Hansard, 1963-12-13

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Order read for consideration in Committee of Supply [2nd Allotted Day].

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Head 17-

MAIN ESTIMATES OF EXPENDITURE FOR 1964 We are on Head 17 - Ministry of Health. Mr Poh Ber Liak.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Mr Speaker. Sir, I would like to take the two amendments* together. Can I have your ruling, please? * The amendments standing in the name of Mr Poh Ber Liak read as follows:-

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Very well. Will the Member formally move both amendments before he proceeds?

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Mr Speaker. Sir, I accordingly move the amendments* standing in my name as shown on the Order Paper. I have put in the amendments because I am not satisfied with the Government's effort in respect of the Ministry of Health. We are familiar with Press reports nowadays about all sorts of infectious diseases and epidemics. We have read reports of doctors resigning from the service and patients not well looked after because of a shortage of doctors. There is, therefore, an insufficient number of doctors to look after the people. If the poor people living in outlying areas have to go to Government clinics, they have to spend money on transport, and for treatment at certain City Council clinics they have to pay fees. If these clinics are too far away from their homes, they have to see private doctors and the fees are a burden on them.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Order. There seems to be a breakdown in the translation system.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Another reason is that on Sundays and public holidays, or sometimes in the night, there are insufficient doctors in the hospitals to go on shift duty to attend to serious cases like accidents, where the patients have to wait for a long time for treatment. This causes the situation to be serious. Over the past few months we could not find any improvement in the food served to patients and they, of course, cannot recover quickly. The other point we would like to clarify is this: there have been two outbreaks of cholera. Is it due to water rationing? If it is, then what measures is the Ministry of Health taking to improve the situation? Then on dental care. This is also insufficient in aided schools. Government schools are better looked after than aided schools. Although some students from Chinese schools were recruited as nurses, they were actually not well trained. What measures can the Ministry take to improve the situation? How many more regional hospitals can the Government set up to provide medical care for the people? At the moment, the provision of drugs and medicines and maternal care at the Thomson Road Hospital during the night is also inadequate. We also learn that the Cleansing Department intends to extend the hours of water rationing in certain areas so that there will be a greater supply of water in other areas. This is for the purpose of cleaning the drains. The extended time of water supply in these areas is still not enough because certain markets in these areas cannot be cleaned properly. Can the Department think of better ways to clean these markets and so help improve the sanitary conditions generally? The Ministry of Health is asking for an increased provision of drugs and medicines but this has been turned down by the Minister for Finance. We do not think this is proper. This is not a good policy of economising. Money should be spent on buying drugs and medicines for the welfare of the people. In several hospitals and clinics patients have to queue up for registration for treatment. Can the Ministry devise any method of making it more convenient for the patients to register so that they need not waste so much of their time queuing up before they can be treated at these clinics? Another point is that the Ministry is still unable to look after the welfare of the hawkers. There are about 50,000 to 60,000 hawkers in Singapore, and they have formed themselves into hawkers' organisations. These organisations can look after the hawkers but the Government have not been very co-operative with them. On the contrary, they have banned some of these organisations. They have adopted certain measures which are better than those of the Lim Yew Hock Government, but we are of the opinion that these measures are not adequate enough. Adequate shelters and hawking space should be given to the hawkers, but the Government are levying high licence fees for their stalls, and in certain places there is little hawking space as these places are very crowded. 2.45 p.m.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Mr Speaker, the Member is making unusually extensive references to his notes. It amounts to almost reading from a prepared text.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 I have had occasion to rule on this before. I will indicate once again I am prepared to allow him to read from his text at least for these few sittings. Please proceed.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): These points are made from the general outline. So in order to make a speech, I have to refer to my main points in the outline. This is necessary in the course of making a speech in order to be able to give a more comprehensive picture. I am not reading from a prepared text. I would like the relevant Ministry of the Government to provide adequate protection for the hawkers and the general public. This will help the hawkers in their business. There is another instance. The hawkers in Geylang Serai are not very well looked after. In the day-time there are hawkers' stalls at certain bus stops. At night they do some other odd jobs. The Government have not been able to look after these hawkers. There are several eating stalls in Geylang Serai. As from last March they were asked to leave their places. But since then they have not been looked after by the Government. They, therefore, cannot carry on their business and make a living. I am mentioning all these matters in order to point out that there is inadequacy in the services of the Ministry of Health. Since the P.A.P. have now come into office, can the Government from now on try to do something better in order to improve the lot of the hawkers as well as the general public?

