Wednesday, December 26, 2012

Christmas in Kuala Lumpur

Our electronic tree
In 2010 Doug was released from the hospital on Christmas Day (a diabetes related infection) in time for us to go to a favorite restaurant. In 2011 we spent Christmas in Chennai. In 2012 - time to spend a relaxing holiday week at home.

Doug decided that Christmas required a tree. We could have bought an imported fir tree - expensive and we would still need to buy lights and ornaments. Pre-decorated trees for the most part seemed sad. Doug searched the web and found this tree and uploaded it on an electronic picture frame. We haven't discussed how long it will stay up.

On the 23rd as we prepared for the week we discovered one of KL's apparent secrets. Just before Christmas (the 23rd this year) seasonal items were sharply discounted. Christmas cakes and cookies were reduced by 70%. Candy canes were also reduced, but we didn't note the amount. Christmas trees were priced at 1/3 of what they were a week earlier.

Our Christmas week began with a dance performance of Viswa Vinayaka at the Temple of Fine Arts (TFA). The dance celebrates the life of Lord Ganesha The hour went by quickly - the dancing, the music, and the video backdrops were a treat for the eyes and ears. (There is a snippet of a performance in Perth last month.) Throughout TFA were paintings of Lord Ganesha and kolams. We could not photograph the performance, so to leave you with an image of Lord Ganesha this  kolam will have to do.

When we entered TFA I ran a local friend from the senior citizens' yoga class and sat next to her during the performance. While we waited for the program to start she told me that she danced up until the age of 16. She stopped because Malaysian Indian and Sri Lankan families did not think girls/women should expose themselves in public. She also told me that when the British controlled Malaysia the Sri Lankans worked as clerks and Tamil Indians largely were contract workers who worked on rubber plantations. (Love and Struggle, a fictionalized account, fills in part of Malaysia's history. It tells about Tamil workers on Malaysian rubber plantations during the last days of colonialism and the beginning of independence.)  Her comments through light on a conversation I had at a Tamil wedding - one of the guests told me that "this marriage is like Obama - a marriage between a Sri Lankan Tamil and an Indian Tamil.

Getting ready for dinner
For Christmas Eve we booked dinner at Croisette Cafe, the small French restaurant down the hall from our unit and across from the gym where I had worked out earlier. The menu was interesting and the price was reasonable. Dinner was tasty and has some items that we especially like. Doug raved about the duck.  The parsley ramequin was unusual - I would happily order it again. The Christmas log was filled with passion fruit and ice cream - yummy. I gave Doug most of the chocolate trunk, mostly because I find a little chocolate goes a long way.
The first courses were great - can it get better
Do I really have room for this?
Christmas morning was quiet and cool, a perfect day for a walk.. As it started to drizzle we ducked into Bamgsar Shopping Center (BSC). We snapped pictures of the fish, which were well arranged and tempting. Then there was the MYR1500 (USD500) hamper - no post-Christmas reduction.

Christmas Day Fish Display at Jason's (BSC)

MYR1500 (USD500) for that last minute gift
We ate lunch on the balcony using  glass place mats and matching cutlery - bought on sale across the street.

The main event was to see Les Miserables at Mid Valley Mega Mall. "Mega Malll says it all - I have no idea how many eating choices there are. Our favorite, almost every house guest ends up there, is Din Tai Fung where we have always xiao long bau (soup dumplings) and other treats That was our choice for Christmas dinner. The mall was packed - even lines for the escalator.
25 Dec 2012 - Mid Valley Mega Mall, KL
Just a little breathing room
A puzzling mall display

We are often asked - Is Christmas celebrated in Malaysia? You decide
Today is the day after Christmas and the radio station is playing strange Christmas songs, for example, "Roasting Chipmunks over open fire."

Saturday, December 22, 2012

Cataract Eye Surgery In Malaysia

I had my second cataract done here in Malaysia, so I thought I would give a comparison between my surgery 5 years ago in the USA (Rex Hospital Outpatient Surgery, Raleigh, NC) and a similar surgery performed in Malaysia (Assunta Hospital Day Surgery Unit, Petaling Jaya, Malaysia).  The surgeon in Raleigh was a recent graduate of a Baylor University Ophthalmology residency program with a medical degree from University of Michigan (UM), while the surgeon in Malaysia was a graduate of the University of Malaya (UM) medical school and a Singapore residency in Ophthalmology.

In comparison the physical medical practices could not have been more different.  In North Carolina the surgeon practiced in a large practice dedicated to eyes.  Staff abounded,  at least four were involved in check in, and the waiting room was well appointed.  Patients were ushered into sub waiting rooms where eye drops were administered by physician assistants.  Some procedures were administered by the staff person and eventually you were placed in an examination room to wait for the physician.

