce emissions and contribute to climate change mitigation efforts.

Now, 13 per cent of the buildings here have some form of Green Mark certification. The BCA aims to have 80 per cent of all buildings here certified by 2030.

The sports and recreation centre, officially opened last November, is the Singapore Sports Council's (SSC) first Green Mark-certified sports complex. Costing around $40 million to build, it houses an indoor sports hall, swimming pools, futsal and tennis courts and a gym. It also has food and sporting equipment outlets.

The building comes with several environmentally friendly features.

It has 2,400 sq m of rooftop solar panels installed, which generate enough energy to power 43 four-room Housing Board flats. The panels supply up to 12 per cent of the total energy used by the centre and will save the SSC about $57,000 in electricity bills a year.

The complex has energy-efficient LED lighting and green walls installed, and is designed such that wind is funnelled into the corridors for natural ventilation.

The louvres made from the benches shade the corridors from the sun, which further reduces the build-up of heat.

SSC chief of sports facilities Kenneth Hui said the council will gradually introduce green features to its 20 other sports complexes, instead of closing them temporarily for major upgrades. 'We do not want to inconvenience our users. Whatever we can do, we will do in bits and pieces as part of our normal upgrading.'

BCA chief executive John Keung said he expects more owners of existing buildings to introduce green features, especially with rising energy costs.

He highlighted the $100 million Green Mark Incentive Scheme for Existing Buildings as a source of funding to assist building owners in undertaking such projects.

He said the BCA will soon introduce a new Green Mark scheme for data centres. It is developed in partnership with the Infocomm Development Authority.

MOH reviewing pay of health-care staff

Salary, career pathways being looked into in bid to attract staff
By Royston Sim, The Straits Times, 27 Feb 2012

DOCTORS, nurses and allied health professionals working in the public sector could be looking at a pay rise soon.

The Health Ministry is reviewing the salary structure of health professionals to attract more people to join the industry, said Minister of State for Health Amy Khor yesterday. She added that the ministry will touch on salary reviews during the upcoming Committee of Supply debates in Parliament.

This came after Deputy Prime Minister Tharman Shanmugaratnam said in his Budget speech earlier this month that the Government would engage 'many more health-care professionals' and pay them 'more competitively'.

He added that 1,900 public general hospital beds and 1,800 community hospital beds would be added by 2020.


Dr Khor, speaking on the sidelines of a health-care career fair at *Scape yesterday, said about 6,400 nurses and 1,800 allied health professionals and support staff would be needed for those facilities.

Although pay is a key factor in attracting new staff, other things matter as well, she noted. 'We have to pay a reasonable salary to attract people, but I think we have to look at the whole environment as well as career pathways and career enhancement opportunities.'

Health-care fund for the needy elderly in MacPherson

By Phua Mei Pin, The Straits Times, 27 Feb 2012

A FUND subsidising the health-care expenses of the needy elderly in MacPherson was launched yesterday by Minister in the Prime Minister's Office and Second Minister for Home Affairs and Trade and Industry S. Iswaran.

The $150,000 fund will give up to $300 a year in cash reimbursement for medical bills.

The launch of the MacPherson Care Fund capped off the ministerial community visit by Mr Iswaran, who is an MP for West Coast GRC, to the MacPherson division in Marine Parade GRC.

These visits are conducted once a month for ministers to get a better understanding of a constituency other than their own.

During a dialogue session with more than 300 MacPherson residents, Mr Iswaran lauded the Care Fund and other initiatives in the division as complementing the national thrust to support the elderly, lower-income and disabled.


Residents shared their thoughts on issues ranging from long term health-care costs and integrating foreign workers, to encouraging family cohesion and the cost of housing.

Mr Iswaran encouraged the residents to keep up the dialogue between government agencies and community groups.

'We need to work together... not just to deliver services but also to understand new needs on the ground,' he said.

Earlier in the morning, he went on a whirlwind visit through the mature estate, where one in three of the roughly 47,000 residents is aged 50 or above.

