Singapore’s medical tourism and the law courts

Singaporeans, particularly those involved with Medical Tourism, should take heart from recent news reports that Gleneagles Hospital must pay a patient damages amounting to SGD 250,000 (approximately USD 201,000) by the law courts as compensation for a botched operation. The patient, a Hong Kong resident, claimed aggravated damages for "grave mental anguish, distress and depression."

Certainly, no one wishes to see Singapore become a trigger happy legal environment – where individuals sue each other over the slightest of grievances. However, maintaining professionalism requires accountability. In turn, accountability implies a fair and transparent legal framework. In this regard, the court's decision must be applauded by doctors, patients and hospitals alike.

The Doctor

Awarding damages to a patient for a poorly executed medical procedure sends the right message to everyone. Patients – already nervous about complicated medical surgery – gain comfort from knowing a doctor's scalpel is answerable to local law courts. Hospitals understand the seriousness of maintaining the sanctity of medical records. Doctor's will be more careful undertaking surgeries for fear of paying damages in case something goes wrong. The positive ripples are numerous.

Presently, patients looking at international jurisdictions for medical services may find Singapore less expensive than most European countries. Nonetheless, in today's globalized world, medical tourists have many alternatives available, including several countries cheaper than Singapore (e.g. Thailand).

Still, Singapore's medical industry can take heart from the resounding endorsement by none other than Robert Mugabe, Zimbabwe's dear ruler! The Zimbabwean President seems to visit Singapore for medical attention every few months.  

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Imran is a business and management consultant. Through his work at Deodar Advisors and the Deodar Diagnostic, Imran improves profits of businesses operating in Singapore and the region. He can be reached at imran@deodaradvisors.com. 

Kranji War Cemetery: Singapore and the politics of the dead

Politics don't end with life. Whether it is a Japanese Minister honouring the country's war dead by visiting Tokyo's Yasakuni Shrine or the right to (permanent) burial plots here in Singapore, politics is unavoidable even after death.

Burial plots are valuable real estate in land scarce Singapore. Despite having increased the Republic's surface area through land reclamation by about a quarter since 1965, graves are available only on a fifteen year lease-hold basis. In 1998, the Singapore government announced the New Burial Policy to limit the burial period to 15 years. Henceforth, graves after 15 years will be exhumed. The exhumed remains may be cremated and put into a columbarium or be re-buried, according to one's religious requirements. (The New Burial System as described on the National Environment Agency website.)

No rest for the wicked, the weary or the brave ... at least not in Singapore.

However, there is one group of deceased which is privileged in its exemption from exhumation: the brave souls who gave their lives defending Singapore during World War Two; and some who died during the Malayan Emergency; and some of their family members too. Their graves can be found at the Kranji War Cemetery located off Woodlands Road.

Certainly, soldiers deserve to be honoured. Nay, they must be honoured. It is a mark of a civilized society. Disciplined militaries fight to preserve commonly accepted social values, property and a nation's dignity.

These soldiers resting at Kranji fought and died for Malaya. Other than people from Malaya itself, Malaya's defenders came from Britain, Australians, India, New Zealand and other dominions of the British empire.

A glance at the list of the War Dead on the memorial suggests that a significant number of soldiers who died defending the British crown originated from the Indian subcontinent. For example, just in one battle, the Battle for Muar the 45th Indian Infantry Brigade started with 4,000 men and ended with only 800. Furthermore, after Singapore's surrender in 1942 approximately 55,000 servicemen from the Indian subcontinent were taken prisoner of war by the Japanese.

Yet, walk into Kranji War Cemetery and one is forgiven for assuming the cemetery is dedicated only to caucasian war dead.

The prominent areas of the cemetery are taken up with tombstones dedicated to deceased caucasian soldiers. Yes, tucked away at the back, behind the war memorial are some tombstones apparently of Nepalese Gurkha and Indian Hindu soldiers. And, yes, the inscription on the memorial itself is in multiple languages, including Urdu. However, the valuable real estate within the graveyard is virtually monopolized by tombstones dedicated to white soldiers. In fact, I had trouble locating any tombstones pertaining to Muslim soldiers from the Indian subcontinent.

It appears a little piece of Europe survives in the heart of Singapore: the Kranji War Cemetery. To the uninitiated, Singapore's cherished values of plurality and ethnic equality seem conspicuously absent from the many gravestones located at Kranji cemetery.

Undoubtedly, the blemish is a legacy of Singapore's colonial past and the cemetery's management lies with the Commonwealth War Graves Commission (not Singapore). However, that fact does not justify the organization of the cemetery in a manner unbefitting of the sacrifices made by the many non-caucasian Commonwealth soldiers who died defending Singapore and the Malay Peninsula.