In Malaysia, the physician is part of the specialist clinic run by the hospital.  Check in occurs at a very efficient intake department, and the patient is given a several forms which follow you through the appointment. You then make you way to the physician's office.  Two nurses assist the physician, by taking your paperwork and matching it with the records that had been previously delivered by the hospital records office.  Eye drops are administered as necessary. Nurses scan bar codes to record procedures which automatically update your bill resulting in no wait at check-out. 

In Raleigh, the physician saw...maybe 4 patients per hour, in Malaysia, patients appear to be seen every 10 minutes.  In contrast to Raleigh, the physician administers all procedures other than the eye drops.  In contrast to Raleigh, a question about cost is answered directly by the physician (his estimate was within 1% of the final cost....including all pharmaceuticals).  In Raleigh, the time from arriving at the Dr.'s office until I was out the door was probably 1.5 hours, in Malaysia, at Assunta Hospital it is probably 45 minutes.  The questions is, did I get the same service.  Yes I think so, but Malaysian medical practice appears to be more efficient, especially in the scheduling and back office work.

The billing methods are different, especially since I am not covered by an insurance letter.  I have insurance, but must pay in advance and get reimbursed afterwards.  Most Malaysians are covered by some sort of insurance had thus have registered an insurance letter from their provider with the hospital.  In North Carolina I went to the physicians practice to pay my deductibles.  No discussion of costs other than deductibles were discussed, and I seriously doubt if the physician actually knew all the costs involved.  In Malaysia, I had to pay 80% of the estimated costs up front, with the remainder due immediately following the surgery, prior to release from the Day Surgery Unit.

In the US on the day of the surgery, I was requested to check in at least one to two hours prior to the surgical appointment.  At this check in, I provided my insurance information, and filled out forms and forms and forms. I had been a patient at this hospital before, but it did not seem to matter.  After waiting a good 15 to 20 minutes, the check in clerk took an addition 15 minutes of time filling out paperwork.  In the US, I went to the Outpatient Surgical Unit, was assigned a bed, a curtain was drawn, I changed my clothes into a hospital gown that you tried to tie behind your back.  I then got into the bed, as waited for the doctor to appear.  Since my surgery was in the afternoon, I had to fast, and stop taking my standard prescribed medications at least 12 hours prior to surgery.  I think I was given an oral sedative.  The doctor was running behind schedule, so my surgery was 1 hour late.

In Malaysia, I went to the hospital intake unit as normal and gave them my hospital ID card.  The check-in process took approximately 5 minutes (including the wait in the queue...there were 10 numbers before mine).  I proceeded to the Day Surgery Unit and waited approximately 10 minutes.  Although I fasted, I was instructed to take my standard medications.  The nurses checked my blood pressure, pulse, etc. prior to going to a dressing room.  In contrast to the US standard hospital gown (now paper), I was given a freshly laundered and pressed sarong, plus some flip-flops.  The patient has a lot more personal privacy.  My clothes went into gym lockers and I kept the key.  I was then ushered into a surgical waiting room and waited approximately 10 minutes..

In the US, I was wheeled into the surgical theatre (actually closer to a closet) and transferred to the operating table.  What I remember of the procedure was bright lights, and a light show not seen by me since the drug induced ones in the 1960's.  When the surgery was completed, I was taken back to the recovery room.  I violated hospital rules by self medicating with my normal diabetic medications...thus saving a lot of money.  After about an hour of recovery, I was released to the tender mercies of my wife, was driven home and spent the remainder of the day resting.  No check out with finance when leaving.  I had a follow-up appointment the following morning.  I then drove 200 miles to attend the wedding of a friend's daughter.  My only problem was my inability to thread a needle to replace a lost button (Liz is hopeless on these minor domestic chores).  Two additional follow-up appointments occurred, one a week later, and second at the end of a month when the refraction was done for my replacement glass lenses.

In Malaysia, I was escorted and walked back to the surgical operating theatre.  Everything was on schedule.  I got up on the surgical was short with my feet handing over the end.  The surgery was cold and my toes felt it.  The doctor and the nurse both confirmed which eye was being operated on, each twice, repeating the question differently to make sure were were all satisfied.  I think I had a topical anesthetic drops and some more were added.  The doctor explained what he was doing, which did a lot to calm me.    Electronic voices were speaking telling the doctor when certain processes were complete (polishing the capsule) something I did not remember from the US.  When the surgery was completed I was rolled into a recovery room.  It was empty, but within an hour it was overflowing with one nurse for all 10 of us.  Standard monitors periodically checked my O2 level, blood pressure and pulse.  After an hour I was walked to the changing room, changed my cloths and went out to meet Liz.  I needed to go to the finance office to check out and pay the remainder due.....virtually nothing at this time, and picked up my medications from the pharmacist.  I got a thorough review of my medications before returning to the Day Surgery Unit for release. Medications were reviewed again and I was sent home.  I walked down to the taxi queue and we went home.  Follow-up was the next day, 4 days later, a week post-op, two weeks post-op, and a month post-op when refraction was done.  No problem reading immediately following surgery and I could continue to use my existing eyeglasses.