He was also introduced to a slew of other initiatives for the elderly. These included Project Angelz, where volunteers help the elderly through activities like repainting homes and changing light bulbs.

Another project, Say 'No' to Fall, assesses the elderly residents' risks of falling at home with an aim to modify their surroundings to increase their safety.

MediWheels - scheme provides subsidised medical transport services

Wheeling out help for those with trouble getting around
MediWheels scheme to help them get to medical check-ups more easily
By Teo Wan Gek, The Straits Times, 27 Feb 2012

MR YASIN Mohd Ali, 56, unemployed and diabetic, walks three times a week to the kidney dialysis centre which is six bus stops away from his home in Block 924, Hougang Avenue 9, so that he can save on bus fare.

He, however, suffers from numbness in his legs, and has to stop every five minutes for a break.

On the occasions that he takes the bus, he has trouble climbing the steps.

Yesterday, relief came for Mr Yasin, with the launch of a new programme called MediWheels.

He can now rent a mobility scooter at $10 a month and make the trips to the kidney dialysis centre with ease.



The $120,000 programme was launched by Prime Minister Lee Hsien Loong yesterday, together with Mayor of Central Singapore Community Development Council (CDC) Sam Tan, and Mr Yeo Guat Kwang, MP for Ang Mo Kio-Hougang division.

Funded by the CDC and sponsors, it provides subsidised medical transport services to elderly and needy residents, and those with disabilities.

It will undergo a six-month trial in the Ang Mo Kio-Hougang division before being rolled out in the rest of Ang Mo Kio GRC.

Singapore's Casino Control Act under review

By S Ramesh, Channel NewsAsia, 26 Feb 2012

The Government is currently reviewing the Casino Control Act, which among other things, governs the operations of the two Integrated Resorts (IRs) in Singapore.

This was disclosed by Minister in the Prime Minister's Office, Mr S Iswaran, who added that the review is timely.

Mr Iswaran also heads a multi-agency committee looking into issues concerning the IRs.

It has been two years since both Resorts World Sentosa and Marina Bay Sands started operations in Singapore.

And with the two IRs reporting some 135,000 people visiting each casino last year, a stock take is timely.



Mr Iswaran said: "Responsible gaming is an important aspect of the entire integrated resorts and responsible is not just about regulation, it is also about the operators themselves, stepping up as good corporate citizens. If you look at the practices around the world, if you look at Australia and if you look at some of the other countries, they are an important part of the equation.

"Many of them understand very clearly that they have to be ensuring a responsible gaming regime as part of the overall evolution of the market because commercially or in terms of their standing in the committee, it is not in their interest to have some of the egregious aspects become a problem in the community at large.

"The government has a role to play as well. We need to define clearly what our expectations are. Some of these can be achieved through rules and new legislation or regulations. Some of these would have to be working with the community groups, the National Council for Problem Gambling and other interested parties, and the casino operators working together to implement some of these schemes."

Just earlier this week, the Ministry of Community Development, Youth and Sports gave details of gambling trends in Singapore, in particular the types of people and the profiles of the people visiting the two Integrated Resorts.

Govt to tackle pet welfare

Task force to be set up to push for more responsible ownership of dogs and cats
By Judith Tan, The Sunday Times, 26 Feb 2012

A task force will be set up to look into the matter of responsible pet ownership, and how the well-being of cats and dogs can be further improved.

The team will come under the Government Parliamentary Committee (GPC) for National Development.

Speaking to The Sunday Times yesterday, GPC member Yeo Guat Kwang said the task force will study the situation and come up with 'concrete recommendations, hopefully to change policies and regulations on the issues by the end of this year'.

He was speaking on the sidelines of the Singapore Animal Welfare Symposium and Public Forum on Animal Welfare Policies, held at Chong Pang Community Club.

Monday, 27 February 2012

The Round Island Route - A seamless green corridor spanning 150km

Island-wide green link in the works
Route will connect parks, existing cycling paths and heritage spots around S'pore
By Kezia Toh, The Sunday Times, 26 Feb 2012

A seamless green corridor spanning 150km that links up heritage areas in the city, coastal spots in the east and rustic greenery in the north and west will be Singapore's next big green project.