PS – Stay tuned for more on this subject. I expect to do some additional research on the Kranji cemetery and the annual remembrance ceremony to better understand the facts (and correct any errors in this article).

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Imran is a business and management consultant. Through his work at Deodar Advisors and the Deodar Diagnostic, Imran improves profits of businesses operating in Singapore and the region. He can be reached at imran@deodaradvisors.com. 

The World’s newest ‘Banana Republic:’ the United States?

The United States is bankrupt. The government refuses to pay its bills. The US currency is no longer the 'be-all and end-all' of international currencies. Notwithstanding Apple, Microsoft and other entrepreneurial start-up companies, US economic clout is on the wane.

Ok, so the US is not really bankrupt – it can keep printing (and debasing?) more paper currency notes which the rest of the world happily purchases in ever growing amounts. Economic stability equals a free trade environment predicated on trust in the USD.

The rest of the world includes Singapore.

Singapore's foreign currency reserves, one of the largest pools of capital in the world are biased towards the US Dollar (USD). From Temasek Holdings to the Government of Singapore Investment Corporation (GIC), Singapore's stake in international economic stability is great. Singapore is not alone. China – the largest single owner of US government debt – has a lot riding on USD stability.

The day China stops buying US debt, the USD may collapse.

Result: China becomes much less wealthier, on paper at least. Moreover, the US will be unable to keep importing goods from China because it cannot pay for them in the 'new, debased' USD. In turn, this leads to social problems within China as Chinese factories reduce production and lay off workers. Consequently, Chinese consumers, including travellers, decrease consumption and the world suffers more ... and the vicious cycle continues.

Of course, global politics are not so simple. Despite a gradual shift away from US dependencies, the world needs the US to behave responsibly. International stability continues to rest on the US, economically and politically. Shutting down government because of domestic political squabbles is not responsible. It smacks of 'Banana Republic' politics and politicians. The US looks more and more like the Third World countries it chooses to lecture (and bomb when they don't listen) about governance on a regular basis.

The world entered a new socioeconomic era some years ago. The post World War Two Bretton Woods and Cold War orders have wasted away. However, the replacement paradigm has yet to be defined. At least for the next several decades the world will continue to watch US domestic politics as if it were their own.

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Imran is a business and management consultant. Through his work at Deodar Advisors and the Deodar Diagnostic, Imran improves profits of businesses operating in Singapore and the region. He can be reached at imran@deodaradvisors.com. 

City Harvest Church, the law courts and the abstract arena of trust

Forgive me, Lord, for I have sinned! Nope, it should actually say, "The Lord seeks forgiveness from City Harvest Church (CHC) for I, the Lord, have sinned!" At least if one follows the pastor of CHC, then it is perfectly normal for God to apologize for His behaviour to humans.

One does not have to be a theologian of the status of St. Thomas Aquinas or Al-Ghazzali to understand it does not seem right for God to apologize to His subjects. Whether we refer to the Jewish, Sikh, Muslim, Christian or any other religion's Supreme Being, it is generally humans who ask for forgiveness ... not the other way around.

Humans succumb to temptation. Humans do bad deeds. Humans think bad thoughts. Humans seek mercy for sins. For many, to speak of a God with flaws is tantamount to blasphemy.

'God the Father' by Cima da Conegliano (circa 1515)

Still, as a mortal, it is not my place to judge others, especially in matters of personal faith. So, if the leader of the CHC believes God has wronged him and God should apologize, then more power to the reverend. We all believe in our own God(s) – and fight our own demons (in this life and more).

However, religious leaders play to a gallery. They are not alone. They speak to a flock. Their each word is scrutinized. They are opinion formers who speak to thousands weekly. Thus, when a religious leader even indirectly implies that humans are somehow not responsible for personal actions, it seems inappropriate.  

Yes, it is a slippery road I am taking: 'freewill versus destiny.' Squaring the 'freewill versus destiny' circle is not my intention here – nor am I capable of resolving the centuries old debate. Nonetheless, the (earthly) legal framework of laws and courts created by humans rests squarely on the assumption humans are accountable for our deeds. And, if we abuse public trust or harm others, we must face the consequences.

Legal technicalities may win cases in law courts but the yardstick applied to maintain trust in the real world is more stringent. Thus, while the CHC court case continues and no verdict has yet been pronounced, in my books the CHC has already lost an important battle: the claim to have behaved in a morally correct manner.

But then I am neither judge nor theologian, simply a blogger with views on right and wrong.