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Mr Speaker, Sir, the Member for Tampines has talked at great length just now. I would like to ask him a question. Did he say that patients are not being properly treated by doctors in the Government clinics and that they have to go to private practitioners to get treatment? I am wondering whether he did say this or not.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Mr Speaker, Sir, this is the time for Opposition Members to ask the Minister for Health questions. Instead of that, the Parliamentary Secretary is asking questions. He has not listened properly to my colleague. We are asking the Minister,

MAIN ESTIMATES OF EXPENDITURE FOR 1964 I rule that the Member for Thomson is out of order. The Parliamentary Secretary has been replying to the Member for Tampines. In the course of the debate he has asked questions which the Member for Tampines may or may not answer. The Member for Thomson is right when he says that this is the time for Members of the Opposition to ask questions. But surely in the debate Members on the Government side can retaliate with questions. Please proceed. The Deputy Prime Minister (Dr Toh Chin Chye): Mr Speaker, may I suggest, in future, if any Member stands up and queries on a point of order, that he quote which provision of the Standing Orders he is referring to?

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Please proceed, Mr Parliamentary Secretary.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): We have all listened to what the Member for Tampines has said just now. He was very querulous and his arguments were very tedious. He has not made any proper criticism.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 The Member is now quite close again to personal attacks which I will not have in this Assembly. Otherwise these attacks will lead to replies from the Opposition and we go on and on.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): When I said that he was querulous, I did not mean to attack him personally. He was beating about the bush. On the third point, he said that patients who go to the Government clinics are not properly treated and that they have to go to private practitioners for treatment. Can he give a clear explanation as to how this state of affairs has come about?

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Mr Speaker. Sir, the question which I have raised just now is meant to elicit an answer from the Minister for Health. I wonder whether the Parliamentary Secretary is another Minister.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 The Member for Tampines is now personally attacking the Parliamentary Secretary, which is exactly what I have asked the Parliamentary Secretary not to do. Please refrain from attacking personalities.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Mr Speaker, Sir, I hope the Minister for Health will give a clear answer to my questions.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Mr Speaker, Sir, I think the Member for Tampines has ranged right through the Ministry of Health, I believe, over thirteen points. It is a very unlucky number, Sir - like the 13 Barisan Sosialis Assemblymen. That is their trade mark. He started first by talking about the resignation of doctors. I believe a similar question was put to the Central Government at Kuala Lumpur, and it was the Prime Minister who answered to the effect that unfortunately quite a number of doctors spent some time in Government service and then suddenly they appeared to be bitten by the money bug and they decided to resign from Government service arid go into private practice. That unfortunately is also the situation in Singapore. But this shortage of doctors is not typical only for Singapore or for the Federation. It is worldwide. This is because people are now getting more accustomed to employing the services of doctors for their illnesses and ailments and there is a crying need for medical attention. It is, therefore, a world-wide shortage from which we ourselves suffer. May I, however, say that Singapore can consider itself lucky because the ratio of doctors to population is fairly good in our case. It is one doctor to about 2,200 of the population. whereas I believe in Malaya it is one doctor to 7,000 of the population.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Indonesia?

MAIN ESTIMATES OF EXPENDITURE FOR 1964 I think we do not get statistics from the heartland of our Barisan Sosialis Assemblymen. There has been very little information from that quarter. I think we have a little over 700 qualified doctors in Singapore, of whom one-half are in Government service. The remaining half are in private practice. There have been resignations in the past. But since I assumed office as Minister for Health for the last two months, there has been only one resignation of a doctor who is a temporary officer. She is an expatriate who is leaving Singapore to join her husband elsewhere. So I think it is pretty difficult to try to remedy the shortage because it takes at least six years for a doctor to go through university training and an extra year as a houseman before he is permitted to practise. So I am afraid, for that reason, there is no solution in sight. But we can remedy the situation somewhat by making a greater effort to recruit and train auxiliary medical personnel. By that, I mean junior staff like laboratory technicians, hospital assistants, assistant nurses, dental nurses, and so on. I think it is possible to increase the recruitment and training of these personnel within the forseeable future. I believe the second point mentioned by the Member for Tampines is this. He was referring to the hours during which our out-patient clinics are open to look after the people throughout the State. As stated in the speech of the Yang di-Pertuan Negara, we have unfortunately expanded in this respect faster than we were able to get doctors to man them. May I read this particular paragraph of the speech of the Yang di-Pertuan Negara in Hansard of 29th November, 1963, column 124: 3.00 p.m. `The shortage in doctors is being slowly overcome, but the extension of Government clinics and health facilities has been at a higher rate than the recruitment of new doctors, Administrative efficiency and tightening of "referrals" from these clinics to the hospitals are essential if the strain on the medical staff is to be checked,' I would like to repeat the word "strain". It means that we have less doctors and staff than we would like to have to man these clinics, be they outpatient clinics or maternal and child health centres. I say this and this is what our Finance Minister in his Budget speech on the 28th of November, 1963 - I refer to Hansard again col. 97 - said `The expansion in outdoor medical service brought about a severe strain on the available medical staff, and nurses and doctors had to work long and punishing hours to maintain the enlarged services,' Sir, there is a limit to human endurance. May I say, therefore, Mr Speaker, Sir, that I wish in this Assembly to pay the highest tribute to those few but loyal and dedicated doctors and nurses who are serving our people, be they hospitals, out-patient clinics or maternal child health centres, and trying to cope with the tremendous demand for medical services required by our people. Far from wishing to complain against them, I seek the co-operation of Opposition Assemblymen to understand the situation ---