The Round Island Route, which is more than three times the length of Singapore, will connect more than 3.5 million residents.



Deputy Prime Minister Teo Chee Hean announced this yesterday at the launch of the North Eastern Riverine Loop at the Sungei Serangoon park connector.

'The Round Island Route will allow us to embark on journeys to look at Singapore in new and wonderful ways, as it passes through popular recreation nodes and also the less seen and explored corners of our island,' said DPM Teo, who is also Member of Parliament (MP) for Pasir Ris-Punggol GRC, which oversees the Riverine Loop area.

Sunday, 26 February 2012

MOH aims to increase intake of nursing students

By Vimita Mohandas, Channel NewsAsia, 25 Feb 2012

The Ministry of Health (MOH) aims to expand the pool of locally trained healthcare workers to address manpower shortage.

One target is to increase the yearly intake of nursing students at tertiary institutions from the current 1,700 to 2,000 by 2015.

The tertiary institutions include the National University of Singapore, Nanyang Polytechnic, Ngee Ann Polytechnic and Institute of Technical Education.

For allied health courses, the aim is to raise the intake from 270 to 290 by 2014.

There are about 32,000 registered nurses in Singapore and two in 10 are foreigners.

As Singapore move towards reducing its reliance on foreign manpower, expanding its pipeline of local nurses is a key focus.


There are now more training places for nurses. A new nursing degree programme offered by the Singapore Institute of Technology (SIT) in partnership with the University of Manchester launched in September 2011 will offer upgrading opportunities for nursing diploma graduates, adding to the pool of degree-trained nurses.

It also recently announced its partnership with an overseas university, Trinity College Dublin, to offer degree programmes in physiotherapy and occupational therapy which will be launched in September 2012.

However, industry experts said it remains a challenge to get local students to take up nursing.

Opting for death with dignity

By Ken Murray, Published The Straits Times, 24 Feb 2012

YEARS ago, Charlie, a highly respected orthopaedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could treble a patient's five-year-survival odds - from 5 per cent to 15 per cent - albeit with a poor quality of life.

Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn't spend much on him.

It isn't a frequent topic of discussion, but doctors die, too. And they do not die like the rest of us. What is unusual about them is not how much treatment they get compared with most Americans, but how little. For all the time they spend fending off the deaths of others, they tend to be fairly serene when faced with death themselves. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care they could want. But they go gently.

Of course, doctors don't want to die; they want to live. But they know enough about modern medicine to know its limits. And they know enough about death to know what all people fear most: dying in pain, and dying alone. They have talked about this with their families. They want to be sure, when the time comes, that no heroic measures will happen - that they will never experience, during their last moments on earth, someone breaking their ribs in an attempt to resuscitate them with cardiopulmonary resuscitation (that's what happens if CPR is done right).

Almost all medical professionals have seen what we call 'futile care' being performed on people. That is when doctors bring the cutting edge of technology to bear on a grievously ill person near the end of life. The patient will get cut open, perforated with tubes, hooked up to machines, and assaulted with drugs. All of this occurs in the Intensive Care Unit (ICU) at a cost of tens of thousands of dollars a day. What it buys is misery we would not inflict on a terrorist. I cannot count the number of times fellow physicians have told me, in words that vary only slightly: 'Promise me, if you find me like this, that you'll kill me.' They mean it. Some medical personnel wear medallions stamped 'NO CODE' to tell physicians not to perform CPR on them. I have even seen it as a tattoo.

To administer medical care that makes people suffer is anguishing. Physicians are trained to gather information without revealing any of their own feelings, but in private, among fellow doctors, they'll vent. 'How can anyone do that to their family members?' they'll ask. I suspect it is one reason physicians have higher rates of alcohol abuse and depression than professionals in most other fields. I know it is one reason I stopped participating in hospital care for the last 10 years of my practice.

How has it come to this - that doctors administer so much care that they wouldn't want for themselves? The simple, or not-so-simple, answer is this: patients, doctors, and the system.