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Imran is a business and management consultant. Through his work at Deodar Advisors and the Deodar Diagnostic, Imran improves profits of businesses operating in Singapore and the region. He can be reached at imran@deodaradvisors.com. 

Singapore’s Pioneer Generation, work ethics and accountability

How soon will the phrase 'Pioneer Generation' join Singapore's popular lexicon? The answer may reflect upon the values held by Singapore's younger generation. The 'Pioneer Generation' phrase was aptly used by Prime Minister Lee to describe the generation of senior Singaporeans' responsible for propelling Singapore into the developed world's ranks in one generation.

Undoubtedly, Singapore owes a great debt to those who built Singapore into the prosperous city-state of today. The debt becomes greater if one remembers the realities of life during the 1960 – 1980s.

Jobs were not as plentiful – perhaps not plentiful at all; no Medishield program to pay for medical expenses; public transportation was in its infancy: the subway system was inaugurated as recently as 1987. That too with a single train line between Toa Payoh and Yio Chu Kang. Education was about learning survival skills – not a means to actualize creative potential in 'abstract' artistic or creative fields. The transition from kampong attap huts to Housing Development Board (HDB) flats – with all its associated implications for piped water, sanitation, etc. - only began in earnest in the late 1960s.

A glimpse of traditional 'kampong' or village life of yesteryears

Today, in 2013, the quality of public infrastructure is world class. Singaporeans' need not be quite as anxious about basic necessities such as housing, medical care and education. Worries have shifted to questions about quantum of disposable income (how to pay for the next vacation, latest phone, new car, etc.); getting one's child into a secondary school of choice; or the desire to maintain a better work-life balance ... and so on.

I am a newcomer to Singapore. I did not witness the transformation of marshy swamplands into concrete towers leave alone the shift from kampongs to community centers. However, I get the impression the urban landscape is not the only characteristic which has changed in the city-state.

Many Singaporeans' have lost the all-pervasive sense of ownership and accountability held so deeply by the Pioneer Generation. If something needed to happen, the community got together and did it – with the encouragement of local community leaders. The reflex action was not to complain and subsequently expect the government to address the problem by throwing taxpayer money at it.

The changes appear to have permeated the political elite too.

Sure, members of parliament are available to constituents at regular 'meet the people' sessions. However, the 'real' connection between the political elite and the population has weakened. A leadership living in landed properties or condominiums driving expensive cars to work is less able to relate to a population still overwhelmingly living in public housing and using public transport to commute to work. (Something reflected by the SMRT CEO's comments a few years ago about people having a choice to board trains?)

Additionally, many public servants (bureaucrats) seem content to keep their 'iron rice bowl' secure at the expense of delivering quality public services. The incessant 'outsourcing' of tasks to foreign workers, often supervised by more 'skilled' foreign workers, means accountability and quality of work suffers. Perhaps the 'non-Pioneer Generation' is more interested in sitting in an air conditioned office and less inclined to pull up their sleeves and make things happen?

But what do I know? I am not even a 'real' Singaporean ... certainly not a descendant of the Pioneer Generation.

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Imran is a business and management consultant. Through his work at Deodar Advisors and the Deodar Diagnostic, Imran improves profits of businesses operating in Singapore and the region. He can be reached at imran@deodaradvisors.com. 

Singapore’s NDP and the limits to integrating foreigners

Singapore's annual National Day Parade (NDP) is a unique event. The NDP contains enough songs and pageantry to make even the hardest heart melt. Failing the songs and skits, demonstrations of brute military strength and prowess by the Home Team will evoke pride in any armchair general. Though most of all, it is the nostalgia of a Singapore long gone which appears to bind together local hearts and minds – particularly when described through the local Singlish 'dialect.'

All that and more ... but only for 'genuine' Singaporeans.

Yes, I am a Singaporean. Not only did I attend NDP 2013, I also enjoyed it ... to an extent.

A photo taken at Singapore's National Day Parade in 1968

Sure, I could answer most of the NDP's 'pop quiz' questions relating to Singapore's history. Who designed City Hall? What is the oldest building standing in Singapore? In fact, dare I say it, I probably know at least as much about Singapore's history as most of the 27,000 other NDP attendees seated at the Marina Bay Float. (Not surprising, as I regularly relate the 'Singapore Story' to visitors to the National Museum of Singapore (NMS) in my capacity as an NMS volunteer guide.)

Still, something was missing at the NDP.

