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.

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."

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.

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.

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.

Why rule of law remains important

By Simon Chesterman, Published The Straits Times, 22 Feb 2012

THE rule of law is like oxygen: easily taken for granted, but quickly noticed when it is absent.

If you have it, the rule of law makes organised society possible. If you lack the rule of law, it is a recipe for disorder and corruption. An extreme example of the absence of the rule of law is Somalia, where effective government has broken down completely. For many, Singapore epitomises the opposite: a state in which the rule of law is valued almost above all else.

Last week, I attended an international dialogue on this topic with government officials, practising lawyers and academics from Singapore and abroad. The discussion showed how much has been achieved - and how much more there is to do.

The rule of law has long been one of those rare ideas in politics with which everyone says they agree. In a 2005 declaration at the United Nations, it was endorsed by every country on the planet. Even leaders such as Zimbabwean President Robert Mugabe and Russian Prime Minister Vladimir Putin have said they believe in it.

That universal support is possible only because of vagueness about what the rule of law actually means.

Academics have been arguing for decades over whether we should emphasise structures and processes (a formal or 'thin' definition) or focus on outcomes and broader notions of justice (a substantive or 'thick' definition). Over time, this has evolved into a debate over whether the rule of law can exist independently of robust human rights protections and a liberal form of democracy.

But a better way of understanding the rule of law is to look at how the term is used, why it is important and how it can be promoted.

I thought it was telling, for example, that Minister for Law K. Shanmugam argued that the rule of law is the foundation of Singapore's political stability and economic prosperity. Yet he also accepted that measures such as the Internal Security Act derogate from the ordinary process of law and require explanation.

In the same conference, Chief Justice Chan Sek Keong repeated a robust defence of the role of judges in interpreting and applying the rule of law, rejecting criticisms of the judiciary that suggest bias or an overly favourable view of the government. But he acknowledged that academics can and should criticise judgments that err in analysis of law or fact. And he stressed the important role of judges in checking the legislature and executive when issues of illegality are raised.

Overall, the tone of the conference was as interesting as the substance. Alongside familiar defences of government policy, there was also open acceptance that Singapore's system is not perfect and could be improved through dialogue with others who are also committed to the rule of law.

These observations show three ways in which the rule of law remains important.

First, it guards against the arbitrary or abusive exercise of public power. In the case of the Internal Security Act, for example, there are some basic protections in place - but room for debate as to whether those protections are adequate. Mr Shanmugam himself agreed that such exceptions to the rule of law must be closely scrutinised and strictly justified.

Second, it gives legitimacy to the exercise of public power. The rule of law applies to everyone, including the government, with an independent judiciary that applies the law to specific cases.

Third, the rule of law encourages better decisions. Having a rational basis for the exercise of public power precludes prejudicial discrimination and requires that laws apply to all people equally. It must go beyond being simply good in theory to achieve good outcomes in practice.

Some would argue that you need to go beyond this to include human rights and democracy within the definition of the rule of law. This underestimates the progress that has been made in those areas, as suggested by Singapore's acceptance of a review of its human rights record by the United Nations last year, and the robustly contested elections in the same year.

Attempts to include human rights and democracy within the rule of law like some kind of Trojan horse also underestimate the importance of a 'thin' conception of the rule of law.

Many countries with autocratic governments acknowledge the importance of the law in achieving their own stability. Linking the rule of law directly and inextricably to human rights and democracy would make promoting accountability in such countries more difficult.

So how does one promote the rule of law? As the discussion last week made clear, rules and institutions are necessary but not sufficient. One also needs a rule of law culture.

The rule of law does not exist in isolation from its social context or political structures. It makes a well-ordered society possible, but it is a means rather than an end. For too long, many countries thought they had a monopoly on such debates. This was true of the United States and others in the 1960s, when the law and development movement sought to export US legal structures wholesale to the developing world - and failed.

It is also true of many countries that have resisted even constructive criticism of the manner in which they exercise sovereignty.

To me, then, the most promising aspect of the conference was not the rule of law so much as the explicit embrace of a dialogue on this important subject.

It is a conversation we need to have, and one which needs to continue.

The writer is the dean of the National University of Singapore Faculty of Law. This article is based on his closing address at the conference, A Dialogue On The Rule Of Law, organised by the Singapore Academy of Law, the National University of Singapore Faculty of Law and the Singapore Management University School of Law.

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