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Point of order. (In Mandarin) I do not have any complaint against the doctors. What I am complaining is that the time is very short at the out-patient clinics. The whole situation is as a result of the Government's policy.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 That is not a point of order. That should have been a point of clarification and the Member should have asked the Minister to give way to him. Please proceed, Mr Minister - [Interruption] Order.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 The Member for Tampines chooses not to understand; he chooses to misunderstand. He was complaining that doctors will not be available for a sufficiently long period of time to look after sick people. I have explained that doctors are human. There are too few doctors and too few nurses to meet the thousands of cases that come to them. You do not want the doctors and nurses to fall flat and have a nervous breakdown, because then there will be no doctors and nurses to look after them. That is why I say, be understanding and human and not act irresponsibly. That is what the Barisan Sosialis people are. Some hon. Members: Hear, hear!

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Order.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 As for transport expenses, we have endeavoured to spread these clinics and centres throughout the island. I hope the Barisan Sosialis, especially the Member for Tampines, are not expecting a clinic and a health centre at his house for every one of them. That sort of senseless argument which is being persisted ---

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Order. Mr Minister, please leave the Member for Tampines alone. He did not ask for a clinic in his own house. Try to refrain from personal attacks. Please proceed.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Very well, Sir. The third point, I believe, is about the conditions in Woodbridge Hospital. Yes, there is overcrowding there, and there is also a committee studying the situation in Woodbridge Hospital. But I can assure you, Sir, that there are lots of people in this Assembly who could find a place in this hospital. The fourth point - that on Sundays, public holidays and at nights there are not sufficient doctors available - I believe that point has already been covered when I explained that unfortunately there are not enough doctors in Singapore that Singapore would like to have, and therefore certain services have to be reduced, and doctors, nurses, attendants, clerks, hospital attendants, etc., being human, must also have their days of rest before they can look after sick people. The fifth point - poor food in hospitals. It is quite easy just to pick on that. Even in university hostels, food can be considered bad. It is a very simple complaint. It should be put right, of course, but there will always be complaints however much effort may be made in this respect. We come now to cholera. It is unfortunate that there have been two outbreaks of cholera within the last six months in Singapore, in fact, in the whole of Malaya. But I must say that there are perpetual outbreaks in other countries like the heartland of the Barisan Sosialis, be it Indonesia, the Philippines or the China mainland. I think it is reasonable to suggest that the water shortage and water rationing has some part to play in these outbreaks. But what are we to do if there is no adequate rainfall and we have to have water rationing? We can only hope that if the Assemblymen from the Barisan Sosialis would pray hard enough, there would be more rain for all of us. The seventh point referred to the school health service and an allegation that students in aided schools are not as well looked after as those in Government schools. There are in all only seven doctors in the school health service to look after 416,000 pupils. I ask the Member for Tampines to do a little bit of mental arithmetic to see how and why it is almost impossible for those few doctors to look after 400,000 pupils. The allegation that aided schools are being ignored is entirely untrue. Because of the few doctors that are available, what is now possible is only the examination of school pupils when they enter school at Primary I and when they are at Primary VI, and again when they are about to leave secondary school. Of course, we would like to be able to expand the school health service to make it possible for our children to receive medical attention throughout the year. But I think it will take a very, very long time before we will be in the position to have adequate staff to cope with the tremendous increase in our school population over the last few years. The eighth point, Mr Speaker, Sir, was on the question of recruitment of staff like nurses from other than English schools. Never, I think, have there been attempts to recruit nurses from other than English schools in the past and we were quite happy. I believe, in 1960 to make the experiment to second two teachers from a Chinese school and a Malay school to be attached to the Ministry of Health in order to recruit school leavers from Chinese and Malay schools. They received my approval and I can assure the Member for Tampines that I hope to be able to do more than what was done a few years back. I understand that since almost everything is done in English, there are difficulties in trying to bridge this language gap. But it is a problem which I hope I will be able to improve upon if given adequate time. The Member's ninth point refers to hospitals. According to the Yang di-Pertuan Negara's speech, we have already indicated that the Thomson Road Hospital will become the second General Hospital in a few months' time. It is not possible for me to anticipate further than this because the speech only refers to 1964 and the second Five-Year Plan 1965-69 is now in the process of being drawn up. Perhaps the Member for Tampines will be patient enough to wait for the publication of this second Five-Year Plan when the question of a third and, possibly, a fourth general hospital to be established in Singapore will be revealed. The tenth point referred to the recent relaxation of water rationing by the Public Utilities Board to cope with the cholera situation. If our water situation improves - I think it is improving now, probably thanks to the prayer of the Member for Tampines; it is raining outside - there will not only be a further relaxation of water rationing but maybe water rationing will not be necessary, and then this extension of two hours from 8 a.m. to 10 a.m. may be improved. As regards timing, well, it could be one way or another. I think we have to accept the fact that we are lucky to be able to have a relaxation in the water rationing, so that there are two more additional hours for our city cleansing workers to clean up not only the drains that are choked with rubbish over a long period of time, but also to cleanse our markets all over Singapore. 3.15 p.m. The eleventh allegation was that my colleague, the Minister for Finance, has been very unkind by cutting down requests for drugs and chemicals. I think the Member for Tampines would be raising this subsequently and so I shall not anticipate this question and will deal with it when the time comes. All I can say is that what he said is not true. But I will give him a full answer if the Member for Tampines will raise it subsequently. The twelfth point refers to patients queuing up for attention. Well, if there are only a few doctors and more patients, that is to be expected. We would like to have more doctors, and therefore there would be shorter queues. But that will take a long time. [Interruption] Yes, my colleague, the Minister for National Development, says that our clinics must be very popular and so they are prepared to queue up like queuing up for the cinema.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Have you anything like that in Indonesia?