To see how patients play a role, imagine a scenario in which someone has lost consciousness and been admitted to an emergency room. As is so often the case, no one has made a plan for this situation, and shocked and scared family members find themselves caught up in a maze of choices. They are overwhelmed. When doctors ask if they want 'everything' done, they answer yes. Then the nightmare begins. Sometimes, a family really means 'do everything', but often they just mean 'do everything that's reasonable'. The problem is that they may not know what is reasonable, nor, in their confusion and sorrow, will they ask about it or hear what a physician may be telling them. For their part, doctors told to do 'everything' will do it, whether it is reasonable or not.

The above scenario is a common one. Feeding into the problem are unrealistic expectations of what doctors can accomplish. Many people think of CPR as a reliable life-saver when, in fact, the results are usually poor. I have had hundreds of people brought to me in the emergency room after getting CPR. Exactly one, a healthy man who'd had no heart troubles (for those who want specifics, he had a 'tension pneumothorax'), walked out of the hospital. If a patient suffers from severe illness, old age, or a terminal disease, the odds of a good outcome from CPR are infinitesimal, while the odds of suffering are overwhelming. Poor knowledge and misguided expectations lead to a lot of bad decisions.

But of course it's not just patients making these things happen. Doctors play an enabling role, too. The trouble is that even doctors who hate to administer futile care must find a way to address the wishes of patients and families. Imagine, once again, the emergency room with those grieving, possibly hysterical, family members. They do not know the doctor. Establishing trust and confidence under such circumstances is a very delicate thing. People are prepared to think the doctor is acting out of base motives, trying to save time, or money, or effort, especially if the doctor is advising against further treatment.

Some doctors are stronger communicators than others, and some doctors are more adamant, but the pressures they all face are similar. When I faced circumstances involving end-of-life choices, I adopted the approach of laying out only the options that I thought were reasonable (as I would in any situation) as early in the process as possible. When patients or families brought up unreasonable choices, I would discuss the issue in layman's terms that portrayed the downsides clearly. If patients or families still insisted on treatments I considered pointless or harmful, I would offer to transfer their care to another doctor or hospital.

Should I have been more forceful at times? I know that some of those transfers still haunt me. One of the patients of whom I was most fond was an attorney from a famous political family. She had severe diabetes and terrible circulation, and, at one point, she developed a painful sore on her foot. Knowing the hazards of hospitals, I did everything I could to keep her from resorting to surgery. Still, she sought out outside experts with whom I had no relationship. Not knowing as much about her as I did, they decided to perform bypass surgery on her chronically clogged blood vessels in both legs. This did not restore her circulation, and the surgical wounds would not heal. Her feet became gangrenous, and she endured bilateral leg amputations. Two weeks later, in the famous medical centre in which all this had occurred, she died.

It is easy to find fault with both doctors and patients in such stories, but in many ways all the parties are simply victims of a larger system that encourages excessive treatment. In some unfortunate cases, doctors use the fee-for-service model to do everything they can, no matter how pointless, to make money. More commonly, though, doctors are fearful of litigation and do whatever they are asked, with little feedback, to avoid getting in trouble.

Even when the right preparations have been made, the system can still swallow people up. One of my patients was a man named Jack, a 78-year-old who had been ill for years and undergone about 15 major surgical procedures. He explained to me that he never, under any circumstances, wanted to be placed on life support machines again. One Saturday, however, Jack suffered a massive stroke and got admitted to the emergency room unconscious, without his wife. Doctors did everything possible to resuscitate him and put him on life support in the ICU. This was Jack's worst nightmare. When I arrived at the hospital and took over Jack's care, I spoke to his wife and to hospital staff, bringing in my office notes with his care preferences. Then I turned off the life support machines and sat with him. He died two hours later.

Even with all his wishes documented, Jack had not died as he had hoped. The system had intervened. One of the nurses, I later found out, even reported my unplugging of Jack to the authorities as a possible homicide. Nothing came of it, of course: Jack's wishes had been spelt out explicitly, and he'd left the paperwork to prove it. But the prospect of a police investigation is terrifying for any physician. I could far more easily have left Jack on life support against his stated wishes, prolonging his life, and his suffering, a few more weeks. I would even have made a little more money, and Medicare would have ended up with an additional US$500,000 (S$629,000) bill. It is no wonder many doctors err on the side of overtreatment.