It starts with the Singlish. I admit I don't speak Singlish. So many humorous references in the NDP skits left me scratching my head. Secondly, my theoretical or factual knowledge about Singapore cannot replace the experiential familiarity 'born and bred' Singaporeans have gained over a lifetime of living – despite my having lived in our fine city for almost fifteen years.

So, yes, 'true-blue' Singaporeans you are right: first generation foreigners cannot completely immerse themselves in Singaporean culture (however we define the city's culture). I will never relate to Kuehs, Ice Kacang, Laksa or the many other 'Singaporean' things the way you do. It's an honest to goodness fact. No denying it.

However, that simply brings me to the point where most Singaporeans' historically started the 'Singaporean Journey.' That is, as foreigners arriving in Singapore aspiring for a better life and to support families back home.

Over time, 'back home' became a slowly fading memory as roots were sunk on this island. With each passing generation, it became clearer that no person actually intended to return to the 'homeland,' ever. Be that China, India, other islands in the Malay Archipelago, or, as in my case, Pakistan.

Result: the birth of the second or third generation (or more) Singaporean – the so called 'true blue' Singaporean.

I am a Singaporean too - a Pakistani-Singaporean (or a Singaporean-Pakistani if you prefer). Asking me to shed my 'Pakistaniness' is like asking a Singaporean to shed her 'Singaporeanness.'

Can a Singaporean give up Singlish, laksa, roti pratas, and all else 'Singaporean' simply because they migrate to Australia? Unlikely.  So please don't ask me to achieve the impossible.

I cannot be exactly like you. Nor do I aim to be exactly like you. We do not share the same history, though we certainly share many similar values.  

Leave the 'real' integration for the next generation. Until then, please humor me and respect my history.

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Imran is a business and management consultant. Through his work at Deodar Advisors and the Deodar Diagnostic, Imran improves profits of businesses operating in Singapore and the region. He can be reached at imran@deodaradvisors.com. 

Singapore: Monaco of the East!

Cities reinvent and regenerate themselves constantly. At least, cities which thrive and beat the ravages of time to stay relevant are no strangers to change.

Singapore is no exception. During the last ten years, the city explicitly decided to shirk its 'Fine City' image, moving from being a sterile, gum free environment to a hip, happening urban setting. As is often the case, Singapore's policymakers succeeded ... perhaps too well for the city's own good.

The casino, nightlife and incremental lifting of social restrictions worked its magic. From being the fortress 'Gibraltar of the East,' Singapore reinvented itself in the image of Monaco, i.e. the 'Monaco of the East.'

Monaco, of course, is a playground for the world's wealthy. Singapore too has become a playground for the worlds wealthy, particularly China's nouveau riche looking for a 'safer' place to park themselves and their cash. And, the annual haze notwithstanding, breathe fresh air.

Education is a key component of Singapore's drive to retain economic competitiveness in the coming years

To some extent, the 'New Singapore' means accepting larger income gaps between the wealthy and the not so wealthy. According to one widely accepted measure of income inequality, the Gini coefficient, Singapore's income inequality has risen during the last year – even taking into account all government subsidies and other redistribution measures.

However, all is not well in the PAP's (Singapore's ruling People's Action Party) domain.

Singaporeans are pushing back in an unprecedented manner. Locals are unhappy with Chinese immigrants driving Ferraris while subway trains get more crowded; or having to fight with foreigners for places in the local school system.

Nonetheless, there is no turning back for Singapore. The city's 5.3 million people will become 6 or even 6.9 million, maybe not at the PAP's proposed timetable but perhaps sometime within the next decade. (Seats on subway trains will remain a scarcity for commuters, forevermore!)

In the midst of all the changes in Singapore, one change becomes ever more obvious with time: Singapore's price competitiveness is eroding.

According to the latest Mercer cost of living survey, Singapore is the world's fifth most expensive city for expatriates. Hong Kong, Geneva, Zurich and Shanghai are all cheaper cities. The change may not be explicitly policy driven but it is a consequence of multiple factors, including growing Singapore's population by 66 percent in two decades.

To be sure, Singapore has moved beyond the stage of relying simply upon cost to retain economic competitiveness. Nonetheless, can Singapore afford to be the fifth most expensive city in the world and still preserve its 'regional hub' status – or will the Little Red Dot be relegated to being a hub exclusively for knowledge intensive 'Research and Development' areas such as biotechnology?'

Relying on knowledge intensive industries is no bad thing really ... if Singaporeans don't mind the income gap between rich and poor widening further in the coming years.

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Imran is a business and management consultant. Through his work at Deodar Advisors and the Deodar Diagnostic, Imran improves profits of businesses operating in Singapore and the region. He can be reached at imran@deodaradvisors.com.