MAIN ESTIMATES OF EXPENDITURE FOR 1964 His thirteenth and last question - hawkers. He alleges that there are 50,000 to 60,000 hawkers. I think the figures are exaggerated by 50 per cent. I think there are about 40,000 hawkers in Singapore. Here again, there is a question tabled by him which will come up for answer tomorrow. I shall not anticipate the question and I shall give him the answer in due time. Sir, the Yang di-Pertuan Negara's speech was quite clear at column 124 where we came forward with a statement: `On the Public Health side, the Ministry is planning a reorganisation of the City Cleansing services,' I will skip a few lines and go on: `... and the ... huge increase in the number of hawkers, inadequate methods of supervision resulting in lack of discipline in the work force, complicated by secret society elements in their midst, have brought about an increase in rubbish, flies and mosquitoes. All this can and will be put right. Reorganisation can succeed once these factors have been dealt with,' This hawker problem is part and parcel of the reorganisation which the Government will put into operation and I think the best part of the reorganisation is the banning of the two Singapore hawkers' unions which were the front organisations of the Barisan Sosialis. I hope I have been able to answer all the 13 questions put up by the Barisan Sosialis to the best of my ability and I assure them that reorganisation is coming. I do hope that I will get the support of the Barisan Sosialis Assemblymen in putting matters right for Singapore.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Mr Speaker, Sir, I notice that the Minister in his reply did not mention "Communism" or "Communists". This is very rare indeed. But it cannot be denied that although he has given fair answers, he has also made other allegations against us. I will say something on the views he has expressed and on his allegations. The first is about the shortage of doctors. The Minister has said that many doctors in Singapore as well as those in Malaya resigned from Government service in order to practise privately for pecuniary reasons. That was his excuse for the shortage of doctors. As has been admitted by the Minister, half the doctors in Singapore are employed in the Ministry of Health. If there is still this large number of doctors employed, why did he say that more doctors resigned from the Government to make more money in private practice? I would like to have a better explanation from him. I hope the Ministry of Health will be able to recruit more doctors to serve in the hospitals and clinics. If the doctors are not satisfied with their working conditions, the Minister should be patient with them and hear their views so that they will be content to remain in their jobs. Nobody wants to be ill but if a person falls sick, of course, he will have to see a doctor. If the Government will not accommodate the views of the doctors on their working conditions, then naturally there will be a shortage of doctors. The Minister alleged that many doctors resigned because they were not satisfied with their terms of service. There are clinics as well as the Thomson Road Hospital and the General Hospital which are under-staffed. There is also a shortage of nurses. As a result of this, an indisposed person will find it difficult to go to a clinic or a hospital to see a doctor or a nurse. Therefore, I hope the Minister will try to recruit more nurses for the various clinics and hospitals, otherwise the people might think that the nurses are unwilling to serve them. They might not know that there are insufficient nurses. We all know that a small number of nurses cannot look after too many patients. Of course, it is a very good thing to recruit nurses from all schools of the four streams, otherwise many school-leavers will be unemployed. Mr Speaker, Sir, I cannot agree with the Minister that we should pray to God for more rainfall.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 It is raining outside.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Today we have to pray. In the past, the Government tried: to create artificial rain with very little success. I would urge the Government to speed up the Johore River project. The sooner the project is completed the earlier the people of Singapore will be free from water rationing due to water shortage. If it is a question of shortage of funds, it is really unbelievable, as the Government have spent about $100 million on T.V. alone. If they had spent this sum of $100 million on the Johore River project, we would not be experiencing a water shortage today and the incidence of disease and epidemics would be very much less.