What was the same?  The eye drops used were identical, and the replacement lenses were of the same manufacture.

The bottom line.  Both the surgeries in the US and Malaysia were successful.  The recovery in Malaysia was easier as my prescription lenses did not need to be changed.  I actually no longer need my lenses for distance, but since my driver's license says "corrected" I continue to use them.  I do not drive here in Malaysia.  What did I appreciate.  Well, the creature comforts in the US were better (nicer couches), longer beds, but the wait times were incredible.  The complete lack of knowledge about the costs in the  US adds to the stress of the operation.  It is only when bills begin to arrive in the mailbox that you begin to understand the costs.  I do not have them here, but the retail cost was well in excess of USD $5,000.  Then the insurance information came in with the costs being dramatically cut (pre-negotiated prices).  All in all, I recall the total cost being close to USD $2,000 (deductibles, co-pays, refraction costs).  In Malaysia, I appreciated the doctor knowing the cost of his services (accurately), the efficiency of the administrative procedures.  I appreciated getting the costs from the hospital at the time  I left the building. The total cost was less than USD $1,800.  I have yet to submit the claims to my US insurance company which is secondary to Medicare.  Medicare premiums are mandatory at about USD $99 per month, but reimbursement for services overseas are forbidden.

As an aside, both Liz and I get our prescription medications in India.  They are made by the same companies that supply the US generics, and our cost is less that the deductibles we would otherwise pay.

Doug with his plastic protective eye cover.

Wednesday, December 19, 2012

Human Rights: UPR and Suaram

Living in Malaysia has increased my knowledge of human rights. The Fulbright Alumni grant has exposed me to Malaysia's refugee population and people who work on its behalf. Recently I represented some Malaysian NGOs at a workshop in Bangkok (Malaysian staff were busy with year end activities). The International Service for Human Rights held the workshop to prepare Malaysia, Myanmar, and Thailand human rights institutes and NGOs for the 2nd cycle Uniform Periodic Review (UPR) review. Simply put, the UPR is an interactive process between a state and other UN states; in Geneva each state reports what it has done to improve human rights. Between 2007-2011 (the first cycle) all 193 member states were reviewed.The 2nd cycle began in 2012 - Malaysia will report in 2013.(The United States submitted its first cycle report in 2010. This article describes the process, the recommendations, and the State Department's immediate reaction.)

Some stuffed dinner guests

On Day 1 we reviewed the UPR process, the countries' record in implementing 1st cycle recommendations, and linking them to the 2nd cycle review. A common observation was that governments said that they were taking action, but weren't. Malaysia did not accept any recommendation to ratify a UN treaty or covenant. We ended the day with an amazing dinner, comparable to a Chinese wedding banquet.

The most valuable activities were hearing from and meeting with representatives from Indonesia and the Philippines who have had their 2nd cycle review. We met separately with representatives from the Philippines who shared helpful advice and materials. (One Filipino described himself as representing Philippine's "vibrant" NGOs - a perfect description of himself as well.) They recommended that NGOs lobbying embassies, especially those representing countries that had asked questions during the first cycle.

Commissioner Muhammad Sha'ani
I was pleased to meet and work with a SUHAKAM commissioner and staff member. SUHAKAM, is Malaysia's Human Rights Commission. Its commissioners are appointed to three year terms, so the current set of "good" commissioners can be replaced by not so good commissioners.) Commissioner Muhammad Sha'ani was a storehouse of information about food (he was trained/worked in agriculture) and Malaysian politics. His dedication to to the rights of migrant workers (including refugees) and orang asli was impressive. He spends many weekends in orang asli communities learning about them and their needs. Sha-ani and staff member Fahmi were examples of  smart, dedicated Malaysians who are advancing this country's human rights and creating a more just society.

The second day was devoted to small group meetings about implementing and monitoring UPR recommendations.One theme was that NGOs had to continue their engagement after the UPR review. They can educate the public, lobby agencies, and set up or support a monitoring system. I was in one group with a representative from Myanmar who was intense about the need to train soldiers on human rights. Her concerns do no apply in Malaysia where the military keep out of domestic matters. Sha'ani attributed that Malaysia had never had military a coupe, unlike its neighbors other than Singapore.