But doctors still don't over-treat themselves. They see the consequences of this constantly. Almost anyone can find a way to die in peace at home, and pain can be managed better than ever. Hospice care, which focuses on providing terminally ill patients with comfort and dignity rather than on futile cures, provides most people with much better final days. Amazingly, studies have found that people placed in hospice care often live longer than people with the same disease who are seeking active cures. I was struck to hear on the radio recently that the famous reporter Tom Wicker had 'died peacefully at home, surrounded by his family'. Such stories are, thankfully, increasingly common.

Several years ago, my older cousin Torch (born at home by the light of a flashlight) had a seizure that turned out to be the result of lung cancer that had gone to his brain. I arranged for him to see various specialists, and we learnt that with aggressive treatment of his condition, including three to five hospital visits a week for chemotherapy, he would live perhaps four months. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months doing a bunch of things that he enjoyed, having fun together like we hadn't had in decades. We went to Disneyland, his first time. We hung out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He even gained a bit of weight, eating his favourite foods rather than hospital foods. He had no serious pain, and he remained high-spirited. One day, he didn't wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about US$20.

Torch was no doctor, but he knew he wanted a life of quality, not just quantity. Don't most of us? If there is a state of the art of end-of-life care, it is this: death with dignity. As for me, my physician has my choices. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like my fellow doctors.

Ken Murray is clinical assistant professor of family medicine at the University of Southern California.
This article first appeared on the blog www.zocalopublicsquare.org

More being done to help disadvantaged students

By Hoe Yeen Nie, Channel NewsAsia, 24 Feb 2012

More is being done to help students from disadvantaged backgrounds level up with their peers.

Education Minister Heng Swee Keat said this will be addressed when he presents his ministry's plans in Parliament in the coming weeks.

He was speaking to reporters after a visit to Kheng Cheng School on Friday.



During his visit, Mr Heng had breakfast with students on the School Breakfast Programme. Under the scheme, students from low-income families get vouchers for food, so they won't have to start the day on an empty stomach.

Mr Heng said he visited the school to find out how schools like Kheng Cheng are supporting students who fall behind. He sat in on a learning support class aimed at helping Primary One students who cannot quite keep up with Mathematics and English.

The Learning Support Programme is a national early intervention programme for Primary One and Primary Two pupils. Students in the programme are supported for half an hour daily by specially-trained teachers.

It is part of a nationwide early intervention programme, and Mr Heng said such schemes are constantly assessed to make sure the pedagogy is right.

He said: "The more we understand how teaching and learning can be done more effectively, the better our pupils will learn. A lot of this is not just about technical learning, a lot of it is about socio-emotional learning. When the child is motivated, he learns a lot better."

Saturday, 25 February 2012

Turning off the deadly 'light' on cigarette packs

No-go too for 'mild', 'low-tar' as they give false sense of safety
By Poon Chian Hui, The Straits Times, 24 Feb 2012

'LIGHT' cigarettes will soon be a thing of the past here due to new rules that ban misleading descriptions on packets.

Tobacco firms will also be barred from using other words such as 'mild', which can lead smokers to believe the brand is healthy.

In fact, there is no evidence that 'light' cigarettes are any less dangerous than regular ones, said Health Promotion Board (HPB) chief executive Ang Hak Seng.

The ban, which kicks in from March next year, will affect about a quarter of the brands sold in Singapore.

Other changes include a fresh set of graphic images to illustrate the damage smoking can cause to the human body. These will be placed on outer packaging for the first time to boost their impact.

Each cigarette will be allowed to contain no more than 10mg of tar, down from 15mg at present. The maximum amount of nicotine will be reduced from 1.3mg to 1 mg.

A new health information notice will also be printed on packs to tell smokers that the cigarette contains other chemicals such as carbon monoxide and ammonia.