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Malay): Mr Sneaker, Sir, just now the Minister for Health has explained to the Opposition Members that the shortage of doctors is riot only confined to Singapore or, for that matter, to Malaya, but that it is a universal problem. It is not an easy matter to recruit doctors, Mr Speaker, Sir. They must be trained for a number of years before they can be considered as capable doctors. The Minister says one doctor caters for 2,000 people and it will take a lone time to achieve this. We have doctors in Singapore but most of those whose sympathies are with the Barisan Sosialis resigned from Government not because they wanted to go into private practice but because they wanted to encage themselves in political activities. I think if these doctors were to discharge their duties as doctors, it would be of greater benefit to the people of Singapore. On the contrary, they have not attended to the sick but they have spread malicious political propaganda as a result of which the people of Singapore are more sick. The Members opposite talk about the shortage of water. They say that if the Government had accelerated the Tebrau River and the Johore River projects, we would not have experienced the present water shortage. I wish to emphasise that although we have expended millions of dollars on the Tebrau River and the Johore River projects, the purpose will be defeated if there is no rain. The water for Singapore depends on how much rainfall we get. 3.30 p.m.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Mr Speaker, Sir, the first point I want to make is that when I gave notice of the two amendments I did not attack the doctors in the Ministry of Health. I am sympathetic towards these doctors and I hope the P.A.P. will not sour up the relations between the doctors and the Barisan Sosialis because all along the doctors have maintained good relations with the Barisan Sosialis.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Order.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): The reason why the doctors resigned from Government service is that they were not satisfied with their working conditions. They had to work very hard and the Government could not solve their problems and meet their claims. That is why there was an exodus of doctors from Government service. This was admitted by the Minister for Health. Today we can see that many doctors go into private practice. How can you say that there is a shortage of doctors in Singapore? The reason for the shortage is that they do not like to work in Government. Since it is so, why do the Government not improve the working conditions so as to attract more doctors? The money in our coffers is derived from --- [Interruption]

MAIN ESTIMATES OF EXPENDITURE FOR 1964 Will the Government Members allow the Member for Tampines to proceed with his speech and keep silent? I must mention again that the Member is speaking in Mandarin and I am trying to follow the English translation. It is difficult enough trying to follow that translation without Members from the Government side adding to the confusion. Please proceed, Mr Poh.

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Nothing is more valuable than life. But the Government disregard giving medical attention to the people in order to fill up their coffers. Why do the Government not solve all these problems? If I can increase the vote by $1,000 or $10,000 I am willing to do so. [Interruption] If you are competent, we can argue point by point. As regards public holidays and Sundays and at nights, I agree that nurses and doctors should rest. But what will happen to emergency and serious cases? [Interruption] You have not listened properly to the speech made by your Minister. This is ridiculous. The Government should see to it that there are extra doctors to replace those doctors who are off duty. On the question of water rationing, it seems that the Minister has admitted that water rationing has a part to play in the outbreak of cholera. It is a very dangerous situation and we must see that it is eliminated. What steps will the Government take to eliminate this dangerous epidemic? Some people have died of cholera. Do the Government want to see more and more people die of cholera?

MAIN ESTIMATES OF EXPENDITURE FOR 1964 (In Mandarin): Get inoculated.