Fahmi, SUHAKAM staff and drafting partner
The third day Sha'ani, Fahmi, the SUHAKAM staff member, and I met to discuss follow up. Sha'ani suggested that SUHAKAM might engage more of civil society in the UPR process. No need for us to speak  with the same voice, the process is meant to give voice. The workshop ended with participants producing a "good practices" document to summarize the valuable lessons learned. Fahmi and I had worked on the initial draft with the extensive involvement of Eleanor, one of the facilitators.

Thoroughly schooled in UPR processes my next step was to learn the content of Malaysia's human rights issues (although I already had a good idea of what they were). I went to the launch of Suaram's 2012 civil and political rights report. Suaram, a human rights organization, has faced continual police and administrative harassment this year, which has distracted its leaders and its allies.

Suaram Launch. Why all the photographers?
While human rights issues in Malaysia may pale besides Myanmar's child soldiers and forced labor and the Philippines recent experiences with extrajudicial killings and enforced disappearances, the harassment of Suaram is indicative of practices that stifles dissent, The report wasn't all bad news. For example, it commended SUHAKAM for its actions to protect human rights (I was glad to have my impression confirmed.) It documented concerns about range of human rights issues.

In addition to launching the report Suaram awarded its human rights award to Himpunan Hijau and the Murum and Baram communities. Himpunan Hijau recently held a 300 km march to protest a rare earth project that will have serious environmental impact. Murum and Baram communities have fought the building of dams in Sarawak on the island of Borneo. The destruction of the forests in Sarawak is a travesty and building the dams will add to environmental desecration, The awards recognize that a healthy vibrant environment as a human right.

Thursday, December 6, 2012

Another Malaysia Project: Training Teachers of Refugee Children

This is a story in three parts: our Fulbright project funded by the US State Department, refugees in Malaysia, and refugee schools.

The Fulbright invited alumni to form teams of with at least 10 members and submit a proposal to the Alumni Engagement Innovation Fund (AEIF). Colleen, a 2010-2011 Fulbrighter, proposed building on a pilot project that she had implemented and tested, and she enlisted other Fulbrighters to join the team. Our proposal was to implement an "intervention" to "help empower the refugee teachers and improve the emotional and academic future of their students." I joined the team athough I wasn't sure how my skills fit in. Our project was selected and funded (just under $25K). Then reality set in. The majority of team members are not currently living in Malaysia. Only one team member in Malaysia is a psychologist. The State Department disallowed paying a principal investigator/project manager. No money for administrators. Fortunately Wai Sheng has recruited former students and community contacts to conduct focus groups and offer the training. She has cheerfully taken on the role of project organizer. My role - I am the banker and doer of odd jobs. To learn more about the project and track our progress visit our project blog, resilient refugees.

Linking our team, refugee schools, Malaysia Cares of
A psychologist, a teacher, a community organizer
Malaysia has not ratified the UN Convention relating to the status of refugees; therefore, they have no legal right to be in Malaysia. (This article summarizes the history/summary of refugees in Malaysia.) The refugees don't live in camps. They live and blend into cities and towns, where they may crowd into small apartments and they are largely invisible to their neighbors. The sign reminded refugees (potential con artists and victims) that UNHCR services are free. A UNHCR card, based on a case by case analysis of a refugee's case, allows one to work - it does not necessarily prevent police harassment and intimidation.

A sad consequence of government's lack of a refugee policy is that the children of refugees cannot attend government schools. Refugee communities have pooled their money to open and staff community schools. Because of the ambiguous situation of refugees the schools operate a cloud, i.e., what happens if a school is discovered, raid, and the status of the children, their parents or teachers checked? The school we visited has 80 students from 3 years old to 16 and three teachers. Volunteers teach English. They normally come once a week, and as is true of volunteers everywhere - they don't always come each week. We spoke with young teacher whose command of English was excellent. This may seem condescending, but in fact he largely taught himself English. In addition to teaching he is working with Malaysia Cares to develop a youth center for teenagers and young men - the group which is most prone to act out their boredom.

It may be a refugee school, but it still has rules
Team members in a classroom/meeting room

The school we visited is part of the Chin community from Myanmar. They tend to be more developed and have more resources than other refugee communities. We debated reaching out to other communities, but the resources available (time and money) served as constraints. Even working with a well organized community takes time - contacts have to be made and we have to convince agencies and schools that we are offering something of value.

This project is an example of how one's skills can be put to new uses in retirement. In addition I have met and admire dedicated Malaysians and marvel at the resilience, ambitions, and selflessness of young Asians.