This will replace the tar and nicotine levels currently displayed on each pack.



Small cigars, called cigarillos, will be sold in packets of 20 instead of 10 to discourage non-smokers from experimenting.

The changes follow a 2010 amendment to the tobacco laws. At the time, the Ministry of Health announced in Parliament that it planned to tighten the rules to clamp down on smoking.

Tobacco companies were told about the changes by the HPB yesterday, and given a year to implement them. The board will enforce the new rules together with the Health Sciences Authority.

The latest National Health Survey in 2010 showed that about 14 per cent of Singapore residents aged 18 to 69 smoked cigarettes every day.

The move will bring Singapore's restrictions closer to international benchmarks. For example, 73 other countries have banned misleading descriptions under the World Health Organisation's Framework Convention on Tobacco Control. They include Sweden and Australia.

Mr Ang pointed out that smokers struggling to quit tend to switch to brands labelled 'mild', 'light' or 'low-tar', as they believe them to be less dangerous.

A HPB study in 2009 found that 63 per cent of smokers thought 'light' cigarettes were less harmful than the regular ones.
'The reality is that smoking kills, regardless of what type of cigarette it is,' said Mr Ang.

The graphic images on packets were introduced in 2004, and last updated in 2006. They are rotated every few years as their effect tends to wear off eventually, as smokers get used to seeing the same pictures.

Some of the changes echo the results of a public consultation in 2009.


Sixty eight per cent agreed that a general health warning would be more useful than specifying the amount of tar and nicotine in each cigarette.

Another 62 per cent said cigarillos should be sold in bigger packs. These mini-cigars currently cost about $8 for a box of 10. Regular cigarettes go for about $12 for 20 sticks.

'A pack size of fewer than 20 is termed as a kiddy pack, and has been recognised by the World Health Organisation as a marketing strategy to target vulnerable populations with low purchasing powers, such as the young,' said the HPB.

It added that the lower limits on tar and nicotine do not mean cigarettes will be safer than before. They are actually there to prevent manufacturers from adding excessive amounts of these chemicals.

Low-income gamblers are a worry

But proportion of residents gambling has fallen: Poll
By Jessica Lim & Cheryl Ong, The Straits Times, 24 Feb 2012

THE opening of the two integrated resorts in 2010 has not, as feared, led to a higher gambling participation rate in Singapore, a survey has found.

In fact, the proportion of Singapore residents gambling dropped from 54 per cent in 2008 to 47 per cent last year.

But an emerging group of low-income gamblers who bet large amounts is worrying the authorities.
This group, made up of residents who have monthly incomes of less than $2,000, bet an average of more than $1,000 a month.

In 2008, they formed up to 0.8 per cent of those surveyed. Last year, the figure rose to 2 per cent.

To stop them from at least one form of gambling, the government is now looking at expanding third-party casino exclusions to cover a larger number of low-income Singaporeans who are getting government financial aid.

This could include those getting help from the Community Care Endowment Fund.

Currently, third-party exclusions cover only undischarged bankrupts and those on the Public Assistance scheme, where the most needy get cash.

The government is also studying how to implement 'circuit breakers' to discourage frequent gamblers from chasing their losses or keeping up their gambling habits.

This could include working with casinos to limit the amount of time a person can play or spend.

'What we want to do is to take pro-active steps to safeguard the financially vulnerable groups,' said Acting Minister for Community Development, Youth and Sports Chan Chun Sing yesterday.

He was commenting on the results of a survey on gambling conducted by the National Council on Problem Gambling (NCPG) last year. It polled 3,315 Singapore residents aged 18 and above, and followed similar surveys done in 2005 and 2008.

Health alert: One in 3 will develop diabetes

11.3 per cent of those aged 18-69 already had the disease in 2010
By Salma Khalik, The Straits Times, 24 Feb 2012

A TIME bomb is ticking here - and its name is Diabetes.

One in three Singaporeans will develop this condition by the time they are 69, making it one of the most pressing health issues here, said Professor Chia Kee Seng, the dean of the Saw Swee Hock School of Public Health.

'It is no longer a question of 'if I will get diabetes', but 'when I will get diabetes',' he said.

In fact, in 2010, 11.3 per cent of people aged 18 to 69 were already living with this condition, in which a high level of sugar in the blood can damage the organs. In 2004, it was 8.2 per cent.

The disease is fairly widespread among those aged 70 and above.

The 11.3 per cent figure earns Singapore the dubious honour of having one of the highest incidences of this illness among developed countries.

In Europe, it is generally around 6 to 9 per cent; worldwide, it is 8.5 per cent.

Dr Stanley Liew, an endocrinologist at Raffles Hospital, said the rise of diabetes here mirrors the rise in obesity from 6.9 per cent in 2004 to 10.8 per cent in 2010.

The reasons for concern are two-fold:

- Diabetes worsens the older a population gets: On top of this, doctors here are seeing an earlier onset of the disease. In 2004, 8 per cent of those aged 40 to 49 had it; six years later, it had gone up to 12 per cent in that age group.

- Diabetes causes a host of health complications ranging from blindness to kidney failure, poor circulation leading to limb amputations, heart attacks and strokes.

TRE removes post about Lee Hsien Yang

Editors appoint new lawyer; express regret for defaming Mr Lee
By Tessa Wong, The Straits Times, 24 Feb 2012

SOCIOPOLITICAL website TR Emeritus (TRE) did an about-turn last night and removed a defamatory posting about corporate chieftain Lee Hsien Yang from its portal. It also expressed regret for defaming Mr Lee.

This comes less than 24 hours after TRE said it would vigorously resist Mr Lee's demands.

The final decision followed a meeting between Mr Lee's lawyers from Stamford Law, and a TRE editor, Mr Richard Wan, who went into the session with a new lawyer. He is Senior Counsel Kannan Ramesh of Tan Kok Quan Partnership, replacing Mr M. Ravi.

Mr Ravi was discharged abruptly earlier in the day. He had said on Wednesday that TRE intended to fight Mr Lee's demands, in defence of the freedom of expression in cyberspace.

When contacted, Mr Ramesh said his client declined to speak to the media on why TRE made the U-turn.

But in a statement posted on its website after 10pm, TRE's editors said they 'acknowledge and regret that a defamatory comment about Mr Lee Hsien Yang was placed on our website by a netizen'.

'We had and have no intention to defame Mr Lee. We have removed the said defamatory comment from our website.'

Budget 2012 - Boosting Bus Capacity

'Most of 800 new buses to roll out in 2 to 3 years'
By Christopher Tan, The Straits Times, 22 Feb 2012

THE majority of the 800 additional buses which the Government will co-fund to expand capacity will likely be rolled out in the next two to three years.

Sources close to the discussions between the authorities and public transport operators told The Straits Times yesterday that the remainder will arrive within the announced five-year time frame.

Of the 800 buses, 550 will be paid for by the Government, and the rest by operators SBS Transit and SMRT Corp.

The additional buses, equivalent to 20 years' worth of fleet growth, will bump up the public bus fleet by 20 per cent. Their arrival depends on how quickly bus manufacturers can supply the fleet, and - more crucially - how quickly drivers can be hired.

All in, the Government is handing out a $1.1 billion aid package meant to cover the operating costs of the vehicles over 10 years. It is understood to include salaries for drivers.

Friday, 24 February 2012

Kazakhstan presents friendship order to Mr Lee Kuan Yew

By Phua Mei Pin, The Straits Times, 23 Feb 2012

KAZAKHSTAN has conferred a friendship order on former prime minister Lee Kuan Yew in recognition of his role in advancing the friendly ties between Kazakhstan and Singapore.

At a ceremony at the Istana on Tuesday, Kazakhstan Ambassador to Singapore Yerlan Baudarbek-Kozhatayev presented the Dostyk Order of the First Degree to Mr Lee. Mr Lee also received a medal commemorating Kazakhstan's 20 years of independence.

'Dostyk' means 'friendship' in the Kazakh language. The order is for senior political leaders and was awarded to Mr Lee by decree by Kazakhstan President Nursultan Nazarbayev.

Other recipients included United Nations Secretary-general Ban Ki Moon and Thai Princess Maha Chakri Sirindhorn.

In his book The Kazakhstan Way, President Nazarbayev, who visited Singapore in 1996 and 2003, singled out Mr Lee and former French president Charles de Gaulle as two 'eminent founding statesmen' whom he considers good examples.

Mr Baudarbek-Kozhatayev noted that Kazakhstan learns from Singapore's budget policy, infrastructure, public service, and education and health-care systems.

Thursday, 23 February 2012

The Iron Lady's warning about free-lunch mentality

AFTER viewing the film The Iron Lady recently about the life of former British prime minister Margaret Thatcher, I read a transcript of an interview in 1987 between her and journalist Douglas Keay.

The following is an excerpt from that interview taken from the Margaret Thatcher Foundation website:

'I think we have gone through a period when too many children and people have been given to understand 'I have a problem, it is the government's job to cope with it!' or 'I have a problem, I will go and get a grant to cope with it!'; 'I am homeless, the government must house me!' and so they are casting their problems on society and who is society?

'There is no such thing! There are individual men and women and there are families and no government can do anything except through people and people look to themselves first.

'It is our duty to look after ourselves and then also to help look after our neighbour, and life is a reciprocal business and people have got the entitlements too much in mind without the obligations, because there is no such thing as an entitlement unless someone has first met an obligation.'

Mrs Thatcher could well have been describing a common attitude among Singaporeans today.

We complain whenever our expectations, even unrealistic ones, are not met.

Not enough places in top schools? The Government should expand enrolment in these schools, never mind that it is an oxymoron as anything 'top' is always limited in number.

Not enough flats in mature estates? The Government should build more, and so on.

A pervasive 'entitlement mentality' is detrimental to building a more resilient country and economy.

We have a personal responsibility to the community we live in. We will do well to reflect on Mrs Thatcher's sentiments in the same interview: 'There is no such thing as society. There is living tapestry of men and women and people and the beauty of that tapestry and the quality of our lives will depend upon how much each of us is prepared to take responsibility for ourselves and... turn round and help by our own efforts those who are unfortunate.'

Alvin Tan
ST Forum, 22 Feb 2012


Scholarship to boost strategic sectors

Move to groom talent for sectors such as energy, tourism and engineering
By Lin Zhaowei, The Straits Times, 22 Feb 2012

THE Government has launched a new scholarship to develop future Singaporean leaders in various strategic sectors such as engineering, energy and tourism.

Starting this year, the Singapore-Industry Scholarship (SgIS) will be given to 100 students starting their undergraduate studies at the four local autonomous universities or the Singapore Institute of Technology.

Announcing the scholarship yesterday, Education Minister Heng Swee Keat said the initiative underscores the commitment of the Government and top industry leaders to develop Singaporean talent.

He said it is critical for Singapore to develop a talent pool at every level, citing the mobility of companies to invest where conditions suit them.

'We must also develop a core of Singaporean leaders and professionals in every sector, who not only have deep knowledge of their sectors, but also the leadership and business skills to succeed in a more complex and competitive world,' he said during ST Aerospace's groundbreaking ceremony yesterday. It was to mark the company's expansion of its Seletar Aerospace Park facilities.

The $26 million expansion will add infrastructure such as a purpose-built general aviation aircraft hangar and pilot training simulation centre.


A total of 28 Singaporean and global enterprises, including ST Aerospace's parent company ST Engineering, are co- funding the scholarships with the Government. They include international firms such as mining giant BHP Billiton, and technology companies Siemens and Hitachi Asia. Prominent home-grown enterprises have also come on board, such as logistics group YCH, fashion retail group Charles & Keith, the public health clusters such as the National Healthcare Group, and integrated resort operator Resorts World Sentosa.

The scholarship will cover tuition fees and other charges, and give allowances for hostel accommodation and computer purchase. It will also pay for overseas exchange programmes, field trips and summer programmes.